W3.1

| November 28, 2016

Provide a 200 word response to the below discussion question answer in apa format with in-text citations and references:

Answer:

When searching for evidence-based data, it is important to begin by searching for the highest level of evidence possible, which is considered to be systematic reviews or meta-analysis of all relevant randomized controlled trials (RCT). These research sources have gone through an evaluation process and have been filtered. With filtered resources, the literature on a topic has already been searched to provide the best answer to a clinical question or practice issue. According to Melnyk & Fineout-Overholt (2015), EBP methods such as systematic reviews increase our ability to manage the ever-increasing volume of information produced in order to develop best practices. Hence, the focus of EBP is to improve clinical practices based on a quality of knowledge that is certain and will produce a predictable and desirable outcome. To guide practitioners in evaluating the applicability of these scientific resources to healthcare decision making, the level of evidence and strength of evidence are organized around various research designs. The Agency for Healthcare Research and Quality (AHRQ 2002) recommended the incorporation of three domains to grade the strength of a body of evidence and they are: quality, quantity and consistency of the study. The practitioner should be able to answer this question affirmatively to proceed with the application of evidence to practice with confidence:”Is there enough valid and reliable evidence from the search to make a recommended change in clinical practice?”

Melnyk & Fineout-Overholt (2015) highlighted the strength of evidence rating pyramid or levels of evidence assigned to studies based on their methodological quality of their design, validity, and applicability to patient care. These levels of evidence will guide practitioners/clinicians in applying external evidence to practice. Clinicians might not always find the highest level of evidence as they go up the pyramid (i.e. systematic review or meta-analysis) to answer their questions, then they need to work their way down to the next highest level of evidence.

In addition, Ackley et al. (2008) described the following level of evidence to help clinicians feel more confident that the intervention will cause the targeted health effect:

Level I = Evidence from a systematic review or meta-analysis of all relevant RCTs or EB clinical practice

guidelines based on systematic reviews of RCTs or three or more RCTs of good quality that have

similar results.

Level II = Evidence obtained from at least one well-designed RCT.

Level III = Evidence obtained from well-designed controlled trials without randomnization

(ex. quasi-experimental)

Level IV = Evidence from well-designed case-control or cohort studies.

Level V = Evidence from systematic reviews of descriptive and qualitative studies (meta-synthesis).

Level VI = Evidence from a single descriptive or qualitative study.

Level VII = Evidence from the opinion of authorities and/or reports of expert committees.

Randomized controlled trials are placed at the highest level because they are designed to be unbiased and have less risk of systematic errors. Expert opinions are placed at the lowest level of evidence because they are often biased by the author’s experience or opinions and there is no control of confounding factors. The levels of evidence provide an important concept in evidence-based practice and assists clinician in clinical decision making.

Original Question:

What levels of evidence are present in relation to research and practice, and why it is important regardless of the method you use?

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