Determining Relevance

Before bothering to evaluate the validity of an article, it is important to determine its relevance to you and your patients. There are three major relevance criteria, true of any type of article: Will this information, if true, have a direct bearing on the health of my patients and is it something they will care about? Is this problem common to my practice? Will this information, if true, require me to change my current practice? To answer the first question, look at the outcomes being prognosticated. In a study of congestive heart failure, are we predicting mortality, or wall motion? Quality of life, or hemoglobin A1C? Articles which tell us about the prognosis for important patient-oriented outcomes are probably worth reading, while those which only describe intermediate or surrogate outcomes such as lab tests or imaging abnormalities are generally not. The second and third questions can only be answered by the individual practitioner. A rural physician in a small southern town may have a very different spectrum of patients and problems than a suburban HMO physician. In some cases, a rare but severe problem such as pheochromocytoma may prompt a search for an article about prognosis, even if the condition is not common to your practice. Once you have determined that an article is relevant, you have to determine the validity. We will discuss validity in the next section, and give you a worksheet for articles about prognosis.