Search

ObjectiveTo compare secondary patient reported outcomes of perceptions of treatment success and function for patients treated for appendicitis with appendectomy vs. antibiotics at 30 days.Summary background dataThe Comparison of Outcomes of antibiotic Drugs and Appendectomy trial found antibiotics noninferior to appendectomy based on 30-day health status. To address questions about outcomes among participants with lower socioeconomic status, we explored the relationship of sociodemographic and clinical factors and outcomes.MethodsWe focused on 4 patient reported outcomes at 30 days: high decisional regret, dissatisfaction with treatment, problems performing usual activities, and missing >10 days of work. The randomized (RCT) and observational cohorts were pooled for exploration of baseline factors. The RCT cohort alone was used for comparison of treatments. Logistic regression was used to assess associations.ResultsThe pooled cohort contained 2062 participants; 1552 from the RCT. Overall, regret and dissatisfaction were low whereas problems with usual activities and prolonged missed work occurred more frequently. In the RCT, those assigned to antibiotics had more regret (Odd ratios (OR) 2.97, 95% Confidence intervals (CI) 2.05-4.31) and dissatisfaction (OR 1.98, 95%CI 1.25-3.12), and reported less missed work (OR 0.39, 95%CI 0.27-0.56). Factors associated with function outcomes included sociodemographic and clinical variables for both treatment arms. Fewer factors were associated with dissatisfaction and regret.ConclusionsOverall, participants reported high satisfaction, low regret, and were frequently able to resume usual activities and return to work. When comparing treatments for appendicitis, no single measure defines success or failure for all people. The reported data may inform discussions regarding the most appropriate treatment for individuals.Trial registrationClinicaltrials.gov Identifier: NCT02800785.

The ABA pain guidelines were developed 14 years ago and have not been revised despite evolution in the practice of burn care. A sub-committee of the American Burn Association's Committee on the Organization and Delivery of Burn Care was created to revise the adult pain guidelines. A MEDLINE search of English-language publications from 1968 to 2018 was conducted using the keywords "burn pain," "treatment," and "assessment." Selected references were also used from the greater pain literature. Studies were graded by two members of the committee using Oxford Centre for Evidence-based Medicine-Levels of Evidence. We then met as a group to determine expert consensus on a variety of topics related to treating pain in burn patients. Finally, we assessed gaps in the current knowledge and determined research questions that would aid in providing better recommendations for optimal pain management of the burn patient. The literature search produced 189 papers, 95 were found to be relevant to the assessment and treatment of burn pain. From the greater pain literature 151 references were included, totaling 246 papers being analyzed. Following this literature review, a meeting to establish expert consensus was held and 20 guidelines established in the areas of pain assessment, opioid medications, nonopioid medications, regional anesthesia, and nonpharmacologic treatments. There is increasing research on pain management modalities, but available studies are inadequate to create a true standard of care. We call for more burn specific research into modalities for burn pain control as well as research on multimodal pain control.

Laboratories play a crucial role in the undergraduate science curriculum and the effectiveness of learning in laboratories is influenced by learners' interactions with other students, the instructors, and the equipment used. In this study, a pre-lab survey was used to collect information about students' expectations of interactions in chemistry laboratories and how they can be ranked according to their importance. Post-lab surveys were used to capture students' perspectives about the frequency of interactions that existed in laboratory sessions they had completed. Direct observations of some laboratories were also conducted principally to validate students' self-reported interactions. The data were also sorted by three levels of student achievement in order to relate students' expectations of the importance of different interactions (pre-lab survey) and their self-reported frequency of interactions (post-lab survey) with their laboratory grades. Results from the pre-lab survey showed that student-instructor interactions were anticipated to be the most important ahead of conducting the laboratory activity, whereas results from the post-lab surveys showed that the most frequent interactions occurred between students. Students' self-reports (post-lab survey) and the direct observations agreed well suggesting that the post-lab survey is a robust tool for capturing the frequencies of student interactions in this and future studies. The results also showed that students gaining high grades both anticipated the importance of, and then engaged more frequently in, two-way communications with both students and instructors whereas students with lower grades placed a relatively higher reliance upon passive interactions such as the pre-lab briefing, the laboratory manual and internet sources. Finally, recommendations are offered to curriculum designers, instructors and students based on the overall findings of the study.

The molecular basis for estrogen-induced tight nuclear binding of estrogen receptor [alpha] (ER) is described. The effects of estrogen binding on altering DNA binding in whole cells have occurred through estrogen-induced changes in ER-chaperone protein interactions, which have changed the DNA accessibility of ER but have not directly changed the affinity of the ER for DNA.

Coactivators are believed to mediate estrogen-induced gene responses via interaction with estrogen receptors (ER). Currently, a major challenge is to determine the importance of each coactivator in a specific cell type and promoter context in response to a particular ligand. The potential of ER to interact with a growing list of coactivators has been shown in a variety of in vitro and gene transfer assays, yet very few data have demonstrated the interaction of endogenous coactivators with ER in intact cells. We report here a ligand-specific interaction of endogenous human ER (hER) and the AIB1 coactivator in MCF-7 human breast cancer cells by using immunoprecipitation analyses. Complexes between endogenously expressed hER and AIB1 were detected in estradiol-treated cells and to a much lesser extent in cells treated with the partial agonist, monohydroxytamoxifen. We were unable to detect an hER-SRC-1 complex in our immunoprecipitations from MCF-7 cells. The in vitro-binding affinity for mouse ER interaction with AIB1 was estimated to be 40-120 nM. We conclude that AIB1 is a major coactivator for hER in MCF-7 human breast cancer cells.

Introduction: Pain and sedation management is a crucial yet challenging aspect of burn care. We sought to survey a multidisciplinary group of nurses (RN), physicians (MD), advanced practice providers (APP), and therapists (PT/ OT) to determine perceptions of pharmacologic pain and sedation management before and after the implementation of a standardized clinical practice guideline (CPG) at our institution. Methods: A 28-question survey assessing knowledge, pain and sedation practices, and therapy participation was distributed to all intensive care unit (ICU) and non-ICU burn care providers at our institution before (n=135, 2019) and after (n=185, 2022) CPG implementation. Comparison of proportions was calculated using Chi-squared test. Results: Survey response was 61 (45%) before and 51 (28%) after CPG, with 18 participating in both. Most respondents (63%) had 0-5 years of experience caring for burn patients. Patients were perceived to have significant background pain >50% of the time by 69% of RN before vs 55% after (p=0.26). Intermittent opioid boluses were preferred to continuous infusions in intubated patients before (57%) and after (59%) CPG implementation (p=0.87). Perceived utilization of multimodal pain management was high (82%) amongst all responders, except for ICU RN (53%) (p=0.05). While < 30% of all providers believed analgesics were underutilized for procedural pain, non-ICU RN consistently reported patients were in significant pain 50-75% of the time during procedures (78% before vs 85% after, p=0.61). Perceptions of sedative underutilization were unchanged before and after CPG (ICU RN 58% vs 33%, p=0.15; non-ICU RN 69% vs 71%, p=0.91; MD/APP 69% vs 71%, p=0.95). PT/OT reported pain as the most common reason for nonparticipation in therapy sessions with one-third reporting underutilization of analgesics in both surveys. In the after survey, 50% agree we manage pain effectively. Areas for improvement included open communication between disciplines regarding pain and sedation plan, increased use of intermittent sedatives compared to continuous, and less IV opioid utilization with more focus on nonopioid therapy. Fifty percent of after survey respondents were aware of the CPG. Conclusions: Implementation of a CPG did not change perceptions of pain and sedation at our institution. This may be due to limited education surrounding CPG and overall lack of utilization. Future efforts should focus on education and communication between disciplines. Applicability of Research to Practice: Variability in provider perceptions of pain and sedation management in patients with burn injury remain despite implementation of a CPG. [ABSTRACT FROM AUTHOR]