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Introduction Palliative Care (PC) is a limited resource, requiring allocation to those most likely to benefit. One currently underserved population is persons sustaining burns, as these injuries may severely limit quality of life, psychosocial and physical health. Additionally, treatment decisions must frequently be made on an emergent basis on behalf of someone unable to participate in decision making. PC services could benefit patients and caregivers substantially, yet only 2% of persons who have been burned are referred to PC. We developed empirically-derived referral criteria; the purpose of this study was to quantify the sensitivity, specificity, and predictive value of the criteria when retrospectively applied. Methods Retrospective review of regional burn center admissions (1/1/2019-1/31/2022) to determine adherence to criteria indicating referral to PC should be made or considered. Descriptive statistics characterizing the sample and criteria performance were calculated. Results N=388 admissions occurred study period (29.9% female; mean(SD) age=39.9 (24.1) years. N=28 persons were referred to PC; n=27 met consult criteria, and n=1 met consider criteria. Criteria for PC consultation indicated referral for n=62, and had 0.96 sensitivity, 0.90 specificity, 0.44 positive predictive value, 1.00 negative predictive value, 0.91 total accuracy. Criteria for considering PC consultation were indicated for n=181 and had 1.00 sensitivity, 0.45 specificity, 0.01 positive predictive value, 1.00 negative predictive value, 0.45 total accuracy. Conclusions Criteria for PC consultation were sensitive and specific, though the positive predictive value was low. Criteria for consideration show low values; however, documentation did not reveal whether referral was considered or not. Presence of comorbidities was the most commonly-met criterion for referral consideration. Despite the robust sample size, data from a single site may have limited generalizability. Criteria have promising characteristics, may be used as basis for quality improvement efforts, and merit ongoing study and revision to improve predictive ability. Applicability of Research to Practice These criteria advance clinical practice by providing guidance on identifying persons most likely to benefit from specialist PC.

This article was migrated. The article was marked as recommended. Knowledge, attitudes, and skills required to successfully manage business and personal finances are rarely taught within traditional medical education. This has contributed to low financial literacy, high stress related to educational debt, and burnout among physicians. To address this deficiency, we created the Business of Medicine course for fourth-year medical students which teaches basic business and personal finance topics. As we have reflected on lessons learned in the creation and implementation of this course, we have recorded them for the benefit of others who desire to partner with us in teaching this important topic to the next generation of physicians.

α7 nicotinic acetylcholine receptors (nAChRs) modulate network activity in the CNS. Thus, functional regulation of α7 nAChRs could influence the flow of information through various brain nuclei. It is hypothesized here that these receptors are amenable to modulation by tyrosine phosphorylation. In bothXenopusoocytes and rat hippocampal interneurons, brief exposure to a broad-spectrum protein tyrosine kinase inhibitor, genistein, specifically and reversibly potentiated α7 nAChR-mediated responses, whereas a protein tyrosine phosphatase inhibitor, pervanadate, caused depression. Potentiation was associated with an increased expression of surface α7 subunits and was not accompanied by detectable changes in receptor open probability, implying that the increased function results from an increased number of α7 nAChRs. SolubleN-ethylmaleimide-sensitive factor attachment protein receptor-mediated exocytosis was shown to be a plausible mechanism for the rapid delivery of additional α7 nAChRs to the plasma membrane. Direct phosphorylation/dephosphorylation of α7 subunits was unlikely because mutation of all three cytoplasmic tyrosine residues did not prevent the genistein-mediated facilitation. Overall, these data are consistent with the hypothesis that the number of functional cell surface α7 nAChRs is controlled indirectly via processes involving tyrosine phosphorylation.