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Mammograms  

Please cite references that are peer-reviewed/ scholarly.

Please Please do NOT use the following for citation:
1         Up to Date (must use original articles from Up to Date as a resource)
2.       Wikipedia
3.       Cdc.gov- non healthcare professionals section
4.       Webmd.com 
5.       Mayoclinic.com
6.       Babyzone.com
7.       americanheartassociation.com
8.    Huffington Post
9. Healthline.com
10. Medical News Today.com

 


For this Assignment, 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. You also will review examples of pediatric patients and their families as it relates to BMI.

By Day 1 of this week, you will be assigned to one of the following Assignment options (MAMMOGRAM) by your Instructor: Adult Assessment Tools or Diagnostic Tests (option 1), or Child Health Case (Option 2). Note: Please see the “Course Announcements” section of the classroom for your assignments from your Instructor.
Search the Walden Library and credible sources for resources explaining the tool or test you were assigned. What is its purpose, how is it conducted, and what information does it gather?
Also, as you search the Walden library and credible sources, consider what the literature discusses regarding the validity, reliability, sensitivity, specificity, predictive values, ethical dilemmas, and controversies related to the test or tool.
If you are assigned Assignment Option 2 (Child), consider what health issues and risks may be relevant to the child in the health example.
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.

The Assignment
Assignment (3–4 pages, not including title and reference pages):

Assignment Option 1: Adult Assessment Tools or Diagnostic Tests:
Include the following:

A description of how the assessment tool or diagnostic test you were assigned is used in healthcare.
What is its purpose?
How is it conducted?
What information does it gather?
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.

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 Mammograms

Nurses and other caregivers depend on assessment tools and diagnostic tests to enhance positive care outcomes. A diagnostic and assessment tool establishes the presence or absence of disease to create a foundation for any treatment decision. The tests apply to symptomatic individuals and screen positive individuals after a confirmatory test. Usually, nurses rely on assessment tools or diagnostic tests to evaluate the health risk status of an individual and any possible indications for intervention. In recent times, an increase in breast cancer cases have led nurses towards conducting regular diagnostic mammograms for women that present with a plethora of symptoms that could be indicative of breast cancer including a breast lump, nipple discharge, thickening, pain, and a general change in the size and shape of breasts. Herein is a profound discussion of mammograms as an assessment tool and a diagnostic test for women.

Purpose of Mammograms

According to an article by Pérez-Lacasta et al. (2019), breast cancer remains the most frequent form of cancer among women and the second leading cause of cancer deaths in developed nations. The purpose of mammography is to detect and treat breast cancer in its earliest stage. The tool can also detect benign tumors and cysts. Due to the need to reduce breast cancer mortality, care providers consider mammograms as the gold standard (Horsley et al., 2019). Experts maintain that early screening of breast cancer reduces the rate of mortality by 20%. Using low-dose x-rays, care providers can detect breast cancer in its early form before a woman experiences any symptoms (screening mammogram), and at a time when the disease is most treatable.  Also, they are particularly useful when diagnosing women who experience a plethora of symptoms that could be indicative of breast cancer including skin dimpling, nipple discharge, or a lump (diagnostic mammogram).

Procedure

In most cases, care providers provide mammography on an outpatient basis. During the process, a qualified radiologic technologist places a woman’s breast in the mammography unit or a special platform where it goes through gradual compression within a clear plastic paddle. The gradual compression is critical as it evens out the breast allowing a proper visualization of tissue, ensures that no abnormalities remain hidden by any overlying tissue, holds the breast to minimize blurring of the image by motion, and reduces x-ray scatter to promote image sharpness. Based on the facility or technician, a patient might either stand or sit during the mammogram session. Generally, a mammography procedure takes place in three major steps including placing the breast between two plates, pressing the plates to flatten the breast, and taking an x-ray, which lasts for a few seconds. For a screening mammogram, a provider takes images of both breasts and might take additional images for a further diagnostic mammogram. The process takes ten to fifteen minutes but might also take up to one hour for other activities including changing clothes, having an examination, and ensuring that images are clear enough for a proper diagnosis or screening. Masses, on the other hand, are dense breast tissues with an abnormal shape and edges that make them different from the rest of the breast tissue. Masses could be cysts or non-cancerous fluid-filled sacs, or solid tumors such as fibroadenomas. However, they could be an early sign of cancer.

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Information Gathered

A care provider will gather different information from a mammogram. The objective of the procedure is to look for different forms of breast changes such as white spots (calcifications), any abnormally large areas (masses), and other suspicious areas that could be indicative of breast cancer. Calcifications are minute calcium deposits within the breast tissue and appear as white spots in the mammogram. They could be indicative of breast cancer or not and they are of two types including macro-calcifications, which appear due to age, injuries, or inflammation (non-cancerous conditions), and micro-calcifications which could lead to a biopsy to check for cancer.

Validity and Reliability

A mammogram remains the best tool in finding breast cancer among women. According to UCHealth (2015), mammography accurately diagnoses at least 78% of all tested women. The diagnostic accuracy increases to 83% for women above 50 years (UCHealth, 2016). In modern times, technologically improved mammograms can detect breast abnormalities before they are felt in a normal breast exam. In another study by Autier et al. (2017), early detection at stage one breast cancer for three individuals prevented two deaths. In the absence of screening, a possible diagnosis could have only occurred from stages two to four. Despite the accuracy of mammograms, experts maintain that they are 80-90% effective among women with non-dense breast tissue with the effectiveness dropping to 50% for women with dense breast tissue. On sensitivity, mammography sensitivity ranges from 75% to 90% and specificity from 90% to 95% (von Euler-Chelpin et al., 2019). That means that there exists a 75% to 90% chance that a woman with breast cancer will have the disease detected in mammography. According to Zeeshan et al. (2018), digital mammography is highly accurate in detecting breast cancer with a 97% sensitivity, 64.5% specificity, a predictive value of 89%, a negative predictive value of 90.9%, and an 89.3% diagnostic accuracy. However, it is critical to highlight that mammograms are not 100% accurate since they might show a false negative where a mammogram might look normal even when breast cancer is present or a false positive where a mammogram looks abnormal when breast cancer is absent.

References

Autier, P., Boniol, M., Koechlin, A., Pizot, C., & Boniol, M. (2017). Effectiveness of and overdiagnosis from mammography screening in the Netherlands: a population-based study. Bmj, 359. https://doi.org/10.1136/bmj.j5224

Horsley, R. K., Kling, J. M., Vegunta, S., Lorans, R., & Patel, B. K. (2019). Baseline mammography: what is it and why is it important? a cross-sectional survey of women undergoing screening mammography. Journal of the American College of Radiology, 16(2), 164-169. https://doi.org/10.1016/j.jacr.2018.07.002

Pérez-Lacasta, M. J., Martínez-Alonso, M., Garcia, M., Sala, M., Perestelo-Pérez, L., Vidal, C., ... & with the InforMa Group. (2019). Effect of information about the benefits and harms of mammography on women’s decision making: The InforMa randomised controlled trial. PloS one, 14(3), e0214057. https://doi.org/10.1371/journal.pone.0214057

UCHealth. (2016, July 6). How accurate are mammograms? https://www.uchealth.org/today/how-accurate-are-mammograms/

von Euler-Chelpin, M., Lillholm, M., Vejborg, I., Nielsen, M., & Lynge, E. (2019). Sensitivity of screening mammography by density and texture: a cohort study from a population-based screening program in Denmark. Breast Cancer Research, 21(1), 1-7

Zeeshan, M., Salam, B., Khalid, Q. S. B., Alam, S., & Sayani, R. (2018). Diagnostic accuracy of digital mammography in the detection of breast cancer. Cureus, 10(4). https://doi.org/10.7759/cureus.2448

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