Background Palliative care (PC) is an essential part of oncologic care, but its optimal role within a cancer center remains unclear. This study examines oncology healthcare providers’ perspectives about the role of PC at a comprehensive cancer center (CCC). Methods Physicians, nurses, and other oncology healthcare providers at a CCC were surveyed for their opinions about the role of inpatient and outpatient PC, preferences for PC services, and barriers to referral. Chi-squared tests and multiple regression analyses were performed to explore associations. Results We received 137/221 completed questionnaires (61% response rate). Respondents were generally female (78%), had ≤ 10 years of service (69%), and included physicians (32%), nurses (32%), and advanced practice providers (17%). Most respondents (82%) agreed that more patients could benefit from PC. They also agreed that PC is beneficial for both outpatient and inpatient management of complex pain (96 and 88%), complex symptoms (84 and 74%), and advanced cancer patients (80 and 64%). Transition to hospice (64 vs. 42%, p = 0.007) and goals of care (62 vs. 49%, p = 0.011) provided by PC services were more valued by respondents for the inpatient than for the outpatient setting. Barriers to utilizing PC included lack of availability, unsure of when to refer, and poor communication. The majority of respondents (83%) preferred a cancer focused PC team to provide high-quality care. Conclusions Overall, the majority of oncology health care providers believe that more patients could benefit from PC, but opinions vary regarding the roles of inpatient and outpatient PC. Barriers and areas for improvement include availability, referral process, and improved communication.
Objective: To improve recovery of gait after stroke, we need to attain better understanding of lower extremity motor control. Transcranial magnetic stimulation (TMS) allows for evaluation of corticomotor input (CMI) integrity. Our objective was to explore the relationship between CMI to the dorsi-/plantarflexors and measures of motor impairment and gait speed. Methods: Fugl-Meyer for Lower Extremity (FM), gait speed and TMS Motor Evoked Potentials (MEP) were collected for 27 ambulatory chronic stroke survivors. Maximum MEPs (MEP max ) were collected for paretic and non-paretic tibialis anterior (TA) and lateral gastrocnemius muscles (Gastroc) using a cone-shaped TMS coil targeting primary motor cortices. We collected MEPs while seated participants activated their tested muscles to 20% of maximum effort. MEPs were normalized by the maximum compound muscle action potentials obtained by stimulation of the peripheral motor nerves. Symmetry of the corticospinal motor output was calculated as ratio of the normalized paretic and non-paretic MEP max . Analysis included descriptive statistics, paired t-test and Pearson correlation. Non-normally distributed data was log-transformed. Results: Study participants were 65.7±7.5 years old, 5.3±4.4 years after stroke and 81% male. Their mean±SD FM was 24.6±3.7 and gait speed was 0.74±0.38 m/s. For both TA and Gastroc, paretic MEP max were significantly smaller than non-paretic (p=3.8e -18 ). For Gastroc, higher ratio of paretic/non-paretic MEP max correlated with lesser impairment measured with FM (r=0.42, p=0.027). For TA, the correlation was lower and did not reach statistical significance (r=0.33, p=0.088). Gait speed did not have a significant correlation with MEP max . FM moderately correlated with gait speed (r=0.44, p=0.02). Conclusion: Gastroc MEP might be a better biomarker of motor impairment than TA. Thus, CMI to TA and Gastroc may provide different information in elucidating the mechanism of lower limb motor control. Gait speed does not correlate with CMI for dorsi-/plantarflexors which suggests that motor control of ambulation (gait speed) may differ from that of isolated joint movement (FM).
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