Cleveland Clinic journal of medicine
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Deep brain stimulation (DBS) is among the most effective approaches for the treatment of patients with advanced movement disorders. In patients with essential tremor, stimulation typically targets the ventral intermediate nucleus of the thalamus. Results of several studies have shown that over a follow-up period of 1 to 5 years, the severity of tremor decreases by an average of approximately 50% from baseline. ⋯ Serious adverse events were uncommon, and included lead failures and infections. Appropriate candidates for DBS treatment of dystonia include patients with an unequivocal diagnosis of dystonia and significant disability. Several issues in the use of DBS for movement disorders remain unresolved, including the intensity of appropriate medical management before undergoing DBS, the importance of intraoperative mapping, optimal stimulator programming, and the time course of the beneficial effects of treatment.
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Physician Orders for Life-Sustaining Treatment (POLST) is a process that translates a patient's goals for care at the end of life into medical orders that follow the patient across care settings. POLST overcomes the limitations of traditional advance directives. It enables physicians and other health care professionals, through a conversation with a patient or surrogate, to assess and convey the wishes of patients with serious life-limiting illness who may have a life expectancy of less than 1 year, or of anyone of advanced age interested in defining his or her wishes for end-of-life care.