You know that as a nurse leader and/or APRN, critical analysis to help a patient decide whether or not to have a test
Sensitivity and Specificity INFOGRAM Assignment
You are a nurse leader working on an interdisciplinary team to assess whether to use a screening test. You know that as a nurse leader and/or APRN, critical analysis to help a patient decide whether or not to have a test: or to determine protocols for a clinical setting: or assist with health system decisions such as large scale policies, procedures or purchases related to a screening initiative area are a vital part of your role.
The epidemiology, the natural history of the condition, and the sensitivity and specificity of the screening test are explored. You also need to consider the cost in human cost and financial cost of using the test versus not using the test. In addition, you will need to answer: “What are the impact of false negatives? “or ” False positives”? :
Step 1. Choose a Screening test from the list and table below.
• Note that the sensitivity and specificity data are listed in Table 1
Step 2. Present your conclusions in an INFOGRAM or pictogram for a screening test selected from the list.
• Directions:
o For the test you select for this assignment, be sure you can find the sensitivity and specificity (typically on the website of the company that makes the test.) if it is not in Table 1.
o Identify the gold standard used to determine disease. Be sure you understand, from the readings, what is meant by GOLD standard. It will be the test used to confirm diagnosis. It does NOT mean the best screening test.
o Select an INFOGRAM tool to use.
Look for free tools
• CANVA- https://www.canva.com/create/infographics
• Pictochart- https://piktochart.com/
• INFOGRAM – https://infogram/.
o The programs should let you save without paying or save as pdf, or in whatever formats you can and then try to convert to pdf.
o Another option is to submit the link to the INFOGRAM.
• You can also do this assignment using PowerPoint or Visio or any other way that can make an informational flyer. If you use Visio, save as a pdf.
Develop an INFOGRAM that provides the following information concisely in terms a patient might understand:
- What condition does the test screen? Describe the condition in two sentences.
- What is the prevalence in general population (using national, state, and/or local statistics if available and be sure to include APA-formatted references)?
- If relevant, what is the prevalence in a specific group (such as women, people over 65, African Americans, smokers)? Some conditions are more prevalent in some groups and so the S and S may be different. If you are focusing on a specific age group or risk group for this test (such as lung cancer screening for smokers as the test would have different value in a low prevalence group such as non-smokers), describe that group and give disease data for that group.
- State the sensitivity, specificity rates for the test. State the rate of false positives and false negatives. This could be in the form of a table. You may need to calculate TP FP TN FN from the S and S rates.
- Describe what test is used as the “gold standard” diagnostic test. If the screening test is positive, the gold standard is the diagnostic test(s) used to determine if the condition is present.
- Discuss the interpretation of results and the significance of each. This is not just about reporting data; use your critical thinking skills to determine the implications of the results. Write your explanation in clear language so that a patient could understand what a FN, FP, TN, and TP mean. In some cases, it is ok to have low specificity.
- Show (it might be best to do it as bullets) of the pros and cons of this screening test related to the risks of false positives and negatives vs the benefits of testing. What is the balance of the benefits and risks of false positives and false negatives (depending on the S and S) and further testing risks?
- Summary, conclusion, your recommendations (no more than 4 sentences).
- Note: Do not just cite the conclusions of USPSTF, ACS, or another group. Present your reasoning. How would you explain the test(s) to a patient? What do results mean? What do you, nurse leader, recommend, for the population?
List of potential screening tests:
• Pap tests for cervical dysplasia or cancer (specify which test)
• CT Scan for Lung Cancer Screening
• FIT, Cologard, digital rectal, or fecal occult blood (guiac), or colonoscopy for colon cancer (pick one)
• finger stick cholesterol for heart disease
• h pylori breath test
• capillary fasting blood sugar for diabetes
• Urinalysis dipstick (which tests?) for UTI
• HIV screening test
• Malaria rapid diagnostic tests (RDTs)
• Simplified Nutritional Assessment Questionnaire
• PHQ2 or PHQ9 for depression
• Antinuclear antibodies (ANA) for SLE or RA (focus on screening for SLE OR RA, not both)
• Covid-19
Table 1. Screening Tests
Test
Sensitivity
Specificity
Source
Screening Colonoscopy
92.5
73.2
Issa, I. A., & Noureddine, M. (2017). Colorectal cancer screening: An updated review of the available options. World journal of gastroenterology, 23(28), 5086–5096. doi:10.3748/wjg.v23.i28.5086
CT Scan for Lung Cancer
93.8
73.4 U.S. Preventive Services Task Force (2013) Final Recommendation Statement Lung Cancer: Screening
Pap Test (no HPV test)
57
76
Barut, M. U., Kale, A., Kuyumcuoğlu, U., Bozkurt, M., Ağaçayak, E., Özekinci, S., & Gül, T. (2015). Analysis of sensitivity, specificity, and positive and negative predictive values of smear and colposcopy in diagnosis of premalignant and malignant cervical lesions. Medical Science Monitor : International Medical Journal of Experimental and Clinical Research, 21, 3860–3867. doi:10.12659/msm.895227
UA for UTI
64.3
76.7
Chu, C., & Lowder , J. (2018). Diagnosis and treatment of urinary tract infections across age groups. American Journal of Obstetrics and Gynecology, 219 (1), 40-51. Doi: https://doi.org/10.1016/j.ajog.2017.12.231
Urea Breath Test for h pylori
96
93
Ferwana, M., Abdulmajeed, I., Alhajiahmed, A., Madani, W., Firwana, B., Hasan, R., … Knawy, B. (2015). Accuracy of urea breath test in Helicobacter pylori infection: meta-analysis. 21(4), 1305–1314. doi:10.3748/wjg.v21.i4.1305 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4306177/
Pap with HPV
94.6
94.1
Barut, M. U., Kale, A., Kuyumcuoğlu, U., Bozkurt, M., Ağaçayak, E., Özekinci, S., & Gül, T. (2015). Analysis of sensitivity, specificity, and positive and negative predictive values of smear and colposcopy in diagnosis of premalignant and malignant cervical lesions. Medical Science Monitor : International Medical Journal of Experimental and Clinical Research, 21, 3860–3867. doi:10.12659/msm.895227
Generalized Anxiety Disorder (GAD) screening
GAD7- 83
GAD2-76
GAD7- 84
GAD2-81
Plummer F, Manea L, Trepel D, McMillan D (2016).Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. Gen Hosp Psychiatry. 2016
Mar-Apr;39:24-31. doi: 10.1016/j.genhosppsych.2015.11.005.
Cologuard Colon Cancer
92.3
86.6
Imperiale, T. F., Ransohoff, D. F., Itzkowitz, S. H., Levin, T. R., Lavin, P., Lidgard, G. P., … Berger, B. M. (2014). Multitarget stool DNA testing for colorectal-cancer screening. The New England Journal of Medicine, 370, 1287-1297
PHQ9
88
88
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606-13. (old but classic)
Capillary FBS Diabetes
65
72
Zhang, Y., Sun, J., Pang, Z., Gao, W., Sintonen, H., Kapur, A., & Quiao, Q. (2013). Evaluation of two screening methods for undiagnosed diabetes in China: An cost-effectiveness study. Primary Care Diabetes, 7(4), 275-282. doi: 10.1016/j.pcd.2013.08.003
PHQ2 Depression
76
87 Manea L, Gilbody S, Hewitt C, North A, Plummer F, Richardson R, McMillan D .(2016) Identifying depression with the PHQ-2: A diagnostic meta-analysis. J Affect Disord. 6 Oct;203:382-395. doi: 10.1016/j.jad.2016.06.003. Epub 2016 Jun 6.
Rapid Detection Test (RDT) for Malaria
99.4
46.7
Murungi, M; Fulton T, Reyes R, Matte m, Ntaro M, Mulogo E, Nyehangane D, … Boyce R (2017). Improving the specificity of Plasmodium falciparum malaria diagnosis in high-transmission settings with a two-step rapid diagnostic test and microscopy algorithm. Journal of Clinical Microbiology, 55 (5) 1540-1549; DOI: 10.1128/JCM.00130-17
NON Fasting Cholesterol
93
51
Fatima S, Ijaz A, Sharif TB, Khan DA, Siddique A.(2016) Accuracy of non-fasting lipid profile for the assessment of lipoprotein coronary risk. J Coll Physicians Surg Pak. (12):954-957. doi: 2493.
Simplified Nutritional Appetite Questionnaire (SNAQ) in Older Patients
71
74 Rolland Y1 Perrin A Gardette V Filhol N Vellas B (2012) Screening older people at risk of malnutrition or malnourished using the Simplified Nutritional Appetite Questionnaire (SNAQ): a comparison with the Mini-Nutritional Assessment (MNA) tool. J Am Med Dir Assoc.13(1):31-4. doi: 10.1016/j.jamda.2011.05.003.
For some conditions, the impact of high or low false positives or negatives will vary. For example, a high false negative, low sensitivity test for HIV could result in the spread of HIV, while a low sensitivity on a PSA may be acceptable for an older population with slow growing cancer. A false positive BP reading (white coat hypertension) has implications far different from a false negative pre-op pregnancy test. You need to take the specifics of the condition you are screening for and the invasiveness of further testing or other use of the results into account.
Remember you are graded on substantive thinking, not merely reporting from the package insert. As always, it helps to check your paper against the rubric to be sure you have all the requisite components. This should explain the test and its S and S as you would explain it to a patient. Be concise. Brevity is an art.
Format: Follow APA format for references (you can put in small font). The INFOGRAM should present the critical information concisely; it is not meant to be a paper put into an INFOGRAM form.
Reminder: Check APA format for references and citations.
Due Date: see course schedule . find more on how to write to get the best nursing essays online.
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