ABSTRACT
While evidence-based practice is often based on clinical guidelines (systematically developed statements and recommendations to improve the quality of the practice of care and reduce unnecessary variation) new clinical therapies evolve within practice-based clinical communities. Based on our study of the development of aorta implant surgery in Norway we elaborate on the communal aspects influencing the development of clinical therapies. We are especially interested in the complex relationship between guidelines and practice within a context where practice guidelines are regarded as the embodiment of evidence-based medicine (Woolf et al. 1999), protocols and standards are constantly in a state of flux between emerging and established clinical practices (Timmermans and Berg 1997), and guidelines may serve as bases for collective revisions of informal and tacit mindlines (Gabbay and le May 2004).
