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.

Approximately 300,000 Canadians have epilepsy. Of those 30 percent fail to achieve satisfactory seizure control with current antiepileptic drug therapy (Vagus Nerve Stimulator Study Group, 1995). The development and availability of new therapeutic options cannot be overlooked for medically intractable patients. Chronic Vagus Nerve Stimulation (VNS) has demonstrated a 50 percent reduction in seizure frequency in 1/3 of patients with refractory partial onset seizures (Uthman, et al, 1993). Individuals undergoing this procedure require the attention of health care professionals from both the neurological and neurosurgical programs. This unique intervention demands that the patient's device be tested intra-operative, and programming begin during the immediate post-operative phase. Assessment of tolerance and side effects to vagus nerve stimulation therapy, as well as continued evaluation of the patients seizure control are necessary to direct staged programming of the device. This poster will demonstrate how the nurses from the neurology and neurosurgery clinics have been able to collaborate to ensure patients needs are met. Patient education is crucial to assisting the patient through this procedure, and key points will be identified. The implementation of coordinating the approach for programming the patient's device will be depicted. Future recommendations for long-term outcome measurement will be addressed.

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.