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Screening and Prevention. Prevention Can be classified into three types: Primary Secondary Tertiary.

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Presentation on theme: "Screening and Prevention. Prevention Can be classified into three types: Primary Secondary Tertiary."— Presentation transcript:

1 Screening and Prevention

2 Prevention Can be classified into three types: Primary Secondary Tertiary

3 Primary Prevention Removing the cause Sanitation Passive smoking

4 Secondary Prevention Identify presymptomatic disease before damage is done Examples? Blood pressure Diabetic screening

5 Tertiary Prevention Limiting complications and disability in established disease by regular surveillance Examples? Diabetic Retinopathy Screening

6 Methods of Screening Case Finding –opportunistic or anticipatory True screening What are the pros and cons of each?

7 Wilsons Criteria Condition must be: –common –important –diagnosable –have a latent interval Screening must be: –cheap and simple –continuous –targeted towards a high risk group

8 Wilsons Criteria Although the following were not part of Wilsons original criteria we might add: –Disease readily treatable –Tests sensitive, specific, safe, acceptable and easy to interpret –Benefits outweigh costs

9 The Test Explain the following terms: –Sensitivity few false negatives –Specificity few false positives –Positive Predictive Value likely to be correct when positive

10 The Test Discuss the trade off between sensitivity and specificity What happens if the prevalence is low? –even test of high sensitivity and specificity have a low predictive value Do we move the point of death? Imperfect knowledge of natural history of the condition causes what problems?

11 Benefits of Screening Improved mortality Improved morbidity Possible savings on costs of future treatment

12 Costs of Screening Patients: –anxiety –false reassurance –economic Doctors NHS

13 Obstacles to Prevention Discuss the obstacles to prevention from: –patients –doctors –NHS

14 Overcoming Patient Obstacles Point out debits Point out benefits Anticipate and discuss difficulties Suggest coping stategies Simple advice and written information


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