Evidence-based child health: SIGN and NICE.

Clinical medicine is a holistic attempt to provide the best care for patients. What is the relevance of evidence-based child health and guidelines in informing clinical practice? In this review, examples drawn from paediatric endocrinology practice and an outline of the (sometimes contrasting) methodologies of the National Institute for Health and Clinical Effectiveness (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) are used to inform what needs to be a continuing debate. There is regular contact and cooperation between guideline-producing bodies both nationally and internationally, but there are still many impediments to avoiding duplication. Policies and practice do not inevitably flow from research evidence and guidelines. There is an urgent need to produce evidence of the impact of guidelines, not only on changing clinical practice where appropriate, but also on improving child health.