Neuroscience Nursing

The Science of Being a Charge Nurse No abstract available

Executive Summary: Post–Intensive Care Syndrome in the Neurocritical Intensive Care Unit No abstract available

Resolving Clinical Trial Subject Disengagement in Socioeconomically Disadvantaged Subjects BACKGROUND: Clinical trialists may be reluctant to enroll socioeconomically disadvantaged participants because of concerns for subject disengagement leading to noncompliance with longitudinal measures and high lost to follow-up (LTFU) rates. OBJECTIVES: We describe the LTFU problem associated with disadvantaged participants and propose strategies to reduce clinical trial disengagement. METHODS: Difficulties encountered in recruiting and retaining socioeconomically disadvantaged participants along with antecedents of disengagement are discussed. Data in the public domain were used to derive, symbolize, and map engagement by census tract. Exemplars of engaged and disengaged clinical trial participants are shared, and geospatial distribution of socio-spatial disengagement risk is presented. RESULTS: Subject disengagement can be visualized by geospatial informatics suggesting areas of low and high socio-spatial disengagement risk. By failing to enroll socioeconomically disadvantaged subjects, researchers may deliberately exclude those who may benefit the most because of significant health disparities. DISCUSSION: We propose a study of realistic LTFU rates for disadvantaged participants. Realistic clinical trial end points and methods may reduce disengagement among disadvantaged participants.

Pupillary Light Reflex Variability as a Predictor of Clinical Outcomes in Subarachnoid Hemorrhage BACKGROUND: A change in the pupillary light reflex (PLR) is a sensitive indicator for detecting expanding intracranial lesions. Changes in PLR may be a prognostic marker for patients with intracranial lesions. The purpose of this analysis was to explore how PLR readings, size, constriction velocity (CV), dilation velocity (DV), Neurologic Pupil Index (NPi), and latency predict clinical outcome in patients with subarachnoid hemorrhage. METHODS: This is a secondary analysis of prospectively collected multicenter registry data. The within-subject standard deviation (WSD) of PLR values, NPi, size, CV, DV, and latency were explored as predictors of discharge modified Rankin Scale (mRS) in patients with subarachnoid hemorrhagic. RESULTS: Among 4403 pupillary readings from 82 patients with a diagnosis of subarachnoid hemorrhage, with a mean age of 57.7 years, the admission Glasgow Coma Scale median score was 14 (eye, 4; verbal, 4; motor, 6), and the mRS median was 0 on admission and 4 at discharge. Correlation between standard deviation of PLR values and discharge mRS was moderate and negative (r = −0.3 to −0.47, P < .01). The standard deviations for NPi, size, CV, and DV were significant for predicting discharge mRS (r2 = 0.23–0.28, P < .05) after controlling for admission Glasgow Coma Scale. CONCLUSION: Patients with higher WSD PLR values showed better outcomes (ie, lower mRS at discharge), suggesting that patients with narrower WSD PLR are at a higher risk for poor outcomes.

Pupillary Light Reflex Variability as a Predictor of Clinical Outcomes in Subarachnoid Hemorrhage No abstract available

The Effect of Low Back Pain on Daily Activities and Sleep Quality in Patients With Lumbar Disc Herniation: A Pilot Study The aim of this study was to determine the effect of low back pain on the daily activities and sleep quality of patients with lumbar disc herniation. This cross-sectional study was performed between January and July 2015 in 77 patients. A visual analog scale (VAS), the Oswestry Disability Index (ODI), and the Pittsburgh Sleep Quality Index were used for patient assessment. The mean (SD) ODI score was 58.84 (9.51), and the mean (SD) VAS score of patients was 73.26 (24.37) mm. The VAS and ODI scores increased with age. This disability was mainly observed during weight lifting (67.6%), walking (48.1%), and standing (50.7%). A positive correlation was found between VAS score and ODI (r = 0.49, P < .001) and Pittsburgh Sleep Quality Index (r = 0.23, P = .039) scores. In patients with lumbar disc herniation, disability in activities of daily living and sleep quality are directly affected by low back pain and increase with pain intensity. Findings of this study provide useful information for healthcare professionals.

Acute Flaccid Myelitis Acute flaccid myelitis is a poliolike illness affecting mainly children, which seems to occur every 2 years in the late summer and early fall. The 2018 outbreak was alarming to parents and healthcare providers because the etiology is still under investigation and long-term outcomes are unclear. Becoming familiar with what is known about the epidemiology and clinical characteristics of acute flaccid myelitis enables neuroscience nurses to disseminate accurate information and recognize and report suspicious symptoms.

Successful Intrathecal Rituximab Administration in Refractory Nonteratoma Anti–N-Methyl-D-Aspartate Receptor Encephalitis: A Case Report N-methyl-D-aspartate receptor (NMDA-R) antibody encephalitis is an immune-mediated disorder characterized by the presence of anti-NMDA antibody in serum and cerebrospinal fluid, with a characteristic combination of psychological and neurological signs and symptoms. The scientific knowledge pertaining to the management of anti–NMDA-R encephalitis is growing. It is important that neuroscience nurses be aware of treatments as well as the newest novel treatment options available. Early aggressive intervention is imperative to recovery. The first line of treatment often includes high-dose steroids, intravenous immunoglobulin, and therapeutic plasma exchange. Second-line therapy for refractory NMDA-R encephalitis includes intravenous rituximab and cyclophosphamide. Even with these treatments, up to 25% of patients may be left with severe deficits or have a fatal outcome.1 It is well known that penetration of monoclonal anti-CD20 antibody therapy (rituximab) into the cerebrospinal fluid is 0.1% of that in the serum.2 Therefore, efficacy of rituximab in the treatment of NMDA encephalitis may be improved by intrathecal administration in selected cases with a poor response to intravenous rituximab. We present a case of anti–NMDA-R encephalitis that was refractory to first- and second-line therapies, who responded to intrathecal rituximab, to highlight a novel treatment that may be able to prevent long-term disability and improve clinical outcomes.

Subcutaneous Immunoglobulin Therapy for Chronic Inflammatory Demyelinating Polyneuropathy: A Nursing Perspective Chronic inflammatory demyelinating polyneuropathy (CIDP), an immune-mediated peripheral neuropathy, is frequently treated with long-term maintenance intravenous immunoglobulin (IVIG). However, disadvantages of IVIG are the systemic adverse reactions, lengthy infusions, and need for vascular access. Subcutaneous immunoglobulin (SCIG) addresses many of the issues encountered by those unable, or unwilling, to tolerate the treatment burden of long-term IVIG. Subcutaneous immunoglobulin, a 20% solution stabilized with L-proline, is US Food and Drug Administration–approved for CIDP maintenance therapy in patients after being stabilized with IVIG. Approval was based on a randomized, double-blind, placebo-controlled trial where SCIG demonstrated superiority over placebo and was safe and efficacious in maintaining function. In addition to reviewing the primary efficacy results from the clinical trial, this article aims to update the neurology nursing community on a new option for long-term management of CIDP, including the practicalities of initiating and maintaining patients on SCIG therapy.

Glasgow Coma Scale: Generating Clinical Standards: Erratum No abstract available

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com