Discussion topic: Assessment Tools and Diagnostic Tests
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.
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.
� Review this week’s Learning Resources, and consider the factors that impact the validity and reliability of various assessment tools and diagnostic tests.
� Select one of the following assessment tools or diagnostic tests to explore for the purposes of this Discussion:
o Physical tests for sore throat (inspecting the throat, palpating the head and neck lymph nodes, listening to breath sounds)
o Prostate-specific antigen (PSA) test
o Dix-Hallpike test
o Body-mass index (BMI) using waist circumference for adults
� Search from any accredited 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?
� Examine the literature and resources you located for information about the validity and reliability of the test or tool you selected. What issues with sensitivity, specificity, and predictive values are related to the test or tool?
� Are there any controversies or issues related to any of these tests or tools?
� Consider any ethical dilemmas that could arise by using these tests or tools.
Post on or before Day 3 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.
Readings/Recommended References (you may choose your own textbook or articles for this paper)
� Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.
o Chapter 2, “Cultural Awareness”
This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.
o Chapter 3, “Examination Techniques and Equipment”
This chapter explains the physical examination techniques of inspection, palpation, percussion, and auscultation. This chapter also explores special issues and equipment relevant to the physical exam process.
� Dains, J. E., Baumann, L. C., & Scheibel, P. (2012). Advanced health assessment and clinical diagnosis in primary care (4th ed.). St. Louis, MO: Mosby, Elsevier.
o Chapter 1, “Clinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom Analysis”
This chapter introduces the diagnostic process, which includes performing an analysis of the symptoms and then formulating and testing a hypothesis. The authors discuss how becoming an expert clinician takes time and practice in developing clinical judgment.
� LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2009). DeGowin’s diagnostic examination (9th ed.). New York, NY: McGraw Hill Medical.
o Chapter 3, “The Physical Screening Examination”
In this chapter, the authors describe methods for physical examination and procedures for screening physical examinations. In addition, this chapter explains the necessary preparations and equipment for conducting exams.
o Chapter 17, “Principles of Diagnostic Testing”
The authors use this chapter to discuss the principles of diagnostic testing. The chapter specifies tools that may be used in the selection and interpretation of tests.
o Chapter 18, “Common Laboratory Tests”
This chapter details normal and pathologic results for common tests of the blood, urine, cerebrospinal fluid, and serous fluid. Additionally, this chapter describes reasons for ordering different types of lab tests.
� Laine, C. (2012). High-value testing begins with a few simple questions. Annals of Internal Medicine, 156(2), 162-163.
Retrieved from a Library databases.
This article supplies a list of questions physicians should ask themselves before ordering tests. The authors provide general guidelines for maximizing the value received from testing.
� Qaseem, A., Alguire, P., Dallas, P., Feinberg, L. E., Fitzgerald, F. T., Horwitch, C., & – Weinberger, S. (2012). Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care. Annals of Internal Medicine, 156(2), 147-149.
Retrieved from a Library databases.
This article highlights the increasing cost of health care and stresses the need for high-value and cost-conscious testing. The authors provide a list of 37 situations in which more testing provides no benefit or may be harmful.
� Shaw, S. J., Huebner, C., Armin, J., Orzech, K., & Vivian, J. (2009). The role of culture in health literacy and chronic disease screening and management. Journal of Immigrant & Minority Health, 11(6), 460-467.
Retrieved from a Library databases.
This article examines cultural influences on health literacy, cancer screening, and chronic disease outcomes. The authors postulate that cultural beliefs about health and illness affect a patient’s ability to comprehend and follow a health care provider’s instructions.
� Wians, F. H. (2009). Clinical laboratory tests: Which, why, and what do the results mean? LabMedicine, 40, 105-113.
Retrieved from http://labmed.ascpjournals.org/content/40/2/105.full
This article analyzes the laboratory testing cycle and its impact on diagnostic decision making. This article also examines important diagnostic performance characteristics of laboratory tests, methods of calculating performance, and tools used to assess the diagnostic accuracy of a laboratory test.
Assessment Tools and Diagnostic Test
A diagnostic test is utilized to focus the vicinity or absence of a disease when a subject gives signs or side effects of the infection. A screening test recognizes asymptomatic people who may have a sickness. The symptomatic test is performed after a positive screening test to make an authoritative and definite analysis.
When testing or screening for breast malignancy, an X-ray image of the breast known as a mammogram is used. Mammograms assume an essential part in ahead of breast cancer detection and help decline breast growth deaths. A mammogram might be utilized either for screening or symptomatic purposes. How regularly you ought to have a mammogram relies on upon your age and your danger of breast malignancy (Brennecke, 2012).
Sensitivity and specificity
Sensitivity and specificity are the most utilized facts used to portray an indicative test. Shockingly, they are not exceptionally accommodating to clinicians attempting to reconsider the likelihood of infection (H.R. 1740, 2009).
You are running a mammography-screening program in a van that goes around your wellbeing territory. A 45-year-old individual has a mammogram. The study is deciphered as “suspicious for mischief” through the radiologist. The tolerant asks you, “Do this denote I have tumor?”, Moreover, you (precisely) answer “No, we have to do further testing.” She then asks, “Okay, I appreciate that the mammogram is not the last answer, yet given what we know now, what are the dangers that I have chest danger?” Accept that the general threat of bosom tumor in any 45-year-old woman, paying little personality to mammogram result is 0.1% or one in a thousand. What is the likelihood that this person has chest growth?
Although 80% sensitivity and 95% specificity make it sound, as the test is positively right, and the likelihood of chest sickness with a positive test was low. Reviewing the implications of regularity, affectability, and specificity, and exploring Bayes Theorem, will help us fathom why:
• Prevalence or pretest likelihood = likelihood of illness in the pertinent populace (i.e. 5% of patients showing with hack have pneumonia)
• Sensitivity = among patients with illness, the likelihood of a positive test
• Specificity = among patients without illness (i.e. reliable patients), the likelihood of a negative test
• Post-test likelihood = likelihood of illness given a positive or negative test
Note that the meanings of sensitivity and specificity start with learning of whether the patient has ailment. As clinicians, however, we do not know whether the patient has sickness – that is the reason we are requesting the test in any case! Therefore, sensitivity and specificity do not provide for us the data we have to translate the test. (plates., 2009).
The likelihood of having the disease, given the aftereffects of a test, is known as the predictive estimation of the test. Positive prescient value is the likelihood that a patient with a positive (anomalous) test come about has the illness. Contrary prescient worth is the likelihood that an individual with a negative (ordinary) test result is positively free of sickness. Prescient quality is a response to the inquiry: If the patient’s test result is particular, what are the risks that the patient has an illness?
Prescient quality is controlled by the sensitivity and specificity of the test and the pervasiveness of sickness in the populace being tried. (Commonness is characterized as the extent of persons in a characterized populace at a given point in time with the condition being referred to.) The more touchy a test, the more improbable a single person with a contrary test will have the ailment and consequently the more excellent the adverse prescient quality. The more particular the tests, the more outlandish a single person with a constructive test will be free from infection and the more terrific the constructive prescient quality. (Parker, 2005).
The discussion over the impact of mammographic screening on bosom tumor mortality is controversial. Alongside it, advantages many demerit have also been sidelined against this process.
Mammography screening brings about over diagnosis of bosom tumors that would have been innocuous. This study is aimed at educating women. This means that it might be lead to undesired treatment hence abuse of the human body.
Brennecke, C. M. (2012). Breast Imaging Case Review Series. (2nd ed.). London: Elsevier Health Sciences.
H.R. 1740, t. B. (2009).; H.R. 1691, the Breast Cancer Patient Protection Act of 2009; H.R. 2279, the Eliminating Disparities in Breast Cancer Treatment Act of 2009; and H.R. 995, the Mammogr.
Parker, P. M. (2005). Mammogram a medical dictionary, bibliography, and annotated research guide to Internet references. San Diego, CA: ICON Health Publications.
Plates., M. l. (2009). Springfield, Ill.: Jesse White, Secretary of State [Vehicle Services Dept..