以實證醫學角度評論2016與2018TUA治療指引
盧致誠1,2 范文宙１
１奇美醫療財團法人柳營奇美醫院 外科部 泌尿外科
２國立中正大學 資訊管理研究所
viewing from Evidence-Based Medicine on the 2016 and 2018 TUA Pocket guidelines
Chih-Cheng Lu1,2, Wen-Chou Fan１
１Division of Urology, Department of Surgery, Chi Mei Medical Center, Liouying, Tainan
2Department of Management Information System, National Chung Cheng University, Chiayi
Purpose:
Modern clinical practice guidelines (CPGs) are built with the essence of evidence-based medicine (EBM). This study is to provide an EBM view on the latest edition of CPG by Taiwan Urological Association.
Materials and Methods:
A retrospective study for reviewing the 2016 and 2018 TUA Pocket Guidelines was conducted. The first and latest edition CPG by TUA was published in August, 2016 and 2018, respectively. In the modern world, there are many professional societies to level the evidence and the grade of recommendation for CPG. For example, US Preventive Services Task Force(USPSTF) leveled the evidence with I,II-1,II-2,II-3, and III in 2007; Oxford Center for EBM leveled the evidence as 1a,1b,1c,2a,2b, 2c,3a,3b,4,and 5 in 2001. Oxford Center for EBM had published the latest edition in 2009 which was quite different from the old edition in 2001 and 2004.
Results:
A total of 35 topics covered the urological conditions in the latest CPG by TUA (previous 33 topics). Guidelines for priapism and vesicoureteric reflux in children were added. The references of EBM were inconsistent and obscure among topics. Unfortunately, the edition of Oxford EBM is obsolete. The other chapters used the same level of evidence and grade of recommendation based on the CPGs from European Association Urology, but without clear citation. Furthermore, at least in one chapter, the grade of recommendation was inappropriate quoted as level of evidence. In 2 different chapters, the identical urologists were included (or invited) as authors and reviewers in the same time, however it was better than the first edition (at least 6 topics).
Conclusion:
The latest edition of TUA pocket CPG is encouraging. However, for appropriate level of evidence and grade of recommendation, citing the latest edition of EBM is very important. This limited study may help for further revision of the TUA CPG in the future.