Australasian Journal of Neuroscience最新文献

{"title":"Treatment of subarachnoid haemorrhage complicated by hyponatraemia","authors":"J. A. Butler","doi":"10.21307/ajon-2017-002","DOIUrl":"https://doi.org/10.21307/ajon-2017-002","url":null,"abstract":"Abstract Background statement Developing hyponatraemia after a subarachnoid haemorrhage is common, however it is known to worsen patient outcomes. This paper aims to review the practice of managing hyponatraemia in acute subarachnoid haemorrhage patients with administration of 3% hypertonic saline solution. Aim To enquire into the practice and policy of one of Melbourne’s large Metropolitan hospital’s current management of hyponatraemia in subarachnoid haemorrhage patients, and determine if the policy is both current and evidenced based. Methods A search of the terms “subarachnoid haemorrhage”, “hyponatraemia” and “hypertonic saline” was used in databases including Pubmed, Medline and CINAHL. Literature was included if it discussed the use of hypertonic saline for hyponatraemia, the effect of hyponatraemia on subarachnoid haemorrhage patients and the potential causes of acute hyponatraemia. The articles and literature reviews were assessed for inclusion by the author. Results Patients with a subarachnoid haemorrhage and hyponatraemia should not be fluid restricted, as this is contraindicated. Patients should be administered 3% hypertonic saline to avoid hypovolaemia and slowly increase serum sodium to prevent onset or exacerbation of cerebral oedema. Limitation Lack of evidence based data and studies in regard to the dosing of hypertonic saline resulted in the lack of consensus with prescribing rates and volumes to be infused for severe hyponatraemia.","PeriodicalId":32533,"journal":{"name":"Australasian Journal of Neuroscience","volume":"14 1","pages":"1 - 5"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90956037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WFNN 2017 Congress Report","authors":"V. Evans","doi":"10.21307/AJON-2017-007","DOIUrl":"https://doi.org/10.21307/AJON-2017-007","url":null,"abstract":"","PeriodicalId":32533,"journal":{"name":"Australasian Journal of Neuroscience","volume":"65 1","pages":"14 - 14"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80196265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Neurological Integrated Care Pathway","authors":"Kathleen T. McCoy, H. Chan","doi":"10.21307/ajon-2017-125","DOIUrl":"https://doi.org/10.21307/ajon-2017-125","url":null,"abstract":"Abstract Objective To assess the feasibility of service integration for neurological care. Design Observation study Participants A total of 104 admissions for 92 neurological patients treated in a major region hospital and suitable for discharge home were eligible for participation. Intervention A neurological integrated care pathway (NICP) was trialled at a major regional hospital between July 2012 and June 2013. Objective data included patients, gender, age, diagnosis, length of hospital stay, referral dates, discharge dates, dates when patients were seen by the community neurological liaison nurse, and readmissions were collated for analyses. Outcome measures Targeted outcomes included the estimated service impact on the hospital in terms of reduced length of hospital stay and decreased readmissions and increased referral rate to community neurological support service, and quality of patient care. Results The trial saw an increase in efficiency and standard of care despite growth in patient numbers. The CNLN attended to 104 recorded referrals (more than 17 times the number of referrals in 2011), all within 7 days of their referral date (a 77.4% decrease compared to 2011 where patients were attended to up to 31 days). In addition, the average length of hospital stay had decreased significantly from 26 days in 2011 to 9 days (a 65.4% decrease) with a low rate of re-admission (approximately 11.5%). Conclusion The NICP improved service efficiency for both the hospital system and the community neurological support service, with high levels of patient satisfaction. In this case the NICP achieved best value from existing resources and provided a viable model of service delivery for chronic neurological conditions.","PeriodicalId":32533,"journal":{"name":"Australasian Journal of Neuroscience","volume":"56 1","pages":"38 - 43"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91135026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Top of the Charts: Detecting neurological deterioration more efficiently through improved documentation","authors":"Rhiannon Carey, C. Holland","doi":"10.21307/AJON-2017-122","DOIUrl":"https://doi.org/10.21307/AJON-2017-122","url":null,"abstract":"Abstract The Glasgow Coma Scale is a practical tool, accepted and utilised worldwide, to assess a patient’s conscious level. Despite the introduction of other tools, the Glasgow Coma Scale still remains the most reliable and effective method of detecting neurological deterioration. Detecting neurological change in an individual requires skilled observation and must rely on the ability of the clinician to carry out an accurate and reliable assessment. A large limitation of the Glasgow Coma Scale is that observer assessments may vary from clinician to clinician. What one individual may observe as neurological deterioration, another may not notice. It was recognised by senior nursing staff that if a neurological chart could be designed, that enhanced the ability to see the trends in a patient’s conscious level and instructed clinicians on when to report a finding, deterioration may be identified earlier and managed more efficiently. This study outlines a new neurological chart implemented at a busy private hospital in Melbourne and discusses the impact that clear and concise observation and documentation has on the ability to detect neurological deterioration.","PeriodicalId":32533,"journal":{"name":"Australasian Journal of Neuroscience","volume":"25 1","pages":"17 - 20"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82240332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Support My Spine ASAP. A Rural Tele-health care model for patients being managed with a Thoracic Lumbar Sacral Orthotic (TLSO)","authors":"R. Gallagher, J. Morison, M. Giles, Judith Henderson, S. Zehnder","doi":"10.21307/AJON-2017-120","DOIUrl":"https://doi.org/10.21307/AJON-2017-120","url":null,"abstract":"Abstract Question Does a Telehealth model of care facilitating treatment in rural hospitals for patients requiring a TLSO eliminate the need for transfer to a tertiary referral hospital? Design Quantitative pre and post intervention design. Participants Physiotherapists, nursing and medical staff at rural hospital pilot sites. Intervention Pre and post intervention data collection provided patient demographics, and length of stay data around model of care implementation. Pre intervention staff surveys identified knowledge gaps informing educational packages which were provided with a mobile Telehealth link. Outcome measures Primary: Number of patients managed under the new model of care. Secondary: Length of stay, travel distance eliminated and complications. Results 30 patients fitted with TLSO’s and managed under this model of care to date. Length of stay has reduced from 9.14 days pre intervention to 3.8 days post intervention. Approximate savings of $6840 per patient have been identified, with over 6000kms of patient travel eliminated. No complications have occurred. Rural Physiotherapists have been successfully up skilled in managing patients requiring TLSO fitting. Conclusion This intervention successfully created a model of care to facilitate local management of patients requiring TLSO fitting with Telehealth support from a tertiary referral hospital. Considerable savings have occurred from this model of care for patients and the health district. This model is currently being implemented district wide. Key Practice Points Telehealth model of care can be successfully implemented to TLSO management Multidisciplinary team role is critical role in redesigning models of care Telehealth increase the efficiency of healthcare resources","PeriodicalId":32533,"journal":{"name":"Australasian Journal of Neuroscience","volume":"54 1","pages":"7 - 9"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88077801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and health economic benefits of out-patient lumbar microdiscectomies in Australia","authors":"A. Magee, I. Bhaskar, P. Ilett, M. Murphy, Yiyan Wang","doi":"10.21307/ajon-2017-129","DOIUrl":"https://doi.org/10.21307/ajon-2017-129","url":null,"abstract":"Abstract Introduction This study reports on the clinical, nursing and health outcomes on the out-patient lumbar microdiscectomy program at a single institution. A multi-disciplinary team approach to the pre- and post-operative planning and education is key to the success of this program. Methods A retrospective review of prospectively collected data for two patient groups (out-patient microdiscectomy and in-patient microdiscectomy) over a two-year period in a single institution was performed. Clinical, demographical, surgical and economic measures were collected including a 10-point visual analogue pain scale (VAS), patient satisfaction, direct and indirect costs of treatment. Patients included had a single level lumbar disc prolapse with persistent disabling sciatica of more than 8 weeks consistent with failure of conservative measures. Results Twenty-one out-patient and forty-one in-patient microdiscectomy patients were treated over this period. Post operatively pain levels showed a significant improvement in VAS levels from 5.2 ±2.9 to 1.6 ±0.8 and 0.7 ± 0.8 at day 1 and 7 post-operatively respectively. This was not different across both groups. Patient satisfaction was high in both surgical groups. There was a significant cost savings in out-patient lumbar micro-discectomy with the majority of savings coming from costs associated with staff (nursing, allied health and medical) funding. There was successful discharge 100% of out-patient microdiscectomy patients without readmission. Conclusion Outpatient lumbar microdiscectomy is a viable option in Australia. It demonstrates no difference in patient outcomes as compared to in-patient lumbar microdiscectomies and has high patient satisfaction outcomes. There are significant benefits in terms of health economics and nursing care in establishing an out-patient lumbar microdiscetomy program.","PeriodicalId":32533,"journal":{"name":"Australasian Journal of Neuroscience","volume":"18 1","pages":"15 - 20"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86995092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leptomeningeal Carcinomatosis: Cerebral spinal fluid tumours","authors":"M. Stone","doi":"10.21307/ajon-2017-128","DOIUrl":"https://doi.org/10.21307/ajon-2017-128","url":null,"abstract":"Abstract Leptomeningeal Carcinomatosis (LC) is the dissemination of cancer, commonly breast, lung, melanoma, acute lymphoblastic leukaemia and Non-Hodgkin lymphoma occurring through either direct extension from surrounding tumours or metastasis of a preexisting, parenchymal central nervous system tumour. A rise in the diagnosis of leptomeningeal disease has been seen with increased survival rates of cancer due to improved medical treatment, with 5-8% of patients with cancer going on to develop LC. Leptomeningeal Carcinomatosis spreads to the meninges, the outer covering of the brain and spinal cord, directly migrating into the cerebral spinal fluid (CSF), arachnoid and pia mater. This migration of tumour cells occurs throughout the arachnoid vessels or choroid plexus into the surrounding outer layers extending into the CSF. On entry into the CSF, tumour cells are infiltrated in a diffuse or multifocal manner where the leptomeninges cover the surface of the brain and spinal cord. This covering causes the meninges to become irritated causing patients to exhibit signs of photophobia, neck stiffness, neurological decline and cranial nerve defects. LC has a significant morbidity and mortality rate with a median survival of 4-6 weeks if untreated and 2-3 months if treated. Diagnosis is based on analysis of the cerebral spinal fluid, through detection of positive cytology of LC tumour cells, elevated protein and CSF pressures. Magnetic resonance imaging findings identify areas of meningeal enhancement indicative of meningeal irritation. The neuroscience nurse role in the patient care includes providing a supportive environment and thorough assessment of vital and neurological signs. Treatment aims to improve or maintain a patient’s neurological status while prolonging survival and palliation. The literature review will highlight the diagnosis, progression and treatment for LC to further increase awareness and inform neuroscience nurses of increasing trends in management.","PeriodicalId":32533,"journal":{"name":"Australasian Journal of Neuroscience","volume":"18 1","pages":"11 - 14"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77319616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuroscience Nursing in Indonesia: Striving for Recognition through Education and Regional Collaboration","authors":"Linda Nichols, Enny Mulyatsih","doi":"10.21307/AJON-2017-121","DOIUrl":"https://doi.org/10.21307/AJON-2017-121","url":null,"abstract":"Abstract As a speciality practice area, neuroscience nursing is internationally recognised. In 2014 the Australasian Neuroscience Nurses Association celebrated its 40th anniversary. For Indonesian neuroscience nurses, 2014 marked the inaguration of the Indonesian Neuroscience Nurses Association. The following paper provides an overview of health care in Indonesia and development of neuroscience nursing as a specialty through educational and regional collaboration. Postgraduate educational opportunities are open to all nurses in Australia, including neuroscience as a specialty for nurses. However within Indonesia, the focus has been on meeting basic nursing demands, with postgraduate specialisation still in its infancy. The focus on training and producing large numbers of nurses at a basic level has resulted in little regard for the ongoing development and acknowledgement of speciality practice areas, such as neuroscience nursing. The following paper outlines the challenges faced by Indonesian nurses as they strive towards the recognition of neuroscience nursing as a speciality. Through the provision of an overview of current nursing and the health care system in Indonesia, this paper will explore the geographical, economic, political and cultural factors that require consideration when translating experience and expertise.","PeriodicalId":32533,"journal":{"name":"Australasian Journal of Neuroscience","volume":"25 1","pages":"10 - 16"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82251842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does duration and sampling of external ventricular drainage systems influence infection rate?","authors":"N. Moyo","doi":"10.21307/AJON-2017-127","DOIUrl":"https://doi.org/10.21307/AJON-2017-127","url":null,"abstract":"Abstract External ventricular drainage systems are often necessary in neurological and neurosurgical patients. The purpose of this literature review is to review the problem of external ventricular drain related infections resulting from repeated cerebrospinal fluid sampling and manipulation of the drain systems. The aim is to provide an appropriate improved protocol for care of patients undergoing external ventricular drainage treatment. Routine analysis of cerebrospinal fluid is often performed to diagnose external drainage related bacterial meningitis at an early stage. Nurses are routinely instructed to collect cerebrospinal fluid from ventricular catheters for analysis. Does the way in which sampling occurs relate to increased infection? This literature review will discuss that prophylactic frequent cerebrospinal fluid sampling is of no benefit and increases infection risk and should be limited. It will also provide evidence that duration of the external ventricular drain (EVD) systems does not correlate with infection and therefore the EVD should stay insitu for as long as clinically needed or be removed if infected.","PeriodicalId":32533,"journal":{"name":"Australasian Journal of Neuroscience","volume":"4 1","pages":"7 - 14"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87990513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The EPIC (Excellent Practice in Communication) Project. Neurosurgical Nursing Clinical Handover Improvement Practices among acute inpatients: a Best Practice Implementation Project","authors":"Kylie M. Wright","doi":"10.21307/AJON-2017-123","DOIUrl":"https://doi.org/10.21307/AJON-2017-123","url":null,"abstract":"Abstract The nursing handover normally occurs at the beginning of a nurse’s shift and is considered essential for continuity of care. Nursing handover has the potential to communicate accurate information about a patient’s condition, treatment and anticipated needs but also has the potential to be ineffective or even harmful if information is incomplete or omitted. The Australian Commission on Safety and Quality in Health Care (ACSQHC) has recognised clinical handover as a National Standard, thus reinforcing its importance. This project aimed to conduct an audit of nursing clinical handover practices, to implement evidence-based best practice recommendations and to maximise the effectiveness of clinical handover in a neurosurgical unit of a large tertiary hospital. The project used the Joanna Briggs Institute’s (JBI) Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) audit tool for promoting change in healthcare practice. A baseline audit of 30 observations of nursing clinical handover was conducted and measured against seven best practice recommendations, followed by the implementation of targeted strategies and follow up audits. The baseline audit revealed deficits between current practice and best practice in four of the seven criteria. Barriers for implementation of nursing clinical handover best practice criteria were identified by the project team and a neuroscience specific nursing handover framework and bundled education strategy was implemented. There were improved outcomes across the best practice criteria in the follow up audit. The findings showed how audit may be used to promote best practice in healthcare and that focussed education and provision of relevant resources can have an immediate and positive impact on clinical practice. Some of the measured criteria improved to a moderate degree, leaving plenty of room for improvement, however by the end of the project attitudes towards nursing clinical handover had been ‘transformed’ from a passive, routine ‘must do’ task, to an active process with a focus on safety and patient/carer engagement. Future audits are planned to ensure sustainability.","PeriodicalId":32533,"journal":{"name":"Australasian Journal of Neuroscience","volume":"29 1","pages":"21 - 32"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86716627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}