Introduction to symposium held at International Congress of Behavioral Medicine, Groningen, August 2014. Discusses the shortcomings of evidence-based behavioral medicine in light of efforts to reform the shortcomings of the Pharma literature.
The drug effectiveness review project: governments collaborating to use syste...cmaverga
The document summarizes the Drug Effectiveness Review Project, which is a collaboration of organizations that systematically review evidence on the effectiveness and safety of drug classes. It aims to support policymakers by providing reviews of comparative drug effectiveness. The collaboration includes government agencies and non-profits. It produces reviews and updates on many drug classes. Results from reviews have found both differences and no differences between drugs. The project also discusses lessons learned, such as the importance of transparency and maintaining researcher independence.
A Canadian study found that integrating BMJ Clinical Evidence into a computerized physician order entry system was associated with a significant reduction in antibiotic prescription rates for children ages 2 weeks to 2 years presenting with bronchiolitis. The study reviewed antibiotic use for 334 children before and after integration, finding a decrease from 35% receiving antibiotics to 22%. Readily accessible clinical evidence at the point of care may help reduce unnecessary antibiotic use.
MedicalResearch.com Medical Research News and Interviews September 26 2015Marie Benz
This study developed a new PET scan technique using a molecular probe tagged with copper-64 that can specifically detect blood clots anywhere in the body. Testing in animal models found the technique accurately detected 42 arterial and venous clots. It was also able to distinguish newer clots from older clots based on fibrin content and detect multiple clots simultaneously. The non-invasive whole body scan could help clinicians evaluate for clots in different areas with one procedure instead of multiple tests. Translating this technique has potential to improve patient care and management of conditions like pulmonary embolism and stroke.
This document provides an overview of evidence-based medicine (EBM) presented by Dr. Harmanjit Singh. It begins with definitions of EBM and discusses its history from ancient Greek and Chinese medicine to its modern conception in the 1990s. The principles of EBM are explained, including formulating questions based on patient information and evaluating the best evidence from a hierarchy of studies. Critically appraising evidence and integrating it with clinical expertise and patient values are emphasized. Limitations of EBM are addressed.
Strategies to prevent death by suicide: meta-analysis of randomized controlle...Ahsan Aziz Sarkar
This meta-analysis reviewed randomized controlled trials comparing suicide prevention interventions to usual care. It found that the WHO's Brief Intervention and Contact intervention was associated with significantly lower odds of death by suicide. Cognitive behavioral therapy and lithium also showed fewer suicide deaths among intervention groups, but results were not statistically significant. Overall, most psychosocial interventions and pharmacotherapies did not show clear evidence of reducing suicide risk. The study highlights the need for further research on effective prevention strategies.
This study examined factors affecting adherence to Suboxone treatment among 50 African American patients through a retrospective chart review. The results showed significantly negative correlations between adherence and concurrent use of opioids, cocaine, and alcohol. Surprisingly, PTSD showed a positive correlation with adherence, contradicting other studies. No correlation was found between adherence and unemployment. The study concluded that while mental health issues and unemployment may impact adherence, the small sample size likely influenced the results. Larger studies are still needed to fully understand factors affecting Suboxone adherence in minority groups.
PCOMS and an Acute Care Inpatient Unit: Quality Improvement and Reduced Readm...Barry Duncan
High psychiatric readmission rates continue while evidence suggests that care is not perceived by patients as “patient centered.” Research has focused on aftercare strategies with little attention to the inpatient treatment itself as an intervention to reduce readmission rates. Quality improvement strategies based on patient-centered care may offer an alternative. We evaluated outcomes and readmission rates using a benchmarking methodology with a naturalistic data set from an inpatient psychiatric facility (N 2,247) that used a quality-improvement strategy called systematic patient feedback. A systematic patient feedback system, the Partners for Change Outcome Management System (PCOMS), was used. Overall pre-post effect sizes were d 1.33 and d 1.38 for patients diagnosed with a mood
disorder. These effect sizes were statistically equivalent to RCT benchmarks for feedback and depression.
Readmission rates were 6.1% (30 days), 9.5% (60 days), and 16.4% (180 days), all lower than national benchmarks. We also found that patients who achieved clinically significant treatment outcomes were less likely to be readmitted. We tentatively suggest that a focus on real-time patient outcomes as well as care that is “patient centered” may provide lower readmission rates.
This document discusses using patient-reported outcomes (PROs) to measure healthcare quality from the patient's perspective. It argues that PROs capture patients' experiences with illness, impairment, and disability, which is important because patients seek healthcare to improve their ability to function and reduce symptoms. The document also notes that treatments may improve clinical markers but not subjective patient outcomes. It advocates routinely collecting PRO data electronically to develop new performance metrics focused on whether treatments actually improve how patients feel and function. This would help align healthcare with how patients define quality.
The drug effectiveness review project: governments collaborating to use syste...cmaverga
The document summarizes the Drug Effectiveness Review Project, which is a collaboration of organizations that systematically review evidence on the effectiveness and safety of drug classes. It aims to support policymakers by providing reviews of comparative drug effectiveness. The collaboration includes government agencies and non-profits. It produces reviews and updates on many drug classes. Results from reviews have found both differences and no differences between drugs. The project also discusses lessons learned, such as the importance of transparency and maintaining researcher independence.
A Canadian study found that integrating BMJ Clinical Evidence into a computerized physician order entry system was associated with a significant reduction in antibiotic prescription rates for children ages 2 weeks to 2 years presenting with bronchiolitis. The study reviewed antibiotic use for 334 children before and after integration, finding a decrease from 35% receiving antibiotics to 22%. Readily accessible clinical evidence at the point of care may help reduce unnecessary antibiotic use.
MedicalResearch.com Medical Research News and Interviews September 26 2015Marie Benz
This study developed a new PET scan technique using a molecular probe tagged with copper-64 that can specifically detect blood clots anywhere in the body. Testing in animal models found the technique accurately detected 42 arterial and venous clots. It was also able to distinguish newer clots from older clots based on fibrin content and detect multiple clots simultaneously. The non-invasive whole body scan could help clinicians evaluate for clots in different areas with one procedure instead of multiple tests. Translating this technique has potential to improve patient care and management of conditions like pulmonary embolism and stroke.
This document provides an overview of evidence-based medicine (EBM) presented by Dr. Harmanjit Singh. It begins with definitions of EBM and discusses its history from ancient Greek and Chinese medicine to its modern conception in the 1990s. The principles of EBM are explained, including formulating questions based on patient information and evaluating the best evidence from a hierarchy of studies. Critically appraising evidence and integrating it with clinical expertise and patient values are emphasized. Limitations of EBM are addressed.
Strategies to prevent death by suicide: meta-analysis of randomized controlle...Ahsan Aziz Sarkar
This meta-analysis reviewed randomized controlled trials comparing suicide prevention interventions to usual care. It found that the WHO's Brief Intervention and Contact intervention was associated with significantly lower odds of death by suicide. Cognitive behavioral therapy and lithium also showed fewer suicide deaths among intervention groups, but results were not statistically significant. Overall, most psychosocial interventions and pharmacotherapies did not show clear evidence of reducing suicide risk. The study highlights the need for further research on effective prevention strategies.
This study examined factors affecting adherence to Suboxone treatment among 50 African American patients through a retrospective chart review. The results showed significantly negative correlations between adherence and concurrent use of opioids, cocaine, and alcohol. Surprisingly, PTSD showed a positive correlation with adherence, contradicting other studies. No correlation was found between adherence and unemployment. The study concluded that while mental health issues and unemployment may impact adherence, the small sample size likely influenced the results. Larger studies are still needed to fully understand factors affecting Suboxone adherence in minority groups.
PCOMS and an Acute Care Inpatient Unit: Quality Improvement and Reduced Readm...Barry Duncan
High psychiatric readmission rates continue while evidence suggests that care is not perceived by patients as “patient centered.” Research has focused on aftercare strategies with little attention to the inpatient treatment itself as an intervention to reduce readmission rates. Quality improvement strategies based on patient-centered care may offer an alternative. We evaluated outcomes and readmission rates using a benchmarking methodology with a naturalistic data set from an inpatient psychiatric facility (N 2,247) that used a quality-improvement strategy called systematic patient feedback. A systematic patient feedback system, the Partners for Change Outcome Management System (PCOMS), was used. Overall pre-post effect sizes were d 1.33 and d 1.38 for patients diagnosed with a mood
disorder. These effect sizes were statistically equivalent to RCT benchmarks for feedback and depression.
Readmission rates were 6.1% (30 days), 9.5% (60 days), and 16.4% (180 days), all lower than national benchmarks. We also found that patients who achieved clinically significant treatment outcomes were less likely to be readmitted. We tentatively suggest that a focus on real-time patient outcomes as well as care that is “patient centered” may provide lower readmission rates.
This document discusses using patient-reported outcomes (PROs) to measure healthcare quality from the patient's perspective. It argues that PROs capture patients' experiences with illness, impairment, and disability, which is important because patients seek healthcare to improve their ability to function and reduce symptoms. The document also notes that treatments may improve clinical markers but not subjective patient outcomes. It advocates routinely collecting PRO data electronically to develop new performance metrics focused on whether treatments actually improve how patients feel and function. This would help align healthcare with how patients define quality.
Evidence-based medicine (EBM) involves using the best available evidence from systematic research to inform clinical decision-making. It has its origins in the mid-19th century with emphasis on collecting data from patient experiences. Key milestones included the development of randomized controlled trials in the 1940s-50s and emphasis on using evidence from such trials to guide clinical practice. EBM is now the standard for evaluating treatments and making recommendations, though traditional experience and expertise remain important.
Article in Division 29's journal, psychotherapy that reviews the research on routine outcome monitoring, arguing that current efforts are at risk for repeating the history of failed efforts to improve the outcome of psychotherapy.
This randomized clinical trial tested an intervention using interactive voice response (IVR) technology to provide tailored behavioral support to improve statin medication adherence. The trial involved 497 patients from a large health plan who were randomized to an experimental group receiving up to 3 tailored IVR calls and printed materials, or a control group receiving a single generic IVR call and generic printed materials. The primary outcome was 6-month statin adherence based on pharmacy claims. Patients in the experimental group had significantly higher adherence (70.4%) than controls (60.7%), suggesting tailored behavioral support using IVR can effectively improve statin medication adherence.
Pain Validity Test identifies drug seeking behavior. Stop opioid abuse. Prote...Nelson Hendler
Physician prescribing practices are under constant scrutiny. An Internet questionnaire will predict if a patient will have a medical test abnormality with 95% accuracy, and 100% if the patient will not. This Pain Validity Test can be used to detect drug seeking behavior in patients, at a far high level of accuracy than tests currently in use (34.4%-48.2% accuracy).. The Pain Validity test has been admitted as evidence in 30 cases in 9 states.
Antidepressants in Bipolar Disorder (mar 2007)John Reites
This article discusses the use of antidepressants in the treatment of bipolar disorder based on data from the Verispan PDDA database from December 2005 to November 2006. The key findings were:
1) Mood stabilizers were the most commonly prescribed medication category for bipolar disorder at 54%, followed by antipsychotics at 50% and antidepressants at 34%.
2) Of patients prescribed antidepressants, 56% were in combination with a mood stabilizer and 27% were in combination with an antipsychotic. Only 9% received antidepressant monotherapy.
3) An expert commentary discusses concerns about the use of antidepressants in bipolar disorder given risks of inducing mania or rapid cycling, and lack
This document discusses non-adherence to medication. It begins by defining non-adherence and reviewing studies showing patients only adhere to their medications 35-50% of the time. There are two types of non-adherence: passive (barriers outside patient control) and active (intentional non-adherence). Non-adherence increases morbidity, mortality, and costs the healthcare system. Studies show inconsistent gender differences in adherence, with most showing lower adherence in women, and the highest non-adherence rate in adults aged 65-75. The document proposes targeting female patients aged 65-75 in the UK prescribed antihypertensive medication, using a remote intervention informed by the Health Belief Model.
1) Use of psychiatric drugs in the US has increased dramatically in recent decades, with 10% of the population prescribed antidepressants by 2005 and antipsychotics ranking as the top prescription drug in 2009.
2) However, clinical trials have found most psychiatric drugs to be only marginally more effective than placebo for depression and anxiety in adults. For children and adolescents, antidepressants actually show increased risks of suicidality compared to placebo in clinical trials.
3) Stimulants for ADHD show minimal benefits beyond reducing symptoms, with risks including decreased growth and potential for serious adverse cardiac and psychiatric effects. Long-term studies found medication no more effective than behavioral therapies.
2006 presentation at The European Health Psychology Conference in Bath: Can We Bury the Idea That Psychotherapy Extends the survival of Cancer Patients?
This document reviews the evidence from randomized clinical trials and Cochrane Reviews supporting various complementary and alternative medicine (CAM) therapies. It finds:
1) Many CAM therapies like acupuncture, chiropractic care, and certain diets and supplements have shown some benefits for certain conditions based on randomized trials, though the evidence is often limited.
2) Other CAM therapies have not been well studied or have trials with significant limitations.
3) While randomized trials are important, they also have limitations, and medicine sometimes appropriately uses therapies without unambiguous evidence-based support to help patients. More research is still needed on the therapeutic value of many CAM interventions.
The document provides a commentary critiquing the notion that integrating psychotherapy and pharmacotherapy represents a logical or informed direction. It argues that pushing integration as "best practice" contradicts what is known about the effectiveness of pharmacological interventions and how people change in psychotherapy. The commentary examines three articles on this topic, finding they represent typical presentations of myths in professional literature that justify broad medical practice while diminishing the role of clients in the change process.
Comparative effectiveness analysis and quality of lifeelamar129
The document discusses using comparative effectiveness analysis and quality-adjusted life years (QALYs) to evaluate cancer treatments and their costs. It provides examples of calculating QALYs and cost-effectiveness for a hypothetical liver cancer drug under different assumptions about survival time, quality of life, and costs. It then critiques the use of such models, arguing they often underestimate benefits and can be used to deny patients effective treatments based on cost alone.
Comparative effectiveness analysis and quality of lifeelamar129
The document discusses using comparative effectiveness analysis and quality-adjusted life years (QALYs) to evaluate cancer treatments and their costs. It provides examples of calculating QALYs and cost-effectiveness for a hypothetical liver cancer drug under different assumptions about survival time, quality of life, and costs. It then critiques the use of such models, arguing they often underestimate benefits and can be used to deny patients effective treatments based on cost alone.
Comparative effectiveness analysis and quality of life(2)elamar129
The document discusses using comparative effectiveness analysis and quality-adjusted life years (QALYs) to evaluate cancer treatments and their costs. It provides examples of calculating QALYs and cost-effectiveness for a hypothetical liver cancer drug under different assumptions about survival time, quality of life, and costs. It then critiques the use of such models, arguing they often underestimate benefits and can be used to deny patients effective treatments based on cost alone.
The document discusses issues related to measuring and modeling medication adherence using claims data. It covers calculating adherence measures like MPR and PDC, defining adherence thresholds, handling primary non-compliance, and addressing endogeneity and selection bias when modeling adherence as an independent variable to estimate its impact on outcomes. Regression adjustment, propensity score matching, and instrumental variables are some methods discussed to address biases in observational studies of adherence.
Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Systematic Review for the U.S. Preventive Services Task Force
Are most positive findings in psychology false or exaggerated? An activist's ...James Coyne
This document summarizes a presentation given by James Coyne on issues with reliability and bias in positive psychology findings. Some key points:
- John Ioannidis and others have shown that many positive findings in biomedical research do not replicate and are exaggerated or false due to biases.
- Similar issues exist in psychology due to confirmatory bias, flexible data analysis and chasing statistical significance.
- Reforms are needed like pre-registering studies, transparent reporting standards, and making data available for independent analysis.
- However, challenges remain as journals prefer positive results and organizations have conflicts of interest that uphold certain findings. Overall, skepticism is needed regarding many claimed research findings.
PCOMS: A Viable Quality Improvement Strategy for Public Behavioral HealthBarry Duncan
This is the latest from the research team of the Heart and Soul of Change Project, published in the Journal of Consulting and Clinical Psychology. This study demonstrated that PCOMS is not only a viable quality improvement strategy but also that services to the poor and disenfranchised provided in a public behavioral setting, contrary to earlier research, can be as effective as those delivered in randomized clinical trials.
This document provides a critique of 4 recent meta-analyses published in Health Psychology. It finds problems with transparency and completeness in how the meta-analyses were reported. It also notes a dependence on small, underpowered original trials of generally poor quality. The document questions the clinical validity and utility of conclusions drawn from these meta-analyses due to issues like clinical heterogeneity among studies and lack of consideration of methodological quality. Overall, it aims to encourage more rigorous standards for meta-analyses to avoid inaccurate or exaggerated conclusions.
Evidence-based medicine (EBM) involves using the best available evidence from systematic research to inform clinical decision-making. It has its origins in the mid-19th century with emphasis on collecting data from patient experiences. Key milestones included the development of randomized controlled trials in the 1940s-50s and emphasis on using evidence from such trials to guide clinical practice. EBM is now the standard for evaluating treatments and making recommendations, though traditional experience and expertise remain important.
Article in Division 29's journal, psychotherapy that reviews the research on routine outcome monitoring, arguing that current efforts are at risk for repeating the history of failed efforts to improve the outcome of psychotherapy.
This randomized clinical trial tested an intervention using interactive voice response (IVR) technology to provide tailored behavioral support to improve statin medication adherence. The trial involved 497 patients from a large health plan who were randomized to an experimental group receiving up to 3 tailored IVR calls and printed materials, or a control group receiving a single generic IVR call and generic printed materials. The primary outcome was 6-month statin adherence based on pharmacy claims. Patients in the experimental group had significantly higher adherence (70.4%) than controls (60.7%), suggesting tailored behavioral support using IVR can effectively improve statin medication adherence.
Pain Validity Test identifies drug seeking behavior. Stop opioid abuse. Prote...Nelson Hendler
Physician prescribing practices are under constant scrutiny. An Internet questionnaire will predict if a patient will have a medical test abnormality with 95% accuracy, and 100% if the patient will not. This Pain Validity Test can be used to detect drug seeking behavior in patients, at a far high level of accuracy than tests currently in use (34.4%-48.2% accuracy).. The Pain Validity test has been admitted as evidence in 30 cases in 9 states.
Antidepressants in Bipolar Disorder (mar 2007)John Reites
This article discusses the use of antidepressants in the treatment of bipolar disorder based on data from the Verispan PDDA database from December 2005 to November 2006. The key findings were:
1) Mood stabilizers were the most commonly prescribed medication category for bipolar disorder at 54%, followed by antipsychotics at 50% and antidepressants at 34%.
2) Of patients prescribed antidepressants, 56% were in combination with a mood stabilizer and 27% were in combination with an antipsychotic. Only 9% received antidepressant monotherapy.
3) An expert commentary discusses concerns about the use of antidepressants in bipolar disorder given risks of inducing mania or rapid cycling, and lack
This document discusses non-adherence to medication. It begins by defining non-adherence and reviewing studies showing patients only adhere to their medications 35-50% of the time. There are two types of non-adherence: passive (barriers outside patient control) and active (intentional non-adherence). Non-adherence increases morbidity, mortality, and costs the healthcare system. Studies show inconsistent gender differences in adherence, with most showing lower adherence in women, and the highest non-adherence rate in adults aged 65-75. The document proposes targeting female patients aged 65-75 in the UK prescribed antihypertensive medication, using a remote intervention informed by the Health Belief Model.
1) Use of psychiatric drugs in the US has increased dramatically in recent decades, with 10% of the population prescribed antidepressants by 2005 and antipsychotics ranking as the top prescription drug in 2009.
2) However, clinical trials have found most psychiatric drugs to be only marginally more effective than placebo for depression and anxiety in adults. For children and adolescents, antidepressants actually show increased risks of suicidality compared to placebo in clinical trials.
3) Stimulants for ADHD show minimal benefits beyond reducing symptoms, with risks including decreased growth and potential for serious adverse cardiac and psychiatric effects. Long-term studies found medication no more effective than behavioral therapies.
2006 presentation at The European Health Psychology Conference in Bath: Can We Bury the Idea That Psychotherapy Extends the survival of Cancer Patients?
This document reviews the evidence from randomized clinical trials and Cochrane Reviews supporting various complementary and alternative medicine (CAM) therapies. It finds:
1) Many CAM therapies like acupuncture, chiropractic care, and certain diets and supplements have shown some benefits for certain conditions based on randomized trials, though the evidence is often limited.
2) Other CAM therapies have not been well studied or have trials with significant limitations.
3) While randomized trials are important, they also have limitations, and medicine sometimes appropriately uses therapies without unambiguous evidence-based support to help patients. More research is still needed on the therapeutic value of many CAM interventions.
The document provides a commentary critiquing the notion that integrating psychotherapy and pharmacotherapy represents a logical or informed direction. It argues that pushing integration as "best practice" contradicts what is known about the effectiveness of pharmacological interventions and how people change in psychotherapy. The commentary examines three articles on this topic, finding they represent typical presentations of myths in professional literature that justify broad medical practice while diminishing the role of clients in the change process.
Comparative effectiveness analysis and quality of lifeelamar129
The document discusses using comparative effectiveness analysis and quality-adjusted life years (QALYs) to evaluate cancer treatments and their costs. It provides examples of calculating QALYs and cost-effectiveness for a hypothetical liver cancer drug under different assumptions about survival time, quality of life, and costs. It then critiques the use of such models, arguing they often underestimate benefits and can be used to deny patients effective treatments based on cost alone.
Comparative effectiveness analysis and quality of lifeelamar129
The document discusses using comparative effectiveness analysis and quality-adjusted life years (QALYs) to evaluate cancer treatments and their costs. It provides examples of calculating QALYs and cost-effectiveness for a hypothetical liver cancer drug under different assumptions about survival time, quality of life, and costs. It then critiques the use of such models, arguing they often underestimate benefits and can be used to deny patients effective treatments based on cost alone.
Comparative effectiveness analysis and quality of life(2)elamar129
The document discusses using comparative effectiveness analysis and quality-adjusted life years (QALYs) to evaluate cancer treatments and their costs. It provides examples of calculating QALYs and cost-effectiveness for a hypothetical liver cancer drug under different assumptions about survival time, quality of life, and costs. It then critiques the use of such models, arguing they often underestimate benefits and can be used to deny patients effective treatments based on cost alone.
The document discusses issues related to measuring and modeling medication adherence using claims data. It covers calculating adherence measures like MPR and PDC, defining adherence thresholds, handling primary non-compliance, and addressing endogeneity and selection bias when modeling adherence as an independent variable to estimate its impact on outcomes. Regression adjustment, propensity score matching, and instrumental variables are some methods discussed to address biases in observational studies of adherence.
Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Systematic Review for the U.S. Preventive Services Task Force
Are most positive findings in psychology false or exaggerated? An activist's ...James Coyne
This document summarizes a presentation given by James Coyne on issues with reliability and bias in positive psychology findings. Some key points:
- John Ioannidis and others have shown that many positive findings in biomedical research do not replicate and are exaggerated or false due to biases.
- Similar issues exist in psychology due to confirmatory bias, flexible data analysis and chasing statistical significance.
- Reforms are needed like pre-registering studies, transparent reporting standards, and making data available for independent analysis.
- However, challenges remain as journals prefer positive results and organizations have conflicts of interest that uphold certain findings. Overall, skepticism is needed regarding many claimed research findings.
PCOMS: A Viable Quality Improvement Strategy for Public Behavioral HealthBarry Duncan
This is the latest from the research team of the Heart and Soul of Change Project, published in the Journal of Consulting and Clinical Psychology. This study demonstrated that PCOMS is not only a viable quality improvement strategy but also that services to the poor and disenfranchised provided in a public behavioral setting, contrary to earlier research, can be as effective as those delivered in randomized clinical trials.
This document provides a critique of 4 recent meta-analyses published in Health Psychology. It finds problems with transparency and completeness in how the meta-analyses were reported. It also notes a dependence on small, underpowered original trials of generally poor quality. The document questions the clinical validity and utility of conclusions drawn from these meta-analyses due to issues like clinical heterogeneity among studies and lack of consideration of methodological quality. Overall, it aims to encourage more rigorous standards for meta-analyses to avoid inaccurate or exaggerated conclusions.
The PPACA of 2010PPACA of 2010 brought many changes to the types o.docxsuzannewarch
The PPACA of 2010
PPACA of 2010 brought many changes to the types of provider organizations available. ACOs and PCMHs are two new organizations formed under PPACA. Using the readings this week, discuss the origin, structure, and purpose of the new organizations formed under PPACA.
Using South University Online Library (for example, CINAHL) or the Internet, search any three articles from the list below and evaluate the challenges and opportunities facing payers and providers as ACOs and PCMHs are implemented:
The patient-center medical home and managed care: Times have changed, some components have not (Baird, 2011).
Patient-centered medical homes: Will health care reform provide new options for rural communities and providers? (Bolin, Gamm, Vest, Edwardson, & Miller, 2011)
Accountable Care Organizations: The case for flexible partnerships between health plans and providers (Goldsmith, 2011).
Payment reform for primary care within the accountable care organization a critical issue for health system reform (Goroll & Schoenbaum, 2012).
Accountable care organizations, the patient-centered medical home, and health care reform: What does it all mean? (Longworth, 2011)
Implementing accountable care organizations: Ten potential mistakes and how to learn from them (Singer & Shortell, 2011).
Based on your research, summarize your findings on the selected topics and compile your observations in a 5- to 6-page Microsoft Word document.
Support your responses with examples.
Cite any sources in APA format.
References
:
Baird, M. A. (2011). The patient-center medical home and managed care: Times
have changed, some components have not.
The Journal of the American
Board of Family Medicine
,
24
(6), 630–632.
Bolin, J. N., Gamm, L., Vest, J. R., Edwardson, N., & Miller, T. R. (2011).
Patient-centered medical homes: Will health care reform provide new
options for rural communities and providers?
Family & Community
Health
,
34
(2), 93–101.
Goldsmith, J. (2011). Accountable Care Organizations: The case for flexible
partnerships between health plans and providers.
Health Affairs
,
30
(1), 32–40.
Goroll, A. H., & Schoenbaum, S. C. (2012). Payment reform for primary care
within the accountable care organization a critical issue for health system
reform. JAMA:
The Journal of the American Medical Association
,
308
(6), 577–578.
Longworth, D. L. (2011). Accountable care organizations, the patient-centered
medical home, and health care reform: What does it all mean?
Cleveland Clinic Journal of Medicine
,
78
(9), 571–582.
Singer, S., & Shortell, S. M. (2011). Implementing accountable care
organizations: Ten potential mistakes and how to learn from them. JAMA:
The Journal of the American Medical Association
,
306
(7), 758.
Assignment 2 Grading Criteria
Maximum Points
Discussed the impact of health care reform on patients and prov.
Critical Appraisal Of Research Essay Example Paper.docxstudywriters
1) Four peer-reviewed articles on racism and health were critically appraised using an evaluation table.
2) Based on the appraisal, the best practice that emerged was reducing racism in healthcare settings to improve health outcomes and promote equal access to quality care.
3) Stronger measures are needed to eliminate racism through increasing cultural competency training and ensuring non-discriminatory, equitable treatment for all patients.
Critical Appraisal Of Research Essay Example Paper.docxstudywriters
1) Four peer-reviewed articles on racism and health were critically appraised using an evaluation table.
2) Based on the appraisal, the best practice that emerged was reducing racism in healthcare settings to improve health outcomes and promote equal access to quality care.
3) Stronger measures are needed to eliminate racism through improving cultural competency and ensuring all patients receive equitable treatment.
A Systematic Review On The Effectiveness Of Complementary And Alternative Med...Martha Brown
This systematic review assessed the effects of spinal manipulative therapy (SMT), acupuncture, and herbal medicine for chronic non-specific low back pain (LBP) based on 35 randomized controlled trials including over 8,000 patients. The review found that SMT, acupuncture, and herbal medicine provided only short-term relief or improvement for chronic LBP based on low to very low quality evidence. Specifically, SMT was not found to be more clinically beneficial than sham treatments, passive modalities, or other interventions. Acupuncture provided short-term benefit compared to waiting list controls or when added to other interventions. Herbal medicines showed some positive short-term individual trial results but overall effects could not be determined due to
Prescription opioid use among adults with mental health disorders in the US.Paul Coelho, MD
This study analyzed nationally representative health survey data to examine prescription opioid use among US adults with mental health disorders. The key findings were:
1) An estimated 18.7% of the 38.6 million American adults with mental health disorders use prescription opioids, accounting for 51.4% of the total opioid prescriptions distributed in the US each year.
2) Adults with mental health disorders were over 3 times more likely to use opioids compared to adults without mental health disorders.
3) Having a mental health disorder was associated with a more than 2 times greater odds of prescription opioid use after adjusting for other health factors.
Prescription Opioid Use Among Adults with Mental Health Disorders in the USPaul Coelho, MD
This study used nationally representative survey data to examine prescription opioid use among US adults with mental health disorders. The key findings were:
1) An estimated 18.7% of the 38.6 million American adults with mental health disorders use prescription opioids, accounting for 51.4% of the total opioid prescriptions distributed in the US each year.
2) Adults with mental health disorders were over 3 times more likely to use opioids compared to adults without mental health disorders.
3) Having a mental health disorder, such as depression or anxiety, was associated with a more than 2 times greater odds of prescription opioid use after adjusting for other factors.
The document summarizes a systematic review of 23 randomized controlled trials that examined the efficacy of distant healing, which includes prayer, Therapeutic Touch, and other forms of spiritual healing. The trials involved a total of 2774 patients. 13 of the trials, representing 57% of studies, found statistically significant treatment effects of distant healing. While methodological limitations make definitive conclusions difficult, the authors found that given over half of trials showed benefits, further research is warranted.
SLC CME- Evidence based medicine 07/27/2007cddirks
Saint Luke's Care, a quality improvement organization within Saint Luke's Health System, presents a CME presentation by Dr. Brent Beasley on Evidence Based Medical Care.
This document discusses evidence-based laboratory medicine (EBLM) and its key components. It explains that EBLM involves the conscientious, explicit and judicious use of current best evidence in making well-informed decisions in laboratory medicine. The main components of EBLM are individual expertise, best external evidence, and patient values and expectations. It also discusses how to practice EBLM by asking questions, acquiring evidence, critically appraising the evidence, and applying the information while evaluating the process.
The study tested an electronic diabetes tracker shared between patients and providers to improve diabetes care. Patients in the intervention group had access to the tracker and decision support. They saw greater improvements in monitoring of diabetes factors and clinical outcomes like blood pressure and HbA1c levels compared to the control group. However, it is unclear if the improvements were due to the decision support, reminders, or more frequent provider visits in the intervention group.
This systematic review examined 67 studies on strategies to reduce or discontinue long-term opioid therapy (LTOT) for chronic pain and the effect of dose reduction on patient outcomes. The key findings were:
1) Interdisciplinary pain programs had the highest completion and opioid discontinuation rates, ranging from 76-100% and 29-100% respectively across 31 studies of varying quality.
2) Buprenorphine-assisted dose reduction resulted in opioid discontinuation rates ranging from 33-100% in 10 poor quality studies.
3) Among 40 studies of varying quality examining patient outcomes after dose reduction, improvement was reported in pain severity, function, and quality of life, though the overall evidence quality was very
Anorexia Nervosa Treatment A Systematic Review Of Randomized Controlled TrialsLisa Graves
This systematic review examined evidence from randomized controlled trials on the treatment of anorexia nervosa. The review identified 32 treatment studies and rated the quality. The evidence for medication treatments and behavioral treatments for adults with anorexia nervosa was found to be sparse and inconclusive. Variants of family therapy were shown to be efficacious for adolescents with anorexia nervosa, but not for adults. Overall, the review concluded that the evidence for anorexia nervosa treatment is weak due to small sample sizes, lack of standard outcome measures, high dropout rates, and lack of evidence examining differential outcomes based on sociodemographic factors.
The document discusses patient non-adherence to medical treatment plans. It summarizes research showing that healthcare providers and patients have differing views on adherence levels. The main reasons for non-adherence are identified as lack of education, forgetfulness, and cost/complexity of treatment plans. The document reports on surveys of healthcare providers and patients, finding that both groups agree responsibility for adherence is primarily on patients, but that doctors and other providers should better educate patients. Improving communication between providers and patients is seen as key to increasing treatment adherence.
Evidence live 2015 -hierarchical levels of evidence based medicine are incor...Jorge Ramírez
1) The hierarchical levels of evidence in evidence-based medicine are incorrect according to an analysis of studies.
2) Data and analyses support the hypothesis that evidence-based medicine rankings of randomized controlled trials, observational studies, and other research designs may be too simplistic.
3) Evidence-based medicine itself is not truly evidence-based, as its foundations are more based on opinions than real data and it fails to consider the complex relationships involved in human pharmacology.
Similar to “Evidenced based” behavioral medicine as bad as bad pharma (20)
Are Most Positive Findings False? Confirmatory Bias in the Evaluation of Psyc...James Coyne
I was tired of this 2007 presentation being plagiarized and so i am making it available. The time stamp for the file on a hard drive for it is 3.20.2007. An old cv I retrieved indicates that I gave a talk at Catholic University of America and at University of Gronigen with this title in 2007. I recycled some of the slides since and slides 48-50 have been quite popular as seen in some persons using them in publications without appropriate attribution.
Regardless, you should be amazed how prescient this presentation now seems, over a decade later, and how much things have not changed.
The scandal of the £5m PACE chronic fatigue trialJames Coyne
Talk delivered to patients with chronic fatigue/myalgic
encephalomyelitis Belfast Castle February 7, 2016 about trial of psychotherapy that failed to demonstrate effectiveness, despite claims to the contrary
The scandal of the £5m pace trial for myalgic encephalomyelitisJames Coyne
This document summarizes James Coyne's involvement in criticizing the PACE trial for chronic fatigue syndrome. It discusses how Coyne initially published a critique of the trial findings in Lancet Psychiatry. When the PACE investigators refused to share trial data upon request, as they had promised, it became an internationally watched standoff. Coyne aims to obtain and reanalyze the data or get the paper retracted. He also wants to stop the abuse and stigmatization of CFS patients and recognize them as scientists.
Understanding Psychosis and Schizophrenia Royal EdinburghJames Coyne
Offers evidence that group of UK clinical psychologists offer misinformation to persons seeking information about services for serious mental problems.
Researchers face pressure to publish exciting findings that will garner media attention, but must take care not to exaggerate or distort their results. While promotion of their work is necessary, researchers should use appropriate causal language, recognize limitations of their studies, and remain transparent in reporting associations and rationale. Responsible reporting practices help ensure research accurately informs public health policies and recommendations.
Screening for depression in medical settings 2015 updateJames Coyne
This document summarizes a presentation on screening for depression in medical settings. The presenter expresses skepticism about screening and notes controversies should be resolved by evidence. Screening is meant to detect untreated depressed patients but success requires identifying many such patients and engaging them in effective treatment. However, evidence shows recognition alone does not improve outcomes and benefits of screening depend on the quality of routine care available. Overall, the presenter argues the evidence does not clearly support widespread screening and identifies potential harms such as high false positive rates and risks of overdiagnosis.
Maximizng the power of good scientific writingJames Coyne
Presentation at UMCG Central Medical Library, University of Groningen Symposium "How to Write a World-class Paper“ November 14th, 2014
A highly cited author discusses how differently he is now writing and promoting his articles compared to his first ones.
Negative emotions and health: Why do we keep stalking bears.ehpsJames Coyne
This document discusses the tendency of researchers to make spurious claims linking negative emotions to health outcomes. For over 50 years, researchers have claimed to find a modifiable connection between negative emotion and morbidity/mortality, but these claims often lead to embarrassment after being disconfirmed. The document argues that many studies actually find only uninformative risk markers rather than true modifiable risk factors. It warns against continuing to make premature or exaggerated claims without ruling out alternative explanations like residual confounding.
Rethinking, rebuilding psychosocial care for cancer patientsJames Coyne
Presented as the 8th Trevor Anderson Psycho-Oncology Lecture, September 8, 2014, Melbourne, Australia.
Discusses how psychosocial care for cancer patients needs to be reorganized so that a broader range of cancer patients are served. Routine screening for distress is unlikely to be an efficient means of countering tendencies of cancer care more generally becoming more organized around time efficiency and billable procedures. Psychosocial care for many cancer patients involves discussions, negotiations, and care coordination they cannot be well fit into the idea of a counseling session. The unsung heroes of providing such care are underappreciated social workers and oncology nurses.
Why screeing cancer patients for distress will increase disparities in psycho...James Coyne
Keynote address
Implementing screening of cancer patients for distress will not improve patient outcomes and may aggravate existing biases in who get psychosocial services.
Groningen defeating dissertation blues 2104James Coyne
Invited talk to the Groningen Students in Medical Science PhD Council, May 2014. Presents practical strategies for PhD students to combat the blues while writing their theses.
Negative emotion and health why do we keep stalking bears, when we only find ...James Coyne
Describes the frustrating search for a link between specific negative emotions and health and why the search often fails. Integrates epidemiology and psychology.
The folly of believing positive findings from underpowered intervention studiesJames Coyne
Presented at the European Health Psychology Conference, July 13, 2013, This slideshow shows the folly of accepting positive findings from underpowered studies. Much of the "evidence" in health psychology comes from such unreliable studies.
Where’s the evidence that screening for distress benefits cancer patients?James Coyne
“The case against screening for distress.” A presentation delivered as part of an invited debate with Alex Mitchell at the International Psycho Oncology Conference, Rotterdam, November 7, 2013
Advice to junior researchers: High or low road to success?James Coyne
A presentation from the International Psycho-Oncology Society Conference in Rotterdam invited by the IPOS Early Career Professionals Special Interest Group.
Families, Family Interaction and Health 2009 NIMH PresentionJames Coyne
The document summarizes critiques of past studies that claimed to find direct physiological links between family interactions and health outcomes like diabetes control or mortality. Some key criticisms included small sample sizes, overanalyzed data, ignoring obvious behavioral explanations like medication adherence, and findings that did not replicate or pass common sense tests. Later work found marital quality predicted survival through more plausible mechanisms like supporting complex medical regimens rather than direct physiological pathways. The takeaway is to be cautious of strong claims from weak evidence and avoid distractions from testable hypotheses about behavioral pathways.
Evaluates a meta analysis of family therapy interventions for families facing physical illness.
The slide presentation and article is discussed in greater detail at http://jcoynester.wordpress.com/2013/08/12/interventions-for-the-family-in-chronic-illness-a-meta-analysis-i-like/
When cherished beliefs clash with evidenceJames Coyne
The document summarizes challenges faced when scientific evidence contradicts widely held beliefs. It discusses how storylines become entrenched and shape how evidence is perceived, often in a biased way that favors confirming existing beliefs. Even well-conducted studies showing no effect of psychosocial interventions on cancer outcomes have been misrepresented or ignored. The document calls for more transparent and honest reporting of results to establish a climate where null findings are valued rather than hyped results.
Redesigning methods of psychosocial intervention 2 10 13James Coyne
This document discusses redesigning psychosocial services for cancer patients. It notes that international standards for cancer care may not be practical or appropriate for all cultural contexts. When developing new services, it is important to evaluate appropriateness, involve stakeholders, and monitor implementation. Screening all patients for distress may not be feasible and could identify needs without solutions. Alternatively, all patients should have opportunities to discuss their experiences and concerns without screening. The goals of psychosocial care should be better symptom management, access to support, and specialized services for high-risk patients.
The use of Nauplii and metanauplii artemia in aquaculture (brine shrimp).pptxMAGOTI ERNEST
Although Artemia has been known to man for centuries, its use as a food for the culture of larval organisms apparently began only in the 1930s, when several investigators found that it made an excellent food for newly hatched fish larvae (Litvinenko et al., 2023). As aquaculture developed in the 1960s and ‘70s, the use of Artemia also became more widespread, due both to its convenience and to its nutritional value for larval organisms (Arenas-Pardo et al., 2024). The fact that Artemia dormant cysts can be stored for long periods in cans, and then used as an off-the-shelf food requiring only 24 h of incubation makes them the most convenient, least labor-intensive, live food available for aquaculture (Sorgeloos & Roubach, 2021). The nutritional value of Artemia, especially for marine organisms, is not constant, but varies both geographically and temporally. During the last decade, however, both the causes of Artemia nutritional variability and methods to improve poorquality Artemia have been identified (Loufi et al., 2024).
Brine shrimp (Artemia spp.) are used in marine aquaculture worldwide. Annually, more than 2,000 metric tons of dry cysts are used for cultivation of fish, crustacean, and shellfish larva. Brine shrimp are important to aquaculture because newly hatched brine shrimp nauplii (larvae) provide a food source for many fish fry (Mozanzadeh et al., 2021). Culture and harvesting of brine shrimp eggs represents another aspect of the aquaculture industry. Nauplii and metanauplii of Artemia, commonly known as brine shrimp, play a crucial role in aquaculture due to their nutritional value and suitability as live feed for many aquatic species, particularly in larval stages (Sorgeloos & Roubach, 2021).
ESPP presentation to EU Waste Water Network, 4th June 2024 “EU policies driving nutrient removal and recycling
and the revised UWWTD (Urban Waste Water Treatment Directive)”
Remote Sensing and Computational, Evolutionary, Supercomputing, and Intellige...University of Maribor
Slides from talk:
Aleš Zamuda: Remote Sensing and Computational, Evolutionary, Supercomputing, and Intelligent Systems.
11th International Conference on Electrical, Electronics and Computer Engineering (IcETRAN), Niš, 3-6 June 2024
Inter-Society Networking Panel GRSS/MTT-S/CIS Panel Session: Promoting Connection and Cooperation
https://www.etran.rs/2024/en/home-english/
The ability to recreate computational results with minimal effort and actionable metrics provides a solid foundation for scientific research and software development. When people can replicate an analysis at the touch of a button using open-source software, open data, and methods to assess and compare proposals, it significantly eases verification of results, engagement with a diverse range of contributors, and progress. However, we have yet to fully achieve this; there are still many sociotechnical frictions.
Inspired by David Donoho's vision, this talk aims to revisit the three crucial pillars of frictionless reproducibility (data sharing, code sharing, and competitive challenges) with the perspective of deep software variability.
Our observation is that multiple layers — hardware, operating systems, third-party libraries, software versions, input data, compile-time options, and parameters — are subject to variability that exacerbates frictions but is also essential for achieving robust, generalizable results and fostering innovation. I will first review the literature, providing evidence of how the complex variability interactions across these layers affect qualitative and quantitative software properties, thereby complicating the reproduction and replication of scientific studies in various fields.
I will then present some software engineering and AI techniques that can support the strategic exploration of variability spaces. These include the use of abstractions and models (e.g., feature models), sampling strategies (e.g., uniform, random), cost-effective measurements (e.g., incremental build of software configurations), and dimensionality reduction methods (e.g., transfer learning, feature selection, software debloating).
I will finally argue that deep variability is both the problem and solution of frictionless reproducibility, calling the software science community to develop new methods and tools to manage variability and foster reproducibility in software systems.
Exposé invité Journées Nationales du GDR GPL 2024
Describing and Interpreting an Immersive Learning Case with the Immersion Cub...Leonel Morgado
Current descriptions of immersive learning cases are often difficult or impossible to compare. This is due to a myriad of different options on what details to include, which aspects are relevant, and on the descriptive approaches employed. Also, these aspects often combine very specific details with more general guidelines or indicate intents and rationales without clarifying their implementation. In this paper we provide a method to describe immersive learning cases that is structured to enable comparisons, yet flexible enough to allow researchers and practitioners to decide which aspects to include. This method leverages a taxonomy that classifies educational aspects at three levels (uses, practices, and strategies) and then utilizes two frameworks, the Immersive Learning Brain and the Immersion Cube, to enable a structured description and interpretation of immersive learning cases. The method is then demonstrated on a published immersive learning case on training for wind turbine maintenance using virtual reality. Applying the method results in a structured artifact, the Immersive Learning Case Sheet, that tags the case with its proximal uses, practices, and strategies, and refines the free text case description to ensure that matching details are included. This contribution is thus a case description method in support of future comparative research of immersive learning cases. We then discuss how the resulting description and interpretation can be leveraged to change immersion learning cases, by enriching them (considering low-effort changes or additions) or innovating (exploring more challenging avenues of transformation). The method holds significant promise to support better-grounded research in immersive learning.
Unlocking the mysteries of reproduction: Exploring fecundity and gonadosomati...AbdullaAlAsif1
The pygmy halfbeak Dermogenys colletei, is known for its viviparous nature, this presents an intriguing case of relatively low fecundity, raising questions about potential compensatory reproductive strategies employed by this species. Our study delves into the examination of fecundity and the Gonadosomatic Index (GSI) in the Pygmy Halfbeak, D. colletei (Meisner, 2001), an intriguing viviparous fish indigenous to Sarawak, Borneo. We hypothesize that the Pygmy halfbeak, D. colletei, may exhibit unique reproductive adaptations to offset its low fecundity, thus enhancing its survival and fitness. To address this, we conducted a comprehensive study utilizing 28 mature female specimens of D. colletei, carefully measuring fecundity and GSI to shed light on the reproductive adaptations of this species. Our findings reveal that D. colletei indeed exhibits low fecundity, with a mean of 16.76 ± 2.01, and a mean GSI of 12.83 ± 1.27, providing crucial insights into the reproductive mechanisms at play in this species. These results underscore the existence of unique reproductive strategies in D. colletei, enabling its adaptation and persistence in Borneo's diverse aquatic ecosystems, and call for further ecological research to elucidate these mechanisms. This study lends to a better understanding of viviparous fish in Borneo and contributes to the broader field of aquatic ecology, enhancing our knowledge of species adaptations to unique ecological challenges.
Authoring a personal GPT for your research and practice: How we created the Q...Leonel Morgado
Thematic analysis in qualitative research is a time-consuming and systematic task, typically done using teams. Team members must ground their activities on common understandings of the major concepts underlying the thematic analysis, and define criteria for its development. However, conceptual misunderstandings, equivocations, and lack of adherence to criteria are challenges to the quality and speed of this process. Given the distributed and uncertain nature of this process, we wondered if the tasks in thematic analysis could be supported by readily available artificial intelligence chatbots. Our early efforts point to potential benefits: not just saving time in the coding process but better adherence to criteria and grounding, by increasing triangulation between humans and artificial intelligence. This tutorial will provide a description and demonstration of the process we followed, as two academic researchers, to develop a custom ChatGPT to assist with qualitative coding in the thematic data analysis process of immersive learning accounts in a survey of the academic literature: QUAL-E Immersive Learning Thematic Analysis Helper. In the hands-on time, participants will try out QUAL-E and develop their ideas for their own qualitative coding ChatGPT. Participants that have the paid ChatGPT Plus subscription can create a draft of their assistants. The organizers will provide course materials and slide deck that participants will be able to utilize to continue development of their custom GPT. The paid subscription to ChatGPT Plus is not required to participate in this workshop, just for trying out personal GPTs during it.
When I was asked to give a companion lecture in support of ‘The Philosophy of Science’ (https://shorturl.at/4pUXz) I decided not to walk through the detail of the many methodologies in order of use. Instead, I chose to employ a long standing, and ongoing, scientific development as an exemplar. And so, I chose the ever evolving story of Thermodynamics as a scientific investigation at its best.
Conducted over a period of >200 years, Thermodynamics R&D, and application, benefitted from the highest levels of professionalism, collaboration, and technical thoroughness. New layers of application, methodology, and practice were made possible by the progressive advance of technology. In turn, this has seen measurement and modelling accuracy continually improved at a micro and macro level.
Perhaps most importantly, Thermodynamics rapidly became a primary tool in the advance of applied science/engineering/technology, spanning micro-tech, to aerospace and cosmology. I can think of no better a story to illustrate the breadth of scientific methodologies and applications at their best.
The technology uses reclaimed CO₂ as the dyeing medium in a closed loop process. When pressurized, CO₂ becomes supercritical (SC-CO₂). In this state CO₂ has a very high solvent power, allowing the dye to dissolve easily.
“Evidenced based” behavioral medicine as bad as bad pharma
1. “Evidenced-Based” Behavioral
Medicine as Bad as
Bad Pharma
James C. Coyne, Ph.D.
University Medical Center
Groningen (UMCG), Groningen, the
Netherlands
jcoynester@gmail.com
2. Introduction to ICBM Symposium
Groningen, August 2014
Are findings in behavioral medicine believable?
Nick Brown. Physical health outcomes in positive
psychology: Weak evidence for strong claims.
James C. Coyne, Moritz Heene, Gozde Ozakinci.
Unsafe Dependence of Meta Analyses in Behavioral
Medicine on Failsafe N.
Daniel Lakens. How likely is it an intervention study will
replicate? The pain literature as an example.
3. John Ioannidis documented many positive
findings in the biomedical literature do not
replicate and many apparent “discoveries” turn
out to be exaggerated or simply false.
Many apparent discoveries are created by a
combination of confirmatory bias, flexible rules
of design, data analysis and reporting and
significance chasing.
4. “It can be proven that most claimed
research findings are false”
Ioannidis, JPA. (2005). Why most published
research findings are false. PLOS Medicine 2:
696-701.
Ioannidis, JPA. (2005). Contradicted and
initially stronger effects in highly cited clinical
research. JAMA 294: 218-228.
Young, NS., Ioannidis, JPA. et al. (2008). Why
Current Publication Practices May Distort
Science. PLOS Medicine 5: 1418-1422.
5. Ben Goldacre
Drugs are tested by the people who
manufacture them, in poorly designed
trials, on hopelessly small numbers of
weird, unrepresentative patients, and
analysed using techniques which are
flawed by design, in such a way that
they exaggerate the benefits of
treatments. Unsurprisingly, these
trials tend to produce results that
favour the manufacturer. When trials
throw up results that companies don't
like, they are perfectly entitled to hide
them from doctors and patients.
6. Efforts at reform
Preregistration of clinical trials make it more
difficult to hide negative trials or alter analytic
plans after results are known.
Reporting standards ensure more transparent
and detailed article so results can be
independently validated.
Reporting standards and pre-registration of
plans for meta-analyses and systematic reviews.
Making data available for independent
reanalysis.
7. Our modest contribution to
reform
Roseman, M, Milette, K, Bero, LA, Coyne, JC,
Lexchin, J., Turner, EH, & Thombs, BD. (2011).
Reporting of conflicts of interest in meta-
analyses of trials of pharmacological
treatments. JAMA, 2011;305(10):1008-17.
Roseman, M, Turner, EH, Lexchin, J., Coyne,
JC, Bero, LA, & Thombs, BD. (2012). Reporting
of conflicts of interest from drug trials in
Cochrane reviews: cross sectional study. BMJ,
2012; 345.
8.
9. We documented with association of source of
funding with claimed size of effects.
We proposed considering conflict of interest as
a moderator, source of heterogeneity, and
another risk of bias in Cochrane risk of bias
assessment.
The Cochrane Collaboration agreed.
10. Cochrane Risk of Bias
Sequence generation.
Allocation concealment.
Blinding of participants, investigators, outcome
assessors.
Incomplete outcome data.
Selective outcome reporting.
Other threats to validity.
11. In 1979 he wrote, "It is surely a great criticism of our
profession that we have not organised a critical
summary, by specialty or subspecialty, adapted
periodically, of all relevant randomized controlled trials”
Prof Archibald Cochrane,
CBE (1909 - 1988)
The Cochrane Collaboration is
named in honor of Archie
Cochrane, a British researcher.
12. Clinical psychology and
behavioral medicine
CONSORT adopted later and less consistently
than Biomedicine.*
Preregistration of trials is now encouraged, but
enforcement is lax.
Conflict of interest less acknowledged, although
investigator allegiance pervasive and a risk of
bias.
*APS (Association of Psychological Science) journals not yet
compliant.
13.
14. Trickle down of reform
Changes forced upon Pharma slowly and
inconsistently reach clinical psychology.
Larger data sets allow exploration of issues
such as choice of control groups and
investigator allegiance.
Behavioral Medicine adopts changes
occurring in clinical psychology later and
inconsistently.
15. Clinical psychology and
behavioral medicine
RCT literature dominated by methodologically flawed,
underpowered studies obtaining significant results at
statistically improbable rate.
Weak control groups, unusual to have active control group.
Flexible rules of design and selective reporting of outcomes
chosens after results are known.
Strong investigator allegiance effects.
16. Evidence-Based Medicine developed to weed
out ineffective treatments.
Evidence-Based Behavioral Medicine
developed to demonstrate that treatments
worked and should be disseminated and
reimbursed.
19. Guidelines for Guidelines
Shaneyfelt T. In guidelines we cannot trust. Arch Intern
Med;172:1633-1634.
Institute of Medicine Committee on Standards for Developing
Trustworthy Clinical Practice Guidelines (2011). Clinical practice
guidelines we can trust. Washington, DC: National Academies
Press.
Loblaw, D. A., Prestrud, A. A., Somerfield, M. R., et al. (2012).
American Society of Clinical Oncology clinical practice guidelines:
Formal systematic review–based consensus methodology. J Clin
Oncol, 30(25), 3136-3140.
20. AHA Advisory on Screening for
Depression Not Guideline-Congruent!
Ziegelstein RC, Brett D, Thombs BD, Coyne JC, de
Jonge P. Routine Screening for Depression in Patients
with Coronary Heart Disease: Never Mind. Journal of the
American Academy of Cardiology. 2009;54(10):886-90.
Thombs, B. D., Jewett, L. R., Knafo, R., Coyne, J. C., &
Ziegelstein, R. C. (2009). Learning from history: a
commentary on the American Heart Association Science
Advisory on depression screening. American heart
journal, 158(4), 503.
21. Beware “Official” meta-analyses
(Critiqued here)
Coyne JC, Thombs BD, Hagedoorn M. Ain’t Necessarily
So: Review and Critique of Recent Meta-Analyses of
Behavioral Medicine Interventions in Health Psychology.
Health Psychology. 2010;29(2):107-16.
Coyne, J. C. (2012). Re: Meta-analysis of Efficacy of
Interventions Elevated Depressive Symptoms in Adults
Diagnosed With Cancer. Journal of the National Cancer
Institute, djs408.
22. SBM Initiative
Meta-analyses generated by professional
organizations should receive special
critical scrutiny because of tendency to
gloss over limits of literature in order to
promote the services of their membership.
23. “We are grateful to the Society of Behavioral
Medicine (SBM) for selecting the authorship
group. This article is one of three meta-
analyses that have been undertaken under the
aegis of the SBM Evidence-Based Behavioral
Medicine Committee; the other two meta-
analyses examine the effects of psychosocial
interventions on depression and fatigue among
patients with cancer.”
24. What to watch for in meta analyses
commissioned by professional
organizations
Precommitment to conclusion that interventions work
and are ready for dissemination and reimbursement.
Ignoring of preponderance of methodologically flawed,
unpowered sources of bias.
Broad inclusion of diverse interventions into one
category.
Ignoring statistical heterogeneity.
Weak assessment of risk of bias (Cochrane criteria are
seldom used).
26. EHPS 2013: Improving the Credibility of
Health Psychology Intervention Research:
Problems and Solutions
Ozakinci, G., Whitehead, R., Sobota, A., Coyne, JC.
Inaccurate Abstracts in Health Psychology: The Problem
and an Easily Implementable Solution.
Coyne, JC. Too good to be true: Health psychology
depends too much on positive underpowered studies.