scholarly journals Neuroimaging for Disorders of Consciousness: Ethical Priorities in Research, Policy, and Translation

2015 ◽  
Vol 42 (S1) ◽  
pp. S18-S18
Author(s):  
AC Byram ◽  
G Lee ◽  
AM Owen ◽  
U Ribrary ◽  
J Stoessl ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Research Policy ◽  
Clinical Care ◽  
Health Resources ◽  
Disorders Of Consciousness ◽  
Term Care ◽  
Legal Competence ◽  
Neuroimaging Techniques ◽  
Research And Policy

Background: Acquired brain injury is a critical health problem in Canada, placing greater demands on health resources as improvements in intensive care lead to more patients in long-term care. Clinical diagnosis of patients with disorders of consciousness remains difficult, but advances in neuroimaging research have the potential to reshape clinical management of such patients or provide unprecedented ways to communicate with them. Building on our earlier work, this study identifies ethically salient priorities for research and policy before translation of this promising technology. Methods: We interviewed 27 Canadian researchers, ethicists, lawyers, practitioners, allied health care professionals, and patient advocacy leaders, with expertise in neuroimaging or disorders of consciousness. Interviews were semi-structured and data were analyzed for emergent themes. Results: Participants were optimistic that neuroimaging could lead to improved clinical care. They discussed mitigating the risks of misinterpreting results and communication, creating guidelines for clinical use, and defining legal competence in this neuroimaging context as key ethical priorities for translation. Conclusions: The transition of neuroimaging techniques for disorders of consciousness from research to clinical care may yield substantial benefits to these patients, but first requires resolution of research, policy, and translational issues.

scholarly journals #MoreThanAVisitor: Families as “Essential” Care Partners During COVID-19

2020 ◽  
Author(s):  
Candace L Kemp
Keyword(s):  
Family Involvement ◽  
Long Term Care ◽  
Research Policy ◽  
Well Being ◽  
Direct Care ◽  
Negative Consequences ◽  
Public Health Response ◽  
Term Care ◽  
Care Partners

Abstract The public health response to the current Coronavirus pandemic in long-term care communities, including assisted living, encompasses prohibiting visitors. This ban, which includes family members, has been criticized for being unfair, unhealthy, and unsafe. Against this backdrop, I examine the roles family play in residents’ daily lives and care routines. I argue that classifying family as “visitors” rather than essential care partners overlooks their critical contributions and stems from taken-for-granted assumption about gender, families, and care work, and I demonstrate why families are more than visitors. Policies that ban family visits also reflect a narrow understanding of health that focuses on mitigating infection risk, but neglects overall health and well-being. This policy further stems from a limited comprehension of care relations. Research shows that banning family visits has negative consequences for residents, but also families themselves, and direct care workers. I argue that identifying ways to better understand and support family involvement is essential and demonstrate the utility of the Convoys of Care model for guiding the reconceptualization of family in long-term care research, policy, and practice during and beyond the pandemic.

Drugs Used in Neurorehabilitation

2018 ◽  
Author(s):  
Eelco F. M. Wijdicks ◽  
Sarah L. Clark
Keyword(s):  
Intensive Care Unit ◽  
Spinal Cord ◽  
Long Term Care ◽  
Disorders Of Consciousness ◽  
Term Care ◽  
Rehabilitation Programs ◽  
Dopaminergic Agents ◽  
Cord Injury ◽  
Specialized Care

Neurologic rehabilitation arguably starts in the neurosciences intensive care unit. Specialized care is often needed in acute spinal cord injury, particularly if long-term care appears imminent. Much of neurorehabilitation is done without pharmaceuticals, but good options are available in patients with persistent disorders of consciousness, spasticity, and early depression after stroke. Disorders of consciousness are major concerns in neurorehabilitation centers because they obviate traditional rehabilitation programs. Improvement can be achieved with a neurostimulant which would improve attention span to therapy This chapter discusses dopaminergic agents and other neurostimulants for disorders of consciousness and long-term drugs for spasticity to improve outcomes.

scholarly journals Functional Networks in Disorders of Consciousness

2017 ◽  
Vol 37 (05) ◽  
pp. 485-502 ◽  
Author(s):  
Camille Chatelle ◽  
Brian Edlow ◽  
Yelena Bodien
Keyword(s):  
Effective Connectivity ◽  
Clinical Care ◽  
Network Connectivity ◽  
Disorders Of Consciousness ◽  
Functional Network ◽  
Functional Networks ◽  
Positron Emission ◽  
Essential Components ◽  
Network Mapping

AbstractSevere brain injury may cause disruption of neural networks that sustain arousal and awareness, the two essential components of consciousness. Despite the potentially devastating immediate and long-term consequences, disorders of consciousness (DoC) are poorly understood in terms of their underlying neurobiology, the relationship between pathophysiology and recovery, and the predictors of treatment efficacy. Recent advances in neuroimaging techniques have enabled the study of network connectivity, providing great potential to improve the clinical care of patients with DoC. Initial discoveries in this field were made using positron emission tomography (PET). More recently, functional magnetic resonance (fMRI) techniques have added to our understanding of functional network dynamics in this population. Both methods have shown that whether at rest or performing a goal-oriented task, functional networks essential for processing intrinsic thoughts and extrinsic stimuli are disrupted in patients with DoC compared with healthy subjects. Atypical connectivity has been well established in the default mode network as well as in other cortical and subcortical networks that may be required for consciousness. Moreover, the degree of altered connectivity may be related to the severity of impaired consciousness, and recovery of consciousness has been shown to be associated with restoration of connectivity. In this review, we discuss PET and fMRI studies of functional and effective connectivity in patients with DoC and suggest how this field can move toward clinical application of functional network mapping in the future.

scholarly journals Antipsychotic Use in Dementia

2016 ◽  
Vol 62 (3) ◽  
pp. 170-181 ◽  
Author(s):  
Julia Kirkham ◽  
Chelsea Sherman ◽  
Clive Velkers ◽  
Colleen Maxwell ◽  
Sudeep Gill ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Clinical Care ◽  
Neuropsychiatric Symptoms ◽  
Mental Illnesses ◽  
Educational Outreach ◽  
Term Care ◽  
Inappropriate Use ◽  
Regulatory Changes ◽  
Current Controversy

Antipsychotics are necessary for many older adults to treat major mental illnesses or reduce distressing psychiatric symptoms. Current controversy exists over the role of antipsychotics in the management of neuropsychiatric symptoms (NPS) in persons with dementia. Although some NPS may be appropriately and safely treated with antipsychotics, a fine balance must be achieved between the benefits of these medications, which are often modest, and adverse events, which may have significant consequences. Approximately one-third of all persons with dementia are currently prescribed antipsychotic medications, and there is significant variation in the use of antipsychotics across care settings and providers. Reducing the inappropriate or unnecessary use of antipsychotics among persons with dementia has been the focus of increasing attention owing to better awareness of the potential problems associated with these medications. Several approaches can be used to curb the use of antipsychotics among persons with dementia, including policy or regulatory changes, public reporting, and educational outreach. Recently, there has been encouraging evidence of a downward trend in the use of antipsychotics in many long-term care settings, although prescribing rates are still higher than what is likely optimal. Although reducing the inappropriate use of antipsychotics is a complex task, psychiatrists can play an important role via the provision of clinical care and research evidence, contributing to improved care of persons with dementia in Canada and elsewhere.

scholarly journals Partnering to develop resilience in health professionals and faculty through mindfulness-based education

2018 ◽  
Vol 5 (1) ◽  
Author(s):  
Andrea Nadine Frolic ◽  
Elaine Principi ◽  
Alan Taniguichi ◽  
Ken Burgess ◽  
Valerie Spironello ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Role Models ◽  
Clinical Care ◽  
Family Health ◽  
Health Sciences ◽  
Term Care ◽  
Health Team ◽  
Ability To Act ◽  
Family Health Team

Given the pressures that exist in our health care system, health care professionals often are under significant stress to provide both quality clinical care to patients and quality teaching to their learners. We present an innovative program to develop faculty and health professional  skills in reflective practice and resilience, which strengthen participants' ability to act as effective clinicians, educators, role models, and leaders. The basis of the curriculum  rests in the neuroscience of mindfulness  and its applications. This program was enabled through a unique partnership between acute care hospitals (Hamilton Health Sciences and St Joseph's Healthcare Hamilton), Family Health Teams (McMaster Family Health Team and Hamilton Family Health Team) and the McMaster Faculty of Health Sciences Program for Faculty Development (PFD), with additional funding support in 2013 from the Ontario Ministry of Health and Long Term Care (MOH-LTC). Data from 2013 course participants (validated measurement  tools and qualitative feedback) was analyzed to evaluate the effectiveness of this initiative. This poster outlines the journey of this work and a summary of the data gathered to inform further education. 

scholarly journals Resting-State Electroencephalography for Prognosis in Disorders of Consciousness Following Traumatic Brain Injury

2020 ◽  
Vol 11 ◽  
Author(s):  
Ruth Pauli ◽  
Alice O'Donnell ◽  
Damian Cruse
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Resting State ◽  
Disorders Of Consciousness ◽  
Alpha Power ◽  
Disorder Of Consciousness ◽  
Term Care ◽  
Prognostic Utility ◽  
Eeg Recordings

Although the majority of patients recover consciousness after a traumatic brain injury (TBI), a minority develop a prolonged disorder of consciousness, which may never fully resolve. For these patients, accurate prognostication is essential to treatment decisions and long-term care planning. In this review, we evaluate the use of resting-state electroencephalography (EEG) as a prognostic measure in disorders of consciousness following TBI. We highlight that routine clinical EEG recordings have prognostic utility in the short to medium term. In particular, measures of alpha power and variability are indicative of relatively better functional outcomes within the first year post-TBI. This is hypothesized to reflect intact thalamocortical loops, and thus the potential for recovery of consciousness even in the apparent absence of current consciousness. However, there is a lack of research into the use of resting-state EEG for predicting longer-term recovery following TBI. We conclude that, given the potential for patients to demonstrate improvements in consciousness and functional capacity even years after TBI, a research focus on EEG-augmented prognostication in very long-term disorders of consciousness is now required.

The Ethics in Long-Term Care Model: Everyday Ethics and the Unseen Moral Landscape of Assisted Living

2021 ◽  
pp. 073346482110498
Author(s):  
Candace L. Kemp ◽  
Jason Lesandrini ◽  
Jennifer Craft Morgan ◽  
Elisabeth O. Burgess
Keyword(s):  
Decision Making ◽  
Assisted Living ◽  
Long Term Care ◽  
Ethical Issues ◽  
Research Policy ◽  
Term Care ◽  
Case Examples ◽  
Care Partners ◽  
Moral Landscape

Assisted living (AL) communities are long-term care settings where people live, work, and visit, and where social relationships and care, including end-of-life care, are negotiated. Assisted living is fraught with uncertainty and conflict about values, especially given residents’ cognitive and physical frailty. These value-laden issues have implications for both resident and care partners’ experiences. Yet, almost no research has examined ethics in this complex care environment. In this article, we draw on and synthesize existing theory, research, and practice knowledge to offer a conceptual model and discuss case examples that highlight everyday ethical issues in AL. We conceptualize the moral decision-making process and hence the moral landscape of AL, as influenced by a myriad of multi-level factors that shape interpersonal encounters and decision-making involving residents and their care partners, which ultimately shape individuals’ actions and experiences in the setting. We conclude by discussing implications for research, policy, and practice.

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