Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:The Culture of Health Care
Lecture:Phrasing the clinical question
Harm and prognosis
Slide content:Example Studies of Prognosis Extremely preterm birth (Marlow, Wolke, & Bracewell, 2005) Followed cohort of 241 children from UK and Ireland born at 25 or fewer weeks gestation Compared with 160 classmates born at full term 41% of preterm children had serious impairment on cognitive assessment compared with 1.3% in control group Untreated early, localized prostate cancer (Johansson et al., 2004; also see Yao, 2010; Gulati,. 2011) 223 men followed from 1977 to 1984 17% developed generalized disease 16% died of disease 13
Slide notes:13 Here are some example studies. Several prognosis studies have looked at children who were extremely preterm [ pree- turm ], had extremely low birth weight, and were in neonatal intensive care units. There are a number of ethical and philosophical issues about how much intervention is desirable for these extremely small children, and a prognosis study gives us an indication of how they do, especially in this case, six years out. A 2005 study followed a cohort of 241 children from the United Kingdom and Ireland who were born at twenty-five or fewer weeks gestationextremely preterm . They were compared with classmates in their schools who were born at full term. The differences were substantial; forty-one percent of the preterm children had serious impairment on a variety of cognitive tests compared with one-point-three percent of their full-term classmates. Another study of prognosis was published on prostate cancer, specifically untreated, early, localized prostate cancer. This study focused on a group of men who were diagnosed between 1977 and 1984 and had regular long-term follow-up. Today, many of those men would have had surgery, but this study gives us an indication of the natural history of the disease. About seventeen percent of these men developed generalized diseasein other words, the cancer spread, or metastasized [ muh- tas -tuh-sahyzd ], to other areas, and sixteen percent of the men died of the disease. This is another demonstration that many men who develop prostate cancer do not die from it, and it does not even spread outside their prostate.