Term
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Definition
| the first level at which a patient first receives medical attention |
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Term
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Definition
| the usual medical care provided in a hospital, nursing home, or by a home health agency |
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Term
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Definition
| refers to highly specialized care in which the most up-to-date sophisticated technology available is utilized (e.g. transplant surgery, specialized intensive care units) |
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Term
| Primary prevention is the institution of measures aimed at _____ ____ or ___ from occuring. Give examples. |
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Definition
- preventing injury or disease
Vaccination to prevent disease, use of helmets to prevent head injuries, use of condoms to prevent HIV infection, chlorination of water supply to prevent water-borne diseases, use of fluoride to prevent dental cavities, education about hazards (smoking) |
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Term
| Secondary intervention is the institution of measures aimed at ___ or ___ the occurence of ___ ___ or ____ disease, by ___ detection and treatment of the disease. This is aimed at individuals in whom the ___ process has already started but is at the ____ phase. Aimed at ___ ___ of the disease. Give Examples. |
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Definition
- delaying or preventing the occurence of full blown or symptomatic disease by early detection and treatment of the disease
- disease process has already started but is in asymptomatic stage
- reducing prevalence
Cancer screening, screening for HIV infection, screening for early detection of disease |
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Term
Tertiary prevention is the prevention of, or limiting the extent of impairment, disability or complications, of disease with the aim of restoring the afflicted patient to a useful, productive life with the highest quality of possible life. Disease has already occurred and been treated clinically, and the aim is to rehabilitate the patient
Examples
Physical therapy for stroke victims, halfway houses for recovered alcoholics, fitness programs for heart attack patients |
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Definition
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Term
Early diagnosis is not a new idea
Attention has shifted to prevention and early detection
More effective
cost-effective means for disease control
More screening technologies are becoming available
Role of whole body scanning?
Virtual colonoscopies? |
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Definition
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Term
| Screening is the identification of ____ disease in a given population through the application of tests, examinations, etc. which can be applied ___. |
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Definition
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Term
| Screening separates out those that have the disease from those that do not. It differs from diagnosis, which is the process of confirming an actual case of a disease. It is also different from clinical prediction models. The purpose of screening is to ___ ___ as to whether they are ____to have the disease or be disease free. |
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Definition
- classify individuals
- likely |
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Term
Target disorders are relatively rare
Many people need to be screened to find disease
Unforeseen risks, even if rare and minor, may affect large number of screened subjects
Screening test
Diagnosis
Treatment
Benefits affect only few subjects |
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Definition
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Term
| positive screening tests can be: |
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Definition
| true positive or false positive |
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Term
| negative screening tests can be : |
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Definition
| true negatives or false negatives |
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Term
| disease can come up with what results: |
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Definition
- true positive
- false negative |
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Term
| no disease can show what screening results: |
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Definition
- true negative
- false positive |
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Term
| ___ ___ ___ ___ ___ offers guidance on more screening tests. Genetic testing has increased screening methods. |
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Definition
| U.S. Preventative Services Task Force |
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Term
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Definition
Cardiovascular Diseases
Congenital Disorders
Infectious Diseases
Mental Disorders and Substance Abuse
Metabolic, Nutritional, and Environmental Disorders
Musculoskeletal Disorders
Neoplastic Diseases
Prenatal Disorders
Vision and Hearing Disorders |
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Term
| characteristics of a good screening test: |
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Definition
- simple
- rapid
- inexpensive
- safe
- acceptable |
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Term
| Measures used to evaluate screening tests: |
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Definition
- Validity (accuracy)= sensitivity and specificity
- Reliability (precision/repeatability)
- Yield
- Predictive values (+/-) |
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Term
| Validity is how good the test is at identifying those ___ ____ __ ___ from those that __ __. It is the degree to which the results of a measurement correspond to the ___ state of affairs. |
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Definition
- that have the disease from those that do not
- true |
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Term
Sensitivity and Specificity deal with the question:
How good is the test to identify disease and non-disease individuals?
Important public health consideration |
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Definition
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Term
| Sensitivity and Specificity are measures used to determine whether or not testing should be done. They are generally regarded as ___ of disease prevalence. |
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Definition
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Term
| Predictive values are calculated ___ the test results and are dependent on ___, ___, and ___ ___. |
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Definition
- after
- sensitivity, specificity, disease prevalence |
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Term
| Sensitivity measures the ability of a test to ___ ___those __ ___ __ ___. What question does it answer? |
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Definition
- correctly identify those who have the disease
- Of all of those that have the disease and are being screened, what proportion of them will be identified by the test? |
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Term
| equation for sensitivity: |
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Definition
| sensitivity= [TP/(TP+FN)] x100 |
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Term
| Specificity measures the ability of a test to ___ ___ those ___ ___ __ __ __ ___. What question does it answer? |
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Definition
- correctly identify those who do not have the disease
- Of all of those being screened who do not have the disease, what proportion of them will be identified as disease free? |
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Term
| equation for specificity: |
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Definition
| specificity= [TN/(TN+FP)] x100 |
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Term
| To improve sensitivity, the cut point used to classify individuals as diseased should be moved ____ in the range of the ____ individuals. |
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Definition
| - farther in the range of nondiseased individuals |
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Term
| To improve specificity, the cut point should be moved ___ in the range associated with ___ individuals. |
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Definition
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Term
| sensitivity and specificity have an ___ relationship. |
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Definition
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Term
Define HTN as systolic BP > 140
Can make test highly specific by using cut-off point of 200 mm Hg
Unlikely to falsely classify people as hypertensive
Sensitivity will be very low, as subjects with BP between 140 and 199 mm HG will be missed |
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Definition
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Term
To increase sensitivy move towards non-diseased, so A would be increased sensitivity.
To increase specificity, move towards diseased, so C would be increased specificity. |
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Definition
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Term
| If we ___ the cut off level, you increased the number of individuals who correctly test ____, thus we increase ____. But this also would decrease the proportion who correctly test ____, thus decreasing ____. |
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Definition
- raise
- negative
- increase specificity
- positive
- sensitivity |
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Term
| So when you increase specificity you increase the number that correctly test negative, but by doing so, you decrease sensitivity meaning you decrease the number that correctly test positive. |
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Definition
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Term
| procedures to improve sensitivity and specificity: |
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Definition
Retrain screeners--reduces the amount of misclassification in tests that require human assessment
Recalibrate screening instrument--reduces the amount of imprecision
Utilize a different test
Utilize more than one test |
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Term
| With tests in series, a subject is classified as ____ only if he/she tests positive in ___ the tests. He/she is classified as ___ if ___ of the tests are ___. Tests are employed in series to improve the ____ of the first test. |
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Definition
- positive only if all tests are positive
- negative if one of the tests is negative
- specificity |
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Term
| With tests in parallel, a subject is classified as ___ if he/she is ___ in ___ test. Tests are employed in parallel to improve ___ ___, because each test by itself cannot identify all of the cases of disease. |
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Definition
- positive if any of the tests are positive
- overall sensitivity |
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Term
| tests in series improve ____ of the first test. |
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Definition
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Term
| tests in parallel improve overall _____. |
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Definition
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Term
| Repeated measures reliablility is defined as the degree of ___ between or among repeated measurements of the ___ ___ on more than one occasion. This is also referred to as ___ ___ ____. |
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Definition
- consistency
- same individual
- test-retest reliability |
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Term
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Definition
| - degree of homogeneity within items on a questionnaire |
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Term
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Definition
| - degree of agreement among trained experts or observers |
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Term
| how to think about reliability and validity in terms of a target. |
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Definition
- reliability is hitting the same area consistently
- validity is hitting the bulls eye
so results can be reliable but not valid, or valid but not reliable, or both reliable and valid |
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Term
| causes of unreliability/inconsistency: |
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Definition
Technical error
Sampling error
Observer error (intra-observer and inter-observer variation)
halo effect
lack of blinding
Respondent error
social desirability
Biological error |
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Term
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Definition
| i think someone has this condition, so I read the results differently |
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Term
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Definition
| = someone filling out eval on a person may already have pre-judgement therefore tend to slant all responses to that opinion. |
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Term
| Social desirability – answer questions based on what is socially acceptable |
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Definition
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Term
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Definition
| variability in actual physiology or biology of the phenomena - variability of asthma symptoms, etc |
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Term
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Definition
| the number of previously unregonized individuals identified by the screening test |
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Term
| the higher the sensitivity the higher the ____. |
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Definition
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Term
| The higher the prevalence of unrecognized disease, the higher the ___. |
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Definition
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Term
| The more previous screenings there have been, the ___ the yield will be. |
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Definition
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Term
| Applying a screening test in areas with limited health care will have ___ ___. |
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Definition
higher yield
(health behavior affects yield) |
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Term
| predictive value is concerned with test ___. |
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Definition
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Term
| positive predictive value: |
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Definition
| - the proportion of those that screened positive by the test, that actually have the disease |
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Term
| equation for positive predictive value: |
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Definition
[TP/(TP + FP)] x100
looking at proportion of all that screened positive, how many have the disease |
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Term
| define negative predictive value: |
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Definition
| - of all those that screened negative, the proportion that actually do not have the disease |
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Term
| equation for negative predictive value: |
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Definition
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Term
| disease criteria for a successful screening program: |
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Definition
- present in the population screened
- high morbidity and/or mortality must be an important public health problem
- early detection and intervention must improve outcome |
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Term
| test criteria for a successful screening program: |
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Definition
- should be sensitive and specific
- should be simple and inexpensive
- safe
- acceptable to patients and practitioners |
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Term
| risks of screening and getting true positive: |
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Definition
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Term
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Definition
- monetary expense
- harm from confirmatory tests
- anxiety
- fear of future screens |
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Term
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Definition
| - costs and risks of test |
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Term
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Definition
- delayed interventions
- disregard of early signs and symptoms |
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Term
| The number 1 criteria for a mass screening program is that the disease should represent a ___ ___ __ and have a ___, ____, ____ phase. It must be associated with ___ consequences and be ___ ___. Give examples. |
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Definition
- public health problem
- prevalent,asymptomatic nonmetastatic
- severe
- relatively common
Breast Cancer
Colon Cancer
Prostate Cancer
Cervical Cancer |
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Term
| 11 criteria necessary for mass screening program. |
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Definition
1. Disease of interest should represent a public health problem and have a prevalent, asymptomatic nonmetastatic phase. It must be associated with severe consequences and be relatively common.
2. There should be an accepted treatment for patients with recognized disease.
3. Screening should offer a clear benefit
Lung cancer? Skin cancer?
4. Facilities for diagnosis and treatment should be available.
5. There should be a recognized latent or prolonged early symptomatic stage.
6. There should be a suitable test or examination.
7. The test should be acceptable to the population.
8. The natural history of the condition, including development from latent to declared disease, should be adequately understood.
9. There should be an agreed policy on whom to treat as patients.
10. The cost of screening (including diagnosis and treatment of patients diagnosed) should be economically balanced in relation to possible expenditure on medial care as a whole.
11. Detection of unrecognized disease (in apparently healthy subjects) should be a continuing process and not a once and for all project. |
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Term
| ethical considerations for mass screening: |
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Definition
- ability to alter natural history
- availability of services
- insurance issues |
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Term
| screening in developing countries: |
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Definition
The development of advanced screening in developing countries requires special consideration
Local health circumstances must be considered
Unethical to screen without adequate follow-up |
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Term
| Multiphasic screenings use __ or more screening tests together among ___ groups of people. Information is obtained on ___ __ __, __ __ ___, and ___ ___. This is commonly used by ___ and ___ ___. |
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Definition
- 2
- large
- risk factor status, history of illness, and health measurements
- employers
- health maintenance organizations |
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Term
| Mass screening is screening on a ___ scale of ___ population groups regardless of ___ ___. |
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Definition
- large
- total population
- regardless of risk status |
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Term
| Selective screening screens ___ of the population at __ ___ for the disease. This is more ___and likely to __ more __ cases. Give example. |
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Definition
- subsets
- high risk
- more economical, yield more true cases
- screening high-risk persons for Tay-Sachs |
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Term
| Evaluation of a screening program: |
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Definition
Is there direct evidence that screening reduces morbidity and/or mortality?
What is the prevalence of disease in the target group? Can a high-risk group be reliably identified?
Can the screening test accurately detect the target condition?
(a) What are the sensitivity and specificity of the
test?
(b) Is there significant variation between examiners
in how the test is performed?
(c) In actual screening programs, how much earlier
are patients identified and treated?
Does treatment reduce the incidence of the intermediate outcome?
(a) Does treatment work under ideal, clinical trial
conditions?
(b) How do the efficacy and effectiveness of treatments
compare in community settings?
Does treatment improve health outcomes for people diagnosed clinically?
(a) How similar are people diagnosed clinically to those
diagnosed by screening?
(b) Are there reasons to expect people detected by
screening to have even better health outcomes than
those diagnosed clinically?
Is the intermediate outcome reliably associated with reduced morbidity and/or mortality?
Does screening result in adverse effects?
(a) Is the test acceptable to patients?
(b) What are the potential harms, and how often do they occur?
Does treatment result in adverse effects? |
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Term
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Definition
| Persons who participate in screening programs may be different from those who do not. |
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Term
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Definition
Screening test advances time of diagnosis
by detecting disease before onset of symptoms but does not affect the natural history and survival from the disease
Lead Time: amount of time by which diagnosis is advanced |
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Term
Can correct for lead time (y) by comparing survival for X years in the screened group with that for X – y years in the unscreened group.
Can also compare age-specific death rates in screened versus unscreened, instead of survival time from date of detection to death |
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Definition
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Term
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Definition
Slower-progressing diseases with longer preclinical periods are more likely to be detected by screening than those diseases with shorter preclinical stage leading to an increase in the number of cases diagnosed at an early stage
May observe a favorable mortality in the screened group not because of the benefit of screening, but simply because of the over-representation of cases with better prognosis associated with long-preclinical disease. |
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Term
| A subset of the length time bias is the overdiagnosis bias, explain: |
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Definition
extreme example of length bias that occur when
diseases with slow- or non-progression are
screen-detected (e.g., prostate cancer) |
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Term
| types of controlled observational studies: |
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Definition
- cross-sectional
- case-controlled
- cohort |
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Term
| experimental study design: |
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Definition
| - randomized controlled trial |
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Term
Randomized trials are the design of choice for the evaluation of screening procedures
Provides a rigorous experimental evaluation
Randomized trials are often difficult to conduct because of ethical and logistic reasons |
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Definition
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Term
| RCT for screening require: |
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Definition
- large sample size
- high cost
- long follow-up period |
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Term
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Definition
- rare diseases
- when a test becomes widely used before a RCT is conducted |
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