PubMed · 3550713
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I Heywood-Jones. Helping hands. An equal place.. https://pubmed.ncbi.nlm.nih.gov/3550713/
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The authors retrospectively compared 1-year results of bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN; n = 16) and internal pallidum (GPi) (n = 11) in advanced PD and found about equal improvements in "off" period motor symptoms, dyskinesias, and fluctuations. STN stimulation reduced medication requirements by 65% and required significantly less electrical power. These advantages contrasted with a need for more intensive postoperative monitoring and a higher incidence of adverse events related to levodopa withdrawal.
PURPOSE: Establishing shared treatment goals for patients may improve the quality of care by facilitating achievement of appropriate and desired outcomes. The purpose of this study was to describe types of family caregiver and physician treatment goals for frail elderly patients who had a high prevalence of cognitive impairment, and to ascertain the level of agreement between family caregivers and physicians on principal treatment goals. SUBJECTS AND METHODS: We surveyed family caregivers and physicians for 200 consecutive older adults who were initially evaluated at the outpatient geriatric assessment center of a major teaching hospital. Treatment goals for patients were measured after a comprehensive geriatric assessment. RESULTS: Goals commonly chosen as most important by family caregivers and physicians pertained to day-to-day functioning (61 [31%] family caregivers, 81 [41%] physicians), behavior and emotional health (56 [28%] family caregivers, 50 [25%] physicians), and safety (40 [20%] family caregivers, 29 [15%] physicians). Although a substantial proportion of family caregiver and physician pairs shared at least one goal (157 [79%] of 200), agreement on presence or absence of individual categories of goals was poor (kappas from -0.19 to 0.28), and agreement on the most important goal was also poor (kappa 0.20). CONCLUSIONS: Agreement on treatment goals between family caregivers and physicians for patients at the study site was low. These results suggest that encounters between family caregiver and physician may need improvement. Further research is needed to assess whether lack of agreement is found in other settings, persists over time, and affects achievement of goals and optimal health outcomes.
BACKGROUND: In order to estimate the needs of early intervention in a health education program, an ADL instrument measuring feelings of (in)security was needed. The instrument was intended to detect early signs of decline and to evaluate ADL performance among persons with AMD. An evaluative instrument must have a high level of responsiveness, which is the ability to detect true changes over time but must also show a high level of intra-individual agreement in a test-retest assessment. PURPOSE: The purpose of this study was to develop an ADL instrument for evaluative purposes and to establish the reliability and the responsiveness of the instrument. METHOD: The target group comprised all persons referred by an ophthalmologist for low vision rehabilitation, 65 years and older, living at home, with aged-related macular degeneration as the primary diagnosis and with distance visual acuity of the better eye with best correction not lower than 0.1. A non-parametric statistical method that is developed for paired ordered parametrical data was applied in order to measure the systematic and occasional intra-rater disagreement separately and to measure the responsiveness. CONCLUSION: The test-retest study showed that the ADL-instrument had a high level of test-retest stability, which is a condition for responsiveness. The instrument was found to be responsive. It could therefore detect true longitudinal changes and be used for evaluative purposes targeting elderly with AMD.