Using evidence synthesis and clinical practice guidelines in everyday decision-making process

Every decision of a healthcare professional should be according to an evidence-based healthcare (EBHC) approach based on the best available up-to-date evidence, expert experiences and patient's preferences. This EBHC principle seems to be very simple; however, the reality and everyday practice differs completely, not only among different countries, but there is a high heterogeneity in its daily use among regions and even healthcare facilities within one country as well. To discuss the critical question ‘producing and using the best available evidence and guidelines’ on an international level, we organized in December 2018 the ‘European JBI symposium of Evidence-Based Healthcare with focus on the Clinical Practice Guidelines, Decision making process and Evidence synthesis in the Czech Republic’ (JBC European Symposium). The symposium consisted of eight sessions dealing with methodology, transfer and using evidence synthesis and clinical practice guidelines (CPGs) during decision-making process. A total of 18 keynote speakers from Canada, Iran and the most of European countries presented over the 2 days of the symposium, which was formally opened by the President of the symposium Adj. Assoc. Prof. Miloslav Klugar, PhD, Director of The Czech Republic (Middle European), Centre for Evidence-Based Healthcare: The Joanna Briggs Institute Centre of Excellence and Chair of European Joanna Briggs Collaboration. The main topic of the symposium was CPGs. The main keynote speaker at the JBC European Symposium was Prof. Holger Schünemann, who presented a completely new approach for using nonresearch ‘expert evidence’ and argued that to help ensure that expert evidence is used appropriately to inform recommendations within guidelines, it must be collected and appraised systematically and transparently. The President of the symposium presented the first outcomes of the ‘Czech National project for Clinical Practice guidelines’, which is led by the Czech Health Research Council in cooperation with the Ministry of Health of Czech Republic and the Institute of Health Information and Statistics of the Czech Republic. Prof. Cooper from Scotland and Dr Evans from the United Kingdom were talking about using qualitative evidence in development of CPGs. Trustworthy evidence-based CPGs should be according to GRADE methodology based on the systematic review. So, during the symposium the methodology and a role of evidence synthesis in the decision-making process and CPG development were also discussed, and one qualitative systematic review, two scoping reviews and one systematic review protocol of epidemiological evidence were presented. Development of every study including systematic review or guideline has to be justified in terms of necessity. The key part of the planning phase of a systematic review or CPG is not only preliminary search of existing systematic review/CPG but also epidemiological analysis of the defined clinical problem in a particular country. One session including four presentations was focused on the importance and practical use of epidemiological analysis in development of CPGs in the Czech Republic. The most crucial part of the whole evidence-based approach is implementation evidence including recommendations from CPGs into the practice. Prof. Kent, Prof. Loveday and Dr Carrier presented their experiences with implementing new evidence into clinical practice from different parts of the United Kingdom. Dr Moreno introduced the Spanish approach, Prof. Bala talked about guideline adaptation and their transfer into the practice in Poland, and Dr Mazilu shared experiences from Romania. In the context of evidence synthesis, CPG and EBHC approach generally, we should every time keep in mind the educational aspect, which is essential for the increase of producing, transferring and using the systematic review as the highest level of scientific evidence and evidence-based CPGs in practice. Prof. Apostolo presented the Portuguese ‘Evidence-based practice educational program’ and Dr Adriaenssens shared experiences about the Belgian ‘Evidence-based practice educational program and national project’. Part of the symposium was also the official opening of the Masaryk University GRADE Centre, conducted with ceremonial ribbon-cutting by Prof. Schünemann and official opening of the Cochrane Czech Republic, officiated by Prof. Gerd Antes. The opening ceremonial was moderated by the deputy director of both newly established centers and head of the local organizing committee of the symposium Adj. Assoc. Prof. Jitka Klugarová, PhD. Acknowledgements Conflicts of interest The authors report no conflicts of interest.

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