The emergence of evidence based guidelines may be one of the great successes of the evidence based medicine movement. We now have a mature process of development using literature review and appraisal, aligning strength of evidence and grading of recommendations. This has become an international movement and this global expansion is reflected in the development of the Guidelines International Network reported in this issue of QSHC.¹

There have, indeed, been considerable successes, perhaps exemplified by the groundbreaking work of the National Institute of Clinical Excellence in the UK, building on earlier crafting of structured evidence based guidelines methods.^2,3 This industry was fashioned on the background of concerns about unexplained variations in practice and on the exponential growth of information with the problem for clinicians of remaining up to date with reading and assimilating the immense literature, let alone being able to appraise or assess it.⁴ Studies had shown that guidelines available were often widely variable in their content and in their likely impact upon quality of care if applied in practice.^5,6 Early guidelines …