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A hierarchy of evidence, comprising levels of evidence (LOEs), that is, evidence levels (ELs), is a heuristic used to rank the relative strength of results obtained from experimental research, especially medical research. There is broad agreement on the relative strength of large-scale, epidemiological studies.
Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. ...[It] means integrating individual clinical expertise with the best available external clinical evidence from systematic research."
[1] [2] Hierarchy of study design, for example using a case-study, ecological study, cross-sectional, case-control, cohort, or experimental, although not always in this order is a general rule to a high "strength of evidence" of a clinical study. [3] [4] [5]
CEBM has developed a widely adopted [6] systematic hierarchy of the quality of medical research evidence, named the levels of evidence. Systematic reviews of randomised clinical trials (encompassing homogeneity) are seen as the highest possible level of evidence, as full assessment and aggregated synthesis of underlying evidence is possible.
Given their intrinsic methodological limitations, including lack of statistical sampling, case reports are placed at the bottom of the hierarchy of clinical evidence, together with case series. [3] Nevertheless, case reports do have genuinely useful roles in medical research and evidence-based medicine. [4]
Even in reputable medical journals, different papers are not given equal weight. Studies can be categorized into levels in a hierarchy of evidence, [6] and editors should rely on high-level evidence, such as systematic reviews. Low-level evidence (such as case reports or series) or non-evidence (such as anecdotes or conventional wisdom) are ...
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The evidence used to change practice or make a clinical decision can be separated into seven levels of evidence that differ in type of study and level of quality. To properly implement EBN, the knowledge of the nurse, the patient's preferences, and multiple studies of evidence must all be collaborated and utilized in order to produce an ...