Effect of a Pain Protocol on Discomfort in Dementia

相关性：本研究计划的总体目标是改善不适的评估和治疗 老年痴呆症晚期患者的情况。这项研究是对旨在实现这一目标的两种干预措施的测试。 描述：这种竞争性延续的目的是比较连续Jrial的效果 干预加不适负担减轻干预（STI加DBR），以STI单独五 结果：不适、行为症状、压力（皮质醇）、不适合并症和使用急性 护理服务。制定STI是为了协助鉴别诊断和治疗过程：重点是 是及早识别和纠正与不适有关的问题。我们最近的CT显示 使用STI可以有效减少不适。尽管STI有效，但我们发现 在指导治疗中的局限性，持续改善舒适度。因此，我们开发了DBR 以补充STI。DBR的重点是尽量减少临床上可预防和可治疗的疾病， 在较长时间内的不适负担。我们将研究过程变量的组间差异 （评估范围、治疗范围、稳定治疗、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有效性。在 此外，我们建议通过测量组织特征对护理的影响， 人员配备、离职率与护理院文化对住院医师照护群体差异之交互作用 居民的成果。双盲两组重复测量试验设计 将使用程序来比较两种研究条件。12个长期护理设施将分层 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例样本（61例受试者/组）将提供至少80%的把握度来检测0.63的效应量 任何两个群体之间。当受试者出现行为/言语症状时，将开始使用STI 基本护理干预无法改善的潜在不适。护理受试者的护士 STI + DBR组将根据以下人员获得的有效治疗信息启动DBR： 使用STI。计划的推断分析包括：重复测量的混合模型， 方差、卡方和回归模型用于检验剂量反应。

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.