Clinical practice guidelines (CPGs) are statements including recommendations that assist patients' and practitioners' decision making regarding high priority clinical issues to pursue better clinical outcomes for patients. Based on the body of evidence from systematic reviews, CPGs are developed considering their benefit, harm, and so on. With an increased interest in healthcare among the general public and improved infrastructure of information, the relationship between a patient and a healthcare professional has been rapidly changing. For CPGs to be adequately recognized and for them to play a larger/better role in society, it is necessary to use current best evidence judiciously and to facilitate considerations on multiple aspects including patients' values and ethical, legal, and economic issues. Furthermore, discussions by various players, not limited to healthcare professionals, are essential. Beginning with the brief history of evidence-based medicine, this article presents an overview of the present status and the future perspective of CPGs and associated matters.

It has been 15 years since clinical practice guidelines were introduced and implemented in Japan, and the quality of the guidelines has dramatically improved. Clinical practice guidelines, health technology assessments, and systematic reviews share common methodologies, and combinations of these programs have flourished and/or been explored in many organizations and countries such as the National Institute of Clinical and Care Excellence (United Kingdom). In this review, the relationship among the three programs in Japan was explored. Systematic reviews are an essential methodology for both clinical practice guidelines and health technology assessment. Promoting the collaborative use of the three programs in Japan should be encouraged, and the minimum requirements for a "systematic review" should be determined. The role of clinical practice guidelines in the national health policy should also be determined to check whether Japanese clinical practice guidelines should be assessed against the advancing guideline development, reporting and evaluation in health care (AGREE) II and whether they should incorporate economic analyses.

The "Kakaritsuke Physician" is a locally based and reliable doctor, who: has comprehensive capabilities in community health, public health, and welfare; is available for consultation on any health issue; has a good understanding of advanced healthcare information; and can refer patients to specialists or specialized healthcare facilities when needed.

Utilizing the latest information and algorithms published in clinical practice guidelines at outpatient clinics is useful for Kakaritsuke Physicians. The clinical practice guidelines are a lifelong learning material for Kakaritsuke Physicians. They can be used to help the doctor explain to the patients and can be a valuable information source for patients and families.

I hope an application will be developed that can keep updated with new clinical practice guidelines and retrieve necessary information from full-text literature searches of CQ (clinical question) summaries. In addition to the clinical practice guidelines, it would be a good idea to have a means to share veteran doctor experience values.

Following the publication of the Minds Handbook in 2014, the quality of Japanese clinical practice guidelines improved substantially. We created a procedure for developing evidence-based guidelines in the occupational health field that can be used by individual organizations in Japan.

Organizing the guidelines task forces and choosing the key health issues are essential initial steps. Next, it is important to use the population, intervention, control, and outcomes (PICO) format with elements composed of review questions (RQ) for occupational health practice. When high-quality guidance or systematic reviews exist with concordant inclusion criteria and PICO, adaptation can be considered, and recommendations that reflect domestic conditions can be formulated. When no appropriate systematic review exists, a new and transparent systematic review of randomized control trials (RCTs) should be performed. Before publication, collecting public comments and creating an external review board ensure that various opinions are reflected in the final draft, especially for recommendations.

The development of occupational health guidelines differs from clinical practice guidelines because of corporate preferences, particularly regarding cost and resources, and the choice of literature databases. Although there are few RCTs in the Japanese occupational health field, developing evidence-based guidelines may help determine which future research questions should be prioritized in Japan.

Since the 2010s, the methods of developing clinical practice guidelines have dramatically changed worldwide. In Japan, the Medical Information Network Distribution Service (Minds) released a new manual entitled, "Minds Manual for Clinical Practice Guideline Development" in 2014 that adopted the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. However, the practical personnel in charge of developing these guidelines often experience difficulties in using the Minds manual; for example, some items are difficult to fully understand by referring only to the manual and there are questions about how to handle those items in practice. Therefore, in this paper, we present the questions frequently received from practical personnel in the development of clinical practice guidelines as well as answers to them. The workflow for the development of clinical practice guidelines is as follows: 1. Preparation, 2. Scoping, 3. Systematic Review, 4. Recommendations, 5. Finalization, 6. Dissemination, Implementation, and Assessment of Clinical Practice Guidelines. This paper summarizes the questions and answers in line with this flow. In the development of clinical practice guidelines, transparency of the development process ensures unbiasedness (neutrality) of the guidelines that are created. This realizes the development of reliable clinical practice guidelines. On the other hand, the methods of developing clinical practice guidelines are changing worldwide. Please refer to the Minds website for the latest trends in the development of clinical practice guidelines.

It is important to develop clear and reliable clinical practice guidelines through consensus. It is thought that this way of thinking should be considered with the selection of the member, the scope establishment, conflict of interest management, a systematic review, recommended making, and all finalized processes throughout.

The Delphi method is known as one of the effective and popular consensus formation methods. However, it has rarely been used in the development of guidelines. Therefore, I investigated the utility of the Delphi method for this purpose.

In this method, an expert votes independently on each theme, and subsequent votes are gathered based on these results, until consensus is achieved.

Delphi is the name of a place in ancient Greece that housed the temple of Apollo, which is famous for an oracle. This method was named after this place because it was believed that the process involved the use of expertise to arrive at the truth (the Delphi oracle) that was known only by the Almighty God.

In systematic reviews, the evaluation of the risk of bias and indirectness on effect estimates is essential to assess the certainty of the body of evidence. A program in the programming language R was developed to execute a meta-analysis adjusting for the effects of biases after assessing bias magnitudes, directions, and uncertainty. The program visualizes the effects of biases by creating an overlayered forest plot of bias-adjusted and -unadjusted values. When performing meta-analyses and sensitivity analyses, this helps assess the certainty of the body of evidence by setting various estimates for biases and indirectness of individual studies as risk ratios and standard deviations or 95 % confidence intervals.