Thomas Knoll1, Muhammad Imran Omar2, Steven Maclennan3, Virginia Hernández4, Steven Canfield5, Yuhong Yuan6, Max Bruins7, Lorenzo Marconi8, Hein Van Poppel9, James N'Dow3, Richard Sylvester10. 1. Department of Urology, Sindelfingen-Boeblingen Medical Center, University of Tübingen, Sindelfingen, Germany. 2. Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland, UK. Electronic address: m.i.omar@abdn.ac.uk. 3. Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland, UK. 4. Department of Urology, Hospital Universitario Fundacion Alcorcon, Madrid, Spain. 5. Division of Urology, University of Texas McGovern Medical School, Houston, TX, USA. 6. Department of Medicine, McMaster University, Hamilton, ON, Canada. 7. Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands. 8. Department of Urology, Coimbra University Hospital, Coimbra, Portugal. 9. Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium. 10. EAU Guidelines Office, Brussels, Belgium.
Abstract
CONTEXT: The findings of systematic reviews (SRs) and meta-analyses (MAs) are used for clinical decision making. The European Association of Urology has committed increasing resources into the development of high quality clinical guidelines based on such SRs and MAs. OBJECTIVE: In this paper, we have summarised the process of conducting SRs for underpinning clinical practice guidelines under the auspices of the European Association of Urology Guidelines Office. EVIDENCE ACQUISITION: The process involves explicit methods and the findings should be reproducible. When conducting a SR, the essential first step is to formulate a clear and answerable research question. An extensive literature search lays the foundation for evidence synthesis. Data are extracted independently by two reviewers and any disagreements are resolved by discussion or arbitration by a third reviewer. EVIDENCE SYNTHESIS: In SRs, data for particular outcomes in individual randomised controlled trials may be combined statistically in a meta-analysis to increase power when the studies are similar enough. Biases in studies included in a SR/MA can lead to either an over estimation or an under estimation of true intervention effect size, resulting in heterogeneity in outcome between studies. A number of different tools are available such as Cochrane Risk of Bias assessment tool for randomised controlled trials. In circumstances where there is too much heterogeneity, or when a review has included nonrandomised comparative studies, it is more appropriate to conduct a narrative synthesis. The GRADE tool for assessing quality of evidence strives to be a structured and transparent system, which can be applied to all evidence, regardless of quality. A SR not only identifies, evaluates, and summarises the best available evidence, but also the gaps to be targeted by future studies. CONCLUSIONS: SRs and MAs are integral in developing sound clinical practice guidelines and recommendations. PATIENT SUMMARY: Clinical practice guidelines should be evidence based, and systematic reviews and meta-analyses are essential in their production. We have discussed the key steps of conducting systematic reviews and meta-analyses in this paper.
CONTEXT: The findings of systematic reviews (SRs) and meta-analyses (MAs) are used for clinical decision making. The European Association of Urology has committed increasing resources into the development of high quality clinical guidelines based on such SRs and MAs. OBJECTIVE: In this paper, we have summarised the process of conducting SRs for underpinning clinical practice guidelines under the auspices of the European Association of Urology Guidelines Office. EVIDENCE ACQUISITION: The process involves explicit methods and the findings should be reproducible. When conducting a SR, the essential first step is to formulate a clear and answerable research question. An extensive literature search lays the foundation for evidence synthesis. Data are extracted independently by two reviewers and any disagreements are resolved by discussion or arbitration by a third reviewer. EVIDENCE SYNTHESIS: In SRs, data for particular outcomes in individual randomised controlled trials may be combined statistically in a meta-analysis to increase power when the studies are similar enough. Biases in studies included in a SR/MA can lead to either an over estimation or an under estimation of true intervention effect size, resulting in heterogeneity in outcome between studies. A number of different tools are available such as Cochrane Risk of Bias assessment tool for randomised controlled trials. In circumstances where there is too much heterogeneity, or when a review has included nonrandomised comparative studies, it is more appropriate to conduct a narrative synthesis. The GRADE tool for assessing quality of evidence strives to be a structured and transparent system, which can be applied to all evidence, regardless of quality. A SR not only identifies, evaluates, and summarises the best available evidence, but also the gaps to be targeted by future studies. CONCLUSIONS: SRs and MAs are integral in developing sound clinical practice guidelines and recommendations. PATIENT SUMMARY: Clinical practice guidelines should be evidence based, and systematic reviews and meta-analyses are essential in their production. We have discussed the key steps of conducting systematic reviews and meta-analyses in this paper.
Authors: L Broudeur; G Karam; I Chelghaf; S De Vergie; J Rigaud; M A Perrouin Verbe; Julien Branchereau Journal: World J Urol Date: 2019-05-25 Impact factor: 4.226
Authors: Vasileios I Sakalis; Riccardo Campi; Lenka Barreto; Herney Garcia Perdomo; Isabella Greco; Łukasz Zapala; Mithun Kailavasan; Tiago Antunes-Lopes; Jack David Marcus; Kenneth Manzie; John Osborne; Benjamin Ayres; Luc M F Moonen; Andrea Necchi; Juanita Crook; Pedro Oliveira; Lance C Pagliaro; Chris Protzel; Arie S Parnham; Maarten Albersen; Curtis A Pettaway; Philippe E Spiess; Scott T Tagawa; R Bryan Rumble; Oscar R Brouwer Journal: Eur Urol Open Sci Date: 2022-05-02
Authors: Roger Li; Debasish Sundi; Jingsong Zhang; Youngchul Kim; Richard J Sylvester; Philippe E Spiess; Michael A Poch; Wade J Sexton; Peter C Black; James M McKiernan; Gary D Steinberg; Ashish M Kamat; Scott M Gilbert Journal: Eur Urol Date: 2020-03-04 Impact factor: 20.096
Authors: Nadja Schoentgen; Gianluigi Califano; Celeste Manfredi; Javier Romero-Otero; Felix K H Chun; Idir Ouzaid; Jean-François Hermieu; Evanguelos Xylinas; Paolo Verze Journal: Front Surg Date: 2021-04-21
Authors: André N Vis; Roderick C N van den Bergh; Henk G van der Poel; Alexander Mottrie; Philip D Stricker; Marcus Graefen; Vipul Patel; Bernardo Rocco; Birgit Lissenberg-Witte; Pim J van Leeuwen Journal: BJUI Compass Date: 2021-11-09
Authors: Thomas Bjoersum-Meyer; Lasse Kaalby; Lars Lund; Peter Christensen; Marianne S Jakobsen; Gunnar Baatrup; Niels Qvist; Mark Ellebaek Journal: Eur Urol Open Sci Date: 2021-02-03