Category: PhD

Clinical trials are about human dynamics: RCT course in Belfast, May 7-8

As a trialist, the pressure of working on a trial is much bigger than being in a small group educational session. Challenges of implementing a trial are multiple, mainly influenced by the values of outcomes for different people. Whose question is the trial answering? If you’ve ever found yourself puzzled by these issues, you may find some solace in reading my notes from a courseon clinical trials. 


7 instructors and 21 participants – all from Northern Ireland (except 2 Dubliners), 2 medics, three 1-st year PhD students and some professors – talked about clinical trials for two days last week at Queens University Belfast. The aim of the course wasn’t to learn everything, but to think laterally about trials. Professor Clarkecovered the basics of starting trials: formulating a clear research question, deciding on comparisons and placebos and dealing with confounding factors. The 7 main ways of dealing with confounding are:
  1. Matching
  2. Exclusion
  3. Stratified sampling
  4. Standardisation
  5. Multivariate modelling
  6. Randomisation

The pleasures and terrors of trial recruitment were described by Dr Maguire. Everybody struggling with meeting the recruitment targets should read the top 10 tipsfor recruiting into trials at the All-Ireland Hub for Trials Methodology Research website. Trialists should plan for what they’re going to do if things don’t go the way they planned. Recruiters can also become tired and it’s good to think ahead about what would possibly prevent them from recruiting. Even small rewards to recruiters, such as cream eggs, can increase their satisfaction. Satisfaction=Retention. Research networks for General Practitioners can facilitate recruitment.

Dr McAneney introduced us to the role of social networks in clinical trials. We are all connected.  All the users of Facebook can be linked by 3.74 steps. Networks make the trials work or crash. Networks allow diffusion of innovation. Decisions of participants and researchers are influenced by networks.

Prof McAuleyhelped the participants to write the protocol and funding application for their first trial. Publishing a trial protocol sets the bar pretty high for researchers – transparency and accountability are keyIf it’s not possible to publish the protocol in a peer-reviewed journal, then post it online. Every protocol is changed over time and they should be listed on the first page. The CONSORT diagram is an essential part of a protocol. It’s the only slide that’s projected during meetings of grant reviewers.

Dr Shorterand Prof Buntingcontinued with tips for analysing outcomes. The essence of any research is control. Although power calculations for trials seem difficult, they involve only a short sequence of basic steps. Categorical outcomes require more data and more participants than continuous outcomes. Analysis of clinical trials assumes that our participants are all from the same population. The classical assumption of trials analysis was that individual differences do not matter, they were ignored. Another assumption that things are measured perfectly never holds.

Finally, Dr Dunlopfinished the course presentations with ethics and data storage.

How attractive are you for postgraduate students?

700 active research supervisors provide support to post/graduate students in University College Dublin. 17 of them took part in the second out of five last Friday afternoons about research supervisor development. Today’s topic was how to optimise quality applicant attraction. Mr Justin Synnott, Ms Una Condron and Professor Tadhg O’Keeffe explored characteristics of an ‘ideal’ or successful research student:

ii)                   Considering the measurement of applicant ‘success’
iii)                 Optimising your ability to attract desirable applicants
iv)                 Managing applicant expectations
v)                  What International students look for / have concerns about – case study
vi)                 Who sets the doctoral funding agenda / what is Europe’s approach?

Danger on the road

If I knew then… the presentation warned developing supervisors about the dangers of making wrong choices based on wrong expectations. The promotions metrics pressurize some scientists to take many doctoral students. Under pressure, many supervisors make wrong choices. A stressed supervisor typically fears three main things: i) whether the student would complete PhD, ii) if they don’t complete, whether the supervisor would be blamed for it, and iii) whether the thesis would meet the quality standards. A student’s dissertation can be a disaster or a success based on two early warning signs:
1. Ability (motivation is part of ability)
2. Writing – if students’ work isn’t written well, you’re in trouble

As supervisors and scientists, we grow. The speaker illustrated his growth using the PEED model shown in Figure 1 below. With age, concern for Promotions decreases and so do Ego (I care less) and Experience. But the Experience increases over years. The Danger of making wrong choices is biggest at the start. Midway through the career, the conditions for supervising students, as well as supervisors’ ability to make choices, improve.


Figure 1. Peed model


Going international

1.2 billion people live in India, where over 600 universities and 20000 colleges fail to satisfy the growing demand for research training. University College Dublin reached out and started to recruit Indian students. Several roadshows explain the advantages of studying in Ireland to Indian students every year. One of the benefits for supervisors who decide to take on an international student is attracting better fit candidates.

Funding agenda and policy setting

Internationalisation of the university environment remains on the top of agendas of post/graduate research funders. More and more people complete funded doctoral programmes every year. Although the number of PhDs awarded in US over the last couple of years reached 50000, the number of faculty positions didn’t grow so rapidly and stagnates at 5000. The situation is similar in Europe. The question is whether we need so many new PhDs? The growing relationship with industry may offer an answer. A PhD stops being an academia-specific training; acquisition of transferable skills is coming to the forefront of doctoral training, because they can be utilised anywhere outside academia. The challenge for supervisors and universities failing to employ the PhDs is whether they can at least prepare students for some sort of a zig-zag career in- or outside academia.
This post summarised my observations from the UCD Research Supervisor Support and Development Programme Workshop 2: 28-2-14.

A decade in the addictions field

book, envelope, window

Edited March 4, 2020 by janklimas

… or women, men and non-binary folk who mentored me.

Career in addiction health services research can be daunting. There are moments when people in this career path struggle at work. Have you ever been in that situation yourself? Here’s my story.

Needle exchange movie at 16

The internet was still a toddler and I watched the TV rarely. But when I turned on the box on one of such occasions, a summer afternoon, I was brought into the streets of the Slovakian capital, Bratislava, which was a world far far away for me. Young social work students backpacked those streets with bags full with clean needles and distributed them to drug users and sex workers; they talked about what this exciting and controversial pastime meant for them. They worked for a needle exchange project – Odyseus – and I wanted to do it too. I was excited to help drug users in the same way these women did, but I had to wait a couple of years until I grew up.

At that time, they still called it ‘Street work’ which later became ‘Terrain Social Work’. In the following years, I learned from my future boss that the Slovakian public TV screened the film quite often, but mainly as a filler in the downtime hours.

Unanswered phone call at 20

After acceptance at the psychology degree, my world changed and the range of my interests expanded. Nevertheless, I never forgot about that documentary. It was in the second year when I saw a poster at our university board, at advertised Needle Exchange as a part time job for students. I picked up a public phone and dialled a number from the poster – following my teenage dream. Nobody picked it up, so I left a message which too remained unanswered, forever. The number on the advert wasn’t for the Needle Exchange which the documentary talked about, but I didn’t know it at that time. By chance, I ended up working for the agency from the documentary movie because they had an email address posted on the internet and were more responsive than the project which advertised on our student board.

Student project at 21

Part of my comprehensive exam in the 3rd year of my undergrad was a research project. As most of my friends, I struggled with access to patients. Because of that, almost everyone did a literature review – without having a clue what we were doing. I chose the role of family and drugs as my topic, but it wasn’t an easy choice. At that time, my interest in drugs was drifting away and I felt like researching something else, for example depression or disabilities. I don’t remember how I ended up with drugs again, but my review led to working with Dr Timulak, and eventually, to my MSc and PhD projects.

Dr Peter Halama, PhD and Hungarian trams at 25

Dr Halama, PhD was this new face at the Trnava University, when I wrapped up my comprehensive exam. They were good friends with Dr Timulak and when I asked him about ideas for my MSc research, he said that Dr Halama was doing some interviews with drug users. Two years later, I found myself co-presenting our findings with Peter at a psychotherapeutic conference in Slovakia. Read more about that research here. From there, it was easy to continue in my research with Peter at a doctoral level. I enrolled as a part time student in Social Psychology, which did not convince him that I would finish it. When I announced – after two years of studies – that I’m moving to Hungary for a year, I think Peter had a hard time suppressing his doubts that I would finish my PhD from Hungary. My Hungarian adventure was, however, a real turning point. I had to commute between offices and spent long hours in trams. Being too bored of watching cars and people pass by, I started to read open access articles which I downloaded from internet the previous day. Some were more interesting, others less, but when I found something really relevant to my work, I felt like a gold miner who just dug his jewel out of piles of dirt. My passion grew stronger with every new paper.

Irish job hunt at 28

When we arrived to Ireland in early Autumn 2008, all I had was a small EU grant with a budget of 3000 euros and an unclear host organization. We managed to survive for almost a year with a great help of my wife’s EVS stipend and occasional p/t jobs. The work on my PhD and the EU grant took most of my time, leaving only a couple of hours for finding a more stable position. When I eventually ran out of money, it was late winter and the job market had dried up. I submitted my resume to many advertisements, including a research job on men’s sexual health. I must say that research was not on my list of Top 5 jobs, but when this position came up after 8 hopeless months of job hunt it was a true God-send. The pictured ad initially offered a PhD post in drugs research, but at the interview, my current boss – Prof Walter Cullen – told me about a p/t place on the same project. That’s how I came to research drinking among methadone patients in primary care at UCD.

Dr Dennis McCarty, PhD at 31

OK, I know I said that there were 5 key decisions earlier, but there has been a lot going on recently. In July 2011, I have been to a summer school on drugs in Amsterdam, Netherlands – no one could imagine a better place for this adventure. Dr McCarty, lectured for several days on different policy models and evidence based treatments. Two years later, I’m sitting in an office down the hall from Dr McCarty’s office, writing my final report about the INVEST fellowship. Visit this post to read more about how I got here. I did not think that the summer school would lead to a fellowship in Portland, OR and I’m most grateful that it did.

With Dennis, I have learned about things I thought did not exist. For example, about researchers who enjoy writing. Writing up research projects is a task that many new researchers fear the most. Dennis is a master writer and his craft is contagious; I’ve discovered a need in me, a strong urge to write a lot and in many different formats. I hope this ‘fire’ will keep on burning for at least another 10 years.

Engage in not for profit organizations.

Two organizations jump started my work in non-profits, the University Pastoral Centre and a youth club. I learned the power of community building through youth activism with John Lesondak and taught team building for non-profits with Ivan Humenik. With Ivan and friends, we also had a musical band, JK& band. These activities inspired me to get involved in the community projects for people who use drugs.

Access mentors in voluntary service programs.

Petra a Ivan Sedliacik connected us to the world through the European Voluntary Service, which is a training program of the European Union. My youth exchange training took part in Budapest, Hungary, and a small suburban town called Goddollo with Zsuzsa Szabo. I was trained as European volunteer, improving soft skills and contributing to the common good. Petra and Ivan continued to support me throughout my training and shared their own experiences from living abroad and being European volunteers.

Be a life-long learner.

A Leonardo Da Vinci Scholarship, which was European Union’s Lifelong Learning Program, took me to Cork city on the south of Ireland. Geoff Dickson mentored me in the city’s YMCA. A few miles away, in Ballincolig, Ivan McMahon overlooked my evaluation of youth programs for early school leavers and single moms. It was great to see the practical application of science in Ireland while doing my part time doctoral degree. I got to evaluate training programs, develop program databases and identify best practice approaches for real life problems by searching the literature.

Write outside your comfort zone.

While writing scholarly articles is difficult itself, one can easily fall asleep their comfort zone. I stepped out of this zone in 2013 when I enrolled in a prompt-based creative writing workshop in Portland, OR, housed by the state’s largest bookstore, the Powell’s books on Burnside street (https://writearound.org/). This is when I began to take my writing interests seriously thanks to our volunteer instructor, Matt Blair. His workshop re-invigorated my passion for writing and taught me the value of daily writing practice.

Trust: the usual suspect in the addiction story

Believe me, or not, trust is something that has been emphasized in addiction treatment for many years. One can hardly argue that it has become one of the usual suspects in the life stories of most recovering drug users.

In this post, I write about two main findings of my latest research published in the current issue of the Czech academic journal Adiktologie (Addictiology). Although they may not be the key findings, which I discovered, this blog gives me an opportunity to illuminate what I feel people should take away from this paper.

 

 


This comes with no surprise – trust is key for building or restoring relationships of all people. No matter if they have drug problems, or not. In this way, my research confirmed what common sense tells us without any special knowledge of research. Re-prioritisation of relationships during treatment was facilitated by the experience of help, support and restoration of trust in relationships.

Because I was able to look at the pre-recovery years of drug users lives, when they actively used drugs, I could go with the trust issue a little further. Changes in relationship priority during active drug use occurred on the basis of barriers (e.g. the need to obtain drugs, stigma), which restrained active drug users from engaging in and maintaining the social relationships.

 

This research has further deepened my understanding of how problem drug users function and indeed how similar they are to people who don’t have drug problems. Some readers may not like this, but they may be less different to ‘us’ than we thought. The key factors that keep them function in a way that is hardly acceptable  by the main-stream population are drug-related barriers. These barriers prevent them from engaging in the usual social life pleasures, such as keeping in touch with non-drug-using friends, visiting parents etc. My research highlighted that they don’t do these things because they have different priorities, which are not compatible with them (See Figure 1 below).

Saying that they are not bothered with relationships or that they’ve no interest in them is too simplistic, and as suggested by this research, not true. Other research showed that people with drug problems do engage in social relationships, pro-social activities, social relationships, raising children – they just don’t do it in a way that ‘we’ are willing to accept. The question that remains to be answered by future research is what would happen if the barriers of engaging in culturally-acceptable social activities were removed? Would ‘they’ be more like ‘us’? The first signals supporting this question come from the opioid agonist treatment. People maintained on pharmaceutical opioids, substituting their illicit drug use, lead more stable lives, commit less crime and have better chances of being employed than people without these substitutes.


Original abstract:
Background: interpersonal problems among drug users (DU) are frequent, are related to other problems, and improve during the addiction treatment.
Aims: to better understand changes in relationships which occur in the course of drug use and drug treatment, as well as their subjective appraisal by ex-drug users, using retrospective methodology.
Method: semi-structured interviews with DUs in a therapeutic community (TC) were analysed with descriptive-interpretive method. The coding of interview transcripts into categories was performed in two phases using qualitative software NVivo 7. Five interviews were coded in the pilot phase, followed by an audit by an external psychologist and progressive coding of the rest of the transcripts, with data saturation being reached in the second phase.
Participants: nine male and one female client, aged 18-36 years (mean: 25.9), participated in the study and the length of their stay in the TC was 2-35 months (mean: 9.9). The approximate mean age of drug use onset was 15.6 years (12-28).
Results: the analysis provided 21 categories which were divided into three domains based on chronological order. Changes in relationship priority during active drug use occurred on the basis of barriers (such as the need to obtain drugs and stigma), which restrained active DUs from engaging in and maintaining their social relationships. Re-prioritisation of relationships during treatment was facilitated by the experience of help, support and the restoration of trust in relationships.
Conclusions: this study builds on the previous work exploring the broad issue of social consequences of drug use and offers clients’ perspective on this topic.
Cite as: Klimas, J. (2012) Interpersonal relationships during drug use and treatment from the perspective of clients in a therapeutic community. [Interpersonálne vzťahy v priebehu užívania drog a liečby závislosti z pohľadu klientov/iek v terapeutickej komunite.]. Adiktologie (12)1, 36-45
More at: www.adiktologie.cz

Figure 1. Evolution of relationships during drug use, addiction and treatment