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Azmi H, Walter BL, Brooks A, Richard IH, Amodeo K, Okun MS. Editorial: Hospitalization and Parkinson's disease: safety, quality and outcomes. Front Aging Neurosci 2024; 16:1398947. [PMID: 38638192 PMCID: PMC11024459 DOI: 10.3389/fnagi.2024.1398947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 04/20/2024] Open
Affiliation(s)
- Hooman Azmi
- Department of Neurosurgery, Hackensack University Medical Center, Hackensack, NJ, United States
- Hackensack Meridian School of Medicine, Nutley, NJ, United States
| | | | - Annie Brooks
- Parkinson's Foundation, New York, NY, United States
| | - Irene Hegeman Richard
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Katherine Amodeo
- Westchester Medical Center Health Network, Valhalla, NY, United States
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
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Bobek M, Pascarelli P, Cocoziello L, Azmi H. Utilizing the Nursing Professional Development Model to create and sustain nursing education aimed at improving the care of patients with Parkinson's Disease in the hospital. Front Med (Lausanne) 2024; 10:1275970. [PMID: 38327273 PMCID: PMC10847593 DOI: 10.3389/fmed.2023.1275970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/26/2023] [Indexed: 02/09/2024] Open
Abstract
The Nurse Professional Development Model (NPD) has been utilized to improve quality of care for several conditions. Patients with Parkinson's Disease (PD) are susceptible to higher risks while in the hospital. Educational efforts for this patient population are challenged by the small, disbursed number of patients as well as increased turn-over and reliance on temporary nursing staff. To properly care for this patient group, any education has to be hospital wide and ongoing for maintenance of competency. We have used the NPD Model to initiate education for new incoming nurses as well as for continued education for a program that requires hospital-wide reach. Our utilization of the NPD Model for this high risk, low volume patient population has helped us improve the safety of this patient population in the hospital. With this manuscript we detail the need and the educational platform with the hope of it serving as a reference for other institutions facing similar challenges.
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Affiliation(s)
- Mary Bobek
- Department of Clinical Education, Hackensack University Medical Center, Hackensack, NJ, United States
| | - Pamela Pascarelli
- Department of Clinical Education, Hackensack University Medical Center, Hackensack, NJ, United States
| | - Lisa Cocoziello
- Department of Neurosurgery, Hackensack University Medical Center, Hackensack, NJ, United States
| | - Hooman Azmi
- Department of Neurosurgery, Hackensack University Medical Center, Hackensack, NJ, United States
- Hackensack Meridian School of Medicine, Nutley, NJ, United States
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Wu AD, Walter BL, Brooks A, Buetow E, Amodeo K, Richard I, Mundth K, Azmi H. Standardizing default electronic health record tools to improve safety for hospitalized patients with Parkinson's disease. Front Aging Neurosci 2024; 15:1278322. [PMID: 38304735 PMCID: PMC10830808 DOI: 10.3389/fnagi.2023.1278322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/22/2023] [Indexed: 02/03/2024] Open
Abstract
Electronic Health Record (EHR) systems are often configured to address challenges and improve patient safety for persons with Parkinson's disease (PWP). For example, EHR systems can help identify Parkinson's disease (PD) patients across the hospital by flagging a patient's diagnosis in their chart, preventing errors in medication and dosing through the use of clinical decision support, and supplementing staff education through care plans that provide step-by-step road maps for disease-based care of a specific patient population. However, most EHR-based solutions are locally developed and, thus, difficult to scale widely or apply uniformly across hospital systems. In 2020, the Parkinson's Foundation, a national and international leader in PD research, education, and advocacy, and Epic, a leading EHR vendor with more than 35% market share in the United States, launched a partnership to reduce risks to hospitalized PWP using standardized EHR-based solutions. This article discusses that project which included leadership from physician informaticists, movement disorders specialists, hospital quality officers, the Parkinson's Foundation and members of the Parkinson's community. We describe the best practice solutions developed through this project. We highlight those that are currently available as standard defaults or options within the Epic EHR, discuss the successes and limitations of these solutions, and consider opportunities for scalability in environments beyond a single EHR vendor. The Parkinson's Foundation and Epic launched a partnership to develop best practice solutions in the Epic EHR system to improve safety for PWP in the hospital. The goal of the partnership was to create the EHR tools that will have the greatest impact on outcomes for hospitalized PWP.
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Affiliation(s)
- Allan D. Wu
- Parkinson’s Disease and Movement Disorders Center, Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
| | - Benjamin L. Walter
- Center for Neurological Restoration, Department of Neurology, Neurological Institute, Cleveland ClinicCleveland, OH, United States
| | - Anne Brooks
- Parkinson’s Foundation, New York, NY, United States
| | - Emily Buetow
- Parkinson’s Foundation, New York, NY, United States
| | - Katherine Amodeo
- Department of Neurology, Westchester Medical Center, Poughkeepsie, NY, United States
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Irene Richard
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Kelly Mundth
- Epic Systems Corporation, Verona, WI, United States
| | - Hooman Azmi
- Department of Neurosurgery, Hackensack University Medical Center, Hackensack, NJ, United States
- Hackensack Meridian School of Medicine, Nutley, NJ, United States
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Bruno MK, Matsunaga M, Krening E, Gao F, Chen JJ, Seto T, Ross GW. The Prevalence of Hospitalized Parkinson's Disease Patients in All Case Hospitalization among Different Race/Ethnic Subgroups in Hawaii. JOURNAL OF PARKINSON'S DISEASE 2024; 14:725-735. [PMID: 38607763 PMCID: PMC11191512 DOI: 10.3233/jpd-230341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/14/2024]
Abstract
Background Little is known about the epidemiology of Parkinson's disease (PD) patients in Native Hawaiian Or Other Pacific Islander (NHPI) and Asian American (AA) subgroups. Objective To determine if the prevalence of hospitalized PD patients is different across age groups and racial/ethnic subgroups in Hawaii. Methods We conducted a retrospective analysis of Hawaii statewide registry (2016-2020) hospitalization data for patients who were 50 years or older. PD patients were identified using an ICD 10 code: Parkinson's Disease (G20) as their primary/secondary hospitalization discharge diagnosis code. Demographic and clinical characteristics among racial/ethnic subgroups (White, Japanese, Filipino, Chinese, NHPI, or Other) were compared. Results Of 146,844 total hospitalized patients (n = 429,879 records), 1.6% (n = 2,401) had a PD diagnosis. The prevalence of hospitalized PD patients was 2.3% among Japanese and Chinese, followed by 1.7% for Whites, 1.2% for Filipinos and was lowest for NHPI with 0.9% (p < 0.001). As patient's age increased, the prevalence of hospitalized PD patients increased, with 80-84 years old for the highest age range (3.4%). The prevalence of hospitalized PD patients at 80-84 years old varied across the race/ethnic subgroups (Chinese 4.3%, Japanese 4.0%, Whites 3.7%, Filipinos 2.5%, NHPI 2.3%). Conclusions The prevalence of hospitalized PD patients among all case hospitalizations were lower for NHPI and Filipino compared to that of Japanese, Chinese, and Whites. As patients' age increased, the prevalence of hospitalized patients with PD increased, but less so in NHPI and Filipino groups. Further research is warranted to understand the reason for these observed differences among racial/ethnic subgroups.
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Affiliation(s)
- Michiko Kimura Bruno
- The Queen’s Medical Center, Honolulu, HI, USA
- University of Hawaii John A, Burns School of Medicine, Honolulu, HI, USA
| | - Masako Matsunaga
- University of Hawaii John A, Burns School of Medicine, Honolulu, HI, USA
| | | | - Fay Gao
- The Queen’s Medical Center, Honolulu, HI, USA
- University of Hawaii John A, Burns School of Medicine, Honolulu, HI, USA
| | - John J. Chen
- University of Hawaii John A, Burns School of Medicine, Honolulu, HI, USA
| | - Todd Seto
- The Queen’s Medical Center, Honolulu, HI, USA
- University of Hawaii John A, Burns School of Medicine, Honolulu, HI, USA
| | - G. Webster Ross
- Pacific Health Research and Education Institute, VA Pacific Islands Health CareSystem, Honolulu, HI, USA
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George BP, Barbosa WA, Sethi A, Richard IH. Complications and outcomes of hospitalizations for patients with and without Parkinson disease. Front Aging Neurosci 2023; 15:1276731. [PMID: 38161593 PMCID: PMC10757345 DOI: 10.3389/fnagi.2023.1276731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Objective To examine complications and outcomes of hospitalizations for common indications for hospitalization among patients with Parkinson disease (PD). Methods We identified and selected the ten most common indications for hospitalization among individuals ≥65 years of age using principal diagnoses from the California State Inpatient Database, 2018-2020. Patients with comorbid PD were identified using secondary diagnosis codes and matched one-to-one to patients without PD based on principal diagnosis (exact matching), age, gender, race and ethnicity, and Elixhauser comorbidity index (coarsened exact matching). We identified potentially preventable complications based on the absence of present on admission indicators among secondary diagnoses. In the matched cohort, we compared inpatient complications, early Do-Not-Resuscitate (DNR) orders (placed within 24 h of admission), use of life-sustaining therapies, new nursing facility requirement on discharge, and death or hospice discharge for patients with and without PD. Results We identified 35,457 patients with PD among the ten leading indications for hospitalization in older adults who were matched one-to-one to patients without PD (n = 70,914 in total). Comorbid PD was associated with an increased odds of developing aspiration pneumonia (OR 1.17 95% CI 1.02-1.35) and delirium (OR 1.11 95% CI 1.02-1.22) during admission. Patients with PD had greater odds of early DNR orders [placed within 24 h of admission] (OR 1.34 95% CI 1.29-1.39). While there was no difference in the odds of mechanical ventilation (OR 1.04 95% CI 0.98-1.11), patients with PD demonstrated greater odds of tracheostomy (OR 1.41 95% CI 1.12-1.77) and gastrostomy placement (OR 2.00 95% CI 1.82-2.20). PD was associated with greater odds of new nursing facility requirement upon discharge (OR 1.58 95% CI 1.53-1.64). Patients with PD were more likely to die as a result of their hospitalization (OR 1.11 95% CI 1.06-1.16). Conclusion Patients with PD are at greater risk of developing aspiration pneumonia and delirium as a complication of their hospitalization. While patients with PD more often have early DNR orders, they have greater utilization of life-sustaining therapies and experience worse outcomes of their hospitalization including new nursing facility requirement upon discharge and greater mortality.
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Affiliation(s)
- Benjamin P. George
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - William A. Barbosa
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Anish Sethi
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
- Drexel University College of Medicine, Philadelphia, PA, United States
| | - Irene H. Richard
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
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Kulisevsky J, Falup-Pecurariu C, Santens P, Jost WH. Towards improved access to device-aided therapies in advanced PD: the importance of cooperation of different disciplines. J Neural Transm (Vienna) 2023; 130:1433-1441. [PMID: 37439943 DOI: 10.1007/s00702-023-02664-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 07/14/2023]
Abstract
Managing the many issues in advanced Parkinson's disease (PD) requires education, continuous support, and specialized outpatient care involving a variety of allied healthcare professionals. It would be greatly appreciated if general neurologists and professionals from various disciplines who work with people diagnosed with Parkinson's disease (PwP) could remain knowledgeable about the existing therapies and their respective roles within the treatment continuum. The movement disorders specialist and the PD nurse are key actors in the coordination of a targeted and patient-empowering multidisciplinary approach for advanced PD. Affordable and timely access to these therapies for the PwP who may need them is presently a challenge for health systems. Education, training, and support for all the involved stakeholders in the process of PD care may improve quality of life both for PwP and caregivers, and reduce inadequate, expensive, time-consuming, and unsuccessful prolongation of standard medical therapies.
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Affiliation(s)
- Jaime Kulisevsky
- Parkinson and Movement Disorders Unit, Sant Pau Hospital, Universitat Autònoma de Barcelona, C/Mas Casanovas 90, 08041, Barcelona, Spain.
- Departament de Medicina, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
- CIBERNED (Network Centre for Neurodegenerative Diseases), Barcelona, Spain.
| | - Cristian Falup-Pecurariu
- Faculty of Medicine, Transilvania University of Braşov, Braşov, Romania
- Department of Neurology, County Clinic Hospital, Braşov, Romania
| | - Patrick Santens
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Wolfgang H Jost
- University Hospital Carl Gustav Carus, Dresden, Saxony, Germany
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Goldin C, Sillau S, Worledge E, Bremmer J, Cummins R, Tremolet de Villers K, Fullard ME. Reducing the receipt of contraindicated medications in patients with Parkinson disease. Front Aging Neurosci 2023; 15:1271072. [PMID: 37901790 PMCID: PMC10602692 DOI: 10.3389/fnagi.2023.1271072] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
Background The administration of antidopaminergic medications to patients with Parkinson's disease (PD) can exacerbate symptoms, and in the hospital setting, can lead to complications and increased length of stay. Despite efforts to improve medication administration through provider education and patient-centered interventions, the problem persists, with an estimated 21-43% of hospitalized PD patients receiving dopamine blocking medications. Methods In this study, a best practice alert (BPA) was developed that was triggered when an antidopaminergic medication was ordered in the Emergency Department or hospital for a patient with a diagnosis of PD in the EMR. The primary outcomes were receipt of a contraindicated medication, length of stay (LOS) and readmission within 30 days. These outcomes were compared between the 12 months prior to the intervention and the 12 months post intervention. Data were also collected on admitting diagnosis, admitting service, neurology involvement and patient demographics. Results For pre-intervention inpatient encounters, 18.3% involved the use of a contraindicated medication. This was reduced to 9.4% of all inpatient encounters for PD patients in the first 3 months post-intervention and remained lower at 13.3% for the full 12 months post-intervention. The overall rate of contraindicated medication use was low for ED visits at 4.7% pre-intervention and 5.7% post-intervention. Receipt of a contraindicated medication increased the risk of a longer length of stay, both before and after the intervention, but did not significantly affect 30-day readmission rate. Conclusion An EMR BPA decreased the use of contraindicated medications for PD patients in the hospital setting, especially in the first 3 months. Strategies are still needed to reduce alert fatigue in order to maintain initial improvements.
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Affiliation(s)
- Caroline Goldin
- Department of Neurology, Ochsner Medical Center, New Orleans, LA, United States
| | - Stefan Sillau
- Department of Neurology, University of Colorado, Aurora, CO, United States
| | - Elisa Worledge
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Denver Health, Denver, CO, United States
| | | | - Robbie Cummins
- Department of Neurology, University of Colorado, Aurora, CO, United States
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Crooks S, Stark P, Carlisle S, McMullan J, Copeland S, Wong WYA, Blake D, Lyons E, Campbell N, Carter G, Wilson CB, Mitchell G. Evaluation of a co-designed Parkinson's awareness audio podcast for undergraduate nursing students in Northern Ireland. BMC Nurs 2023; 22:370. [PMID: 37814245 PMCID: PMC10561504 DOI: 10.1186/s12912-023-01544-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 09/28/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Parkinson's Disease (PD) is a common neurological condition that often causes stiffness, tremor and slow movement. People living with PD are likely to encounter nursing students throughout their journey from pre-diagnosis to death. Despite this, there is a paucity of evidence about current practice in PD education amongst nursing students. The present study provides an evaluation of a co-designed Parkinson's Awareness audio podcast amongst nursing students in Northern Ireland. METHODS Following co-design of an audio podcast about PD, a mixed methods evaluation was carried out. 332 student nurses completed pre-/post-test questionnaires about their knowledge and perceptions of PD before and after listening to the audio podcast. Further to this, 35 student nurses participated in focus-group interviews six months following listening to explore how the podcast influenced practice. RESULTS Student nurses posted a mean score of 52% before listening to the audio podcast. This mean increased to 80% post-test. These findings were statistically significant (p < 0.001), demonstrating significant increases in PD awareness after listening. Findings from the focus groups suggested that the audio podcast improved empathy and practice towards people with PD. The findings also suggested that students perceived audio podcasts to be a good way to learn about PD. CONCLUSION Provision of a co-designed audio podcast about PD has the potential to improve student nurse knowledge and practice related to PD as evidenced in this study.
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Affiliation(s)
- Sophie Crooks
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern, Ireland
| | - Patrick Stark
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern, Ireland
| | - Susan Carlisle
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern, Ireland
| | - Johanna McMullan
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern, Ireland
| | - Shannon Copeland
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern, Ireland
| | - Wai Yee Amy Wong
- University of East Anglia, Norwich Medical School, Norwich, England
| | | | | | | | - Gillian Carter
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern, Ireland
| | | | - Gary Mitchell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern, Ireland.
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Thakur V, Kessler B, Khan MB, Hodge JO, Brandmeir NJ. Outpatient Deep Brain Stimulation Surgery Is a Safe Alternative to Inpatient Admission. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00656. [PMID: 36929766 DOI: 10.1227/ons.0000000000000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/17/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is usually performed as an inpatient procedure. The COVID-19 pandemic effected a practice change at our institution with outpatient DBS performed because of limited inpatient and surgical resources. Although this alleviated use of hospital resources, the comparative safety of outpatient DBS surgery is unclear. OBJECTIVE To compare the safety and incidence of early postoperative complications in patients undergoing DBS procedures in the outpatient vs inpatient setting. METHODS We retrospectively reviewed all outpatient and inpatient DBS procedures performed by a single surgeon between January 2018 and November 2022. The main outcome measures used for comparison between the 2 groups were total complications, length of stay, rate of postoperative infection, postoperative hemorrhage rate, 30-day emergency department (ED) visits and readmissions, and IV antihypertensive requirement. RESULTS A total of 44 outpatient DBS surgeries were compared with 70 inpatient DBS surgeries. The outpatient DBS cohort had a shorter mean postoperative stay (4.19 vs 39.59 hours, P = .0015), lower total complication rate (2.3% vs 12.8%, P = .1457), and lower wound infection rate (0% vs 2.9%, P = .52) compared with the inpatient cohort, but the difference in complications was not statistically significant. In the 30-day follow-up period, ED visits were similar between the cohorts (6.8% vs 7.1%, P = .735), but no outpatient DBS patient required readmission, whereas all inpatient DBS patients visiting the ED were readmitted (P = .155). CONCLUSION Our study demonstrates that DBS can be safely performed on an outpatient basis with same-day hospital discharge and close continuous monitoring.
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Affiliation(s)
- Vishal Thakur
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
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Dalton KR, Kidd CJ, Hack N. Toxin Induced Parkinsonism and Hospitalization Related Adverse Outcome Mitigation for Parkinson's Disease: A Comprehensive Review. J Clin Med 2023; 12:jcm12031074. [PMID: 36769726 PMCID: PMC9918159 DOI: 10.3390/jcm12031074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Patients with Parkinson's disease admitted to the hospital have unique presentations. This unique subset of patients requires a multidisciplinary approach with a knowledge-based care team that can demonstrate awareness of complications specific to Parkinson's disease to reduce critical care admissions, morbidity, and mortality. Early recognition of toxic exposures, medication withdrawals, or medication-induced symptoms can reduce morbidity and mortality. This review can assist in the critical assessment of new or exacerbating Parkinson's disease symptoms.
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Affiliation(s)
- Kenneth R. Dalton
- Department of Neurology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Charles J. Kidd
- Department of Neurology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Nawaz Hack
- Department of Neurology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Department of Neurology, UTRGV Institute of Neuroscience, UTRGV School of Medicine, Harlingen, TX 78550, USA
- Correspondence: or or
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Dar MN, Akram MU, Yuvaraj R, Gul Khawaja S, Murugappan M. EEG-based emotion charting for Parkinson's disease patients using Convolutional Recurrent Neural Networks and cross dataset learning. Comput Biol Med 2022; 144:105327. [PMID: 35303579 DOI: 10.1016/j.compbiomed.2022.105327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/30/2022] [Accepted: 02/14/2022] [Indexed: 01/04/2023]
Abstract
Electroencephalogram (EEG) based emotion classification reflects the actual and intrinsic emotional state, resulting in more reliable, natural, and meaningful human-computer interaction with applications in entertainment consumption behavior, interactive brain-computer interface, and monitoring of psychological health of patients in the domain of e-healthcare. Challenges of EEG-based emotion recognition in real-world applications are variations among experimental settings and cognitive health conditions. Parkinson's Disease (PD) is the second most common neurodegenerative disorder, resulting in impaired recognition and expression of emotions. The deficit of emotional expression poses challenges for the healthcare services provided to PD patients. This study proposes 1D-CRNN-ELM architecture, which combines one-dimensional Convolutional Recurrent Neural Network (1D-CRNN) with an Extreme Learning Machine (ELM), robust for the emotion detection of PD patients, also available for cross dataset learning with various emotions and experimental settings. In the proposed framework, after EEG preprocessing, the trained CRNN can use as a feature extractor with ELM as the classifier, and again this trained CRNN can be used for learning of new emotions set with fine-tuning of other datasets. This paper also applied cross dataset learning of emotions by training with PD patients datasets and fine-tuning with publicly available datasets of AMIGOS and SEED-IV, and vice versa. Random splitting of train and test data with 80 - 20 ratio resulted in an accuracy of 97.75% for AMIGOS, 83.20% for PD, and 86.00% for HC with six basic emotion classes. Fine-tuning of trained architecture with four emotions of the SEED-IV dataset results in 92.5% accuracy. To validate the generalization of our results, leave one subject (patient) out cross-validation is also incorporated with mean accuracies of 95.84% for AMIGOS, 75.09% for PD, 77.85% for HC, and 84.97% for SEED-IV is achieved. Only a 1 - sec segment of EEG signal from 14 channels is enough to detect emotions with this performance. The proposed method outperforms state-of-the-art studies to classify EEG-based emotions with publicly available datasets, provide cross dataset learning, and validate the robustness of the deep learning framework for real-world application of psychological healthcare monitoring of Parkinson's disease patients.
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Affiliation(s)
- Muhammad Najam Dar
- National University of Sciences and Technology, Islamabad, Postcode: 44000, Pakistan.
| | - Muhammad Usman Akram
- National University of Sciences and Technology, Islamabad, Postcode: 44000, Pakistan.
| | - Rajamanickam Yuvaraj
- Nanyang Technological University (NTU), 639798, Singapore; Science of Learning in Education (SoLE), Office of Education Research (OER), National Institute of Education (NIE), 637616, Singapore.
| | - Sajid Gul Khawaja
- National University of Sciences and Technology, Islamabad, Postcode: 44000, Pakistan.
| | - M Murugappan
- Department of Electronics and Communication Engineering, Kuwait College of Science and Technology, Al-Jahra, Kuwait.
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Krause P, Berking S, Astalosch M, Grünheid R, Kühn AA. Motor and non-motor improvements following short-term multidisciplinary day-clinic care in Parkinson´s disease. J Neural Transm (Vienna) 2022; 129:1419-1426. [PMID: 36335542 PMCID: PMC9649470 DOI: 10.1007/s00702-022-02562-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/24/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Inpatient as well as outpatient care does often not meet PD-patients' individual needs. INTRODUCTION Day-clinic concepts encompassing a multidisciplinary team as well as therapy adjustments accompanying everyday demands aim at filling this gap. METHODS This is a retrospective study on short-term effects of a 3 week multidisciplinary rehabilitation program in patients with Parkinson´s disease (PD) embedded in a specialized movement disorder day-clinic. We analyzed short-term outcome of motor and non-motor symptoms (NMS) in 143 PD-patients (mean age 65.3 ± 11.9 years; Hoehn-and-Yahr-score 2.6 ± 0.7) after 3 weeks with 7.4 ± 1.8 active days of interdisciplinary day-care treatment. Participants attended the day-clinic in groups of five patients at a time. Improvements were evaluated by comparison of standardized physical therapy assessments, disease specific scores for motor symptoms (MDS-UPDRS III), mood (BDI), quality of life (PDQ39, SF36), sleep (PDSS, ESS), impulsiveness (QUIP), apathy (SAS), cognition (MMST), as well as change in medication before and directly after the intervention. RESULTS MDS-UPDRS motor score improved significantly by 22.9 ± 21.5% (p < 0.001) and was accompanied by a significant reduction of imbalance, immobility, and weakness ranging between 6% and 17% in standardized physical therapy tests. In addition, all disease-specific non-motor scales improved significantly. CONCLUSIONS A multidisciplinary day-clinic approach can support benefit on motor, non-motor symptoms and QoL in PD-patients. Given the increase in PD incidence and prevalence as well as the significant treatment effects shown here, more day-clinic treatment opportunities ought to be implemented to improve PD treatment adapted to everyday challenges while still reducing costs to the health care system.
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Affiliation(s)
- Patricia Krause
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Charité – Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Sara Berking
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Charité – Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Melanie Astalosch
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Charité – Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Raymond Grünheid
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Charité – Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Andrea A. Kühn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Charité – Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
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Nunez Y, Boehme AK, Li M, Goldsmith J, Weisskopf MG, Re DB, Navas-Acien A, van Donkelaar A, Martin RV, Kioumourtzoglou MA. Parkinson's disease aggravation in association with fine particle components in New York State. ENVIRONMENTAL RESEARCH 2021; 201:111554. [PMID: 34181919 PMCID: PMC8478789 DOI: 10.1016/j.envres.2021.111554] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND Long-term exposure to fine particulate matter (PM2.5) has been associated with neurodegenerative diseases, including disease aggravation in Parkinson's disease (PD), but associations with specific PM2.5 components have not been evaluated. OBJECTIVE To characterize the association between specific PM2.5 components and PD first hospitalization, a surrogate for disease aggravation. METHODS We obtained data on hospitalizations from the New York Department of Health Statewide Planning and Research Cooperative System (2000-2014) to calculate annual first PD hospitalization counts in New York State per county. We used well-validated prediction models at 1 km2 resolution to estimate county level population-weighted annual black carbon (BC), organic matter (OM), nitrate, sulfate, sea salt (SS), and soil particle concentrations. We then used a multi-pollutant mixed quasi-Poisson model with county-specific random intercepts to estimate rate ratios (RR) of one-year exposure to each PM2.5 component and PD disease aggravation. We evaluated potential nonlinear exposure-outcome relationships using penalized splines and accounted for potential confounders. RESULTS We observed a total of 197,545 PD first hospitalizations in NYS from 2000 to 2014. The annual average count per county was 212 first hospitalizations. The RR (95% confidence interval) for PD aggravation was 1.06 (1.03, 1.10) per one standard deviation (SD) increase in nitrate concentrations and 1.06 (1.04, 1.09) for the corresponding increase in OM concentrations. We also found a nonlinear inverse association between PD aggravation and BC at concentrations above the 96th percentile. We found a marginal association with SS and no association with sulfate or soil exposure. CONCLUSION In this study, we detected associations between the PM2.5 components OM and nitrate with PD disease aggravation. Our findings support that PM2.5 adverse effects on PD may vary by particle composition.
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Affiliation(s)
- Yanelli Nunez
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Amelia K Boehme
- Department of Epidemiology and Neurology, Columbia University, New York, NY, USA
| | - Maggie Li
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Jeff Goldsmith
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Diane B Re
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Aaron van Donkelaar
- Department of Energy, Environmental & Chemical Engineering, Washington University at St. Louis, MO, USA; Department of Physics and Atmospheric Science, Dalhousie University, Halix, Nova Scotia, Canada
| | - Randall V Martin
- Department of Energy, Environmental & Chemical Engineering, Washington University at St. Louis, MO, USA; Department of Physics and Atmospheric Science, Dalhousie University, Halix, Nova Scotia, Canada
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Di Luca DG, McArthur EW, Willis A, Martino R, Marras C. Clinical and Economic Outcomes Associated with Dysphagia in Hospitalized Patients with Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 11:1965-1971. [PMID: 34366378 DOI: 10.3233/jpd-212798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dysphagia is a frequent complication that may increase morbidity and mortality in Parkinson's disease (PD). Nevertheless, there is limited data on its objective impact on healthcare outcomes. OBJECTIVE To investigate the outcomes associated with dysphagia in hospitalized patients with PD and associated healthcare costs and utilization. METHODS We performed a retrospective cohort study using the National Inpatient Sample (NIS) data from 2004 to 2014. A multivariable regression analysis was adjusted for demographic, and comorbidity variables to examine the association between dysphagia and associated outcomes. Logistic and negative binomial regressions were used to estimate odds or incidence rate ratios for binary and continuous outcomes, respectively. RESULTS We identified 334,395 non-elective hospitalizations of individuals with PD, being 21,288 (6.36%) associated with dysphagia. Patients with dysphagia had significantly higher odds of negative outcomes, including aspiration pneumonia (AOR 7.55, 95%CI 7.29-7.82), sepsis (AOR 1.91, 95%CI 1.82-2.01), and mechanical ventilation (AOR 2.00, 95%CI 1.86-2.15). For hospitalizations with a dysphagia code, the length of stay was 44%(95%CI 1.43-1.45) longer and inpatient costs 46%higher (95%CI 1.44-1.47) compared to those without dysphagia. Mortality was also substantially increased in individuals with PD and dysphagia (AOR 1.37, 95%CI 1.29-1.46). CONCLUSION In hospitalized patients with PD, dysphagia was a strong predictor of adverse clinical outcomes, and associated with substantially prolonged length of stay, higher mortality, and care costs. These results highlight the need for interventions focused on early recognition and prevention of dysphagia to avoid complications and lower costs in PD patients.
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Affiliation(s)
- Daniel G Di Luca
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease Research, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | - Allison Willis
- Departments of Neurology and Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rosemary Martino
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Department of Speech Language Pathology, University of Toronto, Toronto, ON, Canada.,Rehabilitation Science Institute, University of Toronto, Toronto, ON, Canada.,Department of Otolaryngology- Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease Research, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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15
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Parihar R, Ferastraoaru V, Galanopoulou AS, Geyer HL, Kaufman DM. Outcome of Hospitalized Parkinson's Disease Patients with and without COVID-19. Mov Disord Clin Pract 2021; 8:859-867. [PMID: 34226870 PMCID: PMC8242623 DOI: 10.1002/mdc3.13231] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/27/2021] [Accepted: 04/11/2021] [Indexed: 12/18/2022] Open
Abstract
Background The Parkinson's disease (PD) patient population, with an already reduced life expectancy, is rendered particularly vulnerable by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Objectives We determined the risk factors that increase the risk of death in patients with Parkinson's disease who are infected by SARS-CoV-2. Methods Patients with a diagnosis of PD admitted to Montefiore Hospital (Bronx, New York) and tested for SARS-CoV-2 were identified. Retrospective review of electronic medical records confirmed the diagnosis; patients were classified by severity of PD. PD severity, demographic, socioeconomic factors, and co-morbidities were correlated with mortality rates in patients with SARS-CoV-2. Results We identified 162 patients meeting criteria; chart review confirmed a diagnosis of PD in 70 patients. Of the 70 patients, 53 were positive for SARS-CoV-2 and 17 were negative. PD patients with SARS-CoV-2 infection had a higher mortality rate (35.8%) compared to PD patients without the infection (5.9%, P = 0.028). PD patients older than 70 years of age, those with advanced Parkinson's disease, those with reductions in their medications, and non-Hispanics (largely comprised of Black/African- Americans) had a statistically significant higher mortality rate, if infected. Conclusions PD did not increase mortality rates from SARS-CoV-2 infection when age was controlled. However, certain unalterable factors (advanced disease and age greater than 70 years) and alterable ones (reductions in PD medications) placed PD patients at increased risk for mortality. Also several socioeconomic factors contributed to mortality, for example, non-Hispanic patients with SARS-CoV-2 infection fared worse, likely driven by poorer outcomes in the Black/African-American cohort.
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Affiliation(s)
- Raminder Parihar
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Victor Ferastraoaru
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Aristea S. Galanopoulou
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Isabelle Rapin Division of Child Neurology, Dominick P. Purpura Department of NeuroscienceAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Howard L. Geyer
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - David M. Kaufman
- Saul R. Korey Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
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16
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Aamodt WW, Travers J, Thibault D, Willis AW. Hospital Magnet Status Associates With Inpatient Safety in Parkinson Disease. J Neurosci Nurs 2021; 53:116-122. [PMID: 33840807 PMCID: PMC8106621 DOI: 10.1097/jnn.0000000000000582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT BACKGROUND: Persons with Parkinson disease (PD) have complex care needs that may benefit from enhanced nursing care provided in Magnet-designated hospitals. Our primary objective was to determine whether an association exists between hospital Magnet status and patient safety events for PD inpatients in the United States. METHODS: We conducted a retrospective cohort study using the Nationwide Inpatient Sample and Agency for Healthcare Research and Quality databases from 2000 to 2010. Parkinson disease diagnosis and demographic variables were retrieved, along with Magnet designation and other hospital characteristics. Inpatient mortality and preventable adverse events in hospitals with and without Magnet status were then compared using relevant Agency for Healthcare Research and Quality patient safety indicators. RESULTS: Between 2000 and 2010, 493 760 hospitalizations among PD patients were identified. Of those, 40 121 (8.1%) occurred at one of 389 Magnet hospitals. When comparing PD patients in Magnet versus non-Magnet hospitals, demographic characteristics were similar. Multivariate regression models adjusting for patient and hospital characteristics identified a 21% reduction in mortality among PD inpatients in Magnet hospitals (adjusted odds ratio [AOR], 0.79; 95% confidence interval [CI], 0.74-0.85). PD inpatients in Magnet hospitals also had a lower odds of experiencing any patient safety indicator (AOR, 0.74; 95% CI, 0.68-0.79), pressure ulcers (AOR, 0.60; 95% CI, 0.55-0.67), death from a low mortality condition (AOR, 0.74; 95% CI, 0.68-0.79), and a higher odds of postoperative bleeding (AOR, 1.45; 95% CI, 1.04-2.04). CONCLUSIONS: PD patients had a reduced risk of inpatient mortality and several nursing-sensitive patient safety events, highlighting the possible benefits of Magnet status on inpatient safety in PD.
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17
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Gandhi AB, Onukwugha E, Albarmawi H, Johnson A, Myers DE, Gray D, Alvir J, Hynicka L, Shulman LM. Health Care Resource Utilization Associated With Parkinson Disease Among Medicare Beneficiaries. Neurology 2021; 97:e597-e607. [PMID: 34045274 DOI: 10.1212/wnl.0000000000012290] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 05/03/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare differences in health care resource utilization (HcRU) over time between Medicare beneficiaries with and without Parkinson disease (PD). METHODS This retrospective observational study used the Chronic Conditions Data Warehouse (5% Medicare sample) between 2005 and 2015. In a propensity score-matched (age, sex, race, and comorbidity adjusted) sample of beneficiaries with and without PD, we examined all-cause HcRU due to inpatient admissions, emergency department (ED) admissions, skilled nursing facility (SNF) admissions, health care provider encounters, neurologist visits, rehabilitation service visits, and non-PD medication fills. Relative to beneficiaries without PD, we reported adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for beneficiaries with PD using generalized linear models with log link and negative binomial variance functions. RESULTS A total of 467,064 Medicare enrollees (unmatched sample) met the inclusion criteria. Of these, 3.3% had PD. In the matched sample and relative to beneficiaries without PD, beneficiaries with PD displayed higher rates of inpatient admissions (IRR 1.29, 95% CI 1.24-1.34), ED admissions (IRR 1.31, 95% CI 1.27-1.34), SNF admissions (IRR 2.00, 95% CI 1.92-2.09), health care provider encounters (IRR 1.18, 95% CI 1.16-1.20), neurologist visits (IRR 5.57, 95% CI 5.35-5.78), rehabilitation service visits (IRR 1.47, 95% CI 1.41-1.53), and non-PD medication fills (IRR 1.10, 95% CI 1.08-1.11) over time. CONCLUSION These results reflect patterns of medical care among Medicare beneficiaries with PD. The findings can help clinicians, payers, and policy makers make evidence-based decisions for the allocation of scarce health care resources for PD management. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that Medicare beneficiaries with PD use more health care resources than matched controls without PD.
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Affiliation(s)
- Aakash Bipin Gandhi
- From the Department of Pharmaceutical Health Services Research (A.B.G., E.O., H.A., A.J.) and Department of Pharmacy Practice and Science (L.H.), University of Maryland School of Pharmacy, Baltimore; Pfizer Inc (D.E.M.), Collegeville, PA; Pfizer Inc (D.G.), Cambridge, MA; Pfizer Inc (J.A.), New York, NY; and Department of Neurology (L.M.S.), University of Maryland, School of Medicine, Baltimore
| | - Eberechukwu Onukwugha
- From the Department of Pharmaceutical Health Services Research (A.B.G., E.O., H.A., A.J.) and Department of Pharmacy Practice and Science (L.H.), University of Maryland School of Pharmacy, Baltimore; Pfizer Inc (D.E.M.), Collegeville, PA; Pfizer Inc (D.G.), Cambridge, MA; Pfizer Inc (J.A.), New York, NY; and Department of Neurology (L.M.S.), University of Maryland, School of Medicine, Baltimore.
| | - Husam Albarmawi
- From the Department of Pharmaceutical Health Services Research (A.B.G., E.O., H.A., A.J.) and Department of Pharmacy Practice and Science (L.H.), University of Maryland School of Pharmacy, Baltimore; Pfizer Inc (D.E.M.), Collegeville, PA; Pfizer Inc (D.G.), Cambridge, MA; Pfizer Inc (J.A.), New York, NY; and Department of Neurology (L.M.S.), University of Maryland, School of Medicine, Baltimore
| | - Abree Johnson
- From the Department of Pharmaceutical Health Services Research (A.B.G., E.O., H.A., A.J.) and Department of Pharmacy Practice and Science (L.H.), University of Maryland School of Pharmacy, Baltimore; Pfizer Inc (D.E.M.), Collegeville, PA; Pfizer Inc (D.G.), Cambridge, MA; Pfizer Inc (J.A.), New York, NY; and Department of Neurology (L.M.S.), University of Maryland, School of Medicine, Baltimore
| | - Daniela E Myers
- From the Department of Pharmaceutical Health Services Research (A.B.G., E.O., H.A., A.J.) and Department of Pharmacy Practice and Science (L.H.), University of Maryland School of Pharmacy, Baltimore; Pfizer Inc (D.E.M.), Collegeville, PA; Pfizer Inc (D.G.), Cambridge, MA; Pfizer Inc (J.A.), New York, NY; and Department of Neurology (L.M.S.), University of Maryland, School of Medicine, Baltimore
| | - David Gray
- From the Department of Pharmaceutical Health Services Research (A.B.G., E.O., H.A., A.J.) and Department of Pharmacy Practice and Science (L.H.), University of Maryland School of Pharmacy, Baltimore; Pfizer Inc (D.E.M.), Collegeville, PA; Pfizer Inc (D.G.), Cambridge, MA; Pfizer Inc (J.A.), New York, NY; and Department of Neurology (L.M.S.), University of Maryland, School of Medicine, Baltimore
| | - Jose Alvir
- From the Department of Pharmaceutical Health Services Research (A.B.G., E.O., H.A., A.J.) and Department of Pharmacy Practice and Science (L.H.), University of Maryland School of Pharmacy, Baltimore; Pfizer Inc (D.E.M.), Collegeville, PA; Pfizer Inc (D.G.), Cambridge, MA; Pfizer Inc (J.A.), New York, NY; and Department of Neurology (L.M.S.), University of Maryland, School of Medicine, Baltimore
| | - Lauren Hynicka
- From the Department of Pharmaceutical Health Services Research (A.B.G., E.O., H.A., A.J.) and Department of Pharmacy Practice and Science (L.H.), University of Maryland School of Pharmacy, Baltimore; Pfizer Inc (D.E.M.), Collegeville, PA; Pfizer Inc (D.G.), Cambridge, MA; Pfizer Inc (J.A.), New York, NY; and Department of Neurology (L.M.S.), University of Maryland, School of Medicine, Baltimore
| | - Lisa M Shulman
- From the Department of Pharmaceutical Health Services Research (A.B.G., E.O., H.A., A.J.) and Department of Pharmacy Practice and Science (L.H.), University of Maryland School of Pharmacy, Baltimore; Pfizer Inc (D.E.M.), Collegeville, PA; Pfizer Inc (D.G.), Cambridge, MA; Pfizer Inc (J.A.), New York, NY; and Department of Neurology (L.M.S.), University of Maryland, School of Medicine, Baltimore
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18
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Nunez Y, Boehme AK, Weisskopf MG, Re DB, Navas-Acien A, van Donkelaar A, Martin RV, Kioumourtzoglou MA. Fine Particle Exposure and Clinical Aggravation in Neurodegenerative Diseases in New York State. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:27003. [PMID: 33555200 PMCID: PMC7869948 DOI: 10.1289/ehp7425] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 05/23/2023]
Abstract
BACKGROUND Adult-onset neurodegenerative diseases affect millions and negatively impact health care systems worldwide. Evidence suggests that air pollution may contribute to aggravation of neurodegeneration, but studies have been limited. OBJECTIVE We examined the potential association between long-term exposure to particulate matter ≤ 2.5 μ m in aerodynamic diameter [fine particulate matter (PM 2.5 )] and disease aggravation in Alzheimer's (AD) and Parkinson's (PD) diseases and amyotrophic lateral sclerosis (ALS), using first hospitalization as a surrogate of clinical aggravation. METHODS We used data from the New York Department of Health Statewide Planning and Research Cooperative System (SPARCS 2000-2014) to construct annual county counts of first hospitalizations with a diagnosis of AD, PD, or ALS (total, urbanicity-, sex-, and age-stratified). We used annual PM 2.5 concentrations estimated by a prediction model at a 1 -km 2 resolution, which we aggregated to population-weighted county averages to assign exposure to cases based on county of residence. We used outcome-specific mixed quasi-Poisson models with county-specific random intercepts to estimate rate ratios (RRs) for a 1-y PM 2.5 exposure. We allowed for nonlinear exposure-outcome relationships using penalized splines and accounted for potential confounders. RESULTS We found a positive nonlinear PM 2.5 - PD association that plateaued above 11 μ g / m 3 (RR = 1.09 , 95% CI: 1.04, 1.14 for a PM 2.5 increase from 8.1 to 10.4 μ g / m 3 ). We also found a linear PM 2.5 - ALS positive association (RR = 1.05 , 95% CI: 1.01, 1.09 per 1 - μ g / m 3 PM 2.5 increase), and suggestive evidence of an association with AD. We found effect modification by age for PD and ALS with a stronger positive association in patients < 70 years of age but found insufficient evidence of effect modification by sex or urbanization level for any of the outcomes. CONCLUSION Our findings suggest that annual increase in county-level PM 2.5 concentrations may contribute to clinical aggravation of PD and ALS. Importantly, the average annual PM 2.5 concentration in our study was 8.1 μ g / m 3 , below the current American national standards, suggesting the standards may not adequately protect the aging population. https://doi.org/10.1289/EHP7425.
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Affiliation(s)
- Yanelli Nunez
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Amelia K. Boehme
- Department of Epidemiology and Neurology, Columbia University, New York, New York, USA
| | - Marc G. Weisskopf
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Diane B. Re
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Aaron van Donkelaar
- Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Randall V. Martin
- Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marianthi-Anna Kioumourtzoglou
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
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19
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Abdulaziz AT, Sander JW. The increasing challenge of epilepsy in the elderly: shortening hospital admission. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:669-671. [PMID: 33263606 DOI: 10.1590/0004-282x20200190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 10/24/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Ammar T Abdulaziz
- Sichuan University, West China Hospital, Department of Neurology, Chengdu, China.,NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, & Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, & Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
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20
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Dodel R, Tinelli M, Deuschl G, Petersen G, Oertel W, Ahmerkamp-Böhme J. The economic benefit of timely, adequate, and adherence to Parkinson's disease treatment: the Value of Treatment Project 2. Eur J Neurol 2020; 28:707-716. [PMID: 33048415 DOI: 10.1111/ene.14584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a chronic progressive neurological disorder with a high psychosocial and economic burden. As part of the European Brain Council (EBC)-led Value of Treatment project, this study aimed to capture the economic benefit of timely, adequate, and adherence to PD treatment. METHODS The EBC Value of Treatment Initiative combined different stakeholders to identify unmet needs in the patients' journey according to Rotterdam methodology. The economic evaluation focused on three major topics identified as major gaps: start of treatment; best treatment for advanced disease; and adherence to treatment. Two separate healthcare systems (Germany and the UK) were chosen. Cost-effectiveness was determined by using decision-analytical modelling approaches. Effectiveness was expressed as quality-adjusted life-years (QALYs) gained and incremental cost-effectiveness ratio (ICER). RESULTS Treatment intervention in PD was found to be cost-effective regardless of the initial health state of the patient receiving the treatment. Cost savings were between -€1000 and -€5400 with 0.10 QALY gain and -€1800 and -€7600 with 0.10 QALY gain for Germany and the UK, respectively. Treatment remains cost-effective within the National Institute for Health and Care Excellence thresholds. Availability of adequate treatment to more patients was also found to be cost-effective, with an ICER of €15,000-€32,600 across country settings. Achieving the target adherence to treatment would generate cost-savings of €239,000-€576,000 (Germany) and €917,000-€2,980.000 (UK) for every 1,000 patients treated adequately. CONCLUSIONS The analyses confirmed that timely, adequate, and adherence to PD treatment will not only improve care of the patients but is also cost-effective across healthcare systems. Further studies with a distinct identification of gaps in care are necessary to develop better and affordable care.
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Affiliation(s)
- R Dodel
- Department of Geriatric Medicine, University Duisburg-Essen, Essen, Germany
| | - M Tinelli
- Care Policy Evaluation Centre (CPEC), London School of Economics and Political Science (LSE), London, UK
| | - G Deuschl
- Department of Neurology, UKSH, Christian-Albrechts University, Kiel, Germany
| | | | - W Oertel
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
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21
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Azmi H, Cocoziello L, Nyirenda T, Douglas C, Jacob B, Thomas J, Cricco D, Finnerty G, Sommer K, Rocco A, Thomas R, Roth P, Thomas FP. Adherence to a strict medication protocol can reduce length of stay in hospitalized patients with Parkinson's Disease. Clin Park Relat Disord 2020; 3:100076. [PMID: 34316654 PMCID: PMC8298768 DOI: 10.1016/j.prdoa.2020.100076] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/07/2020] [Accepted: 10/11/2020] [Indexed: 10/28/2022] Open
Abstract
Background Patients with Parkinson's Disease (PD) are at higher risk of complications when admitted to the hospital. Delays in PD medications and use of contraindicated medications contribute to the increased risk and prolong their lengths of stay (LOS). Using a hospital-wide PD protocol, we aimed to ensure PD medications were placed with "custom" timing to resemble the home schedules, and also to avoid ordering or administering contraindicated medications. Material and methods 569 patients admitted in 2017 and 2018, were reviewed retrospectively. Mean age was 76.5 (SD 10.6), 332 were males and 237 were females. Charts were reviewed to assess if A) PD medications were ordered with custom timing, B) if not, were the orders changed to custom timed C) if contraindicated medications were ordered, and D) if they were administered. We also assessed the actual/expected length of stay during this time period. Chi Square and post hoc analyses were done to compare time points. Poisson regression analysis was done to assess relative improvement of variables. Results There was a 2.7 fold increase in orders placed with custom timing in 2018 compared to 2017 (RR = 2.651, 95%CI: 1.860-3.780, p < 0.0001), and a 3.2 fold increase in correction of non-custom orders in the same time period (RR = 3.246, 95%CI: 1.875-1.619, p < 0.0001). We also observed a decrease in the actual/expected LOS ratio from 1.54 to 1.32 (p < 0.05). Conclusion By utilizing an established platform for quality improvement, we were able to improve adherence to the home medication regimen timing in admitted PD patients. Our findings also suggests that adherence to a strict medication regimen protocol may decrease LOS for this patient population.
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Affiliation(s)
- Hooman Azmi
- Department of Neurosurgery, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Lisa Cocoziello
- Department of Neurosurgery, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Themba Nyirenda
- Clinical Research, Hackensack University Medical Center, Hackensack, NJ, USA.,Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Claudia Douglas
- Evidence Based Practice and Nursing Research, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Blessy Jacob
- Transition Care Pharmacy, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Jewell Thomas
- Transition Care Pharmacy, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Donna Cricco
- Department of Perioperative Nursing, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Giuseppina Finnerty
- Department of Patient Care, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Kirsten Sommer
- Department of Patient Care, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Anthony Rocco
- Department of Patient Safety and Quality, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Randy Thomas
- Department of Neurosurgery, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Patrick Roth
- Department of Neurosurgery, Hackensack University Medical Center, Hackensack, NJ, USA.,Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Florian P Thomas
- Department of Neurology, Hackensack University Medical Center, Hackensack, NJ, USA.,Hackensack Meridian School of Medicine, Nutley, NJ, USA
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22
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van Wijngaarden E, Rich DQ, Zhang W, Thurston SW, Lin S, Croft DP, Squizzato S, Masiol M, Hopke PK. Neurodegenerative hospital admissions and long-term exposure to ambient fine particle air pollution. Ann Epidemiol 2020; 54:79-86.e4. [PMID: 33010415 DOI: 10.1016/j.annepidem.2020.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE Long-term exposure to ambient fine particle (PM2.5) concentrations has been associated with an increased rate or risk of neurodegenerative conditions, but individual PM sources have not been previously examined in relation to neurodegenerative diseases. METHODS Using the Statewide Planning and Research Cooperative System database, we studied 63,287 hospital admissions with a primary diagnosis of either Alzheimer's disease, dementia, or Parkinson's disease for New York State residents living within 15 miles from six PM2.5 monitoring sites. In addition to PM2.5 concentrations, we studied seven specific PM2.5 sources: secondary sulfate, secondary nitrate, biomass burning, diesel, spark-ignition emissions, pyrolyzed organic rich, and road dust. We estimated the rate of neurodegenerative hospital admissions associated with increased concentration of PM2.5 and individual PM2.5 sources average concentrations in the previous 0-29, 0-179, and 0-364 days. RESULTS Increases in ambient PM2.5 concentrations were not consistently associated with increased hospital admissions rates. Increased source-specific PM2.5 concentrations were associated with both increased (e.g., secondary sulfates and diesel emissions) and decreased rates (e.g., secondary nitrate and spark-ignition vehicular emissions) of neurodegenerative admissions. CONCLUSIONS We did not observe clear associations between overall ambient PM2.5 concentrations or source-apportioned ambient PM2.5 contributions and rates of neurologic disease hospitalizations.
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Affiliation(s)
- Edwin van Wijngaarden
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY; Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY.
| | - David Q Rich
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY; Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY; Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Wangjian Zhang
- Department of Environmental Health Sciences, School of Public Health, State University of New York at Albany, Albany
| | - Sally W Thurston
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - Shao Lin
- Department of Environmental Health Sciences, School of Public Health, State University of New York at Albany, Albany
| | - Daniel P Croft
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Stefania Squizzato
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Mauro Masiol
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY; Dipartimento di Scienze Ambientali, Informatica e Statistica, Università Ca' Foscari Venezia, Venice, Italy
| | - Philip K Hopke
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY; Center for Air Resources Engineering and Science, Clarkson University, Potsdam, NY
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Integrated and patient-centred management of Parkinson's disease: a network model for reshaping chronic neurological care. Lancet Neurol 2020; 19:623-634. [DOI: 10.1016/s1474-4422(20)30064-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/31/2020] [Accepted: 02/17/2020] [Indexed: 12/12/2022]
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24
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Fullard M, Thibault D, Zisling H, Crispo JA, Willis A. Parkinson Disease Associated Differences in Elective Orthopedic Surgery Outcomes: A National Readmissions Database Analysis. JOURNAL OF PARKINSONS DISEASE 2020; 10:1577-1586. [PMID: 32597816 PMCID: PMC7683077 DOI: 10.3233/jpd-201992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: Advances in the treatment of Parkinson’s disease (PD) have allowed for improvements in mortality and quality survival, making the management of comorbid conditions of aging, such as osteoarthritis, crucial. Objective: To determine the extent to which PD impacts hospitalization outcomes after an elective orthopedic procedure. Methods: This retrospective cohort study used data from the National Readmissions Database and included adults ages 40 and above with and without PD. Primary outcomes included length of stay of the index admission, discharge disposition and 30-day readmission. Logistic regression was used to compare the odds of readmission for PD patients compared to non-PD. Clinical conditions associated with readmission were compared between the two groups. Results: A total of 4,781 subjects with PD and 947,475 subjects without PD met inclusion criteria. Length of stay (LOS) during the index admission was longer for PD patients. PD patients were much more likely to be discharged to inpatient post-acute care (49.3% vs 26.2%) while non-PD subjects were more likely to be discharged home with (31.9% [PD] vs 44.8% [non-PD]) or without home health (18.7% [PD] vs 28.9% [non-PD]). A total of 271 PD patients (5.66%) and 28,079 non-PD patients (2.96%) were readmitted within 30 days following surgery. After adjusting for age, sex, socioeconomic status, expected payer, comorbidities, index admission LOS, year and discharge disposition, PD subjects were 31% more likely to be readmitted than non-PD subjects (AOR 1.31, 1.07–1.62). Conclusions: Parkinson’s disease patients were readmitted more often than non-PD patients, although the rate of readmission was still low.
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Affiliation(s)
- Michelle Fullard
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - Dylan Thibault
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | - James A Crispo
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,University of Delaware, Newark, DE, USA
| | - Allison Willis
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
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25
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Prell T, Siebecker F, Lorrain M, Eggers C, Lorenzl S, Klucken J, Warnecke T, Buhmann C, Tönges L, Ehret R, Wellach I, Wolz M. Recommendations for Standards of Network Care for Patients with Parkinson's Disease in Germany. J Clin Med 2020; 9:jcm9051455. [PMID: 32414071 PMCID: PMC7290836 DOI: 10.3390/jcm9051455] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/09/2020] [Accepted: 05/09/2020] [Indexed: 02/07/2023] Open
Abstract
Although our understanding of Parkinson’s disease (PD) has improved and effective treatments are available, caring for people with PD remains a challenge. The large heterogeneity in terms of motor symptoms, nonmotor symptoms, and disease progression makes tailored individual therapy and individual timing of treatment necessary. On the other hand, only limited resources are available for a growing number of patients, and the high quality of treatment cannot be guaranteed across the board. At this point, networks can help to make better use of resources and improve care. The working group PD Networks and Integrated Care, part of the German Parkinson Society, is entrusted to convene clinicians, therapists, nurses, researchers, and patients to promote the development of PD networks. This article summarizes the work carried out by the working group PD Networks and Integrated Care in the development of standards of network care for patients with PD in Germany.
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Affiliation(s)
- Tino Prell
- Department of Neurology, Jena University Hospital, 07740 Jena, Germany
- Center for Healthy Ageing, Jena University Hospital, 07740 Jena, Germany
- Correspondence:
| | | | - Michael Lorrain
- Nervenarztpraxis Gerresheim-Pempelfort, 40477 Düsseldorf, Germany;
| | - Carsten Eggers
- Department of Neurology, University Hospital Marburg, 35037 Marburg, Germany;
| | - Stefan Lorenzl
- Professorship for Palliative Care, Paracelsus Medical University, 5020 Salzburg, Austria;
- Department of Palliative Medicine, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
- Department of Neurology, Klinikum Agatharied, 83734 Hausham, Germany
| | - Jochen Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
- Medical Valley-Digital Health Application Center GmbH, 96047 Bamberg, Germany
- Fraunhofer Institute for Integrated Circuits, 91058 Erlangen, Germany
| | - Tobias Warnecke
- Department of Neurology, University of Muenster, 48149 Münster, Germany;
| | - Carsten Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Lars Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44801 Bochum, Germany;
| | | | - Ingmar Wellach
- Office for Neurology and Psychiatry Hamburg Walddörfer, Wiesenkamp 22 c, 22359 Hamburg, Germany;
- Department of Neurology, Ev. Amalie, Sieveking Hospital, 22359 Hamburg, Germany
| | - Martin Wolz
- Department of Neurology, Elblandklinikum Meißen, 01662 Meißen, Germany;
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26
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Challenges in ICU Care. Crit Care Nurs Q 2020; 43:205-215. [DOI: 10.1097/cnq.0000000000000306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Carroll V, Deutschmann K, Andrews J. Purposeful collaboration: Enriching lives for people with Parkinson’s disease. AUSTRALASIAN JOURNAL OF NEUROSCIENCE 2020. [DOI: 10.21307/ajon-2020-004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Ramirez-Zamora A, Tsuboi T. Hospital Management of Parkinson Disease Patients. Clin Geriatr Med 2019; 36:173-181. [PMID: 31733698 DOI: 10.1016/j.cger.2019.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Management of patients with Parkinson disease (PD) during inpatient hospital stays is complex and poses unique challenges for physicians and ancillary staff. Patients with PD have a high risk of complications, encephalopathy, and prolonged hospital stay. Early recognition of complications and implementation of rehabilitation strategies along with appropriate management of medications are critical to improve outcomes. Patients with PD can exhibit worsening mobility and balance, insomnia, orthostatic hypotension, multiple neuropsychiatric symptoms, and gastrointestinal dysfunction while hospitalized. This review summarizes the specific in-hospital concerns observed in patients with PD and discusses potential treatment approaches.
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Affiliation(s)
- Adolfo Ramirez-Zamora
- University of Florida, Fixel Center for Neurological Diseases, 3009 Williston Road, Gainesville, FL 32608, USA.
| | - Takashi Tsuboi
- University of Florida, Fixel Center for Neurological Diseases, 3009 Williston Road, Gainesville, FL 32608, USA
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29
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Harris M, Fry M, Fitzpatrick L. A clinical process redesign project to improve outcomes and reduce care variance for people with Parkinson's disease. Australas Emerg Care 2019; 22:107-112. [DOI: 10.1016/j.auec.2019.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/16/2019] [Accepted: 02/19/2019] [Indexed: 11/17/2022]
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30
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Hobson P, Roberts S, Davies G. The introduction of a Parkinson's disease email alert system to allow for early specialist team review of inpatients. BMC Health Serv Res 2019; 19:271. [PMID: 31039776 PMCID: PMC6492383 DOI: 10.1186/s12913-019-4092-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/12/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patients with Parkinson's disease (PWP) have complex healthcare needs, and compared to the general population, are more likely to have an unplanned emergency department (ED) attendance to hospital, along with poorer outcomes. Innovative methods of notification, when patients have an ED attendance are needed to allow for earlier specialist team interventions. This study describes the introduction of an email alert (e-alert) for a specialist Parkinson's team. In addition, the reason for admission, specialist team interventions, length of stay, frequency of readmission, discharge destination, mortality and the bed cost per ED attendance or admission episode will be explored. METHODS The e-alert was developed in collaboration with academics, a Parkinson's specialist team and hospital Information technology (IT) specialists, by employing existing software and IT system platforms. Patients were identified from an existing hospital patient administration and a specialist movement disorder database. Specific variables along with routine patient data were collected including demographics, clinical variables, specialist team interventions, reason for admission, length of stay, discharge destination, unscheduled readmission, mortality and bed cost per day. RESULTS The initial programming and setup of the e-alert was estimated to be around £3000. In its first six months, the e-alert identified 75 ED attendances, with the most common reasons being, falls and infections. The overall mean LOS was 6.8 days, with 25/75 patients being readmitted within 28 days. The most common specialist team clinical interventions were changes in medication, assessment for postural hypotension, neuropsychiatric and swallowing assessments. The majority of patients (92%) were discharged to their normal place of residence. The crude mortality rate for the cohort was approximately twice that of the hospital average. The total ED and acute bed cost was estimated to be £354,805.88, with exponential rises in healthcare costs when LOS was greater than one day. CONCLUSIONS The Parkinson's e-alert was found to a useful adjunct to existing hospital data systems in identifying PWP who have unplanned emergency attendances. Additionally, this system can also be employed as a service evaluation tool. However, further evaluation is needed to determine if this system can improve patient outcomes during their unplanned emergency attendance to hospital.
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Affiliation(s)
- Peter Hobson
- Academic Unit, Betsi Cadwaladr University Health Board, Glan Clwyd Hospital, Rhyl, Sarn Lane, Bodelwyddan, LL18 5UJ UK
| | - Sally Roberts
- Academic Unit, Betsi Cadwaladr University Health Board, Glan Clwyd Hospital, Rhyl, Sarn Lane, Bodelwyddan, LL18 5UJ UK
| | - Glesni Davies
- Academic Unit, Betsi Cadwaladr University Health Board, Glan Clwyd Hospital, Rhyl, Sarn Lane, Bodelwyddan, LL18 5UJ UK
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31
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The Hamburg Parkinson day-clinic: a new treatment concept at the border of in- and outpatient care. J Neural Transm (Vienna) 2018; 125:1461-1472. [DOI: 10.1007/s00702-018-1918-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 08/20/2018] [Indexed: 12/17/2022]
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32
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Fung A, Lai EC, Lee BC. Usability and Validation of the Smarter Balance System: An Unsupervised Dynamic Balance Exercises System for Individuals With Parkinson’s Disease. IEEE Trans Neural Syst Rehabil Eng 2018; 26:798-806. [DOI: 10.1109/tnsre.2018.2808139] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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33
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Xu K, Alnaji N, Zhao J, Bertoni J, Chen LW, Bhatti D, Qu M. Comorbid Conditions in Parkinson’s Disease: A Population-Based Study of Statewide Parkinson’s Disease Registry. Neuroepidemiology 2017; 50:7-17. [DOI: 10.1159/000484410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/17/2017] [Indexed: 12/23/2022] Open
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Abstract
Parkinson disease (PD) is the second most common neurodegenerative disorder in the United States. Because there is no cure for PD currently, pharmacological therapy is the mainstay of PD symptom management. Despite the importance of medication adherence in PD, several studies have reported medication nonadherence and/or suboptimal adherence. This literature review provides an overview of medication adherence issues in people with PD. Articles were identified for this study using computerized database searches and journal hand searches. Of the 72 medication adherence articles reviewed, the following articles were eligible for this review: (a) 10 articles measuring medication adherence in people with PD, (b) four medication adherence intervention articles, and (c) six studies of medication adherence in hospitalized settings. The importance of adherence assessment and strategies in improving medication adherence are discussed with the goal of improving symptom management and clinical outcomes in people with PD. Because medication taking is a complex and multifaceted phenomena, patient-centered, theory-driven interventions are needed to improve medication adherence and quality of care and life in people with PD.
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35
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Harris M, Fry M. The utilisation of one district hospital emergency department by people with Parkinson's disease. ACTA ACUST UNITED AC 2017; 20:1-5. [PMID: 28073650 DOI: 10.1016/j.aenj.2016.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/08/2016] [Accepted: 12/15/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is the second most common neurodegenerative disorder in Australia and the economic burden is more than $8.3 billion a year and predicted to escalate. However, little is known of the trends and characteristics of people with Parkinson's disease presenting to emergency departments (ED). METHOD The study design was a 12 month retrospective medical record audit. The study was conducted in one metropolitan 300 bed district hospital in an outer suburb of Sydney. RESULTS One hundred and twenty nine adult patients (0.4%) with PD presented with a mean age of 79.5 years (SD 7.7); all were over 60 years of age. Of the 129 PD patient cases, there were 260 separate ED episodes of care with the majority (n=151; 58.1%) of patients living in the community and presenting with falls (n=108; 41.5%). There was no statistical difference in triage code allocation when comparing PD patients and ED adult patients (over 60years). There was no difference in representation rate when comparing those over 80years (n=128) with those under 80 years (n=132). The average length of stay for PD patient episodes was 323min (SD 225) compared with 193min (SD 136) for ED patients. Younger adult patient episodes (n=132; 51.0%) were admitted to hospital more frequently than those aged over 80 years (Pearson's X2 test 162.2; df 1; p<0.001. CONCLUSION We identified in this study that people with PD have a high rate of falls, longer length of stay, high admission rate and represent frequently to the ED. Improved detection, management and a multidisciplinary approach for people with PD along with strict medication regime adherence is likely to improve safety, quality of life, reduce symptom aggravation and ongoing risk of falls.
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Affiliation(s)
| | - Margaret Fry
- Northern Sydney Local Health District, Faculty of Health, University of Technology Sydney, Australia.
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36
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Chaudhuri KR, Bhidayasiri R, van Laar T. Unmet needs in Parkinson's disease: New horizons in a changing landscape. Parkinsonism Relat Disord 2016; 33 Suppl 1:S2-S8. [PMID: 27932224 DOI: 10.1016/j.parkreldis.2016.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/22/2016] [Accepted: 11/25/2016] [Indexed: 11/15/2022]
Abstract
The success of levodopa and other classes of drugs have meant that most people with Parkinson's disease enjoy a good quality of life for many years. However, despite the availability of several drugs and formulations that can be used as monotherapy and in combination, there are a number of disease features that the current therapies are unable to address. The disease continues to progress despite treatment, patients suffer from a myriad of motor and non-motor symptoms, and a neuroprotective therapy is urgently required. To move forward with medical and surgical management, it is important to consider new insights that recent research offers and in this review we examine how a better understanding of the disease pathology and progression might improve and enrich our daily clinical practice. It is also timely to consider the service provision changes that will increasingly be needed to effectively manage the needs of the aging population.
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Affiliation(s)
- K Ray Chaudhuri
- The Maurice Wohl Clinical Neuroscience Institute, King's College London and National Parkinson Foundation Centre of Excellence, King's College Hospital London, UK
| | - Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan.
| | - Teus van Laar
- Department of Neurology, University of Groningen, Groningen, The Netherlands
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Rumalla K, Gondi KT, Reddy AY, Mittal MK. Association of Parkinson's disease with hospitalization for traumatic brain injury. Int J Neurosci 2016; 127:326-333. [PMID: 27647380 DOI: 10.1080/00207454.2016.1239196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The goal of our study was to determine if patients with Parkinson's disease (PD) are more susceptible to hospitalization for traumatic brain injury (TBI). METHODS The US Nationwide Inpatient Sample database was queried (2004-2011) to identify cohorts of patients with PD (N = 1 047 656) and without PD (N = 115 95 173). The age range of the study population was 60-89 years. The incidence of TBI among patients with PD was compared to the incidence of TBI in patients without PD. A multivariate logistic regression model, adjusted for all covariates that significantly differed in the bivariate analyses, was used to determine if PD was an independent predictor of TBI hospitalization. RESULTS The incidence of TBI hospitalization was significantly higher (relative risk: 1.76, 95% CI: 1.73-1.80) in the PD cohort. The PD cohort with TBI had fewer comorbidities and risk factors for falls/TBI compared to the non-PD cohort with TBI. The multivariable analysis, adjusting for other TBI risk factors, revealed that PD status increased the likelihood of TBI hospitalization (odds ratio: 2.99, 95% CI: 2.93-3.05). CONCLUSION Our study shows that patients with PD are more susceptible to hospitalization for TBI. A greater proportion of fall-related TBI occurs in patients with PD compared to patients without PD. Further research is needed to prevent falls in PD patients to avoid TBI.
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Affiliation(s)
- Kavelin Rumalla
- a University of Missouri-Kansas City School of Medicine , Kansas City , MO , USA
| | - Keerthi T Gondi
- a University of Missouri-Kansas City School of Medicine , Kansas City , MO , USA
| | - Adithi Y Reddy
- a University of Missouri-Kansas City School of Medicine , Kansas City , MO , USA
| | - Manoj K Mittal
- b Department of Neurology , University of Kansas Medical Center , Kansas City , KS , USA
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Abstract
Parkinson disease (PD) is a common neurodegenerative disorder in older adults characterized by motor and nonmotor symptoms and complications. Impulse control disorders (ICDs), such as pathological gambling, compulsive shopping, compulsive sexual behavior (hypersexuality), and binge eating disorder, affect 13.6% of the PD population. Use of dopamine receptor agonists (DRAs) is considered a major risk factor for ICD development. Amantadine and a high dose of levodopa were linked to ICDs to a lesser extent than DRAs. Based on the severity of behavior(s), ICDs can negatively impact social, professional, and familial lives of patients and their families. Ideally, all PD patients taking DRAs, high doses of levodopa, and/or amantadine should be routinely asked about or monitored for ICDs during therapy initiation and continuation. Dose decrease or withdrawal of the offending agent, primarily DRAs, is usually the most effective first step in ICD management. Careful dose adjustment with close monitoring is warranted due to risk for worsening of motor symptoms or emergence of dopamine agonist withdrawal syndrome (DAWS). About 1/3 of PD patients with ICD who decrease or discontinue DRA experienced DAWS. The lowest dose of DRA will need to be continued to balance ICDs and DAWS as it is not alleviated by other dopaminergic or psychotropic medications. Other therapies with low empiric evidence, such as amantadine, naloxone, cognitive behavior therapy, deep brain stimulation, and psychopharmacotherapy showed mixed results for ICD management. It is crucial that clinicians are familiar with the psychiatric complications of PD, including ICDs, beyond mere recognition and management of motor symptoms.
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Affiliation(s)
- Marketa Marvanova
- Chair and Associate Professor, Pharmacy Practice Department, College of Health Professions, North Dakota State University, Fargo, North Dakota,
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Gazibara T, Tepavcevic DK, Svetel M, Tomic A, Stankovic I, Kostic VS, Pekmezovic T. Recurrent falls in Parkinson's disease after one year of follow-up: A nested case-control study. Arch Gerontol Geriatr 2016; 65:17-24. [PMID: 26921677 DOI: 10.1016/j.archger.2016.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/30/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
Abstract
The aims of this study were to compare clinical and fall characteristics of single and recurrent falls among persons with PD and to evaluate factors associated with recurrent falls. A total of 120 consecutive persons with PD, who denied having fallen in the past 6 months, were recruited. Occurrence of falling was registered during one year. Each person was given a "fall diary" with the aim at writing characteristics of the fall and contacted by telephone each month. Over one year of follow-up 42 persons with PD (35.0%) reported falling. Of 42 persons, 19 (45.2%) went on to become single and 23 (54.8%) went on to become recurrent fallers. Indoor falls were more common among single fallers, whilst outdoor falls were more common among recurrent fallers (p=0.017). Slipping and freezing of gait was more common among single fallers (p=0.035 and p=0.024, respectively). Lower extremity weakness was more frequent among recurrent fallers (p=0.023). The most common injury both among single and recurrent fallers was the soft-tissue contusion. The only factor associated with recurrent falling among persons with PD, who did not fall in past 6 months before the start of follow-up, was worse motor performance as measured by the UPDRS III score (odds ratio [OR]=1.06, 95% confidence interval [CI] 1.01-1.11, p=0.022). These results could be used in selection of persons with PD to enroll in fall prevention programs.
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Affiliation(s)
- Tatjana Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Serbia
| | | | - Marina Svetel
- Clinic of Neurology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Aleksandra Tomic
- Clinic of Neurology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Iva Stankovic
- Clinic of Neurology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Vladimir S Kostic
- Clinic of Neurology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Serbia.
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Lubomski M, Rushworth RL, Tisch S. Hospitalisation and comorbidities in Parkinson's disease: a large Australian retrospective study. J Neurol Neurosurg Psychiatry 2015; 86:324-30. [PMID: 24876185 DOI: 10.1136/jnnp-2014-307822] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Patients with Parkinson's disease (PD) require higher levels of care during hospitalisation. Management of comorbidities in these patients aims to optimise function while minimising complications. The objective of this study was to examine patterns of hospitalisation of patients with PD in NSW with regards to sociodemographic factors, comorbidities and aspects of clinical management. METHODS A retrospective study of all patients with idiopathic PD and a control group of non-PD patients admitted for acute care to NSW hospitals between 2008 and 2012. RESULTS The study group comprised 5637 cases and 8143 controls. The mean PD patient age was 75.0 years (±10.9). Patients with PD had a significantly longer hospital stay (median 7 days, IQR 3-13 vs 1 day, IQR 1-7, p<0.001) than control patients. Patients with PD were five times more likely to be treated for delirium, three times more likely to experience an adverse drug event and syncope, more than twice as likely to require management of falls/fractures, dementia, gastrointestinal complications, genitourinary infections, reduced mobility and other trauma but half as likely to require hospitalisation for chronic airways disease and neoplasia, including melanoma, than the control group (all p<0.001). CONCLUSIONS Patients with PD are more likely to suffer serious health problems, including delirium, adverse drug reactions, syncope, falls and fractures than controls. These findings highlight PD as a multisystem neuropsychiatric disorder in which motor and non-motor features contribute to morbidity. Increased awareness of the added risk PD poses in acute hospitalised patients can be used to inform strategies to improve patient outcomes.
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Affiliation(s)
- Michal Lubomski
- The University of Notre Dame Australia, School of Medicine, Sydney, New South Wales, Australia Department of Neurology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - R Louise Rushworth
- The University of Notre Dame Australia, School of Medicine, Sydney, New South Wales, Australia
| | - Stephen Tisch
- The University of Notre Dame Australia, School of Medicine, Sydney, New South Wales, Australia Department of Neurology, St Vincent's Hospital, Sydney, New South Wales, Australia
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Gazibara T, Pekmezovic T, Tepavcevic DK, Tomic A, Stankovic I, Kostic VS, Svetel M. Circumstances of falls and fall-related injuries among patients with Parkinson's disease in an outpatient setting. Geriatr Nurs 2014; 35:364-9. [DOI: 10.1016/j.gerinurse.2014.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 05/07/2014] [Accepted: 05/12/2014] [Indexed: 10/25/2022]
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