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Running head: A SYSTEMATIC REVIEW CRITIQUE 1
A SYSTEMATIC REVIEW CRITIQUE:
NAME:
UNIVERSITY:
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A SYSTEMATIC REVIEW CRITIQUE 2
Relevance of the review to nursing practice.
The systemic research review aims to identify benefits of various psychosocial
interventions for reduction of substance abuse in people with mental illness compared to
standard care (Hunt, Siegfried, Morley, Sitharthan & Cleary, 2013). Drug and substance abuse
for people with mental illness is a critical concern in my current practice. Substance abuse
renders management of mental illnesses difficult, poor response to care and has an overall
detrimental result on prognosis. The review will provide a scientific base for my practice, backed
with the scientific rationale for interventions in mental health. Identification of successful
interventions is of fundamental importance in my practice as it expands the body of knowledge
providing evidence-based approaches in managing substance abuse in severe mental illness and
will offer a better treatment alternative for people suffering substance abuse and severe mental
illness. The review through examining and analyzing various research data will identify the cost-
effectiveness of such interventions. Cost is relevant to my practice as identification of cheaper
management alternatives is crucial, more so for long-term severe mental illness patients
undergoing long-term care. Recommendations and findings derived from the review on further
areas of research, are key in expanding evidence-based practice approach to nursing in general.
The research rigor of studies used.
The process of identifying studies for use in this review was sufficient. Inclusion and
exclusion criteria of articles used in the systemic review were clearly stated and followed,
allowing for selection of studies which provided data to the research question. The studies
utilized in the systemic review were identified through a rigorous search of the Cochrane
Schizophrenia Group Trials register which provides a broad range of major scientific and
medical research databases. Further journal searches for past research data from MEDLINE,
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A SYSTEMATIC REVIEW CRITIQUE 3
Cochrane Database of Systemic Reviews and PsycINFO was conducted by the authors of the
systemic review. Authors reviewed the studies searched independently, some articles from the
databases that failed to fit inclusion criteria were excluded. The authors chose articles from an
extensive population data including RCT in United Kingdom, Australia, and Germany, however,
the inclusion of RCTs from low and middle-income countries would have made generalization of
findings more accurate and allow for a wider generalization of findings. The authors checked
references of the studies picked to establish their quality and relevance, authors of new trials to
identify any unpublished or ongoing trials for the review were contacted. The authors scrutinized
the studies using independent reviewers and provided for discussion and adjudication by other
review authors to resolving differences of opinions by the reviewers on the studies trials chosen.
The credibility of the articles would have been enhanced if the authors had inquired for any
conflict of interest declarations by the authors of the trials under review. The intensity of
identifying and validating studies for the systemic review was adequate allowing the systemic
review to answer the research question.
The review was adequate. The review’s research question was focused. The study search
methods employed by the authors was sufficient, they searched databases for studies which they
analyzed and excluded those not meeting the inclusion criteria, conducted independent review of
studies. The authors also included studies from other languages which were translated. The
authors used RCT which are more reliable as they have less risk for bias. The synthesis of study
results was well done, well presented, analysis of the study findings, and its limitations and
future recommendations identified in the review. The review is a good review, however, its
reliability in answering the research question is weakened by the poor data from the studies
included.
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A SYSTEMATIC REVIEW CRITIQUE 4
Critique levels of evidence
The level of evidence of studies included in the study was low. Although the inclusion
criteria employed by the authors was sufficient, the RCTs used in the review had many flaws.
These shortcomings lowered the level of evidence expected from the RCTs. The studies included
in the study failed to meet the threshold for randomized trials as they have high attrition bias,
some unclear risks for bias, skewed data which limits measurement of outcomes and short or
small sample sizes. The evidence from the RCTs included does not provide compelling support
to answer the research question comprehensively. The review authors correctly discarded any
quasi-randomized trials from inclusion. Quasi-randomized trials are of high risk for bias since in
quasi-randomization, is hard to conceal next groups opening them to bias.
The study designs utilized in all the trials chosen for inclusion was randomized controlled
trials. There is a notable inclusion of too many trials allowing for poorly conducted and reported
trials into the review. The study design of the some of the trials included in the review was
sufficient; however, other studies under review had unclear blinding, small sample sizes and
reported skewed data. The poor outcomes and low evidence extracted from the studies, weakens
the results of the review making it less dependable. The authors (in summary) emphasize on need
for inclusion RCTs of higher quality in future studies.
Critique of clarity of presentation of the review
The authors’ clarity of presentation of the review is well organized, easy-to-read and
coherent. There is consistency in flow of information and facts on the statement of the research
question, inclusion and exclusion criteria for studies utilized in the review. The review is
presented with a touch of excellent balance in the presentation of study results, statistical
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A SYSTEMATIC REVIEW CRITIQUE 5
analysis, and study summaries. The authors have utilized reliable methods of testing the
reliability of data obtained from the randomized controlled trials. The authors have presented an
in-depth critique of the studies used in the systemic review. Critique of the studies used in the
review explores the reliability of the studies and data presented from each research, and the bias
or risk for bias. The authors use statistical analysis; confidence intervals, risk ratios, and GRADE
to identify the level of evidence of each article chosen for inclusion this is clearly indicated in the
presentation of the review. The results of these statistical testing methods are presented in a
succinctly in tables, well-marked and elaborated. Levels of evidence are identified and rated for
each research article utilized. The use of tables and figures in the systematic review makes the
review easy to read through and allows for readers to draw conclusions. Clarity in presentation of
the review allows for a clear understanding of the systemic review, review’s study design and
findings.
Description of results and findings
The study examined 32 RCT of 3162 participants; the results indicated that was that there
was no substantial evidence to favor any psychosocial treatment over the others. There is a
notable existence of poor quality trials used in the study which limited evidence in this study.
The findings can be generalized to populations in high-income countries as study trials from low
and middle-income countries were not included.
Comparisons of interventions measured by the analysis of data from included trials
returned results as; a comparison of the models of care versus treatment as usual concluded that
the provision of care by the same team was not necessary for the success of an integrated
services provision. The studies included for this comparison returned a low-quality level of
evidence. Nonintegrated models of care versus treatment as usual, (RR= 1.21) data results did
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A SYSTEMATIC REVIEW CRITIQUE 6
not show any advantages derived from retaining patients in nonintegrated treatment over
standard case management. Comparison of cognitive behavioral therapy (CBT) and motivational
interviewing (MI) versus treatment as usual, there is support for the efficiency of CBT with MI
over treatment as usual (RR=0.99). The findings across studies, however, were inconsistent, and
further research is needed to determine the effectiveness of the combination of CBT and MI.
Comparison on CBT to treatment as usual did not return significant benefits, (RR=1.12), no
benefits were reported in reducing intake of cannabis within six month period (RR=1.30).
However, results pooled from two studies indicated benefits of retaining subjects in CBT there
was low level-quality of evidence. Comparison of cognitive behavioral therapy and
psychological rehabilitation to treatment as usual was inconclusive, data was from one study
which was small and skewed, and the outcomes were not measured. Comparison between a
combination of CBT with intensive case management utilized only one study which showed
some benefit in the combined intervention over treatment as usual. Comparison for intensive
case management alone did not return any real effect in regards to functioning, data used from,
was of a small study and skewed. A comparison of MI and treatment as usual, showed some
effectiveness of MI in reducing substance abuse (Graeber, 2003). Other studies utilized
(Bonsack, 2011) reported a decrease in substance abuse. The studies returned an indication that
multiple MI sessions have an effect in reduction of substance abuse for alcohol (RR=0.36) but
not for other substances. Skills treatment versus treatment as usual, there was no difference
identified in this approach, studies did not measure life satisfaction in general. Comparison of
specialized case management to usual treatment did not return any difference; the outcome was
not measured. Integrated assertive community treatment versus assertive community treatment
team versus treatment as usual did not return any differences in the treatment groups.
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A SYSTEMATIC REVIEW CRITIQUE 7
Contingency management versus standard care, (Mcdonell, 2013) reported a reduction in
substance abuse in patients receiving contingency management over a short term; this; however,
was not significant in six months. The review findings were not all summarized due to the failure
of trials to measure outcomes of interest. Evidence was low or very low, due to poor methods
used in the trials, wide confidence intervals and high /unclear risks for bias.
Critique of the SRR conclusion and its impact on current practice
The authors’ conclusion on lack of compelling evidence support for any psychosocial
intervention over others, is consistent with the findings of the review. The conclusion succinctly
summarizes the results, opening discussion on the need for better research studies on the subject.
The findings of this review add no new knowledge in my current practice, it does, however,
retaliate the need to provide individualized care to mentally ill patients based on the intervention
that best works for the patient, not preferring certain interventions over others. The authors’
proposal for adaption of treatment techniques for people with substance abuse, is consistent with
needs for behavioral health interventions (Hunt et al., 2013). The authors’ fail to identify the
essence of considering the costs of interventions in research, which is of consequence to patients
receiving or intended to receive care. The review restates the need for further reviews to be
conducted on the research question. Future studies in this area are critical; the authors correctly
identify the crucial need for inclusion of more reliable RCTs in future studies in this area. The
authors provide adequate observations on the need for future trials to utilize validated and non-
adapted scales and to observe clear reporting at different stages. Such measures will authenticate
trials and provide better data that can be used to answer the research question.
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A SYSTEMATIC REVIEW CRITIQUE 8
References
Bonsack, C., Manetti, S. G., Favrod, J., Conus, P., Bovet, P., Besson, J., & Montagrin, Y. (2011,
June 1). Motivational intervention to reduce cannabis use in young people with
psychosis: A randomized controlled trial. MEDLINE, 80(5), 287-297. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/21646823.
Graeber, D., Griffith, G., Guajardo, E., Tonigan, S., & Moyers, T. (2011). A pilot study
comparing motivational interviewing and an educational intervention in patients with
schizophrenia and alcohol use disorders. MEDLINE, 39(3), 189-202. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/12836801
Hunt, G. E., Siegfried, N., Morley, K., Sitharthan, T., & Cleary, M. (2013). Psychosocial
interventions for people with both severe mental illness and substance misuse. Cochrane
Database of Systematic Reviews Reviews, (10), 3rd ser., 1-261.
doi:10.1002/14651858.cd001088.pub3
Mcdonell, M. G., Srebnik, D., Angelo, F., Mcpherson, S., Lowe, J. M., Sugar, A., Ries, R. K.
(2013). Randomized Controlled Trial of Contingency Management for Stimulant Use in
Community Mental Health Patients With Serious Mental Illness. American Journal of
Psychiatry AJP, 170(1), 94-101.
doi:10.1176/appi.ajp.2012.11121831
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A SYSTEMATIC REVIEW CRITIQUE 9

Unformatted Attachment Preview

Running head: A SYSTEMATIC REVIEW CRITIQUE A SYSTEMATIC REVIEW CRITIQUE: NAME: UNIVERSITY: 1 A SYSTEMATIC REVIEW CRITIQUE 2 Relevance of the review to nursing practice. The systemic research review aims to identify benefits of various psychosocial interventions for reduction of substance abuse in people with mental illness compared to standard care (Hunt, Siegfried, Morley, Sitharthan & Cleary, 2013). Drug and substance abuse for people with mental illness is a critical concern in my current practice. Substance abuse renders management of mental illnesses difficult, poor response to care and has an overall detrimental result on prognosis. The review will provide a scientific base for my practice, backed with the scientific rationale for interventions in mental health. Identification of successful interventions is of fundamental importance in my practice as it expands the body of knowledge providing evidence-based approaches in managing substance abuse in severe mental illness and will offer a better treatment alternative for people suffering substance abuse and severe mental illness. The review through examining and analyzing various research data will identify the costeffectiveness of such interventions. Cost is relevant to my practice as identification of cheaper management alternatives is crucial, more so for long-term severe mental illness patients undergoing long-term care. Recommendations and findings derived from the review on further areas of research, are key in expanding evidence-based practice approach to nursing in general. The research rigor of studies used. The process of identifying studies for use in this review was sufficient. Inclusion and exclusion criteria of articles used in the systemic review were clearly stated and followed, allowing for selection of studies which provided data to the research question. The studies utilized in the systemic review were identified through a rigorous search of the Cochrane Schizophrenia Group Trials register which provides a broad range of major scientific and medical research databases. Further journal searches for past research data from MEDLINE, A SYSTEMATIC REVIEW CRITIQUE 3 Cochrane Database of Systemic Reviews and PsycINFO was conducted by the authors of the systemic review. Authors reviewed the studies searched independently, some articles from the databases that failed to fit inclusion criteria were excluded. The authors chose articles from an extensive population data including RCT in United Kingdom, Australia, and Germany, however, the inclusion of RCTs from low and middle-income countries would have made generalization of findings more accurate and allow for a wider generalization of findings. The authors checked references of the studies picked to establish their quality and relevance, authors of new trials to identify any unpublished or ongoing trials for the review were contacted. The authors scrutinized the studies using independent reviewers and provided for discussion and adjudication by other review authors to resolving differences of opinions by the reviewers on the studies trials chosen. The credibility of the articles would have been enhanced if the authors had inquired for any conflict of interest declarations by the authors of the trials under review. The intensity of identifying and validating studies for the systemic review was adequate allowing the systemic review to answer the research question. The review was adequate. The review’s research question was focused. The study search methods employed by the authors was sufficient, they searched databases for studies which they analyzed and excluded those not meeting the inclusion criteria, conducted independent review of studies. The authors also included studies from other languages which were translated. The authors used RCT which are more reliable as they have less risk for bias. The synthesis of study results was well done, well presented, analysis of the study findings, and its limitations and future recommendations identified in the review. The review is a good review, however, its reliability in answering the research question is weakened by the poor data from the studies included. A SYSTEMATIC REVIEW CRITIQUE 4 Critique levels of evidence The level of evidence of studies included in the study was low. Although the inclusion criteria employed by the authors was sufficient, the RCTs used in the review had many flaws. These shortcomings lowered the level of evidence expected from the RCTs. The studies included in the study failed to meet the threshold for randomized trials as they have high attrition bias, some unclear risks for bias, skewed data which limits measurement of outcomes and short or small sample sizes. The evidence from the RCTs included does not provide compelling support to answer the research question comprehensively. The review authors correctly discarded any quasi-randomized trials from inclusion. Quasi-randomized trials are of high risk for bias since in quasi-randomization, is hard to conceal next groups opening them to bias. The study designs utilized in all the trials chosen for inclusion was randomized controlled trials. There is a notable inclusion of too many trials allowing for poorly conducted and reported trials into the review. The study design of the some of the trials included in the review was sufficient; however, other studies under review had unclear blinding, small sample sizes and reported skewed data. The poor outcomes and low evidence extracted from the studies, weakens the results of the review making it less dependable. The authors (in summary) emphasize on need for inclusion RCTs of higher quality in future studies. Critique of clarity of presentation of the review The authors’ clarity of presentation of the review is well organized, easy-to-read and coherent. There is consistency in flow of information and facts on the statement of the research question, inclusion and exclusion criteria for studies utilized in the review. The review is presented with a touch of excellent balance in the presentation of study results, statistical A SYSTEMATIC REVIEW CRITIQUE 5 analysis, and study summaries. The authors have utilized reliable methods of testing the reliability of data obtained from the randomized controlled trials. The authors have presented an in-depth critique of the studies used in the systemic review. Critique of the studies used in the review explores the reliability of the studies and data presented from each research, and the bias or risk for bias. The authors use statistical analysis; confidence intervals, risk ratios, and GRADE to identify the level of evidence of each article chosen for inclusion this is clearly indicated in the presentation of the review. The results of these statistical testing methods are presented in a succinctly in tables, well-marked and elaborated. Levels of evidence are identified and rated for each research article utilized. The use of tables and figures in the systematic review makes the review easy to read through and allows for readers to draw conclusions. Clarity in presentation of the review allows for a clear understanding of the systemic review, review’s study design and findings. Description of results and findings The study examined 32 RCT of 3162 participants; the results indicated that was that there was no substantial evidence to favor any psychosocial treatment over the others. There is a notable existence of poor quality trials used in the study which limited evidence in this study. The findings can be generalized to populations in high-income countries as study trials from low and middle-income countries were not included. Comparisons of interventions measured by the analysis of data from included trials returned results as; a comparison of the models of care versus treatment as usual concluded that the provision of care by the same team was not necessary for the success of an integrated services provision. The studies included for this comparison returned a low-quality level of evidence. Nonintegrated models of care versus treatment as usual, (RR= 1.21) data results did A SYSTEMATIC REVIEW CRITIQUE 6 not show any advantages derived from retaining patients in nonintegrated treatment over standard case management. Comparison of cognitive behavioral therapy (CBT) and motivational interviewing (MI) versus treatment as usual, there is support for the efficiency of CBT with MI over treatment as usual (RR=0.99). The findings across studies, however, were inconsistent, and further research is needed to determine the effectiveness of the combination of CBT and MI. Comparison on CBT to treatment as usual did not return significant benefits, (RR=1.12), no benefits were reported in reducing intake of cannabis within six month period (RR=1.30). However, results pooled from two studies indicated benefits of retaining subjects in CBT there was low level-quality of evidence. Comparison of cognitive behavioral therapy and psychological rehabilitation to treatment as usual was inconclusive, data was from one study which was small and skewed, and the outcomes were not measured. Comparison between a combination of CBT with intensive case management utilized only one study which showed some benefit in the combined intervention over treatment as usual. Comparison for intensive case management alone did not return any real effect in regards to functioning, data used from, was of a small study and skewed. A comparison of MI and treatment as usual, showed some effectiveness of MI in reducing substance abuse (Graeber, 2003). Other studies utilized (Bonsack, 2011) reported a decrease in substance abuse. The studies returned an indication that multiple MI sessions have an effect in reduction of substance abuse for alcohol (RR=0.36) but not for other substances. Skills treatment versus treatment as usual, there was no difference identified in this approach, studies did not measure life satisfaction in general. Comparison of specialized case management to usual treatment did not return any difference; the outcome was not measured. Integrated assertive community treatment versus assertive community treatment team versus treatment as usual did not return any differences in the treatment groups. A SYSTEMATIC REVIEW CRITIQUE 7 Contingency management versus standard care, (Mcdonell, 2013) reported a reduction in substance abuse in patients receiving contingency management over a short term; this; however, was not significant in six months. The review findings were not all summarized due to the failure of trials to measure outcomes of interest. Evidence was low or very low, due to poor methods used in the trials, wide confidence intervals and high /unclear risks for bias. Critique of the SRR conclusion and its impact on current practice The authors’ conclusion on lack of compelling evidence support for any psychosocial intervention over others, is consistent with the findings of the review. The conclusion succinctly summarizes the results, opening discussion on the need for better research studies on the subject. The findings of this review add no new knowledge in my current practice, it does, however, retaliate the need to provide individualized care to mentally ill patients based on the intervention that best works for the patient, not preferring certain interventions over others. The authors’ proposal for adaption of treatment techniques for people with substance abuse, is consistent with needs for behavioral health interventions (Hunt et al., 2013). The authors’ fail to identify the essence of considering the costs of interventions in research, which is of consequence to patients receiving or intended to receive care. The review restates the need for further reviews to be conducted on the research question. Future studies in this area are critical; the authors correctly identify the crucial need for inclusion of more reliable RCTs in future studies in this area. The authors provide adequate observations on the need for future trials to utilize validated and nonadapted scales and to observe clear reporting at different stages. Such measures will authenticate trials and provide better data that can be used to answer the research question. A SYSTEMATIC REVIEW CRITIQUE 8 References Bonsack, C., Manetti, S. G., Favrod, J., Conus, P., Bovet, P., Besson, J., & Montagrin, Y. (2011, June 1). Motivational intervention to reduce cannabis use in young people with psychosis: A randomized controlled trial. MEDLINE, 80(5), 287-297. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21646823. Graeber, D., Griffith, G., Guajardo, E., Tonigan, S., & Moyers, T. (2011). A pilot study comparing motivational interviewing and an educational intervention in patients with schizophrenia and alcohol use disorders. MEDLINE, 39(3), 189-202. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12836801 Hunt, G. E., Siegfried, N., Morley, K., Sitharthan, T., & Cleary, M. (2013). Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database of Systematic Reviews Reviews, (10), 3rd ser., 1-261. doi:10.1002/14651858.cd001088.pub3 Mcdonell, M. G., Srebnik, D., Angelo, F., Mcpherson, S., Lowe, J. M., Sugar, A., Ries, R. K. (2013). Randomized Controlled Trial of Contingency Management for Stimulant Use in Community Mental Health Patients With Serious Mental Illness. American Journal of Psychiatry AJP, 170(1), 94-101. doi:10.1176/appi.ajp.2012.11121831 A SYSTEMATIC REVIEW CRITIQUE 9 Name: Description: ...
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