Journal of the American Academy of Child & Adolescent Psychiatry, 2007
We examined baseline demographic and clinical profiles of youths enrolled from 2001 to 2006 in th... more We examined baseline demographic and clinical profiles of youths enrolled from 2001 to 2006 in the publicly funded multicenter, randomized controlled trial Treatment of Early-Onset Schizophrenia Spectrum Disorders. Youths (8-19 years) with schizophrenia (SZ) and schizoaffective disorder were recruited at four academic sites. Diagnosis was made via structured and clinical interviews. Assessments of psychiatric symptoms and social and global functioning were included. A total of 119 youths were enrolled. The mean age at illness onset was 11.1 +/- 3.5 years. Patients with SZ and schizoaffective disorder had similar ratings on the Positive and Negative Symptom Scale, Brief Psychiatric Rating Scale for Children, and Clinical Global Impression-Severity Scale. The overall level of functioning was similar in the two groups. A comparison to published reports of adults with SZ indicates that these youths may have more severe symptoms based on results of the Positive and Negative Symptom Scale. This is one of the largest samples of youths with SZ spectrum disorders studied to date and the largest assessment of youths with schizoaffective disorder. High rates of symptoms and general psychopathology were noted. There was a substantial degree of social and functional impairment. The symptom profiles are consistent with, but more severe than, those reported in the adult literature.
Little is known about the relationship between blood pressure (BP) and the short-term management ... more Little is known about the relationship between blood pressure (BP) and the short-term management costs of hypertension care. The CHOICE study enrolled 512 patients newly diagnosed with hypertension in 55 physician practices. Patients practiced ordinary care while documenting medications, BP, and resource use. Time to next office visit was modeled as a function of BP using COX regression. Resource use
Controversy persists about the most efficient allocation of healthcare funds for cardiovascular d... more Controversy persists about the most efficient allocation of healthcare funds for cardiovascular disease prevention. Previous economic analyses have generally focused on primary or secondary prevention as discrete categories. To address the information required by decision-makers to distribute budgets optimally across an entire population at risk in view of recommendations promulgated by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). The Continuum of Risk Evaluation (CORE) model is an individual patient simulation of the occurrence of cardiovascular disease allowing for analyses over a broad range of risk. All events are tallied, costs are applied, and survival is modified accordingly. Disaggregated presentation of the results allows decision-makers to evaluate the budgetary implications and cost effectiveness of different strategies according to the risk at which treatment is initiated. This process is illustrated for the United States using inf...
Background: Success in treating hypertension is greater in clinical trials than in actual practic... more Background: Success in treating hypertension is greater in clinical trials than in actual practice. To prospectively study real-world antihypertension treatment patterns, therefore, naturalistic studies are essential. Objective: The primary objective of the Caring for Hypertension on Initiation: Costs and Effectiveness (CHOICE) study was to evaluate the feasibility of performing a naturalistic study in patients with newly diagnosed hypertension in terms of enrollment, adequacy, and the timeliness of data collection and study procedures. Methods: The CHOICE study prospectively collected actual practice data from physicians, who were blind to the study purpose and hypotheses, treating newly diagnosed hypertensive patients. The initial therapy was randomly assigned to either Group 1 (diuretics or beta-adrenoceptor antagonists) or Group 2 (calcium channel antagonists or ACE inhibitors). The protocol made no demands on usual medical care in scheduling visits and changing treatment during...
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 12, 1999
Despite the existence of efficacious medications, many patients in actual practice remain with un... more Despite the existence of efficacious medications, many patients in actual practice remain with uncontrolled hypertension. Randomized clinical trials, cannot address this issue well given their highly restricted environment. This paper examines persistence with antihypertensive therapy among patients in actual practice. Cohort study of patients who received a diagnosis of hypertension and were treated between 1989 and 1994 identified through the Saskatchewan Health databases. Patients with concurrent diagnoses likely to affect initial treatment choice were excluded. The resulting population of 79,591 subjects was grouped into those with established hypertension (52,227 [66%]) and those with newly diagnosed hypertension (27,364 [34%]). The initial antihypertensive prescription, subsequent changes in treatment and persistence with antihypertensive therapy were analysed. Persistence with antihypertensive therapy decreased in the first 6 months after treatment was started and continued t...
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 12, 1999
Rational medical decisions should be based on the best possible evidence. Clinical trial results,... more Rational medical decisions should be based on the best possible evidence. Clinical trial results, however, may not reflect conditions in actual practice. In hypertension, for example, trials indicate equivalent antihypertensive efficacy and safety for many medications, yet blood pressure frequently remains uncontrolled, perhaps owing to poor compliance. This paper examines the effect of initial choice of treatment on persistence with therapy in actual practice. The authors examined all outpatient prescriptions for antihypertensive medications filled in Saskatchewan between 1989 and 1994 by over 22,000 patients with newly diagnosed hypertension whose initial treatment was with a diuretic, beta-blocker, calcium-channel blocker or angiotensin-converting-enzyme (ACE) inhibitor. Rates of persistence over the first year of treatment were compared. After 6 months, persistence with therapy was poor and differed according to the class of initial therapeutic agent: 80% for diuretics, 85% for ...
There are quite a few disorders for which regulatory agencies have required a treatment to demons... more There are quite a few disorders for which regulatory agencies have required a treatment to demonstrate a statistically significant effect on multiple endpoints, each at the one-sided 2.5% level, before accepting the treatment's efficacy for the disorders. Depending on the correlation among ...
Introduction Positron emission tomography (PET) is an imaging technique that has the capability o... more Introduction Positron emission tomography (PET) is an imaging technique that has the capability of studying neurotrans-mitter receptor distribution in vivo. Using this technique, it is possible to acquire an index of receptor density in vivo in human brain, assuming that an adequate ...
Journal of the American Academy of Child & Adolescent Psychiatry, 2007
We examined baseline demographic and clinical profiles of youths enrolled from 2001 to 2006 in th... more We examined baseline demographic and clinical profiles of youths enrolled from 2001 to 2006 in the publicly funded multicenter, randomized controlled trial Treatment of Early-Onset Schizophrenia Spectrum Disorders. Youths (8-19 years) with schizophrenia (SZ) and schizoaffective disorder were recruited at four academic sites. Diagnosis was made via structured and clinical interviews. Assessments of psychiatric symptoms and social and global functioning were included. A total of 119 youths were enrolled. The mean age at illness onset was 11.1 +/- 3.5 years. Patients with SZ and schizoaffective disorder had similar ratings on the Positive and Negative Symptom Scale, Brief Psychiatric Rating Scale for Children, and Clinical Global Impression-Severity Scale. The overall level of functioning was similar in the two groups. A comparison to published reports of adults with SZ indicates that these youths may have more severe symptoms based on results of the Positive and Negative Symptom Scale. This is one of the largest samples of youths with SZ spectrum disorders studied to date and the largest assessment of youths with schizoaffective disorder. High rates of symptoms and general psychopathology were noted. There was a substantial degree of social and functional impairment. The symptom profiles are consistent with, but more severe than, those reported in the adult literature.
Little is known about the relationship between blood pressure (BP) and the short-term management ... more Little is known about the relationship between blood pressure (BP) and the short-term management costs of hypertension care. The CHOICE study enrolled 512 patients newly diagnosed with hypertension in 55 physician practices. Patients practiced ordinary care while documenting medications, BP, and resource use. Time to next office visit was modeled as a function of BP using COX regression. Resource use
Controversy persists about the most efficient allocation of healthcare funds for cardiovascular d... more Controversy persists about the most efficient allocation of healthcare funds for cardiovascular disease prevention. Previous economic analyses have generally focused on primary or secondary prevention as discrete categories. To address the information required by decision-makers to distribute budgets optimally across an entire population at risk in view of recommendations promulgated by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). The Continuum of Risk Evaluation (CORE) model is an individual patient simulation of the occurrence of cardiovascular disease allowing for analyses over a broad range of risk. All events are tallied, costs are applied, and survival is modified accordingly. Disaggregated presentation of the results allows decision-makers to evaluate the budgetary implications and cost effectiveness of different strategies according to the risk at which treatment is initiated. This process is illustrated for the United States using inf...
Background: Success in treating hypertension is greater in clinical trials than in actual practic... more Background: Success in treating hypertension is greater in clinical trials than in actual practice. To prospectively study real-world antihypertension treatment patterns, therefore, naturalistic studies are essential. Objective: The primary objective of the Caring for Hypertension on Initiation: Costs and Effectiveness (CHOICE) study was to evaluate the feasibility of performing a naturalistic study in patients with newly diagnosed hypertension in terms of enrollment, adequacy, and the timeliness of data collection and study procedures. Methods: The CHOICE study prospectively collected actual practice data from physicians, who were blind to the study purpose and hypotheses, treating newly diagnosed hypertensive patients. The initial therapy was randomly assigned to either Group 1 (diuretics or beta-adrenoceptor antagonists) or Group 2 (calcium channel antagonists or ACE inhibitors). The protocol made no demands on usual medical care in scheduling visits and changing treatment during...
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 12, 1999
Despite the existence of efficacious medications, many patients in actual practice remain with un... more Despite the existence of efficacious medications, many patients in actual practice remain with uncontrolled hypertension. Randomized clinical trials, cannot address this issue well given their highly restricted environment. This paper examines persistence with antihypertensive therapy among patients in actual practice. Cohort study of patients who received a diagnosis of hypertension and were treated between 1989 and 1994 identified through the Saskatchewan Health databases. Patients with concurrent diagnoses likely to affect initial treatment choice were excluded. The resulting population of 79,591 subjects was grouped into those with established hypertension (52,227 [66%]) and those with newly diagnosed hypertension (27,364 [34%]). The initial antihypertensive prescription, subsequent changes in treatment and persistence with antihypertensive therapy were analysed. Persistence with antihypertensive therapy decreased in the first 6 months after treatment was started and continued t...
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 12, 1999
Rational medical decisions should be based on the best possible evidence. Clinical trial results,... more Rational medical decisions should be based on the best possible evidence. Clinical trial results, however, may not reflect conditions in actual practice. In hypertension, for example, trials indicate equivalent antihypertensive efficacy and safety for many medications, yet blood pressure frequently remains uncontrolled, perhaps owing to poor compliance. This paper examines the effect of initial choice of treatment on persistence with therapy in actual practice. The authors examined all outpatient prescriptions for antihypertensive medications filled in Saskatchewan between 1989 and 1994 by over 22,000 patients with newly diagnosed hypertension whose initial treatment was with a diuretic, beta-blocker, calcium-channel blocker or angiotensin-converting-enzyme (ACE) inhibitor. Rates of persistence over the first year of treatment were compared. After 6 months, persistence with therapy was poor and differed according to the class of initial therapeutic agent: 80% for diuretics, 85% for ...
There are quite a few disorders for which regulatory agencies have required a treatment to demons... more There are quite a few disorders for which regulatory agencies have required a treatment to demonstrate a statistically significant effect on multiple endpoints, each at the one-sided 2.5% level, before accepting the treatment's efficacy for the disorders. Depending on the correlation among ...
Introduction Positron emission tomography (PET) is an imaging technique that has the capability o... more Introduction Positron emission tomography (PET) is an imaging technique that has the capability of studying neurotrans-mitter receptor distribution in vivo. Using this technique, it is possible to acquire an index of receptor density in vivo in human brain, assuming that an adequate ...
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Papers by Joseph Jackson