Dahm Philipp, Yeung Lawrence L, Gallucci Michele, Simone Giuseppe, Schünemann Holger J
Department of Urology, College of Medicine, University of Florida, Gainesville, Florida 32610-0247, USA.
J Urol. 2009 Feb;181(2):472-9. doi: 10.1016/j.juro.2008.10.041. Epub 2008 Dec 13.
Leading organizations increasingly recognize clinical practice guidelines as an important approach in promoting an evidence-based clinical practice of urology. In light of their considerable clinical, economic and medicolegal impact, guideline users should be confident that the guidelines were rigorously developed and address relevant patient questions. In this article we outline a practical approach for critically appraising a clinical practice guideline.
We outline a 3-step approach to the assessment of a clinical practice guideline that answers the questions of whether the recommendations are valid, what the recommendations are and whether they will help in the treatment of an individual patient.
To determine the adequacy of a clinical practice guideline, urologists should carefully review the rigor of the development process and its content. Important questions that relate to the validity of a guideline are whether, for specific questions, all important management options and outcomes were considered, and whether there was an explicit and sensible process to identify, select and combine all relevant evidence. Clinical practice guidelines should formally grade the quality of the available evidence for a given clinical question and outline a formal process of how the recommendations were derived. Value judgments made in the guideline development process about the relative importance of the potential benefits and harms of a given health care intervention should be made transparent to the reader. The recommendations made should be practical and should address important clinical issues. Furthermore, their strength should be graded to reflect the underlying uncertainty about the evidence and the values applied in the guideline development process.
The systematic approach presented in this article will allow urologists to critically appraise clinical practice guidelines. Determining the validity of the recommendations, understanding the recommendations and assessing their applicability to patients are 3 fundamental steps toward an evidence-based approach to using clinical practice guidelines.
领先的组织越来越认识到临床实践指南是促进泌尿外科循证临床实践的重要方法。鉴于其巨大的临床、经济和法医学影响，指南使用者应确信这些指南是经过严格制定的，并能解决相关的患者问题。在本文中，我们概述了一种批判性评估临床实践指南的实用方法。
我们概述了一种评估临床实践指南的三步方法，该方法回答了以下问题：推荐意见是否有效、推荐意见是什么以及它们是否有助于治疗个体患者。
为确定临床实践指南的充分性，泌尿外科医生应仔细审查制定过程的严谨性及其内容。与指南有效性相关的重要问题包括：对于特定问题，是否考虑了所有重要的管理选项和结果；是否有明确且合理的过程来识别、选择和整合所有相关证据。临床实践指南应正式对给定临床问题的现有证据质量进行分级，并概述推荐意见的推导过程。在指南制定过程中对给定医疗保健干预潜在益处和危害的相对重要性所做的价值判断应向读者透明化。所提出的推荐意见应切实可行，并应解决重要的临床问题。此外，其强度应进行分级，以反映指南制定过程中证据和所应用价值观的潜在不确定性。
本文介绍的系统方法将使泌尿外科医生能够批判性地评估临床实践指南。确定推荐意见的有效性、理解推荐意见并评估其对患者的适用性是采用循证方法使用临床实践指南的三个基本步骤。
