The medical prognosis

Forecast of medical - foresight probable development and outcome of the disease based on the knowledge of the regularities of pathological processes and disease.
Form forecast: 1) not whether the disease threatens the life of the patient (prognosis quoad vitam); 2) whether fully recovered patients (prognosis quoad sanationem); 3) how long he will live (prognosis quoad longitudinem vitae); 4) how will leak disease (prognosis quoad decursum morbi). The overall condition from the point of view of the forecast is expressed usually in such wording: prognosis bona (good), dubia (doubtful), mala (bad), pessima (very bad).
Statistics allows to some extent to justify the expected outcome, and the frequency and nature of complications (for example, perforation of the small intestine in typhoid fever and other).
Essential to the forecast has the average duration of the disease: the longer acute disease, the more unfavorable becomes forecast.
The prognosis of the disease depends primarily on the correctness of the diagnosis (see), a correct estimation of age-related features of the patient, his exchange (exhaustion, obesity), emotional attitude (calm, irritable, prone to anger), labor activity related diseases, bad habits, and so on
The prognosis of chronic disease causes more difficulties than acute. Some diseases, incurable at the modern level of medical science, inevitably lead to death within a few months or years, such as leukemia. Other diseases are curable if detected early, such as cancer in the early stages when surgery or radiation therapy.
In chronic diseases, less severe and completely treatable (syphilis, tuberculosis , and others), the forecast may depend on the timing of treatment, such as the treatment of pulmonary tuberculosis.
The possibility of compensation of damage or defect is often essential to forecast.
Prognosis and patient. Usually the patient is primarily interested in the forecast, not a diagnosis. About the diagnosis, he asks also from the point of view of the forecast. The health care worker should always be prepared to answer. With patients suffering from malignant neoplasms, the interview must be conducted more thoroughly and carefully, to avoid accidental awareness about the severity of the patient prognosis. If patients with resectable tumors stubbornly refuse featured operations, in these cases, the prognosis is reported by the patient, must contain a statement only that the delay in operation could threaten the transition, for example, alleged stomach ulcers in cancer.
You should not specify the exact time and the chances of recovery. Prognostic assessment usually expressed in conditional mood ("if there are no complications or serious, but the recovery must occur").
Generally accepted to pay attention to the patient favourable symptoms of recovery and to divert attention from severe manifestations of disease. In severe condition of the patient is poor prognosis should inform the relatives of the patient. Methods of treatment of foresight has changed along with the development of medicine.
At the dawn of medical science only method of forecast was empirical. Modern forecast is proved by a large number of actual data obtained in the result of observation, study the functional state of organs and systems and patient treatment. Also take into account the patient's medical history, the development of the disease. Prognostics as a scientific discipline that studies the methods of medical foresight, is constantly being improved.

Forecast (gr. prognosis is to predict, forecast) medical - foreseeing the emergence, development and outcome of the disease based on the knowledge of the regularities of pathological processes of diseases; the forecast can also be defined as the diagnosis of the future.
General questions of the forecast are the most important, but also the most difficult area of clinical medicine. The forecast value in the clinic is determined the main objectives of practical medicine - prevention of diseases and treatment of patients. In this respect, the job of a physician is similar to the problem of the scientist: explore the laws to provide phenomena and predict phenomena, to master them. Knowledge of the etiology of diseases, harmful factors of working and living conditions, deteriorating health conditions, allows to predict, under what conditions can get individual or collective. This foreknowledge is based prevention public and private life. Extensive preventive measures against epidemic diseases are based on timely detection of diseases and foreseeing the possibility of their occurrence, as well as on the knowledge of the ways of transmission of infectious disease. For example, the detection of cases of diphtheria or typhoid forces to conduct a wide range of sanitary and preventive measures, forecasting seasonal flu outbreaks makes spending within a certain timeframe vaccination against him. When the possibility of exacerbation or relapse preventive treatment, for example to prevent recurrence of rheumatic fever, acute ulcerative disease, etc., planning the work of health authorities is based on a forecast of the frequency of certain forms of the disease and overall morbidity of the population.
The form of the forecast. The first and most important question of the doctor and the patient, not fatal for the disease, patient alive (prognosis quoad vitam), then fully recovered patients (prognosis quoad sanationem), how long he will live (prognosis quoad longitudinem vitae), as will be the disease for the first time in the future (prognosis quoad decursum morbi). It is also important to know what effect will provide treatment, how dangerous surgery, after the disease defects health, whether working sick, what is the value of its residual ability to work, what form of labour harmless for him. The overall condition from the point of view of the forecast is expressed usually in such wording: prognosis bona, dubia, mala, pessima. It is impossible to list all questions about the nature of the disease and about the future of the patient, which arise in medical practice. Each Board and the action of the doctor is preceded by foreknowledge or assumption about the results of its activities.


The prognosis of the disease. In modern medicine, the Outlook depends primarily on accurate diagnosis of the disease. P. danger may be based on statistics, i.e. quantitative regularities in the mass investigating cases (frequency of full recovery, the residual phenomena, the percentage of mortality). Statistics allows to some extent to justify the expectation of a particular outcome, but it is only one of the landmarks of creating individual forecast, i.e., prediction of disease-specific patient. No less essential statistical data on the incidence and nature of complications of a specific disease, such as perforation of the small intestine of typhoid fever, gastrointestinal bleeding in cirrhosis of the liver, etc.
The age of the patient determines the whole nature of the disease; at a young age P. in General is always better; youth - the best friend of the patient. However, in infants, especially newborns like must be made with great caution. The Constitution, the hereditary characteristics and exogenous conditions (illness, living conditions influence the course of diseases, as well as the General condition of an organism to diseases.
Heavy prognostic value of individual symptoms installed a long time, as, for example, cooling of the extremities after surgery or in infectious diseases or noise pericardial friction with uraemia and so on, in most cases, justified, but currently they are not as simple empirical signs, and as manifestations of the extent or quality, underlying pathological process.
The forecast is practically healthy. The life span of a practically healthy person, if to exclude randomness, such as a car accident depends on the characteristics of the human body and numerous environmental conditions. Define (estimated) life expectancy healthy person is a challenge, always facing organisations life insurance.
These organizations using a number of indicators and statistical processing of mass surveys can provide average estimates of life expectancy for people of different ages; these statistical laws are justified on a massive scale.
See duration of life of parents sometimes is essential for prediction; as they say, "a wise choice of ancestors" is often determines a long life. Directly to the question of heredity (see) is the definition of the Constitution (see) and its importance for the life of this man.
The role of labour in maintaining health is revealed, for example, in some cases decrease and somatic nervous tone, resistance to a number of diseases in the elderly, who moved to retire. Enough is known, that the conditions of life (housing, meals, etc.,) and habits that do not meet hygiene standards, predispose to the development of various diseases; excessive eating, Smoking, alcohol consumption should be considered as a real illness, and not just bad habits, which often leads to severe consequences in the near or distant future.
The overall Outlook is closely linked with the success of the treatment; the percentage of mortality from most diseases is decreasing every year as a result of new discoveries of scientific medicine and improve health organization. It should be noted the importance of determining the stage of the disease, the regularities of course, as each period of the disease carries its own risks; variations in the patterns of trends are alarming. Is the average duration of disease is essential for forecasting: the longer acute illness, especially becomes gloomy forecast. Reaction to the etiological factor can be so excessive that leads to death.
The prognosis of chronic disease causes more difficulties than acute. Some diseases, incurable at the modern level of medical science, inevitably lead to death within a few months or years, such as leukemia. Other diseases in principle curable, such as cancer in the early stages with timely surgery or radiation therapy. In such cases, the prognosis is not of course a hopeless and is based on the definition of the cure. The state of the vital organs and the degree of depletion allow partly to assess the severity of the situation of the patients.
The third group is comprised of chronic disease, less malignant and completely treatable, such as tuberculosis, syphilis, with more or less defects due to an illness or applied treatments (for example, pulmonectomy, limb amputation). The duration and outcome of the diseases in this group and, therefore, P. largely depend on the results of treatment.
The possibility of compensation of damage or defect is often essential to forecast. When solving this problem must be taken into account, in particular, the time factor, or the rate of progression of damage.
Adaptation of the body to the changing conditions of the external environment is the basis for P. for chronic diseases. As is known, adaptability - the main quality of all living things is not the same for different people. For P. disease and disability of the patient is essential to his temperament and character features.
Prognosis and patient. Usually the patient is primarily interested in the forecast, not the diagnosis of the disease (the patient lives mainly future); about the diagnosis, he asks also from the point of view P.: heavy, can be treated for the disease. The doctor is obliged to answer the questions of the patient about the future, so it should always be prepared to answer. The relationship between the doctor and the patient completely follow the goals of medicine (prevention and treatment of diseases, relieving the suffering of the sick), so the message patient P. should not conflict with the medical task. Fatal P. always excluded from the conversation with the patient, as well as with others, if there is a possibility of transferring the last patient. With the exception of patients with resectable tumors that refuses from the recommended operation. But in these cases, the prognosis is reported by the patient, must contain a statement only that the delay in operation can lead to getting the disease (for example, the alleged ulcers of the stomach) cancer. The same caution may be required in the case of really precancerous diseases to which the patient belongs lightly. The doctor should be wary random awareness about the severity of the patient P. (careless word, gesture, and so on). The physician should inform P. using understandable to the patient of terms, without going into details. Uncertain P., as the lack of diagnosis, can only reinforce the concerns and doubts of the patient, however, you should not use the word "never" or "always", and also to determine the exact time or the chances of recovery. Prognostic assessment usually expressed in conditional mood, for example, the prospects are quite good if there are no complications or serious, but recovery is to come, if will be executed therapeutic purposes, etc., In some cases, individuals are afraid to know the true state of the case, fearing that the doctor will deprive them of hope, confirming neizlechimoj suffering; in other cases, really heavy, neither the patient nor the physician does not say P.; there are cases when patients, even the sick, the doctors, they deceive themselves with the hope of recovery, despite the apparent severity of the disease, such as cancer. This kind of protective reaction of the psyche, protective illusion should be maintained, if this is not the cause of the categorical refusal of the patient from vital surgical interventions, such as limb amputation IX etc.
Generally accepted to pay attention to the patient favourable symptoms, or signs of recovery and to divert attention from severe manifestations of disease. The doctor forced to hide from the sick heavy prediction, but a truthful assessment of the state should inform someone from family members, if you are sure that it will remain a mystery, and to record it in history. A good prognosis is useful both for being patient and for the success of the treatment; if P. relaxes and gives courage to the patient, the "prediction coincides with medical treatment" (G. A. zaharyin).
Methods of medical foresight changed with the development of medicine. At the dawn of medical science only method of forecast was empirical, which has some value and now.
Sharp deviation of separate functions of the organism from the norm indicates dangerous situation, but not reliably determine the outcome of the disease, since the change of the functions are not only from damage, but are often a reaction to this damage (often the reaction is useful, for example a severe vomiting or diarrhea when some poisoning, etc., followed by a recovery. The second method of empirical method P. is based on the assumption of a repetition of the pain, if symptoms are usually pre-nm, i.e. foresight is based on the symptoms. Such prognostic signs had been of great value at the time of Hippocrates, but they do not have the force of obligation or necessity, which appears only in a causal relationship. Consequently, the validity of such evidence relative. The third way of determining P. based on the sum of a large number of separate phenomena (i.e., statistical laws), but for P. separate cases has only roughly approximate value. Statistical laws are not reveal causal relationships, and can only lead to their discovery. Statistics for prognosis of diseases are of importance only for a certain time, because of the success of treatment of mortality from any disease can be several times smaller. One of the major reasons for the determination of Peterhof is a medical experience. Prognostic judgments are usually defined by analogy, to the memory about the course and outcome of similar cases. Valuable experience in anticipation of the disease is the observation of the patient from the beginning to the end of the disease. Along with medical experience essential scientific data about the peculiarities of course and outcome of a disease, which allow to foresee what can or should occur with the patient in the future. Scientific researches include not only a description of the possible course of the disease depending on its form and stage, the Constitution of the patient, etc., but also highlighted the causes of this or that course, mechanisms of damage to the organism, the nature of the healing process and their signs. Knowledge of etiological factors of pathogenesis of the disease and current effects of pathological processes in the patient allow P. more credible and convincing. The disease is caused by damage to the body (in whole or part) and the body's response to injury; an example is the inflammatory reaction in the introduction of a microbe or injury. In the simplest case, when simultaneous action causes, such as burns, developing biological chain reaction in the place of damage (inflammation, reparative processes), and the General reaction (fever, change in the composition of the blood and so on), which are used for a certain period of time, ie, a self-development of the pathological process, and on local and General changes to judge the severity of a protective reaction, the possibilities of recovery and terms of outcome. Prognosis of the specific disease depends on the accuracy and completeness of diagnosis, taking into account local variations and General condition.
Thus, to determine the prognosis attract more facts of the patient than for the diagnosis, and add the results of treatment. The process of reasoning is more complex than the costs of the present state of the organism.
The logical framework P. differs substantially from the diagnostic knowledge. Recognition of the present condition of the patient the doctor looks at him, looks for and fixes signs (symptoms) of the disease and on the basis of their combination, of a sequence of occurrence and other characteristics comes to the conclusion about the nature of the pathological process (i.e. phenomena goes to the entity) and then specify the etiology and the conditions under which the disease occurs. On the basis of the present condition and medical history, the doctor may restore the picture preceded the development of the disease, i.e. past.
While the forecast is the task of reasoning is that of cause, or the terms and condition of the individual patient to bring the investigation, which corresponds to the deductive method of reasoning. Because of the complexity of life processes is rarely possible to take into account all the trends or patterns, and a prediction should be based on the main of them.
It is known that any pathological process can not be changed, that he always calls opposite process and combined with it and, thus, the merger of both processes the disease progresses to the next stage of its development or to a qualitatively new stage; the final recovery or death. The body's response to injury is not simultaneously, but is a process carried out in time and pass through certain phases that can be considered as self-development of the pathological process and the regularities found forecast. In reality, the situation is more complicated, because in the natural course of the disease interferes with the doctor; therefore, when establishing P. should be considered and treatment.
On the basis of actual data, by their synthesis, i.e. the interplay of all phenomena, creates a view on the dynamics and direction of developing the disease of the organism as a whole, and not the simple addition of features (even Lao-Tzu said that the sum of the parts do not have a whole). So before formulated the answer, it is necessary to discuss the future course of the disease, to weigh all the pros and cons of different options and to determine the degree of probability of each. This part of the medical conclusions is the subject of differential prognostication, which has not yet been developed; it can be based on the type of differential diagnosis. Prognostics as a scientific discipline that studies the means, methods of medical and vision still very imperfect though it began on Hippocrates. A significant indicator is the most complete understanding and explanation of the condition of the patient, in addition to the diagnosis (see), and is a correct prediction.