Axone (Dartmouth, N.S.)最新文献

Huntington Disease is a well known autosomal dominant inherited disease resulting in emotional problems, abnormalities of movement, and eventually dementia. It stands out as one of the most devastating illnesses, not only for its neurodegenerative progression but also for its impact on families. Care often becomes fragmented due to the person's response to symptoms and/or family breakdown. The successful interaction of health care disciplines working with Huntington Disease in our centers, namely, the family physicians, nursing, Genetics, Neurology, Psychiatry, Social Work, and Long Term Care has resulted in a comprehensive program of care for our patients and their families. This article will describe the history, structure and interaction of the multidisciplinary group. It will describe the difficulties we have overcome and offer suggestions for the implementation of similar programs for the care of people with other disorders.

Injectable treatments for Multiple Sclerosis inspire hope and challenges. Abilities, anxiety levels and acceptance of treatment modalities vary so a creative program and comprehensive care plan combined to meet individual needs. A flexible, two session program developed at the University of Pennsylvania MS Center includes planning, practice, and even "homework" before the initiation of drug therapy. Hints are given to manage anticipated side effects and written instructions supplement product literature. Training focuses on subcutaneous or intramuscular injection technique. Since IM injections require special skills, those prescribed Avonex (beta Interferon la) are given "anatomy lessons"; they ease tension and are fun. Learning is informal, stories are shared and expectations discussed. The patient is encouraged to maintain an informed, active role in his care, adopt a wellness lifestyle and participate fully in goals of treatment. Physical, psychological and cognitive capabilities are assessed. Safety, compliance, and relationship issues are evaluated. Rapport developed during training goes far to promote adherence to therapy, minimize lifestyle disruption and preserve an acceptable quality of life. The nurse as liaison to other professionals, particularly the prescribing physician, facilitates innovative management of treatment issues. Moving patients and carepartners toward self responsibility, informed choices and competent administration of treatments benefits all. New models of care develop and by empowering others, we empower ourselves.

Brain and spinal cord injuries are a leading cause of death and disability for the youth of Canada (Damba et al, 1996). The costs of these injuries to the individual, the family, and society at large are immense. Most of these injuries are preventable (Tator et al, 1993). Over the last decade, a number of injury prevention programs have been developed to address the high incidence of traumatic central nervous system (CNS) injuries in young people. However, what remains unclear is how effective these programs are in terms of altering risk-taking behaviours. The following paper/presentation will highlight three injury prevention programs currently offered in the Toronto area: The Party Program. The Heroes Program, and The Think First Program. Each program will be outlined in terms of historical development and infrastructure, content, setting, format, and intended audience. In addition, each program will be evaluated based on criteria established by the author. Measurement of outcomes will also be addressed.

The Children's Health Resource Centre was created to give children, youth and parents access to information concerning the health issues of children. As humans, whether we are children or adults, have a tendency to deal with situations better if we feel that we have some control. Knowledge empowers us-gives us that control. It enhances our ability to cope and frequently improves our recovery as well as our recovery rate. The Resource Centre is there to supply that knowledge--to become a Provincial Inquiry line for children's health. This paper will encompass the why, how, when, response, effect and future plans of the Children's Health Resource Centre.

How to manage neurologically impaired patients is a challenge we all face. Lions Gate Hospital in North Vancouver, B.C. successfully developed a padded environment for confused, restless, and agitated patients. The following article describes how patients are managed without restraints in a safe environment.

The incidence of alcohol dependence/abuse in patients of a general health care facility is 35-50%. The diagnosis and treatment of patients experiencing or at risk of alcohol withdrawal is problematic. The admitting diagnosis is usually another medical condition, illness or injury. Signs and symptoms of alcohol withdrawal is complicated by pre-existing conditions. In an attempt to improve the quality of care, decrease the length of stay of these patients, and decrease demands on nursing staff, a protocol for intervention and treatment of alcohol withdrawal was developed on the orthopedic ward of Royal University Hospital. The protocol enables each nurse to assess. Intervene and initiate the proper referrals. The recognized tool of assessment used to identify at risk patients is the CAGE questionnaire. The Clinical Institute WithDrawal Assessment for Alcohol scale is used to determine when it is appropriate to use Benzodiazepines. General nursing considerations are addressed through a pre-printed care plan. Nurses refer to social work, Alcoholics Anonymous and make use of available resource material. The protocol enables nurses to provide safe and effective care with few associated costs. Except for mass immunization, there is no other single intervention in health care that has the same far reaching consequences (Sullivan, 1995).

Surgical treatments for PD and ET are promising. Medial Pallidotomy, the surgical lesioning of the pallidum, often improves symptoms of long-standing PD. We enrolled twenty-seven late stage PD patients for unilateral medial pallidotomy who were then assessed by the Core Assessment Program for Intracranial Transplantation (CAPIT) protocol. One year after surgery persistent improvement was seen contralateral to the lesion in the following features: drug-induced dyskinesias (92%), akinesia (38%), rigidity (51%), and tremor (42%). Complications included transient dysarthria (7 patients), facial weakness (9 patients), limb weakness (1 patient), swallowing problems (4 patients) and intracerebral haemorrhage (1 patient). Thalamic DBS may improve tremor in PD and ET patients. Therefore, we enrolled fifteen patients (9 PD and 6 ET patients) with disabling tremor, unresponsive to medication. They were assessed by the United Parkinson's Disease Rating Scale (UPDRS) and the Tremor Rating Scale (for PD and ET patients, respectively). Three months after surgery, limb tremor contralateral to stimulation improved by 71% in PD patients and 76% in ET patients. Complications included transient paresthesias (all), confusional state (1 patient) and intracerebral bleed (1 patient). Unilateral medial pallidotomy safely improves some Parkinsonian symptoms contralateral to the lesion. Thalamic DBS may effectively and safely improve contralateral limb tremor in PD and ET.

Pain is necessary for survival but chronic pain is disabling and causes significant health and economic problems. This study provides an understanding of the future for spinal cord stimulation. Stimulation by means of chronically implanted electrodes, was carried out in 200 patients with pain of varied benign organic etiology. In 177 of them, pain was confined to the failed back syndrome. Most patients were referred by a Pain Management Service. 226 epidural implants were used: 80 unipolar, 59 Resume, 12 bipolar, and 75 quadripolar. Patients were followed for periods of 6 months to 12 years, with a mean follow-up of 44 months. 84 patients (42%) were able to control their pain by stimulation alone, 22 patients (11%) needed occasional analgesic supplements along with their stimulation program. Pain secondary to failed back syndrome, multiple sclerosis, peripheral vascular disease, sympathetic dystrophy and diabetic neuropathy responded favorably. Pain due to cauda equina injury, paraplegic pain and phantom limb pain responded poorly. Complications included wound infection, displaced or fracture electrode, and fibrosis at the stimulating tip. Spinal cord stimulation has proven to be effective in the treatment of chronic benign pain.