Stewart Suzanne B, Dahm Phillip, Scales Charles D
Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Indian J Urol. 2011 Oct;27(4):525-31. doi: 10.4103/0970-1591.91446.
Advances in treatment and disease prevention occur frequently in urology. Urologists must identify a framework within which to evaluate these therapeutic innovations.
The evidence-based approach to critical appraisal is described using an example from the urological literature. A three-part assessment of the trial validity, treatment effect, and applicability of results will permit the urologist to critically incorporate medical and surgical advances into practice.
Validity of clinical trials hinges upon balancing patient prognosis at the initiation, execution, and conclusion of the trial. Readers should be aware of not only the magnitude of the estimated treatment effect, but also its precision. Finally, urologists should consider all patient-important outcomes as well as the balance of potential benefits, harms, and costs, and patient values and preferences when making treatment decisions.
Use of this framework for critical appraisal will lead to a more evidence-based application of new therapies for patients. Incorporation of a more evidence-based practice within urology will lead to an increase in the quality of patient care.
泌尿外科在治疗和疾病预防方面的进展屡见不鲜。泌尿外科医生必须确定一个用以评估这些治疗创新的框架。
通过泌尿外科文献中的一个例子，描述了基于证据的批判性评价方法。对试验有效性、治疗效果及结果适用性进行三部分评估，将使泌尿外科医生能够批判性地将医学和外科进展纳入临床实践。
临床试验的有效性取决于在试验开始、实施及结束时对患者预后的平衡。读者不仅应了解估计治疗效果的大小，还应知晓其精确性。最后，泌尿外科医生在做出治疗决策时，应考虑所有对患者重要的结局以及潜在益处、危害和成本之间的平衡，还有患者的价值观和偏好。
使用此批判性评价框架将促使新疗法更基于证据地应用于患者。在泌尿外科纳入更基于证据的实践将提高患者护理质量。
