Best Evidence Topics

Survey (including pre-test probabilities)

Irina Mikolaenko et al.
A Review of Methadone Deaths in Jefferson County, Alabama.
The American Journal of Forensic Medicine and Pathology.
23(3)pp 299-304
  • Submitted by:Jenifer Barrie - Student
  • Institution:University of Manchester
  • Date submitted:17th July 2005
Before CA, i rated this paper: 7/10
1 Objectives and hypotheses
1.1 Are the objectives of the study clearly stated?
  Yes, in the introduction. It looks into the contribution of benzodiazepines in death of opiate overdose patients and the mechanisms responsible.
2 Design
2.1 Is the study design suitable for the objectives
2.2 Who / what was studied?
  Retrospective study of cases where methadone was detected in postmortem drug testing.
2.3 Was this the right sample to answer the objectives?
2.4 Did the subject represent the full spectrum of the population of interest?
  Heroin related deaths could have been included in the sample.
2.5 Is the study large enough to achieve its objectives? Have sample size estimates been performed?
  No mention of sample size estimates.
2.6 Were all subjects accounted for?
2.7 Were all appropriate outcomes considered?
  Yes. the cause of death was deemed to be caused by methadone, coincidental, possibleyand probably caused by methadone.
2.8 Has ethical approval been obtained if appropriate?
2.9 What measures were made to contact non-responders?
  see below
2.10 What was the response rate?
3 Measurement and observation
3.1 Is it clear what was measured, how it was measured and what the outcomes were?
  Yes, the relation of methadone to death and the other drugs found at post-mortem.
3.2 Are the measurements valid?
3.3 Are the measurements reliable?
3.4 Are the measurements reproducible?
4 Presentation of results
4.1 Are the basic data adequately described?
  Yes demographics were described as percentages. Mean blood levels of drugs were described.
4.2 Are the results presented clearly, objectively and in sufficient detail to enable readers to make their own judgement?
  Yes, tables one two and three show results clearly.
4.3 Are the results internally consistent, i.e. do the numbers add up properly?
5 Analysis
5.1 Are the data suitable for analysis?
5.2 Are the methods appropriate to the data?
  see above
5.3 Are any statistics correctly performed and interpreted?
  see above
6 Discussion
6.1 Are the results discussed in relation to existing knowledge on the subject and study objectives?
  Yes, several theories as to how benzodiazepines interact with opiates are given.
6.2 Is the discussion biased?
6.3 Can the results be generalised?
7 Interpretation
7.1 Are the authors' conclusions justified by the data?
  Yes. It is concluded that interactions with methadone and benzodiazepines alter blood levels of the drugs.
7.2 What level of evidence has this paper presented? (using CEBM levels)
  level 3-survey
7.3 Does this paper help me answer my problem?
  Not directly but it does demonstrate that benzodiazepines affect levels of opiates.
After CA, i rated this paper: 7/10
8 Implementation
8.1 Can any necessary change be implemented in practice?
  An awareness of how benzodiazepines may affect opiates and discouragement of polydrug use should be advised.
8.2 What aids to implementation exist?
  Health professionals getting the message across to users.
8.3 What barriers to implementation exist?
  Many users may not see health professionals regularly.