Evidence-based practice is a conscientious, problem-solving approach to clinical practice that incorporates the best evidence from well-designed studies, patient values and preferences, and a
clinician's expertise in making decisions about a patient's care. Unfortunately, no standard formula exists for how much these factors should be weighed in the clinical decision-making process. However, there are a variety of rating systems and hierarchies of evidence that grade the strength or quality of evidence generated from a research study or report. Being knowledgeable about evidence-based practice and levels of evidence is important to every clinician as clinicians need to be confident
about how much emphasis they should place on a study, report, practice alert or clinical practice guideline when making decisions about a patient's care. The levels of evidence listed here have been developed with the help of nurse experts and other industry resources. We thank those who have contributed to making our system relevant and applicable to determining the levels of evidence that support our CE publications. Evidence-based information ranges from
Level A (the strongest) to Level C (the weakest). In 2013, Level ML, multilevel, was added to identify clinical practice guidelines that contain recommendations based on more than one level of evidence: LEVEL A: Evidence obtained from:
LEVEL B: Evidence obtained from:
LEVEL C: Evidence obtained from:
LEVEL ML (multilevel): clinical practice guidelines, recommendations based on evidence obtained from:
Evidence-based Practice Resources:
References for EBP:Alfaro-LeFevre R. Critical Thinking, Clinical Reasoning, and Clinical Judgment: A Practical Approach. 5th ed. St. Louis, MO: Elsevier-Saunders; 2013. Ebell MH, Siwek J, Weiss BD, et al. Strength of recommendation taxonomy (SORT): a patient centered approach to grading evidence in the medical literature. Am Fam Physician. 2004;69(3):548-556. http://www.aafp.org/afp/2004/0201/p548.html. Published February 1, 2004. Accessed November 11, 2015. Evidence-based medicine toolkit. American Academy of Family Physician Web site. http://www.aafp.org/journals/afp/authors/ebm-toolkit.html. Accessed November 11, 2015. What is evidence based medicine? University of Illinois at Chicago University Library Web site. http://researchguides.uic.edu/ebm. Updated March 7, 2008. Accessed November 11, 2015. Levels of evidence. Oxford Centre for Evidence-Based Medicine Web site. http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/. Published March 2009. Updated April 15, 2011. Accessed November 11, 2015. Melnyk BM, Fineout-Overholt E. Evidence-Based Practice in Nursing & Healthcare. A Guide to Best Practice. Philadelphia, PA: Lippincott Williams & Wilkins; 2005. Newhouse RP, Dearholt SL, Poe SS, Pugh LC, White KM. Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines. Indianapolis, IN: Sigma Theta Tau International; 2007. Strength of recommendation taxonomy (SORT). American Academy of Family Physicians Web site. http://www.aafp.org/dam/AAFP/documents/journals/afp/sortdef07.pdf. Accessed November 11, 2015. Understanding research study designs. University of Minnesota Bio-Medical Library Web site. http://www.biomed.lib.umn.edu/guides/understanding-research-study-designs. Accessed November 11, 2015. Which type of research study provides the best evidence in an evidence report?Systematic Reviews and Meta Analyses
Well done systematic reviews, with or without an included meta-analysis, are generally considered to provide the best evidence for all question types as they are based on the findings of multiple studies that were identified in comprehensive, systematic literature searches.
Which type of evidence is considered the highest quality quizlet?Which is considered the highest quality evidence? A systematic review or meta-analysis of an RCT is considered the highest level of quality evidence.
Which type of research study is considered to be the most reliable source of evidence quizlet?Research reports detailing study events, including results and analysis of findings included in refereed professional journals, are considered one of the most credible types of evidence and are typically considered one of the most useful sources for researchers as they conduct a literature review for a current study.
Which of the following types of research has the highest level of evidence?Types of Resources
When searching for evidence-based information, one should select the highest level of evidence possible--systematic reviews or meta-analysis. Systematic reviews, meta-analysis, and critically-appraised topics/articles have all gone through an evaluation process: they have been "filtered".
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