Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Create a 6- to 7-slide PowerPoint presentation in which you do the following:
- Identify and briefly describe your chosen clinical issue of interest.
- Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
- Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
- Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
- Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.
vidence Types
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Guide Search Terms
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1. OASIS
3. Evidence Types
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· Joanna Briggs Institute Search Help
Introduction
Not all evidence is the same, and appraising the quality of the evidence is part of evidence-based practice research. The hierarchy of evidence is typically represented as a pyramid shape, with the smaller, weaker and more abundant research studies near the base of the pyramid, and systematic reviews and meta-analyses at the top with higher validity but a more limited range of topics.
Several versions of the evidence pyramid have evolved with different interpretations, but they are all comprised of the types of evidence discussed on this page. Walden's Nursing 6052 Essentials of Evidence-Based Practice class currently uses a simplified adaptation of the Johns Hopkins model .
Evidence Levels:
Level I: Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis
Level II: Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis
Level III: Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis (see Daly 2007 for a sample qualitative hierarchy)
Level IV: Respected authorities’ opinions, nationally recognized expert committee or consensus panel reports based on scientific evidence
Level V: Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence
Systematic review
What is a Systematic Review?
A systematic review is a type of publication that addresses a clinical question by analyzing research that fits certain explicitly-specified criteria. The criteria for inclusion is usually based on research from clinical trials and observational studies. Assessments are done based on stringent guidelines, and the reviews are regularly updated. These are usually considered one of the highest levels of evidence and usually address diagnosis and treatment questions.
Benefits of Systematic Reviews
Systematic reviews refine and reduce large amounts of data and information into one document, effectively summarizing the evidence to support clinical decisions. Since they are typically undertaken by a entire team of experts, they can take months or even years to complete, and must be regularly updated. The teams are usually comprised of content experts, an experienced searcher, a bio-statistician, and a methodologist. The team develops a rigorous protocol to thoroughly locate, identify, extract, and analyze all of the evidence available that addresses their specific clinical question.
As systematic reviews become more frequently published, concern over quality led to the PRISMA Statement to establish a minimum set of items for reporting in systematic reviews and meta-analyses.
Many systematic reviews also contain a meta-analysis.
What is a Meta-Analysis?
Meta-analysis is a particular type of systematic review that focuses on selecting and reviewing quantitative research. Researchers conducting a meta-analysis combine the results of several independent studies and reviews to produce a synthesis where possible. These publications aim to assist in making decisions about a particular therapy.
Benefits of Meta-Analysis
A meta-analysis synthesizes large amounts of data using a statistical examination. This type of analysis provides for some control between studies and generalized application to the population.
To learn how to find systematic reviews in the Walden Library, please see the Levels of Evidence Pyramid page:
· Levels of Evidence Pyramid: Systematic Reviews
Further reading
· Cochrane Handbook for Systematic Reviews of Interventions
*updated 2022
Guidelines & summaries
Practice Guidelines
A practice guideline is a systematically-developed statement addressing common patient health care decisions in specific clinical settings and circumstances. They should be valid, reliable, reproducible, clinically applicable, clear and flexible. Documentation must be included and referenced. Practice guidelines may come from organizations, associations, government entities, and hospitals/health systems.
Best Evidence Topics
Best evidence topics are sometimes referred to as Best BETs. These topics are developed and supported for situations or setting when the high levels of evidence don't fit or are unavailable. They originated from emergency medicine providers' need to conduct rapid evidence-based clinical decisions.
Critically-Appraised Topics
Critically-appraised topics are a standardized one- to two-page summary of the evidence supporting a clinical question. They include a critique of the literature and statement of relevant results. They can be found online in many repositories.
To learn how to find critically-appraised topics in the Walden Library, please see the Levels of Evidence Pyramid page:
· Levels of Evidence Pyramid: Critically-Appraised Topics
Critically-Appraised Articles
Critically-appraised articles are individual articles by authors that evaluate and synopsize individual research studies. ACP Journal Club is the most well known grouping of titles that include critically appraised articles.
To learn how to find critically-appraised articles in the Walden Library, please see the Levels of Evidence Pyramid page:
· Levels of Evidence Pyramid: Critically-Appraised Articles
Randomized controlled trial
A randomized controlled trial (RCT) is a clinical trial in which participants are randomly assigned to either the treatment group or control group. This random allocation of participants helps to reduce any possible selection bias and makes the RCT a high level of evidence. Having a control group, which receives no treatment or a placebo treatment, to compare the treatment group against allows researchers to observe the potential efficacy of the treatment when other factors remain the same. Randomized controlled trials are quantitative studies and are often the only studies included in systematic reviews.
To learn how to find randomize controlled trials, please see our CINAHL & MEDLINE help pages:
· CINAHL Search Help: Randomized Controlled Trials
· MEDLINE Search Help: Randomized Controlled Trials
Cohort study
A cohort study is an observational longitudinal study that analyzes risk factors and outcomes by following a group (cohort) that share a common characteristic or experience over a period of time.
Cohort studies can be retrospective, looking back over time at data that has already been collected, or can be prospective, following a group forward into the future and collecting data along the way.
While cohort studies are considered a lower level of evidence than randomized controlled trials, they may be the only way to study certain factors ethically. For example, researchers may follow a cohort of people who are tobacco smokers and compare them to a cohort of non-smokers looking for outcomes. That would be an ethical study. It would be highly unethical, however, to design a randomized controlled trial in which one group of participants are forced to smoke in order to compare outcomes.
To learn how to find cohort studies, please see our CINAHL and MEDLINE help pages:
· CINAHL Search Help: Cohort Studies
· MEDLINE Search Help: Cohort Studies
Case-controlled studies
Case-controlled studies are a type of observational study that looks at patients who have the same disease or outcome. The cases are those who have the disease or outcome while the controls do not. This type of study evaluates the relationship between diseases and exposures by retrospectively looking back to investigate what could potentially cause the disease or outcome.
To learn how to find case-controlled studies, please see our CINAHL and MEDLINE help pages:
· CINAHL Search Help: Case Studies
· MEDLINE Search Help: Case Studies
Background information & expert opinion
Background information and expert opinion can be found in textbooks or medical books that provide basic information on a topic. They can be helpful to make sure you understand a topic and are familiar with terms associated with it.
To learn about accessing background information, please see the Levels of Evidence Pyramid page:
· Levels of Evidence Pyramid: Background Information & Expert Opinion
· Previous Page: Levels of Evidence Pyramid
· Next Page: CINAHL Search Help
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EVIDENCE-BASED PROJECT, PART 2: ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS
Your quest to purchase a new car begins with an identification of the factors important to you. As you conduct a search of cars that rate high on those factors, you collect evidence and try to understand the extent of that evidence. A report that suggests a certain make and model of automobile has high mileage is encouraging. But who produced that report? How valid is it? How was the data collected, and what was the sample size?
In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyze the evidence you have collected.
RESOURCES
Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources.
To Prepare:
· Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
· Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.
· Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
· Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.
The Assignment (Evidence-Based Project)
Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Create a 6- to 7-slide PowerPoint presentation in which you do the following:
· Identify and briefly describe your chosen clinical issue of interest.
· Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
· Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
· Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
· Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.
BY DAY 7 OF WEEK 5
Submit Part 2 of your Evidence-Based Project.
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EVIDENCE BASED LIBRARY AND INFORMATION PRACTICE
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4. Commentaries
Formulating the Evidence Based Practice Question: A Review of the Frameworks
Authors
· Karen Sue DaviesUniversity of Wisconsin – Milwaukee
DOI:
https://doi.org/10.18438/B8WS5N
Keywords:
PICO, ECLIPSE, SPICE, framework
ABSTRACT
No abstract.
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PUBLISHED
2011-06-24
HOW TO CITE
Davies, K. S. (2011). Formulating the Evidence Based Practice Question: A Review of the Frameworks. Evidence Based Library and Information Practice, 6(2), 75–80. https://doi.org/10.18438/B8WS5N
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The Creative Commons-Attribution-Noncommercial-Share Alike License 4.0 International applies to all works published by Evidence Based Library and Information Practice. Authors will retain copyright of the work.
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