NR 439 Literature and Levels of Evidence DQ

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NR 439 Literature and Levels of Evidence DQ

NR 439 Literature and Levels of Evidence DQ


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  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?

    EBM Pyramid

    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.

    simple graphic stating "Subject Terms plus Methodological Terms and Clinical Filters equal Optimal Retrieval of High Levels of Evidence"

    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:

    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.)
    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


    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


    • 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

    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

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