Guidelines are not evidence

How Evidence-Based Are the Recommendations in Evidence-Based Guidelines?

BACKGROUND Treatment recommendations for the same condition from different guideline bodies often disagree, even when the same randomized controlled trial (RCT) evidence is cited. Guideline appraisal tools focus on methodology and quality of reporting, but not on the nature of the supporting evidence. This study was done to evaluate the quality of the evidence (based on consideration of its int...

Intravenous estrogen is not proven effective for abnormal uterine bleeding: guidelines are based on flawed evidence

A clinical appraisal and clinical application of: DeVore GR, Owens O, Kase N. treatment of dysfunctional uterine bleeding--a double This appraisal identifies significant statistical irregularities in the study. A reworking of the study's statistics lea different from that put forth by the authors of this paper: intravenous estrogen therapy is not, in fact, significantly more compared to placebo...

Community-acquired pneumonia guidelines: much guidance, but not much evidence.

Community-acquired pneumonia (CAP) is changing. The emergence and spread of antibiotic resistance in common causative bacteria, the development of new microbiological diagnostic techniques, new understandings in the area of severity assessment and the development of new antibiotics are just some of the issues. Methods of guideline writing have also evolved [1]. The categorisation of evidence an...

Guidelines in real life. Why are they not always enforced?

Low-toxicity dusts: current exposure guidelines are not sufficiently protective.

Exposure to low-toxicity dusts, which have previously been viewed as 'nuisance dusts', can cause chronic obstructive pulmonary disease or other nonmalignant respiratory disease. In Britain, the 'de facto' airborne exposure limits for these dusts have remained unchanged for >30 years; currently, they are 10mg m(-3) for inhalable dust and 4mg m(-3) for respirable dust. During this time, exposures...