Transcript Novel tools, resources, and gadgets for evidence

Novel tools, resources, and
gadgets for evidence-based
practice
Barbara Walker
Indiana University
Bloomington, Indiana
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
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
2002
1999
2003
1997
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)
2005
2006
Two Components of EBP
The framework of EBM
Operationalization: 5 STEPS
1. Convert information needs into questions.
Best
research
available
2. Search for the best evidence in the literature.
3. Critically appraise the evidence.
CD
Patient
characteristics,
culture,
preferences
Clinical
Expertise
4. Integrate with a patient’s characteristics, culture
and preferences.
5. Evaluate the outcome.
120
Content Distribution of Books on EBP
100
EBP
Framework
EBP Skills
80
60
How to teach
EBP
40
20
0
EBM (Sackett
et.al)
EBN (Craig,
Smyth, et.al)
SW (Gibbs)
LIB
(McKibbon)
PSYCH
(Norcross,
Beutler,
Levant)
PSYCH
(Goodheart,
Kazdin,
Sternberg)
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
• 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.
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.
EBP Resources
• For finding the evidence
• For having the evidence find you
• For linking clinicians and researchers
Finding evidence
THIS SERIES COURTESY OF SUE LONDON
IUPUI LIBRARY
High Sensitivity
High Specificity
Types of EBP Questions
•
•
•
•
•
By Content
By Format
Diagnosis
Effectiveness
Etiology
Prognosis
Harm
• Background
• Foreground
COURTESY OF SUE LONDON
Ruth Lilly Medical Library
High Specificity
WHAT
WHERE
HOW
High Specificity
WHAT: Systematic review
WHERE: Specialized databases
HOW: Search strategies (controlled vocabulary)
SECONDARY
LITERATURE:
papers that synthesize
original studies
PRIMARY
LITERATURE
Traditional
reviews
SECONDARY
LITERATURE:
papers that synthesize
original studies
SYSTEMATIC
REVIEWS
PRIMARY
LITERATURE
Traditional
reviews
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
SECONDARY
LITERATURE:
papers that synthesize
original studies
SYSTEMATIC
REVIEWS
PRIMARY
LITERATURE
METAANALYSES
Traditional
reviews
What about Medline and
PsycINFO?
Medical / Health Databases
PSYCINFO
MEDLINE
Adapted from Shahram Yazdani, 2002
EMBASE
PSYCINFO
Cochrane / others
MEDLINE
Cochrane and
other EBM
databases are not
linked to
PsycINFO
Overlap between
Medline and
Embase =30-70%
Adapted from Shahram Yazdani, 2002
Clinicians need to “…know when
their uncertainty stems from gaps
in the evidence rather than gaps
their own knowledge.”
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)
• What: systematic review, other syntheses
• Where: Cochrane, other specialized
databases, EB on-line text books
• How
– Controlled vocabulary
– SUMSEARCH
Controlled Vocabulary
Librarians “tag” each article with labels
based on the concepts in the article.
These labels are standardized.
• Medline: MeSH terms
• PsycINFO: Thesaurus
• Finding the evidence
• The evidence can find you: Alerts
“To have more evidence-based practice, we
need more practice-based evidence.”
CATs
•
•
•
•
•
•
Critically appraised topics: SHORT
Cat Maker
Cat Banks
Cat Crawler
Kittens
BETs
Linking scientists and practitioners
CAT BANKS
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
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.