Description
To answer you have to refer to the answered example to see how to answer fill the template with the answer and the referanses the research question is ( Are the HRT patches more effective than the oral pills when used to treat menupose symptoums in women ?)
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Name
Case number
Sign
date
‘Copy and Paste’ is also considered plagiarism and will result in zero marks for the
assignment.
Case
Give brief ANONYMISED details of the case you saw in practice which involved a clinical
dilemma related to prognosis
52 years old women at menupose attended the clinc for the regular check up and vaccination.
She also asked to renew her prescription for her regular meds and one of them was the HRT
‘estrogen’ , she asked to change the form from the oral pills to the patches that she used to use
before as the pills were not much helpful in terms of treating the hot flashes especially at night
She mentiond that the HRT “estrogen “ patches were better that she rarly had any symptoms
with them
So I wondered are the HRT patches more effective than the oral pills when used to treat
menupose symptoums in women ?
PRO
Formulate a PRO for your case, and clarify your clinical question
P
Population
R
Risk
O
Outcome
CCQ
Clinical Question
Searching for the evidence
SOURCES AND SEARCHES
Detail the source and search results which you carried out to find the evidence to answer your
clinical question
Source Summaries
Search terms used and results found
Articles/ entries
UpToDate
DynaMed
Source
Cochrane Library
PubMed
Guidelines
(derived from Dynamed,
UpToDate, Library EBM
webpage)
From these searches, choose a cohort study appropriate to your clinical question to critically
appraise. Only one
Title
Lead Author
Journal
PDF of paper
Critical appraisal
Validity
Critically appraise the study which you have chosen according to the following questions
Are the results of this study valid?
Was a representative sample of
patients recruited at an early point
in the course of their disease?
Please comment
What were the outcome criteria?
Were the outcomes objective?
Please comment
Were the patients followed up and
do you think follow up was
appropriate?
Please comment
Were important prognostic factors
considered? Please comment.
Was the data collected
prospectively?
Was the design of the study
prospective?
Results
What were the results of this study?
Please explain the results of this study.
How likely is the outcome event over a
specified period of time?
Were confidence intervals provided? If
so, what were they? Please comment
on their precision.
Applicability
Can I apply these results to my patient?
Is my patient similar to the patients in
the study? Please explain.
Are the results useful for reassuring or
counselling my patient?
What are MY conclusions regarding this article?
Conclusion
Validity:
Results:
Applicability:
Conclusion:
‘Copy and Paste’ is also considered plagiarism and will result in zero marks for the
assignment.
Case
Give brief ANONYMISED details of the case you saw in practice which involved a clinical
dilemma related to prognosis
A 40-year old man attends the surgery for treatment of a sports injury. He mentions in
passing that his father was recently diagnosed with dementia, and that his mother is very
upset about her husband’s diagnosis.
He is keen to find out about the prognosis of patients with dementia, and about how long
he should expect his father to live with this diagnosis – he says that he and his relatives
would like to be prepared so that they could organise long-term care if necessary.
I wondered how long patients and their carers can expect to live with dementia.
PICO
Formulate a PRO for your case, and clarify your clinical question
P
Population
Elderly patients in otherwise good health
R
Risk / Exposure
Recent diagnosis of Alzheimer’s dementia
O
Outcome
Survival
CCQ
Clinical Question
Is the life expectancy of patients with a recent diagnosis
of dementia significantly shorter than that of patients
without dementia
Searching for the evidence
SOURCES AND SEARCHES
Detail the source and search results which you carried out to find the evidence to
answer your clinical question
Source
Search terms used and results found
Articles/
Summaries
entries
UpToDate
‘Alzheimer’s’
8 references
No specific mention of prognosis in Alzheimer’s
are given in
dementia in index, but ‘Clinical Course’ section
the’ Clinical
mentions that Alzheimer’s disease ‘progresses
Course’
inexorably’. Patients tend to decline 3-3.5
paragraph
MMSE scale points per year, with less than
UpToDate AD
10% declining more rapidly than that.
UpToDate reports mean survival of 3-8 years
after diagnosis.
DynaMed
‘Alzheimer’s’
Prognosis, Alzheimer’s disease – median
survival 4-6 years after diagnosis of Alzheimer’s
disease (Level 1 evidence). Survival with
dementia decreases with increasing age.
Mortality rates are highest in the first year
following diagnosis.
Detailed
paragraph
with
prognostic
information
Dynamed AD
Clinical Evidence
‘Alzheimer’s’
Mean life expectancy after diagnosis is about 6
years, though many people live far longer.
One reference
given
Clinical
Evidence AD
‘Alzheimer’s’
63 reviews regarding treatment of Alzheimer’s
dementia, but none regarding prognosis
Cochrane AD
None relevant
Source
Cochrane Library
PubMed
Alzheimer* AND prognosis
Limits: Human, >65y, English
Links to free full text (article below)
Dementia AND prognosis
Limits: Human, >65y, English, free full text
Article chosen was # 195 in this search
Guidelines
(derived from
Dynamed,
UpToDate,
Library EBM
webpage)
No specific guidelines, but good information in
Dynamed (above)
2932
1948
263
6062
491
From these searches, choose a cohort study appropriate to your clinical question to
critically appraise
Survival times in people with dementia: analysis from population
Title
based cohort study with 14 year follow-up
Lead Author
Jing Xie
Journal
British Medical Journal 2008: 336: 258-262
PDF of paper
Link
Critical appraisal
Critically appraise the study which you have chosen according to the following
questions
Are the results of the study valid?
Was a representative sample of
patients recruited at an early point
in the course of their disease?
Please comment.
What were the outcome criteria?
Were the outcomes objective?
Please comment
Validity
Were the patients followed up and
do you think the follow up was
appropriate?
Please comment
Were important prognostic factors
considered? Please comment
Was the data collected
prospectively?
Was the design of the study
prospective?
Yes: Recruitment also included
institutionalized patients, which increases the
validity of the study.
Cognitive impairment state (by mini mental
state examination) and death were the
outcomes used, and yes these are objective
measures.
Patients were interviewed at recruitment,
and at two, six, and ten years – and at six
years and eight years in some sub-samples.
This is a lengthy follow-up which is
appropriate for a prognostic study. However,
the long interval between follow-up
interviews is a disadvantage, as assumptions
were made that the onset of dementia was at
the midpoint of the two interviews.
Yes – Age, marital status, sex,
accommodation type, educational level,
functional status, self-reported health, and
area deprivation were all taken into account
– these are all variables which are known to
have an association with mortality.
Yes
Yes
Results
What were the results of this study?
Please explain the results of this study.
How likely is the outcome event over a
specified period of time?
Median survival from the estimated
onset of dementia was 4.6 years for
women and 4.1 years for men.
The shortest survival times were found
in patients who were male, functionally
impaired, and older (these were
significant findings). Non-significant
links were higher educations, and poor
self-reported health status.
Were confidence intervals provided? If
so, what were they? Please comment
on their precision.
Interquartile range and 95% confidence
intervals were provided.
Applicability
Can I apply these results to my patient?
Is my patient similar to the patients in
the study? Please explain
Yes – he is elderly, with a recent
diagnosis of dementia.
Are the results useful for reassuring or
counselling my patient?
It may enable me to counsel the patient
and his family about some aspect of
prognosis – so that they can start
planning long term care if they require.
What are MY conclusions regarding this article?
Validity:
Patients in nursing homes were included in this study, which increases the validity as this is likely to be a care option for a significant number of elderly patients.
Although the duration of follow-up was lengthy, the frequency of follow-up
interviews and visits for cognitive impairment measurement were insufficient –
ideally the patients should have been assessed annually, as significant changes can
occur within this time period.
Conclusion
Results:
The results were significant, and given that this patient is older, and male, that
places him in the group which may have a shorted survival time. However, it seems
that he is not yet functionally impaired, which may be associated with a longer
survival time.
Applicability:
This paper is applicable to my patient, as it was carried out in a similar community
(non-in-patient) population. However, there may be some difficulties as the
population studied were mainly Chinese, and that may have an impact on the
applicability to my patient.
Conclusion:
I think this is a useful paper, and it has provided me with some information which I
can pass on to my patient. However, I would emphasise to my patient that these
are estimates, and that other reviews (mentioned in the ‘Search’ results section of
this submission) suggest that there can be a very wide variation in life expectancy.
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