rss_2.0Australasian Journal of Neuroscience FeedSciendo RSS Feed for Australasian Journal of Neuroscience Journal of Neuroscience Feed 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 and management of agitation in the neuroscience patient: Recommendations from Australasia<abstract> <title style='display:none'>Abstract</title> <sec> <title style='display:none'>Background</title> <p>Neuroscience patients can present with agitation due to a number of factors such as the presence of cerebral abnormalities, tumours, trauma, or medications. Agitation among neuroscience patients that escalates to violence and aggression appears to be increasing and highly challenging for neuroscience nursing practice across Australasia. Neuroscience wards or units endeavour to effectively manage patients who are affected by agitation and provide appropriate training for clinical and non-clinical staff. Following a workshop through Australasian Neuroscience Nurses’ Association (ANNA), a group of neuroscience nurses, passionate about improving the care of neuroscience patients presenting with agitation and the safety of the staff; collaborated and researched the most effective prevention and management strategies that can be used to ensure that care delivery for these patients is therapeutic and effective.</p> </sec> <sec> <title style='display:none'>Purpose</title> <p>The purpose of this paper is to share recommendations that can guide the prevention and management of agitation among neuroscience patients from the perspective of neuroscience nurses in Australasia.</p> </sec> <sec> <title style='display:none'>Discussion</title> <p>These recommendations have been discussed from hospitals across Australasia including Perth, Brisbane, Sydney, Canberra, Melbourne, and Wellington in the hope that other cities can make changes in their own hospitals to inform neuroscience nurses and allied clinicians, improve guidelines and provide effective education for staff members that interact with neuroscience patients.</p> </sec> </abstract>ARTICLEtrue’s Disease Movement Disorder Nurse Specialist Demographic Survey 2021<abstract> <title style='display:none'>Abstract</title> <p>Parkinson’s disease is a common neurological condition. Patients benefit from patient centred care provided by a Parkinson’s disease or movement disorder nurse specialist. This study is the second in a series of annually recurring publications to progressively monitor the growth and development of the PDMDNS profession in Australia. Results will firstly; provide evidence to support the PDMDNS professional body in Australia to advocate for adequate resources, sufficient training and appropriate levels of qualifications and pay grades, secondly; assist in identifying gaps in the provision of services to people living with PD.</p> </abstract>ARTICLEtrue’s Australia – a New National Association to Support the Huntington’s Community<abstract> <title style='display:none'>ABSTRACT</title> <p>Huntington’s disease (HD) is a rare, progressive, neuropsychiatric disorder that is inherited. Although there are treatment options for some of the symptoms, currently there is no cure, despite much research. In addition to medical, nursing and allied health care, a person with HD needs a great deal of support. Until now, this support, for individuals and their families, has been facilitated by Huntington’s Disease Associations in each Australian state and territory. It has been a long-held dream to merge these Associations to form a national body, so as to provide better and more equitable support, increased resources, greater sustainability and create consistent educational material for everyone impacted by HD. The ultimate goal is to help people impacted by the condition live their best life. This dream is about to be realised as 5 states and 2 territories will merge to create Huntington’s Australia, planning to begin operations later this year. The journey over the last 3 years towards this dream is described in this paper.</p> </abstract>ARTICLEtrue’s Australia Assessment: Practice Review’<abstract> <title style='display:none'>ABSTRACT</title> <sec> <title style='display:none'>Background statement</title> <p>Accurate completion of a Neurological Assessment including the Glasgow Coma Scale (GCS) is of the upmost importance in identifying and escalating neurological deterioration. This assessment must be standardised to ensure patient safety and quality care.</p> </sec> <sec> <title style='display:none'>Aim</title> <p>This paper aims to review the standardisation of the GCS inclusive of a comprehensive Neurological Assessment in metropolitan hospitals in Australia. Existing literature on this tool in clinical practice, will be further explored in this review. It will primarily focus on efficacy, standardisation and accuracy of completing a Neurological Assessment on an Adult.</p> </sec> <sec> <title style='display:none'>Methods</title> <p>A comprehensive review of the topic was undertaken, to reveal literature that supports the aim of this paper. Medline and Embase were accessed, with the use of Boolean operators to ensure literature met the inclusion and exclusion criteria.</p> </sec> <sec> <title style='display:none'>Results</title> <p>Five articles were selected as appropriate and relevant to meet the needs and expectations of this review. Research suggests inconsistency and validity of the tool, which may affect patient safety.</p> </sec> </abstract>ARTICLEtrue Video—Educating Schools<abstract> <title style='display:none'>Abstract</title> <p>Concussion awareness became a priority for the Northern Sydney Local Health District as the increase in children, teenagers, and young adults with concussion, had an effect on emergency department (ED) presentations, follow-up, schooling and sports-related activities. Education in some of the local schools from the Neuroscience Clinical Nurse Consultant had been occurring, but the need far outweighed the in-person approach. Therefore, it was decided that the development of an educational concussion video for schools was required.</p> <sec> <title style='display:none'>AIM</title> <p>To produce a 5-minute educational video for use in schools in the PDHPE Program / Sport sessions, that could then be broken down into shorter 1-minute versions for social media bursts.</p> </sec> <sec> <title style='display:none'>METHOD</title> <p>A focus group was established and the process of devising and parenting this video took approximately 11months. It is pitched at a 12-year-old and combines animation and realistic scenes.</p> </sec> <sec> <title style='display:none'>OUTCOME</title> <p>The video can be found at - <ext-link ext-link-type="uri" xmlns:xlink="" xlink:href=""></ext-link></p> <p>It has been sent to and accessed by schools within the Northern Sydney Local Health District and has been integrated into the NSW Education Department teacher training as a tool for teachers and students. It has been accessed throughout NSW, other Australian states and accepted for use in the New Zealand schooling system.</p> </sec> </abstract>ARTICLEtrue Beginnings and Domperidone Review<abstract> <title style='display:none'>Abstract</title> <p>Apomorphine is generally a safe and well tolerated therapy used in acute and intermittent treatment of the motor symptoms, the ‘off’ motor state in Parkinson’s disease, and there is growing evidence supporting its clinical value in non-motor symptoms. It has an excellent efficacy profile in clinical practice, though the use of the agent continues to be underutilised. One of the most common reasons of this is most likely the perception of how difficult it is to use the agent, and the management of the adverse events (AE’s). The discontinuation due to AE’s is not as common as it has been believed. Apomorphine is generally well tolerated by most patients and if AE’s do develop, they are manageable in most cases.</p> <p>The objective of this literature review was to examine the body of literature regarding the risk of Electrocardiogram (ECG) changes, and cardiac arrest in apomorphine challenges; and to look for safety parameters for people commencing and continuing apomorphine therapy. There is evidence that apomorphine can prolong a QTc interval, leading to cardiac arrhythmias. During the apomorphine challenge the drug domperidone is widely used to combat the side effects of nausea and vomiting, and vasodilation side effects of postural hypotension from the apomorphine. Domperidone has also been identified and studied as a medication with risks of QTc prolongation.</p> </abstract>ARTICLEtrue the role of clinician-researcher: Insights from a Constructivist Grounded Theory study in traumatic brain injury<abstract> <title style='display:none'>Abstract</title> <p>Using the case of traumatic brain injury, this paper explores 1) challenges to academic and ethical integrity when in the role of clinician-researcher, and 2) potential strategies to enhance ethical qualitative research involving people with possible physical and/or emotional trauma and temporary or permanent cognitive disruption. When undertaking qualitative research with patients, families, and/ or health professionals, a researcher’s clinical background may stimulate insightful and relevant research questions, interviews, and/or field observations of care to inform meaningful and translatable practice improvements. However, there may be tension between clinician versus researcher values, and these priorities affect what the clinician sees and interprets in the field. A clinician’s ingrained values and professional socialisation can make it difficult to hold their professional assumptions about various phenomena at bay. The principles of human research merit and integrity, justice, beneficence, and respect, along with methodological clarity, can provide a rigorous foundation for discussion of ethical research in traumatic brain injury.</p> <p>This paper discusses challenges and strategies through: 1) examining clinical assumptions; 2) determining capacity for consent; 3) considering dependent or unequal power relationships; 4) determining the scope for field observations; 5) responding to unprofessional practice; 6) discriminating between research interviews and clinical conversations; and 7) critically reflecting on research data. Implications for clinical research are evident: seeing past one’s own construct of understanding is challenging for clinician-researchers aiming to illuminate both patient and family experiences of care, and nuanced clinical skills. Careful ethical and methodological planning can protect participants while illuminating elements of specialist practice.</p> </abstract>ARTICLEtrue Dystonia: A Summary of the Basics<abstract> <title style='display:none'>Abstract</title> <p>Dystonia is a neurological movement disorder characterised by abnormal and involuntary twisting movements and postures. It comes in many forms and can affect various parts of the body. Dystonia is seen in children and adults as a standalone condition, or as one part of a complex disease. Dystonia can be caused by genetic mutations, specific medications, environmental and chemical factors, or, as in the majority of cases, the cause is unknown. There is currently no cure or disease modifying agent for dystonia, so treatments are aimed at managing symptoms and maintaining quality of life. The treatment options for dystonia include invasive surgeries, medications, botulinum toxin and non-pharmaceutical therapies. Dystonia is often a misunderstood and misdiagnosed disorder, which makes diagnosis difficult. The diagnosis of dystonia is usually made by a Neurologist who specialises in Movement Disorders. Research is ongoing to better understand the disorder and aims to find more effective and efficient treatments, and ultimately a cure for dystonia.</p> </abstract>ARTICLEtrue and Mentorship for Nurses Matters’s Disease: A Nursing Perspective body Dementia: What are the challenges of early and accurate diagnosis?<abstract> <title style='display:none'>Abstract</title> <p>Collectively, Lewy Body Dementia (LBD) including Parkinson’s Disease Dementia (PDD) and dementia with Lewy Bodies (DLB) account for the second leading type of dementia following Alzheimer’s disease (AD) (<xref ref-type="bibr" rid="j_ajon-2022-005_ref_16">Lee et al., 2019</xref>). Despite revised consensus criteria, detection rates in routine clinical practice remain poor (<xref ref-type="bibr" rid="j_ajon-2022-005_ref_35">Vann Jones &amp; O’Brien, 2013</xref>) with cases commonly misdiagnosed as AD (<xref ref-type="bibr" rid="j_ajon-2022-005_ref_22">McKeith et al., 2017</xref>).</p> <p>Diagnosis can be challenging due to the presentation of an extensive range of autonomic, motor, sleep, cognitive and neuropsychiatric symptoms which can vary within a person and between individuals (<xref ref-type="bibr" rid="j_ajon-2022-005_ref_30">Taylor et al., 2020</xref>). Given the disparity in management and prognosis of LBD compared to other dementias (<xref ref-type="bibr" rid="j_ajon-2022-005_ref_9">Fujishiro et al., 2013</xref>), the timing and accuracy of diagnosis is of great consequence.</p> </abstract>ARTICLEtrue in the treatment of Pembrolizumab induced Myasthenia Gravis<abstract> <title style='display:none'>Abstract</title> <p>Pembrolizumab is a monoclonal antibody programmed cell death 1 inhibitor that is an established treatment for melanoma and various lung cancers. Whilst an effective treatment option, it is known to have multiple immune related adverse events associated with its use, including neurological complications such as myasthenia gravis. Previous case reports on the treatment of Pembrolizumab induced myasthenia gravis have detailed the difficulty in managing the condition. There is increasing evidence that Rituximab, a monoclonal antibody directed at CD20 antigen B cells may be an effective treatment option for this condition. This case report outlines the successful treatment of a patient with Pembrolizumab induced myasthenia gravis who was managed with Rituximab.</p> </abstract>ARTICLEtrue are in this together of the corona virus (Covid 19)pandemic on stroke code activities and outcome. A retrospective observational study<abstract> <title style='display:none'>Abstract</title> <sec id="j_ajon-2022-004_s_001"> <title style='display:none'>Background</title> <p>The Coronavirus 2019 (COVID-19) pandemic has affected the delivery of healthcare around the world. We assessed the impact of the COVID-19 pandemic on hospital presentations, reperfusion treatment and outcomes in a comprehensive stroke centre.</p> </sec> <sec id="j_ajon-2022-004_s_002"> <title style='display:none'>Methods</title> <p>In this observational study seven months of retrospective data from February 2020 (at the beginning of the pandemic) were compared to data collected for the same time frame in 2019.</p> </sec> <sec id="j_ajon-2022-004_s_003"> <title style='display:none'>Results</title> <p>There was a transient reduction in stroke presentation only at the beginning of the wave of COVID-19 community transmissions in Sydney. There were significantly more haemorrhagic strokes in the COVID-19 period (n = 66, 15.4 % vs n = 95, 21.5 %, <italic>P</italic> = 0.02) and baseline stroke severity was higher (NIHSS median 3 vs 4, <italic>P</italic> = 0.049). Similar proportions of ischaemic stroke patients received reperfusion therapy in the two time periods (IV thrombolysis [n = 51, 17.3% vs n = 52, 17.9%, <italic>P</italic> = 0.838]; and ECR [n = 38, 12.9% vs n = 46, 15.9%, <italic>P</italic> = 0.30]). The time from presentation to stroke bed admission was significantly shorter during the COVID-19 period (median 295 vs 260 minutes, <italic>P</italic> = 0.031). Three-month follow-up Modified Rankin Score was 2 (median) in both periods (P = 0.92).</p> </sec> <sec id="j_ajon-2022-004_s_004"> <title style='display:none'>Conclusion</title> <p>There was no change in stroke presentations overall during the 2020 COVID 19 pandemic time period with the exception of the first phase of the pandemic. Baseline stroke severity scores were higher. There was no a difference in the degree of disability at three-month follow-up.</p> </sec> </abstract>ARTICLEtrue