Screening involves applying a medical test to asymptomatic individuals to identify those at high risk of a disease. It aims to reduce disease burden through early detection and treatment before symptoms appear. For a disease to be suitable for screening, it must be life-threatening, treatable at an early stage, and have a high prevalence of pre-clinical cases. An ideal screening test is low-cost, easy to administer, valid, reliable, and reproducible. Screening programs must also be feasible and effective to justify their implementation.
The ppt is a short description about how to ascertain the validity, ie; sensitivity and specificity of a screening test as well as their predictive powers. you can also find the technique to ascertain the best possible screening test through the help of an ROC curve...
Diagnostic, screening tests, differences and applications and their characteristics, four pillars of screening tests, sensitivity, specificity, predictive values and accuracy
Study designs, Epidemiological study design, Types of studiesDr Lipilekha Patnaik
Study design, Epidemiological study designA study design is a specific plan or protocol
for conducting the study, which allows the investigator to translate the conceptual hypothesis into an operational one.
Application of a test or a procedure to large number of population who have no symptoms of a particular disease for the purpose of determining their likelihood of having the disease.
The ppt is a short description about how to ascertain the validity, ie; sensitivity and specificity of a screening test as well as their predictive powers. you can also find the technique to ascertain the best possible screening test through the help of an ROC curve...
Diagnostic, screening tests, differences and applications and their characteristics, four pillars of screening tests, sensitivity, specificity, predictive values and accuracy
Study designs, Epidemiological study design, Types of studiesDr Lipilekha Patnaik
Study design, Epidemiological study designA study design is a specific plan or protocol
for conducting the study, which allows the investigator to translate the conceptual hypothesis into an operational one.
Application of a test or a procedure to large number of population who have no symptoms of a particular disease for the purpose of determining their likelihood of having the disease.
Screening of Diseases_Community Medicine
Slides may be referred by both undergraduate and postgraduate students and anyone affiliated to Public health.
Any comments or doubts may be addressed to vineeta1992@gmail.com
Epidemiological method to determine utility of a diagnostic testBhoj Raj Singh
The usefulness of diagnostic tests, that is their ability to detect a person with disease or exclude a person without disease, is usually described by terms such as sensitivity, specificity, positive predictive value and negative predictive value (NPV). Many clinicians are frequently unclear about the practical application of these terms (1). The traditional method for teaching these concepts is based on the 2 × 2 table (Table 1). A 2 × 2 table shows results after both a diagnostic test and a definitive test (gold standard) have been performed on a pre-determined population consisting of people with the disease and those without the disease. The definitions of sensitivity, specificity, positive predictive value and NPV as expressed by letters are provided in Table 1. While 2 × 2 tables allow the calculations of sensitivity, specificity and predictive values, many clinicians find it too abstract and it is difficult to apply what it tries to teach into clinical practice as patients do not present as ‘having disease’ and ‘not having disease’. The use of the 2 × 2 table to teach these concepts also frequently creates the erroneous impression that the positive and NPVs calculated from such tables could be generalized to other populations without regard being paid to different disease prevalence. New ways of teaching these concepts have therefore been suggested.
Epidemiological Approaches for Evaluation of diagnostic tests.pptxBhoj Raj Singh
Diagnosis of a disease or a problem is the first step towards solution/ treatment. Clinical Diagnosis or Provisional Diagnosis is the first step in diagnosis and is done after a physical examination of the patient by a clinician. Clinical diagnosis may or may not be true and to reach Final diagnosis Laboratory Investigations using gross and microscopic pathological observations and determining the disease indicators are required. The diagnostic tests may be Non-dichotomous Diagnostic Tests (when continuous values are given by the test in a range starting from sub-normal to above-normal range) and Dichotomous Diagnostic Tests (when results are given either plus or minus, disease or no-disease). To make non- Dichotomous diagnostic test a Dichotomous one you need to establish the cut-off values based on reference values or Gold Standard test readings or with the use of Receiver operator characteristic (ROC) curves, Precision-Recall Curves, Likelihood Ratios, etc., and finally establishing statistical agreement (using Kappa values, Level of Agreement, χ2 Statistics) between the true diagnosis and laboratory diagnosis. Thereafter, the Accuracy, Precision, Bias, Sensitivity, Specificity, Positive Predictive value, and Negative Predictive value, of a diagnostic test are established for use in clinical practice. Diagnostic tests are also used to determine Prevalence (True prevalence, apparent prevalence) and Incidence of the disease to estimate the disease burden so that control measures can be implemented. There are several Phases in the development and use of a diagnostic assay starting from conceptualization of the diagnostic test, development and evaluation to determine flaws in diagnostic test use and Interpretation influencers. This presentation mainly deals with the epidemiological evaluation procedures for diagnostic tests.
Screening is an essential concept in the field of Medicine, specially in Preventive Medicine. This presentation covers the essentials to understand Screening of Diseases.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. Screening
“ application of a medical procedure
or a test,
rapidly,
to people who as yet have not
developed symptoms of disease
for the purpose of
determining their likelihood of
developing of disease” .
Akhilesh Bhargava 2
3. Why screen
Purpose:
To reduce morbidity/mortality
by detection at an early stage
where treatment is more successful,
and cost effective
Assumption- “Favorable prognosis”
as treatment will start before clinical
manifestation and arrest the
process
Akhilesh Bhargava 3
4. Screening criteria
a disease need to satisfy:
Ø Life threatening,irreversible,serious
Ø Treatment at early stage to be more
effective than one given after.
Ø High prevalence of detectable pre-
clinical stage
Akhilesh Bhargava 4
5. Qualities of screening test
üLow cost
üEasy to administer
Øskills
Øtechnique
Øminimal discomfort
ü Valid
ü Reliable
ü Reproducible
Akhilesh Bhargava 5
6. Validity
“ ability of a test to do what it is intended to do”
expressed as sum of-
Sensitivity+
Specificity+
Reliability(reproducibility)
Yield
Akhilesh Bhargava 6
7. Sensitivity
“ A test’s ability to designate an
individual with a disease as
positive”, expressed as a/(a+c)
Highly sensitive
• a few false negatives
• fewer cases of disease
missed
Disease
Test +ve -ve
+ve a b a+b
-ve c d c+d
a+c b+d
Results depend on criteria of
positivity
Akhilesh Bhargava 7
8. Specificity
“ability of a test to designate an
individual who does not have a
disease as negative, expressed as
d / b+d .”
a highly specific test:
- a few false positives
- a fewer cases without
Disease disease are included
Test +ve -ve
+ve a b a+b
-ve c d c+d
a+c b+d
Akhilesh Bhargava 8
9. Changes in specificity/sensitivity…
? Ideal:
Sensitivity 100%
Specificity 100% (Increase in one at cost
on other and depend on positivity criterion)
Less stringent- sensitivity increases
(more of actually diseased test +ve,
no. without disease also increase)
More strict - specificity increases
(large no. test –ve, more no. of true cases
will be missed)
Akhilesh Bhargava 9
10. Conditions that ask for increase---
Increase Sensitivity-
Øserious diseases
Øa definite treatment exists
Øsubsequent diagnostic tests
cost less
Increase Specificity-
Øsubsequent diagnosis costly,
risky
Akhilesh Bhargava 10
11. Reliability
“ ability to reproduce same results with
consistency ”
Factors:
Biological variations
Variation in method of testing
Intra-observer variation
Inter- observer variation
Akhilesh Bhargava 11
12. Evaluation of a screening
test/program
Disease’s appropriateness Can a screening
determined test
Valid test available be introduced ?
Feasibility ?
Effectiveness ?
Akhilesh Bhargava 12
13. Feasibility
Ø Acceptability
• Quick
• Easy to administer-Less discomfort
Ø Cost-effectiveness
• Total cost
• Unit cost
• Follow-up cost
Ø Subsequent diagnosis & treatment of +ve
Ø Yield (no. detected)
Measure- Predictive value
Akhilesh Bhargava 13
14. Predictive value of a test
“ a measure to ascertain whether or not a person
tested positive, has the disease ”
Disease
Test Present Absent
+ve 900(a) 4950(b) PV+ve
(TP) ( FP) (TP/TP+FP)=91%
-ve 100(c) 94050(d) PV-ve
( FN ) (TN ) (TN/FN+TN)=99.9%
Total 1000 99000
Sensitivity-TP/TP+F=
Specificity-TN/FP+TN=
Akhilesh Bhargava 14
16. PV- interpretations…
Change in -prevalence PV+ve Sensitivity Specificity
0.1 1.8 90 95
1.0 15.4 90 95
5.0 48.6 90 95
50.0 94.7 90 95
PV+ve can be increased by
-increasing specificity
-increasing prevalence
17. Effectiveness
Screening objective- To reduce morbidity/mortality
through
early detection &
offering treatment in
pre-clinical stage
To be effective- -groups need to be comparable
-scrutinized for ascertainment
of outcome
-bias reduced
18. Bias in screening
Ø Self-selection
Ø Time
Ø Lead time bias (identification----------------diagnosis
during screening after
symptoms
Ø Length bias- over representation of those with
long pre-clinical phase, amongst
screened
(heterogeneous nature of disease,
prevalence dependent on duration)