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56 Cards in this Set

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natural history of disease
begins with optimum health, then pathogenic risk factors (when the physician should intervene), 3)presymptomatic stage-detectable screenings are available-damage is occuring but the pt is unaware, 4. Sympatomic stage-symptoms of disease-when clincal disease may be diagnosed/treated 5. death
primoridial prevention
preventing risks factors; ie.education, family, counseling
Primary prevention
prevent disease; ie. risk factors are present but disease can be prevented ie. modify diet or already started smoking and try to convince to quit
secondary prevention
treat asymptomatic disease; pt shows no symptoms, but disease could be present, ie. pap smear, other screening tests (chest x-ray)
tertiary prevention
prevent worsening of symptomatic disease; treatemnt such as chemotherapy
Role of osteopathtic physician in disease prevention
try to incorporate indiviudal, family, and the community
Give one example of how an osteopathtic tenant can help rid body of disease
body has ability to heal itself..ie the elimination of risk factors (stop smoking) will allow cilia to re-establish in throat
Using a chapman point on a smoker who refuses to quit an example of
secondary prevention
lung cancer pt, using the throaric pump
tertiary prevention
person is pain free and exercises more
primoridial prevention
person excercises he may stop smoking
primary prevention
top 5 leading causes of death in WV and US
heart disease, cancer, stroke, COPD, and unintentiolnal death from injury
What 3 things contrubute to this heart disease?
Sedentary lifestyle, bad diet, and smoking
What other 8 things are high on both WV and US list?
Cancer, diabetes, COPD, pneumonia, renal disease, septicemia, ALZ, and CVD
list 5 behavioral risk factors
physical inactivity, smoking, drinking (all contribute to hypertension); not wearing seatbelt, and smokeless tobacco
What are the low risks in WV?
Binge drinking 18-24; more out of state
2. drinking and driving
3. seatbelt use-younger peeps
What are the high risks in WV?
#1 hypertension
#2 Sless Tobacco
#3Obesity and smoking (27.6 BMI)
#2 Diabetes
#11 physical inactivity
overall, west virginia rates of death are much higher than nationally, what specific part of heart disease are we #1?
we're ranked first for heart attacks, angina, and stroke
Is HIV high in WV?
no, .1% of WV deaths, in age 25-35 range 2.7% males and 0% femailes
poordiet and exercise relate to what 35% of what disease
cancer
What's the most leading cause of actual death?
#1 tobacoo
#2 poor diet/exercise
What four factors contriubte to death and what percent is the highest?
LIfestyle 51%
human biology 20%
environment 19%
health care 10%
T or F--most phyicians ask pateints on rountine check ups about annualy screening tests?
false only 63% ask
What are the three things you can do to modify a pt's behavior?
1. eliminate self-destructive behav
2. encourage healthy behav/dec
3. **compliance with therapetuic regimes-
Explain the RISE formula
Risk identification--be open with lifestyle
Immunizations/chemoprophylaxis-know side effects
S creening-(primary and 2nd)
E ducation***
change implies making
an essentail difference; requires acknowledging a need for change
What are the five stages of the transtheteretical model of change?
1. precontemplation
2. contemplation
3. prepartion
4. action
5. maintainence
Which stage is the person aware of the problem but not ready to change?
Contemplation
Which stage requires support from the physician?
action and maintainence
What should the phyician provide in the prep phase?
Ideas
Desribe the keller/white model of change?
Confidence vs. conviction
(how sure you can do it vs. how impt it is for you to do it)
Which stages might the physicain have influence over?
high confidence, low conviction, where the pt is skeptical
Which stage gives not so great success?
Low conficence, high conviction, PCP should pep talk here b/c pt is FRUSTARTED
Which stage should you give the pt tips on approaching barriers and overcoming them?
committed pt, high CF and High CN
What are the 5 A's for change?
Address agenda
Ask
Advise
Assist
Arrange follow-up
Who sets the classication of recommendation for US?
U.S. preventive task force classification codes?
What are these codes
A: stronlgy recommends (evidence enough)
B: Recommends-not as strong
C: No recommendation
What are the last two of the codes?
D: recommends against
I: insufficient evidence to recommend

Be careful b/n C and I here...C has the evidence but shows favor towards niether benefits or risks, I doesn't have the evidence on either
what are the effectiveness of intervention based on?
1. good-evidene well conducted
2. fair: evidence is suffienceint but its strength is limited
3. poor-insufficient evidence

Remeber, incidence first, then prevlance...but the first time you do a screen is a prevlance screen
Relative risk
The raio of disease b/n those w/ the risk vs. those w/o; example 1.38
Abosolute risk
the proportion of those with the risk that will develop the disease; better idea how imp. risk factor is; actual number of ppl w/disease? amt of ppl in pop; usually expressed as a %
Attributable risk
the additional incidence of disease related to the risk factor itself
population attributable risk
takes into account the proportion of the population that is affected; multiplyh C x # in population;
attirubte riskx 1 mil with the risk=1000 lives saved
when disease prevlance is low
most positivie tests will be flase positives unless the test is extrememly specific
when disease prvelance is high
useful=highly specific test
- test, that's not highly sensitve-does not reduce the likilhood of the disease
Validity
wether the measurement is an accurate reflection of reality
external validity
can it be applied to ppl outside the study?
internal validity
do the results tell the truth?
branch of internal validity
a. bias-conscious or unconsiouc action influencing the resluts in one way or another
another branch of internal validity
confoudning: incrorect corrleation such as ppl who have lung cance3r carry matches, so matches cause lung cancer**look at slide on this
if there's a conflict in screening guidlenines, what do we go by?
sensitivity, and reate of progression of the disease (other things to go by are national guidlenines, and the barriers that affect the screening)
What are some barriers that exist to health screening?
1. lack of time (both)
2. tranpsortion difficulties
3. finaincial
4. fear of pain/findings
5. uncertainity of value of test
6. conflict among experts
7. lack of motivation
8. potential side effects of screen
In terms of evulation, what three ways to we have to evaulate?
a. national guidleines
b. outcome research-compares dif outcomes in a varity of treamtnts
c. quality assurance progrm
What does quality assurance program measure?
is what is occuring supposed to cocurr?
The most two things charted in teh 1996 WVSOM quality assurance program are?
Tobacco use and alcholhol use, top two things charted
What are the top three barriers to prevention that physicians face?
lack of time
uncertainity of value of screeing test
3. conflict of expert recommendations