NR 439 Literature and Levels of Evidence DQ

NR 439 Literature and Levels of Evidence DQ

NR 439 Literature and Levels of Evidence DQ

2424 unread replies.108108 replies.

1. Reflect on your practice, and identify a significant nursing clinical issue or change project that you would like to search for evidence in online sources. Formulate searchable, clinical questions in the PICO(T) format for your nursing clinical issue.
2. Next, review the guidelines for the PICOT Assignment due Week 3. Use your PICOT elements to search for one report of a single, original study that has been published within the last 5 years from the CCN Library that is relevant to your nursing clinical issue.
3. Briefly describe how it is relevant to your nursing clinical issue. Remember to give a complete reference to the study.

   Is All Evidence Created Equal?

   

   The medical literature is immense, but only a small portion of it is immediately useful in answering clinical questions. The literature reports the whole spectrum of the scientific research process — the long journey from in-vitro studies to double-blind randomized controlled trials. This has been called the “wedge of evidence” or the “pyramid of evidence.” (for a visual representation see More Information)

   An understanding of how various levels of evidence are reported and how this literature is organized will help the searcher retrieve the highest levels of evidence for a particular clinical question. High levels of evidence may not exist for all clinical questions because of the nature of medical problems and research and ethical limitations.

   Adding METHODOLOGY terms and CLINICAL FILTERS to SUBJECT terms will result in the most efficient and optimal retrieval in terms of finding the highest level of evidence in answering clinical questions.

   

   Study Design Concepts

   Studies can be descriptive (or observational), such as :

   • case reports (a detailed description of a single case)
   • case series (descriptions of groups of patients with a disease)
   • cohort studies (defined populations which are followed in an attempt to determine distinguishing subgroup characteristics)

   Or evaluative (interventional), such as a:

   • randomized/controlled clinical trials (a clinical trial involving one or more test treatments, at least one control treatment, specified outcome measures for evaluating the studied intervention, and a bias-free method for assigning patients to the test treatment)

     Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS:NR 439 Literature and Levels of Evidence DQ

   Levels of Clinical Evidence in the Primary Literature

   Type of Question	Type of Study Methodology	MEDLINE Filters
   Therapy: information needed about treatments (effectiveness, cost, etc.)	Double-Blind Randomized Controlled Trial	Randomized Controlled Trial [PT] double [TW] and blind [TW]
   Diagnosis: information needed about a diagnostic test (sensitivity, accuracy, etc.)	Controlled Trial	Sensitivity and Specificity [MH] Diagnosis [SH]
   Prognosis: information needed about the course of the disease over time, expected complications, etc.	Cohort Studies Case Control Case Series	Cohort Studies [MH] Prognosis [MH] Survival Analysis [MH]
   Etiology/Harm: information needed about causes of disease or contributing factors of disease	Cohort Studies	Cohort Studies [MH] Risk [TW]
   Prevention: information needed about the prevention of disease (immunization, social factors, etc.)	Randomized Controlled Trial Cohort Studies	Randomized Controlled Trial [PT] Cohort Studies [MH] Prevention and Control [SH]
   Quality Improvement: information needed about clients’ and health professionals’ experiences and concerns	Randomized Controlled Trial	Randomized Controlled Trial [PT] Practice Guideline [PT] Consensus Development Conference [PT]

   (Abbreviations: MH=Medical Subject Heading; PT=Publication Type; SH=Subheading; TW=Text Word)

   Secondary Literature

   The practice and teaching of Evidence-Based Medicine has outcome products which help the health care provider and consumer keep up with the medical literature and assess the evidence. This secondary literature synthesizes, filters, and evaluates the primary research literature. Dissemination and incorporation of valid clinical research findings into medical practice is the ultimate goal.

   Filtered or Synthesized Information	Description/Definition	How to Find This Type of Information
   Systematic Reviews	differ from traditional review articles in that conclusions are evidence-based rather than commentary start with a clearly articulated question use explicit, rigorous methods to identify, critically appraise, and synthesize relevant studies appraise relevant published and unpublished evidence before combining and analyzing data include description of how primary data sources are identified assess individual studies for validity	Use Cochrane Collaboration Cochrane Database of Systematic Reviews York Database of Abstracts of Reviews of Effectiveness Cochrane Controlled Trials Register Cochrane Review Methodology Database Use PubMed/MEDLINE searching Review [PT] AND medline [TW] (Quantitative OR Systematic OR Methodologic) AND (Review OR Overview) Use PubMed Clinical Queries “Systematic Review” is available as a limit option
   Meta-Analyses	specific methodologic and statistical technique for combining quantitative data type of systematic overview	Use Cochrane Collaboration Use PubMed/MEDLINE searching Meta-analysis [PT] meta-anal* [TW] OR metaanal* [TW]
   Evidence-Based Practice Guidelines	gather, appraise, combine evidence systematically include statements designed to assist practitioner and patient decisions developed by professional groups, government agencies, local practices include a structured abstract: objective, option, outcomes, evidence, values, benefits/harms/costs, recommendation, validation, sponsors	Use National Guideline Clearinghouse Use Agency for Healthcare Research and Quality Use US Preventive Services Task Force Recommendations
   Critically Appraised Topics (CATs)	scan literature for clinically relevant studies critically appraise the studies provide commentary on strength of study and clinical significance provided in a one-page format	Use EBM Reviews ACP Journal Club Use Essential EvidencePLUS (UIC affiliate access) InfoPOEMS Use CATmaker software from CEBM
   Decision Analyses/Decision Tools	studies that analyze decisions faced by clinicians for an individual patient, about clinical policy, or a global health care policy application of explicit, quantitative methods to analyze decisions under conditions of uncertainty risks and benefits of a decision are made fully explicit decision tree is included	Use PubMed/MEDLINE searching Decision Support Techniques [MH] Cost-Benefit Analysis [MH] decision analysis [TI]
   Consensus Development Reports	assessments of emerging or critical health issues based on available research and expert opinion to identify needs for policy development and further research (description based on information from the NIH Consensus Development Program now ‘retired’ in light of “many other organizations that conduct [evidence] reviews”)	Use PubMed/MEDLINE searching “consensus statement” [TW] OR “consensus report” [TW]

    

   Study Design Terminology

   • Control Group – the group that does not receive the treatment, etc.
   • Randomization – assigns participants by chance to either the treatment group or the control group.
   • Blinding – the participants and/or some of the researchers do not know the groups to which the participants have been assigned.
   • Loss to Follow-up/Intention to Treat – all of the participants should be accounted for even if they did not fully participate.
   • P Value – the probability of any observed differences having happened by chance.  The convention is that .05 is required.
   • Power – the likelihood that a study will detect a statistically significant difference.  The convention is that a power of at least 80% is required.
   • See also Scientific Experiment Terminology from the Appraisal tab.

   More Information

   • SUNY Downstate Medical Center EBM Course: A Guide to Research Methods.

     A visual “evidence pyramid”