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PubMed2004

The impact of a neurointensivist-led team on a semiclosed neurosciences intensive care unit.

OBJECTIVE: To evaluate the impact of a newly appointed neurointensivist on neurosciences intensive care unit (NICU) patient outcomes and quality of care variables. DESIGN: Observational cohort with historical controls. SETTING: Ten-bed neurointensive care unit in tertiary university hospital. PATIENTS: Mortality, length of stay (LOS), and discharge disposition of all patients admitted to the NICU were compared between two 19-month periods, before and after the appointment of a neurointensivist. Data regarding these patients were collected using the hospital database and the University Hospitals Consortium database. Individual patient medical records were reviewed for major complications and important prognostic variable documentation. INTERVENTIONS: Appointment of a neurointensivist. MEASUREMENTS AND MAIN RESULTS: We analyzed 1,087 patients before and 1,279 after the neurointensivist's appointment. The unadjusted in-hospital mortality decreased from 10.1% in the before to 9.1% in the after period (95% confidence interval, -1.3 to 3%, relative mortality reduction of 9.9%), but this decrease was significantly different than the expected increase of 1.4% in University Hospitals Consortium mortality during the same period (p = .048). The unadjusted mortality in the NICU decreased from 8% to 6.3% (95% confidence interval, -0.5 to 4, relative mortality reduction 21%) and mean NICU LOS from 3.5 to 2.9 days (95% confidence interval, 0.2 to 0.9, relative NICU LOS reduction 17%). A significant 42% reduction of the risk of death during the first 3 days of NICU admission (p = .003) and a 12% greater risk for NICU discharge (p = .02) were found in the after period in multivariate proportional hazard models. Discharge home increased from 51.7% in the before to 59.7% in the after period (95% confidence interval, 4 to 12, relative increase of 15%) and discharge to a nursing home decreased from 8.1% to 6.8% (95% confidence interval, -1 to 4, relative decrease of 16%). Although a higher total number of complications occurred in the after period, fewer of them occurred in the NICU (odds ratio, 0.2; 95% confidence interval, 0.08 to 0.54, p = .001); this may possibly be due to the better documentation by the NICU team in the after period. CONCLUSIONS: The institution of a neurointensivist-led team model was associated with an independent positive impact on patient outcomes, including a lower intensive care unit mortality, LOS, and discharge to a skilled nursing facility and a higher discharge home.

Adult↗
PubMed1986

The role of the neuroscience nurse in the nurse-physician relationship.

Productivity and quality patient care depend on a strong and collaborative nurse-physician relationship. A questionnaire was developed to assess physicians' opinions regarding services provided by the nursing staff at Barrow Neurological Institute. This article discusses the importance of a working nurse-physician relationship; variables that physicians perceive as important to the neuroscience nurse's role; factors that positively affect the nurse's role in a nurse-physician relationship; and strategies to improve nurse-physician relations.

Humans↗
PubMed1991

Acoustic neuroma: postoperative deficits and the role of the neuroscience nurse.

Although the technical aspects of nursing care and management of acoustic neuroma patients have been discussed in literature, both the apparent and subtle neurological and psychological residuals of acoustic tumor have been largely overlooked. Long-term sequelae, unless acute, usually are not attended by the neuroscience nurse. However, nursing instruction and enhanced care while hospitalized can prepare the patient for self-care and improve final recovery. Responses of 541 members of the Acoustic Neuroma Association to a multipart questionnaire on aspects of the acoustic neuroma experience reveal the nurse plays an important role in preparing the patient for maximum recovery after hospital discharge.

Humans↗
PubMed1991

FAMLI-RESCUE: a family assessment tool for use by neuroscience nurses in the acute care setting.

Family function information is essential to providing holistic nursing care, assessing specific areas of family dysfunction and assisting the client in adaptation to stress using family or external resources. This article presents an assessment tool developed by the author for collection and evaluation of family data in a simple format that can be used by neuroscience nurses caring for the ill or injured family member in the acute care setting. Theoretical rationale is presented along with a description of the instrument and its application. Based on assessment data, the health care plan is developed by nurses using expertise from health team members where appropriate.

Adaptation, Psychological↗
PubMed1991

Nursing case management: application to neuroscience nursing.

The changing health care environment has challenged nurses to develop creative care delivery systems that provide for quality, comprehensive, cost-effective care in a time of restricted reimbursement and diminishing human and material resources. Nursing case management has been identified as one such approach to health care delivery that has resulted in quality, patient-centered care and improved resource utilization. The case management plan, critical path and discharge planning sheet are primary tools in this care delivery model. Because of the diverse case types and variety of patient care settings, neuroscience nursing is an ideal arena for implementing a nursing case management model of care.

Female↗
PubMed1993

Development of printed teaching materials for neuroscience patients.

Neuroscience nurses are challenged by the current climate of cost containment and the nursing shortage to continue to provide quality patient education. One strategy for meeting this challenge is to follow the process outlined in this overview for the development and use of printed materials.

Humans↗
PubMed1994

Coordinated care for the neuroscience patient: future directions.

A coordinated care model was developed on a neuroscience unit to achieve positive outcomes in a cost-effective environment. This included the development of a patient care coordinator (PCC) role, critical paths and a system for variance tracking. The PCC was responsible for coordinating care of patients and ensuring that patients progressed toward expected outcomes. Multidisciplinary critical paths were developed for four medical diagnoses. To evaluate the effectiveness of the program, an analysis of length of stay data, cost comparison, patient and staff satisfaction, and variance reports of one critical path, the microvascular decompression for trigeminal neuralgia were completed. Results from the pilot project were positive and provided valuable information for the use of coordinated care as a hospital-wide patient care delivery model.

Attitude of Health Personnel↗
PubMed1994

Neurotoxins: a neuroscience nursing challenge.

Societal awareness of toxins in general has been heightened in the past few decades with the increased focus on environmental concerns. The medical profession has been aware of the effects of some toxins such as lead and mercury for centuries, while other toxins have more recently been identified. Neuroscience nurses are challenged to be aware of the neurological effects of lesser known toxins, such as ciguatera and methyl bromide, and to meet the complex needs of patients who are suffering from the effects of toxic levels of these substances.

Adult↗
PubMed1995

The role of the neuroscience nurse in lumbar fusion.

Lumbar spinal fusion is a major surgical procedure that joints together two or more vertebral bodies to restore stability to the lower spine. Spinal fusion may be indicated as a result of a variety of causes. Regardless of the underlying problem, if instability of the spine occurs, fusion may be necessary. In recent years there have been a number of new spinal instrumentation systems introduced that provide stabilization and immobilization of the spine while bony fusion occurs. Neuroscience nurses must be prepared to care for patients undergoing this procedure as their ability to educate, assess and intervene throughout the perioperative period can have a positive effect on the outcome of lumbar spinal fusion.

Humans↗
PubMed1995

Hope: implications for neuroscience nursing.

Hope is a response of patients and families to actual and potential health problems. The study of this phenomenon in neuroscience populations is limited. Facilitating hope in the health care setting results from an understanding of its definition and significance to nursing, multidisciplinary origins and scientific investigations. Nursing interventions should include attention to the environment, goals, relationships, change and energy.

Humans↗
PubMed2006

End-of-Life care concepts in Journal of Neuroscience Nursing.

This descriptive study evaluated concepts relating to end-of-life care addressed in Journal of Neuroscience Nursing during a 10-year period. An analysis of 377 articles published from 1993 to 2002 found 40 articles addressing some area of end-of-life content. Of 2,558 pages reviewed, 201 pages (7.8%) contained end-of-life content. The primary areas of end-of-life care discussed in the articles were needs assessment for families, coping strategies and support systems, and recognition of family and caregiver needs. The most common diseases and disorders addressed were epilepsy, stroke, traumatic brain injury, multiple sclerosis, and Parkinson's disease. To increase overall content in the field of palliative and end-of-life care, authors can include end-of-life content in articles submitted for publication.

Bibliometrics↗
PubMed1997

The cognitive neuroscience of memory: perspectives from neuroimaging research.

Cognitive neuroscience approaches to memory attempt to elucidate the brain processes and systems that are involved in different forms of memory and learning. This paper examines recent research from brain-damaged patients and neuroimaging studies that bears on the distinction between explicit and implicit forms of memory. Explicit memory refers to conscious recollection of previous experiences, whereas implicit memory refers to the non-conscious effects of past experiences on subsequent performance and behaviour. Converging evidence suggests that an implicit form of memory known as priming is associated with changes in posterior cortical regions that are involved in perceptual processing; some of the same regions may contribute to explicit memory. The hippocampal formation and prefrontal cortex also play important roles in explicit memory. Evidence is presented from recent PET scanning studies that suggests that frontal regions are associated with intentional strategic efforts to retrieve recent experiences, whereas the hippocampal formation is associated with some aspect of the actual recollection of an event.

Animals↗
PubMed2004

A cognitive neuroscience framework for understanding causal reasoning and the law.

Over the past couple of decades, there have been great developments in the fields of psychology and cognitive neuroscience that have allowed the advancement of our understanding of how people make judgements about causality in several domains. We provide a review of some of the contemporary psychological models of causal thinking that are directly relevant to legal reasoning. In addition, we cover some exciting new research using advanced neuroimaging techniques that have helped to uncover the underlying neural signatures of complex causal reasoning. Through the use of functional imaging, we provide a first-hand look at how the brain responds to evidence that is either consistent or inconsistent with one's beliefs and expectations. Based on the data covered in this review, we propose some ideas for how the effectiveness of causal reasoning, especially as it pertains to legal decision-making, may be facilitated.

Brain↗
PubMed2001

Cognitive neuroscience of aging: contributions of functional neuroimaging.

By revealing how brain activity during cognitive performance changes as a function of aging, studies using positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) are contributing to the development of a new discipline of Cognitive Neuroscience of Aging. This article reviews functional neuroimaging studies of cognitive aging in the domains of visual perception, episodic memory encoding and semantic memory retrieval, episodic memory retrieval, implicit memory, and working memory. The most consistent finding of these studies was that brain activity tends to be less lateralized in older adults than in younger adults. This finding is conceptualized in terms of a model called Hemispheric Asymmetry Reduction in Old Adults (HAROLD). According to a compensation hypothesis, bihemispheric involvement could help counteract age-related neurocognitive decline, whereas, according to a dedifferentiation hypothesis, it reflects a difficulty in recruiting specialized neural mechanisms.

Aged↗
PubMed1990

Receptor autoradiography and 2-deoxyglucose techniques in neuroscience.

The use of the receptor autoradiography and 2-deoxyglucose (2-DG) techniques in neuroscience are reviewed. Receptors and other binding sites can be visualized autoradiographically in microtome tissue sections after labelling with radioligand in vivo or in vitro. Autoradiograms are generated by apposition of the labelled tissue to photographic emulsions. Combined with computerized image analysis, this technique can be used to analyse and quantify the microscopic distribution of receptors and receptor alterations associated with lesions or disease in human and animal tissues. The 2-DG technique permits microscopic analysis of modifications in brain glucose utilization induced by physiological and pharmacological manipulations. Limitations of these techniques and attempts to optimize their resolution are also discussed.

Animals↗
PubMed1975

An innovative course in undergraduate neuroscience. Experiment in problem-based learning with 'problem boxes'.

A novel course in undergraduate neurosciences is described in this paper. The course features a 'problem-box' and use of an educational prescription, each designed to foster the continual development of problem solving and self-directed study skills. The use of a wide range of evaluation tools, stimulated patients, questionnaires, tutorial evaluations, and interviews indicated that it was successful in its attempt. The philosophy of the design of problem-boxes and the problem-solving approach are discussed.

Curriculum↗
PubMed1994

ANTISENSE oligonucleotides: a new tool in neuroscience.

1. Recent studies have shown that gene expression can be selectively attenuated by administration of short sequences of nucleotides (oligonucleotides) that are complementary to a portion of messenger RNA coding for a particular gene product. 2. This technique is known as ANTISENSE, because the oligonucleotides are complementary to the mRNA which has the same sequence as the SENSE strand of DNA. 3. In the present review we focus, after a brief discussion of gene expression and mechanisms of action of ANTISENSE, on the methodological aspects of ANTISENSE experiments in neuroscience. In particular, we address the advantages, disadvantages and controls for the ANTISENSE technique, as well as the choice, design, mode of delivery, dose and storage of ANTISENSE oligonucleotides.

Animals↗