ABSTRACT
Traditional deep brain stimulation requires intraoperative neurophysiological confirmation of electrode placement. Recently, purely image guided methods are being evaluated as to their clinical efficacy in comparison to surgery using microelectrode recordings. We used the ClearPoint(®) system to place electrodes in both the subthalamic nucleus and globus pallidus internus in patients with advanced Parkinson's disease. Off medication UPDRS scores were assessed before and 1 year after surgery as well as pre- and 1 year post-operative neuropsychological outcomes. Targeting precision was also assessed. Patients implanted in the subthalamic nucleus improved by 46.2 % in their UPDRS scores post-operatively (p = 0.03) whereas the globus pallidus group improved by 41 % (p = 0.06). There were no significant adverse neuropsychological outcomes in either group of patients. Mean radial error for the STN group was 1.2 ± 0.7 mm and for the GPi group 0.8 mm ± 0.3 mm. Image guided DBS using the ClearPoint(®)system has high targeting precision with robust clinical outcomes. Our data are in accord with recent studies using the same or similar technologies and provide a rationale for a large comparative study of image-guided versus microelectrode guided DBS.
Subject(s)
Deep Brain Stimulation/methods , Magnetic Resonance Imaging, Interventional/methods , Neurosurgical Procedures/methods , Parkinson Disease/diagnostic imaging , Parkinson Disease/therapy , Aged , Female , Globus Pallidus/diagnostic imaging , Globus Pallidus/surgery , Humans , Male , Middle Aged , Motor Activity , Neural Prostheses , Neuropsychological Tests , Parkinson Disease/physiopathology , Parkinson Disease/psychology , Retrospective Studies , Subthalamic Nucleus/diagnostic imaging , Subthalamic Nucleus/surgery , Treatment OutcomeABSTRACT
Research on breaking bad news has involved undergraduates, medical students, and physicians. However, to date, no studies have examined how, or whether, psychologists are trained to break bad news, as well as their current practice of breaking bad news. This mixed methods study explored the training and practice of 329 licensed psychologists/APA members in breaking bad news, using the MUM effect as a theoretical backdrop. Results suggest (1) psychologists are, as hypothesized, significantly more reluctant to break bad news than good news, (2) anxiety accounts for 30.6% of the variance in their reluctance, and (3) three-out-of-four psychologists break bad news "to some extent" or more, most typically related to a patient's psychological health, major Axis I diagnosis, or learning disability. Results also suggest most psychologists are not trained to break bad news, with only 2.7% being familiar with existing recommendations and guidelines; and anxiety, concerns for self/other, context, and norms play an important role in the bad news breaking process. Implications for theory, research, and practice are discussed and a training model is proposed.
