Towards evidence-based clinical supervision: the development and evaluation of four CBT guidelines

2010 ◽  
Vol 3 (2) ◽  
pp. 43-57 ◽  
Author(s):  
Derek Milne ◽  
Chris Dunkerley
Keyword(s):  
Clinical Supervision ◽  
Ad Hoc ◽  
Reference Group ◽  
Guideline Development ◽  
Continuing Professional Development ◽  
Clinical Excellence ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Evidence Based ◽  
Evaluation Tool

AbstractClinical supervision is central to evidence-based practice (EBP) and continuing professional development (CPD), but the evidence base has made little impact on supervision, a major form of CPD. We unite the two by developing four evidence-based guidelines for cognitive behavioural therapy (CBT) supervision. The guidelines were designed to address the supervision cycle (i.e. collaborative goal-setting; methods of facilitating learning; evaluation and feedback) within the context of the supervision alliance. Guideline development followed the National Institute for Clinical Excellence approach, including a representative stakeholder working group (with local service users and supervisees), a national group of supervisors and supervisor trainers, plus an expert reference group. A total of 106 such participants completed an ad-hoc guideline evaluation tool, designed to provide a multi-dimensional reaction evaluation of the guidelines. The guidelines were all rated favourably, satisfying the key initial criteria of accuracy and acceptability, and were judged to represent a CBT approach to supervision. It is concluded that the use of the guidelines might help CBT supervisors to better meet demands for CPD (including specialization in supervision) and EBP.

scholarly journals Cognitive-behavioural therapy for schizophrenia: Filling the therapeutic vacuum

2003 ◽  
Vol 183 (2) ◽  
pp. 98-99 ◽  
Author(s):  
Douglas Turkington ◽  
David Kingdon ◽  
Paul Chadwick
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Clinical Excellence ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Convincing Evidence ◽  
Family Work ◽  
Standard Clinical Practice ◽  
Cognitive Behavioural ◽  
Accepted Part ◽  
The Cost

When does a therapeutic intervention become an accepted part of standard clinical practice? Is it when there is sufficient research evidence? But what constitutes ‘sufficient’? What about available resources and acceptability to patients? Do we have to wait until the National Institute for Clinical Excellence pronounces? A convincing evidence base for family work in schizophrenia (Kuipers, 2000) has existed for many years but has been poorly implemented (Anderson & Adams, 1996). Will cognitive-behavioural therapy (CBT) for psychosis suffer the same fate? Which professional group will champion such an implementation? The evidence for other psychological treatments is less robust. Psychoeducation may prolong time to relapse and improve insight but at the cost of increasing suicidal ideation (Carroll et al, 1998). Personal therapy (Hogarty et al, 1997) may be of value but is contra-indicated for patients who are living alone in the community. Psychodynamic approaches are advocated (Mace & Margison, 1997) but most psychiatrists do not support their use in practice, owing to lack of evidence of efficacy.

scholarly journals Management of obesity in Scotland: development of the latest evidence-based recommendations

2010 ◽  
Vol 69 (2) ◽  
pp. 195-198 ◽  
Author(s):  
J. Thompson
Keyword(s):  
Young People ◽  
Clinical Excellence ◽  
Evidence Base ◽  
Evidence Based ◽  
Healthy Weight ◽  
Guideline Adaptation ◽  
Lifestyle Measures ◽  
Scottish Government ◽  
Clinical Conditions ◽  
The Cost

The problem of obesity in Scotland has reached epidemic proportions and this reality is recognised at Scottish Government level. The financial impact of treating obesity and obesity-related disease is substantial and in Scotland the cost was estimated at £171×106 in 2001 but only a small proportion of this estimate included weight-loss interventions. The Scottish Intercollegiate Guidelines Network (SIGN) define clinical guidelines as ‘systematically developed statements to help practitioner and patient decisions’ that ‘provide recommendations for effective practice in the management of clinical conditions where variations in practice are known to occur and where effective care may be known not to occur’. The evidence base for successful interventions has progressed since the publication by SIGN of Obesity in Scotland: Integrating Prevention with Weight Management in 1996 and Management of Obesity in Children and Young People in 2003. In 2007 SIGN commissioned a review of these two publications. In 2006 the National Institute for Health and Clinical Excellence (NICE) published a comprehensive obesity guideline and to avoid duplication of effort SIGN used the ADAPTE guideline adaptation framework to utilise and update evidence tables produced by NICE (where appropriate) as a basis for considered judgement. The new SIGN guideline is due for publication in 2010 and addresses children, young people (<18 years old) and adults. It will provide evidence-based recommendations on primary prevention of obesity (defined as intervention when individuals are at a healthy weight and/or overweight to prevent or delay the onset of obesity) within the clinical setting and treatment by lifestyle measures, drugs and surgery.

scholarly journals Supervisor practice when guiding therapists working with depression: the impact of supervisor and patient characteristics

2018 ◽  
Vol 11 ◽  
Author(s):  
Chloe Simpson-Southward ◽  
Glenn Waller ◽  
Gillian Hardy
Keyword(s):  
Clinical Supervision ◽  
Personal Characteristics ◽  
Patient Characteristics ◽  
Behavioural Therapy ◽  
Evidence Based ◽  
Clinical Supervisors ◽  
Cognitive Behavioural ◽  
Clinical Complexity ◽  
Consistent Manner ◽  
The Impact

AbstractCurrently recommended psychotherapies for depression are not always delivered in a consistent manner. There is an assumption that the use of clinical supervision will ensure reliable treatment and patient recovery. However, there is limited research supporting this assumption. This study explored the role of supervision in the treatment of depression. In particular, it examined how supervisors’ own characteristics and those of patients can influence the focus of supervision sessions. Clinical supervisors who worked with cognitive behavioural therapy (CBT) therapists treating depression cases were asked to indicate their supervision focus for three different patient vignettes. These vignettes varied in clinical complexity. Participants’ intolerance to uncertainty and their self-esteem were also assessed. Supervisors tended to focus their supervisees on the use of evidence-based therapeutic techniques for both straightforward and complex cases. However, their approach was less evidence-based for diffuse cases. Three supervisory types emerged: an ‘Alliance- and Technique-Focused’ group, a ‘Case Management-Focused’ group, and an ‘Unfocused’ group. Personal characteristics of the supervisors varied across the groups. The content of supervision sessions is influenced by factors from outside the therapy process. These factors might cause supervisors to avoid focusing on evidence-based aspects of therapy, thus feeding therapist drift. Suggestions are made for new supervision protocols that consider the supervisor's personal characteristics.

Intervention for acute radiotherapy induced skin reactions in cancer patients: the development of a clinical guideline recommended for use by the college of radiographers

2000 ◽  
Vol 2 (2) ◽  
pp. 75-84 ◽  
Author(s):  
E. Glean ◽  
S. Edwards ◽  
S. Faithfull ◽  
C. Meredith ◽  
C Richards ◽  
...  
Keyword(s):  
Best Practice ◽  
Health Care Policy ◽  
Ad Hoc ◽  
Clinical Guideline ◽  
Guideline Development ◽  
Wound Care ◽  
The United States ◽  
Evidence Base ◽  
Skin Reactions ◽  
Care Assessment

The aim of this retrospective study is to develop an evidence-based approach to managing radiation induced skin reactions. A Clinical Guideline Development Group was established to undertake a systematic review of literature and a survey of cancer centres with the objectives of highlighting and recommending best practice. Thirty-one papers were reviewed using the United States Health Care Policy and Research and Scottish Intercollegiate Guidelines Network criteria and 42 United Kingdom Cancer Centres responded with a mix of guidelines and information about skin care assessment and advice. The evidence base for the findings is mainly levels II, III and IV.Although perceived as common, the incidence of skin reactions has not been quantified. There is little evidence of consistent assessment of acute reactions and the survey data shows that the use of a scoring tool such as the Radiation Oncology Group criteria (RTOG/EORTC 1985) is rare. It also demonstrates that advice to patients is variable and sometimes contradictory. Appropriate and timely information is essential to relieve anxiety and reduce problems.There appears to be a place for the use of creams in the management of early (RTOG/EORTC 0,1, 2a) skin reactions and in delaying the onset of subsequent skin breakdown, however this evidence is not clear and several of the studies identified some allergic reactions to creams. The intervention used varies between departments and individual patients and is ad hoc rather than based on firm evidence.For reactions graded RTOG/EORTC 2b and 3, evidence from wound care literature suggests the use of hydrocolloids or hydrogels which are founded on moist wound healing principles. No evidence could be found to support the management of RTOG 4.The study recommends the development of a clinical guideline encompassing factors affecting the onset of reactions, assessment and management principles, and patient information and makes suggestions for much needed further research.

Virtual Dementia Tour®: limitations and ethics

2018 ◽  
Vol 19 (2) ◽  
pp. 146-155 ◽  
Author(s):  
Alessandra Merizzi
Keyword(s):  
Quality Of Life ◽  
Clinical Excellence ◽  
Evidence Base ◽  
Standards Of Care ◽  
Original Research ◽  
Evidence Based ◽  
Supporting Evidence ◽  
National Guidelines ◽  
Content Type

Purpose Dementia care is an important aspect affecting the quality of life of people living with dementia. There are many studies that test the efficacy of methods of care in order to support and even increase the quality of life of dementia patients (e.g. Gridley et al., 2016; Thyrian et al., 2017). A novel approach developed by Beville (2002) called Virtual Dementia Tour® (VDT®) also aims to improve the care of people living with dementia in their middle and late stages of deterioration. VDT® is now becoming popular internationally (see www.provdt.co.uk/) and it is sold to the general public as an evidence-based method through which people can experience what it is like to live with dementia, aiming to increase empathy and improve the delivery of care. The purpose of this paper is to explore the validity of the VDT® intervention. Design/methodology/approach The author explores the original research article upon which the VDT® was developed, highlighting critical points and reviewing these through a rigorous selection of references. Findings The supporting evidence base is consistently weak on closer scrutiny, and in combination with anecdotal evidence of distress related to the VDT® experience, this analysis suggests a need for caution in implementation. Originality/value Although high-quality standards of care from the national guidelines (National Institute for Health and Clinical Excellence, 2010) ensure that health services implement evidence-based interventions, it may be important to discern that which is empirically based from that which is not.

scholarly journals Psychoanalytic and psychodynamic therapies for depression: the evidence base

2008 ◽  
Vol 14 (6) ◽  
pp. 401-413 ◽  
Author(s):  
David Taylor
Keyword(s):  
Guideline Development ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Current Approach ◽  
Short Term ◽  
Cognitive Behavioural ◽  
Treatment Of Depression ◽  
Evidence Gathering ◽  
Randomised Controlled ◽  
Psychodynamic Therapies

This article argues that the current approach to guideline development for the treatment of depression is not supported by the evidence: clearly depression is not a disease for which treatment efficacy is best determined by short-term randomised controlled trials. As a result, important findings have been marginalised. Different principles of evidence-gathering are described. When a wider range of the available evidence is critically considered the case for dynamic approaches to the treatment of depression can be seen to be stronger than is often thought. Broadly, the benefits of short-term psychodynamic therapies are equivalent in size to the effects of antidepressants and cognitive–behavioural therapy (CBT). The benefits of CBT may occur more quickly, but those of short-term psychodynamic therapies may continue to increase after treatment. There may be a ceiling on the effects of short-term treatments of whatever type. Longer-term psychodynamic treatments may improve associated social, work and personal dysfunctions as well as reductions in depressive symptoms.

scholarly journals NICE CG178 Psychosis and Schizophrenia in Adults: Treatment and Management – an evidence-based guideline?

2015 ◽  
Vol 206 (5) ◽  
pp. 357-359 ◽  
Author(s):  
Mark Taylor ◽  
Udayanga Perera
Keyword(s):  
At Risk ◽  
Cognitive Behavioural Therapy ◽  
Clinical Guideline ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Evidence Based ◽  
Nice Guidelines ◽  
Cognitive Behavioural ◽  
Evidence Based Guideline ◽  
Nice Clinical Guideline

SummaryNational Institute for Health and Care Excellence (NICE) clinical guideline (CG)178 was published in 2014. NICE guidelines occupy an important international position. We argue that CG178 overemphasises the use of cognitive–behavioural therapy for schizophrenia and those ‘at risk’ of psychosis, with recommendations that do not always reflect the evidence base. The CG178 recommendations on medications are limited.

scholarly journals Evidence-Based Guidelines in Laboratory Medicine: Principles and Methods

2004 ◽  
Vol 50 (5) ◽  
pp. 806-818 ◽  
Author(s):  
Wytze P Oosterhuis ◽  
David E Bruns ◽  
Joseph Watine ◽  
Sverre Sandberg ◽  
Andrea R Horvath
Keyword(s):  
Multidisciplinary Team ◽  
Guideline Development ◽  
Scientific Evidence ◽  
Evidence Base ◽  
Laboratory Medicine ◽  
Evidence Based ◽  
Consensus Methods ◽  
Evidence Based Guideline ◽  
Evidence Based Guidelines ◽  
Study Designs

Abstract Background: Guidelines are commonly used tools for supporting medical decisions. Formulating evidence-based recommendations has become a leading principle in guideline development. Aim: This narrative review integrates the most recent methods of evidence-based guideline development and adapts those to the field of laboratory medicine. Summary: We present a 10-step process and a list of criteria for the development of laboratory guidelines. Laboratory guidelines should be outcome oriented, be developed by a multidisciplinary team, and begin with a clear statement of the clinical question(s) that the use of the test(s) is addressing. The clinical questions define the type of study designs that offer the best evidence to answer those questions. Guidelines should be based on the critical appraisal and systematic review of literature and explicitly state the strength of evidence supporting each recommendation. Pragmatic considerations dictate that priority is given to topics with the highest clinical or economic impact. Scientific evidence is necessary but insufficient for recommendations, as considered judgment is required about benefits, harms, costs, and local applicability of recommendations. Formal consensus methods are needed when the evidence base is lacking or controversial. Guidelines should be disseminated widely and their impact monitored regularly. Regular reviewing is needed because the lack of timely updates is a major cause of nonadherence to guidelines. Conclusions: Guidelines should be developed in a transparent process by a multidisciplinary team, with graded recommendations based on critically appraised scientific studies. Systematic, standardized, and explicit methodology, adapted to laboratory medicine, should be followed when developing recommendations involving the use of laboratory tests.

Comparison of methodological quality between the 2007 and 2019 Canadian dietary guidelines

2020 ◽  
Vol 23 (16) ◽  
pp. 2879-2885
Author(s):  
Zhaoli Dai ◽  
Cynthia M Kroeger ◽  
Mark Lawrence ◽  
Gyorgy Scrinis ◽  
Lisa Bero
Keyword(s):  
Food Intake ◽  
Methodological Quality ◽  
Guideline Development ◽  
Evidence Base ◽  
Dietary Guidelines ◽  
Evidence Based ◽  
Processed Food ◽  
Dietary Recommendations ◽  
Dietary Guideline ◽  
Development Methods

AbstractObjective:With significant shifts in the dietary recommendations between the 2007 and 2019 Canadian dietary guidelines, such as promoting plant-based food intake, reducing highly processed food intake and advocating the practice of food skills, we compared their differences in guideline development methods.Design:Two reviewers used twenty-five guided criteria to appraise the methods used to develop the most recent dietary guidelines against those outlined in the 2014 WHO Handbook for Guideline Development.Setting:Canada.Participants:2007 and 2019 dietary guidelines.Results:We found that the 2019 guidelines were more evidence-based and met 80 % (20/25) of the WHO criteria. For example, systematic reviews and health organisation authoritative reports, but not industry reports, constituted the evidence base for the dietary recommendations. However, recommendations on food sustainability and food skill practice were driven primarily by stakeholders’ interests. By contrast, less information was recorded about the process used to develop the 2007 guidelines, resulting in 24 % (6/25) consistency with the WHO standards.Conclusions:Our analysis suggests that a more transparent and evidence-based approach is used to develop the 2019 Canadian dietary guidelines and that method criteria should support further incorporation of nutrition priorities (food sustainability and food skills) in future dietary guideline development.

scholarly journals Reading about self-help books on depression

2006 ◽  
Vol 30 (8) ◽  
pp. 318-319
Author(s):  
Graeme Whitfield ◽  
Chris Williams
Keyword(s):  
Clinical Excellence ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Stepped Care ◽  
Self Help ◽  
Moderate Depression ◽  
Cognitive Behavioural ◽  
Key Skills ◽  
Per Se ◽  
Treatment Package

Self-help resources for depression are widely available in bookshops and via the internet. They are increasingly being recommended for use by healthcare practitioners as part of a stepped care treatment package (Bower & Gilbody, 2005). Such materials provide key information and key skills to help readers tackle mild-to-moderate depression (National Institute for Clinical Excellence, 2004). The recent review of self-help by the National Institute for Mental Health in England confirmed that it is cognitive–behavioural therapy (CBT) self-help that has an evidence base rather than self-help per se (Lewis et al, 2003).

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