The use of Fogs' test to assess associated movements in Parkinsonism, dystonia, and controls.

The Fogs' test elicits non-homologous associated movements which reflect underlying pathology or immaturity of the CNS, but has not been thoroughly studied. We filmed participants performing a modified Fogs' test and developed a reliable scoring system for the associated movements. We assessed scores in healthy controls of all ages and compared scores in dystonia and parkinsonism to age similar controls. Associated movements were marked in children, lessened as they matured into adults, and then increased in old age. Associated movements were marked in dystonia but not in parkinsonism. Our scoring system showed robust inter- and intra-rater reliability. The Fogs' test is a reliable addition to the clinical examination that can be used to screen for both normal and abnormal neurological status. We suggest a potential neural pathway via cervical-lumbosacral connections within the spinal cord which are modulated by propriospinal and cerebral input.

Preferences of patients with Parkinson's disease for communication about advanced care planning.

BACKGROUND: Despite shortening life, Parkinson's disease (PD) is often not considered "terminal." Uncertainty exists about when to discuss end-of-life planning. METHODS: A survey was sent to patients with PD assessing attitudes toward the timing and initiation of discussions regarding their disease. Data were analyzed for patient preferences regarding communication. RESULTS: Of 585 surveys, 267 were returned. Ninety-four percent of patients wanted prognosis and treatment information early. Half of the patients wanted to discuss advanced care documents early. Some wanted early discussions about end-of-life care planning (27%) or end-of-life care options such as hospice (21%). The majority felt shared responsibility for initiating discussions about life expectancy, advance care documents, and end-of-life care planning. CONCLUSIONS: Preferences regarding end-of-life discussions vary. Consequently, neurologists should ask patients about their preferences for this information and offer discussion periodically.

Life-sustaining treatment orders, location of death and co-morbid conditions in decedents with Parkinson's disease.

INTRODUCTION: End-of-life care in Parkinson's Disease (PD) is poorly described. Physician Orders for Life Sustaining Treatment (POLST) forms specify how much life-sustaining treatment to provide. This study aims to better understand end-of-life care in PD using data from the Oregon POLST and Death Registries. METHODS: Oregon death certificates from the years 2010-2011 were analyzed. Death certificates were matched with forms in the Oregon POLST Registry. Descriptive analyses were performed for both the full PD dataset as well as those with POLST forms. RESULTS: There were 1073 (1.8%) decedents with PD listed as a cause of death and 56,961 without. Three hundred and seventy three (35%) decedents with PD had a POLST form. POLST preferences were not significantly different between those with or without PD, however location of death was; hospital (13% PD vs 24% without p < 0.01), home (32% vs 40% p < 0.01) and care facility (52% vs 29% p < 0.01). Compared to those without a POLST or those without a Comfort Measures Only (CMO) order, decedents with PD and a CMO order were less likely to die in a hospital (5.4% vs 14.7% p < 0.01) and more likely to die at home (39.1% vs 29.1% p < 0.01). In those with PD, dementia was the most common comorbid condition listed on death certificates (16%). CONCLUSION: Decedents with PD die less frequently at home than the general population. POLST forms mitigate some of this discrepancy. While not often thought to be terminal, PD and its complications are commonly recorded causes of death.

Survey of Residents' Attitudes and Awareness Toward Teaching and Student Feedback.

BACKGROUND: Teaching medical students is an important component of residency; however, little is known about student feedback regarding resident teaching skills. OBJECTIVE: We sought to explore resident awareness of medical student feedback mechanisms and how feedback is obtained, and also identified attitudes about teaching more commonly found in residents who seek feedback. METHODS: We surveyed all resident physicians at a university-affiliated academic health center about awareness of student feedback regarding their teaching abilities, and their attitudes related to teaching that may impact whether residents seek feedback. RESULTS: Of 605 residents, 335 (55%) responded, with 72% (242 of 335) noting they did not formally review student feedback of their teaching with their advisor during regularly scheduled meetings, 42% (140 of 332) reporting they did not know of any formal feedback mechanisms, and 28.4% (95 of 334) reporting they had not received feedback from students in any format. Although only a quarter of residents solicit feedback always or often, more than half would like feedback always or often. Reported barriers to feedback included student apprehension, time constraints, and lack of a formal system. A majority of residents had positive attitudes toward teaching and felt that student feedback would help teaching ability and medical proficiency. CONCLUSIONS: A large percentage of residents at 1 teaching institution reported not receiving feedback from students on their teaching abilities. Residents who did receive feedback were more likely to have actively solicited it. Overall, residents believe that this feedback from students would benefit their clinical and teaching performance.