The effectiveness of a nurse practitioner-led pain management team in long-term care: A mixed methods study

BACKGROUND: Considering the high rates of pain as well as its under-management in long-term care (LTC) settings, research is needed to explore innovations in pain management that take into account limited resource realities. It has been suggested that nurse practitioners, working within an inter-professional model, could potentially address the under-management of pain in LTC.

OBJECTIVES: This study evaluated the effectiveness of implementing a nurse practitioner-led, inter-professional pain management team in LTC in improving (a) pain-related resident outcomes; (b) clinical practice behaviours (e.g., documentation of pain assessments, use of non-pharmacological and pharmacological interventions); and, (c) quality of pain medication prescribing practices.

METHODS: A mixed method design was used to evaluate a nurse practitioner-led pain management team, including both a quantitative and qualitative component. Using a controlled before-after study, six LTC homes were allocated to one of three groups: 1) a nurse practitioner-led pain team (full intervention); 2) nurse practitioner but no pain management team (partial intervention); or, 3) no nurse practitioner, no pain management team (control group). In total, 345 LTC residents were recruited to participate in the study; 139 residents for the full intervention group, 108 for the partial intervention group, and 98 residents for the control group. Data was collected in Canada from 2010 to 2012.

RESULTS: Implementing a nurse practitioner-led pain team in LTC significantly reduced residents' pain and improved functional status compared to usual care without access to a nurse practitioner. Positive changes in clinical practice behaviours (e.g., assessing pain, developing care plans related to pain management, documenting effectiveness of pain interventions) occurred over the intervention period for both the nurse practitioner-led pain team and nurse practitioner-only groups; these changes did not occur to the same extent, if at all, in the control group. Qualitative analysis highlighted the perceived benefits of LTC staff about having access to a nurse practitioner and benefits of the pain team, along with barriers to managing pain in LTC.

CONCLUSIONS: The findings from this study showed that implementing a nurse practitioner-led pain team can significantly improve resident pain and functional status as well as clinical practice behaviours of LTC staff. LTC homes should employ a nurse practitioner, ideally located onsite as opposed to an offsite consultative role, to enhance inter-professional collaboration and facilitate more consistent and timely access to pain management.

Commentary on Copinger's Law of Copyright (1870)

A landmark treatise on the law of copyright, establishing a body of work that still has great relevance for professionals and academics today.
The commentary situates the publication of the treatise in the context of the emerging trends in legal publishing in the mid- to late nineteenth century. It considers Copinger's theoretical approach to the subject of copyright, and explores the significance of the writings and work of two American jurists George Ticknor Curtis and Justice Joseph Story in shaping Copinger's attitude and approach to the copyright regime.

Towards automated Android app collusion detection

Android OS supports multiple communication methods between apps. This opens the possibility to carry out threats in a collaborative fashion, c.f. the Soundcomber example from 2011. In this paper we provide a concise definition of collusion and report on a number of automated detection approaches, developed in co-operation with Intel Security.

Extracting bridge frequencies from dynamic responses of two passing vehicles

A conventional way to identify bridge frequencies is utilizing vibration data measured directly from the bridge. A drawback with this approach is that the deployment and maintenance of the vibration sensors are generally costly and time-consuming. One of the solutions is in a drive-by approach utilizing vehicle vibrations while the vehicle passes over the bridge. In this approach, however, the vehicle vibration includes the effect of road surface roughness, which makes it difficult to extract the bridge modal properties. This study aims to examine subtracting signals of two trailers towed by a vehicle to reduce the effect of road surface roughness. A simplified vehicle-bridge interaction model is used in the numerical simulation; the vehicle - trailer and bridge system are modeled as a coupled model. In addition, a laboratory experiment is carried out to verify results of the simulation and examine feasibility of the damage detection by the drive-by method.