Axone (Dartmouth, N.S.)最新文献

Jane was a healthy 16 year old girl who attended a high school dance and subsequently had a grand mal seizure--her first! She was taken home, developed a decreasing level of consciousness and was admitted to the local hospital, where it progressed to status epilepticus. We will describe the classifications of seizures including status epilepticus, which demands the highest level of clinical expertise and attention to preventative medicine, for a desirable outcome. During the eleven months of care a massive multi disciplinary team approach was instituted which extended across borders. Jane's story demonstrates a truly Neuroscience team effort from acute care to a rehabilitation center to home.

A recent focus in health care is to develop a seamless transition for patients between the variety of health care agencies with whom they interact. The continuum of care for patients with stroke is complex and many levels of care are required, from acute intervention through to rehabilitation and reintegration into the community. A group of nurses from a variety of agencies in Southwestern Ontario received funding from the Ontario province Wide Nursing Project to effect a desirable change in the way nurses care for the stroke patient. This article describes the Ontario Province Wide Nursing project and the process of and challenges in developing a nursing model for stroke. The development of a nursing model for stroke patients and their families involved conducting nursing, and patient and family focus groups to identify key issues. Thirty-eight nurses participated in the nursing focus groups, and 8 patients and 18 family members participated in the patient and family focus groups. The common themes were the need for improved communication and the need to better prepare patients and families for the many transitions they experience during their recovery from stroke. A Stroke Education Record, which identifies a comprehensive list of potential learning needs of stroke patients and their families, and a Stroke Education and Resource Guide, which provides a reference for nurses, were developed and will be implemented in September 1998. Implementation of the model included a workshop, staff inservices, a self-learning package, and unit displays. Evaluation of the model will include nursing and patient and family focus groups, a chart review, written nursing evaluations, and patient and family telephone interviews.

Nurses have demonstrated an interest in research in stroke. Studies encompass a broad variety of subjects; some clearly within the traditional realm of nursing and others that are common to multiple disciplines. Studies are limited in number and most lack the necessary numbers or controls that make data meaningful. Important beginnings are evident. Research about nurses who care for stroke survivors attempts to find correlations between attitudes and knowledge or outcome measures. Care delivery systems and models of nursing practice may impact on a variety of outcome measures, both those which are patient centred (functional status, quality of life) and those which are system driven (length of stay, recidivism). Information regarding the experience of stroke is rich in detail but limited in quantity. Much more information must be gained from a broader segment of the population to provide a baseline of understanding. Similarly, caregiver research begins to touch on the experience but considerable variation must exist between spouse caregivers and adult children or others, and between cultures. Finally, our interventions and their effect on outcomes are only just beginning to be studied. We remain a great distance from our ideal "evidence based practice". On a positive note, the research that nurses have conducted within the field of stroke is indicative of the broad interests that exist. To provide the care that is needed for our aging population while resources shift and shrink, it is essential that we not only test our interventions and their impact on outcomes but that we also are prepared to blur the traditional professional boundaries. Nurses do not have a monopoly on family centred care and care for the caregivers, nor do we act in isolation when we implement strategies to normalize bowel function post stroke. Collaborative research between disciplines and across cultural and political barriers is essential; resources for funding are available but have not been successfully accessed. The time is now for research by nurses and colleagues to begin to bridge the many knowledge gaps that persist.

Multiple Sclerosis (MS), a demyelinating disease of the central nervous system, is the most common neurological disease affecting young adults in North America and, in the majority of cases, is associated with accumulating disability. Urinary tract dysfunction affects up to 90% of the MS population, and urinary tract infections are encountered in up to 74% of the tested population. Viral infections have previously been shown to trigger acute exacerbation and it is our experience that urinary tract infection also commonly precedes relapse, and, when recurrent, is associated with neurologic progression. We present three case studies from our MS Clinic where recurrent UTI was associated with acute exacerbation and neurologic progression refractory to intravenous steroid treatment. Interferons, protein signaling molecules, have recently been found to play a role in acute exacerbation and disease progression in individuals with MS. Viral infections induce interferon release which may activate T cells to produce gamma-interferon. Interferon-gamma precipitates relapse and stimulates production of tumour necrosis factor-alpha, a cytokine directly toxic to oligodendrocytes. Bacterial infections similarly induce interferon release and may activate immune pathways that result in MS exacerbation and neurologic progression.

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.