title: Evidence based clinical practice: a primer for urologists.
abstract: OBJECTIVE
  Evidence based clinical practice has been defined as the conscientious, explicit and judicious use of the current best evidence in making decisions about the care of individual patients. It refers to a broad set of principles and methods intended to ensure that medical decisions, guidelines and health policy are based on well designed studies of therapeutic effectiveness and benefit.
  
  
  METHODS
  We review the principles and practice of evidence based clinical practice using examples from the urology literature. We further provide a guide to currently available web based evidence based clinical practice resources and guidelines for urologists.
  
  
  RESULTS
  Evidence based clinical practice integrates a hierarchy of evidence and patient values with practitioner judgment to guide decision making for the individual patient. Important steps in the evidence based clinical practice process include the formulation of an answerable question and a systematic search of the literature. In the absence of pre-appraised evidence or disease specific guidelines, the practice of evidence based clinical practice relies heavily on the evaluation of the primary literature by the individual urologist. Depending on the question domain (therapy/prevention, etiology/cause/harm, diagnosis or prognosis) and study design, a given study is critically appraised for validity, impact and applicability. Evidence is then integrated with clinical judgment, and patient circumstances and preferences. Finally, the practice of evidence based clinical practice includes a self-assessment of provider performance.
  
  
  CONCLUSIONS
  Knowledge, practice and documentation of evidence based clinical practice are of increasing importance to every urologist. Urologists should embrace evidence based clinical practice principles by acquiring the necessary skills to critically appraise the literature for the best evidence applicable to patient care.
authors.affiliation: Department of Surgery, Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Scales
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Preminger
authors.forename: Sheri A
authors.initials: SA
authors.lastname: Keitz
authors.forename: Philipp
authors.initials: P
authors.lastname: Dahm
mesh_terms: D019317:Evidence-Based Medicine / Q000379:methods / Q000592:standards; D006801:Humans; D014572:Urology