Question
We have discovered that there are numerous threats to the environment such as overpopulation, global warming, disposal of wastes, and even eco-terrorism.   Do you believe that these concerns are real or are they overstated to satisfy industrial and political agendas?  Of these problems, what concerns you the most?
Answer
1. Introduction
We find ourselves increasingly aware of major concerns about issues in the environment; some so widely known that those not “environmentally aware” are aware of only by name. Depletion of the ozone layer, widespread deforestation, air and water pollution, and the extinction of countless species are all leading examples of issues that have far greater effects than most of us realize. It is important to realize that every action has a reaction, even if we do not see the effects firsthand. These problems are all contributed to human interference in the environment, directly or indirectly. With an expanding population comes the need for more land to support the greater numbers of people, and while providing living space may be a direct cause of habitat destruction, the greater indirect cause is the need for more food sources and economic growth. Economic well-being is important to people all over the world, and this has driven the need for resources and energy. Using cleaner, sustainable energy sources and preventing energy waste can reduce harmful effects on the environment. Unfortunately, the trend is that richer countries are able to move in this direction of sustainable energy, while those countries and communities who are poor often rely on cheaper, dirtier energy sources. These contribute to not only pollution, but damage to ecosystems and health problems for the inhabitants. All these issues are deeply interconnected and are all contributors to the overall issue of global change. This report aims to explain the progression and interconnections of these issues in a logical manner, and to come out with a clearer understanding of the bigger issue at hand. The purposes of my work are to explain and demonstrate through various examples and statistics the vast array of environmental issues that are of global concern today. By increasing awareness and understanding of these issues, we can hope to enable a world that will seek to prevent further damage to the environment, and through active participation each make an impact as an individual. This leads to the next purpose of this work, to show that all these issues are of equal importance when considering their effects on the environment. It is quite often the case that people are aware of only the most publicized issues such as pollution and climate change, and while being big issues in themselves, they are all rooted from a wide array of other issues discussed in this report. An awareness of the global effects and solutions of these issues is necessary on all levels from the individual to the political, so in knowing that the big issue is global change, individuals who are better informed can make better choices and influence others to do the same.
1.1. Background
In the 1960s, concern for the environment resulted in an explosion of environmental legislation and the establishment of such agencies as the U.S. Environmental Protection Agency (EPA) and the UK Environment Agency. These agencies were designed to protect the environment and also to regulate the exploitation of the environment—development, industry, and land use. In many ways, given its concern for environmental sustainability—the ability to have our increasing material needs met without jeopardizing the quality of life now and for future generations—environmental economics is part and parcel of ecological economics. This field, which emerged in the late 1980s, is a policy-driven effort to change the way the economy affects the environment in largely the same way environmental economics emerged from the concerns of the 1960s regarding environmental degradation. The primary difference between the two is that while ecological economists are inclined to regulate the economy for the sake of environmental protection, environmental economists are inclined to change environmental policy using market-based tools. Despite the economic and environmental concerns, there are many who criticize the SMS process due to its overemphasis on science and economics and its failure to adequately involve the public in defining what is meant by the “healthy ecosystem” that is to be restored or preserved. This charge is founded on a belief that a healthy ecosystem is one whose preservation allows for human activities and settlement patterns that have already encroached upon the ecosystem. Though the SMS process is still new and its efficacy still unproven, the current trend in environmental management—whether market-based or regulatory—is consistent with the field of environmental economics and its underlying doctrine that the environment is valuable for the sake of human welfare. This holds great promise for graduates of economics programs.
1.2. Purpose of the Work
It is asserted that in order for a student to devise solutions for the future, he or she intending to begin a career in these areas should first have an understanding of the problems and their scope. Therefore, a major area of this work is to address the paradox that we face in 1992: that we know the environment is threatened, but we still do not understand precisely why this is so. It is hoped that these students will find the work directly and thoroughly addressing their needs and, in doing so, develop increased awareness and concern for their own environment.
The primary objective of this work is to bring the subject of environmental threats to the attention of students and, in so doing, foster concern and eventually collective action on the part of such readers. The importance of this issue is, of course, enormous, and it is the intention of the writer that some of this concern is reflected in the work to be found here. As a biology teacher, I have become increasingly aware of the desperation of the environmental problems facing the coming generation of students. Unfortunately, the subject is complex and interdisciplinary on one hand, while on the other, there is a wealth of biased and often contradictory literature available. It is therefore difficult to know where to begin in presenting a clear picture of the threats in 1992, and thus it is with some relief that the work is completed. The target audience, however, are not biologists, but rather students of environmental science, geography, economics, and social/policy studies studying within the tertiary sector.
2. Environmental Threats
2.1. Overpopulation
2.1.1. Impact on Resources
2.1.2. Pressure on Ecosystems
2.2. Global Warming
2.2.1. Rising Temperatures
2.2.2. Melting Ice Caps
2.3. Waste Disposal
2.3.1. Pollution of Land and Water
2.3.2. Health Hazards
2.3.3. Recycling Efforts
2.4. Eco-terrorism
2.4.1. Definition and Examples
2.4.2. Impact on Environmental Security
3. Debate: Real Concerns or Political Agendas?
3.1. Arguments for Real Concerns
3.1.1. Scientific Evidence
3.1.2. Global Consensus
3.2. Arguments for Overstated Concerns
3.2.1. Economic Interests
3.2.2. Political Manipulation
4. Personal Concerns
4.1. Evaluation of Threats
4.2. Identifying the Most Pressing Concern
4.2.1. Impact on Future Generations
4.2.2. Immediate Environmental Consequences
5. Conclusion

question
Discuss treatment recommendations that are supported by the literature for a client facing moderate depression. Be sure to include suggestions from both psychological and biological perspectives. For which would you advocate most strongly, and why?
Answer
1. Psychological Treatment Recommendations
Recent meta-analyses and reviews have found that the effects of CBT for depression are large and that it is a highly effective treatment, particularly for outpatients. Beck’s original cognitive therapy (CT) model has been modified over the years, and there are now several manual-based therapies which are informed by CBT principles.
CBT also involves behavioral strategies, regular activity, and routine scheduling. It assesses the patient’s current level of activity and routine compared to what it was prior to the onset of depression or to a previously non-depressed person of the same age. It is suggested that a lack of positive activities or the adoption of avoidant behaviors may serve to maintain or further lower an individual’s mood. In these instances, activity scheduling will be used to plan and implement activities which are aimed to increase positive mood, a sense of achievement, or pleasure.
The most well-known cognitive-behavioral intervention for depression is the ABC model. This suggests that an individual’s thoughts (B) about an event or problem directly cause their emotional and behavioral responses (C). This is a result of the activating event (A). Often in depression, negative thoughts about self, the world, and the future are triggered by a negative event or situation. The ABC model is useful in discovering the relationship between thoughts and mood, which in turn can be used to test the validity of the particular thoughts. If the thoughts are found to be unrealistic or unhelpful, it is likely that there is a significant improvement in mood by changing them to a more realistic or helpful alternative. This method is usually used in conjunction with monitoring an individual’s mood and thought diary.
Cognitive Behavioral Therapy (CBT) is the most well-established evidence-based psychological treatment for depression in children, adolescents, adults, and older adults. It is designed to be a short-term, problem-specific approach which typically takes 12-16 weeks to complete. CBT is a highly directive therapy, which is based on the cognitive model: that depression is caused by a particular pattern of negative thinking which, in turn, leads to changes in behavior and mood. Treatment is focused on the present and is goal-oriented.
1.1. Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is a widely used method for moderating depression (Gloaguen et al., 1998; Veale, 2008). Its effect has been demonstrated in numerous controlled trials and a variety of patient groups (Dobson, 1989; Hollon et al., 2002). CBT focuses on helping the patient to overcome a range of psychological difficulties. The concept of the therapy is that how we feel and what we do is determined by the way we think. This can be seen in Figure 1 when the patient has automatic negative thoughts about a specific situation. This will lead to a negative mood and no longer enjoying the activities that are usually found pleasurable. This can then spark a vicious cycle, making the patient become more and more depressed. The role of the therapist is to identify the negative thoughts and bring them to the attention of the patient. This can be achieved by collaboration with the patient using guided discovery. The automatic thoughts can be identified during the session or the therapist can assign the patient homework to monitor their moods at set times during the week and record the thought that coincided with the mood when it was lowered (Beck, 1995). Once the thought has been identified, the next step is to assess whether the thought is rational and if there is an alternative explanation. This is done by examining the evidence that the thought exists and creating a ‘thought record’. This thought record compares the positive and negative evidence for the thought and then looks for alternative explanations and if they are believed to be true. If the negative thought is deemed to be true, the third step is to try and decatastrophize and reduce the belief in the thoughts. This method of analysis also applies to the core beliefs of the patient and the way they view themselves in the world. The goal of this is to relieve the distress by resolving the psychological difficulties and disturbing thoughts which in turn will change the patient’s feelings and behavior (Beck, 1976). This can be contrasted to other therapies that focus on the past of the patient with the aim of bringing an understanding as to why the patient may be depressed. CBT only looks at the past in terms of identifying the cause of a psychological difficulty and does not dwell on historical issues. Beck’s model has been known to exhaust cognitive therapy and to try and define specific similarities that exist among patients with the same psychological difficulties, e.g. depression (Dobson, 1989). This has led to recent attempts of a more precise treatment based on an individual formulation. Step prologue CBT has also been proven to be an effective relapse prevention tool for recurrent depression and in many cases has a higher rate of improvement than various antidepressants (Bockting et al., 2009).
1.2. Interpersonal Therapy (IPT)
This IPT theory was developed in 1984 by Klerman and his colleagues in a medication treatment study at the University of North Carolina at Chapel Hill. Klerman’s group and an NIMH convened team subsequently refined, further developed and tested the psychotherapy over the next decade. IPT is a manual-based treatment with efficacy in the treatment of a range of psychiatric illnesses. It was first tested in major depressive disorder and then adapted for use in a variety of other mood and non-mood disorders. IPT has been most extensively tested in major depressive disorder where it is a monotherapy of equal potency to medication treatment and there is a wealth of converging evidence supporting its use. IPT theorizes that psychiatric illness can be termed a medical state with psychological symptoms. It posits that there are sometimes events which precipitate the onset of a psychiatric disorder, whether it be major events or a more insidious slow change. Once an episode is established, this will have effects on the interpersonal life situation of the sufferer. A depressive episode can have a profound effect on a person’s identity and character, and they may become this aggregated illness self. IPT understands the illness as separate from the patient and works via the management of specific symptoms and the prevention of future episodes to relieve the illness’s effect on the person’s identity. This effect is achieved through an effect on one of the patient’s four Interpersonal Problem Areas.
1.3. Mindfulness-Based Cognitive Therapy (MBCT)
Cognitive therapy provides a cognitive framework, which is treated as a simulation of the problems or a hypothesis (Beck, Rush, Shaw & Emery, 1979). This model is used to test the validity of the assumptions to identify areas of conflict in the brain and revise the assumptions (Teasdale, 1988). Although effective, it is difficult for the depressed patient to understand how this process can affect change, cognitive insight into one’s problems does not suffice to produce recovery from mood disorders. Instead, patients need to learn to disengage from the unconstructive modes of processing the facilitative of depressive relapse and learn a mode of processing that is more adaptive when recognizing early signs of progression into mood disturbance (Teasdale, Segal & Williams, 1995). Mindfulness is a mode of processing that is the opposite of autopilot, it enables cognitive reappraisal concerning the habit of a certain automatic process (i.e. becoming lost in rumination) and is seen as an alternative or precursor to CBT regarding cognitive change strategies (Teasdale, 1999). It is this principle that is the focus of Mindfulness-Based Cognitive Therapy (MBCT) for the prevention of major depressive relapse. MBCT was developed by Segal, Williams, and Teasdale (2002) as a psychological intervention designed to prevent the relapse of depression by teaching people with a history of depression to recognize the early signs of warning that a depressive relapse may occur and to disengage from the mode of mind that can draw them back into depression. This is achieved by cultivating mindfulness, an awareness that is in the present moment and adopting an accepting orientation to what is (Kabat-Zinn, 1990). The rationale of MBCT is in its understanding that a current episode of depression is characterized by automatic disengagement from the present moment into a rumination concerning the self and automatic assimilation of mood with its solutions being to attempt to fix the mood state by thinking and acting reactively to it, therefore avoidance of recurrence is best achieved by teaching patients to foster a mode of being that is detached, focused, and non-judgmental.
1.4. Behavioral Activation Therapy
Behavioral activation (BA), a component within the third wave of behavior therapy, constitutes a simple, yet elegant approach to treating depression. Its basis on the reinforcement contingency model and its use of functional assessment has allowed for vast developments within the treatment of depression and more importantly in the experimental and applied psychological field. From its theoretical roots to its current standing, BA has far-reaching implications in our understanding and treatment of depression. Simple, yet elegant, the reinforcement contingency model for depression states that depression is a disorder of low response-contingent positive reinforcement. In more understandable language, depression is a disorder occurring when positive outcomes in life no longer reinforce positive behaviors necessary for healthy living. With less activity and fewer chances for positive reinforcement from the environment, a person becomes subtly withdrawn or inactive. This state is self-perpetuating – continued inactivity leads to fewer experiences of reward or pleasure, resulting in depression that becomes more severe. The final result is always an increase in avoidance behaviors and generally low response-contingent positive reinforcement. This simple theory proposed by Lewinsohn represents a powerful explanation of the nature of depressive disorders and suggests an easy place to begin for treatment. Lewinsohn states that “a person who is depressed can be helped to recover if the positive reinforcement contingencies can be increased in the person’s life”. By targeting the issue of positive reinforcement, the hallmark of BA is its idiographic methodology which continues to influence assessment and experimental research.
2. Biological Treatment Recommendations
2.1. Selective Serotonin Reuptake Inhibitors (SSRIs)
2.2. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
2.3. Tricyclic Antidepressants (TCAs)
2.4. Monoamine Oxidase Inhibitors (MAOIs)
3. Combined Psychological and Biological Treatment Approaches
3.1. Cognitive Behavioral Therapy with Medication
3.2. Interpersonal Therapy with Medication
3.3. Mindfulness-Based Cognitive Therapy with Medication
3.4. Behavioral Activation Therapy with Medication
4. Factors to Consider in Treatment Selection
4.1. Severity of Symptoms
4.2. Treatment History
4.3. Potential Side Effects
4.4. Patient Preferences and Values
5. Advocacy for Psychological Treatment
5.1. Efficacy of Psychological Approaches in Research
5.2. Focus on Long-Term Coping Skills
5.3. Potential for Personal Growth and Insight
6. Advocacy for Biological Treatment
6.1. Effectiveness of Medication in Symptom Reduction
6.2. Quick Onset of Action
6.3. Potential for Relief from Physical Symptoms

question 
Should an incompetent inmate be forcibly medicated to restore competency for execution? Why or why not?

Answer
Should an incompetent inmate be forcibly medicated to restore competency for execution? Why or why not?
1. Introduction
In the United States, criminal defendants may not be tried or punished for a crime while they are incompetent to do so. Godinez v. Moran, 509 U.S. 389, 391 (1993). This principle is well established and has been the law in the United States since the nation was founded. Incompetent criminal defendants may be confined to a mental health facility for treatment designed to restore their competency. During the past ten years, there has been a significant increase in the number of incompetent defendants whose cases are pending in the criminal justice system due to the shift in many states from custodial care in state hospitals to community-based treatment. It is estimated that there are presently over 15,000 defendants incarcerated in jails who are deemed incompetent to stand trial and are awaiting transfer to state mental health facilities (Slobogin, 1993). The increase in the number of incompetent defendants in the criminal justice system and the trend toward community-based restoration treatment has brought the issue before the courts and created a need for clear legal standards to govern the involuntary administration of antipsychotic medication to restore competency.
1.1 Definition of incompetence
Diminished Capacity Was formerly considered as a full defense. It is not incompetence in the sense that the defendant did not understand the charges or the legal process, but rather it is a non-capital murder charge with the premise that the defendant’s capacity was so diminished that he was unable to entertain the legal and moral intent requisite to the commission of the crime. Now regarded as a partial defense, this will still have bearing on execution-related issues as the defendant may have a later tenuous understanding of the reason for the sentence and still be more likely to plead incompetence to avoid execution. This would entitle him to a competency evaluation at the time of the proceeding.
Incompetency Incompetency is a legal rather than a psychiatric term. It refers to a defendant’s current state of mind rather than his factual knowledge in regard to the legal process and its implications. The criteria for deciding whether a defendant is competent varies from state to state, but the standard is generally a determination of the defendant’s rational and factual understanding of the proceeding and an ability to consult with his attorney. While the term is not ambiguous in itself, its interpretation and requisite level of functioning have yet to be universally agreed upon (Pinals & Mossman, 1986). When the Supreme Court first addressed the issue of competency in Dusky v United States (1960), they stated that a defendant is competent to stand trial if he has sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding. Now, with the surge in research regarding competency restoration, more specific psycho-legal standards are being developed which better define various components of incompetence.
1.2 Importance of competency for execution
Proponents of restoration cite the therapeutic benefit of restoration efforts, the underlying goal of the criminal justice system to serve justice by punishing those responsible for wrongdoing, and general moral and ethical considerations relevant to equal and fair treatment of mentally disordered capital defendants. In contrast, critics of restoration believe that it is unfair and discriminatory to prolong the incarceration of mentally disordered persons solely because they are facing a capital charge. They argue that a mentally disordered defendant who is not facing a capital charge would not receive the same level of treatment simply to render him or her fit to stand trial, and that it is discriminatory to force treatment solely because execution is at stake (Grisso et al., 2005). This is complicated by the absence of a clear answer in the question of how long it is ethically and morally justifiable to try to restore competency for a consequence that becomes increasingly elusive and in effect serves as life without parole.
A finding of incompetence to be executed in the United States now results in indefinite detention (Sell v. United States, 2003). Because execution is the legally prescribed consequence for a capital crime, there is a public assumption that capital defendants are fit to be executed. Even though there is no medical evidence to suggest that persons with mental illness are at increased risk of danger to self or others compared with mentally competent persons (Appelbaum, 2001), there remains a societal appetite for removal of mentally disordered individuals from the community. People found incompetent to be executed are now often detained in high-security hospital facilities that resemble prisons more than therapeutic settings. In such locales they may be confined alongside persons committed through the criminal justice system, possibly resulting in long periods of incarceration with no hope of release (Slobogin, 1999; Bonnie et al., 2002). This is a far cry from the outcome in Jackson’s era, when a finding of incompetence led to quick release back to the community for those thought unlikely to regain their fitness (Perlin and Dorfman, 2009).
1.3 Ethical considerations
This leads us to ask the question of what is to be achieved by forcibly medicating an inmate. If it is said that it is done so the state can be “freed of the administrative burdens that court proceedings place on the state” and it “clears the docket of criminal cases,” then it would be argued that it is not in the interest of the inmate, but the state. This is shown by the fact that it creates an opportunity for the trial to continue should the inmate be restored to competency and lead to the charges not being dismissed. The death penalty is said to be a punishment for the seriousness of the crime committed and will be carried out in furtherance of justice.
Another important aspect to consider is whether forcibly medication violates the inmate’s Eighth Amendment rights. This is the right not to be subjected to cruel and unusual punishment. According to the Eighth Amendment, it would be unconstitutional to execute a person who is insane. Since medication is used in an effort to have the inmate carry on with the execution, it would be likely that the real intention would be to try and execute the inmate who otherwise would not be fit to do so. This is certainly unnerving and the use of the death penalty on an incompetent person may be considered cruel (2004). Say it is determined that a mentally ill inmate who was on death row would be treated and restored to competency. The trial court will lose jurisdiction of the inmate and he will be returned to the penal system because charges were not dismissed (1994). There is a real chance that the inmate who is only restored to competency to stand trial will have to face the front of court again and his charge and penalty will not be dismissed. This is another real possibility that medication will result in an incompetent person being sentenced to death.
2. Arguments in favor of forcibly medicating incompetent inmates
2.1 Ensuring justice is served
2.2 Upholding the rule of law
2.3 Providing closure to victims’ families
3. Arguments against forcibly medicating incompetent inmates
3.1 Violation of human rights
3.2 Ethical implications of involuntary medication
3.3 Potential for misdiagnosis or errors
4. Alternatives to forcible medication
4.1 Rehabilitation and treatment programs
4.2 Postponing the execution until competency is restored
4.3 Reviewing the validity of the death penalty
5. Legal considerations
5.1 Constitutional rights of inmates
5.2 Precedents and court rulings
5.3 Balancing the rights of the inmate and the state
6. Psychological evaluations and assessments
6.1 Diagnostic criteria for incompetence
6.2 Role of mental health professionals
6.3 Assessing the potential for restoration of competency
7. Implications for the criminal justice system
7.1 Impact on public perception and trust
7.2 Challenges in implementing forcible medication
7.3 Ensuring transparency and accountability
8. International perspectives on forcible medication
8.1 Comparison of policies in different countries
8.2 Human rights implications on a global scale
8.3 International standards and recommendations
9. Case studies and examples
9.1 Notable cases involving forcible medication
9.2 Outcomes and controversies surrounding these cases
9.3 Lessons learned and potential improvements
10. Conclusion
10.1 Summary of arguments for and against forcible medication
10.2 Considerations for future policy and legal reforms
10.3 Final thoughts on the ethical dilemmas involved

Question
For this discussion, consider the ways in which technology and informatics are used to support evidence-based practice. Please address each of the following questions in your discussion response for this week:
Choose a specific evidence-based practice (examples: CAUTI reduction, sepsis protocol, SCIP protocol, bedside shift report, etc.).
Describe how technology and informatics are used to support the interventions used in practice?
Describe how employing evidence-based practice guidelines improve patient outcomes?
What benefits and challenges have you experienced with (the integration of) information technology in your practice?
What strategies did you, or could you, use to overcome these challenges?
Answer
1. Introduction
Informatics is any practice that involves the use of information. It involves using information and applying cognitive and practical skills for manipulating the information (knowing), and comparing this with the various health sciences aiming at a better understanding of health problems and evidence leading to decisions or actions (doing). Informatics has a broad application across health care including management data on service utilization, assessing population health needs, disease management, and consumers making informed decisions about their health. For EBP, informatics can provide enhanced access to and dissemination of information. It provides means to the management of vast volumes of information and presenting this at the right time in the right place to enable high-quality decisions. Today with the internet, the amount of information is huge, informatics can help break this down and provide the correct research for the right area in the instance of say a clinical encounter. For evidence-based clinical decisions, there are methods of decision analysis and modeling using probability to predict the best course of action and assess potential outcomes. Finally, informatics can provide monitoring and audit against best evidence through various means of information, to determine if practice is effective and to make improvements in areas of sub-optimal care. All of these methods are a vast improvement for integrating evidence into practice in contrast to the traditional methods of medical education which focus on retraining the facts to be recalled at a later time.
Evidence-based practice (EBP) involves making clinical decisions based on the best available evidence, using it alongside clinical expertise and patient values. Evidence-based practice is not new, but it is now receiving increasing attention in health care as medicine becomes more complex with more decisions and therapy options. There is some resistance to EBP which arises from the ‘art’ of medicine with its individualistic craft approach and its tradition of passing down information from mentor to protégé. We must stress, EBP is not about cookbook medicine. EBP is about integrating individual clinical expertise with the best available external clinical evidence from systematic research. In ideological terms, it aims to keep the ‘art’ of medicine while emphasizing some of the science-based aspects in the ‘art’. For medical practitioners, it is applying a conscientious, explicit, and judicious process in making decisions. This will help to improve the quality of their clinical judgments and keep up to date with the new and relevant research. Evidence-based practice is patient-centered. It’s about providing care that is of the best quality with the understanding of the potential risks and benefits for treatment and non-treatment for the patient, with the use of informed consent. For the patient, it means receiving high-quality care which is up to date with minimal error in diagnosis and treatment with the view that will increase the length and quality of life. With the explosion of research, medicine has a struggle to change practice. Major barriers include problems with the volume and lack of awareness of new research, and the lack of resources and time, so changing practice can be quite slow. Measures need to be taken and doctors must come to understand the research and change their practice, and patients must understand that the quality of care is directly linked to the care that’s been proved to be effective through research.
1.1 Importance of Evidence-Based Practice
The practice of evidence-based medicine can be regarded as a systematic and disciplined way of evaluating clinical problems and practice. EBM is a lean, mean patient care providing machine. It allows the clinician to quickly, efficiently, and effectively weigh the pros and cons of a particular treatment. If there are no current RCTs suggesting the use of a particular medication, the clinician is able to use clinical experience, hierarchy of evidence, and patient values to make a very informed decision. Evidence-based medicine involves conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of EBM is very important, and in fact, it’s the backbone of our internal medicine residency program. Because many different treatments lead to similar outcomes, we want to ensure that we’re providing the most efficient and effective care for our patients. This residency program is going to teach us how we can acquire the best evidence, how to assess its validity and usefulness, and how to apply it when making medical decisions. The concept of EBM and steps involved are summarized in the article: “Evidence-Based Medicine: What It Is and What It Isn’t” (Sackett, 1996). The practice of EBM has proven successful in many surgical and medical specialties. It’s been shown to reduce costs, improve the quality of intervention, and lead to better patient outcomes. In a study conducted by David L. Berger, M.D., MS (2003) and colleagues, it was found that EBM is most successful when it involves the cooperation of clinical scientists, biostatisticians, and personnel in biomedical informatics. To be EBM practitioners, we must become efficient in avoiding outdated practice habits and to stay informed on recent developments and evidence across all areas of patient care. This is no easy task, but with practice and familiarity, it becomes second nature.
1.2 Role of Technology and Informatics
Technology has come a long way and has become more affordable and easier to use. In a recent survey of US adults, 72% of internet users said they looked online for health information within the past year. One of the many reasons why they are seeking health information online is that it has become easily available and convenient. The use of computers and mobile devices can now allow practitioners and patients to access health information from any location with internet wifi or cellular access. This is an important determinant as with EBP, it is not only important to access evidence, but it is also important to be able to apply and integrate it into clinical practice. This improved access to technology can dispel the restrictive view that evidence-based practice can be limited to only using research when it is available. In a clinical scenario, it is not uncommon to encounter situations where there is no clear evidence or evidence-based guideline to best manage a patient. Often without easy access to research materials, decisions are often defaulted to previous practice habits or even mere intuition. With improved access to information technology, such a situation can prompt the practitioner to search for evidence at the point of care, and thus, will close the gap between practice and research. As a matter of fact, it is suggested that the best method to promote evidence-based practice is to teach clinicians how to form questions about clinical practice and search for the answers. With the improved availability of research materials and evidence, technology can ultimately teach us how to think critically.
The concept of evidence-based practice (EBP) has created a substantial impact in the medical industry. Though its formulation has been a long and rough process, it has proven itself to be a critical player in improving the existing healthcare system, which is filled with outdated practices that are either flawed or have been rendered obsolete by newer and more effective interventions. According to the definition provided by Sackett and colleagues, EBP is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” The expected outcome of EBP is to improve the quality of clinical practice and ultimately improve patient outcomes. It is clear that the goals of EBP correspond with the needs of the healthcare system, and it’s important to recognize that technology and informatics is a key driver behind the success of EBP and the execution of its objectives.
2. Specific Evidence-Based Practice
2.1 Selection of a Practice
2.2 Overview of the Chosen Practice
3. Technology and Informatics in Practice Interventions
3.1 Integration of Technology in Practice
3.2 Informatics Support for Practice Interventions
3.3 Benefits of Technology in Practice Interventions
4. Improving Patient Outcomes through Evidence-Based Practice
4.1 Understanding the Impact of Evidence-Based Practice
4.2 Patient Outcomes and Evidence-Based Guidelines
5. Benefits and Challenges of Information Technology in Practice
5.1 Benefits of Information Technology
5.2 Challenges Faced in Integrating Information Technology
6. Strategies to Overcome Challenges
6.1 Identifying and Addressing Barriers
6.2 Training and Education for Information Technology
6.3 Collaboration and Support
7. Conclusion