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Evidence Based Practice for Psychiatry

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Evidence Based Practice for Psychiatry

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  1. Evidence Based Practice for Psychiatry Psychiatry Grand Rounds March 1, 2013 Rick Wallace, MA, MDiv, MAOM, MSLS, EdD Quillen College of Medicine Library

  2. Use of Information in the Clinic:The Literature

  3. Green et al. (2000) : … residents in their continuity clinics encounter new clinical questions- not including those answered by discussions with preceptors- at a rate of 2 questions for every 3 patients …. The residents pursued only 29% of their questions(p. 220).

  4. Green and Ruff (2005): Physicians leave the majority of their clinical questions unanswered, witness their medical knowledge deteriorate after their training, and demonstrate wide practice variations for clinical maneuvers with established efficacy. (p. 176).

  5. Green and Ruff (2005): Physicians leave the majority of their clinical questions unanswered, witness their medical knowledge deteriorate after their training, and demonstrate wide practice variations for clinical maneuvers with established efficacy. (p. 176).

  6. Lucas, et al (2004) Attending physicians changed treatment for 18% of patients as a result of literature searches NNS = 6

  7. Covell, Uman and Manning (1985) Four management decisions might have been altered if needed information had been available at the time of the patient visit

  8. Fineberg (1987) found … that only 2 of 28 landmark trials were implemented within two years following their publication (p. 333). This means that new discoveries in medicine are not being quickly translated into better treatment for patients.

  9. Ebell and Shaughnessy (2003): A study of 85 prominent clinically oriented medical research journals identified over 8,085 articles in a 6-month period. Even if a physician spent only 3 minutes per article, it would still take over 800 hours over the course of a year to keep up to date . A survey of Norwegian primary care physicians found that they spend less than 3 hours per week on all medical reading (p. S57).

  10. Sackett and Straus (1998) … “found that evidence made available within seconds during rounds altered the clinical approach of at least 1 team member 48% of the time , but when evidence was not readily available, the clinicians rarely searched for it” (p. 1338).

  11. Shin, Haynes and Johnston (1993) …found significant differences among how physicians treated patients with hypertension based on when they finished their training.

  12. Ross and Verdieck (2003). “ One credible goal of residency education should be to endow our residents with a practical working knowledge of EBM, so we can graduate competent, confident life-long learners who provide first-class patient care according to the best evidence available” (p. 412).

  13. Use of Information in the Clinic:Basic Principles

  14. The Usefulness Equation Slawson, Shaughnessy Usefulness = Relevance x Validity Work

  15. The 5S Pyramid From: http://guides.library.upenn.edu/content.php?pid=192036&sid=1610308

  16. EBM Steps Assess patient Ask question Acquire information Appraise information Apply to patient

  17. PICO- formulating an answerable clinical question P- Population or patient I- Intervention C- Comparative intervention O- Outcome

  18. Anatomy of the Medical Literature

  19. Use of Information in the Clinic:The Resources

  20. Acquiring Information:Primary Literature • Citation Databases • PubMed • MeSH • Limits • PsychInfo • Textbooks • Clinical Key • StatRef • EBSCO eBooks • Access Medicine/Access Pharmacy • R2 Library • Online and Print Journals • Proxy server

  21. Citation Databases PubMed 2. PsychInfo

  22. www.etsu.edu/medlib

  23. PubMed

  24. PsychInfo

  25. E- Books

  26. Clinical Key

  27. Also available for SmartPhone

  28. EBSCO eBooks