The evidence-based practice of psychotherapy: Facing the challenges that lie ahead

What does the future hold for psychotherapy research and practice? We review some key influences, including declining psychotherapy utilization, increasing impact of evidence-based medical practices, over-medicalizing of mental health problems, and changing priorities from grant funding agencies. These factors hold potential opportunities but also major pitfalls that will need to be carefully navigated related to implementation/dissemination issues, interdisciplinary collaborations, and psychosocial versus biomedical perspectives related to the nature and treatment of psychopathology. In addition, we review and comment on the other articles contained in this special issue pertaining to the future of evidence-based psychotherapy.     

Integrating Interventions and Services Research: Progress and Prospects

Although interventions and services research paradigms have distinct historical roots and methodologic traditions, both aim to improve mental health services for adults and youth. This article introduces a series of articles that represent examples of innovative and integrative (i.e., integration of services and interventions research) research efforts. This work involves an integration of the interventions and services research paradigms to address the difficult questions related to improving mental health services in diverse settings. Each of the four articles takes a distinctly different path in bringing together the interventions and services research traditions, with foci ranging from (a) using psychotherapy measurement tools to assess the content of usual care practice in collaboration with providers, (b) adapting randomized clinical trial design to fit nonmental healthcare settings while addressing relevant outcomes, (c) understanding and incorporating patient preferences into treatment research, and (d) identifying organization-level variables relevant to interventions development and implementation. In the introductory article, we provide a brief précis concerning the interventions and services research traditions, highlight how each of the four articles illustrates an innovative integration of interventions and services research, and discuss additional future directions beyond the work introduced in this series.     

Qualitative Inquiry in Athletic Training: Principles,Possibilities, and Promises

OBJECTIVE: To discuss the principles of qualitative research and provide insights into how such methods can benefit the profession of athletic training. BACKGROUND: The growth of a profession is influenced by the type of research performed by its members. Although qualitative research methods can serve to answer many clinical and professional questions that help athletic trainers navigate their socioprofessional contexts, an informal review of the Journal of Athletic Training reveals a paucity of such methods. DESCRIPTION: We provide an overview of the characteristics of qualitative research and common data collection and analysis techniques. Practical examples related to athletic training are also offered. APPLICATIONS: Athletic trainers interact with other professionals, patients, athletes, and administrators and function in a larger society. Consequently, they are likely to face critical influences and phenomena that affect the meaning they give to their experiences. Qualitative research facilitates a depth of understanding related to our contexts that traditional research may not provide. Furthermore, qualitative research complements traditional ways of thinking about research itself and promotes a greater understanding related to specific phenomena. As the profession of athletic training continues to grow, qualitative research methods will assume a more prominent role. Thus, it will be necessary for consumers of athletic training research to understand the functional aspects of the qualitative paradigm.     

Quantitative morphology of the nervous system: expanding horizons.

In this review, we show how some of the recent developments in quantitative morphology (QM) are creating exciting new opportunities for studying the structure of the nervous system. We begin with a brief overview of QM, focusing on the problems neurobiologists are likely to encounter when collecting and interpreting data from tissue sections. Many of these problems, which range from selecting a sampling method to learning the latest methods, are being solved by creating a new generation of research tools. We describe several of these new tools and show how they can be used to assemble new quantitative methods for in situ hybridization, immunocytochemistry, and camera lucida drawings. The review includes examples of how QM is being used to study the brain and concludes with a brief discussion of diagnostic pathology and its need for new quantitative approaches.     

Approaches to assessing the provider experience with clinical pharmacogenomic information: a scoping review

PurposeBarriers to the implementation of pharmacogenomics in clinical practice have been thoroughly discussed over the past decade.MethodsThe objective of this scoping review was to characterize the peer-reviewed literature surrounding the experiences and actions of prescribers, pharmacists, or genetic counselors when using pharmacogenomic information in real-world or hypothetical research settings.ResultsA total of 33 studies were included in the scoping review. The majority of studies were conducted in the United States (70%), used quantitative or mixed methods (79%) with physician or pharmacist respondents (100%). The qualitative content analysis revealed five major methodological approaches: hypothetical clinical case scenarios, real-world studies evaluating prescriber response to recommendations or alerts, cross-sectional quantitative surveys, cross-sectional qualitative surveys/interviews, and a quasi-experimental real-world study.ConclusionThe findings of this scoping review can guide further research on the factors needed to successfully integrate pharmacogenomics into clinical care.     

Guidelines for Reporting and Using Prediction Tools for Genetic Variation Analysis

Computational prediction methods are widely used for the analysis of human genome sequence variants and their effects on gene/protein function, splice site aberration, pathogenicity, and disease risk. New methods are frequently developed. We believe that guidelines are essential for those writing articles about new prediction methods, as well as for those applying these tools in their research, so that the necessary details are reported. This will enable readers to gain the full picture of technical information, performance, and interpretation of results, and to facilitate comparisons of related methods. Here, we provide instructions on how to describe new methods, report datasets, and assess the performance of predictive tools. We also discuss what details of predictor implementation are essential for authors to understand. Similarly, these guidelines for the use of predictors provide instructions on what needs to be delineated in the text, as well as how researchers can avoid unwarranted conclusions. They are applicable to most prediction methods currently utilized. By applying these guidelines, authors will help reviewers, editors, and readers to more fully comprehend prediction methods and their use.     

A qualitative study of physicians' engagement in reducing healthcare disparities

Despite calls for physician engagement to reduce disparities, little is known about what drives physicians to become engaged or what engaged physicians are doing. We conducted in-depth interviews with a group of highly engaged physicians and used qualitative methods to identify how these physicians became interested in alleviating healthcare disparities and what strategies they use to improve care for their minority patients. We found that most participants have experienced being a minority, though only half were racial minorities, and many related extensive childhood experiences with minorities. Participants identified several key barriers to quality care for minorities, including language barriers, resource limitations, lack of patient education and low patient empowerment. When asked how physicians can reduce health disparities, most subjects emphasized interpersonal respect, though some promising non-interpersonal approaches to reducing disparities were also identified. These interviews document the lived experiences of a group of physicians who are highly engaged in reducing disparities and suggest that connecting with experiences as a minority and other early life experiences can prompt later professional engagement in this important issue.     

Theory and concepts of prevention science as applied to clinical psychology.

This article provides an overview for this special issue on prevention science in clinical psychology. A brief historical perspective on prevention in clinical psychology is presented. An even greater emphasis on prevention in the future is related to changes in the current health-care system and their likely impact on psychological practice as we move into the next century. Conceptual and theoretical models of the prevention enterprise are addressed with a distinction drawn between health promotion and disease prevention in the areas of mental disorders and general physical health. The classification of preventive interventions is discussed and methodological challenges to outcomes research are outlined. The article concludes with a discussion of training and public policy implications and a brief overview of the other articles included in this special issue on prevention science.     

Gene-targeted therapies: Overview and implications

Gene-targeted therapies (GTTs) are therapeutic platforms that are in principle applicable to large numbers of monogenic diseases. The rapid development and implementation of GTTs have profound implications for rare monogenic disease therapy development. This article provides a brief summary of the primary types of GTTs and a brief overview of the current state of the science. It also serves as a primer for the articles in this special issue.     

Molecular epidemiology of viral infections. How sequence information helps us understand the evolution and dissemination of viruses

Viruses evolve much faster than cellular organisms. Together with recent advances in nucleic acid sequencing and biocomputing, this allows us to distinguish between related strains of viruses, and to deduce the relationships between viruses from different outbreaks or individual patients. Databases of nucleotide sequences contain a large number of viral sequences with which novel sequences from local outbreaks can be compared. In this way the dissemination of viruses can be followed both locally and globally. We here review the biological and technological background to the use of virus nucleic acid sequences in epidemiological studies, and provide examples of how this information can be used to monitor human viruses. Molecular studies are particularly valuable for understanding the dissemination and evolution of viruses. The knowledge obtained is useful in epidemiological reconstructions, in real-time surveillance, and may even enable us to make predictions about the future developments of viral diseases.     

Impact of clinical information-retrieval technology on physicians: a literature review of quantitative, qualitative and mixed methods studies

PURPOSE: This paper appraises empirical studies examining the impact of clinical information-retrieval technology on physicians and medical students. METHODS: The world literature was reviewed up to February 2004. Two reviewers independently identified studies by scrutinising 3368 and 3249 references from bibliographic databases. Additional studies were retrieved by hand searches, and by searching ISI Web of Science for citations of articles. Six hundred and five paper-based articles were assessed for relevance. Of those, 40 (6.6%) were independently appraised by two reviewers for relevance and methodological quality. These articles were quantitative, qualitative or of mixed methods, and 26 (4.3%) were retained for further analysis. For each retained article, two teams used content analysis to review extracted textual material (quantitative results and qualitative findings). RESULTS: Observational studies suggest that nearly one-third of searches using information-retrieval technology may have a positive impact on physicians. Two experimental and three laboratory studies do not reach consensus in support of a greater impact of this technology compared with other sources of information, notably printed educational material. Clinical information-retrieval technology may affect physicians, and further research is needed to examine its impact in everyday practice.     

Examining the role of collaboration in studies of health information technologies in biomedical informatics: A systematic review of 25 years of research

PurposeOur objective was to identify and examine studies of collaboration in relation to the use of health information technologies (HIT) in the biomedical informatics field.MethodsWe conducted a systematic literature review of articles through PubMed searches as well as reviewing a variety of individual journals and proceedings. Our search period was from 1990–2015. We identified 98 articles that met our inclusion criteria. We excluded articles that were not published in English, did not deal with technology, and did not focus primarily on individuals collaborating.ResultsWe categorized the studies by technology type, user groups, study location, methodology, processes related to collaboration, and desired outcomes. We identified three major processes: workflow, communication, and information exchange and two outcomes: maintaining awareness and establishing common ground. Researchers most frequently studied collaboration within hospitals using qualitative methods.DiscussionBased on our findings, we present the “collaboration space model”, which is a model to help researchers study collaboration and technology in healthcare. We also discuss issues related to collaboration and future research directions.ConclusionWhile collaboration is being increasingly recognized in the biomedical informatics community as essential to healthcare delivery, collaboration is often implicitly discussed or intertwined with other similar concepts. In order to evaluate how HIT affects collaboration and how we can build HIT to effectively support collaboration, we need more studies that explicitly focus on collaborative issues.     

Community-based Youth Participatory Action Research studies with a focus on youth health and well-being: A systematic review

On the basis of the systematic literature review, we investigate the characteristics of community-based Youth Participatory Action Research (YPAR) programs with a focus on health and well-being and their recommendations for future programs. The study was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram. Most included a case study design, mixed or qualitative methodology, interview as data collection, and YPAR youth in data reporting. The sample differs between studies, and most of the work took place in the United States. The stages (raise awareness, capacitation, design, motivation, implementation, evaluation, dissemination, and replication) are evident as a fundamental strategy in these programs.     

Pre-exposure Prophylaxis State of the Science: Empirical Analogies for Research and Implementation

Pre-exposure prophylaxis (PrEP) has the potential to become a powerful biomedical approach to HIV prevention; however, its success depends on behavioral and social factors that may determine its appropriate use. This article is designed to facilitate interdisciplinary empirical analogies relevant to PrEP implementation, reviewing behavioral and social science findings that may provide lessons critical to the success of PrEP as a biomedical–behavioral prevention strategy. As we prepare for the dissemination of new biomedical approaches to HIV prevention, integrating the state of the science across disciplines may result in innovative strategies for implementation that can enhance their success.     

How qualitative methods contribute to understanding combination antiretroviral therapy adherence

Strict adherence to medication regimens is generally required to obtain optimal response to combination antiretroviral therapy (ART). Yet, we have made limited progress in developing strategies to decrease the prevalence of nonadherence. As we work to understand adherence in developed countries, the introduction of ART in resource-poor settings raises novel challenges. Qualitative research is a scientific approach that uses methods such as observation, interviews, and verbal interactions to gather rich in-depth information about how something is experienced. It seeks to understand the beliefs, values, and processes underlying behavioral patterns. Qualitative methods provide powerful tools for understanding adherence. Culture-specific influences, medication beliefs, access, stigma, reasons for nonadherence, patterns of medication taking, and intervention fidelity and measurement development are areas ripe for qualitative inquiry. A disregard for the social and cultural context of adherence or the imposition of adherence models inconsistent with local values and practices is likely to produce irrelevant or ineffective interventions. Qualitative methods remain underused in adherence research. We review appropriate qualitative methods for and provide an overview of the qualitative research on ART nonadherence. We discuss the rationales for using qualitative methods, present 2 case examples illustrating their use, and discuss possible institutional barriers to their acceptance.     

Reflections on Treatment Integrity in a Dissemination and Implementation Framework

This commentary reflects on issues related to linking the conceptual frame for treatment fidelity presented in the special issue articles to the most current thinking on treatment fidelity within the emerging field of implementation science. The commentary presents several aspects of treatment fidelity in implementation science that generally were not discussed or addressed in the special issue articles, such as the placement of treatment fidelity as only one among several critical implementation outcomes, the relationship of treatment fidelity to design elements such as external validity as well as internal validity, and the importance of considering implementation issues in the measurement of treatment fidelity even in the earlier stages of efficacy and effectiveness research. The excellent in‐depth discussion of treatment fidelity in the special series is a promising start to linking this critical concept to the emerging field of implementation science.