Pain Intensity and Pain Interference in Male and Female Iraq/Afghanistan-era Veterans.

BACKGROUND: Chronic pain conditions are common among both male and female Iraq/Afghanistan-era veterans and can have substantial negative impacts on quality of life and function. Although in general women tend to report higher levels of pain intensity than men, findings remain mixed on whether gender differences in pain exist in Iraq/Afghanistan-era veterans. Additionally, the relationships between functional impairment, pain intensity, and gender remain unknown. METHODS: This project examined gender differences in pain intensity and pain interference in 875 male and female Iraq/Afghanistan-era veterans. Nonparametric Wilcoxon rank-tests examined gender differences in pain scores. Multivariable generalized linear regression modeling was used to evaluate the magnitude of pain intensity and interference across levels of chronicity and gender, and to evaluate the role of chronicity in gender effects in measures of pain and function. RESULTS: Pain intensity and interference scores were significantly greater among both male and female veterans reporting chronic pain relative to acute pain. Women veterans endorsed higher levels of pain intensity and pain interference compared with men. Results derived from multivariable analyses implicated pain intensity as a factor underlying gender differences in functional impairment among chronic pain sufferers, indicating that gender differences in functional measures were eliminated after controlling statistically for pain intensity. CONCLUSIONS: Results demonstrate that the effects of functional impairment are impacted by pain intensity, and not by gender.

Interferences with urine drug screens.

Qualitative urine drug assays are frequently used in conjunction with opioid contracts as a means of monitoring use of prescribed controlled substances as well as concurrent use of illicit substances in patients receiving opioids for chronic nonmalignant pain (CNMP) management. Appropriate use of these screening tests, in conjunction with opioid contracts, may provide the health care provider with additional information needed to safely prescribe opioids for selected individuals with CNMP. It is important for the practitioner caring for patients subject to random urine drug screening to understand interferences with the commonly used urine drug assays, as well as knowing options to confirm contested test results. We reviewed the literature on urine drug assay test interferences and present a summary of this information in this article.

Addressing diversity in clinical nursing education: support for preceptors.

Nursing preceptors are challenged by a broad set of teaching-learning diversity issues that are related to their role as clinical teachers of senior nursing students in clinical settings. A lack of awareness and understanding of these diversity issues may contribute to preceptor-student miscommunication and conflict. Ultimately, these factors can impact on the extent to which the educational objectives are achieved. Most of the health sciences literature focuses on diversity and patient care, and unfortunately, the literature that does address diversity and learning primarily examines the influence of culture and language in classroom education. Few resources are available to guide preceptors as they engage in "real life" real-time clinical learning encounters. To assist preceptors with their teaching strategies and skills, a diversity and learning workshop was developed to support preceptors in their critical role as both clinical teachers and role models. A diversity and learning framework is suggested and applied to the set of teaching-learning diversity issues.