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Foundations of health and disease > screening > Flashcards

screening Flashcards

1
Q

what is the phases of the natural history of disease

A

underlying
susceptible
subclinical
recovery/disability/death

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2
Q

what is primordial prevention

A

targets the population rather than individuals
focuses on social and environmental intervential
targets conditions that would lead to disease onset

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3
Q

what is primary prevention

A

targets susceptible populations of individual
prevent a disease from emerging and targets healthy individuals
reduces exposure to risk factors

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4
Q

what is secondary prevention

A

targets individuals with subclinical disease
early detection
screening programs

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5
Q

what is tertiary prevention

A

targets clinical and outcome stages of the disease
reduce disease severity and associated complications

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6
Q

what is quaternary prevention

A

Measures taken to identify patients at risk of over-medicalisation
Targets are patients with illness but no disease
Prevents harmful medical interventions

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7
Q

what are the disadvantages of classification systems

A

Classification systems are imperfect
Overlap between different types of prevention, and interventions may fall into more than one category
How can smoking cessation fall into primary, secondary and tertiary prevention?
Is all screening secondary prevention, or can some be classified as primary prevention?

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8
Q

what is screening

A

Screening is the presumptive identification of unrecognized disease or defect by the application of tests, examinations, or other procedures which can be applied rapidly.

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9
Q

what are the principles of screenings

A
  1. The condition should be an important health problem.
  2. There should be an accepted treatment for patients with recognized diseases.
  3. Facilities for diagnosis and treatment should be available.
  4. There should be a recognizable latent or early symptomatic phase.
  5. There should be a suitable test or examination.
  6. The test should be acceptable to the population.
  7. The natural history of the condition should be adequately understood.
  8. There should be an agreed policy on whom to treat as patients.
  9. The cost of case-finding should be economically balanced
  10. Case-finding should be a continuous process
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10
Q

what is the purpose of a screening test

A

detect potential disease indictators

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11
Q

what is the purpose of diagnostic tests

A

establish presence/absence of disease

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12
Q

what is the target population of screening tests

A

Large numbers of asymptomatic, but potentially at risk individuals

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13
Q

what is the target population of diagnostic test

A

Symptomatic individuals to establish diagnosis, or asymptomatic individuals with a positive screening test

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14
Q

what is the test method of screening tests

A

Simple, acceptable to patients and staff, should not be harmful

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15
Q

what is the test method of diagnostic test

A

maybe invasive, expensive but justifiable as necessary to establish diagnosis

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16
Q

what is the positive result threshold of a screening test

A

Generally chosen towards high sensitivity not to miss potential disease

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17
Q

what is the positive result threshold of a diagnostic test

A

Chosen towards high specificity (true negatives). More weight given to accuracy and precision than to patient acceptability

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18
Q

what is the postive result of a screening test

A

Essentially indicates suspicion of disease that warrants confirmation

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19
Q

what is the positive result of a diagnostic test

A

Result provides a definite diagnosis

20
Q

what is the cost of a screening test

A

Cheap

21
Q

what is the cost of a diagnostic test

A

higher costs

22
Q

what are the aims of screening

A

To reduce mortality by early detection and early treatment of a condition
To reduce the incidence of a condition by identifying and treating its precursors
To reduce the severity of a condition by identifying people with the condition and offering effective treatment
To increase choice by identifying conditions or risk factors at an early stage in a life-course when more options are available

23
Q

what are the screening steps

A

identify the population eligible for screening
invitation and information
testing
referral of screen positives and reporting of screen-negative results
diagnosis
intervention, treatment and follow-up
reporting of outcomes

24
Q

what is population-based screening

A

Systematically screen every person within a population

25
Q

what is selective screening

A

Applied to a particular subset of the population, e.g. high-risk group

26
Q

what is multiphasic screening

A

more than one test is applied for more than one condition

27
Q

what is opportunistic screening

A

during routine healthcare visists

28
Q

what does the national screening committee do

A

advises ministers in the 4 UK countries on implementing, continuing and modifying population-based screening programmes
considers all the evidence and makes recommendations based on a set of criteria that have evolved from the Wilson Jungner criteria

29
Q

what does public health england do

A

advises on implementation of safe, high quality screening programmes in England
develops standards and provides services that help the localNHSimplement and run screening services consistently across the country

30
Q

what does UKHSA do

A

is responsible for planning, preventing and responding to external health threats, and providing intellectual, scientific and operational leadership at national and local level, as well as on the global stage
Is an executive agency sponsored by the Department of Health and Social Care

31
Q

what is sensitivity

A

Proportion of true positives that are correctly identified by the test

32
Q

what is specificity

A

Proportion of true negatives that are correctly identified by the test

33
Q

what is accuracy

A

Proportion of true positives and true negatives that are correctly identified by the test

34
Q

what is a true positive

A

when predicted class and true class is positive

35
Q

what is a false negative

A

when the predicted class is positive but the true class is negative

36
Q

what is a false negative

A

when the predicted class is negative but the true class is positive

37
Q

what is a true negative

A

when the predicted class and true class are negative

38
Q

how do you calculate sensitivity

A

TP / (TP+FN)

39
Q

how do you calculate specificity

A

TN / (FP+TN)

40
Q

How do you calculate the positive predictive value PPV

A

TP / (TP+FP) or

41
Q

How do you calculate the negative predictive value NPV

A

TN / (FN+TN)

42
Q

How do you calculate accuracy

A

(TP+TN) / (TP+FP+FN+TN)

43
Q

what does a high sensitivity mean

A

Most people with the condition have been identified
If a test is negative, there is a high degree of certainty that the test subject does not have the disease
If a test is positive, the test subject may or may not have the disease

44
Q

what does a high specificity mean

A

Most test subjects with a positive test do have the disease
If the test positive, there is a high degree of certainty that the test subject does have the disease
If the test negative, the test subject may or may not have the disease

45
Q

what does the PPV tell us

A

if a test result is positive, what is the probability that the person has the condition?

46
Q

what does NPV tell us

A

if a test result is negative, what is the probability that the person does not have the disease?

Foundations of health and disease (21 decks)

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