Evidence-Based Practice in Mental Health Accessing,Appraising, and Adopting Research Data

Recent calls for improvements in the quality of health care for mental and substance use conditions have emphasized the importance of applying existing knowledge to practice. Referred to by various terms, the basic concept of evidence-based practice is being promoted increasingly to bridge the gap between what is known and what is done in clinical practice. However, the demands of everyday work on clinicians, as well as the professional isolation that often characterizes independent practice, can make it difficult for would-be adopters of relevant evidence to know the best ways to stay current with potentially important developments in clinical research. This article describes specific strategies and resources for clinicians interested in accessing, appraising, and adopting clinical research findings to their professional settings.     

A Cardiovascular Pharmacotherapy Elective Course to Enhance Pharmacy Students�� Literature Evaluation Skills and Ability to Apply Clinical Evidence

Objectives. To design and implement a cardiovascular pharmacotherapy elective course to enhance pharmacy students’ ability to evaluate medical literature and apply clinical evidence.Design. In weekly class sessions, students were provided an overview of the important literature supporting therapeutic guidelines for the management of major cardiovascular diseases. Students worked in groups to complete outside-of-class assignments involving a patient case and then discussed the case in class. During the semester, each student also independently completed a literature search on an assigned topic, summarized the studies found in table format, and presented 1 of the studies to the class.Assessment. Students’ grades on weekly patient case assignments steadily increased over the semester. Also, the average grade on the final examination was higher than the grade on the midterm take-home examination. On the course evaluation, students rated the course favorably in terms of improvement of confidence in evaluating the primary literature and applying it to practice.Conclusion. Completion of the cardiovascular pharmacotherapy elective increased pharmacy students’ level of confidence in evaluating literature and applying clinical evidence in making patient care decisions.     

Good Googling: A Consumer Health Literacy Program Empowering Parents to Find Quality Health Information Online

Only 12% of Americans possess adequate health literacy skills. Among the populations cited with the lowest health literacy are those who experience chronic health conditions. A pilot health information literacy program was designed for parents of children with complex medical needs to help improve low health literacy in this population. The program targeted finding and determining trustworthy information online and was evaluated using a pre-post survey design. After the program parents’ confidence improved significantly in finding, interpreting, and judging quality online health information. These skills play an important role in promoting family-centered care and decreasing the burden on health care consumers.     

The evidence base for the evaluation and management of dizziness

Objectives  Dizziness presentations pose many clinical challenges. The objective of this study is to broadly summarize the evidence base that supports clinical decisions in dizziness presentations.
Methods  MEDLINE (1966 to September 2007), Web of Science and The Cochrane Library were searched for articles with clinical relevance on topics concerning dizziness. Additional sources were also searched for clinical practice guidelines. The following information was abstracted from each article: year of publication, journal type, type of article and the topics of the article.
Results  Of nearly 3000 articles identified, 1244 articles met the inclusion criteria. The most common article type was a case report or case series, followed by expert opinion or review articles, studies of medical tests and clinical trials. Meta-analyses and systematic reviews were found on benign paroxysmal positional vertigo and Meniere's disease, but only a few other topics. No clinical practice guidelines were found that focus specifically on dizziness.
Conclusions  The evidence base for the evaluation and management of dizziness seems to be weak. Future work to establish or summarize evidence in clinically meaningful ways could contribute to efforts to optimize patient care and health care utilization for one of the most common presenting symptoms.     

From the Cover: Bandit solutions provide unified ethical models for randomized clinical trials and comparative effectiveness research

As electronic medical records enable increasingly ambitious studies of treatment outcomes, ethical issues previously important only to limited clinical trials become relevant to unlimited whole populations. For randomized clinical trials, adaptive assignment strategies are known to expose substantially fewer patients to avoidable treatment failures than strategies with fixed assignments (e.g., equal sample sizes). An idealized adaptive case—the two-armed Bernoulli bandit problem—can be exactly optimized for a variety of ethically motivated cost functions that embody principles of duty-to-patient, but the solutions have been thought computationally infeasible when the numbers of patients in the study (the “horizon”) is large. We report numerical experiments that yield a heuristic approximation that applies even to very large horizons, and we propose a near-optimal strategy that remains valid even when the horizon is unknown or unbounded, thus applicable to comparative effectiveness studies on large populations or to standard-of-care recommendations. For the case in which the economic cost of treatment is a parameter, we give a heuristic, near-optimal strategy for determining the superior treatment (whether more or less costly) while minimizing resources wasted on any inferior, more expensive, treatment. Key features of our heuristics can be generalized to more complicated protocols.     

Meet EBE: The Development of an Evidence-Based Endoscopy Simulator

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Performance of a Web-Based Clinical Diagnosis Support System for Internists

BACKGROUND Rigorous guideline development methods are designed to produce recommendations that are relevant to common clinical situations and consistent with evidence and expert understanding, thereby promoting guidelines’ acceptability to providers. No studies have examined whether this technical quality consistently leads to acceptability. OBJECTIVE To examine the clinical acceptability of guidelines having excellent technical quality. DESIGN AND MEASUREMENTS We selected guidelines covering several musculoskeletal disorders and meeting 5 basic technical quality criteria, then used the widely accepted AGREE Instrument to evaluate technical quality. Adapting an established modified Delphi method, we assembled a multidisciplinary panel of providers recommended by their specialty societies as leaders in the field. Panelists rated acceptability, including “perceived comprehensiveness” (perceived relevance to common clinical situations) and “perceived validity” (consistency with their understanding of existing evidence and opinions), for ten common condition/therapy pairs pertaining to Surgery, physical therapy, and chiropractic manipulation for lumbar spine, shoulder, and carpal tunnel disorders. RESULTS Five guidelines met selection criteria. Their AGREE scores were generally high indicating excellent technical quality. However, panelists found 4 guidelines to be only moderately comprehensive and valid, and a fifth guideline to be invalid overall. Of the topics covered by each guideline, panelists rated 50% to 69% as “comprehensive” and 6% to 50% as “valid”. CONCLUSION Despite very rigorous development methods compared with guidelines assessed in prior studies, experts felt that these guidelines omitted common clinical situations and contained much content of uncertain validity. Guideline acceptability should be independently and formally evaluated before dissemination. This document includes content previously published in a RAND report, available online at: .     

Evaluation of a Longitudinal Medical School Evidence-Based Medicine Curriculum: A Pilot Study

Background  Evidence-based medicine (EBM) is increasingly taught in medical schools, but few curricula have been evaluated using validated instruments. Objective  To evaluate a longitudinal medical school EBM curriculum using a validated instrument. Design, Participants, Measurements  We evaluated EBM attitudes and knowledge of 32 medical students as they progressed through an EBM curriculum. The first part was an EBM “short course” with didactic and small-group sessions occurring at the end of the second year. The second part integrated EBM assignments with third-year clinical rotations. The validated 15-item Berlin Questionnaire was administered before the course, after the short course, and at the end of the third year. Results  EBM knowledge scores increased from baseline by 2.8 points at the end of the second year portion of the course (p = .0001), and by 3.7 points at the end of the third year (p < .0001). Self-rated EBM knowledge increased from baseline by 0.8 and 1.1 points, respectively (p = .0006 and p < .0001, respectively). EBM was felt to be of high importance for medical education and clinical practice at all time points, peaking after the short course. Conclusions  A longitudinal medical school EBM curriculum was associated with increased EBM knowledge. This knowledge increase was sustained throughout the curriculum. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.