THUR 122 Parkinson’s kinetigraph improves movement disorder service provision

2018 ◽  
Vol 89 (10) ◽  
pp. A13.3-A13
Author(s):  
Kobylecki Christopher ◽  
Partington-Smith Lucy ◽  
Silverdale Monty
Keyword(s):  
Movement Disorder ◽  
Service Provision ◽  
Clinical Decision Making ◽  
Hospital Admissions ◽  
Clinical Decision ◽  
Objective Evaluation ◽  
Advanced Therapies ◽  
Subsequent Effect ◽  
Outpatient Appointments ◽  
Deep Brain

IntroductionObjective evaluation of symptoms of Parkinson’s disease (PD) can be challenging. There is increasing interest in technological solutions to assess, monitor and manage people with PD.ObjectiveTo evaluate the effect of the Parkinson’s Kinetigraph (PKG) on management of patients with PD in a large tertiary movement disorder service.MethodsWe retrospectively reviewed the notes of 47 patients with PD (22 female, 25 male) who underwent PKG recording over a six month period. The indications and PKG findings, and the subsequent effect on clinical decision making and service provision were recorded.ResultsManagement was significantly altered in 25 patients (53%), while in 13 patients (28%) PKG confirmed the use of advanced therapies such as deep brain stimulation. Significant effects were seen with regard to service provision. Outpatient appointments could be deferred with advice following PKG in 15 (32%), advanced therapies assessment was improved in 16 (34%), while inpatient admission was avoided in six patients (13%).ConclusionThe use of PKG has enhanced service provision in our movement disorder service. In particular, it enhances our assessment of patients considered for high-cost advanced therapies, allows more efficient use of clinic appointments, and has the potential to reduce hospital admissions.

Using imaging to identify psychogenic parkinsonism before deep brain stimulation surgery

2012 ◽  
Vol 116 (1) ◽  
pp. 114-118 ◽  
Author(s):  
Michael H. Pourfar ◽  
Chris C. Tang ◽  
Alon Y. Mogilner ◽  
Vijay Dhawan ◽  
David Eidelberg
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Metabolic Networks ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Number Of Patients ◽  
Normal Expression ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

The frequency with which patients with atypical parkinsonism and advanced motor symptoms undergo deep brain stimulation (DBS) procedures is unknown. However, the potential exposure of these patients to unnecessary surgical risks makes their identification critical. As many as 15% of patients enrolled in recent early Parkinson disease (PD) trials have been found to lack evidence of a dopaminergic deficit following PET or SPECT imaging. This suggests that a number of patients with parkinsonism who are referred for DBS may not have idiopathic PD. The authors report on 2 patients with probable psychogenic parkinsonism who presented for DBS surgery. They found that both patients had normal caudate and putamen [18F]-fluorodopa uptake on PET imaging, along with normal expression of specific disease-related metabolic networks for PD and multiple system atrophy, a common form of atypical neurodegenerative parkinsonism. The clinical and PET findings in these patients highlight the role of functional imaging in assisting clinical decision making when the diagnosis is uncertain.

Supporting clinical decision making during deep brain stimulation surgery by means of a stochastic dynamical model

2014 ◽  
Vol 11 (5) ◽  
pp. 056019 ◽  
Author(s):  
Sofia D Karamintziou ◽  
George L Tsirogiannis ◽  
Pantelis G Stathis ◽  
George A Tagaris ◽  
Efstathios J Boviatsis ◽  
...  
Keyword(s):  
Decision Making ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Dynamical Model ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

scholarly journals Role of sST2 in prognostication and risk stratification in patients with heart failure

2017 ◽  
Vol 5 (7) ◽  
pp. 2964
Author(s):  
Gaurav Pradip Thakre ◽  
Manjunath Bagur Venkat ◽  
Bhabani Charan Sahoo
Keyword(s):  
Heart Failure ◽  
Risk Stratification ◽  
Clinical Decision Making ◽  
Hospital Admissions ◽  
Clinical Decision ◽  
Cardiac Events ◽  
Risk Of Mortality ◽  
Cardiac Strain ◽  
Patients With Heart Failure ◽  
One Year

Background: sST2, an interleukin (IL)-1 receptor family member, has been identified as a novel biomarker for cardiac strain. Concentrations of sST2 have prognostic value and found to be predictive of the rate of mortality in the follow-up of patients after an acute heart failure episode. The present study aims to study relationship between serum sST2 levels along with prognosis and risk of mortality in heart failure patients.Methods: The Study was conducted in A.J. Institute of Medical Sciences, Mangalore, Karnataka, India with 56 heart failure patients in the duration of 1 year. sST2 level of each patient was taken on the day of admission then after one month, six months and one year.Results: Concentration of sST2 was consistently higher in 55.3% patients. Patients with lower values of ST2 levels were having less number of hospital admissions for heart failure symptoms (44.6%). The patients who were having high ST2 levels died due to cardiac events by the end of one month, six months and one year were 7.1%, 11.5% and 13% respectively (p<0.001) which was highly significant. Overall mortality with the patients who were having higher ST2 levels was 28.5% (p<0.001 HS).Conclusions: Elevated sST2 levels are predictive of cardiac events in patients with heart failure and provide complementary information about prognostication and risk stratification of patient. Serial monitoring of sST2 will aid in clinical decision making.

scholarly journals External validation of the 4C mortality score among COVID-19 patients admitted to hospital in Ontario, Canada: a retrospective study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Aaron Jones ◽  
Tyler Pitre ◽  
Mats Junek ◽  
Jessica Kapralik ◽  
Rina Patel ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Hospital Admissions ◽  
Characteristic Curve ◽  
External Validation ◽  
Risk Groups ◽  
Clinical Decision ◽  
Risk Of Death ◽  
The United Kingdom ◽  
Canadian Population ◽  
Very High

AbstractRisk prediction scores are important tools to support clinical decision-making for patients with coronavirus disease (COVID-19). The objective of this paper was to validate the 4C mortality score, originally developed in the United Kingdom, for a Canadian population, and to examine its performance over time. We conducted an external validation study within a registry of COVID-19 positive hospital admissions in the Kitchener-Waterloo and Hamilton regions of southern Ontario between March 4, 2020 and June 13, 2021. We examined the validity of the 4C score to prognosticate in-hospital mortality using the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals calculated via bootstrapping. The study included 959 individuals, of whom 224 (23.4%) died in-hospital. Median age was 72 years and 524 individuals (55%) were male. The AUC of the 4C score was 0.77, 95% confidence interval 0.79–0.87. Overall mortality rates across the pre-defined risk groups were 0% (Low), 8.0% (Intermediate), 27.2% (High), and 54.2% (Very High). Wave 1, 2 and 3 values of the AUC were 0.81 (0.76, 0.86), 0.74 (0.69, 0.80), and 0.76 (0.69, 0.83) respectively. The 4C score is a valid tool to prognosticate mortality from COVID-19 in Canadian hospitals and can be used to prioritize care and resources for patients at greatest risk of death.

The Influence of Linguistic Bias Upon Speech-Language Pathologists’ Attitudes Toward Clinical Scenarios Involving Nonstandard Dialects of English

2021 ◽  
pp. 1-17
Author(s):  
Catherine Easton ◽  
Sarah Verdon
Keyword(s):  
Decision Making ◽  
Service Provision ◽  
Clinical Decision Making ◽  
Linguistic Diversity ◽  
Clinical Decision ◽  
Assessment Tools ◽  
Speech Language Pathology ◽  
Speech Language Pathologists ◽  
Clinical Scenarios ◽  
Language Pathology

Purpose Variation within languages, including dialects, takes on an indexical function, marking belonging and connection. Meanwhile, attitudes toward these speech varieties become marked by linguistic bias. Within the speech-language pathology profession, research evidence, assessment tools, and intervention programs have largely been designed for and by the White, English-speaking middle class. As such, linguistic bias with a preference for standardized dialects is prevalent in the training and practice of the speech-language pathology profession, resulting in discriminatory and racialized practices. Method To investigate the influence of linguistic bias upon speech-language pathologists' (SLPs') clinical decision making, data were collected from 129 Australian SLPs via an online survey. Inferential statistics were used to investigate the relationship between clinical decision making and SLPs' attitudes toward nonstandard dialects as well as personal and professional factors. A content analysis of extended responses was conducted to identify themes in clinical decision making. Results SLPs with more years of experience and those who had received professional development were significantly more likely to seek out more information before making a diagnosis, while those with more negative attitudes toward linguistic diversity were significantly more likely to identify a disorder than a difference. SLPs provided a range of justifications for their clinical decision making, but few acknowledged the influence of their own attitudes and bias upon their decision making. Conclusions SLPs' linguistic bias towards speakers of nonstandard dialects has the potential to impact upon their clinical judgment of difference versus disorder and lead to inequality of service provision for speakers who do not express themselves in standardized forms. Before the profession can truly move toward an antiracist approach of equitable service provision for all, SLPs must engage in critical self-reflection to disrupt the adherence of the speech-language pathology profession to standardized “White” norms of communication.

Advance care directive documentation: issues for clinicians in New South Wales

2018 ◽  
Vol 42 (1) ◽  
pp. 89 ◽  
Author(s):  
Mark I. Friedewald ◽  
Peter A. Cleasby
Keyword(s):  
Clinical Decision Making ◽  
Hospital Admissions ◽  
New South ◽  
New South Wales ◽  
Clinical Decision ◽  
Record System ◽  
South Wales ◽  
Clinical Scenarios ◽  
Advance Care Directives ◽  
Advance Care

Objective The aim of the present study was to assess the characteristics of documents presented as advance care directives (ACDs) at a public health organisation in New South Wales (NSW). It was envisaged that the findings would inform the refinement of locally developed educational strategies. Methods All ACD documents provided during hospital admissions and entered into the electronic medical record system over a 12-month period were reviewed. An audit tool was developed and used to identify whether key requirements for ACDs in NSW had been addressed. Results Of the 100 ACDs that were reviewed, only 50 were assessed as being valid to inform future clinical scenarios. Multiple templates with different designs and of varying length had been used. Conclusions Documents identified as ACDs may carry doubt about their validity. Clinicians require education about differences in template formats, the application of content to clinical decisions and associated legal responsibilities. What is known about this topic? Advance Care Directives in NSW exist without a specific legislative framework or prescriptive format. Clinicians are presented with a wide variety of documents with broad variance in content. What does this paper add? This paper describes the variance found within ACDs in detail, and identifies concerns about validity that healthcare systems need to consider. What are the implications for practitioners? Clinicians need to discern the validity and utility of ACDs before the content is used in the process of clinical decision-making.

scholarly journals Hospital mortality and resource implications of hospitalisation with COVID-19 in London, UK: a prospective cohort study

2020 ◽  
Author(s):  
Savvas Vlachos ◽  
Adrian Wong ◽  
Victoria Metaxa ◽  
Sergio Canestrini ◽  
Carmen Lopez Soto ◽  
...  
Keyword(s):  
Critical Care ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Clinical Decision Making ◽  
Hospital Admissions ◽  
Clinical Decision ◽  
Hospital Level ◽  
Care Services

Background Coronavirus disease 2019 (COVID-19) had a significant impact on the National Health Service in the United Kingdom (UK), with over 33 000 cases reported in London by July 6, 2020. Detailed hospital-level information on patient characteristics, outcomes and capacity strain are currently scarce but would guide clinical decision-making and inform prioritisation and planning. Methods We aimed to determine factors associated with hospital mortality and describe hospital and ICU strain by conducting a prospective cohort study at a tertiary academic centre in London, UK. We included adult patients admitted to hospital with laboratory-confirmed COVID-19 and followed them up until hospital discharge or 30 days. Baseline factors that are associated with hospital mortality were identified via semi-parametric and parametric survival analyses. Results Our study included 429 patients; 18% of them were admitted to ICU, 52% met criteria for ICU outreach team activation and 61% had treatment limitations placed during their admission. Hospital mortality was 26% and ICU mortality was 34%. Hospital mortality was independently associated with increasing age, male sex, history of chronic kidney disease, increasing baseline C-reactive protein level and dyspnoea at presentation. COVID-19 resulted in substantial ICU and hospital strain, with up to 9 daily ICU admissions and 41 daily hospital admissions, to a peak census of 80 infected patients admitted in ICU and 250 in the hospital. Management of such a surge required extensive reorganisation of critical care services with expansion of ICU capacity from 69 to 129 beds, redeployment of staff from other hospital areas and coordinated hospital-level effort. Conclusions COVID-19 is associated with a high burden of mortality for patients treated on the ward and the ICU and required substantial reconfiguration of critical care services. This has significant implications for planning and resource utilization. 

scholarly journals Time for a New 3-D Image for Globus Pallidus Internus Deep Brain Stimulation Targeting and Programming

2021 ◽  
pp. 1-5
Author(s):  
Joshua K. Wong ◽  
Justin D. Hilliard ◽  
Vanessa M. Holanda ◽  
Aysegul Gunduz ◽  
Aparna Wagle Shukla ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Globus Pallidus ◽  
Brain Stimulation ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Globus Pallidus Internus ◽  
The Past ◽  
Functional Zones ◽  
Spatial Boundary ◽  
Deep Brain

Deep brain stimulation (DBS) is an effective neuromodulatory therapy for Parkinson’s disease (PD). Early studies using globus pallidus internus (GPi) DBS for PD profiled the nucleus as having two functional zones. This concept disseminated throughout the neuromodulation community as the “GPi triangle”. Although our understanding of the pallidum has greatly evolved over the past 20 years, we continue to reference the triangle in our clinical decision-making process. We propose a new direction, termed the spatial boundary hypothesis, to build upon the 2-dimensional outlook on GPi DBS. We believe an updated 3-D GPi model can produce more consistent, positive patient outcomes.

scholarly journals External Validation of the 4C Mortality Score among COVID-19 Patients Visiting the Emergency Department or admitted to Hospital in Ontario, Canada

2021 ◽  
Author(s):  
Aaron Jones ◽  
Tyler Pitre ◽  
Mats Junek ◽  
Jessica Kapralik ◽  
Rina Patel ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Decision Making ◽  
Hospital Admissions ◽  
Characteristic Curve ◽  
External Validation ◽  
Risk Groups ◽  
Clinical Decision ◽  
Emergency Department Visits ◽  
The United Kingdom ◽  
Canadian Population

Abstract Objectives: Risk prediction scores are important tools to support clinical decision-making for patients with coronavirus disease (COVID-19). The objective of this paper was to validate the 4C mortality score, originally developed in the United Kingdom, for a Canadian population. Methods: We conducted an external validation study within a registry of COVID-19 positive emergency department visits and hospital admissions in the Kitchener-Waterloo and Hamilton regions of southern Ontario between March 4 and January 9, 2020. We examined the validity of the 4C score to prognosticate in-hospital mortality using the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals calculated via bootstrapping. Results: The study included 560 individuals, of whom 115 (20.5%) died in-hospital. Median age was 69 years and 281 individuals (51%) were male. The AUC of the 4C score was 0.83, 95% confidence interval 0.79-0.87. Mortality rates across the pre-defined risk groups were 0% (Low), 3.2% (Intermediate), 25.9% (High), and 59.5% (Very High). The AUC was 0.80 (0.76-0.85) among hospital inpatients. Interpretation: The 4C score is a valid tool to prognosticate mortality from COVID-19 in Canadian emergency departments and hospitals.

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