Dataset Information

Medical Record Review to Differentiate between Idiopathic Parkinson's Disease and Parkinsonism: A Danish Record Linkage Study with 10 Years of Follow-Up.

ABSTRACT: Background. The electronic medical records provide new and unprecedented opportunities for large population-based and clinical studies if valid and reliable diagnoses can be obtained, to determine what information is needed to distinguish idiopathic PD from Parkinsonism in electronic medical records. Methods. Chart review of complete medical records of 2,446 patients with a hospital discharge diagnosis of PD, who, between 1996 and 2009, were registered in the Danish National Hospital Register as idiopathic PD. All patients were examined in neurology departments. Clinical features were abstracted from charts to determine Parkinsonian phenotypes and disease course, using predefined criteria for idiopathic PD. Results. Chart review verified that 2,068 (84.5%) patients met criteria for idiopathic PD. The most distinguishing features of idiopathic PD patients were asymmetric onset, and fewer atypical features at onset or follow-up compared to Parkinsonism, and the area under the curve (AUC) for these items alone is moderate (0.74-0.77) and the highest AUC (0.91) was achieved when using all clinical features recorded in addition to PD medication use and a follow-up of 5 years or more. Conclusion. To reduce disease misclassification, information extracted from medical record review with at least 5 years of follow-up after first diagnosis was key to improve diagnostic accuracy.

SUBMITTER: Wermuth L

PROVIDER: S-EPMC4681800 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Medical Record Review to Differentiate between Idiopathic Parkinson's Disease and Parkinsonism: A Danish Record Linkage Study with 10 Years of Follow-Up.

Wermuth Lene L Cui Xin X Greene Naomi N Schernhammer Eva E Ritz Beate B

Parkinson's disease 20151203

Background. The electronic medical records provide new and unprecedented opportunities for large population-based and clinical studies if valid and reliable diagnoses can be obtained, to determine what information is needed to distinguish idiopathic PD from Parkinsonism in electronic medical records. Methods. Chart review of complete medical records of 2,446 patients with a hospital discharge diagnosis of PD, who, between 1996 and 2009, were registered in the Danish National Hospital Register as ...[more]

PMID: 26770868

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Project description:ObjectivesTo examine 10-year mortality and hospital use among individuals categorised as resilient and vulnerable to the impact of chronic pain.DesignA cohort record linkage study.SettingGrampian, Scotland.Participants5858 individuals from the Grampian Pain Cohort, established in 1996, were linked, by probability matching, with national routinely collected datasets.Main outcome measuresHRs for subsequent 10-year mortality and ORs/incidence rate ratios for subsequent 10-year hospital use, each with adjustment for potential confounding variables.Results36.5% of those with high pain intensity reported a low pain-related disability (categorised resilient) and 7.1% of those reporting low pain intensity reported a high pain-related disability (categorised vulnerable). Sex, age, housing, employment and long-term limiting illness were independently associated with being vulnerable or resilient. After adjustment for these variables, individuals in the resilient group were 25% less likely to die within 10 years of the survey compared with non-resilient individuals: HR 0.75, 95% CI 0.62 to 0.91 and vulnerable individuals were 45% more likely to die than non-vulnerable individuals: HR 1.45, 95% CI 1.01 to 2.11. Resilient individuals were less likely to have had an outpatient or day-case visit for anaesthetics: OR 0.46, 95% CI 0.27 to 0.79, but no other clinical specialities. Vulnerable individuals were significantly less likely to have had any outpatient or day-case visit (OR 0.43, 0.25 to 0.75); but more likely to have had a psychiatric visit (OR 1.96, 1.06 to 3.61). No significant differences in likelihood of any inpatient visits were found.ConclusionsResilient individuals have a better 10-year survival than non-resilient individuals indicating that resilience is a phenomenon worth researching. Further research is needed to explore who is likely to become resilient, why and how, as well as to tease out the internal and external factors that influence resilience.

Project description:BACKGROUND:Little information is available on how primary and comorbid acute myocardial infarction contribute to the mortality burden of acute myocardial infarction, the share of these deaths that occur during or after a hospital admission, and the reasons for hospital admission of those who died from acute myocardial infarction. Our aim was to fill in these gaps in the knowledge about deaths and hospital admissions due to acute myocardial infarction. METHODS:We used individually linked national hospital admission and mortality data for England from 2006 to 2010 to identify all primary and comorbid diagnoses of acute myocardial infarction during hospital stay and their associated fatality rates (during or within 28 days of being in hospital). Data were obtained from the UK Small Area Health Statistics Unit and supplied by the Health and Social Care Information Centre (now NHS Digital) and the Office of National Statistics. We calculated event rates (reported as per 100?000 population for relevant age and sex groups) and case-fatality rate for primary acute myocardial infarction diagnosed during the first physician encounter or during subsequent encounters, and acute myocardial infarction diagnosed only as a comorbidity. We also calculated what proportion of deaths from acute myocardial infarction occurred in people who had been in hospital on or within the 28 days preceding death, and whether acute myocardial infarction was one of the recorded diagnoses in such admissions. FINDINGS:Acute myocardial infarction was diagnosed in the first physician encounter in 307?496 (69%) of 446?744 admissions with a diagnosis of acute myocardial infarction, in the second or later physician encounter in 52?374 (12%) admissions, and recorded only as a comorbidity in 86?874 (19%) admissions. Patients with comorbid diagnoses of acute myocardial infarction had two to three times the case-fatality rate of patients in whom acute myocardial infarction was a primary diagnosis. 135?950 deaths were recorded as being caused by acute myocardial infarction as the underlying cause of death, of which 66?490 (49%) occurred in patients who were in hospital on the day of death or in the 28 days preceding death. AMI was the primary diagnosis in 32?695 (49%) of these 66?490 patients (27?678 [42%] diagnosed in the first physician encounter and 5017 [8%] in a second or subsequent encounter), was a comorbid diagnosis in 12?118 (18%), and was not mentioned at all in the remaining 21?677 (33%). The most common causes of admission in people who did not have an acute myocardial infarction diagnosis but went on to die of acute myocardial infarction as the underlying cause of death were other circulatory conditions (7566 [35%] of 21?677 deaths), symptomatic diagnoses including non-specific chest pain, dyspnoea and syncope (1368 [6%] deaths), and respiratory disorders (2662 [12%] deaths), mainly pneumonia and chronic obstructive airways disease. INTERPRETATION:As many acute myocardial infarction deaths occurring within 28 days of being in hospital follow a non-acute myocardial infarction admission as follow an acute myocardial infarction admission. These people are often diagnosed with other circulatory disorders or symptoms of circulatory disturbance. Further investigation is needed to establish whether there are symptoms and information that can be used to predict the risk of a fatal acute myocardial infarction in such patients, which can contribute to reducing the mortality burden of acute myocardial infarction. FUNDING:Wellcome Trust, Medical Research Council, Public Health England, National Institute for Health Research.

Project description:BackgroundA rapidly increasing proportion of people in high-income countries are surviving into their tenth decade. Concern is widespread that the basis for this development is the survival of frail and disabled elderly people into very old age. To investigate this issue, we compared the cognitive and physical functioning of two cohorts of Danish nonagenarians, born 10 years apart.MethodsPeople in the first cohort were born in 1905 and assessed at age 93 years (n=2262); those in the second cohort were born in 1915 and assessed at age 95 years (n=1584). All cohort members were eligible irrespective of type of residence. Both cohorts were assessed by surveys that used the same design and assessment instrument, and had almost identical response rates (63%). Cognitive functioning was assessed by mini-mental state examination and a composite of five cognitive tests that are sensitive to age-related changes. Physical functioning was assessed by an activities of daily living score and by physical performance tests (grip strength, chair stand, and gait speed).FindingsThe chance of surviving from birth to age 93 years was 28% higher in the 1915 cohort than in the 1905 cohort (6·50% vs 5·06%), and the chance of reaching 95 years was 32% higher in 1915 cohort (3·93% vs 2·98%). The 1915 cohort scored significantly better on the mini-mental state examination than did the 1905 cohort (22·8 [SD 5·6] vs 21·4 [6·0]; p<0·0001), with a substantially higher proportion of participants obtaining maximum scores (28-30 points; 277 [23%] vs 235 [13%]; p<0·0001). Similarly, the cognitive composite score was significantly better in the 1915 than in the 1905 cohort (0·49 [SD 3·6] vs 0·01 [SD 3·6]; p=0·0003). The cohorts did not differ consistently in the physical performance tests, but the 1915 cohort had significantly better activities of daily living scores than did the 1905 cohort (2·0 [SD 0·8] vs 1·8 [0·7]; p<0·0001).InterpretationDespite being 2 years older at assessment, the 1915 cohort scored significantly better than the 1905 cohort on both the cognitive tests and the activities of daily living score, which suggests that more people are living to older ages with better overall functioning.FundingDanish National Research Foundation; US National Institutes of Health-National Institute on Aging; Danish Agency for Science, Technology and Innovation; VELUX Foundation.

Dataset Information

Medical Record Review to Differentiate between Idiopathic Parkinson's Disease and Parkinsonism: A Danish Record Linkage Study with 10 Years of Follow-Up.

Publications

Medical Record Review to Differentiate between Idiopathic Parkinson's Disease and Parkinsonism: A Danish Record Linkage Study with 10 Years of Follow-Up.

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