<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>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

<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 history of aneurysmal subarachnoid haemorrhage (aSAH) is far from modern, spanning close to 5000 years. There are many parallels and references to epidemiological principles that remain current today and are central to modern nursing research techniques. The importance of epidemiology in nursing cannot be overestimated, nursing practice closely aligns with the ultimate goals of epidemiological principle in the promotion of health and reduction of disease related risk factors. Despite nursing holding the conceptual key to enriching epidemiological research, nursing has historically distanced itself from front line epidemiological research, often hesitant about both capability and clinical expertise in leading epidemiological research. The following historical narrative serves as a reminder of how far we have come in the diagnosis, treatment and care of individuals post aSAH as well as serving as inspiration for future nursing research.</abstract>

The Circle of Willis, Aneurysms and Subarachnoid Haemorrhages: a Historical Narrative of Parallels from Observation to Intervention

<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

CTE the New News Story

What's the story with CTE?

<abstract>
<title style='display:none'>Abstract</title>
Parkinson's disease (PD) is a multi-system disease, with clinical features typically described across three domains: motor, non-motor, and neuropsychiatric symptoms. There is no known cause or cure for PD, and diagnosis occurs often through a process of elimination, remaining one of clinical assessment, expert opinion, and observing disease progression over time. In the absence of disease modifying therapy for PD, pharmacological treatments play a role in symptomatic relief and improving quality of life (QoL). A narrowing therapeutic window and motor fluctuations present a challenge to the pharmacological management of PD. Device assisted therapies including Duodopa, Apomorphine and deep brain stimulation are based on the concept of providing stable and continuous stimulation to minimise pulsatile sudden or unexpected fluctuations. Studies continue to demonstrate the benefit of multidisciplinary input and the impact on functional status, mood, motor abilities, cognitive performance, speech skills, independence and QoL of a person with PD. Nurses are well placed to identify complications, escalate concerns, and initiate timely referral to members of a multidisciplinary team. Understanding the clinical features of PD as well as the basic assessment and management of the disease is essential in providing holistic care and supports to maintain QoL for those with PD and their caregivers.
</abstract>

Understanding Parkinson's Disease: A Basic Overview

Book Review: The Trembling Mountain: A Personal Account of Kuru, Cannibals and Mad Cow Disease.

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Aim</title>
To synthesise the literature pertaining to surgical site infections (SSIs) in neurosurgical patients following cranial surgery.
</sec>
<sec><title style='display:none'>Background</title>
SSIs in neurosurgical patients following cranial surgery present a major healthcare problem for healthcare providers worldwide. The most widely reported outcomes following SSIs include increased length of inpatient stay, morbidity, mortality, higher treatment costs and increased care burden for families and caregivers.
</sec>
<sec><title style='display:none'>Design</title>
Integrative review.
</sec>
<sec><title style='display:none'>Methods</title>
Using an integrative review framework, electronic database searches were conducted in CINAHL, Embase, Medline and ProQuest from 2012 – 2022. The search was limited to peer reviewed full text publications. Reference lists of identified studies were reviewed, and additional articles were accessed. Methodological rigour for included studies was evaluated using Critical Appraisal Skills Program tools.
</sec>
<sec><title style='display:none'>Results</title>
Twenty articles were reviewed, and four themes emerged relating to: preoperative patient preparatory practices and SSIs; risk factors for developing SSIs post cranial surgery; patient-reported outcomes and healthcare implications; and strategies for preventing SSIs within hospital settings.
</sec>
<sec><title style='display:none'>Conclusion</title>
Surgical site infections post cranial surgery among neurosurgical patients can be contained through administration of pre-surgical prophylactic antibiotics, adhering to aseptic hand hygiene, utilising evidence based infection control protocols, educating neurosurgical nurse clinicians in post cranial surgical wound care, and providing tailored education for patients and families in postoperative cranial surgical wound care.
</sec>
</abstract>

Surgical site infections in neurosurgical patients following cranial surgery: An integrative review

<abstract>
<title style='display:none'>Abstract</title>
Enhanced recovery after surgery (ERAS) programs – also referred to as fast-track programs - are multidisciplinary, evidence-based perioperative pathways, designed to achieve early recovery for patients undergoing major surgery (<xref ref-type="bibr" rid="j_ajon-2023-014_ref_002">Ali et al., 2018</xref>). ERAS utilises strategies to optimise the patient's condition for surgery and recovery. In particular, the aim is to achieve an earlier discharge from hospital for the patient and a more rapid resumption of normal activities after surgery, without an increase in complications or readmissions (<xref ref-type="bibr" rid="j_ajon-2023-014_ref_005">Dietz et al., 2019</xref>). An essential element of ERAS programs is multidisciplinary collaboration between surgical, anaesthetic, nursing and allied health teams. While elements of ERAS may vary between surgical units and hospitals, there are many common features in the preoperative, intraoperative and postoperative phases.
Minimally invasive spine surgery techniques and instrumentation have evolved rapidly over the past decade, and there is now a worldwide interest in ERAS programs for spine surgeries, including lumbar and cervical decompression and fusion procedures (<xref ref-type="bibr" rid="j_ajon-2023-014_ref_011">Li et al., 2021</xref>). Nurses have a pivotal role in the successful implementation and sustainability of ERAS protocols because of their specialised knowledge and skill, and their constant presence throughout the patient care pathway (<xref ref-type="bibr" rid="j_ajon-2023-014_ref_019">Wainwright et al., 2022</xref>). This publication presents learnings from the implementation of an ERAS program for minimally invasive spine surgery at Westmead Hospital, NSW.
</abstract>

Spine Surgery and Home Again: The Nurse's Role in the Patient Journey

<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

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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...