Efficacy and side effects of botulinum toxin treatment for blepharospasm and hemifacial spasm

Purpose : To analyse the effectiveness and rate of side effects of botulinum toxin treatment for blepharospasm and hemifacial spasm.
Methods : In a prospective trial, 81 patients with blepharospasm and 70 with hemifacial spasm were treated with botulinum toxin A in the neuro-ophthalmology clinic at St Vincent's Hospital, Melbourne. Some 989 treatments were given and the mean follow-up time was 28.7 months.
Results : The duration of action was longer for patients with hemifacial spasm than for those with blepharospasm (median 12.0 weeks compared with 7.0 weeks, P <0.0001). There was no change in the duration of effect over time with repeated treatments of the same dose (F = 0.4, P > 0.05). Once an effective dosage was reached, increasing the dose further did not prolong the duration of effect. There were no systemic side effects, but there were a number of local transient side effects. The most significant side effect was ptosis, which occurred in 12% of treatments given to those patients with blepharospasm and hemifacial spasm.
Conclusion : Botulinum toxin is an effective treatment for blepharospasm and hemifacial spasm, but there are a number of side effects, the most significant being ptosis.     

Towards a reconceptualization of hope for patients with a diagnosis of cancer

Recent years have seen increased attention given to examining the phenomenon of hope in patients with metastatic cancer One of the results of this activity has been a greater appreciation of the significance of hope for the dying patient However, there are many questions about the experience of hope and its impact on the lives of patients with cancer which remain to be answered This paper discusses how hope is currently conceptualized in the nursing literature, and considers the implications that this conceptualization has for how we care for cancer patients Some alternative ways of looking at the experience and the impact of hope are also discussed     

DIAGNOSIS AND MANAGEMENT OF LOST MUSCLE FOLLOWING STRABISMUS SURGERY

Of all the complications of strabismus surgery, the lost muscle is one of the most alarming, and yet with patience and careful management it may be one of the most amenable to treatment.
This paper reports seven cases of lost muscle following strabismus surgery, in six of the seven cases referred to the Department of Clinical Ophthalmology there had been delay in diagnosis for periods varying from six weeks to 17 years. All the lost muscles were successfully retrieved.
With good illumination and magnification and a careful search of the sub-Tenon's capsule space it is unusual to need to explore the orbital fat to retrieve the muscle.     

ECG Interpretation Part 1: Understanding Mean Electrical Axis

We have provided a concise overview of the knowledge required to interpret the mean electrical axis on the 12-lead ECG. In essence, the QRS electrical axis is useful because it helps determine the position of the heart in the chest, patency of electrical pathways, and integrity of muscle mass. By itself, it is not diagnostic, but it does lend support to the observant clinician’s suspicions for each of these anomalies. The ability to determine the mean electrical axis provides the emergency nurse with an additional readily available clinical tool to assist in the early and rapid detection of potentially life-threatening changes in the patient’s cardiovascular status.     

Social participation and family carers of people living with dementia in Australia

This paper reports on a study exploring the experiences and meaning of social participation for family carers of people living with dementia. Participants were 33 family carers (17 spouses and 16 adult children) of older adults diagnosed with dementia (any stage or type) who responded to advertisements by the national Alzheimer's association, Alzheimer's Australia. Data were collected through semi‐structured face‐to‐face and/or telephone interviews using an interview guide, which included prompts such as ‘Tell me about what social participation means to you’, and ‘How did this change…’. The methods of grounded theory were drawn upon to guide sampling and analysis of data, which continued until theoretical saturation was achieved and occurred over the period September 2011 to March 2012. Data arising from the interviews were analysed line‐by‐line and coded and categorised using the constant comparative method, with codes clustered into themes and with abstraction from the themes to arrive at the core process. The core category arising from the data was adaptation, which encompassed four main themes: autonomy to choose; the impact of care‐giving; employing strategies; and establishing meaningful connections. Carers went through a process whereby the ways in which they had previously participated socially were compromised, which often prompted an exploration of new ways in which to remain socially engaged.     

Nursing students' perceptions of difficult or challenging clinical situations

This study examined students' perceptions of difficult or challenging clinical situations and how facilitators assisted students in relation to these specific situations Responses to open-ended questions from first-year nursing students before and after a series of hospital and community nursing practice placements were analysed The findings suggest that students do find certain clinical situations difficult or challenging and that facilitators can greatly assist students to effectively deal with these through specific teaching strategies     

Assessment of the elderly: it’s worth covering the risks

Background Comprehensive assessments provide an invaluable opportunity to identify those at risk of adverse health events, enabling timely access to appropriate health care. Aims This study aimed to evaluate the effectiveness of a comprehensive assessment tool, the Adult Patient Assessment Tool (APAT), particularly in relation to early identification of older people at risk of falls, pressure areas, cognitive impairment or delirium, or patients with mental illness or substance abuse. Methods Concurrent mixed methods including an initial retrospective medical record audit and focus groups were used. Results With the introduction of the APAT, assessment of falls risk and mental illness increased. The number of nursing actions relating to pressure areas and falls also increased, indicating a greater awareness of patients’ individual needs. Non-clinical information gathered through the APAT enabled a more holistic approach to patient care. Conclusion The use of electronic medical records would alleviate pressures on nurses’ time, providing an opportunity to store and retrieve comprehensive nursing assessment and benefit patient health care. Implications for nursing management Early assessment results in an increased number of nursing activities related to patient care. Further education relating to mental health and substance abuse screening and cognitive assessment may enhance the completion of these tools.