Aim: To elicit preferences for prognostic information, attitudes towards withdrawal of life-sustaining treatment (WLST) and perspectives on acceptable quality of life after post-anoxic coma within the adult general population of Germany, Italy, the Netherlands and the United States of America. Methods: A web-based survey, consisting of questions on respondent characteristics, perspectives on quality of life, communication of prognostic information, and withdrawal of life-sustaining treatment, was taken by adult respondents recruited from four countries. Statistical analysis included descriptive analysis and chi2-tests for (...) dierences between countries. Results: In total, 2012 respondents completed the survey. In each country, at least 84% indicated they would prefer to receive early prognostic information. If a poor outcome was predicted with some uncertainty, 37-54% of the respondents indicated that WLST was not to be allowed. A conscious state with severe physical and cognitive impairments was perceived as acceptable quality of life by 17–44% of the respondents. Clear differences between countries exist, including respondents from the U.S. being more likely to allow WLST than respondents from Germany (OR = 1.99, p < 0.001) or the Netherlands (OR = 1.74, p < 0.001) and preferring to stay alive in a conscious state with severe physical and cognitive impairments more than respondents from Italy (OR = 3.76, p < 0.001), Germany (OR = 2.21, p < 0.001), or the Netherlands (OR = 2.39, p < 0.001). Conclusions: Over one-third of the respondents considered WLST unacceptable when there is any remaining prognostic uncertainty. Respondents had a more positive perspective on acceptable quality of life after coma than what is currently considered acceptable in medical literature. This indicates a need for a closer look at the practice of WLST based on prognostic information, to ensure responsible use of novel prognostic tests. (shrink)

Negative prognostic communication is often delayed in intensive care units, which limits time for families to prepare for end‐of‐life. This descriptive study, informed by ethnographic methods, was focused on exploring critical care physician communication of negative prognoses to families and identifying timing influences. Prognostic communication of critical care physicians to nurses and family members was observed and physicians and family members were interviewed. Physician perception of prognostic certainty, based on an accumulation of empirical data, and the perceived need for decision‐making, (...) drove the timing of prognostic communication, rather than family needs. Although prognoses were initially identified using intuitive knowledge for patients in one of the six identified prognostic categories, utilizing decision‐making to drive prognostic communication resulted in delayed prognostic communication to families until end‐of‐life (EOL) decisions could be justified with empirical data. Providers will better meet the needs of families who desire earlier prognostic information by separating prognostic communication from decision‐making and communicating the possibility of a poor prognosis based on intuitive knowledge, while acknowledging the uncertainty inherent in prognostication. This sets the stage for later prognostic discussions focused on EOL decisions, including limiting or withdrawing treatment, which can be timed when empirical data substantiate intuitive prognoses. This allows additional time for families to anticipate and prepare for end‐of‐life decision‐making. (shrink)

Background: Patients in a vegetative state pose problems in diagnosis, prognosis and treatment. Currently, no prognostic markers predict the chance of recovery, which has serious consequences, especially in end-of-life decision-making. Objective: We aimed to assess an objective measurement of prognosis using advanced electroencephalography (EEG). Methods: EEG data (19 channels) were collected in 14 patients who were diagnosed to be persistently vegetative based on repeated clinical evaluations at 3 months following brain damage. EEG structure parameters (amplitude, duration and variability within quasi-stationary (...) segments, as well as the spatial synchrony between such segments and the strength of this synchrony) were used to predict recovery of consciousness 3 months later. Results: The number and strength of cortical functional connections between EEG segments were higher in patients who recovered consciousness (P < .05 – P < .001) compared with those who did not recover. Linear regression analysis confirms that EEG structure parameters are capable of predicting (P = .0025) recovery of consciousness 6 months post-injury, whereas the same analysis failed to significantly predict patient outcome based on aspects of their clinical history alone (P = .629) or conventional EEG spectrum power (P = .473). Conclusions: The result of this preliminary study demonstrates that structural strategy of EEG analysis is better suited for providing prognosis of consciousness recovery than existing methods of clinical assessment and of conventional EEG. Our results may be a starting point for developing reliable prognosticators in patients who are in vegetative state, with the potential to improve their day-to-day management, quality of life, and access to early interventions. (shrink)

The article presents social simulation from theoretical and philosophical perspectives as a prognostic tool for researching, analysing and anticipating communication and other processes in social environments. The first part discusses the phenomena of ontological and epistemological simulation, treating social simulation processes as epistemological ones. The second part analyses the attitude of the French sociologist and media philosopher Jean Baudrillard towards social simulation, which he himself treats as ontological one. The counterarguments to introduce Baudrillard’s unidentified distinction between ontological and epistemological simulation (...) processes are presented. The third part deals with the principles of the functioning of social simulations as a prognostic tool and provides analytical possibilities for various social environments, communication and other processes. At the end of the article, it is concluded that Baudrillard’s concept of ontological simulation, which annihilates classical Western metaphysics, erroneously reduces the difference between ontos and epistēmē. (shrink)

This book offers an analysis of the status and function of the Anglo-Saxon prognostics in their manuscript context, a study of their introduction to and transmission in Anglo-Saxon England, and, for the first time, a comprehensive edition of prognostics in Old English and Latin.

Background: Cognitive Training may contribute to the maintenance and even enhancement of cognitive functions in healthy older adults. However, the question who benefits most from multi-domain CTs is still highly under-investigated.Objective: The goal is to investigate prognostic factors and models for changes in cognitive test performance in healthy older adults after a multi-domain CT.Methods: The data bases MEDLINE, Web of Science Core Collection, CENTRAL, and PsycInfo were searched up to July 2019. Studies investigating prognostic factors and/or models on cognitive outcomes (...) after conducting a multi-domain CT in healthy older adults were included. Risk of Bias was assessed using the QUIPS and the PROBAST tool.Results: 23 prognostic factor and model studies were included. Results indicate a high heterogeneity regarding the conducted multi-domain CTs, the investigated prognostic factors, the investigated outcomes, and the used statistical approaches. Age and neuropsychological performance at study entry were the most investigated predictors, yet they show inconsistent results.Conclusion: Data on prognostic factors and models of changes after multi-domain CT are still too rare and inconsistent to draw clear conclusions due to statistical shortcomings and low reporting quality. Approaches for future research are outlined.Registration:https://www.crd.york.ac.uk/prospero/, ID: CRD42020147531. (shrink)

In the United States, at least 6% of all hospital beds are in the intensive care unit or coronary care unit. The cost of treating a patient in an intensive care unit averages from $2,000 to $3,500 per day. At least 10–40% of intensive care patients will not survive to hospital discharge. Today, every major category of disease may be found in the modern ICU; common diagnoses are septicemia, postsurgical complications, cerebrovascular accidents, gastrointestinal bleeding, neoplasia, and respiratory failure. ICUs employ (...) some of the most sophisticated medical technology, routinely monitoring the cardiopulmonary performance of patients and often providing assisted ventilation. ICUs are high intensity in terms of their staffing, involving 24-hour physician supervision and nurse:patient ratios from 1:3 to 1:1. (shrink)

Prognostication, the process offormulating and communicating a prognosis, isno longer considered by most physicians to bean essential task in caring for patients withserious illness. Because of this fact, it isnot surprising to find that when physiciansattempt to engage in prognostication, they doit poorly. What may be surprising to thoseoutside the medical community is the extent towhich professional norms have developed whichactively discourage physicians from engaging inprognostication. This article explores thecauses of this state of affairs and thejustifications offered for (...) it. The conclusionis reached that physicians have a professionalresponsibility to competently engage inprognostication based upon the doctrine ofinformed consent, and that a failure or refusalto do so has not only potential legalramifications, but serious negativeimplications for many of the core issues inbioethics, such as the use of advancedirectives, palliative medicine, and medicalfutility. (shrink)

Conventional understanding and research regarding prognostic understanding too often focuses on transmission of information. However, merely overcoming barriers to patient understanding may not be sufficient. In this article the authors provide a more nuanced understanding of prognostic awareness, using oncological care as an overarching example, and discuss factors that may lead to prognostic discordance between physicians and patients. We summarize the current literature and research and present a model developed by the authors to characterize barriers to prognostic awareness. Ultimately, multiple (...) influences on prognostic understanding may impede acceptance by patients even when adequate transfer of information takes place. Physicians should improve how they transmit prognostic information, as this information may be processed in different ways. A model of misunderstandings in awareness, ranging from patient understanding to patient belief, may be useful to guide future discussions. Future decision-making studies should consider these many variables so that interventions may be created to address all aspects of the prognostic disclosure process. (shrink)

An adolescent’s last moment of life is an emotionally and medically complex time. Children may grapple with understanding the things happening to them and with grief of a future lost; caregivers struggle to simultaneously balance deep sorrow, hope, and love; and healthcare providers fight to maintain sound medical and ethical decision making. Increased discussion regarding adolescent end-of-life care is needed so that clinicians may better understand how to engage in ethically based medical management during these events. This holds particularly true (...) in situations where potentially conflicting ideas exist between clinicians and family members. We describe the case of an acutely and terminally ill adolescent who remained cognitively intact but with rapidly advancing multiple organ failure and whose parents requested that he remain uninformed of his critical illness and prognosis. (shrink)

Introduction. The article is focused on analyzing the utopian direction of Russian cosmism and its influence on the Soviet cosmonautics and the development of society in the USSR. This philosophical theory was created in the period that made it possible to incorporate the applied aspects of utopia into scientific and technological progress and thereby embody a number of steps towards the outer space exploration. The authors have developed criteria and parameters for assessing the utopian component of the Russian cosmism theories, (...) which made it possible to bring this construct to a higher level of abstraction and thereby create a working model for conducting such studies in the context of other utopias of models. The purpose of the article is to show the influence of the Russian cosmism utopia on the cosmonautics development in the USSR, develop empirical criteria for evaluating the phenomenon. Achieving the goal required solving the following tasks: 1) considering and analyzing the subject matter of the cosmism utopia; 2) developing parameters for assessing the impact of utopia on the development of the social system; 3) applying the developed parameters to assess the impact of utopian ideas on the development of the Soviet cosmonautics system. Methods. Developing the theoretical model for assessing social utopias, as well as considering and analyzing the cosmism utopia, required the use of structural-functional and systems analysis. The research was conducted within the framework of a synergistic paradigm. Scientific novelty of the research. The article conceptualizes the concept of utopia. It is shown that most of the definitions of utopia as a socio-political ideal focus on the limitations of its existence: utopia cannot be embodied, often has an unscientific character, does not correlate with the real state of the system, i.e. definitions of utopia are often reduced to the negative format. The authors believe that the influence of utopia on society, as a rule, is positive. It is noted that, along with limitations, utopianism has certain unique essential features that qualitatively affect the social projects implementation. Utopia in the systemic understanding acts as a complex of ideas influencing the development of the system, being both internal (since it is created artificially and consciously by the very elements of the system) and an external factor of influence. Unlike Plato’s eidos, the projection of which is reality, utopia is created inductively, but after its creation it again “descends” to the level of reality, since it begins to influence the social model in which it was created. Results. The article discusses the prognostic and modeling functions of the social utopias of Russian cosmists. It has been proved that one of the essential functions of the Russian cosmism utopias is the formation of an ideal type, towards which, in a historical perspective, the real social system begins to strive. It is convincingly demonstrated that utopia acts as a cognitive support and inevitably forms the canvas along which society begins to move, defining the utopian model as an attractor, although such a goal is not always formulated when creating a utopia. This relationship makes it possible to assess the degree of influence of utopian ideas on the formation of reality in each specific case, which, in turn, provides an opportunity to answer the question of how and to what extent the utopian ideal type participates in determining the characteristics and parameters of a real social system. Conclusions. It was found that the social utopia of cosmists as a cognitive concept is an important effective factor influencing the development of the space industry in the USSR. The parameters adopted in the study allow us to describe the measure of its influence as both an internal and an external factor on the development of the society in which it is implemented. The validity of perceiving the utopia of cosmists as a construct with a certain life cycle, the main part of which is the period of functioning, is stated. During this time period, utopian theory can have a significant impact on the actual development of society from various angles. (shrink)

I offer a reconstruction of contemporary medical procedures of sex assignment for infants with intersex conditions. In the perspective adopted, sex assignment to intersexed newborns can be understood as a procedure that imposes determinate sex predicates. The account describes two stages of sex assignment. At the first stage of the process, the sex predicates ‘female’, ‘male’, or ‘intersexed’ are taken to denote genital morphology. Initial genital assessment of newborns imposes clear boundaries upon the extensions of these predicates through diagnostic schemes (...) of precisification. At the second stage, the sex predicates ‘female’ and ‘male’ denote sex of rearing, a therapeutic and pedagogical project aimed at producing stable and psycho-socially well-adjusted gender identity. The multi-dimensional indeterminacy of prognosticating sex of rearing at the second stage is mitigated through the prioritization of some subsets of the medical data. (shrink)

As societies become increasingly technologised, the need for careful and critical assessment rises. However, attempts to assess or normatively evaluate technological development invariably meet with an antinomy: both structurally and historically, technologies display multistable possibilities regarding uses, effects, side effects and other outcomes. Philosophers, usually expected to play applied ethics roles, often come to the scene after these effects are known. But others who participate at the research and development stages find even more difficulties with prognosis. Recent work on ‘revenge’ (...) effects (Tenner) and negative side effects (Kevles) are examined, as well as several cases of philosophers in ‘R&D’ roles. After sketching the antinomy,I outline a heuristic pragmatics of prognosis that addresses this quandary. (shrink)

Figner, Mackinlay, Wilkening, and Weber (2009) developed the Columbia Card Task (CCT) to measure risk-taking attitudes. This tool consists of two versions: in the COLD version the decision maker needs to state in advance how many cards (out of 32) they want to turn over (so called static risk taking), in the HOT version they have the possibility of turning over all 32 cards one-by-one until they decide to finish (dynamic risk taking). We argue that the HOT version confounds an (...) individual’s willingness to accept risk with their beliefs in trend continuation vs. trend reversal in a prognostic task. In two experimental studies we show that people believing in trend continuation (momentum subjects) turn over more cards than those believing in trend reversal (contrarians) in the HOT version of the task. However, this is not the case in the COLD version. Thus, we provide evidence that, when considered as a dynamic risk propensity measure, the number of turned over cards in the HOT version of the CCT is a contaminated measure and reflects two phenomena: (1) risk preference and (2) the decision-maker’s belief in trend continuation. We speculate that other dynamic risk taking measures can also be biased by a momentum strategy. (shrink)

AimThe functional prognosis of patients after coma following either cardiac arrest or acute structural brain injury is often uncertain. These patients are associated with high mortality and disability. N20 and N70 somatosensory evoked potentials are used to predict prognosis. We evaluated the utility of SSEP as an early indicator of long-term prognosis in these patients.MethodsThis was a retrospective cohort study of patients admitted to the intensive care unit with a diagnosis of coma after CA or ABI. An SSEP study was (...) performed, including N20 and N70 at 24–72 h, after coma onset. Functional recovery was assessed 6–12 months later using the modified Glasgow scale. The study was approved by our local research ethics committee.ResultsIn the CA and ABI groups, the absence of N20 or N70 was a strong indicator of poor outcome. Conversely, the presence of N70 was an indicator of a good outcome.ConclusionSomatosensory evoked potentials are useful early prognostic markers with high specificity and sensitivity. Moreover, N70 has additional potential value for improving the prediction of good long-term functional outcomes.Clinical Trial Registration:[https://clinicaltrials.gov/], identifier [2018/01/001]. (shrink)

Parents frequently attempt to shield their children from distressing prognostic information. Pediatric oncology providers sometimes follow parental request for non-disclosure of prognostic information to children, invoking what we call the stability of the family argument. They believe that if they inform the child about terminal prognosis despite parental wishes, cohesion and family structure will be severely hampered. In this paper, we argue against parental request for non-disclosure. Firstly, we present the stability of the family argument in more detail. We, then, (...) set out the (conceptual, legal, systemic) entitativity of the family and the kind of value the stability of the family argument assumes, before we set on to critically evaluate the argument. Our analysis shows that disclosure of prognostic information to children does not necessarily destabilize the family to a greater extent than non-disclosure. In fact, a systemic perspective suggests that mediated disclosure is more likely to result in a (long-term) stability of the family than non-disclosure. It is in the interest of the family to resist the initial aversive reaction to delivering bad news. In the final part, we draw a set of recommendations on how to facilitate decision-making in face of parental request for non-disclosure. (shrink)

In many forms of severe acute brain injury there is an early phase when prognosis is uncertain, followed later by physiological recovery and the possibility of more certain predictions of future impairment. There may be a window of opportunity for withdrawal of life support early, but if decisions are delayed there is the risk that the patient will survive with severe impairment. In this paper I focus on the example of neonatal encephalopathy and the question of the timing of prognostic (...) tests and decisions to continue or to withdraw life-sustaining treatment. Should testing be performed early or later; and how should parents decide what to do given the conflicting values at stake? I apply decision theory to the problem, using sensitivity analysis to assess how different features of the tests or different values would affect a decision to perform early or late prognostic testing. I draw some general conclusions from this model for decisions about the timing of testing in neonatal encephalopathy. Finally I consider possible solutions to the problem posed by the window of opportunity. Decision theory highlights the costs of uncertainty. This may prompt further research into improving prognostic tests. But it may also prompt us to reconsider our current attitudes towards the palliative care of newborn infants predicted to be severely impaired. (shrink)

BackgroundFear of cancer recurrence is an important cause of suffering for cancer survivors, and both empirical evidence and theoretical models suggest that prognostic uncertainty plays a causal role in its development. However, the relationship between prognostic uncertainty and FCR is incompletely understood.ObjectiveTo explore the relationship between prognostic uncertainty and FCR among patients with ovarian cancer.DesignA qualitative study was conducted utilizing individual in-depth interviews with a convenience sample of patients with epithelial ovarian cancer who had completed first-line treatment with surgery and/or (...) chemotherapy. Semi-structured interviews explored participants’ understanding of their prognosis; experiences, preferences, and attitudes regarding prognostic information; and strategies for coping with prognostic uncertainty. Inductive qualitative analysis and line-by-line software-assisted coding of interview transcripts was conducted to identify key themes and generate theoretical insights on the relationship between prognostic uncertainty and FCR.ResultsThe study sample consisted of 21 participants, nearly all of whom reported experiencing significant FCR, which they traced to an awareness of the possibility of a bad outcome. Some participants valued and pursued prognostic information as a means of coping with this awareness, suggesting that prognostic uncertainty causes FCR. However, most participants acknowledged fundamental limits to both the certainty and value of prognostic information, and engaged in various strategies aimed not at reducing but constructing and maintaining prognostic uncertainty as a means of sustaining hope in the possibility of a good outcome. Participants’ comments suggested that prognostic uncertainty, fear, and hope are connected by complex, bi-directional causal pathways mediated by processes that allow patients to cope with, construct, and maintain their uncertainty. A provisional dual-process theoretical model was developed to capture these pathways.ConclusionAmong patients with OC, prognostic uncertainty is both a cause and an effect of FCR—a fear-inducing stimulus and a hope-sustaining response constructed and maintained through various strategies. More work is needed to elucidate the relationships between prognostic uncertainty, fear, and hope, to validate and refine our theoretical model, and to develop interventions to help patients with OC and other serious illnesses to achieve an optimal balance between these states. (shrink)

No fact in human nature is more characteristic than its willingness to live on a chance. The existence of the chance makes the difference between a life of which the keynote is resignation and a life of which the keynote is hope.Powerful forces are promoting the ideal of prognostic disclosure in endof-life care. Advances in the science of prognostication—ranging from increasingly accurate clinical prediction models to new genomic risk factors—are expanding the supply of prognostic information. Meanwhile, the growing palliative (...) medicine and shared decision-making movements are heightening the demand to disclose prognosis to seriously ill patients. Prognostic disclosure is thought to be beneficial in facilitating... (shrink)

Agent-based models (ABMs) are one type of simulation model used in the context of the COVID-19 pandemic. In contrast to equation-based models, ABMs are algorithms that use individual agents and attribute changing characteristics to each one, multiple times during multiple iterations over time. This paper focuses on three philosophical aspects of ABMs as models of causal mechanisms, as generators of emergent phenomena, and as providers of explanation. Based on my discussion, I conclude that while ABMs cannot help much with causal (...) inference, they can be viewed as etio-prognostic explanations of illness occurrence and outcome. (shrink)

Prognosis after severe brain injury is highly uncertain, and decisions to withhold or withdraw life‐sustaining treatment are often made prematurely. These decisions are often driven by a desire to avoid a situation where the patient becomes ‘trapped’ in a condition they would find unacceptable. However, this means that a proportion of patients who would have gone on to make a good recovery, are allowed to die. I propose a shift in practice towards the routine provision of aggressive care, even in (...) cases where the probability of survival and acceptable recovery is thought to be low. In conjunction with this shift, I argue in favour of a presumption towards withdrawing life‐sustaining treatment, including artificial nutrition and hydration, when it becomes clear that a patient will not recover to a level that would be acceptable to them. I then respond to three potential objections to this proposal. (shrink)

Volume 19, Issue 12, December 2019, Page 57-60.

Most jurisdictions require a patient to consent to any medical intervention. Clinicians ask a patient, ‘Given the pain and distress associated with our intervention and the predicted likelihood of this best-case outcome, do you want to accept the treatment?’ When a patient is incapable of deciding, clinicians may ask people who know the patient to say what the patient would decide; this is substituted judgement. In contrast, asking the same people to say how the person would make the decision is (...) substituted interests.1 The UK Mental Capacity Act 2005 uses the latter approach, and my comments appertain to that approach. When a patient lacks capacity, the question facing clinicians is, ‘Given the likely outcome of this treatment plan for the patient’s life in the long term, would the patient decide to accept the plan?’ This answer depends on the patient’s wishes, values and other factors they would use when deciding. The proposed development of an algorithm involves the following:2. (shrink)