Pain and delirium in people with dementia in the acute general hospital setting

YesBackground: Pain and delirium are common in people with dementia admitted to hospitals. These are often under-diagnosed and under-treated. Pain is implicated as a cause of delirium but this association has not been investigated in this setting. Objective: To investigate the relationship between pain and delirium in people with dementia, on admission and throughout a hospital admission. Design: Exploratory secondary analysis of observational prospective longitudinal cohort data. Setting: Two acute hospitals in the UK. Methodology: Two-hundred and thirty participants aged ≥70 years were assessed for dementia severity, delirium ((Confusion Assessment Method (CAM), pain (Pain Assessment in Advanced Dementia (PAINAD)) scale and prescription of analgesics. Logistic and linear regressions explored the relationship between pain and delirium using cross-sectional data. Results: Pain at rest developed in 49%, and pain during activity for 26% of participants during their inpatient stay. Incident delirium developed in 15%, of participants, and 42% remained delirious for at least two assessments. Of the 35% of participants who were delirious and unable to self-report pain, 33% of these participants experienced pain at rest, and 56 experienced pain during activity. The odds of being delirious were 3.26 times higher in participants experiencing pain at rest (95% Confidence Interval 1.03–10.25, P = 0.044). Conclusion: An association between pain at rest and delirium was found, suggesting pain may be a risk factor for delirium. Since pain and delirium were found to persist and develop during an inpatient stay, regular pain and delirium assessments are required to manage pain and delirium effectively.The Impact of Acute Hospitalisation on People with Dementia: The Behaviour and Pain (BepAID Study (jointly funded by the Alzheimer’s Society and BUPA foundation (Grant reference number: 131). Dr Sampson’s, Dr White’s, Dr Kupeli’s and Miss Vickerstaff ’s posts are supported by Marie Curie core funding, grant (MCCC-FCO-16-U)

AI is a viable alternative to high throughput screening: a 318-target study

: High throughput screening (HTS) is routinely used to identify bioactive small molecules. This requires physical compounds, which limits coverage of accessible chemical space. Computational approaches combined with vast on-demand chemical libraries can access far greater chemical space, provided that the predictive accuracy is sufficient to identify useful molecules. Through the largest and most diverse virtual HTS campaign reported to date, comprising 318 individual projects, we demonstrate that our AtomNet® convolutional neural network successfully finds novel hits across every major therapeutic area and protein class. We address historical limitations of computational screening by demonstrating success for target proteins without known binders, high-quality X-ray crystal structures, or manual cherry-picking of compounds. We show that the molecules selected by the AtomNet® model are novel drug-like scaffolds rather than minor modifications to known bioactive compounds. Our empirical results suggest that computational methods can substantially replace HTS as the first step of small-molecule drug discovery

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Scaling Up Evidence-Based Practices for Teachers is a Profitable But Discredited Paradigm

This article takes issue with the notion that professional learning communities need to be more focused on teacher expertise through the use of online videos of lessons taught by expert teachers that are aligned with the Common Core State Standards. The authors argue that the use of externally developed, research-based, and standards-aligned videos violates the principles of authentic inquiry that underlie professional learning communities. They also caution that a profit-seeking education industry is increasingly behind the promotion of evidence-based products

Oral History for Student Empowerment: Capturing Students’ Inner Voices

Through a close analysis of the oral history of Victor, a Hispanic student in an affluent Anglo institution, this paper provides an example of how oral history methods can capture student voices and uncover the silencing that often takes place in well-intentioned educational institutions, and demonstrates how some of the multiple voices that exist within students and school communities are legitimated, while others are not. Drawing on Mikhail Bakhtin’s theory of inner voice, the analysis illustrates the potential of oral history methods for probing the multiple voices and lived experience of students. It suggests how these voices help to reveal how students construct their identities in educational institutions

The Action Research Dissertation : A Guide for Students and Faculty

https://digitalcommons.montclair.edu/all_books/1144/thumbnail.jp

The Cultural Politics of Identity: Student Narratives from Two Mexican Secondary Schools

This narrative study provides an analysis of the identity construction of students in two Mexicansecondary schools within the structural, cultural, and informational resources that schools asinstitutions provide. A within-case analysis of the narratives of two students is explored in depth, emphasizing, in one case, issues of social class and, in the other, issues of gender. The analysisexplores the lack of congruence between the resources educational institutions provide studentsand their daily struggles to construct personal and occupational identities.Characteristics specific to the Mexican context are provided, and the ways that Mexican students’ dilemmas are at once different from and similar to the U.S. context are explored

Violent Youth Or Violent Schools? a Critical Incident Analysis of Symbolic Violence

Utilizing critical incidents primarily from a year-long ethnographic study of a single gender middle school, the authors attempt to capture the mechanisms of symbolic violence as described by Bourdieu and Passeron in Reproduction in Education, Society and Culture and by Bourdieu in latter publications. Our analysis suggests that problems of persistent social inequality, crime, and incarceration are linked to symbolic forms of violence that occur in schools and that current policies attempting to address these issues are flawed, based on a limited theorization of violence

Anderson, Gary L., & Kathryn Herr, The New Paradigm Wars: Is There Room for Rigorous Practitioner Knowledge in Schools and Universities? Educational Researcher, 28(June-July, 1999), 12-21; 40.*

Discusses the question of legitimacy of practitioner research in academia and schools and raises several related issues

The action research dissertation: A guide for students and faculty

Thousand Oaks,CA.xvii, 155 p.; 22 c