1. Locating Clinical Guidelines on the World Wide Web LIFT Forum November 10, 1999 Mary Youngkin, Librarian for Reference Services Eccles Health Sciences Library maryy@lib.med.utah.edu 801-581-5534

2. Presentation overview zDefinitions - Clinical Guidelines, Practice Guidelines, Clinical Practice Guidelines, Recommendations, Criteria? zNational Guideline Clearinghouse zSociety and agency sites zMEDLINE strategies for locating guidelines in the medical literature zOther Web lists

3. What are Practice Guidelines? “Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery.” (Medical Subject Headings, National Library of Medicine)

4. What are Clinical Practice Guidelines? As defined by the Institute of Medicine: "Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances."1 “These guidelines are not fixed protocols that must be followed, but are intended for health care professionals and providers to consider…” z1.Institute of Medicine. (1990). Clinical Practice Guidelines: Directions for a New Program. M.J. Field and K.N. Lohr (eds.) Washington, DC: National Academy Press (page 39).

5. National Guideline Clearinghouse

6. National Guideline Clearinghouse http://www.guideline.gov/index.asp zComprehensive database of evidence-based clinical practice guidelines and related documents zProduced by the Agency for Health Care Policy and Research (AHCPR), in partnership with the American Medical Association (AMA) and the American Association of Health Plans (AAHP)

7. National Guideline Clearinghouse zSearch engine zDetailed Search yallows for restriction by specific aspects of guidelines such as those with a formal cost analysis or clinical algorithm zBrowse by Disease/Condition zBrowse by Treatment/Intervention zBrowse by Organization

8. National Guideline Clearinghouse zStructured abstracts (summaries) about the guideline and its development zA utility for comparing attributes of two or more guidelines in a side-by-side comparison z Syntheses of guidelines covering similar topics, highlighting areas of similarity and difference

9. NGC contd. zLinks to full-text guidelines, where available, and/or ordering information for print copies zAn electronic forum, NGC-L for exchanging information on clinical practice guidelines, their development, implementation and use zAnnotated bibliographies on guideline development, methodology, implementation, and use

10. National Guideline Clearinghouse Demo

11. Association and Agency Sites zNot all guidelines or organizations are currently included on the NGC. Try direct connections EG: zCDC Recommendations: http://www2.cdc.gov/mmwr/mmwr_rr.html zAmerican Academy of Neurology Practice Advisories, Practice Parameters, Therapeutic and Technology Assessments, Credentialing Guidelines, Ethics Statements and Other AAN Position Statements http://www.aan.com/public/practiceguidelines/list.htm

12. Sample Association/Agency Sites contd. zAmerican Academy of Pediatrics yPolicy Statements http://www.aap.org/policy/pprgtoc.cfm yClinical Guidelines http://www.aap.org/policy/paramtoc.html zAmerican College of Cardiology http://www.acc.org/clinical/guidelines/index.html

13. Sample Association/Agency Sites contd. zAmerican Diabetes Association yClinical Practice Recommendations http://www.diabetes.org/DiabetesCare/Supplement199/ default.asp zCanadian Medical Association - CPG Infobase http://www.cma.ca/cpgs/index.htm ySearch engine yLists by category, title, titles by developer yRecent additions

14. American Diabetes Association& CPG Infobase Demo

15. Finding Guidelines in MEDLINE zIndexed in the “Publication Type” [PT] field (most accurate) yPractice Guideline yGuideline zMeSH Heading Practice Guidelines yGuidelines xUsed for articles on the form, value, use & creation of guidelines...

16. Finding Guidelines in MEDLINE zSilverPlatter ydiabetes-mellitus/di and PT=PRACTICE-GUIDELINE zPubMED http://www.ncbi.nlm.nih.gov/entrez/query.fcgi ydiabetes mellitus/di AND practice guideline[pt] yor use the new “Limit” feature yfor VERY current info, search for keywords such as guideline* OR recommendation* OR criteri* xretrieves articles which have not yet been indexed ysome links to the fulltext version

17. Finding Guidelines in specific journals zSilverPlatter yAnn-Intern-Med and PT=PRACTICE-GUIDELINE zPubMed yAnnals of Internal Medicine[jour] AND (guideline* OR recommendation* OR criteri* OR practice guideline[pt]) zOr go straight to an online journal and use its internal search engine

18. PubMed Demo http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

19. Other Web Sites zMedscape http://www.medscape.com/Home/Topics/multispecialty /directories/dir-MULT.PracticeGuide.cfm zMedical Matrix http://www.medmatrix.org/_SPages/Practice_Guidelines.asp zMedWeb http://www.MedWeb.Emory.Edu/MedWeb/

20. Questions?

21. HSTAT zNational Library of Medicine HSTAT (Health Services/Technology Assessment Text) zhttp://text.nlm.nih.gov/This full-text database provides searchable access to the many publications, including AHCPR Clinical Practice Guidelines z(English and Spanish) and Technology Assessments and Reviews, ATIS (HIV/AIDS Technical Information), NIH Warren zG. Magnuson Clinical Research Studies, NIH Consensus Development Program publications, the Guide to Clinical zPreventive Services (Second Edition), and the SAMHSA/CSAT Treatment Improvement Protocol (TIP).

22. AHCPR zhttp://text.nlm.nih.gov/ftrs/dbaccess/ahcpr