Connectedness of healthcare professionals involved in the treatment of patients with Parkinson's disease: a social networks study

<p>Abstract</p> <p>Background</p> <p>Patients with chronic illness typically receive ambulatory treatment from multiple health professionals. Connectedness between these professionals may influence their clinical decisions and the coordination of patient care. We aimed to describe and analyze connectedness in a regional network of health professionals involved in ambulatory treatment of patients with Parkinson's disease (PD).</p> <p>Methods</p> <p>Observational study with 104 health professionals who had joined a newly established network (ParkinsonNet) were asked to complete a pre-structured form to report on their professional contacts with others in the network. Using social networks methods, network measures were calculated for the total network and for the networks of individual health professionals. We planned to test differences between subgroups of health professionals regarding 12 network measures, using a random permutation method.</p> <p>Results</p> <p>Ninety-six health professionals (92%) provided data on 101 professionals. The reciprocity of reported connections was 0.42 in the network of professional contacts. Measures characterizing the individual networks showed a wide variation; <it>e.g</it>., density varied between 0 and 100% (mean value 28.4%). Health professionals with ≥10 PD patients had higher values on 7 out of 12 network measures compare to those with < 10 PD patients (size, number of connections, two step reach, indegree centrality, outdegree centrality, inreach centrality, betweenness centrality). Primary care professionals had lower values on 11 out of 12 network measures (all but reach efficiency) compared to professionals who were affiliated with a hospital.</p> <p>Conclusions</p> <p>Our measure of professional connectedness proved to be feasible in a regional disease-specific network of health professionals. Network measures describing patterns in the professional contacts showed relevant variation across professionals. A higher caseload and an affiliation with a hospital were associated with stronger connectedness with other health professionals.</p

Using Medical Claims Analyses to Understand Interventions for Parkinson Patients.

The scientific evidence to support the value of a range of non-pharmacological interventions for people with Parkinson's disease (PD) is increasing. However, showing unequivocally that specific interventions are better than usual care is not straightforward because of generic drawbacks of clinical trials. Here, we address these challenges, specifically related to the context of evaluating complex non-pharmacological interventions for people with PD. Moreover, we discuss the potential merits of undertaking "real world" analyses using medical claims data. We illustrate this approach by discussing an interesting recent publication in The Lancet Neurology, which used such an approach to demonstrate the value of specialized physiotherapy for PD patients, over and above usual care physiotherapy.Professor Bastiaan R. Bloem is supported by a research grant of the Parkinson’s Foundation. Dr. Nienke M. de Vries is supported by a research grant from The Netherlands Organization for Health Research and Development. Dr. Allison Willis is supported by the Parkinson’s Foundation, the National Institutes of Health (R01-NS-099129-01A1), the Patient Centred Outcomes Research Institute, and the University of Pennsylvania

The effects of combined glucosamine sulfate and chondroitin sulfate supplements on condylar cartilage remodeling during functional appliance therapy. A Micro-CT study.

Glucosamine and chondroitin sulphate supplementation is used to prevent the degeneration of articular surfaces and also to enhance repair and regeneration of cartilage. The ability for adaptation of condylar cartilage to mandibular forward positioning is what constitutes the fundamental rationale for orthodontic functional therapy, which partially contributes to the correction of jaw discrepancies in growing Skeletal II mandibular retrusive patients. The purpose of this study was to qualitatively and quantitatively analyse the effect of Glucosamine sulphate (GS) and Chondroitin sulphate (CS) supplementation on condylar remodeling with functional appliance therapy in rats. One hundred and forty 3-week-old female Sprague-Dawley rats were randomly divided into 4 groups consisting of; baseline controls, supplementation only, functional appliances only and those receiving both supplements and functional appliances. Supplements were preloaded for a period of 2 weeks prior to the placement of functional appliances at five weeks of age. The animals were sacrificed at days 0, 7 and 21 after appliance placement. The appliances were removed in the remaining experimental animals on day 21 with sacrifice on day 28 to analyse post growth modification changes. Condylar samples were then soaked in 0.2 M Gadolinium Chloride (GdCl3) (aq) for 6 days and analyzed using micro-computed tomography (μCT) for morphological characteristics and linear and volumetric measurements of the mandibular condyle. The results demonstrated supplement therapy increased the volume of cartilage with and without functional appliance therapy. Functional appliance therapy alone resulted in increases in cartilage volume over untreated animals, with peak volume increases occurring by day 7 of appliance wear followed with decreases as endochondral ossification ensued. Supplement therapy was found to enhance the normal biological response to functional appliance therapy in the rat model

Marker assisted approach for incorporating durable rust resistance in popular Indian wheat cultivars

Item does not contain fulltextParkinson disease (PD) is common in long term care (LTC) facilities. The number of institutionalized patients with PD will rise sharply in the coming decades because of 2 concurrent phenomena: aging of the population leads to an increased PD prevalence and improved quality of care has led to a prolonged survival in advanced disease stages. Only a few studies have investigated the prevalence and clinical characteristics of patients with PD in LTC facilities. Even fewer studies have addressed the treatment strategies used to support these institutionalized patients, who are mostly in advanced stages of the disease. The available evidence suggests that current management of patients with PD in LTC facilities is less than optimal. In the Netherlands, and we suspect in many other countries, there are no formal guidelines for treating patients with PD who have been admitted to a LTC facility. In this review, we describe the epidemiology, clinical characteristics, and clinical management of patients with PD in LTC settings. We also address potentially modifiable elements of care and provide several recommendations to improve the management of PD in these facilities. We conclude by suggesting a possible guide for future research in this area

Rationale and design to evaluate the PRIME Parkinson care model:a prospective observational evaluation of proactive, integrated and patient-centred Parkinson care in The Netherlands (PRIME-NL)

Contains fulltext : 236935.pdf (Publisher’s version ) (Open Access

Integrated and patient-centred management of Parkinson’s disease:a network model for reshaping chronic neurological care

Contains fulltext : 221521.pdf (Publisher’s version ) (Closed access

From trials to clinical practice: Temporal trends in the coverage of specialized allied health services for Parkinson's disease

Background and purpose: To determine how the coverage of specialized allied health services for patients with Parkinson's disease (PD) has developed in the Netherlands since the publication of trials that demonstrated cost-effectiveness. Methods: We used healthcare expenditure-based data on all insured individuals in the Netherlands to determine the annual proportion of patients with PD who received either specialized or generic allied health services (physiotherapy, occupational therapy, speech–language therapy) in 2 calendar years separated by a 5-year interval (2012 and 2017). Specialized allied health services were delivered through the ParkinsonNet approach, which encompassed professional training and concentration of care among specifically trained professionals. Results: Between 2012 and 2017, there was an increase in the number of patients with any physiotherapy (from 17,843 [62% of all patients with PD that year] to 22,282 [68%]), speech–language therapy (from 2171 [8%] to 3378 [10%]), and occupational therapy (from 2813 [10%] to 5939 [18%]). Among therapy-requiring patients, the percentage who were treated by a specialized therapist rose substantially for physiotherapy (from 36% in 2012 to 62% in 2017; χ2 = 2460.2; p < 0.001), speech–language therapy (from 59% to 85%; χ2 = 445.4; p < 0.001), and occupational therapy (from 61% to 77%; χ2 = 231.6; p < 0.001). By contrast, the number of patients with generic therapists did not change meaningfully. By 2017, specialized care delivery had extended to regions that had been poorly covered in 2012, essentially achieving nationwide coverage. Conclusions: Following the publication of positive trials, specialized allied healthcare delivery was successfully scaled for patients with PD in the Netherlands, potentially serving as a template for other healthcare innovations for patients with PD elsewhere

Proactive and Integrated Management and Empowerment in Parkinson’s Disease:designing a new model of care

Contains fulltext : 218585.pdf (publisher's version ) (Open Access

Physical inactivity in Parkinson’s disease

Patients with Parkinson’s disease (PD) are likely to become physically inactive, because of their motor, mental, and emotional symptoms. However, specific studies on physical activity in PD are scarce, and results are conflicting. Here, we quantified daily physical activities in a large cohort of PD patients and another large cohort of matched controls. Moreover, we investigated the influence of disease-related factors on daily physical activities in PD patients. Daily physical activity data of PD patients (n = 699) were collected in the ParkinsonNet trial and of controls (n = 1,959) in the Longitudinal Aging Study Amsterdam (LASA); data were determined using the LAPAQ, a validated physical activity questionnaire. In addition, variables that may affect daily physical activities in PD were recorded, including motor symptoms, depression, disability in daily life, and comorbidity. Patients were physically less active; a reduction of 29% compared to controls (95% CI, 10–44%). Multivariate regression analyses demonstrated that greater disease severity, gait impairment, and greater disability in daily living were associated with less daily physical activity in PD (R2 = 24%). In this large study, we show that PD patients are about one-third less active compared to controls. While disease severity, gait, and disability in daily living predicted part of the inactivity, a portion of the variance remained unexplained, suggesting that additional determinants may also affect daily physical activities in PD. Because physical inactivity has many adverse consequences, work is needed to develop safe and enjoyable exercise programs for patients with PD