PubMed Health⌕ Search

Biomedical subjects

D MacIntosh

Publications and source records attributed to D MacIntosh.

5 recordsLinked to original sources
PubMed2000

Anti-tuberculous therapy for maintaining remission of Crohn's disease.

OBJECTIVES: To evaluate the effects of anti-tuberculous therapy for the maintenance of remission in patients with Crohn's disease. SEARCH STRATEGY: We searched the Inflammatory Bowel Disease Trials Register, the Cochrane Controlled Trials Register and MEDLINE from 1966 to 1998 (supplemented by a manual search of Index Medicus from 1966 to 1994). We also searched for abstracts in Gut, Gastroenterology, and The American Journal of Gastroenterology from 1990 to 1996. Date of most recent search: August 1998. SELECTION CRITERIA: Randomized trials of anti-tuberculous therapy in patients with Crohn's disease. DATA COLLECTION AND ANALYSIS: Data on the number of patients maintaining remission for each treatment group were abstracted. These data were pooled to yield Mantel-Haenszel odds ratios and numbers needed to treat for maintenance of remission in treated versus control groups. MAIN RESULTS: A total of seven randomized trials which included 355 patients were identified. Two trials used anti-tuberculous therapy (clofazimine or clofazimine, rafmpin, ethambutol, and dapsone) in combination with corticosteroids to induce remission. Maintenance therapy consisted of the anti-tuberculous agents without corticosteroids. Control patients received corticosteroids to induce remission but no anti-tuberculous therapy. The analysis of all seven trials yielded an odds ratio for maintenance of remission of 1.36 (95% CI 0.87-2. 13). Removing the two studies that were published as abstracts did not significantly affect this result: the pooled odds ratio was 1.14 (95% CI 0.71-1.83). The two trials reported as abstracts were excluded from subgroup analyses because they did not include any information on adjunct therapy. Subgroup analysis of the two trials which used steroids to induce remission yielded an odds ratio for maintenance of remission of 3.37 (95% CI 1.38-8.24). The number needed to treat was three. However, these two trials included only 89 patients, and the results should be interpreted with caution. The remaining three trials compared the combination of anti-tuberculous therapy and 'standard therapy' with 'standard therapy alone'. The pooled odds ratio was 0.70 (95% CI 0.39-1.25). REVIEWER'S CONCLUSIONS: Anti-tuberculous therapy may be effective in maintaining remission in patients with Crohn's disease when remission has been induced with corticosteroids combined with anti-tuberculous therapy. However, the results which support this conclusion come from a subgroup of only two trials with small numbers of patients and should be interpreted with caution. Use of this therapy cannot be recommended on the basis of this evidence.

Antitubercular Agents↗
PubMed1987

Captopril: 4 years of post marketing surveillance of all patients in New Zealand.

The Intensive Medicines Monitoring Programme (IMP), a specialised part of the New Zealand Post Marketing Surveillance system, has been used to monitor captopril since it was first approved for marketing for the treatment of hypertension and heart failure. Monitoring has consisted of (1) spontaneous reporting for which doctors have been encouraged to report all clinical events, (2) a specific event recording survey at the end of the first year and (3) a controlled patient survey of taste disturbance. The IMP gathers prescription information on about 85% of all patients. There were 4,124 patients at the end of the first 4 years. Reported events involved 4% of patients, the majority being cutaneous (1%) and gastrointestinal (0.7%). The event recording survey gave an overall rate of adverse events of 2.2 per patient year. The taste survey showed a remarkably high incidence of taste disturbance in the control population and only taste loss was significantly higher (P less than 0.01) for captopril. This ongoing study has so far demonstrated a low incidence of adverse effects due to captopril, which is reassuring in view of its increasing use for mild hypertension and early cardiac failure.

Adolescent↗
PubMedDate not supplied

Use of expert judgment in exposure assessment. Part I. Characterization of personal exposure to benzene.

This paper presents the results of the first phase of a study, conducted as an element of the National Human Exposure Assessment Survey (NHEXAS), to demonstrate the use of expert subjective judgment elicitation techniques to characterize the magnitude of and uncertainty in environmental exposure to benzene. In decisions about the value of exposure research or of regulatory controls, the characterization of uncertainty can play an influential role. Classical methods for characterizing uncertainty may be sufficient when adequate amounts of relevant data are available. Frequently, however, data are neither abundant nor directly relevant, making it necessary to rely to varying degrees on subjective judgment. Since the 1950s, methods to elicit and quantify subjective judgments have been explored but have rarely been applied to the field of environmental exposure assessment. In this phase of the project, seven experts in benzene exposure assessment were selected through a peer nomination process, participated in a 2-day workshop, and were interviewed individually to elicit their judgments about the distributions of residential ambient, residential indoor, and personal air benzene concentrations (6-day integrated average) experienced by both the non-smoking, non-occupationally exposed target and study populations of the US EPA Region V pilot study. Specifically, each expert was asked to characterize, in probabilistic form, the arithmetic means and the 90th percentiles of these distributions. This paper presents the experts' judgments about the concentrations of benzene encountered by the target population. The experts' judgments about levels of benzene in personal air were demonstrative of patterns observed in the judgments about the other distributions. They were in closest agreement about their predictions of the mean; with one exception, their best estimates of the mean fell within 7-11 microg/m(3) although they exhibited striking differences in the degree of uncertainty expressed. Their estimates of the 90th percentile were more varied with the best estimates ranging from 12 to 26 microg/m(3) for all but one expert. However, their predictions of the 90th percentile were far more uncertain. The paper demonstrates that coherent subjective judgments can be elicited from exposure assessment scientists and critically examines the challenges and potential benefits of a subjective judgment approach. The results of the second phase of the project, in which measurements from the NHEXAS field study in Region V are used to calibrate the experts' judgments about the benzene exposures in the study population, will be presented in a second paper.

Benzene↗