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Cullen, Walter
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Cullen, Walter
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Cullen, Walter
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- PublicationPsychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users(Wiley-Blackwell, 2012-11)
; ; ; ; ; ; ; ; Background: Problem alcohol use is common among illicit drug users and is associated with adverse health outcomes. It is also an important factor in poor prognosis among drug users with hepatitis C virus (HCV) as it impacts on progression to hepatic cirrhosis or opiate overdose in opioid users.Objectives: To assess the effects of psychosocial interventions for problem alcohol use in illicit drug users (principally problem drug users of opiates and stimulants).Search methods: We searched the Cochrane Drugs and Alcohol Group trials register (November 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 11, November 2011), PUBMED (1966 to 2011); EMBASE (1974 to 2011); CINAHL (1982 to 2011); PsycINFO (1872 to 2011) and reference list of articles. We also searched: 1) conference proceedings (online archives only) of the Society for the Study of Addiction (SSA), International Harm Reduction Association (IHRA), International Conference on Alcohol Harm Reduction (ICAHR), and American Association for the Treatment of Opioid Dependence (AATOD); 2) online registers of clinical trials, Current Controlled Trials (CCT), Clinical Trials.org, Center Watch and International Clinical Trials Registry Platform (ICTRP).Selection criteria: Randomised controlled trials comparing psychosocial interventions with another therapy (other psychosocial treatment, including non-pharmacological therapies or placebo) in adult (over the age of 18 years) illicit drug users with concurrent problem alcohol use.Data collection and analysis: Two review authors independently assessed risk of bias and extracted data from included trials.Main results: Four studies, 594 participants, were included. Half of the trials were rated as having high or unclear risk of bias. They considered six different psychosocial interventions grouped into four comparisons: (1) cognitive-behavioural coping skills training versus 12-step facilitation (N = 41), (2) brief intervention versus treatment as usual (N = 110), (3) hepatitis health promotion versus motivational interviewing (N = 256), and (4) brief motivational intervention versus assessment-only group (N = 187). Differences between studies precluded any pooling of data. Findings are described for each trial individually:comparison 1: no significant difference; comparison 2: 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; comparison 3 (group and individual format): no significant difference; comparison 4: more people reduced alcohol use (by seven or more days in the past 30 days at 6 months) in the brief motivational intervention compared to controls (RR 1.67; 95% CI 1.08 to 2.60).Authors' conclusions: Very little evidence exists that there is no difference in the effectiveness between different types of interventions and that brief interventions are not superior to assessment only or treatment as usual. No conclusion can be made because of the paucity of the data and the low quality of the retrieved studies.1079 - PublicationStudy Protocol: Prospective, observational, cohort study of COVID-19 in General Practice (North Dublin COVID-19 Cohort [‘ANTICIPATE’] Study)(Health Research Board, 2020-09-17)
; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; Background: It is accepted that COVID-19 will have considerable long-term consequences, especially on people’s mental and physical health and wellbeing. Although the impacts on local communities have been immense, there remains little data on long term outcomes among patients with COVID-19 who were managed in general practice and primary care. This study seeks to address this knowledge gap by examining how the COVID-19 pandemic has impacted the medium and long-term health and wellbeing of patients attending general practice, especially their mental health and wellbeing. Methods: The study will be conducted at 12 general practices in the catchment area of the Mater Misericordiae University Hospital, i.e. the North Dublin area, an area which has experienced an especially high COVID-19 incidence. Practices will be recruited from the professional networks of the research team. A member of the general practice team will be asked to identify patients of the practice who attended the practice after 16/3/20 with a confirmed or presumptive diagnosis of COVID-19 infection. Potential participants will be provided with information on the study by the clinical team. Data will be collected on those patients who consent to participate by means of an interviewer-administered questionnaire and review of clinical records. Data will be collected on health (especially mental health) and wellbeing, quality of life, health behaviours, health service utilisation, and wider impacts of COVID-19 at recruitment and at two follow up time points (6, 12 months). Deliverables: The project involves collaboration with Ireland’s Health Service Executive, Ireland East Hospital Group, and the Mater Misericordiae University Hospital, Dublin. The study is funded by the Health Research Board. Findings will inform health policies that attenuate the adverse impacts of COVID-19 on population mental health and health generally.269 - PublicationPsychosocial interventions for problem alcohol use in illicit drug users (Protocol)(John Wiley & Sons, 2011-08-10)
; ; ; ; ; ; ; ; This is the protocol for a review and there is no abstract. The objectives are as follows:To determine the effectiveness of psychosocial interventions targeting problem alcohol use versus other treatments in illicit drug users.417 - PublicationWhat Are the Self-Assessed Training Needs of Early Career Professionals in Addiction Medicine? A BEME Focused Review(Association for Medical Education in Europe (AMEE), 2020-04-03)
; ; ; ; ; Background: Substance use disorders represent a significant social and economic burden globally. Accurate diagnosis and treatment by early career professionals in addiction medicine (ECPAM) falls short, in part, due to a lack of training programmes targeting this career stage. Prior research has highlighted the need to assess the specific training needs of ECPAM. Therefore, this focused review assessed self-reported training needs of ECPAM. Methods: Medical and medical education databases (Medline, EMBASE, CINAHL, ERIC, PSYCHInfo, BEI, and AEI) were searched to June 2018 for studies reporting self-reported training needs of ECPAM (trained at most five years before assessment occurred). Retrieved citations were screened for eligibility; two independent researchers reviewed included studies, assessed quality and extracted data. Experts reviewed study findings. Results: Of 1364 identified records, three cross-sectional studies were included, originating from China, USA and England. All studies surveyed ECPAM using self-reported questionnaires, with one study including face-to-face interviews. Participants included residents, physicians and social workers. All studies had a low risk of bias, and reported a wide range of training needs including rehabilitation, relapse prevention, buprenorphine treatment and risk assessment. Conclusions: There is little evidence for and substantial heterogeneity of training needs of ECPAM found in this review, particularly at the level of skills and knowledge. Study quality varies greatly. ECPAM training needs assessments are a priority.272 - PublicationPreliminary 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.405Scopus© Citations 4 - PublicationOff the record: Substance-related disorders in the undergraduate medical curricula in IrelandBackground: 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.
518Scopus© Citations 3 - Publication
383Scopus© Citations 1 - PublicationLarge Variation in Provincial Guidelines for Urine Drug Screening During Opioid Agonist Treatment in Canada(Wolters Klumer, 2018-06)
; ; ; ; ; Urine drug screening (UDS) is commonly used to detect or validate self-reported substance use, particularly when beginning and maintaining opioid agonist therapy. However, there is currently no summary of the published clinical practice guidelines for UDS in Canada, and no measure of the consistency with which different provinces suggest administering UDS. Therefore, we conducted a policy scan of UDS guidelines, examining the published clinical practice guidelines for each Canadian province and extracting all relevant data in March 2017. Our Canadian guideline and policy scan found that UDS frequency recommendations vary greatly among Provinces for persons receiving opioid agonist therapy for opioid use disorder.362Scopus© Citations 6 - PublicationBarriers and facilitators to implementing addiction medicine fellowships: a qualitative study with fellows, medical students, residents and preceptorsBackgroundAlthough progress in science has driven advances in addiction medicine, this subject has not been adequately taught to medical trainees and physicians. As a result, there has been poor integration of evidence-based practices in addiction medicine into physician training which has impeded addiction treatment and care. Recently, a number of training initiatives have emerged internationally, including the addiction medicine fellowships in Vancouver, Canada. This study was undertaken to examine barriers and facilitators of implementing addiction medicine fellowships.MethodsWe interviewed trainees and faculty from clinical and research training programmes in addiction medicine at St Paul¿s Hospital in Vancouver, Canada (N = 26) about barriers and facilitators to implementation of physician training in addiction medicine. We included medical students, residents, fellows and supervising physicians from a variety of specialities. We analysed interview transcripts thematically by using NVivo software.ResultsWe identified six domains relating to training implementation: (1) organisational, (2) structural, (3) teacher, (4) learner, (5) patient and (6) community related variables either hindered or fostered addiction medicine education, depending on context. Human resources, variety of rotations, peer support and mentoring fostered implementation of addiction training. Money, time and space limitations hindered implementation. Participant accounts underscored how faculty and staff facilitated the implementation of both the clinical and the research training.ConclusionsImplementation of addiction medicine fellowships appears feasible, although a number of barriers exist. Research into factors within the local/practice environment that shape delivery of education to ensure consistent and quality education scale-up is a priority.
489Scopus© Citations 6 - PublicationCommentary on Zeremski et al. (2016): Improvements in HCV-related Knowledge Among Substance Users on Opioid Agonist Therapy After an Educational Intervention(Lippincott, Williams and Wilkins, 2016-10)
; ; ; ; ; Zeremski et al highlight how improving patients’ knowledge about Hepatitis C virus (HCV) care can enhance adherence to treatment plans and improved treatment outcomes (Zeremski et al. 2016). In this regard we believe that patients’ knowledge of HCV care can best be optimised through community based approaches to HCV treatment as supported by recent findings from Wade et al and Grebely et al (Wade et al. 2015, Grebely et al. 2016).247Scopus© Citations 1