Evidence-based practice refers to a thorough, thoughtful and explicit utilization of the most current and best evidence to make decisions. Some practices do not use evidence in decision making, hence use unproven methods, intuition and traditions. Evidence-based practices revolved in the field of medicine in the 1990s. It involved changing from traditional approaches of treating patients to the use of evidence-based approach on research. Up to now, it is clear that medical professionals base their decisions on evidence to carry out their duties. However, not all evidence has equal value, which is reflected in the pyramid of evidence hierarchy.
Meta-analysis is the highest level of evidence in the pyramid. It entails pooling of data and quantitatively summarizing it to get the final results. In practice some form of biasness has been observed from this level and this may lead to a compulsory “funnel plotting with cut and fill” being introduced to ensure that there is no possible bias (Tidy, 2014). Systematic review involves an in-depth evaluation of the available medical content regarding a particular topic to produce a summary. To improve accuracy, a standard cut off number of medical publications may be introduced.
In a critically appraised topic, a meticulous synthesis of numerous studies is carried out, while for critically appraised articles which are just beneath the critically appraised topics, the same process is undertaken for individual studies in addition to providing a synopsis (“Evidence-Based Practice for Health Professionals: Levels of Evidence”, 2019). In Randomized Control Trials (RCTs) the subjects of study are randomly chosen where one group is placed in the experiment category and the other acts as the control group, and then the outcomes recorded. In all drug trials, RCTs with “double-blind placebo controls” could be made the standard procedure. Below the RCTs are cohort studies whereby among the selected group of interest, a part of it has some level of exposure to the object of study and observations of each group are made. To enhance accuracy, only prospective and not retrospective studies should be conducted in cohort studies (Tidy, 2014).
In a case control study, two groups are identified where one has the outcome of interest while the other does not have. This is done to find out if the latter group had a prior exposure to the factor of interest (Evidence-Based Practice for Health Professionals, 2019). Case series study is the lower type of evidence. This design entails that the research involves a sample group of patients who have the same diagnosis and receive the same treatment. Similar to the case report study, which is placed lower in the pyramid of evidence hierarchy, case series have the descriptive nature and involve particular patient data such as gender, age or ethnicity.
Expert opinion is obtained from published materials such as handbooks or manufacturer’s manuals and it is mostly basic. A comparison of multiple experts’ opinions could be made a requirement for better diagnosis. Animal studies are lower on the pyramid of evidence hierarchy, as they may be applicable to trace certain reactions, but usually are associated with ethical issues, which makes the scope of the areas of research limited. However, some of the animal studies provided a scientific breakthrough, with Pavlov’s dogs and study of conditioning being one of the most famous examples. Finally, at the lowest level of the pyramid are lab studies, which entail conducting laboratory researches using models to test primary ideas. Field study could be made an equal substitute to lab studies.
References
Doleac, J. L. (2019). “Evidence-based policy” should reflect a hierarchy of evidence. Journal of Policy Analysis and Management, 38(2), 517-519.
Evidence-Based Practice for Health Professionals: Levels of Evidence. (2019). Northern Virginia Community College. Web.
Parameswaran, R., & Agarwal, A. (2018). Hierarchy of Evidence. Evidence-Based Endocrine Surgery, 1
Tidy, C. (2014). Different Levels of Evidence. Web.