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40 Cards in this Set

  • Front
  • Back
VALIDITY
the ability of a test to detect who does and does not have disease
SENSITIVITY
the ability of a test to ID correctly who has the disease of interest
SPECIFICITY
the ability of a test to ID correctly those who do not have the disease of interest
RELIABILITY/REPRODUCTIBILITY
extent to which results obtained by a test are replicated if the test is repeated
WHAT IS THE KEY ASSUMPTIOIN FOR SCREENING?
early detection leads to a more favorable prognosis
Screening is more like a ____ test that tells you whether you should go on for another test or not.
crude
When you screen people for disease, are they symptomatic or asymptomatic?
asymptomatic
Why do we screen participants?
Name 3 reasons.
1. to favorably modify the natural history of disease
2. improve morbidity
3. reduce mortality
Disease with _____ consequences are appropriate for screening.
serious
Disease where tx is given ____ sxms is more beneficial than tx given ____ are more appropriate for screening.
before, later
Disease where prevalence of detectable preclinical disease is ____ in population to be screened is more appropriate for screening.
high
Name 6 characteristics that make a screening test suitable.
1. inexpensive
2. easy to administer
3. well-tolerated
4. valid
5. reliable
6. reproducible
Draw example of 2x2 screening table.

Explain in a legend what a,b,c,d represent
Early Disease ("truth") (top)
Screening Test (side)

a b
c d

a= true positives
b=false positives
c=false negatives
d=true negatives
PREDICTIVE VALUE POSITIVE
probability of having disease given you have a positive screen
PREDICTIVE VALUE NEGATIVE
probability of not having disease given you have a negative screen
Maximize sensitivity at expense of specificity then you:

Decrease false ______, but yield false _______
negatives, positives
Choose to increase sensitivity when penalty for not identifying cases is ____
high
choose to increase sensitivity when disease is _____.
serious
choose to increase sensitivity when _______.
treatment exists (if it doesn't exist, do you want to know you have disease?)
choose to increase sensitivity when _______.
disease can be spread
choose to increase sensitivity when _______.
subsequent dx has minimal costs and risks
choose to ____ specificity when penalty for incorrectly identifying someone as case is ____
increase, high
Name 3 ways that we can assess whether the screening program works or not.
1. follow up with those who tested positive

2. assess cost per case detected

3. asses how many of those who test positive have the disease (PV+)
PV+ is influenced by _____, _____, and ______ of the detectable preclinical phase of the disease.
sensitivity, specificity, prevalence
PV+ is most influenced by ____ and ____
sensitivity, prevalence
How do you increase prevalence?
target populations at high risk
Name 3 biases specific to screening.
1. volunteer
2. lead-time
3. length
VOLUNTEER BIAS
people who choose to be screened will be different from those who do not.

these people are usually healthier with lower mortality rates

"the worried well"
LEAD-TIME BIAS
cases detected by screening appear to survive longer due to their earlier dx
what does lead-time mean?
the duration by which the diagnosis of disease is moved forward in time among each case detected by the screening program
LENGTH BIAS
cases with a longer detectable preclinincal phase and thus a more favorable prognosis tend to be overrepresented among screen detected cases
BASIC PRINCIPLES OF MASS SCREENING:

Condition should be _______.
an important public health issue
BASIC PRINCIPLES OF MASS SCREENING:

should be accepted ____ for pts with disease
effected treatment
BASIC PRINCIPLES OF MASS SCREENING:

if no tx, then ____
do not screen
BASIC PRINCIPLES OF MASS SCREENING:

adequate ____ and ___ facilities should exist
dx, tx
BASIC PRINCIPLES OF MASS SCREENING:

Natural history of condition should ___ understood
reasonably be
BASIC PRINCIPLES OF MASS SCREENING PROGRAMS:

it should be ID in ____ or ___ sxm stage
latent, early
BASIC PRINCIPLES OF MASS SCREENING PROGRAMS:

Should (not be/be) invasive
not
BASIC PRINCIPLES OF MASS SCREENING PROGRAMS:

Screenigns hould be a ________ rather than a _____ program--people get upset if it's taken away
continuing process, temporary
BASIC PRINCIPLES OF MASS SCREENING PROGRAMS:

Screening program shoul dbe shown to be effective in reducing ____, ____ from the disease--though this isn't always the case
morbidity,mortality