Evaluating the Efficacy of Opioids vs Nonopioids in Chronic Pain Patients

Objective: The purpose of this report is to assess the effectiveness of opioids compared to nonopioids in managing chronic noncancer pain. Methods: Randomized control trials, meta analyses, and systematic reviews published in 2018 or later were searched in medical research databases including PubMed, JAMA, Medline Plus, ScienceDirect, and Google Scholar. Sources were included that expand on data from RCTs assessing the efficacy of opioids, nonopioids, or both as treatment for chronic noncancer pain in adults. A total of six articles with a diverse patient population were selected and reviewed which included 2 RCTs, 2 meta-analyses, and 2 systematic reviews. The primary outcome measures were quantified through pain relief and intensity, physical functioning, and sleep quality. Results: Among these articles, findings indicate that both opioid and nonopioid pharmacologic therapy are comparable in pain reduction. Furthermore, opioid treatment compared to nonopioid treatment was not superior in treating adults with chronic noncancer pain in regards to pain relief, pain intensity, physical functioning, and sleep quality. Conclusion: This comprehensive analysis indicates that nonopioid medication can be equally effective as opioids for treatment of chronic pain in addition to offering a superior safety profile. Nonopioid analgesics should be exhausted prior to prescribing opioids for chronic noncancer pain due to insufficient evidence to support the superiority of opioids. Key Words: chronic pain, opioids, nonopioids, analgesics, noncance

Matilda the Musical : the potential value of the arts in children's nursing education

Background: Final-year children’s nursing students evaluated the content of their course and there was strong evidence they would benefit from supplementary teaching of safeguarding before qualification. Aim: To explore the potential for the arts to enable children’s nursing students to think critically and reflectively about the safeguarding of children and young people. Method: An action research approach was used, recruiting final-year children’s nursing students in one university in the south of England. Questionnaires containing open and closed questions were used to collect data after a field trip to see Matilda the Musical, followed by discussion boards. Findings: Data analysis indicated the use of the arts was a departure from traditional pedagogy, which was relished and described by the students as an interesting and exciting way of learning. Students highlighted how ‘seeing’ Matilda aided them later on the discussion boards to identify categories of abuse and correlate this with the effects of abuse. Conclusion: The use of musical theatre and discussion boards was beneficial to acquiring knowledge and bonding when delivering safeguarding teaching to final-year children’s nursing students

Does mainstream BRCA testing affect surgical decision-making in newly-diagnosed breast cancer patients?

Background: Germline pathogenic variants mutations) in the BRCA1 and BRCA2 genes cause an increased risk of breast cancer and ovarian cancer. Mainstream cancer genetic testing (MCG) was introduced for breast cancer patients in our unit in 2013. Non-geneticist clinicians have been trained to offer genetic testing during initial treatment planning. We assessed the impact of timely test results on surgical decision-making. Methods: Women who had undergone mainstream genetic testing for breast cancer between September 2013 and September 2018 were identified from a prospective database. Surgical data were collected retrospectively. Results: 580 eligible women had mainstream genetic testing. For 474 this was their first breast cancer diagnosis. The median age was 46 years (interquartile range (IQR) 38–57). The indications were: age ≤45 years for 233 (49%); triple negative disease for 192 women (40.5%); bilateral breast cancer age \u3c60 for 39 (8%) and other for 72 (14%) women. The median time for test initiation to result was 18 days (IQR 15-21). 302 (64% received results before surgery. 88% of those found to have a BRCA mutation before surgery opted for bilateral mastectomy (compared to 5% with BRCA wild type). An additional 106 patients had a new diagnosis on a background of previous treatment. Of these all with a pathogenic variant chose bilateral mastectomy. Conclusion: Timely BRCA gene testing influences surgeons’ and patients’ choice of surgery. It reassures women with a negative result and allows those with a positive result to take an active decision about the management of their future risk

Cross-Shelf Differences in the Response of Herbivorous Fish Assemblages to Severe Environmental Disturbances

Cross-shelf differences in coral reef benthic and fish assemblages are common, yet it is unknown whether these assemblages respond uniformly to environmental disturbances or whether local conditions result in differential responses of assemblages at different shelf positions. Here, we compare changes in the taxonomic and functional composition, and associated traits, of herbivorous reef fish assemblages across a continental shelf, five years before and six months after two severe cyclones and a thermal bleaching event that resulted in substantial and widespread loss of live hard coral cover. Each shelf position maintained a distinct taxonomic assemblage of fishes after disturbances, but the assemblages shared fewer species among shelf positions. There was a substantial loss of species richness following disturbances within each shelf position. Total biomass of the herbivorous fish assemblage increased after disturbances on mid- and outer-shelf reefs, but not on inner-shelf reefs. Using trait-based analyses, we found there was a loss of trait richness at each shelf position, but trait specialisation and originality increased on inner-shelf reefs. This study highlights the pervasiveness of extreme environmental disturbances on ecological assemblages. Whilst distinct cross-shelf assemblages can remain following environmental disturbances, assemblages have reduced richness and are potentially more vulnerable to chronic localised stresses

Does mainstream BRCA testing affect surgical decision-making in newly-diagnosed breast cancer patients?

Background: Germline pathogenic variants mutations) in the BRCA1 and BRCA2 genes cause an increased risk of breast cancer and ovarian cancer. Mainstream cancer genetic testing (MCG) was introduced for breast cancer patients in our unit in 2013. Non-geneticist clinicians have been trained to offer genetic testing during initial treatment planning. We assessed the impact of timely test results on surgical decision-making. Methods: Women who had undergone mainstream genetic testing for breast cancer between September 2013 and September 2018 were identified from a prospective database. Surgical data were collected retrospectively. Results: 580 eligible women had mainstream genetic testing. For 474 this was their first breast cancer diagnosis. The median age was 46 years (interquartile range (IQR) 38–57). The indications were: age ≤45 years for 233 (49%); triple negative disease for 192 women (40.5%); bilateral breast cancer age \u3c60 for 39 (8%) and other for 72 (14%) women. The median time for test initiation to result was 18 days (IQR 15-21). 302 (64% received results before surgery. 88% of those found to have a BRCA mutation before surgery opted for bilateral mas- tectomy (compared to 5% with BRCA wild type). An additional 106 patients had a new diagnosis on a back- ground of previous treatment. Of these all with a pathogenic variant chose bilateral mastectomy. Conclusion: Timely BRCA gene testing influences surgeons’ and patients’ choice of surgery. It reassures women with a negative result and allows those with a positive result to take an active decision about the management of their future risk

Adenosine receptor expression and function in rat striatal cholinergic interneurons

1. Cholinergic neurons were identified in rat striatal slices by their size, membrane properties, sensitivity to the NK(1) receptor agonist (Sar(9), Met(O(2))(11)) Substance P, and expression of choline acetyltransferase mRNA. A(1) receptor mRNA was detected in 60% of the neurons analysed, and A(2A) receptor mRNA in 67% (n=15). 2. The A(1) receptor agonist R-N(6)-(2-phenylisopropyl)adenosine (R-PIA) hyperpolarized cholinergic neurons in a concentration dependent manner sensitive to the A(1) antagonist 8-cyclopentyl-1,3-dipropylxanthine (DPCPX, 100 nM). 3. In dual stimulus experiments, the A(2A) receptor antagonist 8-(3-chlorostyryl)caffeine (CSC, 500 nM) decreased release of [(3)H]-acetylcholine from striatal slices (S2/S1 0.78±0.07 versus 0.95±0.05 in control), as did adenosine deaminase (S2/S1 ratio 0.69±0.05), whereas the A(1) receptor antagonist DPCPX (100 nM) had no effect (S2/S1 1.05±0.14). 4. In the presence of adenosine deaminase the adenosine A(2A) receptor agonist 2-p-((carboxyethyl)phenylethylamino)-5′-N-ethylcarboxamidoadenosine (CGS21680, 10 nM) increased release (S2/S1 ratio 1.03±0.05 versus 0.88±0.05 in control), an effect blocked by the antagonist CSC (500 nM, S2/S1 0.68±0.05, versus 0.73±0.08 with CSC alone). The combined superfusion of bicuculline (10 μM), saclofen (1 μM) and naloxone (10 μM) had no effect on the stimulation by CGS21680 (S2/S1 ratio 0.99±0.04). 5. The A(1) receptor agonist R-PIA (100 nM) inhibited the release of [(3)H]-acetylcholine (S2/S1 ratio 0.70±0.03), an effect blocked by DPCPX (S2/S1 ratio 1.06±0.07). 6. It is concluded that both A(1) and A(2A) receptors are expressed on striatal cholinergic neurons where they are functionally active

Quorum Sensing Signal Production and Microbial Interactions in a Polymicrobial Disease of Corals and the Coral Surface Mucopolysaccharide Layer

Black band disease (BBD) of corals is a complex polymicrobial disease considered to be a threat to coral reef health, as it can lead to mortality of massive reef-building corals. The BBD community is dominated by gliding, filamentous cyanobacteria with a highly diverse population of heterotrophic bacteria. Microbial interactions such as quorum sensing (QS) and antimicrobial production may be involved in BBD disease pathogenesis. In this study, BBD (whole community) samples, as well as 199 bacterial isolates from BBD, the surface mucopolysaccharide layer (SML) of apparently healthy corals, and SML of apparently healthy areas of BBD-infected corals were screened for the production of acyl homoserine lactones (AHLs) and for autoinducer-2 (AI-2) activity using three bacterial reporter strains. AHLs were detected in all BBD (intact community) samples tested and in cultures of 5.5% of BBD bacterial isolates. Over half of a subset (153) of the isolates were positive for AI-2 activity. AHL-producing isolates were further analyzed using LC-MS/MS to determine AHL chemical structure and the concentration of (S)-4,5-dihydroxy-2,3-pentanedione (DPD), the biosynthetic precursor of AI-2. C6-HSL was the most common AHL variant detected, followed by 3OC4-HSL. In addition to QS assays, 342 growth challenges were conducted among a subset of the isolates, with 27% of isolates eliciting growth inhibition and 2% growth stimulation. 24% of BBD isolates elicited growth inhibition as compared to 26% and 32% of the bacteria from the two SML sources. With one exception, only isolates that exhibited AI-2 activity or produced DPD inhibited growth of test strains. These findings demonstrate for the first time that AHLs are present in an active coral disease. It is possible that AI-2 production among BBD and coral SML bacteria may structure the microbial communities of both a polymicrobial infection and the healthy coral microbiome

Patients\u27 Willingness to Accept Social Needs Navigation After In-Person Versus Remote Screening

Social needs screening and referral interventions are increasingly common in health care settings. Although remote screening offers a potentially more practical alternative to traditional in-person screening, there is concern that screening patients remotely could adversely affect patient engagement, including interest in accepting social needs navigation

Engaging Gypsy, Roma, and Traveller Communities in research: Maximizing opportunities and overcoming challenges

Gypsy, Roma, and Traveller people are marginalized worldwide and experience severe health inequalities, even in comparison to other ethnic minority groups. While diverse and hard to categorize, these communities are highly cohesive and members have a strong sense of identity as a group apart from the majority population. Researchers commonly experience challenges in accessing, recruiting, and retaining research participants from these communities, linked to their outsider status, insular nature, and history of discrimination. In this article, the challenges and the opportunities of engaging Gypsies, Roma, and Travellers in a multicenter qualitative research project are discussed. The management of public involvement and community engagement in this U.K.-based project provides insights into conducting research effectively with ethnically and linguistically diverse communities, often considered to be “hard to reach.”