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Background and objectives: delirium is a distressing but potentially preventable condition common in older people in long-term care. It is associated with increased morbidity, mortality, functional decline, hospitalization and significant healthcare costs. Multicomponent interventions, addressing delirium risk factors, have been shown to reduce delirium by one-third in hospitals. It is not known whether this approach is also effective in long-term care. In previous work, we designed a bespoke delirium prevention intervention, called 'Stop Delirium!' In preparation for a definitive trial of Stop Delirium, we sought to address key aspects of trial design for the particular circumstances of care homes. Design: a cluster randomized feasibility study with an embedded process evaluation. Setting and participants: residents of 14 care homes for older people in one metropolitan district in the UK. Intervention: Stop Delirium!: a 16-month-enhanced educational package to support care home staff to address key delirium risk factors. Control homes received usual care. Measurements: we collected data to determine the following: recruitment and attrition; delirium rates and variability between homes; feasibility of measuring delirium, resource use, quality of life, hospital admissions and falls; and intervention implementation and adherence. Results: two-thirds (215) of eligible care home residents were recruited. One-month delirium prevalence was 4.0% in intervention and 7.1% in control homes. Proposed outcome measurements were feasible, although our approach appeared to underestimate delirium. Health economic evaluation was feasible using routinely collected data. Conclusion: a definitive trial of delirium prevention in long-term care is needed but will require some further design modifications and pilot work. [ABSTRACT FROM AUTHOR]

The authors explore the Foucauldian concept of self-surveillance in the context of the use of Individual Action Planning (IAP) as a central process of a 1-year teacher training course. Drawing on work that examined whether IAP was experienced by student-teachers as empowerment or control, the article postulates that Action Planning can be seen as a central technique of a system of self-surveillance. The effect of IAPs in creating self-surveillance is investigated empirically, utilizing an original and non-Foucaldian pre-post questionnaire technique, in order to attract the widest possible audience to the idea of self-surveillance as a key process of governance in advanced liberal societies. The findings support the idea that self-surveillance is one of the outcomes of the IAP process, but also finds Foucauldian 'resistances' among the cohort investigated. [ABSTRACT FROM AUTHOR]