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World-class teaching and research that helps general practitioners and other health professionals deliver better care in the community.

  • Ten essential papers for the practice of evidence-based medicine.

    5 December 2017

    In this article we signpost readers to 10 papers we consider essential reading for anyone starting out on an evidence-based medicine journey. We have considered papers consisting a mix of old and new, seminal and cutting-edge that offer insight into what evidence-based medicine is, where it came from, why it matters and what it has achieved. This is balanced against some of the common criticisms of evidence-based medicine and efforts to tackle them. We have also highlighted papers acknowledging the importance of teaching and learning of the principles of evidence-based medicine and how health professionals can better use evidence in clinical decisions with patients.

  • Identifying clinical features in primary care electronic health record studies: methods for codelist development.

    15 December 2017

    OBJECTIVE: Analysis of routinely collected electronic health record (EHR) data from primary care is reliant on the creation of codelists to define clinical features of interest. To improve scientific rigour, transparency and replicability, we describe and demonstrate a standardised reproducible methodology for clinical codelist development. DESIGN: We describe a three-stage process for developing clinical codelists. First, the clear definition a priori of the clinical feature of interest using reliable clinical resources. Second, development of a list of potential codes using statistical software to comprehensively search all available codes. Third, a modified Delphi process to reach consensus between primary care practitioners on the most relevant codes, including the generation of an 'uncertainty' variable to allow sensitivity analysis. SETTING: These methods are illustrated by developing a codelist for shortness of breath in a primary care EHR sample, including modifiable syntax for commonly used statistical software. PARTICIPANTS: The codelist was used to estimate the frequency of shortness of breath in a cohort of 28 216 patients aged over 18 years who received an incident diagnosis of lung cancer between 1 January 2000 and 30 November 2016 in the Clinical Practice Research Datalink (CPRD). RESULTS: Of 78 candidate codes, 29 were excluded as inappropriate. Complete agreement was reached for 44 (90%) of the remaining codes, with partial disagreement over 5 (10%). 13 091 episodes of shortness of breath were identified in the cohort of 28 216 patients. Sensitivity analysis demonstrates that codes with the greatest uncertainty tend to be rarely used in clinical practice. CONCLUSIONS: Although initially time consuming, using a rigorous and reproducible method for codelist generation 'future-proofs' findings and an auditable, modifiable syntax for codelist generation enables sharing and replication of EHR studies. Published codelists should be badged by quality and report the methods of codelist generation including: definitions and justifications associated with each codelist; the syntax or search method; the number of candidate codes identified; and the categorisation of codes after Delphi review.

  • Antihelminthic Drugs

    28 November 2017

    © 2017 Elsevier B.V. This chapter on antihelminthic drugs published in the literature between January 2016 and December 2016 includes albendazole, ivermectin, levamisole, mebendazole, oxantel pamoate, praziquantel, pyrvinium, thiabendazole and tribendimidine. Observational and placebo-controlled studies involving the use of albendazole, mebendazole, praziquantel, or tribendimidine in antihelminthic therapy are reported. A dose-comparison study examining the safety of oxantel pamoate is reported. Meta-analysis assessing the safety of albendazole, thiabendazole and ivermectin in comparative trials is included. The first report of laryngeal lesions in a patient with levamisole-induced vasculitis is described. A new case of renal pathology caused by levamisole-adulterated cocaine is reported, and the clinical and histopathologic features of pyoderma gangrenosum attributed to levamisole in a cohort of abusers are described. Hepatic failure attributed to albendazole therapy is reported. The association between administration of mebendazole or pyrvinium in pregnancy and the risk of congenital malformation is explored in a large observational study. The effect of praziquantel therapy in pregnancy on the rates of in-utero fetal death and congenital anomalies is also examined. A case of angioedema in a child caused by mebendazole-cotrimoxazole-herb interaction is reported.

  • The commissioning process in the NHS: The theory and application

    27 October 2017

    This article explores the commissioning process introduced into the NHS in 1991. Its purpose is to consider the relevance of this experience for future commissioning structures. In particular the implementation of Changing Childbirth (Department of Health 1993) is discussed as an illustration of the commissioning process in action. The article is informed by empirical data gathered from four research sites within the NHS. © 2002 Taylor and Francis Ltd.

  • EBM DataLab

    25 April 2017

  • Cancer Research

    26 June 2012

  • Heart Failure Research

    26 June 2012

    Research into the main causes and impact of heart failure, with a linked programme on its better diagnosis.

  • Stroke Prevention and Atrial Fibrillation

    26 June 2012

    Reducing the risk of stroke is vital to improving the health of older people. We research ‘funny turns’ that are a warning sign of stroke (termed ‘transient ischaemic attacks’) and the detection and treatment of major risk factors for stroke - high blood pressure and atrial fibrillation.

  • Primary Care for the Developing World

    26 June 2012

    Our aim is to support the provision of high quality primary health care in countries with limited economic resources, undertaking research and policy development in collaboration with academic institutions, NGOs and government agencies.

  • Cochrane Tobacco Addiction Group

    26 June 2012

    We produce and help others to produce systematic reviews and meta-analyses of interventions to prevent and treat tobacco addiction. Cochrane is dedicated to making high quality, accurate information about the effects of healthcare readily available worldwide.

  • Monitoring and Diagnosis (MaDOx)

    26 June 2012

    Our aim is to improve monitoring and diagnostics used in primary care and community settings.

  • Infectious Diseases Research Group

    26 June 2012

    We investigate infectious diseases in primary care to find out how we can identify patients with serious infection in primary care, and more effective ways of diagnosing and treating patients with common infections.

  • Medical Statistics Group

    26 June 2012

    Our aim is to support clinical research in primary care and to advance the way we answer clinical questions using statistics to improve healthcare worldwide.