Users' Guides to the Medical Literature

Abstract

for the Evidence-Based Medicine Working Group CLINICAL SCENARIO You are about to see a 76-year-old retired schoolteacher for the second time. You first saw her in the clinic a month ago because of cognitive problems. Your evaluation at that time included a Standardized Mini-Mental StateExamination,1 on which she scored 18 out of a possible 30 points, and a physical examination that was normal including no focal neurological signs. You arranged investigations for the treatable causes of dementia that were negative, and you thus feel she has probable Alzheimer's disease.The patient has lived with her son since her husband died 6 years ago. Her son thinks that she first developed significant problems with her memory about 3 years ago. However, she has become increasingly agitated and paranoid during the last year. She has refused to allow him to look after her financial affairs, despite the fact that she owns three pieces of property and isn't able to manage them herself. Her son asked you about her prognosis, and whether she is likely to die soon from

Medium-term prognosis of an incident cohort of parkinsonian patients compared to controls

“…The main strength of this study is its design, which follows best practice for studying prognosis [3]: namely a population-based incident cohort gathered using multiple methods of case-ascertainment to maximize recruitment, which was then followed up forwards in time to collect pre-specified information on a number of different aspects of prognosis. There were few exclusions due to lack of consent and few losses to follow-up, partly because patients were seen at home when they were unable to come to the clinic.…”

“…The optimal design for a prognostic study is prospective follow-up of a representative group of patients from diagnosis to death, ideally an incident cohort of patients [3]. Unfortunately, to our knowledge, only one true incidence study of PD or any other parkinsonian disorder has provided long-term prognostic data [4], although a few population-based studies using inception cohorts from the time of diagnosis have published survival data [5].…”

RB family members as predictive and prognostic factors in human cancer

“…A predictive factor is any measurement associated with response or lack of response to a particular therapy (Laupacis et al, 1994).…”

Appraisal and use of a prognostic study from the urological literature

“…After browsing through the associated abstracts from, you select a seemingly appropriate article entitled “An outcome prediction model for patients with clear cell RCC treated with radical nephrectomy based on tumor stage, size, grade and necrosis: The SSIGN Score” by Frank et al .,[1] You decide to critically appraise your selected article using a framework specific to prognostic studies. [23]…”