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Journal Club

Explore prevalence of co-occurring medical conditions in individuals with FASD through systematic review and meta-analysis. Study results, validity, and implications for patient care assessed.

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Journal Club

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  1. Journal Club Alcohol, Other Drugs, and Health: Current Evidence March–April 2016 www.aodhealth.org

  2. Featured Article Comorbidity of fetal alcohol spectrum disorder: a systematic review and meta-analysis. Popova S, et al. Lancet. 2016;387(10022):978–987.

  3. Study Objective • To examine the prevalence of co-occurring medical conditions in individuals with fetal alcohol spectrum disorders (FASD). www.aodhealth.org

  4. Study Design • Systematic review and meta-analysis performed assuming a random-effects model. • Studies reported on the comorbidity and cause of death in individuals with FASD and were published up to July, 2012. www.aodhealth.org

  5. Assessing an Overview Article (Systematic Reviews and Meta-Analyses) • Are the results of the study valid? • What are the results? • Will the results help me in caring for my patients? www.aodhealth.org

  6. Are the Results of the Study Valid? • Did the overview address a focused clinical question? • Were the criteria used to select articles for inclusion appropriate? • Is it unlikely that important, relevant studies were missed? • Was the validity of the included studies appraised? • Were assessments of studies reproducible? • Were the results similar from study to study? www.aodhealth.org

  7. Did the overview address a focused clinical question? • Yes. • Main outcomes: • “To identify the comorbid conditions that co-occur in individuals with FASD and estimate the pooled prevalence of comorbid conditions occurring in individuals with fetal alcohol syndrome (FAS).” www.aodhealth.org

  8. Were the criteria used to select articles for inclusion appropriate? • Yes and no. Only English language articles were included. • 127 trials met inclusion criteria from a pool of 5068. • Articles were peer reviewed published in English up until 2012. • Authors used criteria for determining study quality: • use of an established FASD diagnostic guideline, • study setting, • method of data collection, • sample size. www.aodhealth.org

  9. Is it unlikely that important, relevant studies were missed? • Yes, except for the concern about studies not published in English • The authors conducted the search according to guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). • They did a manual search and also searched the following databases: • Ovid MEDLINE, PubMed, Embase, Web of Science (including Science Citation Index, Social Sciences Citation Index, Arts and Humanities Citation Index), PsycINFO, ERIC, Epscohost, CINAHL, Scopus, Campbell Collaboration, Cambridge Scientific Abstracts Sociological Abstracts, Social Work Abstracts, Canadian Centre on Substance Abuse Library Collection Database, and Centre for Addiction and Mental Health Library Database. www.aodhealth.org

  10. Was the validity of the included studies appraised? • Yes. • Three members of the study team independently reviewed the articles and performed the data extraction and another team member separately reconciled any discrepancies. www.aodhealth.org

  11. Were assessments of studies reproducible? • Yes. • The authors state their specific criteria for searching and study quality assessment. www.aodhealth.org

  12. Were the results similar from study to study? • “Heterogeneity (I2 >75%; statistically significant Q statistics [ie, p≤0·1]) was present for the pooled analyses of 38 (21%) of 183 comorbid conditions that co-occur in individuals with FAS, which is probably due to study differences with respect to patient characteristics, definitions of comorbid condition used, study design, methodology, and sample size.” www.aodhealth.org

  13. What Are the Results? • What are the overall results of the review? • How precise were the results? www.aodhealth.org

  14. What are the overall results of the review? • Data abstraction identified 428 conditions—excluding diagnostic criteria for fetal alcohol syndrome (FAS). Eighteen conditions had a pooled prevalence of > 50% in individuals with FASD. www.aodhealth.org

  15. How precise were the results? • The authors found 18 comorbid conditions (excluding conditions that are part of the diagnostic criteria used for identifying FAS) with a pooled prevalence higher than 50% in individuals with FAS. www.aodhealth.org

  16. Will the Results Help Me in Caring for My Patients? • Can the results be applied to my patient care? • Were all clinically important outcomes considered? www.aodhealth.org

  17. Can the results be applied to my patient care? • Yes. • Study participants were drawn from countries all over the world (36% from US). www.aodhealth.org

  18. Were all clinically important outcomes considered? • Yes. www.aodhealth.org

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