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An ACOG Note from MLA

May 24, 2010
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I’m at the Medical Library Association conference in D.C. this week (hey, I ‘m one of the bloggers over here in the interim), and had a chance to ask an ACOG rep a question as they have a publications exhibit at the conference. My question concerned the issue of ACOG recommendations and the fact that they are completely removed from online sources when a new version is issued. As was explained to me – and as I expected – many of the changes are minor, and it’s desirable to take the old versions away immediately so clinicians don’t follow the old guidelines.

My concern, though, is that it makes it really difficult, then, to compare the old and new version if one wants to see them side by side and compare documents/changes. Immediate removal is probably great for clinicians and liability reasons, but it’s not so great for historical research. The rep indicated that what people are “supposed” to do is print the new recs off when they’re issued – if they were doing that, they’d have the old print out, but I wondered how many people were actually doing that when the documents are so ubiquitously available online through subscription resources. I also learned that the Compendium publication would include the old versions, although I don’t think the Compendium is frequently preserved in libraries (a quick WorldCat search seems to confirm this) – so again, maybe handy to clinicians, but no good for historical research purposes.

One thing we discussed was that if it’s a major change, there will be a press release, and the press release will almost certainly describe the changes. It’s not as good as having the documents side by side for comparison, but it could provide at least some descriptive information for those wanting some record of the changes.

Hmm. Now I need to make a list of ACOG guidelines to print for posterity…

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6 Comments leave one →
  1. May 24, 2010 7:44 pm

    I think it’s a great idea that they remove the old guidelines. And they indeed are very good at telling us what the changes are.

    Indeed, though, this is the problem with the online world, isn’t it? It’s so ephemeral.

    Peggy

    • May 24, 2010 9:43 pm

      I think I’d prefer to see them annotated in some absolutely unambiguous way – like, This document replaced by [Whatever the New One is], no longer current as of [Date]. Maybe even as an interstitial, so you have to acknowledge this to click through to the old version. I see the need to not have people relying on the old information, but I hate to see them vanish because I think there are probably interesting things to be said about that history that are then no longer accessible. I think I’ve seen some other guideline/recommendation/evidence summary-type resources that manage this pretty well. Cochrane citations in PubMed for example, although it may not be as clear on the actual documents.

      On an unrelated note, my colleague and roommate for the conference was just asking me if I ever read your blog and telling me she likes it. ;)

  2. May 29, 2010 4:35 pm

    I’m glad you followed up on this, Rachel. I remember this being an issue with the EFM guidelines. I do keep the PDFs (not printed, but electronic copies) of most ACOG guidelines, and will now make sure I do so more consistently.

    I think another reason the older guidelines are good to have some sort of access to is that people may want to go back and see what the standard of care was at the time a clinical situation occurred in the past.

    Also, I think the PR around the issuing of an updated guideline is really misleading. We saw that with the EFM guideline. Folks got so excited that ACOG was finally admitting that EFM is ineffective/limited and intermittent auscultation was safe, because that’s what the press release said. But the guidelines didn’t change one bit with respect to that language.

    Anyway, interesting indeed and thanks for following up and blogging it.

    • May 30, 2010 11:57 am

      Thanks, Amy – that’s a good point about the EFM guideline not really being a huge change – as you and I discussed at the time, it was really hard to go back and figure that out because of the way the old documents are pulled (sort of makes our case for us!). I think the rep was suggesting it more in the other direction – that if there’s no press release, you can kind of guess that it wasn’t a major change, although you give a great example of when the existence of a press release doesn’t necessarily mean it *is* a major change (now, if we could get people to actually follow that cEFM guideline…)

      You’re exactly right about the standard of care questions, too – what happens when someone 50 years from now wants to know what the #@%$! was going on with VBAC/cesarean?

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  1. Posts from the Medical Library Association 2010 Conference « Women's Health News
  2. Dispatches from Medical Libraryland | Our Bodies Our Blog

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