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Non-cardiac chest pain (NCCP) is a common and distressing condition. Prior studies suggest that psychotropic medication or pain coping skills training (CST) may benefit NCCP patients. To our knowledge, no clinical trials have examined the separate and combined effects of CST and psychotropic medication in the management of NCCP. This randomized clinical trial examined the separate and combined effects of CST and antidepressant medication (sertraline) in participants with non-cardiac chest pain. A sample of individuals diagnosed with NCCP was randomly assigned to one of four treatments: (1) CST plus sertraline (CST + sertraline), (2) CST plus placebo (CST + placebo), (3) sertraline alone, or (4) placebo alone. Assessments of pain intensity, pain unpleasantness, anxiety, pain catastrophizing, depression, and physical disability were collected prior to treatment, and at 10- and 34-weeks following randomization. Data analyses revealed that CST and sertraline either alone or in combination significantly reduced pain intensity and pain unpleasantness. The combination of CST plus sertraline may have the greatest promise in that, when compared to placebo alone, it not only significantly reduced pain but also pain catastrophizing and anxiety. Overall, these findings support the importance of further research on the effects of CST and sertraline for non-cardiac chest pain.

Objective. To identify barriers to return to work (RTW) among persons likely to be seen in a clinician's practice who are unemployed due to arthritis and musculoskeletal disorders.Methods. Two hundred eighteen persons unemployed due to arthritis and musculoskeletal disorders were interviewed at baseline and followed up for 1 year, at which time their work status was ascertained. Backward stepwise logistic regression was used to determine the association of baseline clinical, sociodemographic, and work-related factors to their work status at 1 year of Results. Fifty-one (24%) of 216 initially unemployed subjects had returned to permanent paid employment of 220 hourdweek after 1 year. Having rheumatoid arthritis, Social Security Disability Insurance (SSDI) status, a high pain level, older age, and lower education were barriers to reemployment.Conclusion. This study establishes the importance of chronic pain and having rheumatoid arthritis as factors independently associated with failure to RTW among persons unemployed due to arthritis and musculoskeletal disorders. The importance of SSDI beneficiary status, age, and education level in RTW is further followup.

Objective This study examined the contributions of chest pain, anxiety, and pain catastrophizing to disability in 97 patients with non-cardiac chest pain (NCCP). We also tested whether chest pain and anxiety were indirectly related to greater disability via pain catastrophizing. Methods Participants completed daily diaries measuring chest pain for seven days prior to completing measures of pain catastrophizing, trait anxiety, and disability. Linear path model analyses examined the contributions of chest pain, trait anxiety, and catastrophizing to physical disability, psychosocial disability, and disability in work, home, and recreational activities. Results Path models accounted for a significant amount of the variability in disability scales (R2=.35 to .52). Chest pain and anxiety accounted for 46% of the variance in pain catastrophizing. Both chest pain (β=.18, Sobel test Z=2.58, p<.01) and trait anxiety (β=.14, Sobel test Z=2.11, p<.05) demonstrated significant indirect relationships with physical disability via pain catastrophizing. Chest pain demonstrated a significant indirect relationship with psychosocial disability via pain catastrophizing (β=.12, Sobel test Z=1.96, p=.05). After controlling for the effects of chest pain and anxiety, pain catastrophizing was no longer related to disability in work, home, and recreational activities. Conclusions Chest pain and anxiety were directly related to greater disability and indirectly related to physical and psychosocial disability via pain catastrophizing. Efforts to improve functioning in NCCP patients should consider addressing pain catastrophizing.

In previous work using the Saccharomyces cerevisiae model system, a mutant version of histone H3—H3-L61W—was found to confer a variety of abnormal growth phenotypes and defects in specific aspects of the transcription process, including a pronounced alteration in the distribution pattern of the transcription elongation factor Spt16 across transcribed genes and promotion of cryptic transcription initiation within the FLO8 gene. To gain insights into the contribution of the H3-L61 residue to chromatin function, we have generated yeast strains expressing versions of histone H3 harboring all possible natural amino acid substitutions at position 61 (H3-L61X mutants) and tested them in a series of assays. We found that whereas 16 of the 19 H3-L61X mutants support viability when expressed as the sole source of histone H3 in cells, all 19 confer abnormal phenotypes ranging from very mild to severe, a finding that might in part explain the high degree of conservation of the H3-L61 residue among eukaryotes. An examination of the strength of the defects conferred by each H3-L61X mutant and the nature of the corresponding substituted residue provides insights into structural features of the nucleosome required for proper Spt16−gene interactions and for prevention of cryptic transcription initiation events. Finally, we provide evidence that the defects imparted by H3-L61X mutants on Spt16−gene interactions and on repression of intragenic transcription initiation are mechanistically related to each other.

Because nurses are the healthcare providers who spend the most time with patients and their families at the end of life, baccalaureate nursing students should be adequately prepared for this role before they graduate. However, many undergraduate nursing programs fail to provide adequate end-of-life content, and many undergraduate nursing students often do not have the opportunity to care for dying patients during clinical rotations. Faculty in an undergraduate community health nursing course incorporated an end-of-life clinical experience using high-fidelity patient simulation to allow students to provide holistic care to a dying patient and his family in a safe learning environment. The simulator was used to play the role of the dying patient, and a course faculty member acted as the patient's daughter. Students were given the role of the hospice nurse. At the end of the experience, students expressed a greater understanding of the pathophysiology at the end of life, as well as enhanced communication skills. Because many nursing students may not encounter an actively dying patient during their clinical rotations, high-fidelity patient simulation is an effective mechanism for providing students with exposure to end of life. KEY WORDSend-of-life care, nursing education, simulation D espite the growth in hospice and palliative care and the publication of undergraduate nursing competencies for providing quality end-of-life (EOL) care, 1 EOL content continues to be inadequate in undergraduate nursing curricula, 1 and both new graduates and qualified nurses report not feeling adequately prepared to deliver EOL care. 2 Nursing programs in the United States typically focus their curricula on acute care interventions in the context of medical-surgical nursing and cover EOL content sparingly, 3 and EOL content is typically limited to lectures that may be scattered throughout various courses. 4 In addition to providing theoretical content related to EOL care, nursing programs should incorporate hands-on experiences that will allow students to recognize their own feelings and expectations about death while demonstrating respect for the patient's and family's views, concerns, and wishes during EOL care. 1

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