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DermNez NZ and the Royal New Zealand College of General Practitioners presents Dermatology CME Quizzes, at http://old.dermnetnz.info/doctors/quizzes/index.html, which they describe as being "especially suitable for family physicians and dermatologists in training." Nine quizzes, each with 10 cases, ask you to suggest appropriate investigations, diagnosis, treatment, management, etc, for the conditions illustrated in the photographs. For each case presented there is a "Mark Question" button to reveal answers to the questions. Members of the New Zealand Medical Council can complete the answers and submit the quiz for credit toward a CME certificate. There are listings of further reading for each of the pathologies discussed in the quizzes, and these are sourced to either DermNez, which has extensive cross referencing, or to Emedicine.com. The quizzes offer a selection of varied and interesting pathologies.

Clinical practice guidelines from the Kidney Disease Quality Outcomes Initiative, http://www.kidney.org/professionals/kdoqi/guidelines.cfm, of the National Kidney Foundation "provides a standardized terminology for the evaluation and classification of kidney disease; the proper monitoring of kidney function from initial injury to end stage; a logical approach to stratification of kidney disease by risk factors and comorbid conditions; and consequently a basis for continuous care and therapy throughout the course of chronic kidney disease." A three-staged evidence-based process is used to ensure methodological rigor. There are 10 completed guidelines with six under development, and they are subdivided into chapters each carrying its own set of guidelines. Although the chapters round up all the usual suspects, they are interrogated in depth. Since their publication in 1997, the Kidney Disease Quality Outcomes Initiative guidelines have had a significant and measurable impact on the care and outcomes of dialysis patients.

Published clinical guidelines are a fairly recent and ubiquitous international development. One organization seeking to "build links between relevant international organizations so as to improve coordination with clinical practice guidelines and other healthcare quality initiatives" is Guidelines International Network (GIN), http://www.g-i-n.net/index.cfm?fuseaction=about. Founded in November 2002, GIN has now grown to 52 member organizations from 26 countries, including the World Health Organization, and aims to establish a forum for international communication between those involved in developing, appraising, and implementing clinical guidelines and to avoid unnecessary duplication. Click on "Guideline Resources" and then "Health Topics Collection" for a listing of international guidelines.

National Institute for Clinical Excellence, http://www.nice.org.uk/page.aspx?o=ourguidance, part of the National Health Service, UK, publishes "Technology Appraisals," "Clinical Guidelines," and "Interventional Procedures." For each of these categories, information is provided either as PDF files (predominantly) or as HTML and includes both published guidelines and also those still being developed. The clinical guidelines are divided into 37 categories each of which contain between 5 and 10 detailed guidelines.

The Scottish Intercollegiate Guidelines Network (SIGN), http://www.sign.ac.uk/guidelines/index.html, was formed in 1993 and the executive is based at Royal College of Physicians of Edinburgh. There are 80 guidelines grouped under 14 categories. The individual guidelines expand into either a quick reference guide or the full guideline. They are available as HTML or in PDF format. SIGN has published their own Guideline Developers Handbook http://www.sign.ac.uk/guidelines/fulltext/50/index.html which provides guideline users with information on the methodology used by SIGN when developing their guidelines; it also provides resources for groups embarking on new guideline development projects.

Both National Institute for Clinical Excellence and SIGN aim to meet the international standard set by Appraisal of Guidelines, Research and Evaluation (AGREE), http://www.agreecollaboration.org, and as members of AGREE (established 1998), they collaborate in developing guidelines to the same basic principles of multidisciplinary involvement based on systematic review and critical appraisal of the evidence base. A list of AGREE guidelines can be viewed at http://www.sign.ac.uk/guidelines/published/index.html.

In the USA the National Guidelines Clearinghouse, http://www.guideline.gov is also a member of GIN and is an initiative of the Agency for Healthcare Research and Quality in partnership with the American Medical Association and the U.S. Department of Health and Human Services. The guideline index arranged by organization can be accessed at http://www.guideline.gov/resources/guideline_index.aspx, which at the time of writing lists 1,503 guidelines.

Email: jimnet49-smj@yahoo.co.uk with your favorite web sites.
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Title Annotation:DermNez NZ and the Royal New Zealand College of General Practitioners presents Dermatology CME Quizzes, National Kidney Foundation and National Health Service's guidelines
Author:Young, Jim
Publication:Southern Medical Journal
Geographic Code:1USA
Date:Aug 1, 2005
Words:737
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