STUDENTS HANDOUT FOR THE WORKSHOP

CRITICAL APPRAISAL OF AN ARTICLE

ABOUT PROGNOSIS
(SESSION BRIEFING)
OBJECTIVES
The purpose of the workshop is to introduce to the participants the concept of medical
decision making using an article about prognosis. Another objective is to introduce
concepts of critical appraisal of an article regarding prognosis:
Validity
Representative sample
Interpretation of the results
Applicability of the results

CASE SCENARIO
A 35 years old female underwent total thyroidectomy for a thyroid nodule which turned
out to be follicular variant of papillary cancer (measurement of the nodule is 2.5 cm), T 2
No Mo.
She asks you about the prognosis because if it is poor she would consider other
treatment like radioactive iodine.
You searched the literature and found this article: Differential Clinicopathological Risk
and Prognosis of Major Papillary Thyroid Cancer Variants . by Shi et al. J Clin
Endocrinol Metab, January 2016, 101(1):264

Evidence-based Medicine: Learning Module on

Prognosis_______________________________________________

INSTRUCTIONS
Divide the participants into groups of six to ten persons per group. Assign a case
scenario to each group and formulate an answerable problem from the scenario.
Ask the group to read the article retrieved to answer the problem in the scenario. Focus
on the abstract, methods and results section.
Critically appraise the article using the appraisal sheet provided. Answer validity
questions, analyze the results and determine the applicability of the results. Resolve the
case scenario.
Process the exercise. Focus on barriers and solution to the application of the exercise in
usual clinic practice.

TIME ALLOTTED
The time allotted for this workshop is two hours. The recommended breakup is:
15 minutes to analyze the scenario and develop consensus
15 minutes to read the article
45 minutes to appraise the validity
15 minutes to analyze results
Evidence-based Medicine: Learning Module on Prognosis

20 minutes to establish applicability

10 minutes to summarize the process

DESIRED OUTCOME
The participants should make a clinical decision on the scenario based on the critical
appraisal of the evidence.

Evidence-based Medicine: Learning Module on Prognosis

Appraisal Sheet
CLINICAL DECISION ON PROGNOSIS
______________________________________________________________________
CLINICAL SCENARIO OR QUESTION
What is the prognosis among patients who have been diagnosed with follicular variant
type of papillary cancer without metastasis who have also underwent thyroidectomy?
______________________________________________________________________
SEARCH

______________________________________________________________________
CRITICAL APPRAISAL
______________________________________________________________________
RELEVANCE
Is the objective of the article on harm similar to your clinical dilemma?( 1 point)
Yes, since the article shows us the prognosis of follicular variant of papillary cancer
(FVPC). This goes hand in hand with the case presented wherein we are looking for the
clinical prognosis of the patient.
______________________________________________________________________
PRIMARY VALIDITY GUIDES
Was there a representative sample of patients without the outcome at the start of
observation?( 2 points)

Yes, patients without the outcome were include. Mortality (patient dies or lives) and
tumor recurrence were the outcome being measured in the study. However, since the
study is a retrospective cohort type, then the samples were grouped by their exposure
and followed them up to determine if they had the outcome or not.
Was followup sufficiently long and complete?( 2 points)
The follow up is thought to be incomplete with only 473 of the patients with FVPTC had
follow up from a total of 6,282 patients involved in the study. The length of follow up
ranged from 9-68 months with a mean of 29 months thus, this study provides a 2-year
survival and recurrence rate.
Were the criteria for determining the prognostic factor and outcome explicit and
credible? ( 3 points)
Yes, the criteria for determining the prognostic factor and outcome explicit and credible
since the data came from different reliable hospitals around the world.
Was there adjustment for other prognostic factors?( 2 points)
The adjustment made was for the age and sex of the patients for the comparison of the
mortality and recurrence rates of the other variants of thyroid cancer (TCPTC and
CPTC) with FVPTC.
_____________________________________________________________________
OVERALL, IS THE STUDY VALID?
Yes, the study was valid.

Evidence-based Medicine: Learning Module on Prognosis

WHAT ARE THE RESULTS?

How large is the chance of the outcome to occur in a specified period of time?
How precise were they? (4 points )
FVPTC had a mortality rate of 0.6% and a recurrence rate of 9.1% total. But for patients
under age 45 it had a mortality rate of 0% and recurrence of 10.7%

______________________________________________________________________
CAN THE RESULTS HELP ME IN CARING FOR MY PATIENTS?
Are the study patients similar to my own?(2 points)
The profile of the patient is similar to the journal presented. Among the 1126 patients
from the study, almost 50% were within the age range of 45 years old. In addition, the
intervention (thyroidectomy) was also part of the inclusion criteria in this study.
Can I use the results to decide on the intervention or reassure my patient?( 2
points)
Results from this study can aid us in prognostication for our patients. Reassurance that
the patients condition has low mortality rates and low recurrence rates may hopefully
alleviate the patients stress and improve quality of life.

_____________________________________________________________________
_
RESOLUTION OF THE PROBLEM IN THE SCENARIO ( 2 points)
.