Clinical guidelines are controversial devices. While some are objective, current, evidence-based and of excellent quality, others are biased, consensus-based, obsolete and lack quality assurance effort. The problem for the clinician is determining which is which. There are no international organizations overseeing standards and expirations of clinical guidelines internationally. This situation is discussed in the current article as well as the need for a recurring review process so that a safe and effective protocol will have to pass a rigorous evaluation on a periodic basis. Without this periodic review, a protocol could be effective one week and outdated the following week. Even though finely crafted evidence-based protocols enhance quality and can lead toward optimal, cost-effective therapy, practitioners are reluctant to adopt guidelines that are of unknown origins, age and without the benefit of an objective peer-review process.
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