scholarly journals Clinical features of metastatic cancer in primary care: a case–control study using medical records

2015 ◽  
Vol 65 (637) ◽  
pp. e516-e522 ◽  
Author(s):  
William Hamilton ◽  
Jacqueline Barrett ◽  
Sally Stapley ◽  
Debbie Sharp ◽  
Peter Rose
Keyword(s):  
Primary Care ◽  
Clinical Features ◽  
Medical Records ◽  
Case Control Study ◽  
Metastatic Cancer ◽  
Case Control ◽  
Control Study

scholarly journals Clinical Features Observed in General Practice Associated With the Subsequent Diagnosis of Progressive Supranuclear Palsy

2021 ◽  
Vol 12 ◽  
Author(s):  
Mary J. Kwasny ◽  
Denise M. Oleske ◽  
Jorge Zamudio ◽  
Robert Diegidio ◽  
Günter U. Höglinger
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Electronic Medical Records ◽  
Clinical Features ◽  
Random Forests ◽  
Medical Records ◽  
Primary Care Physicians ◽  
Case Control Study ◽  
Case Control ◽  
Control Study

Background: Progressive supranuclear palsy (PSP) is a rare neurodegenerative disorder that is difficult for primary care physicians to recognize due to its progressive nature and similarities to other neurologic disorders. This case-control study aimed to identify clinical features observed in general practice associated with a subsequent diagnosis of PSP.Methods: We analyzed a de-identified dataset of 152 PSP cases and 3,122 matched controls from electronic medical records of general practices in Germany. We used a random forests algorithm based on machine learning techniques to identify clinical features (medical conditions and treatments received) associated with pre-diagnostic PSP without using an a priori hypothesis. We then assessed the relative effects of the features with the highest importance scores and generated multivariate models using clustered logistic regression analyses to identify a subset of clinical features associated with subsequent PSP diagnosis.Results: Using the random forests approach, we identified 21 clinical features associated with pre-diagnostic PSP (odds ratio ≥2.0 in univariate analyses). From these, we constructed a multivariate model comprising 9 clinical features with ~90% likelihood of identifying a subsequent PSP diagnosis. These features included known PSP symptoms, common misdiagnoses, and 2 novel associations, diabetes mellitus and cerebrovascular disease, which are possible modifiable risk factors for PSP.Conclusion: In this case-control study using data from electronic medical records, we identified 9 clinical features, including 2 previously unknown factors, associated with the pre-diagnostic stage of PSP. These may be used to facilitate recognition of PSP and reduce time to referral by primary care physicians.

scholarly journals Clinical features in primary care electronic records before diagnosis of Ankylosing Spondylitis: a nested case-control study.

2019 ◽  
Author(s):  
Mohammed Talha Bashir ◽  
Lisa Iversen ◽  
Christopher Burton
Keyword(s):  
Primary Care ◽  
Clinical Features ◽  
Diagnostic Tests ◽  
Case Control Study ◽  
Case Control ◽  
Electronic Records ◽  
Large Joint ◽  
Axial Pain ◽  
Nested Case Control ◽  
Control Study

Abstract Background Ankylosing spondylitis (AS) often has a long period from first symptom presentation to diagnosis. We examined the occurrence of symptoms, prescriptions and diagnostic tests in primary care electronic records over time prior to a diagnosis of AS.Methods Nested case-control study using anonymised primary care electronic health records from Scotland. Cases were 100 adults with a first diagnosis of AS between 1994 and 2010. Controls were matched for age, sex and GP practice: (a) 400 randomly selected adults (b) 236 adults whose records contained codes indicating spinal conditions or symptoms. We extracted clinical features (symptoms, AS-related disorders, prescriptions and diagnostic tests). Conditional logistic regression was used to examine the association between clinical features (both individually and in combinations) and diagnosis of AS. We examined the associations between clinical features and diagnosis over time prior to diagnosis.Results Several new composite pointers were predictive of AS: including distinct episodes of axial pain separated by more than 6 months (OR 3.7, 95% CI 1.8 to 7.5) and the co-occurrence of axial pain with either large joint symptoms (OR 2.7, 95% CI 1.1 to 6.3) or tendon symptoms within the same year (OR 3.6, 95% CI 1.3 to 10.3). Coded episodes of axial pain increased steadily over the three years before diagnosis. In contrast, large joint symptoms and enthesopathy showed little or no time trend prior to diagnosis.Conclusions We identified novel composite pointers to a diagnosis of AS in GP records. These may represent valuable targets for diagnostic support systems.

scholarly journals Clinical features in primary care electronic records before diagnosis of Ankylosing Spondylitis: a nested case-control study.

2019 ◽  
Author(s):  
Mohammed Talha Bashir ◽  
Lisa Iversen ◽  
Christopher Burton
Keyword(s):  
Primary Care ◽  
Clinical Features ◽  
Diagnostic Tests ◽  
Case Control Study ◽  
Case Control ◽  
Electronic Records ◽  
Large Joint ◽  
Axial Pain ◽  
Nested Case Control ◽  
Control Study

Abstract Background Ankylosing spondylitis (AS) often has a long period from first symptom presentation to diagnosis. We examined the occurrence of symptoms, prescriptions and diagnostic tests in primary care electronic records over time prior to a diagnosis of AS.Methods Nested case-control study using anonymised primary care electronic health records from Scotland. Cases were 100 adults with a first diagnosis of AS between 1994 and 2010. Controls were matched for age, sex and GP practice: (a) 400 randomly selected adults (b) 236 adults whose records contained codes indicating spinal conditions or symptoms. We extracted clinical features (symptoms, AS-related disorders, prescriptions and diagnostic tests). Conditional logistic regression was used to examine the association between clinical features (both individually and in combinations) and diagnosis of AS. We examined the associations between clinical features and diagnosis over time prior to diagnosis.Results Several new composite pointers were predictive of AS: including distinct episodes of axial pain separated by more than 6 months (OR 3.7, 95% CI 1.8 to 7.5) and the co-occurrence of axial pain with either large joint symptoms (OR 2.7, 95% CI 1.1 to 6.3) or tendon symptoms within the same year (OR 3.6, 95% CI 1.3 to 10.3). Coded episodes of axial pain increased steadily over the three years before diagnosis. In contrast, large joint symptoms and enthesopathy showed little or no time trend prior to diagnosis.Conclusions We identified novel composite pointers to a diagnosis of AS in GP records. These may represent valuable targets for diagnostic support systems.

scholarly journals Clinical features in primary care electronic records before diagnosis of Ankylosing Spondylitis: a nested case-control study.

2020 ◽  
Author(s):  
Mohammed Talha Bashir ◽  
Lisa Iversen ◽  
Christopher Burton
Keyword(s):  
Primary Care ◽  
Clinical Features ◽  
Diagnostic Tests ◽  
Case Control Study ◽  
Case Control ◽  
Electronic Records ◽  
Axial Pain ◽  
Nested Case Control ◽  
Control Study ◽  
Over Time

Abstract Background Ankylosing spondylitis (AS) often has a long period from first symptom presentation to diagnosis. We examined the occurrence of symptoms, prescriptions and diagnostic tests in primary care electronic records over time prior to a diagnosis of AS.Methods Nested case-control study using anonymised primary care electronic health records from Scotland. Cases were 74 adults with a first diagnosis of AS between 2000 and 2010. Controls were matched for age, sex and GP practice: (a) 296 randomly selected adults (b) 169 adults whose records contained codes indicating spinal conditions or symptoms. We extracted clinical features (symptoms, AS-related disorders, prescriptions and diagnostic tests). Conditional logistic regression was used to examine the association between clinical features (both individually and in combinations) and diagnosis of AS. We examined the associations between clinical features and diagnosis over time prior to diagnosis.Results Several new composite pointers were predictive of AS: including distinct episodes of axial pain separated by more than 6 months (OR 12.7, 95% CI 4.7 to 34.6); the occurrence of axial pain with and tendon symptoms within the same year (OR 21.7, 95% CI 2.6 to 181.5); and the co-occurrence (within 30 days) of axial pain and a prescription for nonsteroidal anti-inflammatory drug (OR 10.4, 95%CI 4.9 to 22.1). Coded episodes of axial pain increased steadily over the three years before diagnosis. In contrast, large joint symptoms and enthesopathy showed little or no time trend prior to diagnosis. Conclusions We identified novel composite pointers to a diagnosis of AS in GP records. These may represent valuable targets for diagnostic support systems.

scholarly journals Clinical features in primary care electronic records before diagnosis of Ankylosing Spondylitis: a nested case-control study.

2020 ◽  
Author(s):  
Mohammed Talha Bashir ◽  
Lisa Iversen ◽  
Christopher Burton
Keyword(s):  
Primary Care ◽  
Clinical Features ◽  
Diagnostic Tests ◽  
Case Control Study ◽  
Case Control ◽  
Electronic Records ◽  
Axial Pain ◽  
Nested Case Control ◽  
Control Study ◽  
Over Time

Abstract Background Ankylosing spondylitis (AS) often has a long period from first symptom presentation to diagnosis. We examined the occurrence of symptoms, prescriptions and diagnostic tests in primary care electronic records over time prior to a diagnosis of AS. Methods Nested case-control study using anonymised primary care electronic health records from Scotland. Cases were 74 adults with a first diagnosis of AS between 2000 and 2010. Controls were matched for age, sex and GP practice: (a) 296 randomly selected adults (b) 169 adults whose records contained codes indicating spinal conditions or symptoms. We extracted clinical features (symptoms, AS-related disorders, prescriptions and diagnostic tests). Conditional logistic regression was used to examine the association between clinical features (both individually and in combinations) and diagnosis of AS. We examined the associations between clinical features and diagnosis over time prior to diagnosis. Results Several new composite pointers were predictive of AS: including distinct episodes of axial pain separated by more than 6 months (OR 12.7, 95% CI 4.7 to 34.6); the occurrence of axial pain with and tendon symptoms within the same year (OR 21.7, 95% CI 2.6 to 181.5); and the co-occurrence (within 30 days) of axial pain and a prescription for nonsteroidal anti-inflammatory drug (OR 10.4, 95%CI 4.9 to 22.1). Coded episodes of axial pain increased steadily over the three years before diagnosis. In contrast, large joint symptoms and enthesopathy showed little or no time trend prior to diagnosis. Conclusions We identified novel composite pointers to a diagnosis of AS in GP records. These may represent valuable targets for diagnostic support systems.

scholarly journals Clinical features of bowel disease in patients aged <50 years in primary care: a large case-control study

2017 ◽  
Vol 67 (658) ◽  
pp. e336-e344 ◽  
Author(s):  
Sally A Stapley ◽  
Greg P Rubin ◽  
Deborah Alsina ◽  
Elizabeth A Shephard ◽  
Matthew D Rutter ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Features ◽  
Rectal Bleeding ◽  
Bowel Disease ◽  
Inflammatory Markers ◽  
Case Control Study ◽  
Case Control ◽  
Colorectal Disease ◽  
Bowel Habit ◽  
Control Study

BackgroundIncidences of colorectal cancer (CRC) and inflammatory bowel disease (IBD) are increasing in those aged <50 years.AimTo identify and quantify clinical features in primary care of CRC/IBD in those aged <50 years. This study considered the two conditions together and aimed to determine which younger patients, presenting in primary care with symptoms, would benefit from investigation for potentially serious colorectal disease.Design and settingMatched case-control study using primary care records from the Clinical Practice Research Datalink, UK.MethodIncident cases (aged <50 years) of CRC (n = 1661) and IBD (n = 9578) diagnosed between 2000 and 2013 were each matched with up to three controls (n = 3979 CRC; n = 22 947 IBD). Odds ratios (OR) and positive predictive values (PPV) were estimated for features of CRC/IBD in the year before diagnosis.ResultsTen features were independently associated with CRC/IBD (all P<0.001): rectal bleeding, change in bowel habit, diarrhoea, raised inflammatory markers, thrombocytosis, abdominal pain, low mean cell volume (MCV), low haemoglobin, raised white cell count, and raised hepatic enzymes. PPVs were >3% for rectal bleeding with diarrhoea, thrombocytosis, low MCV, low haemoglobin or raised inflammatory markers; for change in bowel habit with low MCV, thrombocytosis or low haemoglobin; and for diarrhoea with thrombocytosis.ConclusionThis study quantified the risk of serious bowel disease in symptomatic patients aged <50 years in primary care. Rectal bleeding and change in bowel habit are strongly predictive of CRC/IBD when combined with abnormal haematology. The present findings help prioritise patients for colonoscopy where the diagnosis is not immediately apparent.

scholarly journals Clinical features of kidney cancer in primary care: a case-control study using primary care records

2013 ◽  
Vol 63 (609) ◽  
pp. e250-e255 ◽  
Author(s):  
Elizabeth Shephard ◽  
Richard Neal ◽  
Peter Rose ◽  
Fiona Walter ◽  
William T Hamilton
Keyword(s):  
Primary Care ◽  
Clinical Features ◽  
Kidney Cancer ◽  
Case Control Study ◽  
Case Control ◽  
Control Study

scholarly journals Selection of men for investigation of possible testicular cancer in primary care: a large case–control study using electronic patient records

2018 ◽  
Vol 68 (673) ◽  
pp. e559-e565 ◽  
Author(s):  
Elizabeth A Shephard ◽  
William T Hamilton
Keyword(s):  
Primary Care ◽  
Testicular Cancer ◽  
Clinical Features ◽  
Case Control Study ◽  
Case Control ◽  
Clinical Practice Research Datalink ◽  
Predictive Values ◽  
Risk Of Cancer ◽  
Control Study ◽  
Selection Of

BackgroundTesticular cancer incidence has risen over the last two decades and is expected to continue to rise. There are no primary care studies on the clinical features of testicular cancer, with recent National Institute for Health and Care Excellence (NICE) guidance based solely upon clinical consensus.AimTo identify clinical features of testicular cancer and to quantify their risk in primary care patients, with the aim of improving the selection of patients for investigation.Design and settingA matched case–control study in males aged ≥17 years, using Clinical Practice Research Datalink records.MethodPutative clinical features of testicular cancer were identified and analysed using conditional logistic regression. Positive predictive values (PPVs) were calculated for those aged <50 years.ResultsIn all, 1398 cases were available, diagnosed between 2000 and 2012, with 4956 age-, sex-, and practice-matched controls. Nine features were independently associated with testicular cancer, the top three being testicular swelling (odds ratio [OR] 280, 95% confidence interval [CI] = 110 to 690), testicular lump (OR 270, 95% CI = 100 to 740), and scrotal swelling (OR 170, 95% CI = 35 to 800). The highest PPV for 17–49-year-olds was testicular lump, at 2.5% (95% CI = 1.1 to 5.6). Combining testicular lump with testicular swelling or testicular pain produced PPVs of 17% and 10%, respectively.ConclusionTesticular enlargement carries a risk of cancer of 2.5% — close to the current 3% threshold in UK referral guidance. Contrary to traditional teaching, painful testicular enlargement may signify cancer. Some initial hydrocele diagnoses appear to be wrong, with missed cancers, suggesting an ultrasound may be useful when a hydrocele diagnosis is uncertain. These results support the existing NICE guidelines, and help to characterise when an ultrasound should be considered in symptomatic men.

scholarly journals Relation of severe COVID-19 to polypharmacy and prescribing of psychotropic drugs: the REACT-SCOT case-control study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Paul M. McKeigue ◽  
◽  
Sharon Kennedy ◽  
Amanda Weir ◽  
Jen Bishop ◽  
...  
Keyword(s):  
Primary Care ◽  
Rate Ratio ◽  
Case Control Study ◽  
Fatal Outcome ◽  
Case Control ◽  
Care Practice ◽  
Drug Classes ◽  
Increased Risk ◽  
Co Morbidity ◽  
Control Study

Abstract Background The objective of this study was to investigate the relation of severe COVID-19 to prior drug prescribing. Methods Severe cases were defined by entry to critical care or fatal outcome. For this matched case-control study (REACT-SCOT), all 4251 cases of severe COVID-19 in Scotland since the start of the epidemic were matched for age, sex and primary care practice to 36,738 controls from the population register. Records were linked to hospital discharges since June 2015 and dispensed prescriptions issued in primary care during the last 240 days. Results Severe COVID-19 was strongly associated with the number of non-cardiovascular drug classes dispensed. This association was strongest in those not resident in a care home, in whom the rate ratio (95% CI) associated with dispensing of 12 or more drug classes versus none was 10.8 (8.8, 13.3), and in those without any of the conditions designated as conferring increased risk of COVID-19. Of 17 drug classes postulated at the start of the epidemic to be “medications compromising COVID”, all were associated with increased risk of severe COVID-19 and these associations were present in those without any of the designated risk conditions. The fraction of cases in the population attributable to exposure to these drug classes was 38%. The largest effect was for antipsychotic agents: rate ratio 4.18 (3.42, 5.11). Other drug classes with large effects included proton pump inhibitors (rate ratio 2.20 (1.72, 2.83) for = 2 defined daily doses/day), opioids (3.66 (2.68, 5.01) for = 50 mg morphine equivalent/day) and gabapentinoids. These associations persisted after adjusting for covariates and were stronger with recent than with non-recent exposure. Conclusions Severe COVID-19 is associated with polypharmacy and with drugs that cause sedation, respiratory depression, or dyskinesia; have anticholinergic effects; or affect the gastrointestinal system. These associations are not easily explained by co-morbidity. Measures to reduce the burden of mortality and morbidity from COVID-19 should include reinforcing existing guidance on reducing overprescribing of these drug classes and limiting inappropriate polypharmacy. Registration ENCEPP number https://EUPAS35558

Sign in / Sign up

Export Citation Format

Share Document