2015 EAU-Extended-Guidelines, Tutaj wrzucacie
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//-->EuropeanAssociationof UrologyGuidelines2015 editionEuropeanAssociationof UrologyGuidelines2015 editionEuropean Association of Urology Guidelines - 2015IntroductionWe are honoured and privileged to introduce you to the 2015 update of the EAU Guidelines. The Guidelinesare a priority for the EAU, they are a priority for every practicing urologist across Europe and beyond, andimportantly, they are a priority for the continued improvement of patient care and outcomes. This means thatthe EAU Guidelines are by default an important priority for healthcare policy-makers and funders. The EAUGuidelines Office oversees the production of 20 International Guidelines across 20 Guideline Panels. OurGuideline panels have some of the most respected, talented and dedicated urologists from across the breadthof Europe and beyond that work on a voluntary basis for the Guidelines Office.For this 2015 print, observant readers will notice a decrease in size of all individual guidelines topics based onstructured templates (oncology- and non-oncology) developed by the EAU Guidelines Office Methods sub-Committee. All texts have been subjected to a robust double blind peer review process prior to publication.In mapping out the future of the EAU Guidelines over the next 5 years, our readership will witness increasingstandardisation of the structure of the guidelines, high quality systematic reviews underpinning keyrecommendations, and increasing standardisation in phrasing of actionable recommendations. In order to meetthis requirement of high quality systematic reviews underpinning recommendations, the Guidelines Office hasembarked on systematically introducing Cochrane review methodology across all 20 Guideline panels. Thisprocess is ongoing and the benefits and impact of this transition will be seen in this and future updates of theEAU Guidelines. The past year has seen a considerable uptake of new systematic review projects, the resultsof which will become more apparent to the readers in each subsequent update.Strengthening the evidence base that underpin EAU Guidelines recommendations and improving thetransparency from evidence to recommendations is a critical area the EAU Guidelines Office must continue tobe vigilant about. More meaningful involvement of patients in the development of the EAU guidelines is anotherarea that the EAU is investing in. After all, we produce guideline recommendations for urologists to use in theirdaily practice but the recommendations are not applied to urologists, they are applied to patients, and so weare committed to ensuring that the clinical questions the recommendations are based on, and the outcomesof interest that are considered, take important patient views into account. Difficult as such a transition may be,that is our responsibility, if we are to maintain our position at the cutting edge of quality international guidelineproduction.Important as it is to produce comprehensive high quality clinical practice guidelines, more effectivedissemination and assessment of their value in day-to-day clinical practice is crucial and the EAU GuidelinesOffice is well positioned now to embark on this programme of work. Doing so, could provide further insightinto what may well be more optimum ways to present our findings in the future, thereby making EAU guidelinerecommendations more relevant and actionable, also enhancing their influence on patient care.The EAU Guidelines Office is embracing New Media tools (Facebook / Twitter) as a means to enhance not onlythe dissemination of the EAU guidelines but also to promote discussion and feedback from our users. We arecounting on your active engagement in helping us with this endeavor, which is led by a dedicated GuidelinesOffice Dissemination sub-Committee.The yearly publication of the EAU Guidelines would not be possible without the trust and support of each andevery user of the Guidelines globally, our EAU membership, our valued Guideline panels, the young GuidelineAssociates, the EAU Executive Committee & Management team, our EAU National Societies, and importantly,the Guidelines Office staff (especially Karin Plass, Esther Robijn and Eva Lowther). So, on behalf of the EAUGuidelines Office Board, thank you for your support and inspiration.We hope you enjoy using the 2015 update of the EAU Guidelines!Prof.Dr. James N’DowChairman EAU Guidelines OfficeUPDATE MARCH 20151Board members EAU Guidelines OfficeProf.Dr. J. N’DowAberdeen (UK)(Chair)Prof.Dr. J. IraniPoitiers (FR)(Vice-chair)Prof.Dr. T. KnollSindelfingen (DE)Prof.Dr. C. LlorenteMadrid (ES)Prof.Dr. T. LochFlensburg (DE)Prof.Dr. M. De SantisVienna (AT)Prof.Dr. R. SylvesterBrussels (BE)Prof.Dr. H. Van Poppel(ex-officio)Leuven (BE)The EAU Guidelines Office has set up dedicated sub-Committees responsible for critical aspects of guidelinesdevelopment. The Methods sub-Committee, supported by methodologists, is charged with the development ofmethodological standards and quality control. The Dissemination sub-Committee oversees the development ofdissemination and implementation strategies.EAU Guidelines Office Methods sub-CommitteeProf.Dr. R. Sylvester, Brussels (BE) (Chair)Prof.Dr. S. Canfield, Houston (TX, USA)Dr. T. Lam, Aberdeen (UK)Dr. L. Marconi, Porto (PT)Prof.Dr. J. N’Dow, Aberdeen (UK) (ex-officio)MethodologistsDr. T. Adewuyi, Aberdeen (UK)Dr. S. MacLennan, Aberdeen (UK)Dr. M.I. Omar, Aberdeen (UK)EAU Guidelines Office Dissemination sub-CommitteeProf.Dr. C. Llorente, Madrid (ES) (Chair)Prof.Dr. J. Irani, Poitiers (FR)Prof.Dr. M. Ribal, Barcelona (ES)Dr. S. Loeb, New York (USA)Prof.Dr. M. Rouprêt, Paris (FR)Dr. I. van Oort, Nijmegen (NL)Prof.Dr. J. N’Dow, Aberdeen (UK) (ex-officio)2UPDATE MARCH 2015Methodology sectionIn this 2015 EAU Guidelines compilation, all standard information on levels of evidence (LE) and grading ofrecommendations (GR) has been taken out of the individual guidelines topics for the sake of brevity.Recommendations and statements issued in the EAU guidelines are based on the following system, modifiedfrom the Oxford Centre for Evidence-based Medicine [1].Table 1.1: Level of evidence [1]*Level1a1b2a2b34Type of evidenceEvidence obtained from meta-analysis of randomised trials.Evidence obtained from at least one randomised trial.Evidence obtained from one well-designed controlled study without randomization.Evidence obtained from at least one other type of well-designed quasi-experimental study.Evidence obtained from well-designed non-experimental studies, such as comparative studies,correlation studies and case reports.Evidence obtained from expert committee reports or opinions or clinical experience of respectedauthorities.Table 1.2: Grade of recommendation [1]*Nature of recommendationsBased on clinical studies of good quality and consistency addressing the specific recommendationsand including at least one randomised trial.BBased on well-conducted clinical studies, but without randomised clinical trials.CMade despite the absence of directly applicable clinical studies of good quality.* Modified from [1].The aim of assigning a LE and grading recommendations is to provide transparency between the underlyingevidence and the recommendation given.It should be noted that when recommendations are graded, the link between the level of evidence and grade ofrecommendation is not directly linear. Availability of randomized controlled trials may not necessarily translateinto a grade A recommendation where there are methodological limitations or disparity in published results.Alternatively, absence of high level evidence does not necessarily preclude a grade A recommendation, if thereis overwhelming clinical experience and consensus. In addition, there may be exceptional situations wherecorroborating studies cannot be performed, perhaps for ethical or other reasons and in this case unequivocalrecommendations are considered helpful for the reader. The quality of the underlying scientific evidence -although a very important factor - has to be balanced against benefits and burdens, values and preferencesand costs when a grade is assigned.The EAU Guidelines Office do not perform cost assessments, nor can they address local/national preferencesin a systematic fashion. But whenever this data is available, the panel will include the information.Reference1.Produced by Bob Phillips, Chris Ball, Dave Sackett, Doug Badenoch, Sharon Straus, Brian Haynes,Martin Dawes since November 1998. Updated by Jeremy Howick March 2009.GradeAUPDATE MARCH 20153 [ Pobierz całość w formacie PDF ]
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//-->EuropeanAssociationof UrologyGuidelines2015 editionEuropeanAssociationof UrologyGuidelines2015 editionEuropean Association of Urology Guidelines - 2015IntroductionWe are honoured and privileged to introduce you to the 2015 update of the EAU Guidelines. The Guidelinesare a priority for the EAU, they are a priority for every practicing urologist across Europe and beyond, andimportantly, they are a priority for the continued improvement of patient care and outcomes. This means thatthe EAU Guidelines are by default an important priority for healthcare policy-makers and funders. The EAUGuidelines Office oversees the production of 20 International Guidelines across 20 Guideline Panels. OurGuideline panels have some of the most respected, talented and dedicated urologists from across the breadthof Europe and beyond that work on a voluntary basis for the Guidelines Office.For this 2015 print, observant readers will notice a decrease in size of all individual guidelines topics based onstructured templates (oncology- and non-oncology) developed by the EAU Guidelines Office Methods sub-Committee. All texts have been subjected to a robust double blind peer review process prior to publication.In mapping out the future of the EAU Guidelines over the next 5 years, our readership will witness increasingstandardisation of the structure of the guidelines, high quality systematic reviews underpinning keyrecommendations, and increasing standardisation in phrasing of actionable recommendations. In order to meetthis requirement of high quality systematic reviews underpinning recommendations, the Guidelines Office hasembarked on systematically introducing Cochrane review methodology across all 20 Guideline panels. Thisprocess is ongoing and the benefits and impact of this transition will be seen in this and future updates of theEAU Guidelines. The past year has seen a considerable uptake of new systematic review projects, the resultsof which will become more apparent to the readers in each subsequent update.Strengthening the evidence base that underpin EAU Guidelines recommendations and improving thetransparency from evidence to recommendations is a critical area the EAU Guidelines Office must continue tobe vigilant about. More meaningful involvement of patients in the development of the EAU guidelines is anotherarea that the EAU is investing in. After all, we produce guideline recommendations for urologists to use in theirdaily practice but the recommendations are not applied to urologists, they are applied to patients, and so weare committed to ensuring that the clinical questions the recommendations are based on, and the outcomesof interest that are considered, take important patient views into account. Difficult as such a transition may be,that is our responsibility, if we are to maintain our position at the cutting edge of quality international guidelineproduction.Important as it is to produce comprehensive high quality clinical practice guidelines, more effectivedissemination and assessment of their value in day-to-day clinical practice is crucial and the EAU GuidelinesOffice is well positioned now to embark on this programme of work. Doing so, could provide further insightinto what may well be more optimum ways to present our findings in the future, thereby making EAU guidelinerecommendations more relevant and actionable, also enhancing their influence on patient care.The EAU Guidelines Office is embracing New Media tools (Facebook / Twitter) as a means to enhance not onlythe dissemination of the EAU guidelines but also to promote discussion and feedback from our users. We arecounting on your active engagement in helping us with this endeavor, which is led by a dedicated GuidelinesOffice Dissemination sub-Committee.The yearly publication of the EAU Guidelines would not be possible without the trust and support of each andevery user of the Guidelines globally, our EAU membership, our valued Guideline panels, the young GuidelineAssociates, the EAU Executive Committee & Management team, our EAU National Societies, and importantly,the Guidelines Office staff (especially Karin Plass, Esther Robijn and Eva Lowther). So, on behalf of the EAUGuidelines Office Board, thank you for your support and inspiration.We hope you enjoy using the 2015 update of the EAU Guidelines!Prof.Dr. James N’DowChairman EAU Guidelines OfficeUPDATE MARCH 20151Board members EAU Guidelines OfficeProf.Dr. J. N’DowAberdeen (UK)(Chair)Prof.Dr. J. IraniPoitiers (FR)(Vice-chair)Prof.Dr. T. KnollSindelfingen (DE)Prof.Dr. C. LlorenteMadrid (ES)Prof.Dr. T. LochFlensburg (DE)Prof.Dr. M. De SantisVienna (AT)Prof.Dr. R. SylvesterBrussels (BE)Prof.Dr. H. Van Poppel(ex-officio)Leuven (BE)The EAU Guidelines Office has set up dedicated sub-Committees responsible for critical aspects of guidelinesdevelopment. The Methods sub-Committee, supported by methodologists, is charged with the development ofmethodological standards and quality control. The Dissemination sub-Committee oversees the development ofdissemination and implementation strategies.EAU Guidelines Office Methods sub-CommitteeProf.Dr. R. Sylvester, Brussels (BE) (Chair)Prof.Dr. S. Canfield, Houston (TX, USA)Dr. T. Lam, Aberdeen (UK)Dr. L. Marconi, Porto (PT)Prof.Dr. J. N’Dow, Aberdeen (UK) (ex-officio)MethodologistsDr. T. Adewuyi, Aberdeen (UK)Dr. S. MacLennan, Aberdeen (UK)Dr. M.I. Omar, Aberdeen (UK)EAU Guidelines Office Dissemination sub-CommitteeProf.Dr. C. Llorente, Madrid (ES) (Chair)Prof.Dr. J. Irani, Poitiers (FR)Prof.Dr. M. Ribal, Barcelona (ES)Dr. S. Loeb, New York (USA)Prof.Dr. M. Rouprêt, Paris (FR)Dr. I. van Oort, Nijmegen (NL)Prof.Dr. J. N’Dow, Aberdeen (UK) (ex-officio)2UPDATE MARCH 2015Methodology sectionIn this 2015 EAU Guidelines compilation, all standard information on levels of evidence (LE) and grading ofrecommendations (GR) has been taken out of the individual guidelines topics for the sake of brevity.Recommendations and statements issued in the EAU guidelines are based on the following system, modifiedfrom the Oxford Centre for Evidence-based Medicine [1].Table 1.1: Level of evidence [1]*Level1a1b2a2b34Type of evidenceEvidence obtained from meta-analysis of randomised trials.Evidence obtained from at least one randomised trial.Evidence obtained from one well-designed controlled study without randomization.Evidence obtained from at least one other type of well-designed quasi-experimental study.Evidence obtained from well-designed non-experimental studies, such as comparative studies,correlation studies and case reports.Evidence obtained from expert committee reports or opinions or clinical experience of respectedauthorities.Table 1.2: Grade of recommendation [1]*Nature of recommendationsBased on clinical studies of good quality and consistency addressing the specific recommendationsand including at least one randomised trial.BBased on well-conducted clinical studies, but without randomised clinical trials.CMade despite the absence of directly applicable clinical studies of good quality.* Modified from [1].The aim of assigning a LE and grading recommendations is to provide transparency between the underlyingevidence and the recommendation given.It should be noted that when recommendations are graded, the link between the level of evidence and grade ofrecommendation is not directly linear. Availability of randomized controlled trials may not necessarily translateinto a grade A recommendation where there are methodological limitations or disparity in published results.Alternatively, absence of high level evidence does not necessarily preclude a grade A recommendation, if thereis overwhelming clinical experience and consensus. In addition, there may be exceptional situations wherecorroborating studies cannot be performed, perhaps for ethical or other reasons and in this case unequivocalrecommendations are considered helpful for the reader. The quality of the underlying scientific evidence -although a very important factor - has to be balanced against benefits and burdens, values and preferencesand costs when a grade is assigned.The EAU Guidelines Office do not perform cost assessments, nor can they address local/national preferencesin a systematic fashion. But whenever this data is available, the panel will include the information.Reference1.Produced by Bob Phillips, Chris Ball, Dave Sackett, Doug Badenoch, Sharon Straus, Brian Haynes,Martin Dawes since November 1998. Updated by Jeremy Howick March 2009.GradeAUPDATE MARCH 20153 [ Pobierz całość w formacie PDF ]