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Learning Objectives
Define and discuss reliability and validity Define the term screening Define and discuss sensitivity and specificity
Multiphasic Screening
Defined as the use of two or more screening tests together among large groups of people. Information obtained on risk factor status, history of illness, and health measurements. Commonly used by employers and health maintenance organizations.
More economical, and likely to yield more true cases. Example: Screening high-risk persons for Tay-Sachs disease.
Social
The health problem should be important for the individual and the community. Diagnostic follow-up and intervention should be available to all who require them. There should be a favorable cost-benefit ratio. Public acceptance must be high.
Scientific
Natural history of the condition should be adequately understood.
This knowledge permits identification of early stages of disease and appropriate biologic markers of progression.
Ethical
The program can alter the natural history of the condition in a significant proportion of those screened. Suitable, acceptable tests for screening and diagnosis of the condition as well as acceptable, effective methods of prevention are available.
Validity types
Content Criterionreferenced
Predictive Concurrent
Construct
Reliability (Precision)
The ability of a measuring instrument to give consistent results on repeated trials. Repeated measurement reliability--the degree of consistency among repeated measurements of the same individual on more than one occasion.
Reliability (contd)
Internal consistency reliability--evaluates the degree of agreement or homogeneity within a questionnaire measure of an attitude, personal characteristic, or psychologic attribute. Interjudge reliability--reliability assessments derived from agreement among trained experts.
Validity (Accuracy)
The ability of a measuring instrument to give a true measure. Can be evaluated only if an accepted and independent method for confirming the test measurement exists.
Validity (contd)
Content validity--the degree to which a measure covers the range of meanings included within the concept. Criterion-referenced validity--found by correlating a measure with an external criterion of the entity being assessed.
Validity (contd)
Two types of criterion-referenced validity:
Predictive validity--denotes the ability of a measure to predict some attribute or characteristic in the future. Concurrent validity--obtained by correlating a measure with an alternative measure of the same phenomenon taken at the same point in time.
Validity (contd)
Construct Validity--degree to which the measurement agrees with the theoretical concept being investigated.
Example: All items of a checklist evaluation of an employee may be filled out in the same general direction based on the supervisors opinion of the individual.
Respondent answers questions in a manner that agrees with desirable social norms.
Fourfold (2 by 2)Table
Gold Standard Present Absent Total Test Result Positive Negative a c b d a+b c+d
Total
a+c
b+d
Sample Calculation
Subjects receive either the new screening test or usual care. Compare geographic regions with screening programs to those without.
Case-control studies
Length bias
The perception that the screen-detected case has longer survival because the disease was identified early. Particularly relevant to cancer screening. Tumors identified by screening are slower growing and have a better prognosis. Motivated participants have a different probability of disease than do those who refuse to participate.
Selection bias
Natural history of disease in relation to time of diagnosis. C to D, survival time for unscreened case; B to D, survival time for screened case; B to C, lead time.
Causal Manifestational