In conjunction with the 4th edition of the CARPA Standard Treatment Manual (STM) we have the intention, (and obligation to funders) to develop a background document to the STM. The purpose of the background document will be to present why the protocols are as they are. Users who want to know about the evidence derived from the literature and the local decisions regarding the application of the literature to local needs will be able find the answers in the background document.

The editorial committee realizes that developing a high quality background document to go with the STM will place a considerable extra workload on contributors. However, it will add value and authority to the manual, it will be a valuable resource for future revisions of the manual and will assist health services considering use of the STM to assess its relevance to their local situation.

The background document may be published as a CD-ROM, on a web site and in hard copy. It will be far lengthier than the condensed manual itself. There is a future possibility that the background document could be regularly maintained and updated as a web site. The language and style of the background does not have to be the same as the STM, clearly it will be a more technical reference document.

Most of the protocols and associated background documents will probably be prepared by individuals or small groups of people with a special interest in the area. Dan Ewald will be able to help you get in touch with others interested in particular topics to assist collaboration. In this way topic specific expert groups can be formed (particularly for the bigger more complex topics that can be split into sections.)

The suggested content of the background document is set out below. Some topics will clearly not fit this outline well, however this is what we will be aiming for, adapting it as necessary to fit time and resources. We do not want contributors to do Cochrane style systematic reviews for all the protocols or necessarily go back to original articles that have been well dealt with in existing systematic reviews. However, where high quality reviews of the available evidence have already been done (eg "Aboriginal Primary Health Care. An evidence based approach" by Couzos and Murray), or the various reviews of literature available regarding diabetes, renal disease or ear disease), they should be built upon as needs be.

• Relevance of the topic to the CARPA manual - why is it included
• Define the scope of the topic
• Regional epidemiology of the condition, where available and relevant
• Aspects of the natural history of the conditions that are peculiar to the CARPA-use area, and relevant aspects of the history of the management of the condition.

• What are the key issues needing a rationale and why are these the key questions (logic)
• Address each issue as well as possible from the literature.
• Pay particular attention to unpublished literature such as theses that may be highly relevant / local data / topical / evaluations etc. The RDH and ASH librarians are likely to be able to be of great assistance in finding this "grey literature". Dan can also help with this task, working with the librarians.
• The nature of the literature review will change with the topic/protocol under review, and with the available time and resources. The editorial committee recognizes that some authors will not be familiar with literature review methods or may find it difficult to do from "out bush". However, we are keen to maintain a high level of input from remote practitioners and plan to help this happen as needed.
• (Where appropriate and time permits) Synthesis of the evidence from the literature (often existing systematic reviews), including comments on: the level of evidence (study design / review process), quality of the design in terms of potential bias, confounding, chance (internal validity), relevance of the results to the CARPA client group (external validity), strength of effect (does it make a big difference or a marginal difference?)
• Highlight what is new, controversial, may be different from other guidelines
• Synthesis of the evidence in light of the local epidemiology and service delivery characteristics.

• The all-important application of local wisdom and practical issues to the available evidence. This section will only be possible to complete after the review processes and will capture the reasons for significant changes made during review and editing.