Publications by authors named "Christina L Vaughan"

13 Publications

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Interdisciplinary neuropalliative care: a unique and valuable clinical training experience for geropsychology trainees.

Gerontol Geriatr Educ 2021 May 27:1-13. Epub 2021 May 27.

Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.

To address workforce issues in professional geropsychology, clinical training sites must offer opportunities to build skills for working with older adults and aging families. Neuropalliative care (NPC) may offer a valuable learning environment for geropsychology trainees to develop professional competencies, while positively contributing to patient care. This article describes a novel clinical rotation for an advanced geropsychology trainee in an interdisciplinary specialty NPC clinic. A co-assessment model emerged as a useful strategy for integrating the trainee into the established NPC team. Two case examples illustrate the co-assessment's ability to enhance: collaboration within the clinic; psychological care for patients and care partners; and opportunities for the trainee to build competencies related to assessment, intervention, teams, and consultation. This paper concludes with a discussion of the benefits of NPC as a clinical training rotation for geropsychology trainees, as well as practical considerations for implementation in other clinics.
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http://dx.doi.org/10.1080/02701960.2021.1925891DOI Listing
May 2021

Hoping for the best, planning for the worst: Palliative care approach to Parkinson disease during the COVID-19 pandemic.

Parkinsonism Relat Disord 2020 11 6;80:203-205. Epub 2020 Oct 6.

Departments of Neurology and Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.

Palliative care emphasizes expertise in handling difficult conversations, discussing patients' wishes and supporting the caregiver(s). Here we outline the palliative approach of hoping for the best while preparing for the worst in several "what if" scenarios for people with Parkinson disease and their families during the COVID-19 pandemic.
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http://dx.doi.org/10.1016/j.parkreldis.2020.09.042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537621PMC
November 2020

Oro-Bucco-Lingual Dyskinesia, Weight Loss, and Cognitive Decline in Anti-DPPX Antibody-Mediated Encephalitis.

Mov Disord Clin Pract 2020 Sep 29;7(Suppl 3):S80-S82. Epub 2020 Sep 29.

Department of Neurology University of Vermont Medical Center SA, Burlington Vermont USA.

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http://dx.doi.org/10.1002/mdc3.13058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7525198PMC
September 2020

Top Ten Tips Palliative Care Clinicians Should Know About Interventional Pain and Procedures.

J Palliat Med 2020 10 27;23(10):1386-1391. Epub 2020 Aug 27.

Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA.

Pain is a common symptom for patients with advanced illness. Palliative care (PC) clinicians are experts in pharmacologic and nonpharmacologic treatment of pain and other symptoms for these patients. True multimodal pain control should include consideration of interventional procedures and pumps to improve difficult-to-manage pain. This article, written by clinicians with expertise in interventional pain and PC, outlines and explains many of the adjunctive and interventional therapies that can be considered for patients with pain in the setting of serious illness. Only by understanding and considering all available options can we ensure that our patients are receiving optimal care.
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http://dx.doi.org/10.1089/jpm.2020.0487DOI Listing
October 2020

Neuropalliative care essentials for the COVID-19 crisis.

Neurology 2020 09 26;95(9):394-398. Epub 2020 Jun 26.

From the Departments of Neurology and Medicine (B.M.K. and R.G.H.), University of Rochester Medical Center, NY; Departments of Neurology and Medicine (C.L.V.), University of Colorado Anschutz Medical Campus, Aurora; Departments of Neurology and Family Medicine (M.T.R.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.C.), University of Washington Harborview Medical Center, Seattle; and Department of Neurology (I.S.), Geffen School of Medicine, UCLA, and West LA Veterans Affairs Medical Center, CA.

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http://dx.doi.org/10.1212/WNL.0000000000010211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538223PMC
September 2020

Top Ten Tips Palliative Care Clinicians Should Know About Caring for Patients with Neurologic Illnesses.

J Palliat Med 2019 02;22(2):193-198

5 Perelman School of Medicine and Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania.

Patients with neurologic illnesses are commonly encountered by palliative care (PC) clinicians though many clinicians feel uncomfortable caring for these patients. Understanding how to diagnose, treat, communicate with, and prognosticate for neurology patients will improve the confidence and competence of PC providers in the neurology setting. This article offers PC providers 10 useful tips that neurologists with PC training think all PC providers should know to improve care for patients with neurologic illness.
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http://dx.doi.org/10.1089/jpm.2018.0617DOI Listing
February 2019

Hydromorphone-induced chorea as an atypical presentation of opioid neurotoxicity: A case report and review of the literature.

Palliat Med 2018 10 13;32(9):1529-1532. Epub 2018 Jul 13.

1 Moores Cancer Center, University of California-San Diego, La Jolla, CA, USA.

Background: While opioid-induced myoclonus is well described, there are limited reports of opioid-induced chorea. Here we present the first case of chorea as a manifestation of opioid neurotoxicity due to hydromorphone.

Case Presentation: A 20-year-old woman presenting with fevers and cutaneous lesions was diagnosed with hemophagocytic lymphohistiocytosis secondary to primary cutaneous lymphoma. Surgical resection of a cutaneous lesion was complicated by severe postoperative pain requiring rapid opioid dose escalation. Seven days after hydromorphone was initiated, she developed positive myoclonus, hallucinations, delirium, and involuntary, flowing movements consistent with chorea. She had no personal or family history of nervous system disorders and was not taking any medications associated with drug-induced chorea. Case management: The remainder of her neurologic examination was unremarkable. Her renal function was normal and no etiology was found on neuroimaging or laboratory workup. Hydromorphone was discontinued and pain control was achieved with fentanyl. Case outcome: The patient's neurotoxic symptoms including chorea resolved within 72 h of hydromorphone discontinuation.

Conclusion: Further studies are needed to determine which patients have a unique sensitivity to opioids predisposing them to chorea. Clinicians should be aware that chorea may be a sign of such toxicity so that rapid corrective action can be taken.
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http://dx.doi.org/10.1177/0269216318786861DOI Listing
October 2018

Palliative Care for Movement Disorders.

Curr Treat Options Neurol 2018 Feb 21;20(1). Epub 2018 Feb 21.

Department of Neurology, University of Colorado Anschutz Medical Campus, 12631 E 17th Avenue, Mail Stop B-185, Aurora, CO, 80045, USA.

Purpose Of Review: While care for patients with movement disorders has traditionally focused on motor symptoms, there is increasing evidence that optimal care for these disorders is more complex both in terms of the spectrum of symptoms experienced by patients (e.g., pain, depression) and the multidimensional needs of patients and their families. Palliative care is an approach to the care of patients and families affected by serious illnesses that seeks to relieve suffering by addressing complex medical symptoms, psychosocial issues, spiritual well-being, and goals of care. While traditionally associated with cancer and hospice, more recent work in palliative care has focused on integrating a palliative care approach from the time of diagnosis for patients with chronic illnesses, including movement disorders.

Recent Findings: Studies of patients with movement disorders and their family caregivers suggest that these patients have significant unmet needs under current models of care, including underrecognition and treatment of non-motor symptoms, inadequate psychosocial support, and suboptimal end-of-life care. We describe how a palliative care approach can empower clinicians, patients, and families to reduce common sources of suffering and optimize quality of life. This field recognizes the importance of primary palliative care (palliative skills useful for any clinician caring for persons caring for serious illness) as a foundation of the palliative care approach and complementary to specialist palliative care. In this article, we will focus on primary palliative care skills for movement disorder specialists including providing a diagnosis and prognosis with compassion, discussing goals of care, complex symptom management, caregiver support, spiritual and emotional well-being, and referral to hospice and specialist palliative care. A palliative care approach complements other efforts in movement disorder care. Research is needed to evaluate and develop therapeutic interventions and models of care applying a palliative care approach.
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http://dx.doi.org/10.1007/s11940-018-0487-4DOI Listing
February 2018

Delirium: Use Antipsychotics When Appropriate and Appropriately.

J Palliat Med 2017 08 14;20(8):799. Epub 2017 Apr 14.

4 Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Health System, Samuel Oschin Comprehensive Cancer Institute , Los Angeles, California.

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http://dx.doi.org/10.1089/jpm.2017.0145DOI Listing
August 2017

I finally see what you see: Parkinson's disease visual hallucinations captured with functional neuroimaging.

Mov Disord 2014 Jan 10;29(1):115-7. Epub 2013 Jul 10.

Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA.

Background: Functional neuroimaging studies have described alterations in neural activation in PD patients with chronic hallucinations. These studies have not, however, captured neural activation patterns during an actual hallucinatory event. The objective of this work was to investigate neuroanatomical substrates active during visual hallucinations in a patient with Parkinson's disease (PD).

Methods: We conducted an event-related functional magnetic resonance imaging (fMRI) case-study examination of a 66-year-old male PD patient with stereotypic, chronic, and frequent visual hallucinations.

Results: The patient reported 16 hallucinations during the fMRI scan. Increased activation during hallucinations was found in the cingulate, insula, frontal lobe, thalamus, and brain stem. Decreased activation was found in the lingual and fusiform gyri, inferior occipital gyrus, and middle frontal and superior temporal lobes.

Conclusions: To our knowledge, this report is the first published case documenting the cortical activation patterns using fMRI techniques in a PD patient during active hallucinations. Our results suggest that during a visual hallucination, a marked desynchronization occurs between posterior and anterior cortical areas involved in visual processing.
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http://dx.doi.org/10.1002/mds.25554DOI Listing
January 2014

An update expert opinion on management and research strategies in Parkinson's disease psychosis.

Expert Opin Pharmacother 2011 Sep 2;12(13):2009-24. Epub 2011 Jun 2.

Rush University Medical Center, Department of Neurological Sciences, 1725 W. Harrison Street, Chicago, IL 60612, USA.

Introduction: Psychosis, a frequent complication in Parkinson's disease (PD), contributes significantly to morbidity, mortality, nursing-home placement and quality of life. Medication side effects, issues of trial design and negative outcomes have limited clinical advances of new treatments for PD psychosis. Evidence-based medicine maintains clozapine as the most effective antipsychotic in PD without motor worsening, despite risk of agranulocytosis. Safe, effective treatments that improve psychosis without exacerbating parkinsonism are urgently needed.

Areas Covered: This article reviews the: i) phenomenology of PD psychosis, ii) pharmacological rationale for antipsychotics in PD; iii) clinical trials of antipsychotics in PD; iv) novel research strategies such as neuroimaging, genetics and animal models; and v) associated challenges in studying and treating PD psychosis. Preparation of this review included an extensive literature search using PubMed.

Expert Opinion: Management of PD psychosis is complex. Challenges pertaining to study design, rating scales, subject recruitment and completion have limited PD psychosis treatment trials. Novel research strategies focus on nondopaminergic systems and incorporate neuroimaging, genetic associations and animal models. These strategies also have challenges but have the potential to enhance our understanding of PD psychosis and advance the development of agents that can ultimately be tested in well-designed, randomized, controlled trials.
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http://dx.doi.org/10.1517/14656566.2011.587122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152685PMC
September 2011

Lack of sex effect on brain activity during a visuomotor response task: functional MR imaging study.

AJNR Am J Neuroradiol 2003 Mar;24(3):488-94

Johns Hopkins Hospital, the Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Neuroradiology, Baltimore, MD 21205, USA.

Background And Purpose: As more individuals are enrolled in clinical functional MR imaging (fMRI) studies, an understanding of how sex may influence fMRI-measured brain activation is critical.

Methods: We used fixed- and random-effects models to study the influence of sex on fMRI patterns of brain activation during a simple visuomotor reaction time task in the group of 26 age-matched men and women. We evaluated the right visual, left visual, left primary motor, left supplementary motor, and left anterior cingulate areas.

Results: Volumes of activations did not significantly differ between the groups in any defined regions. Analysis of variance failed to show any significant correlations between sex and volumes of brain activation in any location studied. Mean percentage signal-intensity changes for all locations were similar between men and women. A two-way t test of brain activation in men and women, performed as a part of random-effects modeling, showed no significant difference at any site.

Conclusion: Our results suggest that sex seems to have little influence on fMRI brain activation when we compared performance on the simple reaction-time task. The need to control for sex effects is not critical in the analysis of this task with fMRI.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7973619PMC
March 2003

Correlation of reaction time in and out of the functional MR unit.

Acad Radiol 2002 May;9(5):513-9

Rationale And Objectives: The authors performed this study to determine whether reaction times (RTs) recorded in the functional magnetic resonance (MR) imaging environment reflect the performance of the patient outside the imaging room.

Materials And Methods: Fifteen healthy control subjects (mean age, 61.6 years) performed a simple reaction time (SRT) task outside the MR magnet and a visuomotor response time task inside the magnet with use of block-design and event-related paradigms. For both behavioral and functional MR imaging tests, subjects tapped the right index finger upon the appearance of a visual cue. The mean RTs for out-of-magnet and functional MR imaging paradigms were compared. Results. There was a statistically significant difference in RTs between block-design and single-event paradigms (t = 3.458, P < .004). The RT values during functional MR imaging and SRT tasks did not show significant differences (.65 < P < .7, paired t test). However, no correlation was found in RT values between event-related (p = -0.004, P = .15) or block-design (p = 0.03, P = .13) paradigms and SRT data. With the block-design functional MR imaging paradigm, the RT was significantly faster (P < .0003) at the beginning of the session than the end, illustrating the effect of anticipation.

Conclusion: Functional MR imaging RTs must be used to determine the correlation between subjects' performance and the volume of brain activation in a functional MR imaging experiment. The effect of anticipation should be minimized, which could best be achieved by using event-related paradigms.
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http://dx.doi.org/10.1016/s1076-6332(03)80327-6DOI Listing
May 2002