screening

1. screening Prepared by : Aysha Hasan Shatha Khader Mohamad Salahat For : Dr.Aida Al-Qaisi

2. *Screening has received growing recognition as a valuable tool for health care professionals *The actual process of screening is form of secondary prevention *The objective of that : is the detection of a disease in its early stages to treat it and deter its progression. SCREENING *The ultimate goal could be curative ; to prevent further development 0f the disease &to reduce the cost of treating

3. Advantages and disadvantages Advantages: 1-screening tests are often simple ; inexpensive& frequently 2-the ability to apply the screening process to both individuals and large groups 3-ability to provide one –test specific screening as (Bp-risk of HTN ) or multiple –test screening as a blood sample to evaluated glucose &cholesterol.

4. Disadvantages: 1-from Imperfection of modern science ; which result in a margin of error for most instruments and tests 2-Some individuals who don’t have the condition will be referred for further tests &some who do have the disease will not 3-Those in correctly referred suffer needles anxiety while awaiting more definitive diagnostic procedures 4-They must also bear the burden of the cost of follow –up visits ;lost time ;&inconvenience. 5-They leave with a false sense of a healthful state that will be shattered eventually. They lose the chance to receive early TXT that could prevent irreversible damage

5. SELCTION OF A SCREENABLE DISEASE *The selection process must often encompass less tangible factors; such as the emotional &financial impact of disease's detection on screened population *T he answers to following 3 questions provide abasis for designating a disease as screenable or not screenable: 1-Dose the significance of the disorder warrant its consideration as a community problem? 2-Can the disease be screened ? 3-Should the disease be screened?

6. *Significance *The significance of disease refers to level of priority assigned to the disease as a puplic health concern *Its determined by the Quantity and quality of life affected by disorder *the 1st step in assessing screenability is evaluation of this significance to decide if the disorder warrant the time ,effort,&fuds that must be allocated to screenable disease

7. *Estimating the quality of life affected by a disease presents a problem e.x: some of people make adjustments & cope, whereas do not. *measure of the quantity of life affected by the disease are more hi obtainable . Disease –specific mortality rates presents one picture of this effect, whereas prevalence &incidence rate provide another

8. Can the disease be screened ? *With relative significance of the disease established , the next step is to determine if health professionals can screen for disease . Do well –documented diagnostic criteria for the disorder exit ? Is there a screening instrument ? Are sufficient community resources & TXT modalities available to support a screening program ?

9. Diagnostic criteria *Detection of a disease require knowledge of characteristics that clearly indicate its presence or , as in screening , its early pathogenic , asymptomatic state. selected Dx criteria should be well documented *Some disease are defined by presence or absence of a single factor, such as sickle cell anemia *Other condition are indicated by the measurement of statistically derived numerical value for which a normal range has been set , such as HTN

10. Screening instruments *The next step is to determined if methods exist to detect the disease during early pathogenesis . If instruments are available , a careful analysis should determine if any of them fullfill the requirements for the screening process ;safe ,cost-effective , &accurate.

11. Screening instruments *The next step is to determined if methods exist to detect the disease during early pathogenesis . If instruments are available , a careful analysis should the screening process ;safe ,cost-effective , &accurate. *The variables that aid in instrument evaluation include reliability &validity *Reliability : is an assessment of reproducibility of test's results when different individuals with the same level of skill perform the test during different periods &under different condition

12. *Validity : its measures the test's ability to correctly distinguished between disease &non diseased individuals *The ideal result is to have the instrument : -ve reaction (non diseased people )\ +ve reaction (diseased people) *Its divided into 2componants that quantify the error in the screening instrument: *sensitivity :refer to the +ve reaction result *specificity : refer to the –ve reaction result

13. Should the disease be screened ? After determining that the disease is significant &can be screened , establishing whether health professionals should screen for the disorder is the final step Several questions must be considered : If a test is accurate in the identification of a condition in the early stages , is there any benefit to the indiviual ? are there effective TXT modalities in place for the identified condition?

14. Intervention Screening is based on the disease s asymptomatic period ; therefore adequate information must exit concerning: 1-the optimal time for screening 2- specific intervention during this time 3-knowledge as to the effect of early detection &TXT on the prognosis.

15. Commonly screened conditions The following section reviews several commonly screened disease to demonstrate the complexity of issues that may surround the screening process. Ultimately, a systematic approach where decision making is collaborative in nature will move the targeted population toward health improvement and attainment of the two central goals of healthy people 2010 (U.S department of human services, 2000): • Increased quality and years of healthy life • Elimination of health disparities

16. Phenylketonuria (PKU) PKU is a condition characterized by the genetically determined lack of phenylalanine hydroxylase, an eenzyme necessary to metabolize an important amino acid, phenylalanine. In its absence, blood levels of the phenylalanine increase, causing irreversible damage to the brain and central nervous system and resulting in severe mental retardation .

17. In American women, the incidence of breast cancer increase with: *Age *nulliparous women *women who have never given birth * women who start mentruating at an earlier age than average and reach menopause at a later age than average * women who bore their first child in their late 30s

18. *women with fibrocystic disease *family history *Extended use of estrogen *obesity, and diet high in fat *women who had their first child before the age 20 constitute the lowest risk group

19. Three screening tests usually considered appropriate for early detection include: • The clinical breast examination • Mammography • Self breast examination

20. The sensitivity and specificity of these tests depends on multiple factors: • The size of lesion • The characteristic of the breast • The age of the individual being examined • The skill and experience of examiner • The mammography equipment and the skills of the technicians and radiologist (U.S Preventive Services Task Force 1996)

21. The nurse and midwife are often the health care providers who teach a women how to perform a monthly self examination of the breast, this practice has proved to be lifesaving. Although it is encouraged and considered an important screening test for early detection of breast cancer

22. Cervical Cancer The tenth most common cancer among women in the U.S is cervical cancer (U.S Department of Human Services,2000). The principal screening test for cervical cancer is the Papaniclaou`s (Pap) smear.

23. The disease is more common among : • Women of low socioeconomic status. • women with a history of multiple sex parents • Women with an early first sexual intercourse • Smokers • Woman with certain types of human papilloma virus and human immunodeficiency

24. Colorectal Cancer • Colorectal Cancer is the second leading cause of cancer deaths in the United state (U.S Department of Human Services,2000). • Early detection of colorectal cancer is associated with a better outcome in both morbidity and mortality . • The five year survival rate is over 90% for patients with localized disease.

25. The American Cancer Society (2000) developed guidelines for both men and women who at age of 50, should follow one of the following procedures: • An annual fecal occult blood test plus a flexible sigmoidoscopy every five years. • A colonoscopy every 10 years or double contrast barium enema every 5 to 10 years. • A digital rectal examination at the time of each screening

26. Prostate cancer • Prostate cancer is the most common cancer in western world after skin cancer (Europian Journal of Cancer 2005) • Risk increase with age beginning at 50 years and is higher among black men

27. Three principal screening tests are used for prostate cancer: • digital rectal examination (DRE) • Analysis for the serum tumor marker prostate specific antigen (PSA) • Transrectal ultrasound (TRUS)

28. summary • As a method of preclinical secondery prevention, screening is the rapid administration of a simple test to distinguish individuals who may have a condition • It can be an effective efficient tool in preventive health care if used for condition applicable to the screening model & directed towardan at risk population

30. Thanks for you