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Evidence-Based Treatment

Evidence-Based Treatment (EBT) or Evidence-Based Practice (EBP) refers to the practice of incorporating study results and procedures into everyday practical application by practitioners. While study results may seem like an obvious source of knowledge for practitioners, in reality it has been a difficult procedure to transfer that knowledge from the researcher to the practitioner. Thus, EBT establishes guidelines on finding, critically analyzing, incorporating, and applying the knowledge to practice.

For an excellent description of the origins, process, and future directions of EBT (referred to as Evidence-Based Medicine here), please refer to this book chapter, located in the SAGE Reference Library database:

Hupert, J. & Niederman, J. (2009). Evidence-Based Medicine. In M. Kattan (Ed.), Encyclopedia of medical decision making. Retrieved from http://knowledge.sagepub.com.proxy1.ncu.edu/view/medical/n140.xml

EBT Process

The EBT Process contains four steps:

1) Formulating the question
2) Searching for and acquiring evidence from literature
3) Assessing the evidence for methodological validity and analyzing the study results for statistical significance and importance
4) Applying, where appropriate, the valid study results to the patient

1) Formulating the question

EBT is a patient-centered process, so your information need will begin when a patient presents physical or mental symptoms. To ensure that you, as a practitioner, are providing the best options to your patient, you will need to design a query that takes into account the particular symptoms and condition of your patient. Designing an appropriate question is critical. A well thought out question will focus your research efforts and provide clear criteria to evaluate search results. The PICO method of question formulation is most commonly used in EBT.

Patient, population, or problem
Intervention
Comparison
Outcome 

Example of a PICO formulated question:

P: In a group of otherwise healthy 10-12 year olds who are exhibiting symptoms of asthma, I: what are the effects of bronchodilators, C: versus theophylline (comparison can also be placebo), O: to control and eliminate asthma symptoms?  

2) Searching for and acquiring evidence from literature

PubMed (an open access database) and MEDLINE (a subscription database available through the Northcentral University Library) are excellent resources to use when in need of evidence based literature.

PubMed, MEDLINE, and many other medical databases use MeSH subject headings as the official terms to describe concepts related in medical articles. MeSH (Medical Subject Headings) terms, which are created by the National Library of Medicine, can be thought of as a dictionary or thesaurus which assists in finding and using the correct terms to find the most relevant articles. To view examples of clinical questions translated to database searches, see this link (under #2 Narrow your search with filters):

http://library.uams.edu/help-guides/evidence-based-medicine/evidence-based-medicine-acquiring-evidence-2/

Identifying MeSH terms can also be a challenge. PubMed includes a searchable database of MeSH terms which allow the user to type in a keyword and see the closest matching MeSH terms. To watch a short video demonstration of searching the PubMed MeSH database, click this link:

http://www.nlm.nih.gov/bsd/viewlet/mesh/searching/mesh1.html

 

PubMed has designed a search page specifically for clinical queries. This will assist you in using the appropriate filters, selecting clinical categories, and finding systematic reviews of primary research. To access this search screen select Clinical Queries under the PubMed Services menu, or use this link:

https://www.ncbi.nlm.nih.gov/pubmed/clinical

MEDLINE also uses similar Methodology limits. To access MEDLINE go to the Library home page and select Databases. Scroll down and select MEDLINE. There are two special search limits in MEDLINE that you can use to better refine your search results: EBM Reviews and Clinical Queries.

By checking the EBM Reviews box, you will only retrieve search results from selected journals that publish EBM Reviews. These articles will generally be meta-analyses of primary research studies.

The Clinical Queries limit allows you to limit your search to articles that address a particular area of your topic. MEDLINE will limit based upon nine areas: Therapy, Diagnosis, Prognosis, Reviews, Clinical Prediction Guides, Qualitative, Causation (Etiology), Costs, and Economics. The "High Sensitivity" option for each area will run a broad search and retrieve all relevant material. The "High Specificity" option for each area will run a narrower search and only retrieve the most relevant results. The "Best Balance" option for each area will combine both of the above options. For more information about the Clinical Queries limit see the EBSCOhost support article at:     

http://support.epnet.com/knowledge_base/detail.php?id=4622 

3) Assessing the evidence for methodological validity and analyzing the study results for statistical significance and importance
4) Applying, where appropriate, the valid study results to the patient 

Steps 3 and 4 of the EBT process will vary depending on the type of information you find in step 2. If you are working with primary studies then you will need to evaluate that study for validity and understand how the results of that study apply to your patient's particular case. If you have found meta-analyses of primary resources then much of the validation will be provided for you in the analysis.

Remember, EBT is a patient-centered process, so you must take into account other factors like patient preference and cost of treatment when determining the options for the patient. Through EBT research you may have found promising options for the patient, but your experience and judgment will be an important part of the process. 

EBT Resources

Tutorials and Guides:

PubMed Online Training: http://www.nlm.nih.gov/bsd/disted/pubmed.html
Short, video tutorials focusing on different search techniques and features of the PubMed database.

SUNY Downstate Medical Center Evidence Based Medicine Tutorial: http://library.downstate.edu/EBM2/contents.htm
Information organized according to EBM process; includes Glossary and Other Resources. "What Kind of Answer Do You Want?" section includes detailed descriptions and diagrams of study methodologies.

University of Minnesota Evidence Based Practice Tutorial: https://www.lib.umn.edu/apps/instruction/ebp/  
This tutorial, composed of five lessons and sample case studies, walks the user through each step of the Evidence Based Practice process. Self-testing opportunities are provided.

 

Databases and Resources:

Bureau of Justice Assistance Center for Program Evaluation and Program Measurement: http://www.ojp.usdoj.gov/BJA/evaluation/index.html
Includes information on DOJ program areas and evaluation/measurement resources for each program area. The Resources page lists many helpful organization and association websites.

Cambridge Center for Behavioral Studies Solutions: http://www.behavior.org/groups.php
Evidence-Based Practice resources for twenty different areas in the behavioral science discipline. Groups are free to join and offer the opportunity for social networking with other EBP behavioral science practitioners. Includes an extensive Links page.

Coalition for Evidence Based Policy: http://coalition4evidence.org/
Offers free, brief, expert advice on implementing evidence based policies. Works with researchers to create a rigorous evidence based program which ensures valid evidence.

The Cochrane Library: http://www.thecochranelibrary.com/view/0/index.html
One of the most important EBM related resources available, The Cochrane Library publishes systematic reviews and protocols. The Library can be searched for free, however Northcentral University Library does not have a subscription to this database. Please request articles through the Interlibrary Loan service. For information about using The Cochrane Library see How to use The Cochrane Library help page.

Evidence-Based Practice for the Helping Professions: http://www.evidence.brookscole.com/database.html
Chart with databases arranged by discipline and client type. Note that while many of the databases are open access (free) some require a subscription. If you have questions about which databases you have access to as a Northcentral University Learner please contact the Library.

Institute of Education Sciences What Works Clearinghouse: http://ies.ed.gov/ncee/wwc/
Access practice guides, intervention reviews, and standards that are published through the US Department of Education.

Office of Juvenile Justice and Delinquency Prevention Model Programs Guide: http://www.ojjdp.gov/mpg/
Browse intervention programs, or enter in criteria to find intervention programs which match the focus group.

Substance Abuse and Mental Health Services Administration National Registry of Evidence-Based Programs and Practices: http://www.nrepp.samhsa.gov/
Searchable online registry of more than 160 interventions.

Trip Database: http://www.tripdatabase.com/
Searches several open access databases and aggregates search results based on resource type and probable depth of topic discussion.

University of York Centre for Reviews and Dissemination Database: http://www.crd.york.ac.uk/crdweb/
Searches abstracts of systematic reviews and papers that are published by various European medical organizations.

KU Medical Center SUMSearch: http://sumsearch.org/
Searches several open access databases and aggregates search results based on resource type and probable depth of topic discussion. Allows searcher to focus searching using clinical filters, ties search terms into MeSH subject headings, and allows searcher to check search strategy before searching. Also includes a Clinical Calculator.

 

Definitions:

APA Policy Statement on Evidence-Based Practice in Psychology: https://www.apa.org/practice/guidelines/evidence-based-statement.aspx
Statement approved as of August 2005.

State of Oregon Addictions and Mental Health Services Evidence-Based Practices: http://www.oregon.gov/oha/amh/pages/ebp/main.aspx
Example of state implementation of EBP procedures. The Revised EBP Definition will be useful in defining key terms and ideas, as well as various levels of EBP implementation.

 

Articles and Books:

Bickman, L. (2008). A Measurement Feedback System (MFS) is necessary to improve mental health outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 47(10), 1114-19. 

Colorado Division of Criminal Justice, Office of Research and Statistics. (2007). Evidence based correctional practices (Accession Number 023340). Retrieved from http://nicic.gov/Library/023340

Evidence-Based Mental Health: http://ebmh.bmj.com/content/by/year
Journal published by the British Medical Journal Publishing Group. Archives (pre-2006) are available upon completing a free registration. Recent articles may be requested through the Northcentral University Library Interlibrary Loan service.

Hupert, J. & Niederman, J. (2009). Evidence-Based Medicine. In M. Kattan (Ed.), Encyclopedia of medical decision making. Retrieved from http://www.sage-ereference.com.proxy1.ncu.edu/medical/Article_n140.html

Kazdin, A. (2006). Arbitrary metrics: Implications for identifying evidence-based treatmentsAmerican Psychologist, 61(1)42-49.

Patterson, J. E., Miller, R. B., Carnes, S., & Wilson, S. (2004). Evidence-Based Practice for marriage and family therapists. Journal of Marital and Family Therapy, 30(2), 183-195.

Tanenbaum, S. J. (2005). Evidence-Based Practice as mental health policy: Three controversies and a caveat. Health Affairs,   24(1). doi: 10.1377/hlthaff.24.1.163

Welch-Ross, M.K. & Fasig, L. (Eds.). (2007). Handbook on communicating and disseminating behavioral science. Retrieved from http://www.sage-ereference.com.proxy1.ncu.edu/hdbk_behavioralsci/TableOfContents.html
In particular, see chapters in Part V: Disseminating Behavioral Medicine Research to Practitioners: Recommendations for Researching, and Disseminating and Implementing Evidence-Based Practices for Mental Health.