4-Evidence Based Practice (EBP) is a problem-solving approach to clinical decision-making within a health care organization. It integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence. EBP considers internal and external influences on practice and encourages critical thinking in the judicious application of such evidence to the care of individual patients, a patient population, or a system. The level of evidence are as follows: Level I  Experimental study, randomized controlled trial (RCT) Systematic review of RCTs, with or without meta-analysis Level II  Quasi-experimental Study Systematic review of a combination of RCTs and quasi-experimental, or quasi-experimental studies only, with or without meta-analysis. Level III  Non-experimental study Systematic review of a combination of RCTs, quasi-experimental and non-experimental, or non-experimental studies only, with or without meta-analysis. Qualitative study or systematic review, with or without meta-analysis Level IV Opinion of respected authorities and/or nationally recognized expert committees/consensus panels based on scientific evidence.     Includes:          - Clinical practice guidelines          - Consensus panels Level V  Based on experiential and non-research evidence.     Includes:       - Literature reviews       - Quality improvement, program or financial evaluation       - Case reports       - Opinion of nationally recognized expert(s) based on experiential evidence. According to U.S Department of Health and Human services, Evidence Classification Scheme for a Diagnostic Measure include: Class I: A prospective study in a broad spectrum of persons with the suspected condition, using a 'gold standard' for case definition, where the test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy Class II: A prospective study of a narrow spectrum of persons with the suspected condition, or a well-designed retrospective study of a broad spectrum of persons with an established condition (by 'gold standard') compared to a broad spectrum of controls, where test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy Class III: Evidence provided by a retrospective study where either person with the established condition or controls are of a narrow spectrum, and where test is applied in a blinded evaluation Class IV: Any design where test is not applied in blinded evaluation OR evidence provided by expert opinion alone or in descriptive case series (without controls). References Agency for Healthcare Research and Quality. (n.d.). Agency for healthcare research and quality: a profile. Retrieved December 3, 2018, from https://www.ahrq.gov/cpi/about/profile/index.html Winona State University. (2018). Evidence based practice toolkit. Retrieved December 3, 2018, from https:// ...

1. 4-Evidence Based Practice (EBP) is a problem-solving approach
to clinical decision-making within a health care organization. It
integrates the best available scientific evidence with the best
available experiential (patient and practitioner) evidence. EBP
considers internal and external influences on practice and
encourages critical thinking in the judicious application of such
evidence to the care of individual patients, a patient population,
or a system. The level of evidence are as follows:
Level I
Experimental study, randomized controlled trial (RCT)
Systematic review of RCTs, with or without meta-analysis
Level II
Quasi-experimental Study
Systematic review of a combination of RCTs and quasi-
experimental, or quasi-experimental studies only, with or
without meta-analysis.
Level III
Non-experimental study
Systematic review of a combination of RCTs, quasi-
experimental and non-experimental, or non-experimental studies
only, with or without meta-analysis.

2. Qualitative study or systematic review, with or without meta-
analysis
Level IV
Opinion of respected authorities and/or nationally recognized
expert committees/consensus panels based on scientific
evidence.
Includes:
- Clinical practice guidelines
- Consensus panels
Level V
Based on experiential and non-research evidence.
Includes:
- Literature reviews
- Quality improvement, program or financial evaluation
- Case reports
- Opinion of nationally recognized expert(s) based on
experiential evidence.
According to U.S Department of Health and Human services,
Evidence Classification Scheme for a Diagnostic Measure
include:

3. Class I: A prospective study in a broad spectrum of persons
with the suspected condition, using a 'gold standard' for case
definition, where the test is applied in a blinded evaluation, and
enabling the assessment of appropriate tests of diagnostic
accuracy
Class II: A prospective study of a narrow spectrum of persons
with the suspected condition, or a well-designed retrospective
study of a broad spectrum of persons with an established
condition (by 'gold standard') compared to a broad spectrum of
controls, where test is applied in a blinded evaluation, and
enabling the assessment of appropriate tests of diagnostic
accuracy
Class III: Evidence provided by a retrospective study where
either person with the established condition or controls are of a
narrow spectrum, and where test is applied in a blinded
evaluation
Class IV: Any design where test is not applied in blinded
evaluation OR evidence provided by expert opinion alone or in
descriptive case series (without controls).
References
Agency for Healthcare Research and Quality. (n.d.). Agency for
healthcare research and quality: a profile. Retrieved December
3, 2018, from
https://www.ahrq.gov/cpi/about/profile/index.html
Winona State University. (2018). Evidence based practice
toolkit. Retrieved December 3, 2018, from
https://libguides.winona.edu/ebptoolkit

4. 5-Evidence based medicine uses evidence to make clinical
decisions. There is a hierarchal system for classification of
evidence. This hierarchy is known as the levels of evidence.
Physicians are encouraged to find the highest level of evidence
to answer clinical questions (Barnes, Rohrich, & Chung, 2012,
p. 305). The higher the level the more strength the evidence has.
Randomized controlled trials (RCT’s) are the strongest research
designs for treatment or intervention studies because they exert
the most control over the methods and the results are considered
more trustworthy (Thomas, 2017). It is important to note that a
high level of evidence for a treatment study may not be the
highest level of evidence for a study for prognosis. The
strongest levels of evidence are at the top of the hier archy.
Some examples put concepts into practice from the different
levels of evidence that may include practice alerts for revising
current policies and instituting new practices.
Meta-Analysis
A systematic review that uses quantitative methods to
summarize the results.
Systematic Review
An article in which the authors have systematically
searched for, appraised, and summarized all the medical
literature for a specific topic.
Critically Appraised Topic
Authors of critically-appraised topics evaluate and
synthesize multiple research studies.
Critically Appraised Articles

5. Authors of critically-appraised individual articles evaluate
and synopsize individual research studies.
Randomized Controlled Trials
RCT's include a randomized group of patients in an
experimental group and a control group. These groups are
followed up for the variables/outcomes of interest.
Cohort Study
Identifies two groups (cohorts) of patients, one which did
receive the exposure of interest, and one which did not, and
following these cohorts forward for the outcome of interest.
Case-Control Study
Involves identifying patients who have the outcome of
interest (cases) and control patients without the same
outcome and looking to see if they had the exposure of
interest.
Background Information / Expert Opinion
Handbooks, encyclopedias, and textbooks often provide a
good foundation or introduction and often include
generalized information about a condition. While
background information presents a convenient summary,
often it takes about three years for this type of literature to
be published.
Animal Research / Lab Studies
Information begins at the bottom of the pyramid: this is
where ideas and laboratory
research takes place. Ideas turn into therapies and
diagnostic tools, which then are tested with lab models and
References

6. Barnes, P. B., Rohrich, R. J., & Chung, K. C. (2012, July 1).
The Levels of Evidence and their role in Evidence-Based
Medicine.
Plastic Reconstructive Surgery
,
128
(1), 305-310. https://doi.org/doi:
[10.1097/PRS.0b013e318219c171]
Thomas, C. J. (2017, May 23). What Does “Levels of Evidence”
Mean in Evidence-Based Practice?
Nursing Education Expert
. Retrieved from https://nursingeducationexpert.com/levels-of-
evidence/
6-In attempting to prove the accuracy of a case study or other
investigation, various levels of evidence are utilized in
associating well
reputed and accurate sources and data collection methods
(Petrisor & Bhandari,
2007). These evaluations grade the overall validity of the
study, and help to
show whether or not the evidence is accurate in its findings
(Petrisor &
Bhandari, 2007). These levels of evidence are generally seen
on seven levels,
with the first being the most valid and the seventh being the

7. least valid. The
first level is gathered through a systematic review of
randomized control
trials (RCT), and due to the wide range of its data is the most
accurate and
can be used as a basis for broad changes in practice methods
(Burns, Rohlich
& Chung, 2011). The second level is gathered through a single
RCT that
could be applied to a wide range of practice changes, such as
determining intervention
method effectiveness (Darrell W. Krueger Library, 2018). The
third level of
evidence is similar to the second, but the participants to groups
are not
assigned randomly. This form of evidence can be used in
detecting extraneous
variables in a study by examining a particular factor (DWKL,
2018).
The fourth
level of evidence consists of cohort and case-control studies
which compare two
different outcomes between similar studies retrospectively,
such as those with

8. and without a disease to determine outcomes. The fifth and
sixth levels relate
to descriptive and non-quantitative studies, with the fifth level
examining
numerous studies, and the sixth only examines one (DWKL,
2018). These studies
can be used to describe personal experiences. The final level of
evidence is
based off of expert opinions, which are worth exploring for
new ideas, but not
scientifically valid (DWKL, 2018).
References
Burns, P. B., Rohrich, R. J., &
Chung, K. C. (2011). The levels of evidence and their role in
evidence-based medicine.
Evidence-based Medicine Toolkit
,
128
(1),
94-96. doi:10.1002/9780470750605.ch15
Darrell W. Krueger Library. (2018, September 18). Evidence
based
practice toolkit. Retrieved from

9. https://libguides.winona.edu/c.php?g=11614&p=61584
Petrisor, B. A., & Bhandari, M. (2007). The
hierarchy of evidence: Levels and grades of recommendation.
Retrieved from
www.unm.edu/~unmvclib/cascade/handouts/PICOTpyramidofevi
dence.pdf