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II. How to Use an Article About Therapy or Prevention A. Are the Results of the Study Valid?

Gordon H. Guyatt, MD, MSc; David L. Sackett, MD, MSc; Deborah J. Cook, MD, MSc; the Evidence-Based Medicine Working Group; Gordon Guyatt, MD, MSc; Eric Bass, MD, MPH; Patrick Brill-Edwards, MD; George Browman, MD, MSc; Deborah Cook, MD, MSc; Michael Farkouh, MD; Hertzel Gerstein, MD, MSc; Brian Haynes, D, MSc, PhD; Robert Hayward, MD, MPH; Anne Holbrook, MD, PharmD, MSc; Roman Jaeschke, MD, MSc; Elizabeth Juniper, MCSP, MSc; Andreas Laupacis, MD, MSc; Hui Lee, MD, MSc; Mitchell Levine, MD, MSc; Virginia Moyer, MD, MPH; Jim Nishikawa, MD; Andrew Oxman, MD, MSc, FACPM; Ameen Patel, MD; John Philbrick, MD; W. Scott Richardson, MD; Stephane Sauve, MD, MSc; David Sackett, MD, MSc; Jack Sinclair, MD; K. S. Trout, FRCE; Peter Tugwell, MD, MSc; Sean Tunis, MD, MSc; Stephen Walter, PhD; John Williams, Jr, MD, MHS; Mark Wilson, MD, MPH

JAMA. 1993;270(21):2598-2601.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

CLINICAL SCENARIO

You are working as an internal medicine resident in a rheumatology rotation and are seeing a 19-year-old woman who has had systemic lupus erythematosus diagnosed on the basis of a characteristic skin rash, arthritis, and renal disease. A renal biopsy has shown diffuse proliferative nephritis. A year ago her creatinine level was 140 µmol/L, 6 months ago it was 180 µmol/L, and in a blood sample taken a week before this clinic visit, 220 µmol/L. Over the last year she has been taking prednisone, and over the last 6 months, cyclophosphamide, both in appropriate doses.

You are distressed by the rising creatinine level and the rheumatology fellow with whom you discuss the problem suggests that you contact the hematology service to consider a trial of plasmapheresis. The fellow states that plasmapheresis is effective in reducing the level of the antibodies responsible for the nephritis and cites a number . . . [Full Text PDF of this Article]

Author Affiliations
From the Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario.

Footnotes
A complete list of the members (with affiliations) of the Evidence-Based Medicine Working Group appears in the first article of this series (JAMA. 1993;270:2093-2095). The following members contributed to this article: Gordon Guyatt (Chair), MD, MSc; Eric Bass, MD, MPH; Patrick Brill-Edwards, MD; George Browman, MD, MSc; Deborah Cook, MD, MSc; Michael Farkouh, MD; Hertzel Gerstein, MD, MSc; Brian Haynes, MD, MSc, PhD; Robert Hayward, MD, MPH; Anne Holbrook, MD, PharmD, MSc; Roman Jaeschke, MD, MSc; Elizabeth Juniper, MCSP, MSc; Andreas Laupacis, MD, MSc; Hui Lee, MD, MSc; Mitchell Levine, MD, MSc; Virginia Moyer, MD, MPH; Jim Nishikawa, MD; Andrew Oxman, MD, MSc, FACPM; Ameen Patel, MD; John Philbrick, MD; W. Scott Richardson, MD; Stephane Sauve, MD, MSc; David Sackett, MD, MSc; Jack Sinclair, MD; K. S. Trout, FRCE; Peter Tugwell, MD, MSc; Sean Tunis, MD, MSc; Stephen Walter, PhD; John Williams, Jr, MD, MHS; and Mark Wilson, MD, MPH.

Reprint requests to McMaster University Health Sciences Centre, 1200 Main St W, Room 2C12, Hamilton, Ontario, Canada L8N 3Z5 (Dr Guyatt).

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