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Improving comfort in people with dementia and pneumonia: a cluster randomized trial

Overview of attention for article published in BMC Medicine, August 2016
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Title
Improving comfort in people with dementia and pneumonia: a cluster randomized trial
Published in
BMC Medicine, August 2016
DOI 10.1186/s12916-016-0663-x
Pubmed ID
Authors

Tessa van der Maaden, Henrica C. W. de Vet, Wilco P. Achterberg, Froukje Boersma, Jos M. G. A. Schols, David R. Mehr, Francisca Galindo-Garre, Cees M. P. M. Hertogh, Raymond T. C. M. Koopmans, Jenny T. van der Steen

Abstract

Pneumonia in people with dementia has been associated with severe discomfort. We sought to assess the effectiveness of a practice guideline for optimal symptom relief for nursing home residents with dementia and pneumonia. A single-blind, multicenter, cluster randomized controlled trial was conducted in 32 Dutch nursing homes. Outcomes were assessed on the patient level. The main outcome measures were discomfort and symptoms: discomfort (DS-DAT: Discomfort Scale-Dementia of Alzheimer Type), (lack of) comfort (EOLD-CAD: End Of Life in Dementia-Comfort Assessment in Dying), pain (PAINAD: Pain Assessment in Advanced Dementia), and respiratory distress (RDOS: Respiratory Distress Observation Scale). Outcomes were scheduled daily from diagnosis until 10 days later and a final time between 13-15 days from diagnosis by trained observers who were blinded to the intervention and the residents' condition and treatment. In a pre-intervention phase, usual care was provided to all homes. In the intervention phase, matched clusters of homes were randomized to either the control (n = 16) or intervention condition (n = 16). Between 1 January 2012 and 1 May 2015, 464 episodes of pneumonia were included. Outcomes were obtained for 399 episodes in 367 residents. Longitudinal multilevel linear regression analyses were performed on log-transformed outcomes, so coefficients should be interpreted as a ratio, and a coefficient of 1 means no difference. The practice guideline in the intervention phase did not reduce the level of discomfort and symptoms: DS-DAT: 1.11 (95 % CI 0.93-1.31), EOLD-CAD: 1.01 (95 % CI 0.98-1.05), PAINAD: 1.04 (95 % CI 0.93-1.15), RDOS: 1.11 (95 % CI 0.90-1.24). However, in both the intervention and control groups, lack of comfort and respiratory distress gradually decreased during the entire 3.5 years of data collection, and were lower in the intervention phase compared to the pre-intervention phase: DS-DAT: 0.93 (95 % CI 0.85-1.01), EOLD-CAD: 0.98 (95 % CI 0.97-1.00), PAINAD: 0.96 (95 % CI 0.91-1.01), RDOS: 0.92 (95 % CI 0.87-0.98). When compared to usual care, the practice guideline for optimal symptom relief did not relieve discomfort and symptoms in nursing home residents with dementia and pneumonia. However, discomfort and symptoms decreased gradually throughout the data collection in both the intervention homes and the control homes. An intervention that focuses on creating awareness may be more effective than a physician practice guideline. The Netherlands National Trial Register (ID number NTR5071 . Registered 10 March 2015).

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The data shown below were collected from the profiles of 3 X users who shared this research output. Click here to find out more about how the information was compiled.
Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 121 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 121 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 20 17%
Student > Bachelor 12 10%
Other 10 8%
Researcher 10 8%
Student > Doctoral Student 8 7%
Other 26 21%
Unknown 35 29%
Readers by discipline Count As %
Medicine and Dentistry 28 23%
Nursing and Health Professions 23 19%
Social Sciences 7 6%
Psychology 5 4%
Neuroscience 3 2%
Other 15 12%
Unknown 40 33%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 12 August 2016.
All research outputs
#18,078,017
of 23,230,825 outputs
Outputs from BMC Medicine
#3,187
of 3,499 outputs
Outputs of similar age
#260,493
of 357,168 outputs
Outputs of similar age from BMC Medicine
#40
of 42 outputs
Altmetric has tracked 23,230,825 research outputs across all sources so far. This one is in the 19th percentile – i.e., 19% of other outputs scored the same or lower than it.
So far Altmetric has tracked 3,499 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 43.7. This one is in the 6th percentile – i.e., 6% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 357,168 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 22nd percentile – i.e., 22% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 42 others from the same source and published within six weeks on either side of this one. This one is in the 4th percentile – i.e., 4% of its contemporaries scored the same or lower than it.