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Effect of a Pain Protocol on Discomfort in Dementia

疼痛方案对痴呆症不适的影响

基本信息

批准号：
7743788
负责人：
CHRISTINE R KOVACH
金额：
$ 49.95万
依托单位：
UNIVERSITY OF WISCONSIN MILWAUKEE
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-02-01 至 2011-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7743788
关键词：
Accounting Acetaminophen Acute Address Affective Analgesics Analysis of Variance Behavior Behavioral Behavioral Symptoms Care given by nurses Caring Characteristics Cognitive Comorbidity Consultations Control Groups Dementia Differential Diagnosis 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 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 Quality of life Randomized Recurrence Reliance Research Research Personnel Sampling Services Severities Site Sleep disturbances Socialization Specific qualifier value Staging Stress Symptoms Techniques Testing Therapeutic Thinking Time Treatment Efficacy United States Vulnerable Populations advanced dementia base cost effective therapy functional decline group intervention immune function improved meetings mortality programs research study response social standard care therapy design treatment effect treatment strategy treatment trial trend

项目摘要

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进不适的评估和治疗患有晚期痴呆症的人。这项研究是对旨在实现该目标的两种干预措施的测试。说明：本次竞赛延续的目的是比较 Serial Jrial 的效果干预加不适负担减轻干预（STI 加 DBR）仅对 5 名 STI 进行干预结果：不适、行为症状、压力（皮质醇）、不适合并症以及急性使用护理服务。 STI 的开发是为了协助鉴别诊断和治疗过程：重点是关于及早识别和纠正与不适相关的问题。我们最近的 CT 显示使用性传播感染可以有效减少不适。尽管性传播感染很有效，但我们发现指导持续改善舒适度的治疗的局限性。因此，我们开发了DBR 干预以补充性传播感染。 DBR 的重点是最大限度地减少临床上可预防和可治疗的疾病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、治疗稳定、增加治疗、停止治疗、静态护理和反应性护理）；并计划评估与剂量相关的干预措施的功效。在此外，我们建议通过测量组织特征对接受的护理的影响人员配置水平、流动水平和疗养院文化对居民护理群体差异的相互作用和居民成果。两组重复测量双盲实验设计将使用程序来比较两种研究条件。 12个长期护理机构将分层根据规模、位置和医疗补助报销百分比，然后随机分配到其中一组。 122 个样本（61 个受试者/组）的总样本将提供至少 80% 的功效来检测 0.63 的效应大小任意两组之间。当对象表现出行为/语言症状时，将开始使用性传播感染基本护理干预措施无法改善的可能不适。护士在护理中心照顾受试者 STI 加 DBR 小组将根据获得的有效治疗信息启动 DBR 使用性传播感染。计划的推理分析包括：重复测量的混合模型、分析用于测试剂量反应的方差、卡方和回归模型。