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Semester 4 > HaDSoc Session 6 > Flashcards

HaDSoc Session 6 Flashcards

1
Q

What is opportunistic case finding in disease presentation?

A

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

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2
Q

What is screening?

A

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

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3
Q

Describe the process of diagnosis.

A

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

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4
Q

Describe the process of screening.

A

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

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5
Q

What is the purpose of screening?

A

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

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6
Q

What screening and diagnostic tests are used for breast cancer?

A

Mammography and fine needle aspiration

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7
Q

Who is screened for breast cancer and how often?

A

50-70 y.o. Females, 3 yearly

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8
Q

What screening and diagnostic tests are used for bowel cancer?

A

Faecal occult blood test and colonoscopy

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9
Q

What are the screening and diagnostic tests used in AAA?

A

Single US scan and surgery is appropriate

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10
Q

Who is screened for bowel cancer and how often?

A

60-69 y.o. Males 2 yearly

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11
Q

What are the advantages of AAA screening?

A

Decreases risk of death from rupture by ~50%

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12
Q

What are the disadvantages of AAA screening?

A

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

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13
Q

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

A

Could do more harm than good

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14
Q

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

A

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

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15
Q

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

A

Simple, safe, precise, valid and acceptable to population

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16
Q

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?

A

Distribution of test values

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17
Q

What is a true +ve screening result?

A

Disease present and +ve test

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18
Q

What is a false +ve screening test?

A

Disease absent, +ve test

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19
Q

What is a false -ve screening result?

A

Disease present and -ve test

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20
Q

How is disease detected?

A

Spontaneous presentation, opportunistic case finding, screening

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21
Q

What is a true -ve screening result?

A

Disease absent and -ve test

22
Q

What are the implications of false +ve screening results?

A

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

23
Q

What are the implications of false -ve test results?

A

Inappropriately reassured and therefore may delay presentation with symptoms

24
Q

What is sensitivity?

A

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

25
Q

What does high sensitivity of a screening test mean?

A

Test good for detecting screened for disease

26
Q

What is specificity?

A

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

27
Q

What does high specificity of a screening test mean?

A

Tests good at correctly identifying non-cases

28
Q

What is +ve predictive value?

A

Probability a +ve test is a case

29
Q

What is +ve predictive value strongly influenced by?

A

Prevalence

30
Q

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

A

Reduces it

31
Q

What is -ve predictive value?

A

Proportion of test -ves that are not cases

32
Q

Do sensitivity and specificity vary with the population?

A

No

33
Q

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

A

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
Q

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

A

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

35
Q

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

A

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

36
Q

What are some of the issues in screening for disease?

A

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

37
Q

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

A

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

38
Q

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

A

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

39
Q

When are women aged 65+ screened for cervical cancer?

A

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

40
Q

What process is used in cervical screening?

A

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

41
Q

What is lead time bias?

A

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
Q

What is length time bias?

A

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

43
Q

What is selection bias in screening programmes?

A

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

44
Q

How can selection bias be overcome in new screening programmes?

A

Use of RCTs

45
Q

What are the limitations of screening programmes?

A

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
Q

What are structural critiques of screening programme?

A

Victim blaming and individualising pathology

47
Q

What is victim blaming?

A

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

48
Q

What is the problem with individualising pathology in screening?

A

Suggests we should invest in primary intention more

49
Q

What are the surveillance critiques of screening?

A

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

50
Q

What are the social constructionist critiques of screening?

A

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
Q

What is the feminist critique of screening?

A

Targeted more at women than men

52
Q

What are the Wilson-Junger criteria?

A

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

Semester 4 (33 decks)

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