Axone (Dartmouth, N.S.)最新文献

Patients admitted with subarachnoid hemorrhage are monitored for symptoms of vasospasm. A prospective study was designed to compare two monitoring instruments: a standard neurological tool (SNR) and the National Institutes of Health Stroke Scale (NIHSS). The two assessment tools were compared to evaluate their concordance and to identify areas where efficiency in recording assessments might be improved. We found no statistical difference between the two tools in detecting symptomatic cerebral vasospasm. Substantial discrepancies in the documentation of observations were noted, particularly in the assessment of limb drift. Avoidance of these discrepancies may require further definition in the SNR tool. A qualitative component consisting of a review of the nurses' notes regarding neurological status in the patients' charts was conducted. It was demonstrated that nurses commonly document information in the progress notes that is already captured in the SNR. Further education of nurses in the use of assessment tools is therefore recommended to avoid redundancies and increase efficiency in recording clinical observations.

Much work has been done in the past 10 years to research and document best practices in stroke care along the continuum of care. The challenge now for stroke care practitioners is to turn those best practices into reality in a clinical setting. In spite of a general understanding and acceptance of the benefits to the patient, an organization's culture and limited access to resources can frustrate our best efforts to introduce best practices at the bedside. Trillium Health Centre, a community hospital serving a diverse community of more than one million people, has turned best practice stroke care guidelines into reality by developing a 14-bed comprehensive stroke unit. This innovative approach to care uses specialized stroke teams, an interdisciplinary approach to care, and a single unit where the patient remains in the same bed throughout the acute and rehabilitation stages of care. Commitment to the new delivery model by formal leaders, informal leaders, and front-line staff and a supportive organizational structure contributed to an expedited and successful implementation. All changes were implemented without an increase in the overall resources assigned to the unit. Early results show that the average length of stay is shorter than the national standard and that provider and patient satisfaction have improved.

The shift towards patient-centred care is the priority in health care today. Providing quality care that is highly efficient and patient-friendly while also being cost-effective is a difficult, but not impossible task. Since 1996, awake, image-guided day surgery for resection of brain tumors has been performed at Toronto Western Hospital in an attempt to combine the concept of patient-centred care with responsible resource allocation. Nurses can play a vital role in facilitating a shift in outpatient neurosurgery towards a more patient-care focused environment. By providing information and education to patients and families, nurses have enormous potential to improve satisfaction and outcomes for patients undergoing these procedures. Thoroughly preparing patients for their surgery and helping them manage their care post-operatively are the keys to decreased complications and re-admission. This would undoubtedly improve cost-effectiveness for the system while simultaneously improving the patients' quality of life.

Gamma Knife surgery (GKS) is a minimally invasive neurosurgical procedure used to treat a variety of cranial lesions and disorders. Gamma Knife surgery technology and conditions treated are discussed in this paper. The patient experiences during the treatment phases are also reviewed. The incision-free technology was introduced by Lars Leksell and Bjorn Larson in 1967 in Europe, and has been available in the United States since 1987 (Ganz, 1997). Gamma Knife surgery has expanded internationally with over 170 sites worldwide treating over 250,000 patients using focused beams of Cobalt-60 radiation. Winnipeg's Health Sciences Centre opened the first Canadian Gamma Knife centre in November 2003.

Until recently, the effects of a minor head injury have been minimalized by health care workers. Few resources have been available to individuals who experienced a mild traumatic brain injury who were discharged from hospital emergency services. Recognizing the needs of these individuals and their families, health care workers in Nova Scotia, including nurses, have developed a specific program of rehabilitation for patients who have suffered mild brain injuries.

The purpose of this study was to conduct focus group interviews to obtain information for development of a needs assessment questionnaire. Four focus groups were conducted with 10 people with multiple sclerosis (MS) and five significant others. A facilitator from the learning services department at the hospital conducted the interviews guided by questions developed by the researcher. The focus group interviews were audiotaped and transcribed. The researcher analyzed the transcribed interviews. Content analysis was used to analyze the transcribed data creating categories from key words and phrases as they appeared. The findings were grouped by themes. The results highlighted the participants' experiences and needs regarding physical changes; sources of assistance; unmet needs; psychological, employment, leisure, and informational needs. A comparison of themes developed from the focus groups and in the literature captured categories for questionnaire development. One new theme, leisure, was not found in the literature and was incorporated based on the findings of this study. The final categories for questionnaire development were: physical, health, psychological, financial, employment/meaningful daytime activity and leisure, accessibility and information. A survey questionnaire was developed from the focus group data using the phraseology of the participants.