TP6.2.13 A PEG insertion pathway for Motor Neurone Disease patients improves efficiency and patient outcomes

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Benjamin Rossi ◽  
Rola Salem ◽  
Stuart Andrews ◽  
Kirk Bowling
Keyword(s):  
Length Of Stay ◽  
Patient Outcomes ◽  
Motor Neurone ◽  
Motor Neurone Disease ◽  
Admission Rates ◽  
Palliative Procedure ◽  
Endoscopic Gastrostomy ◽  
Chi Squared ◽  
Swallowing Difficulties ◽  
Anaesthetic Assessment

Abstract Aims Patients with Motor Neurone Disease (MND) often require a Percutaneous Endoscopic Gastrostomy (PEG) as a palliative procedure during the later stages of their illness, due to swallowing difficulties. More recently these are being inserted earlier before the inevitable decrease in nutritional intake and subsequent fall in albumin levels. This allows patients to eat food they enjoy rather than concentrating on maintaining intake. Insertion has traditionally been done with local anaesthetic and OGD, which can be difficult and traumatic. We propose a method of insertion using TIVA (Totally Intravenous Anaesthetic) in theatre with no intubation, performed by the surgical team, with a pathway including pre-operative anaesthetic assessment. Methods Data was collected from all PEG insertions performed in theatre from 1/1/2011 to 1/9/2019. MND patients following our pathway were compared to all other indications for PEG insertions. Length of stay (LOS), 30-day re-admission rates, 30-day, 90-day and 1-year mortality were analysed. Results 98 patients were identified. Median LOS was 3 days (mean 12.2) with a 3% 30-day mortality, 12.2% 90-day mortality and 34.7% 1-year mortality. In the MND group there were 27 patients. Median LOS was 2 days (mean 8.6) with a 7.4% (2 patients) 30-day mortality, which remained 7.4% at 90 days. There were 13 re-admissions (13.3%) overall compared to 0% in the MND group (p = 0.04 (Chi-squared test)). Conclusions PEG insertion under TIVA for MND patients is safe. A set pathway for admission and pre/post-insertion care increases efficiency with reduced length of stay and improves patient outcomes with no re-admissions.

Reducing length of stay for patients with Motor Neurone Disease admitted to a Specialist Ventilation Unit

2019 ◽  
Author(s):  
Emma Flowers ◽  
Louise Hesketh ◽  
David Gavin ◽  
Saba Bokhari ◽  
John Ealing ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Motor Neurone ◽  
Motor Neurone Disease

Breaking bad news in amyotrophic lateral sclerosis

1993 ◽  
Vol 7 (4_suppl) ◽  
pp. 37-40 ◽  
Author(s):  
V. Meininger
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Motor Neurone ◽  
Bad News ◽  
Motor Neurone Disease ◽  
Breaking Bad News ◽  
Open Communication ◽  
Breaking Bad ◽  
Alternative Approach ◽  
Swallowing Difficulties ◽  
Lateral Sclerosis

There are many difficulties of communication with patients with amyotrophic lateral sclerosis (motor neurone disease). In France, most physicians have a policy of keeping the fact of this diagnosis from both patients and relatives. This paper describes an alternative approach based on open communication, and applies that principle to handling issues of communication associated with various aspects of four different topics: the diagnosis itself, the development of handicap, swallowing difficulties, and respiratory difficulties.

scholarly journals 978 Acute Appendicitis in The Age of COVID-19 – How Changing Standards Affect Patient Outcomes

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
G Karagiannidis ◽  
Omar Toma
Keyword(s):  
Length Of Stay ◽  
Acute Appendicitis ◽  
Patient Outcomes ◽  
Time Frame ◽  
Operative Intervention ◽  
Primary Study ◽  
Routine Practice ◽  
Admission Rates ◽  
Retrospective Data Collection ◽  
The Mean

Abstract Introduction The COVID-19 -19 pandemic has forced changes in the management of Acute Appendicitis (AA), such as prioritising conservative management and avoiding laparoscopic procedures. We aim to assess how these changes affected patient outcomes in comparison to routine practice during the same time frame in 2019. The primary study outcomes are operative intervention, length of stay and hospital re-admission within 30 days. Method Retrospective data collection for all patients admitted to Ipswich Hospital with suspicion of AA since lockdown came into effect in England on March 23 up to May 10th, 2020 and the same time frame in 2019. Results 23 patients were admitted during the lockdown period. 39%(N = 9) were treated conservatively.14 (61%) operatively, of which 71% (N = 10) had open appendicectomy while 29% (N = 4) underwent laparoscopic appendicectomies. The mean Length of Stay(LOS) was 3.83 days. In 2019,21 patients were admitted. 33%(N = 7) were treated conservatively. All appendicectomies were laparoscopic. Mean LOS was 2 days. Re-admission rates were similar in both groups. Conclusions Due to Covid19 a majority of patients requiring surgery underwent open appendicectomies. We noted a significant increase in both length of stay and progression from non-operative to operative intervention rates compared to 2019. The general case load was similar.

scholarly journals Overview and audit against Motor Neurone Disease (MND) Association guidelines of a MND consultant’s practice over the last 3 years at the [Hospital]

Res Medica ◽  
2017 ◽  
Vol 24 (1) ◽  
pp. 65-74 ◽  
Author(s):  
Dominic Adam Worku ◽  
Unnat Krishna ◽  
Karen E Morrison
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Primary Care Physicians ◽  
Diagnostic Delay ◽  
Motor Neurone ◽  
Motor Neurone Disease ◽  
Life Care ◽  
Endoscopic Gastrostomy ◽  
Bulbar Onset ◽  
Prompt Diagnosis

Background: Motor neurone disease (MND) is an incurable neurodegenerative condition. Recent guidelines from the MND Association UK (MNDA) emphasise prompt diagnosis and monitoring of quality of life (QOL). However, primary literature indicates that diagnosis is often delayed through several factors, including unawareness of how MND presents and delays through multiple secondary referrals. The [hospital] operates an internationally-recognised MND clinic whose service has not been audited against the MNDA UK guidelines for the last 3 years.Aim: To assess how well the MND consultant’s service ensures prompt diagnosis and the provision of end-of-life care or appropriate respiratory or nutritional support.Methods: Using the [hospital’s] database, records from 77 patients consulted consecutively in the MND clinic were obtained. Service parameters were compared against reference standards for diagnostic delay and treatment provision.Results:  84.4% of referrals came from neurologists outside of the MND service, with only 13% from general practitioners. On average, it took 14.7 months for patients to be seen in the MND clinic following symptom onset. Riluzole and percutaneous endoscopic gastrostomy (PEG) were prescribed faster in bulbar-onset versus limb-onset patients, by 4 times and 9 times respectively. End-of-life care discussion was recorded for 26% of patients.Conclusion:    Diagnosing MND remains challenging for primary care physicians, which may be alleviated by disseminating recent Red Flag Committee guidelines. Investigation and treatment provision differed between MND subtypes, given the poorer prognosis associated with bulbar-onset. End-of-life care documentation remains low, which is an issue for the multi-disciplinary team (MDT) to resolve through incorporating palliative services. 

Occupational Exposure to Electric Shocks and Extremely Low-Frequency Magnetic Fields and Motor Neurone Disease

2020 ◽  
Author(s):  
Grace X Chen ◽  
Andrea’t Mannetje ◽  
Jeroen Douwes ◽  
Leonard H Berg ◽  
Neil Pearce ◽  
...  
Keyword(s):  
Occupational Exposure ◽  
Magnetic Fields ◽  
Low Frequency ◽  
Population Based ◽  
Motor Neurone ◽  
Motor Neurone Disease ◽  
Cumulative Exposure ◽  
Spine Injury ◽  
Extremely Low Frequency ◽  
Electric Shocks

Abstract In a New Zealand population-based case-control study we assessed associations with occupational exposure to electric shocks, extremely low-frequency magnetic fields (ELF-MF) and motor neurone disease using job-exposure matrices to assess exposure. Participants were recruited between 2013 and 2016. Associations with ever/never, duration, and cumulative exposure were assessed using logistic regression adjusted for age, sex, ethnicity, socioeconomic status, education, smoking, alcohol consumption, sports, head or spine injury and solvents, and mutually adjusted for the other exposure. All analyses were repeated stratified by sex. An elevated risk was observed for having ever worked in a job with potential for electric shocks (odds ratio (OR)=1.35, 95% confidence interval (CI): 0.98, 1.86), with the strongest association for the highest level of exposure (OR=2.01, 95%CI: 1.31, 3.09). Analysis by duration suggested a non-linear association: risk was increased for both short-duration (<3 years) (OR= 4.69, 95%CI: 2.25, 9.77) and long-duration in a job with high level of electric shock exposure (>24 years; OR=1.88; 95%CI: 1.05, 3.36), with less pronounced associations for intermediate durations. No association with ELF-MF was found. Our findings provide support for an association between occupational exposure to electric shocks and motor neurone disease but did not show associations with exposure to work-related ELF-MF.

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