Context

The findings of systematic reviews (SRs) and meta-analyses (MAs) are used for clinical decision making. The European Association of Urology has committed increasing resources into the development of high quality clinical guidelines based on such SRs and MAs.

Objective

In this paper, we have summarised the process of conducting SRs for underpinning clinical practice guidelines under the auspices of the European Association of Urology Guidelines Office.

Evidence acquisition

The process involves explicit methods and the findings should be reproducible. When conducting a SR, the essential first step is to formulate a clear and answerable research question. An extensive literature search lays the foundation for evidence synthesis. Data are extracted independently by two reviewers and any disagreements are resolved by discussion or arbitration by a third reviewer.

Evidence synthesis

In SRs, data for particular outcomes in individual randomised controlled trials may be combined statistically in a meta-analysis to increase power when the studies are similar enough. Biases in studies included in a SR/MA can lead to either an over estimation or an under estimation of true intervention effect size, resulting in heterogeneity in outcome between studies. A number of different tools are available such as Cochrane Risk of Bias assessment tool for randomised controlled trials. In circumstances where there is too much heterogeneity, or when a review has included nonrandomised comparative studies, it is more appropriate to conduct a narrative synthesis. The GRADE tool for assessing quality of evidence strives to be a structured and transparent system, which can be applied to all evidence, regardless of quality. A SR not only identifies, evaluates, and summarises the best available evidence, but also the gaps to be targeted by future studies.

Conclusions

SRs and MAs are integral in developing sound clinical practice guidelines and recommendations.

Patient summary

Clinical practice guidelines should be evidence based, and systematic reviews and meta-analyses are essential in their production. We have discussed the key steps of conducting systematic reviews and meta-analyses in this paper.

中文翻译：

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进行系统评价以支持临床实践指南的关键步骤：欧洲泌尿外科协会的方法论

语境

系统评价（SR）和荟萃分析（MA）的发现可用于临床决策。欧洲泌尿外科协会已承诺增加资源，用于基于此类SR和MA的高质量临床指南的开发。

客观的

在本文中，我们总结了在欧洲泌尿外科指南办公室的主持下进行的SR，以作为临床实践指南的基础。

取证

该过程涉及明确的方法，其发现应具有可​​重复性。进行SR时，必不可少的第一步是提出一个明确而负责的研究问题。广泛的文献搜索为证据综合奠定了基础。数据由两名审稿人独立提取，任何分歧均由第三名审稿人通过讨论或仲裁解决。

证据综合

在SR中，当研究足够相似时，可以在荟萃分析中对个别随机对照试验中特定结局的数据进行统计合并，以提高功效。包括在SR / MA中的研究中的偏差可能导致对实际干预效果大小的高估或低估，从而导致研究之间结果的异质性。有许多不同的工具，例如用于随机对照试验的Cochrane偏倚风险评估工具。在异质性太多的情况下，或者当审查包括非随机比较研究时，进行叙述性综合更合适。用于评估证据质量的GRADE工具努力成为一个结构化且透明的系统，无论质量如何，都可以将其应用于所有证据。SR不仅可以识别，评估和总结最佳的现有证据，而且还可以作为未来研究的目标。

结论

SR和MA在制定合理的临床实践指南和建议中不可或缺。

病人总结

临床实践指南应以证据为基础，并且在其生产中必须进行系统的审查和荟萃分析。我们在本文中讨论了进行系统评价和荟萃分析的关键步骤。