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Objectives: Selection of autoimmune/paraneoplastic antibody panels remains challenging because health-care professionals often lack familiarity with panel contents, recommended specimen types, and antibody combinations for a given patient. Inappropriate use adds cost, prompts unnecessary additional workup, and delays the identification of the true cause of patient symptoms. In this study, we assessed whether order-entry clinical decision support can improve autoimmune/paraneoplastic antibody panel utilization., Methods: An order-entry clinical decision support tool was embedded in the electronic health record system. Using a nested panel structure, the decision support tool prompted clinicians to identify their patient's clinical presentation and guided selection of the appropriate tests. In addition, the tool featured a duplicate checking function to alert clinicians when placing multiple orders with substantially similar antibody content within a 3-month period. Panel ordering practices were assessed during the 12 months before implementation and compared with the 6 months immediately following implementation., Results: Clinical decision support significantly reduced the monthly test volume of all orderables from 75.8 per month before implementation to 54.5 per month after implementation (incident rate ratio [IRR], 0.72; 95% CI, 0.63-0.81; P < .001). Placement of multiple orders for panels with substantially overlapping antibody content also decreased significantly, from 7.0 per month to 1.2 per month (IRR, 0.17; 95% CI, 0.07-0.33; P < .001). The number of neural-specific antibodies detected remained unchanged, but the reduction in total test volume increased the neural-specific antibody positivity rate from 4.2% to 6.8% (IRR, 1.61; 95% CI, 0.94-2.70; P = .075)., Conclusions: Order-entry clinical decision support offers an efficient and effective approach to improve the utilization of autoimmune/paraneoplastic antibody panels., (© The Author(s) 2024. Published by Oxford University Press on behalf of American Society for Clinical Pathology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objective: Advance Care Planning (ACP) is one of 10 key elements in the American Academy of Neurology Parkinson disease (PD) clinical practice quality measures. We know little about how aging influences ACP views in people with PD., Methods: We conducted a cross-sectional survey of 39 participants (mean age 70.3 years; range: 52-81) with PD to explore correlations between older age and life-sustaining treatment preferences while controlling for confounders including years of education, Montreal Cognitive Assessment score and Movement Disorders Society Unified Parkinson's disease Rating Scale motor score. Scenarios asked participants to choose their level of interest in pursuing life-sustaining measures in the setting of specific medical illnesses including stroke, metastatic cancer, severe heart attack, and dementia. All participants were men and were recruited from the Veterans Affairs Ann Arbor Healthcare System., Results: In the hypothetical stroke, metastatic colon cancer, and dementia scenarios, older age correlated with more aggressive care goals related to the use cardiopulmonary resuscitation to treat cardiopulmonary arrest., Conclusions: Advancing age in PD may correlate with paradoxically more aggressive goals as it relates to life-sustaining treatment preferences including cardiopulmonary resuscitation. This may reflect a response to heightened concern among older adults with PD about the potential for compromised autonomy in the setting of aging., (© 2021 American Academy of Neurology.)

Background: Caregiver burden (CB) in Parkinson's disease (PD) does not improve in the short term after bilateral subthalamic nucleus (STN) deep brain stimulation (DBS), despite motor improvement. This may be due to increased caregiver demands after surgery or the possibility that DBS unresponsive non-motor factors, such as executive dysfunction, contribute to CB., Objective: To evaluate the trajectory of CB in year 2 following bilateral STN DBS surgery for PD, and to test whether post-operative CB changes correlate with changes in executive function in a subgroup with available neuropsychological testing., Methods: This retrospective analysis included 35 patients with PD whose caregivers completed the Caregiver Burden Inventory (CBI) at baseline and between 9 and 24 months after bilateral STN DBS. 14 of these patients had neuropsychological testing both at baseline and within 6 months of their follow up CBI assessment., Results: CBI scores showed worsened CB from baseline to follow-up (16.4-21.5, p = 0.006). There was no correlation between change in executive function and change in CBI in the smaller subsample., Conclusion: CB worsens in the 2 years after bilateral STN DBS despite improvement in motor symptoms and is not associated with change in executive dysfunction in the setting of advancing PD. These findings have implications on pre-operative counselling for patients and caregivers considering DBS for PD., (Copyright © 2020 Elsevier Ltd. All rights reserved.)