Now showing 1 - 10 of 68
  • Publication
    Key performance indicators for mental health and substance use disorders: a literature review and discussion paper
    (Taylor and Francis (Routledge), 2014-03) ; ; ;
    With an increasing recognition of the importance of mental and substance use disorders (MESUDS) for population health and health systems and the potential value of systems-based performance indicators in addressing this issue, we aimed to describe the development and content of key performance indicators (KPIs) for MESUDS. Publications were identified through official websites, Google searches and PubMed. Following 'PRISMA' guidelines, 25 studies were kept for qualitative synthesis and six for quantitative analysis. We describe their use in practice by comparing their application across a range of public and mixed healthcare systems. Currently, the KPI development for MESUDS adopts several methodologies, including expert opinion, literature review, stakeholder consultation, and the structured consensus method. The rationales provided for selection of particular KPIs vary greatly between systems. Systems exhibit different levels of KPI adaptability, which is reflective of dynamic changes in evidence-based practices. We noted bias in the level of KPI assessment toward system/health plan evaluation followed by program/service evaluation. Similarly, there is a large skew toward KPIs that reflect evaluation of processes. Collection of data in all systems is nearly exclusively reliant on electronic administrative/medical data. Experiences from these systems are synthesized into methodological recommendations and considerations for further research and clinical practice are provided.
      763Scopus© Citations 5
  • Publication
    Development and process evaluation of an educational intervention for overdose prevention and naloxone distribution by general practice trainees
    Background: Overdose is the most common cause of fatalities among opioid users. Naloxone is a life-saving medication for reversing opioid overdose. In Ireland, it is currently available to ambulance and emergency care services, but General Practitioners (GP) are in regular contact with opioid users and their families. This positions them to provide naloxone themselves or to instruct patients how to use it. The new Clinical Practice Guidelines of the Pre-hospital Emergency Care Council of Ireland allows trained bystanders to administer intranasal naloxone. We describe the development and process evaluation of an educational intervention, designed to help GP trainees identify and manage opioid overdose with intranasal naloxone. Methods: Participants (N = 23) from one postgraduate training scheme in Ireland participated in a one-hour training session. The repeated-measures design, using the validated Opioid Overdose Knowledge (OOKS) and Attitudes (OOAS) Scales, examined changes immediately after training. Acceptability and satisfaction with training were measured with a self-administered questionnaire. Results: Knowledge of the risks of overdose and appropriate actions to be taken increased significantly post-training [OOKS mean difference, 3.52 (standard deviation 4.45); P < 0.001]; attitudes improved too [OOAS mean difference, 11.13 (SD 6.38); P < 0.001]. The most and least useful delivery methods were simulation and video, respectively. Conclusion: Appropriate training is a key requirement for the distribution of naloxone through general practice. In future studies, the knowledge from this pilot will be used to inform a train-the-trainer model, whereby healthcare professionals and other front-line service providers will be trained to instruct opioid users and their families in overdose prevention and naloxone use.  
    Scopus© Citations 15  543
  • Publication
    How Can We Investigate the Role of Topiramate in the Treatment of Cocaine Use Disorder More Thoroughly?
    We read with interest Drs Darke and Farrell’s commentary on our meta-analysis of Topiramate published in the eight issue of 2016. To elaborate on some of the ideas raised by the commentary, we focus our response on the question of why some studies implied a benefit and others did not. Overall, although the current evidence is not strong enough to support the routine clinical use of Topiramate for the treatment of cocaine use disorder, it may be useful for researching in certain circumstances in terms of helping people with cocaine use disorders stay abstinent from cocaine use.
    Scopus© Citations 2  305
  • Publication
    General practitioners tackle complex addictions: how complex interventions can assist in dealing with addiction
    (Cambridge University Press, 2016-08-30)
    Substance use disorder treatment is a complex problem. Complex problems require complex interventions, ideally tested via randomised controlled trials. Complex interventions are best developed in stages, using established implementation frameworks. Starting with a historical patient case study, we explore how treatment of this challenging population group has been approached, how an evidence-based framework has informed formulation of a complex health intervention and how this has been progressed via the U.K.'s Medical Research Council (MRC) approach.
    Scopus© Citations 1  457
  • Publication
    Optimizing writing schemes for addiction researchers
    (Elsevier, 2016-12-02)
    Writing constitutes a significant challenge for junior addiction researchers. Writing support programmes appear to improve writing skills and enhance productivity. However, addiction researchers have not benefited from writing support groups to the same extent as other professions, mainly due to the lack of support for and considerable variation among these programmes. Given a lack of research about the contribution of writing support programmes to publication productivity among early-stage addiction researchers, this article offers critical insights into the process and outcomes of such programmes, based on the substantial experience accumulated from taking part in several writing support programmes, including the scheme of the International Society of Addiction Journal Editors (ISAJE). A better understanding of what makes writing groups effective may help build evidence for writing programs and universities to equip addiction investigators with the skills they need to improve the health of people with substance use disorders via better writing.
      243Scopus© Citations 1
  • Publication
    Treatment of stimulant use disorder: A systematic review of reviews
    (Public Library of Science (PLoS), 2020-06-18) ; ; ; ;
    AIMS:Stimulant use disorder contributes to a substantial worldwide burden of disease, although evidence-based treatment options are limited. This systematic review of reviews aims to: (i) synthesize the available evidence on both psychosocial and pharmacological interventions for the treatment of stimulant use disorder; (ii) identify the most effective therapies to guide clinical practice, and (iii) highlight gaps for future study. METHODS:A systematic database search was conducted to identify systematic reviews and meta-analyses. Eligible studies were those that followed standard systematic review methodology and assessed randomized controlled trials focused on the efficacy of interventions for stimulant use disorder. Articles were critically appraised using an assessment tool adapted from Palmeteer et al. and categorized for quality as 'core' or 'supplementary' reviews. Evidence from the included reviews were further synthesized according to pharmacological or non-pharmacological management themes. RESULTS:Of 476 identified records, 29 systematic reviews examining eleven intervention modalities were included. The interventions identified include: contingency management, cognitive behavioural therapy, acupuncture, antidepressants, dopamine agonists, antipsychotics, anticonvulsants, disulfiram, opioid agonists, N-Acetylcysteine, and psychostimulants. There was sufficient evidence to support the efficacy of contingency management programs for treatment of stimulant use disorder. Psychostimulants, n-acetylcysteine, opioid agonist therapy, disulfiram and antidepressant pharmacological interventions were found to have insufficient evidence to support or discount their use. Results of this review do not support the use of all other treatment options. CONCLUSIONS:The results of this review supports the use of contingency management interventions for the treatment of stimulant use disorder. Although evidence to date is insufficient to support the clinical use of psychostimulants, our results demonstrate potential for future research in this area. Given the urgent need for effective pharmacological treatments for stimulant use disorder, high-quality primary research focused on the role of psychostimulant medications for the treatment of stimulant use disorder is needed.
    Scopus© Citations 96  271
  • Publication
    Community first responders for out-of-hospital cardiac arrest in adults and children
    Background: Mobilization of community first responders (CFRs) to the scene of an out-of-hospital cardiac arrest (OHCA) event has been proposed as a means of shortening the interval from occurrence of cardiac arrest to performance of cardiopulmonary resuscitation (CPR) and defibrillation, thereby increasing patient survival. Objectives: To assess the effect of mobilizing community first responders (CFRs) to out-of-hospital cardiac arrest events in adults and children older than four weeks of age, in terms of survival and neurological function. Search methods We searched the following databases for relevant trials in January 2019: CENTRAL, MEDLINE (Ovid SP), Embase (Ovid SP), and Web of Science. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov, and we scanned the abstracts of conference proceedings of the American Heart Association and the European Resuscitation Council. Selection criteria We included randomized and quasi-randomized trials (RCTs and q-RCTs) that compared routine emergency medical services (EMS) care versus EMS care plus mobilization of CFRs in instances of OHCA.Trials with randomization by cluster were eligible for inclusion, including cluster-design studies with intervention cross-over. In some communities, the statutory ambulance service/EMS is routinely provided by the local fire service. For the purposes of this review, this group represents the statutory ambulance service/EMS, as distinct from CFRs, and was not included as an eligible intervention. We did not include studies primarily focused on opportunistic bystanders. Individuals who were present at the scene of an OHCA event and who performed CPR according to telephone instruction provided by EMS call takers were not considered to be CFRs. Studies primarily assessing the impact of specific additional interventions such as administration of naloxone in narcotic overdose or adrenaline in anaphylaxis were also excluded. We included adults and children older than four weeks of age who had experienced an OHCA. Data collection and analysis Two review authors independently reviewed all titles and abstracts received to assess potential eligibility, using set inclusion criteria. We obtained and examined in detail full-text copies of all papers considered potentially eligible, and we approached authors of trials for additional information when necessary. We summarized the process of study selection in a PRISMA flowchart. Three review authors independently extracted relevant data using a standard data extraction form and assessed the validity of each included trial using the Cochrane ’Risk of bias’ tool. We resolved disagreements by discussion and consensus. We synthesized findings in narrative fashion due to the heterogeneity of the included studies. We used the principles of the GRADE system to assess the certainty of the body of evidence associated with specific outcomes and to construct a ’Summary of findings’ table. Main results: We found two completed studies involving a total of 1136 participants that ultimately met our inclusion criteria. We also found one ongoing study and one planned study. We noted significant heterogeneity in the characteristics of interventions and outcomes measured or reported across these studies, thus we could not pool study results. One completed study considered the dispatch of police and fire service CFRs equipped with automatic external defibrillators (AEDs) in an EMS system in Amsterdam and surrounding areas. This study was an RCT with allocation made by cluster according to non-overlapping geographical regions. It was conducted between 5 January 2000 and 5 January 2002. All participants were 18 years of age or older and had experienced witnessed OHCA. The study found no difference in survival at hospital discharge (odds ratio (OR) 1.3, 95% confidence interval (CI) 0.8 to 2.2; 1 RCT; 469 participants; low-certainty evidence), despite the observation that all 72 incidences of defibrillation performed before EMS arrival occurred in the intervention group (OR and 95% CI-not applicable; 1 RCT; 469 participants; moderate-certainty evidence). This study reported increased survival to hospital admission in the intervention group (OR 1.5, 95% CI 1.1 to 2.0; 1 RCT; 469 participants; moderate-certainty evidence). The second completed study considered the dispatch of nearby lay volunteers in Stockholm, Sweden, who were trained to perform cardiopulmonary resuscitation (CPR). This represented a supplementary CFR intervention in an EMS system where police and fire services were already routinely dispatched to OHCA in addition to EMS ambulances. This study, an RCT, included both witnessed and unwitnessed OHCA and was conducted between 1 April 2012 and 1 December 2013. Participants included adults and children eight years of age and older. Researchers found no difference in 30-day survival (OR 1.34, 95% CI 0.79 to 2.29; 1 RCT; 612 participants; low-certainty evidence), despite a significant increase in CPR performed before EMS arrival (OR 1.49, 95% CI 1.09 to 2.03; 1 RCT; 665 participants; moderate-certainty evidence). Neither of the included completed studies considered neurological function at hospital discharge or at 30 days, measured by cerebral performance category or by any other means. Neither of the included completed studies considered health-related quality of life. The overall certainty of evidence for the outcomes of included studies was low to moderate. Authors’ conclusions Moderate-certainty evidence shows that context-specific CFR interventions result in increased rates of CPR or defibrillation performed before EMS arrival. It remains uncertain whether this can translate to significantly increased rates of overall patient survival. When possible, further high-quality RCTs that are adequately powered to measure changes in survival should be conducted. The included studies did not consider survival with good neurological function. This outcome is likely to be important to patients and should be included routinely wherever survival is measured. We identified one ongoing study and one planned trial whose results once available may change the results of this review. As this review was limited to randomized and quasi-randomized trials, we may have missed some important data from other study types.
    Scopus© Citations 4  239
  • Publication
    Development and Evaluation of the Online Addiction Medicine Certificate: Free Novel Program in a Canadian Setting
    Background: Despite the enormous burden of disease attributable to drug and alcohol addiction, there remain major challenges in implementing evidence-based addiction care and treatment modalities. This is partly because of a persistent lack of accessible, specialized training in addiction medicine. In response, a new online certificate in addiction medicine has been established in Vancouver, Canada, free of charge to participants globally. Objective: The objective of this study was to evaluate and examine changes in knowledge acquisition among health care professionals before and after the completion of an online certificate in addiction medicine. Methods: Learners enrolled in a 17-module certificate program and completed pre- and postknowledge tests using online multiple-choice questionnaires. Knowledge acquisition was then evaluated using a repeated measures t test of mean test scores before and after the online course. Following the certificate completion, a subset of learners completed the online course evaluation form. Results: Of the total 6985 participants who registered for the online course between May 15, 2017 and February 22, 2018, 3466 (49.62%) completed the online pretest questionnaire. A total of 1010 participants completed the full course, achieving the required 70% scores. TThe participants self-reported working in a broad range of health-related fields, including nursing (n=371), medicine (n=92), counseling or social work (n=69), community health (n=44), and pharmacy (n=34). The median graduation year was 2010 (n=363, interquartile range 2002-2015). Knowledge of the addiction medicine increased significantly postcertificate (mean difference 28.21; 95% CI 27.32 to 29.10; P<.001). Physicians scored significantly higher on the pretest than any other health discipline, whereas the greatest improvement in scores was seen in the counseling professions and community outreach. Conclusions: This free, online, open-access certificate in addiction medicine appeared to improve knowledge of learners from a variety of disciplines and backgrounds. Scaling up low threshold learning opportunities may further advance addiction medicine training, thereby helping to narrow the evidence-to-practice gap.
    Scopus© Citations 5  278
  • Publication
    Preliminary Results and Publication Impact of a Dedicated Addiction Clinician Scientist Research Fellowship
    (Lippincott, Williams and Wilkins, 2017-02) ; ; ; ;
    Clinician-scientists serve to bridge the gap between addiction research and clinical practice but cultivating clinician-scientists, who are able to develop and publish clinical research, remains a challenge. Therefore, we describe the design and first-year data from a controlled, non-randomized comparison trial that prospectively evaluates how a dedicated research-training program for addiction medicine physicians contributed to subsequent research involvement and research productivity.
      398Scopus© Citations 4
  • Publication
    Off the record: Substance-related disorders in the undergraduate medical curricula in Ireland
    Background: Substance use disorders (SUDs) are a worldwide problem, and have become a major health concern in Ireland particularly. We aimed to determine the extent to which addiction medicine is embedded in the undergraduate medical curriculum in Ireland. Methods: To further investigate the degree to which drug addiction is taught in the Irish medical curriculum an online literature search was performed using Google Scholar, PubMed (from 2009 to present), EMBASE, PsycINFO, CINAHL, and Medline using the keywords 'substancerelated disorders,' 'undergraduate,' 'curriculum' and 'Ireland.' Additionally, all Irish medical school websites were examined (n = 6), and a Google search and manual searches of conference programs were performed. We used the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to systematically review and discuss findings. Results: A total of zero published studies met the criteria for inclusion in an updated systematic literature search of addiction medicine education in the undergraduate medical curriculum in Ireland. Conclusion: There is currently no documentation of drug addiction teaching sessions in Irish medical schools. Investigations that offer direct contact with medical schools, such as a telephone survey, may provide a more accurate representation of how addiction medicine education is incorporated into the medical school curricula.
    Scopus© Citations 3  506