Category: Community

Posts by Jano Klimas about community, collaboration, charity and social welfare.

Two years on blogger Today

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Do talking treatments help problem drinkers who also use illicit drugs? We’re still guessing – by Sarah Chapman

19 Nov 2012

Do talking treatments help problem drinkers who also use illicit drugs? We’re still guessing

shutterstock_98318528

Alcohol Awareness Week starts today, with the theme ‘It’s time to talk about drinking’, so I thought we’d kick-start the week in this bit of the woodland by doing just that. Alcohol Concern’s Hair of the Dog campaign poster displays facts which may well achieve their aim of prompting conversation on this subject, including the surprising information that around 200,000 people will have turned up to work with a hangover today (and people who work are more likely to drink alcohol than unemployed people).
Talking treatments were the focus for a new Cochrane review, published last week, which looked at different psychosocial interventions to reduce alcohol consumption in people with problem alcohol and drug use. Four studies with 594 people were included, comparing cognitive-behavioural coping skills training with 12-step facilitation, a brief intervention with treatment as usual, motivational interviewing with hepatitis health promotion and brief motivational interviewing with assessment only.
Here’s what they found:
  • The only study finding a significant difference found that people in the control group receiving ‘treatment as usual’ drank less alcohol at three and nine months than those receiving a brief intervention.
  • The evidence is weak, coming from low quality studies
  • Studies differed too much for their results to be combined
I was rather surprised to read a positive result favouring the control group, until I discovered that the only additional intervention for the intervention group was a single one-hour talking session. Otherwise, everyone in the trial received ‘treatment as usual’ which included a barrage of things including drugs, medical and psychiatric follow-up AND, wait for it, psychosocial interventions…
The reviewers, not surprisingly, said that
 no conclusion can be made because of the paucity of the data and the low quality of the retrieved studies.
So targeting drug and alcohol use together may be a logical approach, given the high rate of these problems occuring together, but one that still lacks an evidence base. If you want to talk about drinking this week, check-out the drinkaware website for some facts about alcohol and you could use the MyDrinkaware feature to track or cut down your drinking. I’m off now to grab a glass of water, something I definitely don’t drink enough.

Links:

Klimas J, Field CA, Cullen W, O’Gorman CSM, Glynn LG, Keenan E, Saunders J, Bury G, Dunne C. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD009269. DOI: 10.1002/14651858.CD009269.pub2. Cochrane summary 

Sarah Chapman

My name is Sarah Chapman. I have worked on systematic reviews and other types of research in many areas of health for the past 17 years, for the Cochrane Collaboration and for several UK higher education institutions including the University of Oxford and the Royal College of Nursing Institute. I also have a background in nursing and in the study of the History of Medicine.

Read the full article here

Evidence-based solutions for #alcoholharm: Campaigning for change seminar

The wide acceptance of alcohol harms in the Irish society is worrying. Is the proposed public health alcohol bill a step change opportunity for Irish people? Alcohol Action Ireland, an advocacy charity which has been around for more than 10 years, hosted a public seminarwith experts and politicians in the Royal Irish Academy on March 3rd.
Campaigning for Change seminar in Dublin, March 3, 2014 
Minister White opened the night by pledging the government’s goal to reduce the national consumption of alcohol below the OECD average by 2020. The new public health alcohol bill proposes radical measures, such as minimum unit pricing and alcohol advertising ban, which will cause discomfort. Therefore, the government should proceed with evidence-based consensus. A new North-South minimum unit pricing study will bring concrete evidence for the regulations that the bill proposes.
Dil Wickremasinghe, the second-to-speak activist, broadcaster and Director of Insight Matters, shared her story of coming out as a teenage lesbian. Alcohol companies are behind the sponsoring for many LGBT events. The sponsors and culture create an enormous pressure on immigrants to keep up drinking with the local community. Alcohol and socializing go hand in hand in Ireland – We’re Irish, we need a pint to have a good time.
A public health specialist, Dr Bedford talked about his life-long experience of campaigning for alcohol regulations, such as random breathalyzing, which brought immediate drop in the alcohol harms. Because of the success with previous campaigns, he recommended the public health advocacy tool.  If we organize ourselves well, we can get results, but we need to keep the campaign message simple. Celebrities can draw audience to our campaigns, such as Gay Byrne did for the RSA random breath testing. If you’re not in the media in this business, you don’t exist. Repeat the message; repeat the message – same simple message all the time. The public health campaigning is for marathon runners, not sprinters.

Alastair Campbell, a writer, campaigner and a former Director of Communications and Strategy for Tony Blair, pondered when the change comes and how the countries are similar to individuals in their alcohol denial. The leadership comes from people who decide to make change happen; the countries have to admit that they have a problem. Countries’ leaders hesitate with changes, as Mr Campbell recalled a Tony Blair anecdote about the introduction of smoking ban law in UK “let’s see how it works in Ireland”. UK failed with introducing the prepared minimum pricing policy because of the alcohol industry pressure. Ireland can learn from that failure. Unless we understand that we are all paying for fixing of harms caused by alcohol, we won’t understand the minimum pricing. Low-risk drinkers – don’t be afraid of minimum pricing.

Irish Network of Medical Educators (#INMED2014): The 7th Annual Scientific Meeting

A network of volunteers for all interested in medical education on the island of Ireland met in Belfast yesterday. The network’s aim is to improve education. Network’s vision:

“The Network seeks to enhance medical education on the island of Ireland by bringing together individuals and organisations with an interest in and responsibilities in medical and healthcare education in a National Medical Education Network.”

The 2014 conference theme was creating supportive learning environments. See figure 1 below.

This year, the programme extended over two half-days and a full day between them.
The Wednesday half day offered five pre-conference workshops: Maximising clinical education opportunities, Researching clinical workplaces, Identifying trainees in difficulty, Overcoming obstacles to reflective practice, and Mixed methods research. As of Tuesday, February 18 (8am), there were 152 names on the delegate list. Of those, 7 were marked as judges, 4 as chairs, and 4 as chair/judge – a transparent practice rather unusual at conferences.

Thursday was the main day of the conference. It started with the usual welcomes and opening addresses in a packed room. In fact, delegates who came late stood in the back of the room, because there were no free seats left.

Two keynotes attracted most delegates, Prof Billet from Australia and Prof McAvoy from Britain. Prof Billet’s lecture was pre-recorded and projected on a large screen, because he was in Geneva at the time of conference. He explained meaning of important education terms, such as curriculum or apprenticeship. In simple words, he talked about learning by doing, but his theory-heavy talk with big words was difficult to follow in some places, as reported by delegates. The organizers helped the audience by pausing the video, interacting with the audience, and letting 20 seconds of silence for free-flow thinking

Doctors in difficulty and the re-mediators were discussed by Prof McAvoy (shown in Figure 2). Her talk reminded us that doctors are people too. Most are motivated, they’re not burned out. The reasons for their underperformance are subject of McAvoy’s research: professional, personal, physical health (e.g., high blood pressure), or mental health problems; the group identified 18% of cognitive problems among doctors, and in one case recommended psychiatric assessment which ended doctor’s career. Comprehensive assessment of underperforming doctors is critical – if you’re not getting the diagnosis right, the treatment won’t be effective. Following the assessment, absolute clarity of feedback is paramount for performance improvement.

Figure 2. Professor McAvoy

An hour and a half before the lunch, the delegates viewed 77 research and education posters. Judges assessed the posters allowing 3 minutes for presenters’ speech plus a couple of question.

Lunchtime provided opportunities for meeting the experts. After lunch, the delegates scattered into 5 workshops: i. student narratives (n= 6), ii. clinical ethics (n= 15), iii. emotional intelligence (n= 12), iv. organizational culture (n= 13), and v. emotions (n= 16). The numbers of delegates who attended workshops but did not put their names on the list are not included. Students led the mental health session from 4-5PM. The day finished with traditional AGM, drinks and dinner.

Friday half day concluded the conference with four sessions including research presentations, keynote speech by Prof Dornan from Netherlands, and hot topics in medical education. Read more about the conference here: www.inmed.ie

Is it easier to recruit participants in space? Ten years of Cochrane and Mike Clarke in Ireland

Tenth annual Cochrane in Ireland conference“From evidence to clinical guidelines” took place on 24 January 2014 at School of Nursing& Human Sciences, Dublin City University.

The 7-hours programme kicked off with a welcome by Professor John Costello, Executive Dean of the Faculty of Science and Health, Dublin City University, followed by the National Clinical Effectiveness Agenda of Dr Kathleen MacLellan, Director National Clinical Effectiveness Committee, Department of Health, Dublin.

Figure 1 Yellow arrow card
Mike Clarke’s (Professor & Director of MRC Methodology Hub, Queen’s University Belfast) random thoughts about randomised trials covered some of the more unusual things people have studied. There are approximately 25000 new randomised trials every year, leading to around 700 000 trials registered in CENTRAL Cochrane database. From this overwhelming amount of evidence, Dr Clarke cherry-picked the most unusual, controversial and interesting trials. His presentation started by distributing yellow-arrow cards to delegates in anticipation of active engagement (See figure 1).

Figure 2 Votes and Mike Clarke
Dr Clarke’s random thoughts started with sweets as tip boosters and continued through gamgee hats to lipsticks, restaurants and vegetables, organ music, citruses, chocolate and space trials – a truly spectacular collection. We all voted on Clarke’s provoking questions about these trials (shown in figure 2): did sweets increase, decrease or unchanged the size of the tip? Does smiley face make more difference in tips size than a hand-written thank you? How beneficial is doodling while working or phone-calling? Mike encouraged us to relate each of these entertaining questions to bigger dilemmas about trials, for example, who is in charge of interpreting whether an intervention works? Or, do we believe something because it was published? Ending on a positive note, Clarke presented trials that were conducted on astronauts in the international space station. The drop-out rate was 0 because they had nowhere to go?

Help, I’m stuck.

After a brief tea and coffee break, the participants dispersed into three parallel sessions (N=25:12:7). Dr Clarke’s session was most popular. Traditionally, Mike uses the power and knowledge of a group of people at his workshops that might have some problems with their Cochrane reviews, but collectively have the knowledge to solve them. The list of participants’ questions that he wrote on the white board at the session start was left with only 2-3 questions unanswered. The group disciplines were mutually helpful – psychology, general practice, nursing or information science, experienced reviewers and Cochrane’s novices.
Two other sessions happened in parallel with Clarke’s workshop. Drs O’Rourke & O’Toole covered practicalities of generating clinical guidelines for cancer treatment in Ireland. Dr Matthews, HRB Cochrane Fellow and Senior Lecturer, School of Nursing & Human Sciences, Dublin City University, helped delegates with issues around starting Cochrane reviews.

Lunch was in the campus canteen – each delegate got a €10 voucher. The atmosphere in the canteen was conducive to contact making; we sat by long tables surrounded by students.

The afternoon programme included 2 lectures by Susan Smith and Anne Matthews, and a conclusion by Dr Teresa Maguire – Head of the population science and health services research at the Health Research Board in Ireland. Dr Matthews corroborated on her experience of doing a review on morning sicknessand being a Cochrane fellow – it’s for life, not just for the 2-year fellowship. Dr Smith is a Professor of general practice at Royal College of Surgeons in Ireland who has done 9 Cochrane reviews. Her rich experiences from these reviews were especially useful for those interested in multimorbidity.