This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related article  • Related letters  • Similar articles in JAMA  Topic Collections  • Medical Practice  • Medical Education  • Cardiovascular System  • Quality of Care  • Evidence-Based Medicine  • Quality of Care, Other  • Statistics and Research Methods  • Prognosis/ Outcomes  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic  Social Bookmarking   What's this?

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: The study by Dr Tricoci and colleagues¹ underlined the difference between the reality of clinical work (which is extremely complex and cannot easily be reduced to simple standardized procedures) and clinical practice guidelines. These guidelines are intended to cover clinical reality as far as possible. However, the broader the reality, the less precise the guidelines become. From 1984 to 2008, the number of recommendations increased from 1330 to 1973 (a 48% increase), but only 11% of these recommendations were classified as level of evidence A, with 48% classified as level of evidence C.

Jorge Luis Borges wrote a 1-paragraph story² of a fictional empire where the art of cartography had attained great perfection. The map of a single province occupied an entire city. In time these gigantic maps were no longer satisfactory to the cartographers, who then designed a map of the empire with a size equal . . . [Full Text of this Article]

Francesco Enia, MD
francescoenia@gmail.com
Divisione di Cardiologia
AO V. Cervello
Palermo, Italy

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Scientific Evidence Underlying the ACC/AHA Clinical Practice Guidelines
Pierluigi Tricoci, Joseph M. Allen, Judith M. Kramer, Robert M. Califf, and Sidney C. Smith, Jr
JAMA. 2009;301(8):831-841.
ABSTRACT | FULL TEXT  

RELATED LETTERS

Clinical Practice Guidelines and Scientific Evidence
Susan L. Norris
JAMA. 2009;302(2):142.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
Finlay A. McAlister
JAMA. 2009;302(2):142-143.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
Christian M. Pettker and Edmund F. Funai
JAMA. 2009;302(2):143.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
Elliott M. Antman and Raymond J. Gibbons
JAMA. 2009;302(2):143-144.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
Mark D. Huffman and Robert O. Bonow
JAMA. 2009;302(2):144-145.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
John Concato and Ralph I. Horwitz
JAMA. 2009;302(2):145.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
Robert S. Bobrow
JAMA. 2009;302(2):145.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
Shyam S. Kothari
JAMA. 2009;302(2):145.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence—Reply
Pierluigi Tricoci, Robert M. Califf, and Sidney C. Smith, Jr
JAMA. 2009;302(2):145-146.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence—Reply
Terrence M. Shaneyfelt and Robert M. Centor
JAMA. 2009;302(2):146-147.
EXTRACT | FULL TEXT