Using evidence-based principles to make clinical decisions.

evidence-based principles (EBP) into the clinical decision-making process, I thought it would be worthwhile to assemble a special issue of JAAA concerned with how researcher-clinicians integrate evidence to create an effective treatment plan for their patients/clients. With this in mind, I asked the contributors to this special issue to “walk” the reader through the process of how they arrived at their decision(s) regarding the chosen clinical path. The call for increased use of EBP is not unique to audiology. The implementation of EBP into medical education and other clinical practices has been going on for a period much longer than the recent trend for its implementation in our profession. In fact, there are entire books, courses, chapters, and websites on this topic! What is EBP? It is the process by which clinicians make decisions on providing the best patient care (e.g., best practice guidelines). EBP does not support decisions based on “hunches,” or common statements such as “it’s worked before,” “this is the way I was taught,” or “this is the way it’s always been done.” Rather, EBP is based on the rigorous process of critically analyzing the research (evidence) and implementing, or not implementing, the evidence into their clinical practice. In order to be appropriate users of EBP, a clinician must be skilled in “sizing up” the evidence based on its strength or weakness.Thus, strong evidence might be judged a Level 1 (systematic review and meta-analysis of randomized controlled trials), Level 2 (welldesigned randomized controlled trial), or perhaps even a Level 3 (nonrandomized intervention study). If the evidence is judged as being Level 1, 2, or 3, then the decision might be to incorporate these results/recommendations into his or her practice because the results/recommendations are based on strong, or relatively strong, scientific evidence. If, on the other hand, the evidence is judged to be Level 4 (cohort study, case-control, cross-sectional surveys, or an uncontrolled experiment), Level 5 (case report), or Level 6 (expert opinion), then the clinician might decide not to incorporate the findings into his or her practice because the results/recommendations are not based on strong scientific evidence. It should be mentioned that the findings of Levels 4–6 might be integrated into clinical practice later if it can be demonstrated that the finding has been addressed using the methodologies of Levels 1–3. The logic of implementing EBP into audiology practice is self-evident.Without doubt, one cannot argue against the idea of clinicians providing patient care based on the best available evidence. Clearly, the same clinicians who are providing services to their hearing-impaired patients would not tolerate any less from their own personal health-care professionals. The five manuscripts within this issue reflect, for the most part, how these researcher-clinicians use the evidence and their experience to support their decision-making process. Jackie Clark and Ross Roeser report on a 23-month-old female referred for hearing aid fitting after failing a newborn hearing screening. Following medical clearance, binaural digital programmable hearing aids were fit using Desired Sensation Level (DSL) parameters. Behavioral testing and probe microphone measures showed significant aided benefit. Unfortunately, decreased hearing sensitivity was observed six months following the hearing aid fitting. Radiological