Screening Programs

Question 1

Agency for Healthcare research and quality

Answer 1

Look through all research to determine burden of disease on society, pain of individual, cost of screening and treatment, etc. to determine a reliable system to work with

Question 2

Types of disease prevention

Answer 2

1) Primary - prevention of a disease before it happens (Immunizations, etc.), health promotion
2) Secondary - treatment of complications of a disease to prevent it from worsening or progressing (B-blockers, drug therapy), pre-symptomatic diagnosis and treatment
3) Tertiary - Assistance mitigating an already established bad outcome (OT, PT, rehab), disability limitation
4) Quaternary - Avoidance of unnecessary medical interventions (error in medicine)

Question 3

Sensitivity

Answer 3

Ability of a test to identify all individuals who actually are positive, including false positives (example of all spirochetes opposed to specifically syphilis)

Question 4

Specificity

Answer 4

Ability of a test to differentiate between individuals who are positive and negative, such as ignoring false positives

Question 5

USPSTF

Answer 5

United States Preventative Services Task Force that recommends screening for common diseases

Question 6

WHO Definition of health

Answer 6

State of complete physical, mental, and social well-being and not merely an absence of disease

Question 7

State of health (individual level)

Answer 7

reflects the degree to which a person is able to function physically, emotionally, and socially, with or without aid from the health care system.

Question 8

Measures of health status (community level)

Answer 8

• Mortality data
• Age adjusted death rate
• Health related indexes: quality adjusted life years, healthy life expectancy, general well being adjustment scale

Question 9

Rationed healthcare and example

Answer 9

Decisions made regarding health treatment based on age, quality of life, etc to determine what kind of treatment a person will receive (no screening for lung cancer over 70)

Question 10

Important example of primary prevention example

Answer 10

Pre-conceptive care (nutritional activity before even trying to become pregnant)

Question 11

Community screening

Answer 11

Identifying a subgroup of a population who are at high risk for having asymptomatic disease or who have a risk factor that puts them at high risk

Question 12

Case finding

Answer 12

Searching for asymptomatic disease while in the clinical setting

Question 13

Example of where screening tests do more harm than good

Answer 13

PSA (prostate specific antigen), which is highly sensitive but not very accurate

Question 14

Example of good tertiarty treatment

Answer 14

Diabetes treatment to prevent kidney disease

Question 15

Screening is NOT…

Answer 15

…Diagnosis

Question 16

Who gets screened?

Answer 16

• Some screenings are offered to anyone who wants to be (ie blood pressure testing)
• Some screenings are given on a mass basis to almost all people (PKU in infants)
• Some are for select groups of people (sickle cell testing in black individuals, mammogrpahy in women)

Question 17

Screening test flowchart

Answer 17

Negative - record and inform
Positive - perform diagnostic test
Negative diagnostic - record and inform
Postive diagonostic - start treatment
Positive response treatment - continue
Negative response treatment - revise treatment and reevaluate

Question 18

Multiphasic screening

Answer 18

More than one method used in combination (family history, social history, physical examination, diagnostic testing)

Question 19

Greatest predictor of health

Answer 19

Socioeconomic status

Question 20

Greatest predictor of socioeconomic status

Answer 20

Education

Question 21

Social considerations for screening

Answer 21

• Availability of therapy
• cost effective
• quality of life

Question 22

Reliability

Answer 22

Getting precise results consistently, necessary, but not sufficient in determining validity

Question 23

Validity

Answer 23

Getting accurate results

Question 24

What is the most accurate measure of blood pressure?

Answer 24

Inter-arterial measure

Question 25

3 Levels of evidence

Answer 25

Level A - meta-analysis, high quality randomized, controlled trials that considers all important outcomes, using comprehensive search strategies Always followed
Level B - Other evidence, well designed, nonrandomized clinical trial, quantitative systematic review with well substantiated conclusions, Almost always followed
Level C - Consensus/expert opinion, only sometimes used

Question 26

Screening definition

Answer 26

Examination of a large sample/population in order to detect the presence of a disease, an initial test with high sensitivity but low specificity done often to prelude more specific DIAGNOSTIC tests