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1. Introduction to Evidence-Based Medicine
1.1 Critical Appraisal
1.2 Systematic Reviews
1.3 Clinical Practice Guidelines
2. Guiding Principles of EBM
2.1 Hierarchy of Evidence
2.2 Evidence Alone Is Never Enough
3. How to Practice EBM
3.1 Ask
3.2 Acquire
3.3 Appraise
3.4 Apply
3.5 Assess
4. How To Formulate An Answerable Question
5. How To Search Effectively
6. How To Appraise A Study: The Users’ Guide Framework
6.1 Are The Results Valid?
6.2 What Are The Results?
6.3 Are The Results Applicable To My Patient?
7. Questions Of Therapeutic Effectiveness And Prevention
7.1 Randomization
7.2 Allocation Concealment
7.3 Blinding
7.4 Intention-To-Treat Analysis
7.5 Completeness Of Follow-Up
8. Questions of Diagnostic Test Accuracy
8.1 Did The Investigators Face Diagnostic Uncertainty?
8.2 Did The Investigators Compare The “Index” Test To An Appropriate, Independent Reference Standard?
8.3 Were Those Interpreting The Test And Reference Standard Blind To The Other Results?
8.4 Did Investigators Perform The Same Reference Standard In All Patients Regardless Of The Results Of The Test Under Investigation?
9. Questions of Prognosis
9.1 Was The Sample Of Patients Representative?
9.2 Were The Patients Sufficiently Homogenous With Regards To Prognostic Risk?
9.3 Was Follow-Up Sufficiently Complete?
9.4 Were Outcome Criteria Objective And Unbiased?
10. Questions of Harm
11. Systematic Reviews
12. Clinical Practice Guidelines
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Evidence-Based Medicine

D. Robert Siemens, MD
Philipp Dahm, MD, MHSc
Last Updated:
Monday, March 1, 2021

1. Introduction to Evidence-Based Medicine

Evidence-based medicine (EBM) today represents the confluence of three major movements that all originated in the early nineties. Although the principles of EBM have been widely endorsed in the urological community, many barriers impede evidence-based clinical practice.1 These include the low quality of evidence provided by many studies in urology and poor reporting practices2,3,4,5,6,7 and the lack of familiarity with EBM knowledge and skills, which this chapter in the AUA Core Curriculum seeks to address.

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