Pain in severe dementia: A comparison of a fine-grained assessment approach to an observational checklist designed for clinical settings.

BACKGROUND: Fine-grained observational approaches to pain assessment (e.g. the Facial Action Coding System; FACS) are used to evaluate pain in individuals with and without dementia. These approaches are difficult to utilize in clinical settings as they require specialized training and equipment. Easy-to-use observational approaches (e.g. the Pain Assessment Checklist for Limited Ability to Communicate-II; PACSLAC-II) have been developed for clinical settings. Our goal was to compare a FACS-based fine-grained system to the PACSLAC-II in differentiating painful from non-painful states in older adults with and without dementia. METHOD: We video-recorded older long-term care residents with dementia and older adult outpatients without dementia, during a quiet baseline condition and while they took part in a physiotherapy examination designed to identify painful areas. Videos were coded using pain-related behaviours from the FACS and the PACSLAC-II. RESULTS: Both tools differentiated between painful and non-painful states, but the PACSLAC-II accounted for more variance than the FACS-based approach. Participants with dementia scored higher on the PACSLAC-II than participants without dementia. CONCLUSION: The results suggest that easy-to-use observational approaches for clinical settings are valid and that there may not be any clinically important advantages to using more resource-intensive coding approaches based on FACS. We acknowledge, as a limitation of our study, that we used as baseline a quiet condition that did not involve significant patient movement. In contrast, our pain condition involved systematic patient movement. Future research should be aimed at replicating our results using a baseline condition that involves non-painful movements. SIGNIFICANCE: Examining older adults with and without dementia, a brief observational clinical approach was found to be valid and accounted for more variance in differentiating pain-related and non-pain-related states than did a detailed time-consuming fine-grained approach.

2-Azetidinone cholesterol absorption inhibitors: structure-activity relationships on the heterocyclic nucleus.

A series of azetidinone cholesterol absorption inhibitors related to SCH 48461 ((-)-6) has been prepared, and compounds were evaluated for their ability to inhibit hepatic cholesteryl ester formation in a cholesterol-fed hamster model. Although originally designed as acyl CoA: cholesterol acyltransferase (ACAT) inhibitors, comparison of in vivo potency with in vitro activity in a microsomal ACAT assay indicates no correlation between activity in these two models. The molecular mechanism by which these compounds inhibit cholesterol absorption is unknown. Despite this limitation, examination of the in vivo activity of a range of compounds has revealed clear structure-activity relationships consistent with a well-defined molecular target. The details of these structure-activity relationships and their implications on the nature of the putative pharmacophore are discussed.

Effects of hyperbaric oxygen upon S. aureus, Ps. aeruginosa and C. albicans.

Numerous in vitro investigations have reported that prolonged, continuous hyperbaric oxygen (OHP) exposure to certain bacteria and yeast is bacteriostatic. While it is tempting to attribute the lower infection rates reported in OHP-treated patients to this bacteriostatic effect, the duration and intensity of OHP exposure in these experimental studies exceeds that of normal therapeutic use. This study was designed to investigate the effects of human OHP treatment protocols upon the in vitro growth and survival of Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans. Additional studies using antibiotic-containing culture media were conducted to investigate the possible OHP enhancement of antibiotic sensitivity. No differences were observed between the bacterial and yeast growth curves of the control and experimental group. OHP also failed to produce any measurable difference in the bactericidal effectiveness of the selected antibiotics.