Clinical Task Force Research Articles

Toward Equitable Kidney Function Estimation in Critical Care Practice: Guidance From the Society of Critical Care Medicine's Diversity, Equity, and Inclusion in Renal Clinical Practice Task Force.

Accurate glomerular filtration rate (GFR) assessment is essential in critically ill patients. GFR is often estimated using creatinine-based equations, which require surrogates for muscle mass such as age and sex. Race has also been included in GFR equations, based on the assumption that Black individuals have genetically determined higher muscle mass. However, race-based GFR estimation has been questioned with the recognition that race is a poor surrogate for genetic ancestry, and racial health disparities are driven largely by socioeconomic factors. The American Society of Nephrology and the National Kidney Foundation (ASN/NKF) recommend widespread adoption of new "race-free" creatinine equations, and increased use of cystatin C as a race-agnostic GFR biomarker. Literature review and expert consensus. English language publications evaluating GFR assessment and racial disparities. We provide an overview of the ASN/NKF recommendations. We then apply an Implementation science methodology to identify facilitators and barriers to implementation of the ASN/NKF recommendations into critical care settings and identify evidence-based implementation strategies. Last, we highlight research priorities for advancing GFR estimation in critically ill patients. Implementation of the new creatinine-based GFR equation is facilitated by low cost and relative ease of incorporation into electronic health records. The key barrier to implementation is a lack of direct evidence in critically ill patients. Additional barriers to implementing cystatin C-based GFR estimation include higher cost and lack of test availability in most laboratories. Further, cystatin C concentrations are influenced by inflammation, which complicates interpretation. The lack of direct evidence in critically ill patients is a key barrier to broad implementation of newly developed "race-free" GFR equations. Additional research evaluating GFR equations in critically ill patients and novel approaches to dynamic kidney function estimation is required to advance equitable GFR assessment in this vulnerable population.

Clinical Use of Trabecular Bone Score: The 2023 ISCD Official Positions

Osteoporosis can currently be diagnosed by applying the WHO classification to bone mineral density (BMD) assessed by dual-energy x-ray absorptiometry (DXA). However, skeletal factors other than BMD contribute to bone strength and fracture risk. Lumbar spine TBS, a grey-level texture measure which is derived from DXA images has been extensively studied, enhances fracture prediction independent of BMD and can be used to adjust fracture probability from FRAX® to improve risk stratification. The purpose of this International Society for Clinical Densitometry task force was to review the existing evidence and develop recommendations to assist clinicians regarding when and how to perform, report and utilize TBS. Our review concluded that TBS is most likely to alter clinical management in patients aged ≥ 40 years who are close to the pharmacologic intervention threshold by FRAX. The TBS value from L1-L4 vertebral levels, without vertebral exclusions, should be used to calculate adjusted FRAX probabilities. L1-L4 vertebral levels can be used in the presence of degenerative changes and lumbar compression fractures. It is recommended not to report TBS if extreme structural or pathological artifacts are present. Monitoring and reporting TBS change is unlikely to be helpful with the current version of the TBS algorithm. The next version of TBS software will include an adjustment based upon directly measured tissue thickness. This is expected to improve performance and address some of the technical factors that affect the current algorithm which may require modifications to these Official Positions as experience is acquired with this new algorithm.

The clinical task force: Improving quality of medical students’ internship

BackgroundUp to 40% of young medical doctors feel that the internships prepared them insufficiently for the clinical work. This study investigated whether a Clinical Task Force (CTF) could improve internship quality. MethodsThe CTF visited internship departments with a triple-targeted approach: first, departments pre-filled a self-evaluating questionnaire; secondly, CTF visited departments to discuss the self-evaluation and previous student evaluations; and thirdly, CTF and departments agreed on several quality-improving focus points to work on after the meeting. Focus points were followed-up after three and 12 months. The impact on internship quality was assessed with departments’ student evaluation scores, number of completed focus points, and the effect of completed focus points on a range of learning parameters. The CTF learned several things along the way, that potentially could affect the quality of internships. A shortlist of these was provided to illustrate unmeasurable benefits. ResultsThe CTF met with 53 out of 60 eligible departments. The CTF and departments agreed upon 197 focus points of which 64% were completed. The three most frequent categories of focus points were Introduction of the students, The departments' evaluation percentage, and The departments' function as an educational site. The mean student evaluation scores did not change significantly, but the individual evaluation parameters changed significantly in two categories. It decreased in the category regarding the students’ satisfaction with the clinical lecturers and the scheduled teaching and increased in the category regarding the percentage of students evaluating the department. ConclusionThe CTF's triple-targeted approach did not increase the mean student evaluation score significantly. For departments that completed the agreed focus points, one category increased and another decreased. However, the unmeasurable benefits illustrated that CTF was a good viable linking element between the faculty, departments, and students with the potential of improving other aspects of the quality of internships.

Leveraging Clerkship Experiences to Address Segregated Care: A Survey-Based Approach to Student-Led Advocacy

Phenomenon: Many academic medical centers (AMCs) have a history of separating patients on the basis of insurance status. In New York State, where Black and Latino patients are more than twice as likely to have Medicaid as white patients, this practice leads to de facto racial segregation in healthcare. Emerging evidence suggests that this segregation of care is detrimental to both patient care and medical education. Medical students are uniquely positioned to be change makers in this space but face significant barriers to speaking out about these disparities and successfully advocating for institutional change. Approach: The authors designed, piloted, and distributed a 16-item survey on segregated care to third-year medical students at a large academic medical center in New York City. Students were asked both open- and close-ended questions about witnessing separation and differences in patient care on the basis of insurance during their clinical rotations. The survey was shared with 140 students in March 2019 with a response rate of 46.4% (n = 65). Preliminary findings were presented to school and hospital administrators. Findings: More than half of survey respondents reported witnessing separation of patient care or differences in patient care on the basis of insurance (56.3%, n = 36 and 51.6%, n = 33 respectively). Many students reported that these experiences contributed to cynicism and burnout. The authors leveraged these results to advocate for quality improvement measures. In Ob-Gyn, department leadership launched a clinical transformation taskforce and recruited a new Vice Chair of Clinical Transformation/Chief Patient Experience Officer, whose role includes addressing segregated care and disparities in health outcomes. The hospital committed to establishing integrated practices in new clinical spaces and launching a similar survey among house staff. Insights: Many medical students experience and participate in segregated care during their clerkships and this has the potential to impact their education. Medical students are well-positioned to recognize segregated care across health systems and leverage their experiences for advocacy. A survey-based approach can be a powerful tool enabling students to collect these experiences to address segregated care and other health equity issues.

COVID-19 Update for the GRAPPA 2021 Annual Meeting: Focus on COVID-19 Vaccination.

The efficacy and safety of coronavirus disease 2019 (COVID-19) vaccination in patients with autoimmune inflammatory diseases (AIRDs) who are treated with immunomodulatory therapies was the focus of a symposium at the 2021 virtual annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). The keynote address was delivered by Dr. Jeffrey Curtis, chair of the American College of Rheumatology COVID-19 Vaccine Clinical Guidance task force, detailing what we do and do not know about vaccine efficacy and safety in patients with AIRDs and providing guidance about the need for modification of dosing in some immunomodulatory medications for optimal vaccine response. A consensus of the task force was that all patients with AIRDs should be vaccinated as soon as it is allowed in their respective locations, since the benefits of increased protection against COVID-19 infection outweigh the potential for vaccination reactions, including flares of underlying disease, or for reduced efficacy of vaccination because of disease state or medications. Key issues among patient research partners with psoriatic disease expressed in the premeeting survey and panel discussion/question-and-answer period included: vaccine efficacy and safety, the need to continue safe social habits and masking, how to assess efficacy of vaccination, how to deal with vaccine hesitancy among social contacts, medication management relative to vaccination, and concerns about the adequacy of ongoing telehealth visits vs the convenience of that technology.

The Clinical Task Force: Improving Quality of Medical Students’ Internship

The Clinical Task Force: Improving Quality of Medical Students’ Internship

Immunomodulatory and immunosuppressive medication modification among patients with rheumatic diseases at the time of COVID-19 vaccination.

Due to concerns about underlying immune dysregulation and immunosuppression, patients with systemic rheumatic diseases might modify their medications at the time of COVID-19 vaccination to optimise their immune response and mitigate vaccine side-effects. Immunosuppressed patients in New York state were approved for vaccination on Feb 15,2021,1 soon after the American College of Rheumatology COVID-19 Vaccine Clinical Guidance Task Force issued its first management guidelines on Feb 8, 2021.2 Whether real-world behaviour was aligned with these guidelines is unknown.

EAACI guidelines: Anaphylaxis (2021 update).

Anaphylaxis is a clinical emergency which all healthcare professionals need to be able to recognize and manage. The European Academy of Allergy and Clinical Immunology Anaphylaxis multidisciplinary Task Force has updated the 2014guideline. The guideline was developed using the AGREE II framework and the GRADE approach. The evidence was systematically reviewed and recommendations were created by weighing up benefits and harms. The guideline was peer-reviewed by external experts and reviewed in a public consultation. The use of clinical criteria to identify anaphylaxis is suggested with blood sampling for the later measurement of tryptase. The prompt use of intramuscular adrenaline as first-line management is recommended with the availability of adrenaline autoinjectors to patients in the community. Pharmacokinetic data should be provided for adrenaline autoinjector devices. Structured, comprehensive training for people at risk of anaphylaxis is recommended. Simulation training and visual prompts for healthcare professionals are suggested to improve the management of anaphylaxis. It is suggested that school policies reflect anaphylaxis guidelines. The evidence for the management of anaphylaxis remains mostly at a very low level. There is an urgent need to prioritize clinical trials with the potential to improve the management of patients at risk of anaphylaxis.

Diagnostic Accuracy of Surveillance of FDG-PET/CT in Detection of Early Relapse in Malignant Lymphoma.

Introduction: Integrated PET/CT has been shown to be more accurate for lesion localization and characterization in lymphoma than PET and CT alone. Addition of CECT to PET/CT changed management of lymphoma in only about 10% of patients, while FDG/PET resulted in a management change in almost 50 % of HL patients compared with CECT alone. The majority of patients with high-grade non-Hodgkin’s lymphomas (NHL) are cured with combination treatments. However, acute and long-term toxicities impair survival. Patients with poor-risk, progressive, or relapsed disease; the goal is to improve survival with a strategy using more intensive therapy. Hence, the focus of management has now shifted towards reducing the treatment toxicity and long-term side effects while maintaining favorable outcomes especially in low-risk patients. The successful application of this tailored approach is dependent on an accurate and non-invasive diagnostic test that would reflect the true extent of disease as well as its viability early during the course of treatment. Metabolic parameters in malignant lymphoma: An imaging task force was created to update the relevance of existing imaging for staging, assessing bulk, and bone marrow involvement (BMI); the role of interim PET; standardization of PET reporting; and role for quantitative evaluation using PET and CT. A clinical task force assessed the current relevance of Ann Arbor and how best to incorporate PET/CT into staging lymphoma, the relevance of B symptoms and bone marrow biopsy (BMB), as well as to create recommendations relevant to both FDG-avid and non-avid lymphomas. The revised IWG response criteria (rIWG) incorporated FDG PET to accurately assess end-therapy persistent masses in both NHL and HL. PET/CT in surveillance assessment: Surveillance CT or PET-CT scans are widely used because of the impression that treatment at relapse is more likely to be effective when the disease is in a preclinical stage with a small tumor burden: the earlier the detection of disease the higher the treatment efficacy. The authors concluded that the routine use of surveillance PET in HL patients entering complete remission after first-line treatment should be reserved for high-risk patients. Current guidelines warrant that, once the first clinical remission is obtained, surveillance should be grounded on frequent physical examination and routine blood tests. By contrast, a significant proportion of these patients undergo follow-up CT radiological studies and fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT, especially in the first 2 years after therapy. FDG-PET/CT follow up exams may be associated with false positive results. These confounding findings add up to the already significant FDG-PET/CT expense, which in turn is significantly more resource-consuming when compared to clinical and biochemical evaluation. CONCLUSION: PET/CT imaging for surveillance in malignant lymphoma may be useful in special subtypes of both Hodgkin and non-Hodgkin lymphoma.

Collaborations between Clinical Pharmacologists in Japan and in the United States ‐ Report from the IQ CPLG and JPMA CPTF Meeting in Tokyo, Japan

The International Consortium for Innovation and Quality in Pharmaceutical Development (IQ) Clinical Pharmacology Leadership Group (CPLG) held its first meeting of Japan‐based representatives at Astellas Pharma headquarters in Tokyo on October 1, 2019. The meeting was also attended by Japan Pharmaceutical Manufactures Association (JPMA) Clinical Pharmacology Task Force (CPTF) members. Overall, nearly 30 clinical pharmacologists representing 14 companies attended the event. The meeting met its goal of enhancing mutual understanding of each organization’s activities. In a number of break‐out sessions, participants identified scientific topics for potential future collaboration between JPMA CPTF and IQ CPLG.

Development and testing of an advanced practice clinical advancement program within an academic medical center.

Faculty advanced practice registered nurses (APRNs) and physician assistants (PAs) employed by Vanderbilt University Medical Center (VUMC) have historically participated in rank promotion tracks for recognition of professional accomplishments in education, practice, and research. However, there has not been a clinical advancement program for nonfaculty practitioners. Satisfaction, engagement, and health surveys indicated VUMC APRNs and PAs were seeking opportunities for professional growth and development. Many health care organizations have incorporated clinical advancement programs as key recruitment and retention strategies. With a growing number of nonfaculty APRNs and PAs, VUMC began to explore the development, implementation, and evaluation of a clinical advancement program. A VUMC Clinical Advancement Task Force was created to explore, develop, implement, and evaluate an advanced practice clinical advancement pilot. Two teams were selected to participate in a 6-month pilot. Presurveys and postsurveys were conducted, and postpilot focus groups were held with participating practitioners. A 9-square tool was developed as a rubric for evaluating the practitioner's progress. Applications, leader assessments, and recommendations were housed in a secure database for a selected advancement committee to evaluate. Of 23 participants, 47% indicated satisfaction with professional development opportunities, when compared with 84% postpilot. Postpilot focus groups further improved the tool and the process for the program. Opportunities for advancement/professional development positively influence APRN and PA perceptions of job satisfaction. This program could be tested with other APRN and PA teams for impact on job satisfaction, engagement, and retention.

AGE-RELATED HEARING LOSS, LATE-LIFE DEPRESSION, AND RISK FOR INCIDENT DEMENTIA IN OLDER ADULTS

Introduction Age-related hearing loss, late-life depression, and dementia are three prevalent and disabling conditions found in older adults, but the inter-relationships between these disorders remain poorly understood. We aimed to determine whether the presence of hearing loss increases risk for incident depression and dementia, and examine whether depression partially mediates the hearing loss-dementia relationship. Methods Data from the National Alzheimer's Coordinating Center (NACC) Uniform Dataset were used to evaluate Cox proportional hazard models to determine the effect of hearing loss on incident depression and dementia. A total of 8,529 participants aged 60?years or older who were free of dementia or cognitive impairment at their first NACC visit were available for analysis. Hearing categories included no hearing loss, untreated hearing loss, and treated hearing loss. The main outcome measures were incident depression (15-item Geriatric Depression Scale ≥5) and conversion to dementia (as defined by the Alzheimer's Disease Centers Clinical Task Force). Two Cox proportional hazard models were used: Model A included only baseline variables (hearing loss, depression, and demographics) and Model B included time-varying depression in order to evaluate for the direct effect of incident depression on dementia over time. Results Subjects with treated hearing loss had increased risk for incident depression (OR = 1.24, 95% CI 1.02-1.51) and conversion to dementia (HR = 1.27, 95% CI 1.02-1.60). The presence of baseline depression was a strong independent predictor of conversion to dementia (HR = 2.44, 95% CI 1.86-3.21). Development of depression partially mediated the pathway from hearing loss to dementia, accounting for 8% of the direct hearing-dementia relationship (beta = 0.24 [SE 0.12] in Model A to beta = 0.22 [SE 0.12] in Model B). Conclusions Both hearing loss and depression are independent risk factors for eventual conversion to dementia. The development of depression in a hearing-impaired older adult may be an intermediate step in this pathway. Understanding the brain and behavioral mechanisms linking these conditions may facilitate identification and dissemination of interventions (such as treatment for hearing loss and depression) capable of protecting brain health during aging. This research was funded by: None

Version 3 of the National Alzheimer's Coordinating Center's Uniform Data Set.

In 2015, the US Alzheimer's Disease Centers (ADC) implemented Version 3 of the Uniform Data Set (UDS). This paper describes the history of Version 3 development and the UDS data that are freely available to researchers. UDS Version 3 was developed after years of coordination between the National Institute on Aging-appointed Clinical Task Force (CTF), clinicians from ∼30 ADCs, and the National Alzheimer's Coordinating Center (NACC). The CTF recognized the need for updates to align with the state of the science in dementia research, while being flexible to the diverse needs and diseases studied at the ADCs. Version 3 also developed a nonproprietary neuropsychological battery. This paper focuses on the substantial Version 3 changes to the UDS forms related to clinical diagnosis and characterization of clinical symptoms to match updated consensus-based diagnostic criteria. Between March 2015 and March 2018, 4820 participants were enrolled using UDS Version 3. Longitudinal data were available for 25,337 of the 37,568 total participants using all UDS versions. The results from utilization of the UDS highlight the possibility for numerous research institutions to successfully collaborate, produce, and use standardized data collection instruments for over a decade.

Version 3 of the Alzheimer Disease Centers' Neuropsychological Test Battery in the Uniform Data Set (UDS).

Introduction:The neuropsychological battery of the Uniform Data Set (UDSNB) was implemented in 2005 by the National Institute on Aging (NIA) Alzheimer Disease Centers program to measure cognitive performance in dementia and mild cognitive impairment due to Alzheimer Disease. This paper describes a revision, the UDSNB 3.0.Methods:The Neuropsychology Work Group of the NIA Clinical Task Force recommended revisions through a process of due diligence to address shortcomings of the original battery. The UDSNB 3.0 covers episodic memory, processing speed, executive function, language, and constructional ability. Data from 3602 cognitively normal participants in the National Alzheimer Coordinating Center database were analyzed.Results:Descriptive statistics are presented. Multivariable linear regression analyses demonstrated score differences by age, sex, and education and were also used to create a normative calculator available online.Discussion:The UDSNB 3.0 neuropsychological battery provides a valuable non proprietary resource for conducting research on cognitive aging and dementia.

Implementation of a New UPMC Gamma Knife Radiosurgery Quality Assurance Registry

Object: In this report, we discuss the development of a new, comprehensive, Health Insurance Portability and Accountability Act-compliant electronic quality assurance (QA) registry for Gamma Knife (GK) radiosurgery patients. This registry can be used to query outcomes, link with current hospital electronic medical records, and share data with future corporate or national professional society registries under development. Methods: A clinical task force comprising physicians and regulatory, legal, and information technology (IT) experts was created to define the nomenclature, regulatory requirements, hosting site, and required capabilities of the proposed system. A team of physicians and IT experts defined the clinical parameters and designed the query functions for the registry. Results: The UPMC GK Registry was established as a QA registry exempt from Institutional Review Board oversight. In order to facilitate subsequent query functions (analytics), data entry was created for 3 main categories: brain tumors, vascular malformations, and functional disorders. A Microsoft SQL-based database infrastructure was employed. Conclusions: We developed a new UPMC GK QA registry and successfully migrated our previous data on 13,000 patients into the registry. This simplified and user-friendly registry offers clinicians the opportunity to participate in national registries and to contribute to multicenter evidence-based outcome analyses.

Changes in Drug Eluting Stent Usage During a Four-Year Time Period in a Regional Cath Lab in New South Wales

The safety and cost effectiveness of Drug eluting stents (DES) were not well established compared to Bare metal stents (BMS) in the past1. Earlier guidelines had recommended a selective use of DES2,3. However, subsequent studies have shown that DES, particularly the newer generation stents have better safety profile than BMS4. The aim of this analysis was to study the changes in DES usage in a regional Cath Lab at Lismore Base Hospital in NSW during a four year time period from 2012 to 2015. A total of 515 cases of coronary angioplasty with stenting were done during this period (average age 67+/-12 years; 67% males). 666 stents were used. Average number of stents used per case was 1.3. In 2012 out of the 146 stents used for 112 cases, 90 were DES (62%) and 56 were BMS (38%). The number of DES used was 116(70%) and BMS was 50(30%) out of a total 166 stents used for 125 cases in 2013. In 2014 the number of DES used was 123(64%) and BMS was 68(36%) out of total 191 stents for 146 cases. In 2015 the DES usage was 146(90%) and BMS usage was 17(10%) out of 163 stents used in 132 cases. The current study showed a clear increase in DES usage from an average 65% between 2012 and 2014 to 90% in 2015. This reflects the current recommendations for use of new generation DES, which have improved safety profile, clinical efficacy and cost effectiveness compared to BMS4,5.1.Lagerqvist B, James SK, Stenestrand U, Lindback J, et al. Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden. N Engl J Med 2007;356(10):1009-1019.2.King SB 3rd, Smith SC Jr, Hirshfeld JW Jr et al., 2007 focussed update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice guidelines. J Am Coll Cardiol. 2008 Jan 15;51(2):172-209.3.Clinical Guidelines for the Use of Drug Eluting Coronary Artery Stents in Public Hospitals in NSW. Greater Metropolitan Clinical Taskforce Cardiac Coordinating Committee, May 2008.4.Windecker S, Kolh P, Alfonso F et al., 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2014 Oct 1;35(37):2541-2619..5.Revision of clinical guidelines for the use of Drug eluting coronary artery stents in public hospitals in NSW. Agency for clinical innovation draft publication 2015.

APA Task Force to Address ‘What’s Next?’ for Ketamine

APA Task Force to Address ‘What’s Next?’ for Ketamine

Singapore Cancer Network (SCAN) Guidelines for Front-Line Systemic Therapy of Newly Diagnosed Advanced Epithelial Ovarian Cancer

The SCAN gynaecological cancers systemic therapy workgroup aimed to develop Singapore Cancer Network (SCAN) clinical practice guidelines for front-line systemic therapy of advanced epithelial ovarian cancer. The workgroup utilised a modified ADAPTE process to calibrate high quality international evidence-based clinical practice guidelines to our local setting. Five international guidelines were evaluated- those developed by the National Comprehensive Cancer Network (2013), the European Society of Medical Oncology (2013), the National Institute of Health and Clinical Excellence (2011), the Scottish Intercollegiate Guidelines Network (2011) and the Greater Metropolitan Clinical Taskforce (2009). Recommendations on the role of systemic therapy with intravenous chemotherapy, intraperitoneal chemotherapy, anti-angiogenic agents and neoadjuvant chemotherapy in newly diagnosed advanced epithelial ovarian cancer were developed. These adapted guidelines form the SCAN Guidelines 2015 for front-line systemic therapy of advanced epithelial ovarian cancer.

Fracture Risk Prediction by Non-BMD DXA Measures: the 2015 ISCD Official Positions Part 2: Trabecular Bone Score

Bone mineral density (BMD) as measured by dual-energy X-ray absorptiometry (DXA) is the gold standard for the diagnosis and management of osteoporosis. However, BMD explains only 60%–80% of bone strength, and a number of skeletal features other than BMD contribute to bone strength and fracture risk. Advanced imaging modalities can assess some of these skeletal features, but compared to standard DXA, these techniques have higher costs and limited accessibility. A major challenge, therefore, has been to incorporate in clinical practice a readily available, noninvasive technology that permits improvement in fracture-risk prediction beyond that provided by the combination of standard DXA measurements and clinical risk factors. To this end, trabecular bone score (TBS), a gray-level textural index derived from the lumbar spine DXA image, has been investigated. The purpose of this International Society for Clinical Densitometry task force was to review the evidence and develop recommendations on how to incorporate TBS in clinical practice. Clinical applications of TBS for fracture risk assessment, treatment initiation, monitoring of treatment, and use of TBS in special conditions related to greater fracture risk, were addressed. We present the official positions approved by an expert panel following careful review of the recommendations and evidence presented by the TBS task force.

The CPA Presidential Task Force on Evidence-Based Practice of Psychological Treatments.

In 2011, the Board of Directors of the Canadian Psychological Association (CPA) launched the Task Force on Evidence-Based Practice of Psychological Treatments to support and guide practice as well as to inform stakeholders. This article describes the work of this task force, outlining its raison d'etre, providing a comprehensive definition of evidence-based practice (EBP), and advancing a hierarchy of evidence that is respectful of diverse research methodologies, palatable to different groups, and yet comprehensive and compelling. The primary objective was to present an overarching methodology or approach to thinking about EBP so that psychologists can provide and implement the best possible psychological treatments. To this end, our intention for this document was to provide a set of guidelines and standards that will foster interest, encourage development, and promote effectiveness in EBP.Keywords: evidence-based practice, evidence-based treatment, empirically supported treatment, psychotherapy, psychological treatmentAs part of the 2011-2012 Canadian Psychological Association (CPA) President's mandate (see Dozois, 2012, 2013), the Board of Directors voted in favor of a motion (March 2011) that the CPA establish a task force on the evidence-based practice (EBP) of psychological treatments that would generate a set of criteria and develop a position statement regarding the optimal integration of research evidence into practice. The board members believed that it was important for the CPA to develop a position on EBP in psychology to support and guide practice as well as to inform stakeholders. Psychological health and psychological disorders are clearly a priority for many of Canada's stakeholder groups (e.g., the Mental Health Commission of Canada, Treasury Board, Public Health Agency of Canada), and effective psychological treatment is also an important priority for CPA.BackgroundImportant objectives in professional psychology include the generation of treatment-relevant scientific knowledge and the ap- plication of this knowledge to the development of efficacious and effective interventions for mental and behavioral health problems (Baker, McFall, & Shoham, 2009; Kazdin, 2008; Lilienfeld, 2010; Treat, Bootzin, & Baker, 2012). Such objectives arise from a growing recognition in the field that the practice of psychological treatments should be based on valid evidence regarding which approaches to intervention are most likely to be successful. Al- though there is controversy regarding what constitutes evidence, most psychologists believe in the utility of research for informing clinical practice and view EBP positively (Lilienfeld, Ritschel, Lynn, Cautin, & Latzman, 2013).In 1995, the American Psychological Association's (APA) So- ciety of Clinical Psychology Task Force on Promotion and Dis- semination of Psychological Procedures published its initial report, which listed treatments considered to be well-established or prob- ably efficacious according to a standard set of criteria (e.g., Chambless & Ollendick, 2001; Chambless et al., 1996). These criteria were subsequently adopted by the CPA Section on Clinical Psychology in their task force report, Empirically Supported Treat- ments in Psychology: Implications for Canadian Professional Psy- chology (Hunsley, Dobson, Johnston, & Mikail, 1999a, 1999b).Although many researchers and practitioners were enthusiastic about these efforts to promote empirically supported treatments, the criteria used to designate such treatments elicited considerable controversy. Concerns with the focus on empirically supported treatments have done little to narrow the gap between research and practice and to alter many clinicians' utilization of scientific liter- ature (see Hunsley, 2007a; Kazdin, 2008; Lilienfeld et al., 2013, for reviews of some of the challenges and solutions). For example, some psychologists have argued that the type of research deemed necessary to produce supportive evidence for a treatment is in- compatible with schools of psychotherapy outside of the cognitive behavioral therapy (CBT) framework (e. …