Discussion: NURS 6512 Assessment Tools and Diagnostic Tests in Adults and Children
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The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools; however, different factors affect the validity and reliability of the results produced by these tests or tools. Nurses must be aware of these factors in order to select the most appropriate test or tool and to accurately interpret the results.
Not only do these diagnostic tests affect adults, body measurements can provide a general picture of whether a child is receiving adequate nutrition or is at risk for health issues. These data, however, are just one aspect to be considered. Lifestyle, family history, and culture-among other factors-are also relevant. That said, gathering and communicating this information can be a delicate process.
In this Discussion, you will consider the validity and reliability of different assessment tools and diagnostic tests. You will explore issues such as sensitivity, specificity, and positive and negative predictive values. You will also consider examples of children with various weight issues. You will explore how you could effectively gather information and encourage parents and caregivers to be proactive about their children’s health and weight.
To prepare:
Review this week’s learning resources and consider factors that impact the validity and reliability of various assessment tools and diagnostic tests. We will also review examples of pediatric patients and their families as it relates to BMI.
This week you will be assigned one of the following DB by your instructor.
Select one of the following assessment tools or diagnostic tests to explore for the purposes of this Discussion:
Mammogram
Prostate-specific antigen (PSA) test
Body-mass index (BMI) using waist circumference for adults
Select one of the examples on which to focus for this Discussion. What health issues and risks may be relevant to the child you selected?
Overweight 5-year-old boy with overweight parents
5-year-old girl of normal weight with obese parents
Severely underweight 12-year-old girl with underweight parents
Search the Walden Library and credible sources for resources explaining the tool or test you selected. What is its purpose, how is it conducted, and what information does it gather?
What does the literature discuss regarding the validity, reliability, and are there any issues with sensitivity, specificity, predictive values, ethical dilemmas, and controversies related to the test or tool?
Based on the risks you identified, consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
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Consider how you could encourage parents or caregivers to be proactive toward the child’s health.
By Day 3
Post a description of how the assessment tool or diagnostic test you selected is used in health care. Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.
OR
Post an explanation of the health issues and risks that are relevant to the child you selected. Describe additional information you would need in order to further assess his or her weight-related health. Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information. Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues who selected a different tool test, or child health example than you, using one or more of the following approaches:
Critique your colleague’s evaluation of the validity and reliability of the tool or test selected.
Suggest alternative or additional tools or tests that should be considered when gathering information about specific conditions or symptoms.
Based on the risks you identified, consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
Consider how you could encourage parents or caregivers to be proactive toward the child’s health.
Suggest additional health risks or issues that could be relevant to the child.
Critique your colleagues’ questions, and suggest how the parents or caregivers might interpret these questions. Provide alternate or additional questions.
Suggest an additional strategy for gathering patient information or promoting proactivity
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Sample Answer for Discussion NURS 6512 Assessment Tools and Diagnostic Tests in Adults and Children
Assessment tests and tools play an important role in the diagnosis of various diseases conditions in both adults and children. In adults, the role of protein-specific antigen test vis-à-vis the diagnosis of prostate cancer cannot be underestimated. According to statistics, prostate cancer afflicts more people from the age of 65 and above in the United States (Adhyam & Gupta, 2012). Further, genetics play a role in the prevalence of the disease as more African-Americans have been found with the condition compared to their white counterparts whereas family history also predisposes men to it. Given that prostate cancer can advance either slowly or rapidly, screening plays an important role in its management. The purpose of this paper therefore is to examine the prostate-specific antigen test from the provided list of tools.
Description of the Tool
Prostate cancer is primarily screened through a blood-test referred to as the prostate-specific antigen-test (PSA). PSA is thus the biomarker for prostate cancer and is actually a protein produced by both malignant and non-malignant tissues in the affected region. The PSA test works through drawing of blood from a patient’s artery or vein, which will be sent to the laboratory for examination (Adhyam & Gupta, 2012). If the level of the PSA in the blood sample is more than 4 mg/ml, then cancer could be diagnosed. However, the utilization of this PSA level is still shrouded in controversy since such results may also indicate the presence of other diseases such as inflamed or enlarged prostate. Thus, in order to truly conclude the presence of prostate cancer, additional tests such as biopsy, ultrasound, prostate exams and even the recent multiparametric-prostate-magnetic resonance imagining (MP-MRI) become necessary (Stamatakis & Pinto, 2014).
PSA Test’s Validity, Reliability, Sensitivities, and Predictive Values
The validity of the PSA Test for screening cancer patients has always been a subject of discussion. Whereas the test is valid when it comes to cancer screening, particularly in early stages, its overall validity does not inspire confidence since its effect on mortality has not been determined (Leal, Welton, & Martin, 2018). Further, the PSA test’s reliability has also been called into question. Whereas the tool can detect abnormal levels of PSA in the blood, it does not offer an accurate diagnostic information concerning the state of one’s prostate. Thus, one needs to adopt the usage of other tests in order to achieve this objective. Also, it is not useful in screening early stages of this cancer as mentioned above without proving useful for late stage prostate cancer.
Moreover, the usage of PSA test has been characterized by diametrically different opinions from doctors and studies. For instance, while the tool has provided early detection of prostate cancer, its usefulness as regards saving lives has no clear cut answer. Also, the existence of the PSA levels of more than 4mg/ml has generated controversy in the scientific circles as it does not necessarily appear as a biomarker for prostate cancer (Laine, 2012). Recommendations have also been made to use the upper range of values of normal when it comes to PSA for older adults. However, this only serves to reduce the sensitivity of the PSA tool for older adults’ prostate screening. Therefore, whereas the PSA cut off 4 ng/mL has expressed low sensitivities in studies, its specificity has increased as incidences of false positive tests are almost negligible.
References
Adhyam, M., & Gupta, A. K. (2012). A Review on the Clinical Utility of PSA in Cancer Prostate. Indian journal of surgical oncology, 3(2), 120-9.
Laine, C. (2012). High-value testing begins with a few simple questions. Annals of Internal Medicine, 156(2), 162–163. Retrieved from the Walden Library databases.
Leal, J., Welton, N., & Martin, R. (2018). Estimating the sensitivity of a prostate cancer screening programme for different PSA cut-off levels: A uk case study. Cancer Epidemiology, 52, 99-105.
Stamatakis, L., & Pinto, P. A. (2014). Diagnostic value of biparametric magnetic resonance imaging (MRI) as an adjunct to prostate-specific antigen (PSA)-based detection of prostate cancer in men without prior biopsies. BJU International, 115(3), 381-388. doi:10.1111/bju.12639
Sample Answer 2 for Discussion NURS 6512 Assessment Tools and Diagnostic Tests in Adults and Children
Introduction
Colorectal cancer, often known as colon cancer, is the third most common cancer in men and women. Fortunately, it is detectable and preventable with early screening approaches that may begin as early as age 45. To identify abnormalities in the colon, colonoscopy is the recommended form of colon cancer screening, a sort of imaging examination. The procedure is carried out by introducing a camera-equipped flexible tube into the anus and rectum. Cologuard, a less invasive and more convenient alternative to colonoscopy, has gained popularity. Cologuard’s usage has increased in popularity due to the COVID-19 epidemic, owing to its ease of administration. While the Cologuard screening has some advantages, it also has some disadvantages. A significant worry is its inaccuracy, making it not a substitute for a colonoscopy. This paper will cover the goal of the Cologuard test, how it is administered, the data obtained, and the test’s validity and reliability, among others.
Description of how Cologuard is used in Healthcare
Cologuard is a rectal and colon cancer screening test. Each day, the colon loses cells from its lining. These cells move through the colon with the excrement. Specific genes in cancer cells may have undergone mutations. Cologuard is capable of detecting the changed DNA. The presence of abnormal cells or blood in faces may suggest the presence of cancer or precancerous tumors. Cologuard is designed to identify DNA markers associated with colorectal neoplasia and detect occult hemoglobin in human faces. A positive result might suggest the presence of colorectal cancer (CRC) or advanced adenoma and should be followed up with a diagnostic colonoscopy (Ned et al., 2011). Cologuard may be used by those with 45 years and above also having an average risk of getting colorectal cancer. Cologuard is not a substitute for colonoscopy monitoring or diagnostic colonoscopy in high-risk people. Colon cancer may be detected with Cologuard since the colon’s lining releases cells daily. These cells eventually end up in the feaces. The feaces may also include abnormal cells from a malignant tumor or precancerous polyp and blood from any ruptured blood vessels. Polyps are benign growths on the surface of the colon that have the potential to develop into cancer.
Cologuard’s instructions are straightforward, and the screening process is completed in a matter of minutes. The test should be completed within five days after obtaining the kit. After obtaining the kit, begin by removing all materials except those required for the sample. The sample of the stool should not exceed the size of the liquid bottle contained in the package. Attempting to avoid getting pee on the sample is critical. This may be accomplished by emptying the bladder first and avoiding contaminating the faces sample with toilet paper or other things. The sample should be obtained when a person knows he or she can return the sample within a day of collection (Ned et al., 2011). After that, the huge sample container is inserted into the toilet bracket using the included instructions. A fecal sample must be taken using the large sample container when one is on the toilet. It is important to remove a sample container from the toilet mount after collecting it, then set it on a flat surface. Place the scraped sample in a small test tube. Before labeling and sealing the tiny and big sample containers, apply the preservative to the larger container. Before delivering the sample to the lab, be sure to follow the included packing instructions to the letter. Cologuard is a stool test that detects DNA and hemoglobin (blood) produced by these aberrant cells.
Validity and Reliability Cologuard Test
Cologuard is a test intended to identify cancer, not prevent it (JAMA , 2014). Cologuard detects just 42% of big polyps, while a colonoscopy detects 95% of large polyps. When polyps are discovered during a colonoscopy, they are simultaneously removed. If polyps are found using Cologuard, they must be removed by colonoscopy. Cologuard cannot identify the majority of big precancerous polyps. This may give patients the erroneous impression that they avoid colon cancer by getting the Cologuard test. In a nutshell, there is no genuine substitute for a colonoscopy. Due to its astounding success rate in diagnosing colorectal cancer early on, the illness has become one of the most preventable types of cancer (Imperiale et al., 2014). While alternative tests, such as Cologuard, are available and may have some advantages, such as little preparation and invasiveness, the findings are less trustworthy. Individuals with abnormal results will still need a colonoscopy for confirmation.
Cologuard testing has several downsides, most notably accuracy, particularly when compared to a colonoscopy. Cologuard has an overall sensitivity of 95.2 percent for colon cancer (Exact Sciences, 2022). Additional studies revealed a sensitivity of 57.2 percent for all advanced precancerous lesions and 83.3 percent for high-grade dysplasia. Colonoscopy detects precancerous lesions and polyps more accurately than stool sample testing, according to Li (2018). Physicians prefer to send patients for colonoscopies rather than a stool test since false positives are more common. The major purpose of screening tests is to rule out illnesses like cancer; therefore, sensitivity is a critical consideration. Imperiale et al. (2014) argue that with an 87 percent overall specificity, the DNA test’s sensitivity for advanced precancerous lesions was half that of colorectal cancer.
References
Exact Sciences, (2022). Exact Sciences presents data showing improved accuracy of second-generation Cologuard® test and progress toward an even better colorectal cancer screening solution for patients. https://www.exactsciences.com/newsroom/exact-sciences-presents-data-showing-improved-accuracy-of-second-generation-cologuard-test
Imperiale, T. F., Ransohoff, D. F., Itzkowitz, S. H., Levin, T. R., Lavin, P., Lidgard, G. P., Ahlquist, D. A., & Berger, B. M. (2014). Multitarget stool DNA testing for colorectal-cancer screening. New England Journal of Medicine, 370(14), 1287–1297.
Li, D. (2018). Recent advances in colorectal cancer screening. Chronic Diseases and Translational Medicine, 4(03), 139–147.
Ned, R. M., Melillo, S., & Marrone, M. (2011). Fecal DNA testing for colorectal cancer screening: The ColoSureTM test. PLoS Currents, 3.
A Stool DNA Test (Cologuard) for Colorectal Cancer Screening. (2014). JAMA: The Journal of the American Medical Association, 312(23), 2566. https://doi.org/10.1001/jama.2014.15746
Sample Answer 3 for Discussion NURS 6512 Assessment Tools and Diagnostic Tests in Adults and Children
In the present discussion, the Prostrate-specific antigen test will form the basis of the examination. According to statistics, prostate cancer afflicts more people from the age of 65 and above in the United States (Adhyam & Gupta, 2012). Genetics play a role in the prevalence of the disease as more African-Americans have been found with the condition compared to their counterparts whereas family history also predisposes men to it. Given that prostate cancer can occur slowly or rapidly, screening plays an important role in its management. The purpose of this paper therefore is to examine the prostrate-specific antigen test as well as assess children from the provided list.
Description of the Tool
Prostate cancer is primarily screened through a blood-test referred to as the prostate-specific antigen-test (PSA). PSA is thus the biomarker for prostate cancer and is actually a protein produced by both malignant and non-malignant tissues in the affected region. The PSA test works through drawing of blood from a patient’s artery or vein, which will be sent to the laboratory for examination (Adhyam & Gupta, 2012). If the level of the PSA in the blood sample is more than 4 mg/ml, then cancer could be diagnosed. However, the utilization of this PSA level is still shrouded in controversy since such results may also indicate the presence of other diseases such as inflamed or enlarged prostate. Thus, in order to truly conclude the presence of prostate cancer, additional tests such as biopsy, ultrasound, prostate exams and even the recent multiparametric-prostate-magnetic resonance imagining (MP-MRI) become necessary (Stamatakis & Pinto, 2014).
PSA Test’s Validity, Reliability, Sensitivities, and Predictive Values
The validity of the PSA Test for screening cancer patients has always been a subject of discussion. Whereas the test is valid when it comes to cancer screening, particularly in early stages, its overall validity does not inspire confidence since its effect on mortality has not been determined (Leal, Welton, & Martin, 2018). Further, the PSA test’s reliability has also been called into question. Whereas the tool can detect abnormal levels of PSA in the blood, it does not offer an accurate diagnostic information concerning the state of one’s prostate. Thus, one needs to adopt the usage of other tests in order to achieve this objective. Further, it is not useful in screening early stages of this cancer as mentioned above without proving useful for late stage prostate cancer.
Moreover, the usage of PSA test has also been characterized by diametrically different opinions from doctors and studies. For instance, while the tool has provided early detection of prostate cancer, its usefulness as regards saving lives has no clear cut answer. Also, the existence of the PSA levels of more than 4mg/ml has generated a controversy in the scientific circles as it does not necessarily appear as a biomarker for prostate cancer (Laine, 2012). Recommendations have also been made to use the upper range of values of normal when it comes to PSA for older adults. However, this only serves to reduce the sensitivity of the PSA tool for older adults’ prostate screening. Therefore, whereas the PSA cut off 4 ng/mL has expressed low sensitivities in studies, its specificity has increased as incidences of false positive tests are almost negligible.
References
Adhyam, M., & Gupta, A. K. (2012). A Review on the Clinical Utility of PSA in Cancer Prostate. Indian journal of surgical oncology, 3(2), 120-9.
Laine, C. (2012). High-value testing begins with a few simple questions. Annals of Internal Medicine, 156(2), 162–163. Retrieved from the Walden Library databases.
Leal, J., Welton, N., & Martin, R. (2018). Estimating the sensitivity of a prostate cancer screening programme for different PSA cut-off levels: A uk case study. Cancer Epidemiology, 52, 99-105.
Stamatakis, L., … Pinto, P. A. (2014). Diagnostic value of biparametric magnetic resonance imaging (MRI) as an adjunct to prostate-specific antigen (PSA)-based detection of prostate cancer in men without prior biopsies. BJU International, 115(3), 381-388. doi:10.1111/bju.12639