Clinical questions are derived from the scoping exercise and are similar in form to the questions that guide systematic reviews (see Chapter 4). The development of recommendations is derived from appraisal of the literature, but will include issues of prioritisation, implementation and audit of compliance and effectiveness. Once again, because of the broad nature of the guideline creation process and the many groups involved with the process, writing the eventual guideline is typically an iterative process, with the writers seeking feedback from all stakeholders and reviewing the way the guideline is written in the light of that feedback, in order to increase the usability and acceptability of the guideline to those for whom it is intended. These issues relate to content as well as style, because stakeholders may well have suggestions about which aspects of a guideline are more and less applicable to the local context. Finally, the team should set an agenda for updating, in the expectation that new research will become available and that the local context within which the guidelines operate will change.

And finally…

This is pretty much the end of this book, and we hope you have found it useful. We have tried to stress four things throughout. First, that research and the evidence-based care that springs from it are practical undertakings. As a result of this, whilst we hope that reading this book alone will help you in your understanding and conduct of research, we also want very much for you to go out and get involved, in whatever way best fits with and informs your clinical practice. This brings us to our second point, the one this particular chapter has been all about – that research is about clinical practice. It is, in our view, vitally important to gather evidence which will guide our activities with patients. Third, research is complex and difficult, but no more so than many clinical tasks. And finally, that, even though it is complex and difficult, it is entirely possible for you, as a clinician, to become involved and to truly make a difference to the care of your patients. Remember the story about eating an elephant, and just take it a bit at a time.

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