Need For Care In Patients Research Articles

Examining emerging trends in palliative care utilization for malignant neoplasms with the highest mortality rates.

e24066 Background: Lung, colorectal, pancreatic, breast & prostate cancer account for the top 5 malignancies resulting in mortality in the US. The need for palliative care in patients with these malignancies continues to grow & monitoring its utilization is crucial, especially among different racial groups & ethnicities. Methods: In this study, the TriNetX database which is a collaboration between; pharmaceutical companies, research organizations & HCOs was used. A total of 3,221,731 de-identified pts (pediatric, AYA & adult) was analyzed. The impact of palliative care use vs absence between 2009-2023 was compared in 4-year cohorts, with univariate & multivariate analyses. A p-value < 0.05 was deemed significant. Chi-square was employed to assess palliative care utilization or absence through the years for each group. Results: Analyzing Table 1, palliative care utilization was greater among Non-Hispanics and Whites, as evidenced by the mean. White pts consistently exhibit a higher use compared to other racial groups, but it declined between 2019-2023. The lowest use of palliative care was among Native Hawaiians, Native Americans, & Asians. Black, Latino, Other race, Unknown Race & unknown ethnicity pts accounted for about 50% of its use. Similarly, in most racial & ethnic groups a decline in its non-utilization was observed progressively. Based on the chi-square test, overall results show a significant P-value for all racial & ethnic groups through the years, except for white pts with a p-value of 0.1847. Conclusions: The study highlights disparities that exist in palliative care utilization among racial & ethnic groups. Despite increasing trend in its use, its utilization remains constant among minorities. These details are pivotal in advancing an inclusive healthcare that enhances end of life outcomes for all patients. [Table: see text]

Field trauma triage criteria associated with need for dedicated trauma center care: a single-center retrospective cohort study.

Direct transport from the scene of injury to a trauma centre reduces saves lives. In Ontario,paramedics use the field trauma triage standard (FTTS) to determine if a patient meets trauma bypass criteria. Recent studies have questioned the efficacy of the FTTS in identifying severely injured patients. The objective of this study was to determine the predictive performance of the FTTS on the need for trauma center care in patients who were transported to a trauma center. This was a single-center health records study of patients transported by ambulance directly to a level 1 trauma center. Hospital based trauma center need and injury severity score-based needwere defined. Bivariate associations with one or more FTTS criteria were tested using the Wilcoxon two-sample test for continuous variables, and the Chi-square or Fisher's exact test for categorical indicators. The sensitivity and specificity of each category of the FTTS were calculated. There were 1427 patients included in the study, with76% men, mean age of 40, and 76% had a blunt mechanism. The overall sensitivity and specificity of the FTTS was 90.9% and 20.8% for hospital-based needand 91.6% and 20.3 for injury severity need. The most sensitive variable for hospital-based need was physiologic criteria (53.7).Mechanism of injury was the most sensitive criteria for injury severity need(54.8). Physiological criteria had the highest association with hospital-based and injury severity need (adjusted odds ratios 7.5[95% CI 5.8-9.8] and 5.1[95% CI 3.9-6.7]). The FTTS has fair performance in identifying the need for hospital-based and injury severity need. Systolic blood pressure less than 90mmHg, Glasgow Coma Scale (motor) less than 6,and falls greater than 6m were most predictive of trauma center need. Improving prehospital trauma triage is critical to ensure timely transport to a trauma centre.

Palliative Care Needs of Patients with Musculoskeletal Malignancies.

This review aims to assess the literature regarding current treatment options for the palliative care of patients with advanced musculoskeletal malignancies whether primary or metastatic. The inclusion of specialized palliative care physicians, in conjunction with surgeons, medical oncologists, radiation oncologists, interventional radiologists, and mental health professionals, results in better control of end-of-life symptoms in both children and adults with terminal musculoskeletal malignancies. The palliative care of patients with musculoskeletal malignancies requires a multi-disciplinary team and benefits from specialized palliative care physicians. The unique impacts of musculoskeletal malignancies on ambulation and independence creates additional mental and physical burdens on patients and care-takers alike. Palliative care should focus on preserving ambulatory function and patient independence, in addition to managing chronic pain and other end-of-life symptoms common to these malignancies.

Cell free DNA as a new prognostic biomarker for COVID-19, A prospective cohort study

Predicting the need of hospitalization and intensive care in COVID-19 patients has been challenging with current diagnostic tests since the beginning of the pandemic. We aimed to test cell free DNA (cfDNA) as a novel biomarker for COVID-19 disease severity and mortality. cfDNA concentration was quantified by RT-PCR based test. One hundred and sixty-eight patients(85 outpatients, 61 inpatients,22 ICU) included the study. Mean initial plasma cfDNA levels were significantly different (p < 0.01) in outpatients (1.190,66 ng/ml), inpatients (8.258,10 ng/ml) and ICU patients (84.806,87 ng/ml). ROC analysis showed with 95 % specificity that patients with initial cfDNA concentrations ≥6.389 ng/ml need to be hospitalized and those ≥26.104 ng/ml require ICU referral. cfDNA concentration was correlated with neutrophil/lymphocyte ratio, lymphocyte level, CRP, AST, LDH, CK, fibrinogen, ferritin and D-dimer. Plasma cfDNA levels on admission, well correlating with disease severity and mortality in COVID-19 that found as a useful biomarker.

Quantifying the Need for Specialist Palliative Care Management in Patients With Systemic Sclerosis.

The importance of early integration of palliative care in the management of complex multisystem diseases has been recognized. In this study, we aimed to quantify the need for specialist palliative care in patients with systemic sclerosis (SSc). Using data from 875 patients enrolled in the Australian Scleroderma Cohort Study, we defined the need for palliative care as a high symptom burden at two or more consecutive study visits, at ≥50% of overall study visits, or at the study visit immediately before death. Symptoms of interest included breathlessness, fatigue, pain, depression, anxiety, constipation, and diarrhea. Logistic regression analyses evaluated the association between individual symptoms and SSc manifestations. Linear regression analysis evaluated the relationship between palliative care needs and quality of life (QoL) and function. Almost three-quarters of patients (72.69%) met the threshold for specialist palliative care needs. Severe fatigue (54.17%) was most common, followed by breathlessness (23.66%) and severe constipation (21.14%). Concurrent severe symptoms were frequently observed. Severe breathlessness (coefficient [coef] -7.95, P < 0.01) and pain (coef -7.70, P < 0.01) were associated with the largest reductions in physical QoL. Severe mood symptoms were associated with the greatest reduction in mental QoL (coef -12.91, P < 0.01). Severe pain (coef 0.56, P < 0.01), breathlessness (coef 0.49, P < 0.01), and mood symptoms (coef 0.40, P < 0.01) had a significant impact on function. SSc is frequently associated with multiple severe symptoms that may be amenable to palliative care intervention. Given the strong association between symptom burden and impaired QoL targeted, effective symptom management in parallel with standard-of-care treatments may improve overall patient outcomes.

Supportive Care Needs of Patients With Temporary Ostomy in Enhanced Recovery After Surgery: A Mixed-Methods Study.

Enhanced recovery after surgery (ERAS), a global surgical quality improvement initiative, reduces the length of stay in the hospital. Temporary stoma care for rectal cancer is complex, and patients require prolonged care services to adjust to the stoma. The shorter stay durations in the new model challenge the conventional care pathways and create new patient needs. This study was designed to explore the supportive care needs of patients under the new surgical model to provide a reference for the design of ERAS nursing care plans. A convergent parallel mixed-methods design was used in this study. Patients with temporary stomas for rectal cancer were recruited using a convenience sampling method in gastrointestinal surgery wards and wound & stoma clinics in two public tertiary care hospitals in China. Standardized questionnaires were administered to 140 patients to collect quantitative data, and semistructured interviews were conducted individually with 13 patients to collect qualitative data. The questionnaire data were analyzed using descriptive statistics, and the interview data were analyzed using thematic analysis. "Health system and information needs" and "care and support needs" were identified in both the qualitative and quantitative analyses as the most significant unmet needs of the participants. In addition, the qualitative analysis identified receiving focused stoma care instructions and easily understandable information as essential to fulfilling health system and information needs. Care and support needs included access to continued postdischarge services and attention from medical professionals. The participants in this study experienced a variety of unmet supportive care needs under the ERAS protocol, with gaps particularly notable in two categories: "health system and information needs" and "care and support needs." Increased perioperative care and shorter hospital stays under the ERAS protocol reduce opportunities for patients to receive targeted instruction and shift much of the ostomy education and care workload out of the hospital, requiring greater attention from clinical nurses to ensure quality of care.

Exploring Digital Health Tool Adoption and the Impact of HR Analytics on Decision-making in Jalandhar’s Healthcare Organizations

This study assesses the virtual tool adoption panorama within healthcare organizations. The healthcare enterprise is undergoing a length of huge transformation, pushed by way of the ever-developing need for advanced performance, patient care, and value control. Digital fitness equipment, encompassing a wide variety of technologies from affected person portals and telemedicine platforms to wearable health trackers and digital fitness records (EHRs), are hastily reworking how healthcare is introduced. This study delves into now not most effective the extent of virtual tool adoption however additionally the influence of HR analytics on choice-making within these businesses. HR analytics, the software of statistics analysis techniques to human resource management practices, offers precious insights into personnel traits, recruitment strategies, and employee performance. By examining how healthcare organizations leverage HR statistics to shape their group of workers strategies, the have a look at explores the ability blended effect of those developments on decision-making inside the healthcare panorama. This research seeks to offer insights into the changing landscape of healthcare pushed via technology and its considerable impact on HR decision making. Understanding the elements that power virtual tool adoption within healthcare corporations is critical for optimizing using these technologies. This observe will explore the perceived benefits and demanding situations related to digital health equipment, in conjunction with the position of leadership and organizational tradition in facilitating a success implementation. Additionally, the studies will study how HR analytics are being utilized to tell staffing decisions, training programs, and overall performance control inside healthcare groups.

Spiritual Care Needs of Patients with Cancer Belonging to Dharmic Religions: A Mixed Methods Study

Spiritual Care Needs of Patients with Cancer Belonging to Dharmic Religions: A Mixed Methods Study

Parkinson's disease - The dentist's role as part of the healthcare team.

Parkinson's disease is a neurodegenerative disease that results in patients exhibiting uncontrolled movements, changes in saliva production, and difficulty in swallowing and speech. Understanding the staging of the disease and the available therapies allows dentists to treat these patients safely and with compassion to meet their oral health care needs for an optimal quality of life. This appraisal discusses Parkinson's disease as it relates to clinically relevant facts to manage and treat the oral health care needs of these patients in the short and long term including general dental care recommendations. Important observations related to Parkinson's disease include disease causation,; stages,pharmacologic treatment, the effects on saliva,mastication, dysphagia, and aspiration pneumonia. Dental recommendations are made for the dentate, the partially edentulous, and the completely edentulous Parkinson's patients with a focus on late-stage concerns. Optimizing dental health will help maintain the quality of life as the disease progresses. In late stages of Parkinson's disease, dental treatment should focus on keeping the patient comfortable and out of pain. While benign neglect is an often-used term, compassionate therapy in the late stages of Parkinson's disease is a more compelling term for defining the patient's needs. Since dysphagia in Parkinson's patients has been underdiagnosed, neurologists must be aware of the important part that dentists play in the early diagnosis for these patients. Early referral to a dentist is vital to mitigate the unfortunate consequence of the need for extensive dental care in late-stage patients.

Revitalizing motivation for healthcare office workers: An Analysis of Job Diagnostic Survey Through the Lens of Hackman and Oldham's Model

The unprecedented nature of technological advancements, emphasis on the need for superior patient care, and evolving workplace dynamics lead to the need for revitalizing various factors that improve motivation for healthcare workers. The study aims to comprehend motivation for healthcare workers through the intricate lens of the Hackman and Oldham model by conducting a job diagnostic survey. Healthcare is a crucial industry where timely delivery of patient care is prioritized, workers often aim to exceed expectations and stay motivated. The conceptual framework of Hackman and Oldham provides insight into understanding the motivational factors of the job design, employee satisfaction in their role, and channel efforts into improving the same. A key application of the survey can be identifying areas of focus and improvement that can significantly improve motivation levels for employees thereby improving their performance and reshaping the healthcare workforce. A novel approach to research has been adopted, as previous studies have extensively focused on health care workers; however, most have overlooked the challenges healthcare office workers face to support the physicians and nurses at hospitals. The originality of the study stems from this finding as healthcare administrative workers face unique challenges that may be absent in other industries, and with the current nature of jobs post the pandemic, employers have found difficulty in retaining talent, keeping workers motivated, and empowering them to perform. This study will lead to both empirical and practical implications, aims to provide insight to future researchers as well as organizational leaders to acknowledge the newer dynamics of the workplace where healthcare office workers face many struggles in their workplace like long hours of working, stressful work environment, and constant pressure to perform as their performance is directly related to patient care and often involves saving lives, leading to lack of work-life balance; and how motivation resolves these issues. The study is performed on healthcare office workers in a North Texas Hospital and Healthcare organization, by surveying them with the Hackman and Oldham instrument to grasp their motivation levels and provide suggestions to the leadership to assist employees to stay motivated and focused.

Role of family medicine physicians in providing nutrition support to older patients admitted to orthopedics departments: a grounded theory approach.

Care of older adults requires comprehensive management and control of systemic diseases, which can be effectively managed by family physicians. Complicated medical conditions in older patients admitted to orthopedic departments (orthopedic patients) necessitate interprofessional collaboration. Nutrition is one of the essential components of management involved in improving the systemic condition of older patients. Nutrition support teams play an important role in nutrition management and can be supported by family physicians. However, the role of family physicians in nutrition support teams is not well documented. This study aimed to investigate the role of family physicians in supporting nutrition management in orthopedic patients. This qualitative study was conducted between January and June 2023 using constructivist grounded theory methodology. Eight family medicine physicians, three orthopedic surgeons, two nurses, two pharmacists, four rehabilitation therapists, four nutritionists, and one laboratory technician working in Japanese rural hospitals participated in the research. Data collection was performed through ethnography and semi-structured interviews. The analysis was performed iteratively during the study. Using a grounded theory approach, four theories were developed regarding family physicians' role in providing nutrition support to orthopedic patients: hierarchical and relational limitation, delay of onset and detection of the need for geriatric care in orthopedic patients, providing effective family medicine in hospitals, and comprehensive management through the nutrition support team. The inclusion of family physicians in nutrition support teams can help with early detection of the rapid deterioration of orthopedic patients' conditions, and comprehensive management can be provided by nutrition support teams. In rural primary care settings, family physicians play a vital role in providing geriatric care in community hospitals in collaboration with specialists. Family medicine in hospitals should be investigated in other settings for better geriatric care and to drive mutual learning among healthcare professionals.

The Palliative Care Needs of Patients with Multiple Sclerosis, Parkinson's Related Diseases, and Motor Neurone Disease: A Secondary Analysis of the OPTCARE Neuro Trial Data.

Background: Long-term neurological conditions include multiple sclerosis, Parkinson's-related diseases, and motor neurone disease. National and international guidelines recommend a palliative approach for advancing neurological disease, but there is little research describing and comparing the palliative care needs of these patients side by side. Objective: The aim of this study was to describe and compare the symptom burden and psychological distress of patients with multiple sclerosis, Parkinson's-related diseases, and motor neurone disease. Design: A cross-sectional secondary analysis of the OPTCARE Neuro trial data was performed. Setting/Subjects: Recruitment was from seven sites across the United Kingdom. Patients aged 18 years or older, severely affected by advanced stages of multiple sclerosis or Parkinson's-related diseases or any stage of motor neurone disease, with an unresolved symptom, and one other issue despite usual care were eligible. Measurements: Baseline demographics, Integrated Palliative care Outcome Scale (IPOS) Neuro, and Hospital Anxiety and Depression Scale (HADS) results were analyzed. Results: Data from 348 participants were analyzed. The mean IPOS Neuro-S24 score was 27, with no statistical difference found between groups (p = 0.341). The most common symptoms were poor mobility (68.5%), problems using legs (63%), and fatigue (34.8%). The HADS revealed that a quarter of participants met the criteria for a diagnosis of anxiety and depression. Conclusions: Multiple sclerosis, Parkinson's-related disease, and motor neurone disease patients who were eligible for the OPTCARE Neuro trial have unmet needs in the form of distressing physical and psychological symptoms. It is unclear how to address these needs. The answer likely lies in a collaborative approach between neurology, palliative care, psychology, and specialized allied health professionals. Future work should focus on investigating this.

Effective Communication: Need for Quality Patient Care and Doctors’ Job Satisfaction

Abstract Effective communication is decisive in providing healing care to patients’ satisfaction at the juxta level, i.e. for physicians, it is essential and should be taken care of. Healthy dividends in the form of desired patient outcomes with collateral doctor’s safety and gratification are easily achieved. Identifying the critical areas of communication hindrance necessitates applying different communication techniques to overcome the barriers. Advocacy for inclusion and execution of more innovative and adequate communication approaches will foster a strong bond between future patient and doctor relationships and ensure positive patient outcomes.

IJCM_152A: Assessment of Supportive Care Needs of Breast Cancer Patients and their Caregivers - A Cross Sectional Study at a Tertiary Care Centre, Vadodara

Background: Cancer diagnosis can be difficult for the patients as well as their families; who bear a disproportionate amount of caring burden. Research indicates that as patients’ needs rise, so do those of their caregivers. For holistic health care delivery, it is important for service providers to be cognizant of the difficulties faced by both. Objective: 1. To assess the needs of breast cancer patients and their caregivers. 2. To explore the factors associated with needs of the patients and their caregivers 3. To assess the relation between the needs of the patients and their caregivers Methodology: One hundred and fifty dyads of patients and their caregivers were purposely sampled and administered Supportive-Care-Needs-Surveys (SCNS) Short-form34 (SF-34), and SCNS-Partners and Caregivers respectively, by the interviewer in local language. Cronbach a was used to check reliability and median (IQR) scores were calculated for domains in each survey. Univariate analysis was done to identify factors affecting needs, followed by calculation of correlation coefficient between the needs of patients and of their caregivers. Results: All domains in the two scales were acceptable (Cronbacha&gt;0.6) except Patient Care and Support (0.51) and Sexuality (0.19) domains in SCNS-SF34. Highest needs were reported by patients in Physical and Daily Living domain 40.62(31.5-56.5) and by caregivers in Work and Social Security 30.4(25-35.7), and Emotional and Psychological Needs 30.4(21.4- 35.7) domains. Patients’ and caregivers’ needs were significantly associated with patient’s disease status (p&lt; 0.05), and a moderately positive correlation (r (148) = 0.41, p&lt;0.001) was found between their needs. Conclusion: Patients and caregivers both reported unmet needs which were influenced by the patient’s disease status, and caretakers’ needs increased in tandem with patients’ needs. Studies to validate existing scales or create new ones and larger-scale comparable research including the private sector could aid in generalizability.

Intelligent method to predict intensive care unit admission after drainage operation in patients with deep neck space abscess: A multicenter retrospective study.

A deep neck space abscess (DNSA) is a critical condition resulting from infection of deep neck fascia and soft issue, leading to high morbidity and mortality. Therefore, intensive care can be very significant for patients with DNSA. This study aimed to develop models to predict the need for postoperative intensive care in patients with DNSA. We retrospectively analyzed the records of 332 patients with DNSA who received drainage operation between 2015 and 2020. Multivariate logistic regression analysis and the eXtrem Gradient Boosting (XGBoost) algorithm were used to develop predictive models. We developed two predictive models, the nomogram and the XGBoost model. The area under the curve (AUC) of the nomogram was 0.911 and of the XGBoost model was 0.935. We developed two predictive models for guiding clinical decision making for postoperative ICU admission for DNSA patients, which may help improve prognosis and optimize intensive care resource allocation.

Insomnia as a presentation of hypertension in a 37-year-old male: A case report

This case report explores the rare presentation of insomnia as a symptom of hypertension in a 37-year-old male labor worker named Dinesh. Presenting with a 3-week history of insomnia, the patient’s diagnosis of hypertension highlights the importance of considering systemic conditions in patients with nonspecific symptoms like insomnia. The report delves into the interplay between hypertension and sleep disturbances, emphasizing the influence of lifestyle factors, particularly alcohol consumption, on blood pressure and sleep quality. The case underscores the necessity for clinicians to be aware of atypical presentations of common conditions like hypertension, which is often asymptomatic in its early stages but can manifest in varied and unexpected ways. Through this case, the report demonstrates the effectiveness of a comprehensive management approach, combining pharmacological treatment with lifestyle modifications, in improving both hypertension and related insomnia, thereby emphasizing the need for holistic patient care.

Measuring the continuing care needs of inpatients in rural China

BackgroundInternational experience shows that the suitability of a high-performance healthcare system for its given purposes is reflected in its ability to provide a continuum of services that match the changing health status of the given population. Although many low- and middle-income countries have sought to bring movement away from hospital-centered and towards patient-centered healthcare, such efforts have often had poor results, and one of the major reasons for this is the inability to accurately identify which inpatients need continuing care and what kind of continuing of care is needed.ObjectivesTo measure and assess the continuing care needs of discharged patients and its influencing factors in rural China.MethodsData were obtained from the hospital database of Medical Center M in County Z from May to July 2022. County Z is a county of 1 million people in central China. The database includes basic patient information, disease-related information, and information on readiness for hospital discharge. Factors related to the need for continuing care were included in the analysis. The Readiness for Hospital Discharge Scale was used to assess the need for continuing care. The statistical data are expressed in terms of both frequency and composition ratio. Finally, linear regression was used to analyze the factors influencing the need for continuing care.ResultsThe analysis included a total of 3,791 patients, 123 of whom (3.25%) had continuing nursing needs. The need of continuing nursing was related to patients’ age group, mode of admission, occupation and major diagnostic categories (P < 0.05).ConclusionsDeveloping continuing care is an important initiative for bridging the fragmentation of health services, and an appropriate supply system for continuing care, interconnected with inpatient services, should be established in rural areas in China as soon as possible. And provide more appropriate care for patients in need.

Innovative Transformation in Rehabilitation and Allied Health Sciences in the Post COVID-19 Era

Editorial: In the not-so-distant past, not so long ago in our story of human civilization when the field of rehabilitation and allied health sciences operated within the confines of traditional methodologies. Patient assessments, diagnoses, and treatments followed conventional paths, with healthcare professionals relying heavily on hands-on techniques and their practical experience. This traditional mode, deeply rooted in humancentric practices, proved effective for decades until the unforeseen arrival of an unprecedented challenge. It is said that there is no engaging story without an unforeseen twist and the novel Coronavirus did just that in our story as it put the whole world to a complete halt and shook the entire traditional healthcare system to its very foundations, transforming the healthcare industry for eons to come. In addition to implementing preventative measures to stop the virus from spreading in a highly interactive, multidisciplinary setting, the COVID-19 pandemic has presented significant hurdles for inpatient rehabilitation services in terms of developing a recovery route for patients who have recovered from the virus(1) In response to this crisis, there was a rapid paradigm shift in the fields of healthcare, especially rehabilitation and allied health sectors. Conventional practices gave way to innovative approaches, and the industry witnessed an accelerated adoption of telerehabilitation and allied health services. This sudden transformation marked a turning point, highlighting the significance of adaptability and technological integration in rehabilitation and allied healthcare. The need for remote patient care offered Telehealth services which is an acceptable means to get over physical obstacles and safety concerns so that patients and caregivers could receive the proper medical care.(2)

Determining the Spiritual Care Needs of Patients with Indwelling Urinary Catheterization: A Cross-Sectional Descriptive Study in Turkey

This study was undertaken to ascertain the spiritual care requirements of patients undergoing indwelling urinary catheterization. Identifying the spiritual care needs of patients with indwelling urinary catheterization is crucial for fortifying their resilience and fostering positive health behaviors. Furthermore, it proves pivotal in devising customized nursing interventions. A descriptive cross-sectional study involving 122 participants (50 female, 72 male) undergoing indwelling urinary catheterization within the inpatient clinics of a state hospital in Turkey was conducted. Data were meticulously gathered through a participant information form and the Spiritual Care Needs Scale. The subsequent analysis employed the Kruskal-Wallis and Mann-Whitney U tests, facilitated by the SPSS 22.0 program. This study adhered to the STROBE recommendations in reporting. The findings indicated that individuals with indwelling urinary catheters exhibit spiritual care needs exceeding the norm, with heightened scores in subdimensions such as meaning and hope, caring, and respect. A statistically significant positive association was identified, revealing a difference in spiritual care needs between women and men. Similarly, a positive association, statistically significant, was observed in the spiritual care needs of patients aged 72–98 compared to those aged 41–71. Furthermore, a positive and statistically significant difference surfaced in the spiritual care needs of patients with long-term indwelling urinary catheters as opposed to those with medium and short-term urinary catheters. Therefore, it is imperative to consider the spiritual care needs of patients undergoing indwelling urinary catheterization.

The Care Needs of Patients With Cognitive Impairment in Late-Stage Parkinson's Disease.

Cognitive impairment is common in Parkinson's disease (PD), but care needs and resource use for those with significant cognitive impairment are not well established. 675 participants with PD from the international Care of Late-Stage Parkinsonism (CLaSP) study were grouped into those without (n = 333, 49%) and with cognitive impairment (MMSE < 24/30 or diagnosis of dementia or Mild Cognitive Impairment; n = 342, 51%) and their clinical features, care needs and healthcare utilisation compared. The relationship between cognition and healthcare consultations was investigated through logistic regression. Cognitive impairment was associated with more motor and non-motor symptoms, less antiparkinsonian but higher rates of dementia and antipsychotic medication, worse subjective health status and greater caregiver burden. A considerable proportion did not have a pre-established cognitive diagnosis. Care needs were high across the whole sample but higher in the cognitive impairment group. Home care and care home use was higher in the cognitive impairment group. However, use of healthcare consultations was similar between the groups and significantly fewer participants with cognitive impairment had had recent PD Nurse consultations. Worse cognitive impairment was associated with lower frequency of recent PD nurse and multidisciplinary therapy consultation (physiotherapy, massage, occupational therapy, speech training and general nursing). Those with cognitive impairment have more severe PD, higher care needs and greater social care utilisation than those with normal cognition, yet use of health care services is similar or less. Cognitive impairment appears to be a barrier to PD nurse and multidisciplinary therapy consultations. This challenges current models of care: alternative models of care may be required to serve this population. Parkinson's disease is a long-term progressive health condition. Over time, many people with Parkinson's develop problems with thinking and memory, called cognitive impairment. This can negatively impact the daily lives of the person with Parkinson's and their caregiver. It is also thought to be a barrier to accessing healthcare. How people with Parkinson's who have cognitive impairment use healthcare and detail of their care needs is not well known.We analysed data from a large sample of people with advanced Parkinson's from six European countries to investigate their symptoms, care needs and healthcare use. We compared those with cognitive impairment to (342 people) to those without cognitive impairment (333 people).We found that those with cognitive impairment had more severe Parkinson's across a range of symptoms compared to those without cognitive impairment. They also had more care needs, reported their health status to be worse, and their caregivers experienced greater strain from caring. Whilst use of other healthcare services was similar between the two groups, those with cognitive impairment were less likely to have recently seen a Parkinson's nurse than those without cognitive impairment. Further analysis showed an association between cognitive impairment and not having seen a Parkinson's nurse or therapist recently, taking psychiatric symptoms, functional disability and care home residence into account. Therapists included were physiotherapy, massage, occupational therapy, speech training and general nursing. These findings highlight unmet need. We suggest that healthcare should be more targeted to help this group of people, given their higher care needs.