Approach to Basic Prevention Flashcards
Actions aimed at eradicating, eliminating, or minimizing the impact of disease and disability
Prevention
The concept of prevention is best defined in the context of levels, traditionally called
Primary, secondary, and tertiary prevention
Prevention before exposure, i.e. sanitation, nutrition, immunization,and education
Primary Prevention
Prevention after exposure, i.e. early detection (screening), and early intervention
Secondary prevention
Prevention after the disease process, i.e. reversing the course of disease, rehabilitation, and treatment
Tertiary Prevention
A classic example of primary prevention is
Immunizations
New Jersey requires that children be vaccinated to attend
School or daycare
State vaccine requirements do allow
Religious or medical exemption
A general philosophical or moral objection to the vaccination is not sufficient for an exemption on
Religious grounds
During the existence of an emergency, immunization exceptions can be suspended by the
State commissioner of Health
What are four routine immunizations for adults?
- ) DTap (Diptheria, Tetanus, acellular Pertussis)
- ) Polio (IPV)
- ) MMR
- ) Varicella
Early detection sounds good in theory, but we need to make sure that the tests are
Valid
What are the criteria for screening tests?
Characteristics of the:
- ) Disease
- ) Population
- ) Test
What is a classic example of secondary prevention?
Screening Tests
Significant morbidity and/or mortality, prolonged asymptomatic phase, and whether or not there are effective treatments available are all examples of characteristics of the
Disease
The prevalence of the disease, the acceptance of screening tests, and the ability to comply/report are examples of characteristics of the
Population
Incidence conveys information about the risk of contracting the disease, where as prevalence indicates
How widespread the disease is
The sensitivity and specificity, the validity and reliability, and the cost effectiveness are characteristics of the
Test
We need to make sure that our screening test fits the
Population
The idea that if you discover a disease early in its course the patient will live longer by virtue of knowing the diagnosis, EVEN if the intervention had no effect
Lead-time bias
Bias in screening tests cause by the fact that slower growing tumors that are less likely to kill are more likely to be detected by one time or periodic/interval screening
Length-time bias
A bias in the statistics of screening tests, caused by the fact that persons who participate in screening are MORE LIKELY to engage in healthy activities, hence they are likely to live longer
Compliance/Adherence bias
One problem with length time bias is that slow growing cancers may never
Kill
What are the controversies associated with Mammography?
- ) When (age) should we start screening
- ) When (age) should we stop screening?
- ) Is it ever cost effective?
Reports yearly to congress about the critical evidence gaps in research related to clinical preventive services and recommends priority areas that deserve further examination
US Preventative Services Task Force (USPSTF)
A main component of tertiary prevention is
Choosing Wisely
Interventions to improve health care quality and reduce harm
Choosing Wisely
Choosing wisely says that the measles and mumps vaccines have negligible egg protein; thus MMR can be given to
People allergic to eggs
Choosing wisely suggest not screening for carotid artery stenosis in
Asymptomatic adult patients
Says that the presence of bruit alone does not warrant serial duplex ultrasounds in low-risk, asymptomatic patients
Choose Wisely
Choosing wisely says that performing routine admission or preoperative chest x-rays is not recommended for
Ambulatory Patients
Choosing wisely says that the use of topical antibiotics on clean surgical wounds does NOT reduce the rate of infection compared to the use of
Non-antibiotic ointment or no ointment
Usually indicated but doesn’t always save money
Primary prevention
Screening must answer questions such as
Is the condition prevalent?
Does it have a prolonged asymptomatic phase?
Is it treatable early (i.e. does screening even matter)?
Pay attention to who is making the recommendations and how they came up with their
Conclusions
Not all tertiary interventions are
Indicated
Don’t do a test for
“baseline” purposes
Prevent the disease through education and immunizations
Primary prevention
Screening for disease early and reducing the impact of the disease
Secondary Prevention
Treating the disease and supporting people with the disease
Tertiary prevention
Making sure not to repeat tests
Quaternary prevention
Broad steps to prevent disease (Not individual preventions)
Primordial prevention
