Understanding Evidence-Based Practice: National Guidelines, Systematic Reviews, and Nonresearch Evidence

QUESTION

What is the difference of national guidelines, systematic reviews with and without meta-analysis, and nonresearch evidence.

• Describe the various sources of nonresearch evidence.
• Based on the hierarchy of evidence in your readings this week, provide 1 example of systematic reviews and nonresearch evidence and provide the Level I, II, III, IV, or V.
• Review the section for appraising national guidelines on the Johns Hopkins nonresearch appraisal tool (located in this week’s Learning Activities folder). Describe the characteristics and discuss the reason these characteristics are important to ensure a national guideline is high quality.

ANSWER

Understanding Evidence-Based Practice: National Guidelines, Systematic Reviews, and Nonresearch Evidence

Introduction

In evidence-based practice (EBP), healthcare professionals rely on a diverse range of evidence sources to inform clinical decisions and interventions. Three essential types of evidence often utilized in healthcare are national guidelines, systematic reviews with and without meta-analysis, and nonresearch evidence. This essay aims to explore the differences between these evidence sources, describe the various sources of nonresearch evidence, provide examples of systematic reviews and nonresearch evidence, and discuss the importance of characteristics in appraising national guidelines.

Differences between National Guidelines, Systematic Reviews, and Nonresearch Evidence

National Guidelines: National guidelines are evidence-based recommendations developed by national healthcare organizations or expert panels. They offer clinicians standardized, best-practice approaches to patient care based on the most current research evidence available. These guidelines are updated periodically to ensure they reflect the latest advancements in medical science and clinical practice.

Systematic Reviews with Meta-Analysis: A systematic review is a rigorous synthesis of research evidence from multiple studies on a specific topic. It aims to provide a comprehensive and unbiased summary of the existing literature. When a systematic review includes a meta-analysis, it combines and analyzes quantitative data from selected studies to derive a more precise estimate of the treatment effect.

Systematic Reviews without Meta-Analysis: Systematic reviews without meta-analysis still follow a rigorous methodology for synthesizing evidence but do not conduct quantitative data pooling. Instead, they present a narrative summary of the included studies‘ findings.

Nonresearch Evidence: Nonresearch evidence encompasses information derived from sources other than scientific studies, such as expert opinions, clinical experience, quality improvement initiatives, and clinical practice guidelines.

Sources of Nonresearch Evidence

Expert Opinions: Insights and recommendations from experienced healthcare professionals in a particular field.

Clinical Experience: Information drawn from the personal experiences and observations of healthcare practitioners.

Quality Improvement Initiatives: Data from ongoing quality improvement projects aimed at enhancing healthcare delivery and patient outcomes.

Clinical Practice Guidelines: Recommendations developed by professional organizations based on expert consensus and clinical experience.

Examples of Systematic Reviews and Nonresearch Evidence

Systematic Review: “Effectiveness of Cognitive-Behavioral Therapy for Anxiety Disorders: A Meta-Analysis” (Level I Evidence).

Nonresearch Evidence: Clinical practice guidelines for the management of heart failure by the American Heart Association (Level II Evidence).

Appraising National Guidelines

The Johns Hopkins nonresearch appraisal tool for national guidelines assesses the following characteristics:

Authorship: National guidelines should be authored by reputable organizations or expert panels with relevant expertise.

Scope and Purpose: Guidelines should clearly define their scope and purpose, ensuring they are relevant and applicable to the targeted patient population.

Stakeholder Involvement: High-quality guidelines involve input from key stakeholders, including patients, healthcare providers, and other relevant parties.

Rigor of Development: The guidelines should adhere to a rigorous methodology for evidence synthesis, including systematic literature searches and transparent criteria for study inclusion.

Clarity and Presentation: Guidelines should be well-organized and presented in a clear and accessible manner to facilitate implementation.

Applicability: The guidelines should address applicability, feasibility, and potential barriers to implementation in real-world clinical settings.

Editorial Independence: Guidelines should be free from undue influence or bias from commercial entities or stakeholders.

Consistency: Recommendations within the guidelines should be internally consistent and supported by the best available evidence.

Conclusion

In evidence-based practice, healthcare professionals draw upon a range of evidence sources, including national guidelines, systematic reviews with and without meta-analysis, and nonresearch evidence. Each type of evidence contributes to informed decision-making and best-practice patient care. By critically appraising national guidelines and considering the level of evidence from systematic reviews and nonresearch sources, healthcare practitioners can confidently apply evidence-based interventions to improve patient outcomes and optimize healthcare delivery.