Users' guides to the Medical Literature. VIII. How to use clinical practice guidelines. B. what are the recommendations and will they help you in caring for your patients? The Evidence-Based Medicine Working Group

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