Category Archives: Archive

2014 Bruce A. Gibbard Memorial Lecture

Bruce A. Gibbard, M.D. Memorial Lectureship Program
Sponsored by the University of Vermont College of Medicine Department of Psychiatry

Jonathan Shedler, Ph.D.
The Efficacy of Psychodynamic Therapy:
The Talking Cure in the Era of Evidence-Based Practice

Friday, April 11, 2014

The Davis Auditorium
Fletcher Allen/UVM Medical Education Center, Burlington

Morning Program:

10:15 – 10:30 A.M.    Vermont Psychiatric Association’s Presentation of the Bruce A. Gibbard, M.D. Award for Clinical Excellence for 2013

10:30 – 11:45 A.M.    Gibbard Lecture (Grand Rounds Workshop # 14-128-32)

The Efficacy of Psychodynamic Therapy: The Talking Cure in the Era of Evidence-Based Practice

12:00 – 1:00 P.M.       Lunch Reception—Davis Auditorium Lobby

Afternoon Program:

1:00 – 3:00 P.M.         Workshop* (Davis Auditorium)

Personality Pathways to Depression: A Clinical Conversation with Dr. Jonathan Shedler

*The Afternoon Workshop is open to Clinicians and Mental Health Professionals only.  Attendance and clinical affiliation will be taken at the door. 

Lecture and Workshop Descriptions:

Morning Lecture

The Efficacy of Psychodynamic Therapy: The Talking Cure in the Era of Evidence-Based Practice

Psychodynamic therapy is an evidence-based treatment. Effect sizes are as large as those for other therapies that are actively promoted as “empirically supported” or “evidence-based”, and patients who receive psychodynamic therapy not only maintain therapeutic gains, but continue improving after treatment ends.  Research also shows that other forms of therapy may be effective in part because the more skilled practitioners incorporate  psychodynamic methods. Dr. Shedler will discuss the seven key features of contemporary psychodynamic treatment, review empirical evidence from randomized controlled trials and meta-analyses, and discuss how psychodynamic therapy compares to other evidence-based treatments such as CBT and antidepressant medication.

Learning Objectives:   

  1. Participants will be able to describe seven distinctive features of contemporary psychodynamic therapy.
  2. Participants will understand the concepts of effect size and meta-analysis.
  3. Participants will be able to describe empirical evidence supporting psychodynamic therapy.

Afternoon Workshop

Personality Pathways to Depression: A Clinical Conversation with Dr. Jonathan Shedler

It has become increasingly common to refer to depression as a “disease”, but it may be more helpful to view it as a nonspecific symptom—the psychic equivalent of fever—of a wide range of underlying disturbances.  For most patients, these disturbances are rooted in characteristic patterns of thinking, feeling, attaching, coping, defending, relating and experiencing self and others—in other words, in personality.  This seminar will focus on common personality pathways to depression and their practical treatment implications, with discussion of clinical case material and clinical vignettes to demonstrate case formulation and treatment strategies.

Learning Objectives:

  1. Participants will understand how different personality styles and syndromes (e.g., borderline, narcissistic, avoidant) constitute unique diatheses for depression.
  2. Participants will practice clinical case formulation linking depression to personality dynamics.
  3. Participants will develop greater understanding of effective treatment strategies based on personality patterns and syndromes.

About Our Speaker:

Jonathan Shedler, Ph.D. is known internationally as a psychologist, consultant, researcher, and author.  He is best known for his article The Efficacy of Psychodynamic Psychotherapy, which won worldwide acclaim for establishing psychodynamic therapy as an evidence-based treatment.  His research and writing on personality are shaping contemporary views of personality syndromes and their treatment.  He has authored numerous scholarly and scientific articles in psychiatry, psychology, and psychoanalysis, and is author of the Shedler-Westen Assessment Procedure (SWAP) for personality diagnosis and case formulation.

Dr. Shedler lectures and leads workshops for professional audiences nationally and internationally, consults on psychological issues to U.S. and foreign government agencies, and provides clinical consultation and study groups by teleconference to mental health professionals worldwide.  Dr. Shedler is a Clinical Associate Professor of Psychiatry at the University of Colorado School of Medicine and was formerly Director of Psychology at the University of Colorado Hospital Outpatient Psychiatry Department. When not teaching or practicing psychology, he is a certified professional ski instructor at Vail Ski Resort.

Continuing Education Credits:

The morning lecture (Workshop #14-128-32) is part of the UVM Department of Psychiatry Grand Rounds Series.  Attendees will receive 1.25 AMA PRA Category 1 CreditsTM

The University of Vermont College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The University of Vermont designates this educational activity for a maximum of 1.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The Afternoon Workshop is not accredited for Category 1 CME or CEU Credits.

Application has been made for CEUs for Psychologists, Social Workers, and Mental Health Counselors.

Registration and Program Fees:

No registration is required for the morning program. Attendance and clinical affiliation will be recorded for the afternoon program. The annual Gibbard Lectureship Program is provided at no charge to participants, thanks to donations made to the Bruce A. Gibbard M.D. Lectureship in Psychiatry Fund at the University of Vermont, College of Medicine. To learn more about the Gibbard Lectureship Fund or to make a donation, contact: james.gilbert@uvm.edu   

Directions to Davis Auditorium:

From the Fletcher Allen Health Center parking garage Level 2 (orange), enter the Ambulatory Care Center (ACC).  Once inside, follow the signs to the Medical Education Center.  At the snack kiosk, turn left through the double glass doors.  Davis Auditorium is on the right.

Directions to Fletcher Allen Health Center Parking Garage: 

Map available at:  http://www.fletcherallen.org/patients_visitors/directions/map/?campus=69

Questions?

Contact: Jean Pieniadz, Ph.D., UVM Gibbard Committee Chair, at 802.651.7506
Committee Members:  Brooke Barss, M.D., James Jacobson, M.D., Judith Lewis, M.D., & Debra Lopez, M.D.

Nicholas Wilkie: Medical Student, App Creator

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Imagine you’re a physician with a disaster-relief group. You’ve bounced over bad roads to get to a remote cholera clinic, leaving behind Internet and cell-tower access. You keep careful medical records of patients by typing the information into your shirt-pocket smartphone. Once in range, your phone (and those of your colleagues at other remote clinics) uploads these records to a central server, where the data may not only benefit your patients in the future, but also help decision-makers monitor the outbreak all over the region.

Thanks in part to UVM medical student Nicholas Wilkie, that scenario may soon be reality. As a volunteer with the humanitarian-aid organization Médecins Sans Frontières (MSF, also known as Doctors Without Borders), Wilkie is developing software that stores cholera patients’ medical records on a smartphone.

The third-year student, who is also a veteran programmer, was inspired to write to MSF in June 2011, after hearing Professor of Surgery Bruce Leavitt, M.D.’81 share his experiences with MSF in Nigeria and Sri Lanka. In those field hospitals, Leavitt says, the patient’s surgical record consisted of handwritten notes in manila folders. “At the end of the day, they’d pile them up in a room in a corner,” he recalls. Wilkie approached Leavitt with his idea.

Getting the green light from Doctors Without Borders

Wilkie then found his way to Thang Dao, MSF’s Switzerland-based director of information services. His timing was fortuitous, as MSF was in the process of changing how it managed patient information. Soon he had written a crucial piece of software, one that gets central computers running OpenMRS and far-flung Androids to talk to each other. “It will send electronic health information in a cogent way to the server and record it the way that we want it to,” Wilkie explains.

Dao was so impressed that he invited the student to meet with him and his colleagues in Geneva to discuss adapting the design for doctors responding to cholera outbreaks. “We are one of the few organizations in the world that can deal on a large scale with cholera epidemics,” said Dao. “What was missing for us was how to collect data quickly, and closest to the sources of contamination — which is to say in the villages.”

“Nick is one of these people who can launch himself in very thick snow and make a track for us,” says Dao.

Reposted from the UVM College of Medicine website.

Match Day!

Match Day, class of 2012. Danielle Scribner.

Congratulations to all our 2014 graduates!

Match Day is the culmination of four challenging and arduous years and, in some ways, is the most exciting day of the Medical School experience. Students receive notice of their residency matches beginning at Noon (EST) p.m. on the third Friday of March.

By UVM tradition, names are randomly selected by the Associate Dean for Students and, as each person receives the envelope, he or she places a dollar in a fishbowl. The last person called gets to keep all the money as a reward for their patience in the face of high anxiety.

The medical school sponsors a reception for students immediately following the Match Day Ceremony. The celebration then continues at a variety of local establishments.

To be announced: Class of 2014 students and their matching residencies. Use this link to view the Class of 2014 Match Day, streaming LIVE. Photo Gallery will be posted shortly after the event.

Dana Celebrates UVM Women’s HERStory Month

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The Dana Medical Library is currently displaying “American Women in Medicine and Health Care Sciences” in celebration of UVM Women’s HERStory Month. The exhibit highlights some of the extraordinary achievements and famous firsts by women, and is on view throughout the month of March 2014. The exhibit is also on display at the College of Medicine Hoehl Gallery in the Given Medical building.

smallbooks The exhibit also features a small collection of books relevant to the exhibit including, The Tangled Field by Nathaniel Comfort which chronicles the genetic research of Barbara McClintock; Carolyn Skinner’s, Women & Professional Ethos in Nineteenth Century America; and Mary Eliza Mahoney and the Legacy of African-American Nurses by Susan Muaddi Darraj. These books will be available to check out on April 1, 2014.

Technology Upgrades for the Library Classroom

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Over the winter break many technological upgrades were made to the projector, screen and podium in the Library Classroom in order to improve the teaching and learning experience. Students will now have a larger screen that is clearer and easier to read, and instructors will be able to project content from their favorite devices, including tablets and laptops. All technological changes were made with a focus on flexibility. Good teaching and learning happens in a variety of modalities and environments, so having spaces that are flexible enough to accommodate those differences was a priority in planning the upgrades.

Most noticeable is the now very large screen. A new Eiki screen, 87 X 139 inches, or 164 inches diagonally, was installed. The larger screen is more visible from the back of the room and displays a clearer image.

The old projector was replaced with a new, significantly brighter projector, making the images projected onto the screen crisper and more detailed than before. The new projector can also project HD 1080p quality video in wide screen format, which makes it compatible with DVD movies and wide-screen PowerPoint presentations. It is also much more flexible than the old projector, and can accommodate other devices, such as tablets.

The electronics in the podium, except for the computer, have been completely upgraded. The VCR has been removed and a new DVD player that is capable of reading multiple formats (DVD Video/MP3/WMA/WAV, etc.) has been added. In addition, instructors can now plug in devices that are HDMI compatible (such as the iPad) in addition to just the standard VGA. Finally, there is a new Crestron touch screen control panel to run all of the technology in the podium. The new electronics in the podium can also be expanded to adapt to new technology, which will give instructors greater flexibility going forward.

Dana also obtained a new Sharp 55″ High Definition flat panel monitor mounted on a movable cart so that it can be moved from room to room as needed. Instructors and students can plug their laptops into the panel and display what is on their laptop on the monitor. Dana librarians foresee using this set up with smaller groups of people when the big screen would be too overwhelming.

As classes settle into this new space, Dana education librarian, Gary Atwood, who oversaw the project, will be surveying instructors and students alike for feedback on these technological improvements.

Retirement in Interlibrary Loan Department

DDILL

Marie McGarry, Interlibrary Loan (ILL) Specialist, retires on February 28, 2014 after 29 years of service for the University of Vermont. Marie came to the Dana Medical Library in January of 1985. Initially working in cataloging, Marie then moved to ILL Borrowing, where she filled requests from UVM and Fletcher Allen patrons for materials to be borrowed from other libraries or institutions. Marie has borrowed books and other materials from as far away as Hong Kong and Australia, and is known for filling requests at lightning speed. ILL regularly receives requested journal articles as quickly as 4 hours after the request has been placed. Marie has been particularly good at meeting patron needs for high quality materials delivered quickly, and she does so while saving the Library money but never sacrificing quality patron service.

Many health sciences area patrons appreciate her work. In a recent survey of Dana ILL users, 87% indicated that being able to borrow materials for patient care, research or academic work was “essential”, with 13% rating it “very important.” Many respondents commented positively on Interlibrary Loan. “Being able to… request articles from the [Interlibrary Loan] service is absolutely critical to the teaching mission,” said one respondent. Another noted, “This [Interlibrary Loan] service is so efficient and reliable, I really depend on it to keep me up to date on related research, etc.” Speed of delivery was also rated as important and commented on by survey respondents. One respondent said, “I have been amazed that many of my ILL requests are filled the same day.”

Judging by patron feedback, Interlibrary Loan is an important service for all kinds of work: from student assignments to clinical practice. Dana Library is committed to continuing this high level of service, but there can be no denying that Marie has been a key member of the Interlibrary Loan team. She will be missed by colleagues and patrons alike. Dana Library faculty and staff wish her the very best in her new adventure of retirement!

Nationally Normed Survey Highlights Student and Faculty Success at Dana

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In April 2013 the Dana Medical Library and Bailey-Howe Library made the LIbQual+ Survey available to UVM and Fletcher Allen faculty, staff, and students. Thank you to the 942 individuals who completed the survey.

The Dana Medical Library is committed to providing high quality medical and health sciences information and services to our patrons. One tool available to libraries for assessing service quality is the LibQual+ Survey. The U.S. Association for Research Libraries developed and rigorously tested this web-based survey. It has been used by more than 1,200 libraries, including University of Massachusetts, Northeastern University, University of Connecticut, University of Rhode Island, and SUNY Stony Brook.

The survey asked for patrons to indicate their minimum acceptable service level, their desired service level, and the level of service they perceive for 22 attributes.

The three attributes that Dana Library patrons were most satisfied with were:

  1. Employees who are consistently courteous
  2. Willingness to help users
  3. Readiness to respond to users’ questions.

Dana Library patrons indicated that their three most desired service attributes are:

  1. Print and/or electronic journal collections I require for my work
  2. The electronic information resources I need
  3. Making electronic resources accessible from my home or office

Mean scores for Dana Library services exceeded the minimum acceptable service level for all 22 attributes, including the three most desired attributes listed above.

Dana Medical Library also has data from its 2009 LibQual+ survey. Almost all scores were higher in 2013, but two specific changes stand out. First, survey results from 2013 indicated an increased score for “Employees who have the knowledge to answer user questions.” Second, the scores for “Community space for group learning and group study,” while not large in 2009 or 2013, were higher in 2013.

Stay tuned for Dana Library’s plans to use the data from the 2013 LibQual+ Survey, including information gleaned from survey comments.

Donna O’Malley, MLS
donna.omalley@uvm.edu

Find It Yourself or Ask a Librarian? Studies show medical librarian search gets better results and reduces costs

keypadstethoscope

Health care providers are incorporating more evidence-based practice skills and information sources into their patient care. When providers recognize an uncertainty in determining a diagnosis or treatment plan, they frequently turn to available knowledge sources. At University of Vermont/Fletcher Allen Health Care many providers and professionals turn to Library–licensed sources such as UpToDate, DynaMed, and Nursing Reference Center as their first stop in finding the evidence to answer a patient care question. These sources helpfully provide the “strength of recommendation” based on accepted standards of appraisal of research studies. The typical duration of a search session on DynaMed or UpToDate is less than five minutes, which is manageable at or near the point of care. When those sources do not answer the question adequately either because the latest findings are too new, or because the patient situation and values are too complex, clinicians often seek the primary literature through PubMed. In doing so, some find the search frustrating and time-consuming. If you are among those who need a potentially time-consuming and complex search of the primary literature, consider requesting a literature search from Dana Library medical librarians.

In a randomized trial, information retrieval searches performed by a medical librarian for complex clinical questions were faster and retrieved more favorable results when compared to physician self-searches. The librarians answered the question in 13 minutes compared to 20 minutes for physicians searching on their own. The physicians reported that the librarian results contained a higher level of evidence and had a greater impact on patient care than physician self-searches.1

In a controlled study, patient cases were presented at morning report with a medical librarian in attendance. The librarian performed a literature search on questions that arose and disseminated the findings to the attending physician and presenting resident. The control patients were drawn from patient records and matched for age and primary and secondary diagnoses. The study results included association with reduced hospital length of stay (LOS) for the case group. LOS differed by 2 days between matched cases and controls (3 days vs. 5 days, P < 0.024). Median total hospital charges were $7,045 for the intervention group, and $10,663 for the control group. 2

In these studies, the librarian-conducted literature search saved physician time, reduced hospital costs, and may have improved patient outcomes. UVM and Fletcher Allen physicians, residents, nurses, therapists, and others may receive help finding the literature to answer clinical questions, develop guidelines, and do background research for presentations. To request a literature search or consultation, go to Ask a Librarian on the Dana website to get help by phone, email, or in person.

1. McGowan J, Hogg W, Campbell C, Rowan M. Just-in-time information improved decision-making in primary care: a randomized controlled trial. PLoS ONE. 2008;3(11):e3785.

2. Banks DE, Shi R, Timm DF, et al. Decreased hospital length of stay associated with presentation of cases at morning report with librarian support. J Med Libr Assoc. Oct 2007;95(4):381-387.

Marianne Burke, MLS AHIP
Director, Dana Medical Library
marianne.burke@uvm.edu

ClinicalKey Added to Dana’s List of Databases

Clinical_Key

Dana Medical Library now provides access to ClinicalKey. Replacing MDConsult and Procedures Consult, this new Clinical Insight Engine is designed to provide clinicians with fast, clinically-relevant answers from Elsevier’s library of proprietary medical and surgical content. ClinicalKey offers access to:

  • over 1,000 Elsevier medical and surgical reference books*
  • over 500 Elsevier medical and surgical journals
  • all medical and surgical clinics of North America
  • Procedures Consult procedural videos
  • First Consult point-of-care clinical monographs
  • patient education handouts
  • additional videos and images, practice guidelines, patient handouts, and drug information.

It also supports researchers and instructors with the included presentation builder for use with ClinicalKey’s multimedia collection-export to PowerPoint. User guides are available at http://www.elsevier-data.de/ClinicalKey/ClinicalKey_user_guide.pdf.

*HTML version of chapters provided. To view PDF files you must create a FREE “User Profile” and login.

 

UpToDate Goes Anywhere… and Everywhere!

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The UVM Libraries/FAHC-licensed UpToDate goes anywhere and everywhere!

This new version, called UpToDate Anywhere, allows full access to UpToDate at UVM, Fletcher Allen Health Care, all FAHC practice sites… and from anywhere with an Internet connection.

To take advantage of UpToDate Anywhere, users must first register an individual account from within the UVM or FAHC networks. These networks include accessing UpToDate:

  • while at UVM;
  • while at FAHC;
  • remotely with EZ Proxy or VPN;
  • through FAHC’s Remote Access Gateway;
  • on the UVM wireless network;
  • or on FAHC’s employee wireless network (NOT the FAHC guest wireless network).

With this account, UpToDate can then be accessed anywhere just by logging in with the registered user name and password. The account also enables users to accrue CME credits for reading UpToDate articles, and to download an UpToDate app to a mobile device.

Directions for downloading and installing the iPhone/iPad/iPod Touch and Android versions of the mobile app are available at http://danaguides.uvm.edu/mobile. A more detailed description of UpToDate Anywhere can be found here: http://danaguides.uvm.edu/uptodate.

As usual, if you have any questions or concerns, please do not hesitate to contact the Library at 802-656-2201 or danaref@uvm.edu.