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Centre for Evidence-
Based Medicine

Completed Prognosis Worksheet for Evidence-Based Nursing

Citation

Janssen HG, Cuisinier MC, de Graauw KP, Hoogduin KA. A prospective study of risk factors predicting grief intensity following pregnancy loss. Arch Gen Psychiatry. 1997;54:56-61.

Are the results of this prognosis study valid?

  1. Was a defined, representative sample of patients assembled at a common (usually early) point in the course of their disease?
    Yes. Data on baseline variables for 227 women who had a miscarriage were collected before the miscarriage. These women had volunteered to be part of a long-term study about how they coped with normal pregnancy, delivery, and complications. Baseline data included information on reproductive history, factors around this pregnancy, sociodemographic data, and personal history.
  2. Was patient follow-up sufficiently long and complete?
    Yes. 94% of all women who had a miscarriage after a singleton pregnancy completed all questionnaires (at baseline before the miscarriage, just after the miscarriage, and 6, 12, and 18 months after the miscarriage).
  3. Were objective outcome criteria applied in a "blind" fashion?
    No, but outcomes were measured in many ways using several standardised and validated forms.
  4. If subgroups with different prognoses are identified, was there adjustment for important prognostic factors?
    Repeated measure analyses factored in differences in baseline characteristics.
  5. Was there validation in an independent group ("test-set") of patients?
    No.

Are the valid results of this prognosis study important?

  1. How likely are the outcomes over time?
    Data were not presented this way. However, grief intensity was predicted by length of pregnancy before the loss, time since the loss, preloss neuroticism, preloss psychiatric symptoms, and absence of living children. Childless and older women showed more intense grief. Grief intensity, active grief, difficulty with coping, and despair decreased with time.
  2. How precise are the prognostic estimates?
    No confidence intervals provided.

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 some prognostic event, etc) where:

the number of patients = n

the proportion of these patients who experience the event = p
sqrt((px(1-p))/n)
where p is proportion and n is number of patients
If p = 24/60 = 0.4 (or 40%) and n=60
sqrt((0.4x(1-0.4))/60)
= 0.063 (or 6.3%)

95% CI is 40% ± 1.96 x 6.3% or 27.6% to 52.4%
n from your evidence: ________

p from your evidence: ________
sqrt((px(1-p))/n)
where p is proportion and n is number of patients
Your calculation:
SE = ____________

95% CI: ____________

Can you apply this valid, important evidence about prognosis in caring for your patient?

  1. Were the study patients similar to your own?
    Yes, on many factors, especially age. The biggest difference was nationality. There is, however, no reason why women from a developed countries would differ in ways that would make the research irrelevant.
  2. Will this evidence make a clinically important impact on your conclusions about what to offer or tell your patient?
    Yes, helpful to know that grief is more intense in women who have no other children, and that grief lessens with time.

Additional Notes

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