DESCRIBE THE SEVEN” LEVELS OF EVIDENCE” AND PROVIDE AN EXAMPLEOF THE TYPE OF PRACTICE CHANGE THAT COULD RESULT FROM EACH OTHER NRS 433

Topic 4 DQ 2

Describe the seven “levels of evidence” and provide an example of the type of practice change that could result from each.

Replies

University of Wisconsin (2022) described the seven levels of evidence as the following. “Level I: Evidence from a systematic review of all relevant randomized controlled trials (RCT’s), or evidence-based clinical practice guidelines based on systematic reviews of RCT’s. Level II: Evidence obtained from at least one well-designed Randomized Controlled Trial (RCT). Level III: Evidence obtained from well-designed controlled trials without randomization, quasi-experimental. Level IV: Evidence from well-designed case-control and cohort studies. Level V: Evidence from systematic reviews of descriptive and qualitative studies. Level VI: Evidence from a single descriptive or qualitative study. Level VII: Evidence from the opinion of authorities and/or reports of expert committees” As you can see from this, as the studies become more reliable, they move from the higher levels to the lower levels. Based off of this system, opinion is usually considered the worst of the hierarchy of the studies while meta analysises of RCTs are the best. One example of a meta analysis of RCTs include one by Galie about PAH. The level 7 might be a group of experts giving their expert opinion about a certain subject, such as about hypertension. Level 6 would be one such as a study of how the wait times made a person feel about their experience in an ED. Level 5 would be a meta analysis of looking at those level 6 studies. Level 4 would be researching how antibiotics affected the ICU patients drug resistance over a time period, and 3 would be grouping those studies together to look at a meta analysis of it. The level two are RCTs such as a randomized trial of two antibiotics for Pseudomonas in the ICU over a time period.

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Galie, N. (2009). A meta-analysis of randomized controlled trials in pulmonary arterial hypertension. Retrieved from https://academic.oup.com/eurheartj/article/30/4/394/415127

University of Wisconsin (2022). Nursing Resources : Levels of Evidence (I-VII). Retrieved from https://researchguides.library.wisc.edu/c.php?g=861013&p=6170092

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Justina Aguilar

replied toMary-Korine Insunsa

Aug 21, 2022, 2:09 AM

·  Replies to Mary-Korine Insunsa

Hi Mary-Korine,

I liked your example of pulmonary arterial hypertension by the European Heart Journal (2009). A meta-analysis of all randomized controlled trials with drugs published in this condition was performed. The results of this meta-analysis suggested an improvement of survival in the patients treated with the targeted therapies approved for pulmonary arterial hypertension (Nazzareno Galiè, 2009). In the hierarchy of evidence this was a good example of level I, Evidence from a systematic review or meta-analysis of all relevant RCTs (randomized controlled trial) or evidence-based clinical practice guidelines based on systematic reviews of RCTs or three or more RCTs of good quality that have similar results (WSU, 2022).

Reference

Nazzareno Galiè, Alessandra Manes, Luca Negro, Massimiliano Palazzini, Maria Letizia Bacchi-Reggiani, Angelo Branzi, A meta-analysis of randomized controlled trials in pulmonary arterial hypertension, European Heart Journal, Volume 30, Issue 4, February 2009, Pages 394–403, https://doi.org/10.1093/eurheartj/ehp022

Research hub: Evidence based practice toolkit: Levels of evidence. WSU. (2022). https://libguides.winona.edu/ebptoolkit/Levels-Evidence

·  Calorine Mahungana

replied toMary-Korine Insunsa

Aug 21, 2022, 3:41 AM

·  Replies to Mary-Korine Insunsa

Hello Mary-Korine,

Thank you for your post. I would like to elaborate on stage V of evidence which is Cohort studies. It categorises participants according to the level of exposure to risk factors who are then followed over a period of time to observe the possible occurence of a disease. The NHMRC, (2009), explains that prospective cohorts are observed at a point in time to be exposed to an intervention whereas retrospective studies are usually done from medical records.

Reference

National Health and Medical Research Council., (2009). NHMRC levels of evidence and grades for recommendations for developers and guidelines.

·  Krishna Turner

replied toMary-Korine Insunsa

Aug 21, 2022, 8:43 PM

·  Replies to Mary-Korine Insunsa

Hi Mary,

Thank you for providing the different levels of evidence and using example of PAH. Level I of evidence which entails systematic or meta analysis this identify evidence synthesis. PAH study would include adults that are diagnosis with PAH, a couple of approved drugs that are appropriate for the study. This drug will show if it is effective and safe for future use of patients with PAH. The study will always start off with a smaller population and later increase population before being approved by the FDA for further treatment of PAH, and this will support the first 3 levels of evidence.

Reference:

Schlueter, M., Beaudet, A., Davies, E., Gurung, B., & Karabis, A. (2020, July 28). Evidence synthesis in pulmonary arterial hypertension: A systematic review and critical appraisal – BMC pulmonary medicine. BioMed Central. Retrieved August 21, 2022, from https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-020-01241-4 

·  Misty Diaz

replied toMary-Korine Insunsa

Aug 21, 2022, 10:21 PM

• Replies to Mary-Korine Insunsa

Hello Mary-Korine!

Your levels of hierarchy are great! I just wanted to say, that it is difficult to get the levels of hierarchy down, and I noticed that the “pyramid” varies a little from source to source (Ingham-Broomfield, 2016). Now, there are only 5 levels of hierarchy to keep in mind, which does help out in trying to keep things clear. The best thing to keep in mind, is that there is a hierarchy of the research, and to continue to gather as much information as possible about the subject you are considering changing, discard the ones which are not-so-strong in their structure or statistics, and rely on those highest up on the hierarchy pyramid as possible. Nurses need to be competent in their ability to evaluate research for strengths and weaknesses, of which we are learning now (Ingham-Broomfield, 2016).

Ingham-Broomfield, R. (2016). A nurses guide to the hierarchy of research designs and evidence. Australian Journal of Advanced Nursing, 33(3): 38-43. https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN114833287&site=eds-live&scope=site