HaDSoc Session 6 Flashcards Preview

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Flashcards in HaDSoc Session 6 Deck (52):
1

What is opportunistic case finding in disease presentation?

Health professional takes opportunity to check for potential conditions on presentation of symptoms for a different disease

2

What is screening?

Systematic attempt using simple, rapid and cheap tests to detect an unrecognised condition in apparently well people

3

Describe the process of diagnosis.

Presentation --> Hx, examination and tests --> disease/no disease --> Tx that pt is willing to take risks of due to self-identification of problem

4

Describe the process of screening.

Rapid, cheap test --> screen +ve = high risk, -ve = low risk --> diagnostic tests if +ve --> disease/no disease --> Tx if necessary

5

What is the purpose of screening?

Give a better outcome in comparison with spontaneous presentation or opportunistic case finding

6

What screening and diagnostic tests are used for breast cancer?

Mammography and fine needle aspiration

7

Who is screened for breast cancer and how often?

50-70 y.o. Females, 3 yearly

8

What screening and diagnostic tests are used for bowel cancer?

Faecal occult blood test and colonoscopy

9

What are the screening and diagnostic tests used in AAA?

Single US scan and surgery is appropriate

10

Who is screened for bowel cancer and how often?

60-69 y.o. Males 2 yearly

11

What are the advantages of AAA screening?

Decreases risk of death from rupture by ~50%

12

What are the disadvantages of AAA screening?

Of 238 invited only one would present in the next 10 years, Tx may result in death anyway, reduced QoL with Tx, intolerable anxiety of having untested AAA

13

Why is there currently no national screening programme for prostate cancer, breast cancer

Could do more harm than good

14

What disease criteria must be met for a screening programme to be introduced?

Important, epidemiology and natural Hx well understood, early detectable stage, cost-effective primary interventions fully explored

15

What test criteria must be met for a screening programme to be introduced?

Simple, safe, precise, valid and acceptable to population

16

What must be known about a test used for screening in order for an agreed cut-off and policy of further investigation to be defined?

Distribution of test values

17

What is a true +ve screening result?

Disease present and +ve test

18

What is a false +ve screening test?

Disease absent, +ve test

19

What is a false -ve screening result?

Disease present and -ve test

20

How is disease detected?

Spontaneous presentation, opportunistic case finding, screening

21

What is a true -ve screening result?

Disease absent and -ve test

22

What are the implications of false +ve screening results?

Undergo stress, anxiety and inconvenience and cause direct and opportunity costs

23

What are the implications of false -ve test results?

Inappropriately reassured and therefore may delay presentation with symptoms

24

What is sensitivity?

Detection rate = proportion of people with disease detected, probability of cases test +ve

25

What does high sensitivity of a screening test mean?

Test good for detecting screened for disease

26

What is specificity?

Proportion of non-cases that test -ve = probability non-case tests -ve

27

What does high specificity of a screening test mean?

Tests good at correctly identifying non-cases

28

What is +ve predictive value?

Probability a +ve test is a case

29

What is +ve predictive value strongly influenced by?

Prevalence

30

What effect does low prevalence have of +ve predictive value?

Reduces it

31

What is -ve predictive value?

Proportion of test -ves that are not cases

32

Do sensitivity and specificity vary with the population?

No

33

What treatment criteria must be met for a screening programme to be put in place?

Must have effective EBP for which early implementation is advantageous and clinical management must be optimised in practices before they can participate in screening

34

What programme criteria must be met for screening to be implemented?

Proven effectiveness, quality assurance, facilities for counselling false +ves and facilities for diagnosis and Tx

35

Why must the knowledge base be much stronger for screening compared to clinical practice?

Targets apparently healthy people to offer them help for something they may never thought about

36

What are some of the issues in screening for disease?

Alteration of usual dr-pt contact, complexity of screening programmes, evaluation, limitations of programmes and sociological critiques of programmes

37

Why are women less than 25 y.o. Not screened for cervical cancer?

It is rare and lesions detected at this stage are likely to regress

38

What is cervical screening not conducted more frequently in women aged 50-64 y.o.?

Natural Hx means older onset unlikely and will not lead to mortality

39

When are women aged 65+ screened for cervical cancer?

If they have not been screened since 50 or if there have been recent abnormalities

40

What process is used in cervical screening?

Speculum --> cervix cell sample --> cells in preservative fluid --> cytology lab interprets and grades

41

What is lead time bias?

Early diagnosis falsely appears to prolong survival by shifting start-point of known disease so pts love for the same length of time but longer knowing about disease

42

What is length time bias?

Screening programmes better at picking up slow-growing cases that may never have needed curing

43

What is selection bias in screening programmes?

Those who engage in screening are more likely to perform health promoting behaviours

44

How can selection bias be overcome in new screening programmes?

Use of RCTs

45

What are the limitations of screening programmes?

Screening can reduce risk of disease/complications but not guarantee protection; all programmes have false +ves and -ves; pts need to make an informed choice; uncertainties and extent of over-diagnosis; communicating benefits and risks can be challenging

46

What are structural critiques of screening programme?

Victim blaming and individualising pathology

47

What is victim blaming?

Not all individuals are equally able to take responsibility for their own health

48

What is the problem with individualising pathology in screening?

Suggests we should invest in primary intention more

49

What are the surveillance critiques of screening?

Individuals and population are more subject to surveillance potentially offering an apparatus of social control

50

What are the social constructionist critiques of screening?

Health and illness practices moral so give meaning through social relationships e.g. Screening is responsible and needs to be 'gotten used to' with non-attendance being deviant or irresponsible

51

What is the feminist critique of screening?

Targeted more at women than men

52

What are the Wilson-Junger criteria?

4 criteria screening programmes must meet regarding the disease/condition, the test, treatment and programme