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SRDR Project Indexing


Public Project Complete

Statistics: 168 Studies, 1 Key Question, 1 Extraction Form,
Date Published: Jun 23, 2020 05:17PM
Description: This is a Methods Research project that catalogs the various projects with publicly available data on the SRDR Webpage.
Contributor(s): Ian Saldanha, Bryant Smith
Funding Source: Agency for Healthcare Research and Quality
Methodology Description: None Provided

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Interventions for Drug Use – Supplemental Report: A Systematic Review for the U.S. Preventive Services Task Force [Entered Retrospectively]


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Statistics: 91 Studies, 6 Key Questions, 1 Extraction Form,
Date Published: Jun 23, 2020 02:30PM
Description: Background: A U.S. Preventive Services Task Force (USPSTF) report found no consistent evidence that counseling interventions are effective at reducing drug use or improving other health outcomes in populations whose drug use was identified through primary care-based screening with questions about drug use or drug-related risks (i.e., “screen-detected populations”). Evidence from studies of persons seeking or referred for treatment for substance use or with clinical signs or symptoms of substance use (i.e., “treatment-seeking populations”) might also be useful for informing assessments regarding screening in primary care settings. Purpose: This report updates a 2008 USPSTF report on screening for illicit drug use and supplements an updated USPSTF report on screening for any drug use, focusing on the benefits and harms of pharmacotherapy and psychosocial interventions for persons whose drug use was identified when seeking substance use treatment, when presenting with signs or symptoms of drug use, when screened for drug use in primary care or other settings with questions about drug use or drug-related risks, or other means. Data Sources: The Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Ovid MEDLINE, Embase, and PsycINFO from inception to September 2018; surveillance for new literature was conducted through November 22, 2019. Study Selection: We included trials of Food and Drug Administration (FDA)-approved pharmacotherapies for opioid use disorder (methadone, buprenorphine, and naltrexone) and trials of psychosocial interventions for persons engaging in opioid, stimulant, cannabis, and mixed drug or polysubstance use. We also included trials of preemptive prescribing of naloxone in primary care settings as a rescue medication for opioid-related overdose. Trials compared included interventions against placebo, a minimal intervention, waitlist control, or usual care, and evaluated outcomes at >3 months for drug use or other risky behaviors; health, social, and legal consequences of drug use; or harms of treatment. Data Extraction: One investigator abstracted data and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF. Data Synthesis (Results): We included a total of 71 trials, with 19 trials of pharmacotherapies and 52 trials of psychosocial interventions. All trials of pharmacotherapies and 25 trials of psychosocial interventions were conducted in treatment-seeking populations. Psychosocial interventions commonly incorporated cognitive-behavioral or motivational interventions and ranged from brief interventions consisting of one or two sessions of no more than one hour to multiple treatment sessions over weeks or months. In most pharmacotherapy trials, drug use counseling was provided to all patients. No study evaluated benefits or harms of preemptive naloxone prescribed in primary care settings versus placebo or no naloxone as a rescue medication for opioid-related overdose. In treatment-seeking populations with opioid use disorder, naltrexone (12 trials; relative risk [RR] 0.73, 95% confidence interval [CI] 0.62 to 0.85; number needed to treat [NNT] 5.3) and opioid agonist therapy with methadone or buprenorphine (4 trials; RR 0.75, 95% CI 0.59 to 0.82; NNT 2.9) were associated with decreased risk of drug use relapse compared with placebo or no pharmacotherapy. Naltrexone and methadone/buprenorphine therapy were also associated with increased likelihood of retention in substance use treatment (9 trials; RR 1.71, 95% CI 1.13 to 2.49; NNT 6.7 and 7 trials; RR 2.58, 95% CI 1.78 to 4.59; NNT 2.6; respectively). Evidence on harms of pharmacotherapies was limited, but indicated no increased risk of serious adverse events. Psychosocial interventions were associated with increased likelihood of abstinence from drug use versus control conditions at 3 to 4 months (15 trials, RR 1.60, 95% CI 1.24 to 2.13; NNT 11) and at 6 to 12 months (14 trials; RR 1.25, 95% CI 1.11 to 1.52; NNT 17), based on trials primarily conducted in treatment-seeking populations. Psychosocial interventions were also associated with a greater decrease versus control conditions in the number of drug use days (19 trials; mean difference -0.49 day in the last 7 days, 95% CI -0.85 to -0.13) and a small but statistically significant greater decrease in drug use severity (16 trials; standard mean difference -0.18, 95% CI -0.32 to -0.05) at 3- to 4-month followup. There was no difference between psychosocial interventions versus controls on drug use days or severity at longer (6 to 12 month) followup. Effects of psychosocial interventions were generally stronger in trials of treatment-seeking than screen-detected populations, trials that evaluated cannabis use than other types of drug use, and trials of more intensive than brief interventions. Few trials evaluated effects of psychosocial interventions for opioid or stimulant use, and estimates were imprecise. Limitations: Limitations included restriction to English-language articles, statistical heterogeneity in pooled analyses, and little evidence on drug-related health, social, or legal outcomes; most trials had methodological limitations. Evidence was lacking on effectiveness of treatments for opioid use disorder related to prescription drug use or stimulant use and evidence was limited for adolescents or pregnant persons. Conclusions: Pharmacotherapy and psychosocial interventions are effective at improving drug use outcomes, but evidence of effectiveness remains primarily derived from trials conducted in treatment-seeking populations. Although the applicability of data from such trials to persons whose drug use is identified through primary care-based screening is uncertain, intervention trials that enrolled patients based on screening identified a spectrum of drug use, ranging from mild drug use to more severe, untreated disease. The applicability of current evidence on drug use interventions to screening might be greater for the subset of patients screened in primary care settings with severe, untreated drug use who could utilize pharmacotherapies or more intensive psychosocial interventions.
Contributor(s): Roger Chou, MD Tracy Dana, MLS Ian Blazina, MPH Sara Grusing, BA Rongwei Fu, PhD Christina Bougatsos, MPH
DOI: DOI pending.
Funding Source: This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-290-2015-00007-I, Task Order No. 4)
Methodology Description: Study Selection: We included trials of Food and Drug Administration (FDA)-approved pharmacotherapies for opioid use disorder (methadone, buprenorphine, and naltrexone) and trials of psychosocial interventions for persons engaging in opioid, stimulant, cannabis, and mixed drug or polysubstance use. We also included trials of preemptive prescribing of naloxone in primary care settings as a rescue medication for opioid-related overdose. Trials compared included interventions against placebo, a minimal intervention, waitlist control, or usual care, and evaluated outcomes at >3 months for drug use or other risky behaviors; health, social, and legal consequences of drug use; or harms of treatment. Data Extraction: One investigator abstracted data and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF. Data Synthesis (Results): We included a total of 71 trials, with 19 trials of pharmacotherapies and 52 trials of psychosocial interventions. All trials of pharmacotherapies and 25 trials of psychosocial interventions were conducted in treatment-seeking populations. Psychosocial interventions commonly incorporated cognitive-behavioral or motivational interventions and ranged from brief interventions consisting of one or two sessions of no more than one hour to multiple treatment sessions over weeks or months. In most pharmacotherapy trials, drug use counseling was provided to all patients. No study evaluated benefits or harms of preemptive naloxone prescribed in primary care settings versus placebo or no naloxone as a rescue medication for opioid-related overdose. In treatment-seeking populations with opioid use disorder, naltrexone (12 trials; relative risk [RR] 0.73, 95% confidence interval [CI] 0.62 to 0.85; number needed to treat [NNT] 5.3) and opioid agonist therapy with methadone or buprenorphine (4 trials; RR 0.75, 95% CI 0.59 to 0.82; NNT 2.9) were associated with decreased risk of drug use relapse compared with placebo or no pharmacotherapy. Naltrexone and methadone/buprenorphine therapy were also associated with increased likelihood of retention in substance use treatment (9 trials; RR 1.71, 95% CI 1.13 to 2.49; NNT 6.7 and 7 trials; RR 2.58, 95% CI 1.78 to 4.59; NNT 2.6; respectively). Evidence on harms of pharmacotherapies was limited, but indicated no increased risk of serious adverse events. Psychosocial interventions were associated with increased likelihood of abstinence from drug use versus control conditions at 3 to 4 months (15 trials, RR 1.60, 95% CI 1.24 to 2.13; NNT 11) and at 6 to 12 months (14 trials; RR 1.25, 95% CI 1.11 to 1.52; NNT 17), based on trials primarily conducted in treatment-seeking populations. Psychosocial interventions were also associated with a greater decrease versus control conditions in the number of drug use days (19 trials; mean difference -0.49 day in the last 7 days, 95% CI -0.85 to -0.13) and a small but statistically significant greater decrease in drug use severity (16 trials; standard mean difference -0.18, 95% CI -0.32 to -0.05) at 3- to 4-month followup. There was no difference between psychosocial interventions versus controls on drug use days or severity at longer (6 to 12 month) followup. Effects of psychosocial interventions were generally stronger in trials of treatment-seeking than screen-detected populations, trials that evaluated cannabis use than other types of drug use, and trials of more intensive than brief interventions. Few trials evaluated effects of psychosocial interventions for opioid or stimulant use, and estimates were imprecise.

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The Use of Chloroquine and Hydroxychloroquine for Prophylaxis and Treatment of COVID-19


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Statistics: 24 Studies, 1 Key Question, 1 Extraction Form,
Date Published: May 29, 2020 06:30PM
Description: The purpose of this review is to determine if hydroxychloroquine or chloroquine is effective and safe when used alone or when combined with azithromycin for the prophylaxis and treatment of COVID-19.
Contributor(s): Adrian V. Hernandez, MD, PhD; Yuani M. Roman, MD, MPH; Vinay Pasupuleti, MD, MS, PhD; Joshuan J. Barboza, MSc; C. Michael White, PharmD.
DOI: DOI pending.
Funding Source: Prepared by the University of Connecticut Evidence-based Practice Center under Contract No. HHSA290-2015-00012I | Task Order 1
Methodology Description: On May 8, 2020, we comprehensively searched: PubMed-Medline, EMBASE-OVID, Scopus, Web of Science, the Cochrane Library, pre-prints and pre-proofs from the following web pages: http://eppi.ioe.ac.uk/COVID19_MAP/covid_map_v3.html, https://connect.biorxiv.org/relate/content/181, https://www.preprints.org/, and Trial registry websites of the WHO, USA, and China: https://www.who.int/ictrp/en/, www.clinicaltrials.gov, and http://www.chictr.org.cn/. The searches were very broad containing the agents under investigation “hydroxychloroquine or chloroquine” and the virus or disease state “SARS-CoV-2 or COVID-19”. As such, it would capture efficacy and harm outcome studies as well as active treatment and prophylaxis studies. We did not predefine outcomes to allow the broadest assessment of the literature base available. Three investigators independently selected studies, and disagreements were resolved by discussion. We used a pre-defined extraction sheet that was modified dynamically as new outcomes were identified in the studies. Extractions were performed independently by two authors and revised by two other authors. Discrepancies in extractions were resolved by discussion. Risk of bias assessments were performed independently by two investigators in comparative studies using the ROBINS-I tool for non-randomized studies of interventions and the Cochrane risk of bias 2.0 tool for randomized controlled trials. Discrepancies in risk of bias assessments were resolved by discussion. We only performed random effects meta-analyses of two RCTs for dichotomous outcomes. The inverse variance method was used, and effects were described as relative risks (RR) and their 95% confidence intervals. Heterogeneity of effects between RCTs were described with the I2 statistic, being a value >60% considered high heterogeneity. The certainty or quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach (27). GRADE profile v2 tables were developed in GRADEpro Guideline Development Tool.

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Maternal and Fetal Effects of Mental Health Treatments in Pregnant and Breastfeeding Women: A Systematic Review of Pharmacological Interventions


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Statistics: 142 Studies, 4 Key Questions, 1 Extraction Form,
Date Published: May 21, 2020 06:31PM
Description: A systematic review to assess the efficacy and comparative effectiveness of pharmacological interventions for pregnant and postpartum women with psychiatric disorders.
Contributor(s): To be announced after the final report has been completed.
DOI: DOI pending.
Funding Source: AHRQ
Methodology Description: Systematic review

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Interventions for Substance Use Disorders in Adolescents: A Systematic Review


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Statistics: 118 Studies, 1 Key Question, 1 Extraction Form,
Date Published: May 19, 2020 09:56PM
Description: The review aims to inform health care providers, policymakers, and a clinical practice guideline update from the American Academy of Child and Adolescent Psychiatry (AACAP) about the currently available evidence on interventions for adolescents to reduce or cease substance use. The review addresses both behavioral and pharmacological interventions used for adolescents or young adults with problematic substance use or a diagnosis of a substance use disorder (SUD), excluding tobacco.
Contributor(s): Dale W. Steele, Sara J. Becker, Kristin J. Danko, Ethan M. Balk, Ian J. Saldanha, Gaelen P. Adam, Sarah M. Bagley, Catherine Friedman. Anthony Spirito, Kelli Scott, Evangelia E. Ntzani, Iman Saeed, Bryant Smith, Jonah Popp, Thomas A. Trikalinos
DOI: DOI pending.
Funding Source: HHSA 290-2015-00002-I
Methodology Description: We conducted literature searches in MEDLINE, the Cochrane CENTRAL Trials Registry, Embase, CINAHL, and PsycINFO databases (all from inception) to identify primary studies meeting our criteria through April 11, 2019. As a part of an independent methods project, an interim search of MEDLINE was undertaken using text mining tools on October 30, 2018. A separate search for SRs of interventions for alcohol disorders/problematic alcohol use in the college setting was conducted in MEDLINE, Cochrane Database of Systematic Reviews, and Epistemonikos also through April 11, 2019; after discussion with the Technical Expert Panel (TEP), it was decided to restrict the review of this topic to existing SRs because the literature is vast and has been extensively reviewed. The literature search yielded 33,272 citations. We found 118 randomized controlled trials that evaluated treatment of adolescents or young adults with problematic substance use or substance use disorders.

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