Evidence-Based Treatment (EBT) or Evidence-Based Practice (EBP) denotes the integration of research findings and methodologies into practical applications by professionals in their respective fields. Although research findings serve as a valuable source of knowledge for practitioners, the translation of this knowledge from researchers to practitioners has historically posed challenges. EBT addresses this by establishing protocols for locating, critically evaluating, assimilating, and applying research-based knowledge to real-world practice scenarios.
For an in-depth exploration of the origins, methodologies, and future trajectories of EBT, also known as Evidence-Based Medicine in some contexts, consider referring to the following book chapter available in the SAGE Reference Library database:
Hupert, J., & Niederman, J. (2009). Evidence-based medicine. In M. W. Kattan (Ed.), Encyclopedia of medical decision making (pp. 468-470). Thousand Oaks, CA: SAGE Publications Ltd. doi: 10.4135/9781412971980.n140
This chapter provides comprehensive insights into the principles and applications of EBT, offering valuable perspectives for practitioners and researchers alike.
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
Step 1: Formulating the Question
The Evidence-Based Treatment (EBT) process is inherently patient-centered, initiating when a patient presents physical or mental symptoms. As a practitioner, your information need arises from the need to provide optimal care for your patient. Formulating a precise and relevant question is paramount, guiding your research efforts and ensuring the evaluation of search results against clear criteria. In EBT, the PICO method is commonly employed for question formulation:
P – Patient, population, or problem: Define the characteristics of the patient population or the specific problem under consideration.
I – Intervention: Specify the intervention or treatment being evaluated or considered.
C – Comparison: Identify the alternative interventions or treatments being compared, including placebos or standard treatments.
O – Outcome: Determine the desired outcomes or effects of the interventions being studied.
Example of a PICO-formulated question:
In a group of otherwise healthy 10-12 year olds exhibiting symptoms of asthma (P), what are the effects of bronchodilators (I) compared to theophylline or placebo (C) in controlling and eliminating asthma symptoms (O)?
By employing the PICO framework, practitioners can tailor their inquiries to address the specific needs and circumstances of their patients, facilitating the integration of research evidence into clinical decision-making and ultimately improving patient outcomes.
Step 2: Searching For Evidence
PubMed
PubMed Central is a comprehensive database containing citations to millions of biomedical journal articles, along with select books, book chapters, and reports. It serves as an indispensable resource for researchers and practitioners in the fields of biomedical and health sciences.
As an open-access platform, PubMed Central offers free access to a vast repository of scholarly literature, making it an essential tool for accessing evidence-based research. One of its notable features is the inclusion of Medical Subject Headings (MeSH) search functionality, which facilitates precise and efficient searching by providing standardized terminology for medical concepts.
In addition to PubMed Central, other subscription-based databases available through the Northcentral University Library, such as MEDLINE, CINAHL, Cochrane Library, and Ovid, offer valuable resources for evidence-based literature.
MeSH terms play a crucial role in navigating medical databases effectively. Developed by the National Library of Medicine, MeSH terms serve as a standardized vocabulary that helps users identify and select relevant articles. While identifying MeSH terms can be challenging, PubMed offers a searchable MeSH database where users can input keywords to find matching MeSH terms.
To streamline the search process further, PubMed provides a dedicated search page tailored specifically for clinical queries. This feature assists users in applying appropriate filters, selecting clinical categories, and locating systematic reviews of primary research. Users can access this specialized search screen by selecting Clinical Queries under the PubMed Services menu or by clicking the provided link for PubMed Clinical Queries.
By leveraging the robust features of PubMed Central and other related databases, researchers and practitioners can access high-quality evidence-based literature to inform clinical decision-making and advance medical knowledge.
MEDLINE
MEDLINE Complete is a comprehensive database containing biomedical and health journals, offering access to a wealth of scholarly content. It provides Medical Subject Headings (MeSH) to facilitate precise searching and includes the full text of numerous popular MEDLINE-indexed journals, enhancing its utility for researchers and practitioners.
The primary purpose of MEDLINE Complete is to inform users about various health and medicine topics, making it an invaluable resource for evidence-based research and clinical decision-making. One of its notable features is the inclusion of a text-to-speech function for select articles, enhancing accessibility for users.
In addition to MEDLINE Complete, other databases like PubMed, CINAHL, Cochrane Library, and Ovid, available through the Northcentral University Library, are essential resources for evidence-based literature.
MeSH subject headings play a vital role in navigating medical databases effectively. Developed by the National Library of Medicine, MeSH terms serve as a standardized vocabulary that helps users identify and select relevant articles. Users can refer to guides such as Evidence Based Medicine: Acquiring Evidence to understand how clinical questions can be translated into database searches using MeSH terms.
MEDLINE Complete offers specialized search limits to refine search results further. Users can access MEDLINE through the Library’s homepage and utilize the EBM Reviews and Clinical Queries limits to tailor their searches. The EBM Reviews limit retrieves articles from selected journals publishing evidence-based medicine (EBM) reviews, often comprising meta-analyses of primary research studies.
The Clinical Queries limit allows users to narrow their search based on specific areas related to their topic, such as therapy, diagnosis, prognosis, reviews, and more. Users can choose between options like “High Sensitivity” for a broad search, “High Specificity” for a narrower search, or “Best Balance” for a combination of both.
For detailed guidance on utilizing the Clinical Queries limit, users can refer to resources like the EBSCOhost support article “What are MEDLINE Clinical Queries?” By leveraging the advanced features of MEDLINE Complete and other related databases, researchers and practitioners can access high-quality evidence-based literature to support their work in the medical field.
CINAHL
CINAHL Complete, offered by EBSCO, is a robust nursing database encompassing biomedicine, alternative/complementary medicine, consumer health, and allied health disciplines. It serves as a comprehensive resource for conducting research in nursing, medicine, and consumer health.
One of the key features of CINAHL Complete is its emphasis on qualitative studies, making it particularly valuable for researchers interested in exploring this methodological approach. Additionally, the database offers various filters, allowing users to refine their searches based on criteria such as nurse as author, evidence-based practice, and study type. These filters help users pinpoint relevant studies efficiently.
Furthermore, CINAHL Complete incorporates several advanced features to enhance the user experience. It includes MESH indexing, which provides standardized vocabulary for accurately describing medical concepts. The PICO search functionality assists users in formulating focused clinical questions by organizing key components: Patient/Population, Intervention, Comparison, and Outcome.
Moreover, some articles in CINAHL Complete are equipped with a text-to-speech feature, promoting accessibility for users with different learning preferences or abilities. Additionally, the database offers a tool for discovering citing articles, enabling users to explore the broader scholarly conversation surrounding a particular topic.
To access CINAHL Complete, users can navigate to the Library’s homepage and select A-Z Databases or choose from the available resources. Within the database, users can utilize the Methodology limit, similar to other medical databases, to refine their searches. This limit allows users to focus specifically on evidence-based practice, ensuring that search results are tailored to this approach.
By leveraging the comprehensive features of CINAHL Complete and its methodological filters, researchers and practitioners can access high-quality evidence-based literature in the fields of nursing, medicine, and consumer health. This database serves as an essential tool for those seeking to stay abreast of the latest research findings and advancements in healthcare practices.
Ovid Nursing Full Text
Ovid Nursing Full Text PLUS is a comprehensive medical database covering a wide range of disciplines, including nursing, allied health, education and training, development and management, midwifery, health and healthcare economics, clinical medical and healthcare social work, psychiatry and mental health, and traumatology, emergency and critical-care medicine.
With its extensive coverage, Ovid Nursing Full Text PLUS serves as a vital resource for accessing information relevant to nursing and nursing education. Whether users are seeking research articles, educational materials, or clinical guidelines, this database provides comprehensive coverage of topics pertinent to the field of nursing.
One of the standout features of Ovid Nursing Full Text PLUS is its advanced search functions, which include MESH (Medical Subject Headings) capability. This functionality enables users to conduct precise and targeted searches, ensuring that they retrieve the most relevant and up-to-date information on their chosen topics.
In addition to its robust content and search capabilities, Ovid Nursing Full Text PLUS also offers a similar Methodology limit feature, akin to other medical databases. By accessing this limit, users can refine their searches to focus specifically on evidence-based medicine, streamlining the process of identifying high-quality research relevant to their needs.
To access Ovid Nursing Full Text PLUS, users can navigate to the Library’s homepage and select A-Z Databases or choose from the available resources. Once within the database, users can utilize the Methodology limit feature to tailor their searches according to their specific requirements.
By leveraging the comprehensive content and advanced search functionalities of Ovid Nursing Full Text PLUS, users can access a wealth of evidence-based literature to support their research, education, and clinical practice in the field of nursing. This database serves as an indispensable tool for nurses, educators, and healthcare professionals alike, empowering them to stay informed and make informed decisions in their respective roles.
Cochrane Library
The Cochrane Library is a comprehensive database comprising seven distinct resources, each designed to provide high-quality, evidence-based information to support healthcare decision-making and inform clinical practice. These resources include:
- Cochrane Database of Systematic Reviews (CDSR): A collection of systematic reviews and meta-analyses that critically assess the effectiveness of healthcare interventions based on rigorous research methodologies.
- Cochrane Central Register of Controlled Trials (CENTRAL): A database containing records of controlled trials from around the world, including both published and unpublished studies.
- Cochrane Methodology Register (CMR): An index of publications related to the methods used in systematic reviews and other forms of evidence synthesis.
- Database of Abstracts of Reviews of Effects (DARE): A repository of critical assessments and structured abstracts of systematic reviews that evaluate the effects of healthcare interventions.
- Health Technology Assessment Database (HTA): A collection of research studies and reports assessing the clinical effectiveness, cost-effectiveness, and broader impact of healthcare technologies and interventions.
- NHS Economic Evaluation Database (EED): A database containing economic evaluations of healthcare interventions conducted within the National Health Service (NHS) in the United Kingdom.
In addition to these databases, the Cochrane Library also provides information about Cochrane groups, which are collaborative networks of researchers and healthcare professionals dedicated to producing and disseminating systematic reviews.
With its diverse array of resources, the Cochrane Library serves as a valuable tool for healthcare professionals, researchers, policymakers, and consumers seeking evidence-based information to guide healthcare decision-making. Whether searching for systematic reviews, clinical trials, methodological guidance, or economic evaluations, users can access a wealth of high-quality evidence to inform their practice and improve patient outcomes.
To access the Cochrane Library, users can navigate to the Library’s homepage and select A-Z Databases or choose from the available resources. Once within the database, users can utilize the advanced search functionality and search limits to tailor their searches according to their specific information needs and preferences.
Steps 3 and 4
Steps 3 and 4 of the Evidence-Based Treatment (EBT) process play a crucial role in translating research findings into clinical practice. These steps involve evaluating the evidence obtained in step 2 and applying it to the specific context of the patient’s case.
When working with primary studies, it’s essential to assess the validity and reliability of the research methodology, including factors such as study design, sample size, and statistical analysis. This evaluation helps clinicians determine the strength of the evidence and its relevance to the patient’s condition.
For meta-analyses of primary resources, much of the validation is provided through the comprehensive analysis conducted by researchers. Meta-analyses aggregate data from multiple studies to provide a more robust assessment of the effectiveness of interventions, making them valuable resources for evidence-based decision-making.
However, regardless of the type of evidence obtained, it’s important to remember that EBT is a patient-centered process. This means considering factors beyond the research findings, such as patient preferences, values, and the cost of treatment. Clinical decision-making should incorporate a holistic understanding of the patient’s needs and circumstances to determine the most appropriate course of action.
While EBT research may identify promising treatment options, clinicians must also rely on their experience and judgment to tailor recommendations to the individual patient. This personalized approach ensures that evidence-based interventions are effectively implemented in clinical practice, leading to improved patient outcomes and quality of care.
EBT Resources
Definitions
Policy Statement on Evidence-Based Practice in Psychology
The Policy Statement on Evidence-Based Practice in Psychology offers a comprehensive definition of evidence-based practice in psychology (EBPP), outlining its purpose and providing additional information and resources for practitioners. It serves as a guiding framework for professionals in the field to integrate research findings into clinical decision-making and enhance the quality of psychological services.
Operational Definition for Evidence-Based Practices Addictions and Mental Health Division
The Operational Definition for Evidence-Based Practices Addictions and Mental Health Division delineates key terms and concepts related to evidence-based practices (EBP) within the Oregon Addictions and Mental Health Division. It not only clarifies the fundamental principles underlying EBP but also delineates various levels of EBP implementation, offering a structured approach to promoting evidence-based interventions and improving service delivery in the field of addictions and mental health.
Library databases
Introduction to Key Databases:
- CINAHL Complete:
- Content: A nursing database by EBSCO, covering biomedicine, alternative/complementary medicine, consumer health, and allied health disciplines.
- Purpose: Serves as a comprehensive resource for research in nursing, medicine, and consumer health.
- Special Features: Offers strong qualitative studies, filters for studies by nurse as author, evidence-based practice, and study type. Includes MESH indexing, PICO search functionality, text-to-speech feature for select articles, and a tool for discovering citing articles.
- Cochrane Library:
- Content: Focuses on systematic reviews of interventions.
- Purpose: Aims to understand the effectiveness of interventions through evidence-based research.
- Special Features: Provides MESH and PICO search functionality. Contains various databases such as Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register (CMR), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database (HTA), and NHS Economic Evaluation Database (EED).
- MEDLINE Complete:
- Content: Includes biomedical and health journals, featuring MESH subject headings and full text of many popular MEDLINE-indexed journals.
- Purpose: Informs users about various health and medicine topics.
- Special Features: Offers a text-to-speech function for select articles.
- Ovid Nursing Full Text PLUS:
- Content: Encompasses nursing, allied health, education and training, development and management, midwifery, health and healthcare economics, clinical medical and healthcare social work, psychiatry and mental health, and traumatology, emergency, and critical-care medicine.
- Purpose: Provides information on all nursing and nursing education-related topics.
- Special Features: Advanced search functions including MESH capability.
- PubMed Central:
- Content: Contains citations to millions of biomedical journal articles, along with some books, book chapters, and reports.
- Purpose: Serves as an essential database for biomedical and health-related topics.
- Special Features: Includes MeSH search functionality.
- SAGE Research Methods:
- Content: Offers books, reference works, journal articles, and instructional videos on research methods and design.
- Purpose: Used to learn more about qualitative, quantitative, and mixed methods research.
- Special Features: Includes a methods map, project planner, and “which stats” test for comprehensive research support.
Websites
Explore Evidence-Based Practice Websites:
- Bureau of Justice Assistance Center for Program Evaluation and Program Measurement:
- Provides information on DOJ program areas and evaluation/measurement resources for each program.
- Offers a Resources page listing many helpful organization and association websites.
- Cambridge Center for Behavioral Studies Solutions:
- Offers Evidence-Based Practice resources for twenty different areas in the behavioral science discipline.
- Free groups provide the opportunity for social networking with other EBP practitioners.
- Includes an extensive Links page for further exploration.
- Coalition for Evidence Based Policy:
- Provides free, brief, expert advice on implementing evidence-based policies.
- Collaborates with researchers to create rigorous evidence-based programs ensuring validity.
- The Cochrane Library:
- One of the most important EBM-related resources available, publishing systematic reviews and protocols.
- The Library can be searched for free, although subscription may be required for full access.
- Evidence-Based Practice for the Helping Professions:
- Features a chart with databases organized by discipline and client type.
- Note that while many databases are open access, some require a subscription.
- Institute of Education Sciences What Works Clearinghouse:
- Accesses practice guides, intervention reviews, and standards published through the US Department of Education.
- KU Medical Center SUMSearch:
- Simultaneously searches for original studies, systematic reviews, and practice guidelines from multiple open-access sources.
- Office of Juvenile Justice and Delinquency Prevention Model Programs Guide:
- Allows browsing of intervention programs or criteria-based search for matching intervention programs.
- SAMHSA Evidence-Based Practices Resource Center:
- Contains a collection of scientifically-based resources for various audiences, including Treatment Improvement Protocols, toolkits, and clinical practice guidelines.
- Trip Database:
- A clinical search engine designed to allow users to quickly find and use high-quality research evidence to support practice and care.
- University of York Centre for Reviews and Dissemination Database:
- Searches abstracts of systematic reviews and papers published by various European medical organizations.
Articles and Books
Explore Relevant Articles and Books:
- Bickman, L. (2008). A Measurement Feedback System (MFS) is necessary to improve mental health outcomes.
- Published in the Journal of the American Academy of Child and Adolescent Psychiatry.
- Provides insights into the importance of a Measurement Feedback System in enhancing mental health outcomes.
- Evidence-Based Mental Health
- A journal published by the British Medical Journal Publishing Group.
- Archives (pre-2006) are accessible upon completing a free registration.
- Recent articles can be requested through the Northcentral University Library Interlibrary Loan service.
- Hupert, J. & Niederman, J. (2009). Evidence-Based Medicine.
- Part of the Encyclopedia of Medical Decision Making, edited by M. Kattan.
- Offers comprehensive insights into evidence-based medicine.
- Kazdin, A. (2006). Arbitrary metrics: Implications for identifying evidence-based treatments.
- Published in the American Psychologist.
- Explores the implications of arbitrary metrics in identifying evidence-based treatments.
- Patterson, J. E., Miller, R. B., Carnes, S., & Wilson, S. (2004). Evidence-Based Practice for marriage and family therapists.
- Featured in the Journal of Marital and Family Therapy.
- Discusses evidence-based practices specifically tailored for marriage and family therapists.
- Tanenbaum, S. J. (2005). Evidence-Based Practice as mental health policy: Three controversies and a caveat.
- Published in Health Affairs.
- Explores the intersections of evidence-based practice and mental health policy, highlighting controversies and offering a caveat.
- Welch-Ross, M.K. & Fasig, L. (Eds.). (2007). Handbook on communicating and disseminating behavioral science.
- Offers a comprehensive guide on communicating and disseminating behavioral science research.
- Particularly focuses on Part V: Disseminating Behavioral Medicine Research to Practitioners, offering recommendations for researching, disseminating, and implementing evidence-based practices for mental health.
Tutorials and Guides
- PubMed Online Training
- Access short, video tutorials that delve into various search techniques and features available on the PubMed database.
- Learn how to effectively navigate and utilize PubMed’s functionalities to enhance your research experience.
- University of Minnesota Evidence Based Practice Tutorial
- Comprising five comprehensive lessons and sample case studies, this tutorial guides users through every stage of the Evidence Based Practice process.
- Offers self-testing opportunities to reinforce learning and understanding.
- Gain practical insights and skills to integrate evidence-based practices into your professional endeavors.
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