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

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.

Download Full-text

Frontotemporal dementia and mild cognitive impairment in motor neurone disease

PsycEXTRA Dataset ◽

10.1037/e578362014-031 ◽

2009 ◽

Author(s):

S. Tsermentseli

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Frontotemporal Dementia ◽

Motor Neurone ◽

Motor Neurone Disease

Download Full-text

Motor Neurone Disease - Systematic Multi-Arm Adaptive Randomised Trial

Case Medical Research ◽

10.31525/ct1-nct04302870 ◽

2020 ◽

Author(s):

Keyword(s):

Randomised Trial ◽

Motor Neurone ◽

Motor Neurone Disease

Download Full-text

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

American Journal of Epidemiology ◽

10.1093/aje/kwaa214 ◽

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.

Download Full-text