NR 503 Week 2: Descriptive Epidemiology, Screening, Prevention and the Importance of the Randomized Control Trial

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From the U.S. Preventive Task Force
website https://www.uspreventiveservicestaskforce.org/BrowseRec/Index (Links to an
external site.)Links to an external site., 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?

Collapse SubdiscussionDarnesha Clanton
Darnesha Clanton
Jul 15, 2018Jul 15 at 1:04pm
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Dr. Anttila and class,
A Papanicolaou test or better known as Pap
smear testing is a method of cervical cancer
screening. It is used to detect cervical epithelial
changes that can be pre-cancerous and
cancerous (Sachan, Singh, Patel, & Sachan,
2018). There are two forms of cervical screening
testing, conventional and liquid-based cytology.
There is no clinical or significant difference in the
results. As with any testing and results, there can
be a potential false-positive or a false-negative. In
essence, one is not better than the other. Both
methods share the same high accuracy rate. If

further testing is needed a colposcopy is
performed as the diagnostic test.
Cervical cancer screening consist of cytology
(Pap smear) for women with a cervix at ages 21-
29 every 3 years and for women 30 to 65 cytology
every 3 years or cytology with human papilloma
virus (HPV) every 5 years. There has been a
large reduction rate of cervical cancers in the
United States. Early screening and detection
reduces cervical rates 60% to 90% within 3 years
of interventions (U.S. Preventive Services Task
Force [USPSTF], 2012). Unfortunately, for
developing countries cervical cancer is higher due
to the lack of knowledge, technology, and
experience.
“The overall sensitivity of the Pap test in detecting
a high-grade squamous intraepithelial lesion
(HSIL) is 70.2%. A Pap screening done in
association with a HPV DNA test increases the
sensitivity for early detection of precancerous
lesions” (Sachan, Singh, Patel, & Sachan, 2018).
There can be 6 different pap results, I will list the
severity in ascending order: negative, atypical
squamous cells (ASC-US), low-grade squamous
intraepithelial lesion (LSIL), high-grade squamous
intraepithelial lesion (HSIL), atypical squamous
cells-cannot exclude HSIL (ASC-H), and atypical
glandular cells (ACG) (The American College of
Obstetrician and Gynecologists [ACOG], 2016).
Depending on the results and the patient’s age
will depend on if a colposcopy, biopsy, or an
endocervical sampling is needed.
Situations that can alter the screening for this
patient is having a total hysterectomy (medical
history). It is not recommended a pap smear be
performed on someone without a cervix due to a
lack of cervical precancerous lesions. Another
alteration could be if their immediate family
member has been diagnosed with cancer early in
life (family history). If a patient is HIV positive they
may require more frequent screening. Also, the
patient’s age. Studies have found screening prior
to age 21 and after age 65 with previous normal
Pap smear results is not beneficial. The risk

outweighs the benefits and can potentially cause
physical and/or psychological damage.
Reference

The American College of Obstetrician and
Gynecologists. (2016). Abnormal cervical cancer
screening test results. Retrieved from
https://www.acog.org
Sachan, P.L., Singh, M., Patel, M.L., & Sachan,
R. (2018). A study on cervical cancer screening
using pap smear test and clinical
correlation. Asia-Pacific Journal of Oncology
Nursing, 5(3), 337-341.
U.S. Preventive Services Task Force. (2012).
Cervical Cancer: Screening. Retrieved from
https://www.uspreventiveservicestaskforce.org.
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Rosangelly Colon-Torres
Rosangelly Colon-Torres
Jul 18, 2018Jul 18 at 7:56pm
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Good Evening,
I enjoy reading your post, it was quite informative.
Cancer is the second leading cause of death
globally, and was responsible for 8.8 million
deaths in 2015. Globally, nearly 1 in 6 deaths is
due to cancer (WHO, 2018). Approximately 15%
of cancers diagnosed in 2012 were attributed to
carcinogenic infections, including Helicobacter
pylori, Human papillomavirus (HPV), Hepatitis B
virus, Hepatitis C virus, and Epstein-Barr virus
(Plummer, Martel, Vignat, Ferlay, Bray, &
Franceschi, 2016). More specifically, cervical
cancer was a known cause of death for American

women. However, this rate of death was
decreased due to the use of the Pap test (WHO,
2018). It has been my experience that many
young women visit the ED with vaginal complaints
and have never obtained a Pap smear, let alone
visit the gynecologist for these complaints. The
challenge as a nurse is educating these young
women on the importance of this screening. The
views or beliefs held by the young ladies are that
they are not in need of this test, embarrassed, or
just lack of knowledge. To enable a positive
moment where the information presented is
grasped by the female patient, the nurse should
strive to provide education that stresses the
importance of the Pap smear and strategies
allowing greater understanding of one’s own body
(Plummer et.al, 2016). Additionally, continue to
build trust and allow for opportunities to plant the
seeds of knowledge.
Screening aims to identify individuals with
abnormalities suggestive of a specific cancer or
pre-cancer who have not developed any
symptoms and refer them promptly for diagnosis
and treatment. Screening programms can be
effective for select cancer types when appropriate
tests are used, implemented effectively, linked to
other steps in the screening process and when
quality is assured. In general, a screening
program is a far more complex public health
intervention compared to early diagnosis.
Examples of screening methods are:
visual inspection with acetic acid (VIA) for cervical
cancer in low-income settings;
HPV testing for cervical cancer;
PAP cytology test for cervical cancer in middle-
and high-income settings; and

NR 503 Week 2 Descriptive Epidemiology, Screening, Prevention and the Importance of the Randomized Control Trial

mammography screening for breast cancer in
settings with strong or relatively strong health
systems.

Plummer, M., Martel, C., Vignat, J., Ferlay, J.,
Bray, F., & Franceschi, S. (2016). Global burden
of cancers attributable to infections in 2012: a

synthetic analysis. Lancet Glob Health. 4(9):e609-
16. doi: 10.1016/S2214-109X(16)30143-7.
World Health Organization (2018). Cancer.
Retrieved from http://www.who.int/news-
room/fact-sheets/detail/cancer on 07/18/2018

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Grading Rubric Guidelines

Performance Category	10	9	8	4	0
Scholarliness Demonstrates achievement of scholarly inquiry for professional and academic decisions.	Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions Evaluates literature resources to develop a comprehensive analysis or synthesis. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion	Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions. Evaluates information from source(s) to develop a coherent analysis or synthesis. Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis. Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion. Demonstrates little or no understanding of the topic.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) without any interpretation/evaluation. The posting uses information that is not valid, relevant, or reliable	No evidence of the use of scholarly inquiry to inform or change professional or academic decisions. Information is not valid, relevant, or reliable
Performance Category	10	9	8	4	0
Application of Course Knowledge – Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources; Applies concepts to personal experience in the professional setting and or relevant application to real life.	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources. Applies concepts to personal experience in their professional setting and or relevant application to real life Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content	Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson. Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life Does not demonstrate a solid understanding of the principles and concepts presented in the lesson	Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post. Posts are superficial and do not reflect an understanding of the lesson content Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life	Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category	5	4	3	2	0
Interactive Dialogue Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. *(5 points possible per graded thread)*	Exceeds minimum post requirements Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days. Replies to a post posed by faculty and to a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days Replies to a question posed by a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Meets expectations of 2 posts on 2 different days. The main post is not made by the Wednesday deadline Does not reply to a question posed by a peer or faculty	Has only one post for the week Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments	Does not post to the thread No connections are made to the topic
	Minus 1 Point	Minus 2 Point	Minus 3 Point	Minus 4 Point	Minus 5 Point
Grammar, Syntax, APA Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition	2-3 errors in APA format. Written responses have 2-3 grammatical, spelling, and punctuation errors. Writing style is generally clear, focused, and facilitates communication.	4-5 errors in APA format. Writing responses have 4-5 grammatical, spelling and punctuation errors. Writing style is somewhat focused.	6-7 errors in APA format. Writing responses have 6-7 grammatical, spelling and punctuation errors. Writing style is slightly focused making discussion difficult to understand.	8-10 errors in APA format. Writing responses have 8-10 grammatical, spelling and punctuation errors. Writing style is not focused, making discussion difficult to understand.	Post contains greater than 10 errors in APA format. Written responses have more than 10 grammatical, spelling and punctuation errors. Writing style does not facilitate communication. The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
	0 points lost				-5 points lost
Total Participation Requirements *per discussion thread*	The student answers the threaded discussion question or topic on one day and posts a second response on another day.				The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirement *per discussion thread*	The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.				The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.