PubMed Health⌕ Search

Biomedical subjects

Corri Black

Publications and source records attributed to Corri Black.

10 recordsLinked to original sources

Community hospitals--the place of local service provision in a modernising NHS: an integrative thematic literature review.

BACKGROUND: Recent developments within the United Kingdom's (UK) health care system have re-awakened interest in community hospitals (CHs) and their role in the provision of health care. This integrative literature review sought to identify and assess the current evidence base for CHs. METHODS: A range of electronic reference databases were searched from January 1984 to either December 2004 or February 2005: Medline, Embase, Web of Knowledge, BNI, CINAHL, HMIC, ASSIA, PsychInfo, SIGLE, Dissertation Abstracts, Cochrane Library, Kings Fund website, using both keywords and text words. Thematic analysis identified recurrent themes across the literature; narrative analyses were written for each theme, identifying unifying concepts and discrepant issues. RESULTS: The search strategy identified over 16,000 international references. We included papers of any study design focussing on hospitals in which care was led principally by general practitioners or nurses. Papers from developing countries were excluded. A review of titles revealed 641 potentially relevant references; abstract appraisal identified 161 references for review. During data extraction, a further 48 papers were excluded, leaving 113 papers in the final review. The most common methodological approaches were cross-sectional/descriptive studies, commentaries and expert opinion. There were few experimental studies, systematic reviews, economic studies or studies that reported on longer-term outcomes. The key themes identified were origin and location of CHs; their place in the continuum of care; services provided; effectiveness, efficiency and equity of CHs; and views of patients and staff. In general, there was a lack of robust evidence for the role of CHs, which is partly due to the ad hoc nature of their development and lack of clear strategic vision for their future. Evidence for the effectiveness and efficiency of the services provided was limited. Most people admitted to CHs appeared to be older, suggesting that admittance to CHs was age-related rather than condition-related. CONCLUSION: Overall the literature surveyed was long on opinion and short of robust studies on CHs. While lack of evidence on CHs does not imply lack of effect, there is an urgent need to develop a research agenda that addresses the key issues of health care delivery in the CH setting.

Health Services Research↗

Cesarean delivery in the United Kingdom: time trends in the general practice research database.

OBJECTIVE: To estimate recent temporal trends in delivery by cesarean during the past decade and the proportion of vaginal deliveries after prior caesarean in the United Kingdom. METHODS: We conducted a cohort study using information from the General Practice Research Database. We identified all women with 1 or more deliveries between January 1990 and December 1999 and determined the method(s) of delivery. We estimated the proportion of women with vaginal delivery after cesarean in a subcohort who had at least 3 years of follow-up. RESULTS: We identified 39,938 cesareans among 271,663 deliveries (14.7%), with an increase from 12.5% in 1990 to 18.3% in 1999. The proportion of cesarean deliveries increased with age and increased over time in all age groups except women aged younger than 20 years. Among 26,480 women with a caesarean delivery between 1990 and 1996, 7,649 (28.9%) had a subsequent delivery. The proportion of vaginal delivery after prior cesarean decreased from 45% in 1991 to 37% in 1999. CONCLUSION: Cesarean deliveries increased as a proportion of all deliveries in the United Kingdom during the past decade, and the proportion of vaginal delivery after prior cesarean decreased. Still, the proportion of cesarean deliveries is lower and the proportion of vaginal deliveries after prior cesarean is higher in the United Kingdom than in the United States. LEVEL OF EVIDENCE: II-2.

Adult↗

Incidence of thrombotic thrombocytopenic purpura/hemolytic uremic syndrome.

BACKGROUND: Thrombotic thrombocytopenic purpura and hemolytic uremic syndrome are rare disorders characterized by platelet aggregation, microthrombi, and resulting tissue damage. We studied the incidence and possible risk factors for these diseases in 3 large populations in the United States, United Kingdom, and Canada. METHODS: Data were derived from a large health insurer in the United States, general practices in the United Kingdom, and the Province of Saskatchewan. We identified potential cases of thrombotic thrombocytopenia purpura and hemolytic uremic syndrome in computerized data and verified them by medical record review. We estimated incidence rates for thrombotic thrombocytopenia purpura and hemolytic uremic syndrome together and separately, and we conducted a case-control study to evaluate potential risk factors. RESULTS: The age-sex standardized incidence of thrombotic thrombocytopenia purpura and hemolytic uremic syndrome was higher than previously reported (6.5, 2.2, and 3.2 per million per year in the United States, United Kingdom, and Saskatchewan, respectively), but there was no secular trend. The incidence of thrombotic thrombocytopenia purpura and hemolytic uremic syndrome was higher in women than men. Most cases of hemolytic uremic syndrome occurred before 20 years of age. We confirmed several known risk factors for thrombotic thrombocytopenia purpura and hemolytic uremic syndrome (cancer, bone marrow transplantation, pregnancy). CONCLUSION: The incidence of thrombotic thrombocytopenia purpura and hemolytic uremic syndrome is higher than previously reported but does not appear to be rising. Apparent international differences in incidence could be the result of imprecision in identifying thrombotic thrombocytopenia purpura and hemolytic uremic syndrome in large research databases.

Adult↗

Incidence and prevalence of drug-treated attention deficit disorder among boys in the UK.

BACKGROUND: Drug treatment for attention deficit disorder (ADD) was rare in the United Kingdom (UK) until in the mid-1990s. This contrasts with North America, where such treatment has been used to treat ADD for many decades. Since no quantitative data on the incidence and prevalence of drug-treated ADD are available in the UK, we used the general practice research database (GPRD) to obtain such information. AIMS: To provide estimates of incidence and prevalence of treated ADD in the UK for the years 1996-2001. DESIGN OF STUDY: Follow-up study of boys aged 5-14 years. SETTING: Data from UK general practices. METHODS: From the GPRD, we identified all boys aged 5-14 years who were prescribed methylphenidate for ADD. Based on the population in that age and sex category, we estimated incidence rates and the prevalence for treated ADD for the years 1996-2001. RESULTS: The incidence of first-time diagnosis of treated ADD increased among boys from the age of 5 years to reach a peak in boys aged 9-10 years, after which the incidence rate decreased. No material change in incidence was noted during the years 1996-2001. The prevalence of treated ADD was estimated to be 5.3 per 1000 boys in 1999. CONCLUSION: Drug treatment for ADD for boys treated for this disorder in the UK is substantially lower than the proportion of boys treated in North America.

Adolescent↗

MMR vaccine and idiopathic thrombocytopaenic purpura.

AIMS: To estimate the relationship between idiopathic thrombocytopaenic purpura (ITP) and the measles, mumps and rubella (MMR) vaccination in children; calculating the relative risk estimate for ITP with in 6 weeks after MMR vaccination and the attributable risk of ITP within 6 weeks after MMR vaccination. METHODS: Using the General Practice Research Database we identified children with a first-time diagnosis of ITP from a base population of children aged less than 6 years between January 1988 and December 1999. After describing the characteristics of all the children identified with ITP, we focused on cases aged 13-24 months to perform a population-based, case-control analysis to estimate the relative risk of developing ITP within 6 weeks after MMR vaccination. We also calculated the risk of ITP attributable to the MMR vaccination. RESULTS: Sixty-three children with a first time diagnosis of ITP were identified; 23 cases were between 13 and 24 months old. The relative risk estimate for ITP within 6 weeks after MMR vaccination, compared to the combined group of unvaccinated children and children vaccinated with MMR more than 26 weeks previously was 6.3 (95% CI 1.3-30.1). The attributable risk of developing ITP within 6 weeks after MMR vaccination was estimated to be 1 in 25,000 vaccinations (95% confidence interval 21,300, 89,400). CONCLUSION: This study confirms the increased risk of ITP within 6 weeks after MMR vaccination. However, the attributable risk of ITP within 6 weeks after MMR vaccination is low.

Case-Control Studies↗

Validity of the general practice research database.

The United Kingdom General Practice Research Database (GPRD) is an office-based, computer-generated, medical resource designed from its inception to be used for epidemiologic research. A distinct version of the GPRD is maintained by the Boston Collaborative Drug Surveillance Program and has been the source of more than 130 scientific articles primarily addressing drug safety issues. We reviewed evidence related to the validity of the GPRD. Specifically, with our extensive experience with this automated database, we evaluated the quality and completeness of the data that it contains.

Databases, Factual↗

Relation of childhood gastrointestinal disorders to autism: nested case-control study using data from the UK General Practice Research Database.

OBJECTIVES: To assess whether children with autism are more likely to have a history of gastrointestinal disorders than children without autism. DESIGN: Nested case-control study. SETTING: UK General Practice Research Database. SUBJECTS: Children born after 1 January 1988 and registered with the General Practice Research Database within 6 months of birth. OUTCOME MEASURES: Chronic inflammation of the gastrointestinal tract, coeliac disease, food intolerance, and recurrent gastrointestinal symptoms recorded by the general practitioner. RESULTS: 9 of 96 (9%) children with a diagnosis of autism (cases) and 41 of 449 (9%) children without autism (matched controls) had a history of gastrointestinal disorders before the index date (the date of first recorded diagnosis of autism in the cases and the same date for controls). The estimated odds ratio for a history of gastrointestinal disorders among children with autism compared with children without autism was 1.0 (95% confidence interval 0.5 to 2.2). CONCLUSIONS: No evidence was found that children with autism were more likely than children without autism to have had defined gastrointestinal disorders at any time before their diagnosis of autism.

Autistic Disorder↗

Clinical risk factors for venous thromboembolus in users of the combined oral contraceptive pill.

AIMS: To estimate the risk of venous thromboembolism among women prescribed the oral contraceptive pill who have acute clinical conditions such as lower limb fractures, compared with women with idiopathic venous thromboembolism. METHODS: A nested case-control analysis using the General Practice Research Database, January 1993 to December 1999 was carried out. The participants were women aged 15-39 years, prescribed third generation oral contraceptives (gestodene and desogestrel) or oral contraceptives containing levonorgestrel. The main outcome measures were odds ratios as a measure of the relative risk estimate for venous thromboembolism in women with clinical conditions that predispose to VTE. RESULTS: The adjusted relative risk estimate for venous thromboembolism among patients with the acute clinical conditions, compared with those without such illness, and adjusted for oral contraceptive use, was 17 (95% CI 6.5, 46). CONCLUSIONS: This paper documents the strong independent association between certain acute clinical conditions and venous thromboembolism in women prescribed oral contraceptives. Failure to accurately identify and exclude such patients from a study of the effect of oral contraceptives on the risk of venous thromboembolism would result in an underestimate of the risk of venous thromboembolism associated with oral contraceptives.

Adolescent↗

Etiology and frequency of rhabdomyolysis.

STUDY OBJECTIVES: To describe the etiology and characteristics of patients with clinically diagnosed rhabdomyolysis in the United Kingdom General Practice Research Database (GPRD), and to estimate the risk of rhabdomyolysis in general and that associated with lipid-lowering agents in particular. DESIGN: Retrospective analysis. SETTING: The GPRD. PATIENTS: A base population of patients aged 20-75 years. Intervention. Patients hospitalized with a computer-recorded code for acute myositis or myoglobinuria, or with "rhabdo" recorded in free text comments were reviewed for evidence of rhabdomyolysis. Lipid-lowering treatment among the base population also was calculated. MEASUREMENTS AND MAIN RESULTS: We identified 25 patients with rhabdomyolysis among 2.5 million in the base population between 1990 and 1999. Seven cases (28%) occurred after a drug overdose and 5 (20%) after septicemia. Among the 2935 concurrent users of statin and fibrate agents, one developed rhabdomyolysis. CONCLUSION: Only 25 patients out of 2.5 million were found to have rhabdomyolysis. Of those, only one patient was taking a statin and fibrate concurrently, out of almost 3000 concurrent users. The free-text comments field in the GPRD helped to identify patients with rhabdomyolysis.

Adult↗