Week 8 - Evidence-based practice prognosis Flashcards
What are the 5 steps of prognosis?
- Ask answerable clinical questions about prognosis
- Track down the evidence
- Find out if you can believe the study of prognosis
- Find out what the study of prognosis is telling you
- Apply the results to pt: advise them/their parents about their prognosis
List the 3 factors your should specify when asking answerable clinical questions.
- population or condition of interest
- outcome of interest
- time frame of interest
Give an example of a good clinical questions about prognostic factors
For an obese (prognostic factor) 12 year old boy with stress fracture of the tibia (population) what is the likelihood (risk) of returning to soccer (outcome) within 3 months (time frame)?
What are the 2 main types of cohorts in prognosis studies and define each?
- Survivor cohort - a sample of the population of all people with condition, including those with long-standing problems (population had condition different lengths of time)
- Inception cohort - A sample of the population taken at a uniform (often early) point in the course of the disease (more accurate estimate of prognosis)
Explain retrospective studies
Using data base of medical record to see outcomes and prognosis. Loss to follow up cannot usually be calculated
How is prognosis expressed in continuous outcomes and give an example
expressed in terms of magnitude such as pain intensity
How is prognosis expressed in dichotomous outcomes and give an example
expressed as risk of an event such as recovered vs. not recovered
Define Survival curves
Modeling of an event or endpoint against time (ie. injury, recovery, return to work)
Define prognostic Factors
Characteristics that are likely to make prognosis much better or worse than average
How can we determine which factors influence prognosis and explain
high quality research - help estimate how much the presence of particular prognostic factor modifies prognosis and generate more precise estimates of the prognosis
What is one of the most important determinants of patient satisfaction in patient care?
Interpersonal relationship between therapist and patient which involves the ability to communicate effectively with sensitivity
What are 2 types of questions about prognosis?
- Outcome expected
2. Prognositc factors / patients characteristics
What are the main factors to specify when asking about prognosis? (3)
-
POT*
1. Population or condition
2. Outcome of interest
3. Time frame
What is the ideal type of study to get prognosis?
Prospective cohort studies
Define prospective cohort study
Longitudinal study that follows over time a group of similar individuals (cohort) who differ with respect to certain factors under study, to determine how these prognostic factors affect rates of certain outcomes.
What database is best to use for tracking down evidence for prognosis?
PubMed
What are the 3 criteria for a believable study of prognosis?
SIF
- sampling from a well-defined (target) population?
- inception cohort?
- complete/near-complete follow-up?
Was is the equation to find the 95% CI of continuous outcomes?
95% CI = mean +/- 3 x SD//2N
Define odds ration in prognostic factor studies
Odds of the event happening in the group with the prognostic factor comported with the odds of the event happening in the group without the prognostic factor (ie. parents not being compliant)
= 1, event is equally likely (no affect of prognostic factor)
>1, event is likely to occur in group with prognostic factor
<1, the event is less likely to occur in group with prognostic factor
What difference can prognostic information make to clinical practice? (2)
- Inform patients/parents likely outcome of condition based on evidence
- Use information to guide clinical decision making about treatment (poor vs. good prognosis tells us whether use treatment or let it take natural history or clinical course)
