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Dr. Okun

Post of the Week: More Hospitalization Issues in PD

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Dear Forum Members,


NPF is going to make a push to improve the care of the hospitalized PD patient. Here are two recent articles (one by NPF docs, and another about per-operative care). NPF will also publish an article detailing care across centers of excellence in 2011, and also identfying important care gaps.


Parkinsonism Relat Disord. 2010 Dec 13. [Epub ahead of print]

Management of the hospitalized patient with Parkinson's disease: Current state of the field and need for guidelines.

Aminoff MJ, Christine CW, Friedman JH, Chou KL, Lyons KE, Pahwa R, Bloem BR, Parashos SA, Price CC, Malaty IA, Iansek R, Bodis-Wollner I, Suchowersky O, Oertel WH, Zamudio J, Oberdorf J, Schmidt P, Okun MS; for the National Parkinson Foundation Working Group on Hospitalization in Parkinson’s Disease.


National Parkinson Foundation Center of Excellence, University of California San Francisco, Neurology Department, USA.


OBJECTIVE: To review the literature and to identify practice gaps in the management of the hospitalized Parkinson's disease (PD) patient.


BACKGROUND: Patients with PD are admitted to hospitals at higher rates, and frequently have longer hospital stays than the general population. Little is known about outpatient interventions that might reduce the need for hospitalization and also reduce hospital-related complications.


METHODS: A literature review was performed on PubMed about hospitalization and PD between 1970 and 2010. In addition, in press peer-reviewed papers or published abstracts known to the authors were included. Information was reviewed by a National Parkinson Foundation workgroup and a narrative review article was generated.


RESULTS: Motor disturbances in PD are believed to be a causal factor in the higher rates of admissions and complications. However, other conditions are commonly recorded as the primary reason for hospitalization including motor complications, reduced mobility, lack of compliance, inappropriate use of neuroleptics, falls, fractures, pneumonia, and other important medical problems. There are many relevant issues related to hospitalization in PD. Medications, dosages and specific dosage schedules are critical. Staff training regarding medications and medication management may help to avoid complications, particularly those related to reduced mobility, and aspiration pneumonia. Treatment of infections and a return to early mobility is also critical to management.


CONCLUSIONS: Educational programs, recommendations, and guidelines are needed to better train interdisciplinary teams in the management of the PD patient. These initiatives have the potential for both cost savings and improved outcomes from a preventative and a hospital management standpoint.


Copyright © 2010 Elsevier Ltd. All rights reserved.

PMID: 21159538 [PubMed - as supplied by publisher]



J Perioper Pract. 2010 Nov;20(11):406-10.

Care of patients with Parkinson's disease in the operating department.

Holland J.


Royal Sussex County Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BE. joanna.holland@bsuh.nhs.uk


As our elderly population increases, theatre staff are frequently presented with the challenges of caring for patients with co-morbidities who are undergoing surgery. This article aims to educate the reader about Parkinson's disease, and suggest interventions that perioperative practitioners may want to consider in order to improve the patient's experience in the operating department.


PMID: 21162357 [PubMed - in process]


LinkOut - more resources

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