Bridging the gap between best evidence and best practice in mental health

Question 1

scientist-practitioner model =

Answer 1

the practice of clinical psychology is built upon the principles of integrated evidence-based treatment and treatment-based evidence

Question 2

science-practice gap=

Answer 2

the gap between clinical empirical findings and their integration into practice

Question 3

supporting conclusions regarding the effectiveness of psychotherapies

Answer 3

1. the provision of therapy has demonstrated greater effectiveness than no treatment and placebo treatment
2. majority of patients make reliable or clinically significant improvement
3. improvements often continue after the termination of treatment and are maintained in the longer term

Question 4

maar wat weten we nog niet over psychotherapies

Answer 4

what the threshold of support has to be in order for a treatment to be empirically supported

Question 5

2 strategies of incorporating evidence-base into practice=

Answer 5

1. clinical guidelines towards particular diagnostic categories
2. individualized case formations

Question 6

by focusing on … it will be possible for clinicians to identify treatment successes and failures

Answer 6

session-to-session changes

Question 7

wat is STAR*D programme

Answer 7

sequenced treatment alternatives to relieve depression

= incorporate the patients preferences by having the patients nominate the medication strategies that are suitable to them

Question 8

CCS=

Answer 8

comprehensive cohort studies

Question 9

what does CCS allow

Answer 9

it allows participants who do not wish to be in the randomized trial, to receive a target evidence-based treatment, with consistent data collection across all cohorts. dus mensen die hun eigen treatment willen kiezen (en dus niet gerandomiseerd kunnen worden) ook toevoegen aan de trial (soms als een aparte arm of zoiets).

maar hierbij wel risico op misinterpretatie

Question 10

wat is de oplossing voor supershrinks en pseudoshrinks

Answer 10

national occupational standards: interactive competencies map reveals detailed lists of skills required to give a treatment

Question 11

wat zijn 4 redenen dat clinicians niet perse randomized controlled trials gebruiken

Answer 11

1. the patient sample in RCTs not representative of wider clinical population
2. treatments are inflexible; dus niet persoonlijk
3. clinicians sometimes reluctant with using evidence based
4. clinical practice does not only focus on symptoms, but also life functioning, coping with stressors, life quality etc (meestal niet gemeten in rcts)

Question 12

dodo bird verdict=

Answer 12

a view arguing that all treatments demonstrate equivalent efficacy, and that treatment effects are due to non-specific factors such as the therapeutic alliance between patient and clinician.

Question 13

wat zegt het dodo bird effect dus over evidence based

Answer 13

dat de emphasis hierop niet nodig is

Question 14

wat zijn 2 problemen met statistical significance=

Answer 14

1. provides no info on the magnitude of change
2. statistical significance provides no description of within group variability

Question 15

wat zou dan beter zijn dan statistical significant

Answer 15

de effect size (geeft wel info over de magnitude, maar alleen bij een kleine effect size zegt het iets over de within-group variability)

Question 16

two part criteria of clinical significance=

Answer 16

• statistically reliable change
• meaningful reduction in symptoms

(hiermee bereken je de reliable change index)

Question 17

er is ook variatie in welke definities gebruikt worden, sommige trials gebruiken de RCI, of een andere clinical cut off, maar dit is niet duidelijk

Answer 17

oke

Question 18

sommige mentale aandoeningen zullen ook niet zo snel verbeteren (bv chronic schizophrenia), dus hoe zie je ‘recovery’ dan in dat geval? dat is ook niet duidelijk

Answer 18

oke

Question 19

wat zijn 5 redenen waarom treatments niet werken

Answer 19

• clinical judgement
• patients judgement
• dose-response and phase models
• length of treatment
• early response to treatment

Question 20

clinical judgement

Answer 20

positive attributional bias to the treatment, negative towards the patient (patient centred attitude towards treatment failure)

oplossing: progress monitoring and feedback

Question 21

patient judgement

Answer 21

soms is de self report van de patient heel anders dan zijn progress laat zien

Question 22

dose-response and phase models

Answer 22

recovery is fast in the beginning, and slower but continued in the remainder of therapy. (= decelerating dose)

Question 23

welke 3 phases zijn er van dose response and phase models

Answer 23

1. remoralization
2. remediation
3. rehabilitation

Question 24

remoralization =

Answer 24

alleviation of hopelessness and boosting of wellbeing

Question 25

remediation=

Answer 25

therapeutic relationship and symptom reduction

Question 26

rehabilitation=

Answer 26

modification of previous patterns and towards enhanced life functioning

Question 27

length of treatment

Answer 27

door economische redenen zijn treatments korter geworden, maar dit kan voor de persoon zelf niet optimaal zijn

Question 28

early response to treatment

Answer 28

for most patients, early treatment response is dramatic, and predicts a positive final outcome.

solution: mapped treatment response at every session

Question 29

what are clinical implications of providing therapies with information about the client process

Answer 29

beiden data verzameling en clinical care quality in een keer

Question 30

what could bridge the scientist-practitioner gap

Answer 30

patient focused research

Question 31

waarom kan patients focused research daartoe leiden

Answer 31

• enables evaluation of treatment
• facilitates the study of variability between the samples
• allows for grouping of patients according to outcome, assess their trajectory
• risk of missing final session data is eliminated for drop outs
• ethical responsibilities of assessing practice and patient wellbeing are fulfilled
• greater accountability and transperancy in health care

Question 32

wat is patient focused research

Answer 32

Patient-oriented research is conducted in collaboration with patients (including their families and informal caregivers), clinicians and decision-makers; focuses on priorities and outcomes that matter to patients; and ultimately aims to integrate research into policy and practice to improve health care outcomes

dus patients are active parts of the research team

Question 33

2 challenges with patient-focused research

Answer 33

1. nog geen goede monitoring systems
2. evaluation with group-format may be helpful (want dan moeten ze anderen tolereren en leren van anderen)

Question 34

internet heeft een grote invloed

Answer 34

oke

Question 35

the use of risk-adjusted outcomes information has become standard, but is difficult to achieve without the use of physiological measures. by adjusting for case-mix, the quality of outcome evaluation would increase

Answer 35

oke

Question 36

fair reporting=

Answer 36

difficulty to ensure that the public receives reliable data, and is able to make valid interpretations from them

Question 37

4 x m van dit artikel

Answer 37

scientist practitioner has the opportunity to…
- match appropriate treatments
- monitor patient progress
- measurement of treatment outcomes
- management of services