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However, little attention has been given to the updating process, in contrast to the appraisal of the available literature.We conducted an international survey to identify current practices in CPG updating and explored the need to standardize and improve the methods.We developed a questionnaire (28 items) based on a review of the existing literature about guideline updating and expert comments.) based on a literature review about guideline updating (unpublished).For this review, we studied websites of institutions that had published methodological handbooks and searched for published studies in MEDLINE (via Pub Med) until June 2008 using a combination of descriptors (Practice Guidelines as Topic; Clinical Practice Guidelines) and free text terms (clinical guideline, practice guideline, updat*, up to date).

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Tune in each week for regular features like Hill-Mail (each weekday), Inside the Simple Male Mind with LB (Mondays), Facts Schmacts (Tuesdays), Reverse Title-Fight (Wednesdays), Stow Five-O (Thursdays), Inside the Warped Female Brain (Thursdays) and LB on History (Fridays).