Does item overlap render measured relationships between pain and challenging behaviour trivial? Results from a multicentre cross-sectional study in 13 German nursing homes.

Several studies suggest that pain is a trigger for challenging behaviour in older adults with cognitive impairment. However, such measured relationships might be confounded due to item overlap as instruments share similar or identical items. The purpose of this study was to examine whether the frequently observed association between pain and challenging behaviour might be traced back to item overlap. This multicentre cross-sectional study was conducted in 13 nursing homes and examined pain (measure: Pain Assessment in Advanced Dementia Scale) and challenging behaviour (measure: Cohen-Mansfield Agitation Inventory) in 150 residents with severe cognitive impairment. The extent of item overlap was determined by juxtaposition of both measures' original items. As expected, comparison between these instruments revealed an extensive item overlap. The statistical relationship between the two phenomena can be traced back mainly to the contribution of the overlapping items, which renders the frequently stated relationship between pain and challenging behaviour trivial. The status quo of measuring such associations must be contested: constructs' discrimination and instruments' discrimination have to be discussed critically as item overlap may lead to biased conclusions and assumptions in research as well as to inadequate care measures in nursing practice.

Adherence of pain assessment to the German national standard for pain management in 12 nursing homes.

BACKGROUND: Pain is very common among nursing home residents. The assessment of pain is a prerequisite for effective multiprofessional pain management. Within the framework of the German health services research project, 'Action Alliance Pain-Free City Muenster', the authors investigated pain assessment adherence according to the German national Expert Standard for Pain Management in Nursing, which is a general standard applicable to all chronic/acute pain-affected persons and highly recommended for practice. OBJECTIVES: To evaluate the state of pain assessment and to identify need for improvement in 12 nursing homes in a German city. METHODS: In the present study, the authors used an ex-post-facto design (survey methodology). Available written policies for routine pain assessment in residents ≥65 years of age were reviewed and a standardized online survey completed by 151 of 349 nurses in 12 nursing home facilities was conducted between September 2010 and April 2011. RESULTS: Most of the included nursing homes provided written policies for pain assessment, and the majority of nurses reported that they assess and regularly reassess pain. However, observational tools for residents with severe cognitive impairment and written reassessment schedules were lacking in many facilities or were inconsistent. CONCLUSIONS: Essentially, pain assessment appeared to be feasible in the majority of the German nursing homes studied. However, the absence or inconsistency of reassessment schedules indicate that pain management guidelines should include a detailed and explicit reassessment schedule for the heterogenic needs of nursing home residents. For residents with severe cognitive impairment, assessment tools are needed that are simple to use and clearly indicate the presence or absence of pain.

Emerging standards of care in pain management in Germany.

A research project addressing roles of nurses in pain management is described. The role of specialized pain management nurses is discussed. Standards, communication, and multidisciplinary care, as well as roles of nurses in hospitals, nursing homes, and home care are described. Specialization is discussed including training and certification. The German National Expert Standard for Pain Management in Nursing is described.

The Arabidopsis receptor kinase FLS2 binds flg22 and determines the specificity of flagellin perception.

Flagellin, the main building block of the bacterial flagellum, acts as a pathogen-associated molecular pattern triggering the innate immune response in animals and plants. In Arabidopsis thaliana, the Leu-rich repeat transmembrane receptor kinase FLAGELLIN SENSITIVE2 (FLS2) is essential for flagellin perception. Here, we demonstrate the specific interaction of the elicitor-active epitope flg22 with the FLS2 protein by chemical cross-linking and immunoprecipitation. The functionality of this receptor was further tested by heterologous expression of the Arabidopsis FLS2 gene in tomato (Lycopersicon esculentum) cells. The perception of flg22 in tomato differs characteristically from that in Arabidopsis. Expression of Arabidopsis FLS2 conferred an additional flg22-perception system on the cells of tomato, which showed all of the properties characteristic of the perception of this elicitor in Arabidopsis. In summary, these results show that FLS2 constitutes the pattern-recognition receptor that determines the specificity of flagellin perception.