Understanding Public Perception of Naloxone: A Study of FAQs and Answer Source Credibility.

PURPOSE: The most commonly used intervention for opioid overdoses is naloxone. With naloxone soon to be sold over-the-counter in the United States, the goal of this paper is to categorize frequently asked questions (FAQs) and answers about naloxone using internet sources in a cross-sectional fashion. METHODS: Terms "narcan" and "naloxone" were searched on a clean Google Chrome browser using the "People also asked" tab to find FAQs and their answer sources. We classified questions and sources and assessed each website's quality and credibility grading with JAMA benchmark criteria. The Kruskal-Wallis H test was used to determine variance of mean JAMA score by source type and Post-Hoc Dunn's test with Bonferroni corrected alpha of 0.005 used to compare source types. RESULTS: Of the 305 unique questions, 202 (66.2%) were classified as facts, 78 (25.6%) were policy, and 25 (8.2%) were value. Of the 144 unique answer sources, the two most common included 55 (38.2%) which were government entities and 47 (32.6%) which were commercial entities. Ninety-two (of 144, 63.9%) sources met three or more JAMA benchmark criteria. Statistical analysis showed a significant difference between the JAMA benchmark scores by source type H(4) = 12.75, p = 0.0126 and between the mean rank of academic and government sources (p = 0.0036). CONCLUSION: We identified FAQs and their citations about naloxone, highlighting potential lack of understanding and knowledge of this important intervention. We recommend updating websites to accurately reflect current and useful information for those that may require naloxone.

Quantifying Adverse Childhood Experiences in Oklahoma With the Oklahoma Adversity Surveillance Index System (OASIS): Development and Cross-Sectional Study.

BACKGROUND: Developmental trauma depending on several factors may lead to later adult health risks and is an increasing public health concern, especially in states with predominantly rural populations. Oklahoma remains one of the states in America with the highest count of adverse childhood experiences (ACEs); therefore, more refined research methods for quantifying ACEs are vital for ensuring proper statewide interventions. OBJECTIVE: While data sets already exist at the state level measuring specific ACEs like divorce or child abuse, the state currently lacks a single source for specific ACEs that can incorporate regions to allow for the identification of counties where ACEs are especially high. This county identification will allow for assessing trends in adversity prevalence over time to indicate where targeted interventions should be done and which counties experience amplified long-term consequences of high ACE rates. Thus, the model for the Oklahoma Adversity Surveillance Index System (OASIS) was born-a public health tool to map ACEs at the county level and grade them by severity over time. METHODS: County-level data for 6 ACEs (mental illness, divorce, neglect, child abuse, domestic violence, and substance use) were collected from the Oklahoma Department of Human Services, Oklahoma State Department of Health, and Oklahoma Community Mental Health Centers for the years 2010 to 2018. First, a potential ACEs score (PAS) was created by standardizing and summing county rates for each ACE. To examine the temporal change in the PAS, a bivariate regression analysis was conducted. Additionally, an ACEs severity index (ASI) was created as a standardized measure of ACE severity across time. This included scoring counties based on severity for each ACE individually and summing the scores to generate an overall ASI for each county, capturing the severity of all ACEs included in the analysis. RESULTS: Mental illness and substance use showed the highest rates at the state level. Results from the regression were significant (F1,76=5.269; P=.02), showing that county PAS showed an increase over years. The ASI scores ranged from 0 to 6, and 4 Oklahoma counties (Adair, McCurtain, Muskogee, and Pittsburg) received a score of 6. CONCLUSIONS: OASIS involves the identification of counties where ACEs are most prevalent, allowing for the prioritization of interventions in these "hot spot" counties. In addition, regression analysis showed that ACEs increased in Oklahoma from 2010 to 2018. Future efforts should center on adding additional ACEs to the ASI and correlating adverse outcome rates (such as violence and medical disorder prevalence) at the county level with high ASI scores.

Associations of clinical personnel characteristics and controlled substance prescribing practices.

CONTEXT: Over 68,000 deaths were attributed to opioid-related overdose in 2020. Evaluative studies have shown that states that utilized Prescription Drug Monitoring Program (PDMP) systems have decreased opioid-related deaths. With the growing use of PDMPs and an ongoing opioid epidemic, determining the demographics of physicians at risk of overprescribing can elucidate prescribing practices and inform recommendations to change prescribing behaviors. OBJECTIVES: This study aims to assess prescribing behaviors by physicians in 2021 based on four demographics utilizing the National Electronic Health Record System (NEHRS): physician's age, sex, specialty, and degree (MD or Doctor of Osteopathic Medicine [DO]). METHODS: We performed a cross-sectional study of the 2021 NEHRS to determine the relationship between physician characteristics and PDMP use on opioid-prescribing behaviors. Differences between groups were measured via design-based chi-square tests. We constructed multivariable logistic regression models to assess the relationships, via adjusted odds ratios (AOR), between physician characteristics and alternate prescribing patterns. RESULTS: Compared to female physicians, male physicians were more likely to alter their original prescription to reduce morphine milligram equivalents (MMWs) prescribed for a patient (AOR: 1.60; CI: 1.06-2.39; p=0.02), to change to a nonopioid/nonpharmacologic option (AOR: 1.91; 95 % CI: 1.28-2.86; p=0.002), to prescribe naloxone (AOR=2.06; p=0.039), or to refer for additional treatment (AOR=2.07; CI: 1.36-3.16; p<0.001). Compared to younger physicians, those over the age of 50 were less likely to change their prescription to a nonopioid/nonpharmacologic option (AOR=0.63; CI: 0.44-0.90; p=0.01) or prescribe naloxone (AOR=0.56, CI: 0.33-0.92; p=0.02). CONCLUSIONS: Our results showed a statistically significant difference between specialty category and frequency of prescribing controlled substances. After checking the PDMP, male physicians were more likely to alter their original prescription to include harm-reduction strategies. Optimizing the use of PDMP systems may serve to improve prescribing among US physicians.

Factors Associated With Short-Term Recovery Following Single-Event Multilevel Surgery for Children With Cerebral Palsy.

PURPOSE: To examine the role of multiple factors, including therapy dose, on recovery of mobility function during post-single-event multilevel surgery (SEMLS) rehabilitation in youth with cerebral palsy. METHODS: Several factors expected to influence postoperative change in Gross Motor Function Measure (GMFM) were examined: age, Gross Motor Function Classification System (GMFCS) level, cognition, number of osteotomies, surgical complications, medical comorbidities, number of therapy sessions, and preoperative measures of gait, balance, and gross motor function. RESULTS: Sixty-nine youth with cerebral palsy, GMFSC levels I-IV, who had undergone SEMLS and rehabilitation had on average 2.6 osteotomies and 89 postoperative therapy sessions. Fewer osteotomies, higher therapy dose, higher preoperative GMFM, and lower GMFM at postoperative admission were significant in determining GMFM change. CONCLUSIONS: The most relevant factors on post-SEMLS recovery were therapy dose, surgical burden, and level of gross motor function immediately before and after surgery.

Within Clinic Reliability and Usability of a Voice-Based Amazon Alexa Administration of the Patient Health Questionnaire 9 (PHQ 9).

Over the last two decades, metric-based instruments have garnered popularity in mental health. Self-administered surveys, such as the Patient Health Questionnaire 9 (PHQ 9), have been leveraged to inform treatment practice of Major Depressive Disorder (MDD). The aim of this study was to measure the reliability and usability of a novel voice-based delivery system of the PHQ 9 using Amazon Alexa within a patient population. Forty-one newly admitted patients to a behavioral medicine clinic completed the PHQ 9 at two separate time points (first appointment and one-month follow up). Patients were randomly assigned to a version (voice vs paper) completing the alternate format at the next appointment. Patients additionally completed a 26-item User Experience Questionnaire (UEQ) and open-ended questionnaire at each session. Assessments between PHQ 9 total scores for the Alexa and paper version showed a high degree of reliability (α = .86). Quantitative UEQ results showed significantly higher overall positive attitudes towards the Alexa format with higher subscale scores on attractiveness, stimulation, and novelty. Further qualitative responses supported these findings with 85.7% of participants indicating a willingness to use the device at home. With the benefit of user instruction in a clinical environment, the novel Alexa delivery system was shown to be consistent with the paper version giving evidence of reliability between the two formats. User experience assessments further showed a preference for the novel version over the traditional format. It is our hope that future studies may examine the efficacy of the Alexa format in improving the at-home clinical treatment of depression.

Rates of discontinuation and non-publication of trials for the pharmacologic treatment of alcohol use disorder.

Objective: With approximately 15 million individuals in the United States meeting criteria for Alcohol Use Disorder (AUD), advancing effective medication-assisted treatment options is crucial. This advancement stems from the publication of clinical trial (CT) results. The primary objective of this study was to assess the rates of discontinuation and non-publication of results in CTs focused on the pharmacologic treatment of AUD and to assess associated factors. Design: A cross-sectional study was completed after acquiring trials focused on AUD within the ClinicalTrials.gov database. Inclusion criteria for CTs were the use of a pharmaceutical intervention with an outcome measure of alcohol intake or craving, conducted between October 2008 through September 2018. The primary outcome measures were the frequency of trial discontinuation and non-publication. Discontinuation was assessed as the listed status on ClinicalTrials.gov. Publications were identified through verification of listings on ClinicalTrials.gov, or via searches of PubMed, Embase, and Google Scholar. If publications were not found, correspondence to trial contacts were sent. Data analysis occurred on December 5th, 2020. Results: Of 235 trials returned from the search, 87 met inclusion criteria. Our study found that 12.6% (11) of CTs involving pharmaceutical treatments for AUD were prematurely terminated, and 39.1% (34) had no published results. Recruitment and lower cutoff of targeted age groups were significantly associated with discontinuation and non-publication, respectively. Conclusions: Scientific evidence advances faster when all results are known-furthering the progress of positive studies, while avoiding duplicative efforts to test the same hypotheses with the same methods, thereby reducing scientific waste. Given the number of unpublished AUD trials, potentially useful information regarding treatment for individuals with AUD may be inaccessible to clinicians while also adding to the abundance of research waste.Key pointsQuestion: What are the rates of discontinuation or non-publication of clinical trials for pharmacological treatments for AUD and associated factors?Findings: Among 87 trials, 11 (12.6%) were prematurely terminated and 34 (39.1%) did not reach publication, with trials that included participants 21 years and older more likely to reach publication than those with younger participants.Meaning: Low publication rates of CTs for pharmacological treatments of AUD may (1) stunt the advancement of AUD research, (2) decrease the value in funding AUD research from government entities, and (3) needlessly expose participants to potentially harmful interventions.

Alcohol use disorder: An analysis of the evidence underpinning clinical practice guidelines.

BACKGROUND: As Clinical Practice Guidelines (CPGs) provide effective guidance for providing medical care for individuals with alcohol use disorder (AUD), the evidence behind them should be robust. OBJECTIVE: Our primary objective was to critically appraise the methodological and reporting quality of systematic reviews cited within CPGs regarding the treatment of AUD. Our secondary objective was to determine how frequently Cochrane Reviews were cited as justification and to evaluate appraisals between Cochrane and non-Cochrane reviews. METHODS: We searched PubMed to identify CPGs for the treatment of AUD published between 2015 and 2021. Systematic reviews included in each CPG were evaluated using the Preferred Reporting Instrument for Systematic Reviews and Meta-Analyses (PRISMA) and a validated quality assessment tool (AMSTAR-2). Additional study characteristics were recorded. RESULTS: From the screening process, 98 systematic reviews from 6 CPGs met inclusion criteria. PRISMA adherence ranged from 72% to 85% (mean of 79%). AMSTAR-2 adherence ranged from 52% to 73% (mean of 68%). AMSTAR appraisal ratings found 32 (35.6%) critically low, 10 (11.1%) low, 35 (38.9%) moderate, and only 13 (14.4%) high systematic reviews. Cochrane systematic reviews displayed greater PRISMA (0.92 vs. 0.75: p < 0.001) and AMSTAR-2 (0.90 vs. 0.61.; p < 0.001) scores compared to the non-Cochrane studies. CONCLUSION: Systematic reviews included in CPGs for AUD treatment showed variable adherence to PRISMA and AMSTAR-2 guidelines, with almost half of the systematic reviews being critically low to low methodological quality. Given the prevalence of alcohol use disorder, methodological and reporting quality recommendations are important to strengthening evidence informing CPGs.

Perceptions and Opinions Towards Data-Sharing: A Survey of Addiction Journal Editorial Board Members.

Background: We surveyed addiction journal editorial board members to better understand their opinions towards data-sharing. Methods: Survey items consisted of Likert-type (e.g., one to five scale), multiple-choice, and free-response questions. Journal websites were searched for names and email addresses. Emails were distributed using SurveyMonkey. Descriptive statistics were used to characterize the responses. Results: We received 178 responses (of 1039; 17.1%). Of these, 174 individuals agreed to participate in our study (97.8%). Most respondents did not know whether their journal had a data-sharing policy. Board members "somewhat agree" that addiction journals should recommend but not require data-sharing for submitted manuscripts [M=4.09 (SD=0.06); 95% CI: 3.97-4.22]. Items with the highest perceived benefit ratings were "secondary data use (e.g., meta-analysis)" [M=3.44 (SD=0.06); 95% CI: 3.31-3.56] and "increased transparency" [M=3.29 (SD=0.07); 95% CI: 3.14-3.43]. Items perceived to be the greatest barrier to data-sharing included "lack of metadata standards" [M=3.21 (SD=0.08); 95% CI: 3.06-3.36], "no incentive" [M=3.43 (SD=0.07); 95% CI: 3.30-3.57], "inadequate resources" [M=3.53 (SD=0.05); 95% CI: 3.42-3.63], and "protection of privacy"[M=3.22 (SD=0.07); 95% CI: 3.07-3.36]. Conclusion: Our results suggest addiction journal editorial board members believe data-sharing has a level of importance within the research community. However, most board members are unaware of their journals' data-sharing policies, and most data-sharing should be recommended but not required. Future efforts aimed at better understanding common reservations and benefits towards data-sharing, as well as avenues to optimize data-sharing while minimizing potential risks, are warranted.

Fatality Review and the Role of the Forensic Psychiatrist.

Multidisciplinary Fatality Review teams have operated for decades in the United States and across the developed world. Goals of these teams include examining individual deaths in the community to determine preventability and to make recommendations for future prevention. Fatality Review teams initially focused on child deaths but have expanded to include deaths from domestic violence, elder abuse, overdose, and maternal mortality. Case reviews include data from various agencies that have had contact with victims and perpetrators prior to the deaths. Cause of death and preventability are analyzed. Preventable deaths often include those with risk from mental illness or addiction. Recommendations made by Fatality Review teams have led to important changes for mental health services and prevention, including the Safe Haven laws for neonaticide prevention, suicide and homicide prevention, child murder prevention, firearm laws, and domestic violence screening. Fatality Review teams, which already include law enforcement and forensic pathologists, can benefit from collaboration with forensic psychiatrists because of their specialized knowledge about the intersection of mental illness and violence, should forensic psychiatrists have an opportunity to join them.

Evaluating spin in the abstracts of systematic reviews and meta-analyses on cannabis use disorder.

BACKGROUND: Clinicians rely upon abstracts to provide them quick synopses of research findings that may apply to their practice. Spin can exist within these abstracts that distorts or misrepresents the findings. Our goal was to evaluate the level of spin within systematic reviews (SRs) focused on the treatment of cannabis use disorder (CUD). Methods: A systematic search was conducted in May 2020. To meet inclusion criteria, publications had to be either an SR or meta-analysis related to the treatment of cannabis use. Screening and data extraction was performed in a duplicate and masked fashion. Study quality was assessed using AMSTAR-2 Results: 16/24 SRs (66.7%) contained at least one form of spin in the abstract. The most common forms of spin identified were type 3-selective reporting of or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention (45.8%)-and type 8-the review's findings from a surrogate marker or a specific outcome to the global improvement of the disease (37.5%). No significant association between spin and intervention type, PRISMA requirements, or funding source was identified. Weak positive correlations were found between the presence of spin and abstract word count (r =.217) and between spin and AMSTAR-2 rating (r = 0.143). "Moderate" was the most common AMSTAR-2 rating (9/24, 37.5%), followed by "low" (7/24, 29.2%) and "critically low" (7/24, 29.2%). One systematic review received an AMSTAR-2 rating of "high" (1/24, 4.2%). Conclusions: Spin was common among abstracts from the SRs focused on the treatments for CUD. Higher quality studies may help reduce the overall rate as well as standardizing treatment outcomes. To facilitate this, we encourage all authors, peer-reviewers, and editors to be more aware of the various types of spin as they can help reduce the overall amount of spin seen within the literature.

Evaluation of spin in the abstracts of systematic reviews and meta-analyses of studies on opioid use disorder.

BACKGROUND: Spin, or the inappropriate formatting of information to emphasize certain outcomes, should not be present in research. This study focuses on identifying and characterizing the presence of spin in systematic review and meta-analysis abstracts that focus on the treatment of opioid use disorder. Methods: Search strategies were developed to identify studies pertaining to the treatment of opioid use disorder. The studies were then screened by two authors. These qualifying studies were then evaluated for the presence of spin within their abstracts by two trained authors. These studies were also evaluated by the AMSTAR-2 standards to evaluate the quality of the qualifying systematic reviews by two trained reviewers. Results: The sample in this study included 113 systematic reviews and meta-analyses. Spin was present in 20 of these studies (20/113, 17.7%). The most common spin form was spin type 3 (6/20, 30%), followed by types 5 and 9 (both 4/20, 20%), type 6 (3/20, 15%), type 7 (2/20, 10%), and type 8 (1/20, 5%). The remaining spin types 1, 2, and 4 were not present in the sample. Of the 113 included studies, the most common intervention type was pharmacologic (93/113, 82%). No significant association was found between the quality of a systematic review and the presence of spin. Conclusions: Findings in this study show positive trends in prevalence of five forms of spin evaluated in abstracts of systematic reviews and meta-analyses looking at treatments for opioid use disorder. However, study quality had no significant association with the presence of spin. Misrepresentation of results, or spin, may alter a clinician's perceptions about treatment efficacies. Therefore, increasing physician awareness of spin may improve clinical decision-making.

Prescription Opioid Use and Laboratory Value Derangements: A Cross-Sectional Analysis of NHANES Data.

BACKGROUND: The use of opioids for the treatment of pain is a risk versus benefit analysis and metabolic disease is an often overlooked variable in the equation and may lead to increased risk of comorbidities of cardiovascular and cerebrovascular disease and diabetes. OBJECTIVES: Our objective was to identify and describe abnormalities among the comprehensive metabolic and lipid panels of individuals taking prescription opioids. STUDY DESIGN: We performed a cross-sectional study of the laboratory values with 3 cycles (2011-2016) of the National Health and Nutrition Examination Survey (NHANES) in March 2020. SETTING: NHANES sampling is conducted using a multistaged, stratified, cluster sampling technique to create a representative sample of the United States. METHODS: We excluded patients with histories of cancer and under the age of 25 years. Our final sample size was 11,061 (n = 162,547,635), with 797 reportedly using a prescription opioid in the past 30 days-a weighted percent representing 22.95% of the US population. Our analyses identified mean differences in biomarkers between individuals taking prescription opioids and the US population. RESULTS: Laboratory values from the comprehensive metabolic panel were all within reference ranges for both groups, with only bilirubin levels being statistically lower in the group currently taking prescription opioids. Values from the lipid panel of both the opioid using and comparison groups were above reference range for total cholesterol and fasting glucose. The opioid using group was also higher than the reference range for triglycerides (mean [M] = 165.4, standard deviation [SD] = 14.2) and insulin (M = 15.5, SD = 2.2), whereas the comparison group was not.  The oral glucose measure was within normal ranges for both groups; however, the opioid using group was 13.7 points higher than the comparison group (M = 122.3, SD = 1.8; M = 108.6, SD = 4.0; P < 0.01). LIMITATIONS: While our study uses a large sample for a robust generalizable analysis it is a correlation study and a longitudinal cohort would provide better evidence linking potential disease states to prescription opioid use. CONCLUSIONS: Although all Americans should be alarmed at the lipid levels reported in this study, specific combinations of heightened lipid laboratory values among prescription opioid users accelerate the trajectories toward comorbidities-heart disease, cerebrovascular disease, and diabetes-leading to diminished quality of life. Therefore pain management and comprehensive drug recovery programs should include nutritional counseling and physical activity as part of their overall treatment plan.

Public awareness of the National Suicide Prevention Lifeline following the release of a hip-hop song.

OBJECTIVE: In light of the current national mental health crisis, we use Google Trends, Twitter and data obtained from the National Suicide Prevention Lifeline to evaluate the effect of '1-800-273-8255' on public awareness for the National Suicide Prevention Lifeline. DESIGN: Cross-sectional analysis. MAIN OUTCOME MEASURES: We extracted data from Google Trends and Twitter for terms related to suicide following the release of Logic's song, '1-800-273-8255'. We then used a forecasting autoregressive integrated moving algorithm model to determine the greater than expected search interest. RESULTS: Google searches for 'Suicide Hotline' increased 49% more than expected the day after Logic's song was released and sustained increase of queries resulted in an average relative search volume of 59.5%-9.1% higher than the mean forecasted value of 50.4% for the 28 days following the release. Tweets that engaged with the account '@800 273talk' on Twitter increased by 10 450% more than expected the day after the song was released and increased by a mean of 1497% greater than expected the week after the songs released. CONCLUSION: Findings from our study suggest that the entertainment industry can play an important role in increasing awareness of hotline numbers. Logic's song provides an example of a positive influence on public health and provides support for further development and standards for proper awareness of suicide in the public view.

An evaluation of the practice of transparency and reproducibility in addiction medicine literature.

BACKGROUND: Credible research emphasizes transparency, openness, and reproducibility. These characteristics are fundamental to promoting and maintaining research integrity. The aim of this study was to evaluate the current state of reproducibility in the field of addiction science. DESIGN: Cross-sectional design. MEASUREMENTS: The National Library of Medicine catalog was searched for all journals using the subject terms tag: Substance-Related Disorders [ST]. Journals were then searched via PubMed to identify publications from January 1, 2014, to December 31, 2018; 300 publications were randomly selected from among those identified. A pilot-tested Google form containing reproducibility/transparency characteristics was used for data extraction in a duplicated and blinded fashion by two investigators. FINDINGS: Slightly more than half of the publications were open access (152/300, 50.70%). Few publications had pre-registration (7/244, 2.87%), material availability (2/237, 0.84%), protocol availability (3/244, 1.23%), data availability (28/244, 11.48%), or analysis script availability (2/244, 0.82%). Most publications provided a conflict of interest statement (221/293, 75.43%) and funding sources (268/293, 91.47%). One replication study was reported (1/244, 0.4%). CONCLUSION: Our study found that current practices that promote transparency and reproducibility are lacking, thus, there is room for improvement. In particular, investigators should pre-register studies prior to commencement. Researchers should also make the materials, data, and analysis script publicly available. Further, individuals should be transparent about funding sources for the project and financial conflicts of interest. Research stakeholders should work together toward improvements on these matters. With such protections, the field of addiction medicine can better disseminate the information necessary to treat patients.

The use of person-centered language in scientific research articles focusing on alcohol use disorder.

AIMS: Worldwide, alcohol use disorder (AUD) is one of the most common substance use disorders, yet often goes undertreated. One major barrier that prevents adequate treatment of AUD is the high stigmatization the disorder receives, including from the scientific community. Thus, we evaluated the current use of patient-centered language (PCL) among AUD-related, journal publications. METHODS: This cross-sectional analysis included a systematic search of PubMed AUD-related articles from May 2018 to April 2020. All journals with 20 or more AUD-related, PubMed indexed items with human subjects and available in English were included, resulting in 3445 articles from 49 journals. A random sample of 500 publications were screened and examined for inclusion of pre-specified, non- PCL terminology.. RESULTS: After excluding editorials and commentaries, 292 were retained. We found 59 (20.1 %) publications adhered to PCL. Among articles with non-PCL, labeling occurred in 198 (67.8 %) articles, and emotional language implying helplessness was identified in 123 (42.1 %). We found no difference in PCL adherence with journal ranking nor authorship guidelines requiring AMA/ICMJE adherence. CONCLUSIONS: Our investigation showed that a majority of current AUD literature does not conform to PCL standards. PCL carries a positive connotation and is recommended by multiple professional groups. In continuing the shift toward reducing stigma and increasing advocacy for individuals with AUD, it is necessary for the sources of information that guide clinical practice adhere to PCL. This study is not intended to impede the autonomy of individuals to label themselves or influence terms purposefully used in support programs.

Treating schizophrenia: the quality of evidence behind treatment recommendations and how it can improve.

OBJECTIVE: To assess the methodological and reporting quality of systematic reviews that comprise the American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Schizophrenia and to determine the extent to which results from Cochrane systematic reviews published after guideline development would alter or confirm current recommendations. PARTICIPANTS: Systematic reviews that underpinned recommendations in the APA guidelines and Cochrane systematic reviews. MAIN OUTCOME: Three independent reviewers scored all systematic reviews referenced in the guideline for quality and reporting using AMSTAR and PRISMA checklist, respectively. Items in both tools were individually graded and compared to identify consistently low-performing areas within the systematic reviews. Post hoc analysis of the Cochrane systematic reviews since the latest revision of APA's guidelines were performed to determine whether their findings were congruent with recent recommendations. RESULTS: The mean score of the 57 reviews on the PRISMA checklist was 70%. The mean AMSTAR score was 6.8, correlating with a moderate quality score. Post hoc analysis revealed that 171 Cochrane reviews had been published since the APA guideline release. Only half of the reviews of pharmacological interventions confirmed current recommendations. CONCLUSIONS AND RELEVANCE: The methodological quality of the systematic reviews included in the APA guideline was deficient in key areas. Our study brings to light the importance of using high-quality evidence in the development of clinical practice guidelines. An updated APA guideline (last updated in 2009) is necessary to provide the highest quality treatment recommendations for clinicians in the management of schizophrenia. TRIAL REGISTRATION NUMBER: UMIN-CTR, UMIN000023099.

Evaluation of spin in abstracts of papers in psychiatry and psychology journals.

We have identified 'spin' in abstracts of randomised controlled trials (RCTs) with nonsignificant primary endpoints in psychiatry and psychology journals. This is a cross-sectional review of clinical trials with nonsignificant primary endpoints published in psychiatry and psychology journals from January 2012 to December 2017. The main outcome was the frequency and manifestation of spin in the abstracts. We define spin as the 'use of specific reporting strategies, from whatever motive, to highlight that the experimental treatment is beneficial, despite a statistically nonsignificant difference for the primary outcome, or to distract the reader from statistically nonsignificant results'. We have also assessed the relationship between industry funding and spin. Of the 486 RCTs examined, 116 were included in our analysis of spin. Spin was identified in 56% (n=65) of those included. Spin was found in 2 (2%) titles, 24 (21%) abstract results sections and 57 (49.1%) abstract conclusion sections. Evidence of spin was simultaneously identified in both results and conclusions sections in 15% of RCTs (n=17). Twelve articles reported industry funding (10%). Industry funding was not associated with increased odds of spin in the abstract (unadjusted OR: 1.0; 95% CI: 0.3 to 3.2). We found no relationship between industry funding and spin in abstracts. These findings raise concerns about the effects spin may have on clinicians. Further steps could be taken to address spin, including inviting reviewers to comment on the presence of spin and updating Consolidated Standards of Reporting Trials guidelines to contain language discouraging spin.

Methodological quality of systematic reviews referenced in clinical practice guidelines for the treatment of opioid use disorder.

INTRODUCTION: With efforts to combat opioid use disorder, there is an increased interest in clinical practice guidelines (CPGs) for opioid use disorder treatments. No literature exists examining the quality of systematic reviews used in opioid use disorder CPGs. This study aims to describe the methodological quality and reporting clarity of systematic reviews (SRs) used to create CPGs for opioid use disorder. METHODS: From June to July 2016 guideline clearinghouses and medical literature databases were searched for relevant CPGs used in the treatment of opioid use disorder. Included CPGs must have been recognized by a national organization. SRs from the reference section of each CPG was scored by using AMSTAR (a measurement tool to assess the methodological quality of systematic reviews) tool and PRISMA (preferred reporting items for systematic reviews and meta-analyses) checklist. RESULTS: Seventeen CPGs from 2006-2016 were included in the review. From these, 57 unique SRs were extracted. SRS comprised 0.28% to 17.92% of all references found in the CPGs. All SRs obtained moderate or high methodological quality score on the AMSTAR tool. All reviews met at least 70% of PRISMA criteria. In PRISMA, underperforming areas included accurate title labeling, protocol registration, and risk of bias. Underperforming areas in AMSTAR included conflicts of interest, funding, and publication bias. A positive correlation was found between AMSTAR and PRISMA scores (r = .79). CONCLUSION: Although the SRs in the CPGs were of good quality, there are still areas for improvement. Systematic reviewers should consult PRISMA and AMSTAR when conducting and reporting reviews. It is important for CPG developers to consider methodological quality as a factor when developing CPG recommendations, recognizing that the quality of systematic reviews underpinning guidelines does not necessarily correspond to the quality of the guideline itself.

Comprehensive vestibular and balance testing in the dizzy pediatric population.

OBJECTIVE: To describe the spectrum of balance disease in a large population of children presenting to a tertiary care vestibular and balance laboratory. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care pediatric hospital. MAIN OUTCOME MEASURES: Results of audiometric, vestibular, and balance tests and final diagnosis. SUBJECTS AND METHODS: Retrospective review of audiometric, vestibular, balance testing, and final diagnosis from a patient database. RESULTS: Between September 2003 and September 2007, 132 children were evaluated at the Alfred I. duPont Hospital for Children Vestibular Disorders Program. Sixty-nine of the patients were boys and 63 were girls. The average age was 9.7 ± 5.0 years (range, 1-17 years). Although not all were able to complete the entire test battery (99 children completed at least 50% of the tests in the protocol), a diagnosis was achieved in most cases. The most common diagnoses were peripheral vestibulopathy (29.5%), migraine/benign recurrent vertigo of childhood (24.2%), motor/developmental delay (10.6%), traumatic brain injury (9.8%), and central nervous system structural lesion (9.1%). CONCLUSIONS: Peripheral vestibular deficits and migraine disease account for most of the pathology in the pediatric population. With a multidisciplinary approach, diagnosis of the source of vertigo and imbalance is possible in most children.