Effect of a Pain Protocol on Discomfort in Dementia

相关性：这项研究的总体目标是改善对不适的评估和治疗 在患有严重痴呆症的人身上。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：这一竞争延续的目的是比较连续审判的效果 干预+不适减负干预(STI+DBR)单独对STI进行5次 结果：不适、行为症状、压力(皮质醇)、不适并存和使用急性皮质醇 护理服务。开发STI是为了帮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 STI的使用在减少不适方面是有效的。尽管STI很有效，但我们发现 指导治疗的局限性使舒适性持续改善。因此，我们开发了DBR 对性传播感染的补充干预。DBR的重点是尽量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中的组差异 (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)；并计划评估与剂量有关的干预效果。在……里面 此外，我们建议通过测量来检验组织特征对接受护理的影响 人员配备水平、人员流动水平和养老院文化对住院护理群体差异的交互作用 和居民的结果。双盲两组重复测量实验设计 程序将被用来比较两种研究条件。将对12个长期护理机构进行分层 根据大小、位置和医疗补助报销百分比，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0.63的效应大小 在任何两个群体之间。当受试者表现出行为/言语症状时，将启动STI的使用 不能通过基本护理干预改善的可能的不适。护理对象的护士在 STI+DBR小组将根据以下项目获得的有效治疗信息启动DBR 使用STI。计划的推论分析包括：重复测量的混合模型，分析 检验剂量反应的方差、卡方和回归模型。

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.