Appraisal of Evidence: Evidence-based practice (EBP) is the conscientious, explicit, and judicious use of current best research-based evidence when making decisions about the care of individual patients (Hamric, 2013, p. 237). Three levels of EBP include interpreting and utilizing EBP principles for individual clinical decision making; to determine policies for patient care; and to evaluate clinical practice (Hamric, 2013). Critical appraisal is a detailed examination of published research in order to make a decision about scientific merit and for making a decision about use of the evidence in practice (Thompson, 2018). The evidence pyramid ranks the contribution of a study based on design. The base of the pyramid is identified as laboratory-based in-vitro and in-vivo studies (Hamric, 2013). The second level consists of case studies. The results of case studies can be used as evidence that an intervention is feasible, offers an attractive alternative to usual care, can be applied safely in a selected patient
or patients, and merits further investigation to determine clinical effectiveness (Hamric, 2013, p. 249). Case studies however, do not always compare the intervention of interest with standard care and their results cannot be used to reach conclusions about efficacy, effectiveness, or predictive power (Hamric, 2013). The higher levels of the pyramid include randomized and non-randomized controlled trials, cohort/case-control studies. The results of these studies are often used to define current best practices. Randomized and non-randomized trials compare outcomes from at least two groups, including one cohort that is exposed to an experimental intervention, and a second group exposed to usual care, sham device, or placebo (Hamric, 2013). The Randomized control trial is considered the gold standard for measuring efficacy of an intervention or the predictive power of an assessment strategy A cohort study is an observational design in which a large sample is identified and followed over time to determine which participants will develop the disease or disorder under scrutiny (Hamric, 2013). Systematic reviews and meta-analyses combine the results of many studies to determine the effect created by a specific intervention (Hamric, 2013). The systematic review analyzes and appraises studies based on measurable results. A meta-analysis analyzes the results from multiple study to determine the direction and magnitude of an intervention's effect (Hamric,2013). The Grade Scale: 1.High evidence indicates a small likelihood that additional research is unlikely to change confidence of the direction or magnitude of the effect size associated with a specific intervention.
2.Moderate evidence indicates that additional research may significantly influence the magnitude of treatment effect. 3.Low evidence indicates that new research may affect the direction and magnitude of treatment effect.
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- Fall '17
- Advanced practice nurse, nursing practice, advanced practice nursing, APRN Consensus Model, Hamric