Reasoning in clinical practice
R. Paul Thompson, Ross E.G. Upshur in Philosophy of Medicine, 2017
The fourth element in our taxonomy is prognosis. Hippocrates praised prognosis, considering it to be a crucial skill for physicians: It appears to me a most excellent thing for the physician to cultivate Prognosis; for by foreseeing and foretelling, in the presence of the sick, the present, the past, and the future, and explaining the omissions which patients have been guilty of, he will be the more readily believed to be acquainted with the circumstances of the sick; so that men will have confidence to entrust themselves to such a physician. Prognosis is prediction, based on diagnosis, therapy and past experience (collectively and individually). It attempts to determine the likely course of a disease given its diagnosed cause, available therapies and the success of those therapies. That is, it rests on the logic of causation entailed by diagnosis and appropriate therapy. The greater the degree of certitude in the accuracy of the diagnosis and effectiveness of therapy, the greater should be the physician’s accuracy in foretelling what the consequences are for the patient. Nonetheless, prognosis relies on a set of complex considerations around the predictability of the future for a particular patient at a particular time.
Prognosis: Studies of disease course and outcomes
Milos Jenicek in Foundations of Evidence-Based Medicine, 2019
Prognosis (from the Greek ‘foreknowledge’) is traditionally defined as ‘the act or art of foretelling the course of disease’. or better, ‘the prospect of survival and recovery from a disease as anticipated from the usual course of that disease or indicated by special features of the case in question’.3 Such a conceptual definition of prognosis as stated above is found in many dictionaries but requires precision. Contemporary prognosis is not a guess or a product of clinical flair. It is an estimation of probabilities, as is the evaluation of risk. The basic epidemiological approach is the same. In risk assessment, probabilities of developing disease are estimated according to the characteristics of the individual and their general environment. In prognostic assessment, probabilities of various good and bad events as well as outcomes in the already diseased individual are assessed.While risk is usually related to one event (falling ill), prognostic studies are multidimensional in that they deal with several outcomes, not just death.Whereas risk depends mostly on nonmedical factors, prognosis is largely determined by clinical factors, human biology and pathology.
Evidence-Based Communication in the Palliative Conversation
Kathleen Benton, Renzo Pegoraro in Finding Dignity at the End of Life, 2020
Another factor in knowledge that affects communication is prognostication. Prognostication plays a key role in end-of-life choices. Having appropriate knowledge of prognostication is crucial in these discussions. However, physicians have been found to have a tendency to overestimate a patient’s survival and may be able to predict better for patients who have a more immediate risk of dying (Glare et al., 2003). One process to curtail the challenge of prognosticating accurately is to have early advanced-care planning discussions. By individually adapting these discussions to the patient’s hopes and goals and conducting them progressively through the patient’s course of care, patients and families are empowered to express their personal preferences and goals; receive care concordant with their wishes; and have the opportunity to prepare physically, psychosocially, mentally, and financially for what awaits in their disease process (Agarwal & Epstein, 2018).
A proposed novel traumatic brain injury classification system – an overview and inter-rater reliability validation on behalf of the Society of British Neurological Surgeons
Published in British Journal of Neurosurgery, 2022
Mark H. Wilson, Emily Ashworth, Peter J. Hutchinson
A distinction needs to be made between ‘classification’ and ‘prognostication’ tools. Although commonly referred to as classification tools, the Marshall9 and Rotterdam10 systems are principally used for scoring (which can then be used to classify ‘severity’) but they do not classify the type of brain injury. Brain injury is often heterogenous, and an individual patient may have several different brain injuries (e.g. right subdural and left frontal contusion). A comprehensive system needs to account for these different injuries, not just report ‘the worst one’ as occurs in the abbreviated injury scoring (AIS) system.11 The AIS system (as used by the Trauma Audit Research Network in the UK) is a form of radiological classification in that it reports the highest scoring brain injury, but it takes the fidelity of a location and size of injury and converts it to a number (/score). Not all of those numbers are comparable. For example, a cerebellar extradural (score = 3) is not the same as a cerebral laceration (score also = 3). A system that classifies and scores by pathologies may improve specificity.
External validation of the MSKCC nomogram to estimate five-year overall survival after surgery for stage I–III colon cancer in a Dutch population
Published in Acta Oncologica, 2022
Marinde J. G. Bond, Patricia A. H. Hamers, Geraldine R. Vink, Wilhelmina M. U. van Grevenstein, Miangela M. Laclé, Maarten van Smeden, Miriam Koopman, Jeanine M. L. Roodhart, Cornelis J. A. Punt, Anne M. May
We preferred to externally validate an existing model rather than develop yet another prediction model for estimating survival after curative surgery for stage I–III colon cancer patients. Numerous newly developed prognostic models are published to meet the need for better prognostication. However, few of these are used in daily practice. One of the reasons for this is that because many prognostic models have not been validated in other populations, clinicians may (and perhaps should) distrust probabilities provided by these models [16]. Many experts in the field support the view that no prediction model should be implemented in practice until, at a minimum, its performance has been validated in new individuals [16]. We decided to validate the MSKCC model as this is the only one using variables that are readily available in daily practice and it has the advantage of a web-based interface [17] that provides easy access to its use. Besides, the web-based tool provides a ‘likely range’ around the survival probability that informs on the uncertainty of the estimates.
Sarcopenia in Lung Cancer: A Narrative Review
Published in Nutrition and Cancer, 2023
Uzair Jogiat, Zaharadeen Jimoh, Simon R. Turner, Vickie Baracos, Dean Eurich, Eric L. R. Bédard
In 2010, Baracos et al. published an innovative study reporting a significant association between lung cancer and sarcopenia, independent of body mass index (12). To our knowledge, 10 systematic reviews have currently been published specifically on sarcopenia in lung cancer, excluding reviews which have combined lung cancer with other tumor types (Table 1) (14–19,22–26). Of the reviews which conducted meta-analyses, sarcopenia was consistently associated with worse overall survival (OS), with a pooled hazard ratio (HR) ranging from 2.23 to 3.13 (15,17–19,23). Two meta-analyses were conducted on disease-free survival (DFS), both reporting a significant association with a pooled HR ranging from 1.28 to 1.66 (19,23). Despite the substantial evidence on these long term outcomes, there exist under explored areas of research. Specifically, the impact of sarcopenia on OS and DFS in small cell lung cancer (SCLC), with only a single meta-analysis, including two retrospective studies, reporting on this outcome (19). This raises the question, does the prognostic effect of sarcopenia change with variations in therapeutic decision-making and more aggressive disease? The management of lung cancer is multi-faceted, taking into consideration resectability, stage, histology, and performance status, among other factors. How does sarcopenia impact the prognosis of patients with unresectable lung cancer undergoing medical therapy? Prognostication for patients with incurable disease is of significant importance, providing patients with essential information to make timely decisions about their care.
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