<abstract><title style='display:none'>Abstract</title><sec id="j_ajon-2017-002_s_001" sec-type="background"><title style='display:none'>Background statement</title>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.</sec><sec id="j_ajon-2017-002_s_002" sec-type="aim"><title style='display:none'>Aim</title>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.</sec><sec id="j_ajon-2017-002_s_003" sec-type="methods"><title style='display:none'>Methods</title>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.</sec><sec id="j_ajon-2017-002_s_004" sec-type="results"><title style='display:none'>Results</title>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.</sec><sec id="j_ajon-2017-002_s_005" sec-type="limitation"><title style='display:none'>Limitation</title>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.</sec></abstract>

Treatment of subarachnoid haemorrhage complicated by hyponatraemia

<abstract><title style='display:none'>Abstract</title>The thrill to go fast and push boundaries is something that many seek. From John Stapp’s rocket sled at Edwards Air Force Base in the late 1950’s to todays’ Formula 1 drivers, the “need for speed” is broadcast across TV screens weekly. So too are the horror stories of crashes, many at over 300km/hr. Yet “need for speed” continues. It appears that the higher and faster the rollercoaster, the better. This leads to several questions. How does the brain stand up to speed and G-forces? Do Newton’s Laws still have reference in today’s world?There has been much attention in the general press on the possibility that high G-force rollercoasters are inducing brain injury in riders. However, research does not wholeheartedly support this notion, but rather the risk of brain injury from a rollercoaster is not in the rides, but in the rider – caused by previously undetected brain or neck conditions. That said there is some truth that high G-forces do affect the brain at a chemical and structural level.This paper will discuss the mechanism of head injury at speed and generally what Newton’s Law means in a neurological setting in todays’ world. Formula 1 racing and rollercoaster rides will be evaluated within a neuroscience context.</abstract>

Newton’s Laws, G-forces and the impact on the brain

<abstract><title style='display:none'>Abstract</title>Venous thromboembolism (VTE), the collective term for Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE), remains a major cause of morbidity and a significant cause of mortality in hospitalised patients across Australia and internationally. It is important that adequate prophylaxis is provided for patients at risk. Measures including; anti-clotting medication, graduated compression stockings, adequate hydration and early mobilisation are known to be effective in reducing the incidence of VTE.The prevention of VTE in acute care hospitals has been recognised worldwide as a priority patient safety issue because of the strong evidence base for preventive measures and high potential for improvements in patient outcomes.With the introduction of risk assessment tools identifying patients of increased risk of VTE, more neurosurgical patients are now receiving VTE prophylaxis during their postoperative clinical course. This raises the question of the role and the impact of VTE anticoagulation when it comes to surgical drain tube removal and the risk of bleeding after spinal surgery. With multiple neurosurgeons and a variety of opinions, the clinical nursing team decided to review the role of anticoagulation and drain tube removal through evidence based research.</abstract>

Drain tube removal in the presence of anticoagulation in Spinal Surgery

<abstract><title style='display:none'>Abstract</title>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.</abstract>

Top of the Charts: Detecting neurological deterioration more efficiently through improved documentation

<abstract><title style='display:none'>Abstract</title><sec id="j_ajon-2017-008_s_001"><title style='display:none'>Background</title>Ischaemic stroke accounts for 87% of strokes and occurs when a clot or a thrombus blocks a blood vessel, cutting off blood flow to a part of the brain. If large areas of brain are affected, space-occupying oedema may result, leading to rapid neurological deterioration, coma and death. Malignant middle cerebral artery infarction (MMCAI) is a life-threating ischaemic stroke involving the whole middle cerebral artery (MCA) territory and comprises up to 10% of MCA infarctions.</sec><sec id="j_ajon-2017-008_s_002"><title style='display:none'>Methods</title>We report the case of a 62 year old female ‘Mary’ who presented with a MMCAI together with a summary of the most recent and relevant evidence for treatment options in terms of survival and quality of life for her. We also focus on the vital role of the nurse in Mary’s care and treatment.</sec><sec id="j_ajon-2017-008_s_003"><title style='display:none'>Results</title>Intravenous thrombolysis and endovascular clot retrieval (ECR) during the hyperacute phase have been shown to improve outcomes but Mary did not meet the criteria for thrombolysis and received unsuccessful ECR. Her neurological condition deteriorated so she underwent surgical decompression, which is one of the major advances for MMCAI treatment together with expert neuro critical care nursing. Mary made a good functional recovery, returning home to live independently.</sec><sec id="j_ajon-2017-008_s_004"><title style='display:none'>Conclusion</title>This case highlights the need to consider all contextual and patient preferences in relation to treatment options. In addition the case emphases the vital role the neuro critical care nurse specialist plays in the complex assessment and treatment of this patient who experienced a MMCAI and underwent complex interventions.</sec></abstract>

Malignant middle cerebral artery infarct: A clinical case report

<abstract><title style='display:none'>Abstract</title>Managing raised intracranial pressure (ICP) with the use of an external ventricular drain (EVD) is a common occurrence in a neurosurgical setting. A central role of the neuroscience nurse in managing that EVD is to monitor the patient for signs and symptoms of infection otherwise known as ventriculitis. Cerebrospinal fluid (CSF) sampling from an EVD has historically been completed as a daily routine specimen to monitor for any signs of infection. However, in more recent times there has been evidence to suggest that specimens should only be collected when infection or ventriculitis is suspected to minimise the interruption of the closed system. Different practices have been identified related to the frequency of sampling, the best solution for decontamination of the sampling site/port and preferable port for obtaining the specimen. Our aim was to complete an integrative literature review. Medline Complete and CINAHL were searched and articles were screened. Nine articles were used to form the integrated review. The main findings were collated and found that daily sampling is no longer recommended. The proximal port was the most popular choice for sampling. Decontaminating solutions used for accessing an EVD varied with no evidence to support the choice of solution. Findings of the majority of papers were focussed on sampling frequency and other associated ways to minimise infection rather than choice of sampling site or the use of specific decontaminating solutions.</abstract>

Yesterday, Today &amp; Tomorrow: Best Practice for CSF Sampling of an EVD to Minimise Patient Risk

<abstract>
<title style='display:none'>Abstract</title>
Apomorphine therapy was first discovered in the 19th century and became clinically available for use in 1980’s. Apomorphine therapy has been described as an underutilised therapy for Parkinson’s disease (The aim of this study was to determine the incidence of Impulse Control Disorders (ICD) using a clinician administered rating scale the ‘Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease Rating Scale’ (QUIP-RS). The results of this study were consistent with the current literature that was reviewed. We found that apomorphine therapy were unlikely to worsen ICD and the use of apomorphine infusion may even improve ICD. In addition, concomitant use of dopamine agonists was not likely to worsen ICD.
</abstract>

The incidence of worsening impulse control disorders in the initiation of apomorphine therapy

<abstract>
<title style='display:none'>Abstract</title>
Huntington’s Disease (HD) is a complex neurodegenerative disorder, with a life expectancy 10-20 years after symptom onset which is usually in middle age. Symptoms of HD include physical deterioration, cognitive impairment and a high incidence of suicide and suicidal ideation, which may cause intolerable suffering. While the strong association between depression and other psychiatric manifestations with suicide is discussed, this paper explores whether suicide can ever be deemed rational. By the time a person with HD reaches an advanced and terminal stage, their decisionmaking capacity will be so impaired as to make them ineligible for Voluntary Assisted Dying (VAD) under all current and proposed legislation in Australia and New Zealand. Given that Advance Care Planning (ACP) can provide an opportunity to refuse all medical treatment, except palliative treatment, could this provide an acceptable alternative to suicide and VAD? Nurses need to consider these ethical dilemmas and remain informed on the debates. They may experience moral conflict when a person wishes to discuss their view on rational suicide or seek to implement refusal of treatment in an advanced care directive. They must be aware and consider how their professional obligations and personal opinions interact with this complex topic.
</abstract>

The Intersection between Voluntary Assisted Dying, Suicide and Advance Care Planning in Huntington’s Disease

<abstract>
<title style='display:none'>Abstract</title>
Most of us know Roald Dahl’s Childrens works but few of us are familiar with his fascination with medicine and in particular neuroscience. During Dahl’s adult life his family suffered some terrible medical tragedies, and it was the medical interactions during these times that influenced some of his most famous writing from explosive potions in George’s Marvellous Medicine to Gobblefunk, the language created by Dahl for the BFG.
</abstract>

Book Review: Roald Dahl’s Marvellous Medicine

Reflections

<abstract>
<title style='display:none'>Abstract</title>
<sec>
<title style='display:none'>Introduction</title>
Changes in intravenous thrombolysis treatment rates for acute ischaemic stroke during the COVID-19 pandemic have been reported. We examined the differences in the provision of intravenous thrombolysis in patients with acute ischaemic stroke, two years prior to and two years into the COVID-19 pandemic.
</sec>
<sec>
<title style='display:none'>Methods</title>
Data were compared between March 1, 2018 to February 28, 2020 (Pre-COVID-19) and March 1, 2020 to February 28, 2022 (COVID-19). Data collected included patients’ demographics, intravenous thrombolysis rates, and patient outcomes.
</sec>
<sec>
<title style='display:none'>Results</title>
There was an increase in ischaemic stroke patient admissions during the COVID-19 period (Pre-COVID-19 n=1041, vs COVID-19 n=1087). Yet, fewer stroke patients received intravenous thrombolysis (19.2% vs 13.9%, p&lt;0.001), and there were more stroke mimics thrombolysed (8.3% vs 15.6%, p=0.021) during this period. During the COVID-19 period, there was a significant delay in hospital presentation for patients who were thrombolysed (Pre-COVID-19 = 86 minutes vs COVID-19 = 107 minutes, p = 0.004); and delay in giving thrombolysis (median door to needle time: Pre-COVID-19 = 59 minutes vs COVID-19 = 65 minutes, p = 0.002). Fewer patients had severe stroke symptoms (National Institute of Health Stroke Scale score = &gt;15) (12.2% vs 4.8%, p=0.009) during the COVID-19 period. There was no significant difference in patients’ post-thrombolysis outcome (median National Institute of Health Stroke Scale score = 1, p=0.136; discharge modified Rankin Scale score = 1, p=0.647; and mortality p=0.655).
</sec>
<sec>
<title style='display:none'>Conclusion</title>
This study showed that during the first 2 years of the COVID-19 pandemic, there was a significant decline in the thrombolysis rates and delay in the administration of the intravenous thrombolysis treatment.
</sec>
</abstract>

Intravenous Thrombolysis in Acute Ischaemic Stroke Two Years into the COVID-19 Pandemic: A Retrospective Study

<abstract>
<title style='display:none'>Abstract</title>
Drug induced parkinsonism (DIP) is one of the most frequently occurring side effects of dopamine-receptor blocking agents such as antipsychotic (neuroleptic) and antiemetic drugs. It typically presents with extrapyramidal signs, such as slowed movements, reduced facial expression and muscle stiffness. In contrast to Parkinson’s disease, which is caused by a progressive degeneration of pre-synaptic dopaminergic neurons that project from the substantia nigra in the brainstem, DIP is thought to usually occur due to the post-synaptic antagonism of dopamine receptors in the striatum. However, the two conditions can sometimes be clinically indistinguishable, and may even occur together, and thus it can be challenging to make an accurate diagnosis of DIP. It is important to consider DIP in the differential diagnosis of any person with extrapyramidal signs within the context of recent medication changes as the condition is reversible when the offending drug is withdrawn and, without early identification, there is substantial risk of increased morbidity, complications such as falls, and poor quality of life. Recent advancements in cerebral imaging have improved diagnostic accuracy but this technology is costly and not widely available.
There is a dearth of literature pertaining to the role of neuroscience nurses and DIP. This is concerning as the potential for DIP presentations to occur within the neuroscience setting is high. Neuroscience nurses, particularly those working within the movement disorder speciality areas, need the skills to advocate and pursue further investigation for patients who present with extrapyramidal signs, especially if these begin in the context of the prescription of dopamine-blocking drugs. This review is written primarily for neurosciences nurses but will be applicable to a wide range of healthcare workers; it aims to outline potential causative drugs, risk factors and the key clinical characteristics of DIP. It also highlights useful features that help distinguish DIP from Parkinson’s disease, summarises investigations and discusses management and care.
</abstract>

Identifying and Managing Drug Induced Parkinsonism: The Role of Neuroscience Nurses

<abstract><title style='display:none'>Abstract</title>Myasthenia gravis (MG) is a disorder of the neuromuscular junction (NMJ) that causes fatigue and fluctuating muscle weakness (Hickey, 2009). The physiology of this disease is well understood and there are numerous medically focused articles that outline historical data, randomized controlled trials of treatment options and unusual case studies. The nursing literature about MG is limited and dated.The aim of this study was to examine and understand the lived experiences of adults with MG. An interpretive phenomenological approach has been used that applies the research methodology of van Manen (1990). Seven people living with MG were interviewed and their experiences of the disease recorded. Questions were broadly worded about various topics related to MG and were guided by individual experiences. Thematic analysis revealed that MG affects every aspect of a person’s ‘lifeworld’: their sense of time, body, space and their relationships with others.The findings of this study highlight three main themes embedded in the data that a person with MG experiences: living with uncertainty, living with weakness and living with change. These experiences have been interpreted and discussed to gain a deep understanding of the meaning of the disease. This study raises awareness of MG for neuroscience nurses and provides a unique view of this disease.</abstract>

The lived experience of adults with myasthenia gravis: A phenomenological study

<abstract><title style='display:none'>Abstract</title>Delirium is defined as a mental disorder characterized by an abnormal state of cognition and awareness. Delirium is associated with an annual cost of $350 billion between the United States and Europe. Approximately 80% of delirium cases are either not identified or misdiagnosed. Older adults have the highest incidence due to the consequences of aging. Hypoactive delirium or “quite delirium” is the most common delirium subtype experienced by older adults.Hypoactive delirium, is difficult to recognize and has worse outcomes than other subtypes. If detected, symptoms of hypoactive delirium are frequently dismissed as depression or dementia. Therefore, nurses need heightened vigilance in assessment and identification of hypoactive delirium. This article seeks to assist nurses in identifying hypoactive delirium by outlining factors that increase an individual’s potential for developing hypoactive delirium.</abstract>

Considering Causes for Hypoactive Delirium

<abstract><title style='display:none'>Abstract</title><sec id="j_ajon-2017-125_s_001"><title style='display:none'>Objective</title>To assess the feasibility of service integration for neurological care.</sec><sec id="j_ajon-2017-125_s_002"><title style='display:none'>Design</title>Observation study</sec><sec id="j_ajon-2017-125_s_003"><title style='display:none'>Participants</title>A total of 104 admissions for 92 neurological patients treated in a major region hospital and suitable for discharge home were eligible for participation.</sec><sec id="j_ajon-2017-125_s_004"><title style='display:none'>Intervention</title>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.</sec><sec id="j_ajon-2017-125_s_005"><title style='display:none'>Outcome measures</title>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.</sec><sec id="j_ajon-2017-125_s_006"><title style='display:none'>Results</title>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%).</sec><sec id="j_ajon-2017-125_s_007"><title style='display:none'>Conclusion</title>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.</sec></abstract>

A Neurological Integrated Care Pathway

<abstract><title style='display:none'>Abstract</title><bold>This project was presented at the 2018 ANNA conference. Funding to support the author’s conference attendance was received from Parkinson’s New South Wales and Mid North Coast Local Health District.</bold><bold>Background:</bold> Individuals with Parkinson’s disease (PD) have more hospital admissions, longer hospital stay, more complications and worse outcomes compared with similar patients without PD. Limited understanding about PD among healthcare professionals and medication management are key issues for individuals with PD.<bold>Methods:</bold> This study presents a collaborative clinical practice improvement project that was implemented in a hospital in New South Wales, Australia (September 2015 to May 2018) to resolve issues for patients with PD on admission to hospital. Innovative interventions were implemented to address specific issues identified in the study setting, including an emergency department patient tracking icon, early referral to pharmacists and measures to ensure on-time medication administration and avoidance of contraindicated medications. Qualitative and quantitative data were collected through focus group discussions with PD support group members, surveys involving nurses and patients/carers and a chart audit. Data were analysed using descriptive statistics.<bold>Results:</bold> These initiatives resulted in practice improvements including identification of 100% of patients with PD presenting/admitted to hospital within 4 hours of presentation/admission, a 19% increase in patients receiving medications on time, an 89% reduction in prescription of contraindicated medications and reduced length of hospital stay. In addition, 80% of patients/carers reported they were very satisfied with their medication management.<bold>Conclusion:</bold> Patient safety was improved and clinical staff expressed satisfaction with care provision. The initiatives were also standardised across the hospital in a clinical guideline for the care of patients with PD.</abstract>

Purposeful collaboration: Enriching lives for people with Parkinson’s disease

<abstract><title style='display:none'>Abstract</title><sec id="j_ajon-2017-111_s_001"><title style='display:none'>Purpose</title>In the field of neuroscience nursing in Japan, the “sitting position without back support” (SB) has promoted earlier ambulation, improved level of consciousness, and prevented disuse syndrome in patients with disturbance of consciousness and impaired mobility. This research was conducted with the aim of examining if respiratory function improved using SB on acute patients on ventilation in ICU.</sec><sec id="j_ajon-2017-111_s_002"><title style='display:none'>Method</title>The research design involved daily administration of SB to 10 participants in a controlled trial to compare respiratory function before, during, and after implementation. The measurement indexes were respiratory functions such as tidal volume and lung compliance value and the number of incidences that occurred during implementation, and tools such as APACHE II were used to measure deteriorations of physical condition. Analysis used non-parametric and parametric methods and an alpha level of 0.05 was used for all statistical tests.</sec><sec id="j_ajon-2017-111_s_003"><title style='display:none'>Results</title>Tidal volume and lung compliance value during SB implementation significantly increased, compared to before and after implementation. There were no incidents such as decannulation during implementation, and APACHE II scores were seen to significantly drop after the commencement of SB until discharge from ICU. However, a decline in pulse rate and blood pressure were seen during implementation of SB (4.8%).</sec><sec id="j_ajon-2017-111_s_004"><title style='display:none'>Conclusion</title>The sitting position without back support administered to acutely ill patients on a ventilator was effective in improving respiratory function. In the future, there is a need to create a nurse’s assessment guide for implementation of SB and test the SB on a larger population.</sec></abstract>

Effectiveness of the Sitting Position Without Back Support

<abstract><title style='display:none'>Abstract</title>Sex-linked dystonia parkinsonism (XDP) also known as Lubag Syndrome is a rare sex-linked genetic progressive movement disorder affecting almost exclusively males from the province of Capiz in the Philippines and their descendants. At the Mater Centre for Neurosciences we have recently treated two patients with XDP utilising Deep Brain Stimulation (DBS) implants. Mr G. Infante was the second patient to be treated, the first being his uncle. Mr G. Infante’s case was brought to the attention of the Mater Centre for Neurosciences at South Brisbane after the success of his uncle’s treatment two years prior.In the three years from when Mr G. Infante’s dystonia symptoms were first noticed, his condition progressively worsened until he was wheelchair bound. With severe chronic pain, unable to walk, difficulties talking and swallowing, Mr G’s quality of life was severely impacted by XDP.XDP is a movement disorder considered a variation to Parkinson’s Disease. The difference being that the XDP starts with a long period of dystonia that eventually evolves into the tremor and associated symptoms typical of Parkinson’s Disease. Due to the similarity of the conditions the patient’s needs and treatment methods, both medical and surgical, are almost identical. Deep brain stimulation surgery involves implantation of electrodes into specific regions of the brain. The electrodes are then used to deliver finely tuned electrical currents in order to reduce the signs and symptoms of both neuropsychiatric and movement disorders such as Parkinson’s and XDP. The high frequency electrical charges sent to deep structures in the brain stimulate or shut down nerve cells around the electrode. The areas of the brain that the electrodes target are thought to participate in the circuitry involved and effectively disrupts these processes and reduces the symptoms of the disease.This paper presents the journey of Mr G. Infante’s XDP and DBS and provides an explanation of how DBS works to improve the quality of life for patients who suffer from XDP.</abstract>

Lubag Syndrome (X-linked Dystonia Parkinsonism) Case Study of Mr G. Infante

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Australasian Journal of Neuroscience

Australasian Journal of Neuroscience (AJoN) Journal Scope and Aims  Published bi-annually (May and October), the Australasian...

Australasian Journal of Neuroscience (AJoN) Journal Scope and Aims Published bi-annually (May and October), the <A...