Introduction
- Literature and evidence review essential in public health practice
- Exponential growth in volume of literature
- Initial first steps usually:
- Developing search strategy
- Reviewing and filtering abstracts
- Obtaining full text (if possible)
- Data extraction
This can be a manual and protracted iterative process which may involve using specialised searching services, downloading abstracts, reading and filtering, secondary searching and so on, and may involve sifting many thousands of abstracts.
Often we may just want a rapid overview of the literature to help focus further reviewing.
In this vignette we demonstrate the use of R packages for large scale extraction of abstracts, and analytical techniques for identifying topics or themes in the abstracts.
The vignette is based on a number of R packages:
europepmc- this is a sophisticated tool which interacts with the PubMedCentral API and provides access to additional fields.adjutant- this is a fully fledged package with retrieval and clustering functions. 3.tidytext- a package for text mining using tidy data principles.
Rtsne- this uses the tSNE algorithm for data reduction and cluster visualisationdbscan- applies the HDBSCAN algorithm for data clusteringmyScrapers- wraps some functions built on other packages to automate the search, extraction, and filtering process.
We have “hacked” some of the functions in these packages and written additional functions to develop a work flow from searching and retrieval to analysis
A simple example using europepmc
Searching Europe PubMed Central (epmc)
This is a package which allows searching of EuropePMC via the API.
It can be downloaded from CRAN.
if(!require("europepmc")) install.packages("europepmc")
library(europepmc)The main function is epmc_search which allows us to search the site and retrieve abstracts, metadata and citation counts.
We’ll use it with the search term CPRD OR “The Health Improvement Network”.
head(epmc_search(params$search, limit = 10))
#> # A tibble: 6 x 28
#> id source pmid doi title authorString journalTitle issue
#> <chr> <chr> <chr> <chr> <chr> <chr> <chr> <chr>
#> 1 3155~ MED 3155~ 10.1~ Long~ Šumilo D, N~ BMJ Open 9
#> 2 3113~ MED 3113~ 10.1~ Stud~ Fortuny J, ~ Drug Saf 10
#> 3 3113~ MED 3113~ 10.1~ Card~ Gilsenan A,~ Drug Saf 10
#> 4 3117~ MED 3117~ 10.1~ Codi~ Metcalfe D,~ BMC Med Res~ 1
#> 5 3127~ MED 3127~ 10.1~ Iden~ Carreira H,~ BMJ Open 7
#> 6 3121~ MED 3121~ 10.1~ How ~ Ghosh RE, C~ Ther Adv Dr~ <NA>
#> # ... with 20 more variables: journalVolume <chr>, pubYear <chr>,
#> # journalIssn <chr>, pageInfo <chr>, pubType <chr>, isOpenAccess <chr>,
#> # inEPMC <chr>, inPMC <chr>, hasPDF <chr>, hasBook <chr>,
#> # hasSuppl <chr>, citedByCount <int>, hasReferences <chr>,
#> # hasTextMinedTerms <chr>, hasDbCrossReferences <chr>,
#> # hasLabsLinks <chr>, hasTMAccessionNumbers <chr>, firstIndexDate <chr>,
#> # firstPublicationDate <chr>, pmcid <chr>This doesn’t extract the abstract text or Mesh headings (keywords) - to facilitate this we have wrapped the search function, into get_full_search in myScrapers.
library(tictoc)
set.seed(42)
tic()
search1 <- get_full_search(search = params$search, limit = params$limit)
toc()
#> 734.04 sec elapsed
head(search1, 20)
#> # A tibble: 20 x 33
#> id source pmid doi title authorString journalTitle issue
#> <chr> <chr> <chr> <chr> <chr> <chr> <chr> <chr>
#> 1 3155~ MED 3155~ 10.1~ Long~ Šumilo D, N~ BMJ Open 9
#> 2 3113~ MED 3113~ 10.1~ Stud~ Fortuny J, ~ Drug Saf 10
#> 3 3113~ MED 3113~ 10.1~ Card~ Gilsenan A,~ Drug Saf 10
#> 4 3117~ MED 3117~ 10.1~ Codi~ Metcalfe D,~ BMC Med Res~ 1
#> 5 3127~ MED 3127~ 10.1~ Iden~ Carreira H,~ BMJ Open 7
#> 6 3121~ MED 3121~ 10.1~ How ~ Ghosh RE, C~ Ther Adv Dr~ <NA>
#> 7 3146~ MED 3146~ 10.1~ Herp~ Curran D, H~ BMJ Open 8
#> 8 3128~ MED 3128~ 10.1~ Redu~ Sun X, Gull~ BMJ Open 7
#> 9 3126~ MED 3126~ 10.3~ Qual~ Booth HP, G~ Br J Gen Pr~ 686
#> 10 3154~ MED 3154~ 10.1~ Soci~ Rafiq M, Ha~ BMJ Open 9
#> 11 3116~ MED 3116~ 10.1~ "Com~ Pufulete M,~ BMJ Open 6
#> 12 3066~ MED 3066~ 10.1~ The ~ McGuinness ~ Pharmacoepi~ 2
#> 13 3132~ MED 3132~ 10.1~ Conc~ Saine ME, C~ Pharmacoepi~ 10
#> 14 3136~ MED 3136~ 10.1~ Inci~ Cairns V, W~ BMJ Open 7
#> 15 3139~ MED 3139~ 10.1~ Eval~ Vogelmeier ~ Respir Res 1
#> 16 PPR9~ PPR <NA> 10.1~ Data~ Rockenschau~ <NA> <NA>
#> 17 3146~ MED 3146~ 10.1~ Gout~ Stack AG, J~ BMJ Open 8
#> 18 3131~ MED 3131~ 10.1~ The ~ Pate A, Ems~ BMC Med 1
#> 19 3119~ MED 3119~ 10.1~ Meth~ Minassian C~ Pharmacoepi~ 7
#> 20 3139~ MED 3139~ 10.1~ What~ Tiffin PA, ~ BMJ Open 8
#> # ... with 25 more variables: journalVolume <chr>, pubYear <chr>,
#> # journalIssn <chr>, pageInfo <chr>, pubType <chr>, isOpenAccess <chr>,
#> # inEPMC <chr>, inPMC <chr>, hasPDF <chr>, hasBook <chr>,
#> # hasSuppl <chr>, citedByCount <int>, hasReferences <chr>,
#> # hasTextMinedTerms <chr>, hasDbCrossReferences <chr>,
#> # hasLabsLinks <chr>, hasTMAccessionNumbers <chr>, firstIndexDate <chr>,
#> # firstPublicationDate <chr>, pmcid <chr>, bookid <chr>, name <int>,
#> # absText <list>, mesh <list>, keywords <chr>We can see that the get_full_search function returns addition metadata such as citation counts, whether the journal is open access and whether there is PDF available. By default, 1000 article descriptions are downloaded. It also includes mesh headings and abstract text.
we can see how many articles are available altogether by running epmc_profile.
profile <- epmc_profile(query = params$search)
Running epmc_profile allows us to see that there are 2380 articles of which 1854 are full text articles, and 1378 are open access.
Analysing abstracts
Abstracts per year
We can easily look at annual abstract frequency - we can readily see the growth in publication frequency in the last 3 years.
search1 %>%
count(pubYear) %>%
ggplot(aes(pubYear, n)) +
geom_col(fill = "blue") +
labs(title = "Abstracts per year",
subtitle = paste("Search: ", params$search)) +
phecharts::theme_phe() +
theme(axis.text.x = element_text(angle = 45 ,hjust = 1))
Journal frequency
Similarly we can identify the most frequent journals
journal_count <- search1 %>%
count(journalTitle) %>%
top_n(20) %>%
arrange(-n)
journal_count %>%
ggplot(aes(reorder(journalTitle, n), n)) +
geom_col(fill = "blue") +
coord_flip() +
labs(title = "Journal frequency") +
phecharts::theme_phe()
BMJ Open and PLoS One are the most frequent journals publishing articles on CPRD OR “The Health Improvement Network”.
Topic identification
Once we have a data frame of 2380 records with abstract text, we can prepare the data for analysis. The create_corpus function is designed for this.
out1 <- search1 %>%
select(pmid, pmcid ,doi, title, pubYear, citedByCount, absText, journalTitle) %>%
filter(absText != "NULL") %>%
mutate(text = paste(title, absText))
Text mining
We will use a method exemplified in the adjutant package which uses unsupervised machine learning to try and cluster similar articles and attach themes.
In this approach undertake some natural language processing. We will
- Split each abstract into groups is single words
- Remove numbers and common (stop) words
- Stem each word (definition:)
- Calculate the tf-idf score for each word in each abstract - this gives more weight to words which are more “typical” of the abstracts
- Create a document feature matrix
- Undertake dimensionality reduction using tSNE to simplify
- Run HDBSCAN to identify clusters
- Name the clusters
- QA the result
The ultimate output of this analysis is a visualisation of clustered and labelled abstracts and a interactive table.
library(tidytext)
corp <- create_corpus(df = search1)
head(corp$corpus)
#> # A tibble: 6 x 6
#> pmid word n tf idf tf_idf
#> <chr> <chr> <int> <dbl> <dbl> <dbl>
#> 1 10353904 allel 1 0.0106 5.56 0.0591
#> 2 10353904 analysi 1 0.0106 1.21 0.0129
#> 3 10353904 appar 2 0.0213 4.50 0.0956
#> 4 10353904 arrai 1 0.0106 6.37 0.0677
#> 5 10353904 assumpt 1 0.0106 4.29 0.0456
#> 6 10353904 care 1 0.0106 0.717 0.00762
corp$corpus %>%
count(pmid)
#> # A tibble: 2,331 x 2
#> pmid n
#> <chr> <int>
#> 1 10353904 60
#> 2 10651904 80
#> 3 10859185 66
#> 4 11004165 103
#> 5 11104519 19
#> 6 11231352 95
#> 7 11401576 92
#> 8 11525991 80
#> 9 12237467 95
#> 10 12381026 83
#> # ... with 2,321 more rows
clust <- create_cluster(corpus = corp$corpus, minPts = params$minPts, perplexity = params$perplexity)
#> If there are small numbers of abstracts,
#> try lowering the perpexlity value to less than 30% of the number of returns490.94 sec elapsed
clust$cluster_size
#> # A tibble: 57 x 2
#> cluster n
#> <dbl> <int>
#> 1 0 519
#> 2 1 70
#> 3 2 38
#> 4 3 25
#> 5 4 13
#> 6 5 14
#> 7 6 29
#> 8 7 42
#> 9 8 41
#> 10 9 65
#> # ... with 47 more rowsLabelling clusters
labels <- label_clusters(corp$corpus, clustering = clust$clustering, top_n = 4)
#> 0.86 sec elapsed
labels$labels
#> # A tibble: 57 x 2
#> # Groups: cluster [57]
#> cluster clus_names
#> <dbl> <chr>
#> 1 0 patient-health-practic-studi
#> 2 1 fractur-risk-ag-studi
#> 3 2 gout-risk-patient-studi
#> 4 3 psoriasi-base-popul-patient-studi
#> 5 4 psa-psoriasi-arthriti-psoriat-studi
#> 6 5 psa-psoriat-arthriti-patient-cohort-studi
#> 7 6 pregnanc-women-databas-studi
#> 8 7 smoke-cessat-primari-care
#> 9 8 dementia-risk-ag-studi
#> 10 9 antibiot-prescrib-prescript-care-studi
#> # ... with 47 more rowsVisualise
p <- labels$results %>%
left_join(search1, by = c("pmid.value" = "pmid")) %>%
ggplot(aes(X1, X2)) +
geom_point(aes(colour = clustered, size = citedByCount) ) +
ggrepel::geom_text_repel(data = labels$plot, aes(medX, medY, label = clus_names), size = 3, colour = "blaCK", alpha = 0.9)
p + scale_alpha_manual(values=c(1,0)) +
viridis::scale_color_viridis(discrete = TRUE, option = "viridis", alpha = .5, begin = .8, end = .1, direction = -1) +
phecharts::theme_phe() +
theme(panel.background = element_rect(fill = "#ffffff")) +
labs(subtitle = paste("Clustering: ", nrow(labels$plot), " topics" ),
title = paste("Search ", "= ", params$search ))
Understanding the labels
Most cited articles
most_cited <- labels$results %>%
left_join(search1, by = c("pmid.value" = "pmid")) %>%
filter(cluster !=0) %>%
group_by(clus_names) %>%
top_n(n = 3, citedByCount) %>%
select(clus_names, title, pubYear, citedByCount) %>%
ungroup() %>%
arrange(clus_names, -citedByCount)
most_cited %>%
formattable::formattable()| clus_names | title | pubYear | citedByCount |
|---|---|---|---|
| antibiot-prescrib-prescript-care-studi | Antibiotic exposure and IBD development among children: a population-based cohort study. | 2012 | 108 |
| antibiot-prescrib-prescript-care-studi | Continued high rates of antibiotic prescribing to adults with respiratory tract infection: survey of 568 UK general practices. | 2014 | 56 |
| antibiot-prescrib-prescript-care-studi | Potential association between the oral tetracycline class of antimicrobials used to treat acne and inflammatory bowel disease. | 2010 | 51 |
| atrial-fibril-patient-increas | Adverse prognosis of incidentally detected ambulatory atrial fibrillation. A cohort study. | 2014 | 36 |
| atrial-fibril-patient-increas | Trends in the prescription of novel oral anticoagulants in UK primary care. | 2017 | 31 |
| atrial-fibril-patient-increas | Temporal Trends in Incidence, Prevalence, and Mortality of Atrial Fibrillation in Primary Care. | 2017 | 24 |
| bmi-obes-bodi-index-studi | Effectiveness of behavioural weight loss interventions delivered in a primary care setting: a systematic review and meta-analysis. | 2014 | 45 |
| bmi-obes-bodi-index-studi | Impact of body mass index on prevalence of multimorbidity in primary care: cohort study. | 2014 | 44 |
| bmi-obes-bodi-index-studi | Metabolically Healthy Obese and Incident Cardiovascular Disease Events Among 3.5 Million Men and Women. | 2017 | 44 |
| cancer-ci-risk-studi | Validation studies of the health improvement network (THIN) database for pharmacoepidemiology research. | 2007 | 309 |
| cancer-ci-risk-studi | Hormonal therapies and meningioma: is there a link? | 2012 | 25 |
| cancer-ci-risk-studi | Study of adverse outcomes in women using testosterone therapy. | 2009 | 23 |
| cancer-risk-patient-studi | Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5·24 million UK adults. | 2014 | 361 |
| cancer-risk-patient-studi | The CAPER studies: five case-control studies aimed at identifying and quantifying the risk of cancer in symptomatic primary care patients. | 2009 | 105 |
| cancer-risk-patient-studi | The incidence of cancer in patients with idiopathic pulmonary fibrosis and sarcoidosis in the UK. | 2007 | 97 |
| cardiovascular-risk-diseas-studi | An independent and external validation of QRISK2 cardiovascular disease risk score: a prospective open cohort study. | 2010 | 85 |
| cardiovascular-risk-diseas-studi | Predicting the 10 year risk of cardiovascular disease in the United Kingdom: independent and external validation of an updated version of QRISK2. | 2012 | 75 |
| cardiovascular-risk-diseas-studi | The Framingham Heart Study’s impact on global risk assessment. | 2010 | 36 |
| cardiovascular-risk-diseas-studi | Cardiovascular risk prediction models for people with severe mental illness: results from the prediction and management of cardiovascular risk in people with severe mental illnesses (PRIMROSE) research program. | 2015 | 36 |
| care-patient-cohort-record | Health care resource utilisation in primary care prior to and after a diagnosis of Alzheimer’s disease: a retrospective, matched case-control study in the United Kingdom. | 2014 | 10 |
| care-patient-cohort-record | Investigation of the effect of deprivation on the burden and management of venous leg ulcers: a cohort study using the THIN database. | 2013 | 9 |
| care-patient-cohort-record | Backdating of events in electronic primary health care data: should one censor at the date of last data collection. | 2016 | 5 |
| cell-analysi-identifi-increas-studi | A comprehensive in vitro and in silico analysis of antibiotics that activate pregnane X receptor and induce CYP3A4 in liver and intestine. | 2008 | 36 |
| cell-analysi-identifi-increas-studi | Depletion of CD4(+) T cells aggravates glomerular and interstitial injury in murine adriamycin nephropathy. | 2001 | 27 |
| cell-analysi-identifi-increas-studi | Modulation of sodium/iodide symporter expression in the salivary gland. | 2013 | 25 |
| children-ag-care-studi | The epidemiology of pharmacologically treated attention deficit hyperactivity disorder (ADHD) in children, adolescents and adults in UK primary care. | 2012 | 86 |
| children-ag-care-studi | Gastroesophageal reflux disease in children and adolescents in primary care. | 2010 | 29 |
| children-ag-care-studi | The prevalence and incidence, resource use and financial costs of treating people with attention deficit/hyperactivity disorder (ADHD) in the United Kingdom (1998 to 2010). | 2013 | 27 |
| ckd-kidnei-chronic-diseas-studi | Risk models to predict chronic kidney disease and its progression: a systematic review. | 2012 | 51 |
| ckd-kidnei-chronic-diseas-studi | Validation of The Health Improvement Network (THIN) database for epidemiologic studies of chronic kidney disease. | 2011 | 31 |
| ckd-kidnei-chronic-diseas-studi | Assessing the risk of incident hypertension and chronic kidney disease after exposure to shock wave lithotripsy and ureteroscopy. | 2016 | 14 |
| copd-obstruct-chronic-diseas-patient | Increased risk of myocardial infarction and stroke following exacerbation of COPD. | 2010 | 164 |
| copd-obstruct-chronic-diseas-patient | Prevalence and burden of breathlessness in patients with chronic obstructive pulmonary disease managed in primary care. | 2014 | 33 |
| copd-obstruct-chronic-diseas-patient | Risk factors for acute exacerbations of COPD in a primary care population: a retrospective observational cohort study. | 2014 | 33 |
| copd-obstruct-diseas-patient | Validation of chronic obstructive pulmonary disease recording in the Clinical Practice Research Datalink (CPRD-GOLD). | 2014 | 59 |
| copd-obstruct-diseas-patient | Validation of the Recording of Acute Exacerbations of COPD in UK Primary Care Electronic Healthcare Records. | 2016 | 30 |
| copd-obstruct-diseas-patient | Long-term exposure to outdoor air pollution and the incidence of chronic obstructive pulmonary disease in a national English cohort. | 2015 | 22 |
| cost-patient-health-clinic | Generic and therapeutic substitutions in the UK: are they a good thing? | 2010 | 66 |
| cost-patient-health-clinic | Health economic impact of managing patients following a community-based diagnosis of malnutrition in the UK. | 2011 | 41 |
| cost-patient-health-clinic | Resource implications and budget impact of managing cow milk allergy in the UK. | 2010 | 34 |
| cost-patient-health-clinic | Health economic burden that wounds impose on the National Health Service in the UK. | 2015 | 34 |
| data-research-record-studi | Feasibility study and methodology to create a quality-evaluated database of primary care data. | 2004 | 176 |
| data-research-record-studi | Recent advances in the utility and use of the General Practice Research Database as an example of a UK Primary Care Data resource. | 2012 | 158 |
| data-research-record-studi | Using Electronic Health Records for Population Health Research: A Review of Methods and Applications. | 2016 | 44 |
| databas-patient-improv-data-studi | Testosterone lab testing and initiation in the United Kingdom and the United States, 2000 to 2011. | 2014 | 61 |
| databas-patient-improv-data-studi | Declining public health burden of digoxin toxicity from 1991 to 2004. | 2008 | 14 |
| databas-patient-improv-data-studi | Use of demographic and pharmacy data to identify patients included within both the Clinical Practice Research Datalink (CPRD) and The Health Improvement Network (THIN). | 2015 | 7 |
| dementia-risk-ag-studi | BMI and risk of dementia in two million people over two decades: a retrospective cohort study. | 2015 | 104 |
| dementia-risk-ag-studi | Survival of people with clinical diagnosis of dementia in primary care: cohort study. | 2010 | 78 |
| dementia-risk-ag-studi | Trends in the prevalence of antipsychotic drug use among patients with Alzheimer’s disease and other dementias including those treated with antidementia drugs in the community in the UK: a cohort study. | 2013 | 21 |
| diabet-type-patient-studi | Trends in the prevalence and incidence of diabetes in the UK: 1996-2005. | 2009 | 133 |
| diabet-type-patient-studi | The impact of treatment noncompliance on mortality in people with type 2 diabetes. | 2012 | 83 |
| diabet-type-patient-studi | Acute pancreatitis in association with type 2 diabetes and antidiabetic drugs: a population-based cohort study. | 2010 | 65 |
| diseas-risk-ag-studi | The inflammatory bowel diseases and ambient air pollution: a novel association. | 2010 | 80 |
| diseas-risk-ag-studi | Environmental triggers for inflammatory bowel disease. | 2013 | 51 |
| diseas-risk-ag-studi | Epidemiology of the rotator cuff tears: a new incidence related to thyroid disease. | 2014 | 32 |
| dose-low-risk-primari-patient-network-improv-health-studi | Acid suppressants reduce risk of gastrointestinal bleeding in patients on antithrombotic or anti-inflammatory therapy. | 2011 | 36 |
| dose-low-risk-primari-patient-network-improv-health-studi | Risk of Upper Gastrointestinal Bleeding in a Cohort of New Users of Low-Dose ASA for Secondary Prevention of Cardiovascular Outcomes. | 2010 | 18 |
| dose-low-risk-primari-patient-network-improv-health-studi | Proton pump inhibitors reduce the long-term risk of recurrent upper gastrointestinal bleeding: an observational study. | 2008 | 15 |
| drug-safeti-research-health-studi | CNODES: the Canadian Network for Observational Drug Effect Studies. | 2012 | 35 |
| drug-safeti-research-health-studi | Bridging differences in outcomes of pharmacoepidemiological studies: design and first results of the PROTECT project. | 2014 | 31 |
| drug-safeti-research-health-studi | Good Signal Detection Practices: Evidence from IMI PROTECT. | 2016 | 24 |
| epilepsi-risk-data-studi | Suicidal behavior and antiepileptic drugs in epilepsy: analysis of the emerging evidence. | 2011 | 18 |
| epilepsi-risk-data-studi | Childhood epilepsy recorded in primary care in the UK. | 2013 | 16 |
| epilepsi-risk-data-studi | Association between antibiotic prescribing in pregnancy and cerebral palsy or epilepsy in children born at term: a cohort study using the health improvement network. | 2015 | 11 |
| fractur-risk-ag-studi | A systematic review of intervention thresholds based on FRAX : A report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation. | 2016 | 52 |
| fractur-risk-ag-studi | Type 1 diabetes is associated with an increased risk of fracture across the life span: a population-based cohort study using The Health Improvement Network (THIN). | 2015 | 45 |
| fractur-risk-ag-studi | Predicting risk of osteoporotic and hip fracture in the United Kingdom: prospective independent and external validation of QFractureScores. | 2011 | 44 |
| fractur-risk-effect-databas-increas-patient-health-studi | Adverse reactions and drug-drug interactions in the management of women with postmenopausal osteoporosis. | 2011 | 79 |
| fractur-risk-effect-databas-increas-patient-health-studi | Explaining variation in referral from primary to secondary care: cohort study. | 2010 | 34 |
| fractur-risk-effect-databas-increas-patient-health-studi | The epidemiology of osteonecrosis: findings from the GPRD and THIN databases in the UK. | 2010 | 27 |
| gene-cell-protein-result | An overview of the structures of protein-DNA complexes. | 2000 | 153 |
| gene-cell-protein-result | A stress-inducible gene for 9-cis-epoxycarotenoid dioxygenase involved in abscisic acid biosynthesis under water stress in drought-tolerant cowpea. | 2000 | 125 |
| gene-cell-protein-result | YakA, a protein kinase required for the transition from growth to development in Dictyostelium. | 1998 | 77 |
| gout-risk-patient-studi | Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. | 2015 | 154 |
| gout-risk-patient-studi | Epidemiology of gout. | 2014 | 68 |
| gout-risk-patient-studi | Antihypertensive drugs and risk of incident gout among patients with hypertension: population based case-control study. | 2012 | 58 |
| gp-care-patient-practic-clinic | Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007-14. | 2016 | 125 |
| gp-care-patient-practic-clinic | Clinical characteristics and patterns of healthcare utilization in patients with painful neuropathic disorders in UK general practice: a retrospective cohort study. | 2012 | 25 |
| gp-care-patient-practic-clinic | Do financial incentives for delivering health promotion counselling work? Analysis of smoking cessation activities stimulated by the quality and outcomes framework. | 2010 | 20 |
| health-practic-data-studi | No longer simply a Practice-based Research Network (PBRN) health improvement networks. | 2011 | 12 |
| health-practic-data-studi | The clinical profile of tuberous sclerosis complex (TSC) in the United Kingdom: A retrospective cohort study in the Clinical Practice Research Datalink (CPRD). | 2016 | 12 |
| health-practic-data-studi | Payment methods for outpatient care facilities. | 2017 | 10 |
| hemorrhag-stroke-risk-data-increas-studi | Antithrombotic drugs and risk of hemorrhagic stroke in the general population. | 2013 | 47 |
| hemorrhag-stroke-risk-data-increas-studi | Mortality after hemorrhagic stroke: data from general practice (The Health Improvement Network). | 2013 | 36 |
| hemorrhag-stroke-risk-data-increas-studi | Complications and mortality in hereditary hemorrhagic telangiectasia: A population-based study. | 2015 | 23 |
| incid-ag-practic-studi | Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. | 2014 | 316 |
| incid-ag-practic-studi | Generalisability of The Health Improvement Network (THIN) database: demographics, chronic disease prevalence and mortality rates. | 2011 | 218 |
| incid-ag-practic-studi | Incidence and prevalence of celiac disease and dermatitis herpetiformis in the UK over two decades: population-based study. | 2014 | 91 |
| incid-confid-interv-ratio-studi | Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers: systematic review and meta-analysis. | 2012 | 32 |
| incid-confid-interv-ratio-studi | Do selected drugs increase the risk of lupus? A matched case-control study. | 2010 | 23 |
| incid-confid-interv-ratio-studi | The incidence of pneumonia using data from a computerized general practice database. | 2009 | 15 |
| insulin-type-diabet-treatment | Clinical inertia in people with type 2 diabetes: a retrospective cohort study of more than 80,000 people. | 2013 | 205 |
| insulin-type-diabet-treatment | Clinical inertia with regard to intensifying therapy in people with type 2 diabetes treated with basal insulin. | 2016 | 77 |
| insulin-type-diabet-treatment | Delayed initiation of subcutaneous insulin therapy after failure of oral glucose-lowering agents in patients with Type 2 diabetes: a population-based analysis in the UK. | 2007 | 65 |
| metformin-cancer-risk-studi | Incidence of bladder cancer in patients with type 2 diabetes treated with metformin or sulfonylureas. | 2014 | 30 |
| metformin-cancer-risk-studi | Initial metformin or sulphonylurea exposure and cancer occurrence among patients with type 2 diabetes mellitus. | 2013 | 25 |
| metformin-cancer-risk-studi | Metformin use and survival after colorectal cancer: A population-based cohort study. | 2016 | 16 |
| metformin-diabet-patient-studi | Can people with type 2 diabetes live longer than those without? A comparison of mortality in people initiated with metformin or sulphonylurea monotherapy and matched, non-diabetic controls. | 2014 | 69 |
| metformin-diabet-patient-studi | Risk of lactic acidosis or elevated lactate concentrations in metformin users with renal impairment: a population-based cohort study. | 2014 | 43 |
| metformin-diabet-patient-studi | Combination therapy with metformin plus sulphonylureas versus metformin plus DPP-4 inhibitors: association with major adverse cardiovascular events and all-cause mortality. | 2014 | 39 |
| mortal-ag-increas-studi | Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: a population-based cohort study. | 2016 | 89 |
| mortal-ag-increas-studi | 1 and 5 year survival estimates for people with cirrhosis of the liver in England, 1998-2009: a large population study. | 2014 | 39 |
| mortal-ag-increas-studi | Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000-2014. | 2017 | 34 |
| mutat-retin-cone-gene-caus-patient-diseas | Shared mutations in NR2E3 in enhanced S-cone syndrome, Goldmann-Favre syndrome, and many cases of clumped pigmentary retinal degeneration. | 2003 | 81 |
| mutat-retin-cone-gene-caus-patient-diseas | Evidence for complex mutations at microsatellite loci in Drosophila. | 1999 | 53 |
| mutat-retin-cone-gene-caus-patient-diseas | NR2E3 mutations in enhanced S-cone sensitivity syndrome (ESCS), Goldmann-Favre syndrome (GFS), clumped pigmentary retinal degeneration (CPRD), and retinitis pigmentosa (RP). | 2009 | 39 |
| null-care-health-studi | Data Resource Profile: The Danish National Prescription Registry. | 2017 | 67 |
| null-care-health-studi | External validation of clinical prediction models using big datasets from e-health records or IPD meta-analysis: opportunities and challenges. | 2016 | 54 |
| null-care-health-studi | Helping everyone do better: a call for validation studies of routinely recorded health data. | 2016 | 17 |
| patient-clinic-practic-studi | Prevalence of long-term oral glucocorticoid prescriptions in the UK over the past 20 years. | 2011 | 65 |
| patient-clinic-practic-studi | Future projections of total hip and knee arthroplasty in the UK: results from the UK Clinical Practice Research Datalink. | 2015 | 46 |
| patient-clinic-practic-studi | Inhaled corticosteroids and the risk of pneumonia in people with asthma: a case-control study. | 2013 | 45 |
| pioglitazon-cancer-risk-patient-studi | Association between longer therapy with thiazolidinediones and risk of bladder cancer: a cohort study. | 2012 | 64 |
| pioglitazon-cancer-risk-patient-studi | Thiazolidinediones and associated risk of bladder cancer: a systematic review and meta-analysis. | 2014 | 57 |
| pioglitazon-cancer-risk-patient-studi | Pioglitazone use and risk of bladder cancer: population based cohort study. | 2016 | 55 |
| pregnanc-women-databas-studi | Safety of pertussis vaccination in pregnant women in UK: observational study. | 2014 | 86 |
| pregnanc-women-databas-studi | Pregnancy as a major determinant for discontinuation of antidepressants: an analysis of data from The Health Improvement Network. | 2011 | 62 |
| pregnanc-women-databas-studi | Antiepileptic drugs during pregnancy in primary care: a UK population based study. | 2012 | 30 |
| prescrib-increas-practic-studi | Suicidal behavior and severe neuropsychiatric disorders following glucocorticoid therapy in primary care. | 2012 | 57 |
| prescrib-increas-practic-studi | Prescribing trends in bipolar disorder: cohort study in the United Kingdom THIN primary care database 1995-2009. | 2011 | 47 |
| prescrib-increas-practic-studi | Trends in depression and antidepressant prescribing in children and adolescents: a cohort study in The Health Improvement Network (THIN). | 2012 | 41 |
| primari-care-patient-practic-studi | Prediagnostic presentations of Parkinson’s disease in primary care: a case-control study. | 2015 | 120 |
| primari-care-patient-practic-studi | Identifying periods of acceptable computer usage in primary care research databases. | 2013 | 50 |
| primari-care-patient-practic-studi | The incidence of other gastroenterological disease following diagnosis of irritable bowel syndrome in the UK: a cohort study. | 2014 | 17 |
| protein-structur-residu-site-result-studi | A surface loop of the potato leafroll virus coat protein is involved in virion assembly, systemic movement, and aphid transmission. | 2005 | 34 |
| protein-structur-residu-site-result-studi | Bacterial degradation of chlorophenols and their derivatives. | 2014 | 33 |
| protein-structur-residu-site-result-studi | Changes in hydrogen-bond strengths explain reduction potentials in 10 rubredoxin variants. | 2005 | 27 |
| psa-psoriasi-arthriti-psoriat-studi | Risk of major cardiovascular events in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: a population-based cohort study. | 2015 | 114 |
| psa-psoriasi-arthriti-psoriat-studi | Obesity and the risk of psoriatic arthritis: a population-based study. | 2012 | 89 |
| psa-psoriasi-arthriti-psoriat-studi | Diabetes incidence in psoriatic arthritis, psoriasis and rheumatoid arthritis: a UK population-based cohort study. | 2014 | 46 |
| psa-psoriat-arthriti-patient-cohort-studi | Atherosclerosis in psoriatic disease: latest evidence and clinical implications. | 2015 | 16 |
| psa-psoriat-arthriti-patient-cohort-studi | Incidence and Management of Cardiovascular Risk Factors in Psoriatic Arthritis and Rheumatoid Arthritis: A Population-Based Study. | 2017 | 16 |
| psa-psoriat-arthriti-patient-cohort-studi | Cause-specific mortality in patients with psoriatic arthritis and rheumatoid arthritis. | 2017 | 8 |
| psoriasi-base-popul-patient-studi | Prevalence of metabolic syndrome in patients with psoriasis: a population-based study in the United Kingdom. | 2012 | 151 |
| psoriasi-base-popul-patient-studi | Psoriasis severity and the prevalence of major medical comorbidity: a population-based study. | 2013 | 148 |
| psoriasi-base-popul-patient-studi | The association between psoriasis and obesity: a systematic review and meta-analysis of observational studies. | 2012 | 126 |
| result-model-base-compar-studi | Hot spots of retinoic acid synthesis in the developing spinal cord. | 1994 | 73 |
| result-model-base-compar-studi | Treatment of adult-onset acute macular retinoschisis in enhanced s-cone syndrome with oral acetazolamide. | 2009 | 19 |
| result-model-base-compar-studi | Contrasting physiological effects of partial root zone drying in field-grown grapevine (Vitis vinifera L. cv. Monastrell) according to total soil water availability. | 2012 | 12 |
| risk-increas-ag-ratio-studi | Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: nested case-control study. | 2013 | 95 |
| risk-increas-ag-ratio-studi | Incidence of community-acquired lower respiratory tract infections and pneumonia among older adults in the United Kingdom: a population-based study. | 2013 | 55 |
| risk-increas-ag-ratio-studi | Impact of age, sex, obesity, and steroid use on quinolone-associated tendon disorders. | 2012 | 41 |
| risk-increas-patient-studi | Role of dose potency in the prediction of risk of myocardial infarction associated with nonsteroidal anti-inflammatory drugs in the general population. | 2008 | 144 |
| risk-increas-patient-studi | Risk of upper gastrointestinal complications among users of traditional NSAIDs and COXIBs in the general population. | 2007 | 106 |
| risk-increas-patient-studi | Use of combined oral contraceptives and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. | 2015 | 44 |
| risk-patient-cohort-studi | Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1·25 million people. | 2014 | 312 |
| risk-patient-cohort-studi | Completeness and diagnostic validity of recording acute myocardial infarction events in primary care, hospital care, disease registry, and national mortality records: cohort study. | 2013 | 126 |
| risk-patient-cohort-studi | Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: interrupted time series study. | 2011 | 114 |
| smoke-cessat-primari-care | Smoking cessation treatment and risk of depression, suicide, and self harm in the Clinical Practice Research Datalink: prospective cohort study. | 2013 | 49 |
| smoke-cessat-primari-care | The impact of the Quality and Outcomes Framework (QOF) on the recording of smoking targets in primary care medical records: cross-sectional analyses from The Health Improvement Network (THIN) database. | 2012 | 32 |
| smoke-cessat-primari-care | Impact of contractual financial incentives on the ascertainment and management of smoking in primary care. | 2007 | 31 |
| statin-risk-patient-studi | Effect of statins on a wide range of health outcomes: a cohort study validated by comparison with randomized trials. | 2009 | 105 |
| statin-risk-patient-studi | The epidemiology of cardiovascular disease in the UK 2014. | 2015 | 89 |
| statin-risk-patient-studi | Cardiovascular events as a function of serum bilirubin levels in a large, statin-treated cohort. | 2012 | 65 |
| statin-risk-patient-studi | Higher potency statins and the risk of new diabetes: multicentre, observational study of administrative databases. | 2014 | 65 |
| stroke-risk-increas-studi | Risk of stroke following herpes zoster: a self-controlled case-series study. | 2014 | 53 |
| stroke-risk-increas-studi | Use of nicotine replacement therapy and the risk of acute myocardial infarction, stroke, and death. | 2005 | 47 |
| stroke-risk-increas-studi | Herpes zoster as a risk factor for stroke and TIA: a retrospective cohort study in the UK. | 2014 | 45 |
| vaccin-ag-practic-studi | Declining genital Warts in young women in england associated with HPV 16/18 vaccination: an ecological study. | 2013 | 31 |
| vaccin-ag-practic-studi | Modelling estimates of the burden of Respiratory Syncytial virus infection in adults and the elderly in the United Kingdom. | 2015 | 29 |
| vaccin-ag-practic-studi | Quantification of risk factors for postherpetic neuralgia in herpes zoster patients: A cohort study. | 2016 | 22 |
| vaccin-influenza-risk-ag-studi | Sustained Effectiveness of the Maternal Pertussis Immunization Program in England 3 Years Following Introduction. | 2016 | 41 |
| vaccin-influenza-risk-ag-studi | International collaboration to assess the risk of Guillain Barré Syndrome following Influenza A (H1N1) 2009 monovalent vaccines. | 2013 | 37 |
| vaccin-influenza-risk-ag-studi | Influenza but not pneumococcal vaccination protects against all-cause mortality in patients with COPD. | 2009 | 33 |
| valid-record-identifi-data | Development and validation of an electronic frailty index using routine primary care electronic health record data. | 2016 | 92 |
| valid-record-identifi-data | Data resource profile: cardiovascular disease research using linked bespoke studies and electronic health records (CALIBER). | 2012 | 91 |
| valid-record-identifi-data | ClinicalCodes: an online clinical codes repository to improve the validity and reproducibility of research using electronic medical records. | 2014 | 57 |
Use of keywords
We can review the commonest Mesh headings associated with each cluster tag.
labels$results %>%
left_join(search1, by = c("pmid.value" = "pmid")) %>%
select(clus_names, mesh) %>%
filter(mesh != "NULL") %>%
unnest(mesh) %>%
count(clus_names, mesh,sort = TRUE) %>%
filter(n < 30) %>%
ungroup() %>%
group_by(clus_names) %>%
top_n(10) %>%
mutate(summary = paste(mesh, collapse = "; " )) %>%
select(-c(mesh, n)) %>%
distinct() %>%
arrange(clus_names) %>%
knitr::kable()| clus_names | summary |
|---|---|
| antibiot-prescrib-prescript-care-studi | Middle Aged; Practice Patterns, Physicians’; Aged; United Kingdom; Primary Health Care; Adult; Respiratory Tract Infections; Adolescent; Young Adult; England |
| atrial-fibril-patient-increas | Aged; Female; Humans; Male; Atrial Fibrillation; Middle Aged; Anticoagulants; Aged, 80 and over; Risk Factors; Incidence; United Kingdom |
| bmi-obes-bodi-index-studi | Humans; Female; Male; Middle Aged; Body Mass Index; Obesity; Adult; Aged; Primary Health Care; United Kingdom |
| cancer-ci-risk-studi | Humans; Female; Aged; Middle Aged; Male; Case-Control Studies; Risk Factors; Aged, 80 and over; United Kingdom; Adult |
| cancer-risk-patient-studi | Case-Control Studies; Cohort Studies; Colorectal Neoplasms; Young Adult; Databases, Factual; Lung Neoplasms; Early Detection of Cancer; Adolescent; Risk Assessment; Breast Neoplasms; Retrospective Studies |
| cardiovascular-risk-diseas-studi | Female; Humans; Male; Cardiovascular Diseases; Middle Aged; Aged; Risk Factors; Risk Assessment; Adult; England; United Kingdom |
| care-patient-cohort-record | Humans; Female; Male; Aged; Aged, 80 and over; Databases, Factual; Incidence; Adult; Middle Aged; Primary Health Care; United Kingdom |
| cell-analysi-identifi-increas-studi | Humans; Animals; Male; Adolescent; Adult; Aged; Female; Middle Aged; Alleles; Base Sequence; Case-Control Studies; Cell Line; Electron Transport; Genome, Bacterial; Incidence; Mice; RNA, Messenger; United Kingdom; Young Adult |
| children-ag-care-studi | Child; Female; Child, Preschool; Adolescent; Infant; United Kingdom; Attention Deficit Disorder with Hyperactivity; Incidence; Primary Health Care; Adult; Infant, Newborn |
| ckd-kidnei-chronic-diseas-studi | Humans; Female; Male; Renal Insufficiency, Chronic; Middle Aged; Adult; Aged; United Kingdom; Glomerular Filtration Rate; Aged, 80 and over; Risk Factors |
| copd-obstruct-chronic-diseas-patient | Humans; Pulmonary Disease, Chronic Obstructive; Female; Male; Aged; Middle Aged; Disease Progression; Aged, 80 and over; Risk Factors; United Kingdom |
| copd-obstruct-diseas-patient | Humans; Pulmonary Disease, Chronic Obstructive; Aged; Female; Male; Middle Aged; Primary Health Care; Aged, 80 and over; Databases, Factual; Risk Factors |
| cost-patient-health-clinic | Aged; Middle Aged; Cost-Benefit Analysis; Health Care Costs; Adult; Retrospective Studies; Aged, 80 and over; State Medicine; Cohort Studies; Quality-Adjusted Life Years; Treatment Outcome |
| data-research-record-studi | Electronic Health Records; Databases, Factual; Female; Male; Adult; Primary Health Care; Data Collection; Feasibility Studies; Data Mining; Health Services Research; Information Storage and Retrieval; Middle Aged; Research Design; United Kingdom |
| databas-patient-improv-data-studi | Humans; Male; United Kingdom; Female; Middle Aged; Aged; Databases, Factual; Retrospective Studies; Adult; United States; Young Adult |
| dementia-risk-ag-studi | Humans; Dementia; Male; Aged; Female; United Kingdom; Risk Factors; Aged, 80 and over; Middle Aged; Cohort Studies |
| diabet-type-patient-studi | Cohort Studies; Incidence; Blood Glucose; Glycated Hemoglobin A; Primary Health Care; Databases, Factual; Young Adult; Adolescent; Sulfonylurea Compounds; Cardiovascular Diseases; Diabetes Mellitus, Type 1; Dipeptidyl-Peptidase IV Inhibitors |
| diseas-risk-ag-studi | Humans; Female; Male; Middle Aged; United Kingdom; Aged; Adult; Incidence; Proportional Hazards Models; Risk Factors |
| dose-low-risk-primari-patient-network-improv-health-studi | Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Aspirin; Adult; United Kingdom; Cardiovascular Diseases; Risk Factors |
| drug-safeti-research-health-studi | Humans; Adverse Drug Reaction Reporting Systems; Drug-Related Side Effects and Adverse Reactions; Databases, Factual; Electronic Health Records; Pharmacovigilance; Pharmacoepidemiology; Europe; Product Surveillance, Postmarketing; Research Design; Risk Assessment; United Kingdom |
| epilepsi-risk-data-studi | Humans; Adult; Epilepsy; Female; Male; Middle Aged; Cohort Studies; Anticonvulsants; Adolescent; Aged; Child; Risk Factors; United Kingdom |
| fractur-risk-ag-studi | Aged, 80 and over; United Kingdom; Fractures, Bone; Hip Fractures; Incidence; Osteoporotic Fractures; Adult; Cohort Studies; Retrospective Studies; Risk Assessment; Risk Factors |
| fractur-risk-effect-databas-increas-patient-health-studi | Humans; Female; Male; Aged; Adult; Middle Aged; Case-Control Studies; Fractures, Bone; Hip Fractures; Aged, 80 and over; Benzodiazepines; Databases, Factual; Osteoporosis; United Kingdom |
| gene-cell-protein-result | Dictyostelium; Animals; Molecular Sequence Data; Amino Acid Sequence; Cyclic AMP; Protozoan Proteins; Base Sequence; Cloning, Molecular; Humans; Sequence Homology, Amino Acid; Signal Transduction |
| gout-risk-patient-studi | Humans; Male; Gout; Female; Aged; Middle Aged; United Kingdom; Risk Factors; Incidence; Adult |
| gp-care-patient-practic-clinic | Humans; Female; Male; Aged; England; General Practice; Workload; Adult; Middle Aged; General Practitioners; Practice Patterns, Physicians’; Primary Health Care; United Kingdom |
| health-practic-data-studi | Humans; Female; Male; Middle Aged; England; Primary Health Care; Adolescent; Adult; United Kingdom; Aged; Child; Child, Preschool; Cross-Sectional Studies; Databases, Factual; Delivery of Health Care; Employment; Logistic Models; Program Evaluation; Quality Improvement; Retrospective Studies |
| hemorrhag-stroke-risk-data-increas-studi | Female; Humans; Male; Stroke; Middle Aged; Case-Control Studies; Cerebral Hemorrhage; Adult; Aged; Databases, Factual |
| incid-ag-practic-studi | Humans; Female; Middle Aged; Adult; Male; United Kingdom; Incidence; Adolescent; Aged; Young Adult |
| incid-confid-interv-ratio-studi | Humans; Middle Aged; Female; Male; Adult; Aged; Incidence; Risk Factors; Case-Control Studies; United Kingdom; Young Adult |
| insulin-type-diabet-treatment | Diabetes Mellitus, Type 2; Female; Humans; Male; Middle Aged; Hemoglobin A, Glycosylated; Hypoglycemic Agents; Insulin; Retrospective Studies; Aged; United Kingdom |
| metformin-cancer-risk-studi | Humans; Hypoglycemic Agents; Metformin; Aged; Female; Diabetes Mellitus, Type 2; Middle Aged; Adult; Aged, 80 and over; Cohort Studies; Male |
| metformin-diabet-patient-studi | Female; Humans; Male; Diabetes Mellitus, Type 2; Hypoglycemic Agents; Metformin; Middle Aged; Aged; Cohort Studies; Sulfonylurea Compounds |
| mortal-ag-increas-studi | Humans; Female; Male; Aged; Middle Aged; Cohort Studies; Adult; United Kingdom; Risk Factors; Aged, 80 and over |
| mutat-retin-cone-gene-caus-patient-diseas | Humans; Mutation; Orphan Nuclear Receptors; Adolescent; Molecular Sequence Data; Pedigree; Adult; Amino Acid Sequence; Animals; Electroretinography; Eye Diseases, Hereditary; Eye Proteins; Male; Protein Binding; Retinitis Pigmentosa |
| null-care-health-studi | United Kingdom; Female; Male; Primary Health Care; Electronic Health Records; Databases, Factual; General Practice; Aged; Data Collection; Middle Aged |
| patient-clinic-practic-studi | Adult; Asthma; Databases, Factual; Primary Health Care; Aged, 80 and over; Pulmonary Disease, Chronic Obstructive; Retrospective Studies; Adolescent; Adrenal Cortex Hormones; Arthritis, Rheumatoid |
| patient-health-practic-studi | Time Factors; Odds Ratio; Child, Preschool; Infant; Hypoglycemic Agents; Logistic Models; Practice Patterns, Physicians’; Comorbidity; Risk; Longitudinal Studies; Pregnancy |
| pioglitazon-cancer-risk-patient-studi | Humans; Female; Urinary Bladder Neoplasms; Hypoglycemic Agents; Male; Thiazolidinediones; Diabetes Mellitus, Type 2; Middle Aged; Risk Factors; United Kingdom |
| pregnanc-women-databas-studi | Female; Humans; Pregnancy; Adult; United Kingdom; Young Adult; Adolescent; Cohort Studies; Middle Aged; Pregnancy Complications |
| prescrib-increas-practic-studi | Female; Male; United Kingdom; Adult; Middle Aged; Aged; Practice Patterns, Physicians’; Antidepressive Agents; Adolescent; Drug Prescriptions |
| primari-care-patient-practic-studi | Humans; Female; Male; Primary Health Care; United Kingdom; Adult; Aged; Middle Aged; Age Factors; Case-Control Studies; Electronic Health Records; Time Factors |
| protein-structur-residu-site-result-studi | Rubredoxins; Clostridium; Models, Molecular; Bacterial Proteins; Iron; Nuclear Magnetic Resonance, Biomolecular; Oxidation-Reduction; Hydrogen Bonding; Adult; Cysteine; Female; Humans; Iron-Sulfur Proteins; Magnetic Resonance Spectroscopy; Middle Aged; Pyrococcus furiosus |
| psa-psoriasi-arthriti-psoriat-studi | Arthritis, Psoriatic; Female; Humans; Male; Middle Aged; Adult; Aged; Psoriasis; Incidence; Cohort Studies; United Kingdom |
| psa-psoriat-arthriti-patient-cohort-studi | Humans; Male; Female; Middle Aged; Adult; Aged; Arthritis, Psoriatic; Aged, 80 and over; Cohort Studies; Incidence; United Kingdom |
| psoriasi-base-popul-patient-studi | Humans; Psoriasis; Female; Male; Middle Aged; Adult; United Kingdom; Aged; Young Adult; Adolescent; Aged, 80 and over |
| result-model-base-compar-studi | Humans; Male; Adult; Electroretinography; Female; Middle Aged; Retinal Degeneration; Visual Acuity; Adolescent; Child; Fundus Oculi; Retina; Retrospective Studies; Tomography, Optical Coherence |
| risk-increas-ag-ratio-studi | Female; Humans; Male; Aged; Middle Aged; United Kingdom; Adult; Cohort Studies; Incidence; Aged, 80 and over; Risk Factors |
| risk-increas-patient-studi | Humans; Female; Middle Aged; Aged; Male; Adult; United Kingdom; Case-Control Studies; Risk Factors; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal |
| risk-patient-cohort-studi | United Kingdom; Cohort Studies; Adult; Aged, 80 and over; Incidence; Cardiovascular Diseases; Myocardial Infarction; Retrospective Studies; Heart Failure; Blood Pressure; Electronic Health Records; Hypertension |
| smoke-cessat-primari-care | Female; Male; Middle Aged; Smoking; Adult; United Kingdom; Adolescent; Primary Health Care; Aged; Young Adult |
| statin-risk-patient-studi | Risk Factors; Cardiovascular Diseases; Adult; Aged, 80 and over; Cohort Studies; Primary Prevention; Databases, Factual; Primary Health Care; Risk Assessment; Retrospective Studies |
| stroke-risk-increas-studi | Humans; Stroke; Female; Male; Middle Aged; Aged; Risk Factors; United Kingdom; Adult; Myocardial Infarction |
| vaccin-ag-practic-studi | Humans; Female; Male; Aged; Adolescent; United Kingdom; Adult; Middle Aged; Young Adult; Aged, 80 and over; Child; Databases, Factual; Influenza, Human; Seasons |
| vaccin-influenza-risk-ag-studi | Female; Male; Influenza Vaccines; Vaccination; Influenza, Human; Adult; Aged; Middle Aged; United Kingdom; Adolescent |
| valid-record-identifi-data | Humans; Databases, Factual; Female; Male; Aged; Electronic Health Records; United Kingdom; Adult; Middle Aged; Primary Health Care |
Systematic reviews
We can extract systematic revews in a similar way.
sr <- labels$results %>%
left_join(search1, by = c("pmid.value" = "pmid")) %>%
filter(str_detect(keywords, "Review")|str_detect(absText, "systematic review"))
table_sr <- sr %>%
select(title, journalTitle, pubYear, clus_names, keywords, absText)
There are 66 articles tagged with public health as a Mesh heading. These are shown in the table 2.
| title | journalTitle | pubYear | clus_names | keywords | absText |
|---|---|---|---|---|---|
| Trends in longer-term survival following an acute myocardial infarction and prescribing of evidenced-based medications in primary care in the UK from 1991: a longitudinal population-based study. | J Epidemiol Community Health | 2011 | risk-patient-cohort-studi | c(“Humans”, “Myocardial Infarction”, “Adrenergic beta-Antagonists”, “Angiotensin-Converting Enzyme Inhibitors”, “Incidence”, “Survival Analysis”, “Longitudinal Studies”, “Evidence-Based Medicine”, “Age Factors”, “Sex Factors”, “Time Factors”, “Adult”, “Aged”, “Middle Aged”, “Drug Utilization Review”, “Primary Health Care”, “Female”, “Male”, “Hypolipidemic Agents”, “United Kingdom”) | BACKGROUND:Both the incidence of myocardial infarction (MI) and short-term case fatality have declined in the UK. However, little is known about trends in longer-term survival following an MI. The aim of the study was to investigate trends in longer-term survival, alongside trends in medication prescribing in primary care. METHODS:Data came from 218 general practices contributing to the Health Improvement Network, a UK-wide primary care database. 3-year survival and medication use were determined for 6,586 men and 3,766 women who had an MI between 1991 and 2002 and had already survived 3 months. RESULTS:Adjusting for age and gender, the 3-year post-MI case-fatality rate among 3-month survivors fell by 28% (95% CI 13 to 40), from 83 deaths per 1000 person-years for MI occurring in 1991-2 to 61 deaths per 1000 person-years for MI in 2001-2. Relative declines in the case-fatality rate of 37% (20 to 50) and 14% (-11 to 34) were observed for men and women, respectively (p=0.06 for interaction). Prescribing in the 3 months following the MI of lipid-regulating drugs increased from 3% of patients in 1991 to 79% in 2002, prescribing of beta-blockers increased from 26% to 68%, prescribing of ACE inhibitors increased from 11% to 71% and prescribing of anti-platelet medication increased from 46% to 86%. CONCLUSION:There has been a moderate improvement in longer-term survival following an MI, distinct from improvements in short-term survival, although men may have benefited more than women. Increased medication prescribing in primary care may be a contributing factor. |
| The diagnostic value of symptoms for colorectal cancer in primary care: a systematic review. | Br J Gen Pract | 2011 | cancer-risk-patient-studi | c(“Humans”, “Colorectal Neoplasms”, “Gastrointestinal Hemorrhage”, “Weight Loss”, “Abdominal Pain”, “Constipation”, “Diarrhea”, “Predictive Value of Tests”, “Referral and Consultation”, “General Practice”) | BACKGROUND: Over 37,000 new colorectal cancers are diagnosed in the UK each year. Most present symptomatically to primary care. AIM: To conduct a systematic review of the diagnostic value of symptoms associated with colorectal cancer. DESIGN: Systematic review. METHOD: MEDLINE, Embase, Cochrane Library, and CINAHL were searched to February 2010, for diagnostic studies of symptomatic adult patients in primary care. Studies of asymptomatic patients, screening, referred populations, or patients with colorectal cancer recurrences, or with fewer than 100 participants were excluded. The target condition was colorectal cancer. Data were extracted to estimate the diagnostic performance of each symptom or pair of symptoms. Data were pooled in a meta-analysis. The quality of studies was assessed with the QUADAS tool. RESULTS: Twenty-three studies were included. Positive predictive values (PPVs) for rectal bleeding from 13 papers ranged from 2.2% to 16%, with a pooled estimate of 8.1% (95% confidence interval [CI] = 6.0% to 11%) in those aged ≥ 50 years. Pooled PPV estimates for other symptoms were: abdominal pain (three studies) 3.3% (95% CI = 0.7% to 16%); and anaemia (four studies) 9.7% (95% CI = 3.5% to 27%). For rectal bleeding accompanied by weight loss or change in bowel habit, pooled positive likelihood ratios (PLRs) were 1.9 (95% CI = 1.3 to 2.8) and 1.8 (95% CI = 1.3 to 2.5) respectively, suggesting higher risk when both symptoms were present. Conversely, the PLR was one or less for abdominal pain, diarrhoea, or constipation accompanying rectal bleeding. CONCLUSION: The findings suggest that investigation of rectal bleeding or anaemia in primary care patients is warranted, irrespective of whether other symptoms are present. The risks from other single symptoms are lower, though multiple symptoms also warrant investigation. |
| Accuracy of pneumonia hospital admissions in a primary care electronic medical record database. | Pharmacoepidemiol Drug Saf | 2012 | valid-record-identifi-data | c(“Humans”, “Pneumonia, Bacterial”, “Community-Acquired Infections”, “Pneumonia, Viral”, “Pneumonia”, “Anti-Bacterial Agents”, “Hospitalization”, “Cohort Studies”, “Cross-Sectional Studies”, “Reproducibility of Results”, “Predictive Value of Tests”, “International Classification of Diseases”, “Databases, Factual”, “Adult”, “Drug Utilization Review”, “Primary Health Care”, “Electronic Health Records”, “United Kingdom”) | When using electronic medical record data to study drug use, hospitalizations are markers of severe outcomes. To identify events within a specified time window, it is important to validate hospitalization diagnoses and dates. Our objective was to validate pneumonia hospitalizations and their dates identified using hospitalization codes in The Health Improvement Network (THIN), a UK primary care electronic medical record.This cross-sectional study used a cohort of THIN adult visits for acute nonspecific respiratory infections from June 1985 to August 2006. Pneumonia hospitalizations within 30 days after the visit were identified using THIN diagnosis and hospitalization codes; 60 participants were randomly selected for validation. Patients’ general practitioners (GPs) returned de-identified hospital summaries and consultants’ letters regarding overnight hospitalizations within a 180-day window around the THIN hospitalization. Positive predictive value (PPV) was the number of GP-validated hospitalizations divided by THIN documented hospitalizations.GPs returned 59 of 60 patient records; 52 had confirmed hospitalizations. PPV of THIN hospitalization documentation was 88% (95%CI = 77-95). One admission was not for pneumonia; PPV of THIN-documented pneumonia admission was 86% (95%CI = 75-94). Of 52 valid THIN hospitalizations, 50 were actually admitted within 14 days of the documented THIN date (range = -2 to +18). The absolute median difference between THIN and validated admission dates was +0.5 days, and the absolute mean difference was +3.1 days. In 16 of 52 admitted patients, the THIN admission date was the actual discharge date.THIN hospitalization codes performed well in identifying acute pneumonia hospitalizations and their timing. Admission date validity might be better for conditions associated with shorter versus longer hospitalizations. |
| The association between psoriasis and obesity: a systematic review and meta-analysis of observational studies. | Nutr Diabetes | 2012 | psoriasi-base-popul-patient-studi | NULL | OBJECTIVE: Psoriasis is an inflammatory skin disease affecting 2-4% of the world population. The objective of this study was to perform a systematic review and meta-analysis synthesizing the epidemiological associations between psoriasis and obesity. DATA SOURCES: We searched for observational studies from MEDLINE, EMBASE and Cochrane Central Register from 1 January 1980 to 1 January 2012. We applied the Meta-Analysis of Observational Studies in Epidemiology guidelines in the conduct of this study. STUDY SELECTION: We identified 16 observational studies with a total of 2.1 million study participants (201 831 psoriasis patients) fulfilling the inclusion criteria. RESULTS: Using random-effects meta-analysis, the pooled odds ratio (OR) for obesity among patients with psoriasis was 1.66 (95% confidence interval (CI) 1.46-1.89) compared with those without psoriasis. From the studies that reported psoriasis severity, the pooled OR for obesity among patients with mild psoriasis was 1.46 (95% CI 1.17-1.82) and the pooled OR for patients with severe psoriasis was 2.23 (95% CI 1.63-3.05). One incidence study found that psoriasis patients have a hazard ratio of 1.18 (95% CI 1.14-1.23) for new-onset obesity. CONCLUSIONS: Overall, compared with the general population, psoriasis patients have higher prevalence and incidence of obesity. Patients with severe psoriasis have greater odds of obesity than those with mild psoriasis. |
| The efficiency of cardiovascular risk assessment: do the right patients get statin treatment? | Heart | 2013 | statin-risk-patient-studi | c(“Humans”, “Cardiovascular Diseases”, “Hydroxymethylglutaryl-CoA Reductase Inhibitors”, “Treatment Outcome”, “Risk Assessment”, “Risk Factors”, “Primary Prevention”, “Decision Support Techniques”, “Patient Selection”, “Time Factors”, “Adult”, “Aged”, “Middle Aged”, “Drug Utilization”, “Drug Utilization Review”, “Primary Health Care”, “Health Services Accessibility”, “Female”, “Male”, “Dyslipidemias”, “Drug Prescriptions”, “Kaplan-Meier Estimate”, “Practice Patterns, Physicians’”, “United Kingdom” | |
| ) To evaluate targeting of statin prescribing for primary prevention to those with high cardiovascular disease (CVD) risk.Two cohort studies including the general populat | ion and initiators of statins aged | 35-74 yea | rs.UK primary care records in the Clinica | l Practice Research Datalink.3.8 million general population patients and 300 914 statin users.Statin prescribing.Statin prescribing by CVD risk; observed 5-year CVD risks; variability between practices.Statin prescribing increased substantially over time to patients with high 10-year CVD risk (≥ 20%): 7.0% of these received a statin prior to 2007, and 30.4% in 2007 onwards. Prescribing to patients with low risk (<15%) also increased (from 1.9% to 5.0%). Only about half the patients initiating statin treatment were high risk according to CVD risk score. The 5-ye | ar CVD risks, as observed during statin treatment, reduced over calendar time (from 17.0% to 7.1%). There was a large variation between general practices in the percentage of high-risk patients prescribed a statin in 2007 onwards, ranging from 8.2% to 61.5%. For low-risk patients, these varied from 2.1% to 29.1%.There appeared to be substantive overuse in low CVD risk and underuse in high CVD risk (600 000 and 850 000 patients, respectively, in the UK since 2007). There is wide variation between practices in statin prescribing to patients at high CVD risk. There is a clear need for randomised trials for the best strategy to target statin treatment and manage CVD risk for primary prevention. |
| Challenges of using primary care electronic medical records in the UK to study medications in pregnancy. | Pharmacoepidemiol Drug Saf | 2013 | pregnanc-women-databas-studi | c(“Humans”, “Cohort Studies”, “Follow-Up Studies”, “Pregnancy”, “Pregnancy Trimester, First”, “Adolescent”, “Adult”, “Middle Aged”, “Drug Utilization Review”, “Primary Health Care”, “Female”, “Drug Prescriptions”, “Prescription Drugs”, “Young Adult”, “Electronic Health Records”, “Practice Patterns, Physicians’”, “United Kingdom”) | This paper aimed to assess the prescription of medications during pregnancy by primary care physicians in the UK.We identified both completed pregnancies and pregnancies losses (ectopic pregnancies, miscarriages, terminations, and stillbirths) in women aged 13-49 years enrolled in The Health Improvement Network (THIN) between 1996 and 2010 following an algorithm with three sequential cycles that searched for Read Code groups in hierarchical order: (1) indicators of conception; (2) delivery or pregnancy loss; and (3) other codes suggestive of pregnancy. Completed pregnancies were linked to liveborn infants by means of the family identification number and date of birth. Prescription of specific drugs during the first trimester and time trends during the last decade were calculated.A total of 191 000 pregnancies were identified, including 148 544 completed pregnancies and 42 456 (22.2%) pregnancies losses (ectopic pregnancies, miscarriages, terminations, and stillbirths). Of the completed pregnancies, 131670 (88.6%) were successfully linked with the offspring. The most commonly prescribed drugs were antibiotics, antimycotics, asthma/allergy medications, and analgesics. From 1996 to 2010, the proportion of completed pregnancies with at least one prescription during the first trimester increased for antidepressants (1.8% to 4.2%), thyroid hormones (0.7% to 1.6%), and opiods (1.5% to 2.6%), among other drugs.In conclusion, the prescription of several medications by primary care physicians during the first trimester of pregnancy has risen in the UK during the last decade. We discuss how, when important challenges are considered, THIN may be a promising resource to study specific therapies during pregnancy. |
| Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. | Gut | 2014 | incid-ag-practic-studi | c(“Humans”, “Gastroesophageal Reflux”, “Incidence”, “Prevalence”, “North America”, “South America”, “Asia”, “Middle East”, “Australia”, “Europe”) | To update the findings of the 2005 systematic review of population-based studies assessing the epidemiology of gastro-oesophageal reflux disease (GERD).PubMed and Embase were screened for new references using the original search strings. Studies were required to be population-based, to include ≥ 200 individuals, to have response rates ≥ 50% and recall periods <12 months. GERD was defined as heartburn and/or regurgitation on at least 1 day a week, or according to the Montreal definition, or diagnosed by a clinician. Temporal and geographic trends in disease prevalence were examined using a Poisson regression model.16 studies of GERD epidemiology published since the original review were found to be suitable for inclusion (15 reporting prevalence and one reporting incidence), and were added to the 13 prevalence and two incidence studies found previously. The range of GERD prevalence estimates was 18.1%-27.8% in North America, 8.8%-25.9% in Europe, 2.5%-7.8% in East Asia, 8.7%-33.1% in the Middle East, 11.6% in Australia and 23.0% in South America. Incidence per 1000 person-years was approximately 5 in the overall UK and US populations, and 0.84 in paediatric patients aged 1-17 years in the UK. Evidence suggests an increase in GERD prevalence since 1995 (p<0.0001), particularly in North America and East Asia.GERD is prevalent worldwide, and disease burden may be increasing. Prevalence estimates show considerable geographic variation, but only East Asia shows estimates consistently lower than 10%. |
| Performance of risk assessment instruments for predicting osteoporotic fracture risk: a systematic review. | Osteoporos Int | 2014 | fractur-risk-ag-studi | c(“Humans”, “Osteoporosis”, “Calibration”, “Risk Assessment”, “Bone Density”, “Osteoporotic Fractures”, “Bias”) | UNLABELLED:We systematically reviewed the literature on the performance of osteoporosis absolute fracture risk assessment instruments. Relatively few studies have evaluated the calibration of instruments in populations separate from their development cohorts, and findings are mixed. Many studies had methodological limitations making susceptibility to bias a concern. INTRODUCTION:The aim of this study was to systematically review the literature on the performance of osteoporosis clinical fracture risk assessment instruments for predicting absolute fracture risk, or calibration, in populations other than their derivation cohorts. METHODS:We performed a systematic review, and MEDLINE, Embase, Cochrane Library, and multiple other literature sources were searched. Inclusion and exclusion criteria were applied and data extracted, including information about study participants, study design, potential sources of bias, and predicted and observed fracture probabilities. RESULTS:A total of 19,949 unique records were identified for review. Fourteen studies met inclusion criteria. There was substantial heterogeneity among included studies. Six studies assessed the WHO’s Fracture Risk Assessment (FRAX) instrument in five separate cohorts, and a variety of risk assessment instruments were evaluated in the remainder of the studies. Approximately half found good instrument calibration, with observed fracture probabilities being close to predicted probabilities for different risk categories. Studies that assessed the calibration of FRAX found mixed performance in different populations. A similar proportion of studies that evaluated simple risk assessment instruments (≤5 variables) found good calibration when compared with studies that assessed complex instruments (>5 variables). Many studies had methodological features making them susceptible to bias. CONCLUSIONS:Few studies have evaluated the performance or calibration of osteoporosis fracture risk assessment instruments in populations separate from their development cohorts. Findings are mixed, and many studies had methodological limitations making susceptibility to bias a possibility, raising concerns about use of these tools outside of the original derivation cohorts. Further studies are needed to assess the calibration of instruments in different populations prior to widespread use. |
| Testosterone lab testing and initiation in the United Kingdom and the United States, 2000 to 2011. | J Clin Endocrinol Metab | 2014 | databas-patient-improv-data-studi | c(“Humans”, “Hypogonadism”, “Testosterone”, “Hormone Replacement Therapy”, “Retrospective Studies”, “Adolescent”, “Adult”, “Aged”, “Aged, 80 and over”, “Middle Aged”, “Drug Utilization Review”, “United States”, “Male”, “Young Adult”, “United Kingdom”) | New formulations, increased marketing, and wider recognition of declining testosterone levels in older age may have contributed to wider testosterone testing and supplementation in many countries.Our objective was to describe testosterone testing and testosterone treatment in men in the United Kingdom and United States.This was a retrospective incident user cohort.We evaluated commercial and Medicare insurance claims from the United States and general practitioner healthcare records from the United Kingdom for the years 2000 through 2011.We identified 410,019 US men and 6858 UK men who initiated a testosterone formulation as well as 1,114,329 US men and 66,140 UK men with a new testosterone laboratory measurement.Outcome measures included initiation of any injected testosterone, implanted testosterone pellets, or prescribed transdermal or oral testosterone formulation.Testosterone testing and supplementation have increased pronouncedly in the United States. Increased testing in the United Kingdom has identified more men with low levels, yet US testing has increased among men with normal levels. Men in the United States tend to initiate at normal levels more often than in the United Kingdom, and many men initiate testosterone without recent testing. Gels have become the most common initial treatment in both countries.Testosterone testing and use has increased over the past decade, particularly in the United States, with dramatic shifts from injections to gels. Substantial use is seen in men without recent testing and in US men with normal levels. Given widening use despite safety and efficacy questions, prescribers must consider the medical necessity of testosterone before initiation. |
| Cost-effectiveness of a universal strategy of brief dietary intervention for primary prevention in primary care: population-based cohort study and Markov model. | Cost Eff Resour Alloc | 2014 | cost-patient-health-clinic | NULL | A healthy diet is associated with reduced risk of diabetes, cardiovascular disease and cancer. The study aimed to evaluate the cost-effectiveness of a universal strategy to promote healthy diet through brief intervention in primary care.The research was informed by a systematic review of randomised trials which found that brief interventions in primary care may be associated with a 0.5 portion per day increase in fruit and vegetable consumption. A Markov model that included five long-term conditions (diabetes, coronary heart disease, stroke, colorectal cancer and depression) was developed. Empirical data from a large cohort of United Kingdom-based participants sampled from the Clinical Practice Research Datalink populated the model. Simulations compared an intervention promoting healthy diet over 5 years in healthy adults, and standard care in which there was no intervention. The annual cost of intervention, in the base case, was one family practice consultation per participant year. Health service costs were included and the model adopted a lifetime perspective. The primary outcome was net health benefit in quality adjusted life years (QALYs).A cohort of 262,704 healthy participants entered the model. Intervention was associated with an increase in life years lived free from physical disease of 41.9 (95% confidence interval -17.4 to 101.0) per 1,000 participants entering the model (probability of increase 88.0%). New incidences of disease states were reduced by 28.4 (18.7 to 75.8) per 1,000, probability reduced 84.6%. Discounted incremental QALYs were 4.3 (-8.8 to 18.0) per 1,000, while incremental costs were £139,755 (£60,466 to 220,059) per 1,000. Net health benefits at £30,000 per QALY were -0.32 (-13.8 to 13.5) QALYs per 1,000 participants (probability cost-effective 47.9%). When the intervention was restricted to adults aged 50 to 74 years, net health benefits were 2.94 (-21.3 to 26.4) QALYs per 1000, probability increased 59.0%.A universal strategy to promote healthy diet through brief intervention in primary care is unlikely to be cost-effective, even when delivered at low unit cost. A targeted strategy aimed at older individuals at higher risk of disease might be more cost-effective. More effective dietary change interventions are needed. |
| Unintended effects of statins from observational studies in the general population: systematic review and meta-analysis. | BMC Med | 2014 | statin-risk-patient-studi | c(“Humans”, “Dementia”, “Diabetes Mellitus”, “Hydroxymethylglutaryl-CoA Reductase Inhibitors”, “Treatment Outcome”, “Population Surveillance”, “Randomized Controlled Trials as Topic”, “Observational Studies as Topic”) | Efficacy of statins has been extensively studied, with much less information reported on their unintended effects. Evidence from randomized controlled trials (RCTs) on unintended effects is often insufficient to support hypotheses generated from observational studies. We aimed to systematically assess unintended effects of statins from observational studies in general populations with comparison of the findings where possible with those derived from randomized trials.Medline (1998 to January 2012, week 3) and Embase (1998 to 2012, week 6) were searched using the standard BMJ Cohort studies filter. The search was supplemented with reference lists of all identified studies and contact with experts in the field. We included prospective studies with a sample size larger than 1,000 participants, case control (of any size) and routine health service linkage studies of over at least one year duration. Studies in subgroups of patients or follow-up of patient case series were excluded, as well as hospital-based cohort studies.Ninety studies were identified, reporting on 48 different unintended effects. Statins were associated with lower risks of dementia and cognitive impairment, venous thrombo-embolism, fractures and pneumonia, but these findings were attenuated in analyses restricted to higher quality studies (respectively: OR 0.74 (95% CI 0.62 to 0.87); OR 0.92 (95% CI 0.81 to 1.03); OR 0.97 (95% CI 0.88 to 1.05); OR 0.92 (95% CI 0.83 to 1.02)); and marked heterogeneity of effects across studies remained. Statin use was not related to any increased risk of depression, common eye diseases, renal disorders or arthritis. There was evidence of an increased risk of myopathy, raised liver enzymes and diabetes (respectively: OR 2.63 (95% CI 1.50 to 4.61); OR 1.54 (95% CI 1.47 to 1.62); OR 1.31 (95% CI 0.99 to 1.73)).Our systematic review and meta-analyses indicate that high quality observational data can provide relevant evidence on unintended effects of statins to add to the evidence from RCTs. The absolute excess risk of the observed harmful unintended effects of statins is very small compared to the beneficial effects of statins on major cardiovascular events. |
| Prescription of antihypertensive medications during pregnancy in the UK. | Pharmacoepidemiol Drug Saf | 2014 | pregnanc-women-databas-studi | c(“Humans”, “Pregnancy Complications, Cardiovascular”, “Hypertension”, “Antihypertensive Agents”, “Cohort Studies”, “Pregnancy”, “Databases, Factual”, “Adolescent”, “Adult”, “Middle Aged”, “Drug Utilization Review”, “Female”, “Drug Prescriptions”, “Young Adult”, “Electronic Health Records”, “United Kingdom”) | This study aimed to describe the management of antihypertensive medications in pregnancy by general practitioners in the UK and compare it with current guidelines.We used electronic medical records from The Health Improvement Network database from 1996 to 2010 to identify completed pregnancies. The study cohort included the first pregnancy identified during the study period in women aged 13-49 years. Information on both hypertension diagnoses and prescription of specific antihypertensive medications within the 90 days before the last menstrual period (LMP) and during pregnancy was ascertained from electronic medical records.Among 148,544 eligible pregnancies, we identified 1995 (1.3%) during which the women had pre-existing hypertension diagnosed by the LMP date. Overall, the prevalence of antihypertensive medications during the first trimester was 1.5%; beta-blockers were the most commonly prescribed antihypertensive. Among women with pre-existing hypertension, 36% were prescribed an antihypertensive medication during the 90 days before the LMP. Among those, 9.6% and 22.2% had discontinued their medication by the first and second trimesters, respectively. For contraindicated drugs such as angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, the corresponding discontinuation rates were around 25% and 70%. Women who switched therapy received preferably either methyldopa or an alpha/beta-blocker.In this population of UK pregnant women, prescription patterns of antihypertensive medications were dominated by recommended treatments, although some patients continued on contraindicated drugs throughout pregnancy or switched to preferred agents in a delayed fashion. |
| The risk of heart failure associated with the use of noninsulin blood glucose-lowering drugs: systematic review and meta-analysis of published observational studies. | BMC Cardiovasc Disord | 2014 | patient-health-practic-studi | c(“Humans”, “Diabetes Mellitus, Type 2”, “Metformin”, “Sulfonylurea Compounds”, “Thiazolidinediones”, “Blood Glucose”, “Hypoglycemic Agents”, “Odds Ratio”, “Risk Assessment”, “Risk Factors”, “Chi-Square Distribution”, “Heart Failure”, “Biomarkers”, “Bias”) | BACKGROUND:Patients with type 2 diabetes mellitus (T2DM) are at high risk of heart failure. A summary of the effects of blood glucose-lowering drugs other than glitazones on the risk of heart failure in routine clinical practice is lacking. The objective of this study was to conduct a systematic review and meta-analysis of observational studies on the risk of heart failure when using blood glucose-lowering drugs. METHODS:We systematically identified and reviewed cohort and case-control studies in which the main exposure of interest was noninsulin blood glucose-lowering medications in patients with T2DM. We searched Medline, Embase, and the Cochrane Library to identify publications meeting prespecified eligibility criteria. The quality of included studies was assessed with the Newcastle-Ottawa Scale and the RTI item bank. Results were combined using fixed and random-effects models when at least 3 independent data points were available for a drug-drug comparison. RESULTS:The summary relative risk of heart failure in rosiglitazone users versus pioglitazone users (95% CI) was 1.16 (1.05-1.28) (5 cohort studies). Heterogeneity was present (I2 = 66%). For new users (n = 4) the summary relative risk was 1.21 (1.14-1.30) and the heterogeneity was reduced (I2 = 31%);. The summary relative risk for rosiglitazone versus metformin was 1.36 (95% CI, 1.17-1.59) (n = 3). The summary relative risk (95% CI) of heart failure in sulfonylureas users versus metformin users was 1.17 (95% CI, 1.06-1.29) (5 cohort studies; I2 = 24%) and 1.22 (1.02-1.46) when restricted to new users (2 studies).Information on other comparisons was very scarce. Information on dose and duration of treatment effects was lacking for most comparisons. Few studies accounted for disease severity; therefore, confounding by indication might be present in the majority of the within-study comparisons of this meta-analysis. CONCLUSIONS:Use of glitazones and sulfonylureas was associated with an increased risk of heart failure compared with metformin use. However, indication bias cannot be ruled out. Ongoing large multidatabase studies will help to evaluate the risk of heart failure in treated patients with diabetes, including those using newer blood glucose-lowering therapies. |
| Comparative cardiovascular morbidity and mortality in patients taking different insulin regimens for type 2 diabetes: a systematic review. | BMJ Open | 2015 | diabet-type-patient-studi | c(“Humans”, “Cardiovascular Diseases”, “Diabetic Angiopathies”, “Diabetes Mellitus, Type 2”, “Insulin”, “Hypoglycemic Agents”, “Randomized Controlled Trials as Topic”, “Practice Guidelines as Topic”) | OBJECTIVES:To summarise the literature evaluating the association between different insulin regimens and the incidence of cardiovascular morbidity and mortality in adults with type 2 diabetes. DESIGN:Systematic review. METHODS:Multiple biomedical databases (The Cochrane Library, PubMed, EMBASE, and International Pharmaceutical Abstracts) were searched from their inception to February 2014. References of included studies were hand searched. Randomised controlled trials (RCTs), cohort studies or case-control studies examining adults (≥18 years) with type 2 diabetes taking any type, dose and/or regimen of insulin were eligible for inclusion in this review. OUTCOME MEASURES:Primary outcomes were cardiovascular morbidity and mortality including fatal and/or non-fatal myocardial infarction, fatal and/or non-fatal stroke, major adverse cardiac events and cardiovascular death. All-cause mortality was assessed as a secondary outcome. RESULTS:Of the 3122 studies identified, 2 RCTs and 6 cohort studies were selected. No case-control studies met the inclusion criteria. The studies examined a total of 109,910 patients. Quantitative synthesis of the results from included studies was not possible due to a large amount of clinical heterogeneity. Each study evaluated cardiovascular outcomes across different insulin-exposure contrasts. RCTs did not identify any difference in cardiovascular risks among a fixed versus variable insulin regimen, or a prandial versus basal regimen, albeit clinically important risks and benefits cannot be ruled out due to wide CIs. Findings from cohort studies were variable with an increased and decreased risk of cardiovascular events and all-cause mortality being reported. CONCLUSIONS:This systematic review of randomised and non-randomised studies identifies a substantive gap in the literature surrounding the cardiovascular morbidity and mortality of patients using different regimens of insulin. There is a need for more consistent high-quality evidence investigating the impact of insulin use on cardiovascular outcomes in patients with type 2 diabetes. TRIAL REGISTRATION NUMBER: PROSPERO:CRD42014007631. |
| Risk of community-acquired pneumonia with outpatient proton-pump inhibitor therapy: a systematic review and meta-analysis. | PLoS One | 2015 | patient-health-practic-studi | c(“Humans”, “Community-Acquired Infections”, “Pneumonia”, “Risk Factors”, “Outpatients”, “Proton Pump Inhibitors”) | Proton-pump inhibitors (PPIs) are among the most frequently prescribed medications. Community-acquired pneumonia (CAP) is a common cause of morbidity, mortality and healthcare spending. Some studies suggest an increased risk of CAP among PPI users. We conducted a systematic review and meta-analysis to determine the association between outpatient PPI therapy and risk of CAP in adults.We conducted systematic searches of MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Scopus and Web of Science on February 3, 2014. Case-control studies, case-crossover, cohort studies and randomized controlled trials reporting outpatient PPI exposure and CAP diagnosis for patients ≥18 years old were eligible. Our primary outcome was the association between CAP and PPI therapy. A secondary outcome examined the risk of hospitalization for CAP and subgroup analyses evaluated the association between PPI use and CAP among patients of different age groups, by different PPI doses, and by different durations of PPI therapy.Systematic review of 33 studies was performed, of which 26 studies were included in the meta-analysis. These 26 studies included 226,769 cases of CAP among 6,351,656 participants. We observed a pooled risk of CAP with ambulatory PPI therapy of 1.49 (95% CI 1.16, 1.92; I2 99.2%). This risk was increased during the first month of therapy (OR 2.10; 95% CI 1.39, 3.16), regardless of PPI dose or patient age. PPI therapy also increased risk for hospitalization for CAP (OR 1.61; 95% CI: 1.12, 2.31).Outpatient PPI use is associated with a 1.5-fold increased risk of CAP, with the highest risk within the first 30 days after initiation of therapy. Providers should be aware of this risk when considering PPI use, especially in cases where alternative regimens may be available or the benefits of PPI use are uncertain. |
| Statin use and breast cancer survival and risk: a systematic review and meta-analysis. | Oncotarget | 2015 | patient-health-practic-studi | c(“Humans”, “Breast Neoplasms”, “Hydroxymethylglutaryl-CoA Reductase Inhibitors”, “Risk”, “Female”) | The purpose of this study is to determine the associations between statin use and breast cancer survival and risk by performing a systematic review and meta-analysis. We searched PubMed, Embase and Web of Science up to August 2015 for identifying relevant prospective or case-control studies, or randomized clinical trials. Five prospective studies involving 60,911 patients reported the association between statin use and breast cancer mortality. Eleven prospective studies, 12 case-control studies and 9 randomized clinical trials involving 83,919 patients reported the association between statin use and breast cancer risk. After pooling estimates from all available studies, there was a significantly negative association between pre-diagnosis statin use and breast cancer mortality (for overall survival (OS): hazard ratio (HR) = 0.68, 95% confidence interval (CI) 0.54-0.84; for disease specific survival (DSS): HR = 0.72, 95% CI 0.53-0.99). There was also a significant inverse association between post-diagnosis statin use and breast cancer DSS (HR = 0.65, 95% CI 0.43-0.98), although the association with breast cancer OS did not reach statistical significance (HR = 0.71, 95% CI 0.48-1.07). Additionally, there was a non-linear relationship for the duration of post-diagnosis statin use with breast cancer specific mortality. On the other hand, with regards to the relationship between statin use and breast cancer risk, no significant association was detected. Our analyses suggest that although statin use may not influence breast cancer risk, the use of statin may be associated with decrease mortality of breast cancer patients. Further large-scale studies are warranted to validate our findings. |
| Effect of Diabetes Mellitus on Survival in Patients with Pancreatic Cancer: A Systematic Review and Meta-analysis. | Sci Rep | 2015 | diabet-type-patient-studi | c(“Humans”, “Pancreatic Neoplasms”, “Diabetes Mellitus”, “Disease-Free Survival”, “Proportional Hazards Models”, “Risk”, “Databases, Factual”, “Kaplan-Meier Estimate”) | Concurrent diabetes has been linked with an increased risk of death in many cancers, but findings in pancreatic cancer have been inconsistent. We performed a systematic review and meta-analysis to assess the effect of diabetes on survival in patients with pancreatic cancer. Of 4, 463 original articles, 41 were included in the review; 29 studies with 33 risk estimates were included in the meta-analysis. In the overall comparison of patients with pancreatic cancer and diabetes with their nondiabetic counterparts, the former had significantly higher all-cause mortality (pooled HR: 1.13; 95% CI: 1.04-1.22). Subgroup analyses showed that diabetes was associated with poor survival in patients with resectable disease (HR: 1.37; 95% CI: 1.15-1.63) but not in those with unresectable disease (HR: 1.07; 95% CI: 0.89-1.29). The HR (95% CI) was 1.52 (1.20-1.93) for patients with new-onset diabetes (≤ 2 years of diabetes duration) and 1.22 (0.83-1.80) for those with longstanding diabetes (> 2 years). Diabetes was associated with higher mortality overall in patients with pancreatic cancer. The effect of diabetes on overall survival was associated with the stages of tumor and the duration of diabetes. |
| The risk of major cardiac malformations associated with paroxetine use during the first trimester of pregnancy: a systematic review and meta-analysis. | Br J Clin Pharmacol | 2016 | patient-health-practic-studi | c(“Humans”, “Heart Defects, Congenital”, “Abnormalities, Drug-Induced”, “Paroxetine”, “Serotonin Uptake Inhibitors”, “Risk Assessment”, “Maternal Exposure”, “Pregnancy”, “Pregnancy Trimester, First”, “Female”) | The aim of this study was to perform an up-to-date meta-analysis on the risk of cardiac malformations associated with gestational exposure to paroxetine, taking into account indication, study design and reference category.A systematic review of studies published between 1966 and November 2015 was conducted using embase and MEDLINE. Studies reporting major malformations with first trimester exposure to paroxetine were included. Potentially relevant articles were assessed and relevant data extracted to calculate risk estimates. Outcomes included any major malformations and major cardiac malformations. Pooled odds ratios and 95% confidence intervals were calculated using random-effects models.Twenty-three studies were included. Compared with non-exposure to paroxetine, first trimester use of paroxetine was associated with an increased risk of any major congenital malformations combined (pooled OR 1.23, 95% CI 1.10, 1.38; n = 15 studies), major cardiac malformations (pooled OR 1.28, 95% CI 1.11, 1.47; n = 18 studies), specifically bulbus cordis anomalies and anomalies of cardiac septal closure (pooled OR 1.42, 95% CI 1.07, 1.89; n = 8 studies), atrial septal defects (pooled OR 2.38, 95% CI 1.14, 4.97; n = 4 studies) and right ventricular outflow track defect (pooled OR 2.29, 95% CI 1.06, 4.93; n = 4 studies). Although the estimates varied depending on the comparator group, study design and malformation detection period, a trend towards increased risk was observed.Paroxetine use during the first trimester of pregnancy is associated with an increased risk of any major congenital malformations and cardiac malformations. The increase in risk is not dependent on the study method or population. |
| Bisphosphonates and evidence for association with esophageal and gastric cancer: a systematic review and meta-analysis. | BMJ Open | 2015 | cancer-risk-patient-studi | c(“Humans”, “Esophageal Neoplasms”, “Stomach Neoplasms”, “Diphosphonates”, “Alendronate”, “Bone Density Conservation Agents”) | OBJECTIVES:Concerns have been raised about a possible link between bisphosphonate use, and in particular alendronate, and upper gastrointestinal (UGI) cancer. A number of epidemiological studies have been published with conflicting results. We conducted a systematic review and meta-analysis of observational studies, to determine the risk of esophageal and gastric cancer in users of bisphosphonates compared with non-users. DESIGN:We searched PubMed, MEDLINE, EMBASE, Web of Knowledge and Cochrane Database of Systematic Reviews for studies investigating bisphosphonates and esophageal or gastric cancer. We calculated pooled ORs and 95% CIs for the risk of esophageal or gastric cancer in bisphosphonate users compared with non-users. We performed a sensitivity analysis of alendronate as this was the most common single drug studied and is also the most widely used in clinical practice. RESULTS:11 studies (from 10 papers) examining bisphosphonate exposure and UGI cancer (gastric and esophageal), met our inclusion criteria. All studies were retrospective, 6/11 (55%) case-control and 5/11(45%) cohort, and carried out using data from 5 longitudinal clinical databases. Combining 5 studies (1 from each database), we found no increased risk, OR 1.11 (95% CI 0.97 to 1.27) of esophageal cancer in bisphosphonate users compared with non-users and no increased risk of gastric cancer in bisphosphonate users, OR 0.96 (95% CI 0.82 to 1.12). CONCLUSION:This is the fourth and most detailed meta-analysis on this topic. We have not identified any compelling evidence for a significantly raised risk of esophageal cancer or gastric cancer in male and female patients prescribed bisphosphonates. |
| Incidence of adult Huntington’s disease in the UK: a UK-based primary care study and a systematic review. | BMJ Open | 2016 | incid-ag-practic-studi | c(“Humans”, “Huntington Disease”, “Incidence”, “Prevalence”, “Age of Onset”, “Adult”, “Middle Aged”, “Primary Health Care”, “Electronic Health Records”, “United Kingdom”) | OBJECTIVES:The prevalence of Huntington’s disease (HD) recorded in the UK primary care records has increased twofold between 1990 and 2010. This investigation was undertaken to assess whether this might be due to an increased incidence. We have also undertaken a systematic review of published estimates of the incidence of HD. SETTING:Incident patients with a new diagnosis of HD were identified from the primary care records of the Clinical Practice Research Datalink (CPRD). The systematic review included all published estimates of the incidence of HD in defined populations. PARTICIPANTS:A total of 393 incident cases of HD were identified from the CPRD database between 1990 and 2010 from a total population of 9,282,126 persons. PRIMARY AND SECONDARY OUTCOME MEASURES:The incidence of HD per million person-years was estimated. From the systematic review, the extent of heterogeneity of published estimates of the incidence of HD was examined using the I(2) statistic. RESULTS:The data showed that the incidence of HD has remained constant between 1990 and 2010 with an overall rate of 7.2 (95% CI 6.5 to 7.9) per million person-years. The systematic review identified 14 independent estimates of incidence with substantial heterogeneity and consistently lower rates reported in studies from East Asia compared with those from Australia, North America and some–though not all–those from Europe. Differences in incidence estimates did not appear to be explained solely by differences in case ascertainment or diagnostic methods. CONCLUSIONS:The rise in the prevalence of diagnosed HD in the UK, between 1990 and 2010, cannot be attributed to an increase in incidence. Globally, estimates of the incidence of HD show evidence of substantial heterogeneity with consistently lower rates in East Asia and parts of Europe. Modifiers may play an important role in determining the vulnerability of different populations to expansions of the HD allele. |
| Symptoms of adult chronic and acute leukaemia before diagnosis: large primary care case-control studies using electronic records. | Br J Gen Pract | 2016 | primari-care-patient-practic-studi | c(“Humans”, “Leukemia”, “Acute Disease”, “Survival Rate”, “Logistic Models”, “Odds Ratio”, “Risk Assessment”, “Case-Control Studies”, “Age Factors”, “Primary Health Care”, “Quality of Health Care”, “Female”, “Male”, “Review Literature as Topic”, “Electronic Health Records”, “United Kingdom”) | Leukaemia is the eleventh commonest UK cancer. The four main subtypes have different clinical profiles, particularly between chronic and acute types.To identify the symptom profiles of chronic and acute leukaemia in adults in primary care.Matched case-control studies using Clinical Practice Research Datalink records.Putative symptoms of leukaemia were identified in the year before diagnosis. Conditional logistic regression was used for analysis, and positive predictive values (PPVs) were calculated to estimate risk.Of cases diagnosed between 2000 and 2009, 4655 were aged ≥40 years (2877 chronic leukaemia (CL), 937 acute leukaemia (AL), 841 unreported subtype). Ten symptoms were independently associated with CL, the three strongest being: lymphadenopathy (odds ratio [OR] 22, 95% confidence interval [CI] = 13 to 36), weight loss (OR 3.0, 95% CI = 2.1 to 4.2), and bruising (OR 2.3, 95% CI = 1.6 to 3.2). Thirteen symptoms were independently associated with AL, the three strongest being: nosebleeds and/or bleeding gums (OR 5.7, 95% CI = 3.1 to 10), fever (OR 5.3, 95% CI = 2.7 to 10), and fatigue (OR 4.4, 95% CI = 3.3 to 6.0). No individual symptom or combination of symptoms had a PPV >1%.The symptom profiles of CL and AL have both overlapping and distinct features. This presents a dichotomy for GPs: diagnosis, by performing a full blood count, is easy; however, the symptoms of leukaemia are non-specific and of relatively low risk. This explains why many leukaemia diagnoses are unexpected findings. |
| Respiratory effect of beta-blocker eye drops in asthma: population-based study and meta-analysis of clinical trials. | Br J Clin Pharmacol | 2016 | patient-clinic-practic-studi | c(“Lung”, “Humans”, “Asthma”, “Ocular Hypertension”, “Adrenergic beta-Antagonists”, “Ophthalmic Solutions”, “Forced Expiratory Volume”, “Drug Utilization”) | AIMS:To measure the prevalence of beta-blocker eye drop prescribing and respiratory effect of ocular beta-blocker administration in people with asthma. METHODS:We measured the prevalence of ocular beta-blocker prescribing in people with asthma and ocular hypertension, and performed a nested case-control study (NCCS) measuring risk of moderate exacerbations (rescue steroids in primary care) and severe exacerbations (asthma hospitalization) using linked data from the UK Clinical Practice Research Datalink. We then performed a systematic review and meta-analysis of clinical trials evaluating changes in lung function following ocular beta-blocker administration in people with asthma. RESULTS:From 2000 to 2012, the prevalence of non-selective and selective beta-blocker eye drop prescribing in people with asthma and ocular hypertension fell from 23.0% to 13.4% and from 10.5% to 0.9% respectively. In the NCCS, the relative incidence (IRR) of moderate exacerbations increased significantly with acute non-selective beta-blocker eye drop exposure (IRR 4.83, 95% CI 1.56-14.94) but not with chronic exposure. In the meta-analysis, acute non-selective beta-blocker eye drop exposure caused significant mean falls in FEV1 of -10.9% (95% CI -14.9 to -6.9), and falls in FEV1 of ≥20% affecting one in three. Corresponding values for selective beta-blockers in people sensitive to ocular non-selective beta-blockers was -6.3% (95% CI -11.7 to -0.8), and a non-significant increase in falls in FEV1 of ≥20%. CONCLUSION:Non-selective beta-blocker eye drops significantly affect lung function and increase asthma morbidity but are still frequently prescribed to people with asthma and ocular hypertension despite safer agents being available. |
| Use of antipsychotics and risk of myocardial infarction: a systematic review and meta-analysis. | Br J Clin Pharmacol | 2016 | patient-health-practic-studi | c(“Humans”, “Myocardial Infarction”, “Antipsychotic Agents”) | AIM:There is emerging concern that antipsychotics may be associated with an increased risk of myocardial infarction (MI). A previous review identified five observational studies that did not provide an accurate estimate of the association between antipsychotic drug use and MI risk. More recent studies have produced variable results. METHODS:We performed a systematic review and meta-analysis of observational studies to determine whether antipsychotic use affects the risk for MI. Our analysis included all observational studies that compared MI incidence among patients receiving antipsychotics vs. no treatment. RESULTS:Nine observational studies were included in the analysis. The odds for developing MI were 1.88-fold higher (odds ratio (OR) 1.88, 95% confidence interval (CI) 1.39, 2.54) in antipsychotic users compared with individuals who had not taken antipsychotics. Subgroup analyses found an OR of 2.48 (95% CI 1.66, 3.69) among patients with schizophrenia and an OR of 2.64 (95% CI 2.48, 2.81) among short term (<30 days) antipsychotic users. CONCLUSION:The findings of this meta-analysis support an increased risk of MI in antipsychotic drug users. The present systematic review expands previous knowledge by demonstrating an increased and more pronounced risk in short term users. |
| Validation of chronic obstructive pulmonary disease (COPD) diagnoses in healthcare databases: a systematic review protocol. | BMJ Open | 2016 | copd-obstruct-diseas-patient | c(“Humans”, “Pulmonary Disease, Chronic Obstructive”, “Research Design”, “International Classification of Diseases”, “Databases, Factual”, “Delivery of Health Care”, “Disease Management”, “Validation Studies as Topic”, “Clinical Coding”, “Systematic Reviews as Topic”) | INTRODUCTION:Healthcare databases are useful sources to investigate the epidemiology of chronic obstructive pulmonary disease (COPD), to assess longitudinal outcomes in patients with COPD, and to develop disease management strategies. However, in order to constitute a reliable source for research, healthcare databases need to be validated. The aim of this protocol is to perform the first systematic review of studies reporting the validation of codes related to COPD diagnoses in healthcare databases. METHODS AND ANALYSIS:MEDLINE, EMBASE, Web of Science and the Cochrane Library databases will be searched using appropriate search strategies. Studies that evaluated the validity of COPD codes (such as the International Classification of Diseases 9th Revision and 10th Revision system; the Real codes system or the International Classification of Primary Care) in healthcare databases will be included. Inclusion criteria will be: (1) the presence of a reference standard case definition for COPD; (2) the presence of at least one test measure (eg, sensitivity, positive predictive values, etc); and (3) the use of a healthcare database (including administrative claims databases, electronic healthcare databases or COPD registries) as a data source. Pairs of reviewers will independently abstract data using standardised forms and will assess quality using a checklist based on the Standards for Reporting of Diagnostic accuracy (STARD) criteria. This systematic review protocol has been produced in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) 2015 statement. ETHICS AND DISSEMINATION:Ethics approval is not required. Results of this study will be submitted to a peer-reviewed journal for publication. The results from this systematic review will be used for outcome research on COPD and will serve as a guide to identify appropriate case definitions of COPD, and reference standards, for researchers involved in validating healthcare databases. TRIAL REGISTRATION NUMBER:CRD42015029204. |
| Impact of the UN convention on the rights of persons with disabilities (UN-CRPD) on mental health care research - a systematic review. | BMC Psychiatry | 2016 | patient-health-practic-studi | c(“Humans”, “Mental Health”, “Mental Disorders”, “Human Rights”, “Mentally Disabled Persons”, “Health Services Research”, “United Nations”) | The United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD) aims at stimulating profound changes and social development in many areas of the society. We wanted to examine the impact of the convention on mental health care research up to now by a systematic review.We searched relevant electronic databases for empirical studies from the area of mental health which focused directly on the content of the UN-CRPD.One thousand six hundred ten articles were screened, 36 of which fulfilled the inclusion criteria and came from 22 different countries. 25 studies (69 %) are related to persons with intellectual disabilities, only 11 to other mental disorders. Study designs were quantitative and qualitative as well. Issues were realisation of the UN-CRPD, implementation and financing, development of instruments, and attitudes towards the UN-CRPD.In contrast to possible wide-reaching consequences for the organisation of mental health care, theoretical debates prevail as of yet and empirical research is still scarce. Research on the UN-CRPD is more advanced for intellectual disabilities and provides good suggestions for relevant research aspects in major mental disorders. |
| The prevalence of giant cell arteritis and polymyalgia rheumatica in a UK primary care population. | BMC Musculoskelet Disord | 2016 | incid-ag-practic-studi | c(“Humans”, “Polymyalgia Rheumatica”, “Health Surveys”, “Prevalence”, “Age Factors”, “Sex Factors”, “Aged”, “Middle Aged”, “Primary Health Care”, “Female”, “Male”, “Giant Cell Arteritis”, “United Kingdom”) | To update community-based prevalence values for Polymyalgia Rheumatic (PMR) and Giant Cell Arteritis (GCA) using case record review supplemented by population survey and subsequent clinical review.Clinical data were obtained from case records of a large primary care practice in Norfolk, UK and reviewed for diagnoses of GCA and PMR. In addition postal survey was carried out to capture potentially undiagnosed cases within the practice population. Those screening positive for potential diagnoses of GCA and PMR were invited for clinical review. A cumulative prevalence estimate was subsequently calculated on those diagnosed within the GP practice and subsequently on those fulfilling the various published classification criteria sets. The date of the database lock and mail merge was March 2013.Through detailed systematic review of 5,159 GP case records, 21 patients had a recorded diagnosis of GCA and 117 had PMR.No new cases were identified among 2,227 completed questionnaires returned from the population survey of a sample of 4,728. The resulting cumulative prevalence estimate in those aged ≥ 55 years meeting the ACR classification criteria set for GCA was 0.25 % (95 % CI 0.11 to 0.39 %) and for five published criteria sets for PMR ranged from 0.91 to 1.53 % (95 % CI ranges 0.65 %, 1.87 %). The prevalence of both conditions was higher in women than in men and in older age groups.This study provides the first UK prevalence estimate of GCA and PMR in over 30 years and is the first to apply classification criteria sets. |
| Deep Brain Stimulation for Parkinson’s Disease with Early Motor Complications: A UK Cost-Effectiveness Analysis. | PLoS One | 2016 | cost-patient-health-clinic | c(“Humans”, “Parkinson Disease”, “Deep Brain Stimulation”, “Probability”, “Motor Activity”, “Quality-Adjusted Life Years”, “Models, Theoretical”, “Quality of Life”, “Middle Aged”, “Cost-Benefit Analysis”, “United Kingdom”) | Parkinson’s disease (PD) is a debilitating illness associated with considerable impairment of quality of life and substantial costs to health care systems. Deep brain stimulation (DBS) is an established surgical treatment option for some patients with advanced PD. The EARLYSTIM trial has recently demonstrated its clinical benefit also in patients with early motor complications. We sought to evaluate the cost-effectiveness of DBS, compared to best medical therapy (BMT), among PD patients with early onset of motor complications, from a United Kingdom (UK) payer perspective.We developed a Markov model to represent the progression of PD as rated using the Unified Parkinson’s Disease Rating Scale (UPDRS) over time in patients with early PD. Evidence sources were a systematic review of clinical evidence; data from the EARLYSTIM study; and a UK Clinical Practice Research Datalink (CPRD) dataset including DBS patients. A mapping algorithm was developed to generate utility values based on UPDRS data for each intervention. The cost-effectiveness was expressed as the incremental cost per quality-adjusted life-year (QALY). One-way and probabilistic sensitivity analyses were undertaken to explore the effect of parameter uncertainty.Over a 15-year time horizon, DBS was predicted to lead to additional mean cost per patient of £26,799 compared with BMT (£73,077/patient versus £46,278/patient) and an additional mean 1.35 QALYs (6.69 QALYs versus 5.35 QALYs), resulting in an incremental cost-effectiveness ratio of £19,887 per QALY gained with a 99% probability of DBS being cost-effective at a threshold of £30,000/QALY. One-way sensitivity analyses suggested that the results were not significantly impacted by plausible changes in the input parameter values.These results indicate that DBS is a cost-effective intervention in PD patients with early motor complications when compared with existing interventions, offering additional health benefits at acceptable incremental cost. This supports the extended use of DBS among patients with early onset of motor complications. |
| A systematic review of intervention thresholds based on FRAX : A report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation. | Arch Osteoporos | 2016 | fractur-risk-ag-studi | c(“Humans”, “Osteoporosis”, “Risk Assessment”, “Bone Density”, “Aged”, “Eligibility Determination”, “Female”, “Male”, “Practice Guidelines as Topic”, “Osteoporotic Fractures”, “Early Medical Intervention”, “Global Health”) | UNLABELLED:This systematic review identified assessment guidelines for osteoporosis that incorporate FRAX. The rationale for intervention thresholds is given in a minority of papers. Intervention thresholds (fixed or age-dependent) need to be country-specific. INTRODUCTION:In most assessment guidelines, treatment for osteoporosis is recommended in individuals with prior fragility fractures, especially fractures at spine and hip. However, for those without prior fractures, the intervention thresholds can be derived using different methods. The aim of this report was to undertake a systematic review of the available information on the use of FRAX® in assessment guidelines, in particular the setting of thresholds and their validation. METHODS:We identified 120 guidelines or academic papers that incorporated FRAX of which 38 provided no clear statement on how the fracture probabilities derived are to be used in decision-making in clinical practice. The remainder recommended a fixed intervention threshold (n = 58), most commonly as a component of more complex guidance (e.g. bone mineral density (BMD) thresholds) or an age-dependent threshold (n = 22). Two guidelines have adopted both age-dependent and fixed thresholds. RESULTS:Fixed probability thresholds have ranged from 4 to 20 % for a major fracture and 1.3-5 % for hip fracture. More than one half (39) of the 58 publications identified utilised a threshold probability of 20 % for a major osteoporotic fracture, many of which also mention a hip fracture probability of 3 % as an alternative intervention threshold. In nearly all instances, no rationale is provided other than that this was the threshold used by the National Osteoporosis Foundation of the USA. Where undertaken, fixed probability thresholds have been determined from tests of discrimination (Hong Kong), health economic assessment (USA, Switzerland), to match the prevalence of osteoporosis (China) or to align with pre-existing guidelines or reimbursement criteria (Japan, Poland). Age-dependent intervention thresholds, first developed by the National Osteoporosis Guideline Group (NOGG), are based on the rationale that if a woman with a prior fragility fracture is eligible for treatment, then, at any given age, a man or woman with the same fracture probability but in the absence of a previous fracture (i.e. at the ‘fracture threshold’) should also be eligible. Under current NOGG guidelines, based on age-dependent probability thresholds, inequalities in access to therapy arise especially at older ages (≥70 years) depending on the presence or absence of a prior fracture. An alternative threshold using a hybrid model reduces this disparity. CONCLUSION:The use of FRAX (fixed or age-dependent thresholds) as the gateway to assessment identifies individuals at high risk more effectively than the use of BMD. However, the setting of intervention thresholds needs to be country-specific. |
| Limited evidence on persistence with anticoagulants, and its effect on the risk of recurrence of venous thromboembolism: a systematic review of observational studies. | Patient Prefer Adherence | 2016 | atrial-fibril-patient-increas | NULL | The risk of venous thromboembolism (VTE) recurrence is high following an initial VTE event, and it persists over time. This recurrence risk decreases rapidly after starting with anticoagulation treatment and reduces by ~80%-90% with prolonged anticoagulation. Nonpersistence with anticoagulants could lead to increased risk of VTE recurrence. This systematic review aimed to estimate persistence at 3, 6, and 12 months with anticoagulants in patients with VTE, and to evaluate the risk of VTE recurrence in nonpersistent patients.PubMed and Embase(®) were searched up to May 3, 2014 and the search results updated to May 31, 2015. Studies involving patients with VTE aged ≥18 years, treatment with anticoagulants intended for at least 3 months or more, and reporting data for persistence were included. Proportions were transformed using Freeman-Tukey double arcsine transformation and pooled using the DerSimonian-Laird random-effects approach.In total, 12 observational studies (7/12 conference abstracts) were included in the review. All 12 studies either reported or provided data for persistence. The total number of patients meta-analyzed to estimate persistence at 3, 6, and 12 months was 71,969 patients, 58,940 patients, and 68,235 patients, respectively. The estimated persistence for 3, 6, and 12 months of therapy was 83% (95% confidence interval [CI], 78-87; I (2)=99.3%), 62% (95% CI, 58-66; I (2)=98.1%), and 31% (95% CI, 22-40; I (2)=99.8%), respectively. Only two studies reported the risk of VTE recurrence based on nonpersistence - one at 3 months and the other at 12 months.Limited evidence showed that persistence was suboptimal with an estimated 17% patients being nonpersistent with anticoagulants in the crucial first 3 months. Persistence declined over 6 and 12 months. Observational data on persistence with anticoagulation treatment, especially direct oral anticoagulants, in patients with VTE and its effect on risk of VTE recurrence were scarce and further research is required. |
| The burden of chronic obstructive pulmonary disease associated with maintenance monotherapy in the UK. | Int J Chron Obstruct Pulmon Dis | 2016 | patient-health-practic-studi | c(“Lung”, “Humans”, “Pulmonary Disease, Chronic Obstructive”, “Disease Progression”, “Adrenal Cortex Hormones”, “Muscarinic Antagonists”, “Bronchodilator Agents”, “Treatment Outcome”, “Drug Therapy, Combination”, “Hospitalization”, “Administration, Inhalation”, “Retrospective Studies”, “Time Factors”, “Databases, Factual”, “Middle Aged”, “Health Resources”, “Drug Utilization Review”, “Office Visits”, “Referral and Consultation”, “Female”, “Male”, “Drug Prescriptions”, “Adrenergic beta-2 Receptor Agonists”, | |
| “Practice Patterns, Physicians’”, “United Kingdom”) This study characterized a cohort of chronic obstructive pulmonary disease (COPD) patients on maintenance bronchodilator monotherapy for ≥6 months to establish their disease burd | en, measured by health care utiliz | ation.Data | were extracted from the UK Clinical Prac | tice Research Datalink and linked to Hospital Episode Statistics. The monotherapy period spanned the first prescription of a long-acting β2-adrenergic agonist or a long-acting muscarinic antagonist until the end of the study (December 31, 2013) or until step up to dual/triple therapy, for example, addition of another long-acting bronchodilator, an inhaled corticosteroid, or both. A minimum of four consecutive prescriptions and 6 months on continuous monotherapy were required. Patients <50 years old at first COPD diagnosis or with another significant respiratory | disease before starting monotherapy were excluded. Disease burden was evaluated by measuring patients’ rate of face-to-face interactions with a health care professional (HCP), COPD-related exacerbations, hospitalizations, and referrals.A cohort of 8,811 COPD patients (95% Global initiative for chronic Obstructive Lung Disease stage A/B) on maintenance monotherapy was identified between 2002 and 2013; 45% of these patients were still on monotherapy by the end of the study. Median time from first COPD diagnosis to first monotherapy prescription was 56 days, while the median time on maintenance bronchodilator monotherapy was 2 years. The median number of prescriptions was 14. On average, patients had 15 HCP interactions per year, and one in ten patients experienced a COPD exacerbation (N=8,811). One in 50 patients were hospitalized for COPD per year (n=4,848).The average monotherapy-treated patient had a higher than average HCP interaction rate. We also identified a large cohort of patients who were stepped up to triple therapy despite a low rate of exacerbations. The use of the new class of long-acting muscarinic antagonist/long-acting β2-adrenergic agonist fixed-dose combinations may provide a useful step-up treatment option in such monotherapy patients, before the use of inhaled corticosteroids. |
| Prognostic role of metformin intake in diabetic patients with colorectal cancer: An updated qualitative evidence of cohort studies. | Oncotarget | 2017 | metformin-cancer-risk-studi | c(“Humans”, “Colorectal Neoplasms”, “Diabetes Mellitus, Type 2”, “Metformin”, “Hypoglycemic Agents”, “Prognosis”, “Proportional Hazards Models”, “Cohort Studies”, “Qualitative Research”, “Publication Bias”) | Several observational studies have shown that metformin can modify the risk and survival of colorectal cancer (CRC) in patients with diabetes mellitus, although the magnitude of this relationship has not been determined. We conducted an updated systematic review and meta-analysis to analyze the association between metformin and CRC mortality and searched relevant databases up to July 2016. The primary outcome was overall survival (OS). Secondary outcomes were cancer-specific survival (CS) and disease-free survival (DFS). Summary hazard ratios (HRs) were calculated using a random-effects model. Seventeen studies enrolling 269,417 participants were eligible for inclusion. Comparing with non-metformin users in diabetic CRC patients, the summary HRs for OS in metformin users were 0.69 (95% CI, 0.61-0.77). Subgroup analyses stratified by the study characteristics and sensitivity analysis by the trim-and-fill method (adjusted HR 0.77, 95% CI, 0.67-0.87) confirmed the robustness of the results. However, significant OS benefit was noted in patients with stage II and III disease. Five studies reported the CRC prognosis for CS and three for DFS; metformin intake was significantly associated with patient CS (HR 0.75, 95% CI, 0.59-0.94), but not DFS (HR 0.38, 95% CI, 0.13-1.17). Our findings suggest that metformin intake is associated with improved survival outcomes in terms of OS and CS in CRC patients with diabetes, particular for OS in stage II and stage III patients. Further studies should be conducted to determine CRC survival between metformin use and patient specific clinical and molecular profiles. |
| Economic Evaluations Alongside Efficient Study Designs Using Large Observational Datasets: the PLEASANT Trial Case Study. | Pharmacoeconomics | 2017 | cost-patient-health-clinic | c(“Humans”, “Asthma”, “Probability”, “Regression Analysis”, “Quality-Adjusted Life Years”, “Research Design”, “Databases, Factual”, “Adolescent”, “Child”, “Child, Preschool”, “Cost Savings”, “Female”, “Male”, “Randomized Controlled Trials as Topic”, “United Kingdom”) | BACKGROUND:Large observational datasets such as Clinical Practice Research Datalink (CPRD) provide opportunities to conduct clinical studies and economic evaluations with efficient designs. OBJECTIVES:Our objectives were to report the economic evaluation methodology for a cluster randomised controlled trial (RCT) of a UK NHS-delivered public health intervention for children with asthma that was evaluated using CPRD and describe the impact of this methodology on results. METHODS:CPRD identified eligible patients using predefined asthma diagnostic codes and captured 1-year pre- and post-intervention healthcare contacts (August 2012 to July 2014). Quality-adjusted life-years (QALYs) 4 months post-intervention were estimated by assigning utility values to exacerbation-related contacts; a systematic review identified these utility values because preference-based outcome measures were not collected. Bootstrapped costs were evaluated 12 months post-intervention, both with 1-year regression-based baseline adjustment (BA) and without BA (observed). RESULTS:Of 12,179 patients recruited, 8190 (intervention 3641; control 4549) were evaluated in the primary analysis, which included patients who received the protocol-defined intervention and for whom CPRD data were available. The intervention’s per-patient incremental QALY loss was 0.00017 (bias-corrected and accelerated 95% confidence intervals [BCa 95% CI] -0.00051 to 0.00018) and cost savings were £14.74 (observed; BCa 95% CI -75.86 to 45.19) or £36.07 (BA; BCa 95% CI -77.11 to 9.67), respectively. The probability of cost savings was much higher when accounting for BA versus observed costs due to baseline cost differences between trial arms (96.3 vs. 67.3%, respectively). CONCLUSION:Economic evaluations using data from a large observational database without any primary data collection is feasible, informative and potentially efficient. Clinical Trials Registration Number: ISRCTN03000938. |
| Drug prescribing during the last year of life in very old people with diabetes. | Age Ageing | 2017 | diabet-type-patient-studi | c(“Humans”, “Cardiovascular Diseases”, “Diabetes Mellitus, Type 2”, “Cardiovascular Agents”, “Hypoglycemic Agents”, “Polypharmacy”, “Terminal Care”, “Age Factors”, “Comorbidity”, “Aging”, “Time Factors”, “Databases, Factual”, “Aged, 80 and over”, “Drug Utilization Review”, “Primary Health Care”, “Female”, “Male”, “Drug Prescriptions”, “Practice Patterns, Physicians’”, “United Kingdom”) | Objective:To evaluate primary care drug utilisation during the last year of life, focusing on antidiabetic and cardiovascular drugs, in patients of advanced age with diabetes. Design:Population-based cohort study. Setting:Primary care database in the UK. Subjects:Patients with type 2 diabetes who died at over 80 years of age between 2011 and 13. Methods:Main outcome measures included proportions of patients prescribed different classes of drugs, comparing the first (Q1) and the fourth quarters (Q4) of the last year of life. Results:The study included 5,324 patients, with the median age 86 years and 50% female. Three-fourths of the patients received five or more drugs, and the total number of drugs prescribed was almost stable at 6.2 ± 3.1 (mean ± SD) during the last year of life. Substantial proportions of patients were treated with antidiabetic drugs (78%), antihypertensive drugs (76%), statins (62%) and low-dose aspirin (46%) in Q1. Prescribing of these drugs slightly decreased by 3–8% in Q4. There were increases in prescribing of anti-infectives (35% in Q1 to 50% in Q4), drugs for nervous system (63% to 73%), drugs for respiratory system (24% to 33%) and systemic hormonal drugs (22% to 27%). Conclusion:Patients of advanced age with type 2 diabetes were often treated with antidiabetic and cardiovascular drugs even when approaching death. More research is needed to generate evidence to guide optimal drug utilisation for older people with a limited life expectancy. |
| A meta-analysis of stroke risk following herpes zoster infection. | BMC Infect Dis | 2017 | stroke-risk-increas-studi | c(“Humans”, “Herpes Zoster”, “Risk Factors”, “Stroke”) | The incidence of herpes zoster (HZ) is increasing and poses a significant health concern to aging populations. Several studies suggest an increased risk of stroke following zoster infection, but the results are conflicting. We conducted a systematic review and meta-analysis to determine if stroke risk is increased following HZ infection.A search of MEDLINE, EMBASE, Google scholar, Web of Science, CAB Direct, Cumulative Index to Nursing and Allied Health Literature, and Evidence Based Medicine Reviews was conducted for observational studies of adults with HZ infection that examined stroke and TIA risk from January 1, 1966 to May 31, 2016. Adjusted relative risks reported for similar follow-up durations were pooled across studies separately using random-effects inverse variance models.Data were pooled from nine studies. Relative risk for stroke after zoster was 1.78 (95% CI 1.70-1.88) for the first month following herpes zoster, dropping progressively to 1.43 (95% CI 1.38-1.47) after 3 months, to 1.20 (95% CI 1.14-1.26) after 1 year. We found that stroke risk increases by a larger margin during the first month after a herpes zoster ophthalmicus episode: relative risk 2.05 (95% CI 1.82-2.31). The risk remains elevated one year after the acute episode.Herpes zoster is an established risk factor for increasing the risk of stroke, especially shortly after infection. Vaccination should be encouraged in patients at high risk of cardiovascular disease. |
| Seasonal influenza vaccination in patients with COPD: a systematic literature review. | BMC Pulm Med | 2017 | vaccin-influenza-risk-ag-studi | c(“Humans”, “Pulmonary Disease, Chronic Obstructive”, “Disease Progression”, “Influenza Vaccines”, “Vaccination”, “Hospitalization”, “Severity of Illness Index”, “Quality of Life”, “Influenza, Human”, “Randomized Controlled Trials as Topic”) | Influenza is a frequent cause of exacerbations of chronic obstructive pulmonary disease (COPD). Exacerbations are associated with worsening of the airflow obstruction, hospitalisation, reduced quality of life, disease progression, death, and ultimately, substantial healthcare-related costs. Despite longstanding recommendations to vaccinate vulnerable high-risk groups against seasonal influenza, including patients with COPD, vaccination rates remain sub-optimal in this population.We conducted a systematic review to summarise current evidence from randomised controlled trials (RCTs) and observational studies on the immunogenicity, safety, efficacy, and effectiveness of seasonal influenza vaccination in patients with COPD. The selection of relevant articles was based on a three-step selection procedure according to predefined inclusion and exclusion criteria. The search yielded 650 unique hits of which 48 eligible articles were screened in full-text.Seventeen articles describing 13 different studies were found to be pertinent to this review. Results of four RCTs and one observational study demonstrate that seasonal influenza vaccination is immunogenic in patients with COPD. Two studies assessed the occurrence of COPD exacerbations 14 days after influenza vaccination and found no evidence of an increased risk of exacerbation. Three RCTs showed no significant difference in the occurrence of systemic effects between groups receiving influenza vaccine or placebo. Six out of seven studies on vaccine efficacy or effectiveness indicated long-term benefits of seasonal influenza vaccination, such as reduced number of exacerbations, reduced hospitalisations and outpatient visits, and decreased all-cause and respiratory mortality.Additional large and well-designed observational studies would contribute to understanding the impact of disease severity and patient characteristics on the response to influenza vaccination. Overall, the evidence supports a positive benefit-risk ratio for seasonal influenza vaccination in patients with COPD, and supports current vaccination recommendations in this population. |
| Antibiotic Exposure in Early Life Increases Risk of Childhood Obesity: A Systematic Review and Meta-Analysis. | Front Endocrinol (Lausanne) | 2017 | antibiot-prescrib-prescript-care-studi | NULL | A number of studies have previously assessed the impact of antibiotic exposure in early life on the risk of childhood obesity, but no systematic assessment is currently available. A systematic review and meta-analysis was performed to comprehensively and quantitatively elucidate the risk of childhood obesity caused by antibiotic exposure in early life. Literature search was performed in PubMed, Embase, and Web of Science. Random-effect meta-analysis was used to pool the statistical estimates. Fifteen cohort studies involving 445,880 participants were finally included, and all those studies were performed in developed countries. Antibiotic exposure in early life significantly increased risk of childhood overweight [relative risk (RR) = 1.23, 95% confidence interval (CI) 1.13-1.35, P < 0.001] and childhood obesity (RR = 1.21, 95% CI 1.13-1.30, P < 0.001). Antibiotic exposure in early life also significantly increased the z-score of childhood body mass index (mean difference: 0.07, 95% CI 0.05-0.09, P < 0.00001). Importantly, there was an obvious dose-response relationship between antibiotic exposure in early life and childhood adiposity, with a 7% increment in the risk of overweight (RR = 1.07, 95% CI 1.01-1.15, P = 0.03) and a 6% increment in the risk of obesity (RR = 1.06, 95% CI 1.02-1.09, P < 0.001) for each additional course of antibiotic exposure. In conclusion, antibiotic exposure in early life significantly increases risk of childhood obesity. Moreover, current analyses are mainly taken from developed countries, and therefore the impact of antibiotic exposure on risk of childhood obesity in vulnerable populations or developing countries still needs to be evaluated in future studies. |
| Adverse mental health outcomes in breast cancer survivors compared to women who did not have cancer: systematic review protocol. | Syst Rev | 2017 | cancer-risk-patient-studi | c(“Humans”, “Breast Neoplasms”, “Mental Health”, “Mental Disorders”, “Female”, “Cancer Survivors”) | Recent increasing trends in breast cancer incidence and survival have resulted in unprecedented numbers of cancer survivors in the general population. A cancer diagnosis may have a profound psychological impact, and breast cancer treatments often cause long-term physical sequelae, potentially affecting women’s mental health. The aim of this systematic review is to identify and summarise all studies that have compared mental health outcomes in breast cancer survivors, versus women who did not have cancer.This study will be a systematic review of the literature. Four databases, including MEDLINE and PsycINFO, will be searched to identify potentially relevant studies. The search expressions will use a Boolean logic, including terms for the target population (women who have had breast cancer), outcomes (psychiatric disorders) and comparators (e.g. risk, hazard). All mental disorders will be eligible, except those with onset normally occurring during childhood or strong genetic basis (e.g. Huntington disease). The eligibility of the studies will be assessed in two phases: (1) considering the information provided in the title and abstract; (2) evaluating the full text. Studies including women diagnosed with breast cancer 1 year or more ago and that provide original data on mental health outcomes will be eligible. Studies in which all women were undergoing surgery, chemotherapy or radiotherapy, or hospitalised or institutionalised, will be excluded, as well as studies that include patients selected on the basis of symptomatology. Two investigators will do the screening of the references and the data extraction independently, with results compared and discrepancies resolved by involving a third investigator when necessary. Study quality and risk of bias will be assessed across six broad domains. Results will be summarised by outcome, and summary measures of frequency and/or association will be computed if possible.This review will summarise the evidence on the mental health outcomes of women who have been diagnosed with breast cancer. This information can be used to motivate further research and increase understanding of the most common mental health conditions affecting this growing population of women.PROSPERO CRD42017056946. |
| Epidemiology of adult overweight recording and management by UK GPs: a systematic review. | Br J Gen Pract | 2017 | bmi-obes-bodi-index-studi | c(“Humans”, “Body Mass Index”, “Documentation”, “Adult”, “Referral and Consultation”, “Primary Health Care”, “Guideline Adherence”, “Overweight”, “Practice Guidelines as Topic”, “General Practitioners”, “Practice Patterns, Physicians’”, “United Kingdom”) | Primary care guidelines for managing adult overweight/obesity recommend routine measurement of body mass index (BMI) and the offer of weight management interventions. Many studies state that this is rarely done, but the extent to which overweight/obesity is recognised, considered, and documented in routine care has not been determined.To identify the epidemiology of adult overweight documentation and management by UK GPs.A systematic review of studies since 2006 from eight electronic databases and grey literature.Included studies measured the proportion of adult patients with documented BMI or weight loss intervention offers in routine primary care in the UK. A narrative synthesis reports the prevalence and pattern of the outcomes.In total, 2845 articles were identified, and seven were included; four with UK-wide data and three with regional-level data. The proportion of patients with a documented BMI was 58-79% (28-37% within a year). For overweight/obese patients alone, 43-52% had a recent BMI record, and 15-42% had a documented intervention offer. BMI documentation was positively associated with older age, female sex, higher BMI, coexistent chronic disease, and higher deprivation.BMI is under-recorded and weight loss interventions are under-referred for primary care adult patients in the UK despite the obesity register in the Quality and Outcomes Framework (QOF). The review identified likely underserved groups such as younger males and otherwise healthy overweight/obese individuals to whom attention should now be directed. The proposed amendment to the obesity register QOF could prompt improvements but has not been adopted for 2017. |
| Factors influencing the development of primary care data collection projects from electronic health records: a systematic review of the literature. | BMC Med Inform Decis Mak | 2017 | data-research-record-studi | c(“Humans”, “Data Collection”, “Primary Health Care”, “Electronic Health Records”) | Primary care data gathered from Electronic Health Records are of the utmost interest considering the essential role of general practitioners (GPs) as coordinators of patient care. These data represent the synthesis of the patient history and also give a comprehensive picture of the population health status. Nevertheless, discrepancies between countries exist concerning routine data collection projects. Therefore, we wanted to identify elements that influence the development and durability of such projects.A systematic review was conducted using the PubMed database to identify worldwide current primary care data collection projects. The gray literature was also searched via official project websites and their contact person was emailed to obtain information on the project managers. Data were retrieved from the included studies using a standardized form, screening four aspects: projects features, technological infrastructure, GPs’ roles, data collection network organization.The literature search allowed identifying 36 routine data collection networks, mostly in English-speaking countries: CPRD and THIN in the United Kingdom, the Veterans Health Administration project in the United States, EMRALD and CPCSSN in Canada. These projects had in common the use of technical facilities that range from extraction tools to comprehensive computing platforms. Moreover, GPs initiated the extraction process and benefited from incentives for their participation. Finally, analysis of the literature data highlighted that governmental services, academic institutions, including departments of general practice, and software companies, are pivotal for the promotion and durability of primary care data collection projects.Solid technical facilities and strong academic and governmental support are required for promoting and supporting long-term and wide-range primary care data collection projects. |
| The role of the Quality and Outcomes Framework in the care of long-term conditions: a systematic review. | Br J Gen Pract | 2017 | health-practic-data-studi | c(“Humans”, “Chronic Disease”, “Long-Term Care”, “State Medicine”, “Primary Health Care”, “Delivery of Health Care”, “Quality of Health Care”, “Quality Improvement”, “United Kingdom”) | Improving care for people with long-term conditions is central to NHS policy. It has been suggested that the Quality and Outcomes Framework (QOF), a primary care pay-for-performance scheme that rewards practices for delivering effective interventions in long-term conditions, does not encourage high-quality care for this group of patients.To examine the evidence that the QOF has improved quality of care for patients with long-term conditions.This was a systematic review of research on the effectiveness of the QOF in the UK.The authors searched electronic databases for peer-reviewed empirical quantitative research studying the effect of the QOF on a broad range of processes and outcomes of care, including coordination and integration of care, holistic and personalised care, self-care, patient experience, physiological and biochemical outcomes, health service utilisation, and mortality. Because the studies were heterogeneous, a narrative synthesis was carried out.The authors identified three systematic reviews and five primary research studies that met the inclusion criteria. The QOF was associated with a modest slowing of both the increase in emergency admissions and the increase in consultations in severe mental illness (SMI), and modest improvements in diabetes care. The nature of the evidence means that the authors cannot be sure that any of these associations is causal. No clear effect on mortality was found. The authors found no evidence that the QOF influences integration or coordination of care, holistic care, self-care, or patient experience.The NHS should consider more broadly what constitutes high-quality primary care for people with long-term conditions, and consider other ways of motivating primary care to deliver it. |
| Venous thromboembolism and mortality in breast cancer: cohort study with systematic review and meta-analysis. | BMC Cancer | 2017 | patient-health-practic-studi | c(“Humans”, “Breast Neoplasms”, “Anticoagulants”, “Proportional Hazards Models”, “Risk Factors”, “Cohort Studies”, “MEDLINE”, “Female”, “Venous Thromboembolism”) | Breast cancer patients are at an increased risk of venous thromboembolism (VTE). However, current evidence as to whether VTE increases the risk of mortality in breast cancer patients is conflicting. We present data from a large cohort of patients from the UK and pool these with previous data from a systematic review.Using the Clinical Practice Research Datalink (CPRD) dataset, we identified a cohort of 13,202 breast cancer patients, of whom 611 were diagnosed with VTE between 1997 and 2006 and 12,591 did not develop VTE. Hazard ratios (HR) were used to compare mortality between the two groups. These were then pooled with existing data on this topic identified via a search of the MEDLINE and EMBASE databases (until January 2015) using a random-effects meta-analysis.Within the CPRD, VTE was associated with increased mortality when treated as a time-varying covariate (HR = 2.42; 95% CI, 2.13-2.75), however, when patients were permanently classed as having VTE based on presence of a VTE event within 6 months of cancer diagnosis, no increased risk was observed (HR = 1.22; 0.93-1.60). The pooled HR from seven studies using the second approach was 1.69 (1.12-2.55), with no effect seen when restricted to studies which adjusted for key covariates.A large HR for VTE in the time-varying covariate analysis reflects the known short-term mortality following a VTE. When breast cancer patients are fortunate to survive the initial VTE, the influence on longer-term mortality is less certain. |
| Association between Human Papilloma Virus (HPV) vaccination and risk of Multiple Sclerosis: A systematic review. | Hum Vaccin Immunother | 2018 | vaccin-ag-practic-studi | c(“Humans”, “Papillomaviridae”, “Papillomavirus Infections”, “Multiple Sclerosis”, “Vaccination”, “Incidence”, “Odds Ratio”, “Risk Assessment”, “Uterine Cervical Neoplasms”, “Female”, “Papillomavirus Vaccines”) | INTRODUCTION:The vaccination against Humanpapilloma Virus (HPV) is an effective strategy to prevent high-risk HPV infection and subsequent cervical carcinogenesis. Although the safety profile has been ascertained, the relation with the development of central nervous system (CNS) autoimmune disorders (AD) appears still controversial. Multiple Sclerosis (MS) is the most common cause of chronic neurological impairment in young people, typically striking females. The main purpose of this review was to assess the association between HPV vaccination and MS. METHODS:The systematic review of the literature was carried out using 5 search engines: MEDLINE, SCOPUS, ISI WEB OF KNOWLEDGE, GOOGLE SCHOLAR and ClinicalTrial.gov. The web search was updated on January 2017. PRISMA checklist was adopted to address the content of the systematic review. The measures of outcome were reported as relative risk (RR) in cohort studies and odds ratio (OR) in case-control studies. RESULTS:The systematic review identified 5 observational studies, 9 reviews, and 1 randomized clinical trials (RCT) pooled analysis. The RR of MS onset detected by cohort studies ranged from 1.54 (95%CI, 0.04-8.59) to 1.37 (95%CI, 0.74-3.20). Concerning case-control studies, the OR spanned from 0.3, (95%CI 0.1-0.9) to 1.60 (95%CI = 0.79-3.25) for the group exposed to HPV vaccination. No result was significant. CONCLUSION:This review showed no significant association between HPV vaccination and MS. The low statistical power of the studies agreed with the low incidence of MS disease among general population. In order to overcome the shortcoming the research may be extended to the entire pattern of CNS ADs. |
| Antidepressants use and risk of cataract development: a systematic review and meta-analysis. | BMC Ophthalmol | 2018 | prescrib-increas-practic-studi | c(“Humans”, “Cataract”, “Antidepressive Agents”, “Odds Ratio”, “Risk Factors”) | Epidemiological studies suggest that antidepressants use may increase the risk of cataract, but the results are inconclusive. We aimed to examine this association by performing a systematic review and meta-analysis.Relevant studies were identified by searching PubMed and Web of Science databases through June 2017. We included studies that reported risk estimates for the association between antidepressants use and cataract risk. A random-effects model was used to calculate the summary odds ratio (OR) with its 95% confidence interval (CI).We identified seven studies of antidepressants use and risk of cataract involving 447,672 cases and 1,510,391 controls. Overall, the combined ORs (95% CIs) of cataract for selective serotonin reuptake inhibitors (SSRIs), serotonin noradrenalin reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs) were 1.12 (1.06-1.19), 1.13 (1.04-1.24), and 1.19 (1.11-1.28), respectively. A certain degree of heterogeneity was observed across studies (P < 0.001, I 2 = 92.2% for SSRIs, P = 0.026, I 2 = 67.5% for SNRIs, and P = 0.092, I 2 = 58.0% for TCAs).This meta-analysis provides evidence of a significant positive association between antidepressants use and risk of cataract. Because of the heterogeneity and limited eligible studies, further prospective studies are warranted to confirm the preliminary findings of our study. |
| Are phosphodiesterase type 5 inhibitors associated with increased risk of melanoma?: A systematic review and meta-analysis. | Medicine (Baltimore) | 2018 | patient-health-practic-studi | c(“Humans”, “Melanoma”, “Risk Assessment”, “Phosphodiesterase 5 Inhibitors”) | Phosphodiesterase type 5 (PDE5) inhibitors are recommended for patients with erectile dysfunction by American Urological Association and European Association Urology guidelines. However, recent researches have shown that PDE5 inhibitors may lead to increased melanoma risk. Thus, we aimed to explore whether PDE5 inhibitors are associated with increased melanoma risk based on published literatures.We conducted a systematic online search on PubMed, EMBASE, Cochrane Library, Chinese Biochemical Literature, China National Knowledge Infrastructure, and Chinese Science and Technology Periodical databases to identify the related studies. Odds ratios (ORs), risk ratios, and hazard ratios with 95% confidence intervals (CIs) were extracted and calculated to assess the strength of associations between PDE5 inhibitors and melanoma risk. We also extracted the basal cell carcinoma (BCC) to validate the association in this study.We included 5 studies containing 100,932 participants in our systematic review and meta-analysis. The calculated results suggested positive results of PDE5 inhibitors on melanoma risk (OR: 1.13; 95%CI: 1.04-1.23). For localized and nonlocalized melanoma, the results were different (OR: 1.22; 95%CI: 1.04-1.43 for localized melanoma) (OR: 0.62; 95%CI: 0.39-0.98 for nonlocalized melanoma). It also showed that PDE5 inhibitors were associated with increased BCC risk (OR: 1.18; 95%CI: 1.11-1.27).The association between PDE5 inhibitors and melanoma might not be causal due to potential bias (patient selection, and so on) and limitations. |
| A Systematic Review of Longitudinal Cohort Studies Examining Unintentional Injury in Young Children. | Glob Pediatr Health | 2018 | children-ag-care-studi | NULL | Objective. Injury is the leading cause of death and long-term disability in children. Longitudinal cohorts are designed to follow subjects longitudinally in order to determine if early-life exposures are related to certain health outcomes. Methods. We conducted a systematic review to identify studies of children from birth through 5 years who were followed longitudinally with unintentional injury as an outcome of interest. Results. Of the 1892 unique references based on the search criteria, 12 (published between 2000 and 2013) were included. The studies varied on the population of focus, injury definition, and incidence rates. Existing studies that longitudinally follow children aged 0 to 5 years are limited in number, scope, and generalizability. Conclusions. Further study using population-based longitudinal cohorts is necessary to more comprehensively estimate incidence of injury in young children. |
| Risk of poisoning in children and adolescents with ADHD: a systematic review and meta-analysis. | Sci Rep | 2018 | children-ag-care-studi | c(“Humans”, “Poisoning”, “Wounds and Injuries”, “Odds Ratio”, “Risk Assessment”, “Attention Deficit Disorder with Hyperactivity”, “Adolescent”, “Child”, “Child, Preschool”, “Infant”, “Male”, “Practice Guidelines as Topic”) | Poisoning, a subtype of physical injury, is an important hazard in children and youth. Individuals with ADHD may be at higher risk of poisoning. Here, we conducted a systematic review and meta-analysis to quantify this risk. Furthermore, since physical injuries, likely share causal mechanisms with those of poisoning, we compared the relative risk of poisoning and injuries pooling studies reporting both. As per our pre-registered protocol (PROSPERO ID CRD42017079911), we searched 114 databases through November 2017. From a pool of 826 potentially relevant references, screened independently by two researchers, nine studies (84,756 individuals with and 1,398,946 without the disorder) were retained. We pooled hazard and odds ratios using Robust Variance Estimation, a meta-analytic method aimed to deal with non-independence of outcomes. We found that ADHD is associated with a significantly higher risk of poisoning (Relative Risk = 3.14, 95% Confidence Interval = 2.23 to 4.42). Results also indicated that the relative risk of poisoning is significantly higher than that of physical injuries when comparing individuals with and without ADHD (Beta coefficient = 0.686, 95% Confidence Interval = 0.166 to 1.206). These findings should inform clinical guidelines and public health programs aimed to reduce physical risks in children/adolescents with ADHD. |
| Quality of diabetes care in cancer: a systematic review. | Int J Qual Health Care | 2019 | patient-health-practic-studi | c(“Humans”, “Neoplasms”, “Diabetes Mellitus”, “Hypoglycemic Agents”, “Disease Management”, “Quality of Health Care”, “Medication Adherence”) | PURPOSE:Overlooking other conditions during cancer could undermine gains associated with early detection and improved cancer treatment. We conducted a systematic review on the quality of diabetes care in cancer. DATA SOURCES:Systematic searches of Medline and Embase, from 1996 to present, were conducted to identify studies on the quality of diabetes care in patients diagnosed with cancer. STUDY SELECTION:Studies were selected if they met the following criteria: longitudinal or cross-sectional observational study; population consisted of diabetes patients; exposure consisted of cancer of any type and outcomes consisted of diabetes quality of care indicators, including healthcare visits, monitoring and testing, control of biologic parameters, or use of diabetes and other related medications. DATA EXTRACTION:Structured data collection forms were developed to extract information on the study design and four types of quality indicators: physician visits, exams or diabetes education (collectively ‘healthcare visits’); monitoring and testing; control of biologic parameters; and medication use and adherence. RESULTS OF DATA SYNTHESIS:There were 15 studies from five countries. There was no consistent evidence that cancer was associated with fewer healthcare visits, lower monitoring and testing of biologic parameters or poorer control of biologic parameters, including glucose. However, the weight of the evidence suggests cancer was associated with lower adherence to diabetes medications and other medications, such as anti-hypertensives and cholesterol-lowering agents. CONCLUSION:Evidence indicates cancer is associated with poorer adherence to diabetes and other medications. Further primary research could clarify cancer’s impact on other diabetes quality indicators. |
| Delivery and impact of the NHS Health Check in the first 8 years: a systematic review. | Br J Gen Pract | 2018 | health-practic-data-studi | c(“Humans”, “Cardiovascular Diseases”, “Diabetes Mellitus”, “Program Evaluation”, “Health Promotion”, “Preventive Health Services”, “National Health Programs”, “State Medicine”, “Delivery of Health Care”, “Patient Acceptance of Health Care”, “Evaluation Studies as Topic”, “Quality Improvement”, “Observational Studies as Topic”, “United Kingdom”) | BACKGROUND:Since 2009, all eligible persons in England have been entitled to an NHS Health Check. Uncertainty remains about who attends, and the health-related impacts. AIM:To review quantitative evidence on coverage (the proportion of eligible individuals who attend), uptake (proportion of invitees who attend), and impact of NHS Health Checks. DESIGN AND SETTING:A systematic review and quantitative data synthesis. Included were studies or data reporting coverage or uptake and studies reporting any health-related impact that used an appropriate comparison group or before- and-after study design. METHOD:Eleven databases and additional internet sources were searched to November 2016. RESULTS:Twenty-six observational studies and one additional dataset were included. Since 2013, 45.6% of eligible individuals have received a health check. Coverage is higher among older people, those with a family history of coronary heart disease, those living in the most deprived areas, and some ethnic minority groups. Just under half (48.2%) of those invited have taken up the invitation. Data on uptake and impact (especially regarding health-related behaviours) are limited. Uptake is higher in older people and females, but lower in those living in the most deprived areas. Attendance is associated with small increases in disease detection, decreases in modelled cardiovascular disease risk, and increased statin and antihypertensive prescribing. CONCLUSION:Published attendance, uptake, and prescribing rates are all lower than originally anticipated, and data on impact are limited, with very few studies reporting the effect of attendance on health-related behaviours. High-quality studies comparing matched attendees and non-attendees and health economic analyses are required. |
| Using electronic health records to quantify and stratify the severity of type 2 diabetes in primary care in England: rationale and cohort study design. | BMJ Open | 2018 | diabet-type-patient-studi | c(“Humans”, “Cardiovascular Diseases”, “Diabetes Mellitus, Type 2”, “Hospitalization”, “Severity of Illness Index”, “Risk Factors”, “Cohort Studies”, “Comorbidity”, “Algorithms”, “Research Design”, “Adult”, “Aged”, “Aged, 80 and over”, “Middle Aged”, “Primary Health Care”, “England”, “Female”, “Male”, “Electronic Health Records”, “Glycated Hemoglobin A”) | INTRODUCTION:The increasing prevalence of type 2 diabetes mellitus (T2DM) presents a significant burden on affected individuals and healthcare systems internationally. There is, however, no agreed validated measure to infer diabetes severity from electronic health records (EHRs). We aim to quantify T2DM severity and validate it using clinical adverse outcomes. METHODS AND ANALYSIS:Primary care data from the Clinical Practice Research Datalink, linked hospitalisation and mortality records between April 2007 and March 2017 for patients with T2DM in England will be used to develop a clinical algorithm to grade T2DM severity. The EHR-based algorithm will incorporate main risk factors (severity domains) for adverse outcomes to stratify T2DM cohorts by baseline and longitudinal severity scores. Provisionally, T2DM severity domains, identified through a systematic review and expert opinion, are: diabetes duration, glycated haemoglobin, microvascular complications, comorbidities and coprescribed treatments. Severity scores will be developed by two approaches: (1) calculating a count score of severity domains; (2) through hierarchical stratification of complications. Regression models estimates will be used to calculate domains weights. Survival analyses for the association between weighted severity scores and future outcomes-cardiovascular events, hospitalisation (diabetes-related, cardiovascular) and mortality (diabetes-related, cardiovascular, all-cause mortality)-will be performed as statistical validation. The proposed EHR-based approach will quantify the T2DM severity for primary care performance management and inform the methodology for measuring severity of other primary care-managed chronic conditions. We anticipate that the developed algorithm will be a practical tool for practitioners, aid clinical management decision-making, inform stratified medicine, support future clinical trials and contribute to more effective service planning and policy-making. ETHICS AND DISSEMINATION:The study protocol was approved by the Independent Scientific Advisory Committee. Some data were presented at the National Institute for Health Research School for Primary Care Research Showcase, September 2017, Oxford, UK and the Diabetes UK Professional Conference March 2018, London, UK. The study findings will be disseminated in relevant academic conferences and peer-reviewed journals. |
| Clinical Research Informatics: Contributions from 2017. | Yearb Med Inform | 2018 | patient-health-practic-studi | c(“Humans”, “Information Dissemination”, “Peer Review”, “Biomedical Research”, “Informed Consent”, “Medical Informatics”, “Electronic Health Records”) | OBJECTIVES: To summarize key contributions to current research in the field of Clinical Research Informatics (CRI) and to select best papers published in 2017. METHOD: A bibliographic search using a combination of MeSH descriptors and free terms on CRI was performed using PubMed, followed by a double-blind review in order to select a list of candidate best papers to be then peer-reviewed by external reviewers. A consensus meeting between the two section editors and the editorial team was organized to finally conclude on the selection of best papers. RESULTS: Among the 741 returned papers published in 2017 in the various areas of CRI, the full review process selected five best papers. The first best paper reports on the implementation of consent management considering patient preferences for the use of de-identified data of electronic health records for research. The second best paper describes an approach using natural language processing to extract symptoms of severe mental illness from clinical text. The authors of the third best paper describe the challenges and lessons learned when leveraging the EHR4CR platform to support patient inclusion in academic studies in the context of an important collaboration between private industry and public health institutions. The fourth best paper describes a method and an interactive tool for case-crossover analyses of electronic medical records for patient safety. The last best paper proposes a new method for bias reduction in association studies using electronic health records data. CONCLUSIONS: Research in the CRI field continues to accelerate and to mature, leading to tools and platforms deployed at national or international scales with encouraging results. Beyond securing these new platforms for exploiting large-scale health data, another major challenge is the limitation of biases related to the use of “real-world” data. Controlling these biases is a prerequisite for the development of learning health systems. |
| Development and validation of prediction models to estimate risk of primary total hip and knee replacements using data from the UK: two prospective open cohorts using the UK Clinical Practice Research Datalink. | Ann Rheum Dis | 2019 | patient-clinic-practic-studi | c(“Humans”, “Osteoarthritis, Knee”, “Osteoarthritis, Hip”, “Arthroplasty, Replacement, Hip”, “Arthroplasty, Replacement, Knee”, “Calibration”, “Risk Assessment”, “Prospective Studies”, “Reproducibility of Results”, “Decision Support Techniques”, “Databases, Factual”, “Adult”, “Middle Aged”, “Female”, “Male”, “United Kingdom”) | OBJECTIVES:The ability to efficiently and accurately predict future risk of primary total hip and knee replacement (THR/TKR) in earlier stages of osteoarthritis (OA) has potentially important applications. We aimed to develop and validate two models to estimate an individual’s risk of primary THR and TKR in patients newly presenting to primary care. METHODS:We identified two cohorts of patients aged ≥40 years newly consulting hip pain/OA and knee pain/OA in the Clinical Practice Research Datalink. Candidate predictors were identified by systematic review, novel hypothesis-free ‘Record-Wide Association Study’ with replication, and panel consensus. Cox proportional hazards models accounting for competing risk of death were applied to derive risk algorithms for THR and TKR. Internal-external cross-validation (IECV) was then applied over geographical regions to validate two models. RESULTS:45 predictors for THR and 53 for TKR were identified, reviewed and selected by the panel. 301 052 and 416 030 patients newly consulting between 1992 and 2015 were identified in the hip and knee cohorts, respectively (median follow-up 6 years). The resultant model C-statistics is 0.73 (0.72, 0.73) and 0.79 (0.78, 0.79) for THR (with 20 predictors) and TKR model (with 24 predictors), respectively. The IECV C-statistics ranged between 0.70-0.74 (THR model) and 0.76-0.82 (TKR model); the IECV calibration slope ranged between 0.93-1.07 (THR model) and 0.92-1.12 (TKR model). CONCLUSIONS:Two prediction models with good discrimination and calibration that estimate individuals’ risk of THR and TKR have been developed and validated in large-scale, nationally representative data, and are readily automated in electronic patient records. |
| No Causal Link between Phosphodiesterase Type 5 Inhibition and Melanoma. | World J Mens Health | 2019 | cell-analysi-identifi-increas-studi | NULL | PURPOSE:To examine the association between phosphodiesterase type 5 (PDE5) inhibitor use and melanoma by 1) conducting a systematic review of observational studies; and 2) determining if low PDE5A gene expression in human melanoma correlated with decreased overall survival. MATERIALS AND METHODS:A systematic search of observational studies examining the association between PDE5 inhibitor use and melanoma was performed through ClinicalTrials.gov, the Cochrane Library, EMBASE, PubMed, and Web of Science databases, and seven eligible studies were identified. PDE5A gene expression was analyzed with RNA sequencing data from 471 human melanoma samples obtained from The Cancer Genome Atlas. RESULTS:Four studies reported a positive association between PDE5 inhibitor use and melanoma, and three studies found no correlation. RNA sequencing data analysis revealed that under-expression of the PDE5A gene did not impact clinical outcomes in melanoma. CONCLUSIONS:There is currently no evidence to suggest that PDE5 inhibition in patients causes increased risk for melanoma. The few observational studies that demonstrated a positive association between PDE5 inhibitor use and melanoma often failed to account for major confounders. Nonetheless, the substantial evidence implicating PDE5 inhibition in the cyclic guanosine monophosphate (cGMP)-mediated melanoma pathway warrants further investigation in the clinical setting. |
| Prognostic Effect of Bisphosphonate Exposure for Patients With Diagnosed Solid Cancer: A Systematic Review With Meta-Analysis of Observational Studies. | Front Oncol | 2018 | cancer-risk-patient-studi | NULL | Background: Bisphosphonates are widely prescribed for the prevention and treatment of osteoporosis. Recent epidemiological studies indicate that people with bisphosphonate use may have lower cancer risk and have improved survival. The aim of this study is to determine the association between bisphosphonate use and survival outcomes in solid cancer patients using systematic review and meta-analysis. Methods: A systematic literature search was performed using the PubMed, Embase, and Cochrane databases. Original articles published until April, 2018 were selected. The survival outcome measures assessed included overall survival (OS), cancer-specific survival (CSS) and recurrence-free survival (RFS). Pooled hazard ratio (HR) and their 95% confidence interval (95% CI) were derived using a random-effects model. Results: Out of 9,742 retrieved citations, six cohort studies and two nested case-control studies satisfying the inclusion criteria were included for analyses. Bisphosphonate use was significantly associated with improved OS (HR 0.84, 95% CI 0.76-0.93), CSS (HR 0.73, 95% CI 0.58-0.90) and RFS (HR 0.72, 95% CI 0.53-0.96). The results of subgroup analyses stratified by major study characteristics were generally consistent with the main findings. For individual cancer type, we found that bisphosphonate use was significantly associated with longer OS for patients with gastroesophageal cancer (HR 0.62, 95% CI 0.40-0.98), as well as longer CSS for patients with breast cancer (HR 0.73, 95% CI 0.55-0.95). Conclusions: Current evidence indicates that bisphosphonate use is significantly associated with improved survival for patients with solid cancer. However, the prognostic effects in specific solid tumors remains to be confirmed by further large prospective cohort studies. |
| Vaccination in England: a review of why business as usual is not enough to maintain coverage. | BMC Public Health | 2018 | vaccin-ag-practic-studi | c(“Humans”, “Vaccination”, “Delivery of Health Care”, “England”, “Randomized Controlled Trials as Topic”) | BACKGROUND:The vaccine system in England underwent radical changes in 2013 following the implementation of the Health and Social Care Act. There have since been multi-year decreases in coverage of many vaccines. Healthcare professionals have reported finding the new system fragmented and challenging. This study aims to produce a logic model of the new system and evaluate the available evidence for interventions to improve coverage. METHODS:We undertook qualitative document analysis to develop the logic model using process evaluation methods. We performed a systematic review by searching 12 databases with a broad search strategy to identify interventions studied in England conducted between 2006 and 2016 and evaluated their effectiveness. We then compared the evidence base to the logic model. RESULTS:We analysed 83 documents and developed a logic model describing the core inputs, processes, activities, outputs, outcomes and impacts of the new vaccination system alongside the programmatic assumptions for each stage. Of 9,615 unique articles, we screened 624 abstracts, 45 full-text articles, and included 16 studies: 8 randomised controlled trials and 8 quasi-experimental studies. Four studies suggest that modifications to the contracting and incentive systems can increase coverage, but changes to other programme inputs (e.g. human or capital resources) were not evaluated. Four multi-component intervention studies modified activities and outputs from within a GP practice to increase coverage, but were part of campaigns or projects. Thus, many potentially modifiable factors relating to routine programme implementation remain unexplored. Reminder/recall systems are under-studied in England; incentive payments to adolescents may be effective; and only two studies evaluated carer information. CONCLUSIONS:The evidence base for interventions to increase immunisation coverage in the new system in England are limited by a small number of studies and by significant risk of bias. Several areas important to primary care remain unexplored as targets for interventions, especially modification to organisational management. |
| Serious adverse events reported in placebo randomised controlled trials of oral naltrexone: a systematic review and meta-analysis. | BMC Med | 2019 | databas-patient-improv-data-studi | c(“Humans”, “Naltrexone”, “Narcotic Antagonists”, “Administration, Oral”, “Randomized Controlled Trials as Topic”) | BACKGROUND:Naltrexone is an opioid antagonist used in many different conditions, both licensed and unlicensed. It is used at widely varying doses from 3 to 250 mg. The aim of this review was to extensively evaluate the safety of oral naltrexone by examining the risk of serious adverse events and adverse events in randomised controlled trials of naltrexone compared to placebo. METHODS:A systematic search of the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, other databases and clinical trials registries was undertaken up to May 2018. Parallel placebo-controlled randomised controlled trials longer than 4 weeks published after 1 January 2001 of oral naltrexone at any dose were selected. Any condition or age group was included, excluding only studies in opioid or ex-opioid users owing to possible opioid/opioid antagonist interactions. The systematic review used the guidance of the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-analyses harms checklist throughout. Numerical data were independently extracted by two people and cross-checked. Risk of bias was assessed with the Cochrane risk-of-bias tool. Meta-analyses were performed in R using random effects models throughout. RESULTS:Eighty-nine randomised controlled trials with 11,194 participants were found, studying alcohol use disorders (n = 38), various psychiatric disorders (n = 13), impulse control disorders (n = 9), other addictions including smoking (n = 18), obesity or eating disorders (n = 6), Crohn’s disease (n = 2), fibromyalgia (n = 1) and cancers (n = 2). Twenty-six studies (4,960 participants) recorded serious adverse events occurring by arm of study. There was no evidence of increased risk of serious adverse events for naltrexone compared to placebo (risk ratio 0.84, 95% confidence interval 0.66-1.06). Sensitivity analyses pooling risk differences supported this conclusion (risk difference -0.01, 95% confidence interval -0.02-0.00) and subgroup analyses showed that results were consistent across different doses and disease groups. Secondary analysis revealed only six marginally significant adverse events for naltrexone compared to placebo, which were of mild severity. CONCLUSIONS:Naltrexone does not appear to increase the risk of serious adverse events over placebo. These findings confirm the safety of oral naltrexone when used in licensed indications and encourage investments to undertake efficacy studies in unlicensed indications. TRIAL REGISTRATION:PROSPERO 2017 CRD42017054421 . |
| How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. | Lancet | 2019 | patient-clinic-practic-studi | c(“Humans”, “Osteoarthritis, Knee”, “Prosthesis Failure”, “Arthroplasty, Replacement, Knee”, “Reoperation”, “Registries”, “Follow-Up Studies”, “Time Factors”) | BACKGROUND:Knee replacements are the mainstay of treatment for end-stage osteoarthritis and are effective. Given time, all knee replacements will fail and knowing when this failure might happen is important. We aimed to establish how long a knee replacement lasts. METHODS:In this systematic review and meta-analysis, we searched MEDLINE and Embase for case series and cohort studies published from database inception until July 21, 2018. Articles reporting 15 year or greater survival of primary total knee replacement (TKR), unicondylar knee replacement (UKR), and patellofemoral replacements in patients with osteoarthritis were included. Articles that reviewed specifically complex primary surgeries or revisions were excluded. Survival and implant data were extracted, with all-cause survival of the knee replacement construct being the primary outcome. We also reviewed national joint replacement registry reports and extracted the data to be analysed separately. In the meta-analysis, we weighted each series and calculated a pooled survival estimate for each data source at 15 years, 20 years, and 25 years, using a fixed-effects model. This study is registered with PROSPERO, number CRD42018105188. FINDINGS:From 4363 references found by our initial search, we identified 33 case series in 30 eligible articles, which reported all-cause survival for 6490 TKRs (26 case series) and 742 UKRs (seven case series). No case series reporting on patellofemoral replacements met our inclusion criteria, and no case series reported 25 year survival for TKR. The estimated 25 year survival for UKR (based on one case series) was 72·0% (95% CI 58·0-95·0). Registries contributed 299 291 TKRs (47 series) and 7714 UKRs (five series). The pooled registry 25 year survival of TKRs (14 registries) was 82·3% (95% CI 81·3-83·2) and of UKRs (four registries) was 69·8% (67·6-72·1). INTERPRETATION:Our pooled registry data, which we believe to be more accurate than the case series data, shows that approximately 82% of TKRs last 25 years and 70% of UKRs last 25 years. These findings will be of use to patients and health-care providers; further information is required to predict exactly how long specific knee replacements will last. FUNDING:The National Joint Registry for England, Wales, Northern Ireland, and Isle of Man and the Royal College of Surgeons of England. |
| Pioglitazone use and risk of bladder cancer: a systematic literature review and meta-analysis of observational studies. | Diabetol Int | 2019 | patient-health-practic-studi | NULL | Background:Studies investigating bladder cancer risk in pioglitazone-treated type 2 diabetes mellitus patients report conflicting results. Previous meta-analyses on this topic utilized publications prior to 2013. More long-term observational studies have been published since then. We reviewed the accumulated evidence and updated findings from previous meta-analyses. Methods:This meta-analysis was based on a systematic review of peer-reviewed observational studies published prior to September 30, 2016. Eligible studies were identified using a specified MEDLINE search. References from included studies and from previous meta-analyses were screened for additional records. Meta-analysis hazards ratios were derived using a random-effects model. Several sensitivity analyses including hierarchical Bayesian meta-analysis with country-specific effects were conducted. Results:Of 363 identified records, 23 studies were included in this review and 18 in the actual meta-analyses. For bladder cancer outcome, the estimated effect size for ever vs. never use of pioglitazone was 1.16 [95% confidence interval (CI), 1.04-1.28]. In the cumulative dose and duration analyses, highest effect was observed in the highest/longest exposure group, but substantial heterogeneity was present. In the sensitivity analysis, only studies adjusted for lifestyle-related factors were included and the frequentist effect size was 1.18 (95% CI, 1.00-1.40, p = 0.054). However, the risk was not verified in the Bayesian framework with an effect size of 1.17 [95% credible interval (CrI), 0.94-1.54]. Conclusions:In line with previous meta-analyses, we observed a small but statistically significant association between ever (vs. never) use of pioglitazone and bladder cancer risk; however, causality is not established and alternative explanations cannot be ruled out. |
| Compression Stockings for the Prevention of Venous Leg Ulcer Recurrence: A Health Technology Assessment. | Ont Health Technol Assess Ser | 2019 | cost-patient-health-clinic | c(“Humans”, “Varicose Ulcer”, “Leg Ulcer”, “Recurrence”, “Markov Chains”, “Cost-Benefit Analysis”, “Health Care Costs”, “Patient Satisfaction”, “Stockings, Compression”, “Secondary Prevention”) | Background:People with chronic venous insufficiency who develop leg ulcers face a difficult condition to treat. Venous leg ulcers may persist for long periods of time and have a negative impact on quality of life. Treatment requires frequent health care provider visits, creating a substantial burden across health care settings.The objective of this health technology assessment was to evaluate the effectiveness, safety, cost-effectiveness, budget impact, and patient experiences of compression stockings for prevention of venous leg ulcer recurrence. Methods:We conducted a systematic review of the literature to identify randomized trials and observational studies examining the effectiveness of compression stockings in reducing the risk of recurrence of venous leg ulcers after healing and/or reported on the quality of life for patients and any adverse events from the wearing of compression stockings. We performed a literature search to identify studies and evaluated the quality of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.We conducted a cost-utility analysis with a 5-year time horizon from the perspective of the Ontario Ministry of Health and Long-Term Care. We compared compression stockings to usual care (no compression stockings) and simulated a hypothetical cohort of 65-year-old patients with healed venous ulcers, using a Markov model. Model input parameters were obtained primarily from the published literature. In addition, we used Ontario costing sources and consultation with clinical experts. We estimated quality-adjusted life years gained and direct medical costs. We conducted sensitivity analyses and a budget impact analysis to estimate the additional costs required to publicly fund compression stockings in Ontario. All costs are presented in 2018 Canadian dollars.We spoke to people who recently began using compression stockings and those who have used them for many years to gain an understanding of their day-to-day experience with the management of chronic venous insufficiency and compression stockings. Results:One randomized controlled trial reported that the recurrence rate was significantly lower at 12 months in people who were assigned to the compression stocking group compared with people assigned to the control group (risk ratio 0.43, 95% CI, 0.27-0.69; P = .001) (GRADE: Moderate). Three randomized controlled trials reported no significant difference in recurrence rates between the levels of pressure. One randomized controlled trial also reported that the risk of recurrence was six times higher in those who did not adhere to compression stockings than in those who did adhere. One single-arm cohort study showed that the recurrence rate was considerably higher in people who did not adhere or had poor adherence (79%) compared with those who adhered to compression stockings (4%).Compared with usual care, compression stockings were associated with higher costs and with increased quality-adjusted life years. We estimated that, on average, the incremental cost-effectiveness ratio of compression stockings was $27,300 per quality-adjusted life year gained compared to no compression stockings. There was some uncertainty in our results, but most simulations (> 70%) showed that the incremental cost-effectiveness ratio remained below $50,000 per quality-adjusted life-year. We estimated that the annual budget impact of funding compression stockings would range between $0.95 million and $3.19 million per year over the next five years.People interviewed commonly reported that chronic venous insufficiency had a substantial impact on their day-to-day lives. There were social impacts from the difficulty or inability to walk and emotional impacts from the loss of independence and fear of ulcer recurrence. There were barriers to the wearing of compression stockings, including replacement cost and the difficulty of putting them on; however, most people interviewed reported that using compression stockings improved their condition and their quality of life. Conclusions:The available evidence shows that, compared with usual care, compression stockings are effective in preventing venous leg ulcer recurrence and likely to be cost-effective. In people with a healed venous leg ulcer, wearing compression stockings helps to reduce the risk of recurrence by about half. Publicly funding compression stockings for people with venous leg ulcers would result in additional costs to the Ontario health care system over the next 5 years. Despite concerns about cost and the daily chore of wearing compression stockings, most people interviewed felt that compression stockings provided important benefits through reduction of swelling and prevention of recurrence. |
| Code sets for respiratory symptoms in electronic health records research: a systematic review protocol. | BMJ Open | 2019 | valid-record-identifi-data | NULL | INTRODUCTION:Asthma and chronic obstructive pulmonary disease (COPD) are common respiratory conditions, which result in significant morbidity worldwide. These conditions are associated with a range of non-specific symptoms, which in themselves are a target for health research. Such research is increasingly being conducted using electronic health records (EHRs), but computable phenotype definitions, in the form of code sets or code lists, are required to extract structured data from these large routine databases in a systematic and reproducible way. The aim of this protocol is to specify a systematic review to identify code sets for respiratory symptoms in EHRs research. METHODS AND ANALYSIS:MEDLINE and Embase databases will be searched using terms relating to EHRs, respiratory symptoms and use of code sets. The search will cover all English-language studies in these databases between January 1990 and December 2017. Two reviewers will independently screen identified studies for inclusion, and key data will be extracted into a uniform table, facilitating cross-comparison of codes used. Disagreements between the reviewers will be adjudicated by a third reviewer. This protocol has been produced in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines. ETHICS AND DISSEMINATION:As a review of previously published studies, no ethical approval is required. The results of this review will be submitted to a peer-reviewed journal for publication and can be used in future research into respiratory symptoms that uses electronic healthcare databases. PROSPERO REGISTRATION NUMBER:CRD42018100830. |
| Validated methods to identify patients with asthma-COPD overlap in healthcare databases: a systematic review protocol. | BMJ Open | 2019 | patient-health-practic-studi | NULL | INTRODUCTION:Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is characterised by patients presenting symptoms of both asthma and COPD. Many efforts have been made to validate different methods of identifying asthma-COPD overlap cases based on symptoms, spirometry and medical history in epidemiological studies using healthcare databases. There are various coding algorithm strategies that can be used and selection depends on targeted validation. The primary objectives of this systematic review are to identify validated methods (or algorithms) that identify patients with ACO from healthcare databases and summarise the reported validity measures of these methods. METHODS:MEDLINE, EMBASE databases and the Web of Science will be systematically searched by using appropriate search strategies that are able to identify studies containing validated codes and algorithms for the diagnosis of ACO in healthcare databases published, in English, before October 2018. For each selected study, we require the presence of at least one test measure (eg, sensitivity, specificity etc). We will also include studies, in which the validated algorithm is compared with an external reference standard such as questionnaires completed by patients or physicians, medical charts review, manual review or an independent second database. For all selected studies, a uniform table will be created to summarise the following vital information: name of author, publication year, country, data source, population, clinical outcome, algorithms, reference standard method of validation and characteristics of the test measure used to determine validity. PROSPERO REGISTRATION NUMBER:CRD42018087472. |
| The cost effectiveness of REACH-HF and home-based cardiac rehabilitation compared with the usual medical care for heart failure with reduced ejection fraction: A decision model-based analysis. | Eur J Prev Cardiol | 2019 | cost-patient-health-clinic | NULL | BACKGROUND:The REACH-HF (Rehabilitation EnAblement in CHronic Heart Failure) trial found that the REACH-HF home-based cardiac rehabilitation intervention resulted in a clinically meaningful improvement in disease-specific health-related quality of life in patients with reduced ejection fraction heart failure (HFrEF). The aims of this study were to assess the long-term cost-effectiveness of the addition of REACH-HF intervention or home-based cardiac rehabilitation to usual care compared with usual care alone in patients with HFrEF. DESIGN AND METHODS:A Markov model was developed using a patient lifetime horizon and integrating evidence from the REACH-HF trial, a systematic review/meta-analysis of randomised trials, estimates of mortality and hospital admission and UK costs at 2015/2016 prices. Taking a UK National Health and Personal Social Services perspective we report the incremental cost per quality-adjusted life-year (QALY) gained, assessing uncertainty using probabilistic and deterministic sensitivity analyses. RESULTS:In base case analysis, the REACH-HF intervention was associated with per patient mean QALY gain of 0.23 and an increased mean cost of £400 compared with usual care, resulting in a cost per QALY gained of £1720. Probabilistic sensitivity analysis indicated a 78% probability that REACH-HF is cost effective versus usual care at a threshold of £20,000 per QALY gained. Results were similar for home-based cardiac rehabilitation versus usual care. Sensitivity analyses indicate the findings to be robust to changes in model assumptions and parameters. CONCLUSIONS:Our cost-utility analyses indicate that the addition of the REACH-HF intervention and home-based cardiac rehabilitation programmes are likely to be cost-effective treatment options versus usual care alone in patients with HFrEF. |
| Quality standards in respiratory real-life effectiveness research: the REal Life EVidence AssessmeNt Tool (RELEVANT): report from the Respiratory Effectiveness Group-European Academy of Allergy and Clinical Immunology Task Force. | Clin Transl Allergy | 2019 | data-research-record-studi | NULL | Introduction:A Task Force was commissioned jointly by the European Academy of Allergy and Clinical Immunology (EAACI) and the Respiratory Effectiveness Group (REG) to develop a quality assessment tool for real-life observational research to identify high-quality real-life asthma studies that could be considered within future guideline development. Methods:The resulting REal Life EVidence AssessmeNt Tool (RELEVANT) was achieved through an extensive analysis of existing initiatives in this area. The first version was piloted among 9 raters across 6 articles; the revised, interim, version underwent extensive testing by 22 reviewers from the EAACI membership and REG collaborator group, leading to further revisions and tool finalisation. RELEVANT was validated through an analysis of real-life effectiveness studies identified via systematic review of Medline and Embase databases and relating to topics for which real-life studies may offer valuable evidence complementary to that from randomised controlled trials. The topics were selected through a vote among Task Force members and related to the influence of adherence, smoking, inhaler device and particle size on asthma treatment effectiveness. Results:Although highlighting a general lack of high-quality real-life effectiveness observational research on these clinically important topics, the analysis provided insights into how identified observational studies might inform asthma guidelines developers and clinicians. Overall, RELEVANT appeared reliable and easy to use by expert reviewers. Conclusions:Using such quality appraisal tools is mandatory to assess whether specific observational real-life effectiveness studies can be used to inform guideline development and/or decision-making in clinical practice. |
| Epidemiology of systemic sclerosis and systemic sclerosis-associated interstitial lung disease. | Clin Epidemiol | 2019 | incid-ag-practic-studi | NULL | Background: Interstitial lung disease (ILD) is one of the leading causes of mortality in patients with systemic sclerosis (SSc). To further understand this patient population, we present the first systematic review on the epidemiology of SSc and SSc-associated ILD (SSc-ILD). Methods: Bibliographic databases and web sources were searched for studies including patients with SSc and SSc-ILD in Europe and North America (United States and Canada). The systematic review was limited to publications in English, German, French, Spanish, Italian, and Portuguese, published between January 1, 2000 and February 29, 2016. For all publications included in the review, the methodologic quality was assessed. For each dimension and region, data availability in terms of quantity and consistency of reported findings was evaluated. Results: Fifty publications reporting epidemiologic data (prevalence, incidence, demographic profile, and survival and mortality) were included; 39 included patients with SSc and 16 included patients with SSc-ILD. The reported prevalence of SSc was 7.2-33.9 and 13.5-44.3 per 100,000 individuals in Europe and North America, respectively. Annual incidence estimates were 0.6-2.3 and 1.4-5.6 per 100,000 individuals in Europe and North America, respectively. Associated ILD was present in ~35% of the patients in Europe and ~52% of the patients in North America. In Europe, a study estimated the prevalence and annual incidence of SSc-ILD at 1.7-4.2 and 0.1-0.4 per 100,000 individuals, respectively. In both Europe and North America, SSc-ILD was diagnosed at a slightly older age than SSc, with both presentations of the disease affecting 2-3 times more women than men. Ten-year survival in patients with SSc was reported at 65-73% in Europe and 54-82% in North America, with cardiorespiratory manifestations (including ILD) associated with poor prognosis. Conclusion: This systematic review confirms that SSc and SSc-ILD are rare, with geographic variation in prevalence and incidence. |
| In Silico Toxicology Data Resources to Support Read-Across and (Q)SAR. | Front Pharmacol | 2019 | result-model-base-compar-studi | NULL | A plethora of databases exist online that can assist in in silico chemical or drug safety assessment. However, a systematic review and grouping of databases, based on purpose and information content, consolidated in a single source, has been lacking. To resolve this issue, this review provides a comprehensive listing of the key in silico data resources relevant to: chemical identity and properties, drug action, toxicology (including nano-material toxicity), exposure, omics, pathways, Absorption, Distribution, Metabolism and Elimination (ADME) properties, clinical trials, pharmacovigilance, patents-related databases, biological (genes, enzymes, proteins, other macromolecules etc.) databases, protein-protein interactions (PPIs), environmental exposure related, and finally databases relating to animal alternatives in support of 3Rs policies. More than nine hundred databases were identified and reviewed against criteria relating to accessibility, data coverage, interoperability or application programming interface (API), appropriate identifiers, types of in vitro, in vivo,-clinical or other data recorded and suitability for modelling, read-across, or similarity searching. This review also specifically addresses the need for solutions for mapping and integration of databases into a common platform for better translatability of preclinical data to clinical data. |
| Increased risk of non-alcoholic fatty liver disease in women with gestational diabetes mellitus: A population-based cohort study, systematic review and meta-analysis. | J Diabetes Complications | 2019 | patient-health-practic-studi | NULL | AIMS:Non-Alcoholic Fatty Liver Disease (NAFLD) is one of the leading causes of liver transplantation in the West. This study seeks to examine whether women with gestational diabetes mellitus (GDM) are at increased risk of developing NAFLD compared to women without GDM. METHODS:We conducted a population-based retrospective matched-controlled cohort study utilising The Health Improvement Network (THIN), a large primary care database representative of the United Kingdom population, between 01/01/1990 to 31/05/2016 followed by systematic review of available literature. The study population included 9640 women with GDM and 31,296 controls without GDM, matched for age, body mass index (BMI) and time of pregnancy. All study participants were free from NAFLD diagnosis at study entry. Patients with GDM and patients developing NAFLD were identified by clinical codes. RESULTS:The median (range) follow-up duration was similar in women with and without GDM (2.95 (1.21-6.01) vs 2.85 (1.14-5.75) years respectively). Unadjusted incidence rate ratio (IRR) for NAFLD development in women with vs without GDM was 3.28 (95% CI 2.14-5.02), which remained significant after adjustment for wide range of potential confounders (IRR 2.70; 95% CI 1.744-4.19). The risk of NAFLD in GDM remained high (IRR 2.46: 95% CI 1.51-4.00) despite women being censored after they developed type 2 diabetes. The meta-analysis of 3 studies (including the current study) showed increased NAFLD risk in women with vs without GDM (OR 2.60; 95% CI 1.90-3.57, I2 = 0%). As our study is based on routine clinical diagnosis of NAFLD, this study could potentially have underestimated the risk of NAFLD development. CONCLUSIONS:Women with GDM are at increased risk of developing NAFLD in their later life compared to women without GDM regardless of the development of type 2 diabetes. Clinicians should have a low threshold to investigate women with history of GDM for the presence of NAFLD. Further studies to identify screening strategies are needed. |
| Global burden of atherosclerotic cardiovascular disease in people with hepatitis C virus infection: a systematic review, meta-analysis, and modelling study. | Lancet Gastroenterol Hepatol | 2019 | patient-health-practic-studi | NULL | BACKGROUND:More than 70 million people worldwide are estimated to have hepatitis C virus (HCV) infection. Emerging evidence indicates an association between HCV and atherosclerotic cardiovascular disease. We aimed to determine the association between HCV and cardiovascular disease, and estimate the national, regional, and global burden of cardiovascular disease attributable to HCV. METHODS:For this systematic review and meta-analysis, we searched MEDLINE, Embase, Ovid Global Health, and Web of Science databases from inception to May 9, 2018, without language restrictions, for longitudinal studies that evaluated the risk ratio (RR) of cardiovascular disease in people with HCV compared with those without HCV. Two investigators independently reviewed and extracted data from published reports. The main outcome was cardiovascular disease, defined as hospital admission with, or mortality from, acute myocardial infarction or stroke. We calculated the pooled RR of cardiovascular disease associated with HCV using a random-effects model. Additionally, we calculated the population attributable fraction and disability-adjusted life-years (DALYs) from HCV-associated cardiovascular disease at the national, regional, and global level. We also used age-stratified and sex-stratified HCV prevalence estimates and cardiovascular DALYs for 100 countries to estimate country-level burden associated with HCV. This study is registered with PROSPERO, number CRD42018091857. FINDINGS:Our search identified 16 639 records, of which 36 studies were included for analysis, including 341 739 people with HCV. The pooled RR for cardiovascular disease was 1·28 (95% CI 1·18-1·39). Globally, 1·5 million (95% CI 0·9-2·1) DALYs per year were lost due to HCV-associated cardiovascular disease. Low-income and middle-income countries had the highest disease burden with south Asian, eastern European, north African, and Middle Eastern regions accounting for two-thirds of all HCV-associated cardiovascular DALYs. INTERPRETATION:HCV infection is associated with an increased risk of cardiovascular disease. The global burden of cardiovascular disease associated with HCV infection was responsible for 1·5 million DALYs, with the highest burden in low-income and middle-income countries. FUNDING:British Heart Foundation and Wellcome Trust. |
Full texts
library(rvest)
get_pmcids <- sr %>%
select(id, pmcid) %>%
filter(!is.na(pmcid))
details <- mutate(get_pmcids, details = map(id, epmc_details))
full_text <- details %>%
mutate(full_text = map(details, "ftx")) %>%
unnest(full_text) %>%
filter(availability == "Open access", url != "pdf") %>%
select(id, url)
ftxt <- mutate(full_text, ftext = map(url, get_page_text)) %>%
unnest() %>%
distinct()
# summary_ftext <- ftxt %>%
# group_by(id) %>%
# mutate(col = paste(ftxt, collapse = " ")) %>%
# select(-ftext) %>%
# distinct() %>%
# mutate(summary = map(col, text_summariser, 6))
Full table of abstracts
Finally we can gather all the abstracts into a single interactive table which can be searched, filtered and shared.
labels$results %>%
left_join(search1, by = c("pmid.value" = "pmid")) %>%
select(cluster, clus_names, doi, title, journalTitle, pubYear, citedByCount, absText) %>%
mutate(doi = paste0("<a href = http://google.com/search?q=", doi, ">doi</a>")) %>%
DT::datatable(escape = FALSE, extensions = c('Responsive','Buttons', 'FixedHeader'),
filter = "top",
options = list(
autoWidth = TRUE,
columnDefs = list( ),
dom = 'Bfrtip',
buttons = c('csv', 'excel'),
fixedHeader=TRUE)
)