REPLY POSTS:
Reply separately to two of your classmates posts (See attached classmates posts, post#1 and post#2).
Note: The expectation is not that you “agree” or “disagree” with your peers but that you develop a conversation with information that is validated via citations to encourage learning and to bring your own perspective to the conversation.
Please, send me the two documents separately, for example one is the reply to my peers Post #1, and the other one is the reply to my other peer Post #2.
TURNITIN ASSIGNMENT (FREE OF PLAGIARISM)
Runninghead: CONGENITAL ANOMALIES 1
Congenital Anomalies
Jillian Zucco
Regis College, PMHNP
CONGENITAL ANOMALIES 2
Congenital Anomalies
The purpose of this assignment is to critique an article about a topic covered in this
week’s reading material and discuss both the topic and the article with classmates. The topic I
chose for this assignment is: congenital anomalies. Congenital anomalies are genetic or inherited
disorders or developmental disorders that are present at birth. A congenital anomaly can be
caused by a single-gene disorder, which is a mutation in one gene in the ova or sperm that is
passed down to later generations. Mutations in body cells that are not reproductive cells can
cause a disorder or dysfunction but cannot be passed down the way mutations in reproductive
cells can (Vanmeter, 2014).
Chromosomal defects can also be the cause congenital anomalies. During meiosis, DNA
fragments can be displaced or lost. This kind of error is what usually causes chromosomal
anomalies and is more common when the mother is older than age 35. Some congenital
disorders happen at birth, but do not have a genetic component. These can occur from premature
birth, exposure to teratogenic agents, or a traumatic labor or delivery. Teratogenic agents are
those that can damage the embryo or fetus and its development. Some congenital anomalies are
caused by multiple genes, making them polygenic disorders (Vanmeter, 2014).
The article I chose to critique is entitled “Dietary glycemic index and glycemic load
during pregnancy and offspring risk of congenital heart defects: a prospective cohort study.” It
was authored by Amalie Schmidt, Marie Lund, Giulia Corn, Thorhallur Halldorsson, Nina Oyen,
Jan Wohfahrt, Sjurdur Olsen, and Mads Melbye, all of whom are affiliated with reputable
institutions, such as the University of Bergen Department of Global Public Health, Harvard TH
Chan School of Public Health, and Stanford University School of Medicine. The article was
published this year, 2020, in The American Journal of Clinical Nutrition. The purpose of this
CONGENITAL ANOMALIES 3
article was research- to examine the relationship between mid-pregnancy dietary glycemic index,
glycemic load, and the risk of congenital heart defects in the baby. The article does not include a
formal literature review, but the introduction section provides information already published
about the topic from previous studies, mostly in the discipline of medicine. The journals cited
from are mostly medical journals on the topics of pediatrics, epidemiology, and diabetes. The
authors identify a research gap by stating that only one other study exists that assesses the risks
between glycemic index and heart defects. The first aim of the study was to investigate the
association between glycemic index and glycemic load during pregnancy and offspring risk of
congenital heart defects using a food-frequency questionnaire, and the second aim was to
investigate the association between high intake of sugary beverages and offspring risk of
congenital heart defects (Schmidt, 2020). The study design is a prospective cohort study. Women
were recruited at antenatal visits to their primary care providers to participate in 2 phone
interviews. Women in the Danish National Birth Cohort were recruited and invited to fill out
food-frequency questionnaire. Discharge and outpatient diagnoses from hospital encounters were
collected from the National Patient Register. Maternal and fetal characteristics related to
pregnancy and birth were collected form the Medical Birth Register. Statistical analyses were
performed to determine the association between glycemic index, glycemic load, and congenital
heart defects as well as the association between sugary beverages and congenital heart defects.
The sample size included 101,042 pregnancies, which seems sufficient for the project (Schmidt,
2020).
The researchers found no significant association between glycemic index and glycemic
load during pregnancy and congenital heart defects. The researchers found a significant
association between high intake of sugary carbonated beverages and congenital heart defects. It
CONGENITAL ANOMALIES 4
was concluded that high dietary glycemic index in pregnancy does not increase the offspring risk
of congenital heart defects, but that sugary carbonated beverages pose a moderate risk of
offspring heart defects. The authors do not state any implications for further research but since
this seems to be only the second study on this topic, further research is necessary to confirm
these findings. APRNs should apply this knowledge when assessing, treating, and educating
expecting mothers. Expecting mothers should be instructed to limit their intake of sugary
carbonated beverages like soda. I would recommend this article to others, since it appears to be
new information.
Congenital heart defects can be caused by both genetic and environmental factors,
making them multifactorial congenital anomalies (Vanmeter, 2014). Environmental factors are
often modifiable. As APRNs, it is our responsibility to educate patients about modifiable risk
factors and encourage healthy decisions. This knowledge of congenital anomalies as well as this
new information about sugary carbonated beverages posing a risk for congenital heart defects are
important for us to relay to our patients regardless of our specialty area as nurse practitioners. It
is worth noting that another article I found concludes that a higher maternal body mass index is
related to increased risk of offspring congenital heart defects (Liu, 2019). It is possible that many
of the women in the first study who consume sugary carbonated beverages have a higher BMI,
and that a higher BMI poses the risk and not the sugary carbonated beverages alone. Regardless,
we must educate pre- and perinatal patients to make healthy decisions including cutting down on
sugary carbonated beverage consumption.
CONGENITAL ANOMALIES 5
References
Liu, X., Ding, G., Yang, W., Feng, X., Li, Y., Liu, H., Zhang, Q., Ji, L., & Li, D. (2019).
Maternal body mass index and risk of congenital heart defects in infants: A dose-
response meta-analysis. BioMed Research International, 2019, 1315796.
Schmidt, A. B., Lund, M., Corn, G., Halldorsson, T. I., Øyen, N., Wohlfahrt, J., Olsen, S. F., &
Melbye, M. (2020). Dietary glycemic index and glycemic load during pregnancy and
offspring risk of congenital heart defects: a prospective cohort study. The American
Journal of Clinical Nutrition, 111(3), 526–535.
VanMeter, K. C., & Hubert, R. J. (2014). Gould’s pathophysiology for the health professions. St.
Louis, MO: Elsevier Saunders.
Runninghead: DISCUSSION POST 1
Chapter 20: Cervical Cancer Screening and Diagnosis
Anita Opdycke
Regis College
Pathophysiology NURS 606
Terri Kanner
May 12, 2020
DISCUSSION POST 2
Chapter 20: Cervical Cancer Screening and Diagnosis
Diagnostic testing is important in early detection of cancer (Hubert & VanMeter, 2018).
Hubert & VanMeter (2018), state that the examination of tumor cells is the only definitive
method to diagnose cancer cells. Other tests should be used in conjunction with cytologic tests
and to monitor treatment and follow up after a diagnosis is made (Hubert & VanMeter, 2018).
Cytologic testing, are used to screen individuals as high risk, to make a diagnosis, and to follow a
clinical plan of care or monitor (Hubert & VanMeter, 2018). To make a diagnosis, clinicians use
histologic and cytologic examinations to gather cells that are sent to a lab for further examination
(Hubert & VanMeter, 2018). In some cases, biopsies are retrieved and in other cases exfoliative
cytology is used to make a dependable confirmation of malignancy (Hubert & VanMeter, 2018).
For all tests, good technique and preservation of the sample is key in obtaining an accurate
evaluation (Hubert & VanMeter, 2018). The Papanicolaou (Pap) test is the standard of care for
screening, evaluating and diagnosing cervical cell changes that can lead to cervical cancer
(Hubert & VanMeter, 2018).
Cervical dysplasia, or atypical glandular cells on cervical cytology, are categorized based
on the degree of cellular change (Goodman & Huh, 2020). The three main categories of cervical
intraepithelial lesions (CIN) include: CIN-1 or lesser abnormalities, CIN 2 and CIN 3 (Goodman
& Huh, 2020). CIN-1 or lesser abnormalities includes atypical cells of undetermined significance
(AS-CUS) and low grade squamous intraepithelial lesions (LSIL) with HPV 16 or 18 infection,
or persistent HPV infection (Goodman & Huh, 2020). Low grade CIN has a low potential to
progress to malignancy (cancer) but high grade CIN has a high potential to develop into cancer
(Goodman & Huh, 2020). The Pap test has significantly contributed to the decrease in invasive
cervical cancer incidence however every year there are 12, 000 new cases of invasive cervical
DISCUSSION POST 3
cancer are diagnosed in the U.S (Zhao, et al., 2014). Zhao, et al. (2014) explored Factors
Associated with Reduced Accuracy in Papanicolaou Tests With Invasive Cervical Cancer in an
effort to highlight the importance of accurate interpretation of screening tests.
The study, Factors Associated with Reduced Accuracy in Papanicolaou Tests With
Invasive Cervical Cancer, was published in Cancer Cytopathology on May, 28, 2014. The
authors, Lichao Zhao, Nicolas Wentzensen, Roy Zhang, Terence Dunn, Michael Gold, Sophia
Want, Mark Schiffman, Joan Walker and Rosemary Zuna conducted research to explore and
evaluate the limiting factors in Pap tests from women who were diagnosed with invasive cervical
cancer and to discuss ways to identify problematic cases in clinical practice (Zhao, et al.,
2014).
The literature was drawn from the discipline of oncology or the study of cancer. The authors
conducted a cross sectional analysis of cytologic and HPV results by studying 3003 women who
had a wide range of cervical lesions via the ThinPreP Pap test and HPV genotyping (Zhao, et al.,
2014). The methods and materials for the study included recruiting 3015 women, aged 18 and
older, referred for colposcopy from 2002-2010 into the Study to Understand Cervical Cancer
Early Endpoints and Determinants (SUCCEED) and the National Cancer Institute University of
Oklahoma Health Sciences Center Biopsy Study (Biopsy Study) (Zhao, et al., 2014).
All women who were recruited had a spectrum of benign, intraepithelial, and invasive
cervical neoplasia (Zhao, et al., 2014). Twelve participants were excluded due to previous
surgical treatment for cervical neoplasia, non-cervical neoplasm, pregnancy or HIV infection
(Zhao, et al., 2014). Each participant has a colposcopic visit as their first visit, which also
included a ThinPrep Pap test (Zhao, et al., 2014). HPV genotyping was also performed on the
specimens (Zhao, et al., 2014). Zhao, et al. (2014) noted that all cases within this research study
attempted to mimic the normal screeing process (Zhao, et al., 2014). As such, this study bias
DISCUSSION POST 4
could have caused some results that were diagnosed as “abnormal” to have been classified as
“unsatisfactory” in a normal clinic setting (Zhao, et al., 2014). This gap could have
underestimated the unsatisfactory rate for these women in a clinical setting (Zhao, et al., 2014).
The results used the Pearson chi-square and Fisher exam test and statistical significance was
assisgned to 2-sided probablity values <0.. The findings of the study concluded that there was a
statistical significance demonstrating patients with cervical cancer have a significantly higher
rate of unsatisfactory and limited quality Pap tests (Zhao, et al., 2014). This poses a challenge
for providers to deliver timely treatment, especially in women who do not obtain regular
screening (Zhao, et al., 2014). The major reasons leading to an unsatisfactor test results included
scant cellularity, obscuring blood, and inflammation or the presence of lubrication (Zhao, et al.,
2014).
Implications for further research include investigating the incidence of falsely negative
PAP tests, particularly in women with adenocarcinoma, decreasing testing intervals in women
over 30 or who have previous tested positive for HPV (Zhao, et al., 2014). The information in
the article could be applied to advance nursing practice by being aware of PAP technique,
adhering to best practice, ensure follow up for screeing for high risk female populations, and
being aware of post-exam bleeding and/or a friable cervix and the implications this may have on
the specimen collected (Zhao, et al., 2014). I would recommend this article to a collegue and
classmate to further understand the classification of cervical cell changes in the presence of HPV
genotype and the implications for progression to malignant carcinoma.
DISCUSSION POST 5
References
Goodman, A., & Huh, W. (2020, April). Cervical Cytology Evaluation. Retrieved from UptoDate:
https://www.uptodate.com/contents/cervical-cytology-evaluation-of-atypical-and-
malignant-glandular-
cells?search=cervical%20dysplasia&topicRef=3215&source=related_link
Hubert, R. J., & VanMeter, K. C. (2018). Gould’s Pathophysiology for the Health Professions (6th
ed.). St. Louis: Elsevier.
Zhao, L., Wentzensen, N., Zhang, R., Dunn, T., Gold, T., Wang, S., . . . Zuna, R. (2014). Factors
associated with reduced accuracy in Papanicolaou tests for patients with invasive
cervical cancer. 1-8. Retrieved from
https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.21443