Effect of a Pain Protocol on Discomfort in Dementia

疼痛方案对痴呆症不适的影响

• 批准号: 7342097
• 负责人: CHRISTINE R KOVACH
• 金额: $ 49.11万
• 依托单位: UNIVERSITY OF WISCONSIN MILWAUKEE
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-02-01 至 2010-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7342097
• 关键词: Accounting; Acetaminophen; Acute; Address; Affective; Analgesics; Analysis of Variance; Behavior; Behavioral; Behavioral Symptoms; Care given by nurses; Caring; Characteristics; Classification; Cognitive; Comorbidity; Condition; Consultations; Control Groups; Dementia; Differential Diagnosis; Disease regression; Dose; Double-Blind Method; Early identification; Education; Educational process of instructing; Effectiveness; Elderly; Evaluation; Exhibits; Experimental Designs; Failure; Foundations; Goals; Health; Healthcare; Hydrocortisone; Individual; Intervention; Intervention Trial; Left; Light; Link; Location; Long-Term Care; Malnutrition; Measurement; Measures; Medicaid; Mental Depression; Modeling; Monitoring for Recurrence; Morbidity - disease rate; Motor; Numbers; Nurses; Nursing Assessment; Nursing Homes; Nursing Process; Nursing Students; Nursing Theory; Outcome; Pain; Persons; Pharmaceutical Preparations; Pharmacological Treatment; Physical assessment; Preventive; Procedures; Process; Protocol Compliance; Protocols documentation; Purpose; Quality of life; Randomized; Recurrence; Reliance; Research; Research Personnel; Sampling; Services; Severities; Site; Sleep disturbances; Socialization; Specific qualifier value; Staging; Standards of Weights and Measures; Stress; Symptoms; Techniques; Testing; Therapeutic; Thinking; Time; Treatment Efficacy; United States; Vulnerable Populations; advanced dementia; base; cost; day; functional decline; immune function; improved; mortality; programs; research study; response; size; social; therapy design; treatment effect; treatment trial; trend

Relevance: The overall goal of this program of study is to improve assessment and treatment of discomfort in people with advanced dementia. This study is a test of two interventions designed to meet that goal. Description: The purpose of this competing continuation is to compare the effect of the Serial Jrial intervention plus Discomfort Burden Reduction intervention (STI plus DBR) to the STI alone on five outcomes: discomfort, behavioral symptoms, stress (cortisol), discomfort comorbidities, and use of acute care services. The STI was developed to assist in the differential diagnosis and treatment process: the focus is on early identification and correction of problems associated with discomfort. Our recent CT demonstrated that use of the STI was effective in decreasing discomfort. Despite the effectiveness of the STI, we found limitations in directing treatmentthat sustained improvements in comfort. Thus, we have developed the DBR intervention to supplement the STI. The DBR focuses on minimizing the clinically preventable and treatable burden of discomfort over a longer time period. We will examine group differences in process variables (scope of assessment,scope of treatment, stabilization of treatment, treatments added, treatment stopped, static cares and reactive cares); and plan to evaluate the efficacy of interventions in relation to dose. In addition, we propose to examine the effect of organizational characteristics on care received by measuring the interactionof staffing level, turnover level, and nursing home culture on group differences in resident care and resident outcomes. A two group repeated measures experimental design with double blinding procedures will be used to compare the two study conditions. Twelve long-term care facilities will be stratified based on size, location, and % Medicaid reimbursement, and then randomly assigned to one of the groups. A total sample of 122 (61 subjects/group) will provide at least 80% power to detect an effect size of 0.63 between any two groups. Use of the STI will be initiated when a subject exhibits behavioral/verbalsymptoms of possible discomfort that are not ameliorated by basic care interventions. Nurses caring for subjects in the STI plus DBR group will initiate the DBR based upon information regarding effective treatment gained by using the STI. Inferential analyses planned include: mixed models for repeated measures, analysis of variance, Chi square and regression models for testing dose response.

相关性：该研究计划的总体目标是改善不适的评估和治疗 在患有晚期痴呆症的人中。这项研究是对旨在满足该目标的两种干预措施的测试。 描述：这种竞争延续的目的是比较串行的效果 干预加上减轻不适负担干预（STI加DBR），仅在五个 结果：不适，行为症状，压力（皮质醇），不适性合并症和急性使用 护理服务。开发了STI以协助鉴别诊断和治疗过程：重点 正在提早识别和纠正与不适有关的问题。我们最近的CT证明了 STI的使用可有效减少不适感。尽管STI有效，我们发现 指导治疗的局限性，舒适性的持续改善。因此，我们开发了DBR 干预以补充性传播感染。 DBR的重点是最大程度地减少临床预防和可治疗的 较长时间内的不适负担。我们将检查过程变量的群体差异 （评估范围，治疗范围，稳定治疗，添加治疗，治疗停止， 静态护理和反应性照顾）；并计划评估干预措施与剂量有关的功效。在 此外，我们建议通过测量来检查组织特征对收到的护理的影响 人员配备水平的相互作用水平，营业额和疗养院文化在居民护理中的群体差异 和居民结果。两组重复测量的实验设计，并具有双盲 程序将用于比较两个研究条件。十二个长期护理设施将进行分层 根据大小，位置和％医疗补助的报销，然后随机分配给其中一个组。 总样本为122个（61名受试者/组）将提供至少80％的功率，以检测效应大小为0.63 在任何两组之间。当受试者表现出行为/动词的症状时，将启动STI的使用 基本护理干预措施无法改善可能的不适感。护士照顾受试者 STI Plus DBR组将根据有关有效治疗的信息启动DBR 使用STI。推论分析计划包括：重复度量的混合模型，分析 用于测试剂量反应的方差，卡方和回归模型。