management of advanced parkinson

8/3/2019 Management of Advanced Parkinson

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JOURNAL CRITICISM

T he Rationale For Improved Integration Between

Home Care And Neurology Hospital Services In

Patients With Advanced Parkinson’s Disease

By:

Group 1 B

✔ Shindy Anggreini Putri 105070201131001

✔ Yolanda Annisa Aji 105070201131011

✔ Yossie Charolina 105070201131015

K3LN 2010

NURSING DEPARTEMENT

MEDICAL FACULTY

BRAWIJAYA UNIVERCITY

2011



T he Rationale For Improved Integration Between Home Care AndNeurology Hospital Services In Patients With Advanced Parkinson’sDisease

Authors : Angelo Antonini · Luisa Mirò · Carlo Castiglioni · Gianni Pezzoli

I.Analysis Of The Article

At least one third of outpatient visits, as well as over 50% of

emergency ward (EW) visits and admissions for PD (DRG 012) involve

patients in an advanced stage of the disease. For example, at a county

hospital in Vimercate, there were 373 EW visits for DRG 12 (Parkinson’

disease) in the period from 2000 to 2005; 72% were admitted to

General Medicine or Surgery and only 28% to the Neurology ward. Once

patients are admitted, the average number of hospitalisation days is stillvery high in Italy and reflects difficulties in the management of

complications in these patients, particularly when neurologists are only

marginally involved (see Table 1).

Symptom control in PD patients often requires the use of high-cost

alternative therapies which are characterised by particular drug

administration methods or by direct intervention through

neurostimulation of cerebral areas such as the subthalamic nucleus:

1. Apomorphine.

This drug is administered subcutaneously through an infusionmicro-pump that normally used in day-time hours only and must

be reutilized. Patients must be trained in the use of the pump,

which is programmed by the reference clinical centre and

periodically refilled by patients. The quantity of materials must be

adequate to the needs (most side effects affecting the skin are

due to reutilisation of already used materials and poor hygiene at

the infusion site).

2. Duodopa.

This drug is administered into the jejunum through an ostomyusing an external infusion device (pump), therefore patients must

undergo a minor surgery procedure in order to then receive

therapy.

3. Neurostimulation : Deep Brain Stimulation (DBS).

Neurostimulation is carried out by applying a pacemaker whose

electrode is positioned in the subthalamic region or the internal

globus pallidus bilaterally. Electrostimulation is normally started

1–6 weeks after implantation.

Currently patients are usually instructed by their reference clinical

centre on how they should behave to manage their therapies, but



training only takes place in hospital facilities; when patients go back

home, no support is provided, and the only point of reference for these

patients is their clinical centre, which they access either by phone or

directly, showing up at outpatients’ departments. To help develop this

phase, the authors proposing an approaching step for patients who can

no longer adequately control their disease by oral therapies.

Management for each therapy and standard care :



Given the current environment, it is critical to define a structured

pathway for patients with advanced PD that will ensure their

management in the community and reduce hospital visits. Active

management, possibly through a dedicated call centre, will help identify

clinical issues that must be supported by the reference centre and

separate them from those that can be managed either directly by thepatient or by a home care service.

In conclusion, these interventions will help to maintain residual

autonomy as long as possible, eventually leading to reduced emergency

ward visits and unnecessary hospitalisations.

I.Suggestion Over The ArticleAdvantages of the journal

1. It explained that actually neurology ward is important for

Parkinson’s Disease patients rather than general medicine orsurgery. The fact shows in Vimercate, Italia, only 28% were

admitted to the neurology ward while the rest are cared for in

general Medicine and surgery. After the patients were treated in

general medicine or surgery, the average number of days of

hospitalization is still very high, and reflects the difficulty in the

management of complications.

2. In the journal also explained if the management of Parkinson's

disease requires a good medicine. When the patient can go home

to their house (outpatient care), patient's family should also be

given more education so that the medicine management remain

good for at home and not go back to be hospitalized.

3. As nurses, we actually have a great opportunity related to home

care, it might be services or the like. Because the research which

took place in Italy, precisely in district Vimercate, Parkinson's

patient’s hospitalization were much longer in general medicine

and surgical treatments with the reasons because the less focus

and difficulty in managing its complications.

Disadvantages journals:

1. Samples of this journal is limited, only one area. Shall in more

than one area in order to strengthen this study.

2. No more in-depth explanation of Parkinson's disease itself,

whereas in the journal mentioned abstrack Parkinson's disease.

The journal described only related to the management of

Parkinson's alone, the authors should provide more explanation

related to Parkinson's disease.

3. Explanation of activities related to home care and hospital

activities only described with scheme. It should also describe thewritten essay in order make it easier for readers to understand



clearly about the differences in hospitalization and caring home .

I.Application Of The Research In Health Care Setting In

Indonesia

Integrated Home Care which was researched by the authorssubstantively can be done in Indonesia especially by nurse to

increase successfulness of treatment after patients were discharged

from hospital. The problem is, home care management in Indonesia

doesn’t work well and often blocked by the always-changing policy

of Health Department.

In Indonesia, Parkison’s disease’s treatment and ways to improve

the control of body movements and perform basic functions are

founded, such as walking and dressing. Also there are therapy such

as music therapy. If this treatment are applied in home care like

what were implemented in journal, it will give a huge advantages for

patients and their family.

Health professional in Indonesia also give explanations about the

whole disease to patients and their familiy, this will make an

understanding for better cooperation if the Integrated Home Care

are carried out.

management of advanced parkinson

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