Evidence Based Practice for Psychiatry

Psychiatry Grand RoundsMarch 1, 2013

Rick Wallace, MA, MDiv, MAOM, MSLS, EdDQuillen College of Medicine Library

Use of Information in the Clinic:

The Literature

Green et al. (2000) :

• … residents in their continuity clinics encounter new clinical questions- not including those answered by discussions with preceptors- at a rate of 2 questions for every 3 patients …. The residents pursued only 29% of their questions (p. 220).

Green and Ruff (2005):

• Physicians leave the majority of their clinical questions unanswered, witness their medical knowledge deteriorate after their training, and demonstrate wide practice variations for clinical maneuvers with established efficacy. (p. 176).

Green and Ruff (2005):

• Physicians leave the majority of their clinical questions unanswered, witness their medical knowledge deteriorate after their training, and demonstrate wide practice variations for clinical maneuvers with established efficacy. (p. 176).

Lucas, et al (2004)

• Attending physicians changed treatment for 18% of patients as a result of literature searches

• NNS = 6

Covell, Uman and Manning (1985)

• Four management decisions might have been altered if needed information had been available at the time of the patient visit

Fineberg (1987) found

• … that only 2 of 28 landmark trials were implemented within two years following their publication (p. 333). This means that new discoveries in medicine are not being quickly translated into better treatment for patients.

Ebell and Shaughnessy (2003):

• A study of 85 prominent clinically oriented medical research journals identified over 8,085 articles in a 6-month period. Even if a physician spent only 3 minutes per article, it would still take over 800 hours over the course of a year to keep up to date .

• A survey of Norwegian primary care physicians found that they spend less than 3 hours per week on all medical reading (p. S57).

Sackett and Straus (1998)

• … “found that evidence made available within seconds during rounds altered the clinical approach of at least 1 team member 48% of the time , but when evidence was not readily available, the clinicians rarely searched for it” (p. 1338).

Shin, Haynes and Johnston (1993)

• …found significant differences among how physicians treated patients with hypertension based on when they finished their training.

Ross and Verdieck (2003).

• “ One credible goal of residency education should be to endow our residents with a practical working knowledge of EBM, so we can graduate competent, confident life-long learners who provide first-class patient care according to the best evidence available” (p. 412).

Use of Information in the Clinic:

Basic Principles

The Usefulness Equation

• Usefulness = Relevance x Validity Work

Slawson, Shaughnessy

The 5S Pyramid

From: http://guides.library.upenn.edu/content.php?pid=192036&sid=1610308

EBM Steps

1. Assess patient2. Ask question3. Acquire information4. Appraise information5. Apply to patient

PICO- formulating an answerable clinical question

P- Population or patientI- InterventionC- Comparative interventionO- Outcome

Anatomy of the Medical Literature

Use of Information in the Clinic:

The Resources

Acquiring Information: Primary Literature

• Citation Databases PubMed

MeSHLimits

PsychInfo• Textbooks

Clinical Key StatRef EBSCO eBooks Access Medicine/Access

Pharmacy R2 Library

• Online and Print JournalsProxy server

Citation Databases

1. PubMed

2. PsychInfo

www.etsu.edu/medlib

PubMed

PsychInfo

E- Books

Clinical Key

Also available for SmartPhone

EBSCO eBooks

AccessPharmacy

Mainly atlases

Clinical Key and Access Pharmacy do not show up with other book collection icons yet.

Username:wallacerPassword:********

A dialog box will appear when you go to our web page and click on one of our proprietary databases from off-campus (exception VA). You need to enter your ETSU email username and password. That will allow you to access all of our thousands of full-text journals, books, and databases.

Off-Campus Access of Databases, Journals, Books

Acquiring Information:Secondary Resources

•Dynamed (Daily Poems)•UpToDate- not available off-campus•Essential Evidence Plus•First Consult•ACP PIER•Guidelines.gov•Cochrane

Can be downloaded to a SmartPhone

Has mobile web site

First Consult

ACP PIER

Free- guidelines from around the world

Cochrane Database

Additional Services

SmartPhone Helphttp://com.etsu.edu/pda/

Online Searching and Individual Instruction

• Nakia Woodward, MSIS woodwardn@etsu.edu

• Katie Wolf, MLIS wolfkm@etsu.edu

• Rick Wallace, MSLS, EdD wallacer@etsu.edu

Study Space

– Library Hours:• Sunday 1 pm – midnight• Monday – Friday 7:30 am – midnight• Saturday 10 am – midnight

– Basement- 24 hour access for residents

– We have a limited number of laptops, projectors, Nooks and MP3 players that we check out

Daily POEMs Alerts

• Delivered directly to you by e-mail every Monday through Friday, Daily POEMs identify the most valid, relevant research that may change the way you practice. Monthly, the complete set is compiled and sent for additional summary review.

• Ongoing since 1996, our editors now review more than 1,200 studies monthly from more than 100 medical journals, presenting only the best and most relevant as POEMs.

• The acclaimed POEMs process applies specific criteria for validity and relevance to clinical practice. About 1 in 40 studies qualifies

Conclusion• We will work with you one-on-one or in small groups at

any time, any place.• We will load clinical databases on your smartphone• We will sign you up for the DailyPoems.• We stay open 24/7. Residents have access to the

basement with an ETSU ID card during the hours the library is closed.

• We will regularly attend morning reports and do searches.

• We will assist faculty with Systematic Review searching.

Additional Handouts

• PICO worksheet• Sign up sheet for:

1. Daily POEMS2. Smartphone help3. Individual instruction

Thank- You