The pandemic COVID‐19 (SARS‐CoV‐2) has had a major global impact on the healthcare systems worldwide as they deal with the surge of critically ill persons. Additionally, the preventative measure of stay‐at‐home orders and closure of... more
The pandemic COVID‐19 (SARS‐CoV‐2) has had a major global impact on the healthcare systems worldwide as they deal with the surge of critically ill persons. Additionally, the preventative measure of stay‐at‐home orders and closure of nonessential businesses has caused the disruption of entire communities. The child/youth mental health workforce bears the additional burden of the disruption of the systems‐based practice crucial to the successful provision of mental health services. Major sources of stress for the workforce include: (a) a threat to the worker’s personal/family health and life (traumatic injury), (b) a loss of colleagues or threat to professional mastery and identity (grief injury), (c) an inner conflict between ones’ values and aspirations and what they are able to accomplish in their work (moral injury), and (d) fatigue, simply feeling worn out by the relentless work and need, without time for rest and recovery (fatigue injury). The rapid transformation of the in‐pers...
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The child and adolescent psychiatry trials network (CAPTN):
This practice parameter describes the epidemiology, clinical picture, differential diagnosis, course, risk factors, and pharmacological and psychotherapy treatments of children and adolescents with major depressive or dysthymic disorders.... more
This practice parameter describes the epidemiology, clinical picture, differential diagnosis, course, risk factors, and pharmacological and psychotherapy treatments of children and adolescents with major depressive or dysthymic disorders. Side effects of the antidepressants, particularly the risk of suicidal ideation and behaviors are discussed. Recommendations regarding the assessment and the acute, continuation, and maintenance treatment of these disorders are based on the existent scientific evidence as well as the current clinical practice.
Research Interests: Psychology, Psychiatry, Epidemiology, Personality Assessment, Adolescent, and 15 moreMedicine, Comorbidity, Clinical Practice, Humans, Child, Alcoholism, Mental Disorders, Risk factors, Psychotropic Drugs, Risk Factors, Reference Values, Cross Sectional Studies, Psychology and Cognitive Sciences, dysthymic disorder, and Medical and Health Sciences
ABSTRACTIntroduction:Attention-deficit/hyperactivity disorder (ADHD) is a serious neurobehavioral disorder of childhood onset that often persists into adolescence and adulthood. Functional impairments, underachievement, and difficult... more
ABSTRACTIntroduction:Attention-deficit/hyperactivity disorder (ADHD) is a serious neurobehavioral disorder of childhood onset that often persists into adolescence and adulthood. Functional impairments, underachievement, and difficult interpersonal relationships illustrate the need for effective treatment of ADHD through adulthood.Method:This prospective, multisite, randomized, double-blind, placebo-controlled, parallel-group, dose-escalation study was conducted to assess the efficacy, safety, and duration of action of mixed amphetamine salts extended-release (MAS XR) in adults with ADHD, combined type. Adults ≥ 18 years of age were given placebo or MAS XR 20, 40, or 60 mg/day for 4 weeks. The main outcome measures were the ADHD Rating Scale and Conners' Adult ADHD Rating Scale Short Version Self-Report (CAARS-S-S).Results:Two hundred fifty-five subjects were randomly assigned to treatment with MAS XR or placebo. MAS XR treatment was associated with statistically and clinically s...
Research Interests: Psychology, Adolescent, Medicine, Humans, Placebo, and 15 moreFemale, Male, Clinical Sciences, Rating Scale, Middle Aged, Adult, Randomized Controlled Trial, CNS, Amphetamines, Delayed-Action Preparations, Neurosciences, Extended release, Attention deficit disorder with hyperactivity, Attention deficit hyperactivity disorder, and Central nervous system stimulants
Psychiatrists need to update their skills to incorporate advances in psychiatric practice and to do so "at the bedside."To this end, evidence-based medicine (EBM), which is widely used as an educational heuristic in other areas... more
Psychiatrists need to update their skills to incorporate advances in psychiatric practice and to do so "at the bedside."To this end, evidence-based medicine (EBM), which is widely used as an educational heuristic in other areas medicine and has begun to make inroad in psychiatry training programs, provides practical methods to access, evaluate, and interpret the medical literature regarding disease causation, prognosis, diagnostic tests, and treatment strategies.With respect to treatment, EBM asserts the primacy of randomized, controlled trials for demonstrating efficacy, and, in some cases, the use of meta-analytic or systematic literature reviews conducted according to pre-specified criteria. Using the common clinical problem of when and how to combine drug and psychosocial interventions at the level of the individual patient, this article illustrates the principles of EBM as they pertain to how best to combine drug and psychosocial treatments for children and adolescent...
Research Interests: Anxiety Disorders, Evidence Based Medicine, Causation, Adolescent, Medicine, and 10 moreHumans, Child, Cognitive Therapy, Psychological Intervention, Psychosocial, Randomized Controlled Trial, Reproducibility of Results, Combined Modality Therapy, Attention deficit disorder with hyperactivity, and Central nervous system stimulants
Research Interests: Psychology, Drug interactions, Medicine, Substance Abuse Treatment, Humans, and 14 morePlacebo, Female, Male, Heart rate, Young Adult, Adult, Public health systems and services research, Psychotropic Drugs, Pilot Projects, Methylphenidate, Cross-Over Studies, Psychomotor Performance, Central nervous system stimulants, and Dronabinol
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Research Interests: Psychology, Terrorism, Child and adolescent mental health, Mental Health, Disaster Studies, and 15 morePolitical Violence and Terrorism, Child Clinical Psychology, Disaster Mental Health, Medicine, Anxiety, Intervention, Psychoeducation, Disaster, Psychological Intervention, Psychotherapist, ANXIETY, Child and Adolescent Mental Health, Debriefing, Guidance and Counseling Intervention Programs, and Eye Movement Desensitization and Reprocessing
Research Interests: Psychology, Clinical Psychology, Adolescent, Medicine, Anxiety, and 15 moreHumans, Child, Placebo, Female, Cognitive Therapy, Male, Separation Anxiety, ANXIETY, Logistic Models, Combined Modality Therapy, Psychiatric Status Rating Scales, Adverse effect, Psychology and Cognitive Sciences, Phobic disorders, and Medical and Health Sciences
This practice parameter describes the psychiatric assessment and management of physically ill children and adolescents. It reviews the epidemiology, clinical presentation, assessment, and treatment of psychiatric symptoms in children and... more
This practice parameter describes the psychiatric assessment and management of physically ill children and adolescents. It reviews the epidemiology, clinical presentation, assessment, and treatment of psychiatric symptoms in children and adolescents with physical illnesses and the environmental and social influences that can affect patient outcome.
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Research Interests: Psychology, Psychiatry, Medicine, Humans, Female, and 15 moreMale, Adult, Attention Deficit, Methylphenidate, Area Under the Curve, Area Under Curve, Choice Behavior, Control Group, Attention deficit disorder with hyperactivity, Attention deficit hyperactivity disorder, Psychology and Cognitive Sciences, Progressive Ratio, Central nervous system stimulants, Medical and Health Sciences, and Pharmacology and pharmaceutical sciences
OBJECTIVE: To evaluate the efficacy and tolerability of atomoxetine for the treatment of attention-deficit/hyperactivity disorder (ADHD) in 5- and 6-year-old children. METHODS: This was an 8-week, double-blind, placebo-controlled... more
OBJECTIVE: To evaluate the efficacy and tolerability of atomoxetine for the treatment of attention-deficit/hyperactivity disorder (ADHD) in 5- and 6-year-old children. METHODS: This was an 8-week, double-blind, placebo-controlled randomized clinical trial of atomoxetine in 101 children with ADHD. Atomoxetine or placebo was flexibly titrated to a maximum dose of 1.8 mg/kg per day. The pharmacotherapist reviewed psychoeducational material on ADHD and behavioral-management strategies with parents during each study visit. RESULTS: Significant mean decreases in parent (P = .009) and teacher (P = .02) ADHD–IV Rating Scale scores were demonstrated with atomoxetine compared with placebo. A total of 40% of children treated with atomoxetine met response criteria (Clinical Global Impression–Improvement Scale indicating much or very much improved) compared with 22% of children on placebo, which was not significant (P = .1). Decreased appetite, gastrointestinal upset, and sedation were significa...
Research Interests: Pediatrics, Education, Psychometrics, Personality Assessment, Medicine, and 14 moreHumans, Child, Placebo, Female, Male, Age Factors, Atomoxetine, Double Blind, Combined Modality Therapy, Child preschool, Attention deficit disorder with hyperactivity, Psychology and Cognitive Sciences, Central nervous system stimulants, and Medical and Health Sciences
Research Interests: Medicine, Humans, Child, Micronuclei, Female, and 15 moreMale, Amphetamine, Cohort Study, Peripheral blood lymphocyte, Amphetamines, Lymphocytes, Methylphenidate, Dextroamphetamine, Micronucleus Test, Attention deficit disorder with hyperactivity, Attention deficit hyperactivity disorder, Micronucleus tests, Central nervous system stimulants, Chromosome aberrations, and Medical and Health Sciences
Research Interests: Pharmacology, Pediatrics, Psychiatry, Psychopharmacology, Methodology, and 15 moreAdolescent, Medicine, Humans, Child, Female, Feasibility Studies, Adverse Events, Male, Mental Disorders, Health Status, Adverse Event, Psychotropic Drugs, Adverse effect, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests: Psychology, Psychiatry, Anxiety Disorders, Social Anxiety, Adolescent, and 15 moreMedicine, Anxiety, Humans, Child, Female, Male, Social Adjustment, Children and Adolescents, SERTRALINE, ANXIETY, Anxiety Disorder, Psychology and Cognitive Sciences, Medical and Health Sciences, Antidepressive agents, and preadolescent
Objective: The goal of this study was to assess the efficacy and tolerability of lis-dexamfetamine dimesylate (LDX) as an adjunct to nicotine replacement therapy in adult smokers with ADHD who were undergoing a quit attempt. Methods:... more
Objective: The goal of this study was to assess the efficacy and tolerability of lis-dexamfetamine dimesylate (LDX) as an adjunct to nicotine replacement therapy in adult smokers with ADHD who were undergoing a quit attempt. Methods: Thirty-two regular adult smokers with ADHD were randomized to receive LDX ( n = 17) or placebo ( n = 15) in addition to nicotine patch concurrent with a quit attempt. Results: There were no differences between smokers assigned to LDX versus placebo in any smoking outcomes. Participants treated with LDX demonstrated significant reductions in self-reported and clinician-rated ADHD symptoms. LDX was well tolerated in smokers attempting to quit. Discussion: In general, LDX does not facilitate smoking cessation in adults with ADHD more than does placebo, though both groups significantly reduced smoking. LDX demonstrated efficacy for reducing ADHD symptoms in adult smokers engaging in a quit attempt.
Research Interests: Psychology, Treatment Outcome, Medicine, Humans, Smoking Cessation, and 14 morePlacebo, Smoking, Nicotine, Female, Male, Adult, Attention Disorders, Pilot Projects, Dextroamphetamine, Attention deficit disorder with hyperactivity, Tolerability, Tobacco use disorder, Central nervous system stimulants, and nicotine patch
The purpose of this practice parameter is to promote the appropriate and safe use of psychotropic medications in children and adolescents with psychiatric disorders by emphasizing the best practice principles that underlie medication... more
The purpose of this practice parameter is to promote the appropriate and safe use of psychotropic medications in children and adolescents with psychiatric disorders by emphasizing the best practice principles that underlie medication prescribing. The evidence base supporting the use of psychotropic medication for children and adolescents with psychiatric disorders has increased over the past 15-20 years as has their
Research Interests: Psychiatry, Psychotherapy, Evidence Based Medicine, Adolescent, Medicine, and 15 moreHumans, Child, Best practice, Child and Adolescent Psychiatry, Mental Disorders, Children and Adolescents, Parents, Combination drug therapy, Psychotropic Drugs, Medical Treatment, Combined Modality Therapy, Psychology and Cognitive Sciences, Psychiatric disorder, discontinuation, and Medical and Health Sciences
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This summary provides an overview of the assessment and treatment recommendations contained in the Practice Parameters for the Assessment and Treatment of Children and Adolescents with Depressive Disorders. Depressive disorders in... more
This summary provides an overview of the assessment and treatment recommendations contained in the Practice Parameters for the Assessment and Treatment of Children and Adolescents with Depressive Disorders. Depressive disorders in children and adolescents are marked by core symptoms similar to those seen in adults, although symptom expression varies greatly with developmental stage. These disorders are common, chronic, and recurrent, and they are associated with comorbid psychiatric conditions and poor outcome that can be alleviated by early identification and treatment. Opinions differ regarding treatment planning and duration of treatment required. Development of a treatment relationship with the patient and family is crucial for a successful outcome. Psychotherapy is an appropriate treatment for all children and adolescents with depressive disorders. Antidepressants may prove useful in some cases and are especially recommended for patients with psychosis, bipolar depression, and severe depression. Continuation treatment is necessary in all patients after the acute phase; long-term maintenance is required in some. Early detection and intervention is effective in ameliorating the poor psychosocial outcome.
Research Interests: Education, Psychotherapy, Rehabilitation, Mental Health, Primary Health Care, and 49 moreSex, Suicide, Dual Diagnosis, Treatment Outcome, Adolescent, Intellectual Disability, Mental Illness, Post traumatic stress disorder, Mental Retardation, Child Behavior, Humans, Child, Child Sexual Abuse, Posttraumatic stress disorder, Language Skills, United States, Female, Cognitive Therapy, Male, Sexual Behavior, Child Psychiatry, Child and Adolescent Psychology, Obsessive Compulsive Disorder, Developmental disabilities, Depressive Disorder, Differential Diagnosis, Mental Disorders, Mental Disorder, Children and Adolescents, Mood Disorders, Spectrum, Adult, Patient Care Team, Biological treatment, Learning Disorders, Juvenile, Adolescent Psychiatry, Hotlines, Literature Search, Clinical Presentation, Clinical Protocols, Remedial Teaching, Adolescent Behavior, Attempted Suicide, General Population, Substance-Related Disorders, Serotonin Uptake Inhibitors, Psychiatric Status Rating Scales, and Child preschool
Research Interests: Family Therapy, Anxiety Disorders, Psychotherapy, Autism, Mental Health, and 54 moreSchizophrenia, Bipolar Disorder, Health Care, Juvenile Justice, Juvenile Delinquency, Personality Assessment, Cultural Competence, Evaluation, Treatment, Policy Development, Autoimmunity, Public Health, Adolescent, Comorbidity, Early Childhood, Social behavior, Continuing Medical Education, Humans, Child, Substance Abuse, Child Sexual Abuse, Behavior Therapy, Female, Cognitive Therapy, Male, Sexual Behavior, Child Psychiatry, Obsessive Compulsive Disorder, Social Services, Infant, Depressive Disorder, The, Differential Diagnosis, Substance Dependence, Conduct Disorder, Mental health services, Recurrence, Children and Adolescents, Mood Disorders, Ethical Issues, Prognosis, Psychotic Disorders, Social Behavior, Adjustment Disorders, Adolescent Psychiatry, Social Behavior Disorders, Psychosexual Development, Suicide Attempt, Reactive Attachment Disorder, Substance-Related Disorders, Serotonin Uptake Inhibitors, Trichotillomania, The American, and Child preschool
PRACTICE PARAMETER FOR THE PSYCHIATRIC ASSESSMENT AND MANAGEMENT OF PHYSICALLY ILL CHILDREN AND ADOLESCENTS ABSTRACT This practice parameter describes the psychiatric assessment and management of physically ill children and adolescents. It reviews the epidemiology, clinical presentation, assessme...more
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Research Interests: Family Therapy, Anxiety Disorders, Psychotherapy, Autism, Mental Health, and 54 moreSchizophrenia, Bipolar Disorder, Health Care, Juvenile Justice, Juvenile Delinquency, Personality Assessment, Cultural Competence, Evaluation, Treatment, Policy Development, Autoimmunity, Public Health, Adolescent, Comorbidity, Early Childhood, Social behavior, Continuing Medical Education, Humans, Child, Substance Abuse, Child Sexual Abuse, Behavior Therapy, Female, Cognitive Therapy, Male, Sexual Behavior, Child Psychiatry, Obsessive Compulsive Disorder, Social Services, Infant, Depressive Disorder, The, Differential Diagnosis, Substance Dependence, Conduct Disorder, Mental health services, Recurrence, Children and Adolescents, Mood Disorders, Ethical Issues, Prognosis, Psychotic Disorders, Social Behavior, Adjustment Disorders, Adolescent Psychiatry, Social Behavior Disorders, Psychosexual Development, Suicide Attempt, Reactive Attachment Disorder, Substance-Related Disorders, Serotonin Uptake Inhibitors, Trichotillomania, The American, and Child preschool
The primary aim of this paper is to examine the characteristics of a large sample of youth with OCD who are partial responders (i.e., still have clinically significant symptoms) to serotonin reuptake inhibitor (SRI) medication. The sample... more
The primary aim of this paper is to examine the characteristics of a large sample of youth with OCD who are partial responders (i.e., still have clinically significant symptoms) to serotonin reuptake inhibitor (SRI) medication. The sample will be described with regard to: demographics, treatment history, OCD symptoms/severity, family history and parental psychopathology, comorbidity, and global and family functioning. The sample includes 124 youth with OCD ranging in age from 7 to 17 with a primary diagnosis of OCD and a partial response to an SRI medication. The youth are a predominantly older (age 12 and over), Caucasian, middle to upper income group who had received significant past treatment. Key findings include moderate to severe OCD symptoms, high ratings of global impairment, and significant comorbidity, despite partial response to an adequate medication trial. Considerations regarding generalizability of the sample and limitations of the study are discussed.
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Background In 2003, the National Institute of Mental Health funded the Child and Adolescent Psychiatry Trials Network (CAPTN) under the Advanced Center for Services and Intervention Research (ACSIR) mechanism. At the time, CAPTN was... more
Background In 2003, the National Institute of Mental Health funded the Child and Adolescent Psychiatry Trials Network (CAPTN) under the Advanced Center for Services and Intervention Research (ACSIR) mechanism. At the time, CAPTN was believed to be both a highly innovative undertaking and a highly speculative one. One reviewer even suggested that CAPTN was "unlikely to succeed, but would be a valuable learning experience for the field." Objective To describe valuable lessons learned in building a clinical research network in pediatric psychiatry, including innovations intended to decrease barriers to research participation. Methods The CAPTN Team has completed construction of the CAPTN network infrastructure, conducted a large, multi-center psychometric study of a novel adverse event reporting tool, and initiated a large antidepressant safety registry and linked pharmacogenomic study focused on severe adverse events. Specific challenges overcome included establishing structures for network organization and governance; recruiting over 150 active CAPTN participants and 15 child psychiatry training programs; developing and implementing procedures for site contracts, regulatory compliance, indemnification and malpractice coverage, human subjects protection training and IRB approval; and constructing an innovative electronic casa report form (eCRF) running on a web-based electronic data capture system; and, finally, establishing procedures for audit trail oversight requirements put forward by, among others, the Food and Drug Administration (FDA). Conclusion Given stable funding for network construction and maintenance, our experience demonstrates that judicious use of web-based technologies for profiling investigators, investigator training, and capturing clinical trials data, when coupled to innovative approaches to network governance, data management and site management, can reduce the costs and burden and improve the feasibility of incorporating clinical research into routine clinical practice. Having successfully achieved its initial aim of constructing a network infrastructure, CAPTN is now a capable platform for large safety registries, pharmacogenetic studies, and randomized practical clinical trials in pediatric psychiatry.
Research Interests: Psychology, Psychiatry, Clinical Trial, Data Management, Health, and 13 morePsychological Well Being, Infrastructure Development, Clinical Practice, Clinical research, Lessons Learned, And, Adverse Event, Learning Experience, Human Subjects, National Institute of Mental Health, Food and Drug Administration, Training Program, and Electronic Data Capture
At the 2005 Annual Meeting of the American Academy of Child and Adolescent Psychiatry (AACAP), the... more
At the 2005 Annual Meeting of the American Academy of Child and Adolescent Psychiatry (AACAP), the Academy's Workgroup on Research conducted a Research Forum entitled "Increasing Research Literacy Through the Adoption of Evidence-Based Practice (EBP) in Pediatric Psychiatry." Forum participants focused on speeding the adoption of EBP across five areas: EBP as the preferred heuristic for teaching research literacy, use of EBP in training programs, dissemination of EBP in clinical practice, EBP in partnership with industry, and EBP as a framework for developing practice guidelines. EBP provides an easy-to-understand method for accessing and evaluating the research literature and then applying this information to decisions about patient care. Although EBP has been gaining greater visibility in pediatric psychiatry, it is far from the preferred heuristic. To move the field toward fully embracing EBP will require greater understanding of what EBP is (and is not), educating mental health professionals in EBP skills, access to EBP resources, and a commitment to apply EBP to the conceptualization and design of research protocols and practice guidelines. Pediatric psychiatry would benefit from a principled commitment to follow other areas of medicine in adopting EBP.
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Background: Depression as a disorder in childhood began to be increasingly recognised in the 1970s. Epidemiologic community and clinic-based studies have characterised the prevalence, clinical course, and complications of this illness... more
Background: Depression as a disorder in childhood began to be increasingly recognised in the 1970s. Epidemiologic community and clinic-based studies have characterised the prevalence, clinical course, and complications of this illness throughout childhood and adolescence into adulthood. This paper reviews two instruments for assessing depression in prepubertal children – the Dominic Interactive and The Preschool Age Psychiatric Assessment. Both instruments are useful in screening for psychiatric disorders and reliably identifying the presence of depressive symptoms in young children.
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To test whether adoption of a collaborative consultative service model results in improved patient outcomes. Twelve pediatric practices were randomly assigned to receive access to collaborative consultative services or to a control group.... more
To test whether adoption of a collaborative consultative service model results in improved patient outcomes. Twelve pediatric practices were randomly assigned to receive access to collaborative consultative services or to a control group. Community-based pediatric offices. Fifty-two pediatricians and their 377 patients with attention-deficit/hyperactivity disorder (ADHD). Intervention A collaborative consultative service promoting the use of titration trials and periodic monitoring during medication maintenance. Main Outcome Measure Physician practice behaviors and child ADHD symptomatology. Using self-report of pediatricians, the collaborative consultative service increased the use of evidence-based practices by pediatricians, but no difference in children's ADHD symptomatology was observed between the groups. However, many pediatricians did not fully use the collaborative consultative services. Those children who actually received collaborative consultative services showed significant behavioral improvement compared with children not receiving these services. When actually implemented by pediatricians, the collaborative consultative service appears to be an effective method for facilitating evidence-based treatment procedures for ADHD and use of these procedures appear to improve children's outcomes. Barriers to implementation of collaborative consultative service in pediatric practice need to be further understood.
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To test whether adoption of a collaborative consultative service model results in improved patient outcomes. Twelve pediatric practices were randomly assigned to receive access to collaborative consultative services or to a control group.... more
To test whether adoption of a collaborative consultative service model results in improved patient outcomes. Twelve pediatric practices were randomly assigned to receive access to collaborative consultative services or to a control group. Community-based pediatric offices. Fifty-two pediatricians and their 377 patients with attention-deficit/hyperactivity disorder (ADHD). Intervention A collaborative consultative service promoting the use of titration trials and periodic monitoring during medication maintenance. Main Outcome Measure Physician practice behaviors and child ADHD symptomatology. Using self-report of pediatricians, the collaborative consultative service increased the use of evidence-based practices by pediatricians, but no difference in children's ADHD symptomatology was observed between the groups. However, many pediatricians did not fully use the collaborative consultative services. Those children who actually received collaborative consultative services showed significant behavioral improvement compared with children not receiving these services. When actually implemented by pediatricians, the collaborative consultative service appears to be an effective method for facilitating evidence-based treatment procedures for ADHD and use of these procedures appear to improve children's outcomes. Barriers to implementation of collaborative consultative service in pediatric practice need to be further understood.
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Evidence-based medicine (EBM) is defined as a set of processes that facilitate the conscientious, explicit, and judicious integration of individual clinical expertise with the best available external clinical evidence from systematic... more
Evidence-based medicine (EBM) is defined as a set of processes that facilitate the conscientious, explicit, and judicious integration of individual clinical expertise with the best available external clinical evidence from systematic research in making decisions about the care of individual patients. EBM focuses not only on grading the strength of the evidence but also on the processes and tools that are necessary for clinicians to continually upgrade their knowledge and skills for those problems encountered in daily practice. This article, authored by members of the Duke Pediatric Psychiatry EBM Seminar Team, (1) describes EBM as applied to the training of child and adolescent psychiatrists in the Division of Child and Adolescent Psychiatry, Department of Psychiatry at Duke University Medical Center; (2) presents a simplified discussion of EBM as a technology for training and patient care; (3) discusses the basic principles and procedures for teaching EBM in the setting of a multidisciplinary training program; and (4) briefly mentions two training and research initiatives that are furthered by incorporating EBM.