Clinical guidelines

Clinical guidelines are a simple way to put evidence into practice. As they are not often published in peer reviewed journals, the internet is an ideal way to find them. To begin searching for a specific clinical guideline, look at the website of the relevant royal college, (www.rcplondon.ac.uk/general/gen_links.htm). If you get no result, try the National Institute for Clinical Excellence website (www.nice.org.uk/page.aspx?o=guidelines.completed); you may find the latest formally and systematically produced guidelines in the United Kingdom. Have a thorough look round then check monthly for newly added guidelines in the special section for this.

The Scottish Intercollegiate Guidelines Network (SIGN; www.sign.ac.uk/guidelines/index.html) also provides clinical guidelines with well recognised and accepted methodology. They do not cover many topics, however; for example, they only have three relevant guidelines in obstetrics and gynaecology.

The www.eguidelines.co.uk site requires an annual fee (£23.50; €34.48; $44.20) for full access, where I found a collection of guidelines that already exist but from multiple sources.

The Guidelines Finder provided by the National Electronic Library for Health (http://libraries.nelh.nhs.uk/guidelinesFinder/aboutUs.asp) is a database of UK approved evidence based clinical guidelines with associated information. This is a perfect source that supplies many high quality clinical guidelines.

In www.tripdatabase.com, if your search for a guideline is fruitless, you still have more categories to look at; for example, a collection of evidence based articles, clinical questions and answers, etextbooks, and peer reviewed journals relating to your search. The website allows you to search five times a week for free, otherwise you need to pay a yearly subscription fee of £35.25.

From the US, there is the National Guideline Clearinghouse (www.guideline.gov), a giant website containing more than 1200 guidelines. You can search by name, or browse by disease, treatment, intervention, or organisation. The site also has a tool to compare guidelines. To do this, add the guideline that you are interested in to My Collection then start comparing. This is helpful for evaluating the methodology of the relevant guidelines.

The National Institutes of Health consensus statements (http://consensus.nih.gov/cons/cons.htm) gives many guidelines based on expert opinion, which is less scientifically valid but still useful if you cannot find anything more methodologically rigorous. The Canadian Medical Association (http://mdm.ca/cpgsnew/cpgs/index.asp) has the advantage of being written in English and French.

Finally, if you are a general practitioner, visit the University of California site (http://medicine.ucsf.edu/resources/guidelines/index.html), which gives guidelines to treat most of the top 25-40 diagnoses which make up 60%-90% of office visits.