Care Of Neurological Patients Research Articles

Transition to end-of-life care in patients with neurological diseases in an acute hospital ward

BackgroundTransitioning to end-of-life care and thereby changing the focus of treatment directives from life-sustaining treatment to comfort care is important for neurological patients in advanced stages. Late transition to end-of-life care for neurological patients has been described previously.ObjectiveTo investigate whether previous treatment directives, primary medical diagnoses, and demographic factors predict the transition to end-of-life care and time to eventual death in patients with neurological diseases in an acute hospital setting.MethodAll consecutive health records of patients diagnosed with stroke, amyotrophic lateral sclerosis (ALS), and Parkinson’s disease or other extrapyramidal diseases (PDoed), who died in an acute neurological ward between January 2011 and August 2020 were retrieved retrospectively. Descriptive statistics and multivariate Cox regression were used to examine the timing of treatment directives and death in relation to medical diagnosis, age, gender, and marital status.ResultsA total of 271 records were involved in the analysis. Patients in all diagnostic categories had a treatment directive for end-of-life care, with patients with haemorrhagic stroke having the highest (92%) and patients with PDoed the lowest (73%) proportion. Cox regression identified that the likelihood of end-of-life care decision-making was related to advancing age (HR = 1.02, 95% CI: 1.007–1.039, P = 0.005), ischaemic stroke (HR = 1.64, 95% CI: 1.034–2.618, P = 0.036) and haemorrhagic stroke (HR = 2.04, 95% CI: 1.219–3.423, P = 0.007) diagnoses. End-of-life care decision occurred from four to twenty-two days after hospital admission. The time from end-of-life care decision to death was a median of two days. Treatment directives, demographic factors, and diagnostic categories did not increase the likelihood of death following an end-of-life care decision.ConclusionsResults show not only that neurological patients transit late to end-of-life care but that the timeframe of the decision differs between patients with acute neurological diseases and those with progressive neurological diseases, highlighting the particular significance of the short timeframe of patients with the progressive neurological diseases ALS and PDoed. Different trajectories of patients with neurological diseases at end-of-life should be further explored and clinical guidelines expanded to embrace the high diversity in neurological patients.

An Analysis of Drug-Related Problems in the Neurology Ward of a Tertiary Teaching Hospital: A Cross-Sectional Study.

Background and objective Drugs that act on the central nervous system have a high potential to cause drug-related problems (DRPs). A clinical pharmacist aided by collaborative efforts within an interdisciplinary healthcare team can prevent, detect, and resolve DRPs, thereby contributing to the promotion of medication safety and improving the quality of life of individuals under care.This study aimed to assess DRPs identified in the neurology ward of a tertiary hospital from February 2016 to November 2019. Methods This was a descriptive study with a cross-sectional and retrospective design involving secondary data collected from pharmaceutical care (PC) records. Student's t-tests, Pearson correlation coefficients, Poisson models, and logistic regression models were used to analyze the associations between age, number and type of medications, duration of hospitalization, and the occurrence of DRPs. Results A total of 130 patients were included in the study, and a total of 266 DRPs were detected, with 93 patients experiencing more than one DRP and 37 not presenting any DRPs. Necessity-related DRPs were the most prevalent (46.6%) type, followed by safety-related DRPs (28.6%). The prevalence of safety-related DRPs was higher in individuals older than 60 years (p<0.001). Conclusions Of note, 84.6% of the interventions suggested by pharmacists to resolve DRPswere accepted by the healthcare team. The high number of DRPs found underscores the importance of the clinical role of the pharmacist and interprofessional collaboration in the care of neurological patients, especially in the pharmaceutical follow-up of elderly individuals.

Survey of Teleneurology Use by Neurologists in a Low-Middle Income Country.

Background Teleneurology has been in existence for decades, and the COVID-19 pandemic has escalated its widespread usage. Neurological conditions are a leading cause of death globally, with sub-Saharan Africa bearing the bulk of the burden. Nigeria has few trained neurologists with the few available concentrated in an urban region. The adoption of teleneurology will help close this treatment gap. Despite evidence of its advantage, the adoption and state of teleneurology in Nigeria are very low. This study aims to determine the state and perception of teleneurology in the care of neurological patients in Nigeria and identify challenges to its wide usage. Methods The primary research method was a descriptive cross-sectional survey among 48 neurologists in Nigeria acrossthe six geo-political zones of the country. Descriptive statistics such as frequency and percentage were used to summarize and present the results. Results A total of 48 neurologists participated, of which 46 (95.8%) specialized in general neurology. Videoconferencingis the most preferred means of telemedicine (24, 50%), followed by phone calls (16, 33.3%) and short messages (6, 12.5%). Three-quarters of the respondents are concerned about legal actions from telemedicine use. The majority (34, 70.9%) are not familiar with telemedicine tools, and 40 (83.3%) indicate low telemedicine seminar attendance. More than 90% (46) of neurologists believe that it is a viable approach and can save time and money. Barriers to telemedicine included the lack of incentive to use the technology (38, 79.2%), poor Internet connectivity (36, 75%), and the lack of exposure to telemedicine (36, 75%). Conclusions It is importantto overcome the existing barrier to teleneurology in order to fully harness its potential in addressing the shortage of health professionals in Nigeria as most neurologists are open to using it.

The evolution of Big Data in neuroscience and neurology

Neurological diseases are on the rise worldwide, leading to increased healthcare costs and diminished quality of life in patients. In recent years, Big Data has started to transform the fields of Neuroscience and Neurology. Scientists and clinicians are collaborating in global alliances, combining diverse datasets on a massive scale, and solving complex computational problems that demand the utilization of increasingly powerful computational resources. This Big Data revolution is opening new avenues for developing innovative treatments for neurological diseases. Our paper surveys Big Data’s impact on neurological patient care, as exemplified through work done in a comprehensive selection of areas, including Connectomics, Alzheimer’s Disease, Stroke, Depression, Parkinson’s Disease, Pain, and Addiction (e.g., Opioid Use Disorder). We present an overview of research and the methodologies utilizing Big Data in each area, as well as their current limitations and technical challenges. Despite the potential benefits, the full potential of Big Data in these fields currently remains unrealized. We close with recommendations for future research aimed at optimizing the use of Big Data in Neuroscience and Neurology for improved patient outcomes.

A Systematic Review of PET Contrasted with MRI for Detecting Crossed Cerebellar Diaschisis in Patients with Neurodegenerative Diseases.

There has not been extensive research into crossed cerebellar diaschisis (CCD) in neurodegenerative disorders. CCD is frequently detected using positron emission tomography (PET). However, advanced MRI techniques have come forth for the detection of CCD. The correct diagnosis of CCD is crucial for the care of neurological patients and those with neurodegenerative conditions. The purpose of this study is to determine whether PET can offer extra value over MRI or an advanced technique in MRI for detecting CCD in neurological conditions. We searched three main electronic databases from 1980 until the present and included only English and peer-reviewed journal articles. Eight articles involving 1246 participants met the inclusion criteria, six of which used PET imaging while the other two used MRI and hybrid imaging. The findings in PET studies showed decreased cerebral metabolism in the frontal, parietal, temporal, and occipital cortices, as on the opposite side of the cerebellar cortex. However, the findings in MRI studies showed decreased cerebellar volumes. This study concludes that PET is a common, accurate, and sensitive technique for detecting both crossed cerebellar and uncrossed basal ganglia as well as thalamic diaschisis in neurodegenerative diseases, while MRI is better for measuring brain volume. This study suggests that PET has a higher diagnostic value for diagnosing CCD compared to MRI, and that PET is a more valuable technique for predicting CCD.

Developing and testing inter-rater reliability of a data collection tool for patient health records on end-of-life care ofneurological patients in an acute hospital ward.

Develop and test a data collection tool-Neurological End-Of-Life Care Assessment Tool (NEOLCAT)-for extracting data from patient health records (PHRs) on end-of-life care of neurological patients in an acute hospital ward. Instrument development and inter-rater reliability (IRR) assessment. NEOLCAT was constructed from patient care items obtained from clinical guidelines and literature on end-of-life care. Expert clinicians reviewed the items. Using percentage agreement and Fleiss' kappa we calculated IRR on 32 nominal items, out of 76 items. IRR of NEOLCAT showed 89% (range 83%-95%) overall categorical percentage agreement. The Fleiss' kappa categorical coefficient was 0.84 (range 0.71-0.91). There was fair or moderate agreement on six items, and moderate or almost perfect agreement on 26 items. The NEOLCAT shows promising psychometric properties for studying clinical components of care of neurological patients at the end-of-life on an acute hospital ward but could be further developed in future studies.

A comprehensive approach to palliative care in neurological pathology

Palliative care for neurological patients is an approach to patient care and assistance to their families facing chronic, progressive, life-limiting and disabling conditions. The peculiarity of palliative care in neurology is due to the signifi cant duration of the late stages of many neurological diseases and the distinctive features of some diseases (cognitive disorders, mental disorders, speech disorders, pelvic organ dysfunction, paresis, convulsions, contracture development, etc.), as well as the presence of concomitant common symptoms (eating disorders, pain, bedsores, respiratory failure, etc.). The symptoms developing in the advanced stages of neurological diseases requiring palliative care are described. Drug and non-drug methods of treatment are described, measures aimed at improving the quality of life and preventing complications are considered. The features of pharmacotherapy, taking into account their interaction with drugs for the treatment of concomitant pathology, are considered.

II Encuentro entre Asociaciones y Pacientes Neurológicos de la Sociedad Española de Enfermería Neurológica

Empowerment is known as enabling the patient to manage their self-care. In this process patients acquire knowledge, attitudes, and skills regarding their disease in a facilitative environment. Neurology nurses are fundamental in educating and motivating this population. Nevertheless, collaboration between professionals and patients is the key to patient empowerment and coping. This is why SEDENE held the second meeting between neurological patients and associations in the context of the XXIXNational and VInternational Congress of SEDENE in the city of Granada in 2022. The nurse Pedro Soriano and patients’ associations of multiple sclerosis (AGDEM), epilepsy (APICE), Parkinson's disease (Parkinson Granada), stroke (NEUROAFEIC), headache (AEMICE), and ALS (AGRAELA) collaborated. Soriano spoke about helping relationships where patients can express emotions, feelings, and healthcare professionals are able to create an environment of trust to develop patient empowerment. Concerning patient coping skills, they talk about their fears regarding the diagnosis process, resilience, and strategies to improve their abilities in a special visit. The social and work circumstances that are affected in these patients’ lives were discussed, and their difficulties trying to balance their symptoms and their jobs or exams. They explained to us how changes in roles due to their disease affect social integration and family relationships. They reiterated how they had lost their personal identity with the diagnosis of their disease and its progression. Neurology nurses are a point of reference in their care, essential in interdisciplinary teams, and they highlight inequalities in care according to communities and areas. We would therefore like to thank all the attendees for their testimonies and participation, and hope that these activities will influence nursing practice in the care of neurological patients.

Second meeting between neurological patients and associations from the Spanish Society of Neurology Nursing

Empowerment is known as enabling the patient to manage their self-care. In this process patients acquire knowledge, attitudes, and skills regarding their disease in a facilitative environment. Neurology nurses are fundamental in educating and motivating this population. Nevertheless, collaboration between professionals and patients is the key to patient empowerment and coping. This is why SEDENE held the second meeting between neurological patients and associations in the context of the XXIX National and V International Congress of SEDENE in the city of Granada in 2022. The nurse Pedro Soriano and patients’ associations of multiple sclerosis (AGDEM), epilepsy (APICE), Parkinson’s disease (Parkinson Granada), stroke (NEUROAFEIC), headache (AEMICE), and ALS (AGRAELA) collaborated. Soriano spoke about helping relationships where patients can express emotions, feelings, and healthcare professionals are able to create an environment of trust to develop patient empowerment. Concerning patient coping skills, they talk about their fears regarding the diagnosis process, resilience, and strategies to improve their abilities in a special visit. The social and work circumstances that are affected in these patients’ lives were discussed, and their difficulties trying to balance their symptoms and their jobs or exams. They explained to us how changes in roles due to their disease affect social integration and family relationships. They reiterated how they had lost their personal identity with the diagnosis of their disease and its progression. Neurology nurses are a point of reference in their care, essential in interdisciplinary teams, and they highlight inequalities in care according to communities and areas. We would therefore like to thank all the attendees for their testimonies and participation, and hope that these activities will influence nursing practice in the care of neurological patients.

The First Neuropalliative Care Unit in Germany-Characteristics of Patients.

We retrospectively analyzed the characteristics of patients treated in our NPC unit between February 2021-February 2022. Data were extracted from medical records and PC assessment including diagnosis, mode of admission and discharge, length of stay, and palliative symptoms. Data are presented as averages with a 95% confidence interval [lower limit; upper limit] or percentage (absolute number). We included 143 patients (52% (75) female, 67.9 years [65.6; 70.2]). Patients were admitted from general wards (48%; 68), their homes (22%; 32), intensive care units (16%; 23) or emergency departments (14%; 20). The main diagnoses were tumors of the nervous system (39%; 56), neurodegenerative diseases (30%; 43), neurologic complications (13%; 19) and cerebrovascular diseases (12%; 17). Complaints most frequently rated as severely to overwhelmingly burdensome were motor- or fatigue-associated problems, problems communicating, dysphagia and pain. The average length of stay was 13.7 days [12.2; 15.2]. Forty-five percent (64) of patients were discharged without further PC, 17% (24) were referred to a hospice and 13% (18) were discharged with outpatient PC. Five percent (7) were referred to neurorehabilitation and 21% (30) of patients died. Our NPC unit is a new model of care for neurological patients with substantial PC needs especially within the structures of a highly specialized and individualized medicine.

Optimizing home-based long-term intensive care for neurological patients with neurorehabilitation outreach teams – protocol of a multicenter, parallel-group randomized controlled trial (OptiNIV-Study)

BackgroundEven with high standards of acute care and neurological early rehabilitation (NER) a substantial number of patients with neurological conditions still need mechanical ventilation and/or airway protection by tracheal cannulas when discharged and hence home-based specialised intensive care nursing (HSICN). It may be possible to improve the home care situation with structured specialized long-term neurorehabilitation support and following up patients with neurorehabilitation teams. Consequently, more people might recover over an extended period to a degree that they were no longer dependent on HSICN.MethodsThis healthcare project and clinical trial implements a new specialised neurorehabilitation outreach service for people being discharged from NER with the need for HSICN. The multicentre, open, parallel-group RCT compares the effects of one year post-discharge specialized outpatient follow-up to usual care in people receiving HSICN. Participants will randomly be assigned to receive the new form of healthcare (intervention) or the standard healthcare (control) on a 2:1 basis. Primary outcome is the rate of weaning from mechanical ventilation and/or decannulation (primary outcome) after one year, secondary outcomes include both clinical and economic measures. 173 participants are required to corroborate a difference of 30 vs. 10% weaning success rate statistically with 80% power at a 5% significance level allowing for 15% attrition.DiscussionThe OptiNIV-Study will implement a new specialised neurorehabilitation outreach service and will determine its weaning success rates, other clinical outcomes, and cost-effectiveness compared to usual care for people in need for mechanical ventilation and/or tracheal cannula and hence HSICN after discharge from NER.Trial registrationThe trial OptiNIV has been registered in the German Clinical Trials Register (DRKS) since 18.01.2022 with the ID DRKS00027326.

The Degree of Independence of the Charges and the Level of Physical and Mental Burden of Nurses Caring for Neurological Patients in Geriatric Age

Introduction. Caring for neurological patients in the elderly has in its scope many problems and difficulties which a modern nurse has to “pay attention to”. Patients require round-the-clock and comprehensive care, which can lead to both the physical and mental exhaustion of the nurse, lack of time for family and friends, or free time to regenerate one’s strength. It can also lead to exhaustion or depression. Then a phenomenon called loading occurs.Aim. The aim of the study was to assess the influence of the degree of independence of charges on the level of physical and mental burden of nurses caring for neurological patients in geriatric age.Material and Methods. The study included 120 people — male and female nurses from treatment and conservative departments. The Katz Scale — Basic Life Activities (ADL) and the Lawton Scale (IADL) — Complex Activities were used. A self-survey questionnaire was used as a research tool. The obtained results were analysed statistically.Results. After analysing the data, the biggest problem for the respondent is: bathing, using the toilet and getting out of bed. According to the respondents, their charges have the least problems: using the telephone, managing money and administering medications. The biggest ones, however: doing housework and washing. The study also showed that more than half of the people (73) are dependent, which is 60.8%. Attention was also paid to the most common diseases that occur among the studied group of charges. According to the respondents, a large percentage of the charges were people after stroke — 63.50% and, for example, Alzheimer’s disease — 29.17%. According to the respondents, the greatest psychological burden, such as: depression of mood 64.5% occurs when caring for dependent patients, although a large percentage of depression can also be observed among caregivers of people with moderate dependency. Statistical analysis showed significant correlation between the respondents’ opinion of how high their psychological burden is in the care of neurological patients in geriatric age and the degree of independence of the patient (p = 0.008). Most of the respondents noticed the frequent possibility of physical stress, taking care of people 82.8%.Conclusions. The degree of independence of charges has a significant impact on the phenomenon of physical and mental strain in nurses. Along with the charge’s worse efficiency and the decrease in their independence, the degree of negative influence of the care on the nurse increases. Neurological diseases (Alzheimer’s disease, Parkinson’s disease, dementia and strokes) are also important. This is largely due to the additional time burden, as this care must be provided continuously and uninterruptedly. (JNNN 2022;11(1):22–26)

Development and validation of the Myasthenia Gravis TeleScore (MGTS)

ObjectiveThe aim of our study was to validate the Myasthenia Gravis TeleScore (MGTS), a scale for the evaluation of MG patients in telemedicine.IntroductionCOVID-19 pandemic has boosted telemedicine in clinical practice. It could be crucial in the care of neurological patients with chronic disease. However, there is a lack of validated disease-specific tools to evaluate MG patients in telemedicine.MethodsThe MGTS included ten items divided in four districts: ocular, generalized muscular strength, bulbar, and respiratory. Patients were assessed with two different scales: the MGTS and the INCB-MG chosen as a reference from which MGTS was partially derived. Visit in presence with INCB-MG and televisit with MGTS were performed consecutively. Televisit was conducted by another neurologist between two rooms. A blind method was adopted. The strength of correlation was determined by the correlation coefficient (r); analysis of covariance (ANOVA—Kruskal–Wallis test) was used to compare subgroups. Significance was set to p < 0.05.ResultsOne hundred thirty-one patients were included in the study, 71 females and 60 males. The Spearman correlation coefficient between the INCB-MG scale and the MGTS was 0.825 (p < 0.001), indicating a very strong correlation between them. Different items showed different correlations from low to high (0.32 to 0.80). As expected, correlation was lower between items with different evaluation modality (anamnestic vs clinical).DiscussionThe MGTS demonstrated a good correlation with INCB-MG, reliability and construct validity.

Comment: Introducing Neuromodulation in 2035: Future Forecasting Series.

One of the easiest ways to conjure a futuristic image of medicine is to discuss how devices—implanted and otherwise—will be integrated into clinical care. In this issue of Neurology ®, Drs. Denison and Morrell1 explore the rapidly advancing field of neuromodulation, and how it will affect the care of neurologic patients in 2035.

Telephone Interview for Cognitive Status (TICS): Italian adaptation, psychometrics and diagnostics.

Background Telephone-based cognitive screening (TBCS) is crucial to telehealth care of neurological patients, prevention campaigns, and epidemiological studies on cognitive impairment. The Telephone Interview for Cognitive Status (TICS) is one of the most widespread and psychometrically/diagnostically sound TBCS test, with several versions developed worldwide (e.g., with and without a delayed recall item). In Italy, only attempts of adaptation and preliminary evidence of its statistical features have been provided so far. This study thus aimed at (1) developing an Italian version of the TICS and assessing its (2) psychometric and (3) diagnostic properties.MethodsA back-translated and culturally adapted version of the TICS was developed. Three-hundred and sixty-five healthy individuals from different regions of Italy (147 males, 216 females; age: 53.2 ± 16 years; education: 13 ± 4.5 years) were administered the TICS and the Italian telephone-based Mini-Mental State Examination (Itel-MMSE). Validity was tested by convergence and at the structure level, whereas reliability as internal consistency, test–retest, and inter-rater. Diagnostic accuracy, item difficulty, and discrimination were also examined.ResultsThe TICS featured a single component and its score converged with that of the Itel-MMSE (rs = .37). Reliability was excellent as inter-rater (ICC = .94), good as test–retest (ICC = .78), and acceptable as internal consistency (Cronbach’s α = .63). Accuracy was high as tested against the Itel-MMSE (AUC = .83) and did not improve when adding the delayed recall. Backward subtraction was the most difficult and discriminative task.DiscussionThe Italian TICS is a valid, reliable, and diagnostically accurate TBCS test. The original format of the TICS can be thus adopted in both clinical and research settings.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10072-021-05729-7.

Development and validation of the myasthenia gravis telescore (MGTS)

Covid-19 pandemic has boosted telemedicine in clinical practice. It could be crucial in the care of neurological patients with chronic disease. However there is a lack of specific disease tools to evaluate patients in telemedicine. The aim of our study was to validate the Myasthenia Gravis TeleScore (MGTS), a scale for the evaluation of MG patients in telemedicine.

Optimizing telemedical care in neurological outpatients by characterizing the patients\u2019 needs in the physician\u2013patient relationship\u2014content analysis of guideline-based interviews

BackgroundThe use of new concepts in patient care, such as video-consultations, reminder systems, and online evaluation portals, is becoming increasingly important in the physician–patient relationship and outpatient care. This study examines the acceptance of these approaches in a neurological setting and determines the patients’ preferences.MethodsWe analyzed 16 guideline-based qualitative interviews with neurological patients using qualitative content analysis (inductive category formation).ResultsThe patients commented on the benefits and challenges of integrating new concepts of medical care. They identified advantages of telemedical care, including time savings (7 of 16; 43,8%) for both the patient and the physician, the prospect of more intensive (4 of 16; 25%) care, and the possibility for a quick response in case of urgent needs (3 of 16; 18.8%). Several challenges were reported, such as the limitations for patients with psychiatric (2 of 16; 12.5%) or complex diseases (4 of 16; 25%) and limited options for diagnostic procedures (such as physical examination (4 of 16; 25%)).For individual neurological patients' needs, telemedical and telecommunication structures could be discussed, which support the patients' specific requirements, such as answering questions while having a recall (2 of 16; 12.5%) and avoiding the journey (8 of 16; 50%). Also, patients are rejecting evaluation portals and are skeptical of telecare in the treatment of neurological diseases.DiscussionThe perception of telemedical care and the successful integration of new medical care concepts depend on fulfilling the individual patient’s needs. Regardless of the preferred nature of physician–patient interactions, there are specific instruments that can intensify the relationship. These individual needs of the patients must be inquired about and accommodated for.ConclusionsFor the first time, we could characterize the properties of optimal telemedical care for neurological patients. Interviews like the ones we conducted should be repeated during and after the pandemic, referring to our results and compare.

Mitigating Disruptions in Care for Neurological Patients during the COVID19 Pandemic

Mitigating Disruptions in Care for Neurological Patients during the COVID19 Pandemic

A Short Note on Neuro-Cardiology

Neuro-cardiology is defines the pathophysiological reciprocal action of the both nervous and cardiology system. The constant communication between the heart and brain has the invaluable to multidimensional fields of the both neurological and cardiology. Clinical management of the heart and brain related diseases cannot be viewed in isolation. Cardiac issues often influence the intense care of neurologic patients. A brain–heart link is more known to cardiologists than the neurologists. This chapter provides some insight into the pathophysiology of these pathologic neuro-cardiac states and their most appropriate management relevant to neurologists.

A Department Approach to Teleneurology

The coronavirus disease-19 (COVID-19) pandemic has compelled health care practices and academic departments to evaluate the suitability of telemedicine for various specialties and attempt rapid implementation to enable continuation of health care that is safe for providers and patients. Many patients with neurological disorders are well suited to evaluations through video. The department of neurology at the University of Pennsylvania (Penn Neurology), with the support of the health system, rapidly expanded telemedicine services to meet the needs of our patient population. This accomplishment required the complex coordination of multiple disciplines and roles within the department and the health care system, including faculty, residents, administrative staff, research and technical staff, information services, and the connected health team. Procedures for provider and patient education were established. Surveys of the provider and patient experience were developed and deployed. The process has demonstrated the vital role telemedicine in neurology (teleneurology) should play in the care of neurological patients beyond the pandemic. We describe our experience as a template for other departments and practices seeking to establish teleneurology programs, as well as an illustration of the challenges and barriers to its implementation.