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 influence of marbling and maturity on beef tenderness

The beef carcass quality grading system currently used has been challenged by many who say current standards are too high and that the amount of marbling to attain a given grade should be decreased

The Tenderometer as a tool for evaluating beef tenderness

Numerous instruments have been developed to objectively measure tenderness, an important eating characteristics of beef. The Kramer shear press and Warner-Bratzler shear show the best relationships to taste panel tenderness scores. However, shear values of raw muscle are poorly correlated with shear value of cooked meat. An instrument that could be used in the beef cooler an raw carcass muscle to predict tenderness of cooked meat would be valuable

Kansas meat marketing innovations

The U.S. system of producing, marketing, and distributing farm products has been heralded as the world’s most efficient, with lower distribution costs than any other nation. Research continues to improve marketing through new methods and technology. Central cryogenic-frozen meat packaging is an example

Changes in beef carcass composition with changes in animal weight and finish

Information on animal growth and development, although complex and not fully understood, is necessary to determine the stage at which a beef animal will produce the most desirable carcass. True growth involves an increase in the structural tissues (muscle, bone and organs) and should be distinguished from increases by fat deposition. Optimum time to slaughter animals is when muscle growth and quality are at their most desirable combination

Influence of breeding and length of feeding period on carcass characteristics and palatability of beef

Carcass measurement, muscle quality, and palatability data have been collected on 88 paternal half-sib Angus steers. At weaning they were subdivided into one of the 11 nutritional and management regimes shown in Table 58. Phase I involved feeding from 0 to 224 days after weaning. Phase II was essentially deferred feeding. The intermittent slaughter of animals from both phases made possible the study of muscle and fat tissue development within as well as between phases. Quantity and quality of muscle are the two factors that determine true beef carcass value

A biopsy technique to predict quality in the live beef animal with emphasis on tenderness

Because tenderness is considered the most desired eating characteristic in meat, more emphasis should be placed on this trait in evaluating beef quality in breeding and selection programs. Both tenderness and marbling are highly heritable traits (Heritability = approximately 0.6), therefore much improvement could be made through progeny testing of sires; however, this requires considerable time and expense. This consideration, plus an increasing interest in feeding young beef bulls for market, led to an interest in applying a biopsy technique to evaluate and predict meat quality in the live animal

Performance and carcass characteristics of different cattles types—A preliminary report

This report contains results from the U.S. Meat Animal Research Center Cattle Germ Plasm Evaluation Program. Dr. Keith Gregory and Dr. Hudson Glimp, U.S. Meat Animal Research Center, Clay Center, Nebraska, initiated and designed the cattle germ plasm evaluation program. Dr. Dan Laster and Dr. John Crouse are currently working on the project from the Research Center. Kansas State University and the Livestock Division, C&MS, U.S.D.A. are cooperating on the project

Performance and carcass characteristics of different cattle types—A preliminary report

This report contains results from the U.S. Meat Animal Research Center Cattle Germ Plasm Evaluation Program. Dr. Keith Gregory and Dr. Hudson Glimp, U.S. Meat Animal Research Center, Clay Center, Nebraska, initiated and designed the cattle germ plasm evaluation program. Kansas State University and the Livestock Division, C&MS, U.S.D.A. are cooperating on the project