Evidence-Based Practice Projects – Clinical & Statistical significance Essay Assignment

Evidence-Based Practice Projects – Clinical & Statistical significance Essay Assignment

Evidence-Based Practice Projects – Clinical & Statistical significance Essay Assignment

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Evidence-based practice projects are fundamental in medical practice. This is the reason as to why such projects emanate into results that are statistically significant. A distinction between clinical significance and statistical significance will be discussed in its relation to evidence based projects (Gillani, 2011). The use of clinical significance in supporting positive outcomes in the project will also be highlighted.

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Clinical significance refers to that ability displayed by a treatment to enable a patient return to his or healthy state of body functioning. However, it differs from statistical significance in a sense that it is more objective i.e. it determines whether the prescribed treatment was able to achieve the intended purpose (Sedgwick, 2014). Statistical significance, though a determinant that was only used sometimes back is expressed as a variable meaning that it is never exact on whether the treatment recommended is going to restore a patient’s normality. It operates on the principle of probability.

The ultimate aim of the evidence-based practice project is to bring forth positive outcome. Incorporation of clinical significance can prove to be of great help in achieving this. Carrying out a clinical interpretation in the entire research process will be fundamental in ensuring that the patient’s safety, as well as efficacy need, is put into consideration when it comes to decisions made. This will significantly enhance positive outcomes of the research work.

A critical evaluation of the research project by clinicians so as to qualify internal as well as external validity will trigger positive results. The employment of all these aspects of clinical significance will see to it that Evidence-based practice project becomes not only meaningful but also helpful to those seeking medical solutions to their unhealthy conditions.

References for Evidence-Based Practice Projects – Clinical & Statistical significance Essay Assignment

Gillani, S. (2011). Is statistical significance a relevant tool for assessing clinical significance?. Journal Of Pharmaceutical Negative Results, 2(2), 121. http://dx.doi.org/10.4103/0976-9234.90227.

Sedgwick, P. (2014). Clinical significance versus statistical significance. BMJ, 348(mar14 11), g2130-g2130. http://dx.doi.org/10.1136/bmj.g2130.

Evaluating Evidence: Questions to Ask When Reading a Research Article or Report

For guidance on the process of reading a research book or an article, look at Paul N. Edward’s paper, How to Read a Book (2014). When reading an article, report, or other summary of a research study, there are two principle questions to keep in mind:

1. Is this relevant to my patient or the problem?

  • Once you begin reading an article, you may find that the study population isn’t representative of the patient or problem you are treating or addressing. Research abstracts alone do not always make this apparent.
  • You may also find that while a study population or problem matches that of your patient, the study did not focus on an aspect of the problem you are interested in. E.g. You may find that a study looks at oral administration of an antibiotic before a surgical procedure, but doesn’t address the timing of the administration of the antibiotic.
  • The question of relevance is primary when assessing an article–if the article or report is not relevant, then the validity of the article won’t matter (Slawson & Shaughnessy, 1997).

2. Is the evidence in this study valid?

  • Validity is the extent to which the methods and conclusions of a study accurately reflect or represent the truth. Validity in a research article or report has two parts: 1) Internal validity–i.e. do the results of the study mean what they are presented as meaning? e.g. were bias and/or confounding factors present?; and 2) External validity–i.e. are the study results generalizable? e.g. can the results be applied outside of the study setting and population(s)?
  • Determining validity can be a complex and nuanced task, but there are a few criteria and questions that can be used to assist in determining research validity. The set of questions, as well as an overview of levels of evidence, are below.

For a checklist that can help you evaluate a research article or report, use our checklist for Critically Evaluating a Research Article.

Levels of Evidence

In some journals, you will see a ‘level of evidence’ assigned to a research article. Levels of evidence are assigned to studies based on the methodological quality of their design, validity, and applicability to patient care. The combination of these attributes gives the level of evidence for a study.  Many systems for assigning levels of evidence exist.  A frequently used system in medicine is from the Oxford Center for Evidence-Based Medicine.  In nursing, the system for assigning levels of evidence is often from Melnyk & Fineout-Overholt’s 2011 book, Evidence-based Practice in Nursing and Healthcare: A Guide to Best Practice.  The Levels of Evidence below are adapted from Melnyk & Fineout-Overholt’s (2011) model.

Evidence-Based Practice Projects – Clinical & Statistical significance Essay Assignment

Uses of Levels of Evidence: Levels of evidence from one or more studies provide the “grade (or strength) of recommendation” for a particular treatment, test, or practice. Levels of evidence are reported for studies published in some medical and nursing journals. Levels of Evidence are most visible in Practice Guidelines, where the level of evidence is used to indicate how strong a recommendation for a particular practice is. This allows health care professionals to quickly ascertain the weight or importance of the recommendation in any given guideline. In some cases, levels of evidence in guidelines are accompanied by a Strength of Recommendation.

About Levels of Evidence and the Hierarchy of Evidence: While Levels of Evidence correlate roughly with the hierarchy of evidence (discussed elsewhere on this page), levels of evidence don’t always match the categories from the Hierarchy of Evidence, reflecting the fact that study design alone doesn’t guarantee good evidence. For example, the systematic review or meta-analysis of randomized controlled trials (RCTs) are at the top of the evidence pyramid and are typically assigned the highest level of evidence, due to the fact that the study design reduces the probability of bias (Melnyk, 2011), whereas the weakest level of evidence is the opinion from authorities and/or reports of expert committees. However, a systematic review may report very weak evidence for a particular practice and therefore the level of evidence behind a recommendation may be lower than the position of the study type on the Pyramid/Hierarchy of Evidence.

About Levels of Evidence and Strength of Recommendation: The fact that a study is located lower on the Hierarchy of Evidence does not necessarily mean that the strength of recommendation made from that and other studies is low–if evidence is consistent across studies on a topic and/or very compelling, strong recommendations can be made from evidence found in studies with lower levels of evidence, and study types located at the bottom of the Hierarchy of Evidence. In other words, strong recommendations can be made from lower levels of evidence.

For example: a case series observed in 1961 in which two physicians who noted a high incidence (approximately 20%) of children born with birth defects to mothers taking thalidomide resulted in very strong recommendations against the prescription and eventually, manufacture and marketing of thalidomide. In other words, as a result of the case series, a strong recommendation was made from a study that was in one of the lowest positions on the hierarchy of evidence.