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

1. Novel tools, resources, and gadgets for evidence-based practiceBarbara WalkerIndiana UniversityBloomington, 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

4. 1999 2002 2003 1997

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)

6. 2005 2006

7. Best research available CD Clinical Expertise Patient characteristics, culture, preferences The framework of EBM Two Components of EBP Operationalization: 5 STEPS • 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.

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 • Convert information needs into a clear question. • Search for the best evidence in the literature. • Critically appraise the evidence. • Integrate with a patient’s needs, preferences, circumstances, and values. • 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. Diagnosis Effectiveness Etiology Prognosis Harm Background Foreground Types of EBP Questions By Content By Format 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. Traditional reviews SECONDARY LITERATURE: papers that synthesize original studies PRIMARY LITERATURE

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

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

26. What about Medline and PsycINFO?

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

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

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

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.