Nursing and Parkinson's Disease: A Scoping Review of Worldwide Studies.

This scoping review aims to evaluate the characteristics of worldwide studies evolving the scope of nursing practice in Parkinson's disease (PD). We conducted a three-step search strategy using 11 databases and reference lists. Of the 4,174 screened studies we included 324 (8%). Most were published during 1978 to 2020, with significant increasing in publications from 2002 onwards and a forecast to double in the next 10 years (total expected = 614, ±62.2, R2 = .998). We identified studies involving nine contexts of nursing practice in PD, in four continents and 31 countries, most of them of observational design (47.2%), funded (52.2%), authored by nurses (70.1%), and related to Nursing care/Guidelines (32.1%), Educational/Research content (16.4%), Symptom management/Medication adherence (14.5%), and Family caregiving (11.1%). The worldwide studies evolving the scope of nursing practice in PD is growing in several health context. These results can guide future research and evidence-based practice involving the role of nurses in PD.

Quality improvement study on early recognition and intervention of caregiver burden in a tertiary hospital.

BACKGROUND: Caregivers play a crucial role in taking over the important task of looking after patients post-hospitalisation. Caregivers who are unfamiliar with patients' post-discharge care often experience caregiver stress, while patients may see deterioration in their condition. As caregivers are our core partners in healthcare, it is therefore necessary for patient navigators to recognise, assess and address caregivers' needs or burden as early as on admission to hospital. Patient navigators are trained registered nurses whose main role is to provide patients and caregivers with personalised guidance through the complex healthcare system. OBJECTIVES: This quality improvement study examined the efficacy of using the Zarit Burden Interview as a tool in helping patient navigators recognise caregiver burden early and the effectiveness of targeted interventions on caregiver burden. METHODS: Various quality improvement tools were used. Eighty-six patient-caregiver dyads who met the inclusion criteria were enrolled. Informal caregivers were assessed for caregiver burden using the Zarit Burden Interview during hospital admission (T0) and again at 30 days postdischarge (T1), post-intervention. RESULTS: There was significant improvement in the Zarit Burden mean scores from T0 to T1 reported for the 80 dyads who completed the study, even after adjusting for covariates (T0 mean=11.08, SD=7.64; T1 mean=2.48, SD=3.36, positive ranks, p<0.001). Highest burden identified by most caregivers were the personal strain; trying to meet other responsibilities and uncertain about what to do in caring for their loved one. By recognising the different aspects of caregiver burden early, patient navigators were able to focus their interventions. CONCLUSION: Early recognition of caregiver burden and targeted interventions were found to be effective at reducing caregiver burden in a tertiary hospital.

Parkinson's Disease Caregiver Strain in Singapore.

Background: Caregiver strain is recognized globally with Parkinson's disease (PD). Comparatively little is understood about caregiver burden and strain in Asia. Objective: To investigate caregiver strain for families living with PD in Singapore, in light of international data. Methods: Ninety-four caregivers were recruited via people living with idiopathic PD in Singapore. Caregiver strain was assessed using the Zarit Burden Interview (ZBI); health status was assessing using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). PD disability measures were the Unified Parkinson's Disease Rating Scale (UPDRS) and modified Hoehn and Yahr (1967) Scale. Results: Primary caregivers of people living with PD in Singapore were mostly cohabiting spouses, partners or offspring. Around half employed foreign domestic helpers. Mean caregiving duration was 5.9 years with an average of eight hours per day spent in caregiving roles. Most care providers were comparatively healthy. Caregivers reported significant levels of strain which increased with greater level of disability (r = 0.36, n = 94, p < 0.001). Associations were significant between caregiver strain and scores on the UPDRS mentation, behavior, and mood subscales [r = 0.46, n = 94, p < 0.001, 95% CI (0.28, 0.60)]. High scores on the UPDRS activities of daily living subscale were associated with caregiver strain [r = 0.50, n = 94, p < 0.001, CI (0.33, 0.64)]. Conclusion: Most caregivers in this Singapore sample reported high levels of strain, despite comparatively good physical function. Caregiver strain in PD spans geopolitical and cultural boundaries and correlates with disease severity. These results support the need for better early recognition, education, and support for caregivers of people living with PD.

Adequacy of different measurement methods in determining nasogastric tube insertion lengths: An observational study.

BACKGROUND: Distance from the tip of the nose to earlobe to xiphisternum is commonly used to determine the length of nasogastric tube to be inserted. However, it is not evidence-based and frequently leads to improper positioning. OBJECTIVES: This study evaluated four formulae and the distance from the tip of the nose to earlobe to xiphisternum in estimating the internal length of nasogastric tube required for optimal positioning. DESIGN: Observational Study. SETTINGS: Tertiary hospital in Singapore involving patients from the medical and surgical intensive care units and a neurosurgical ward. PARTICIPANTS: Inclusion criteria were patients who required a nasogastric tube insertion and age > = 21 years old and =<85 years old. Patients who required an orogastric tube insertion or did not require a chest x-ray post nasogastric tube insertion were excluded. METHODS: Upon nasogastric tube insertion, the external length of the tube was measured and the corresponding internal length calculated. Several anatomical measurements were taken as required in the formulae below: 1. ((Distance from tip of nose to earlobe to xiphisternum-50 cm)/2) + 50 cm. 2. 29.38 + 4.53*gender+0.34*distance from nose to umbilicus with head flat on bed-0.06*weight (gender = 1 for male, and 0 for female). 3. Distance from xiphisternum to earlobe to nose + 10 cm. 4. Distance from earlobe to xiphisternum to umbilicus-distance from tip of the nose to earlobe. Post insertion chest x-rays were examined to evaluate the position of the nasogastric tube. For those with optimal positioning, the distance from tip of the nose to earlobe to xiphisternum and the four formulae were compared to determine which provided the least difference with the internal length of the nasogastric tube. RESULTS: Ninety-two participants were recruited. The average age of the cohort was 62.9 years old with 54% being male. Twenty-five had nasogastric tubes in optimal position; 13 had it too short and 54 had it too long. For nasogastric tubes in optimal position, distance from xiphisternum to earlobe to nose + 10 cm provided the best estimate of the internal length. Average difference between the distance from xiphisternum to earlobe to nose + 10 cm and internal length of the nasogastric tubes in optimal position was only 1.8 cm which was by far the least difference compared to other formulae. CONCLUSION: This study found distance from xiphisternum to earlobe to nose + 10 cm to provide the best estimate for the internal length of nasogastric tube required. However, even this formula could result in placement that is not optimal due to anatomical differences.

Automated analysis of gait and modified timed up and go using the Microsoft Kinect in people with Parkinson's disease: associations with physical outcome measures.

Instrumenting physical assessments in people with Parkinson's disease can provide valuable and sensitive information. This study aimed to investigate whether variables derived from a Kinect-based system can provide incremental value over standard habitual gait speed (HGS) and timed up and go (TUG) variables by evaluating associations with (1) motor and (2) postural instability and gait difficulty (PIGD) subscales of the Unified Parkinson's Disease Rating Scale (UPDRS). Sixty-two individuals with Parkinson's disease (age 66 ± 7 years; 74% male) undertook an instrumented HGS and modified TUG tests, in addition to the UPDRS. Multivariable regression models were used to evaluate the associations of the Kinect measures with UPDRS motor and PIGD scores. First step length during the TUG and average step length and vertical pelvic displacement during the HGS were significantly associated with the PIGD subscale (P < 0.05). The only Kinect-derived variable showing additive benefits over the standard measures for the PIGD association was HGS vertical pelvic displacement. The only standard or Kinect-derived variable significantly associated with the motor subscale was first step length during the TUG (P < 0.01). This study provides preliminary evidence to support the use of a low-cost, non-invasive method of instrumenting gait and TUG tests in people with Parkinson's disease. Graphical abstract ᅟ.

Effectiveness of an Advanced Practice Nurse-Led Preoperative Telephone Assessment.

The purpose of this project was to determine the effectiveness of an advanced practice nurse-led preoperative telephone assessment in reducing day-of-surgery cancellations of patients at an ambulatory surgery center. We concluded that a good history obtained by a trained and experienced advanced practice nurse or registered nurse can reduce day-of-surgery cancellations. Patients who were identified at high risk for preoperative complications during the telephone assessment were referred to the preoperative evaluation clinic for further evaluation.

Effectiveness of multidisciplinary interventions to improve the quality of life for people with Parkinson's disease: a systematic review.

AIMS: To conduct a systematic review and critically evaluate the literature on the effectiveness of multidisciplinary interventions to improve quality of life for people with Parkinson's disease. METHODS: An electronic search of the following publication databases was performed for records from 1995 to 2011: CINAHL PLUS (EBSCO), Joanna Briggs Institute, Pubmed, Web of Science (ISI), psycINFO, Scopus and Cochrane library. The keywords used were Parkinson's disease, nursing, allied health, doctor, intervention, quality of life, rehabilitation, multidisciplinary team and their various combinations. Key terms were matched to MeSH subject headings and exploded where relevant to include all subheadings and related terms to each key term used. 1808 articles were initially identified based on our selection criteria and the reference list of these articles was hand searched. Nine studies were included after this sifting process and critiqued by two reviewers. RESULTS: Three randomised controlled trials and 6 non-randomised cohort studies were included. For these studies the level of evidence ranged from the Scottish Intercollegiate Network (SIGN) level of 1- to 2-. The outcome measures assessed were heterogeneous, including measures of disability of disease, stage of disease and various quality of life measures. CONCLUSION: The evidence quantifying positive and sustained effects of multidisciplinary interventions to improve quality of life for people with Parkinson's disease is inconclusive. There has been relative lack of controlled experimentation to quantify therapy outcomes. The studies reviewed were varied and lacked long-term follow-up to quantify retention of the intervention. It is recommended that interventions to improve quality of life are tested in randomised controlled trials using standardised outcome measures, adequately powered samples and longer follow-up periods to assess intervention sustainability.

A questionnaire survey of patient experience with the Rheumatology Monitoring Clinic in Singapore.

AIM: The concept of a pharmacist/advanced practice nurse (APN)-led Rheumatology Monitoring Clinic (RMC) is a novel service in Singapore; we therefore conducted a questionnaire survey of patient experience. METHODS: Patients attending the RMC were provided with a set of questionnaires. As a substudy, a separate questionnaire was given to the rheumatologists and therapists conducting the RMC. RESULTS: Of the 105 patients surveyed, a total of 97 (92.4%) patients were satisfied/strongly satisfied with the overall service, and none were dissatisfied; 96% felt that the pharmacists/APNs provided clear, detailed information about their disease and medication, while 92% of patients were confident they knew what side-effects were possible. Ninety-two percent and 93% of patients were more likely to adhere to treatment, and were willing to come back for follow-up at the RMC, respectively. There was no difference in patient satisfaction in the average Likert summed scores, between the pharmacists and APNs. Age, gender, ethnicity and underlying disease did not exert any influence on the responses. All the rheumatologists surveyed were satisfied with the patients' management and the professionalism of the therapists. They opined that the RMC freed up time for them to see more complex cases. All the pharmacists/APNs concurred that the referrals were appropriately selected. CONCLUSIONS: We established the acceptability of a non-physician-led clinic in our local setting and highlighted the usefulness of having a routine clinic for monitoring medication toxicity and patient education. The RMC received positive feedback from patients, rheumatologists and allied health therapists, with a high degree of satisfaction among the respondents.

Experiences of caregivers of people with Parkinson's disease in Singapore: a qualitative analysis.

AIMS AND OBJECTIVES: To conduct an in-depth qualitative examination of the experiences of Singaporean people caring for those with Parkinson's disease (PD). BACKGROUND: The need to provide care for people with PD will increase with the extended life expectancy of Singaporeans. Caring for people with PD in their own homes for as long as possible is argued to provide psychosocial benefits as well as benefiting the community by delayed institutionalisation and reduced healthcare costs. DESIGN: This study reports the qualitative exploratory component of a large mixed method sequential explanatory design. METHODS: Caregivers were selected through a purposive sampling technique and stratified based on the Hoehn and Yahr disease staging. Twenty-one semi-structured interviews were conducted in the home setting. Interviews were audio-taped and transcribed verbatim. The qualitative data were analysed using Ritchie and Spencer's framework method of qualitative analysis (1994, Analyzing Qualitative Data, Routledge, London). RESULTS: Seventeen (81%) caregivers were women, and their ages ranged from 31 years to more than 71 years. The length of the interview ranged from 42-106 minutes. The interview transcriptions produced 1731 free nodes, and after careful scrutiny for redundancy, 11 sub-themes were identified, which were organised into four key themes. These themes pertained to: (1) Coping and adaptation, (2) Challenges of caregiving, (3) Effects of caregiving on the caregivers and the (4) Need for better caregiver support. CONCLUSION: The results of this study have provided insights into the coping and well-being of caregivers of people with PD. The progressive nature of PD placed a significant burden on caregivers' emotional well-being. The findings of this study underscore the need for formal caregiver support and education to reduce strain in caregivers targeted at every stage of PD as there is no clear pattern of disease progression. RELEVANCE TO CLINICAL PRACTICE: This study has provided important findings that will inform the construction of interventional strategies to reduce caregiver burden and the provision of better support services for caregivers.