Clubb Adrian B, Dahm Philipp
University of Florida, Departments of Urology and Prostate Disease Center, College of Medicine, Gainesville, Florida, USA.
Indian J Urol. 2011 Oct;27(4):498-502. doi: 10.4103/0970-1591.91441.
Clinical practice guidelines play a critical role in guiding the evidence-based clinical practice of urology. We describe a systematic approach to critical appraisal of urology guidelines.
Based on a focused clinical question derived from a clinical scenario, we identified a relevant clinical practice guideline that we critically appraised using the Users' Guide to the Medical Literature framework as to whether the results are valid, what are the results, and can they be applied to the care of an individual patient.
A clinical practice guideline by the National Institute for Clinical Excellence on the use of sunitinib as the first line treatment for patients with metastatic renal cell carcinoma was identified. The guideline development process was found to be appropriately rigorous and included an explicit rating of the quality of evidence. The recommendations were clearly stated and appeared applicable to the specific patient in the clinical scenario.
Clinical practice guidelines should be developed using rigorous evidence-based methodology. Urologists should have the skills and knowledge to critically appraise a guideline before applying it to the care of their patients.
临床实践指南在指导泌尿外科循证临床实践中起着关键作用。我们描述了一种对泌尿外科指南进行批判性评价的系统方法。
基于从临床情景中得出的重点临床问题，我们确定了一项相关的临床实践指南，并使用《医学文献用户指南》框架对其进行批判性评价，以判断结果是否有效、结果是什么以及这些结果能否应用于个体患者的护理。
确定了英国国家临床优化研究所关于使用舒尼替尼作为转移性肾细胞癌患者一线治疗的临床实践指南。发现该指南制定过程严谨适当，包括对证据质量的明确评级。建议表述清晰，似乎适用于临床情景中的特定患者。
临床实践指南应采用严谨的循证方法制定。泌尿外科医生在将指南应用于患者护理之前，应具备批判性评价指南的技能和知识。
