Novel tools, resources, and gadgets for evidence-based practice. Barbara Walker Indiana University Bloomington, Indiana

Transcription

1 Novel tools, resources, and gadgets for evidence-based practice Barbara Walker Indiana University Bloomington, Indiana

2 Acknowledgements!The Miriam Hospital and Brown University!IU Dept. of Psychological and Brain Sciences!Society of Behavioral Medicine " Bonnie Spring, Ph.D.!IU Ruth Lilly Library " Susan London: Librarian Extraordinaire at IU Medical School

3 Overview EBPP : The broader context 2 components Resources/Techniques For finding the evidence For having the evidence find you For linking clinicians and researchers The future

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5 Psychology introduces EBPP Best research available Clinical Expertise CD Patient characteristics, culture and preferences The integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences (became policy of the American Psychological Association in August, 2005)

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7 Two Components of EBP The framework of EBM Operationalization: 5 STEPS Best research available 1. Convert information needs into questions. 2. Search for the best evidence in the literature. Patient characteristics, culture, preferences CD Clinical Expertise 3. Critically appraise the evidence. 4. Integrate with a patient s characteristics, culture and preferences. 5. Evaluate the outcome.

8 Content Distribution of Books on EBP EBP Framework EBP Skills How to teach EBP 20 0 EBM (Sackett et.al) EBN (Craig, Smyth, et.al) SW (Gibbs) LIB (McKibbon) PSYCH (Norcross, Beutler, Levant) PSYCH (Goodheart, Kazdin, Sternberg)

9 ON-LINE EBP TUTORIAL SITES evidence based nursing tutorial (26) evidence based social work tutorial (4) evidence based psychology tutorial (0) evidence based practice in psychology tutorial (0) evidence based medicine tutorial (603) SEARCH TERM = evidence based.tutorial August 31, 2006

10 EBP is more than just the framework. Specific resources have emerged to help practitioners do EBP. These have been the major focus in other fields. New to psychology.

11 Techniques / Resources for doing EBP 1. Convert information needs into a clear question. 2. Search for the best evidence in the literature. 3. Critically appraise the evidence. 4. Integrate with a patient s needs, preferences, circumstances, and values. 5. Evaluate the outcome.

12 EBP Resources For finding the evidence For having the evidence find you For linking clinicians and researchers

13 Finding evidence

14 THIS SERIES COURTESY OF SUE LONDON IUPUI LIBRARY

15 High Sensitivity

16 High Specificity

17 Types of EBP Questions By Content Diagnosis Effectiveness Etiology Prognosis Harm By Format Background Foreground COURTESY OF SUE LONDON Ruth Lilly Medical Library

18 High Specificity WHAT WHERE HOW

19 High Specificity WHAT: Systematic review WHERE: Specialized databases HOW: Search strategies (controlled vocabulary)

20 SECONDARY LITERATURE: papers that synthesize original studies Traditional reviews PRIMARY LITERATURE

21 SECONDARY LITERATURE: papers that synthesize original studies SYSTEMATIC REVIEWS PRIMARY LITERATURE Traditional reviews

22 Systematic vs. Traditional Reviews Focus is on a clear clinically relevant question. End with a clinical bottom-line. Specific, pre-determined method and format. Research on research. Search for all relevant studies. Avoid bias Goal is replication

23 SECONDARY LITERATURE: papers that synthesize original studies SYSTEMATIC REVIEWS PRIMARY LITERATURE META- ANALYSES Traditional reviews

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26 What about Medline and PsycINFO?

27 Medical / Health Databases PSYCINFO MEDLINE Adapted from Shahram Yazdani, 2002

28 EMBASE PSYCINFO Cochrane and other EBM databases are not linked to PsycINFO Cochrane / others MEDLINE Overlap between Medline and Embase =30-70% Adapted from Shahram Yazdani, 2002

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31 Clinicians need to know when their uncertainty stems from gaps in the evidence rather than gaps their own knowledge.

32 Postnatal depression QUESTIONS What are the effects of drug treatments for postnatal depression? What are the effects of non-drug treatments for postnatal depression? DRUG TREATMENTS Likely to be beneficial Selective serotonin reuptake inhibitor antidepressants (fluoxetine and paroxetine) Unknown effectiveness Antidepressants other than fluoxetine and paroxetine Hormones NON-DRUG TREATMENTS Likely to be beneficial Cognitive behavioural therapy (individual) Interpersonal psychotherapy Non-directive counselling Psychodynamic therapy Unknown effectiveness Cognitive behavioural therapy (group) Light therapy Mother infant interaction coaching Psychoeducation with partner Telephone based peer support (mother to mother)

33 What: systematic review, other syntheses Where: Cochrane, other specialized databases, EB on-line text books How Controlled vocabulary SUMSEARCH

34 Controlled Vocabulary Librarians tag each article with labels based on the concepts in the article. These labels are standardized. Medline: MeSH terms PsycINFO: Thesaurus

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42 Finding the evidence The evidence can find you: Alerts

43 To have more evidence-based practice, we need more practice-based evidence.

44 CATs Critically appraised topics: SHORT Cat Maker Cat Banks Cat Crawler Kittens BETs

45 Linking scientists and practitioners CAT BANKS

46 Overview EBPP within the broader context: 2 components Resources/Techniques For finding the evidence (what, where, how) For having the evidence find you (alerts) For linking clinicians and researchers (CATs) Future

47 Opportunities and Challenges, Risks and Benefits EBP new Does practicing EBP change health outcomes? Choosing / Adapting resources PsycINFO Teaching ourselves Contributing to the literature Collaborating with other health professions EBP and training scientist-practitioners Programmatic translational research Tashiro and Mortensen, American Psychologist, December 2006.