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Biomedical subjects

J A Malcolm

Publications and source records attributed to J A Malcolm.

17 recordsLinked to original sources
PubMed1992

Changes in drug treatment and case fatality of patients with acute myocardial infarction. Observations from the Newcastle MONICA Project, 1984/1985 to 1988/1990.

OBJECTIVE: To describe changes in medications administered to patients with acute myocardial infarction between 1984/1985 and 1988/1990 and changes in case fatality. DESIGN: Descriptive study from the Newcastle MONICA Project, which monitors all heart attacks in men and women aged 25 to 69 years in the Lower Hunter Region of New South Wales. SUBJECTS: All patients admitted to hospital with a "definite" acute myocardial infarction who survived at least 28 days during periods in 1984/1985 (513 events) and 1988/1990 (790 events). MAIN OUTCOME MEASURES: Changes in drugs being taken immediately before the onset of the myocardial infarction, prescribed during hospitalisation and on discharge from hospital, and changes in case fatality rates. RESULTS: From the first time period to the second there were significant increases in the use of aspirin, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors and hypolipidaemic agents, and significant reductions in the use of diuretics. In 1988/1990, 34% of patients with a definite myocardial infarction received thrombolytic therapy compared with fewer than 1% in 1984/1985. Among those patients who survived at least one hour from onset of symptoms, the case fatality rate declined from 13.5% to 7.9% (change -5.6%; 95% confidence limits, -8.9%, -2.2%). CONCLUSION: Large changes in drug treatment of patients with acute myocardial infarction have occurred in the second half of the 1980s. These may be responsible for the reduction in case fatality. Nevertheless, use of drugs of proven effectiveness in acute care and for secondary prevention is surprisingly low in this population.

Adult↗
PubMed1992

First public report for physicians due this summer.

Public reporting of physician-specific information by the Pennsylvania Health Care Cost Containment Council begins this summer with the release of a report of physician-specific surgical data. Physicians should be aware that the release of such information may have a significant impact on decisions made by patients or potential patients.

Coronary Artery Bypass↗
PubMed1992

Plans proceed to publish physician-specific data.

Physicians should be aware that the release of physician-specific information by the Pennsylvania Health Care Cost Containment Council (PHC4) may have a significant impact on decisions made by patients or potential patients. This article, which outlines PHC4's proposed Research Plan about coronary artery bypass graft (CABG) surgery and related issues, is a follow-up to "First Report Card for Physicians Due This Summer" [Pennsylvania Medicine, May 1992]

Coronary Artery Bypass↗
PubMed1991

Trends in ischaemic heart disease in the Hunter Region of New South Wales 1985-1989.

OBJECTIVE: To find out whether trends in rates of non-fatal myocardial infarction (MI) parallel trends in rates of coronary death. DESIGN: A population-based observational study involving continuous surveillance of all suspected heart attacks or coronary deaths from 1985 to 1989. STUDY POPULATION: Residents of the Hunter Region of New South Wales aged under 70 years. MAIN OUTCOME MEASURES: Rates of non-fatal definite or possible MI or fatal MI or coronary death, as defined by the diagnostic criteria of the WHO MONICA Project. RESULTS: For men, mortality rates declined by an average of 16.2 per 100,000 per year (95% confidence interval [CI]: -23.8, -8.7); rates of non-fatal definite MI declined by 16.2 per 100,000 (95% CI: -27.8, -4.6); rates of non-fatal possible MI increased initially and then stabilised. For women smaller changes occurred in the same directions. CONCLUSION: In this population trends in rates for non-fatal definite MI paralleled the declines in mortality rates. Rates for less severe non-fatal possible MI did not follow this pattern, perhaps reflecting increased medical attention to chest pain.

Adult↗
PubMed1991

HIV and nutrition.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Lessons from Oregon.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Death from myocardial infarction: what are the benefits of early arrival at hospital and thrombolysis?

The potential benefits of early hospital care in the event of myocardial infarction were investigated in a community-based study of all suspected cases of heart attack among people aged under 70 years in the Hunter Region of New South Wales. Between August 1984 and December 1985 acute care data were collected for 1029 cardiovascular events classified as definite myocardial infarction or sudden coronary death; 516 (50%) resulted in death within 28 days from the onset of symptoms and 325 of these deaths (63%) occurred outside hospital. Of 703 people who are known to have reached hospital alive 205 (29%) did so more than four hours after the onset of symptoms. At the time of the study fewer than 1% of patients received streptokinase. To estimate the potential benefits of increased medical care an optimistic scenario was considered in which patients who arrived at hospital more than four hours after the onset of symptoms received medical attention earlier and all eligible patients received thrombolysis. Based on the results of the Second International Study of Infarct Survival (ISIS-2), if streptokinase and aspirin had been used 14% of deaths would have been averted. If, in addition, patients had arrived at hospital earlier and received optimal benefit from thrombolysis another 13% of deaths could have been avoided. These results provide a broader perspective of the potential benefits of improved medical care than can be obtained from hospital-based studies that deal only with those heart attack victims who survive long enough to reach hospital alive.

Adult↗
PubMed1990

Length of hospital stay after acute myocardial infarction.

A number of trials show that long stay in hospital after an acute myocardial infarction (AMI) is not necessary for many patients and that stays of three-ten days may be adequate. All patients aged under 70 years with a diagnosis of AMI admitted to the seven public hospitals in the Lower Hunter Region of New South Wales are monitored as part of the WHO MONICA Study. Between August 1984 and December 1985 of 438 hospitalised patients with a 'definite' AMI according to MONICA criteria and a clinical discharge diagnosis of AMI, 386 (88%) patients were discharged alive from hospital. Four patients had lengths of stay between 46 and 77 days and have been omitted from further analysis. The mean length of hospital stay was 13.6 days (95% confidence intervals 12.9 to 14.3 days); 74% of all patients stayed in hospital for more than ten days. The mean length of stay in the Coronary Care Unit (CCU) was 4.5 days (95% confidence intervals 4.2 to 4.8 days) with 60% staying longer than three days. Mean hospital stay varied from 10.5 to 17.4 days among the seven hospitals, although most of this variation was accounted for by three hospitals with few patients. Restricting analysis to the four hospitals with 90% of all the patients, multiple regression analysis showed that the CK enzyme levels, the evolution of Q waves on ECG, the presence of an anterior AMI and the use of nitrates and digoxin during hospitalisation were all associated with increased length of stay in hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Methodological issues in interpreting trends in MONICA event rates.

Before looking at the trends in coronary event rates and case fatality rates in the WHO MONICA Project, it is necessary to assess the consistency and validity of the data. In the Newcastle MONICA Collaborating Centre, two methods have been used. One involves monitoring data quality by comparisons with external data systems such as hospital discharge data and official mortality records. The other is to examine the internal consistency of MONICA diagnostic findings. For fatal myocardial infarction (MI) or coronary death, there is consistent evidence of a decline, but the MONICA data are not adequate to assess relative changes in sudden compared to non-sudden death rates. For non-fatal definite MI there was an increase early in the study, possibly due to a change in methods, but rates have now stabilized. For non-fatal possible MI there has been a steady increase in rates for events which may be becoming less severe. This is consistent with increasing hospital admissions for subacute ischaemic heart disease (IHD) and angina. This paper exemplifies the importance of maintaining internal and external surveillance of the quality of the data.

Adult↗
PubMed1989

Marriage is associated with a lower risk of ischaemic heart disease in men.

Comparison between subjects who were identified from a register of cases of myocardial infarction and a random sample of the same community showed that in the Lower Hunter region of New South Wales men who currently are not married are at higher risk of acute myocardial infarction or of sudden coronary death than are married men of the same age. While there are indications that unmarried men have a life-style that is different from that of currently married men, their increased risk of ischaemic heart disease is greater than can be accounted for by differences in factors such as age, the previous history of heart disease, their alcohol and tobacco consumption and various socioeconomic factors.

Adult↗
PubMed1989

Social effects of a history of ischaemic heart disease.

The consequences of ischaemic heart disease include adverse personal and social effects as well as morbidity and mortality. This study describes these affects among people registered in a community-based study of all suspected heart attacks. Two groups were compared, those with and those without a previous history of ischaemic heart disease, using information about the subjects' lives before the event which caused them to be registered. Men with a history were more likely to be retired or permanently unable to work (64% compared with 47%). Despite some modification of risk factors, such as reductions of cigarette smoking, men (but not women) with a history were more likely to die from the registered event especially within one hour from onset of symptoms. These results emphasize the need for prevention of heart disease before it causes the effects and disabilities reported here.

Adult↗
PubMed1988

Coronary events in the Hunter region of New South Wales, Australia: 1984-1986.

The results of coronary event registration using the protocol of the World Health Organization MONICA Project are reported for two years for the Hunter Region, the area in and around Newcastle in New South Wales, Australia. The Newcastle MONICA Project monitors all suspected cases of heart attack by identifying patients from hospital admissions and obtaining information while they are still in hospital. For people who die out of hospital, the initial source of information is usually the death certificate. Rates for the most robust MONICA diagnostic categories, non-fatal definite myocardial infarction and all coronary deaths, differed for the two years reported here. Monthly rates suggested possible seasonal effects, and the possible influence of lower respiratory infections including an epidemic of influenza A. The results demonstrate that consistent monitoring over several years will be necessary to establish clear trends in coronary heart disease.

Adult↗
PubMedDate not supplied

Heart attacks and the Newcastle earthquake.

OBJECTIVE: To test the hypothesis that stress generated by the Newcastle earthquake led to increased risk of heart attack and coronary death. DESIGN: A natural experiment. SUBJECTS: People living in the Newcastle and Lake Macquarie local government areas of New South Wales, Australia. INTERVENTION: At 10.27 a.m. on 28 December 1989 Newcastle was struck by an earthquake measuring 5.6 on the Richter scale. OUTCOME MEASURES: Myocardial infarction and coronary death defined by the criteria of the WHO MONICA Project and hospital admissions for coronary disease before and after the earthquake and in corresponding periods in previous years. Well established, concurrent data collection systems were used. RESULTS: There were six fatal myocardial infarctions and coronary deaths among people aged under 70 years after the earthquake in the period 28-31 December 1989. Compared with the average number of deaths at this time of year this was unusually high (P = 0.016). Relative risks for this four-day period were: fatal myocardial infarction and coronary death, 1.67 (95% confidence interval [Cl]: 0.72, 3.17); non-fatal definite myocardial infarction, 1.05 (95% Cl: 0.05, 2.22); non-fatal possible myocardial infarction, 1.34 (95% Cl: 0.67, 1.91); hospital admissions for myocardial infarction or other ischaemic heart disease, 1.27 (95% Cl: 0.83, 1.66). There was no evidence of increased risk during the following four months. CONCLUSION: The magnitude of increased risk of death was slightly less than that previously reported after earthquakes in Greece. The data provide weak evidence that acute emotional and physical stress may trigger myocardial infarction and coronary death.

Adult↗