Anne Gross

Step initiation in Parkinson's disease: Influence of initial stance conditions

In this study, we investigated how the size of preparatory postural adjustments prior to step initiation, and step length and velocity depend on initial stance width in patients with Parkinsons disease (PD) both in the ON and OFF levodopa states and in healthy elderly subjects. Twenty-one subjects with idiopathic PD and 24 age-matched healthy control subjects took two steps starting with feet on a two-plate force-platform, from either narrow or wide stance width. We measured how the magnitude of anticipatory postural adjustments (APA) and step characteristics scaled with stance width. Results showed that preparation for step initiation from wide stance was associated with a larger lateral and backward center of pressure (CoP) displacement than from narrow stance. Velocity and length of the first step were also sensitive to initial stance conditions, probably in relation with the differences in the corresponding APA. On the contrary, the duration of APA was not significantly affected by initial stance width, but it was longer in PD compared to healthy subjects, and speeded up by levodopa. Although subjects with PD did scale up the size of their APA with stance width, they had much more difficulty initiating a step from a wide stance than from a narrow stance, as shown by the greater differences from control subjects in the magnitude of the APA. Our results support the hypothesis that PD subjects maintain a narrow stance as a compensation for their inability to sufficiently increase the size of their lateral APA to allow fast step initiation in wide stance.

Comparison between subthalamic nucleus and globus pallidus internus stimulation for postural performance in Parkinson's disease

Nine subjects with Parkinsons disease, five subjects with electrodes implanted in the subthalamic nucleus (STN) and four with electrodes in the globus pallidus internus (GPi), were compared with a population of ten age-matched control subjects. The measures studied include a set of summary statistic scores, two stochastic parameters, the distribution of the center of pressure (CoP) displacement angles under each foot, and the distribution of bilateral patterns of CoP displacement angles. A Bayes classifier was designed to monitor the trend of postural performance in patients, with different treatments. Results suggested that the selected measures were sensitive to Parkinsonian postural sway abnormalities and highlight differences in response to treatments. Deep brain stimulation restored a more normal postural sway and levodopa increased sway abnormalities. Furthermore, the selected measures appear to detect different responses to levodopa between the STN and GPi groups: the negative side effects of levodopa on posture were less severe for STN than for GPi patients, perhaps due to the decreased need for levodopa intake in STN subjects. The measures proposed in this preliminary study may be useful adjuncts to evaluate balance and postural control strategies in patients with Parkinsons disease and may allow the comparison of DBS electrode sites, on stance posture.

Medication errors involving oral chemotherapy

Given the expanding use of oral chemotherapies, the authors set out to examine errors in the prescribing, dispensing, administration, and monitoring of these drugs.

Perceptions and Experiences of Patients Receiving Oral Chemotherapy

Although many patients prefer orally administered cancer therapy (including oral chemotherapy) because of its convenience, the shift from hospital to home-based administration creates concerns. This article explores the perceptions and experiences of oral chemotherapy users and their caregivers to assess vulnerabilities and improvement opportunities at each stage of the medication process: choosing oral chemotherapy, prescribing, dispensing, administering, and monitoring. The authors recruited 15 current and former oral chemotherapy users, as well as caregivers who administered the medications to children, to participate in one of two focus group sessions at a comprehensive cancer center. Participants largely were satisfied with oral cancer therapy but raised concerns regarding their lack of preparedness for side effects and their unfamiliarity with the possible techniques to mitigate drug toxicity. Participants also described difficulties obtaining medications through retail pharmacies. Parents of pediatric patients with cancer indicated concerns regarding their childrens emotional health and correct medication administration. Participants believed that the initial prescribing encounter should have included more education, and they also wanted more frequent follow-up by healthcare practitioners. As oral cancer therapy is used more widely, oncology healthcare providers will need to create robust mechanisms to support their safe use.

Retaining Oncology Nurses: Strategies for Today's Nurse Leaders

Carolyn Hayes, PhD, RN, is director of clinical initiatives at Dana-Farber/Brigham and Women’s Cancer Center in Boston, MA; Patricia Reid Ponte, DNSc, RN, FAAN, is senior vice president of patient care services and chief of nursing at Dana-Farber Cancer Institute and director of hematology/oncology/bone marrow transplantation nursing and clinical services at Brigham and Women’s Hospital in Boston; Amanda Coakley, PhD, RN, is a staff specialist in patient care services at Massachusetts General Hospital in Boston; Escel Stanghellini, MS, RN, is a nursing coordinator at Brigham and Women’s Hospital; Anne Gross, MS, RN, CNAA, is vice president of adult ambulatory service and director of adult ambulatory nursing, Sharon Perryman, BSN, MHA, RN, is a nurse executive fellow in diversity, and Diane Hanley, MS, RN, BC, is director of cancer care education, practice, and quality, all at Dana-Farber Cancer Institute; Nancy Hickey, MS, RN, is director of personnel and resource applications at Brigham and Women’s Hospital; and Jacqueline Somerville, MS, RN, is associate chief nurse in patient care services at Massachusetts General Hospital. The authors received writing and editing assistance with this article.

Current approaches to the recognition and treatment of alcohol withdrawal and delirium tremens: "old wine in new bottles" or "new wine in old bottles".

Have you ever wondered how much alcohol a person has to drink (and for how long) before he or she risks developing a withdrawal syndrome after sudden abstinence? Have you ever wondered which methods are best to diagnose and quantify the severity of alcohol withdrawal? Have you been uncertain about which strategies can best manage alcohol withdrawal? If you have, then the following discussion and review of the literature should serve as a stimulus to enhance your understanding of the problem and to create effective solutions.

The Assessment and Management of Agitation and Delirium in the General Hospital

The Psychiatric Consultation Service at Massachusetts General Hospital (MGH) sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. Such consultations require the integration of medical and psychiatric knowledge. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss the diagnosis and management of conditions confronted. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. Dr Stern is chief of the Psychiatric Consultation Service at MGH and is a professor of psychiatry at Harvard Medical School (HMS); Drs Celano and Gross are clinical fellows in psychiatry at HMS and fellows in adult psychiatry at MGH and McLean Hospital; Dr Huffman is director of Inpatient Psychiatry Services at MGH; Drs Freudenreich, Kontos, and Nejad are attending physicians on the Psychiatric Consultation Service at MGH; Ms Repper-DeLisi is a psychiatric nurse clinician on the Nursing Consultation Service at MGH; Dr Thompson is director of the Medical Intensive Care Unit at MGH and an associate professor of medicine at HMS. Dr Stern is an employee of the Academy of Psychosomatic Medicine; has served on the speakers board of Reed Elsevier; is a stock shareholder in WiFiMed (Tablet MD); and has received royalties from Mosby/Elsevier and McGraw Hill. Dr Freudenreich has served as a consultant to Beacon Health Strategies and has received grant/research support from Pfizer and honoraria from Reed Medical Education. Drs Celano, Gross, Huffman, Kontos, Nejad, and Thompson and Ms Repper-DeLisi report no financial or other affiliations relevant to the subject of this article.

An approach to symptoms at the interface of medicine and psychiatry: pain, insomnia, weight loss and anorexia, fatigue and forgetfulness, and sexual dysfunction.

Primary care physicians commonly deal with patients who present with a somatic complaint for which no clear organic etiology can be found. This article discusses how a psychiatrist thinks about somatic symptoms (eg, pain, insomnia, weight loss and loss of appetite, fatigue and forgetfulness, sexual dysfunction) in a patient who might have depression. The management of a patient in whom no satisfactory medical or psychiatric diagnosis can be made is also reviewed briefly.

Staying Against Advice: Refusal to Leave the Hospital

Lessons Learned at the Interface of Medicine and Psychiatry The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. Such consultations require the integration of medical and psychiatric knowledge. During their twice-weekly rounds, Dr Stern and other members of the Psychiatric Consultation Service discuss the diagnosis and management of conditions confronted. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. Dr Moran is a clinical fellow in psychiatry at Harvard Medical School, Boston, Massachusetts, and a resident in psychiatry at Massachusetts General Hospital and McLean Hospital, Boston. Dr Gross is a fellow in psychosomatic medicine at Massachusetts General Hospital. Dr Stern is chief of the Psychiatric Consultation Service at Massachusetts General Hospital and a professor of psychiatry at Harvard Medical School. Dr Stern is an employee of the Academy of Psychosomatic Medicine, has served on the speakers board of Reed Elsevier, is a stock shareholder in WiFiMD (Tablet PC), and has received royalties from Mosby/Elsevier and McGraw Hill. Drs Moran and Gross report no financial or other affiliations relevant to the subject of this article.

Partnering With Schools of Nursing: An Effective Recruitment Strategy

Patricia Reid Ponte, DNSc, RN, is senior vice president for patient care services and chief of nursing at Dana-Farber Cancer Institute and director of hematology/oncology/bone marrow transplantation, nursing, and clinical services at Dana-Farber/Brigham and Women’s Hospital in Boston, MA; Carolyn Hayes, PhD, RN, is director of clinical initiatives at Dana-Farber/Brigham and Women’s Cancer Center; Amanda Coakley, PhD, RN, is a staff specialist in patient care services at Massachusetts General Hospital in Boston; Escel Stanghellini, MS, RN, is a nursing coordinator at Dana-Farber/Brigham and Women’s Hospital; Anne Gross, MS, RN, CNAA, is vice president in adult ambulatory service and director of adult ambulatory nursing, Sharon Perryman, BSN, MHA, RN, is a nurse executive fellow in diversity, and Diane Hanley, MS, RN, is director of cancer care education, practice, and quality, all at Dana-Farber Cancer Institute; Nancy Hickey, MS, RN, is director of personnel and resource applications at Dana-Farber/Brigham and Women’s Hospital; and Jacqueline Somerville, MS, RN, is associate chief nurse in patient care services at Massachusetts General Hospital. The authors received writing and editing assistance with this article.