Category: systematic review

Systematic reviews are the cream of the research crop. Those who understand their value thrive at an opportunity to learn more about them.

New review out now: Epilepsy drug fails crack addiction

This review asked whether a drug for epilepsy seizures – Topiramate – can help treat cocaine addiction, reduce cocaine use and prolong treatment retention.
No current evidence supports the clinical use of Topiramate for the treatment of cocaine dependence.
Methodology

·      We looked at all scientific literature up until December 2014.
·      We also wanted to see how whether people quit treatment prematurely and whether they had any side effects. We included people of any gender, age or ethnicity.
Results

photocredit: narconon.com

       We found 5 studies with 518 patients; all were done in USA
       Topiramate did not help people stay in treatment longer
·      The mean duration of the trials was 13 weeks (range eight to 24 weeks).
·      The side effects were the same for Topiramate and placebo.
Topiramate could possibly help people stay cocaine-free without having more side effects than placebo.
Implications

       There is no drug for cocaine dependence.
       In the past, researchers have studied whether drugs for depression, epilepsy or seizures could treat cocaine addiction.
       There is a need to understand how to treat cocaine addiction. 
Reference: Singh, M., Keer, D., Klimas, J., Wood, E., Werb, D. Topiramate for Cocaine Dependence: A Systematic Review and Meta-Analysis of Randomized Control Trials. Addiction, 2016, In Press: http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1360-0443/accepted
More info at:

BC Centre for Excellence in HIV/AIDS | 608-1081 Burrard Street, Vancouver BC V6Z 1Y6, Canada

http://uhri.cfenet.ubc.ca

Reducing drinking in illicit drug users: an impact story @COMETinitiative

Research impact is often hard to prove. It takes years before our findings change the world and the change is often small.  This new abstract published in the Trials journal summarizes a poster presentation from the conference of the Core Outcome Measures in Trials (COMET) Initiative.  This year the conference was in Calgary, Canada, on May 20-21.

credit: trialsjournal.org

One out of three people who receive methadone in primary care drink in excess of the recommended limits. This poses significant risk to their health, especially to their liver; it complicates their care and increases risk of relapse.  
We wanted to inform addiction treatment in primary care with respect to psychosocial interventions to reduce drinking in concurrent problem alcohol and illicit drug users, by: exploring the experience of (and evidence for) psychosocial interventions, developing and evaluating a complex intervention to improve implementation. Evaluation of the intervention tested core feasibility and acceptability outcomes for patients and providers.  
Our Cochrane review found only four studies. Having inconclusive evidence, we interviewed 28 patients, 38 physicians and nurses. Patient interviews informed development of a national clinical practice guideline, as well as design and outcomes of the evaluation project. Feasibility outcome measures included recruitment, retention, completion and follow-up rates, as well as satisfaction with the intervention. Secondary outcome was proportion of patients with problem alcohol use at the follow up, as measured by Alcohol Use Disorders Identification Test.  
Information from the Cochrane review and the qualitative interviews informed an expert panel consultation which developed clinical guidelines for primary care.  The guideline became part of a complex intervention to support the uptake of psychosocial interventions by family physicians; the intervention is currently evaluated in a pilot controlled trial. Two new alcohol education programmes were created as a response of the community to the problem and a lack of specialist support services for patients with dual dependencies. Both Coolmine Therapeutic Community and the Community Response Agency run a 10-week group that specifically seeks to include people with dual dependencies, from methadone programmes. 

Cite this article as: Klimas et al.: Reducing drinking in concurrent
problem alcohol and illicit drug users: an impact story. Trials 2015
16(Suppl 3):P11. doi:10.1186/1745-6215-16-S3-P11

Alcohol and Methadone Don’t Mix! What’s New in Addiction Medicine? lecture series

Please join us on Tuesday, October 27 for this month’s edition of the “What’s New in Addiction Medicine?” lecture series.
 


This (free) event features a presentation by Dr. Jan Klimas and will be held between 12-1pm.  The talk is entitled “Methadone and Alcohol Don’t Mix” and will be hosted at St. Paul’s Hospital in the Hurlburt Auditorium (2nd floor).  A light lunch will be provided.
 
We strongly encourage guests to RSVP as soon as possible to ensure sufficient food and space.  (Please note that you will not need to bring your registration ticket(s) to the event.)
 
To RSVP, please click here.  (If you are experiencing any difficulty accessing the link, please type bit.ly/WNAM23 into your browser or email Cameron Collins at the address listed below.)
 
Please don’t hesitate to forward this email on to anyone who you think may be interested in this lecture or the series more broadly.  A calendar of upcoming presentations is available here.
 
If you have any questions about event logistics, please DO NOT respond to this email.  Instead, contact Cameron Collins ([email protected]).

Health care research is untidy – what does it mean for postdocs? #CochraneCalgary2015

Why do we study health? Because we want to help patients. It’s no rocket science. And yet, most clinical trials do not measure outcomes that are important for patients. Besides, researchers don’t agree on what the core set of outcomes should be. “Health care research is untidy.” — Mike Clarke. In this post, I write about my experience of a conference about outcomes for clinical research and how it relates to postdoc training.


Systematic reviews are often required as part of a PhD or a postdoc training. Over 30,000 authors produce Cochranesystematic reviews of literature for the Cochrane library worldwide. The Canadian Cochrane centre hosted about a hundred of them at a recent joint conference, together with the COMET initiative (Core Outcome Measures in Trials), in Calgary, Canada (#CochraneCalgary2015).

Many junior postdocs who were at the conference struggled to publish papers. Yet, the number of publications is considered a core outcome of a postdoc training. Is it enough? What’s a core outcome set for a postdoc fellowship? “Not everything that can be counted counts, and not everything that counts can be counted.” — Albert Einstein.

 Ultimately, the fellowship should result in a faculty position. But we know that there aren’t enough positions for all PhD’s and postdocs. The truth is that we don’t need so many PhDs. “PhD ‘overproduction’ is not new and faculty retirements won’t solve it,” writes Melonie Fullick in her speculative diction at University Affairs (March 25, 2015): “Yet somehow no matter how many PhDs enrol and graduate, academic careers are the goal.”


What lessons can postdocs take from the Cochrane collaboration to improve their career prospects? All Cochrane reviews must have a protocol. Cochrane protocols get published in the Cochrane library. However, protocols for non-Cochrane systematic reviews are difficult to publish in journals. Nevertheless, postdocs who decide to do a systematic review and can upload the review protocol on to their open-access universities’ depositories. They get picked up by the google.scholar and can be counted in the H-index. This way, junior postdocs can improve one of their core outcome measures – the track record. Although it’s probably not the best measure of a successful training, it’s the currency of science. 

How Cochrane Keeps the Addiction Science in Check

Science isn’t infallible. Humans make mistakes even in this highly sophisticated method of understanding the world around us. Thanks God, addiction researchers get a chance to correct their error. If they publish a big error, the publication may be withdrawn. In smaller cases, the publisher issues a correction. It is interesting to see how such a correction has been issued following publication of our Cochrane systematic review of literature which. Probably this helped to keep the addiction science in check. See it for yourself below.

August 2011: “Alcohol-related brief intervention in patients treated for opiate or cocaine dependence: a randomized controlled study”

Before our review included this study, the authors reported the following figures in tables 3 and 7.

November 2011: “Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users: a Cochrane review”

 Our review was published in November 2011 and re-stated the findings of the above study as: higher rates of decreased alcohol use at three months (risk ratio (RR) 0.32; 95% confidence interval (CI) 0.19 to 0.54) and nine months (RR 0.16; 95% CI 0.08 to 0.33) in the treatment as usual group– See more at: http://summaries.cochrane.org/CD009269/ADDICTN_which-talking-therapies-counselling-work-for-drug-users-with-alcohol-problems#sthash.RcVZGdQA.dpuf

August 2013 “Correction: Alcohol-related brief intervention in patients treated for opiate or cocaine dependence: a randomized controlled study”

After the publication of our review, the authors corrected their figures in tables 1 and 5. The care-as-usual treatment for the control group was no longer stronger than the experimental intervention, the “alcohol-related brief intervention.”

 –

A note on causality in science

Because causal relationships are hard to prove (i.e. cause -> effect), majority of scientific publications rely on correlations. An example of a correlation is a relationship between shorter living expectancy and male gender. Men die younger than women. Although there are many plausible explanations, we cannot pinpoint a single cause.  Similarly, if an article gets corrected following a review in a major synthesis of scientific evidence – the Cochrane review – it may be a pure coincidence or it may be a consequence of the review. 

Substance Abuse Treatment, Prevention and Policy is an open-access peer-reviewed online journal that encompasses all aspects of research concerning substance abuse, with a focus on policy issues. Text taken from www.substanceabusepolicy.com

Cochrane Collaboration hosts the largest database of systematic reviews to inform healthcare decisions. Cochrane reviews are the jaguars of medical evidence synthesis. Cochrane is a global independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making the vast amounts of evidence generated through research useful for informing decisions about health. Cochrane is a not-for-profit organisation with collaborators from over 120 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Text taken from www.cochrane.org