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The next time Rebecca and Carlos meet, they discuss the next
step in the EBP processcritically
appraising the 26 studies. They
obtain copies of the studies by
printing those that are immediately available as full text through
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and the Boston University Medical Center Alumni Medical Library [http://medlib.bu.edu/
bugms/content.cfm/content/
ebmglossary.cfm#R].)
Determining the level of evidence. The team begins to divide
the 26 studies into categories according to study design. To help
in this, Carlos provides a list of
several different study designs
(see Hierarchy of Evidence for
Intervention Studies). Rebecca,
Carlos, and Chen work together
to determine each studys design
by reviewing its abstract. They
also create an I dont know
pile of studies that dont appear
to fit a specific design. When they
find studies that dont actively
answer the clinical question but
Level of evidence
Description
Systematic review or
meta-analysis
II
III
Case-control or
cohort study
IV
Systematic review of
qualitative or descriptive studies
VI
Expert opinion or
consensus
VII
Adapted with permission from Melnyk BM, Fineout-Overholt E, editors. Evidence-based practice in nursing and healthcare:
a guide to best practice [forthcoming]. 2nd ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams and Wilkins.
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SR
Purpose: effect of RRT on
HMR and CR
U Searched 3 databases
from 1990-2005
U Included only studies
with a control group
RCT
Purpose: effect of RRT on
CR, HMR, and UICUA
None
None
Hillman K, et al.
Lancet 2005;
365(9477): 2091-7.
Attrition: none
Setting: Australia
N = 23 hospitals
Average no. beds: 340
U Intervention group
(n = 12)
U Control group
(n = 11)
Attrition: NR
N = 8 studies
Attrition: NR
24 adult hospitals
N = 2 studies
Attrition: NR
N = 18 studies
Sample/Setting
IV: RRT
DV1: HMR
DV2: CR
IV: RRT
DV1: HMR
IV: RRT
DV1: HMR
DV2: CR
HMR
CR
rates of
UICUA
Measurement
Data
Analysis
Findings
Note:
U Criteria for
activating
RRT
Appraisal:
Worth to
Practice
Shaded columns indicate where data will be entered in future installments of the series.
AP = attending physician; CR = cardiopulmonary arrest or code rates; DNR = do not resuscitate; DV = dependent variable; ED = emergency department; HMR: hospital-wide mortality rates; ICU = intensive care unit; IV = independent variable; MD = medical doctor; NR = not reported; Peds = pediatric; RCT = randomized controlled trial; RN = registered
nurse; RRT = rapid response team; SR = systematic review; UICUA = unplanned ICU admissions.
SR (Cochrane review)
Purpose: effect of RRT
on HMR
U Searched 6 databases
from 1990-2006
U Excluded all but 2
RCTs
None
McGaughey J, et al.
Cochrane Database
Syst Rev 2007;3:
CD005529.
Design/Method
SR
Purpose: effect of RRT on
HMR and CR
U Searched 5 databases
from 1950-2008, and
grey literature from
MD conferences
U Included only studies
with a control group
Conceptual
Framework
None
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the RRTs were activated and provided their protocol for calling the
RRTs. However, these elements
might be helpful to the EBP team
later on when they make decisions
REFERENCE
1. Hillman K, et al. Introduction of
the medical emergency team (MET)
system: a cluster-randomised controlled trial. Lancet 2005;365(9477):
2091-7.
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