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Guidelines, Algorithms, Critical Pathways, Templates, and Evidence-based Medicine

There are evolving in medicine a host of guidelines, algorithms, templates, and critical pathways. Each is a significant part of the Guidelines for Evaluation and Research in the Utstein Style, the Executive Summary of which was published in the last issue, and the complete work will be published as a Supplement to Volume 15 in 2000. Another templatelike document is the lead article in this issue. The development of such patterns for the delivery or analysis of medical care is hailed by some who believe these documents provide organization out of chaos. Others object to the structure provided as attempts to "cookbook" medical care. Others point out that the codification of such processes threatens the important role played by "experience" and "logic"; still others insist that such devices establish "standards" and that deviations from these standards present an increased risk for legal actions. Thus, confusion reigns relative to the meaning and utility of such documents. And, to confuse matters further, there now is a drive by some to evolve what they call, "evidence-based medicine". Are these all the same?