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    Ricky Saunders
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    This document provides a checklist for critically appraising an article on prognosis. It addresses whether the results of a prognosis study are valid and important, and whether the evidence can be applied to caring for a patient. To be valid, a prognosis study must assemble a representative sample of patients at a common point in their disease progression and have sufficiently long and complete follow-up using objective outcome criteria. Valid results are important if they precisely estimate the likelihood of outcomes over time. The evidence can be applied if study patients are similar to one's own patient and impacts treatment decisions or patient counseling.

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    This document provides a checklist for critically appraising an article on prognosis. It addresses whether the results of a prognosis study are valid and important, and whether the evidence can be applied to caring for a patient. To be valid, a prognosis study must assemble a representative sample of patients at a common point in their disease progression and have sufficiently long and complete follow-up using objective outcome criteria. Valid results are important if they precisely estimate the likelihood of outcomes over time. The evidence can be applied if study patients are similar to one's own patient and impacts treatment decisions or patient counseling.

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    100 views5 pages

    Worksheet Prognosis OK

    Uploaded by

    Ricky Saunders
    This document provides a checklist for critically appraising an article on prognosis. It addresses whether the results of a prognosis study are valid and important, and whether the evidence can be applied to caring for a patient. To be valid, a prognosis study must assemble a representative sample of patients at a common point in their disease progression and have sufficiently long and complete follow-up using objective outcome criteria. Valid results are important if they precisely estimate the likelihood of outcomes over time. The evidence can be applied if study patients are similar to one's own patient and impacts treatment decisions or patient counseling.

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    of 5

    CRITICAL APPRAISAL CHECKLIST FOR AN ARTICLE

    ON PROGNOSIS.
    Study Design: Cohort study.
    Adapted from:
    Laupacis A, Wells G, Richardson WS, Tugwell P. Users’ guides to the medical
    literature. V. How to use an article on prognosis. JAMA 1994; 272: 234-237.

    I. Are the results of this prognosis study VALID?

    Was a defined, representative sample of patients


    assembled at a common (usually early) point in the course
    of their disease? [ ] Ya
    Apakah ada sampel yang representatif dan didefinisikan [ ] Tidak
    secara jelas pada titik yang sama/similar point pada [ ] Tidak dijelaskan
    perjalanan penyakit?

    Was patient follow-up sufficiently long and complete? [ ] Ya


    Apakah follow-up cukup lama dan lengkap? [ ] Tidak
    [ ] Tidak dijelaskan

    Were objective outcome criteria applied in a "blind"


    fashion? [ ] Ya
    Apakah kriteria kesudahan yang obyektif diterapkan [ ] Tidak
    secara blind [ ] Tidak dijelaskan

    If subgroups with different prognoses are identified, was


    there adjustment for important prognostic factors? [ ] Ya
    Apakah dilakukan penyesuaian/adjustment faktor-faktor [ ] Tidak
    prognosis yang penting? [ ] Tidak dijelaskan

    Was there validation in an independent group ("test set")


    of patients? [ ] Ya
    Apakah dilakukan validasi pada kelompok pasien (test- [ ] Tidak
    set) yang indipenden? [ ] Tidak dijelaskan

    II. Are the valid results of this prognosis study IMPORTANT?

    How likely are the outcomes over time?


    Seberapa besar kecenderungan/ likelihood kejadian [ ] Ya
    [ ] Tidak
    outcome pada suatu waktu yang spesifik? [ ] Tidak dijelaskan

    How precise are the prognostic estimates? [ ] Ya


    Seberapa besar ketepatan/ presisi kecenderungan? [ ] Tidak
    [ ] Tidak dijelaskan

    1
    If you want to calculate a confidence interval around the measure of prognosis:

    Clinical Measure Standard Error (SE) Typical Calculation of CI

    Proportion (as in the rate of If p = 24/60 = 0.4 (or 40%) and


    some prognostic event, etc.) n = 60
    where: sqrt (p x (1 - p) / n)
    where p is proportion and SE = sqrt(0.4 x (1-0.4)/60)=
    the number of patients = n n is number of patients 0.063 = 0.063 (or 6.3%)

    the proportion of these patients 95% CI is


    who experience the event = p 40% ± 1.96 × 6.3% or
    27.6% to 52.4%
    sqrt (p x (1 - p) / n)
    n from your evidence: where p is proportion and Your calculation:
    n is the number of patients SE:

    p from your evidence: 95% CI:

    III. Can you APPLY this valid, important evidence about prognosis in caring for your patient?

    Were the study patients similar to your own?


    Apakah populasi dalam penelitian serupa [ ] Ya
    [ ] Tidak
    dengan pasien? [ ] Tidak dijelaskan

    Will this evidence make a clinically important


    impact on your conclusions about what to offer
    or tell your patient? [ ] Ya
    Apakah hasil akan membantu dalam memilih [ ] Tidak
    [ ] Tidak dijelaskan
    atau menghindari terapi?

    Are the result useful for reassuring or


    counselling my patient [ ] Ya
    [ ] Tidak
    Apakah hasil berguna dalam proses konseling
    [ ] Tidak dijelaskan
    dengan pasien?

    Additional Notes

    2
    JARGON BUSTER.

    Prognosis The possible outcomes of a disease and the frequency with which they
    can be expected to occur.

    Prognostic factors Characteristics of a patient that may be used to more accurately predict
    the outcome in that patient. These may be demographic (e.g. age),
    disease-specific (e.g. tumour stage) or co-morbid (e.g. other diseases
    accompanying the disease in question). Prognostic factors don’t have
    to cause the outcome, just be associated strongly enough to predict
    their development.

    Cohort study Study design in which a group of individuals are followed up prospectively
    over time to see if they develop a disease or outcome of interest.

    Untuk menghindari hilangnya kesudahan pasien karena permulaan penelitian terlalu lambat,
    kita harus meneliti seluruh pasien pada saat gejala klinik pertama kali timbul. Ini disebut
    inception cohort.
    Exception cohort , bila mempelajari prognosis padatadium akhir suatu penyakit. Dalam hal ini
    mengumpulkan suatu sampel yang representatif, didifinisikan dengn baik, yang semuanya
    terdiri dari stadium akhir penyakit

    Contoh:
    Kita mengamati 100 pasien, 4 meninggal & 16 hilang dari pengamatan (case fatality 4 dari 84)
     4:84 = 4,8 %, bagaimana yang 16 hilang? Bila semua meninggal maka case fatality 20:100
    = 20 %. Bila skenario baik tidak semua yang 16 meninggal case fatality ; 4: (84+16) atau 4:100
    = 4 %  hilangnya pasien dalam pengamatan sangat berpengaruh terhadap hasil penelitian.

    3
    I. Are the results valid ? (V)

    1. Is there a clearly focussed question?


    Consider Patients
    Disease/Condition
     Ya Tidak Tidak dijelaskan
    Outcome

    2. Was a defined, representative sample of patients assembled at


    a common (usually early) point in the course of their disease?

    3. Was the follow-up of these patients sufficiently long and


    complete?

    4. Were objective and unbiased outcome criteria used?


    Consider:
    Did the individual assessing the outcome criteria
    know whether or not the patient had a potential  Ya Tidak Tidak dijelaskan
    prognostic factor, i.e. were they blinded?

    5. Was there adjustment for important prognostic factors?


    Consider:
    Was there standardisation for potentially important
    prognostic factors e.g. age?
    Were different sub-groups compared?  Ya Tidak Tidak dijelaskan
    Was there validation in an independent group of
    patients?

     Ya Tidak Tidak dijelaskan

    II. Are the valid results of this diagnostic study important ? ( I )


    6. How likely are the outcome event(s) over a
    specified period of time?

    7. How precise are the estimates of this


    likelihood?
    Consider:
    Are the results presented with confidence
    intervals?

    4
    WILL THE RESULTS HELP ME WITH THIS PATIENT?

    8. Were the study patients similar to this


    patient?

    9. Will the results lead directly to selecting or


    avoiding a treatment?

    10. Are the results useful for reassuring or


    counselling my patient?
    Consider:
    Will the evidence make a clinically important
    impact on your conclusions about what to offer
    or tell this patient?

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