Prevention and Screening- Moen

Question 1

What are the factors responsible for poor health?

Answer 1

-genetics
-environment (is a social factor)
-lifestyle
limited medical care (the answer is affordable healthcare)

Question 2

What is the natural course of disease?

Answer 2

1. Exposure
2. Preclinical disease
3. Clinical disease
4. Complications
5. Death

Question 3

What are the levels of prevention?

Answer 3

• influenza vaccination: annually
• pneumococcal vaccination: after age 65
• tetanus vaccination: every 10 years
• chemoprophylaxis
• correct Identification of patient BEFORE providing medical care services

Question 4

Health is not the absence of disease.

Answer 4

it is a privilege. You have to pay for it to get it. It is to keep your physical, emotional wellbeing.

Question 5

What are the 3 correct Identification of patient BEFORE providing medical care services?

Answer 5

Name
Birthday
Social security

Question 6

Level of Prevention

Answer 6

• hypertension screening
• coronary artery disease screening
• diabetes screening
• breast cancer screening (men are also at risk)
• colon cancer screening

Question 7

What are at least two factors in evaluating prevention services?

Answer 7

1. screening tests
   - accuracy of tests
   - effectiveness of early detection
2. immunization/chemoprophylaxis
   - efficacy of vaccine/chemoprophylaxis
   - effectiveness

VACCINE delays mortality more than preventing

Question 8

You have to be precise with your questions to the patients.

Answer 8

??

Question 9

What are the reasons for screening?

Answer 9

• to separate those most likely to have a disease from those least likely
• to exclude or confirm a diagnosis

Question 10

What is the difference between incidence and prevalence?

Answer 10

all the new cases
incidence conveys information about the risk of contracting the disease, whereas prevalence indicates how widespread the disease is

HIV incidence rates have reduced because of screening and vaccinations

Question 11

Where are places to screen?

Answer 11

1. community
   - prevalence survey
2. provider’s office
   - health and risk assessment
   - diagnostic testing
3. Hospital
4. Work place

Question 12

What are the appropriate reason for screening?

Answer 12

1. disease must be serious (you don’t just do screenings—they COST; you do it when they are Asymptomatic)
2. treatment before symptoms occur more beneficial
3. High prevalence of preclinical disease

Question 13

What is the acceptability of screening tests?

Answer 13

1. affordable
2. acceptable to the public
3. conducted in confidence
4. treatment for the disease

Question 14

What are the evaluative criteria for screening tests?

Answer 14

• reliability
• accuracy
• yield

Question 15

What is reliability?

Answer 15

-test performs consistently when given to individual under same conditions (not be being biased based on one pt dressed up nicely as opposed to another not dressed nicely)

reliability improves with standardization, training, and periodic checks

Question 16

What are threats to reliability?

Answer 16

• variations inherent in subjects
• variations in method
• observer variation

test everything before you apply it

cannot have a questionnaire before administering

Question 17

What is accuracy? What are its two components?

Answer 17

a test that measures what it is designed to measure; the probability of making a mistake is sooo minimal

Accuracy of a test has two components; it has to be:

• sensitive
• specific

Question 18

What is the goal of screening? What is the purpose of medicine?

Answer 18

it is to reduce morbidity or mortality (extending the quality of life) from the disease by detecting diseases in their earliest stages, when treatment is usually more successful

to delay death is the purpose of medicine (medicine does not prevent death but offers you a chance to have a quality of life)

Question 19

What does screening mean?

Answer 19

• refers to the application of a medical procedure or test to people who as yet have no symptoms of a particular disease
• the purpose of which is determining their likelihood of having the disease
• screening procedure itself DOES NOT DIAGNOSE the illness
• those who have a positive result from the screening test will need further evaluation with subsequent diagnostic test or procedure

Question 20

What are some examples of screenings?

Answer 20

pap smear, mammogram, clinical breast exam, blood pressure determination, cholesterol level, eye examination/vision test, and urinalysis.

Question 21

What is sensitivity?

Answer 21

sensitivity refers to a test’s ability to designate an individual with disease as POSITIVE

refers to a tests ability to CORRECTLY classify a person as having a disease or not having a disease

-has very few false negative results, thus fewer cases of disease are missed

Question 22

How is specificity different from sensitivity?

Answer 22

specificity of a test is its ability to designate the individual who does not have a disease as NEGATIVE

Question 23

What is predictive value?

Answer 23

the probability of having the disease, given the results of a test

It is an ANSWER to the question.

Question 24

How is the predictive value determined?

Answer 24

-determined by the sensitivity and specificity of the test and the PREVALENCE of disease in the population being tested

Question 25

What criteria should be considered for an effective screening program?

Answer 25

1. life-threatening diseases, such as those as breast cancer, and those known to have serious and irreversible consequences if not treated early such as congenital hypothyroidism, are appropriate for screening 3. treatment of disease at their earlier stages should be more effective than treatment begun after the development of symptoms 4. the prevalence of the detectable preclinical phase of disease has to be high among the population screened

Question 26

Treatment is more effective during the screening stage than when the cancer has become invasive.

Answer 26

On the other hand, lung cancer has a poor prognosis regardless of the stage at which treatment is initiated. Early diagnosis and treatment appear to prolong life little more than therapy after symptoms have developed. Screening to detect early stage lung cancer using currently available techniques would not be beneficial. The definition of cancer has changed overtime.

Question 27

A suitable screening test must be available. Suitability criteria includes what?

Answer 27

-includes adequate sensitivity and specificity, low cost, ease of administration

Question 28

What is true positive ?

Answer 28

sensitivity a/[a+c]

Question 29

What is true negative ?

Answer 29

specificity | d/[b+d]

Question 30

What is false positive?

Answer 30

Disease/condition is absent but test is positive

Question 31

What is false negative?

Answer 31

disease condition is present but test is negative

Question 32

Again what is the difference between sensitivity and specificity?

Answer 32

sensitivity is the ability of a test to detect the disease/condition when it is truly present specificity is the ability of a test to exclude the disease/condition in patient who do not have the disease/condition

Question 33

What are the 3 factors for measuring sensitivity?

Answer 33

- independent variable - dependent variable - interactions of sensitivity, specificity, and predictive values

Question 34

What is number needed to screen (yield)?

Answer 34

is a measure of how many individuals need to be screened to find a true positive results

Question 35

What is number needed to treat (yield)?

Answer 35

is a measure of how many individuals must be treated to achieve a desired outcome