A Users’ Guide to the Urological Literature: Introducing a Series of Evidence Based Medicine Review Articles

A Users’ Guide to the Urological Literature: Introducing a Series of Evidence Based Medicine Review Articles vidence based medicine (EBM) and related concepts have become so widespread that urologists who wish to understand the medical literature have no choice but to become familiar with its terminology and principles.1– 4 Although the desire to provide the best possible care to patients is clearly the driving force in motivating urologists to learn about and implement EBM, other recent developments underscore this need. Increased awareness of patient safety, quality of care and health care costs has prompted a number of initiatives closely related to the evidence based medicine movement. Foremost, pay for performance will link physician reimbursement not only to outcomes, but also to documented practices of urology that are in accordance with evidence based guidelines as set forth by professional societies.5,6 In addition, recent efforts by the American Board of Urology to integrate the documentation of evidence based care in accordance with the American Urological Association clinical guidelines in the maintenance of certification process are already affecting the practice of urologists.7 Therefore, it appears critically important that all urologists become familiar with the concept and principles of EBM. However, the primary barrier to dissemination of the principles of evidence based medicine in urology has been the lack of educational materials specific to our specialty. While the Users’ Guide to the Medical Literature published in JAMA provides an authoritative and comprehensive reference for those interested in evidence based medicine, it focuses heavily on examples from the practice of internal medicine.8 Similarly, the majority of educational review articles on EBM target family practitioners, internists, pediatricians, psychiatrists and other medical subspecialties. Recognizing the critical need to provide urologists with an educational forum to promote the knowledge and understanding of evidence based medicine, the editors of The Journal of Urology® are taking the initiative to publish a series of review articles on EBM during the next 18 months. The first article of this series was published in the September issue and introduced the guiding principles of EBM, which include the “hierarchy of evidence” concept as well as the understanding that evidence alone is never enough but needs to be integrated with individual patient values, preferences and circumstances.9,10 Subsequent articles in this series will introduce strategies to effectively search the urological literature, review critical appraisal techniques for different types of articles as they relate to surgical interventions, prognostic studies, diagnostic tests, meta-analysis and clinical practice guidelines, and introduce important terms such as number needed to treat and number needed to harm.

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0022-5347/07/1784-1149/0 THE JOURNAL OF UROLOGY® Copyright © 2007 by AMERICAN UROLOGICAL ASSOCIATION

These articles will be distinct from other evidence based medicine publications as they will be written by urologists in conjunction with recognized EBM experts and research methodologists. We believe that using examples from the urological literature will help drive home the concepts of evidence based medicine. We further expect that this series of review articles will serve as a users’ guide to the urological literature and become an invaluable resource to all urologists who wish to enhance their understanding of evidence based medicine. Philipp Dahm Department of Urology University of Florida College of Medicine Gainesville, Florida and Glenn M. Preminger Division of Urologic Surgery, Department of Surgery Duke University Medical Center Durham, North Carolina REFERENCES 1. 2. 3. 4.

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Månsson W: Evidence-based urology—a utopia? Eur Urol 2004; 46: 143. Evans CP: Evidence-based medicine for the urologist. BJU Int 2004; 94: 1. Sand PK: Urogynecology: the death of dogma. Int Urogynecol J Pelvic Floor Dysfunct 2001; 12: 1. Sur RL, Scales CD Jr, Preminger GM and Dahm P: Evidencebased medicine: a survey of American Urological Association members. J Urol 2006; 176: 1127. Jones RS, Brown C and Opelka F: Surgeon compensation: “Pay for performance,” the American College of Surgeons National Surgical Quality Improvement Program, the Surgical Care Improvement Program, and other considerations. Surgery 2005; 138: 829. Miller DC, Wei JT, Montie JE and Hollenbeck BK: Quality of care and performance-based reimbursement: the contemporary landscape and implications for urologists. Urology 2006; 67: 1117. Miller SH: American Board of Medical Specialties and repositioning for excellence in lifelong learning: maintenance of certification. J Contin Educ Health Prof 2005; 25: 151. Guyatt GH and Rennie D: User’s Guide to the Medical Literature, 4th ed. Chicago, Illinois: AMA Press 2002; p. 706. Scales CD Jr, Preminger GM, Keitz SA and Dahm P: Evidence based clinical practice: a primer for urologists. J Urol 2007; 178: 000. Dahm P and Preminger GM: Introducing levels of evidence to publications in urology. BJU Int 2007; 100: 246.

Vol. 178, 1149, October 2007 Printed in U.S.A. DOI:10.1016/j.juro.2007.06.036