Care Of Neurological Patients Research Articles

Treatment and Management of Spasticity

Treatment and Management of Spasticity Abstract. In the care of neurological patients with a lesion of the first motor neuron, for example after stroke or multiple sclerosis, spasticity is a common problem with considerable impairment of quality of life. The treatment is based in the first place on therapeutic and nursing interventions. In addition, a systemic antispastic medication or, depending on the distribution of the spasticity, local injections with botulinum neurotoxin can be applied. If this is insufficient, surgical procedures may be considered.

COVID-19: A neurological point-of-view

Evidence of neurological complications and direct affection of neuronal structures in the course of infections with SARS-CoV-2 is actually emerging. Therefore adequate medical care for neurological patients must also be guaranteed as part of the current SARS-CoV-2 pandemic. Multiple, peripheral and central neurological affections have been described, such as particular headache, consciousness disorders, cranial nerve disorders, peripheral nerve damage, epileptic seizures and ischemic events. Since abundant information on COVID-19 is published on a daily basis, this article aims to summarize and evaluate the current literature on this topic.

Optimization of long-term care of neurological patients through internet- and mobile-based interventions with and without persuasive elements including gamification

In a pilot study of 60 neurological long-term patients (degenerative cerebral microangiopathy with reduced sensorimotor stability), an initial assessment of the practicability of a specially developed concept was carried out focusing on the communication aspect of long-term medical treatment. Patient preferences, methods for increasing the patient's own activity and other factors determining adherence were analysed and optimised. In addition to communication and factual arguments, an affective-emotional, multi-layered message transmission is required, which adapts comprehensively and in real time to the recipient. Persuasion is the targeted addressing of behavioural patterns. Gamification transfers playful elements into a game-free context. Technology-based approaches offer an opportunity to optimize aspects of health, quality of life and positive disease management, e. g. through the use of internet- and mobile-based interventions (IMIs). Based on this information-theoretical and health-communicative background, a pilot study was conducted with 60 neurological long-term patients with symptomatic cerebral microangiopathy patients hospitalised for an existing sensorimotor incompetence. During the one-week inpatient stay, patients received an introduction to a standardized sensorimotor training therapy, which they then continued for six weeks after being discharged as a four-arm intervention study on an outpatient basis on the clinic campus or at home, each without and with gamification. Patients were examined at the beginning and end of the training phase with motor-functional procedures and test psychology. Thereafter, they were subjected to a standardised guideline interview. The most important results were as follows:- The training therapy was effective and was accepted by the patients. They attached particular importance to: high user-friendliness, high precision in reflecting their level of control of even subtle training elements, and personal progress evaluation in real time.- The domestic training results were better than those of the ambulance campus.- A comparison of the individual groups showed almost consistently better results under gamification, both at home and on an outpatient basis.

Validation of a palliative care outcome measurement tool supplemented by neurological symptoms (HOPE+): Identification of palliative concerns of neurological patients

Background: There is growing interest to integrate palliative care and its structures into the care of neurological patients. However, in Germany there is no comprehensive assessment tool capturing the symptoms of patients with advanced neurological diseases. Aim: To validate a newly developed palliative care measurement tool based on an extension of the validated core documentation system Hospice and Palliative Care Evaluation considering additional neurological issues (HOPE+). Design: Prospective, observational study using HOPE+ and as external criteria, the Eastern Cooperative Oncology Group (ECOG) performance status and the 12 months “surprise” question (12-SQ) in a neurological population, and assessment for its construct validity and diagnostic accuracy. Setting/participants: All newly admitted patients to the Department of Neurorehabilitation, Dr. Becker Rhein-Sieg-Clinic aged 18–100 years (#DRKS00010947). Results: Data from 263 patients (63 ± 14 years of age) were analyzed. HOPE+ revealed a moderately correlated six-factor structure (r = –0.543–0.525). Correlation analysis to evaluate discriminant validity using ECOG as external criterion was high (rs(261) = 0.724, p < 0.001) and confirmed for severely affected patients by adding the 12-SQ (“No”-group: 48.00 ± 14.92 vs “Yes”-group: 18.67 ± 7.57, p < 0.009). Operating characteristics show satisfactory diagnostic accuracy (area under the curve: 0.746 ± 0.049, 95% confidence interval = 0.650–0.842). Conclusion: HOPE+ demonstrates promising psychometric properties. It helps to assess palliative care issues of patients in neurological settings and, in combination with the 12-SQ, conceivably conditions when to initiate the palliative care approach in a population underrepresented in palliative care structures so far.

Telemedicine in Palliative Care: Implementation of New Technologies to Overcome Structural Challenges in the Care of Neurological Patients.

Telemedicine provides a possibility to deal with the scarcity of resources and money in the health care system. Palliative care has been suggested to be appropriate for an increasing number of patients with neurodegenerative disorders, but these patients often lack care from either palliative care or neurology. Since palliative care means a multidisciplinary approach it is meaningful to use palliative care structures as a basis. There exists no systematic access to neurological expertise in an outpatient setting. A successful link of two existing resources is shown in this project connecting the Department of Neurology of an University Hospital with specialized outpatient palliative care (SPC) teams. A videocounselling system is used to provide expert care for neurological outpatients in a palliative setting.Methods: A prospective explorative single arm pilot trial was implemented to provide a mobile telesystem for 5 SPC teams. The opportunity was given to consult an expert in neuropalliative care at the specialized center in the hospital (24/7). Semistructured interviews were conducted with the physicians of the SPC teams after a trial duration of 9 months.Results: Our data provides strong evidence that the technical structure applied in this project allows a reasonable neurological examination at distance. Qualitative interviews indicate a major impact on the quality of work for the SPC teams and on the quality of care for neurological patients.Conclusion: The system proves to be useful and is well accepted by the SPC teams. It supplies a structure that can be transported to other disciplines.

Nurses' knowledge about perioperative care of patients with neurological diseases.

This study investigated the level of nurses' knowledge regarding the perioperative care of neurological patients. An author-developed questionnaire of 20 items was used in a sample of 94 hospital nurses serving in the neurology, surgery and anesthesiology departments and the intensive care unit. The average percentage of participants with correct answers was 49.2%. The mean value of participants' score was 9.8 ±3.4. Preexisting experience in the care of cases with multiple sclerosis and Parkinson's disease was positively related to the level of knowledge (p = 0.001 and 0.014 respectively). The ascertained level of nurses' knowledge regarding the perioperative care of neurological patients was moderate, questioning their adequacy to handle such cases. Previous experience in the care of particular diseases had significantly positive impact on knowledge, suggesting potential improvement strategies through targeted education and specialization of nurses. In conclusion, nurse's knowledge regarding perioperative care of neurological patients was insufficient, requiring appropriate improvement interventions.

Nationwide survey of postgraduate medical training in clinical neurology

Currently, no data are available, which reflect the situation of medical doctors specializing in neurology in German hospitals. In order to secure the high standard of neurological patient care it is essential to evaluate the working conditions and the specialty training in neurology. This nationwide survey was conducted throughout Germany with the aim to address problems and to give suggestions for improvements in neurological training curricula. The survey was online from February to May 2017 and 953 neurologists undergoing further training participated. More than half of the young neurologists were satisfied with their medical training. One of the main problems that complicates clinical training is the workload. In addition, organizational obstacles within the clinic, such as poor structure of education or alack of mentors, lead to dissatisfaction among participants. The size or type of the department, as well as the prevailing service system, exert only aminor influence on the quality of specialist training, although there were differences especially in the self-assessment of the participants in connection with the type of department (university hospital versus public or private hospital). Specialist training in neurology can be improved by simple arrangements, e. g., the introduction of abinding rotation scheme, internal mentoring and structured feedback. In addition, it will be necessary to relieve medical staff of administrative duties in order to create time for training and the learning of competencies.

Wilder Penfield, Sir Arthur Currie, and the Montreal Neurological Institute.

Wilder Penfield and the Montreal Neurological Institute (MNI) are inextricably linked. It was Penfield's unique idea to create a building with an academic atmosphere wherein basic neuroscience and clinical care of neurological patients would benefit from interaction and mutual support. It is clear that without Penfield that there would be no MNI; however, the role of another Canadian icon, Sir Arthur Currie, in the development of the MNI has heretofore been barely mentioned. The thesis of this paper is that Currie had a critical role in the gestation of the MNI that has generally been ignored.

New Structures in Neurology: Palliative Care for Neurological Patients

AbstractAlthough patients with incurable neurological diseases suffer from a variety of distressing symptoms and may die from their neurological condition and associated complications, palliative and hospice care for these patients to date remains rare. Initial estimates indicate that on average 10% of all patients suffering from a neurological disease need palliative and hospice care. However, within German neurology departments, only few physicians (on average 1.3/department) and nurses (on average 2.2./department) are specialized in palliative and hospice care and only about 3% of patients cared for in palliative or hospice care structures suffer from neurological diseases (in contrast to the approximately 80% of patients suffering from oncological diseases). This rather low number is due to the gradual increase in the awareness of palliative and hospice care needs for neurological patients and a currently predominant supply of oncological patients in palliative and hospice care structures that are primarily aimed at these patients. Correspondingly, the special aspects of neurological patients are currently not adequately addressed in the palliative training curricula of healthcare professionals. Rather, patients with advanced neurological conditions are medically cared for by general practitioners and by the existing inpatient and outpatient neurology structures, which may also offer sub-specialty services. Consequently, adequate care for severely affected neurological patients becomes difficult as soon as these patients are hardly able to visit these structures because home-based specialist treatment is currently rendered and financed only to a limited degree. Novel yet to date rare approaches, mostly of international origin, suggest that these patients may benefit from specialized home-based services, combining neurological and palliative care expertise. At present, data that characterizes the situation of neuro-palliative care in Germany remains scarce. In addition to the already known supply gaps (e. g., low rate of neurologists trained in palliative medicine as well as of nurses working in neurology trained in palliative care, lack of consideration of the specific (care) needs of neurological patients in general and specialized palliative and hospice care structures, few available home-based outpatient specialists) research is a prerequisite to identify current gaps in palliative care of neurological patients in more detail and how these might be overcome in the future.

Perceptions of clinical neurosciences among trainees in Wuhan, China

Aim: Understand attitudes of Chinese medical students toward clinical neuroscience at a time of medical education reform. Methods: A survey assessed Chinese medical students’ self-perceived knowledge of neurology and comfort in diagnosing/managing neurological disorders. An assessment of students’ preferred methods for learning neurology was also conducted. Results: Chinese students reported knowledge of neurology lower than most but not all other specialties. This self-reported knowledge increased between progressive years of training. However, comfort with the clinical care of neurologic patients did not improve. Bedside teaching, small group sessions and textbooks were deemed the most favored methods for learning. Discussion: An understanding of attitudes toward neurology among medical students in China can play an important step in curriculum development and reform in the neurosciences.

Clinical pharmacist interventions on a Chinese neurology ward: a 2-year service evaluation.

A prospective observational study of clinical pharmacist interventions was conducted over a 2-year period from November 2012 to October 2014 to evaluate the clinical activity of pharmacists in the care they provide to patients and to promote safe and effective medication therapy by quantifying medicine-related interventions on a Chinese neurology ward. All pharmacist interventions made in the department of neurology were recorded, categorized, and assessed for potential patient harm if the intervention had not taken place. The quantity, outcomes, and potential severity of clinical pharmacists' interventions were recorded. 619 interventions were made in 385 patients over the 2-year observational period. The mean severity of potential harm assessment was 3.7 (1.12), range 0.8 - 7.0. 87 of the 619 interventions (14.0%) were classified as medication errors. The results of the clinical pharmacist intervention study demonstrated that pharmacists play an important role in the care of neurological patients by improving patient care and reducing clinical risk.

Need for palliative care for neurological diseases.

The new concept of palliative care supports the idea of palliation as an early approach to patients affected by disabling and life-limiting disease which focuses on the patient's quality of life along the entire course of disease. This model moves beyond the traditional concept of palliation as an approach restricted to the final stage of disease and widens the fields of intervention. There is a growing awareness of the importance of palliative care not only in oncological diseases but also in many other branches of medicine, and it appears particularly evident in the approach to many of the most frequent neurological diseases that are chronic, incurable and autonomy-impairing illnesses. The definition and implementation of palliative goals and procedures in neurology must take into account the specific features of these conditions in terms of the complexity and variability of symptoms, clinical course, disability and prognosis. The realization of an effective palliative approach to neurological diseases requires specific skills and expertise to adapt the concept of palliation to the peculiarities of these diseases; this approach should be realized through the cooperation of different services and the action of a multidisciplinary team in which the neurologist should play a central role to identify and face the patient's needs. In this view, it is paramount for the neurologist to be trained in these issues to promote the integration of palliative care in the care of neurological patients.

Latent Growth Modeling of nursing care dependency of acute neurological inpatients.

Longitudinal three-time point study, addressing how neurological adult patient care dependency varies from the admission time to the 3rd day of acute hospitalization. Nursing care dependency was measured with the Care Dependency Scale (CDS) and a Latent Growth Modeling approach was used to analyse the CDS trend in 124 neurosurgical and stroke inpatients. Care dependence followed a decreasing linear trend. Results can help nurse-managers planning an appropriate amount of nursing care for acute neurological patients during their initial stage of hospitalization. Further studies are needed aimed at investigating the determinants of nursing care dependence during the entire in-hospital stay.

The Impact of Continuous and Ongoing Professional Development on the Nursing Process of Taking Care of Neurological Patients

Introduction. Nurses distinguish continuous professional development intended for career improvement and personal development from continuous professional development intended for improvement of skills and knowledge. Too many requests are put in front of an individual unacceptably stretching it onto the life outside work. Nurses and students have various expectations from their education.Aim. The aim of the study was to recognize the motivation and expectations of nurses undertaking further nursing education.Material and Methods. A three-phase study was conducted in 2007, 2009 and 2010 and included 622 nurses, 132 head nurses and 106 nursing undergraduate students at the University of Applied Health Studies in Zagreb, respectively. Anonymous questionnaire was used in the study.Results. Factors that motivate nurses to study are to improve knowledge, patient care and professional relations. Factors connected to personal development include boost of confidence and embracing of other values. Motivation for additional education is also connected to the change of work, practice improvement, self-confidence improvement, nursing career plans, and necessary intellectual stimulation. The reasons for which nurses decide to undertake further education are also desire for maintenance of clinical competence, but also enjoyment in studying itself.Conclusions. A permanently educated nurse will be able to assess the needs of patients of health care on time and consequently organize the provision of health care by using all human and technical resources. (JNNN 2014;3(1):10–14)

Perspectives of an innovative ophthalmological technology: Optical coherence tomography (OCT) – What should be of interest to the neurologist?

Ocular coherence tomography has revolutionised the prospects of measuring the loss of retinal ganglion cells secondary to degenerative diseases and monitoring time-dependent changes of optic disc morphology, since the resolution has been improved considerably and the time required has been reduced. Although the non-invasive technique promises a high inter-session reproducibility, the limitations of retinal imaging and the problems of segmenting of the retinal layers have to be taken into account. While the first studies were limited to single sessions in small groups, further trials will elucidate how the retinal nerve fibre layer (RNFL) is altered in the course of different episodic forms of multiple sclerosis. This review points out that the examination technique already provides comprehensive information, valuable in the daily care of neurological patients.

Quality of life as the mental aspect of health in the measurement-based care of neurological patients

Quality of life as the mental aspect of health in the measurement-based care of neurological patients

Abstract TP335: Cohorting Patients From Door to Discharge Impact on Improved Patient Outcomes

Background: Evidence-based studies illustrate the effectiveness of specialized stroke services in improving stroke patient outcomes. The American Stroke Association (ASA) has recommended the development of primary (PSC) and comprehensive (CSC) stroke centers to ensure that organizations have the expertise and resources to provide stroke care. Purpose: Cohorting (grouping) stroke and transient ischemic attack (TIA) patients on a dedicated neurological intensive care unit (ICU) and providing continuum of neurological patient care through the stroke unit has shown to improve patient outcomes through 90-100% compliance with stroke core measures and Get With The Guidelines ( GWTG ) quality measures. Methods: The ICU redesigned and selected eight neurological beds; while simultaneously, the medical/surgical stroke unit transitioned to include neuroscience/telemetry. The transition utilized the theoretical framework of Appreciative Inquiry (AI) to promote positive culture change. Through the dedication of nursing leadership, stroke coordinator and neuro educators, a comprehensive education plan was executed for all registered nurses of these units. Through utilization of coordinated NIHSS during change of shift and inter-department report, subjective differences were eliminated and baseline assessment created consistently. A neuroscience task force established and incorporated nurses from emergency room, intensive care unit and neuroscience/telemetry unit to facilitate collegiality and stroke patient care continuum. Results: Examination of the Stroke Core Measures and GWTG quality measures pre and post the transitions confirmed improved compliance with ASA’s stroke core measures and quality indicators. In addition, the patient length of stay decreased well below the national average and 30 day readmission rate decreased as well. Conclusions: The benefit from treatment in a dedicated stroke unit remains a key component of improved outcomes. Therefore, creating a coordinated stroke/TIA continuum of care from door to discharge has exhibited improvement of the core measures and quality indicator compliance thus improving patient outcomes.

Evaluating Exposure to Abuse and Violence in Neurological Patients

The relationship between abuse and violence and the care of neurological patients is an important topic not often addressed, and studies suggest that most neurologists do not routinely screen patients for abuse. In this pilot study, our aim was to demonstrate a simple and effective strategy for screening patients for exposure to abuse. A total of 103 consecutive patients reporting to an academic neurology clinic specializing in autonomic and movement disorders were screened for a history of abuse and violence. A set of 6 questions were included in the standard patient intake questionnaire. The questions were then repeated verbally during the physician history taking. All patients were provided with information on available local resources for abuse counseling during the visit. Retrospective chart review analysis was performed to determine the prevalence of history of abuse in the population, the most common type of abuse suffered, and the number of individuals reporting current abuse. Twenty-two of the 103 patients (21%) screened for abuse reported exposure to abuse or violence. Two patients with ongoing issues with abuse were identified. The most commonly reported abuse was being a witness to violence (65%), followed by physical abuse (41%), sexual and emotional abuse (36% each), and financial abuse (23%). The neurological disorders most frequently observed in these patients were chronic pain, neuropathy, autonomic dysfunction, headache, and Parkinson disease. Patients with neurological disorders may have been exposed to abuse and violence. It is important to recognize these issues and address them routinely in the neurological evaluation. A simple, effective way to accomplish screening in the outpatient setting is through the use of an intake questionnaire combined with verbal clarification.

Nursing care of neurological patients with a permanent cavity filter to prevent pulmonary embolism

Objective To evaluate the neurological deep venous thrombosis in patients with permanent cava filter to prevent pulmonary embolism and explore the nursing character.Methods In our hospital from October 2005 to November 2009 neurological patients admitted in the treatment of deep venous thrombosis, select one of 60 cases to use permanent cavity filter. Nursing care, operation and follow-up data were analyzed.Results All 60 patients have successful filter placement, no acute thrombosis occurred without symptomatic pulmonary embolism. Follow up 1 to 36 months, and no filter migration occurred with serious complications.Conclusions For the patients not able to receive anticoagulant therapy for neurological deep venous thrombosis, permanent cava filter implantation is a safe and effective preventive measure to prevent pulmonary embolism occurred. Key words: Neurosurgery; Pulmonary embolism; Venous thrombosis; Vena cava filter

Malnutrition in hospitalised neurological patients approximately doubles in 10 days of hospitalisation

To measure the nutritional status of neurological patients during admission and after 10 days, with a special focus on those with malnutrition and those at risk of malnutrition, and to measure the association of clinical variables and nutritional status, which may be important for the early detection of patients at risk of malnutrition. Studies have shown high prevalence of malnutrition in hospitalised patients and recommend structured screening and nutritional intervention for these patients. There is a lack of information concerning the nutritional status of neurological patients. A prospective descriptive study. Neurological patients (n = 196) were included from departments of neurology and neurosurgery in Dutch university hospital. Nutritional status was measured with the Mini Nutritional Assessment and functional status with the Barthel Index and the Rankin Scale at admission to the hospital and after 10 days. Of the patients, 34% were at risk of malnutrition, 7% were malnourished, whereas 59% of the patients were well nourished according to the MNA. After 10 days, 57% were at risk of malnutrition, 22% were malnourished and 21% were well nourished. The total group of patients malnourished and at risk of malnutrition was 41% at admission, which had grown to 79% in 10 days. Significant association was found between various clinical variables and nutritional status. A large group of neurological patients is malnourished and at risk of malnutrition during hospital admission, and the nutritional status of most patients worsens in 10 days. Various clinical variables may be of importance in detecting malnourished patients. Nurses need to observe the symptoms of malnutrition and provide evidence-based nutritional interventions to these patients. Improved education of nurses and good collaboration between the professionals and the facilitation of hospital management is essential to improve nutritional care of neurological patients.