Summary literature represents the highest quality of evidence and the top portion of the evidence-based medicine pyramid. In this chapter, summary literature refers specifically to practice guidelines and systematic reviews. If done properly, authors will have performed a comprehensive systematic review of the literature available as well as summarized findings from the available literature for both of these types of manuscripts. For practice guidelines, the summary typically exists in the form of graded recommendations. For systematic reviews, the summary comes in the form of a meta-analysis where a quantitative statistical analysis is conducted of pooled data from several separate but similar studies. Although articles featuring literature reviews (ie, narrative review, aka “review articles”) by authors exist for many clinical topics in medicine, the methods used for reviewing the literature in these articles are not necessarily systematic or comprehensive and it is typically left to the authors’ discretion for which data and studies to include. Table 10-1 offers a comparison of narrative reviews, systematic reviews, meta-analysis, and guidelines.
TABLE 10-1Comparison and Contrast of Overview Article Types |Favorite Table|Download (.pdf) TABLE 10-1 Comparison and Contrast of Overview Article Types
| ||Narrative Review ||Systematic Review ||Meta-Analysis ||Guideline |
|Focused Clinical Question ||Not generally ||Yes ||Yes ||Yes(Multiple questions addressed) |
|Structured Search Strategy ||No ||Yes ||Yes ||Yes |
|Selection of Included Articles ||Dependent on author ||Systematic ||Systematic ||Systematic |
|Quality Assessment of included articles ||No ||Yes ||Yes ||Yes |
|Qualitative or Quantitative result ||Qualitative ||Qualitative ||Quantitative ||Qualitative and Quantitative |
|Sources/Example ||UptoDate or Dynamed ||Cochrane Review ||Cochrane Review ||http://www.guideline.gov |
Hospitalists face the challenging task of managing patients with a diverse array of important and sometimes complicated medical conditions. Clinical practice guidelines exist and are designed to assist both health care providers and patients in making appropriate decisions regarding clinical care for the prevention, diagnosis, and treatment of health care conditions. Practice guidelines are systematically developed statements summarizing available medical literature for a specific clinical circumstance. The summary for practice guidelines usually comes in the form of graded recommendations based on the amount of data and quality of evidence that exists for a specific clinical circumstance. Ideally, practice guidelines should be presented in a user-friendly format that allows hospitalists the ability to deliver the best medical care possible.
Medical practice guidelines facilitate consistency, efficiency, and effectiveness to improve health care outcomes. Good clinical practice guidelines have been compared to receiving good recommendations from a consultant. Practice guidelines should provide clear recommendations, discuss alternatives, acknowledge biases, and consider extenuating circumstances for a specific clinical case.
Physician adherence to guidelines has been demonstrated to be surprisingly low at times. Guidelines have been shown to have had a limited effect on changing physicians’ practices and behaviors despite widespread implementation. ...