BackgroundThe emerging adoption of the electronic medical record (EMR) in primary care enables clinicians and researchers to efficiently examine epidemiological trends in child health, including infant feeding practices.MethodsWe completed a population-based retrospective cohort study of 8815 singleton infants born at term in Ontario, Canada, April 2002 to March 2013. Newborn records were linked to the Electronic Medical Record Administrative data Linked Database (EMRALD™), which uses patient-level information from participating family practice EMRs across Ontario. We assessed exclusive breastfeeding patterns using an automated electronic search algorithm, with manual review of EMRs when the latter was not possible. We examined the rate of breastfeeding at visits corresponding to 2, 4 and 6 months of age, as well as sociodemographic factors associated with exclusive breastfeeding.ResultsOf the 8815 newborns, 1044 (11.8%) lacked breastfeeding information in their EMR. Rates of exclusive breastfeeding were 39.5% at 2 months, 32.4% at 4 months and 25.1% at 6 months. At age 6 months, exclusive breastfeeding rates were highest among mothers aged ≥40 vs. < 20 years (rate ratio [RR] 2.45, 95% confidence interval [CI] 1.62–3.68), urban vs. rural residence (RR 1.35, 95% CI 1.22–1.50), and highest vs. lowest income quintile (RR 1.18, 95% CI 1.02–1.36). Overall, immigrants had similar rates of exclusive breastfeeding as non-immigrants; yet, by age 6 months, among those residing in the lowest income quintile, immigrants were more likely to exclusively breastfeed than their non-immigrant counterparts (RR 1.43, 95% CI 1.12–1.83).ConclusionsWe efficiently determined rates and factors associated with exclusive breastfeeding using data from a large EMR database.Electronic supplementary materialThe online version of this article (10.1186/s12884-017-1633-9) contains supplementary material, which is available to authorized users.

Algorithms developed from health administrative data are sensitive and specific for identifying older adults with AD-RD.

Background: Epidemiological studies for identifying patients with Parkinson's disease (PD) or Parkinsonism (PKM) have been limited by their nonrandom sampling techniques and mainly veteran populations. This reduces their use for health services planning. The purpose of this study was to validate algorithms for the case ascertainment of PKM from administrative databases using primary care patients as the reference standard. Methods: We conducted a retrospective chart abstraction using a random sample of 73,003 adults aged ≥20 years from a primary care Electronic Medical Record Administrative data Linked Database (EMRALD) in Ontario, Canada. Physician diagnosis in the EMR was used as the reference standard and population-based administrative databases were used to identify patients with PKM from the derivation of algorithms. We calculated algorithm performance using sensitivity, specificity, and predictive values and then determined the population-level prevalence and incidence trends with the most accurate algorithms. Results: We selected, ‘2 physician billing codes in 1 year' as the optimal administrative data algorithm in adults and seniors (≥65 years) due to its sensitivity (70.6-72.3%), specificity (99.9-99.8%), positive predictive value (79.5-82.8%), negative predictive value (99.9-99.7%), and prevalence (0.28-1.20%), respectively. Conclusions: Algorithms using administrative databases can reliably identify patients with PKM with a high degree of accuracy.

BackgroundWe have previously validated administrative data algorithms to identify patients with rheumatoid arthritis (RA) using rheumatology clinic records as the reference standard. Here we reassessed the accuracy of the algorithms using primary care records as the reference standard.MethodsWe performed a retrospective chart abstraction study using a random sample of 7500 adult patients under the care of 83 family physicians contributing to the Electronic Medical Record Administrative data Linked Database (EMRALD) in Ontario, Canada. Using physician-reported diagnoses as the reference standard, we computed and compared the sensitivity, specificity, and predictive values for over 100 administrative data algorithms for RA case ascertainment.ResultsWe identified 69 patients with RA for a lifetime RA prevalence of 0.9%. All algorithms had excellent specificity (>97%). However, sensitivity varied (75-90%) among physician billing algorithms. Despite the low prevalence of RA, most algorithms had adequate positive predictive value (PPV; 51-83%). The algorithm of “[1 hospitalization RA diagnosis code] or [3 physician RA diagnosis codes with ≥1 by a specialist over 2 years]” had a sensitivity of 78% (95% CI 69–88), specificity of 100% (95% CI 100–100), PPV of 78% (95% CI 69–88) and NPV of 100% (95% CI 100–100).ConclusionsAdministrative data algorithms for detecting RA patients achieved a high degree of accuracy amongst the general population. However, results varied slightly from our previous report, which can be attributed to differences in the reference standards with respect to disease prevalence, spectrum of disease, and type of comparator group.

MS patients can be accurately identified from administrative data. Our findings illustrated a rising prevalence of MS over time. MS incidence rates also appear to be rising since 2009.

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SUMMARYObjective: Previous validation studies assessing the use of administrative data to identify patients with epilepsy have used targeted sampling or have used a reference standard of patients in the neurologist, hospital, or emergency room setting. Therefore, the validity of using administrative data to identify patients with epilepsy in the general population has not been previously assessed. The purpose of this study was to determine the validity of using administrative data to identify patients with epilepsy in the general population. Methods: A retrospective chart abstraction study was performed using primary care physician records from 83 physicians distributed throughout Ontario and contributing data to the Electronic Medical Record Administrative data Linked Database (EMRALD) A random sample of 7,500 adult patients, from a possible 73,014 eligible, was manually chart abstracted to identify patients who had ever had epilepsy. These patients were used as a reference standard to test a variety of administrative data algorithms. Results: An algorithm of three physician billing codes (separated by at least 30 days) in 2 years or one hospitalization had a sensitivity of 73.7% (95% confidence interval [CI] 64.8-82.5%), specificity of 99.8% (95% CI 99.6-99.9%), positive predictive value (PPV) of 79.5% (95% CI 71.1-88.0%), and negative predictive value (NPV) of 99.7% (95% CI 99.5-99.8%) for identifying patients who had ever had epilepsy. Significance: The results of our study showed that administrative data can reasonably accurately identify patients who have ever had epilepsy, allowing for a "lifetime" population prevalence determination of epilepsy in Ontario and the rest of Canada with similar administrative databases. This will facilitate future studies on population level patterns and outcomes of care for patients living with epilepsy.

SummaryThe effectiveness of ginger (Zingiber ofJicinale) Key wordsSurgery; gynaecological. Vomiting; antiemetics. Nausea and vomiting have long been regarded as some of the most unpleasant sequelae of anaesthesia; effects range from the simply annoying to life threatening electrolyte disturbances and aspiration of stomach contents. There has been no real reduction during the last 50 years in their incidence, which persists at approximately 30%, despite the continued introduction of new antiemetics.' No available antiemetic offers both good pharmacological effectiveness together with an absence of side effects.Recently, there have been reports of the vertigo-reducing effects of ginger root. Mowbrey and Clayson2 found powdered ginger root to have a significantly better effect than placebo or antihistamines, upon experimentally induced motion sickness in volunteers. Grontved and Hentzer' found that ginger root reduced the incidence of induced vertigo significantly more than did placebo in a group of volunteers after calorific stimulation of the vestibular system. There were no reports of nausea in any patient who had received ginger root in this latter study. We therefore postulated that a preparation of ginger root may reduce the incidence of nausea and vomiting after operation and this study was undertaken to investigate the effects of ginger root on postoperative emesis compared with placebo and metaclopramide in patients who have major gynaecological surgery. MethodSixty women who had major gynaecological surgery were included in the study which was approved by the local ethics committee. All patients were ASA grades 1 or 2 and aged between 16 and 65 years. They were informed that the purpose of the study was to compare a commonly used plant derivative, with possible antiemetic properties, with a standard antiemetic or placebo. Written consent was then obtained. Patients who received opioid analgesia or antiemetics 24 hours before surgery were not studied.Capsules were prepared by the pharmacy department at St. Bartholomew's Hospital. The active capsule contained powdered ginger root (Zingiber oficinale) 0.5 g and the placebo capsule lactulose 0.5 g. Both were flavoured with a nonactive chemical essence of ginger. Coloured capsules were used for both to disguise their contents. The capsules were unable to be differentiated when swallowed with 20 ml water. Coded syringes for intravenous injection were prepared freshly by an investigator who did not participate in the anaesthesia or assessment. The active injection contained metoclopramide 10 mg and the placebo injection 2 ml sterile water.Patients were premedicated intramuscularly 1.5 hours before operation with papaveretum and hyoscine: 10 mg and 0.2 mg respectively if bodyweight < 50 kg, 15 mg and 0.3 mg respectively if bodyweight 50-70 kg and 20 mg and 0.4 mg if bodyweight > 70 kg. The study drugs were administered in a double-blind, randomised fashion as follows: Group 1, ginger-root 1 g and placebo injection; Group 2, lactulose 1 g and active injection; ...