Evidence-Based Practice: Beyond Empirically Supported Treatments.

Must the clinician choose between a practice that is strictly objective and data based and one that is purely subjective and experience based? Optimally, practitioners need to follow a model of evidence-based psychotherapy practice, such as the disciplined inquiry or local clinical scientist model, that encompasses a theoretical formulation, empirically supported treatments (ESTs), empirically supported therapy relationships, clinicians' accumulated practical experience, and their clinical judgment about the case at hand. Some shortcomings of ESTs are reviewed, and a form of evidence for psychotherapy practice is presented that entails the accumulation of systematic case studies published online. Practitioners can contribute to such a database and be guided in their practice by those cases most relevant to their clients' problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Forensics and Case Studies in Civil Engineering Education: State of the Art

This paper reviews the state of the art in the use of forensic engineering and failure case studies in civil engineering education. The study of engineering failures can offer students valuable insights into associated technical, ethical, and professional issues. Lessons learned from failures have substantially affected civil engineering practice. For the student, study of these cases can help place design and analysis procedures into historical context and reinforce the necessity of lifelong learning. Three approaches for bringing forensics and failure case studies into the civil engineering curriculum are discussed in this paper. These are stand-alone forensic engineering or failure case study courses, capstone design projects, and integration of case studies into the curriculum. Some of the cases have been developed and used in courses at the United States Military Academy and the Univ. of Alabama at Birmingham, as well as at other institutions. Finally, the writers have tried to assemble many of the known sources of material, including books, technical papers, and magazine articles, videos, Web sites, prepared PowerPoint presentations, and television programs.     

From clinical trials to professional training: A graduate course in evidence-based interventions for children, youth, and families.

In preparing students to become competent professional psychologists, graduate coursework must lay the foundation for the development of competence in the ethical delivery of evidence-based interventions. This paper describes a graduate course designed to introduce students to evidence-based treatments with children and youth. The course is designed to enhance critical thinking in translating research into practice as well as to develop core competencies in intervention planning, implementation, and evaluation. Activities to enhance interaction and to promote problem-based learning include student presentations of a workshop on an effective practice element, as well as a case assignment requiring treatment planning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing students' clinical performance

In this article the authors review the history of clinical assessment and describe the development and implementation of an evidence-based assessment strategy for clinical practice prepared for the Diploma in Nursing curriculum at Keele University.     

Pursuing an evidence-based culture through contextualized feedback: Aligning youth outcomes and practices.

How can contextualized feedback on therapy practices and youth outcomes promote an evidence-based culture for adolescent mental health? Relative to other quality improvement tools, feedback and progress monitoring systems are generally underutilized. This article describes a feedback system collaboratively developed by the Hawai'i Department of Health Child and Adolescent Mental Health Division and private agency staff contracted to provide mental health services to youth. Feedback reports allow providers to monitor progress of their youth clients, compare their progress with youth receiving similar services, examine the extent they are using practices derived from evidence-based protocols, and compare these practice profiles to what other youth are receiving. Providers gather to discuss reports, share success stories, and offer suggestions to improve practices and outcomes based on data from the reports. The provider feedback system in Hawai'i has emphasized youth outcomes and has promoted an “evidence-based culture.” This article encourages direct providers and supervisors to consider how such a system might fit in their current practice and whether contextualized feedback might be one way to enhance services and outcomes for youth with mental health needs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A motivational interviewing and common factors approach to change in working with alcohol use and abuse in college students.

The authors describe an approach for intervening with college students who present for self-referred or mandated treatment for alcohol or other drug issues. The authors offer a conceptual framework for working with such clients that is influenced by the evidence-based motivational interviewing literature and the evidence-based common factors approach to psychotherapy in general. Implications for practice are elaborated on and exemplified through a case study that includes motivational interviewing's guiding principles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The identification of bias in studies of the diagnostic performance of imaging modalities

The demand for evidence-based healthcare is increasing nationally and internationally and it is equally necessary in both diagnostic and therapeutic practice. Evidence may be collected and combined by means of a systematic literature review of published and unpublished data on a well-defined topic. The output of such reviews is then available to guide health policy, influence good practice or direct research. Published guidelines are available on the performance of systematic reviews, especially those of randomized controlled trials. Although there is an extensive literature base of research data in diagnostic imaging there are few such trials, but it is still possible to perform systematic reviews. With the alternative study designs encountered it is important to be aware of the main threats to study validity. In this paper the biases likely to be encountered in studies of diagnostic performance are reviewed, with particular reference to diagnostic imaging tests. The biases are sub-divided into three categories. The first category is patient selection and covers the validity of generalizing results beyond the study population. The other two, concerning study design and execution and the interpretation of results, affect the likely validity of the results of a study. An understanding of these factors is an essential prerequisite for those undertaking or using a systematic literature review in the field of diagnostic imaging. The definitions form the foundations of a defensible review protocol.     

Integrating Nursing Outcomes Classification in nursing education

The importance of standardized language to communicate the contribution of nursing to the health of patients is beginning to be recognized and embraced by the profession. As we move to make standardized language part of nursing practice, it is essential to reach nursing educators who prepare future generations of nurses for the practice realities of the next century. The Nursing Outcomes Classification (NOC) is a valuable tool in nursing education and needs to be integrated into the curriculum at all levels. The current emphasis on evidence-based practice demands that graduates have the skills and mechanisms to measure the outcomes of nursing care.     

Teaching evidence-based interventions: Perceptions of influences on use in professional practice in school psychology.

This study examined perceptions of school psychologists regarding their use of evidence-based interventions in school settings after completing a graduate course in school-based psychosocial interventions. Ninety-four individuals who completed the course during the 10 years prior to the study were asked to complete a survey that focused on personal and organizational factors affecting the implementation of evidence-based interventions through assessment of (a) the extent of their use of interventions in professional school psychology practice, (b) perceptions of facilitators to implementation, and (c) perceptions of barriers to implementation. Fifty-four responded (a 57% response rate); analyses were conducted on the responses of 34 individuals who indicated that they were currently school psychologists working in schools. Results indicated that school psychologists’ personal beliefs about the interventions influenced their decisions to implement them. Several evidence-based interventions were less likely to be used in urban practice settings. Training in evidence-based interventions should address the personal and contextual issues that are related to implementation, as well as the procedures of the interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family practice residency behavioral science training: influence on graduate practice activity

BACKGROUND AND OBJECTIVES: The educational efficacy of family practice residency behavioral science training and how various educational approaches might influence graduate practice activity are poorly understood. In this study, we compare a traditional didactic and clinical block rotation approach to a problem-based learning (PBL) and clinical, experiential behavioral science curriculum. METHODS: Surveys of pre- and post-intervention cohorts were used to assess graduates' perceptions of their understanding of broad behavioral science concepts, their competence to manage specific behavioral conditions, and their behavioral science practice activity. The two cohorts were University of California, Irvine family practice residency program graduates from 1984-1988 (58) and residency graduates from 1993-1995 (27). American Board of Family Practice (ABFP) In-service Training Examination scores were also compared. RESULTS: No significant differences were detected in self-perceived competence and ABFP examination performance. Residency graduates in the post-intervention cohort more often included depression, marital counseling, and eating disorders in their practice and reported more frequent practice activity for situational stress and sexual dysfunction. The post-intervention group reported less involvement with alcohol and substance abuse problems. This group also reported practice activity that exceeded perceived levels of competence for attention deficit disorder, learning disorders, and eating disorders. CONCLUSIONS: Participants in a PBL-clinical experiential curriculum reported higher levels of practice activity for several common behavioral problems. It seems unlikely that these differences were due to curriculum changes. Further investigation of the influence of educational and other factors on residency graduate practice activity is needed.     

Problem-based medical education: development of a theoretical foundation and a science-based professional attitude

Problem-based learning, combined with early patient contact, integration between different subject areas, elements of multiprofessional education, and special emphasis on the development of communications skills has become the basis for the medical curriculum at the Faculty of Health Sciences in Link?ping. Critics have questioned the depth of the scientific and theoretical aspects of the curriculum. Through a series of specific measures in the organization of the curriculum and examinations, and due to the pedagogical principles involved per se, our claim is that students graduating at Link?ping do possess the required theoretical knowledge and a scientific attitude to the practice of medicine, at least equivalent to that obtained in a more conventional medical curriculum. One such specific measure is that all students perform one field study and two scientific studies during the course of the curriculum. An investigation of student opinions regarding the value of performing scientific projects of their own have shown that these projects have had a positive impact on the students' general scientific attitude and their willingness to engage in future scientific work. The specific skills acquired, as confirmed by oral examinations, were largely determined by the scientific nature of the chosen field of study. Our graduates have not yet progressed far enough in their careers for comparisons to be made on the basis of the Swedish Licensing Board Internship Examinations, but continuing evaluations of students, graduates and licensed doctors emerging from the curriculum will provide future evidence as to whether our present evaluation is correct.     

Team resilience for young restaurant workers: Research-to-practice adaptation and assessment.

This paper describes a method for taking a known prevention intervention and modifying it to suit young restaurant workers. Such workers are at high risk for alcohol and other drug (AOD) abuse according to national surveys. While evidence-based programs for AOD prevention exist, they have not been delivered to restaurants. Accordingly, an adaptation methodology was developed by integrating curricula from a previous evidence-based program with research on resilience and input from stakeholders, such as young restaurant workers, their managers, trainers, and subject matter experts. A new curriculum (Team Resilience) maintained fidelity to the original program while incorporating stakeholder insights. At the end of each of three training sessions, participants (n = 124) rated their awareness of AOD risks, help-seeking orientation, and personal resilience. Ratings tended to increase across sessions, showing participants perceived benefits from Team Resilience. Discussion highlights the need for research-to-practice protocols in occupational health psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Survey of the National Civil Engineering Curriculum

This paper presents the results of a comprehensive survey of over 40% of the nation’s undergraduate civil engineering programs. This analysis is based on uniform data collected for accreditation and is principally concerned with three major groups of courses: (1) math and science, (2) general education, and (3) engineering topics. The analysis reveals what is currently being taught in our nation’s civil engineering undergraduate programs, what is not being taught, and the implications for future professional practice. The paper discusses how the average national curriculum has changed historically, how well the curriculum satisfies Accreditation Board for Engineering and Technology criteria, and what the current distribution of courses and topics says about the priorities of civil engineering education. Overall, the curriculum was found to be highly specialized in terms of technical subjects but lacking in focus regarding the liberal arts, professional skills, and systems thinking.     

Terrible when life appears to be meaningless...]

Evidence-based practice (nursing practice that relies on information generated from the results of scientific research) is widely recommended as the method of nursing practice of the future. This is particularly the method of choice in perioperative nursing. In this article the literature on evidence-based practice is reviewed with particular emphasis on the role of the perioperative nurse, research utilization, and barriers to evidence-based practice. Suggestions for change to promote evidence-based practice are also outlined.     

A curriculum based on systems theory

This paper describes an entry-level curriculum based on systems theory that was designed to promote integrated thinking and a shared image of practice among all of the members of an educational community that included students, faculty, and clinicians. Initiated in 1983, the program integrates occupational therapy theory, critical thinking, and knowledge about person-environmental transactions with traditional medical, biological, psychological, and sociological course work to create a unique educational experience. The curriculum model is based on a spiral learning process that encourages integrated thinking. Furthermore, all concepts are systematically tied to the occupation core, the central theme of the program. Fieldwork is used to reinforce ideas presented in the classroom and features discrete learning experiences where students demonstrate their integration of knowledge and skills. In an evaluation of the program, responses from 78 clinician, 51 alumni, and 132 student questionnaires; feedback from 132 fieldwork supervisors; and longitudinal data from 33 alumni confirmed that graduates are critical thinkers who appreciate the diverse needs of clients while demonstrating an appreciation for the curative effect of meaningful, goal-directed activities.     

The impact of evidence-based practice implementation and fidelity monitoring on staff turnover: Evidence for a protective effect.

Staff retention is an ongoing challenge in mental health and community-based service organizations. Little is known about the impact of evidence-based practice implementation on the mental health and social service workforce. The present study examined the effect of evidence-based practice implementation and ongoing fidelity monitoring on staff retention in a children's services system. The study took place in the context of a statewide, regionally randomized effectiveness trial of an evidence-based intervention designed to reduce child neglect. In the study 21 teams consisting of 153 home-based service providers were followed over a 29-month period. Survival analyses revealed greater staff retention in the condition where the evidence-based practice was implemented along with ongoing fidelity monitoring presented to staff as supportive consultation. These results should help to allay concerns about staff retention when implementing evidence-based practices where there is good values–innovation fit and when fidelity monitoring is designed as an aid and support to service providers in providing a high standard of care for children and families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Case for Undergraduate Study of Disasters

Literature on disasters provides the focus for student-based learning exercises in civil and architectural engineering at Queen's University, Belfast, which have been ongoing since 1994. Incorporating these studies in the early part of the curriculum helps students to reorientate from their previous mainly science-based study by gaining some knowledge of the roles, responsibilities, priorities, and work practices of engineers in a way that would not be possible through lectures. In view of the influence of disasters on engineering thinking and work practice, they should have a much larger influence than they currently do on curriculum development.     

Vulvar squamous cell hyperplasia and lichen sclerosus et atrophicus: clinical picture, morphology and treatment

The term evidence-based practice is becoming increasingly common within the health care sector. This is not only because of a search for quality, but also because of economic factors which demand more effective use of resources. This article will present some of the arguments which both support and oppose evidence-based practice. These arguments may at times appear to be contradictory in nature. The implications of evidence-based practice, for both patients and health care workers, is considered.     

Writing a scientific paper as part of the medical curriculum

The curriculum at the Medical School, University of Troms? reserves 23 weeks for optional studies, including a period of 12 weeks at the end of the fifth year when the students carry out an independent study and write a short thesis. Of the first 417 doctors (graduation year 1979-89) from Troms? 84.6% answered a postal questionnaire asking them to evaluate this part of the curriculum. These postgraduates report high levels of satisfaction with and benefit from this part of the curriculum. A total of 26.8% started working on their thesis before the final 12-week period, 32.6% had also published their study, half of these in international journals, and 75.6% found that the skills acquired during the final optional period had been useful in their subsequent work, irrespective of specialty. In conclusion, postgraduates consider their work in preparing a scientific paper as an important and integral part of medical studies.