Chapter 5 Evidence-Based Practice Fundamentals: Identify the six steps of evidence-based practice. Ask a clinical question b. Collect the most relevant evidence c.
This article has been cited by other articles in PMC. 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. 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.
Clinical practice guidelines play a critical role in guiding evidence-based practice and have been defined as systematically developed statements to guide patient and physician decision-making.
Clinical practice guidelines should be developed using rigorous methodology based on a systematic review of the best available evidence for specific clinical questions and provide a rating of the quality of evidence.
To date, no unified system has been adopted by various urological organizations developing guidelines making it very important for urologists to understand what constitutes an evidence-based guideline, rather than one that is primarily consensus-based.
Urological investigations reveal a 6 cm right upper pole renal mass. No other causes of hematuria are detected. Staging investigations reveal multiple small metastases in the lungs bilaterally.
He is otherwise well with an ECOG status of 0. There is no other relevant past medical or surgical history. The patient has utilized the Internet at home to review various treatment options available for metastatic renal cell cancer and asks about the possibility of treatment with sunitinib.
Being a general urologist 15 years out of training who takes care of patients with a broad spectrum of urological conditions you decide to seek out the current best evidence on the appropriateness of sunitinib in this setting.
To guide your search, you formulate the following focused clinical question using the PICO format: In patients with metastatic kidney cancer P patienthow does treatment with sunitinib I intervention compare to systematic immunotherapy C comparison with regards to overall survival O outcome.
Finding the right guideline You are familiar with the hierarchy of evidence-based resources which characterizes clinical practice guidelines as summaries that integrate the best evidence on a full range of treatment options. An excellent resource to identify evidence-based clinical practice guidelines developed by different organizations is the National Guidelines Clearinghouse NGC funded and managed by the Agency for Healthcare Quality and Research.
For example, cancer guidelines by the National Cancer Center Network, although being widely used, are considered consensus and not evidence-based and therefore not included.
An excellent feature of the NGC website is the option of displaying several guideline document side-by-side for comparison. There is furthermore a link to freely download the full-text guideline document.
You decide to review this document to ensure that it was rigorously developed, relevant, and applicable to your patient.
Are the guideline recommendations valid? Similarly to the appraisal of an individual study such as a randomized controlled trial one needs to consider were all relevant outcomes considered, were the inclusion of appropriate studies complete and were any unnecessary studies includedwhether the development process was appropriate and whether potential conflict of interest were appropriately managed Were all relevant outcomes considered?
Clinical decision-making should be based on outcomes that are important to patients. Such outcomes include overall and disease-specific survival, quality of life, and absence of complications secondary to the relevant disease as well as adverse events that are therapy related.
However, very often, clinical research studies employ surrogate endpoints that are associated with patient-important outcomes yet distinct.
Guideline developers and users should be aware of this distinction and clearly differentiate between the two types of outcomes.Clinical Question and Research-Practice Gap. Choose a systematic review from the list of approved reviews based on your interests or your practice situation.
Formulate a significant clinical question related to the topic of the systematic review that will be the basis for your capstone change r-bridal.com://r-bridal.com Clinical Practice Essay - This assignment will underline three key skills learnt during clinical practice; weight monitoring, blood pressure and bed baths.
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Your Clinical Practice Project required you to become a change agent. You selected a problem that was professionally or personally important to you, researched the problem, and developed a plan of action that included strategies for success, stakeholders and resources by linking a QSEN r-bridal.com Learning For Students in Clinical Practice.
Studies carried out to determine the type of communication and relationships between students and stage 2 mentors produced findings that argue their r-bridal.com://r-bridal.com Essay Application of Concept Analysis to Clinical Practice Application of Concept Analysis to Clinical Practice The concept is a general idea that is derived from human perception of events in the environment.