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 Recognising laryngeal cancer in primary care: a large case–control study using electronic records

2019 ◽  
Vol 69 (679) ◽  
pp. e127-e133 ◽  
Author(s):  
Elizabeth A Shephard ◽  
Molly AL Parkinson ◽  
William T Hamilton
Keyword(s):  
Primary Care ◽  
Sore Throat ◽  
Laryngeal Cancer ◽  
Case Control Study ◽  
Case Control ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Predictive Values ◽  
Nice Guidance ◽  
Control Study

BackgroundOver 1700 people are diagnosed with laryngeal cancer annually in England. Current National Institute for Health and Care Excellence (NICE) guidelines on referral for suspected laryngeal cancer were based on clinical consensus, in the absence of primary care studies.AimTo identify and quantify the primary care features of laryngeal cancer.Design and settingMatched case–control study of patients aged ≥40 years using data from the UK’s Clinical Practice Research Datalink.MethodClinical features of laryngeal cancer with which patients had presented to their GP in the year before diagnosis were identified and their association with cancer was assessed using conditional logistic regression. Positive predictive values (PPVs) for each clinical feature were calculated for the consulting population aged >60 years.ResultsIn total, 806 patients diagnosed with laryngeal cancer between 2000 and 2009 were studied, together with 3559 age-, sex-, and practice-matched controls. Ten features were significantly associated with laryngeal cancer: hoarseness odds ratio [OR] 904 (95% confidence interval [CI] = 277 to 2945); sore throat, first attendance OR 6.2 (95% CI = 3.7 to 10); sore throat, re-attendance OR 7.7 (95% CI = 2.6 to 23); dysphagia OR 6.5 (95% CI = 2.7 to 16); otalgia OR 5.0 (95% CI = 1.9 to 13); dyspnoea, re-attendance OR 4.7 (95% CI = 1.9 to 12); mouth symptoms OR 4.7 (95% CI = 1.8 to 12); recurrent chest infection OR 4.5 (95% CI = 2.4 to 8.5); insomnia OR 2.7 (95% CI = 1.3 to 5.6); and raised inflammatory markers OR 2.5 (95% CI = 1.5 to 4.1). All P-values were <0.01. Hoarseness had the highest individual PPV of 2.7%. Symptom combinations currently not included in NICE guidance were sore throat plus either dysphagia, dyspnoea, or otalgia, for which PPVs were >5%.ConclusionThese results expand current NICE guidance by identifying new symptom combinations that are associated with laryngeal cancer; they may help GPs to select more appropriate patients for referral.

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 The usefulness of symptoms alone or combined for general practitioners in considering the diagnosis of a brain tumour: a case-control study using the clinical practice research database (CPRD) (2000-2014)

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e029686 ◽  
Author(s):  
Mio Ozawa ◽  
Paul M Brennan ◽  
Karolis Zienius ◽  
Kathreena M Kurian ◽  
William Hollingworth ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Brain Tumour ◽  
Case Control Study ◽  
Case Control ◽  
Practice Research ◽  
Age Group ◽  
Predictive Values ◽  
Group Sex ◽  
Control Study

ObjectivesTo evaluate the utility of different symptoms, alone or combined, presented to primary care for an adult brain tumour diagnosis.Design and settingMatched case-control study, using the data from Clinical Practice Research Datalink (2000–2014) from primary care consultations in the UK.MethodAll presentations within 6 months of the index diagnosis date (cases) or equivalent (controls) were coded into 32 symptom groups. Sensitivity, specificity, positive predictive values (PPVs) and positive likelihood ratios were calculated for symptoms and combinations of symptoms with headache and cognitive features. Diagnostic odds ratios were calculated using conditional logistic regression, adjusted for age group, sex and Charlson comorbidity. Stratified analyses were performed for age group, sex and whether the tumour was of primary or secondary origin.ResultsWe included 8,184 cases and 28,110 controls. Seizure had the highest PPV of 1.6% (95% CI 1.4% to 1.7%) followed by weakness 1.5% (1.3 to 1.7) and confusion 1.4% (1.3 to 1.5). Combining headache with other symptoms increased the PPV. For example, headache plus combined cognitive symptoms PPV 7.2% (6.0 to 8.6); plus weakness 4.4% (3.2 to 6.2), compared with headache alone PPV 0.1%. The diagnostic ORs were generally larger for patients <70 years; this was most marked for confusion, seizure and visual symptoms.ConclusionWe found seizure, weakness and confusion had relatively higher predictive values than many other symptoms. Headache on its own was a weak predictor but this was enhanced when combined with other symptoms especially in younger patients. Clinicians need to actively search for other neurological symptoms such as cognitive problems.

scholarly journals Metabolic syndrome and risk of cancer: a study protocol of case–control study using data from the Information System for the Development of Research in Primary Care (SIDIAP) in Catalonia

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e025365 ◽  
Author(s):  
Diana Puente ◽  
Tomàs López-Jiménez ◽  
Xavier Cos-Claramunt ◽  
Yolanda Ortega ◽  
Talita Duarte-Salles
Keyword(s):  
Primary Care ◽  
Metabolic Syndrome ◽  
Information System ◽  
Case Control Study ◽  
Descriptive Analysis ◽  
Case Control ◽  
Health Concern ◽  
Risk Of Cancer ◽  
Incident Cases ◽  
Control Study

BackgroundMetabolic syndrome (MS) is defined by the clustering of specific metabolic disorders in one subject. MS is highly prevalent globally and currently considered a growing public health concern. MS comprises obesity, hypertension, dyslipidaemia and insulin resistance. Mechanisms linking MS with cancer are poorly understood, and it is as yet unknown if MS confers a greater risk than the risk entailed by each of its separate components. The main objective of this study is to compare the association between MS and 14 site-specific cancer against the association between one or two individual components of MS and cancer. The secondary objective is to evaluate the time elapsed since the diagnosis of MS and the subsequent onset of cancer within the 2006–2017 period by sex.Methods and analysisA case–control study will be conducted for the main objective and a cohort of patients with MS will be followed for the evaluation of the second objective. Incident cases of fourteen types of cancer in patients ≥40 years of age diagnosed prospectively will be selected from electronic primary care records in the Information System for Research in Primary Care (SIDIAP database;www.sidiap.org). The SIDIAP database includes anonymous data from 6 million people (80% of the Catalan population) registered in 286 primary healthcare centres. Each matched control (four controls for each case) will have the same inclusion date, the same sex and age (±1 year) than the paired case. Logistic regression and a descriptive analysis and Kaplan-Meier analysis will be performed, in accordance with the objectives.Ethics and disseminationThe protocol of the study was approved by the IDIAP Jordi Gol Clinical Research Ethics Committee (protocol P17/212). The study’s findings will be published in a peer-reviewed journal and disseminated at national and international conferences and oral presentations to researchers, clinicians and policy makers.

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 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.

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