Jennifer E. Sanner

The role of serotonin in depression and clotting in the coronary artery disease population.

Background:Despite the strong evidence that depression is an independent risk factor for coronary artery disease (CAD), the underlying physiological mechanisms linking depression and CAD remain poorly understood. Objective:This review of the literature focuses on the current understanding of the physiological effects of serotonin on depression and clotting as well as its role in CAD. Methods:Articles for this review were identified using CINAHL, PsychINFO, and MEDLINE searches. Results:Results revealed that depression is an independent risk factor for CAD. Although the physiological mechanisms underlying depression and related increases in acute coronary events remain unclear, serotonin plays an important role in depression and CAD. Elevated platelet serotonin levels promote clotting, which may be a potential underlying mechanism linking depression with CAD. Conclusions:This review of the literature suggests that elevated platelet serotonin levels may be associated with depression and the occurrence of major adverse coronary events. Future research should investigate if platelet serotonin levels contribute at least in part to the acute coronary events seen in patients with CAD who have elevated levels of platelet serotonin when depressed.

Gender Differences in Self-Reported Symptoms of Depression among Patients with Acute Coronary Syndrome.

This study examined the prevalence of self-reported depressive symptoms and the self reported somatic depressive symptoms as measured by the Beck Depression Inventory-II (BDI-II) among patients hospitalized for acute coronary syndrome (ACS), and explored the impact of gender on both. A convenience sample of 789 adults (248 women and 541 men) was recruited for the study during hospital admission for ACS and participants were screened for self-reported depressive symptoms. BDI-II scores of ≥14 indicate a moderate level of depressive symptoms and this cut-off score was used to categorize patients into depressed and non-depressed groups. Pearson chi-square tests for independence (categorical variables) and t tests for independent samples (continuous variables) were used for gender comparisons. Results showed that depressive symptoms during ACS episodes were different between women and men. Women reported greater overall depressive symptoms (BDI-II mean = 11.89, S.D. = 9.68) than men (BDI-II mean = 9.00, S.D. = 7.93) (P < 0.000). Significantly more women (7.66%) were identified positive for somatic depressive symptoms (sleep and appetite disturbances and fatigue) than men (2.22%) (P = 0.0003). Findings support that there are gender differences in depressive symptoms experienced by patients hospitalized for ACS. Somatic symptoms of depression may be important indicators of depression especially among female ACS patients.

Biobanks and biomarker research in cardiovascular disease.

Purpose: The purpose of this article is to describe biobank processes and the sociocultural and nursing challenges of these processes. The article will present ways that thinking genetically can challenge cardiovascular nurses and help in the development of biobanks for cardiovascular research. It will emphasize the importance of the contributions of nursing to the development of biobanks and biobanking research. Conclusions: The influence of cardiovascular nurses on the development of biobanks for research in cardiovascular disease will result in accelerated discoveries that will lead to innovative, safe, effective therapeutics (translational research and personalized healthcare). The challenge is to educate and encourage clinicians to think genetically and use biobanks for research.

The protection and stabilization of whole blood at room temperature.

Preservation of biospecimens for biobanking applications traditionally involves freezing while maintaining the integrity of the product throughout multiple freeze-thaw cycles. The protection and stabilization of DNA at room temperature (RT) may eliminate the costs associated with freezer storage and reduce the maintenance costs for biobanks. However, there is a paucity of information describing the yield, purity, and integrity of DNA extracted from biospecimens stored at RT. To evaluate the yield, purity, and integrity of DNA extracted from whole blood samples stored at RT (18°C), low (-20°C), and ultra-low (-80°C) temperatures, whole blood samples from sheep and human subjects were collected, and aliquots were stored at RT (18°C), -20°C, and -80°C. Blood samples at RT were stored utilizing biostabilization technology designed to protect genomic DNA in whole blood. The quantification of the extracted DNA was determined by spectrophotometry, and the integrity was assessed following gel electrophoresis. Storage temperature did not influence the DNA yield (p=0.52); DNA yield averaged 13.6 ± 1.2 ng/μL across all storage temperatures. However, DNA yield was influenced (p=0.04) by species. The DNA yield was not influenced by a species × storage temperature interaction (p=0.84). Among the samples stored at RT, the species, type of technology utilized, and the interaction did not influence (p>0.13) DNA yield for both DNAgard and DNAstable. The 260/280 ratio was influenced by a species × storage temperature interaction (p=0.01). Generally, the 260/280 ratios were higher (p<0.05) for human samples stored at low and ultra-low temperatures compared to sheep samples stored at similar temperatures. Ambient temperature-based technologies offer an alternative to low temperature biospecimen preservation for blood that can be utilized by biobanks to reduce freezer storage costs while maintaining the quality of the biospecimen.

Self-reported depressive symptoms in women hospitalized for acute coronary syndrome

The purpose of this cross-sectional observational study was to explore depressive symptoms, among 377 women, during hospitalization for acute coronary syndrome (ACS). Women were screened for depressive symptoms using the Beck Depression Inventory-II (BDI-II). Pearson chi-squared tests for independence were used for comparisons between categorical variables and t-tests for independent samples were used for comparisons between continuous variables. Tukeys honestly significant difference test along with one-way anova test was used to conduct multiple comparisons between the three defined age groups ranging from 29-49, 50-64 to ≥65 years. A total of 118 women screened positive for depression (BDI-II score ≥ 14). The percentage of women that met the criteria for a positive depression screening was significantly different between the three age groups. The proportion of depressed women who reported feelings of sadness, past failures, punishment, self-dislike, agitation, worthlessness, sleep disturbances and irritability varied significantly by age group. Study findings indicate that symptom experience and severity may differ across a lifetime. These results support the need to understand the complexity of depressive symptoms experienced by women. The ability to understand and recognize depressive symptoms in women, with ACS, may assist healthcare professionals with the management of a modifiable cardiovascular risk factor.Accessible summary Depressive symptoms are common in women hospitalized for acute coronary syndrome, but symptom experience and severity may differ across a womens lifetime. Tiredness or fatigue, loss of energy and sleep disturbances were the three depressive symptoms most frequently reported by depressed women, hospitalized for acute coronary syndrome, across all age groups. These results stress the need to further understand the complexity of depressive symptoms in women with cardiovascular disease. Abstract The purpose of this cross-sectional observational study was to explore depressive symptoms, among 377 women, during hospitalization for acute coronary syndrome (ACS). Women were screened for depressive symptoms using the Beck Depression Inventory-II (BDI-II). Pearson chi-squared tests for independence were used for comparisons between categorical variables and t-tests for independent samples were used for comparisons between continuous variables. Tukeys honestly significant difference test along with one-way anova test was used to conduct multiple comparisons between the three defined age groups ranging from 29–49, 50–64 to ≥65 years. A total of 118 women screened positive for depression (BDI-II score ≥ 14). The percentage of women that met the criteria for a positive depression screening was significantly different between the three age groups. The proportion of depressed women who reported feelings of sadness, past failures, punishment, self-dislike, agitation, worthlessness, sleep disturbances and irritability varied significantly by age group. Study findings indicate that symptom experience and severity may differ across a lifetime. These results support the need to understand the complexity of depressive symptoms experienced by women. The ability to understand and recognize depressive symptoms in women, with ACS, may assist healthcare professionals with the management of a modifiable cardiovascular risk factor.

Effects of Delayed Laboratory Processing on Platelet Serotonin Levels

Background: Despite the availability of established guidelines for measuring platelet serotonin, these guidelines may be difficult to follow in a hospital setting where time to processing may vary from sample to sample. Purpose: The purpose of this study was to evaluate the effect of the time to processing of human blood samples on the stability of the enzyme-linked immunosorbent assay (ELISA) for the determination of platelet serotonin levels in human plasma. Method: Human blood samples collected from a convenience sample of eight healthy volunteers were analyzed to determine platelet serotonin levels from plasma collected in ethylene diamine tetra acetic acid (EDTA) tubes and stored at 4°C for 3 hr, 5 hr, 8 hr, and 12 hr. Results: Refrigeration storage at 4°C for 3 hr, 5 hr, 8 hr, and 12 hr altered the platelet serotonin measurement when compared to immediate processing. The bias for the samples stored at 4°C for 3 hr was 102.3 (±217.39 ng/109 platelets), for 5 hr was 200.1 (±132.76 ng/109 platelets), for 8 hr was 146.9 (±221.41 ng/109 platelets), and for 12 hr was −67.6 (±349.60 ng/109 platelets). Discussion: Results from this study show that accurate measurement of platelet serotonin levels is dependent on time to processing. Researchers should therefore follow a standardized laboratory guideline for obtaining immediate platelet serotonin levels after blood sample collection.

The Relationship Between Concussion Knowledge and the High School Athlete’s Intention to Report Traumatic Brain Injury Symptoms: A Systematic Review of the Literature

Sports-related concussion or traumatic brain injury (TBI) is a frequent occurrence among high school athletes. Long-term and short-term effects of TBI on the athlete’s developing brain can be minimized if the athlete reports and is effectively treated for TBI symptoms. Knowledge of concussion symptoms and a school culture of support are critical in order to promote the student’s intention to report TBI symptoms. The purpose of this systematic review is to examine the relationship between the high school athlete’s concussion knowledge and an intention to report TBI symptoms. One hundred eleven articles were retrieved and four articles met established criteria and were included in this systematic review. A link appears to exist between high school athlete concussion knowledge and an intention to report TBI symptoms. School nurses can provide a supportive environment and concussion knowledge to the high school athlete in order to ultimately facilitate TBI symptom reporting.

Using a single screening question for depressive symptoms in patients with acute coronary syndrome.

Background:Despite the prevalence of depressive symptoms and increased risk for future cardiovascular events, depressive symptoms frequently go underrecognized in patients hospitalized for acute coronary syndrome (ACS). Identifying an effective approach to depressive symptom screening is imperative in this population. Objective:The purpose of this cross-sectional study was to explore the agreement between Beck Depression Inventory–II (BDI-II) scores and a single screening question for depressive symptoms in 1122 patients hospitalized for ACS. Methods:Independent-samples t tests and &khgr;2 tests were used to compare the groups with BDI-II scores of 14 or higher and lower than 14. Three separate agreement analyses were conducted using categorized BDI-II scores (≥14, ≥20, and ≥29). Agreement of the BDI-II categories with the responses to the single screening question was assessed with the simple &kgr; statistic. Sensitivity and specificity were calculated using the BDI-II categories as the criterion standards for depressive symptom screening. Results:The agreement analysis revealed a moderate level of agreement (&kgr; coefficient = 0.42) between the BDI-II scores of 14 or higher and the single screening question. Of the participants who reported a BDI-II score of 14 or higher, 61.65% answered yes to the single screening question (sensitivity, 0.62). For those who had BDI-II scores of lower than 14, a total of 82% responded no to the single screening question (specificity, 0.82). When using higher BDI-II scores to define depressive symptoms (≥20 and ≥29), the level of agreement decreased, whereas sensitivity increased to 0.76 and 0.90, with a trade-off in specificity (0.79 and 0.74, respectively). Conclusions:These results suggest that the single screening question for depressive symptoms correctly identifies depressive symptoms 62% of the time but inappropriately identifies depressive symptoms 18% of the time in patients hospitalized for ACS. This suggests that the single screening question for depressive symptoms may be used with caution to initially screen patients with ACS, who can then undergo a more thorough assessment for clinical depression.

Nursing and Genetic Biobanks

Biobanks function as vital components in genetic research, which often requires large disease-based or population-based biospecimens and clinical data to study complex or rare diseases. Genetic biobanks aim to provide resources for translational research focusing on rapidly moving scientific findings from the laboratory into health care practice. The nursing profession must evolve as genetic biobanking practices advance. Nursing involvement in genetic biobanking practices comes with a distinct set of educational, ethical, and practice competencies. In response to these growing competency standards, nursing science developed a conceptual framework and continues to study ethical considerations to guide genetic biobanking initiatives.

Effects of Gender-Specific Differences, Inflammatory Response, and Genetic Variation on the Associations Among Depressive Symptoms and the Risk of Major Adverse Coronary Events in Patients With Acute Coronary Syndrome

Depressive symptoms independently contribute to major adverse coronary events (MACEs), with the biological immune response to depression being a likely mediator of this relationship. To determine whether genetic- and/or gender-specific phenotypic differences contribute to associations among depressive symptoms, inflammatory response, and risk of MACE in patients with acute coronary syndrome (ACS), we conducted a prospective study of 1,117 ACS patients to test a gender-specific model in which depressive symptoms (Beck Depression Inventory-II [BDI-II]) are associated with risk of MACE. Cox proportional hazards models were used to model time to incident MACE and determine whether single-nucleotide polymorphisms (SNPs) in specific inflammatory protein-coding genes and depressive symptoms interact to influence levels of inflammatory proteins or risk of MACE. Females had significantly higher high-sensitivity C-reactive protein and monocyte chemoattractant protein-1 levels. Depression status differed by gender (29.9% of females and 21.1% of males had BDI-II scores indicative of depression [p = .0014]). Depressive symptoms were associated with MACE; however, the interaction between these symptoms and gender was not significant. SNPs and depressive symptoms did not interact to influence inflammation or MACE. More females than males had BDI-II scores indicative of depression, yet the association between positive depressive symptom status and MACE did not vary by gender. Nor did the SNPs interact with depressive symptoms to influence inflammation or MACE. It remains of interest to identify a high-risk subgroup of ACS patients with genetic polymorphisms that result in immunoinflammatory dysregulation in the presence of depressive symptoms.