Users' Guides to the Medical Literature
JAMAPublished 22 November 1995
Mark C. Wilson
Citations224
SJR quartileQ1
SJR score5.35
SNIP10.71
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TL;DR
A colleague who disagrees with your approach to hormone replacement therapy in postmenopausal women shrugs, and avows, "It's entirely a matter of personal preference, the evidence doesn't support either of you."
Abstract
CLINICAL SCENARIO At the conclusion of our first article on practice guidelines1in this series, we left you examining the full text of a practice guideline2that could help you marshal a convincing response to a colleague who disagrees with your approach to hormone replacement therapy (HRT) in postmenopausal women. Later that day, chatting with another colleague, you mention the disagreement. He shrugs, and avows, "It's entirely a matter of personal preference, the evidence doesn't support either of you." You return to the guideline, looking for how particular recommendations may be justified and adapted to your patient's circumstances. WHAT ARE THE RECOMMENDATIONS? Are Practical, Clinically Important, Recommendations Made? To be useful, recommendations should give practical, unambiguous advice about a specific health problem. For guidelines about managing health conditions, you should determine if the intent is to prevent, screen for, diagnose, treat, or palliate the disorder. For guidelines about
Keywords
Decision SciencesMedicine
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The nonexperimental evidence that forms the recalled experiences of seasoned clinicians will tend to overestimate efficacy for the following reasons:.
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A previously well 48-year-old woman with acute dysuria who has never had cervical, ovarian, uterine, breast, or cardiovascular problems, but her mother had a mastectomy at age 57 for postmenopausal breast cancer is seen.
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127 Citations1993Robert Hayward, Mark C. Wilson +4 more
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This article will show how to interpret the results and generalizability of a clinical decision analysis (Table), and decision trees are displayed graphically, oriented from left to right, with the decision to be analyzed on the left, the compared strategies in the center, and the clinical outcomes on the right.
Annals of Internal MedicineThe Resting Electrocardiogram as a Screening Test
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The evidence does not support doing a screening ECG in men without evidence of cardiac disease or cardiovascular risk factors, and there is no evidence that early detection of these findings leads to a clinical intervention that improves health outcomes.
Annals of Internal MedicineThe Role of Exercise Testing in Screening for Coronary Artery Disease
82 Citations1989Harold C. Sox, Benjamin Littenberg +1 more
The effect of exercise testing is too small to justify doing this procedure routinely in healthy persons, but screening older men with risk factors for coronary artery disease may prove to be worthwhile if coronary bypass surgery is found to prolong life in asymptomatic persons.
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31 Citations1990David M. Eddy
It is important to resolve conflicts in policies for several reasons: differences in recommended actions can lead to differences in health outcomes; the existence of conflicting policies implies that at least some patients will be mistreated.
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3 Citations1990Paul K. Whelton
A meaningful reduction in society’s burden of cardiovascular disease can be achieved only by complementing the Task Force recommendations with community-based mass treatment strategies aimed at shifting the distribution of blood pressure and cholesterol toward a biologically more normal pattern.