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Background: Patients with neurological disorders are the second most common patient population to receive inpatient palliative care services after cancer; however, there have been few reports describing the characteristics and needs of this population. Objective: To understand which patients with neurological diagnoses utilized these services, reasons for consultation, and whether patterns of use changed over time. Design: Retrospective case series. Setting/Subjects: Neurological patients seen by our academic hospital-based palliative care consult service from January 2010 through December 2014. Measurement: Demographics, diagnoses, reasons for consultation, patient characterization, and outcomes were extracted from medical record. Methods: Data extracted from the chart was analyzed using primarily descriptive statistics with Chi-square used to compare group proportions and regression to examine temporal trends. Results: A total of 3170 patients received inpatient palliative care consultations, of whom 291 (9.2%) had a neurological diagnosis. Among these patients, 85 were excluded because of insufficient data, leaving 206 patients (mean age 70.0 ± 16.0 years; 111 (54%) female). Of the patients, 49% had a chronic diagnosis and 51% received a new diagnosis during their hospitalization, most commonly ischemic stroke. The proportion of patients with chronic diagnoses increased over time, with dementia representing the most common diagnosis in 2014. The most common reason for consultation was eliciting goals of care (82%). Advance directives were present at admission in 61 (30%), 130 (63%) at the time of consultation, and 190 (92%) patients after consultation. The proportion of people with advance directives after consultation significantly increased over the study period ( p = 0.01). Discussion: Hospital-based palliative care is primarily utilized to clarify goals of care in neurological patients and that advance directives were commonly not completed prior to consultation. Conclusions: Outpatient and hospital neurologists should routinely address advance directives, particularly as the proportion of patients with chronic neurological diagnoses increases. [ABSTRACT FROM AUTHOR]

Introduction. Complementary and alternative medicine (CAM) is frequently used by Parkinson’s disease (PD) patients. We sought to provide information on CAM use and efficacy in PD patients in the Denver metro area with particular attention to cannabis use given its recent change in legal status. Methods. Self-administered surveys on CAM use and efficacy were completed by PD patients identified in clinics and support groups across the Denver metro area between 2012 and 2013. Results. 207 patients (age 69±11; 60% male) completed the survey. Responses to individual CAM therapy items showed that 85% of respondents used at least one form of CAM. The most frequently reported CAMs were vitamins (66%), prayer (59%), massage (45%), and relaxation (32%). Self-reported improvement related to the use of CAM was highest for massage, art therapy, music therapy, and cannabis. While only 4.3% of our survey responders reported use of cannabis, it ranked among the most effective CAM therapies. Conclusions. Overall, our cross-sectional study was notable for a high rate of CAM utilization amongst PD patients and high rates of self-reported efficacy across most CAM modalities. Cannabis was rarely used in our population but users reported high efficacy, mainly for nonmotor symptoms. [ABSTRACT FROM AUTHOR]

Objective To determine if acupuncture-exposed and naïve participants differ in their perceptions of real and sham acupuncture under blinded conditions. Methods The setting was an outpatient clinic at the Colorado School of Traditional Chinese Medicine. Participants were between the ages of 18 and 90 years. Acupuncture-exposed participants had at least five prior acupuncture treatments, with one treatment in the month prior to the study date. Acupuncture-naïve participants had experienced no prior acupuncture treatments. Participants with dementia, cognitive impairment, or neuropathy were excluded. In total, 61 acupuncture-exposed and 59 acupuncture-naïve participants were blindfolded and received either real acupuncture or toothpick sham acupuncture treatment. Following treatment, participants completed a questionnaire rating the realness of the acupuncture and were asked how they made this determination. We used a previously developed scale rating treatments from 1 (definitely real needle) to 5 (definitely imitation needle) to assess outcome. Results Perceptions of the real treatment were rated as more real than sham treatments for all participants. Further analysis revealed that prior acupuncture exposure did not influence ratings of real treatments, but exposed participants rated sham treatments as significantly less real than naïve participants. Conclusions Acupuncture-naïve and exposed participants both reported different perceptions of real and sham acupuncture using a blindfolded toothpick protocol. This suggests that future trials should carefully monitor participant perceptions of treatments received, even for naïve individuals. Differences between groups further suggest that participants with significant and/or recent exposure to real acupuncture may introduce bias to blinded clinical acupuncture trials. [ABSTRACT FROM AUTHOR]