Article Organization: Evidence Versus Clinical Question

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Article Organization: Evidence Versus Clinical Question

Table of Contents

Introduction
Purpose of Article Organization
Types of Organization
Clinical Question Study Organization
Conclusion
References

Introduction

In conducting scholarly research, various methods may be used to ensure the highest quality and reliability of findings. One of the steps that researchers in research-based practice use is organizing articles. Two primary organizational methods are organizing the material by its evidence level or the type of clinical question it poses. These two approaches are distinct in their methodology and intent and may assist scholars in different situations, depending on the context. This work discusses the purpose of organizing gathered articles, compares and contrasts the two approaches, and advises that the best way to structure clinical-question-based studies is through a systematic review.

Purpose of Article Organization

The purpose of the article organization may differ in its specifics (depending on how far along the research is), but the overall idea behind it is the same. Whenever a clinician is considering a change in current treatment practices for a patient, they are involved in the act of clinical prediction (Horwitz et al., 2017, p. 1249). The guidance for such a prediction can be obtained from patient history and the nearest matches found in the literature notably, the topics may not correspond entirely with the specific patient case (Horwitz et al., 2017). As Horwitz et al. (2017) note, the evidence-based practice arose in response to poorly designed observational treatment research and physician reliance on personal experience with other patients (p. 1246). Essentially, article organization aims to systemize the information available to make it easier for the researchers to draw conclusions and make decisions.

However, such conclusions do not have to be limited to decision-making in a single-patient clinical case. In the very first stages, grouping the available information is required even to determine whether there is enough high-quality, relevant evidence to move forward with the study (Dang et al., 2021). Thus, another aim of article organization is to help scholars determine whether a study has enough data to rely on.

Once a quick search of major databases is concluded, and sufficient research seems to be present, the question arises as to what should be considered high-quality. In general, medical professionals are encouraged to find the highest available level of evidence to base their study on, since higher levels are generally assumed to correspond with best practices in the field (Dang et al., 2021). The specifics regarding what is considered to be a higher level are covered further in this essay. The final purpose of article organization is thus quality and relevance control for broader scholarly research, covering the issues of validity and generalizability (Horwitz et al., 2017). Hence, the researchers may organize articles in different manners depending on the nature of their inquiry: whether it is patient-specific or a more generally applicable clinical question.

Types of Organization

In the process of research, healthcare professionals must undertake a few steps to obtain the best evidence for their study. Best is a notion that may refer to data that is of a certain type and thus most suitable, or to data that is of a certain quality and thus most reliable. The search begins with organizing items by the levels of the evidence pyramid. In that process, a hierarchy of best available emerges as an underlying principle of any evidence-based practice in other words, not all evidence is created equal. The article organization by the type of evidence implies relying on this hierarchy to roughly subdivide the material into five principal levels, a number I being the most reliable one and number V being the least reliable (Dang et al., 2021). Levels I-III are referred to as research evidence, meaning that they include studies, whether experimental, quasi-, or non-experimental ones, or a systematic review thereof (Dang et al., 2021). Levels IV-V are deemed non-research evidence and refer to opinions of universally acknowledged experts and authorities, clinical guidelines, or narrative reviews (Dang et al., 2021). Therefore, by organizing the articles into the correspondent levels, healthcare professionals may identify the ones that are most preferred for the study (such as level I) and those that are least preferred (such as level V). A practical example of this may be Waters and Rankins (2019) study that explicitly utilizes the hierarchy in establishing wound care protocols. Essentially, this approach allows the professionals to explicitly identify the best quality evidence in terms of meeting methodology criteria and prioritize that in the research.

The articles may also be structured after the varying types of clinical questions. Framing the search for and organizing the articles relies on structuring the query around four types of clinical information that are otherwise known as the PICO framework: Population, Intervention, Control or comparison and Outcome (Scells et al., 2017, p. 2291). Some of the types of clinical questions that this approach may target may be effectiveness of interventions, diagnostic test accuracy, prognosis, prevalence or incidence of disease, accuracy of measurement instruments, or qualitative data (Pollock & Berge, 2018, p. 138). Grouping the articles by clinical questions allows the researchers to identify more relevant and specific information, especially if the PICO methodology is used to narrow the search. Essentially, after organizing articles by clinical question types, medical professionals can look for a certain kind of information right away for instance, a specific population of interest as studied through a specific clinical approach.

In terms of comparing the two types of article organization, professionals may utilize either approach to discern information that is needed in the given context. During the first phases of research, it is crucial to organize articles by their respective level to find the best quality evidence, which is where organization by evidence level comes in. However, when researchers are looking for specific contexts, the topic organization becomes more relevant, so systematizing information by clinical questions and PICO parameters are needed.

Clinical Question Study Organization

Whenever article organization is based on the clinical question, the approach that is best suited for finding the answer is a systematic review. Systematic reviews of literature, regardless of their inclusion of the meta-analytical component, are deemed to be the best source of evidence, characterized as a level I-III or research evidence (Dang et al., 2021). At the core of this approach lies the process of first appraising and then summarizing scholarly literature, which is a method suitable for a wide variety of clinical questions (Dang et al., 2021). Scells et al. (2017) contend that using PICO annotations for the search and organization of articles is an effective method for obtaining and systematizing sufficiently relevant evidence. Hence, the systematic review approach enables the clinicians to ensure vigorous quality checks whilst keeping the topic-focused organization.

The proposed approach has several advantages in terms of reliability and accuracy. First, the articles for the review undergo rigorous critical appraisal (Dang et al., 2021; Pollock & Berge, 2018). The researcher must critically evaluate the methodology and findings of each article before utilizing any of the results to answer the posed clinical question (Pollock & Berge, 2018). Critically evaluating the articles enables the researcher to ensure that appropriate quality control has been conducted. While it is not strictly required to select only level I articles for the study, most of them are likely going to belong to that category.

Upon the completion of the appraisal procedure, the results are synthesized. This process often takes a form of a qualitative summary, sometimes including a statistical analysis of the breakdown a meta-analysis (Pollock & Berge, 2018). In contrast to the narrative or scoping review that may be broad in range and potentially biased, a systematic review of articles requires comprehensive resources and an explicit search strategy since it is based on a pre-defined question (Pollock & Berge, 2018). Hence, if it is paired with a well-formulated and focused clinical question, it is most effective in obtaining a clear answer through the study.

There are, however, downsides to the systematic review method. For instance, the process may take extensive time sometimes as long as years for one study and thus be outdated by the time of the publication (Pollock & Berge, 2018). Therefore, healthcare professionals are advised to only utilize frequently updated databases and refer to the latest studies (Dang et al., 2021). Lastly, sometimes an extensive and well-conducted singular piece of evidence may provide better and more reliable information than a systematic review of many pieces (Pollock & Berge, 2018). Overall, a systematic review of scholarly literature is a highly appropriate method for searching, checking, and organizing the relevant evidence for a particular clinical question.

Conclusion

In conclusion, medical professionals utilize both types of article organization, depending on the type and stage of research. Organization of materials may be used for clinical prediction in specific cases or to answer broader questions. Ultimately, this method aims to determine two parameters: the quality and relevance of the evidence. Grouping by evidence level entails determining what evidence is best-quality, while grouping by relevance pertains to the organization around specific clinical questions. Lastly, for clinical-question-based studies, it is recommended to utilize a systematic review of literature, as it combines both types of organizations most effectively.

References

Dang, D., Dearholt, S. L., Bissett, K., Whalen, M., & Ascenzi, J. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model & guidelines (4th ed.). Sigma Theta Tau International.

Horwitz, R. I., Hayes-Conroy, A., Caricchio, R., & Singer, B. H. (2017). From evidence-based medicine to medicine-based evidence. The American Journal of Medicine, 130(11), 12461250. Web.

Pollock, A., & Berge, E. (2018). How to do a systematic review. International Journal of Stroke, 13(2), 138156. Web.

Scells, H., Zuccon, G., Koopman, B., Deacon, A., Azzopardi, L., & Geva, S. (2017). Integrating the framing of clinical questions via PICO into the retrieval of medical literature for systematic reviews. Proceedings of the 2017 ACM on Conference on Information and Knowledge Management, 22912294. Web.

Waters, N., & Rankin, J. M. (2019). The hierarchy of evidence in advanced wound care: The social organization of limitations in knowledge. Nursing Inquiry, 26(4), e12312. Web.

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