rss_2.0Australasian Journal of Neuroscience FeedSciendo RSS Feed for Australasian Journal of Neuroscience Journal of Neuroscience Feed Celebrating Fifty Years of Smoke: Moyamoya and the nursing role following STA-MCA bypass<abstract> <title style='display:none'>Abstract</title> <p>Superficial temporal artery (STA) to middle cerebral artery (MCA) bypass, also referred to as STA-MCA bypass, is a direct revascularisation treatment for moyamoya disease. Moyamoya disease is a rare cerebrovascular condition characterised by progressive narrowing of the distal segments of the internal carotid arteries. Untreated, this may cause varied and progressive symptoms for patients, with a significantly increased risk of stroke annually. STA-MCA bypass is performed several times a year at Royal North Shore Hospital by specialist cerebrovascular neurosurgeons. This is a quaternary service with patient referrals received from throughout Australia.</p> <p>This paper will provide an overview of moyamoya, the surgical treatment and nursing care. The pre- and post-procedure nursing care for these patients is paramount, including perioperative blood pressure management, neurological assessment and wound care. The paper will also explore a case study of a patient who underwent a STA-MCA bypass, highlighting the value of specialised neuroscience nursing care, and additional considerations when managing patients living at a distance from the local health district.</p> </abstract>ARTICLEtrue and Managing Drug Induced Parkinsonism: The Role of Neuroscience Nurses<abstract> <title style='display:none'>Abstract</title> <p>Drug induced parkinsonism (DIP) is one of the most frequently occurring side effects of dopamine-receptor blocking agents such as antipsychotic (neuroleptic) and antiemetic drugs. It typically presents with extrapyramidal signs, such as slowed movements, reduced facial expression and muscle stiffness. In contrast to Parkinson’s disease, which is caused by a progressive degeneration of pre-synaptic dopaminergic neurons that project from the substantia nigra in the brainstem, DIP is thought to usually occur due to the post-synaptic antagonism of dopamine receptors in the striatum. However, the two conditions can sometimes be clinically indistinguishable, and may even occur together, and thus it can be challenging to make an accurate diagnosis of DIP. It is important to consider DIP in the differential diagnosis of any person with extrapyramidal signs within the context of recent medication changes as the condition is reversible when the offending drug is withdrawn and, without early identification, there is substantial risk of increased morbidity, complications such as falls, and poor quality of life. Recent advancements in cerebral imaging have improved diagnostic accuracy but this technology is costly and not widely available.</p> <p>There is a dearth of literature pertaining to the role of neuroscience nurses and DIP. This is concerning as the potential for DIP presentations to occur within the neuroscience setting is high. Neuroscience nurses, particularly those working within the movement disorder speciality areas, need the skills to advocate and pursue further investigation for patients who present with extrapyramidal signs, especially if these begin in the context of the prescription of dopamine-blocking drugs. This review is written primarily for neurosciences nurses but will be applicable to a wide range of healthcare workers; it aims to outline potential causative drugs, risk factors and the key clinical characteristics of DIP. It also highlights useful features that help distinguish DIP from Parkinson’s disease, summarises investigations and discusses management and care.</p> </abstract>ARTICLEtrue Thrombolysis in Acute Ischaemic Stroke Two Years into the COVID-19 Pandemic: A Retrospective Study<abstract> <title style='display:none'>Abstract</title> <sec> <title style='display:none'>Introduction</title> <p>Changes in intravenous thrombolysis treatment rates for acute ischaemic stroke during the COVID-19 pandemic have been reported. We examined the differences in the provision of intravenous thrombolysis in patients with acute ischaemic stroke, two years prior to and two years into the COVID-19 pandemic.</p> </sec> <sec> <title style='display:none'>Methods</title> <p>Data were compared between March 1, 2018 to February 28, 2020 (Pre-COVID-19) and March 1, 2020 to February 28, 2022 (COVID-19). Data collected included patients’ demographics, intravenous thrombolysis rates, and patient outcomes.</p> </sec> <sec> <title style='display:none'>Results</title> <p>There was an increase in ischaemic stroke patient admissions during the COVID-19 period (Pre-COVID-19 n=1041, vs COVID-19 n=1087). Yet, fewer stroke patients received intravenous thrombolysis (19.2% vs 13.9%, p&lt;0.001), and there were more stroke mimics thrombolysed (8.3% vs 15.6%, p=0.021) during this period. During the COVID-19 period, there was a significant delay in hospital presentation for patients who were thrombolysed (Pre-COVID-19 = 86 minutes vs COVID-19 = 107 minutes, p = 0.004); and delay in giving thrombolysis (median door to needle time: Pre-COVID-19 = 59 minutes vs COVID-19 = 65 minutes, p = 0.002). Fewer patients had severe stroke symptoms (National Institute of Health Stroke Scale score = &gt;15) (12.2% vs 4.8%, p=0.009) during the COVID-19 period. There was no significant difference in patients’ post-thrombolysis outcome (median National Institute of Health Stroke Scale score = 1, p=0.136; discharge modified Rankin Scale score = 1, p=0.647; and mortality p=0.655).</p> </sec> <sec> <title style='display:none'>Conclusion</title> <p>This study showed that during the first 2 years of the COVID-19 pandemic, there was a significant decline in the thrombolysis rates and delay in the administration of the intravenous thrombolysis treatment.</p> </sec> </abstract>ARTICLEtrue Review: Roald Dahl’s Marvellous Medicine<abstract> <title style='display:none'>Abstract</title> <p>Most of us know Roald Dahl’s Childrens works but few of us are familiar with his fascination with medicine and in particular neuroscience. During Dahl’s adult life his family suffered some terrible medical tragedies, and it was the medical interactions during these times that influenced some of his most famous writing from explosive potions in George’s Marvellous Medicine to Gobblefunk, the language created by Dahl for the BFG.</p> </abstract>ARTICLEtrue Intersection between Voluntary Assisted Dying, Suicide and Advance Care Planning in Huntington’s Disease<abstract> <title style='display:none'>Abstract</title> <p>Huntington’s Disease (HD) is a complex neurodegenerative disorder, with a life expectancy 10-20 years after symptom onset which is usually in middle age. Symptoms of HD include physical deterioration, cognitive impairment and a high incidence of suicide and suicidal ideation, which may cause intolerable suffering. While the strong association between depression and other psychiatric manifestations with suicide is discussed, this paper explores whether suicide can ever be deemed rational. By the time a person with HD reaches an advanced and terminal stage, their decisionmaking capacity will be so impaired as to make them ineligible for Voluntary Assisted Dying (VAD) under all current and proposed legislation in Australia and New Zealand. Given that Advance Care Planning (ACP) can provide an opportunity to refuse all medical treatment, except palliative treatment, could this provide an acceptable alternative to suicide and VAD? Nurses need to consider these ethical dilemmas and remain informed on the debates. They may experience moral conflict when a person wishes to discuss their view on rational suicide or seek to implement refusal of treatment in an advanced care directive. They must be aware and consider how their professional obligations and personal opinions interact with this complex topic.</p> </abstract>ARTICLEtrue incidence of worsening impulse control disorders in the initiation of apomorphine therapy<abstract> <title style='display:none'>Abstract</title> <p>Apomorphine therapy was first discovered in the 19th century and became clinically available for use in 1980’s. Apomorphine therapy has been described as an underutilised therapy for Parkinson’s disease (The aim of this study was to determine the incidence of Impulse Control Disorders (ICD) using a clinician administered rating scale the ‘Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease Rating Scale’ (QUIP-RS). The results of this study were consistent with the current literature that was reviewed. We found that apomorphine therapy were unlikely to worsen ICD and the use of apomorphine infusion may even improve ICD. In addition, concomitant use of dopamine agonists was not likely to worsen ICD.</p> </abstract>ARTICLEtrue's the story with CTE? the New News Story Surgery and Home Again: The Nurse's Role in the Patient Journey<abstract> <title style='display:none'>Abstract</title> <p>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.</p> <p>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.</p> </abstract>ARTICLEtrue Review: The Trembling Mountain: A Personal Account of Kuru, Cannibals and Mad Cow Disease. Parkinson's Disease: A Basic Overview<abstract> <title style='display:none'>Abstract</title> <p>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.</p> </abstract>ARTICLEtrue site infections in neurosurgical patients following cranial surgery: An integrative review<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Aim</title> <p>To synthesise the literature pertaining to surgical site infections (SSIs) in neurosurgical patients following cranial surgery.</p> </sec> <sec><title style='display:none'>Background</title> <p>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.</p> </sec> <sec><title style='display:none'>Design</title> <p>Integrative review.</p> </sec> <sec><title style='display:none'>Methods</title> <p>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.</p> </sec> <sec><title style='display:none'>Results</title> <p>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.</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>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.</p> </sec> </abstract>ARTICLEtrue Annual Demographic Survey of Parkinson's Disease and Movement Disorder Nurse Specialists<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>Parkinson's disease (PD) is a neurodegenerative condition that is the most common form of movement disorder. Caring for people with Parkinson's requires the skills and expertise of a Parkinson's disease and movement disorders nurse specialist (PDMDNS) (Bramble, Carroll, &amp; Rossiter, 2018). The World Health Organisation has identified the importance of monitoring health workforce demographics and distribution trends in order to effectively plan for health care needs (<xref ref-type="bibr" rid="j_ajon-2023-013_ref_006">WHO 2016</xref>). This is the third publication of an annual series reviewing the longitudinal trends of the PDMDNS workforce in Australia (<xref ref-type="bibr" rid="j_ajon-2023-013_ref_005">Williams et al. 2021</xref>, Williams et al. 2023).</p> </sec> </abstract>ARTICLEtrue subcutaneous titration in Parkinson’s disease - the effectiveness and safety of apomorphine challenges: A Literature Review<abstract> <title style='display:none'>Abstract</title> <p>This review examined the body of evidence to determine the efficacy of an apomorphine challenge. Its primary objective is to identify the dose of the most common adverse events involved with apomorphine challenges. The secondary objective is to determine whether a titration challenge is warranted prior to commencing Apomorphine therapy or an alternate option, such as slow titration, is more efficacious.</p> <p>Results: The literature review was developed using the Cochrane handbook of systematic reviews. The search yielded 157 results, only 23 were included in the final analysis. Evidence is largely lacking and traditionally anecdotal and based on clinician experience. Studies inadequately control for reporter and rater bias, have small sample sizes; high level evidence is lacking.</p> <p>Continuous rates range between 2-4mg/hr (<xref ref-type="bibr" rid="j_ajon-2023-005_ref_008">Deleu, 2004</xref>) and an intermittent dose range between 4mg- 6 mg (<xref ref-type="bibr" rid="j_ajon-2023-005_ref_020">Pahwa et al 2007</xref>); doses higher than this are likely to induce side effects. QT interval prolongation is linked with both apomorphine and domperidone use and an electrocardiogram (ECG) should be performed prior to commencing both medications.</p> <p>A positive result for an apomorphine challenge is determined when there is a 20% improvement from baseline score in part III of the Movement Disorder Society – Unified Parkinson’s Disease Rating Scale (MDS- UPDRS), 30 minutes after a dose is given.</p> <p>Lastly, review examines a theoretical way to titrate patients using the Tomlinson levodopa conversion.</p> </abstract>ARTICLEtrue Prevalence of cognitive impairment in patients with Parkinson’s disease presenting to hospital<abstract> <title style='display:none'>Abstract</title> <p>The Parkinson’s passport is a compact document consisting facts and tips about managing PD. The aim of the study was to examine the impact of ‘The Parkinson’s Passport booklet’ on the care and management of patients with Parkinson’s admitted to an Australian hospital. The results suggest the implementation of the Parkinson’s passport booklet does not improve the care and the management of a patient with PD who present to hospital which in turn challenges the efficacy of the document. However, the major unexpected finding during the course of the study was a high incidence of cognitive impairment in PD patients (85%) presenting to hospital.</p> </abstract>ARTICLEtrue literature review of Patient care in the management of agitation leading to violence and aggression in neuroscience nursing<abstract> <title style='display:none'>Abstract</title> <sec> <title style='display:none'>Background</title> <p>A correlation exists between staff retention, staff and patient safety and effective prevention of violence and aggression in neuroscience nursing. Workplace violence leads to a lack of productivity amongst nurses and legally a hospital is required to provide a safe working environment. This literature review aims to determine the themes within the literature and effective patient management of agitation leading to violence and aggression.</p> </sec> <sec> <title style='display:none'>Aim</title> <p>A literature review of articles was conducted using CINAHL, PubMed, Cochrane database and Google Scholar between 2007-2022.</p> </sec> <sec> <title style='display:none'>Discussion</title> <p>The common themes within the literature included assessment of the patient to identify an unmet need, early referrals to members of the interdisciplinary team, effective communication, verbal de-escalation techniques and an understanding of restraint and pharmaceutical management, even though these should be the last resort. Education for staff is fundamental and should include effective communication, warning signs, triggers for aggression, simulation in the clinical context, and verbal de-escalation techniques. Debriefing should take place after an incidence of violence and aggression and effective hospital management should be considered with guidelines and systems in place to support and protect staff and patients.</p> </sec> </abstract>ARTICLEtrue