Novel tools, resources, and gadgets for evidence-based

practice

Barbara WalkerIndiana 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 context2 components

Resources/Techniques…For finding the evidenceFor having the evidence find youFor linking clinicians and researchers

The future

2002

2003

1999

1997

Best research available

Patient characteristics, culture and preferences

Clinical Expertise

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)

CD

Psychology introduces EBPP

2005 2006

The framework of EBM

Best research available

Patient characteristics, culture, preferences

Clinical Expertise

CD

1. Convert information needs into questions.

2. Search for the best evidence in the literature. 3. Critically appraise the evidence.

4. Integrate with a patient’s characteristics, culture and preferences.

5. Evaluate the outcome.

Operationalization: 5 STEPS

Two Components of EBP

Content Distribution of Books on EBP

0

20

40

60

80

100

120

EBM (Sackettet.al)

EBN (Craig,Smyth, et.al)

SW (Gibbs) LIB(McKibbon)

PSYCH(Norcross,

Beutler,Levant)

PSYCH(Goodheart,

Kazdin,Sternberg)

EBPFrameworkEBP Skills

How to teachEBP

ON-LINE EBP TUTORIAL SITES

SEARCH TERM = “evidence based….tutorial”August 31, 2006

“evidence based medicine tutorial”(603)

“evidence based nursing tutorial” (26)

“evidence based social work tutorial” (4)

“evidence based psychology tutorial” (0)

“evidence based practice in psychology tutorial” (0)

• 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

• Diagnosis• Effectiveness• Etiology• Prognosis• Harm

• Background

• Foreground

By ContentBy Content By FormatBy Format

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)

PRIMARY LITERATURE

SECONDARY LITERATURE: papers that synthesize original studies

Traditional reviews

PRIMARY LITERATURE

SECONDARY LITERATURE: papers that synthesize original studies

SYSTEMATIC REVIEWS

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

PRIMARY LITERATURE

SECONDARY LITERATURE: papers that synthesize original studies

SYSTEMATIC REVIEWS

META-ANALYSES

Traditional reviews

What about Medline and PsycINFO?

Medical / Health Databases

MEDLINE

PSYCINFO

Adapted from Shahram Yazdani, 2002

EMBASE

MEDLINE

PSYCINFO

Adapted from Shahram Yazdani, 2002

Cochrane / others

Cochrane and other EBM databases are not linked to PsycINFO

Overlap between Medline and Embase =30-70%

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

Postnatal depressionQUESTIONS 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 beneficialSelective serotonin reuptake inhibitor antidepressants (fluoxetine and paroxetine)Unknown effectivenessAntidepressants other than fluoxetine and paroxetineHormones

NON-DRUG TREATMENTS Likely to be beneficialCognitive behavioural therapy (individual)Interpersonal psychotherapyNon-directive counsellingPsychodynamic therapyUnknown effectivenessCognitive behavioural therapy (group)Light therapyMother–infant interaction coachingPsychoeducation with partnerTelephone 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.