Evidence-based medicine in urology

“Evidence-based medicine” refers to a set of principles and methods to ensure that, to the greatest extent possible, individual decisions and population-based policies are consistent with the evidence of their eVectiveness and beneWt [1]. The term that was coined less than 20 years ago by Gordon Guyatt at McMaster University has grown from a Xedging concept to the fundamental basis of clinical practice that reaches into all aspects of medical practice [2]. The importance of evidence-based medicine and evidence-based clinical practice is highlighted by the fact that statements encouraging adherence to these principles are included in the landmark health care reform legislation enacted in the United States in 2010 and is guiding health care policy in countries such as the United Kingdom. With increasing recognition that greater adherence to evidencebased practice can improve quality of care and reduce costs, it is critically important that all practitioners in urology understand the underpinnings of the concepts of evidencebased medicine as well as its applicability and limitations. This issue of the World Journal of Urology pays tribute to the remarkable and growing impact that evidence-based medicine has had on the practice of urology. It includes eleven articles written by recognized experts in the Weld that provide in-depth analyses of the inXuence of evidencebased medicine on key areas of clinical practice, education, publishing, health policy, and clinical research. Lavallee et al. explore the current and future role of randomized controlled trials—recognized as leading the “hierarchy of evidence” as the best original study design to provide high quality evidence for questions of therapeutic eVectiveness—in guiding the clinical practice of urology. It is followed by studies by Porten et al. and Yu et al. that provide similar analyses of the roles of observational study designs/registries and health services research, respectively, in addressing the most important evidence gaps in urology. The following two articles by Wang et al. and Shelton et al. put these Wndings into perspective by discussing the growing importance of comparative eVectiveness research as well as their implications for health policy decision-making. Recognizing the critical role of clinical practice guidelines to guide evidence-based clinical practice, MacLennan et al. discuss the value of clinical pathways as a guide to their development; an approach that is being promoted by the European Association of Urology and The British Association of Urological Surgeons guideline developer groups. Wolf et al. analyze the considerable eVorts of the American Urological Association (AUA) as an example of how rigorous methodology can feasibly be applied to the development of evidence-based recommendations. A review by CanWeld et al. then discusses the GRADE approach for rating the quality of evidence and strengths of recommendations. It provides a transparent and methodologically rigorous framework for developing clinical practice guidelines that has been adopted by over Wfty professional organizations all over the globe (http://www.gradeworkinggroup.org). GRADE holds the promise of becoming the unifying methodological framework for guideline developers, which would allow enhanced collaboration and improved resource utilization for professional urological organizations. P. Dahm (&) Department of Urology, College of Medicine, Health Science Center, University of Florida, Box 100247, Room N-203, Gainesville, FL 32610-0247, USA e-mail: p.dahm@urology.ufl.edu