NR 503 Week 2 Discussion: Epidemiological Methods
Consider one of the following disease processes:
• Zika
• Salmonella
• MRSA → Selected
... [Show More] Disease
• Clostridioides difficile
• Depression (Choose population:Adult, Older Adult, Adolescent)
• Attention Deficit Disorder
• Dementia
• Osteoporosis
Next, choose a diagnostic or screening method. You may use one of the following web sites to locate a screening tool, a scholarly article, or a tool from a professional web site of your choice (for example, from the American Psychological Association).: U.S. Preventative Services Task Force (Links to an external site.)
Agency for Healthcare Research and Quality (Links to an external site.)Links to an external site.
SAMHSA-HRSA (Links to an external site.).
Reply to the following prompt: Describe the diagnostic or screening tool selected, its purpose, and what age group it targets. Has it been specifically tested in this age group?
Next, discuss the predictive ability of the test. For instance, how do you know the test is reliable and valid? What are the reliability and validity values? What are the predictive values? Is it sensitive to measure what it has been developed to measure, for instance, HIV, or depression in older adults, or Lyme Disease? Would you integrate this tool into your advanced practice based on the information you have read about the test, why or why not?
Need assistance? Click here for the Week 2 FAQ document that discusses these terms.
You should include a minimum of two (2) scholarly articles from the last five (5) years (3 is recommended). Respond to a minimum of two (2) individuals, peer and/or faculty, with a scholarly and reflective post of a minimum of two (2) paragraphs of 4-5 sentences. A minimum of one (1) scholarly article should … utilized to support the post in addition to your textbook.
Your work should have in-text citations integrating at a minimum one scholarly article and the course textbook. APA format should … utilized to include a reference list. Correct grammar, spelling, and APA should … adhered to when writing, work should … scholarly without personalization or first person use.
ANSWER
Class,
Osteoporosis is a common medical condition, especially in the elderly population. Their bones become frail as a result of hormone alterations or a lack of other elements such as calcium (Jeremiah, Unwin, Greenawald, & Casiano, 2015). The fracture risk assessment tool (FRAX) is a screening that can be utilized to predict osteoporosis-related fractures in middle age to older adults. It is predicted that by 2020 over 12 million Americans over age 50 will have osteoporosis (American Family Physician, 2018). Therefore, appropriate screening is a vital and essential factor as healthcare members.
Osteoporosis predisposes individuals to bone fractures and increased morbidity and mortality rates (Stanciu,2016). The FRAX screening tool predicts your chances of breaking a hip or major bone over the next 10 years. FRAX score is calculated by utilizing sex, age, body mass index (BMI), current smoking habits, glucocorticoid usage, parental hip fractures, alcohol use, prior fragility fracture, history of rheumatoid arthritis, and secondary causes of osteoporosis (Kanis et al.,2015). The target group is women who are postmenopausal age 40-90 years old and it has been tested on that age range (Golob & Laya, 2015).
Understanding things such as predictive ability, validity, and reliability along with other numerical information in a study is important as it allows you to determine accuracy and accountability of a study (Curley & Vitale, 2016). The predictive ability of the FRAX screening tool is manifested in its ability to identify the risk for osteoporosis. Multiple research studies have proven the high accuracy of utilizing FRAX to determine individuals’ risk for fractures and osteoporosis (Curry et al.,2018). Predictive validity in one study was at 0.661 and 0.541 in women all age 60 and older when 533 individuals were screened (Chen et al.,2016). FRAX has a low sensitivity of predicting osteoporosis for women ages 50-64 (Bansal et al., 2015). In terms of reliability and validity of the FRAX scores, the reliability is 0.82, and the validity is 0.77.
As with any screening tool, there are both advantages and disadvantages. The FRAX screening tool is a great tool because it is cost-effective which is something that must be considered in a family practice setting for patients. Also, it does not expose the patient to any unnecessary radiation that other screening tools such as the dual-energy x-ray absorptiometry (DXA) do. However, some of the disadvantages of the FRAX tool is that it speculates that BMI and mortality are constant for different ethnicities. Furthermore, it is limited to the known risk factors and not the unknown (Stancui, 2016). Therefore, the FRAX screening tool is a vital tool and an essential factor that health care providers should use in their practices. Since it is fairly accurate and is cost-effective, I would utilize this tool in my future practice as an advanced practice nurse.
Reference:
American Family Physician. (2018). Screening for Osteoporosis to Prevent Fractures: Recommendation Statement. Retrieved from https://www.aafp.org/afp/2018/1115/od1.html
Bansal, S., Pecina, J. L., Merry, S. P., Kennel, K. A., Maxson, J., Quigg, S., & Thacher, T. D. (2015). US Preventative Services Task Force FRAX threshold has a low sensitivity to detect osteoporosis in women ages 50-64 years. Osteoporosis International: A Journal Established As Result Of Cooperation Between The European Foundation For Osteoporosis And The National Osteoporosis Foundation Of The USA, 26(4), 1429–1433. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1007/s00198-015-3026-0
Chen, S., Chen, Y., Cheng, C., Hwang, H., Chen, C., & Lin, M. (2016). Comparisons of different screening tools for identifying fracture/osteoporosis risk among community-dwelling older people. Medicine, 95(20), e3415. DOI: 10.1097/MD.0000000000003415.
Curley, L. A., & Vitale, A. P. (2016). Population-Based Nursing, Concepts and Competencies for Advanced Practice (2nd ed.). New York; NY, Springer Publishing Company.
Curry, S., Krist, A., Owens, D., Barry, M., Caughey, A., Davidson, K., … US Preventive Services Task Force. (2018). Screening for osteoporosis to prevent fractures US Preventive Services Task Force recommendation statement. JAMA-Journal of the American Medical Association, 319(24), 2521–2531. DOI: doi: 10.1001/jama.2018.7498.
Golob, A. L., & Laya, M. B. (2015). Osteoporosis: Screening, Prevention, and Management. Medical Clinics of North America, 99(3), 587–606. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1016/j.mcna.2015.01.010
Jeremiah, M. P., Unwin, B. K., Greenawald, M. H., & Casiano, V. E. (2015). Diagnosis and Management of Osteoporosis. American Family Physician, 92(4), 261–268. Retrieved from https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=mdc&AN=26280231&site=eds-live&scope=site
Kanis, J. A., Harvey, N. C., Johansson, H., Oden, A., Leslie, W. D., & McCloskey, E. V. (2015). FRAX and fracture prediction without bone mineral density. Climacteric, 18(sup2), 2-9.
Stanciu, M. (2016). Evaluation of Osteoporosis Risk Factors with Frax Score in Elderly. Acta Medica Transilvanica, 21(1), 46–48. Retrieved from https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=a9h&AN=119937549&site=eds-live&scope=site
from Week 2: Discussion - Epidemiological Methods
Sep 9, 2019 5:15am
Cassandra Moore
Delanie,
You did a great job further discussing osteoporosis and the DEXA screening tool that can be utilized to assess the risk of fractures. I have heard of the DEXA scan but have very limited knowledge on it as well. In the future as family nurse practitioners, it will be vital to utilize screening tools such as this to further evaluate the at-risk population. I choose osteoporosis as well; however, I choose to look at the FRAX screening tool.
You pointed out that the DEXA scan can be used on patients of all ages, did you find a certain age range that it is typically used for? Also, did you come across any articles regarding the relationship between vitamin D deficiency and osteoporosis? There is a connection between vitamin D deficiency and osteoporosis between the elderly that can be treated to reduce the severity of osteoporosis (Francis et al.,2015). It is always interesting to learn about deficiencies and the body and correlation with disease processes. I often think of our bodies like a car, and how they require oil, gas and appropriate maintenance to run efficiently, just the same as the human body and its requirements.
Incidence rates paint a good picture of how often cases occur within a particular population which allows for better determination of risk assessment (Curley & Vitale, 2016). Reducing fractures by 2.5-3.6% through the utilization of DEXA screening as you stated is a good incidence rate. With that, I would utilize it in my future practice. Finally, you made a great point that a CT scan can be extremely costly, but it also places the patient at risk for unnecessary radiation. Great job on your post. I certainly learned new information from you.
Reference:
Curley, L. A., & Vitale, A. P. (2016). Population-Based Nursing, Concepts and Competencies for Advanced Practice (2nd ed.). New York; NY, Springer Publishing Company.
Francis, R. M., Aspray, T. J., Bowring, C. E., Fraser, W. D., Gittoes, N. J., Javaid, M. K., ... & Tanna, N. (2015). National Osteoporosis Society practical clinical guideline on vitamin D and bone health. Maturitas, 80(2), 119-121
from Week 2: Discussion - Epidemiological Methods
Sep 10, 2019 3:29am
Cassandra Moore
Dr.Sinnaeve,
Screenings are used to catch diseases in people who do not have any symptoms in hopes of decreasing morbidity and mortality (Curley & Vitale, 2016). As a future family nurse practitioner, it is important to first determine who needs to be screened and then secondly convince those in need to follow through with the screening. However, for this to occur the patient population must be educated and see the benefit and need for the screening. Providing patients with this information and education will vital as a provider.
Educating patients on the facts regarding the screening process in terms of what the patient can expect will be beneficial. If you take something like colorectal cancer screening you can find data to show the patient its value and provide them with numerical data that may be convincing. Multiple studies have determined the significance of colorectal cancer screenings in reducing mortality (Williams, Wilkerson, & Holt, 2018). Discussing facts with patients and the value of certain tests will allow them to buy into what you are trying to convince them of and improve the chances of follow-through.
I believe that patients have 100 % control over their health. I believe that it is the job of the providers to educate their patients but not force or attempt to get them to do something they do not want. I appreciate honesty and hope to always be able to provide my patients with that. Discussing with them the alternatives if they do not wish to follow the suggestions is important. However, I do not believe in “trying to scare patients” into following recommendations. Therefore, providing them with the facts and education and allowing them to make their own decisions will be the approach I will use in the future.
Reference:
Curley, L. A., & Vitale, A. P. (2016). Population-Based Nursing, Concepts and Competencies for Advanced Practice (2nd ed.). New York; NY, Springer Publishing Company.
Williams, R. M., Wilkerson, T., & Holt, C. L. (2018). The role of perceived benefits and barriers in colorectal cancer screening in intervention trials among African Americans. Health Education Research, 33(3), 205–217. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1093/her/cyy013 [Show Less]