NGC provides a glossary of clarifying definitions and examples of terms used to describe common properties of evidence-based clinical practice guideline summaries. Visit the AHRQ Web site for a Web-based glossary that provides information about the science of comparative effectiveness.
Clinical SpecialtyAllergy and immunology
A medical specialty concerned with the hypersensitivity of an individual to foreign substances and protection from the resultant infection or disorder.Anesthesiology
A medical specialty concerned with purposeful depression of nerve function, characterized by loss of feeling or sensation, usually the result of pharmacologic action by anesthetics, and induced to allow performance of surgery or other painful procedures. This specialty is also concerned with treating pain associated with diseases/conditions.Cardiology
A medical subspecialty concerned with the study of the heart, its physiology, and its functions. Cardiovascular specialists are trained in diseases of the heart, lungs, and blood vessels and they manage complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.Chiropractic
An occupational discipline based on the relationship of the spine to health and disease. The spine is analyzed by x-rays and palpation, and vertebrae are adjusted manually to relieve pressures on the spinal cord.Colon and rectal surgery
A surgical specialty concerned with the diagnosis and treatment of various diseases of the intestinal tract, colon, rectum, anal canal, and perianal area by medical and surgical means. The specialty is also concerned with other organs and tissues (e.g., liver, urinary, and female reproductive system) involved with primary intestinal disease.Critical care
A subspecialty of medicine concerned with the diagnosis, treatment, and support of patients with multiple organ dysfunction (i.e., critically ill) during a medical emergency or crisis.Dentistry
The profession concerned with the teeth, oral cavity, associated structures, and the diagnosis and treatment of their diseases including prevention and the restoration of defective and missing tissue.Dermatology
A medical specialty concerned with the skin, its structure, functions, diseases, and treatment.Emergency medicine
A medical specialty concerned with resuscitation, transportation, and care from the point of injury or beginning of illness through the hospital or other emergency treatment facility.Endocrinology
A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the internal (endocrine) system (e.g., thyroid and adrenal glands). This branch of medicine also deals with diabetes, metabolic and nutritional disorders, pituitary diseases, and menstrual and sexual problems.Family practice
A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family.Gastroenterology
A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas).Geriatrics
The subspecialty of medicine concerned with the physiological and pathological aspects of the aged, including, but not limited to, the clinical problems of senescence and senility.Hematology
A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues.Infectious diseases
A subspecialty of medicine concerned with illnesses caused by microorganisms of all types in all organs.Internal medicine
A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems in adults, with the provision of long-term, comprehensive care in the office and the hospital settings, managing common and complex illnesses of adolescents, adults, and the elderly.Medical genetics
A medical subspecialty concerned with the reliable prediction of certain genetically-linked disorders as a function of the lineage or genetic makeup of individuals, parents, or potential parents. The clinical areas include: clinical biochemical genetics, clinical cytogenetics, clinical genetics, clinical/medical genetics, and clinical molecular genetics.Nephrology
A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney.Neurological surgery
A surgical specialty concerned with the operative and non-operative management of disorders of the central, peripheral, and autonomic nervous systems, including supporting structures and vascular supply; the evaluation and treatment of pathological processes that modify function or activity of the nervous system, and the operative and non-operative management of pain.Neurology
A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system.Nuclear medicine
A subspecialty field of radiology concerned with diagnostic, therapeutic, and investigative use of radioactive compounds in pharmaceutical form.Nursing
The profession concerned with the provision of care and services essential to the promotion, maintenance, and restoration of health by attending to a patient's needs.Nutrition
The clinical practice concerned with nutrients and other substances contained in food and their action, interaction, and balance in relation to health and disease.Obstetrics and gynecology
The medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and puerperium; the physiology and disorders primarily of the female genital tract; and female endocrinology and reproductive physiology. This physician may serve as a primary care source for women.Oncology
A subspecialty of internal medicine concerned with the study of neoplasms.Ophthalmology
A specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases.Optometry
The professional practice of primary eye and vision care that includes the measurement of visual refractive power, and the correction of visual defects with lenses or glasses.Orthopedic surgery
A surgical specialty that utilizes medical, surgical, and physical methods to treat and correct deformities, diseases, and injuries to the skeletal system, its articulations, and associated structures.Otolaryngology
A surgical specialty concerned with the study and treatment of disorders of the ear, nose, throat, respiratory and upper alimentary systems, and related structures of the head and neck.Pathology
A medical specialty concerned with the causes and nature of disease including diagnosis, prognosis, and treatment through knowledge gained by the laboratory application of the biological, chemical, and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells, body fluids, and clinical laboratory tests on secretions.Pediatrics
A medical specialty concerned with the physical, emotional, and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services. Neonatology is also covered under this specialty.Pharmacology
A clinical specialty concerned with the effectiveness and safety of drugs in humans.Physical medicine and rehabilitation
A medical specialty concerned with the use of physical agents, mechanical apparatuses, and manipulation in rehabilitating patients who are physically diseased, injured, or recovering from elective surgery (e.g., hip replacement) to the maximum degree possible. Physicians practicing this specialty are Physiatrists.Plastic surgery
A surgical specialty that deals with the repair, reconstruction, or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, extremities, breast and trunk, and external genitalia.Podiatry
A profession concerned with the diagnosis and treatment of disorders, injuries and anatomic defects of the foot.Preventive medicine
The medical specialty concerned with the health of individuals and defined populations to protect, promote, and maintain health and well-being, preventing disease, disability, and premature death.Psychiatry
The medical specialty concerned with the origin, diagnosis, prevention, and treatment of mental disorders, addictive disorders, emotional disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders, and adjustment disorders.Psychology
A clinical profession concerned with recognizing and treating behavior disorders.Pulmonary medicine
A subspecialty of internal medicine concerned with the study of the respiratory system, especially the diagnosis and treatment of diseases and defects of the lungs and bronchial tree.Radiation oncology
The specialty concerned with the therapeutic application of radiant energy and its modifiers, including the study and management of disease, especially malignant tumors.Radiology
The specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease.Rheumatology
A subspecialty of internal medicine concerned with the study of inflammatory or degenerative processes and metabolic derangement of connective tissue structures that pertain to a variety of musculoskeletal disorders (e.g., arthritis).Sleep medicine
The specialty concerned with conditions characterized by disturbances of usual sleep patterns or behaviors.Speech-language pathology
A clinical profession concerned with the study of speech/language and swallowing disorders and their diagnosis and correction.Sports medicine
A subspecialty responsible for continuous care, enhancement of health and fitness, and prevention of injury and illness to an individual engaged in physical exercise (sports).Surgery
A medical specialty concerned with manual or operative procedures used in the diagnosis and treatment of diseases, injuries, or deformities. This specialty is usually responsible for the comprehensive management of the trauma victim and the critically ill surgical patient.Thoracic surgery
A surgical specialty concerned with the operative, perioperative, and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum, and diseases of the diaphragm. Airway management and chest injury are within the scope of this specialty.Urology
A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes, and the genital tract in the male. This specialty also includes the management of benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland.
Guideline CategoryAssessment of therapeutic effectiveness
A guideline that provides a purposeful and clear evaluation of the effectiveness of therapeutic modalities. Effectiveness is defined as a measure of the benefit resulting from an intervention for a given health problem under average conditions of use. This form of evaluation considers both the efficacy of an intervention and its acceptance by those to whom it is offered. It answers the question: Does the practice do more harm than good to people to whom it is offered?Counseling
A guideline whose scope includes recommendations for interventions where advice or guidance is provided to patients by knowledgeable professionals. The advice or guidance may include education (on a variety of topics) or psychological support.Diagnosis
A guideline that provides recommendations for interventions that determine the nature of a disease/condition or distinguish one disease/condition from another. Assessment may be made through physical examination, laboratory tests, or the like, and may be assisted by computerized programs designed to enhance the decision-making process.Evaluation
A guideline whose scope may encompass one or both of the following types of clinical practices:
- The initial assessment that may include gathering of information through interview, observation, examination, and use of specific tests that allow patients to be evaluated for the possibility of a condition. Assessments may be performed by physicians, nurses and other health care professionals (e.g., dietitians, chiropractors, physical therapists, etc.).
- The follow-up after an intervention (e.g., evaluating treatment) and studies determining the effectiveness or value of processes, personnel, and equipment.
A guideline whose scope integrates diagnosis, treatment, and monitoring or follow-up.Prevention
A guideline that provides recommendations for the prevention of disease or mental disorders in susceptible individuals or populations through promotion of health (including mental health), and specific protection (e.g., immunization), as well as the prevention of complications or after-effects of an existing disease (i.e., complications of diabetes mellitus).Rehabilitation
A guideline that provides recommendations for interventions intended to promote restoration, to the maximum degree possible, of a person or persons suffering from disease or injury.Risk assessment
A guideline that provides recommendations for a qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences.Screening
A guideline that recommends interventions be performed for the early detection of disease or disease precursors in apparently healthy individuals so that health care can be provided early in the disease or before the disease manifests (e.g., screening for prostate cancer).Technology assessment
A guideline that provides an assessment/evaluation/review on the use of a given technology for a given application(s) and comparison to other technologies used to diagnose or treat the same condition.Treatment
A guideline that recommends procedures or practices that are intended to relieve physical or mental illness or injury.
Implementation ToolsAudit Criteria/Indicators
Systematically developed statements that can be used to assess the appropriateness of specific healthcare decisions, services, and outcomesChart Documentation/Checklists/Forms
Documents, checklists, and/or forms designed to assist healthcare providers in administering and documenting careClinical Algorithm
A diagram of the guideline recommendations presented as a step-by-step decision-treeForeign Language Translations
Non-English translations of the guidelines and/or companion materials to facilitate the diffusion of guideline recommendations among non-English speakersMobile Device Resources
Interactive guideline tools intended to assist the clinician in implementing clinical practice guidelines at the point of care, via smart phones and other hand-held devicesPatient Resources
Information for patients and/or their families or caregivers that is directly derived and/or prepared from the guideline; these resources consist of patient fact sheets, brochures, or reference guidesPocket Guide/Reference Cards
Concise one to two page summary of the guideline recommendations viewed at-a-glance to provide quick reference at the point of care to facilitate the implementation of the guideline; may be sized to fit into a pocketQuality Measures
Quality measures available in the National Quality Measures Clearinghouse™ (NQMC) databaseQuick Reference Guides/Physician Guides
Moderate-sized documents (five or more pages) that provide a detailed synopsis or summary of the original guideline recommendations; these documents may also include algorithms illustrating various diagnostic and/or treatment strategies provided in the original guidelineResources
Tools aimed at facilitating the implementation of the guideline recommendations which may include videos, handbooks, and other general provider resourcesSlide Presentation
Slides that can be downloaded for use in computer slide shows, conventional slide presentations, or for online viewing via the Web that facilitate the dissemination and/or adoption of clinical practice guidelinesStaff Training/Competency Material
Education and/or training support materials and practical tips which may include educational seminars, continuing medical education options, satellite broadcasts, and practical tips for implementation of the guideline in local settingsTool Kits
Collections of tools and/or strategies for implementing the clinical practice guidelines; tool kits can include worksheets/checklists, template letters, pocket cards, quick reference guides, assessment instruments, and related process and quality measuresWall Poster
At-a-glance summary of the guideline recommendations made available in poster format for easy reference in a physician's office and/or other healthcare facility
Institute of Medicine (IOM)
A private, nonprofit institution that provides objective, timely, authoritative information and advice concerning health and science policy to the government, the corporate sector, the professions, and the public under a congressional charter.
Institute of Medicine (IOM) Care NeedsEnd of life care
Care related to those not expected to survive more than six months.Getting better
Care related to acute illness or injury.Living with illness
Care related to chronic or recurrent illness.Staying healthy
Care related to healthy populations or the general health needs of non-healthy populations (e.g., health promotion, disease prevention, risk factor assessment, early detection by screening and treatment of pre-symptomatic disease).
Institute of Medicine (IOM) DomainsEffectiveness
Relates to providing care processes and achieving outcomes as supported by scientific evidence.Patient centeredness
Relates to meeting patients' needs and preferences and providing education and support.Safety
Relates to actual or potential bodily harm.Timeliness
Relates to obtaining needed care while minimizing delays.
Intended UsersAdvanced practice nurses
Professionals qualified by education at an accredited school of nursing and licensed by state law to practice nursing. These individuals have a master's degree or higher. This category includes nurse administrators, nurse anesthetists, nurse clinical specialists, nurse practitioners, nurse psychotherapists, and nurse midwives.Allied health personnel
Health care workers specially trained and licensed or registered/certified to assist and support the work of health professionals. This group is designed to include most assistive personnel and technicians, such as behavioral therapy assistants, community health aides, dental assistants, dental hygienists, dental technicians, home health aides, medical record administrators, medication administration aides, nurses' aides, psychiatric aides, operating room technicians, pharmacists' aides, and radiology technicians. This group may also consist of health professionals who provide ancillary services, such as recreational therapists, music therapists, imaging technologists, and exercise physiologists.Chiropractors
Individuals specially trained and licensed to practice chiropractic.Clinical laboratory personnel
Those health care professionals, technicians, and assistants staffing a health care facility where specimens are collected, grown, tested or evaluated and the results of such are recorded (e.g., clinical laboratory technician/medical laboratory technician, clinical laboratory scientist/medical technologist, histologic technician/technologist, cytotechnologist, and pathologists' assistant).Dentists
Individuals licensed to practice dentistry.Dietitians
Individuals who apply the science of nutrition to the feeding and education of groups of people and individuals in health and disease.Emergency medical technicians/paramedics
Personnel trained and certified to provide basic emergency care and life support under the supervision of physicians and/or nurses. These services may be carried out at the site of the emergency, in the ambulance, or in a health care institution.Health care providers
Individuals working in the provision of health services, whether as individual practitioners or employees of health institutions and programs, whether or not professionally trained, and whether or not subject to public regulation. Also includes those institutions or programs that offer health services.Health plans
Contracts between a health insurer and a subscriber or a group of subscribers whereby a specified set of coverage includes medical, surgical, or hospital care in return for a periodic premium.Hospitals
Includes all hospital facilities such as community hospitals, general hospitals, group practice hospitals, packaged hospitals, private hospitals, public hospitals, satellite hospitals, rural hospitals, special hospitals, teaching hospitals, and urban hospitals.Managed care organizations
Organizations administering health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as health maintenance organizations (HMO), independent practice associations (IPA), and preferred provider organizations (PPO), etc.Nurses
Professionals qualified by education at an accredited school of nursing and licensed by state law to practice nursing. They provide services to patients requiring assistance in recovering or maintaining their physical or mental health. Occupational therapists
Those persons legally qualified by education and training to engage in the practice of occupational therapy, a field concerned with the application of restorative, compensatory or adaptive strategies to promote the rehabilitation of patients.Optometrists
Individuals licensed to practice primary eye and vision care.Patients
Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Pharmacists
Those persons legally qualified by education and training to engage in the practice of pharmacy.Physical therapists
Those persons legally qualified by education and training to engage in the practice of physical therapy, a field concerned with the use of special techniques to prevent, correct, and alleviate movement dysfunction of anatomic or physiologic origin.Physician assistants
Persons academically trained and licensed/credentialed to provide medical care under the supervision of a physician.Physicians
Individuals licensed to practice medicine. This category also includes all physician specialists (e.g., psychiatrists).Podiatrists
Individuals licensed to practice podiatry, the diagnosis and treatment of foot disorders, injuries and anatomic defects of the foot.Psychologist/non-physician behavioral health clinicians
Persons legally qualified by education and training to practice in the field of mental health (e.g., psychology, counseling, and behavioral health).Public health departments
International, national, state, or municipal departments concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of a population.Respiratory care practitioners
Individuals trained and certified in the field of respiratory therapy.Social workers
Individuals trained and certified in the field of social work (e.g., the use of community resources, individual case work, or group work that promotes the adaptive capacities of individuals in relation to their social and economic environments).Speech-language pathologists
Individuals trained and certified in the field of speech-language pathology, a field dealing with the diagnosis and treatment of speech, language, and swallowing disorders. Students
Individuals enrolled in a school or formal education program.Substance use disorders treatment providers
Health professionals providing therapy and/or rehabilitation for substance-dependent individuals.Utilization management
Individuals or groups that conduct organized procedures through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use.
Method of Guideline ValidationClinical validation-pilot testing/clinical validation-trial implementation period
These methods "test drive" the recommendations in an actual clinical setting. The information obtained during the pilot testing or initial implementation period is incorporated back into the guidelines in an attempt to improve their utility in actual practice.Comparison with guidelines for other groups
The process whereby the guideline developer compares their recommendations to those issued by different groups as a way of gauging the validity of their guideline. The authors may explain conflict or agreement with guidelines for the same health problem from other organizations.External peer review
The process whereby the guideline is evaluated by reviewers that do not belong to the same organization that developed the guideline.Internal peer review
The process whereby the guideline is evaluated by reviewers that belong to the same organization that developed the guideline.Peer review
The process to evaluate or audit the relevance, appropriateness, validity, or utility of the final guideline recommendations.
Methods Used to Assess the Quality and Strength of the EvidenceExpert consensus
A formal method used to generate expert collective decisions. The steps in the process are made explicit and could be replicated.Expert consensus (committee)
A formal method involving a dedicated committee to generate expert collective decisions. The steps in the process are made explicit and could be replicated.Expert consensus (Delphi method)
A formal method used to generate expert collective decisions. The steps in the process are made explicit and could be replicated. In the Delphi method, participants receive questionnaires and record their views. The responses are aggregated by the organizers and sent back to participants in summary form, indicating the group judgment and the individual's initial judgment. The participants are given the opportunity to revise their judgments, and the process may be repeated. In this method, the participants never meet face-to-face or interact directly.Subjective review
A process of review relying on the use of an individual's or group's experience or knowledge, as conditioned by personal mental characteristics or states. This method uses a descriptive (qualitative) approach rather than a quantitative and/or numerical method to evaluate the quality and strength of evidence.Weighting according to a rating scheme
This method consists of using a system that assigns a weighted value (e.g., levels or grades) to distinguish high from low quality research studies and/or strong from weak bodies of evidence. Systems have been developed for studies/evidence pertaining to therapy, prevention, diagnosis, prognosis and harm.
Methods Used to Collect/Select the EvidenceHand searches of published literature (primary sources)
Methods based on a manual review (i.e., page-by-page) of literature sources that report original research (e.g., peer-reviewed journal articles).Hand searches of published literature (secondary sources)
Methods based on a manual review (i.e., page-by-page) of literature sources that synthesize and summarize the theories and results of research (e.g., textbooks, monographs, review articles).Searches of electronic databases
Methods that employ the use of free-text keywords/phrases and/or controlled vocabularies to identify information contained within computer-based repositories of information (e.g., bibliographic, full-text).Searches of patient registry data
Methods that employ the use of repositories of patient-specific data maintained by sources such as medical specialty societies, disease-specific associations, government agencies, and manufacturers are accessed.Searches of unpublished data
Methods that employ the use of data that has not been published (e.g., proprietary data, unpublished manuscripts, data from ongoing research).
Methods Used to Formulate the RecommendationsBalance sheets
A tool used in clinical decision-making capturing the benefits, harms, and costs of different interventions. Information to complete the sheet is obtained from data in medical literature, local organizational data, or best estimates when data is of low quality or unknown.Expert consensus
A parent term identifying recommendations formulated by one of several formal consensus development methods.Expert consensus (Consensus development conference)
A selected group (of around ten people) is brought together to reach consensus about an issue in an open meeting. Evidence is presented by various groups/experts (who are not part of the decision-making group) and the selected group retreats to consider the issue and evidence.Expert consensus (Delphi method)
Participants receive questionnaires and record their views. The responses are aggregated by the organizers and sent back to participants in summary form, indicating the group judgment and the individual's initial judgment. The participants are given the opportunity to revise their judgments, and the process may be repeated. In this method, the participants never meet face-to-face or interact directly.Expert consensus (Nominal group technique)
With a purpose of structuring interaction within a group, after participants record views independently and privately, the facilitator will collect one view from each individual and create a list. All views are collected and listed, and discussion ensues about each view. Individuals then privately record their judgments or vote for options. Further discussion and voting may take place. The individual judgments are aggregated statistically to derive group judgment.Informal consensus
An approach to consensus development that lacks structure. Participants publicly express their views, the aggregate of which may be summarized by the group's leader and considered the final decision.
Accreditation Council for Graduate Medical Education (ACGME). Residency Programs 2002-2003. Accreditation Council for Graduate Medical Education (ACGME) Web site. Accessed 01/08/2003 from www.acgme.org .
American Academy of Family Physicians. Strolling through the match - Choosing a clinical specialty. American Academy of Family Physicians Web site. Accessed 01/08/2003 from www.aafp.org .
American Medical Association. FREIDA Online Search - Specialty Criteria: Specialty/Subspecialty Selection. American Medical Association Web site. Accessed 01/08/2003 from www.ama-assn.org .
Black N, Murphy M, Lamping D, et al. Consensus development methods: a review of best practice in creating clinical guidelines. J Health Serv Res Policy Vol 4, No 4, October 1999.
Braddick M, Stuart M, Hrachovec J. The use of balance sheets in developing clinical guidelines. J Am Board Fam Prac 12 (1):48-54, 1999.
Dorland's illustrated medical dictionary. 27th Edition. Philadelphia: W.B. Saunders Co., 1988.
Eddy D. Comparing benefits and harms: the balance sheet. JAMA Vol 263, No. 18: 2493-2505, 1990.
Fink A, Kosecoff J, Chassin M, et al. Consensus methods: characteristics and guidelines for use. Am J Public Health 1984 Sep; 74(9).
International Confederation of Dietetic Associations. Bylaws, Version 1.0. Ontario (Canada): International Confederation of Dietetic Associations, 2000. p. 2.
Murphy MK, Black NA, Lamping DL, et al. Consensus development methods, and their use in clinical guideline development. Health Technol Assessment 1998; 2(3).
National Library of Medicine. Medical subject headings 2003. Accessed 01/15/03, 03/28/03. Available from www.nlm.nih.gov/mesh/meshhome.html .
National Library of Medicine (U.S.). Unified Medical Language System (UMLS) [online]. National Library of Medicine (U.S.), 2003. Available from: www.nlm.nih.gov .
Which medical specialist for you? American Board of Medical Specialties. Evanston, IL, 2002 Apr.
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