An analytical framework for delirium research in palliative care settings: integrated epidemiologic, clinician-researcher, and knowledge user perspectives

peer-reviewedContext. Delirium often presents difficult management challenges in the context of goals of care in palliative care settings. Objectives. The aim was to formulate an analytical framework for further research on delirium in palliative care settings, prioritize the associated research questions, discuss the inherent methodological challenges associated with relevant studies, and outline the next steps in a program of delirium research.Methods. We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting, relevant literature searches, focused input of epidemiologic expertise, and a meeting participant and coauthor survey to formulate a conceptual research framework and prioritize research questions.Results. Our proposed framework incorporates three main groups of research questions: the first was predominantly epidemiologic, such as delirium occurrence rates, risk factor evaluation, screening, and diagnosis; the second covers pragmatic management questions; and the third relates to the development of predictive models for delirium outcomes. Based on aggregated survey responses to each research question or domain, the combined modal ratings of "very'' or "extremely'' important confirmed their priority.Conclusion. Using an analytical framework to represent the full clinical care pathway of delirium in palliative care settings, we identified multiple knowledge gaps in relation to the occurrence rates, assessment, management, and outcome prediction of delirium in this population. The knowledge synthesis generated from adequately powered, multicenter studies to answer the framework's research questions will inform decision making and policy development regarding delirium detection and management and thus help to achieve better outcomes for patients in palliative care settings. (C) 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.PUBLISHEDpeer-reviewe

The Troubled History of Philosophy and Deliberative Democracy

Philosophy has not enjoyed a prominent place in current education movements aimed at strengthening civic engagement and promoting deliberative democracy. This paper provides a brief overview of the history of democracy and philosophy that demonstrates their long but troubled relationship. We argue that the history of Western philosophy provides a much overlooked foundational role in deliberative democracy that must be understood if we are to educate citizens. Furthermore, we argue that philosophy’s central contribution to the contemporary understanding and practice of deliberative democracy is its fostering of the critique of assumptions. We conclude the article with specific pedagogic recommendations that can bring philosophy and deliberative democracy to life for our students both in and beyond the classroom

Behind Bars or Up on a Pedestal: Motherhood and Fetal Harm

[Book abstract] This diverse collection explores the rhetoric of a wide range of public policies that propose to put women and children first, including homeland security, school violence, gun control, medical intervention of intersex infants, and policies that aim to distinguish good from bad mothers. Using various feminist philosophical analyses, the contributors uncover a logic of paternalistic treatment of women and children that purports to protect them but almost always also disempowers them and sometimes harms them. This logic is widespread in contemporary popular policy discourse and affects the way that people understand and respond to social and political issues. Contributors rethink basic philosophical assumptions concerning subjectivity, difference, and dualistic logic in order to read the rhetoric of contemporary public policy discourse and develop new ways of talking and acting in the policy domain

Delirium and depression: inter-relationship and overlap in elderly people

Delirium and depression are complex neuropsychiatric syndromes that are common in the elderly and associated with a variety of poor healthcare outcomes. Accurate detection is key to providing optimal care for these conditions but is complicated by their considerable clinical overlap. This includes shared symptom profiles as well as comorbidity. Careful assessment of symptom character as well as the context and course of disturbances can allow for more accurate diagnosis. Prior depressive illness is a common finding in patients with delirium, while depressive illness is a recognised sequel of delirium. Evidence points to similar pathophysiological mechanisms involving disturbances in stress and inflammatory responses, monoaminergic and melatonergic functions, that in turn point to avenues for therapeutic intervention. Development of better tools for systematic assessment for delirium and depression in populations at high risk by virtue of age, diminished cognitive reserve and frailty is a key target to achieve improved healthcare outcomes

Using the health hardware method to measure poverty in Indigenous Australia

Qld, Australi