Prognosis is a medical Medicine is the art and science of healing. It encompasses a range of health care practices evolved to maintain and restore health by the prevention and treatment of illness term to describe the likely outcome of an illness. When applied to large populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because previous research found that this proportion of patients died. However, it is much more difficult to translate this into a prognosis for an individual patient: additional information is needed to determine whether a patient belongs to the 45% who will succumb, or to the 55% who survive.[1]
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Methodology
Disease and Prognostic Indicators
Two areas where this type of prognosis prediction, or the use of prognostic indicators, is with Hodgkin's lymphoma Hodgkin's lymphoma, also known as Hodgkin's disease, is a type of lymphoma . It was named after Thomas Hodgkin, who first described abnormalities in the lymph system in 1832 and Non-Hodgkin lymphoma The Non-Hodgkin lymphomas are a diverse group of hematologic cancers which encompass any lymphoma other than Hodgkin's Lymphoma.[clarification needed] Specifically with Non-Hodgkin lymphoma, physicians have developed the International Prognostic Index The International Prognostic Index is a clinical tool developed by oncologists to aid in predicting the prognosis of patients with aggressive non-Hodgkin's lymphoma. Prior to 1993, when the IPI was developed, the primary consideration in assessing prognosis was the Ann Arbor stage alone, but this was increasingly found to be an inadequate means of to predict patient outcome.
Prognostic scoring is also used for other cancer outcome predictions. A Manchester score Manchester score is an indicator of prognosis in small cell lung cancer. It is calculated from a number of physical and biochemical markers is an indicator of prognosis in small cell lung cancer Lung cancer is a disease of uncontrolled cell growth in tissues of the lung. This growth may lead to metastasis, which is the invasion of adjacent tissue and infiltration beyond the lungs. The vast majority of primary lung cancers are carcinomas of the lung, derived from epithelial cells. Lung cancer, the most common cause of cancer-related death.
Other medical areas prognostic indicators are used is in Drug-Induced Liver Injury (DILI) (Hy's Law Hy's law is a prognostic indicator that a pure drug-induced liver injury leading to jaundice, without a hepatic transplant, has a case fatality rate of 10% to 50%. The law is based on observations by Hy Zimmerman, a major scholar of drug-induced liver injury) and use of an exercise stress test An exercise stress test is an evaluation modality used in cardiology in which the ability of the heart to respond to stress, either actually induced by exercise or stimulated by pharmacologic maneuvers, is measured in a controlled clinical setting. The image created by its recording is known as an electrocardiogram or ECG as a prognostic indicator after myocardial infarction Myocardial infarction or acute myocardial infarction (AMI), commonly known as a heart attack, is the interruption of blood supply to part of the heart, causing some heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection.
End of Life
Large areas of medicine are still missing statistical figures on the exact prognosis - in these matters the physician's previous experiences largely guides pronouncements in this matter. Medical studies have demonstrated that most doctors are overly optimistic when giving prognostic information, that is, they tend to overstate how long the patient might live. For patients who are critically ill, particularly those in an intensive care unit An intensive care unit , critical care unit (CCU), intensive therapy unit or intensive treatment unit (ITU) is a specialized department used in many countries' hospitals that provides intensive care medicine. Many hospitals also have designated intensive care areas for certain specialities of medicine, as dictated by the needs and available, there are numerical prognostic scoring systems that are more accurate. The most famous of these is the APACHE II APACHE II is a severity of disease classification system (Knaus et al., 1985), one of several ICU scoring systems. After admission of a patient to an intensive care unit, an integer score from 0 to 71 is computed based on several measurements; higher scores imply a more severe disease and a higher risk of death scale. However, this scale is most accurate in the seven days prior to a patient's predicted death.
Knowing the prognosis helps determine whether it makes more sense to attempt certain treatments or to withhold them, and thus plays an important role in end-of-life decisions.
History
Medieval The Middle Ages of European history are a period in history which lasted for roughly a millennium, commonly dated from the fall of the Western Roman Empire in the 5th century to the beginning of the Early Modern Period in the 16th century, marked by the division of Western Christianity in the Reformation, the rise of humanism in the Italian European physicians would sometimes use numerology to calculate a prognosis, using the Sphere of Petosiris.[citation needed]
For the great 19th century physicians, particularly the French school, the main aim of medicine was not to cure disease, but rather to diagnose it and achieve a satisfying prognosis of the patient's chances. Only several decades later did the focus of efforts in Western medicine shift to curing disease.
See also
- Diagnosis In medicine, diagnosis is the process of identifying a medical condition or disease by its signs, symptoms, and from the results of various diagnostic procedures. The conclusion reached through this process is called a diagnosis. The term "diagnostic criteria" designates the combination of signs, symptoms, and test results that allows
- Nocebo In its original application, "nocebo" had a very specific meaning in the medical domains of pharmacology, and nosology, and etiology
- Optimism bias Optimism bias is the demonstrated systematic tendency for people to be over-optimistic about the outcome of planned actions. This includes over-estimating the likelihood of positive events and under-estimating the likelihood of negative events. It is one of several kinds of positive illusion to which people are generally susceptible
- Placebo (origins of technical term) A placebo is a sham medical intervention. In one common placebo procedure, a patient is given an inert sugar pill, told that it may improve his/her condition, but not told that it is in fact inert. Such an intervention may cause the patient to believe the treatment will change his/her condition; and this belief does indeed sometimes have a
- Prognostics Prognostics is an engineering discipline focused on predicting the future condition of a component and/or system of components. The science of prognostics is based on the analysis of failure modes, detection of early signs of wear and aging in complex systems and components, and correlation of these signs with an aging profile . Potential uses for
- Reference class forecasting Reference class forecasting predicts the outcome of a planned action based on actual outcomes in a reference class of similar actions to that being forecast. The theories behind reference class forecasting were developed by Daniel Kahneman and Amos Tversky. They helped Kahneman win the 2002 Nobel Prize in Economics
- Sign (medicine) A medical sign is an objective indication of some medical fact or characteristic that may be detected by a physician during a physical examination of a patient
- Symptom A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality. A symptom is subjective, observed by the patient, and not measured
- Thought experiment A thought experiment , sometimes called a Gedanken experiment, is a proposal for an experiment that would test or illuminate a hypothesis or theory
References
- ^ Gould, SJ, http://www.prognosis.org/what_does_it_mean.php, retrieved 2009-01-07
External links
- Computer models at prognosis.org
- PrognostiCheck® detects changes in tissue electrical properties and is a reliable and objective prognostic indicator in several chronic conditions.
Categories: Medical terms
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