What are the training needs of newly trained professionals working in addiction medicine around the world? Do they get enough and appropriate training to treat people who live with addictions? A new study protocol plans to answer these questions. (more…)
Out-of-hospital cardiac arrest is a major cause of death. It occurs when a person’s heart stops pumping blood around the body. It is most often caused by an abnormal heart rhythm. Cardiac arrest causes death within minutes unless this rhythm restarts. (more…)
Updating Cochrane systematic reviews makes them most useful and fresh for readers. We updated our review on concurrent alcohol and drug problems again.
Which new studies we found?
We found seven studies that examined 825 people with drug problems. Six of the studies were funded by the National Institutes for Health or by the Health Research Board; one study did not report its funding source.
One study focused on the way people think and act versus an approach based on Alcoholics Anonymous. It aimed to motivate the person to develop a desire to stop using drugs or alcohol.
Three studies looked at a counselling style for helping people to explore and resolve doubts about changing their behaviour (group, individual and intensive formats). Their controls were education, or less intensive counselling, or assessment-only.
Two Irish studies and one Swiss study looked at practices that aimed to identify an alcohol problem and motivate the person to do something about it versus usual treatment.
This study has been made into a podcast available at Cochrane.org news item at https://www.cochrane.org/news/podcast-which-talking-therapies-work-people-who-use-drugs-and-also-have-alcohol-problems
and a Network news item https://mhn.cochrane.org/news/podcast-which-talking-therapies-work-people-who-use-drugs-and-also-have-alcohol-problems Listen to the podcast below:
Updating Cochrane Review – Key results
The Swiss and Irish studies were directly compared. They took place in general practices (one trial) or methadone clinics (two trials). They included 170 participants with a mean age of 37 years. All participants had positive alcohol screening test upon entry to the trial. At the end, the scores between groups were similar (average difference in scores: -0.6, 1.7 and -2, respectively).
One study found that a brief motivational intervention led to a reduction of alcohol use (by seven or more days in the past month at 6 months).
It remains uncertain whether talking therapies affect drinking and drug-using in people who have problems with both alcohol and other drugs. We lack high quality studies.
Cited cochrane review: Klimas J, Fairgrieve C, Tobin H, Field C-A, O’Gorman CSM, Glynn LG, Keenan E, Saunders J, Bury G, Dunne C, Cullen W. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database of Systematic Reviews 2018, Issue 11
Read a summary of the previous version of this review here
Systematic reviews are the cream of the research crop. Those who understand their value thrive at an opportunity to meet the review authors at scientific conferences. This year, the annual meeting of the College on Problems of Drug Dependence (CPDD) in San Diego featured several important reviews. Here’s a listing of all the posters presenting reviews from the session on Wednesday, June 13th, 2018.
Non-fatal overdose prevalence among people who inject drugs Samantha Colledge (June 11, 2018);
Prescription drug monitoring programs on nonfatal and fatal drug overdoses David Fink;
Limited inclusion of women in functional neuroimaging studies of opioid-use disorder Hestia Moningka;
Women’s prescription drug misuse Bridgette Peteet;
Gender differences in HIV, anti-HCV and HBsAg prevalence among people who inject Janni Leung;
Case for hospital teams in treatment of opioid use disorders Kelsey Priest;
Addiction-related characteristics of substances users in harm reduction settings Charlotte Kervran;
STDs and injecting
Extremely low HIV incidence among PWID: Terminology, high/middle income settings, methodology, and addressing new outbreaks Don Des Jarlais;
Use of opioids and stimulants by people who inject drugs Amy Peacock;
Factors associated with uptake or willingness to use pre-exposure prophylaxis (PrEP) among people who inject drugs Yohansa Fernández;
Pre-exposure prophylaxis (PrEP) for people who inject drugs? Angela Bazzi;
Cannabis and cannabinoids for the treatment of people with chronic non-cancer pain conditions Emily Stockings;
Medical marijuana laws and adolescent marijuana use in the US Aaron Sarvet;
Does liberalization of cannabis policy influence adolescents’ levels of use? Maria Melchior;
Clinical and toxicological profile of NBOMESs Nino Marchi;
Sensation-seeking personality trait and its association to drug seeking behavior in adolescents Thiago Fidalgo.
Systematic reviews cream of the crop from Brazil through Egypt
NIDA International poster session on Monday, June 11, 2018
Three Australians, two North Americans; an Egyptian, African and Brazilian had one poster on systematic review each. Five were meta-analyses.
The Australian reviews dealt with overdose, STDs and injecting:
Nonfatal overdose prevalence among people who inject drugs S. Colledge, (UK, Australia);
Gender differences in HIV, anti-hepatitis C virus, and hepatitis B virus surface antigen prevalence among people who inject drugs J. Leung, (Australia, UK, Portugal);
Use of opioids and stimulants by people who inject drugs: A. Peacock, (Australia);
The North-Americans reviewed drug monitoring programmes:
Global review of drug-checking services 2017 L.J. Maier, (California);
Urinalysis frequency and health outcomes for persons on opioid agonist therapy: J. McEachern, (Canada);
Anger, brain stimulation and antipsychotics were reviewed too:
Anger in users of psychoactive substances H.V. Laitano, (Brazil);
Noninvasive brain stimulation in addiction medicine A. Elaghoury.(Egypt);
Atypical versus typical antipsychotics for the treatment of addiction: S. Hanu. (Ghana).
With the increasing demands on scientists’ workloads, systematic reviews are an effective way of staying up to date with the most recent developments in the field. See also my previous blog posts about CPDD from the previous years:
When a heart stops beating, first responders can revert the cardiac arrest. But how efficient are they? Can they help save the person before the ambulance arrives? A new project by the Centre for Emergency Medical Science at University College Dublin seeks to find answers to these questions.
This project will be a systematic review of scientific literature on the topic.
We will follow a strict guide for doing systematic reviews by the Cochrane Collaboration. Cochrane reviews are used to inform decisions in health care. First, we will search for every published study about the topic. We will include only the best studies. Then, we will use their findings to calculate the impact of mobilizing community first responders.
“For the purpose of this study, Community first responders (CFRs) are defined as individuals who live or work within a community and are organized in a framework which offers OHCA care in that community, to support the standard ambulance service response.”
The ambulance service dispatch centre, or another service, activates CFRs in real time to attend OHCA in that community.
They can be anyone, including professionals like nurses, police, or fire fighters. But also lay people who volunteer for local community groups. Sometimes, fire fighters act as the designated first responders.
Cardiac arrest in the community
If we do nothing people who have a cardiac arrest die. Community members can save lives by being the first responders on the scene before the ambulance arrives. Especially in remote places without access to medical professionals. However, their training and activation take time and resources. We need to know whether it’s worth it.
Citation example: Barry T, Masterson S, Conroy N, Klimas J, Segurado R., Codd M, Bury G. (2017) Community first responders for out of hospital cardiac arrest [Protocol]. Cochrane Database of Systematic Reviews, Issue 8.