Prognostication in neurology

Risco, Jorge; Kelly, Adam G.; Holloway, Robert G.

doi:10.1016/b978-0-323-85029-2.00003-8

Cited by 3 publications

(3 citation statements)

References 122 publications

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“…Prognostication in neurologic diseases is uniquely difficult, as patients with neurodegenerative disease may remain in a very functionally dependent state for years before they reach the terminal phase of the disease, or they may experience an unanticipated, rapid decline. 19 There are established hospice eligibility guidelines for various neurologic diseases including dementia, ALS, and stroke/coma in the United States, 20 but these are often very narrowly focused and will miss a large subset of patients who ultimately end up having a 6-month prognosis. 21,22 Most neurologists are not familiar with these guidelines and are not trained to discuss hospice care and qualifications with patients and families.…”

Section: Hospice Care In Neurologic Illnessmentioning

confidence: 99%

“…21,22 Most neurologists are not familiar with these guidelines and are not trained to discuss hospice care and qualifications with patients and families. 19 Hospice clinicians are generally not trained in neurologic diseases and may have a degree of discomfort with becoming the primary manager of the patient's disease, as patients often are required to discontinue routine follow-up with their neurologists when they transition to hospice care. This can lead patients to feel abandoned by their neurology team and to worry about how their care will look without the neurologic expertise to which they are accustomed.…”

Section: Hospice Care In Neurologic Illnessmentioning

confidence: 99%

Section: Hospice Care In Neurologic Illnessmentioning

confidence: 99%

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End-of-Life and Hospice Care in Neurologic Diseases

Chou,

Everett,

McFarlin

et al. 2024

Semin Neurol

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The care of a patient with neurologic disease at end-of-life requires expertise in addressing advance care planning, hospice, symptom management, and caregiver support. Neurologists caring for patients with advanced neurologic disease often identify changes in disease trajectory, functional status, or goals of care that prompt discussions of advance care planning and hospice. Patients nearing end-of-life may develop symptoms such as dyspnea, secretions, delirium, pain, and seizures. Neurologists may be the primary clinicians managing these symptoms, particularly in the hospitalized patient, though they may also lend their expertise to non-neurologists about expected disease trajectories and symptoms in advanced neurologic disease. This article aims to help neurologists guide patients and caregivers through the end-of-life process by focusing on general knowledge that can be applied across diseases as well as specific considerations in severe stroke and traumatic brain injury, amyotrophic lateral sclerosis, Parkinson's disease, and dementia.

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Section: Hospice Care In Neurologic Illnessmentioning

confidence: 99%

Section: Hospice Care In Neurologic Illnessmentioning

confidence: 99%

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End-of-Life and Hospice Care in Neurologic Diseases

Chou,

Everett,

McFarlin

et al. 2024

Semin Neurol

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Neurologists' Attitudes and Perceptions on Palliative Care

Wan,

Cristall,

Cooke

2024

Neur Clin Pract

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Background and ObjectivesDespite significant advances in the treatment of neurologic disorders, many conditions require complex care planning and advanced care planning. Neurologists are in a unique position because they are integral in providing patient centered care, understanding neurologic disease and illness trajectory, and how disease can affect patients' sense of self and values. Currently, little is known about neurologists' perceptions and challenges in care planning and palliative care for their patients. MethodsNeurologists from one Canadian academic institution participated in a 30-minute semistructured interview from November 2022 to April 2023. Interviews were conducted until saturation was reached and confirmed. Interviews occurred online through a secure platform or in-person and were recorded. Data were analyzed using a constant comparative method using constructivist grounded theory. Member checking was conducted post interview. ResultsTen neurologists participated across a broad spectrum of neurology experience and subspecialties. We developed a detailed theory of understanding neurologists' attitudes and perceptions of palliative care. When neurologists delay or fail to initiate care planning discussions or palliative care, it results from a complex interplay between patient, physician, and resource accessibility factors. Certain contextual factors, such as a first visit or follow-up, inpatient vs outpatient setting, clinic culture, and the type of clinic practice, are factors that can influence these conversations. As a result, physicians may fail to use available resources, or they may involve other care providers or refer to subspecialty neurologic clinics. However, this delay can still lead to patient and provider harm. Opportunities to improve care exist with continuing education opportunities for trainees and staff, collaboration with palliative care specialists, and health systems support, such as increasing public awareness to address misconceptions about palliative care and resource availability. DiscussionOur findings identify that failure or delay to initiate care planning and palliative care by neurologists results from a complex interplay between local culture, experience, context, practice type, and patient factors. Opportunities to improve care include increasing educational opportunities, building integrated and collaborative practices, and dedicated health systems support.

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A prognostic model for ischemic stroke outcome

Repina,

Romanova,

Poverennova

et al. 2023

Science and Innovations in Medicine

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Aim to develop a mathematical model for the prognosis of ischemic stroke outcome in the acute period of the disease. Material and methods. The study included 103 patients with ischemic stroke in the carotid basin with existing hemiparesis. The comprehensive examination comprised clinical and anamnestic data, state assessment using clinical scales, brain computed tomography, ultrasound, transcranial magnetic stimulation, evoked potential tests, laboratory blood tests. The patients were examined at admission, at discharge and in 12-24 months after leaving hospital. According to the motor function recovery, the patients were divided into two groups with favorable and unfavorable outcome. Statistical methods identified the significantly different results in the two groups. Results. The most significant indicators affecting the prognosis of ischemic stroke were identified.The developed criteria served the basis for a mathematical model using the results of transcranial magnetic stimulation. Conclusion. The obtained mathematical model can be used to determine the outcome of ischemic stroke in the acute period. Transcranial magnetic stimulation is a method that allows for prognosis of the outcome in early period of stroke.

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Prognostication in neurology

Cited by 3 publications

References 122 publications

End-of-Life and Hospice Care in Neurologic Diseases

End-of-Life and Hospice Care in Neurologic Diseases

Neurologists' Attitudes and Perceptions on Palliative Care

A prognostic model for ischemic stroke outcome

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