Screening and Prevention Flashcards
What are the factors responsible for poor health care?
Genetics - 25%
Environment - 16%
Life Style - 48%
Limited Medical Care - 11%
What is the natural course of disease?
Exposure -> preclinical disease -> clinical disease -> complications -> death
How often is the influenza vaccine administered?
annually
How often if the pneumococcal vaccine given?
It is given to person after age 65
When is the tetanus Vaccination given?
every 10 years
Chemoprophylaxis is given with what?
Aspirin
Before providing medical care services what must occur?
Correct identification of patient
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Hypdertension Screening Coronary Artery Disease Screening Diabetes Screening Breast Cancer Screening Colon Screening
In evaluation prevention services, what are the two things that must be examined?
Screening test (accuracy of test and effectiveness of early detection) Immunization/Chemoprophylaxis (efficacy of vaccine/chemoprophylaxis and effectiveness)
What is the reason for screening likely disease?
- To separate those most likely to have disease from those least likely
- To exclude or confirm a diagnosis
Community, provider’s office, hospital, and work place are all examples of?
Screening Sites
What type of screening are available in the community?
Prevalence survey
screening high risk populations
What type of screening is available in a provider’s office?
Health and risk assessment
Diagnostic testing
What are the appropriate reasons for screening?
- Disease must be serious
- Treatment before symptoms occur more beneficial
- High Prevalence of preclinical disease
For a health screen to be accepted what are the 4 qualities it must have?
- Affordable
- Acceptable to the public
- Conducted in confidence
- Treatment for the disease is available
How should a screening test be evaluated?
It should be evaluated based on reliability, accuracy, and yield
What does it mean for a test to have reliability?
Performs consistently when given to individual under same conditions
What are the threats to reliability?
- Variations inherent in subjects (intra and inter)
- Variations in method
- Observer variation (intra and inter)
How can you improve reliability?
Standardization, training, and periodic checks
Test-retest, % agreement, kappa statistic
What is the Kappa statistic?
[(% observed agreement)-(% agreement expected by chance alone)]/[100%-(%agreement expected by chance alone)]
What is accuracy?
How well a test measures what it is designed to measure
Sensitivity and Specificity are two components of what?
Accuracy of a test
Why do we screen?
The goal of screening is to reduce morbidity or mortality from the disease by detecting diseases in their earliest stages, when treatment is usually more successful.
What is screening?
The application of a medical procedure or test to people who as yet have no symptoms of a particular disease Goal is to determine the likelihood of disease.
T/F
Screening procedure can diagnose illness
False
It does not diagnose the illness
Pap smear, mammogram, clinical breast exam, blood pressure determination, cholesterol level, eye examination/vision test, and urinalysis are all examples of what?
Screening test
What is sensitivity and specificity?
Measure of a test’s ability to correctly classify a person as having a disease or not having disease
What is sensitivity?
Test ability to designate an individual with disease as positive (ability of a test to detect the disease/condition when it is truly present)
If a test has few false negative what does that mean?
It is highly sensitive
fewer cases of disease are missed
What is specificity?
ability to designate an individual who does not have a disease as negative. (the ability of a test to exclude the disease/condition in patients who do not have the disease or condition)
What does it mean when a test is highly specific?
Means that there are few false positive results
What is predictive?
The probability of having the disease, given the results of a test
What is positive predictive?
The probability that a patient with a positive (abnormal) test results actually has a disease
What is negative predictive value?
the probability that a person with a negative (normal) test result is truly free of disease.
what is predictive value determined by?
by the sensitivity and specificity of the test and the prevalence of disease in the population being tested
What is prevalence?
defined as the proportion of persons in a defined population at a given point in time with the condition in question
The more sensitive a test, the ______ likely an individual with a negative test will have the disease and thus the greater the negative predictive value.
Less
The more ____ the test, the less likely an individual with a positive test will be free from disease and the greater the positive predictive value.
specific
What happens when the prevalence of preclinical disease is low?
The positive predictive value will also be low, even when using a test with high sensitivity and specificity
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What criteria should be considered for an effective screening program?
- Life threatening diseases
- Treatment of disease at their earlier stage should be more effective than treatment began after the development of symptoms
- The prevalence of the detectable preclinical phase of disease has to be high among the population screened. ?????/
- a suitable screening test must be available.
- there must also be appropriate follow-up of the those individuals with positive screening results to ensure thorough diagnostic testing occurs
What is positive predictive value?
the probability that the patient has the disease/condition given that the test results are positive
What is negative predictive value?
the probability that a patient does not have the disease/condition given that the test results are negative.
Yield includes two components, what are they?
Number need to screen and number needed to treat
number needed to screen
is a measure of how many individuals need to be screened to find a true positive result.
Number needed to treat
is a measure of how many individuals must be treated to achieve a desired outcome
How do you measure the variable results of specificity and sensitivity?
Independent variable
dependent variable
interaction of sensitivity, specificity, and predictive values
Independent variable
The constant variable that is the treatment causing other variables to respond to intervention is defined as independent variable or cause
Dependent variable
Interactive responses as a result of primary causes in a screening test is defined as the effect of interval or dependent variables results of the tests
Interactions of sensitivity, specificity, and predictive values?
The above factors respond to the normal or abnormal results of the relationship between specificity and sensitivity and predictive values about the type of interventions needed in prevention and treatment of a disease in individuals or populations in health care delivery systems.
According to the ACA what is required of private insurances?
requirement that private insurance plans cover recommended preventive services without any patient cost-sharing
