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J J McNeil

Publications and source records attributed to J J McNeil.

At least 19 recordsLinked to original sources
PubMed1999

The extraction of quality-of-care clinical indicators from State health department administrative databases.

OBJECTIVE: To assess whether three proposed quality-of-care indicators (unplanned readmissions, hospital-acquired bacteraemia, and postoperative wound infection) can be accurately identified from State health department databases. DESIGN: Algorithms were applied to State health department databases to maximise the identification of individuals potentially positive for each indicator. Records of these patients were then examined to determine the percentage of cases that met the precise indicator definitions. SETTING: 10 public, acute-care hospitals from Victoria, South Australia and New South Wales. Data from the 1994-95 and 1995-96 financial years were collected. PARTICIPANTS: Individuals 18 years of age or older who were identified from State health department administrative databases as potentially meeting the indicator criteria. MAIN OUTCOME MEASURES: The proportion of screened cases that met the precise indicator definitions, and the elements of the indicator definitions which could not be extracted from the administrative databases. RESULTS: The proportions of cases confirmed by medical record review to be positive for the indicator events were 76.3% for unplanned readmissions within 28 days, 20% for hospital-acquired bacteraemia, 43.5% for wound infections after clean surgery, and 34.8% for wound infections after contaminated surgery. The clinical elements of each indicator definition were not easily extracted from the administrative databases. CONCLUSIONS: The three proposed clinical indicators could not be extracted from current State health department databases without an extensive process of secondary medical record review. If administrative databases are to be used for assessing quality of care, more systematic recording of data is needed.

Algorithms↗
PubMed1999

Risk of primary intracerebral haemorrhage associated with aspirin and non-steroidal anti-inflammatory drugs: case-control study.

OBJECTIVE: To examine the association between use of aspirin or other non-steroidal anti-inflammatory drugs and intracerebral haemorrhage. DESIGN: Case-control study. SETTING: 13 major city hospitals in the Melbourne and metropolitan area. SUBJECTS: 331 consecutive cases of stroke verified by computed tomography or postmortem examination, and 331 age (+/- 5 years) and sex matched controls who were community based neighbours. INTERVENTIONS: Questionnaire administered to all subjects either directly or by proxy with the next of kin. Drug use was validated by reviewing prescribing records held by the participants' doctors. MAIN OUTCOME MEASURES: Previous use of aspirin or other non-steroidal anti-inflammatory drugs. RESULTS: Univariate analysis showed no increased risk of intracerebral haemorrhage with low dose aspirin use in the preceding 2 weeks. Using multiple logistic regression to control for possible confounding factors, the odds ratio associated with the use of aspirin was 1.00 (95% confidence interval 0.60 to 1. 66, P=0.998) and the odds ratio associated with the use of other non-steroidal anti-inflammatory drugs was 0.85 (0.45 to 1.61, P=0. 611) compared with respective non-users in the preceding fortnight. Moderate to high doses of aspirin (>1225 mg/week spread over at least three doses) yielded an odds ratio of 3.05 (1.02 to 9.14, P=0. 047). There was no evidence of an increased risk among subgroups defined by age, sex, blood pressure status, alcohol intake, smoking, and the presence or absence of previous cardiovascular disease. CONCLUSIONS: No increase in risk of intracerebral haemorrhage was found among aspirin users overall or among those who took low doses of the drug or other non-steroidal anti-inflammatory drugs. These data provide evidence that doses of aspirin usually used for prophylaxis against vascular disease produce no substantial increase in risk of intracerebral haemorrhage.

Adolescent↗
PubMed1999

Postmarketing surveillance: strengths and limitations. The flucloxacillin-dicloxacillin story.

Spontaneous reporting of adverse drug reactions continues to be the principal method used for monitoring the safety of marketed drugs. Despite the many successes attributed to these schemes, they can reliably detect only a small fraction of the range of possible drug-related events and provide virtually no useful quantitative data. Some of the limitations of spontaneous reporting were demonstrated recently in relation to flucloxacillin. Reports in Australia suggested the likelihood of an unacceptable risk of flucloxacillin-associated jaundice, but the data from spontaneous reporting in countries with apparently similar use of the drug, such as New Zealand and the UK, were insufficient to confirm or refute this proposition. Spontaneous monitoring should be supplemented by the systematic monitoring of cohorts of users of new drugs, using record-linkage to track their subsequent health. Although several impediments exist to the introduction of such a scheme in Australia, consideration should be given to addressing how such a system might be implemented.

Adverse Drug Reaction Reporting Systems↗
PubMed1999

Variability in digital assessment of cortical and posterior subcapsular cataract.

To identify validity of the standardised Nidek EAS-1000 retroillumination image analysis, images of 450 consecutive patients were analysed for the standard 6.5 mm and for the maximal pupil size. The software allows for separation of cortical and posterior subcapsular opacities and defines threshold for cataract automatically at 12% below the brightest point of the histogram of pixel luminescence. The results were compared with clinical Wilmer cataract grading. Correlation between clinical and digital assessment was 0.48* for cortical opacities in maximal pupil size, 0. 47* in 6.5 mm pupil size analyses, and 0.71* for posterior subcapsular opacities (*p < 0.001). In 24.6% of maximal pupil size analyses and in 11.7% of standard pupil size analyses standardisation revealed confounding features, such as other opacities of media, refractive shadows etc., that masqueraded as cataract and interfered with the cortical opacity measurements. Automatic standardized analysis has reduced many sources of observer variation (level of illumination, pupil size and threshold adjustment), but the revealed range of confounding opacities and artifacts still requires observer interpretation.

Aged↗
PubMed1999

Comparison of clinical and digital assessment of nuclear optical density.

To compare the standardised Nidek EAS-1000 densitometric analysis of the lens with clinical assessment of the nucleus at an early stage of cataract development, 1,200 eyes of 1,204 participants of the VECAT study were assessed at the baseline using both subjective and objective lens grading. Standardisation of the automatic slit image analysis was achieved using a custom-designed EAS-1000 Software version 3.01c. Among 6 measurements of nuclear optical density, the mean pixel luminescence of integrated anterior nuclear density correlated best with clinical assessment (R = 0.662, p < 0.001). Variance components that interfere with the assessment are defined.

Aged↗
PubMed1999

Ischemic stroke risk and passive exposure to spouses' cigarette smoking. Melbourne Stroke Risk Factor Study (MERFS) Group.

OBJECTIVES: This study investigated the association between ischemic stroke risk and passive exposure to cigarette smoking. METHODS: Risk factors among 452 hospitalized cases of first-episode ischemic stroke were compared with 452 age- and sex-matched "neighbor-hood" controls. RESULTS: The risk of stroke was twice as high for subjects whose spouses smoked as for those whose spouses did not smoke (95% confidence interval = 1.3, 3.1), after adjustment for the subject's own smoking, heart disease, hypertension, diabetes, and education level. These results were confirmed when analysis was limited to those who never smoked. CONCLUSIONS: These findings provide evidence that spousal smoking may be a significant risk factor for ischemic stroke.

Aged↗
PubMed1999

Heavy drinking, but not moderate or intermediate drinking, increases the risk of intracerebral hemorrhage.

An increased risk of intracerebral hemorrhage among heavy consumers of alcohol has been demonstrated in several epidemiologic studies. The effect of moderate or intermediate intakes is, however, unclear. Although several studies provide evidence for a protective effect, this conclusion may be spurious, resulting from the inclusion, within the zero intake (reference) group, of past drinkers who have recently abstained for health reasons. The present study describes the relation between alcohol consumption and intracerebral hemorrhage among 331 case-control pairs recruited in Melbourne, Australia. Heavy drinking was associated with an increased risk of intracerebral hemorrhage (odds ratio (OR) 3.4, 95% confidence interval (CI) = 1.4-8.4). The odds ratio of intracerebral hemorrhage with moderate drinking, when compared with never drinkers, was 0.7, (95% CI = 0.4-1.2) and was 0.6 (95% CI = 0.4-1.0) when compared with nondrinkers (never drinkers plus past drinkers). Wine drinkers were apparently protected from intracerebral hemorrhage (OR 0.5, 95% CI = 0.2-0.9). These results are consistent with the possibility that moderate drinking may confer protection from intracerebral hemorrhage, but this protection may be less than that previously reported.

Adult↗
PubMed1998

Undergraduate surgical examinations: an appraisal of the clinical orals.

The aims of this study of examinations in the final year of undergraduate surgery were to determine whether the long case, short cases/orals reflected students' knowledge of surgery effectively, whether their performance indicated the goals of the medical course relative to surgery were achieved, and whether these examinations gave a good and fair appraisal of student clinical skills. To test validity of these examinations, the scores of the long and short cases/oral were correlated with the aggregate score for the medical course, to the final-year total score, the final-year surgery mark, the written examination mark and the final-year internal medicine mark. Whether the surgical goals of the medical course were achieved was assessed by questionnaire to the surgical examiners, and whether there was a good and relevant appraisal of student clinical skills was assessed by questionnaire to students. The response rates to the questionnaires were 100% and 98%. The results showed a poor but significant correlation between long and short cases/oral (rho = 0.24, P = 0.01). The correlation of the long case and short cases/oral to internal medicine was rho = 0.45 and rho = 0.33 (both P < 0.001), and there was a better correlation of short cases/oral to the aggregate medical course score (rho = 0.53 vs. 0.42, both P < 0.001). The long case and short cases/oral had no correlation with the written paper (rho = 0.10 and 0.69, respectively). The goals of the medical course were considered achieved, but less so with assessment of the injured and acutely surgically ill; students considered the long and short cases/orals as a good and relevant appraisal of their clinical skills. The distribution of short cases marks shifted to the left, indicating lower scores for this part of the examination. In conclusion, this study has demonstrated that the long and short cases/orals tested different aspects of student's skills, and so reinforces the importance of retaining the short and long cases in undergraduate surgical examinations. It is suggested that a single long case may be insufficient to distinguish between adequate and inadequate performance.

Clinical Competence↗
PubMed1998

Reproducibility of automatic standard digital analysis of lens opacities.

PURPOSE: This study was designed to assess the repeatability of the standard analysis of images taken with the Nidek EAS-1000 anterior segment analysis system (Nidek Co. Ltd, Japan). METHODS: Participants in a large clinical trial (the vitamin E, cataract and age-related maculopathy study) were asked to undergo two independent examinations to assess the repeatability of primary outcome measures. After pupil dilatation to at least 6.5 mm, 104 eyes were photographed using the retro-illumination method and the slit-beam method. RESULTS: Intra-class correlation coefficients were: slit images, R = 0.982; retro-illumination images, R = 0.978. CONCLUSION: Repeatability of measurement of lens opacity from EAS-1000 images using automated standard analysis was high.

Aged↗
PubMed1998

Three important subgroups of hypertensive persons at greater risk of intracerebral hemorrhage. Melbourne Risk Factor Study Group.

Hypertension as a risk factor for intracerebral hemorrhage (ICH) is poorly quantified, particularly in the setting of the use of modern antihypertensive agents. To investigate this, we studied 331 consecutive hospital cases of primary ICH verified by computed tomography or autopsy, occurring during the period 1990 through 1992, and 331 age- and sex-matched community-based control subjects in a city-wide study involving 13 hospitals. Hypertension approximately doubled the risk of ICH (adjusted odds ratio [OR], 2.45; 95% confidence interval [CI], 1.61 to 3.73). The OR associated with hypertension was significantly greater among those who had ceased taking medications, supervised and unsupervised (OR, 4.98; 95% CI, 2.25 to 11.02), compared with those who had not (OR, 1.95; 95% CI, 1.20 to 3.16), were under the age of 55 years (OR, 7.68; 95% CI, 2.65 to 22.5), or were current smokers (OR, 6.12; 95% CI, 2.29 to 16.35). The presence of hypertension did not influence size or location of the hemorrhage. However, those dying from ICH displayed a greater risk of ICH due to hypertension than survivors, with the ratio of the two ORs being 5.47 (95% CI, 1.23 to 24.44). These findings provide evidence for a greater increase in risk of ICH due to hypertension among younger persons, current smokers, and those discontinuing antihypertensive therapy. This is the first direct evidence for a link between stopping antihypertensive medication use and stroke risk; targeting these individuals for more intensive monitoring and education on the importance of risk factor modification may help to reduce the impact of this form of stroke.

Adolescent↗
PubMed1997

Association of adult glioma with medical conditions, family and reproductive history.

A population-based case-control study of 416 histologically diagnosed, incident gliomas in adults was carried out in Melbourne, Australia, to determine whether past medical, family or reproductive histories are risk factors for developing glioma. A total of 422 controls were selected from the Australian electoral roll and matched to cases for age, sex and post code of residence. An increased risk of developing glioma was observed among first-born individuals OR (95% CI) 2.0 (1.4-2.9). It is possible that this effect is due to residual confounding by socio-economic status or that it is a chance finding. Alternatively, it may be that this is due to some other effect linked to the first pregnancy, such as maternal age, birth weight or circumstances of delivery. There was no apparent association between the development of glioma and other neuropsychiatric or general medical conditions or with family history or reproductive history. Allergies (asthma and eczema) were not associated with a decreased risk of glioma, as has previously been suggested.

Adult↗
PubMed1997

Determinants of plasma concentrations of nicotine and cotinine during cigarette smoking and transdermal nicotine treatment.

OBJECTIVE: Interindividual variability in plasma concentrations of nicotine and its proximate metabolite, cotinine, is considerable during smoking and transdermal nicotine treatment, even among individuals taking in nominally similar doses of nicotine. This report explores the determinants of this variability and the utility of baseline (smoking) plasma concentrations to predict concentrations during transdermal nicotine treatment. METHODS: Data were analysed from a smoking cessation study (n = 466), and from a pharmacokinetic study (n = 12). Multiple regression models examined the relationships of plasma concentrations to individual characteristics such as smoking pattern, absorbed dose of nicotine, and pharmacokinetic parameters. RESULTS: Plasma concentrations of nicotine and cotinine were highly variable in both studies. Indirect estimates of plasma clearance (baseline plasma concentration divided by cigarettes per day) together with other factors could account for 18 to 33% of the variability during transdermal nicotine treatment in the smoking cessation study. In contrast, 75 to 99% was accounted for by direct measurements of plasma clearances and systemic dose of nicotine in the pharmacokinetic study. CONCLUSION: Plasma concentrations of nicotine and cotinine during transdermal nicotine treatment are poorly predicted by clinical history or baseline plasma concentrations. This is a result of inadequate characterisation of highly variable individual pharmacokinetic parameters and absorbed dose of nicotine. Considering the interindividual variability of plasma nicotine and cotinine concentrations together with the lack of clinical end-points for transdermal nicotine dosing, it seems logical to investigate the utility of a therapeutic drug monitoring approach for transdermal nicotine treatment-particularly for high dose regimens (> 22 mg per 24 hours).

Administration, Cutaneous↗
PubMed1997

Feasibility of conducting cardiovascular outcome research in Australian general practice: results from the ANBP2 pilot study. Australian National Blood Pressure Study.

1. The present study aimed to determine the feasibility of conducting a 5 year cardiovascular outcome trial of the treatment of 6000 elderly hypertensive patients in Australian general practices. 2. General practitioners (GPs) were invited to participate by mail and personal follow-up. Patient records were reviewed to identify subjects for a blood pressure (BP) screening programme. Blood pressure was measured on three occasions and eligible subjects were included if the average BP was > or = 160 mmHg systolic or > or = 90 mmHg diastolic if systolic BP was > or = 140 mmHg. 3. Seven hundred and forty-one GPs were approached and 89 were enrolled in the study (12% of mail invites and 75% of those receiving a personal contact). In 16 practices where screening was completed, 82,000 records were reviewed to identify 4% patients eligible for screening. Twenty-two per cent of eligible subjects attended screening. Of 1938 subjects screened, 180 (9%) had BP > or = 160/90 mmHg. Forty-seven per cent of subjects (n = 916) were receiving antihypertensive therapy and 184 (20%) were withdrawn from therapy. One hundred and sixteen (63%) of these subjects had BP return to study entry levels within 6 weeks. Fifty-seven newly diagnosed and 81 previously treated subjects were randomized (7% of the screened population). 4. Based on the high participation rate of GPs, the response rate of patients to attend a BP screening programme and the 7% randomization to screening ratio for entry into the study, the ANBP2 pilot study has demonstrated that it is feasible to recruit subjects from Australian general practices to a cardiovascular outcome trial.

Aged↗