Introducing the new Health Psychology series "Evidence-based treatment reviews": Progress not perfection.

Introduces the new Health Psychology series "Evidence-Based Treatment Reviews." Psychologists struggle continuously with the tension between the general implications of research conducted in their treatment area and the often unique needs and treatment possibilities for their individual patients. Recent concerns about this struggle in psychology have led to the initiation of an American Psychological Association presidential taskforce to propose an evidence-based policy: Evidence-Based Psychology Practice (EBPP). This struggle is not new. Medicine, similarly, has been dealing with the issue of how to translate research findings into evidence-based assessments and treatments. The process of joining our research with our practice, known as Evidence-Based Medicine, will be the cornerstone of a new series of articles in Health Psychology, entitled "Evidence-Based Treatment Reviews." Evidence-Based Behavioral Medicine is an extension of the Evidence-Based Medicine movement that identified the necessity of critically evaluating research to inform clinical practice (Rosenberg & Donald, 1995). In addition to mentoring researchers in presenting their findings in a more user-friendly style (e.g., Consolidated Standards of Reporting Trials, or CONSORT, guidelines; Altman, Schulz, Moher, Egger, Davidoff, Elbourne, et al., 2001), teaching clinicians how to review the evidence (e.g., Evidence Based Medicine Tool Kit), and compiling and summarizing the existing evidence for public consumption (e.g., the Cochrane Collaboration), it makes sense to integrate these efforts by presenting research reviews with clinician commentary in our professional journals as has already been done by the Journal of the American Medical Association (JAMA, e.g., DeAngelis & Fontanarosa, 2002; Levinson & DeAngelis, 2002). We seek to add to the health psychology evidence base by including two articles for each topic chosen: an Evidence Review and a Clinician's Comment. For this series, we envision that three or four evidence-based reviews will be published per year in Health Psychology and that each review will be accompanied by a three- or four-page commentary by a clinician to aid in the application of the research to a clinical practice. In this format, we hope to capture both the state of the clinical science and the challenging art of translating it into clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The periodic health examination: a useless test?

A critical analysis of the theoretical concepts applying to mass screening (Frames' criteria) in relation with the "Evidence-Based Medicine" methodology leads to rule out the basic blood test from the periodic health examination. A good questioning with a good clinical examination will select high risk populations for specific health problems for which some oriented tests can be performed with an acceptable positive predictive value.     

Differences between evidence based-medicine and best conventional medicine

The practical application of rational concepts will be possible in the health care system if two conditions will be met. The legal framework has to fit these goals and new strategies are to establish. The new strategies will be needed to identify from the huge amount of data "evidence" which will support the medical progress. Evidence-Based Medicine (EBM) offers these strategies. Modifications of our conventional procedures are necessary to establish EBM: the conditions of clinical actions, the definitions of goals of medical training, the rational of clinical decisions and the continued medical education.     

Critical assessment of articles on controlled clinical trials. I. Planning

This paper reviews Cochrane Collaboration and its structure. The authors explain the concepts of systematic review and meta-analysis. Some insights are provided on how products of the Cochrane Collaboration, namely the Cochrane Library, can contribute to the practice of Evidence-Based Medicine.     

How to read a scientific article

Medical literature is too prolific and user's guides are necessary to extract useful information for optimal treatment of our patients. The goal of this paper is to help doctors find relevant articles and to read them efficiently for applying the results to their patients. An excerpt has been written concerning the subject by the Mac Master team and the members of the Cochrane Collaboration in the JAMA, the BMJ and on the Internet: a web site is now devoted to user's guides to medical literature. Simple rules facilitating access to relevant papers and interpretation of the results have been given. They have been applied to oncology, especially to papers concerning effectiveness of therapeutic interventions. It is essential that doctors use simple rules and learn how to select relevant articles and understand and use them to treat their patients according to Evidence-Based Medicine Group.     

That was the year that was: an evidence-based clinical geriatrics update

BACKGROUND: Physicians are faced with an ever-growing information base in medical practice. Studies regularly show a disparity between science and patient care, with scientifically validated practices often taking 20 years and more to enter mainstream clinical practice. OBJECTIVES: To review the recent medical literature for high quality studies that practicing geriatricians should be aware of, either because they provide evidence that might lead to a change in clinical practice or because they provide insight into common geriatric syndromes. DESIGN: Overview. DATA SOURCES: All articles abstracted or noted in ACP Journal Club, Evidence-Based Medicine, or The New York Times from July 1996 to June 1997. STUDY SELECTION: Studies that met the standards for inclusion in ACP Journal Club. STUDY DESIGN: Sampling plan (including eligibility criteria), sample size, response rate, data analysis plan, proportion available for follow-up, main outcomes and measures, main results. RESULTS: Review of the 98 articles that met criteria resulted in the identification of several themes of importance to geriatricians, including the hazards of hospitalization, the prevention of NSAID-induced peptic ulcers, and the treatment and prevention of Alzheimer's disease. The results of these studies expand the therapeutic armamentarium of practicing geriatricians, provide new insights into geriatric syndromes, and raise cautions about the use of certain therapies in older adults. CONCLUSIONS: Many methodologically rigorous studies relevant to the medical care of older people have recently been published. Evidence-based medicine and the use of journals of secondary publication are useful tools to enhance the efficiency of journal reading for geriatric practitioners whose interests span the journals of several disciplines and subspecialties.     

Evidence-based medicine. 2. Research of clinically relevant biomedical information. Gruppo Italiano per la Medicina Basata sulle Evidenze--GIMBE

Evidence-based Medicine is a product of the electronic information age and there are several databases useful for practice it--MEDLINE, EMBASE, specialized compendiums of evidence (Cochrane Library, Best Evidence), practice guidelines--most of them free available through Internet, that offers a growing number of health resources. Because searching best evidence is a basic step to practice Evidence-based Medicine, this second review (the first one has been published in the issue of March 1998) has the aim to provide physicians tools and skills for retrieving relevant biomedical information. Therefore, we discuss about strategies for managing information overload, analyze characteristics, usefulness and limits of medical databases and explain how to use MEDLINE in day-to-day clinical practice.     

Meeting information needs in health policy and public health: priorities for the National Library of Medicine and The National Network of Libraries of Medicine

Those seeking information in health policy and public health are not as well served as those seeking clinical information. Problems inhibiting access to health policy and public health information include the heterogeneity of professionals seeking the information, the distribution of relevant information across disciplines and information sources, scarcity of synthesized information useful to practitioners, lack of awareness of available services or training in their use, and lack of access to information technology or to knowledgeable librarians and information specialists. Since 1990, the National Library of Medicine and the National Network of Libraries of Medicine have been working to enhance information services in health policy and public health through expanding the coverage of the NLM collection, building new databases, and engaging in targeted outreach and training initiatives directed toward segments of the health policy and public health communities. Progress has been made, but more remains to be done. Recommendations arising from the meeting, Accessing Useful Information: Challenges in Health Policy and Public Health, will help NLM and the National Network of Libraries of Medicine to establish priorities and action plans for the next several years.     

Expert statement and assessment of medical impairment in work-related pulmonary disease

The Norwegian Societies of Thoracic Medicine and Occupational Medicine established a working group to standardise diagnostic procedures and evaluation of work-related respiratory disorders. In cases of suspected work-related diseases the physician may be asked by the National Insurance Administration or an insurance company to make a statement which will be one of the documents used to decide the patient's right to compensation benefit. We discuss the role of the physician as an independent expert. This is different from his role as clinician. The statement should include a balanced presentation of information from different sources, including health and occupational history, and the employer's information about the work environment (quantitative and qualitative exposure data). The statement must also include the results of a clinical examination and an assessment of functional status based on objective tests. The paper contains recommendations for evaluation of permanent impairment in light of the present Norwegian laws and regulations.     

Evidence-based practice in psychology.

This article focuses on the 2005 American Psychological Association Presidential Task Force on Evidence-Based Practice in Psychology. After describing the rationale and results of this task force, the authors review the literature that has appeared following the approval of the Policy Statement on Evidence-Based Practice in Psychology by the American Psychological Association Council of Representatives, with reference to the implications for practitioners. Finally, the authors discuss the implications of the Policy Statement on Evidence-Based Practice in Psychology for graduate students and early career professionals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based medicine

This paper presents the origins and the concepts in which the paradigm of a new line of clinical reasoning "Evidence Based Medicine", is based. We describe its basic components such as: problem-oriented clinical policy formulation; information retrieval distillation and synthesis of the medical literature; critical appraisal of the evidence and clinical application. Additionally, we describe them already well established, for promoting and Evidence Based Clinical Practice. We particularly focus on the so called "Cochrane Collaboration", an international initiative whose mission is to prepare, maintain and disseminate systematic and updated reviews of the effects of health care.     

Introduction to the special section on evidence-based psychological treatments for older adults.

Psychology has a strong tradition as a science-based discipline. This tradition has also been strong in the subfields of geropsychology and clinical psychology. The convergence of these traditions leads to an expectation that mental health and aging practices will be theoretically sound and empirically tested. This Psychology and Aging Special Section on Evidence-Based Psychological Treatments for Older Adults presents findings which demonstrate that there are a number of evidence-based treatments that can contribute to exemplary care of older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based parent and family interventions in school psychology: Overview and procedures.

This special issue, entitled "Evidence-Based Parent and Family Interventions in School Psychology," examines the data that support the use of interventions as methods for changing children's school-related behavior and learning problems. Taken together, the articles reflect the work of the Parent and Family Intervention domain of the Evidence-Based Interventions in School Psychology Task Force. Across the articles in this special issue, the categories of coding criteria in the Manual were used to organize the presentation of results. Six review articles on the evidence base for parent and family intervention appear next; these are followed by commentary from distinguished scholars and a brief reflective comment from the special issue editors. Parent intervention is the exclusive focus of the reviews of parent education and parent consultation. Two reviews focus on the home-school relationship including the articles on parent involvement and home-school collaboration. Two reviews include both parent and family treatments: early childhood family-focused interventions and parent training and family systems interventions. Commentary was sought from the current co-chairs of the Task Force, an expert in evidence-based practice in child clinical psychology, a researcher in family-school linkages and parent consultation, and a methodologist. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Evidence-based interventions in school psychology: An illustration of Task Force coding criteria using single-participant research design.

Illustrates the application of the Task Force on Evidence-Based Interventions in School Psychology coding criteria using a single-participant research design study. Specifically, the authors review and evaluate a study by M. L. Kelley and A. P. McCain (1995) according to the Procedural and Coding Manual for Review of Evidence-Based Interventions (T. R. Kratochwill and K. C. Stoiber, this issue; see record 2003-01789-005). Following application of the Procedural and Coding Manual to the Kelley and McCain study, the authors conclude that this study possessed several important strengths, including a strong research design, identifiable intervention components, and strong intervention effects for several participants. Limitations to the study, in addition to issues regarding the evaluation of the single-participant investigation are discussed within the context of the coding criteria. Challenges in coding single-participant studies are presented in the context of future work for the Task Force on Evidence-Based Interventions in School Psychology. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Using modern information technology to profile faculty activities

Most academic medical centers (AMCs) have developed mechanisms for tracking the financing of their faculty members' research and clinical activities. However, information systems for managing and reporting financial data often do not provide fully accurate or complete pictures of the accomplishments of an institution or its faculty. Modern information technology can help AMCs integrate more extensive information about their faculties from many different sources; in particular, Web publishing technologies permit large numbers of users to have easy secure access to databases across different platforms. The authors briefly describe five faculty information systems now in use. They then describe in detail the development and implementation of one of these systems, The Johns Hopkins University School of Medicine Faculty Information System (FIS), which uses Web publishing technologies, collecting and making available information about the clinical, teaching, and research activities of faculty members.     

Legal issues surrounding privately funded research cause furore in Toronto

Toronto physician Miriam Shuchman has spent the last 4 months tracking the research issues surrounding a controversial clinical trial conducted in Toronto. Much of the information appearing in this article was gathered while she was preparing a segment for the CBC Radio program Quirks and Quarks. Earlier, she had reported on similar issues in the US for the Annals of Internal Medicine.     

Evaluation of student performance in a multi-site clinical clerkship

A method for examining the equivalency of student performance in multi-site clinical clerkships is presented. Six student performance variables within the clerkship are explored: pretest, posttest, oral examination, presentation of a subject review, general clinical performance, and patient write-ups. Student achievement on two external examinations (a University of Washington School of Medicine third-year comprehensive examination and the Part II examination of the National Board of Medical Examiners) is reviewed and compared. This method applied to an obstetrics and gynecology clerkship at the University of Washington reveals no significant differences in student performance among sites on the pretest, oral examination, and both external examinations, but there were differences on four internal measures (posttest, presentations, write-ups, and clinical ratings). The use of this information for clerkship improvement and faculty development is described.     

Validation of computer-mediated open-ended standardized patient assessments

Quantitative information regarding the development of students' clinical reasoning skills is valuable in assessing third- and fourth-year medical students' clinical knowledge. Standardized patient cases are often used to obtain this quantified information. These cases typically involve a post-patient examination consisting of a series of closed-ended multiple-choice questions. Many medical educators question whether the results from the closed-ended multiple-choice questions truly reflect students' clinical knowledge and reasoning proficiency. Since 1995, the Kirksville College of Osteopathic Medicine (KCOM) has used a computer program, SOAP Note Plus, for standardized patient assessment of students to automate the post-encounter documentation and evaluation. This paper describes the development of the SOAP Note Plus program and a validation study which was conducted to determine the empirical association between the computer-mediated closed-ended and open-ended post-encounter standardized patient assessments. Correlation and GENOVA statistics were used in the analysis of the performance of third-year medical students on the closed-ended and the open-ended assessments following standardized patient encounters and the relationship to their undergraduate GPA, first 2-year medical school GPA and the actual clinical rotation evaluations. The initial results show the positive relationship between the open-ended assessment and the actual clinical rotation evaluations. undergraduate GPA and the first two-years of medical school GPA.     

Seroprevalence of antibodies to Bartonella henselae in patients with cat scratch disease and in healthy controls: evaluation and comparison of two commercial serological tests

As the National Library of Medicine expands access to its products and services by making them available on the Internet, more accurate information about current and future access in medical libraries is needed. The National Network Office of the National Library of Medicine conducted a survey of all network member libraries to determine the extent of connectivity and the barriers preventing 100% connectivity. Respondents called a toll-free number and, using interactive voice technology, answered questions concerning Internet access in their library. Seventy-eight percent of the network member libraries responded. Four percent of academic libraries, 27% of hospital libraries, and 10% of "other" libraries reported that they were not connected. Computer cost, lack of in-house expertise, and lack of management support were the highest ranked barriers to connecting. The National Library of Medicine and the Regional Medical Libraries will use information from this survey to develop strategies to help all member libraries achieve full connectivity.     

Reestablishing clinical psychology's subjective core.

Comments on the report by the APA Presidential Task Force on Evidence-Based Practice (see record 2006-05893-001) entitled Evidence-based practice in psychology. The Task Force is to be commended for their report valuing evidence from "clinical expertise" on a par with "research data" (p. 272) in guiding psychological practices. The current author suggests that the APA not only should make a place at psychology's policymaking table for "clinical expertise" but should prioritize clinical and subjective sources of data--the essence of the psychological--and set policies to ensure that objective data, such as behaviors and DSM diagnoses, are considered in their subjective context. The APA should also encourage researchers to devise ways to preserve as much as possible the personal "feel" of the clinical encounter in their data analysis and published conclusions. The APA also needs to assign priority to subjective emotional and relational skills on a par with academic and analytic skills in the selection and training of clinical psychology students. Reconnecting clinical psychology with its subjective evidentiary roots in ways such as these should help to bring us out from under the dominance of medicine, to the benefit of our profession and our clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)