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Clinical practice guidelines
Deriving recommendations in clinical practice guidelines
  1. M Eccles
  1. Professor of Clinical Effectiveness & The William Leech Professor of Primary Care Research, Centre for Health Services Research, School of Health Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4AA, UK;

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    The content of guideline recommendations is influenced by a range of factors including the published evidence, cost, and the composition of the guideline development group. Increasing the sophistication and validity of guideline recommendations will lead to an increase in their length which will need a corresponding increase in the sophistication of the thinking and methods of those responsible for implementing them.

    Most people who pick up a clinical practice guideline will only ever read the recommendations. Even though guidelines are an efficient exercise in research synthesis and summary, the full documentation can run to hundreds of pages—a volume that is beyond all but the most committed reader. In an attempt to address this, guideline programmes produce summary versions. These are usually formed solely of the guideline recommendations and presenting them in this way removes the possibility of the reader checking the validity of any or all of the recommendations. This means that guideline developers, and the programmes that they work with, must ensure that their processes produce recommendations that accurately reflect, not only the content of the scientific evidence, but also the appropriate range of clinical factors. In this issue of QSHC Manna et al1 present an analysis of the degree to which guideline recommendations reflect clinically important facets of ethnicity and conclude that they do so to a variable extent.

    The content of guideline recommendations is influenced by a range of factors. An assessment of the nature of the published evidence (accepting that some may come from the unpublished “grey” literature) addresses the methodological quality of the evidence in terms of …

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