scholarly journals Evaluation of evidence grades in psychiatry and psychotherapy guidelines

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Lisa Löhrs ◽  
Mirjam Handrack ◽  
Ina Kopp ◽  
Frank Jessen ◽  
Elias Wagner ◽  
...  
Keyword(s):  
Mental Health ◽  
Treatment Guidelines ◽  
Scientific Evidence ◽  
Decision Making Process ◽  
Evidence Based ◽  
Published Evidence ◽  
Psychotherapy Guidelines ◽  
The Mean ◽  
Evaluation Of Evidence ◽  
Related Pattern

Abstract Background Information regarding the distribution of evidence grades in psychiatry and psychotherapy guidelines is lacking. Based on the German evidence- and consensus- based (S3) psychiatry and psychotherapy and the Scottish Intercollegiate Guidelines Network (SIGN) treatment guidelines, we aimed to specify how guideline recommendations are composed and to what extent recommendations are evidence-based. Methods Data was collected from all published evidence- and consensus-based S3-classified psychiatry and psychotherapy guidelines. As control conditions, data from German neurology S3-classified guidelines as well as data from recent SIGN guidelines of mental health were extracted. Two investigators reviewed the selected guidelines independently, extracted and analysed the numbers and levels of recommendations. Results On average, 45.1% of all recommendations are not based on strong scientific evidence in German guidelines of psychiatry and psychotherapy. A related pattern can be confirmed for SIGN guidelines, where the mean average of recommendations with lacking evidence is 33.9%. By contrast, in the German guidelines of neurology the average of such recommendations is 16.5%. A total of 24.5% of all recommendations in the guidelines of psychiatry and psychotherapy are classified as level A recommendations, compared to 31.6% in the field of neurology and 31.1% in the SIGN guidelines. Related patterns were observed for B and 0 level recommendations. Conclusion Guidelines should be practical tools to simplify the decision-making process based on scientific evidence. Up to 45% of all recommendations in the investigated guidelines of psychiatry and psychotherapy are not based on strong scientific evidence. The reasons for this high number remain unclear. Possibly, only a limited number of studies answer clinically relevant questions. Our findings thereby question whether guidelines should include non-evidence-based recommendations to be methodologically stringent and whether specific processes to develop expert-opinion statements must be implemented.

Cluster analysis of novel isometric strength measures produces a valid and evidence-based classification structure for wheelchair track racing

2017 ◽  
Vol 52 (17) ◽  
pp. 1123-1129 ◽  
Author(s):  
Mark J Connick ◽  
Emma Beckman ◽  
Yves Vanlandewijck ◽  
Laurie A Malone ◽  
Sven Blomqvist ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
Classification System ◽  
Scientific Evidence ◽  
Activity Limitation ◽  
Isometric Strength ◽  
Similar Degree ◽  
Evidence Based ◽  
Strength Tests ◽  
The Mean ◽  
Classification Structure

BackgroundThe Para athletics wheelchair-racing classification system employs best practice to ensure that classes comprise athletes whose impairments cause a comparable degree of activity limitation. However, decision-making is largely subjective and scientific evidence which reduces this subjectivity is required.AimTo evaluate whether isometric strength tests were valid for the purposes of classifying wheelchair racers and whether cluster analysis of the strength measures produced a valid classification structure.MethodsThirty-two international level, male wheelchair racers from classes T51–54 completed six isometric strength tests evaluating elbow extensors, shoulder flexors, trunk flexors and forearm pronators and two wheelchair performance tests–Top-Speed (0–15 m) and Top-Speed (absolute). Strength tests significantly correlated with wheelchair performance were included in a cluster analysis and the validity of the resulting clusters was assessed.ResultsAll six strength tests correlated with performance (r=0.54–0.88). Cluster analysis yielded four clusters with reasonable overall structure (mean silhouette coefficient=0.58) and large intercluster strength differences. Six athletes (19%) were allocated to clusters that did not align with their current class. While the mean wheelchair racing performance of the resulting clusters was unequivocally hierarchical, the mean performance of current classes was not, with no difference between current classes T53 and T54.ConclusionsCluster analysis of isometric strength tests produced classes comprising athletes who experienced a similar degree of activity limitation. The strength tests reported can provide the basis for a new, more transparent, less subjective wheelchair racing classification system, pending replication of these findings in a larger, representative sample. This paper also provides guidance for development of evidence-based systems in other Para sports.

What makes a landscape contemplative?

2016 ◽  
Vol 45 (1) ◽  
pp. 7-25 ◽  
Author(s):  
Agnieszka A Olszewska ◽  
Paulo F Marques ◽  
Robert L Ryan ◽  
Fernando Barbosa
Keyword(s):  
Mental Health ◽  
Statistical Tests ◽  
Scientific Evidence ◽  
Reliability And Validity ◽  
Environmental Values ◽  
Green Spaces ◽  
Evidence Based ◽  
Expert Evaluation ◽  
Mental Health Benefits ◽  
Validity Measures

For centuries, landscape architects, architects, and urban planners have been designing outdoor green spaces for one to contemplate. In today’s urban realm, we can understand a contemplative space more specifically as one joining esthetic and environmental values with mental health benefits for its visitors. So far, the concept of contemplativeness of a space has not been operationalized and a definitive list of design principles of such a space has not been developed. In response to this gap of knowledge, we have identified a set of features that may be used in order to design and create a space of contemplation within seven categories: Landscape Layers, Landform, Vegetation, Light and Color, Compatibility, Archetypal Elements, and a Character of Peace and Silence. The developed framework is based on development and analysis of a Contemplative Landscape Questionnaire. This instrument was developed based on literature review and Delphi expert evaluation of multiple landscapes. The statistical tests on the Contemplative Landscape Questionnaire revealed satisfactory reliability and validity measures, which provided evidence-based support for the efficacy of designed spaces. This approach could enhance the practice of landscape architects and urban designers by reinforcing intuition-based designs with scientific evidence. The developed framework can also serve to identify contemplative spaces for subsequent research purposes.

Training trainers in risk assessment

1997 ◽  
Vol 170 (S32) ◽  
pp. 35-36 ◽  
Author(s):  
Michael Harris
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Scientific Evidence ◽  
Rapid Assessment ◽  
The Other ◽  
Decision Making Process ◽  
Evidence Based ◽  
Apprenticeship Model ◽  
Based Medicine ◽  
Early Training

Risk assessment has always been an essential part of all medical practice, and doctors have always been trained to make rapid assessment of risk. Much of the early training of doctors in both medicine and surgery centres on risk assessment. However, the method of acquiring that knowledge is predominantly through the apprenticeship model with observation by the trainee of the trainer's decision-making process. Those decisions, however, are often skewed and biased by a whole variety of influences, rather than always being based on scientific evidence. Clearly the increasing influence of evidence-based medicine will help this. At one extreme, however, there are heroic surgeons taking unnecessary risk or taking on cases which might more appropriately have been left without treatment, and at the other extreme, consultants who may feel demoralised or depressed might well become nihilistic about medicine and therefore might not attempt to treat cases that are treatable.

European psychiatric treatment guidelines: is the glass half full or half empty?

2005 ◽  
Vol 20 (8) ◽  
pp. 554-558 ◽  
Author(s):  
M. Stiegler ◽  
C. Rummel ◽  
K. Wahlbeck ◽  
W. Kissling ◽  
S. Leucht
Keyword(s):  
Development Process ◽  
Treatment Guidelines ◽  
Psychiatric Treatment ◽  
Evidence Based ◽  
Basic Principles ◽  
Additional Item ◽  
Agree Instrument ◽  
The Mean ◽  
Based Medicine

AbstractPurposeWe assessed the quality of European treatment guidelines in the field of mental health that have been produced by national psychiatric associations. The main focus was the question of whether the development process of the guidelines followed basic principles of evidence-based medicine.MethodsSixty-one European clinical practice guidelines from 14 countries, published between 1998 and 2003, were assessed using the ‘Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument’. The domain score was calculated for each of the six domains of the AGREE instrument. The seven items of the domain “rigor of development” and one additional item concerning national particularities were assessed in detail.ResultsThe mean scores in the six domains were rather low, although the quality varied among the different guidelines. The highest mean score was obtained in the domain clarity and presentation (70.8% S.D. 23.5), the lowest on editorial independence (19.7% S.D. 29.3). The recommendations of about half of the assessed guidelines could be considered to be evidence-based.ConclusionThe assessed guidelines showed a broad range of quality: some producers attached importance to an evidence-based development process; but in spite of this, a large number of guidelines were only of middling quality. As national particularities are only rarely mentioned and the development process of guidelines is complex, an international collaboration that aims toward the production of shareable guidelines might be promising.

scholarly journals Psychiatric Pharmacogenomics: How to Integrate into Clinical Practice

CNS Spectrums ◽  
2017 ◽  
Vol 22 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Stephen M. Stahl
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Treatment Guidelines ◽  
Specific Treatment ◽  
Evidence Based ◽  
First Line ◽  
Specific Symptom ◽  
Symptom Profile ◽  
Evidence Based Treatments ◽  
Mental Health Practices

Pharmacogenomic testing can be integrated into modern mental health practices to help select psychotropic drugs for individuals who have failed first-line evidence-based treatments. This can be done by the process of “equipoise”—namely, balancing the weight of all available evidence. That evidence now includes not only diagnosis-specific treatment guidelines and “personalized” patient information, such as an individual’s specific symptom profile, past response to medications, side effects, family history, and patient preference, but also “precision medicine,” which incorporates the ever-expanding base of pharmacogenomic evidence for how an individual’s own biomarkers alter the odds for that individual’s treatment response or treatment intolerance.

scholarly journals Professionalism and Evidence-Based Mental Health Care: The Roadblocks and New Ways

2019 ◽  
Vol 11 (11) ◽  
pp. 33
Author(s):  
Oyeyemi Olajumoke Oyelade ◽  
Agathe Uwintonze ◽  
Munirat Olayinka Adebiyi
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Nursing Care ◽  
Evidence Based Practice ◽  
Scientific Evidence ◽  
World Health Organisation ◽  
World Health ◽  
Evidence Based ◽  
Evidence Based Care

BACKGROUND: Knowledge acquisition and knowledge update through research remains an important factor to ensure quality and cost-effective care, which is the hallmark of professionalism and evidence-based care. Knowledge is vital in nursing due to the centrality of nursing to health care. More importantly is mental health because mental health is primary to general health, just as nursing is the heartbeat of health care. This makes the issue of mental health care, a necessary service that cannot be overemphasised. The World Health Organisation declares mental health as the essential form of health that needs to be acquired without which all others form of health may not be achieved. Further to this, the global emphasis on care and recovery of lost mental health is on the increase. This, therefore, makes evidence-based mental health care, a necessity and not a choice. AIM: To discuss evidence-based nursing, the benefits, challenges and opportunities. METHODOLOGY: This article adopts the traditional review method to assess the concept of discussion on mental health care, evidence-based practice and professionalism. FINDINGS: The term evidence-based care Is gaining recognition in a variety of professions and organisations. The use of evidence in nursing care is influenced by policies, knowledge of time management, availability of human resources, practice autonomy and attitude of professionals. However, the use of evidence-based practice is not debatable. CONCLUSION: The use of scientific evidence for validating nursing care is germane. This article exposed the barriers to evidence-based mental health nursing and the way forward. 

scholarly journals Physiotherapy and Mental Health

2019 ◽  
Vol 18 (2) ◽  
pp. 208-214
Author(s):  
Michel Probst
Keyword(s):  
Mental Health ◽  
Physical Activity ◽  
Healthy Lifestyle ◽  
Scientific Evidence ◽  
Evidence Based ◽  
Appropriate Care ◽  
Wide Range ◽  
The World ◽  
Movement Awareness ◽  
World Confederation

Physiotherapy in mental health care and psychiatry is recognized by the World Confederation for Physical Therapy (WCPT) as a specialty within physiotherapy. Physiotherapy in mental health offers a wide range of interventions in regard of body functions, physical activity, exercises, sensory, body and movement awareness, stress and tense regulation and pain management, based on clinical and scientific evidence-based literature. Additionally, the promotion of a healthy lifestyle and “physio-education” (i.e. the process of providing education and information regarding specific physiotherapy related topics to patients and their family members) should be a responsibility of the physiotherapist. This paper gives a short overview of the interventions in the field of mental health to offer appropriate care to a specific vulnerable but growing group in our society.

scholarly journals Social sustainability and mental health: a threat to evidence-based practice?

2016 ◽  
Vol 13 (1) ◽  
pp. 4-5 ◽  
Author(s):  
Daniel Maughan ◽  
Mark Burgess
Keyword(s):  
Mental Health ◽  
Evidence Based Practice ◽  
Scientific Evidence ◽  
Social Sustainability ◽  
Evidence Based ◽  
Considerable Influence ◽  
The Social ◽  
Mental Health Treatments ◽  
Ethics And Politics

The availability and use of mental health treatments are influenced by many different factors. Prominent among these are scientific evidence, cost, ethics and politics. However, the social sustainability of treatments can also have a considerable influence on their use.

scholarly journals Apps With Maps—Anxiety and Depression Mobile Apps With Evidence-Based Frameworks: Systematic Search of Major App Stores (Preprint)

2019 ◽  
Author(s):  
Jamie M Marshall ◽  
Debra A Dunstan ◽  
Warren Bartik
Keyword(s):  
Mental Health ◽  
Dialectical Behavior Therapy ◽  
Behavioral Therapy ◽  
Therapeutic Interventions ◽  
Anxiety And Depression ◽  
Future Research ◽  
Evidence Based ◽  
Health Apps ◽  
App Store ◽  
Published Evidence

BACKGROUND Mobile mental health apps have become ubiquitous tools to assist people in managing symptoms of anxiety and depression. However, due to the lack of research and expert input that has accompanied the development of most apps, concerns have been raised by clinicians, researchers, and government authorities about their efficacy. OBJECTIVE This review aimed to estimate the proportion of mental health apps offering comprehensive therapeutic treatments for anxiety and/or depression available in the app stores that have been developed using evidence-based frameworks. It also aimed to estimate the proportions of specific frameworks being used in an effort to understand which frameworks are having the most influence on app developers in this area. METHODS A systematic review of the Apple App Store and Google Play store was performed to identify apps offering comprehensive therapeutic interventions that targeted anxiety and/or depression. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was adapted to guide this approach. RESULTS Of the 293 apps shortlisted as offering a therapeutic treatment for anxiety and/or depression, 162 (55.3%) mentioned an evidence-based framework in their app store descriptions. Of the 293 apps, 88 (30.0%) claimed to use cognitive behavioral therapy techniques, 46 (15.7%) claimed to use mindfulness, 27 (9.2%) claimed to use positive psychology, 10 (3.4%) claimed to use dialectical behavior therapy, 5 (1.7%) claimed to use acceptance and commitment therapy, and 20 (6.8%) claimed to use other techniques. Of the 162 apps that claimed to use a theoretical framework, only 10 (6.2%) had published evidence for their efficacy. CONCLUSIONS The current proportion of apps developed using evidence-based frameworks is unacceptably low, and those without tested frameworks may be ineffective, or worse, pose a risk of harm to users. Future research should establish what other factors work in conjunction with evidence-based frameworks to produce efficacious mental health apps.

scholarly journals (A15) Trauma Signature Analysis: Evidence-Based Guidance for Disaster Mental Health Response

2011 ◽  
Vol 26 (S1) ◽  
pp. s4-s4 ◽  
Author(s):  
J.M. Shultz ◽  
Y. Neria ◽  
Z. Espinel ◽  
F. Kelly
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Risk Factor ◽  
Interpersonal Violence ◽  
Psychosocial Support ◽  
Scientific Evidence ◽  
Psychological Impact ◽  
Evidence Based ◽  
Disaster Event ◽  
Psychological Risk

IntroductionThe first decade of the 2000s has advanced the field of mental health and psychosocial support (MHPSS) in disasters by providing expert consensus guidance. Nevertheless, MHPSS response to major disasters is frequently uncoordinated and rarely based on scientific evidence. Moreover, MHPSS response is not customized to the unique constellation of stressors and psychological risk factors that distinguish each disaster event. To address this lack of science and specificity, we have developed trauma signature (TSIG) analysis.MethodsTSIG analysis consists of the following steps. Risk factors for disaster-related psychological distress and psychopathology (e.g., PTSD, depression) are continuously documented, updated, and refined. When disaster strikes, situation reports (sitreps) are issued in the early aftermath. We examine initial sitreps to determine the presence and intensity of evidence-based risk factors, subsumed under the headings of exposure to hazards, loss, and change. We estimate the size of the affected population. We rapidly create an initial TSIG and translate findings into actionable guidance regarding probable MHPSS needs for services and personnel.ResultsWe have constructed TSIGs for prominent 2010 disasters: Haiti earthquake, Deepwater Horizon oil spill, and Pakistan monsoonal flooding. Psychological risk factor profiles contrast sharply across these three salient events. Regarding exposure to hazards, numbers of persons experiencing physical injury and perceiving threat to life are highly divergent. Losses differ dramatically when quantified in terms of deaths, numbers bereaved, homes and livelihoods lost, and economic toll. The degree of lifestyle and societal change, including displacement, lack of survival needs, lack of security, and interpersonal violence, also differentiates the psychological impact of these disparate events.ConclusionTSIG analysis can be used to provide rapid post-impact/pre-deployment MHPSS response guidance based on risk factor assessment. Using TSIG analysis, MHPSS response can be tailored and timed to the defining features of the disaster event.

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