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August 27-28, 2018 | London, UK
International Conference on
Healthcare and Health Management
Cardiology and Cardiac Surgery
Joint Event
&
Journal of Public Health Policy and Planning | Volume: 2
Does the degree of improvement after deep brain stimulation surgery for Parkinson’s disease meet
the patient’s expectations? What is the nurse specialist’s role in the DBS patient care?
Joseph Candelario-Mckeown
National Hospital for Neurology and Neurosurgery, UK
D
eepbrain stimulation (DBS) is an effective surgical treatment
that improves patient quality of life in advanced Parkinson’s
disease (PD). An essential part of patient care in DBS surgery
is to identify and manage expectations. The DBS outcome is
frequently influenced by patients’ expectations of improvement
after DBS surgery.For the whole group, there was a significant
reduction in total Levodopa Equivalent Daily Doses (mg/day)
by 50.45% after DBS and motor symptom improvement on the
UPDRS-IIIOFF(p0.001),mobility(p0.0048),ADL(p0.008);stigma
(p 0.014) after DBS. This objective symptomatic improvement
was also mirrored in the patient expectations being generally
met for the motor symptoms at least. Most patients reported
that expectations of improvement after DBS were met: 64%
for motor symptoms, 71% and 83% for QoL and reductions in
medication daily dose (respectively). Only 25% of the expected
levels of improvement were met for the non- motor symptoms
and for the social domain. The expectations of DBSwere satisfied
6months to2years after the surgery: in theGPi-DBSgroup, 100%
were satisfied for reduction of dyskinesias, 83.3% for motor
symptoms and 66.70% for QoL. STN-DBS patients were satisfied
with the reduction in medication (84.20%), 78.90% for motor
symptoms and 73.70% for QoL. DBS did meet the perceived
expected level of improvement in motor symptoms, QoL and
reduction in medication within 6 months to 2 years after DBS
surgery for the majority of patients which corresponded to the
objective clinical outcome. The pre-DBS expected improvement
of non-motor symptoms and social domain was not met after
surgery. Overall, both STN-DBS and GPi-DBS patients were
satisfied that DBS had met their expectations of surgery.
Speaker Biography
Joseph Candelario-Mckeown has completed his Master’s degree in Advance Nursing
Practice at City University London, UK. His work experience includes working for
the past 10 years as a clinical nurse specialist in Surgical Movement Disorders –
deep brain stimulation (DBS). Also, he is currently the treasurer and committee
member of the Deep Brain Stimulation Nurse Association (DBSNA). He is one
of the main contributors in the objectives of DBSNA which aims to standardize
competency assessments, standardize pre-DBS assessments and improve education
amongst DBS nurse specialists in centres around UK. He has collaborated with
other world renowned neurologist and neurosurgeons in research and publications.
e:
josephcandelario@nhs.net