Wednesday, October 30, 2013

Clinical Research Oriented Workshop (CROW) Meeting: October 24, 2013

Present:  Marianne Burke, Kat Cheung, Abby Crocker, Kairn Kelley, Ben Littenberg, Connie van Eeghen
Guest:     Kathleen Bryant, NP from Associates in Pediatrics

Start Up: Welcome to Kathleen B., who is working on a poster presentation and interested in our research group. 

1.                  Discussion: Marianne – Literature review results based on a query re: adolescents and opioids/analgesic with 172 matched publications (PubMed), plus a GoogleScholar search, and an Ovid search with 19 matches. 
a.       The literature can be divided into 2 overlapping groups: prescribing of opioids and use/misuse of opioids (both related to adolescents).  NAMCS (National Ambulatory Medical Care Survey) includes prescribing data but might not include the reason for prescribing (e.g. “palpitations due to opioid use). Articles reviewed that were of future interest to the group:
                                                  i.      Han, H on the rate of dose escalation in long term opioid therapy
                                                ii.      Lankenau, 2012, on prescription opioids and their misuse
                                              iii.      McCabe, 2013, nonmedical users of prescription opioids who used leftover medications form their own previous prescriptions
                                              iv.      McCabe, 2011, Medical misuse of controlled medications (possibly used YRBS)
                                                v.      McCabe, 2012, medical and nonmedical use of prescription opioids among high school seniors (same study as before, different target populations)
                                              vi.      Meier, 2012, Extramedical use of prescription pain relievers (National Survey on Drug Use and Health) (Michigan State University)
                                            vii.      Osgood, 2012, Oxycodone abuse patterns in adolescents
                                          viii.      Platts-Mills, 2012, age discrimination and pain medication in emergency departments (National Hospital Ambulatory Medical Care Survey)
                                              ix.      Shield, 2013, Use of prescription opioid analgesic – prevalence study from pharmacy data set, Canadian data set
                                                x.      Sjogren, 2010, population-based cohort study on chronic pain: the role of opioids – Danish health interview survey
                                              xi.      Vogel, 2011, prolonged use of benzos associated with childhood trauma in opioid maintained patients
b.      Also, the Ovid search produced another 300 studies based on the criteria used for the above list

2.                  Discussion: Abby – NAMCS data exploration, supported by the CDC. 
a.       Abby briefly reported on what can be found in this data source:
                                                  i.      Focus on prescriptions, including new and continued prescriptions
                                                ii.      Proportion of visits that include a anew or continued prescription
                                              iii.      Three new years for analysis: 2008-2010; cross-sectional study only
                                              iv.      Use of drugs based on standard of care, e.g. long term use of Percocet
b.      Summary: characteristics of continued versus new prescriptions in adolescents with covariates
c.       Two strategies for moving forward:
                                                  i.      Brief descriptive statistics on the above characteristics (Abby).  Describe prescriptions in data base and the covariates in the data base (may want to learn more about what is available in the data set before deciding).  Consider reviewing covariates for further study at later CROW session.
                                                ii.      Follow up on literature search to condense and focus (Marianne)
d.      Also consider a comparison study of changes in prescription patterns; as well as changes in the environment of regulation and evidence that may have affected prescription patterns.

3.                  Next Workshop Meeting(s): Thursdays, 11:45 a.m. – 1:15 p.m., at Given Courtyard South Level 4.   
a.       October 24: Abby review of NAMCS data source and Marianne – results from literature review
b.      October 31: Kat Cheung  
c.       November 7: Rodger Kessler
d.      November 14: Abby: cracking open the prescribing data base
e.       Future agenda to consider:
                                                  i.      Peter Callas or other faculty on multi-level modeling
                                                ii.      Charlie MacLean: demonstration of Tableau; or Rodger’s examples of Prezi
                                              iii.      Journal article: Gomes, 2013, Opioid Dose and MVA in Canada (Charlie)
                                              iv.      Ben: Tukey chapter reading assignments, or other book of general interest

Recorder: Connie van Eeghen

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