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The "levels of evidence"
QUESTION
Describe the "levels of evidence" and provide an example of the type of practice change that could result from each.
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Answer
The Levels of Evidence and Practice Change Impact
Evidence-based practice is the utilization of the scientific method to apply and organize current data to improve healthcare decisions. Levels of evidence are stratified into six different levels; these include level IA, IB, IIA, IIB, III, and IV (Tenny & Varacallo, 2020). Level IA evidence is generated from meta-analyses of well-conducted, multiple, and well-designed randomized trials. Randomized trials generate strongest clinical evidence and the strength of evidence is even greater in meta-analyses of such studies. Level IA evidence can be used for determining efficacy and safety of a new drug (Tenny & Varacallo, 2020). Level IB evidence is generated from a single well-designed and well-conducted randomized control trial. A randomized controlled study is a gold-standard for clinical practice. Level IB evidence can influence decisions such as frequency of bed rounds to improve patient safety and quality of care. Level IIA evidence is obtained from a least one well executed and well-designed non-randomized controlled study. Lack of randomization leads to more bias that is introduced into the study (Tenny & Varacallo, 2020). Level IIA evidence can inform on the efficacy of new diagnostic tests (Roever et al., 2016). Level IIB evidence is obtained from at least one well-designed cohort or case-control study. It is important to note that not all clinical questions can be answered ethically or effectively with a randomized controlled study (Tenny & Varacallo, 2020). Level IIB is useful for understanding pathophysiology of a disease such as cancer (Roever et al., 2016). Level III evidence is obtained from at least one non-experimental study (Tenny & Varacallo, 2020). Level III evidence can be used to determine level of patient satisfaction to care (Roever et al., 2016). Lastly, but not the least Level IV evidence include expert opinions derived from respected authorities on a given subject based on their clinical experience (). Level IV evidence can be used when hospitals who like to adopt new technology in which there are various vendors of the technology such as an electronic healthcare records system.
References
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Roever, L., Resende, E. S., Biondi-Zoccai, G., & Borges, A. S. R. (2016). Degrees of recommendations and levels of evidence: What you need to know? Evidence Based Medicine and Practice, 2(2). https://www.omicsonline.org/open-access/degrees-of-recommendations-and-levels-of-evidence-what-you-need-to-know-2471-9919-1000101.php?aid=74133
Tenny, S., & Varacallo, M. (2020). Evidence based medicine. [Updated 2020 Aug 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470182/
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