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Table 1 Contents of the practice guideline

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

The intervention
A consensus- and literature-based practice guideline for optimal symptom relief for residents with pneumonia and dementia
Practice guideline components:
 1. Checklist of symptoms
 2. Observational instruments to monitor symptoms*
 3. Tailored treatment recommendations
 4. Poster displaying key points and action plan
*Respiratory distress RDOS: Respiratory Distress Observation Scale
*Pain PAINAD: Pain Assessment in Advanced Dementia
  PACSLAC: Pain Assessment Checklist for Seniors with Limited Ability to Communicate
  REPOS: Rotterdam Elderly Pain Observation Scale
Action plan:
 A. Suspected pneumonia in resident with pneumonia and dementia
 B. Right away: complete checklist
 C. Optional: use the RDOS to asses respiratory distress
 D. Optional: observe pain using one of three instruments
 E. Consult relevant treatment recommendations
 F. Re-use the checklist on days 1, 2, and 3 and 7 days after pneumonia diagnosis
 G. Repeat steps at a later time and monitor symptoms using the checklist and observational instruments
Key points:
 - Treatment advice is grouped into supportive care and (non)pharmacological treatments
 - The practice guideline is suitable for all treatment goals, including cure or palliation
 - The practice guideline is intended as a decision aid; the physician is of course free to deviate from it if there are good clinical reasons
 - Administering a low dose of opioids can provide relief of the overall condition of the resident, regardless of the treatment goal
The practice guideline was expected to enhance comfort by:
 - Enhancing awareness with regard to discomfort
 - Providing a more structured treatment approach
 - Ensuring regular observations to monitor symptoms