Evidence-based practice was originally defined by Sackett et al. (1996) as the use of current research evidence, clinical expertise and client wishes in making clinical decisions. To date, several studies have outlined facilitators and barriers to evidence-based practice implementation in mental health treatment settings. Few have studied evidence-based practice implementation in interdisciplinary mental health treatment settings. This research explored how clinicians working in interdisciplinary mental health treatment settings 1) define evidence-based practice, 2) report on factors influencing evidence-based practice implementation, and 3) perceive the promoters and barriers to evidence-based practice implementation. This research analyzed data from three studies. In the quantitative portion 233 clinicians participated in an online survey. Descriptive results indicated that clinician scores for knowledge (understanding of and confidence in evidence based-practice) and attitude (positive opinion about evidence-based practice) were high. However, descriptive results also indicated that scores for outcome (perceived impact of evidence-based practice) were moderate and scores for behaviour (frequency clinicians access research evidence) were low. Further analysis showed that nearly 50% of evidence-based practice outcome was explained by education, profession, knowledge and attitude, and approximately 15% of clinician behaviour was explained by knowledge. In the qualitative portion 8 clinicians were interviewed. The results showed that half of the clinicians defined evidence-based practice as research evidence and the other half defined it as research evidence with clinical expertise and client preferences. The interviews identified four components essential to evidence-based practice implementation: creating conditions; accessing evidence; motivating practice; reflecting critically. The interviews also uncovered four tensions clinicians experienced central to evidence-based practice: valuing research evidence vs. clinical expertise; fidelity vs. customization; defining roles vs. role sharing; implementing evidence-based practice vs. managing clinical workload pressures. The findings across the studies highlighted the importance of knowledge, evidence, access and time to optimize evidence-based practice implementation. The results showed that evidence-based practice implementation could be facilitated by a more unified definition, clearer expectations on the part of clinicians and organizations, and a shift in focus from education to behaviour change and monitoring implementation. / Thesis / Doctor of Philosophy (PhD) / Evidence-based practice involves using research evidence to make decisions about client treatment. The purpose of this project was to examine how different mental health professionals in the same setting define and implement evidence-based practice. This research was conducted using two online surveys of over two hundred clinicians and face-to-face interviews with eight clinicians. The surveys found that clinicians had an understanding of evidence-based practice and positive opinions about evidence-based practices but saw moderate impact of evidence-based practice and infrequency in searching for research evidence. The research found that reasons for impact included: education, profession, knowledge and attitude. One cause for search infrequency was knowledge. The interviews found that about half defined evidence-based practice as only research evidence and the other half as research evidence, clinician experience and client wishes. The interviews also illuminated the process of putting evidence-based practice into place and some areas of tension. Similarities across all of the research were the importance of knowledge, access to evidence and time to engage in evidence-based practice.

This correlational study investigated the relationship between changes in the psychosocial scales of the MPI Screener Patient Report Card (Clark, 1996) with changes in depression and anxiety with a sample of chronic pain patients who completed a 4-week outpatient interdisciplinary treatment program located in a large regional medical center. Race, gender, and primary pain diagnosis were additional predictors. Data analyzed came from an existing patient outcome database (N = 203). Five research assumptions were examined using ten separate (five pre and five post-treatment) hierarchical multiple regression analyses. Statistical significance was found in pre and post-treatment analyses with predictors BDI-II (Beck, Steer, & Brown, 1996) and BAI (Beck & Steer, 1993) on criterions Pain Interference, Emotional Distress, and Life Control, and Total Function.

No description available.

Dizziness is one of the most common reasons patients seek medical care, and because there are many causes of dizziness, management of these patients requires an interdisciplinary approach. Peripheral vestibular dysfunction is the most common cause of dizziness/vertigo diagnosed in specialty clinics. The purpose of this article is to present an interdisciplinary approach to the management of patients with vestibular dysfunction with a focus on the unique and overlapping contributions of audiology and physical therapy to vestibular assessment and rehabilitation.

Estudos anteriores demonstram que fatores psicológicos intervêm nos resultados de um transplante cardíaco. Diferem, em seus achados, em função dos paradigmas a que estão vinculados, que incluem ou não o campo intersubjetivo nos quais os fenômenos emergem. Nesta investigação objetivamos descrever o funcionamento mental de pacientes candidatos ao transplante, a partir de suas relações objetais inconscientes, delimitando uma vivência emocional comum nesta situação, bem como, buscamos averiguar se existem diferenças entre os pacientes, em função da realização ou não da cirurgia. Utilizou-se, como procedimento, o Teste de Relações Objetais de H. Phillipson (TRO), aplicado em 63 cardiopatas com indicação ao procedimento. O material clínico proveniente do acompanhamento psicológico destes pacientes também é utilizado para completarmos as observações. Os resultados apontam a presença de indicadores psicopatológicos, de acordo com a classificação de Grassano (1996) para depressão clínica em 60 casos. Em dois casos observaram-se indicadores para psicopatia e um caso para funcionamento psicótico, com repercussões negativas sobre o vínculo com o tratamento. Constataram-se diferenças estatisticamente significantes na performance dos pacientes frente às lâminas BG e C2, mas não podemos afirmar que as dificuldades de ajuste perceptual nestas lâminas, mais freqüentes entre aqueles que não fazem a cirurgia, seja fator de obstáculo ao procedimento. Sugerimos, como hipótese teórica deste trabalho, a presença de refúgios psíquicos, de acordo com Steiner (1997) como estratégia de sobrevivência psíquica, nesta situação, tendo em vista o predomínio, regressivo, de relações de objeto persecutórias, em virtude da extrema ansiedade depressiva. Assim, neste refúgio (ninho da Fênix), o paciente abriga-se da dor da perda (luto pela vida, pelo coração a ser retirado) e da aniquilação (devastação da doença, risco cirúrgico e da imunossupressão), conseguindo enfrentar o processo de transplante cardíaco. Caso contrário, o paciente sucumbe ao quadro depressivo. / Prior studies have shown that psychological factors influence the results not a hearth transplant. The findings are different in function of the paradigm linked to them that may include or not the inter-subjective field from which the phenomena emerge. The purpose of this research was to describe the mental functioning of patients who are candidate to a heart transplant, starting from their unconscious object relations that delimit a shared emotional existence upon that situation, and we also verified if there were differences between patients as to the accomplishment or not of the surgery. The procedure used was the Object Relation Test (ORT) applied over 63 cardiac patients who had indication for that procedure. The clinical material arose from the psychological follow-up performed with those patients was used to complete the observations as well. The results indicate the presence of psychopathological markers, following the Grassano's classification (1996) to the clinical depression in 60 cases. The markers for psychopathy were observed in two cases, and in one case it was observed the marker for psychotic functioning with negative repercussions on the link to the treatment. It was verified statistically significant differences in the patients' performance on the analysis of the BG and C2 plates, but it was impossible to assert that the difficulties in the perceptual adjustment in those plates which were more frequently found plates in patients who were not submitted to the surgery is an obstacle factor to the procedure. The theoretical hypothesis we have suggested in this paper is the presence of psychic refuges, according to Steiner (1997) as strategy for psychic survival to face such situation, having in mind the regressive predominance of the relationships of persecutory object upon an extremely depressive anxiety. Thus, in such refuge (the Phoenix's nest), the patient has a shelter against the pain caused by the loss (mourning the life because one's heart has to be withdrawn), and the annihilation (devastation caused by the disease, surgical risk, and due to the immunosuppression), in order to face the heart transplant process. Otherwise, the patient succumbs to the depressive situation.

Estudos anteriores demonstram que fatores psicológicos intervêm nos resultados de um transplante cardíaco. Diferem, em seus achados, em função dos paradigmas a que estão vinculados, que incluem ou não o campo intersubjetivo nos quais os fenômenos emergem. Nesta investigação objetivamos descrever o funcionamento mental de pacientes candidatos ao transplante, a partir de suas relações objetais inconscientes, delimitando uma vivência emocional comum nesta situação, bem como, buscamos averiguar se existem diferenças entre os pacientes, em função da realização ou não da cirurgia. Utilizou-se, como procedimento, o Teste de Relações Objetais de H. Phillipson (TRO), aplicado em 63 cardiopatas com indicação ao procedimento. O material clínico proveniente do acompanhamento psicológico destes pacientes também é utilizado para completarmos as observações. Os resultados apontam a presença de indicadores psicopatológicos, de acordo com a classificação de Grassano (1996) para depressão clínica em 60 casos. Em dois casos observaram-se indicadores para psicopatia e um caso para funcionamento psicótico, com repercussões negativas sobre o vínculo com o tratamento. Constataram-se diferenças estatisticamente significantes na performance dos pacientes frente às lâminas BG e C2, mas não podemos afirmar que as dificuldades de ajuste perceptual nestas lâminas, mais freqüentes entre aqueles que não fazem a cirurgia, seja fator de obstáculo ao procedimento. Sugerimos, como hipótese teórica deste trabalho, a presença de refúgios psíquicos, de acordo com Steiner (1997) como estratégia de sobrevivência psíquica, nesta situação, tendo em vista o predomínio, regressivo, de relações de objeto persecutórias, em virtude da extrema ansiedade depressiva. Assim, neste refúgio (ninho da Fênix), o paciente abriga-se da dor da perda (luto pela vida, pelo coração a ser retirado) e da aniquilação (devastação da doença, risco cirúrgico e da imunossupressão), conseguindo enfrentar o processo de transplante cardíaco. Caso contrário, o paciente sucumbe ao quadro depressivo. / Prior studies have shown that psychological factors influence the results not a hearth transplant. The findings are different in function of the paradigm linked to them that may include or not the inter-subjective field from which the phenomena emerge. The purpose of this research was to describe the mental functioning of patients who are candidate to a heart transplant, starting from their unconscious object relations that delimit a shared emotional existence upon that situation, and we also verified if there were differences between patients as to the accomplishment or not of the surgery. The procedure used was the Object Relation Test (ORT) applied over 63 cardiac patients who had indication for that procedure. The clinical material arose from the psychological follow-up performed with those patients was used to complete the observations as well. The results indicate the presence of psychopathological markers, following the Grassano's classification (1996) to the clinical depression in 60 cases. The markers for psychopathy were observed in two cases, and in one case it was observed the marker for psychotic functioning with negative repercussions on the link to the treatment. It was verified statistically significant differences in the patients' performance on the analysis of the BG and C2 plates, but it was impossible to assert that the difficulties in the perceptual adjustment in those plates which were more frequently found plates in patients who were not submitted to the surgery is an obstacle factor to the procedure. The theoretical hypothesis we have suggested in this paper is the presence of psychic refuges, according to Steiner (1997) as strategy for psychic survival to face such situation, having in mind the regressive predominance of the relationships of persecutory object upon an extremely depressive anxiety. Thus, in such refuge (the Phoenix's nest), the patient has a shelter against the pain caused by the loss (mourning the life because one's heart has to be withdrawn), and the annihilation (devastation caused by the disease, surgical risk, and due to the immunosuppression), in order to face the heart transplant process. Otherwise, the patient succumbs to the depressive situation.