Journal Reading Psychiatry Fix

7/27/2019 Journal Reading Psychiatry Fix

1/37

Supervisor : dr. Sabar P.


2/37

BACKGROUNDPhysical inactivity

Unhealthy diets

Psychotropic

medications

Schizophrenia

Bipolar disorder

Major depression

Increased

appetite

High caloric

intake

DM

Hyperten

Dyslipide

Certain Ca2-3x more risk

Impairement in

memory & executive

function

Impede learning and

adoption of new

behaviours

Low Socio-

economic

Status


3/37

to determine the

effectiveness of an 1

tailored behavioral w

loss intervention in a

with serious mental


4/37

STUDY

Institutional reviewJohn

UniversityandSheppard Pra

System

Independent data and safety

Randomized Trial of Ach

Lifestyles in Psychiatric Reh

(ACHIEVE)

SETTING AND STUDY POPULATION Outpatient psychiatric rehabilitation programs

Obese adults (18 years of age) who attended 1 of

10 communitypsychiatric rehabilitation programs in

central Marylandor their affiliated out-patient

mental health clinics


5/37

We excluded persons

with:

a medical

contraindication to

weight loss,

a cardiovascular event

within the previous 6

months,

an inability to walk, or

an active alcohol-use or

substance-use disorder


6/37

InterventionThe intervention was compos

contact types: group weight-mana

sessions, individual weight-manag

sessions, and group exercise sessio

ControlThe control group received st

nutrition and physical activity inf

base-line.

January 2009 to February 2011STUDY PERIODS


7/37

Information on sociodemographic characteristics and

were obtained from participant self-reports and progr

Psychiatric diagnoses were abstracted from program r

Data

the rehabilitation

programs

to determine study eligibility

to perform follow-up

assessments

at 6, 12, and 18 months

Measurements :

Weight

Height

Blood pressure

Waist circumference

Fasting blood chemical levels were obtbaseline and at 6 and 18 months.


8/37

Statistical

Analysis

Done with intention-to-treat

Primary Outcome :

BMI changes

Persentage of weight change

Other weight-related outcomes included :

- Percentage of weight change from baseline

- Percentage of participants at or below base

weight,

- Percentages of participants who lost at leastheir initial weight and those who lost at lea

- Change from baseline in body-mass index

Chi-square test

Sensitivity analysis


9/37


10/37


11/37


12/37

Figure 2.Mean Weight Change, According to Stud

As compared with t

group, the mean ne

in the intervention g

increased progressi18-month study per


13/37

Table 2. Weight-Loss Outcomes at 6, 12, and 18 Mon


14/37

INTERVENTION PARTICIPATION

The median number of

attended sessions was

the first 6 months and

months 7 through 18.

Attendance at the grou

exercise sessions cont

most to the total numb

contacts.


15/37

InterventioGroup 2 death

6 cardiovascular events

18,3% of the participants reporteda medical hospitalization

14,8% of the participants reported

a psychiatric hospitalization

Control

Group

3 death

8 cardiovascular events

13,0% of the participants remedical hospitalization

20,6% of the participants re

psychiatric hospitalization

ADVERSE

EFFECT


16/37

In overweight and obese adults with serious me

were participating in psychiatric rehabilitation p

behavioral weight-loss intervention incorporatin

management counseling and group exercise sig

participant weight over a period of 18 months.

Despite substantial challenges, persons with ser

are able to lose weight with a tailored in-terven Incorporating lifestyle interventions into rehabil

placing such programs in other mental health se

require financial and organizational resources.


17/37

STUDY STRENGTHS

Enrolled a diverse population of patients with seriousmental illnesses from multiple community-basedprograms.

Throughout the trial, we attained high follow-up ratesfor outcome data.

The intervention was offered over a period of 18months, in contrast to the short-term interventions inprevious randomized trials of behavioral weight-lossinterventions in this population.


18/37

STUDY WEAKNESS

Efforts to provide healthy meal options were available to all

in the rehabilitation programs.

Attendance at the intervention sessions andrehabilitation programs decreased.

The trial was not designed or powered to determine the effe

reduction on cardiovascular risk factors in this population.

The trial was not designed to influence the prescribing of

medication.


19/37

Conclusion

Over-weight and obese adults with serious ment

can make substantial lifestyle changes despite thechallenges they face.

Suggestion

Given the epidemic of obesity and weight-related dispersons with serious mental illness, our findings sup

implementation of targeted behavioral weight-loss in

this high-risk population.


20/37

CRITICAL

APPRAISAL


21/37

JoJournal identityThe study come from :

- Johns Hopkins University

The Welch Center for Prevention, Epidemiology, and Clinical Research Johns

Hopkins University, Division of General Internal Medicine and Department o

Psychiatry Johns Hopkins University School of Medicine, Departments of

Epidemiology Health Policy and Management, Mental Health, and Biostatis

Johns Hopkins Bloomberg School of Public Health- University of Maryland

Department of Veterans Affairs Capitol Health Care Network (VISN 5) Mental Illness

Education, and Clinical Research Center (R.W.G.), and Department of Psychiatry, Uni

Maryland School of Medicine (R.W.G.), Baltimore; Sheppard Pratt Health System (F.B


22/37

Jo

- Towson University

Department of Kinesiology, Towson University and Social and Scientific Systems

- University of California

Division of Preventive Medicine, Department of Family and Preventive Medicin

of California, San Diego, La Jolla (C.A.M.A.)

- Department of Research and Evaluation, Kaiser Permane

Southern California, Pasadena (D.R.Y.)

- The National Center for Cardiovascular Research, Madrid

Published on March 21th, 2013, at NEJM.org.


23/37

Jo

TitlesA Behavioral Weight-Loss Intervention in Pewith Serious Mental Illness

Positive: Clearly shows that variables that were investigated

Bold written with a capital letter at the beginning of th

There is no abbreviation

Less than 12 words

Negative: No location

No time


24/37

Jo

Consist of 4 paragraphs

Background

Methods

Results

Conclusion

> 250 words


25/37

Jo

Positive: Participant of study is clear, followed by the inclu

and exclusion criteria

Intergroup interventions are clear

Analysis tools mentioned clearly Measurable outcomes are clear

Technique sampling is randomized

Negative:

Not blind


26/37

Jo

Positive Tables are presented in accordance with the

international journal writing format (without tvertical and horizontal lines in a) with no serianumber and table title and description of the

contents of the table

The values of the statistics written

Negative :

Theres no interpretation of BMI


27/37

Jo

Positive

There is a comparison test of previous research and

There are disadvantages and advantages of the me

research results that have been achieved

There is an emphasis if the results of the research w

applied

There are suggestions for future research

Negative : -


28/37

PICO ANALYSIS POPULATION

Adult patients with serious mental disorders excess

weight or obesity from 10 community rehabilitation

program of outpatient psychiatry at central Marylan

affiliates

INTERVENTION

Behavioral weight loss through lifestyle in adult pati

with serious mental disorders excess body weight o


29/37

COMPARATION

Persentage of weight change at 6, 12, and 18 mbetween intervention group and control group

OUTCOME

A behavioral weight-loss intervention significanreduced weight over a period of 18 months in

overweight and obese adults with serious men

illness.


30/37

VALID EVIDENCEQUESTIONSIs the allocation of patients in the study randomized? Y

Is patient observation done quite long and complete? Y

Are all patients in the randomized, analyzed? Y

Whether patients and physicians remain blind in doing

therapy, apart from the therapy being tested?

Is the treatment and control groups equally? Y


31/37

I

WEIGHT LOSS FROM BASELINE AT 18 MONTHS FOLLOW UP

THE IMPORTANCE OF STUDY

WEIGHT LOSSTota

(+) (-)

Intervention 88 49 137

Control 70 72 142

Total 158 121 279


32/37

IEBM for RCT RRR = -0.303 (95% CI: -0.605 to -0.058)

Weight loss from baseline in the

intervention group was 30.3% higher than

the control group

ARR = -0.149 (95% CI: -0.26 to -0.033)

ARR = -0.149 means absolute advantage

derived from behavioral interventions for

weight loss is a 14.9% increase in the

weight loss from baseline.

NNT = -7 (-4 to -30)

The number of patients who must be

treated (for the duration of the study) inorder to increase the weight loss from

baseline in obese adult patients with

mental disorders are 7 people

All 95%CI does not include the number 1,

indicating that the RRR, ARR, and NNT

meaningful.


33/37

I

WEIGHT LOSS 5% FROM BASELINE AT 18 MONTHS FOLLOW UP

WEIGHT LOSS

Total(+) (-)

Intervention 52 85 137

Control 32 110 142

Total 84 195 297


34/37

IEBM for RCT RRR = -0.684 (95% CI: -1.445 to -0.16)

Weight loss in the intervention group by 5%from baseline was 68.4% higher than thecontrol group

ARR = -0.154 (95% CI: -0.258 to -0.046)

ARR = -0.154 means absolute advantagederived from behavioral interventions forweight loss is a 15.4% increase in the weightloss of 5% from the baseline.

NNT = -7 (-4 to -22)

The number of patients who must be treated(for the duration of the study) in order toincrease the 5% weight loss from baseline inobese adult patients with mental disordersare 7 people.

All 95% CI does not include the number 1,indicating that the RRR, ARR, and NNT

meaningful.


35/37

A

QUESTIONSIs there a difference in our patients

when compared with that found in

previous studies so that the results

can not be applied to our patients?

NO

Whether such therapy may be

applied to our patients?

YES

Does the patient have a potential

beneficial or detrimental treatment

or when the program implemented?

Profitable. Behavioral weight loss in

can significantly reduce body weigh

period of 18 months in adults with o

and obesity with serious mental DIS

APPLICABILITY OF TEST


36/37

CONCLUSION1

Clinical study is valid

2

Clinical study is important

3Clinical study is applicable


37/37

Thank

You

Date post:	14-Apr-2018
Category:	Documents
Upload:	muhammad-nuruddin
View:	223 times
Download:	0 times

Journal Reading Psychiatry Fix

Documents