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Advancing evidence-based practice to improve patient care
  1. Andrea Cipriani1,
  2. Toshi A Furukawa2
  1. 1Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK;
  2. 2Department of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
  1. Correspondence to Dr Andrea Cipriani, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK; andrea.cipriani{at}psych.ox.ac.uk

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The new editorial board has now settled in the new position and, as anticipated, we have started working harder on EBMH. First, we would like to make clear to our readership the scope of this journal: introduce and promote the practices of evidence based medicine in mental health across the world.

This means that we are not interested in simply selecting and disseminating the best evidence by itself. In the scientific literature, a lot of information (sometimes too much and too often misleading) is continuously available and many websites or other sources keep updating, almost in real time, on the newest articles. We think the mission of EBMH is rather different. We want to help interested people learn how to select and use the best available evidence to answer their questions and materially improve their own clinical practice. This journal has to be seen (and built) as a tool to learn how to practice evidence-based-ly in the context of specific and diverse mental health clinical settings across the world. We don't think this scope is completely different from what it has been before. However, we wanted to make it very clear since the very beginning, because these are the grounds from which we want to start working together with our readership. EBMH editorial board thinks that all mental health professionals should inform their practice within the context of evidence-based medicine. This is not because evidence-based medicine is the best way to treat patients, but because it is the best way we have to treat patients. EBMH should move from the dusty shelf of a remote library to the messy desk of each one of us and become a tool for our daily work. We would like EBMH to stimulate a critical approach and a fruitful interaction between the editorial board, the authors, the commentators and the readers. We aim at potentiating the journal website because it will be the interface where we can interact with all these components. Please, add ebmh.bmj.com to your favourite bookmarks and keep checking it for the newest features and most recent information on how to practice evidence-based mental health!

New format of commentaries and use social media

According to this idea, the editorial board also has decided to change the format of the commentaries and the way to abstract the selected papers. From the next issue of the journal, the new commentaries will be more concise and specifically answer the following questions: which are the main methodological strengths and limitation of the study? Do results from this study change your clinical practice? The content of the commentaries will be summarised in a few bullet points to increase its readability, but we hope the discussion can go on and explore all related issues in full details in the EBMH website or via Twitter.

The use of wireless communication devices to support clinical practice (the so called Mobile health, or more commonly, mHealth) is receiving increased attention in both scientific world and clinical settings, largely due to the global penetration of mobile technologies.1 Over 85% of the world's population is now covered by a wireless signal, with over 5 billion mobile phone subscriptions and broad availability of mobile technology also in low- and middle-income countries.2 Therefore, the use of social media has become pervasive in healthcare as well. Five processes facilitated by social networks have been identified, that may affect clinicians’ behaviours: social influence, social engagement, social recommendations, social contagion and social support.3 Social media in healthcare is controversial area with great advantages and huge potential, but also with important concerns.4 However, whether we like it or not, this is the direction where the delivery of scientific information is going to and, to keep up with newer generations of psychiatrists and psychologists, evidence based practice has to try to do the same. As a modern scientific journal, EBMH is aware of this and the editorial team will progressively move the scientific discussion from the print issue to the website, using internet and social media. This is a challenge but also a great opportunity, because we definitely think that scientific evidence can be translated into clinical practice only if evidence-based practice becomes part of our way of daily living.

EBM and younger audience

If it is true that practicing within the frame of evidence-based medicine is the most robust approach we have today to improve care and limit risks for our patients, it is also true that practicing evidence-based-ly is not a one-size-fits-all approach. Evidence based medicine is not like following a recipe: it is not a warranty of clinical success and it is hard because it requires medical knowledge, critical appraisal and clinical skills. Moreover, to practice evidence-based-ly is probably more difficult in mental health, because psychiatry and clinical psychology have specific features which make them quite different from the rest of medicine. Bearing this in mind, however, we need to answer clinical questions for mental health problems adopting a rational and scientific approach, as our colleagues do in the other fields of medicine.

For this reason, our target audience are the younger generations of psychiatrists and psychologists. They are the mental health professionals who are more open to the challenges of practicing EBM in an innovative way. We don't want to change the mind of people who think that an evidence based approach to clinical practice is useless (or possibly wrong). We simply want to show that this is an incorrect assumption and that evidence-based practice can materially improve the outcomes of our patients. EBMH is aimed at engaging psychiatrists and psychologists in the challenges of basing their practice on evidence, providing material to allow professionals to develop the necessary skills and keep up to the ever expanding suite of evidence-based approaches. We want our younger readers to become the best EBMH commentators of the future. The new features and sections of the journal (see below) are a tangible way to prove it and start working together.

Impact factor

Historically, EBMH has been commissioning commentaries and inviting authors to submit original contributions. While keeping doing this, the editorial board decided to open now the possibility of publishing in EBMH to anyone who is interested in. Therefore, EBMH has set up a peer-review system to endorse a standard quality check of the submitted articles. Concomitantly, EBMH has started the long process to finally get an impact factor (IF) for the journal. Even though we all know IF has flaws and can be manipulated, it is the most extensively used index for measuring ‘quantitatively’ the quality of a scientific journal. In a couple of years we will know which will be, if any, the IF of our journal. In terms of bibliometric analysis, we like to consider it as the ‘hard outcome’ of our work. In terms of personal motivation, this challenge will be for us one of the main drivers to leave the best journal possible to our successors as EBMH editors.

New sections of the journal

Starting from this issue and for the whole 2014, we have added three new sections to the journal. ‘Evidence-based clinical conferences’ address a series of complex clinical questions (one per issue) that we will seek to solve ‘pragmatically’ using an evidence-based practice approach. The topics and the clinical cases of the next three issues have been already decided, to offer you a wide range of clinical scenarios. However, we would like to make this new section as close as possible to the real practice, so, together with your comments on the published clinical conferences, we are also happy to consider any suggestions about the next topics that you would like to discuss with an evidence-based practice approach from among the many complex clinical cases you come across in your clinical practice (if interested, please send an email to the Deputy Editor, Toshi Furukawa at furukawa@kuhp.kyoto-u.ac.jp).

The second new section is called ‘Statistics in practice’ and original papers about relevant issues in statistics applied to health sciences will be published here. The first topic to be addressed is publication bias and Dimitris Mavridis and Georgia Salanti discuss in this issue the main characteristics and limitations of different methods to assess publication bias, using a paradigmatic example to illustrate their findings. We also asked the two authors to summarise in just one page and a few bullet points the key take home messages every clinician who wants to practice evidence-based-ly should know about publication bias. The name of this new section (‘Statistics in pills’) was chosen not only to make evident since from the title the very concise nature of these papers, but also to highlight the educational intent of this section. This reading is not for fun. It should be seen as a mandatory reading to everybody, unless someone already knows the basic notions on the topic. Busy clinicians tend to skip the statistical paragraphs of published papers because the statistical methods are too technical and often too complicated. This is often true and different expertise and diverse interests among clinicians should be acknowledged and preserved. However, their basic statistical knowledge should reach a minimum standard, otherwise clinicians won't be able to understand if the information reported in the paper is reliable or not. Only if someone can critically appraise the evidence, an effective evidence-based practice approach can be implemented.

Website

We have expanded the EBMH website, including new open-access video features. Together with the free papers selected by the Editor as Editor's Choice in each issue, we will post in the EBMH website video interviews with experts in the field to have ‘live’ comments on the ‘free choice’ papers. For the November issue the three selected papers were all about suicide and in the EBMH website (http://ebmh.bmj.com/) you can now find the video interviews with Keith Hawton, Professor of Psychiatry at the University of Oxford and Director of the Centre for Suicide Research. These video commentaries are very informative and set a good example on how to summarise a paper from the scientific literature, highlighting strengths, limitations and clinical implications. In this issue, one of the Editor's Choice papers is about violence and the prevalence of intimate partner homicide. This study was published in the Lancet in September last year and we asked Dr Seena Fazel (Wellcome Trust Senior Research Fellow and Honorary Consultant Forensic Psychiatrist at the University of Oxford) to do a video commentary on the paper and related issues (see http://ebmh.bmj.com/).

The new editorial board welcomes any feedback, positive or negative but constructive, and look forward to interaction and collaboration with our readers to make EBMH as useful, meaningful and fun as you like.

References

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Footnotes

  • Competing interests TAF has received honoraria for speaking at CME meetings sponsored by Eli Lilly, Meiji, Mochida, MSD, Pfizer and Tanabe-Mitsubishi. He is diplomate of the Academy of Cognitive Therapy. He has received royalties from Igaku-Shoin, Seiwa-Shoten and Nihon Bunka Kagaku-sha. He is on advisory board for Sekisui Chemicals and Takeda Science Foundation. The Japanese Ministry of Education, Science, and Technology, the Japanese Ministry of Health, Labor and Welfare, and the Japan Foundation for Neuroscience and Mental Health have funded his research projects.

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