PROGNOSIS

and
TREATMENT
Putri Eyanoer,MD.,Ms.Epi.,Ph.D.
 WHAT HAPPEN ?

Diagnostic test
and
Diagnosis

PROGNOSIS ?
TREATMENT?

Complaints
Measurements
Abnormality

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D.

 PROGNOSIS

 How my ilness will affect me?

 Is it dangerous?
 Could I die of it ?
 Will there be pain?
 How long will I be able to
continue my present activities?
 Can I be cure at all?

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D.

 PROGNOSIS

 Diagnosing what is wrong

with them
 Administering treatment that
does more good than harm
 Giving them an indication of
what the future is likely to
hold (prognosis)

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D.

 PROGNOSIS

Considering :
A qualitative aspect
(which outcomes could happen?)
A quantitative aspect
(how likely are they to happen?)
A temporal aspect
(over what time period?)

“expert opinion”
• consulting the appropriate
specialist
• looking it up in a textbook
“clinical experience”
“read up”
Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D.
 A prediction of the future course of disease following its
onset

Review the ways in which the course of disease can be

described

Consider the biases that can affect these descriptions and

how these biases can be controlled

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D.

 NATURAL HISTORY OF DISEASE

Biologic onset of Sign and symptoms

the condition of disease

Pathologic evidence of disease

detectable by screening

Health care sought Treatment of disease

Diagnosis of disease

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D.

 RISK AND PROGNOSTIC FACTORS
RISK FACTOR
Increased risk DISABILITY
of acquiring
disease

Biologic onset Diagnosis

PROGNOSTIC

PROBABILITY? FACTORS
associated with
disease
outcomes
DEATH
Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D.
 RISK FACTOR
RISK AND PROGNOSTIC FACTORS
Increased risk
of acquiring
disease

LOW PROBABILITY OF EVENT

EVENT: ONSET OF DISEASES

QUITE FREQUENT EVENT(HIGH PROBABILITY)

EVENT:SUFFERING, COMPLICATION, DISABILITY, DEATH, etc.

PROGNOSTIC
FACTORS
associated with
disease
outcomes

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D.

 COMMON RATES USED
Rate Definition*
5-year survival Percent of patients surviving 5 years from some point
in the course of their disease
Case fatality Percent of patients with a disease who die of it
Disease-specific Number of people per 10,000 (or 100,000) population
mortality dying of a specific disease
Response Percent of patients showing some evidence of
improvement following an intervention
Remission Percent of patients entering a phase in which
disease is no longer detectable
Recurrence Percent of patients who have return of disease after
a disease-free interval

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D.

SHORT COURSE DISEASES :

CASE FATALITY RATE (%patients with a disease who die of it)

# Death from a disease in a specified period of time
total number of cases of the disease in the same period

RECOVERY RATE (%patients recover from disease)

# Patients recover from a disease in a specified period of time
total number of cases of the disease in the same period

MEDIUM AND LONG COURSE DISEASE WITH LOW DEATH RATE :

RESPONSE RATE
(% patients showing some evidence of improvement after intervention)
# Number of patients showing some evidence of improvement
Total number of cases of the disease at the point period of time

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D.

MEDIUM AND LONG COURSE DISEASE WITH HIGH DEATH RATE :

5 YEAR SURVIVAL RATE

(%patients surviving 5years from some point of the disease)
# Patients surviving 5 years from some point in the course of a disease
Total number of cases of the disease at the point period of time

REMISSION RATE
(% patients showing some evidence of improvement after intervention)
# of patients of a disease in which the disease is no longer detectable
total number of cases of the disease

RECURRENCE RATE
(% patients who have return of disease after a disease free interval)
# of patients of a disease in which the disease detectable again after a
disease free interval
total number of cases of the disease

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D.

 STUDYING
TREATMENT
EFFECTS

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D.

 RANDOMIZED CONTROLLED TRIAL

POPULASI DISE NO
TREATMENT #1
ASE DISEASE

SAMPLE R

NO
PLACEBO DISEASE DISE
ASE

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D.

 SAMPLING in RCT

1. Entry criteria - restrict to heterogeneity of patients

2. Patients refusal – systematically different
3. Unreliability of patients – avoiding wasted efforts

HIGLY SELECTED SAMPLES

FAITH TO GENERALIZATION ↓

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D.

 TYPE OF INTERVENTIONS

LIKELY TO BE SUFFICIENTLY
IMPLEMENTED IN HIGHLY SPECIFIC DIFFERENT
USUAL , ENDED UP IN A FROM
PRACTICE TIDY SCIENCE ALTERNATIVE
MANAGEMENTS

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D.

 COMPARISON GROUPS

NO INTERVENTION
OBSERVATION
PLACEBO
R
USUAL TREATMENT
DISSIMILARITY
DUE TO CHANCE

FREQUENCY TABLES
FOR BOTH GROUPS ARE
RECOMMENDED !
 MANAGEMENT of RCT

Not taking the assignment

Dropping out
Receiving other treatment
Managed differently

Differences not attributable

to treatment

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D.

 PHASES OF STUDIES OF TREATMENT

PHASE 1 PHASE 2 PHASE 3

PHASE 4
Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D.
 RESULTS of RCT

INTENTION TO TREAT ANALYSIS

PER PROTOCOL ANALYSIS

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D.