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Objective: Endoscopic upper urinary tract instrumentation is a common urological procedure; often associated with prior ureteric stenting and postoperative urosepsis. This study aimed to explore the clinical utility of preoperative urine and intraoperative urine and ureteric stent cultures in the management of urosepsis post upper urinary tract instrumentation. Methods: Prospective study involving pre-stented patients whose upper urinary tract was instrumented at a single centre between 2017 and 2018. Five cultures were collected per patient. Patients were tracked for development of postoperative urosepsis. Results: The study included 227 patients, with a 5.7% postoperative urosepsis rate. Risk of urosepsis was significantly associated with female gender, steroid use and having a colonized preoperative urine culture, intraoperative bladder urine or stent-end culture, or kidney urine culture. Patients with a colonized intraoperative bladder urine were 11 times more likely to develop urosepsis and were colonized with the same organism isolated from urosepsis cultures for 50% of cases. Conclusions: To our knowledge this is the largest cohort study which analyses five different urinary tract cultures and the relationship with postoperative urosepsis. A positive intraoperative bladder urine culture is an independent predictor of postoperative urosepsis development and causative organism, which could guide antibiotic management for these patients. Level of Evidence 3-b [ABSTRACT FROM AUTHOR]

General practice electronic health record (EHR) data have significant potential for clinical research. This study demonstrates the feasibility of utilising longitudinal EHR data analysis to address clinically relevant outcomes and uses the relationship between lipid medication prescription and all-cause mortality in the elderly as an exemplar for the validity of this methodology. EHR data were analysed to describe the association of lipid medication use, non-use or cessation with all-cause mortality in patients aged ≥75 years. Survival analysis with Cox regression was used to calculate hazard ratios, which were adjusted for confounders. There was no significant difference in all-cause mortality among patients according to their use, non-use, or cessation of lipid medications. The outcomes of this study correlate well with the results of other research works. This single-practice study demonstrates the feasibility and potential of analysing EHR data to address important clinical issues such as the relationship between all-cause mortality and lipid medication prescription in the elderly. [ABSTRACT FROM AUTHOR]

Aims: This study serves as an exemplar to demonstrate the scalability of a research approach using survival analysis applied to general practice electronic health record data from multiple sites. Collection of these data, the subsequent analysis, and the preparation of practice-specific reports were performed using a bespoke distributed data collection and analysis software tool., Background: Statins are a very commonly prescribed medication, yet there is a paucity of evidence for their benefits in older patients. We examine the relationship between statin prescriptions for general practice patients over 75 and all-cause mortality., Methods: We carried out a retrospective cohort study using survival analysis applied to data extracted from the electronic health records of five Australian general practices., Findings: The data from 8025 patients were analysed. The median duration of follow-up was 6.48 years. Overall, 52 015 patient-years of data were examined, and the outcome of death from any cause was measured in 1657 patients (21%), with the remainder being censored. Adjusted all-cause mortality was similar for participants not prescribed statins versus those who were (HR 1.05, 95% CI 0.92-1.20, P = 0.46), except for patients with diabetes for whom all-cause mortality was increased (HR = 1.29, 95% CI: 1.00-1.68, P = 0.05). In contrast, adjusted all-cause mortality was significantly lower for patients deprescribed statins compared to those who were prescribed statins (HR 0.81, 95% CI 0.70-0.93, P < 0.001), including among females (HR = 0.75, 95% CI: 0.61-0.91, P < 0.001) and participants treated for secondary prevention (HR = 0.72, 95% CI: 0.60-0.86, P < 0.001). This study demonstrated the scalability of a research approach using survival analysis applied to general practice electronic health record data from multiple sites. We found no evidence of increased mortality due to statin-deprescribing decisions in primary care.