Tuesday, May 25, 2010

PROGNOSIS

Clinicians should routinely incorporate prognosis into clinical decision making for older adults. Alex Smith, Sei Lee, and I are seeking your insights to help inform a web-based prognostic calculator and systematic review for prognosis in older adults. We thank you in advance for any feedback on either of the following two questions!:

1) systematic review: what prognostic indices do you use for your patients, or have you read about? There is no Medical Subject Heading (Mesh in PubMed) for Prognostic Model. I am now soliciting Geripal advice to supplement our exhaustive literature search. We are especially interested in prognostic indices that use a multivariate algorithm to predict life expectancy via a risk score, but if in doubt, please still send your suggestion.

2) prognostic calculator: any opinions on a catchy and simple name for a website that contains a prognosis calculator for older adults? This calculator would utilize the prognostic indices we identify in the systematic review above. Special Geripal recognition will be given to the best proposal! Some initial ideas include: geriprog, prognosisweb, or gericalc.

By Lindsey Yourman

6 comments:

Eric Widera said...

My top 5:

1) Hospitalized elderly: Louise Walter's Index (JAMA 2001)

2) Community Elderly: Sei Lee's Index (JAMA 2004)

3) COPD: BODE score

4) CHF in the community: Seattle Heart Failure Model

5) Dementia in a nursing home: Susan Mitchell's MDS index (JAMA 2004)

Anonymous said...

My suggested name:
Horizonview
or Horizonscope

My experience with prognosis and my awareness of the literature (which I don't have systematically indexed or filed) is that progressive loss of ADLs and related nutritional decline are key, no matter what the specific Dx. There are various relevant studies, that I'm sure you know well. Recent important references that impressed me were the JAMA ICU survivor outcome study and the NEJM Disease trajectory report.
Thanks for your excellent and entertaining blog.

Brad Miller MD
Medical Director
Hospice of the Foothills and
Part-time Attending MD, UCSF Palliative Care Service

Anonymous said...

Be sure to include spiritual practice as one of your indicators - people with strong religious beliefs and a regular spiritual practice tend to live longer and healthier lives.
Thanks for this good work,

Rev. Jill Bowden, chaplain

Anonymous said...

How about "How long have I got, doc?" .com??

Eric Widera said...

Bob Arnold emailed me the best title yet - "IC Future".

Lindsey Yourman said...

I just wanted to thank everyone for all of these great thoughts, ideas, and references. We really appreciate it!