John Jordan

Prostate cancer screening: Canadian guidelines 2011

The goal of prostate cancer (PCa) screening is to reduce the morbidity and mortality from this disease through early detection. There has been a steady decline in PCa mortality following the introduction of PSA testing in the late 1980s.1 However, phase III trials on PCa screening have demonstrated a high number needed to treat, suggesting many PCas diagnosed were not destined to have an impact on a patient’s overall survival.2,3 (Level 1 Evidence.) We review the literature on PCa screening and describe what contemporary screening entails. We offer guidelines to facilitate the discussion of the risks and benefits of PCa screening. These guidelines are recommendations; they are not a standard of care for all patients and should not pre-empt a physician’s clinical judgment.

Randomized trial of distance-based treatment for young children with discipline problems seen in primary health care

Objective. Many parents of preschool-age children have concerns about how to discipline their child but few receive help. We examined the effects of a brief treatment along with usual care, compared with receiving usual care alone. Patients. Parents (N = 178) with concerns about their 2- to 5-year olds’ discipline were recruited when they visited their family physician at 1 of 24 practices. Methods. After completing mailed baseline measures, parents were randomly assigned to receive usual care or the Parenting Matters intervention along with usual care. Parenting Matters combined a self-help booklet with two calls from a telephone coach during a 6-week treatment period. Follow-up assessments were completed at 7 weeks post-randomization, and 3 and 6 months later. Results. Behaviour problems (Eyberg Child Behaviour Inventory) decreased significantly more in the Parenting Matters condition compared with Usual Care alone, based on a significant time by treatment group effect in intent-to-treat, growth curve analyses (P = 0.033). The Parenting Matters group also demonstrated greater and more rapid improvement than in usual care alone in terms of overall psychopathology (Child Behaviour Checklist, P = 0.02), but there were no group differences in parenting. The overall magnitude of group differences was small (d = 0.15 or less). Conclusion. A brief early intervention combining a self-help booklet and telephone coaching is an effective way to treat mild behaviour problems among young children. This minimal-contact approach addresses the need for interventions in primary health care settings and may be a useful component in step-care models of mental health.

Development of a decision-making tool for reporting drivers with mild dementia and mild cognitive impairment to transportation administrators

BACKGROUND Driving in persons with dementia poses risks that must be counterbalanced with the importance of the care for autonomy and mobility. Physicians often find substantial challenges in the assessment and reporting of driving safety for persons with dementia. This paper describes a driving in dementia decision tool (DD-DT) developed to aid physicians in deciding when to report older drivers with either mild dementia or mild cognitive impairment to local transportation administrators. METHODS A multi-faceted, computerized decision support tool was developed, using a systematic literature and guideline review, expert opinion from an earlier Delphi study, as well as qualitative interviews and focus groups with physicians, caregivers of former drivers with dementia, and transportation administrators. The tool integrates inputs from the physician-user about the patients clinical and driving history as well as cognitive findings, and it produces a recommendation for reporting to transportation administrators. This recommendation is translated into a customized reporting form for the transportation authority, if applicable, and additional resources are provided for the patient and caregiver. CONCLUSIONS An innovative approach was needed to develop the DD-DT. The literature and guideline review confirmed the algorithm derived from the earlier Delphi study, and barriers identified in the qualitative research were incorporated into the design of the tool.

Meconium Staining and Its Effect on Hospital Care During the Neonatal Period

Abstract Objective: to characterize differences in outcome and course of newborn care between births with meconium-stained amniotic fluid and those with clear amniotic fluid. Design: prospective cohort study complemented by retrospective chart review. Setting: London Health Sciences Centre. Participants: all live singleton births delivered at LHSC between January 1 and December 31, 1996. Excluded were multiple births and elective Caesarean sections. Outcome Measures: degree of resuscitation performed on newborns, Apgar scores, paediatric consultations, transfers from newborn nursery to higher level of care, hospital revisit and readmission rates within 30 days of discharge. Results: there were a total of 126 births associated with thick meconium staining, 194 with thin meconium staining, and 52 with terminal meconium only. Resuscitation efforts were undertaken in 54.0 percent of thick meconium births, 32.5 percent of thin meconium births, 30.8 percent of terminal meconium births and 17.3 percent of births with clear amniotic fluid, a significant difference (p Conclusions: presence and degree of meconium-stained amniotic fluid prior to birth predicts an increased likelihood of resuscitative interventions and a possibility of increased intensity of care needed in the first few days of life.