Application of appropriate use criteria for stress myocardial perfusion imaging at two academic medical centers: compliance and association with image findings.

Purpose: Explore the extent to which stress myocardial perfusion imaging (MPI) studies for coronary heart disease detection met published appropriate use criteria (AUC), and the association between AUC classification and image findings.

Data Sources: Retrospective, descriptive review of stress studies performed at the University of Washington Medical Center (UWMC n= 1377) and the Veterans Health Administration of Puget Sound (VA n= 1445) in the 31 months following AUC publication.

Conclusions: At UWMC and VA, 69% and 89% of MPI studies, respectively, were classified as appropriate, 16% and 3% as inappropriate, and 15% and 8% as uncertain.

Glycemic control among older adult hematopoietic cell transplant recipients.

Adults age 55 and older with hematological malignancies who require hematopoietic cell transplantation (HCT) for survival are at risk for a number of nonmalignancy-related, potentially life-threatening outcomes, often due to suboptimal immune function. Evidence is emerging regarding how abnormal glycemic levels-newly termed malglycemia-impair cells of the immune system. Further, older adult HCT recipients appear highly susceptible to malglycemic states, particularly hyperglycemia, due to treatment regimens, nutritional imbalances, states of immobility, and stress, all coupled with the natural aging process.

The graduate record examination: help or hindrance in nursing graduate school admissions?

Do graduate record examination (GRE) scores serve as strong predictors of student success in graduate school in nursing, and if so, is the extent to which they may indicate success outweighed by their perceived role as a barrier to application to graduate school in nursing? Academic ability, defined as cumulative grade point average (GPA), was used as the outcome indicator for success in graduate school and was compared with admission GRE scores for 217 students admitted to graduate programs at the University of Washington School of Nursing over a 1-year period. The GRE presented a large barrier to application that far outweighed the limited benefit of predicting 5% to 8% of explained variance in GPA.

Heart rate variability and 24-hour minimum heart rate.

Heart rate variability (HRV) indices based on 24-hr electrocardiograph recordings have been used in clinical research studies to assess the aggregate activity of the autonomic nervous system. Although 24-hr HRV is generally considered noninvasive, use in research protocols typically involves considerable data collection and processing expenses and substantial participant burden. The purposes of this research methods evaluation were to describe the relationships between 24-hr minimum heart rate (HR) and several 24-hr time domain HRV indices (Ln SDNN, Ln SDANN, Ln SDNNIDX, Ln RMSSD, and Logit50) across several research data sets (normal women, normal men, children enrolled in a study of recurrent abdominal pain, women with irritable bowel syndrome, sudden cardiac arrest survivors, and heart failure patients) and to explore the possibility that 24-hr minimum HR might serve as a simpler alternative or adjunct to HRV measures in some situations.

Increased symptoms in female IBS patients with dysmenorrhea and PMS.

Women with irritable bowel syndrome often report premenstrual distress syndrome and dysmenorrhea. A descriptive, four-group comparison design was used to compare the symptoms and psychological distress levels of women with irritable bowel syndrome (age 18-45 years) with and without dysmenorrhea and premenstrual distress syndrome. Data from three studies on women with irritable bowel syndrome (n = 226) collected between 1995 and 2004 were combined.

Abdominal pain impacts quality of life in women with irritable bowel syndrome.

Objectives: Patients with irritable bowel syndrome (IBS) report lower health-related quality of life (QoL) as compared to healthy controls. The aims of this analysis were to describe which IBS symptoms were rated on a daily diary as most distressing/severe by IBS women, and determine which IBS symptoms were most predictive of lower QoL and have the greatest impact on daily life.

Methods: This report is a secondary analysis of prospective and retrospective symptom severity and impact data, collected on 242 women with IBS, aged 18-48, who were studied between 1997 and 2004.

Stress, stress response, and health.

Components of stress and the stress response differ between men and women. The tend-and-befriend response, mediated by oxytocin and endogenous opioids, may be more applicable to women than the fight-or-flight response, which was based largely on studies of men. Even within the flight-or-flight response pattern there are sex-based differences.

Sleep-disordered breathing in patients with heart failure: pathophysiology, assessment, and management.

Purpose: To provide clinicians in primary care settings information on the effects of sleep-disordered breathing in patients with heart failure (HF). Assessment and screening tools, as well as management considerations, are presented.

Data Sources: Review of the scientific literature of the past 10 years, along with classic studies and Internet sources.

Natural killer cell cytotoxicity: a methods analysis of 51chromium release versus flow cytometry.

The purpose of this study is to describe design considerations for the use of flow cytometry (FC) compared to 51chromium (51Cr)-release assays utilizing cryopreserved peripheral blood mononuclear cells (PBMCs) to detect natural killer (NK) cell cytotoxicity. Subjects were 10 healthy women aged 18 to 39 years. Intra-assay variability between methods differed only at the lowest effector-target ratios evaluated.

Sense of coherence and quality of life in women with and without irritable bowel syndrome.

Background: Despite ongoing physical and psychological distress, little is known about sense of coherence (SOC) and holistic quality of life (QOL) in women with irritable bowel syndrome (IBS).

Objectives: The purposes of this study were to (a) describe and compare SOC and holistic QOL of women with and without IBS, and (b) examine the relationships among SOC, holistic QOL, and gastrointestinal (GI) and psychological distress symptoms.

Method: A two-group comparison design was used to test the study hypotheses that women with IBS would have lower SOC and holistic QOL than control women without IBS, and that SOC and holistic QOL would be inversely related to GI and psychological distress.

Logit50: a nonlinear transformation of pNN50 with improved statistical properties.

The traditional time domain heart rate variability index pNN50 is a percentage scale-based measure of large beat-to-beat changes in heart period that may reflect parasympathetic neural activity impinging on the sino-atrial node. However, pNN50 exhibits nonlinear saturation effects near 0% and 100% that may adversely affect its statistical properties. The purpose of this paper is to propose a revision of pNN50, Logit50, that is the natural logarithm of the odds of the occurrence of large beat-to-beat differences in R-R interval.

Natural killer cell function and psychological distress in women with and without irritable bowel syndrome.

The primary purpose of this exploratory study was to compare percentages of natural killer (NK) cells and activated NK and T cells, and both cytotoxic and in vitro cytokine production activity in women with and without symptomatic irritable bowel syndrome (IBS). A secondary purpose was to examine the relationships of psychological distress and low sense of coherence with immune function indicators and stress hormones. NK cell percentage and activity have been shown to vary in response to many psychological and physiological stressors.

The relationship between quality of life, sense of coherence and self-esteem in persons after coronary artery bypass graft surgery.

We examined the contribution of Antonovsky's sense of coherence in explaining the variance of quality of life (QOL) in 84 patients 1-2 years following coronary artery bypass graft surgery. The hypothesis was: after controlling for variables related to poor health vulnerability, perceived support, self-esteem, and chronic illness trajectory instability and work, the addition of sense of coherence will significantly add to the explained variance of quality of life. The first two variables explained 49% of the variance of the QOL scale.