ORCID Profile
0000-0001-5208-681X
Current Organisations
University of Queensland
,
Princess Alexandra Hospital
,
University of Otago
,
Sunshine Coast Hospital and Health Service
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Publisher: Wiley
Date: 23-01-2021
DOI: 10.1111/ENE.14728
Abstract: Functional neurological disorders (FND) represent a significant proportion of presentations to outpatient adult neurology services. There is little information relating to patients presenting to acute inpatient care. We identified patients presenting as acute admissions with FND to Christchurch Hospital, Christchurch, New Zealand, from 2016 to 2018. We analyzed relevant demographic and clinical data from electronic records and measured incidence of presentation to secondary care and healthcare utilization. One hundred sixty‐two patients presented on 173 occasions with FND, representing 9% of all admissions to the neurology service during the 3‐year study period. The mean age was 40 (SD 17) years, 111 (69%) patients were female and the median length of stay was 3 (IQR 2–4) days. A total of 92 computed tomography brain scans, 77 magnetic resonance imaging brain scans and 42 electroencephalograms were carried out. On 22 (13%) occasions, patients were referred for outpatient psychological therapy. In the 3 years prior to each patient's last presentation in the study period, these 162 patients had a total of 671 presentations to the emergency department. Healthcare demand did not decrease after the index admission. The rate of acute inpatient admission for FND was 10 per 100,000 per year for the total Christchurch Hospital catchment, 6/100,000/year in rural areas, and 11/100,000/year in urban areas. FND represented almost 1 in 10 acute neurology admissions with significant inpatient healthcare resource utilization.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-01-2021
Publisher: Wiley
Date: 05-05-2023
DOI: 10.1002/MDC3.13757
Abstract: Functional neurological disorder (FND) is a disabling condition which has poor prognosis without treatment. This study aimed to evaluate the effectiveness of an outpatient integrated multidisciplinary intervention for the condition. This study aimed to assess the outcomes of a pilot integrated multidisciplinary treatment clinic for FND with motor symptoms. Patients were seen simultaneously by a neurology doctor, a physiotherapist, a clinical psychologist, and sometimes a psychiatrist. The primary endpoint was change in quality of life measured by Short Form‐36 (SF‐36). Secondary outcomes were change in work and social participation measured by the Work and Social Adjustment Scale (WSAS), ability to participate in full‐time or part‐time employment, self‐rated understanding of FND, and self‐rated agreement with the diagnosis of FND. Over the year, 13 patients were recruited to the clinic, and 11 agreed to participate in the outcome study. Statistically significant improvements in quality of life were seen across seven out of eight domains of the SF‐36, with improvements in in idual domains of between 23 and 39 points (of a possible 100). Mean Work and Social Adjustment Scale score halved from 26 to 13 (worst possible is 40). Of the 12 patients treated, one began to work again after complete unemployment, and two who had been working reduced hours due to disability resumed full time work. No patients had worsened occupational status. This intervention is associated with substantial improvements in quality of life and function, and may be more amenable to delivery at non‐specialist centers than other described interventions for FND.
Publisher: Wiley
Date: 2022
DOI: 10.1111/IMJ.15096
Abstract: Free concentrations of highly protein bound hormones, such as cortisol and thyroxine, are unchanged in critical illness despite substantial decreases in total concentration. Total 25‐hydroxyvitamin D (25(OH)D) concentration is decreased in critical illness, but the free concentration of 25(OH)D has had less attention. To compare total and calculated free 25(OH)D concentrations in critically ill patients with healthy controls. In this case‐control study, 38 patients with critical illness were compared with 68 healthy controls 25(OH)D was measured by liquid chromatography tandem mass spectrometry (LCMS/MS) and vitamin D binding protein (VDBP) by direct sandwich enzyme‐linked immunosorbent assay. Total and calculated free 25(OH)D concentrations were compared using unpaired t ‐tests. Total 25(OH)D concentrations were significantly lower in critically ill patients than controls (37 (95% confidence interval 31–43) vs 57 (53–60) nmol/L). Calculated free concentrations of 25(OH)D were not lower in critically ill patients than healthy controls (26 (22–29) vs 19 (18–20) pmol/L). Calculated free 25(OH)D concentrations are not decreased in critical illness. Measuring total 25(OH)D concentrations in patients with critical illness potentially underestimates vitamin D and overestimates the number of patients who are deficient in vitamin D.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2020
DOI: 10.1161/STROKEAHA.120.030258
Abstract: Left atrial appendage (LAA) is the likely embolic source in atrial fibrillation (AF)–related cardioembolic strokes. We sought to determine the prevalence of LAA thrombus on hyperacute stroke imaging and its association with AF. We retrospectively examined the clinical and radiological features of patients assessed through the hyperacute stroke imaging pathway over a 12-month period at Christchurch Hospital. The LAA was included in the computed tomography angiogram scan-range as part of the multimodal imaging protocol. Two radiological readers blinded to clinical information independently assessed for the presence of LAA thrombus. The association between AF and LAA thrombus was determined by multivariable logistic regression analysis. Of 303 patients included in the analysis, the overall prevalence of LAA thrombus was 6.6% and 14.9% in patients with known AF. Patients with LAA thrombus were older (85 versus 75 years, P .01), more commonly had known or newly diagnosed AF (75% versus 30%, P .01) and heart failure (30% versus 8%, P =0.01), and was associated with intracranial large vessel occlusion (65% versus 39%, P =0.02). In the multivariable model, AF (odds ratio, 3.71 [95% CI, 1.25–11.01] P =0.02) was independently associated with LAA thrombus after adjusting for age and congestive heart failure. Interrater reliability was moderate (kappa=0.56). LAA thrombus is a potential radiological marker of AF and can be assessed as a part of hyperacute stroke imaging.
Location: New Zealand
Location: New Zealand
No related grants have been discovered for David D G Palmer.