Percutaneous transluminal coronary angioplasty (PTCA) in the elderly patient: Experience in the national heart, lung, and blood institute PTCA registry

Because CABG results in a significantly higher morbidity and prolonged hospitalization in the older patient group, PTCA is an attractive alternative for providing myocardial revascularization in the small group of older patients with appropriate lesions for dilation. This analysis of the results of PTCA in 370. older patients in the NHLBI PTCA Registry reveals that PTCA can be performed with acceptably low mortality and morbidity. Therefore, PTCA may offer an alternative to CABG in the highly selected symptomatic older patient.     

The Worst Itch Numeric Rating Scale for patients with moderate to severe plaque psoriasis or psoriatic arthritis

Plaque psoriasis (PP) and psoriatic arthritis (PsA) are autoinflammatory chronic conditions associated with skin involvement. Pruritus, or itching, is a prevalent and bothersome symptom in patients with PP and is associated with reduced health‐related quality of life. The Worst Itch Numeric Rating Scale (WI‐NRS) has been developed as a simple, single item with which to assess the patient‐reported severity of this symptom at its most intense during the previous 24‐hour period. Qualitative research was undertaken to assess the content validity of the WI‐NRS. Patients with moderate to severe PP and patients with PsA were recruited from clinical sites in the USA. The qualitative research entailed two‐part interviews, which began with concept elicitation to gain understanding of patients’ experiences of itching, followed by cognitive debriefing of the WI‐NRS to assess the instrument's understandability, clarity, and degree of appropriateness from the patient's perspective. Twelve patients with PP and 22 with PsA participated in the study. Patients reported that itching was an important and relevant symptom of their psoriatic disease. The WI‐NRS was reported to be complete and easy to understand; the recall period was considered appropriate, the response scale was familiar, and, overall, the instrument was found to be appropriate for assessing itching severity. Patient responses support the content validity of the WI‐NRS. The psychometric properties of the tool will be evaluated in future studies.     

Cardiovascular risk factors for physician-diagnosed lumbar disc herniation

BACKGROUND CONTEXT: Despite the high prevalence of lumbar disc disease among the general population, the determinants of this condition remain poorly understood. A recent hypothesis suggests that atherosclerotic vascular disease may play an important role in the etiology of this disorder. PURPOSE: To explore the relationship between cardiovascular risk factors and the incidence of lumbar disc herniation. STUDY DESIGN/SETTING: We prospectively examined the association between smoking, high cholesterol, high blood pressure, obesity, and diabetes and self-reported lumbar disc herniation. The study was conducted among 98,407 female nurses who in 1976 were ages 30-55 years, free of cancer (except non-melanoma skin cancer), lumbar disc disease, and who responded to the 1992 questionnaire regarding whether or not a physician diagnosis of lumbar disc herniation had been made. RESULTS: During 16 years of follow-up (438,662 person-years), 2,727 nurses who were free of cancer reported a physician-diagnosed lumbar disc herniation that was confirmed either by computed tomography or magnetic resonance imaging. After adjusting for age, body mass index, smoking, vigorous or moderate exercise, employment status, having seen a physician in the last year, and each of the following other factors, the multivariate relative risk for diabetes was 1.52 (95% confidence interval [95% CI], 1.17 to 1.98); for hypertension it was 1.25 (95% CI, 1.11 to 1.41); for high cholesterol it was 1.26 (95% CI, 1.10 to 1.44), and for having a parent who had suffered a myocardial infarction before age 60 it was 1.13 (95% CI, 1.02 to 1.26). In these models, compared with never smokers, the relative risk for past smokers was 1.10 (95% CI, 1.00 to 1.20), for current smokers the risk increased with the number of cigarettes smoked per day. A decrease in risk occurred after cessation. Also in these models, we noted a significant trend of increasing risk with higher body mass index (p=.01). CONCLUSIONS: Cardiovascular risk factors are significantly and independently associated with symptomatic lumbar disc herniation. These findings provide further confirmation that atherosclerosis may be involved in spinal disc degeneration. Modification of risk factors, particularly smoking, may also prove to be beneficial.     

LexGrid: A Framework for Representing, Storing, and Querying Biomedical Terminologies from Simple to Sublime

Many biomedical terminologies, classifications, and ontological resources such as the NCI Thesaurus (NCIT), International Classification of Diseases (ICD), Systematized Nomenclature of Medicine (SNOMED), Current Procedural Terminology (CPT), and Gene Ontology (GO) have been developed and used to build a variety of IT applications in biology, biomedicine, and health care settings. However, virtually all these resources involve incompatible formats, are based on different modeling languages, and lack appropriate tooling and programming interfaces (APIs) that hinder their wide-scale adoption and usage in a variety of application contexts. The Lexical Grid (LexGrid) project introduced in this paper is an ongoing community-driven initiative, coordinated by the Mayo Clinic Division of Biomedical Statistics and Informatics, designed to bridge this gap using a common terminology model called the LexGrid model. The key aspect of the model is to accommodate multiple vocabulary and ontology distribution formats and support of multiple data stores for federated vocabulary distribution. The model provides a foundation for building consistent and standardized APIs to access multiple vocabularies that support lexical search queries, hierarchy navigation, and a rich set of features such as recursive subsumption (e.g., get all the children of the concept penicillin). Existing LexGrid implementations include the LexBIG API as well as a reference implementation of the HL7 Common Terminology Services (CTS) specification providing programmatic access via Java, Web, and Grid services.     

Migraine in Adolescents: Validation of a Screening Questionnaire

Background.— Few studies in adolescents deal with the level of agreement between questionnaire and interview information in relation to headache symptoms.
Objective.— To evaluate the validity of a self-administered questionnaire on headache for use in epidemiological studies of Italian high school students.
Methods.— The questionnaire incorporated all items required for diagnosing migraine according to the criteria from the 2004 International Classification of Headache Disorders. The migraine diagnoses obtained from questionnaires were validated against the gold standard diagnoses by a headache specialist.
Results.— Out of 104 students answering the questionnaires, 93 (89.4%) participated in extensive semi-structured interviews by a neurologist. The chance-corrected agreement rate (kappa) was 0.66, which is considered good. The questionnaire-based migraine diagnosis had a sensitivity of 67.3%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 73.3%.
Conclusions.— The results indicate that our self-administered questionnaire may be an acceptable instrument in determining the prevalence of migraine sufferers in the northeast Italy adolescent population, useful in identifying subjects with definite migraine.