Prognosis: Clinical Scenario
You see a 29 year old woman in an outpatient clinical 3 months after she has been diagnosed as having Crohn's disease. She is married with two young children. Having adjusted to the initial shock of learning about her diagnosis and recovering from a bout of ilieitis she has read about all the potential complications of Crohn's disease and is very concerned that her life expectancy will be greatly reduced. She says "I've read about all these bad problems, what are the chances of me dying young?"
You formulate the question, in a woman with Crohn's disease, what is the risk of death? You search MEDLINE using the terms "Crohn's Disease" and "survival" and find an article which appears to address her questions.
Searching Best Evidence on Disk with the single word "ferritin" yielded a very encouraging meta-analysis of 55 studies and a nice individual study, but your library didn't carry either journal. You perform a MEDLINE search using the MeSH terms "ferritin" and "sensitivity and specificity" and find an article on diagnosing iron deficiency anaemia in the elderly published in a journal that your library does take Gastroenterology 1998;114:1161-1168.
Read the article and decide:
- Is this evidence about prognosis valid?
- Is this valid evidence about prognosis important?
- Can you apply this valid and important evidence about prognosis in caring for your patient?