14 - Vertical Themes Flashcards
What is the definition of screening?
Trying to find people at risk of a disease that are otherwise healthy
What is the difference between primary, secondary and tertiary prevention and give some examples of screening programmes that are aiming to achieve each?
Primary: cervical smear, antenatal, genetic, Q risk
Secondary:
Tertiary: Diabetic retinopathy screening, diabetic foot
What are the different populations that can be used for screening?
- Mass e.g NIPE
- Selective e.g sickle cell
What are the advantages of screening?
- Reassurance
- Reduce morbidity and mortality
What are the disadvantages of screening?
- False negatives and false positives
- Inverse care law
- Expensive
- Overtreatment
- Lead and length time bias
What conditions does a screening programme need to fulfil to be treatable?
Disease, Test, Treatment, Programme, Implementation
Disease
- Must be serious
- Must be treatable
- Must have known disease progression
- All primary prevention strategies should have been implemented
Test
- Simple and safe
- Should be acceptable to target population
- Clear diagnostic investigation
- Sensitivity and specificity must be known
Treatment
- Should be beneficial to have early treatment
- Must have treatment available
What is sensitivity and how do you work it out?
Low false negatives
True +ve/No with disease
What is specificity and how do you work it out?
Low false positives
True negatives / No without disease
What is positive and negative predictive value?
Higher prevalence higher PPV
When patient with high risk result asks the likelihood of them actually having the disease
What is the difference between lead and length time bias?
Lead: early detection confused with increased survival
Length: screening picks up cancers with long latency period so these naturally have better survival
What are the five national screening programmes?
- Bowel cancer
- Antenatal
- Cervical cancer
- AAA
- Breast cancer
- Diabetic retinopathy and foot disease
How much screening is done antenatally?
How much screening is done neonatally?
What is infant mortality rate?
Why has infant mortality improved overtime?
- Less crowding
- Vaccination
- Sanitation
- Nutrition
Why did neonatal deaths improve in 1990’s?
Back to Sleep programme
What is the biggest risk factor with neonatal deaths?
Low birth weight
How can we prevent perinatal mortality worldwide?
What are some causes of maternal death?
- SUDEP
- Underlying cardiac issues
- VTE
- Mental health
- Post partum haemorraghe
What makes up an FBC?
Have to ask for reticulocytes as an add on
What is included in a basic clotting screen?
Always needs to do platelet count with it so do FBC as well
What questions do you need to ask yourself once you know somebody is anaemic?
- Reticulocyte count
- MCV
- Blood film
What are some causes of DIC?
Sepsis
What are some causes of DIC in pregnancy?
What are some common haematological changes in pregnancy?
- Anaemia
- Macrocytic red cells
- Neutrophilia
- Low B12 measurements (even if not truly deficient) in 20%
- Thrombocytopenia
How is VTE in pregnancy diagnosed and managed?
What are some reasons to give LMWH prophylactically in pregnancy?
What are some causes of thrombocytopenia in pregnancy and how is this managed?
- Monthly FBC until 28 weeks, then fortnightly
- Consider risk of neonatal thrombocytopenia (and consequent bleeding)
- Consider risks of eg foetal blood sampling, instrumental delivery, epidurals!!
What is the likely diagnosis?
How can we tackle poor vaccine uptake in india?
- Political involvement
- NGO involvement
What is the second victim recovery process? (6 steps)