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: 7195564
• 负责人: CHRISTINE R KOVACH
• 金额: $ 49.64万
• 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/7195564
• 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

DESCRIPTION (provided by applicant): 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 treatment that 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 interaction of 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/verbal symptoms 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.

描述(由申请者提供)：本研究计划的总体目标是改进对晚期痴呆症患者的不适评估和治疗。这项研究是对两种旨在实现这一目标的干预措施的测试。描述：这项竞争性继续研究的目的是比较连续干预加不适减负干预(STI加DBR)与单纯STI对五种结果的影响：不适、行为症状、压力(皮质醇)、不适并存和急性护理服务的使用。开发STI是为了帮助鉴别诊断和治疗过程：重点是早期识别和纠正与不适相关的问题。我们最近的CT显示，使用STI在减少不适方面是有效的。尽管STI是有效的，但我们发现在指导治疗以持续改善舒适度方面存在局限性。因此，我们开发了DBR干预以补充STI。DBR的重点是将临床上可预防和治疗的较长时间内的不适负担降至最低。我们将检查过程变量(评估范围、治疗范围、治疗的稳定性、增加的治疗、停止的治疗、静态护理和反应性护理)的组间差异；并计划评估与剂量相关的干预效果。此外，我们建议通过测量人员配备水平、人员更替水平和疗养院文化对住院护理和住院结果的群体差异的交互作用来检验组织特征对接受护理的影响。采用双盲法的两组重复测量实验设计，比较两种研究条件。12家长期护理机构将根据规模、地点和医疗补助报销百分比进行分层，然后随机分配到其中一组。总共122个样本(61个受试者/组)将提供至少80%的功率来检测任意两组之间0.63的效应大小。当受试者表现出可能的不适的行为/语言症状，而基本护理干预没有改善时，将开始使用STI。护理STI加DBR组中的受试者的护士将根据通过使用STI获得的有效治疗信息启动DBR。计划进行的推断分析包括：重复测量的混合模型、方差分析、卡方和剂量反应测试的回归模型。