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J K MacDonald

Publications and source records attributed to J K MacDonald.

At least 19 recordsLinked to original sources
PubMed2006

Interventions for treating collagenous colitis.

BACKGROUND: Collagenous colitis is a disorder that is recognized as a cause of chronic diarrhea. Treatment has been based mainly on anecdotal evidence. This review was performed to identify therapies for collagenous colitis that have been proven in randomized trials. OBJECTIVES: To determine effective treatments for patients with clinically active collagenous colitis. SEARCH STRATEGY: Relevant papers published between 1970 and June 2006 were identified via the MEDLINE and PUBMED databases. Manual searches from the references of identified papers, as well as review papers on collagenous or microscopic colitis were performed to identify additional studies. Abstracts from major gastroenterological meetings were searched to identify research submitted in abstract form only. Finally, the Cochrane Controlled Trials Register and the Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Group Specialized Trials Register were searched for other studies. SELECTION CRITERIA: Seven randomized trials were identified. One trial studied bismuth subsalicylate (published in abstract form only), one trial studied Boswellia serrata extract (published in abstract form only), one trial studied probiotics, one trial studied prednisolone, and 3 trials studied budesonide for the therapy of collagenous colitis. DATA COLLECTION AND ANALYSIS: Data were extracted independently by each author onto 2x2 tables (treatment versus placebo and response versus no response). For therapies assessed in one trial only, p-values were derived using the chi-square test. For therapies assessed in more than one trial, summary test statistics were derived using the Peto odds ratio and 95% confidence intervals. Data were combined for analysis only if the outcomes were sufficiently similar in definition. MAIN RESULTS: There were 9 patients with collagenous colitis in the trial studying bismuth subsalicylate (nine 262 mg tablets daily for 8 weeks). Those randomized to active drug were more likely to have clinical (p = 0.003) and histological (p = 0.003) improvement than those assigned to placebo. Eleven patients were enrolled in the trial studying prednisolone (50 mg daily for 2 weeks). There was a trend towards clinical response in patients on active medication compared to placebo (p = 0.064). The effect of prednisolone on histologic improvement was not studied. Thirty-one patients were enrolled in the Boswellia serrata extract trial. Clinical improvement was noted in 44% of patients who received active treatment compared to 27% of patients who received placebo (p = 0.32). Twenty-nine patients were enrolled in the probiotics trial. Clinical improvement was noted in 29% of patients who received probiotics compared to 13% of patients who received placebo (p = 0.635). A total of 94 patients were enrolled in 3 trials studying budesonide (9 mg daily or in a tapering schedule for 6 to 8 weeks). The pooled odds ratio for clinical response to treatment with budesonide was 12.32 (95% CI 5.53-27.46), with a number needed to treat of 2 patients. There was significant histological improvement with treatment in all 3 trials studying budesonide therapy. Budesonide also appears to improve patients' quality of life. AUTHORS' CONCLUSIONS: Budesonide is effective for the treatment of collagenous colitis. The evidence for benefit with bismuth subsalicylate is weaker. The effectiveness of prednisolone, Boswellia serrata extract, probiotics and other therapies for induction or maintenance of remission of collagenous colitis is unknown and requires further study.

Anti-Inflammatory Agents↗
PubMed2004

Interventions for treating collagenous colitis.

BACKGROUND: Collagenous colitis is a disorder that is recognized as a cause of chronic diarrhea. Treatment has been based mainly on anecdotal evidence. This review was performed to identify therapies for collagenous colitis that have been proven in randomized trials. OBJECTIVES: To determine effective treatments for patients with clinically active collagenous colitis. SEARCH STRATEGY: Relevant papers published between 1970 and August 2003 were identified via the MEDLINE and PUBMED databases. Manual searches from the references of identified papers, as well as review papers on collagenous or microscopic colitis were performed to identify additional studies. Abstracts from major gastroenterological meetings were searched to identify research submitted in abstract form only. Finally, the Cochrane Controlled Trials Register and the Cochrane Inflammatory Bowel Disease Group Specialized Trials Register were searched for other studies. SELECTION CRITERIA: Five randomized trials were identified. One trial studied bismuth subsalicylate (published in abstract form only), one trial studied prednisolone, and 3 trials studied budesonide in the therapy of collagenous colitis. DATA COLLECTION AND ANALYSIS: Data were extracted independently by each author onto 2x2 tables (treatment versus placebo and response versus no response). For therapies assessed in one trial only, p-values were derived using the chi-square test. For therapies assessed in more than one trial, summary test statistics were derived using the Peto odds ratio and 95% confidence intervals. Data were combined for analysis only if the outcomes were sufficiently similar in definition. MAIN RESULTS: There were 9 patients with collagenous colitis in the trial studying bismuth subsalicylate (nine 262 mg tablets daily for 8 weeks). Those randomized to active drug were more likely to have clinical (p=0.003) and histological (p=0.003) improvement than those assigned to placebo. Eleven patients were enrolled in the trial studying prednisolone (50 mg daily for 2 weeks). There was a trend towards clinical response in patients on active medication compared to placebo (p=0.064). The effect of prednisolone on histologic improvement was not studied. A total of 94 patients were enrolled in 3 trials studying budesonide (9 mg daily or in a tapering schedule for 6 to 8 weeks). The pooled odds ratio for clinical response to treatment with budesonide was 12.32 (95% CI 5.53-27.46), with a number needed to treat of 2 patients. There was significant histological improvement with treatment in all 3 trials studying budesonide therapy. REVIEWER'S CONCLUSIONS: Budesonide is effective for the treatment of collagenous colitis. The evidence for benefit with bismuth subsalicylate is weaker. Prednisolone may be effective for treatment of collagenous colitis, but only a single very small study has been reported. The effectiveness of these and other therapies for induction or maintenance of remission (as opposed to producing clinical or histological improvement) of collagenous colitis is unknown.

Anti-Inflammatory Agents↗
PubMed2002

Interventions for treating collagenous colitis.

BACKGROUND: Collagenous colitis is a disorder that is recognized as a cause of chronic diarrhea. Treatment has been based mainly on anecdotal evidence. This review was performed to identify therapies for collagenous colitis that have been proven in randomized trials. OBJECTIVES: To determine effective treatments for patients with clinically active collagenous colitis. SEARCH STRATEGY: Relevant papers published between 1970 and January 2002 were identified via the MEDLINE, PUBMED, and EMBASE databases. Manual searches from the references of identified papers, as well as review papers on collagenous or microscopic colitis were performed to identify additional studies. Abstracts from major gastroenterological meetings were searched to identify research submitted in abstract form only. Finally, the Cochrane Controlled Trials Register and the Cochrane Inflammatory Bowel Disease Group Specialized Trials Register were searched for other studies. SELECTION CRITERIA: Four randomized trials were identified. One trial studied bismuth subsalicylate (published in abstract form only), and 3 trials (2 published in abstract form only) studied budesonide in the therapy of collagenous colitis. DATA COLLECTION AND ANALYSIS: Data were extracted independently by each author onto 2x2 tables (treatment versus placebo and response versus no response). For therapies assessed in one trial only, p-values were derived using the chi-square test. For therapies assessed in more than one trial, summary test statistics were derived using the Peto odds ratio and 95% confidence intervals. Data were combined for analysis only if the outcomes were sufficiently similar in definition. MAIN RESULTS: There were 9 patients with collagenous colitis in the trial studying bismuth subsalicylate (nine 262 mg tablets daily for 8 weeks). Those randomized to active drug were more likely to have clinical (p=0.003) and histological (p=0.003) improvement than those assigned to placebo. A total of 86 patients were enrolled in 3 trials studying budesonide (9 mg daily for 6 to 8 weeks). The pooled odds ratio for clinical response to treatment with budesonide was 16.79 (95% CI 7.28-38.74), with a number needed to treat of 2 patients. There was significant histological improvement with treatment in all 3 trials studying budesonide therapy. REVIEWER'S CONCLUSIONS: Budesonide is effective in the treatment of collagenous colitis. The evidence for bismuth subsalicylate is weaker, but still important. The roles of these and other therapies in inducing or maintaining remission (as opposed to clinical or histological improvement) of collagenous colitis are unknown.

Anti-Inflammatory Agents↗
PubMed2002

Toward an accountability framework for Canadian healthcare.

State-funded healthcare systems increasingly recognize accountability as an important public policy issue. This article explores significant aspects of current theory and practice in order to describe an accountability framework for the Canadian health system. Stakeholders include governments, institutions, providers and patients. Their relationships may be framed in constitutional, political, financial, managerial, clinical or ethical terms. The specific processes and instruments to operationalize accountability depend on the terms by which it is framed.

Canada↗
PubMed2000

Oral 5-aminosalicylic acid for inducing remission in ulcerative colitis.

OBJECTIVES: To assess the efficacy, dose-responsiveness and safety of the newer release formulations of 5-aminosalicylic acid (5-ASA) compared to placebo or sulfasalazine (SASP) for the induction of remission in active ulcerative colitis. SEARCH STRATEGY: A computer-assisted literature search for relevant studies (1981-1998) was performed using MEDLINE, BIOS, the Cochrane Controlled Trials Register and the Science Citation Index, followed by a manual search of reference lists from previously retrieved articles, review articles, symposia proceedings, and abstracts from major gastrointestinal conferences. SELECTION CRITERIA: Studies were accepted for analysis if they were randomized, double-blinded, and controlled clinical trials of parallel design, with treatment durations of a minimum of four weeks. DATA COLLECTION AND ANALYSIS: Based on an intention to treat principle, the outcomes of interest in the treatment of active disease were the failure to induce global/clinical remission, global/clinical improvement, endoscopic remission, or endoscopic improvement. MAIN RESULTS: 5-ASA was superior to placebo with regard to all measured outcome variables. For the failure to induce global/clinical improvement or remission, the pooled Peto odds ratio was 0.51 (95% CI, 0.35 to 0.76). A dose-response trend for 5-ASA was also observed. When 5-ASA was compared to SASP, the pooled Peto odds ratio was 0.87 (CI, 0.63 to 1.21) for the failure to induce global/clinical improvement or remission, and 0.66 (CI, 0.42 to 1.04) for the failure to induce endoscopic improvement. SASP was not as well tolerated as 5-ASA. REVIEWER'S CONCLUSIONS: The newer 5-ASA preparations were superior to placebo and tended towards therapeutic benefit over SASP. However, considering their relative costs, a clinical advantage to using the newer 5-ASA preparations in place of SASP appears unlikely.

Aminosalicylic Acids↗
PubMed2000

Sociodemographic and workload characteristics of dentists who participated in national survey, 1995.

Comprehensive, standardized data on the sociodemographic characteristics and workload of dentists in different provinces and territories in Canada are not available. The authors mailed a survey to a stratified random sample of dentists (n = 6,444) with three follow-up attempts. The response rate was 66.4%. Significant provincial and territorial differences in sociodemographic characteristics included gender, age, years since graduation, marital status, population size of town or city where primary practice is located and patient load. There was considerable variation in dentists' workload: more than 10% of dentists from New Brunswick and Prince Edward Island reported seeing > or = 30 patients per day. The majority of respondents reported seeing patients for 25 to 40 hours per week. British Columbia, Ontario, Saskatchewan and Newfoundland had a greater proportion of respondents > or = 60 years of age compared with other provinces/territories, indicating that there may be more opportunities in these provinces for younger dentists as a result of retirements.

Adult↗
PubMed1999

Compliance with recommended infection control procedures among Canadian dentists: results of a national survey.

OBJECTIVES: The objective of this study was to investigate compliance with recommended infection control (IC) practices by dentists in Canada in 1995. DESIGN: A mailed survey of a stratified random sample of dentists (N = 6444), with 3 follow-up attempts. Weighted analyses included multiple logistic regression to identify the best predictors of "excellent" compliance (18 items). RESULTS: The adjusted response rate was 66.4%. Respondents reported use of an IC manual (52%); postexposure protocol (41%); biologic monitoring of heat-sterilizers (71%); hepatitis B immunization of dentists (91%: of these 72% had post-immunization screening; natural immunity 3%) all hygienists (78%), and all other clinical staff (70%); handwashing (before treating patients 76%, after degloving 63%); always wearing gloves (95%); changing gloves after each patient (97%); masks (82%); protective eyewear (82%); protective uniform (48%); puncture-proof container for sharps (94%); recapping needles with scoop technique/device (60%); flushing waterlines (55%); heat-sterilizing handpieces (94%; after each patient 77%); high-volume suction (92%) and "excellent" compliance (6%). Significant predictors of "excellent compliance" included attending continuing education about IC (>/=10 hours, odds ratio [OR] = 6.3; 6-10 hours, OR = 3.3), treating 20 to 29 patients per day (OR = 2.8), being women (OR = 2.7), and population of city in which practice is located (>500,000, OR = 2.5). CONCLUSION: Improvements in IC are necessary in dental practice. The introduction of mandatory continuing education about IC may improve compliance with recommended IC procedures, which is important because of concerns related to transmission of bloodborne pathogens and drug-resistant microorganisms.

Adult↗
PubMed1999

Providers' perceptions of an immunization registry.

OBJECTIVE: To determine providers' perceptions of a statewide immunization registry. DESIGN: Mail survey. SETTING: King County, Washington. METHODS: A random sample of 700 pediatricians, family physicians, and RN/NPs were surveyed. In addition to their perceptions of registries, respondents reported their immunization procedures in the absence of immunization histories. RESULTS: Of 544 eligible participants, 344 returned surveys (63% response rate). Seventy-seven percent of RN/NPs, 60% of pediatricians and 47% of family physicians (p < 0.001) responded that they thought that electronic immunization registries represented the "best chance to solve the lack of documentation problem." Fifty-seven percent of RN/NPs, 61% of pediatricians, and 43% of family physicians reported that the incompleteness of registry data presented a barrier to their using one (p < 0.01). Fewer than 14% of all specialties had concerns about potential compromises of patient confidentiality as a result of registries, although RN/NPs were more concerned about this possibility than both pediatricians and family physicians (p = 0.02). In a multivariate analysis, pediatricians were 43% less likely (p = 0.15) and family physicians were 73% less likely (p < 0.01) than RN/NPs to think registries are the solution to the lack of documentation problem. Familiarity with the existing registry was associated with a significant decrease in the likelihood of thinking that registries are the solution (OR .49 [.26-.90]) and an increase in the likelihood of thinking that registries will take a long time to become of practical value (OR 2.21 [1.09-4.29]). CONCLUSIONS: Specialties differ with respect to their opinions regarding the promise immunization registries hold. Immunization registries appear to be well regarded in theory but may disappoint in practice. Incompleteness of immunization data may be the largest obstacle for registries to overcome.

Adult↗
PubMed1999

Occupational injuries and exposures among Canadian dentists: the results of a national survey.

OBJECTIVES: To measure the frequency of occupational exposures reported by dentists in Canada and to identify factors associated with occupational exposure. DESIGN: A national mailed survey of a stratified random sample of 6,444 dentists with three follow-up attempts. Weighted data were analyzed using t tests, analysis of variance, and multiple logistic regression. RESULTS: The response rate was approximately 66%. Occupational exposures, percutaneous injuries, and mucous membrane exposures in the last year were reported by 67%, 62%, and 29% of respondents, respectively. Fewer than 1% reported exposure to human immunodeficiency virus or hepatitis B virus (HBV). Respondents reported means of 1.5 mucous membrane and 3.0 percutaneous exposures per year. HBV immunization was reported by 91% of dentists, but of these 28% reported no post-immunization serology. Other reports of suboptimal compliance included use of a postexposure protocol by only 41% and HBV vaccination of all assistants or of hygienists by 74% and 77% of respondents, respectively. Factors associated with percutaneous exposure included non-use of postexposure protocol or puncture-proof containers for sharps disposal, treating > or =20 patients per day, and male gender. Risk factors for mucous membrane exposure included non-use of eye protection or masks. CONCLUSION: This study provides evidence of the protective effect of puncture-proof containers, eye protection, and masks and raises concerns related to HBV post-immunization serology and postexposure protocols. To reduce risk of infection, educational interventions are required to improve compliance with Universal Precautions, with emphasis on comprehensive HBV immunization and post-immunization serology, the use of barriers, puncture-proof containers for sharps disposal, and postexposure protocols.

Adult↗
PubMed1999

The role of age- and population-based differences in the attitudes, knowledge and infection control practices of Canadian dentists.

OBJECTIVES: To investigate age- and population-based differences in dentists' infection control practices and willingness and refusal to treat patients with HIV. METHODS: A national mailed survey of a stratified random sample of dentists in Canada (n = 6444) with three follow-up attempts. Pearson's chi-square test and multiple logistic regression were used for data analysis. Predictor variables included population, age, gender, marital status, specialty, number of patients treated per day and continuing education on HIV/AIDS. RESULTS: The adjusted response rate was 66.4%. The best predictors of willingness to treat patients with HIV were younger age (compared with dentists > or = 60 years of age: < 30 years, OR = 8.6, 30-39, OR = 3.4; 40-49, OR = 2.7; 50-59, OR = 1.6), attending continuing education on HIV/AIDS in the past 2 years (> 10 hours, OR = 1.6 compared with zero hours), practicing in small population centres < 10,000 (OR = 1.6 compared with > 500,000) and gender (male OR = 1.3). The best predictors of refusal to treat patients with HIV were older age (compared with dentists < 30 years of age: > or = 60, OR = 6.1; 50-59, OR = 4.1; 40-49, OR = 3.0; 30-39, OR = 2.6); and practicing in population centres > 500,000 (OR = 1.5 compared with < 10,000). However, the latter group also reported treating more HIV patients than respondents in smaller communities. Infection control practices varied significantly with age and population centre. Dentists in communities of < 10,000 were more compliant with HBV vaccination, but less compliant with handwashing after degloving and the use of infection control manuals. Similarly, dentists > 60 years of age were the least compliant with HBV immunization, routine use of barriers and sterilization of handpieces, but reported the highest compliance with handwashing. CONCLUSIONS: Age- and population-based differences need to be considered in planning educational interventions to improve both access to care for patients with HIV and dentists' compliance with recommended infection control procedures.

Adult↗
PubMed1999

Factors associated with refusal to treat HIV-infected patients: the results of a national survey of dentists in Canada.

OBJECTIVES: This study investigated dentists refusal to treat patients who have HIV. METHODS: A survey was mailed to a random sample of all licensed dentists in Canada, with 3 follow-up attempts (n = 6444). Data were weighted to allow for probability of selection and nonresponse and analyzed with Pearson's chi 2 and multiple logistic regression. RESULTS: The response rate was 66%. Of the respondents, 32% had knowingly treated HIV-infected patients in the last year; 16% would refuse to treat HIV-infected patients. Respondents reported willingness to treat HIV-infected patients (81%), injection drug users (86%), hepatitis B virus-infected patients (87%), homosexual and bisexual persons (94%), individuals with sexually transmitted disease(s) (94%), and recipients of blood and blood products (97%). The best predictors of refusal to treat patients with HIV were lack of ethical responsibility (odds ratio = 9.0) and items related to fear of cross-infection or lack of knowledge of HIV. CONCLUSIONS: One in 6 dentists reported refusal to treat HIV-infected patients, which was associated primarily with respondents' lack of belief in an ethical responsibility to treat patients with HIV and fears related to cross-infection. These results have implications for undergraduate, postgraduate, and continuing education.

Adult↗
PubMed1999

Dentists and HIV.

Explore the source record for details and available documents.

Attitude of Health Personnel↗
PubMed1999

Infection control practices across Canada: do dentists follow the recommendations?

This study investigated provincial and territorial differences in dentists' compliance with recommended infection control practices in Canada (1995). Questionnaires were mailed to a stratified random sample of 6,444 dentists, of whom 66.4% responded. Weighted analyses included Pearson's chi-square test and multiple logistic regression. Significant provincial and territorial differences included testing for immune response after hepatitis B virus (HBV) vaccination, HBV vaccination for all clinical staff, use of infection control manuals and post-exposure protocols, biological monitoring of heat sterilizers, handwashing before treating patients, using gloves and changing them after each patient, heat-sterilizing handpieces between patients, and using masks and uniforms to protect against splatter of blood and saliva. Excellent compliance (compliance with a combination of 18 recommended infection control procedures) ranged from 0% to 10%; the best predictors were more hours of continuing education on infection control in the last two years, practice location in larger cities (> 500,000) and sex (female). Clearly, improvements in infection control are desirable for dentists in all provinces and territories. Extending mandatory continuing education initiatives to include infection control may promote better compliance with current recommendations.

Canada↗
PubMed1998

Improved compliance with recommended infection control practices in the dental office between 1994 and 1995.

OBJECTIVE: To investigate changes in Ontario dentists' infection control practices between 1994 and 1995. METHODS: Data from responses of 4003 dentists to a 1994 survey and responses of 987 dentists to a 1995 survey were compared by using descriptive statistics from all respondents and McNemar's test for paired data from those participating in both surveys. RESULTS: Response rates were 70% (1994) and 62% (1995). There were improvements in reports of routine use of gloves (92% to 94%); masks (73% to 79%); and protective eyewear (83% to 84%); vaccination for hepatitis B virus (HBV) or naturally acquired immunity of dentists (93% to 94%); HBV vaccination of clinical staff (64% to 77%); heat sterilization of handpieces (83% to 95%); and no extra precautions for patients with HIV (13% to 48%). Pairwise comparison of data for 788 dentists participating in both surveys showed statistically significant increases in reports of all practices except use of protective eyewear. The 1995 follow-up data also indicated low compliance with handwashing (74% before treating each patient; 62% after removing gloves); flushing water lines after treating each patient (54%); and using postexposure protocol for needlesticks and cuts (36%). CONCLUSIONS: Dentists' reports of compliance with recommended infection control practices and universal precautions against HBV and HIV infection increased between 1994 and 1995, but most dentists apparently have not adopted universal precautions. More education is needed to promote universal precautions, HBV vaccination for clinical staff, handwashing, and postexposure protocol.

Dental Offices↗
PubMed1998

A comparison of infection control practices of different groups of oral specialists and general dental practitioners.

OBJECTIVE: The purpose of this study was to compare the infection control practices of general dentists and dental specialty groups. METHODS: A survey was mailed to 5997 dentists in 1994; the response rate was 70%. The data were analyzed with multiple logistic regression (reference group: general dentists). RESULTS: When sociodemographic influences were taken into consideration, significant predictors of routine infection control practices included all of the following characteristics (odds ratios are in parentheses): 1. Gloves: being younger than 40 years of age (4.5) and being female (5.9). 2. Using gloves and changing gloves after each patient: being younger than 40 years of age (4.0), being female (3.0), being an oral surgeon (3.6), and being an orthodontist (0.2). 3. Using gloves, masks, and protective eyewear: being younger than 40 years of age (2.5), being female (2.3), and being an orthodontist, oral physician, or oral pathologist (0.2). 4. Hepatitis B vaccination for the practitioner: being younger than 40 years of age (5.1). 5. Hepatitis B vaccination for all clinical staff members: being younger than 40 years of age (1.2), being an oral surgeon (1.7), and being an orthodontist (0.6). 6. Heat sterilization of handpieces: being younger than 40 years of age (1.5), being an oral surgeon (5.4), and being an orthodontist (0.2). 7. Taking no additional precautions for patients with HIV: being younger than 40 years of age (1.7), being a periodontist (2.6), being a pedodontist (2.3), and being an oral physician/oral pathologist (4.3). CONCLUSION: Improved compliance with recommended infection control procedures is required for all groups and is particularly necessary for orthodontists.

Adult↗