We compared the types (A, B, or C) of recommendations and levels (I, II, III, or others) of references in the original versus revised practice bulletins (PBs). American College of Obstetricians and Gynecologists (ACOG) compendiums and Web site were used to obtain the PBs. Chi-square test for trend or Wilcoxon matched-pairs tests were used. From December 1998 to December 2008, ACOG published 78 PBs, of which 24% (19) have been revised. Neither the median numbers of recommendations per PB (8 to 10; P = 0.235) nor the type ( P = 0.155) increased significantly. Additionally, the level of references ( P = 0.130) and the type of journals they were published in did not vary significantly ( P = 0.554). In 10 years, approximately one in four PBs has been revised and the number of recommendations per PB has increased, but the types of suggestions and level of references has not improved appreciably.
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