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August 16, 1995

Users' Guides to the Medical Literature: VIII. How to Use Clinical Practice Guidelines A. Are the Recommendations Valid?

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).

JAMA. 1995;274(7):570-574. doi:10.1001/jama.1995.03530070068032

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