Jeremy van Vlymen

Middlesex University, UK · Department of Design Engineering and Mathematics

Introduction Anemia is common in chronic kidney disease (CKD) and is associated with increased cardiovascular risk and reduced quality of life, but is often sub-optimally managed. Most patients are managed in primary care alongside other comorbidities. Interventions to improve the management of anemia in CKD in this setting are needed. Methods We...

Background Anaemia is common in chronic kidney disease (CKD). It is associated with increased cardiovascular risk and reduced quality of life, but is often sub-optimally managed. Most patients are managed in primary care alongside other comorbidities. Interventions to improve the management of anaemia in CKD in this setting are needed. Methods We c...

Background: Anaemia is common in chronic kidney disease (CKD). It is associated with increased cardiovascular risk and reduced quality of life, but is often sub-optimally managed. Most patients are managed in primary care alongside other comorbidities. Interventions to improve the management of anaemia in CKD in this setting are needed. Methods: W...

Aims: To determine whether achieving early glycaemic control, and any subsequent glycaemic variability, was associated with any change in risk of major adverse cardiovascular events (MACE). Materials and methods: A retrospective cohort analysis from the Oxford-Royal College of General Practitioners Research and Surveillance Centre database - a l...

Background Valproate is a teratogenic drug that should be avoided during the preconception period and pregnancy. The aim was to explore general practitioners’ (GPs) prescription patterns over time, describe trends, and explore inter-practice variation within primary care. Methods We identified women of childbearing age (12–46 years old) in the Roy...

BACKGROUND Social distancing and other non-pharmaceutical interventions to reduce spread of COVID-19 infection in the UK have led to substantial changes in delivering ongoing care for patients with chronic conditions, including type 2 diabetes mellitus (T2DM). Clinical guidelines for management and prevention of complications for people with T2DM d...

Background: Social distancing and other non-pharmaceutical interventions to reduce spread of COVID-19 infection in the UK have led to substantial changes in delivering ongoing care for patients with chronic conditions, including type 2 diabetes mellitus (T2DM). Clinical guidelines for management and prevention of complications for people with T2DM...

Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in a rapid change in workload across healthcare systems. Factors related to this adaptation in UK primary care have not yet been examined. Aim To assess the responsiveness and prioritisation of primary care consultation type for older adults during the COVID-19 pandemic. Des...

Background Disparities in type 2 diabetes (T2D) care provision and clinical outcomes have been reported in the last 2 decades in the UK. Since then, a number of initiatives have attempted to address this imbalance. The aim was to evaluate contemporary data as to whether disparities exist in glycaemic control, monitoring, and prescribing in people w...

The mechanisms underlying the adverse cardiovascular effects of increased salt intake are incompletely understood, but parallel increases in serum sodium concentration may be of importance. The aim of this retrospective cohort study was to investigate the relationship between serum sodium, hypertension and incident cardiovascular disease (CVD). Rou...

IntroductionThe aim is to investigate the effect of cardiovascular and diabetes comorbidities on radiotherapy-related side-effects in prostate cancer. Previous research suggests that comorbidities increase the risk of side-effects, but some cardiovascular medications may reduce symptoms by protecting against radiation damage. The evidence is inconc...

Background: Infectious intestinal disease (IID) has considerable health impact; there are 2 billion cases worldwide resulting in 1 million deaths and 78.7 million disability-adjusted life years lost. Reported IID incidence rates vary and this is partly because terms such as "diarrheal disease" and "acute infectious gastroenteritis" are used interc...

Background Ethnicity recording within primary care computerised medical record (CMR) systems is suboptimal, exacerbated by tangled taxonomies within current coding systems. Objective To develop a method for extending ethnicity identification using routinely collected data. Methods We used an ontological method to maximise the reliability and prev...

Background: The aims of this study are the following: to describe the female population of reproductive age having bariatric surgery in the UK, to assess the age and ethnicity of women accessing surgery, and to assess the effect of bariatric surgery on factors that underlie fertility and pregnancy outcomes. Methods: Demographic details, comorbid...

Introduction The UK Nepali community has grown by over 900% since 2004, when settlement rights were introduced for ex-Gurkha servicemen and their dependants. Nepal sits between India and China; two countries with higher rates of hepatitis B & C, but rates in the UK Nepali population is unknown Methods The Nepali community has multiple castes and r...

Purpose The Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) is one of the longest established primary care sentinel networks. In 2015, it established a new data and analysis hub at the University of Surrey. This paper evaluates the representativeness of the RCGP RSC network against the English population. Partici...

Aims: The sodium glucose co-transporter 2 (SGLT2) inhibitors are a new class of oral diabetes medication. Prescribing of these agents was intially limited to secondary care but is now moving into primary care. We analyse the current use this drug class in primary care. Methods: A cohort of people with type 2 diabetes (N=34,278) was identified from...

Aims: The use of glucagon-like peptide-1 (GLP-1) agonists in type 2 diabetes is increasing. We present a description of their current use and prescribing trends in UK primary care. Methods: A large cohort of people with type 2 diabetes (N=34,278) was identified from the University of Surrey-Lilly Real World Evidence (RWE) centre database, using ro...

Aims: The relationship between glycaemic control and lipid metabolism in diabetes is complicated and yet to be fully elucidated. Here we aim to characterise the relationship between glycaemic control and serum triglyceride levels in a population with type 2 diabetes. Methods: We performed a retrospective cross-sectional analysis using the primary...

Aims: Dipeptidyl peptidase-4 (DPP-4) inhibitors are recommended second or third line therapy in type 2 diabetes and have become widely prescribed in primary care. We present a description of their current use and prescribing trends in UK primary care. Methods: A cohort of people with type 2 diabetes (N=34,278) was identified from the University of...

This article explores the prevalence of type 2 diabetes in the UK among ethnic groups. Data from the 2011-2012 National Diabetes Audit and the more recent Royal College of General Practitioners' Research and Surveillance Centre database, which includes data from 2014, was used. The authors suggest theories for the differences observed between ethni...

Introduction Primary Biliary Cirrhosis (PBC) is a progressive cholestatic liver disease, with Anti-mitochondrial antibodies (AMA) found in ∼ 95% of patients. Anti-GP210 and SP100 are suggested as additional markers in AASLD guidance, and may help in predicting disease prognosis. However, the role and benefit of anti-GP210 and SP100 testing in routi...

Autosomal dominant polycystic kidney disease (ADPKD) causes progressive renal damage and is a leading cause of end-stage renal failure. With emerging therapies it is important to devise a method for early detection. We aimed to identify factors from routine clinical data which can be used to distinguish people with a high likelihood of having ADPKD...

Background: Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC) and National Institute for Health and Clinical Excellence (NICE) but there is evidence of substantial under-recording. Aim: To determine whether a simple coding strategy improved recording of maltreatment-related...

Background: The National Institute for Health and Care Excellence (NICE) recommends postpartum and annual monitoring for diabetes for females who have had a diagnosis of gestational diabetes mellitus (GDM). Aim: To describe the current state of follow-up after GDM in primary care, in England. Design and setting: A retrospective cohort study in...

Serum phosphate is a known risk factor for cardiovascular events and mortality in people with chronic kidney disease (CKD), however data on the association of these outcomes with serum phosphate in the general population are scarce. We investigate this relationship in people with and without CKD in a large community-based population. Three groups f...

Strict control of systolic blood pressure is known to slow progression of chronic kidney disease (CKD). Here we compared audit-based education (ABE) to guidelines and prompts or usual practice in lowering systolic blood pressure in people with CKD. This 2-year cluster randomized trial included 93 volunteer general practices randomized into three ar...

Aims: We investigate the impact of failing to monitor renal function on adverse outcomes in people with diabetes using routinely collected primary care data. Methods: A cohort of people with diabetes (N=35,502) from the Quality Improvement in Chronic Kidney Disease (QICKD) trial was followed up over a period of 2.5 years. A composite outcome of al...

Aims: There is a complex interrelationship between hypertension, and chronic kidney disease (CKD) in people with diabetes. We developed a logistic regression model to explore their effect on adverse renovascular outcomes. Methods: A cohort of adults (N=35,502), with diabetes from the Quality Improvement in Chronic Kidney Disease (QICKD) trial has...

Computerised Medical Record (CMR) data are widely used for secondary purposes such as service evaluation and epidemiological research. Data are increasingly aggregated from different medical facilities with various CMR vendors over time. It is increasingly difficult to manage the large quantity of data. Experiential learning in diabetes and chronic...

Introduction: There is an increasing burden of gastro-oesophageal reflux disease (GORD) and Barrett's oesophagus (BO), paralleled by an increasing incidence of oesophageal adenocarcinoma. Methods: Using the General Practice Research Database, we derived the incidence GORD and BO and incidence of oesophageal cancer (OC) populations, between 1996...

No abstract available.

End-digit preference (EDP) is a known cause of inaccurate BP recording. Distortion has been reported around pay-for-performance (P4P) indicators. We studied sequential datasets (n = 148,000 to n = 900,000) and performed a longitudinal analysis of CONDUIT data (n = 250,000) over a 10-year period. We examined general trends in EDP and investigated th...

To develop a computer processable algorithm, capable of running automated searches of routine data that flag miscoded and misclassified cases of diabetes for subsequent clinical review. Anonymized computer data from the Quality Improvement in Chronic Kidney Disease (QICKD) trial (n = 942,031) were analysed using a binary method to assess the accura...

Questionnaire: How confident are General Practitioners & the Primary care team in managing Chronic Kidney Disease (CKD).

Much of chronic disease is managed in primary care and chronic kidney disease (CKD) is a recent addition. We are conducting a cluster randomised study of quality improvement interventions in CKD (QICKD) - Clinical Trials Registration: ISRCTN56023731. CKD registers have a lower than expected prevalence and an initial focus group study suggested vari...

Cases of chronic kidney disease (CKD) are defined by the estimated glomerular filtration rate (eGFR), calculated using the Modified Diet in Renal Disease (MDRD) or, more recently, the CKD Epidemiology Collaboration (CKD-EPI) formula. This study set out to promote a systematic approach to reporting CKD prevalence. The study explores the impact of th...

The Alzheimer's Society wished to raise awareness that people with memory problems may benefit from early assessment and diagnosis, so that appropriate measures could be put in place and management improved. To use routinely collected data to determine whether a leaflet campaign to raise awareness of memory problems would result in increased presen...

Incorrect classification, diagnosis and coding of the type of diabetes may have implications for patient management and limit our ability to measure quality. The aim of the study was to measure the accuracy of diabetes diagnostic data and explore the scope for identifying errors. We used two sets of anonymized routinely collected computer data: the...

A diverse range of tools and techniques can be used to observe the clinical consultation and the use of information technology. These technologies range from transcripts; to video observation with one or more cameras; to voice and pattern recognition applications. Currently, these have to be observed separately and there is limited capacity to comb...

We have used routinely collected clinical data in epidemiological and quality improvement research for over 10 years. We extract, pseudonymise and link data from heterogeneous distributed databases; inevitably encountering errors and problems. To develop a solution-orientated system of error reporting which enables appropriate corrective action. Re...

Background: Chronic kidney disease (CKD) is an important cause of mortality and morbidity, especially in people with cardiovascular disease. Interventions that can be delivered in primary care have the potential to slow the progression of the disease. People with CKD can be identified readily and reliably from GP computer systems. Objective: To rep...

Chronic kidney disease (CKD) is a relatively newly recognised but common long-term condition affecting 5 to 10% of the population. Effective management of CKD, with emphasis on strict blood pressure (BP) control, reduces cardiovascular risk and slows the progression of CKD. There is currently an unprecedented rise in referral to specialist renal se...

Reduction in total cholesterol (TC) and LDL-cholesterol (LDL-C) forms one of the principal objectives of most cardiovascular secondary prevention strategies. Many patients being treated with statins, however, have significant residual dyslipidaemia, with many having suboptimal HDL-cholesterol (HDL-C) levels. The addition of nicotinic acid to a stat...

Lipid management in UK general practice targets the achievement of total cholesterol (TC) targets in high-risk individuals. Statins alone have a modest effect on non-LDL-C components of the lipid profile, leaving these patients at significant residual cardiovascular (CV) risk. Improving risk further would require the addition of non-statin therapie...

There is a lack of tools to evaluate and compare Electronic patient record (EPR) systems to inform a rational choice or development agenda. To develop a tool kit to measure the impact of different EPR system features on the consultation. We first developed a specification to overcome the limitations of existing methods. We divided this into work pa...

Early identification of patients with chronic kidney disease (CKD) may allow health-care systems to implement interventions aimed at decreasing disease progression and eventual morbidity and mortality. Primary care in the United Kingdom is computerized suggesting a separate screening program for CKD may not be necessary because identifying data alr...

In the UK routinely collected computerized clinical data is used to assess progress towards financially incentivised quality targets for chronic disease management including hypertension. To develop a method for assessing the impact of recording quality target data in the clinical consultation. Raters were trained how to rate a multi-channel video...

Statins are recommended for the secondary prevention of cardiovascular disease, although they are often used in suboptimal doses and some patients may not receive lipid-lowering therapy. The Primary Care Data Quality (PCDQ) programme is an audit-based educational intervention. To report the PCDQ programme's effect on the cholesterol management in c...

National guidelines recommend bisphosphonates for secondary prevention of osteoporotic fractures; however, poor compliance may result in sub-optimal prevention. This study reports the feasibility of using GP electronic records to identify poorly compliant post-menopausal women who may be at increased risk of fragility fractures. Cross-sectional stu...

Background Mental health problems are common in England, and new medications potentially offer equal or greater efficacy with increased patient safety and fewer side-effects.Objective To examine the use of psychotropic medications in primary care, in particular the use of more modern drug therapies.Subjects and setting Using routinely collected com...

The current national target in the UK for total cholesterol is 5 mmol/L. The Primary Care Data Quality (PCDQ) programme reported in 2002 that only 50% of patients with coronary heart disease (CHD) achieved the 5 mmol/L target and we report on progress since then. Routinely collected general practice computer data were extracted in two successive da...

To report current levels of obesity and associated cardiac risk using routinely collected primary care computer data. 67 practices took part in an educational intervention to improve computer data quality and care in cardiovascular disease. Data were extracted from 435,102 general practice computer records. 64.3% (229,108/362,861) of people age 15...

UK general practice is computerised, and quality targets based on computer data provide a further incentive to improve data quality. A National Programme for Information Technology is standardising the technical infrastructure and removing some of the barriers to data aggregation. Routinely collected data is an underused resource, yet little has be...

To determine the extent to which routinely collected general practitioner computer data could be used to create disease registers of patients with osteoporosis, and to report any improvement in data quality since previous studies. Audit using anonymized data extracted from general practice computer records from across England. Morbidity Query Infor...

Background Although UK general practice is highly computerised and data from it have been widely used for quality improvement and research in many diseases areas, most data about the prevalence and quality of management of mental illness come from secondary care-based studies. Many of these studies suggest that people with mental health problems ha...

Chronic kidney disease (CKD) is an important predictor of end-stage renal disease, as well as a marker of increased mortality. The New Opportunities for Early Renal Intervention by Computerised Assessment (NEOERICA) project aimed to assess whether people with undiagnosed CKD who might benefit from early intervention could be identified from GP comp...

The annual stroke rate in atrial fibrillation is around 5 per cent with increased risk in those with hypertension, diabetes, left ventricular dysfunction and other cardiovascular risk factors. This study set out to identify the patients with atrial fibrillation and modifiable risk factors for stroke. Analysis of practice computer data taken from ei...

Metadata is data that describes other data or resources. It has a defined number of named elements that convey meaning. Medical data are complex to process. For example, in the Primary Care Data Quality (PCDQ) renal programme, we need to collect over 300 variables because there are so many possible causes of renal disease. These variables are not j...

Background: There are large numbers of schemes that collect and aggregate data from primary care computer systems into large databases. These data are then used for market and academic research. How the data is aggregated, cleaned and processed is usually opaque. Making the method transparent allows researchers to compare methods, and users of the...

To report problems implementing a data quality programme in osteoporosis. Analysis of data extracted using Morbidity Information Query and Export Syntax (MIQUEST) from participating general practices' systems and recommendations of practitioners who attended an action research workshop. Computerised general practices using different Read code versi...

Multi-channel video techniques were developed to observe computer use in routine care. Additionally screen-capture, keystroke, and mouse movement data was collected, and activity coded using a validated scale. However, all these data are difficult to manage during analysis. The objective was to develop an application, using object-oriented design p...