A.6 Evidence Based Practice PowerPoint 2015

7/25/2019 A.6 Evidence Based Practice PowerPoint 2015

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John Hamilton &

Fsun uhadarolu-etinDEPRESSION IN CHIDREN !ND

!DOESCEN"S

Introdu#tion

E$iden#e-%ased

Pra#ti#e in

Child and!doles#ent

ental

Health

!da'ted () Henri*+e ,lasen

Cha'ter !.

Com'anion Po/er'oint

Presentation


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"he 0I!C!P!P "e1t(oo* o2 Child and !doles#ent ental Health3 isa$aila(le at the I!C!P!P /e(site htt'566ia#a'a'or76ia#a'a'-te1t(oo*-o2-#hild-and-adoles#ent-mental-health

Please note that this (oo* and its #om'anion 'o/er'oint are58 Free and no re7istration is re9uired to read or do/nload it8 "his is an o'en-a##ess 'u(li#ation under the Creati$e Commons!ttri(ution Non- #ommer#ial i#ense !##ordin7 to this: use:distri(ution and re'rodu#tion in an) medium are allo/ed /ithout'rior 'ermission 'ro$ided the ori7inal /or* is 'ro'erl) #ited and theuse is non-#ommer#ial


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;


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Random errors are due to un*no/nand6or un'redi#ta(le #han7es in

measurin7 instrument oren$ironment Diminished () lar7er sam'le sies

%ias As)stemati# errorB areina##ura#ies that are #onsistentl) inthe same dire#tion !n e$er 'resent ris*

Evidence-Based Practice

Statisti#al Con#e'ts"he (i77est enemies o2 truth5 random error

and (ias


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Statisti#al Con#e'ts"he (i77est enemies o2 truth5 random error

and (ias


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Mean ():

the most #ommon$alue in a normal

distri(ution Standard

deviation (SDB5

measures $aria(ilit)

Efect size:standardied

dieren#e (et/een

7rou's


Statisti#al Con#e'ts! 2e/ use2ul (asi# #on#e'ts AiB


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Absolte ris! redction (A""): ho/ mu#hdoes one treatment redu#e the ris* o2 a (ad out#ome#om'ared to an alternati$e Atreatment or 'la#e(oB

#on$dence %nterval (#%): an indi#ation o2 the're#ision6im're#ision o2 the stud) sam'le as anestimate o2 the true 'o'ulation $alue

&'ber needed to treat (&&):num(er o2

'eo'le /e must treat to 're$ent oneadditional (adout#ome

&'ber needed to ar' (&&*):9uantiGesthe ris* o2 harm2ul side ee#ts


Statisti#al Con#e'ts! 2e/ use2ul (asi# #on#e'ts AiiB


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!2ter ;= /ee*s on the "!DS stud) .@ o2'atients on 'la#e(o /ere not im'ro$ed#om'ared to > o2 'atients on uo1etine

+at is te A"", +at is te &&,

In the same stud) ;= o2 those treated /ithuo1etine re'orted some harm-related

e$ent: #om'ared to @ o2 those on 'la#e(o +at is te &&*,

+old o se tis treat'ent,


Statisti#al Con#e'tsKot thatL E1am'les5


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Child6!doles#ent!n1iet) ultimodalStud) AC!SB

Com'arin75- Pla#e(o

- C%" alone

- Sertraline alone

-

C%" M SertralineKra'h sho/s s#ores2or P!RS APediatri#!n1iet) Ratin7 S#aleB

- Note error (ars


Statisti#al Con#e'ts


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Ee#t sie A(ased on im'ro$ements in P!RSB5 C%" alone5 >; Asmall6medium ee#tB

Sertraline alone5 ?@ Amedium ee#tB Com(ination5 . Alar7e ee#tB

NN"5 (ased on im'ro$ement A$er) mu#him'ro$edB

C%" alone > Sertraline alone >

Com(ination5 = Athat is lo/ en#oura7in7B


Statisti#al Con#e'ts


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"o ma*e 7ood use o2 E%: dia7noses need to (eali7ned (et/een resear#h and 'ra#ti#e

"eliabilit: #onsisten#) o2 a measurin7

instrument a#ross time: indi$iduals and #lini#ians"est-retest relia(ilit)

Inter-rater relia(ilit)

.alidit: the e1tent () /hi#h a dia7nosti#

instrument measures /hat it #laims to measure O2ten measured indire#tl): 'redi#tion o2 #ourse:

out#ome

Correlation #oe#ients: 2a#tor loadin7 #an 9uanti2)


! $alid and relia(le dia7nosis"he 2oundation o2 e$iden#e (ased medi#ine

AE%B


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&/ B/ Most instr'ents ave onl been tested in te0S and Ero1e


! $alid and relia(le dia7nosis"he 2oundation o2 e$iden#e (ased medi#ine

AE%B


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S#reenin7 9uestions and homin7 in5 E7: semi-stru#tured inter$ie/s su#h as ,-S!DS

Inter$ie/ers do not ha$e to as* ea#h 9uestion I2 'ro(in7 9uestions are ans/ered ne7ati$el) the rest

o2 the se#tion #an (e s*i''ed

Clear thresholds 2or /hen to #ount a s)m'tom as'resent or a(sent and /hen to home in Ae7: =

al#oholi# drin*s 'er /ee* 2or 'ast ? /ee*sB


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Choosin7 a treatment"he ')ramid o2 e$iden#e

Evidence Based Practice


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Remain #urious /hen doin7 #lini#al /or*

!s* 9uestions rele$ant to the 'atients )ou see


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Terry is 10 years old and has ADHD-I (inattentive

type). He was helped by methylphenidate 1mg

three times!day" but lost a lot o# weight.$timulants and atomo%etine both suppress

appetite. &uan#a'ine is nown to help ADHD

'ombined type" but is it also ee'tive #or ADHD-

I* Qhat is the e$iden#e that Kuan2a#ine is

ee#ti$e in a ; )ear old /ith !DHD-IL

I2 ee#ti$e: /hat is the ee#t sieL


Sear#h data(asesele#troni#all)


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%e7in /ith Pu(ed Cli#* on 0!d$an#ed3: sele#t 0!DHD3

2rom the eSH terms: then 0sear#h3

"here are too man) hits o$er ;.

No/ re'eat the 're$ious ste's 2or 07uan2a#ine3 0!ND3 and

0! FIEDS3: then 0sear#h3 A? hitsB

Cli#* 0imits3 and sele#t 0meta-anal)sis3 A= hitsB: (ut (oth

do not a''l) to )our 'atient

Chan7e )our limits to 0RC"3 A hitsB: = o2 them a''li#a(leto a ; )ear old /ith !DHD /ithout ti#s

; arti#le is 2ree: (ut 2unded () 'harma#euti#al #om'anies

A'ossi(le (iasLB and #on#erns e1tended release 7uan2a#ine



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Hal2 li2e 7uan2a#ine5 ;>-;? hours: so t/i#e-dail)

dose mi7ht mimi# e1tended release 2orm

Ee#t sieL De'endin7 on dose (et/een @ and

;>? 2or !DHDtotal s#ores

!nd 2or inattention s'e#iG#all)L

No ee#t sie 7i$en: (ut redu#tions in a(solute

s#ores on a ratin7 s#ale are (i77er 2or inattentionthan 2or h)'era#ti$it)

Result5 It is reasona(le to #on#lude that a ; )ear

old /ith !DHD-I ma) si7niG#antl) im'ro$e /ith

7uan2a#ine at a dose o2 ;-=m7 t/i#e6da)




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a!e o'e 'essage5

+eep sear'h strategies transparentand 'lear and always monitor how

many hits result, these data allow

you to be 'ontinually adusting yoursear'h to your purposes" time and

interest.




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Qhat is the e$iden#e thatU P - ! s'e#iG#patientor problem

% - treated /ith a s'e#iG# intervention

# - )ields in comparisonto alternati$e treatment

2 - /hat outcome*

Sear#h 2or ans/er usin7 PICO 9uestions

Criti#all) a''raise the e$iden#e 2ound Inte7rate /ith #lini#al e1'ertise and 'atient

$alues

E$aluate the results


Classi# E% and 0the ans/era(le9uestion3

Findin7 the (est treatment 2or )our 'atient

Evidence-Based


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Che#* ea#h

ste' o2 a'a'er 2or itsstandard

Evidence-BasedPractice

Classi# E%and 0the

ans/era(le9uestion3Findin7 the

(est treatment2or )our 'atient


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%elie2s and $alues

Documents

A.6 Evidence Based Practice PowerPoint 2015