Prognosis Flashcards
evidence vs theory
evidence- data from clinical research performed on pts
theory- data from basic science research or observation
evidence hierarchy
syst review of randomized trials
singe randomized trial
syst review of ob studies with pt important outcomes
single obs studies with pt important outcomes
physiologic studies
unsystematic clinical observations
systematic reviews- ADV and DISADV
advantages- combines data from different individ studies. Provide consensus
diadvantage- need high quality individ studies
meta analysis also combines stats with literature
randomized clinical trials- ADV and DISADV
Advantages- provides definitive results and reduces influence of bias
Disadvantages- making inferences from a group of pts to an individual pt
Observational studies- ADV and DISADV
advantages- less expensive and can detect low rate occurrences
disadvantage- tx effect often inflated. influnce of bias is inevitable. No control.
Physiologic studies- ADV and DISADV
advantages- provide underlying “mechanisms”
disadvantages- focus on surrogate endpoints (lack clinical meaning)
Unsystematic clinical observations- ADV/DISADV
advantages- good starting points and generate hypothesis or theories
disadvantage- limited scope and can’t consider natural history, placebo effect, expectations, and pts desire to please
PICO
asking a good research question
patient problem or population
intervention
comparison
outcome(s)
PICO-patient problem or population
first step in developing a well built ? is to identify pt problem or population
ex. age, disease/condition, gender
PICO- Intervention
identifying the intervention is the second step in the PICO process
it is important to identify what you want to do for that patient
ex. drug or other tx, diagnostic/screening test
PICO- comparison
third phase of the well built ? which is the main alternative you are considering
should be secific and limited to one alternative choice in order to facilitate an effective computerized search
ex. placebo, stand therapy, no tx, gold standard
PICO-outcome
the final aspect of the PICO question.
specifies the results of what you plan to accomplish, improve or affect and should be measurable
ex. reduced mortality or morbidity, improved memory, accurate and timely diagnosis
prognostic factors
general term that describes characteristics predictive of any type of future outcome is a prognostic factor
identified after disease/target disorder confirmed
specific factors assoc with or predictive of outcome
target disorder/disease already developed influence outcome
risk factors
predictors of future adverse events usually are referred to as risk factors
target disorder/disease not developed
influence development of target disorder/ disease
prognostic factors vs risk factors
ex lung cancer
RF: leads to development of lung cancer-smoking
PF: predictive of a poor outcome from lung cancer- wt loss
