What is case management in palliative care? An expert panel study

Contains fulltext : 110207.pdf (publisher's version ) (Open Access)ABSTRACT: BACKGROUND: Case management is a heterogeneous concept of care that consists of assessment, planning, implementing, coordinating, monitoring, and evaluating the options and services required to meet the client's health and service needs. This paper describes the result of an expert panel procedure to gain insight into the aims and characteristics of case management in palliative care in the Netherlands. METHODS: A modified version of the RAND(R)/University of California at Los Angeles (UCLA) appropriateness method was used to formulate and rate a list of aims and characteristics of case management in palliative care. A total of 76 health care professionals, researchers and policy makers were invited to join the expert panel, of which 61% participated in at least one round. RESULTS: Nine out of ten aims of case management were met with agreement. The most important areas of disagreement with regard to characteristics of case management were hands-on nursing care by the case manager, target group of case management, performance of other tasks besides case management and accessibility of the case manager. CONCLUSIONS: Although aims are agreed upon, case management in palliative care shows a high level of variability in implementation choices. Case management should aim at maintaining continuity of care to ensure that patients and those close to them experience care as personalised, coherent and consistent

Elderly with Autism: Executive Functions and Memory

Cognitive autism research is mainly focusing on children and young adults even though we know that autism is a life-long disorder and that healthy aging already has a strong impact on cognitive functioning. We compared the neuropsychological profile of 23 individuals with autism and 23 healthy controls (age range 51–83 years). Deficits were observed in attention, working memory, and fluency. Aging had a smaller impact on fluency in the high functioning autism (HFA) group than in the control group, while aging had a more profound effect on visual memory performance in the HFA group. Hence, we provide novel evidence that elderly with HFA have subtle neuropsychological deficits and that the developmental trajectories differ between elderly with and without HFA in particular cognitive domains

Oscillatory Mechanisms of Response Conflict Elicited by Color and Motion Direction: An Individual Differences Approach

Contains fulltext : 187705pub.pdf (publisher's version ) (Open Access

Biasing neural network dynamics using non-invasive brain stimulation

Recently, non-invasive brain stimulation (NBS) has been discovered as a tool to improve human performance on a wide variety of tasks. Although these observations are highly intriguing, the underlying mechanisms of such enhancements are still poorly understood. Here, we argue that in order to advance understanding of these mechanisms, it is necessary to focus on intrinsic network dynamics in the brain. Taking into account well-known network dynamics, increased excitation in one particular network or brain region may necessarily lead to inhibition of an opposing network (and vice versa). As a consequence, observed behavioral improvements due to NBS emerge from a shift in the balance between (competing) neural networks in the brain, implicating that behavioral enhancement due to stimulation most likely comes with a cost or side effect. We conclude that more elaborate experimental designs are essential for a better understanding of the relationship between network interactions and the behavioral effects of NBS

Multiple visual objects are sampled sequentially - Fig 1

<p>(A) In the study by Jia et al., two objects were presented. Participants were asked to detect the random appearance of a small target square in one of the objects. (B) The contrast of each object changed randomly over time. (C) The temporal response functions (TRFs) were calculated by relating the recorded EEG to the visual input train (contrast change of each object). The TRF can be considered to reflect the impulse response function that best explains the EEG when convolved with the stimulus train, also termed as perceptual echoes [<a href="http://www.plosbiology.org/article/info:doi/10.1371/journal.pbio.2003230#pbio.2003230.ref013" target="_blank">13</a>]. The TRFs were dominated by approximately 10-Hz alpha-band activity. The sequential sampling was observed as a rhythmic modulation (about 2 Hz) of the envelope of the alpha-band response.</p

Addressing Palliative Sedation during Expert Consultation: A Descriptive Analysis of the Practice of Dutch Palliative Care Consultation Teams

<div><p>Main Objective</p><p>Since palliative sedation is considered a complex intervention, consultation teams are increasingly established to support general practice. This study aims to offer insight into the frequency and characteristics of expert consultations regarding palliative sedation.</p><p>Methods</p><p>We performed a retrospective analysis of a longitudinal database. This database contained all patient-related consultations by Dutch Palliative Care Consultation teams, that were requested between 2004 and 2011. We described the frequency and characteristics of these consultations, in particular of the subgroup of consultations in which palliative sedation was addressed (i.e. PSa consultations). We used multivariate regression analysis to explore consultation characteristics associated with a higher likelihood of PSa consultations.</p><p>Main Results and Their Significance</p><p>Of the 44,443 initial consultations, most were requested by general practitioners (73%) and most concerned patients with cancer (86%). Palliative sedation was addressed in 18.1% of all consultations. Palliative sedation was relatively more often discussed during consultations for patients with a neurologic disease (OR 1.79; <i>95% CI</i>: <i>1</i>.<i>51–2</i>.<i>12</i>) or COPD (OR 1.39; <i>95% CI</i>: <i>1</i>.<i>15–1</i>.<i>69)</i> than for patients with cancer. We observed a higher likelihood of PSa consultations if the following topics were also addressed during consultation: dyspnoea (OR 1.30; <i>95% CI</i>: <i>1</i>.<i>22–1</i>.<i>40</i>), agitation/delirium (OR 1.57; <i>95% CI</i>: <i>1</i>.<i>47–1</i>.<i>68</i>), exhaustion (OR 2.89; <i>95% CI</i>: <i>2</i>.<i>61–3</i>.<i>20</i>), euthanasia-related questions (OR 2.65; <i>95% CI</i>: <i>2</i>.<i>37–2</i>.<i>96</i>) or existential issues (OR 1.55; <i>95% CI</i>: <i>1</i>.<i>31–1</i>.<i>83</i>).</p><p>Conclusion</p><p>In conclusion, PSa consultations accounted for almost one-fifth of all expert consultations and were associated with several case-related characteristics. These characteristics may help clinicians in identifying patients at risk for a more complex disease trajectory at the end of life.</p></div

Number of all consultations by Dutch PCC teams over the period 2004–2011.

<p><b>PCC teams</b>: Palliative Care Consultation Teams; <b>AMN</b>: Annual Mortality Number; <b>PS</b>: palliative sedation; <b>PSa consultation</b>: palliative sedation addressed during consultation; <b>95% CI</b>: 95% confidence interval.</p><p>Number of all consultations by Dutch PCC teams over the period 2004–2011.</p

Characteristics of all consultations by Dutch PCC teams (2004–2011).

<p><b>PCC teams</b>: Palliative Care Consultation Team; <b>PS</b>: palliative sedation; <b>PSa consultation</b>: palliative sedation addressed during consultation; <b>95% CI</b>: 95% confidence interval.</p><p>^a Proportion = (PSa consultations / total consultations)*100%, per single variable.</p><p>^b Total of variables for “Symptoms” and “Issues” exceeds 100% due to more than one symptom / issue registered per consultation.</p><p>Characteristics of all consultations by Dutch PCC teams (2004–2011).</p

Univariate and multivariate analysis of all consultations by Dutch PCC teams (2004–2011)–Characteristics associated with PSa consultations.

<p><b>PCC teams</b>: Palliative Care Consultation Teams; <b>PS</b>: palliative sedation; <b>PSa consultation</b>: palliative sedation addressed during consultation; <b>95% CI</b>: 95% confidence interval.</p><p>Univariate and multivariate analysis of all consultations by Dutch PCC teams (2004–2011)–Characteristics associated with PSa consultations.</p