tech and health - diagnostic tech

Question 1

different imaging tests (imaging tests are common diagnostic testing technologies)

Answer 1

• x-ray
• CT scan
• MRI
• ultrasound
• PET scan

Question 2

the medical model

Answer 2

western view:
- illness is caused by bacteria, genes, virus, or accident (pathophysiological explanation)

• illness can be identified and classified into different types of diseases (nervous system, circulatory system)
• classification of disease is objective science, but relies on doctors interpreting and labeling symptoms)

Question 3

taxonomize

Answer 3

classify

Question 4

nosology

Answer 4

classification of illness

Question 5

etiology

Answer 5

physical explanations of causes

causing/ contributing to disease

Question 6

labelling

Answer 6

labelling signs and symptoms to a category of disease is a SOCIAL process because we aren’t 100% sure

Question 7

michel foucault

Answer 7

critical studies of social institutions (psychiatry, medicine, the human sciences, prison system, history of human sexuality)

extent to what medical processes are a social process as well as a scientific process

the birth of modern medicine is a decisive shift in the structure of knowledge/ ways of seeing and understanding (new way of classifying/ taxonomizing)

Question 8

diagnosis (not an exact science)

Answer 8

1. a) identifying disease from signs and symptoms b) decision reached by diagnosis
2. technical description of a taxon (classification)
3. a) analysis of the cause or nature of a condition, situation or problem (diagnosis of engine trouble, what’s causing the problem) b) statement or conclusion from an analysis (based on signs/ what doctor thinks… instead of symptoms/ what pt thinks)

Question 9

3 elements of diagnosis

Answer 9

1. distinguish among diseases or disorders
2. understand a disease or disorder (pathophysiology)
3. predict course of disease or disorder

Question 10

validity of diagnostic tests (what characteristic does test measure and how accurately does it measure?): analytical validity

Answer 10

how well test detects or measures presence of chemicals, hormones, genetic markers

precise (high degree of specificity), accurate, and reliable

Question 11

validity of diagnostic tests (what characteristic does test measure and how accurately does it measure?): clinical validity

Answer 11

how accurately test predicts presence or risk for condition

meaningful associations

Question 12

validity of diagnostic tests (what characteristic does test measure and how accurately does it measure?): clinical utility

Answer 12

is use of test associated with improved patient outcomes or risks as a result of the test?

Question 13

impetus (momentum) for innovation

Answer 13

screening
- early diagnosis prevent onset of disease (only SUGGESTS problem, don’t stop at screening)

treatment
-more accurate diagnosis to improve choice of treatment

legal
-resolving disputes of who has legal and economic responsibilities (DNA paternity testing of who biological parents are)

Question 14

types of diagnostic technology

Answer 14

lab tests
endoscopy
prenatal tests
diagnostic tests
genetic tests

commonly used devices

Question 15

commonly used devices:

Answer 15

thermometers, stethoscopes, sphygmomanometers (bp), otoscopes (hearing), ophthalmoscopes (eyes), ECGs (heart abnormalities), pulse oximeter (blood O2 level), reflex (percussion) hammer, penlight (pupil response)

Question 16

lab tests

Answer 16

testing samples of blood, urine, other tissues or substances (covid swabs)

blood tests:
- serum (remaining liquid of blood after plasma clots outside of body) is sued in chemical tests and in tests to see how immune system fights disease

lab values that are routinely assessed:
- electrolytes, urine, blood, renal, ABGs (arteriole blood gasses), coagulation (proteins that form from blood clotting), liver function, lipids, blood glucose

Question 17

endoscopy

Answer 17

uses endoscope (scope) that has a camera attached to long thin tube

moved through body passageway or opening to see inside organ

for surgery

ex.
- arthroscopy: joints
- bronchoscopy: lungs
- colonoscopy and sigmoidoscopy: large intestine
- cystoscopy and ureteroscopy: urinary system
- laparoscopy: ABDOMEN/ PELVIS
- upper gastrointestinal endoscopy: esophagus and stomach

Question 18

prenatal tests

Answer 18

testing for identification of OI (osteogenesis imperfecta genetic disorder) and other birth abnormalities

noninvasive
- NIPT and ultrasound

invasive
- chorionic villus sampling (placental)
- cordocentesis (umbillical cord)
- amniocentesis (amnio fluid)

Question 19

diagnostic imaging (nuclear scans, radiography, radionuclide scans)

Answer 19

CAT (CT) scan
“computerized axial tomography”
-combines many x-ray images with computer to get cross sectional and 3D views of internal organs and structures
- to define normal and abnormal structures and help guide placement of instruments/ treatments in procedures

MRI scan
“magnetic resonance imaging”
- motion artifacts (pt moving) distorts MRI image
- makes scan useless
- up to 40% of scans have some motion artifacts impairing quality of diagnosis 8-17% of time

Mammography
- lots of false positive results!!(1-14%)
- causes unnecessary anxiety, and developing more sense of risk for breast cancer, and lost confidence in breast examinations, discouragement
- can prompt breast biopsy which majority are benign but causes distress

PET scan

X-ray (roentgen ray)

Question 20

genetic testing

Answer 20

CAN GIVE US MISLEADING RESULTS

tests on blood, saliva, tissue to find GENETIC DISORDERS
900 tests used for:
- genetic disease in unborn baby
- if people carry gene for disease that can be passed on to child
-screening embryos for disease
-testing for genetic diseases in adults before symptoms
-confirming diagnosis when one has disease symptoms
- paternity testing (biological parent of child)

CAN GIVE US MISLEADING RESULTS
study: “genetic factors account for 40-70% of BMI”… the 1% of people with most obesity-causing variants = 4 pounds heavier than typical person and 10 pounds heavier than the 1% of people with least variants –> risk for obesity related to genetic testing is VERY EXAGGERATED

*diseases are being redefined according to new genetics-based classifications (diagnostic process is changing as genetic testing is improved) (biography info changes there are developments in genetic testing, classification changes and pts ruled into and out of categories)

Question 21

human genome project

Answer 21

international scientific collaboration to understand entire genetic blueprint of human

data from mapping and sequencing the human genome will help us associate specific human traits and inherited diseases with particular genes at precise locations on chromosomes

Question 22

genetic testing: torque (resistance) of nosologic change

Answer 22

genetic tests can:
- confirm expected diagnosis
- arbitrate between 2 diagnoses

sometimes genetic info replaces a traditional diagnosis based on clinical signs and symptoms, and argues a genetic logic of disease definition

people can get CAUGHT IN TORQUE (resistance) and confusion of nosologic change –> uncertainties of what they have and uncertainties of clinical management

Question 23

genetic testing: bottom line

Answer 23

genetic info about disease may be seen as etiologic (causing the disease) but the identification of the cause of disease is never straightforward

GENES DO NOT ALWAYS AND UNIFORMLY DEFINE THE PARAMETERS OF A DISEASE

Question 24

Challenges

Answer 24

many countries allow tests to public without quality check, should that be allowed without them knowing the issues?

• how badly do the tests rely on clinician skills
• are these skills too complex to automate
• should clinicians maintain control of the technology?

as predictive and pre-symptomatic tests increase, so will the demand for monitoring… everyone, even low risk people will want the tests