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Users' Guides to the Medical Literature:  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; 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. doi:10.1001/jama.1993.03510210084032.
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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

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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