NR 503 Week 2: Discussion- Screening and Reliability

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From the U.S. Preventive Task Force website , choose one screening test that might be considered in primary care.

Define the test, its positive predictive value, reliability and validity. Discuss patient medical or family history that may alter your recommendation for screening?

Type 2 Diabetes Mellitus was the screening test I chose (DM). According to Healthy People 2020 (2018), diabetes is a significant public health problem and the seventh leading cause of death in the United States. At work, I see many patients who did not control their glucose levels and ended up in emergency or intensive care units as a result of high blood sugar levels, such as diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS). Diabetes complications cause cardiovascular disease; however, modifiable cardiovascular risk factors such as abnormal blood glucose levels are thought to be preventable if hemoglobin A1c, fasting plasma glucose level, and OGTT levels are under control (Nathan, 2015). This screening test detects abnormal glucose levels through the measurement of HbA1c, fasting plasma glucose, or an oral glucose tolerance test (USPSTF, 2015). According to data from the

NR 503 Week 2 Discussion- Screening and Reliability

NR 503 Week 2 Discussion- Screening and Reliability

United States Preventive Services Administration (2015), patients with Hemoglobin A1c levels greater than 6.5 percent, fasting plasma glucose levels greater than 7.0 mmol/L, and OGTT results greater than 11.1 mmol/L are frequently considered positive for type 2 diabetes. The percentage of patients with a positive test who actually have the disease is referred to as the positive predictive value (PPV) (Gordis, 2014). It tells us how many of the positive test results are true positives, and this figure is as close to 100 as possible (Thomas, Parikh, Mathai, Parikh, Sekhar, & Thomas, 2008). If the number is higher, it means that the test produced accurate results. Sensitivity and specificity are used to calculate PPV. Sensitivity is a test’s ability to correctly classify an individual as ‘diseased,’ while specificity is a test’s ability to correctly identify those who do not have the disease (Thomas, Parikh, Mathai, Parikh, Sekhar, & Thomas, 2008). True positive / true positive + false positive is the PPV formula.

NR 503 Week 2: Discussion- Screening and Reliability SAMPLE RESPONSE

Thank you for your post, I enjoyed reading it.  The screening test that you chose is very important in screening for Diabetes Mellitus.  Type 2 Diabetes Mellitus is a major health problem and leading cause of death in our country.  Like you, I have many patients who do not control their diabetes and end up in the ICU with diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS), as well as amputations of the extremities, neuropathy, cardiovascular disease, etc.  I also think you did a great job of discussing positive predictive values (PPV), validity, sensitivity, and specificity.  Also, as you mentioned, family history is a big factor to consider regarding testing, especially in close relatives.  As primary care providers, it is important for APNs to carefully consider testing for Type 2 Diabetes Mellitus and family history definitely plays an important role. Thank you for your informative post on screening for Type 2 Diabetes Mellitus.

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