Neglected By The Evidence: The Intersection of Medical Complexity and Dementia

被证据忽视：医疗复杂性与痴呆症的交叉点

• 批准号: 8064768
• 负责人: lori A daiello
• 金额: $ 14.97万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8064768
• 关键词: Neglected; Evidence; Intersection; Medical; Complexity

DESCRIPTION (provided by applicant): The applicant Is a Research Associate at the Alzheimer's Disease and Memory Disorders Center at Rhode Island Hospital. Her extensive clinical background in geriatric psychopharmacology and nursing home medicine is the foundation for her long term goal to become an independent health services researcher. This proposal focuses on comparative effectiveness research in an oft neglected population - persons with dementia living in nursing homes. The research questions seek to investigate the cognitive, functional, and neurobehavioral outcomes associated with the use or discontinuation of certain psychoactive drugs in individuals with dementia and comorbid medical illness. The proposed training plan will develop additional skills through 1) coursework in epidemiology to expand methodologic and analytic skills, 2) interaction with the mentorship team, including experts in health services research and dementia research, and 3) completion of two observational pharmacoepidemiologic studies utilizing large automated cross-linked datasets. Findings from these studies will provide clinically relevant information to inform treatment of elderly patients with dementia; a population systematically excluded from clinical trials. Using state of the art methods for estimating treatment effects from non-experimental studies, the aims are 1) to evaluate the longitudinal behavioral, cognitive, and functional effects of discontinuing stable cholinesterase inhibitor (CHEI) therapy compared to continuous CHEI therapy in nursing facility residents with dementia, 2) to determine the extent to which cognitively impaired individuals who receive isoflurane general anesthesia during hip fracture repair experience greater post-operative cognitive and functional decline in the year after surgery compared to patients receiving other types of general anesthesia, and 3) to quantify the effects of isoflurane anesthesia vs. other general or regional (spinal or epidural) anesthesia on the rate of post- operative cognitive and functional decline in cognitively impaired patients in the year after hip fracture repair surgery.

描述（由申请人提供）：申请人是罗德岛医院的阿尔茨海默氏病和记忆障碍中心的研究助理。她在老年心理药理学和疗养院医学方面的广泛临床背景是她长期成为独立卫生服务研究员的基础。该提案着重于在被忽视的人群中进行比较有效性研究 - 居住在疗养院中的痴呆症患者。研究问题旨在调查与痴呆症和合并症患者使用或中断某些精神活性药物有关的认知，功能和神经行为结果。拟议的培训计划将通过1）流行病学课程发展额外的技能，以扩大方法论和分析技能，2）与指导团队的互动，包括卫生服务研究和痴呆症研究专家，以及3）完成了两项使用大型自动化的交叉连接数据集的观察性药物分离学研究。这些研究的发现将提供临床上相关的信息，以告知对痴呆症老年患者的治疗。从临床试验中系统排除的人群。使用艺术方法来估算非实验性研究的治疗效果，目的是1）评估停用稳定胆碱酯酶抑制剂（CHEI）治疗的纵向行为，认知和功能效应（CHEI）疗法（CHEI）疗法（CHEI）疗法（与痴呆症患者的持续性居民相比，2）在接受范围内的人的持续chei疗法相比，该疗法是一般性的。与接受其他类型的一般麻醉的患者相比，手术后一年的骨折后认知和功能下降更大，并且3）可以量化异氟烷麻醉的作用，而其他一般或区域或区域（脊柱或表皮）麻醉对后疗法的术后术中的疗效患者的作用率下降了，这是Cognity Imprimper nip farfer nif fars far nifear nip farfer far nifear far nip after nip after far nip after nip after nip after nip nip nip nip nip。