OBJECTIVE Chronic pain is a major distressing symptom of Parkinson's disease (PD) that is often undertreated. Subthalamic nucleus (STN) deep brain stimulation (DBS) delivers high-frequency stimulation (HFS) to patients with PD and has been effective in pain relief in a subset of these patients. However, up to 74% of patients develop new pain concerns while receiving STN DBS. Here the authors explore whether altering the frequency of STN DBS changes pain perception as measured through quantitative sensory testing (QST). METHODS Using QST, the authors measured thermal and mechanical detection and pain thresholds in 19 patients undergoing DBS via HFS, low-frequency stimulation (LFS), and off conditions in a randomized order. Testing was performed in the region of the body with the most pain and in the lower back in patients without chronic pain. RESULTS In the patients with chronic pain, LFS significantly reduced heat detection thresholds as compared with thresholds following HFS (p = 0.029) and in the off state (p = 0.010). Moreover, LFS resulted in increased detection thresholds for mechanical pressure (p = 0.020) and vibration (p = 0.040) compared with these thresholds following HFS. Neither LFS nor HFS led to changes in other mechanical thresholds. In patients without chronic pain, LFS significantly increased mechanical pain thresholds in response to the 40-g pinprick compared with thresholds following HFS (p = 0.032). CONCLUSIONS Recent literature has suggested that STN LFS can be useful in treating nonmotor symptoms of PD. Here the authors demonstrated that LFS modulates thermal and mechanical detection to a greater extent than HFS. Low-frequency stimulation is an innovative means of modulating chronic pain in PD patients receiving STN DBS. The authors suggest that STN LFS may be a future option to consider when treating Parkinson's patients in whom pain remains the predominant complaint.
Purpose
This paper aims to contribute to the growing body of research on health-care leadership by demonstrating the value of dyads and triads in strengthening capabilities of health-care settings and providing action pathways to accelerate gender parity in senior health-care positions.
Design/methodology/approach
The paper reviews the evidence that when single-leadership models are used and women are under-represented in leadership, the health-care industry may miss out on opportunities to increase efficiency and quality of care. Next, the paper describes a co-leadership model with distinct and overlapping roles, which promotes women’s participation and inspires administrative and clinical leaders to collaborate and achieve optimal performance.
Findings
The dyad as the enabling track for women in health-care leadership creates opportunities for health-care systems to bridge the gender gap in senior positions as well as improve the delivery of cost-effective quality care.
Practical implications
The inclusive co-leadership model with distinct and overlapping roles is a promising pathway for increasing health-care system efficiency and for promoting women to senior roles by tapping into the leadership skills and expertise that women bring to these roles.
Originality/value
The current paper demonstrates the dual effects of using co-leadership in senior health-care positions and fixing the gender imbalance. It has significant implications for advancing similar pathways in other industries as a means for accelerating gender parity in senior management.
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