Hierarchy and Levels of Evidence in Healthcare

Questions and Answers

What is the hierarchy of evidence ranked from less bias to expert opinion?

RCTs (correct)

Unsystematic clinical observations (correct)

Systematic reviews of RCTs (correct)

Case series (correct)

What is the ranking system used in evidence-based questions to describe the strength of the results measured in a clinical trial or research study?

levels of evidence

What do you look at to determine higher levels of evidence?

Grades of recommendations

How does the G.R.A.D.E system rank quality of evidence?

Ranks quality of evidence as A-D (high-very low) Signup and view all the answers

Which system is used for grading levels of evidence and is integrated with the NHBLI system?

ACC/AHA system Signup and view all the answers

What does ACC/AHA Class I mean?

Evidence and/or agreement that a given procedure or treatment is useful and effective Signup and view all the answers

What does ACC/AHA Class II indicate?

Conflicting evidence and/or divergence of opinion about the usefulness/efficacy Signup and view all the answers

What is indicated by ACC/AHA Class IIa?

Weight of evidence/opinion is in favor of usefulness/efficacy Signup and view all the answers

What does ACC/AHA Class IIb suggest?

Usefulness/efficacy is less well established by evidence/opinion Signup and view all the answers

What does ACC/AHA Class III denote?

Evidence and/or agreement that the procedure/treatment isn't useful/effective and may be harmful Signup and view all the answers

What does the NHLBI Grading Strength of recommendation 'A' signify?

Strong recommendation Signup and view all the answers

What does the NHLBI Grading Strength of recommendation 'B' represent?

Moderate recommendation Signup and view all the answers

What does NHLBI Grading Strength of recommendation 'C' imply?

Weak recommendation Signup and view all the answers

What does NHLBI Grading Strength of recommendation 'D' indicate?

Recommendation against Signup and view all the answers

What does NHLBI Grading Strength of recommendation 'E' refer to?

Expert opinion Signup and view all the answers

What does NHLBI Grading Strength of recommendation 'N' signify?

No recommendation for or against Signup and view all the answers

Study Notes

Hierarchy of Evidence

Evidence ranges from less biased expert opinion to more rigorous study designs
Systematic reviews of randomized controlled trials (RCTs) represent the highest level
Followed by meta-analysis, RCTs, cohort studies, case-control studies, case series, and unsystematic clinical observations

Levels of Evidence

Refers to a ranking system that indicates the strength of results in clinical trials or research studies

Grades of Recommendations

Evaluates the entire body of work categorized as higher levels of evidence

G.R.A.D.E System

Ranks the quality of evidence from A (high) to D (very low)
Provides an overall recommendation strength of either strong (1) or weak (2)

ACC/AHA System

A grading system used to classify levels of evidence, incorporates the NHLBI grading recommendations

ACC/AHA Class I

Indicates conditions with strong evidence and general agreement about the effectiveness of a treatment or procedure

ACC/AHA Class II

Refers to conditions with conflicting evidence or varied opinions on the efficacy of a treatment
Divided into Class IIa (favoring usefulness) and Class IIb (less well-established usefulness)

ACC/AHA Class III

Class III indicates conditions where evidence suggests a treatment or procedure is not useful or may cause harm

NHLBI Grading Recommendations

A represents strong recommendations
B signifies moderate recommendations
C indicates weak recommendations
D is a recommendation against a certain treatment
E reflects expert opinion without strong evidence
N denotes no clear recommendation for or against a treatment

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Description

Explore the different levels and grades of evidence used in clinical trials and research studies. This quiz covers the G.R.A.D.E system and the ACC/AHA classification system, highlighting the importance of systematic reviews and randomized controlled trials. Test your understanding of how evidence impacts clinical recommendations.