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Evaluation of Prognosis
· Prognosis: the possible outcomes of a disease or condition and the likelihood that each one will occur.
· How to estimate your patient‟s likely clinical course over time, or anticipate likely complications of the disorder
· Prognostic factor: characteristics associated strongly enough with a condition‟s outcome to predict accurately the development of these outcomes. E.g. demographic (e.g. age), disease specific (e.g. tumour stage), or co-morbidity (e.g. other conditions present)
· Prognostic results are the number of events occurring over time, expressed in absolute terms (e.g. 5 year survival rate), relative terms, or survival curves
· Risk factor: patient characteristics associated with an increased probability of developing a disease in the first place. Neither prognostic or risk factors imply a cause and effect relationship
· Are the results of the study valid?
o Was there a representative and well-defined sample of patients at a similar point in the course of the disease? (ideally at its onset). Is the disease clearly defined (what are the inclusion/exclusion criteria)? Is the sample representative of the whole spectrum of disease? Sources of bias: e.g. selection bias (referrer bias) or lead-time bias
o Was follow-up sufficiently long and complete (what were the potential characteristics of those lost to follow-up?
o Were objective and unbiased outcome criteria used? Were the investigators blind?
o Was there adjustment for important prognostic factors? Were subgroups with different prognoses stratified?
· What are the results?
o How large is the likelihood of the outcome event(s) in a specified period of time
o How precise are the estimates of likelihood? Precision best expressed in confidence intervals
· Will the results help me in caring for my patients?
o Were study patients similar to my own?
o Will the results lead directly to selecting or avoiding therapy?
o Are the results useful for reassuring or counselling patients?
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