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VIII. How to Use Clinical Practice Guidelines A. Are the Recommendations Valid?

Robert S. A. Hayward, MD, MPH; Mark C. Wilson, MD, MPH; Sean R. Tunis, MD, MSc; Eric B. Bass, MD, MPH; Gordon Guyatt, MD, MSc; Evidence-Based Medicine Working Group

JAMA. 1995;274(7):570-574.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

CLINICAL SCENARIO

You are relieved to find that the last patient in your busy primary care clinic is a previously well 48-year-old woman with acute dysuria. There has been no polydipsia, fever, or hematuria; the physical examination reveals suprapubic tenderness; and urinalysis shows pyuria but no casts. You arrange cultures and antibiotic treatment for a lower urinary tract infection. On her way out the door, your patient observes that her friend has just started taking "female hormones," and she wonders whether she should too. Her menstrual periods stopped 6 months ago and she has never had cervical, ovarian, uterine, breast, or cardiovascular problems, but her mother had a mastectomy at age 57 for postmenopausal breast cancer. You give the same general advice you have offered similar patients in the past, but suggest that the matter be discussed at greater length when she returns after completing the antibiotic treatment. Later, as . . . [Full Text PDF of this Article]

Author Affiliations
From the Departments of Medicine (Drs Hayward and Guyatt) and Clinical Epidemiology and Biostatistics (Drs Hayward and Guyatt), McMaster University, Hamilton, Ontario; Division of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Md (Dr Bass); Health Program, Office of Technology Assessment, US Congress, Washington, DC (Dr Tunis); and the Department of Medicine, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC (Dr Wilson).

Footnotes
A complete list of members (with affiliations) of the Evidence-Based Medicine Working Group appears in the first article of this series (JAMA. 1993;270:2093-2095). The following members contributed to this article: Deborah Cook, MD, MSc; Brian Haynes, MD, MSc, PhD; Roman Jaeschke, MD, MSc; Andreas Laupacis, MD, MSc; Virginia Moyer, MD, MPH; David Naylor, MD, DPhil; John Philbrick, MD; W. Scott Richardson, MD; David Sackett, MD, MSc; and Stephen Walter, PhD.

Reprint requests to Room 2C12, McMaster University Health Sciences Centre, 1200 Main St W, Hamilton, Ontario, Canada L8N 3Z5 (Dr Guyatt).

Users' Guides to the Medical Literature section editor: Drummond Rennie, MD, Deputy Editor (West), JAMA.

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