tailieunhanh - Chapter 004. Screening and Prevention of Disease (Kỳ 1)

Harrison's Internal Medicine Chapter 4. Screening and Prevention of Disease Screening and Prevention of Disease: Introduction A primary goal of health care is to prevent disease or to detect it early enough that intervention will be more effective. Strategies for disease screening and prevention are driven by evidence that testing and intervention are practical and effective. Currently most screening tests are readily available and inexpensive. Examples include tests that are biochemical (., cholesterol, glucose), physiologic (., blood pressure, growth curves), radiologic (., mammogram, bone densitometry), or tissue specimens (., Pap smear, fine-needle aspirations). . | Chapter 004. Screening and Prevention of Disease Ky 1 Harrison s Internal Medicine Chapter 4. Screening and Prevention of Disease Screening and Prevention of Disease Introduction A primary goal of health care is to prevent disease or to detect it early enough that intervention will be more effective. Strategies for disease screening and prevention are driven by evidence that testing and intervention are practical and effective. Currently most screening tests are readily available and inexpensive. Examples include tests that are biochemical . cholesterol glucose physiologic . blood pressure growth curves radiologic . mammogram bone densitometry or tissue specimens . Pap smear fine-needle aspirations . In the future it is anticipated that genetic testing will play an increasingly important role for predicting disease risk Chap. 64 . However such tests are not widely used except for individuals at risk for high-penetrance genes based on family or ethnic history . BRCA1 BRCA2 . The identification of low-penetrance but high-frequency genes that cause common disorders such as diabetes hypertension or macular degeneration offers the possibility of new genetic tests. However any new screening test whether based on genetic or other methods must be subjected to rigorous evaluation of its sensitivity specificity impact on disease and cost-effectiveness. Physicians and patients are continuously introduced to new screening tests often in advance of complete evaluation. For example the use of whole-body CT imaging has been advocated as a means to screen for a variety of disorders. Though appealing in concept there is currently no evidence to justify this approach which is associated with high cost and a substantial risk of false-positive results. This chapter will review the basic principles of screening and prevention in the primary care setting. Recommendations for specific disorders such as cardiovascular disease diabetes or cancer are provided in the chapters

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