Quiz 1

Question 1

Dianne Chambless

Answer 1

• 1996, Div 12 Task Force est. Standards of evidence that would help in the selection of treatments that warranted inclusion in psych training programs.
• Committee that created our PSY model of EBP
• Recognized the importance of Individual differences and other factors that play role – cultures, genetics etc
• Recognized the importance of Individual and Group characteristics in research
• EBP – unity, shared/common way and language in providing care, forming clinical decisions and improving scientific methods;
• is known for her extensive research of treating anxiety disorders with CBT

Question 2

Steps of EBP process

Answer 2

• Ask a question
• Acquire (evidence, research)
• Appraise (evidence, what is the best practice)
• Apply (will it be effective and applicable for my client)
• Analyze and adjust;

Question 3

Evolution of the Three Circles

Answer 3

• Over time each discilpline retained research evidence as one of the three circles but otherwise introduced improvements that adapted the model to its own context.
• The transdisciplinary model of EBP evolved to include…
  1. The best available research evidence
  2. Client/population characteristics
  3. Resources including practitioner expertise
  4. Combined to form ‘decisions’
• Clinical expertise is now depicted as an interior circle or ‘decision making process’ to actively tie together and resolve contradictions among a patients state and circumstances, their preferences, and the evidence. ;

Question 4

Three Circles of EBP initial model

Answer 4

• 1.Clincial expertise*
• 2. Research evidence
• 3. Patient preferences
• • clinical judgment may override evidence
• The initial three-circles model remains the best known and served as template for the American Psychological Association’s 2006 conceptualization of EBP
• Clinical expertise is now depicted as an interior circle or ‘decision making process’ to actively tie together and resolve contradictions among a patients state and circumstances, their preferences, and the evidence.

Question 5

19. The McMaster University Group

Answer 5

• Lead by David Sackett at McMaster University in Canada.
• Tackled the problem of physicians not using best research evidence when making clinical decisions about patient care.
• They were using ‘habits’, ‘advice from colleagues’, personal experiences, and/or worries about liability
• His group endorsed practicing “scientific medicine, grounded in the research knowledge base”.
• His group proposed a new model…. 3 data streams all integrated into clinical decision making (3-circles models of EBP);

Question 6

Archibald Cochrane

Answer 6

• Professor Archibald Cochrane (1909–1988) is considered to be the originator of the idea of evidence-based medicine in our era. With his landmark book ‘Effectiveness and Efficiency: Random Reflections on Health services’ he managed to inspire and positively influence the medical society with respect to the proper assessment of reliable evidence for the provision of the best medical care. His vision combined with his scientific achievements can be considered as the foundation of the Cochrane Collaboration, named after him in recognition of and gratitude for his pioneering work.
• He argue for the care decisions to be based on cost-effectiveness, or the efficiency with which the health care system used its human and financial assets.
• He began “Randomized Clinical Trials”
• 1993 formation of the Cochrane Collaboration”
• Worldwide network of published articles using RCT
• Human will outweighs the illness
• One of the 1st to introduce EB in mental health
• Was treated by Freud’s student for sexual dysfunction – became fluent in German
• Prisoner of war – there must be something besides physical body, watched prisoners survive on 600 calories a day, started thinking of the therapeutic power of the mind
• Treatment should be given to all people regardless of socioeconomical status
• led his first RCT in a camp treating ankle oedema, 10 prisoners got east another 10 vitamin C (control placebo group)
• His experience created Randomized Clinical Trials – as the most unbiased way to see what works, or else how do we decide what treatment and what dose to give;

Question 7

The Flexner Report

Answer 7

• No regulation for much of 19th century
• Can you pay.. OK! Then you’re a doctor.
• Turn of the century law makers figured out faculty was making a lot of money off of those who could pay for medical school
• Start of the movement towards regulations
• AMA and the Carnegie Foundation commissioned Abraham Flexner, educator to evaluate the quality of education in US and Canada
• Findings…“financial motives had caused gross overproduction of underqualified physicians…
• Report mandated that medical schools provide students with high-quality, hands-on laboratory and clinical training.
• By 1935 the number of new students entering the programs took a dramatic decline due to “both principles and economics.”
• This led to the closure of 1/3rd of the existing US medical schools.;

Question 8

1. What is the Clinical Interview

Answer 8

o Flexible procedure
o Can include both tight standardization and unstandardized spontaneity
o Focuses primarily on two overarching goals:
 Assessment
 Helping (including referral);

Question 9

History of EBP 3 main factors:?

Answer 9

• The Flexner Report
• The influence of Archibald Cochrane
• The work of the McMaster University Group;