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Prognostic Study
Introduction Prognosis
Introduction Prognosis
Possible
outcomes of a disease and
the frequency with which they can
be expected to occur.
Natural history: the evolution of
disease without medical intervention.
Clinical course: the evolution of
disease in response to medical
intervention.
Natural History
Studies
Natural History
Studies
Natural history studies permit the
development of rational strategies
for:
early detection of disease
e.g., Invasive Cervical CA.
treatment of disease
e.g. Diabetes
Prognosis
Patients at risk
of target event
Prognostic
factor
Suffer target
outcome
Time
Do not suffer
target outcome
?
?
2.
3.
4.
Measurement
bias
Measurement bias can be minimized
by:
Risk factors
Bias in Follow-up
Studies
Bias in Follow-up
Studies
A. Selection or Confounding Bias
2.
Migration bias:
Bias in Follow-up
Studies
A. Selection or Confounding Bias
3. Generalizability bias
related to the selective referral of
patients to tertiary (academic)
medical centers.
highly selected patient pool have
different clinical spectrum of disease.
influences generalizability
Survival Cohorts
Survival cohort (or available patient cohort)
studies can be very biased because:
convenience sample of current patients are likely
to be at various stages in the course of their
disease.
individuals not accounted for have different
experiences from those included e.g., died soon
after trt.
Survival Cohort
Bias
True Cohort
Assemble
Cohort
N=150
Observed
True
ImprovementImprovement
Measure Outcomes
Improved = 75
Not improved = 75
50%
50%
80%
50%
Survival Cohort
Assemble
patients
Begin
Follow-up
N = 50
Measure Outcomes
Improved = 40
Not improved = 10
Not
Observed
N = 100
Dropouts:
Improved = 35
Not improved = 65
Survival Rate
1 year survival
A. Good
B. 20%
C. 20%
D. 20%
Median survival
A. ?
B. 3 months
C. 9 months
D. 7.5 months
likely fate
Guiding treatment decisions
Comparing outcomes to make
inferences about quality of care
Conclusion
Prognosis study beneficial
Communicating to patients their likely
fate
Guiding treatment decisions
Comparing outcomes to make
inferences about quality of care