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ME 536- Patient Care II > Introduction to Health Promotion and Disease Prevention > Flashcards

Introduction to Health Promotion and Disease Prevention Flashcards

1
Q

Main preventative care services

A

Immunizations
Screening
Behavioral counseling
Chemoprevention (meds and immunization)
Colorectal screenings

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2
Q

Primary Prevention

A

Healthy patients (do not have disease yet)

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3
Q

Goal of primary prevention

A

prevent disease from occurring at all
Treat or remove the cause of disease
Occur in clinical settings, community activities, public health

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4
Q

Example of primary prevention

A

Immunizations or behavioral counseling: smoking cessation

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5
Q

Promoting public health through lectures is an example of

A

primary prevention

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6
Q

Onset of diabetes to diagnosis

A

7 years

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7
Q

Secondary prevention

A

Patients already have the disease, but usually early stage and asymptomatic

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8
Q

Goal of secondary prevention

A

Early detection and cure, prevent disease progression
screening
early diagnosis
effective treatment and management

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9
Q

Example of secondary prevention

A

HIV screening

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10
Q

Tertiary prevention

A

patient already has the disease

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11
Q

Goal of tertiary prevention

A

Prevent progression/deterioration
treatment
focus on long term outcomes rather than short term outcomes

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12
Q

Example of tertiary prevention

A

diabetic management: glycemic control, foot care, retinal evaluations

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13
Q

Primary prevention _____________

A

prevents disease from occurring

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14
Q

Secondary prevention ___________

A

detects and cures disease in the asymptomatic phase

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15
Q

Tertiary prevention _____________

A

reduces complications of the disease

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16
Q

Cardiac primary prevention

A

patients do not have ischemic heart disease or vascular disease

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17
Q

Cardiac secondary prevention

A

patients have known disease: treatment to prevent progression
OR
patients at very high risk of disease

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18
Q

Neurology primary prevention

A

prevention of stroke with people with risk factors

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19
Q

Neurology secondary prevention

A

Patients who have had a stroke, patients who have had a TIA, patients who are at a very high risk of ischemic stroke

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20
Q

The same tests can be used for _______ levels of prevention and for diagnosis

A

all

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21
Q

Primary prevention: Colonoscopy

A

screening to find and remove pre-cancerous polyp

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22
Q

Secondary prevention: Colonoscopy

A

screening to find and remove an early colon cancer

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23
Q

Tertiary prevention: colonoscopy

A

follow-up of a patient who has been treated for colon cancer

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24
Q

Primary Prevention KEY

A

Patients do not have the disease, goal is to prevent the development of the disease

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25
Q

Secondary and tertiary prevention KEY

A

patients already have the disease or are at extremely high risk (specialty specific)

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26
Q

Primum non nocere

A

First, do no harm

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27
Q

Non-maleficence is important for patients

A

who do not have disease

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28
Q

What do we consider in screening?

A
  1. How great is the burden of disease?
  2. How good is the screening test?
  3. How good is the treatment?
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29
Q

Burden of disease

A

How common is it (epidemiology, etiology)?
How much suffering does it cause?

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30
Q

The 5 Ds

A

Death
Disease
Disability
Discomfort
Dissatisfaction

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31
Q

How good is the test?

A

Sensitivity and specificity
Positive predictive value and negative predictive value
Simplicity
Cost
Safety
Acceptability

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32
Q

How good is the test: PPD

A

not useful in early stages of disease because IGg, cheap, simple, can be more complicated because more than one appointment needed

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33
Q

Disease State: True Positive

A

(+ test/+ disease state)

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34
Q

Disease State: False Positive

A

(+ test/ - disease state)

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35
Q

Disease State: False negative

A

(- test/ + disease state)

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36
Q

Disease state: true negative

A

(- test/ - disease state)

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37
Q

Sensitivity

A

probability that a patient + with disease will have a + test

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38
Q

If sensitivity if high

A

Most people with disease all have a positive test
Few false negatives
negative test, likely they do not have a disease

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39
Q

SNOUT

A

high sensitivity rules out if the test is negative

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40
Q

Specificity

A

The probability that a patient without the disease will test negative
Very few false positives
If someone has a positive they probably have the disease

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41
Q

Strep test specificity or sensitivity higher?

A

specificity higher

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42
Q

SPIN

A

specificity rules in

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43
Q

Positive predictive value

A

Likelihood that a person with a positive test has the disease
Dependent on the prevalence
“how truly positive is the test”

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44
Q

Negative predictive value

A

Likelihood that a person with a negative test does NOT have the disease.
Dependent on prevalence

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45
Q

When ordering screening test keep in mind

A

prevalence of disease
positive predictive value of your test
negative predictive value

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46
Q

Goal for screening tests

A

-minimal prep by the patient
-easy to administer
-quick-rapid turn around
-cheap (is it covered by insurance)
-no special appointments
-Should be VERY safe
-patients need to be willing to have the test

47
Q

Considerations for how good is the treatment

A
  • is there a treatment that works?
  • what are the risks/harms of the treatment?
  • cost/benefit
  • does it matter if you get treated earlier (asymptomatic) vs. (symptomatic)
48
Q

Harms of preventative care

A
  • adverse effects of screening tests or treatment
  • dealing with false positive tests
  • risk of overdiagnosis
  • finding an “incidentaloma”
49
Q

Harms of false positive tests

A
  • need for additional testing
  • additional cost
  • may involve higher risk procedures
  • stress and anxiety for patients, even if further work-up is negative
50
Q

A good study

A

account for bias and adequately assess risk and benefits

51
Q

Lead time bias

A

People who are diagnosed with screening survive longer after diagnosis than patients who present with symptoms, even if early treatment doesn’t make a difference

just because we find them early doesn’t mean they live longer

52
Q

Lead time bias should use ______

A

mortality rates rather than survival rates

53
Q

Types of bias

A
  • Lead time bias
  • Length time bias
  • Compliance bias
54
Q

Length time bias

A
  • Has to do with growth rates
  • slower growing cancers (which have a better prognosis) are more likely to be found by screening
  • fast growing cancer (which have a worse prognosis) usually present between screenings or before screening starts
55
Q

slow growing cancer

A

prostate

56
Q

fast growing cancer

A

pancreatic cancer, lung cancer

57
Q

Compliance bias

A

patients have a better prognosis than non-compliant patients, regardless of screening

Not clear: more interested in their health, usually healthier

Sometimes treatment is worse than disease

58
Q

USPSTF

A

United States preventative task force

Created in 1984
Independent volunteer panel of national experts in disease prevention and evidence-based medicine

59
Q

Internal validity

A
  • whether the results of the research are correct for the patients who are studies
60
Q

Problems with internal validity

A

chance: random error
bias: systematic error

61
Q

Systematic error bias

A

problems with:
randomization
blind
losing patients to follow-up
publication bias

62
Q

External validity

A

how well does this study apply to patients who were NOT in the study

63
Q

Task forces

A

make evidence-based recommendations about clinical preventative services

64
Q

USPSTF does NOT make recommendations about

A

immunizations

65
Q

USPSTF Recommendation: Grade A

A

recommends this service. High certainty that the net benefit is substantial

66
Q

USPSTF Recommendation: Grade B

A

recommends this service. High certainty that the bet benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial

67
Q

USPSTF Recommendation: Grade C

A

recommends selectively. Offer to individual patients based on professional judgement or patient preference. Moderate certainty that the bet benefit is small

68
Q

USPSTF Recommendation: Grade D

A

recommends against this service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits

69
Q

USPSTF Recommendation: Grade I

A

current evidence is insufficient to assess the balance or benefits of harms in the service. Evidence is lacking, poor quality or conflicting and the risk/benefit can not be determined

70
Q

Level of certainty: High

A

Consistent results from well-designed/conducted studies in representative populations. Result is unlikely to be changed with results from future studies

71
Q

Level of certainty: Moderate

A

evidence sufficient to determine the effects of preventative service on health outcomes with constraints (number, size, quality of studies. inconsistent findings. limited generalizability). Findings could change as further studies performed.

72
Q

Level of certainty: Low

A

current evidence is insufficient to assess effects on health outcomes due to limited size/number of studies, flaws in study/methods, gaps in chain of evidence, findings not generalizable, lack of information on important health outcomes
More information may allow estimation of effects on health outcomes

73
Q

CDC advises

A

on immunization practices

74
Q

Adult immunization recommendations

A

Influenza
TDAP
Zoster
MMR
Varicella
Pneumococcus

75
Q

Adult influenza

A

annually

76
Q

Adult TDAP

A

Single dose for adults 19+ and 10 year booster annually

77
Q

Adult zoster

A

adults >50 years (live vaccine)

78
Q

Adult MMR

A

1-2 doses if born in 1957 or later

79
Q

Adult Varicella

A

> 13 years if no evidence of immunity

80
Q

Adult HPV

A

females: up to age 26 (up to 45 with shared decision making)
Male: up to age 21
Men who have sex with men: up to age 26

81
Q

Adult meningococcal vaccine

A

adults up to age 21 who are living in college dorms

82
Q

Adult Hep B vaccine

A

adults age 19-59 with diabetes
other adults at high risk (HCW)

83
Q

Adult pneumococcus

A

2 separate vaccines:
Pneumovax (PPSV-23)
Prevnar (PCV-13)

> 65 all get PPSV-23

not recommended 19-64 and healthy not recommended

19-64 with chronic conditions: PPSV-23

19+ with immunocompromise PCV-13 and then PPSV-23

84
Q

PPSV-23

A

Pneumovax

85
Q

PCV-13

A

Prevnar

86
Q

Main types of vaccines

A

live attenuated vaccines
inactivated vaccines
subunit vaccines
toxoid vaccines
conjugate vaccines
mRNA vaccines

87
Q

Live attenuated vaccines

A

live version of the organism that has been weakened (attenuated) so that it doesn’t cause disease in patients with healthy immune systems

  • can cause disease in patients who are immunocompromised
  • usually need 1-2 doses for lie-long immunity
88
Q

Examples of live attenuated vaccines

A

MMR, Varicella/Zoster

89
Q

Inactivated vaccines

A

use a killed version of the germ
- may need several boosters to get long-term immunity or maintain immunity

90
Q

Examples of inactivated vaccines

A

polio injection (IPV), Hep A

91
Q

Subunit vaccines

A

contain part of the germ (essential antigen), does not cause infection and has less side effects

92
Q

Example of subunit vaccine

A

petrussis

93
Q

toxoid vaccines

A

prevent disease that are due to toxins that are produced by bacteria, use a weakened form of the toxin (toxoid)

94
Q

Example of toxoid vaccine

A

tetanus, diphtheria

95
Q

Conjugate vaccines

A

some bacteria have outer coating of polysaccharides that can prevent an immature immune system (infant and children) from recognizing them

link antigens or toxoids that the immune system does recognize to the polysaccharides (immune response to polysaccharides)

96
Q

Example of conjugate vaccines

A

Hib (meningitis for infants/toddlers)

97
Q

Major contraindications to vaccines

A
  • anaphylaxis to vaccine or component of vaccine (ex: eggs in flu)
  • pregnancy (no live attenuated vaccines)
  • severe immunodeficiency
98
Q

Allergen in influenza vaccine

A

eggs

99
Q

Allergen in varicella vaccine

A

gelatin

100
Q

Allergen in hepatitis B vaccine

A

baker’s yeast, neomycin

101
Q

Allergen in MMR, polio vaccines

A

streptomycin

102
Q

Live vaccines are contraindicated in:

A

immunocompromised, pregnancy

MMR, varicella, live zoster, live influenza

103
Q

Delay vaccines if patient is moderately or severely ______

A

ill

104
Q

postpone vaccine if patient has received _____________

A

immunoglobulin

105
Q

Side effects of vaccines

A

Guillain-barre, high fevers (104.5), seizures, prolonged/inconsolable crying

106
Q

Cervical cancer screening recommendations

A

ages 21 (25-65)
Frequency and tests depends on age for PAP (maybe will be discontinued), HPV testing (co-testing)

107
Q

Cytology is done every _____ years

A

3

108
Q

Colorectal screening recommendation

A

age 50-75 Grade A
age 45-49 Grade B

109
Q

Breast cancer screening

A

biennial mammography
age 5-74 Grade B

110
Q

Prostate cancer screening

A

age 55-69, PSA, individual decision, Grade C

111
Q

Lung cancer screening

A

smokers/former smokers age 50*-80 years old

112
Q

USPSTF types of counseling

A

tobacco cessation
healthy diet and physical activity
obesity screening
STI
fall prevention
skin cancer behavioral

113
Q

USPSTF types of screening

A

blood pressure (starts at 18)
depression
HIV
alcohol use
diabetes
intimate partner violence
osteoporosis
AAA
chlamydia and gonorrhea
hepatitis

114
Q

USPSTF types of chemoprevention

A
  • use of statins (hyperlipidemia to prevent MI)
  • tobacco cessation
  • ASA to prevent ASCVD (atherosclerotic disease) and colorectal cancer (helps prevent polyp formation)

ME 536- Patient Care II (8 decks)

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