This is a repository copy of Interventions for preventing deliriumin hospitalised non-ICU patients.

SummaryBackgroundStaphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection.MethodsIn this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants.FindingsBetween Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18–45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference −1·4%, 95% CI −7·0 to 4·3; hazard ratio 0·96, 0·68–1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3–4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005).InterpretationAdjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia.FundingUK National Institute for Health Research Health Technology Assessment.

As stroke care has developed, there has been a need to robustly assess the efficacy of interventions both at the level of the individual stroke survivor and in the context of clinical trials. To describe stroke-survivor recovery meaningfully, more sophisticated measures are required than simple dichotomous end points, such as mortality or stroke recurrence. As stroke is an exemplar disabling long-term condition, measures of function are well suited as outcome assessment. In this review, we will describe functional assessment scales in stroke, concentrating on three of the more commonly used tools: the National Institutes of Health Stroke Scale, the modified Rankin Scale, and the Barthel Index. We will discuss the strengths, limitations, and application of these scales and use the scales to highlight important properties that are relevant to all assessment tools. We will frame much of this discussion in the context of “clinimetric” analysis. As they are increasingly used to inform stroke-survivor assessments, we will also discuss some of the commonly used quality-of-life measures. A recurring theme when considering functional assessment is that no tool suits all situations. Clinicians and researchers should chose their assessment tool based on the question of interest and the evidence base around clinimetric properties.

BackgroundIn a research study, to give a comprehensive evaluation of the impact of interventions, the outcome measures should reflect the lived experience of the condition. In dementia studies, this necessitates the use of outcome measures which capture the range of disease effects, not limited to cognitive functioning. In particular, assessing the functional impact of cognitive impairment is recommended by regulatory authorities, but there is no consensus on the optimal approach for outcome assessment in dementia research. Our aim was to describe the outcome measures used in dementia and mild cognitive impairment (MCI) intervention studies, with particular interest in those evaluating patient-centred outcomes of functional performance and quality of life.MethodsWe performed a focused review of the literature with multiple embedded checks of internal and external validity. We used the Cochrane Dementia and Cognitive Improvement Group’s register of dementia studies, ALOIS. ALOIS was searched to obtain records of all registered dementia and MCI intervention studies over a 10-year period (2004–2014). We included both published and unpublished materials. Outcomes were categorised as cognitive, functional, quality of life, mood, behaviour, global/disease severity and institutionalisation.ResultsFrom an initial return of 3271 records, we included a total of 805 records, including 676 dementia trial records and 129 MCI trial records. Of these, 78 % (630) originated from peer-reviewed publications and 60 % (487) reported results of pharmacological interventions. Cognitive outcomes were reported in 70 % (563), in contrast with 29 % (237) reporting measures of functional performance and only 13 % (102) reporting quality of life measures. We identified significant heterogeneity in the tools used to capture these outcomes, with frequent use of non-standardised tests.ConclusionsThis focus on cognitive performance questions the extent to which intervention studies for dementia are evaluating outcome measures which are relevant to individual patients and their carers. The heterogeneity in measures, use of bespoke tools and poor descriptions of test strategy all support the need for a more standardised approach to the conduct and reporting of outcomes assessments.Electronic supplementary materialThe online version of this article (doi:10.1186/s13195-016-0216-8) contains supplementary material, which is available to authorized users.

The IQCODE can be used to identify older adults in the general hospital setting who are at risk of dementia and require specialist assessment; it is useful specifically for ruling out those without evidence of cognitive decline. The language of administration did not affect test accuracy, which supports the cross-cultural use of the tool. These findings are qualified by the significant heterogeneity, the potential for bias and suboptimal reporting found in the included studies.

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The authors draw on the work of Maudsley and Scrivens (2000) to explore the elusive but crucial concept of critical thinking in terms of the extent to which it is reflective practice that joins discussion of critical thinking with experiential learning'. We present some of our evidence base derived from a sequences of formal professional review meetings between induction tutors (mentors) and their newly qualified teachers (NQT) (mentees). We describe the frameworks used for analyses for examination of critical questioning by mentors and the resulting articulation of practice by mentees, and for locating any shifts in the mentoring styles adopted by the mentors in the course of the year of study. We show that the adoption of particular reflective practice strategies, and/or associated interventions, are clearly linked to changes in ways of working by both mentor and mentee and which illustrate, in several instances to an increase in professional independence on the part of the NQT. Finally we present some emerging issues for a range of stakeholders including those involved in mentor training, school managers and policy makers, and the mentors themselves.

Background and Purpose-International guidelines recommend cognitive and mood assessments for stroke survivors; these assessments also have use in clinical trials. However, there is no consensus on the optimal assessment tool(s). We aimed to describe use of cognitive and mood measures in contemporary published stroke trials. Methods-Two independent, blinded assessors reviewed high-impact journals representing: general medicine (nϭ4), gerontology/rehabilitation (nϭ3), neurology (nϭ4), psychiatry (nϭ4), psychology (nϭ4), and stroke (nϭ3) January 2000 to October 2011 inclusive. Journals were hand-searched for relevant, original research articles that described cognitive/mood assessments in human stroke survivors. Data were checked for relevance by an independent clinician and clinical psychologist. Results-Across 8826 stroke studies, 488 (6%) included a cognitive or mood measure. Of these 488 articles, total number with cognitive assessment was 408 (83%) and mood assessment tools 247 (51%). Total number of different assessments used was 367 (cognitive, 300; mood, 67). The most commonly used cognitive measure was Folstein's Mini-Mental State Examination (nϭ180 articles, 37% of all articles with cognitive/mood outcomes); the most commonly used mood assessment was the Hamilton Rating Scale of Depression(nϭ43 [9%]). Conclusions-Cognitive and mood assessments are infrequently used in stroke research. When used, there is substantial heterogeneity and certain prevalent assessment tools may not be suited to stroke cohorts. Research and guidance on the optimal cognitive/mood assessment strategies for clinical practice and trials is required. (Stroke. 2012;43:1678-1680.)