Resisting the Rising Tide of Parkinson’s

By Barbara Hranilovich. All rights reserved. By Barbara Hranilovich. All rights reserved.

The Reflections essay in the October issue of AJN is called “After-Dinner Talks.” These are talks with a purpose, a form of physical therapy with high stakes. Writes the author, Minter Krotzer, of her husband’s long struggle with Parkinson’s disease: “Hal always says Parkinson’s is not his identity, and it isn’t, as long as he doesn’t let it claim him, or as long as it doesn’t claim us.”

Here’s an excerpt from the beginning:

‘I’d like you two to have a conversation every night after dinner,’ Hal’s speech therapist said to us.

. . . . Over the years, Hal’s Parkinson’s disease has made him difficult to understand. His vocal cords have restricted movement and it is hard for him to make it to the end of a sentence. He often swallows his last words or they just barely come out. Sometimes he sounds like he is underwater—the words indistinguishable from one another, blurry and pitchless.

But read the short essay, which is free. In just one page it manages to say a lot about chronic illness and the constant, conscious effort it can require of both patients and family members; about a clinician’s good advice; about marriage and communication; and about the power of language to keep us human.—Jacob Molyneux, senior editor.

Illustration by Barbara Hranilovich; all rights reserved.

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2016-11-21T13:03:45-05:00October 13th, 2014|patient engagement, patient experience, Patients|1 Comment
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How Perioperative Medication Withholding Affects Patients with Parkinson’s Disease

By Sylvia Foley, AJN senior editor

The timing of antiparkinson medications has pro­found implications for motor and cognitive function.… If perioperative surgical staff aren’t sufficiently aware of the importance of minimizing disruptions to patients’ antiparkinson medication regimens, prolonged medi­cation withholding of several hours’ duration can occur. And patients with Parkinson’s disease whose doses are delayed may deteriorate quickly.

In January and again this month, we bring you a pair of CE–Original Research articles that describe the findings of two companion studies on how perioperative medication withholding affects patients with Parkinson’s disease. Here’s a short summary.

The quantitative study—what the EHRs said. The first article, “Perioperative Medication Withholding in Patients with Parkinson’s Disease,” discusses the results of a retrospective review by Kathleen Fagerlund and colleagues. The authors reviewed the electronic health records (EHRs) of 67 surgical patients who had undergone 89 surgeries unrelated to Parkinson’s disease. They looked at the duration of perioperative withholding of carbidopa-levodopa (Sinemet)—the gold standard treatment for Parkinson’s disease, it has a short half-life of just one to two hours—and at symptom exacerbations.

What they found was that medication withholding tended to be prolonged. The median duration of withholding for 32 inpatient and 57 outpatient procedures was more than 16 hours and more than 11 hours, respectively. They also found that for 56% of the inpatient procedures, the patient’s EHR contained a note referencing Parkinson’s disease symptoms or symptom management, which included increased agitation or confusion, increased tremors, and symptom management complicated by pain or pain medications. (Because outpatient EHRs contained […]

2017-07-27T14:51:56-04:00February 4th, 2013|nursing research|1 Comment
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AJN’s February Issue: COPD, Fungal Meningitis Outbreak, SIDs, Nursing Leadership

AJN0213 Cover OnlineAJN’s February issue is now available on our Web site. Here’s a selection of what not to miss.

Last month, we published findings from a quantitative study exploring antiparkinson medication–withholding times during hospitalization and symptom management. This month you can catch part two of this series, which reports on findings from a qualitative study on the perioperative hospitaliza­tion experiences of patients with Parkinson’s disease. Participants’ comments in this study made it clear that the actions of nurses could affect the perioperative experience for better or worse. The article is open access and can earn you 2.1 continuing education (CE) credits.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the U.S. Our CE feature “COPD Exacerbations” outlines current guidelines and evidence-based recommendations for identifying, assessing, and managing COPD exacerbations. The article is open access and can earn you 2.6 CE credits.

This month we introduce our new series, Perspectives on Leadership, which is coordinated by the American Organization of Nurse Executives. This first article, “Partnering for Change,” describes how one hospital’s nurse leaders and staff worked together to change the way nurses conduct shift report.

Matthews_BillboardEach year in the U.S., more than 4,500 infants die suddenly and unexpectedly. February’s In Our Community article, “Babies Are Still Dying of SIDS,” describes how a nurse’s advocacy and activism resulted in safe-sleep legislation. A podcast […]

2016-11-21T13:08:26-05:00February 1st, 2013|Nursing|0 Comments
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Original Research: Perioperative Medication Withholding in Patients With Parkinson’s Disease

Drawing of the face of a Parkinson's disease patient showing characteristic symptoms: mainly hypomimia, a expression-less mask-like face. Appeared in Nouvelle iconographie de la Salpétrière [Tome 1] : clinique des maladies du système nerveux / publiée sous la direction du professeur Charcot,... ; par Paul Richer,... Gilles de la Tourette,... Albert Londe,.... - 1888. Chapter "Habitude exterieure et facies dans la paralyse agitante". Plate XL1V 1888 drawing of face of a Parkinson’s patient revealing “characteristic symptoms: mainly hypomimia, a expression-less mask-like face.” Appeared in Nouvelle iconographie de la Salpétrière [Tome 1] : clinique des maladies du système nerveux./Wikimedia Here’s the abstract of our January original research CE article, “Original Research: Perioperative Medication Withholding in Patients with Parkinson’s Disease: A Retrospective Electronic Health Records Review.”

Abstract

Background: Carbidopa-levodopa (Sinemet), the gold-standard treatment for Parkinson’s disease, has a short half-life of one to two hours. When patients with Parkinson’s disease are placed on NPO (nil per os, or nothing by mouth) status for surgery, they may miss several doses of carbidopa-levodopa, possibly resulting in exacerbation of Parkinson’s disease symptoms. Clear guidelines regarding perioperative symptom management are lacking.

Objectives: The goals of this study were threefold: to measure the perioperative duration of the withholding of carbidopa-levodopa in patients with Parkinson’s disease, to record the time of day surgeries were performed on these patients, and to record perioperative exacerbations of Parkinson’s disease symptoms.

Methods: We conducted a retrospective review of patient electronic health records at a […]

2016-11-21T13:08:31-05:00January 18th, 2013|nursing research|0 Comments
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AJN’s January Issue: Men in Nursing, Perioperative Medication Withholding in Patients with PD, Book of the Year Awards, More

AJN0113.Cover.Online

AJN’s January issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles, which you can access for free.

Even though more men are starting to become nurses, they still make up less than 7% of all RNs.  In “Men in Nursing,” the authors discuss the challenges of recruiting and retaining men in the nursing profession. This article is open access and can earn you 2.1 CE credits.

 In this month’s original research article, the authors report on findings from a quantitative study exploring antiparkinson medication withholding times during hospitalization and symptom management. Part one of a two-part series, this article is open access and can earn you 2.5 CE credits. Look for part two in our next issue, which reports on findings from a qualitative study on the perioperative hospitaliza­tion experiences of patients with PD.

After sustaining a needlestick injury during a research study, nurse Lynn Petrik created a new safety device for a commonly used glucose sensor. “From Putty to Prototype” takes readers through the steps of her invention, from the prototype to the provisional patent.

 Looking for a good read? The votes are in, and the winners of AJN’s annual Book of the Year Awards are listed in this issue. A supplemental online only companion to the article gives the judges reviews for each book.  

 And finally, read “The Clinical Nurse […]

2016-11-21T13:08:39-05:00December 28th, 2012|nursing research|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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