NURS 6512 Week 3 Discussion Posts and Responses
NURS 6512 Week 3 Discussion Posts and Responses
Screening tests are medical tests or procedures performed on members of a defined asymptomatic population to assess the likelihood of their members having a particular disease (Maxim, Niebo & Utell, 2014a). With a few exceptions, screening tests do not diagnose the illness, but signal a need for further evaluation and treatment (2014a). Mammograms are utilized in healthcare as a breast cancer screening tool. Mammograms can be classified as diagnostic or screening. A screening mammogram is defined as bilateral mammograms performed on asymptomatic women that are designed as “routine screening” by the interpreting radiologist (Fenton et al, 2014b). Diagnostic mammograms are classified as testing for patients with a prior history of breast cancer or who report breast symptoms or sign at the time of examination (2014b).
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The US Prevention Task Force (USPTF) recommends mammograms biennially for women aged 50-74 years of age (2016a). Mammography in women aged 40-49 years of age is an individual decision (2016a). Within this age group, the number of deaths averted is smaller than that in older women and the number of false-positive results and unnecessary biopsies is larger (2016a). Beginning screening at a younger age and screening more frequently may increase the risk for over diagnosis and subsequent overtreatment (2016a). Also, mammography is of less diagnostic value in women younger than 30 because of the density of the breast tissue (Dains, Baumann & Scheibel, 2016b) NURS 6512 Week 3 discussion Posts and responses. Although, women with a parent, sibling, or child with breast cancer are at a higher risk for breast cancer and may benefit more than average-risk women from beginning screening in their forties (2016a).
Sensitivity, or true positive, is the measure of the proportion of actual positives that are correctly identified (2014a). It is also the extent in which actual positives are not overlooked (few false negatives) (2014a). Specificity, the true negative rate, measures the proportion of actual negatives that are correctly identified (2014a). Studies have shown that sensitivity and specificity of mammographic screening are influenced by screening interval and length of follow-up (Hofvind et al, 2012). It is desirable to have a test that is both highly sensitive and highly specific (2014a). Studies have shown that there is lower sensitivity in the United States screening for breast cancer because most patients return after one year for a rescreen and the shorter screening interval is known to reduce sensitivity (2014a). One study found no evidence that female patients, 50 years old or greater, that undergo biennial mammography screening to have an increased risk of late-stage breast cancer compared with patients who undergo annual screening (2014a). Overall, the sensitivity of mammography is about 87 percent (Susan G. Koman, 2018). Sensitivity is higher in women over 50 than in younger women and in women with fatty breasts over those with dense breasts (2018). Therefore, it may be a better diagnostic screening tool if biennial mammography screening were consistently performed for those patients that are of low risk for breast cancer.
Reliable mammogram results are dependent on high-quality image and a good reading of the image (2018). In order to achieve a high quality, diagnostic mammogram that enables early detection of breast cancer, properly working equipment is required, in addition to an experienced mammographer and cooperation of the patient (Hill & Robinson, 2015).
In order for mammograms to be valid, they must be able to measure what they set out to measure and not something else (2015). Classifying a mammographic image as reliable, the images must be able to be reproducible by others viewing them (2015). With the move from film/screen combinations of breast images to digital imaging, the quality of images has improved, but the assessment guidelines for the quality have not been adapted to reflect the change in how mammograms are produced (2015). Radiographers utilized the PGMI (Perfect, Good, Moderate, and Inadequate) image appraisal criteria established in 2006, prior to digital imaging (2015). This criteria is still used for digital imaging. NURS 6512 Week 3 discussion Posts and responses. The PGMI assessment tool is neither reliable or valid due to the fact that many of the descriptors are subjective and prone to inter and intra-operator variability (2015). Validity of imaging is also questionable because there is a lack of agreement on national standards regarding what features, e.g. nipple line, constitute a good standard image. (2015). In order to increase the reliability and validity of mammogram imaging, a national standard that is evidence-based implemented by all imaging centers (2015) NURS 6512 Week 3 discussion Posts and responses.
References
Dains, J., Baumann, L., & Scheibel, P. (2016b). Advanced health assessment and clinical diagnosis in primary care. (5th ed.). St. Louis, Missouri: Elsevier
Fenton, J., Zhu, W., Balch, S., Smith-Bindman, R., Fishman, P., Hubbard, R. (2014b). Distinguishing screening from diagnostic mammograms using Medicare claims data. Medical Care, 52(7), e44-e51. doi:10.1097/MLR.0b013e318269e0f5
Hill, C. & Robinson, L. (2015). Mammography image assessment: Validity and reliability of current scheme. Radiology, 21(2015), 304-307. Retrieved from https://dx.doi.org/10.1016/j.radi.2015.07.005
Hofvind, S., Geller, B., Skelly, J., & Vacek, P. (2012). Sensitivity and specificity of mammographic screening as practiced in Vermont and Norway. The British Journal of Radiology, 85(2012), e1226-e1232. doi:10.1259/bjr/15168178
Maxim, L., Niebo, R., & Utell, M. (2014a). Screening tests: A review with examples. Inhalation Toxicology, 26 (13), 811-828. doi:10.3109/08958378.2014.955932 NURS 6512 Week 3 discussion Posts and responses
Susan G. Komen (2018). Accuracy of mammograms. Retrieved from https://ww5.komen.org
US Preventive Services Task Force (2016a). Breast cancer: Screening. Retrieved from https://www.uspreventiveservicestaskforce.org
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Main Post-Week 3
Prostate cancer (PCa) is one of the leading causes of cancer-related mortality in men. A screening test to detect PCa in the early stages can help improve cancer treatment outcomes. Prostate-specific antigen (PSA) testing is a blood test which has been used for the last thirty years to measure protein produced by normal and cancerous cells of the prostate (Kollmer, 2018). The over-use of this screening test has become controversial over time due to its unreliability. Other conditions that are non-cancerous that also raise PSA levels are prostatitis, benign prostatic hyperplasia (BPH), and enlarged prostate (Ferrari, 2011). Having a high PSA level can lead to unnecessary further testing such as biopsy, which can cause harmful side effects such as impotence and incontinence (Kollmer, 2018). Some research suggests that greater than seventy percent of men who have a biopsy due to high PSA levels do not have PCa and twenty percent of men with PCa have normal PSA levels (Ferrari, 2011). Physicians need to explain the pros and cons of PSA screening and practice shared decision making to reduce the negative outcomes of unnecessary testing (Han et al., 2013). While PSA testing can detect early stages of PCa, high rates of false-positive tests lead to overdiagnosis, unnecessary testing, and psychological distress for patients (Mayo Clinic, 2018). For these reasons, new guidelines recommend shared decision making for PSA testing in men ages 55-69 based on individual risks and routine PSA testing for men 70-years and older is not recommended (Kollmer, 2018). Using the best evidence-based practices with routine testing can help reduce unnecessary healthcare cost and procedures. NURS 6512 Week 3 discussion Posts and responses.
References
Ferrari, N. (2011). How reliable is the prostate-specific antigen (PSA) test when it comes to
detecting prostate cancer? Retrieved from
https://www.health.harvard.edu/blog/is-psa-reliable-20110327214
Han, P.K.J., Kobrin, S., Breen, N., Joseph, D.A., Li, J., Frosch, D.K., & Klabunde, C.N. (2013).
National evidence on the use of shared decision making in prostate-specific antigen screening. American Family Medicine, 11(4), 306-314. doi: 10.1370/afm.1539
Kollmer, J. (2018). Screening for prostate cancer: Are PSA blood tests reliable? Retrieved from
https://www.uchicagomedicine.org/forefront/cancer-articles/2018/july/prostate-cancer-are-psa-blood-tests-reliable
Mayo Clinic. (2018). PSA test. Retrieved from
https://www.mayoclinic.org/tests-procedures/psa-test/about/pac-20384731
Lillian,
Thank you for the post regarding prostate specific antigen (PSA) screening for early detection of prostate cancer in men. Men in the United States have a 16% chance of a prostate cancer diagnosis in their lifetime and a 3% chance of dying from prostate cancer (Quass, 2015). Current screening practice involves transrectal ultrasound biopsies if PSA is elevated and/or digital rectal examination is abnormal (Verbeck & Robol, 2018). Currently there is not a definitive recommendation regarding timing of repeat biopsy if the initial biopsy is negative (2018). The pancreatic cancer mortality at 15 years of follow-up was less than 0.5% (2018). Of note, almost half of the men who died from pancreatic cancer with a previous negative biopsy were not compliant with follow-ups (2018). Therefore, as the practitioner, it is important to educate male patients about the importance of follow-up testing when previous testing was negative. Evaluating each patient’s risk factors and providing individualized education is crucial in order to manage follow-up testing. It is important to note that, according to the Centers for Disease Control (CDC), the majority of men diagnosed with prostate cancer never experience symptoms and, without screening, would never know they had the disease (2018b). NURS 6512 Week 3 discussion Posts and responses
References
Centers for Disease Control (2018b). Prostate cancer. Retrieved from https://www.cdc.gov
Quass, J. (2015). PSA screening for prostate cancer. American Family Physician, 91(9). Retrieved from www.aafp.org/afp
Verbeek, J. & Roobol, M. (2018a). What is an acceptable false negative rate in the detection of prostate cancer? Translational Andrology and Urology, 7(1), 54-60. doi:10.21037/tau.2017.12.12
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Initial Post: Week 3
Body Mass Index (BMI) is a person’s weight in kilograms divided by the square of height in meters, (CDC, 2017). It is a measurement that can categorize an individual’s weight status into five categories; underweight, normal, overweight, obesity, and extreme obesity, (Ball et al., 2015). According to Ball et al. (2015), BMI is the most shared method used to measure nutritional status and total body fat percentage (BF %). BMI will be used as the discussion point to compare the validity, reliability, and what sensitivities, and predictive values this tool offers or does not offer. NURS 6512 Week 3 discussion Posts and responses.
Validity & Reliability
According to Romero-Corral et al. (2008), BMI has been used as an assessment tool for BF % and classification of a healthy or unhealthy weight for over the last thirty years. It is the most inexpensive and accessible tool used for practitioners for any aged patient. It assists the practitioner to intervene, provide care, and resources to allow the patient to either gain weight or lose weight.
According to Freedman & Sherry (2009), the validity of the BMI tool can vary regarding the degree of BF %, especially in children. The BMI tool was victorious in the categories of obese and overweight, but differed in results in average to underweight individuals based on the lean mass; which is the bulk of the human weight, (Romero-Corral et al., 2008). It was shown that it was a useful tool and correlating with high BF% when the BMI was high but did not correlate when the individual was thin or underweight. In other studies, using adults as the subject, it generally related to the studies used in children, where the BF % linked with BMI but failed to draw a parallel with lean mass. Overall, as the BMI tool is a valid tool when assessing an overweight or obese patient many studies confirm that it is a tool able to be used solitarily to diagnose obesity; as it might have good specificity, it dismisses more than half of individuals with excess fat, (Romero-Corral, 2008). NURS 6512 Week 3 discussion Posts and responses.
Sensitivities & Predictive Values
BMI has good specificity but low sensitivity to detect obesity, (Romero-Corral, 2008). In one study, a high BMI while identifying one with excess BF% has been reviewed by measuring sensitivity, positive predictive values, and specificity, it concludes that an individual with a high BMI and BF% there is a strong influence estimating the functionality of its screening, (Freedman & Sherry, 2009). The BMI having this high specificity and low sensitivity is still considered to be an excellent indicator to diagnose obesity, but as defined as excess adiposity, (Stettler, Zomorrodi, & Posner, 2012). Additionally, assessing the values of sensitivity, specificity, and predictive values, the functionality of the BMI tool was diminished in increased age, ( Romero- Corral, 2008).
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Conclusion
As a practitioner, evaluating patients and their weight is a sensitive subject that most patient’s discard or are embarrassed to discuss. Using useful tools such as the BMI should be valid and accurate while trying to diagnose and provide treatment and resources to those who are in subpar weight categories. Although the BMI tool has been summarized to be effective in using with obese patients, the provider should be specific and double check their diagnosis of any weight category with a second or third measuring tool to be more accurate with his/her diagnosis. This will ensure the best outcome for the patient. NURS 6512 Week 3 discussion Posts and responses
Resources
Ball, J.W., Dains, J.E., Flynn, J., Solomon, B.S., & Stewart, R. W. (2015) Seidel’s guide to
physical examination (8th ed.). St. Loius, MO: Elsevier Mosby
CDC, (2017). About adult BMI. Retrieved from
https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html#Reliable
Freedman, D.S., & Sherry, B. (2009). The validity of BMI as an indicator of body fatness and
risk among children. Pediatrics, 124 (Supplemental 1). Retrieved from
https://pediatrics.aappublications.org/content/124/Supplement_1/S23
Romero-Corral, A., Somers, V. K., Sierra-Johnson, J., Thomas, R. J., Collazo-Clavell, M. L.,
Korinek, J., Allison, T. G., Batsis, J. A., Sert-Kuniyoshi, F. H., … Lopez-Jimenez, F.
(2008). Accuracy of body mass index in diagnosing obesity in the adult general
population. International journal of obesity (2005), 32(6), 959-66. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877506/
Stettler, N., Zomorrodi, A., & Posner, J.C. (2012). Predictive value of weight-for-age- to
identify overweight children. Obesity Journal, 15(12), 3106-3112. Retrieved from
https://doi.org/10.1038/oby.2007.370
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I enjoyed reading your post on Body Mass Index (BMI). I agree that discussing weight and BMI with patients can be a very sensitive subject. The BMI tool has been implemented by many schools, including my three daughter’s school district, in an effort to raise awareness of parents about their own child’s health status. Childhood obesity is a serious problem in the United States putting children and adolescents at risk for poor health (CDC, 2018a). In the United States, the prevalence of obesity among youth is 18.5% (Hales et al, 2017). It is important to make parents aware of avoidable health issues that can negatively impact their child’s future. Parents have a direct influence over their children’s physical, food, and social environments (Townsend et al, 2018b). It is essential that when providing parents with the BMI of their children that they are also made aware that BMI does not measure body fat directly and that the relationship between BMI and body fat varies by sex, age, and race (2017). As a practitioner, we are obligated to discuss with parents and children the consequences of maintaining a high BMI and that their BMI is a modifiable health factor. We also need to explain that the BMI calculation is a tool used to assist in preventing long-term consequences of unhealthy weight, whether overweight or underweight. NURS 6512 Week 3 discussion Posts and responses
References
Centers for Disease Control (CDC) (2018a). Prevalence of childhood obesity in the United States. Retrieved from https://www.cdc.gov
Hales, C., Carroll, M., Fryar, C., & Ogden, C. (2017). Prevalence of obesity among adults and youth: United States, 2015-2017. NCHS Data Brief, 288(2017). Retrieved from https://www.cdc.gov
Townsend, M., Shilts, M., Styne, D., Drake, C., Lanoue, L., & Ontai, L. (2018b). An obesity risk assessment tool for young children: Validity with BMI and nutrient values. Journal of Nutrition Education and Behavior, 50(7), 705-717. Retrieved from https://doi.org/10.1016/j.jneb.2018.01.022
Dr. S
As a practitioner, it is important to educate patients on the timing and importance of screening mammograms. When a patient is non-compliant with repeat screenings, I will discuss the reasoning behind this decision or lack of prioritizing a life-saving test. One study found that patients with a higher number of chronic diseases had decreased screening rates (Guo et al, 2015). This may be that most health care visits in this population are spent with specialists that aren’t as focused on breast cancer screening (2015). It is also important to address other causes of non-compliance, such as discomfort and pain caused by compression during the mammogram (Mullai et al, 2016). NURS 6512 Week 3 discussion Posts and responses
References
Guo, F., Hirth, J., & Berenson, A. (2015). Effects of cardiovascular disease on compliance with cervical and breast cancer screening recommendations among adult women. Journal of Women’s Health, 24(8), 641-647. doi:10.1089/jwh.2014.5129
Mullai, N., Murugesan, N., Burton, L., Goodin, V., & Stout, A. (2016). Risk of noncompliance due to patient discomfort during screening mammogram. Journal of Clinical Oncology, 27(15s), 1522. doi:10.1200/jco.2009.27.15s.1522 NURS 6512 Week 3 discussion Posts and responses