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The short video below walks you through basic steps for effective searching in PubMed, but this is just the tip of the searching iceberg. Schedule a consultation to get personalized assistance from library experts. OHSU librarians and staff are available to address and support your information needs, including literature searching and citation management. This video also provides an excellent overview of additional and helpful database searching techniques. Evidence HierarchiesFinding and evaluating evidence is the second phase in the Johns Hopkins Evidence-Based Practice Model (JHEBP). Evidence hierarchies guide identifying the best evidence for decision-making based on the rigor of the methods used (level) and the execution of the study or reporting (quality). Appraisal begins with identifying the level of evidence and then the quality. The combination of level and quality determines the overall determination of the strength of the evidence. Levels of EvidenceThe JHEBM uses a five-level evidence hierarchy, which includes research and nonresearch evidence. Below you will find a guide to the evidence levels and types. Still, we recommend consulting the Johns Hopkins Evidence-based Practice for Nurses and Healthcare Professionals book for detailed information about levels and types. If you're unfamiliar with the kinds of evidence noted here, browse the Types of Evidence box on this page.
Table: Dang, D., Dearholt, S., Bissett, K., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines. 4th ed. Sigma Theta Tau International Types of EvidenceTo understand and assess levels of evidence, it's helpful to have an understanding of the basic characteristics of the major evidence types, several of which are defined below. For additional evidence type definitions browse the Center for Evidence-Based Medicine Glossary Systematic Review The application of strategies that limit bias in the assembly, critical appraisal, and synthesis of all relevant studies on a specific topic. Systematic reviews focus on peer-reviewed publications about a specific health problem and use rigorous, standardized methods for selecting and assessing articles. A systematic review may or may not include a meta-analysis, which is a quantitative summary of the results. Randomized Controlled Trial An experiment in which subjects in a population are randomly allocated into groups, usually called study and control groups, to receive or not receive an experimental preventive or therapeutic procedure, maneuver, or intervention. The results are assessed by rigorous comparison of rates of disease, death, recovery, or other appropriate outcomes in the study and control groups. Cohort Studies Cohort studies identify a group of patients who are already taking a particular treatment or have an exposure, follow them forward over time, and then compare their outcomes with a similar group that has not been affected by the treatment or exposure being studied. Cohort studies are observational and not as reliable as randomized controlled studies since the two groups may differ in ways other than in the variable under study. Case-Control Studies Case-control studies are studies in which patients who already have a specific condition are compared with people who do not have the condition. The researcher looks back to identify factors or exposures that might be associated with the illness. They often rely on medical records and patient recall for data collection. These types of studies are often less reliable than randomized controlled trials and cohort studies because showing a statistical relationship does not mean that one factor necessarily caused the other. Cross-Sectional Studies Describe the relationship between diseases and other factors at one point in time in a defined population. Cross-sectional studies lack any information on the timing of exposure and outcome relationships and include only prevalent cases. They are often used for comparing diagnostic tests. Studies that show the efficacy of a diagnostic test are also called prospective, blind comparisons to a gold standard study. This is a controlled trial that looks at patients with varying degrees of an illness and administers both diagnostic tests — the test under investigation and the “gold standard” test — to all of the patients in the study group. The sensitivity and specificity of the new test are compared to that of the gold standard to determine potential usefulness. Case Series and Case Reports Case series and Case reports consist of collections of reports on the treatment of individual patients or a report on a single patient. Because they are reports of cases and use no control groups to compare outcomes, they have little statistical validity. Definitions adapted from: https://www.cebm.ox.ac.uk/resources/ebm-tools/glossary The Evidence Pyramid and Other ConceptualizationsAn evidence pyramid is a visual representation of an evidence hierarchy. As you move up the pyramid, the amount of available evidence on a given topic decreases, but the strength of evidence increases. However, you may not always be able to find the highest level of evidence to answer your question. This illustration is helpful because it also notes the information sources associated with each level. Image: https://guides.himmelfarb.gwu.edu/ebm/studytypes EBP GlossariesHow To Read a Paper eBookHow To Read a PaperDr. Trisha Greenhalgh's clearly written papers (full-text links to each below) discuss how to critically appraise the medical literature. These articles appeared originally in the British Journal of Medicine and were later produced as a book: How to Read a Paper. CriteriaWhen appraising research, keep the following three criteria in mind: Quality Validity Size These are the criteria on which we should judge evidence. For it to be strong evidence, it has to fulfill the requirements of all three criteria. Source: Critical Appraisal. Bandolier. Which of the following statement is true of the credibility of a study finding quizlet?Which of the following statement is true of the credibility of a study finding? The credibility of a finding mainly rests on the funding source and the credentials of the researchers.
What should you consider when evaluating the clinical significance of a clinical practice guideline recommendation quizlet?What should you consider when evaluating clinical significance of clinical practice guideline recommendation? The likelihood that implementation of the recommendation will produce good patient outcomes.
Which of the following characteristics of a recommendation is the most important determinant of its credibility?Which of the following characteristics of a recommendation is the most important determinant of its credibility? D. The linkage between the recommendation and the evidence supporting it.
Which of the following is part of an integrated literature review?The 5-stage integrative review process includes (1) problem formulation, (2) data collection or literature search, (3) evaluation of data, (4) data analysis, and (5) interpretation and presentation of results.
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