Week 7 Screenings

Question 1

Screening

Answer 1

• detection of a disease in its early stages
• treat the disease, stop the disease from progressing
• also reduce cost of disease management by avoiding costly interventions required at later stages

Question 2

Early Detection

Answer 2

key
- some diseases preceded by a period of asymptomatic pathogenesis or latency
- can be simple and inexpensive compared to the burden of disease
- avoids more intensive intervention later

Question 3

Individual Screening

Answer 3

• one person tested
• often chosen based on risk factors
• sometimes chosen based on universal screening
• mammogram for young adult who has family hx of breast cancer

Question 4

Group or mass screening

Answer 4

target population selected on basis of increased risk
- vision screening in school children
- testing for PKU in neonates

Question 5

One-test disease specific screening

Answer 5

• single test
• detects characteristic indicating high risk
• Hemoglobin A1C and diabetes
• Cholesterol levels and hypercholesterolemia

Question 6

Multiple test screening

Answer 6

2 or more tests to detect one disease
- tuberculosis = tb skin test, blood test, chest x-ray, sputum cultures
- if one comes back positive, then they do more

Question 7

Screening Criteria

Answer 7

• detection
• diagnostic criteria
• screening measures

Question 8

Detection

Answer 8

• for a certain disease, are there well-documented diagnostic criteria?
• Resources/treatment that are available to support that screening?

Question 9

Diagnostic criteria

Answer 9

• disease should have early asymptomatic state, if not should we be screening for it?
• risk factors: who should be screened?

Question 10

Screening measures

Answer 10

• must be safe, cost-effective, accurate
• screening tool must accurately distinguish those with and without disease

Question 11

Advantages of Screening

Answer 11

• simple screening tests are cost-effective
• screening process can be applied to both individuals and larger populations (like BP check at appt or fairs)
• some screenings mandated by law (ex. PKU)
• screening can be one test disease specific or multiple test screening
• creates opportunity for health teaching

Question 12

Disadvantages of screening

Answer 12

• uncertainty in scientific evidence/possibility of errors
• any margin of error can have serious consequences
• false positive = anxiety, unnecessary interventions
• false negatives = disease is overlooked, missed opportunity for early intervention, provide false assurance
• ex = microcalcification on mammogram leads to painful biopsy

Question 13

Selection of a “screenable” disease

Answer 13

• just because we can, does it mean we should
• Consider the following q’s =
• Does its significance warrant its consideration as a community problem?
• Does it affect multiple people? Rare?
• Can the disease be detected by a screening?
• Should screening for the disease be done? Like if we don’t have treatment for it
• Health benefits: can it be treated?
• Tangible and intangible costs (emotional and financial)
  Answers = complex and ethical

Question 14

Should screening be done?

Answer 14

• Is there any benefit to early detection?
• Are there effective treatments available?

Question 15

Interventions/treatment modalities

Answer 15

• specific interventions that will affect disease progression needed to justify screening
• f/u critical to aid implementing interventions
• consider safety = avoid risks or harmful effects
• some screenings are not recommended due to false positives and overtreatment
• USPSTF = may recommend against screening, where the guidelines come from

Question 16

Quality of Life

Answer 16

subjective, difficult to assess
- some formulas for calculating

Question 17

Epidemiology

Answer 17

method used to find cause of disease (and outcomes) in populations

Question 18

Morbidity

Answer 18

diseased state or disability from any cause
- includes range or degree of illness
Rate?

Question 19

Mortality

Answer 19

deaths in a given population as a result of a specific disease/illness/event

Question 20

Significance

Answer 20

level of priority of disease as public health concern

Question 21

Incidence

Answer 21

rate of a new population problem and estimates risk of individual developing disease
- measures new cases
rate of a new population problem, risk of individual developing disease ACUTE
IN = incidence and new

Question 22

Prevalence

Answer 22

proportion of the population with disease at any one point in time
- measures all cases within a set period of time
proportion of population with disease at any given one point in time
CHRONIC
CP = current and prevalence

Question 23

Screening Measues

Answer 23

Reliable ≠ Valid

Question 24

Reliability

Answer 24

Extent to which a measuring procedure yields consistent results on repeated administrations of the scale
- exact same results every time

Question 25

Inter-observer

Answer 25

same results when 2 persons do test

Question 26

Intra-observer

Answer 26

same person able to reproduce results in same pt

Question 27

Validity

Answer 27

Degree that a measuring procedure accurately reflects, assess, or captures the specific concept that the researcher is attempting to measure - measuring what you actually want to measure measurement of accuracy, is the test able to distinguish who has the disease

Question 28

Test sensitivity

Answer 28

the ability of a test to correctly identify those with the disease (true positive rate) - if you do have the disease, you would have true positive

Question 29

Test specificity

Answer 29

the ability of a test to correctly identify those without the disease (true negative rate) - if you don't have a disease, you would want a true negative

Question 30

Guidelines

Answer 30

come from USPSTF - change over time

Question 31

Ethical considerations

Answer 31

request for participation implies a health benefit - ethical and economic

Question 32

Clinical preventative services

Answer 32

- save years of life and help people live better during those years - save money, provide quality care, reduce death, disability, and disease

Question 33

USPSTF

Answer 33

panel of experts in primary care and prevention who reviews the evidence of effectiveness and develops recommendations for clinical prevention services - 16 categories in their guide to clinical preventive services

Question 34

USPSTF Grading

Answer 34

A B C D I

Question 35

Grading = A

Answer 35

- recommends the service - high certainty that the net benefit is substantial - offer or provide this service

Question 36

Grading = B

Answer 36

recommends this service - high certainty that net benefit is moderate or there is moderate certainty that the net benefit is moderate or substantial - offer or provide this service

Question 37

Grading = C

Answer 37

- recommends selectively offering or providing this service to individual patients based on professional judgement and pt preference - there is at least small to moderate certainty that the net benefit is small - offer or provide this service for selected patients depending on individual circumstances

Question 38

Grading = D

Answer 38

- recommends against this service - moderate or high certainty that the service has no net benefit or that the harms outweigh the benefit - Discourage the use of this service

Question 39

Grading = I

Answer 39

- concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service - evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined - pt's should be aware of the uncertainty about the balance of benefits and harms, if the service is offered

Question 40

Nursing role in screening

Answer 40

- development and implementation of screening programs - decision maker - planner - education and counseling - follow up - collaborate with other HCPs - focus on primary and secondary prevention