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 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 Exposure to domestic violence and abuse and consultations for emergency contraception: nested case-control study in a UK primary care dataset

2018 ◽  
Vol 69 (680) ◽  
pp. e199-e207 ◽  
Author(s):  
Joni Jackson ◽  
Natalia V Lewis ◽  
Gene S Feder ◽  
Penny Whiting ◽  
Timothy Jones ◽  
...  
Keyword(s):  
Primary Care ◽  
Domestic Violence ◽  
General Practice ◽  
Emergency Contraception ◽  
Case Control Study ◽  
Case Control ◽  
Exposure To Domestic Violence ◽  
Nested Case Control ◽  
Domestic Violence And Abuse ◽  
Control Study

BackgroundEvidence of an association between exposure to domestic violence and abuse (DVA) and use of emergency contraception (EC) is lacking in the UK.AimTo quantify the association between exposure to DVA and consultations for EC in general practice.Design and settingNested case-control study in UK general practice.MethodUsing the Clinical Practice Research Datalink, the authors identified all women all women aged 15–49 years registered with a GP between 1 January 2011 and 31 December 2016. Cases with consultations for EC (n = 43 570) were each matched on age and GP against four controls with no consultations for EC (n = 174 280). The authors calculated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between exposure to DVA in the previous year and consultations for EC. Covariates included age, ethnicity, socioeconomic status, pregnancy, children, alcohol misuse, and depression.ResultsWomen exposed to DVA were 2.06 times more likely to have a consultation for EC than unexposed women (95% CI = 1.64 to 2.61). Women aged 25–39 years with exposure to DVA were 2.8 times more likely to have a consultation for EC, compared with unexposed women (95% CI = 2.08 to 3.75). The authors found some evidence of an independent effect of exposure to DVA on the number of consultations for EC (OR 1.48, 95% CI = 0.99 to 2.21).ConclusionA request for EC in general practice can indicate possible exposure to DVA. Primary care consultation for EC is a relevant context for identifying and responding to DVA as recommended by the World Health Organization and National Institute for Health and Care Excellence guidelines. DVA training for providers of EC should include this new evidence.

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.

A Case-Control Study of Pediatric Falls Using Electronic Medical Records

2013 ◽  
Vol 38 (2) ◽  
pp. 73-79 ◽  
Author(s):  
Patricia Ruth Messmer ◽  
Phoebe D. Williams ◽  
Arthur R. Williams
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Case Control Study ◽  
Case Control ◽  
Control Study

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.

Eating Disorders in the General Practice: A Case-Control Study on the Utilization of Primary Care

2012 ◽  
Vol 20 (5) ◽  
pp. 410-413 ◽  
Author(s):  
Gabriëlle E. Van Son ◽  
Hans W. Hoek ◽  
Daphne Van Hoeken ◽  
François G. Schellevis ◽  
Eric F. Van Furth
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
General Practice ◽  
Case Control Study ◽  
Case Control ◽  
Control Study
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