A young onset Parkinson's patient: a case study.

Young onset Parkinson's disease (YOPD) is defined as idiopathic Parkinson's disease (IPPD) occurring in people between 21 and 40 years of age; it strikes approximately 5% of Parkinson's patients. YOPD has earlier onset of motor complications than later onset Parkinson's disease. Motor complications and disease progression are responsible for devastating morbidity. Current medical and surgical treatments can dramatically ameliorate motor complications and help maintain function and employment. Patient education, support, and advocacy provided by nursing staff can influence the treatment options for these patients, having a significant effect on the future course of the disease. This case history documents the course of a YOPD patient with unusually severe motor complications. He is the only patient at Puget Sound Neurology ever to develop rhabdomyolysis due to dyskinesias. Following bilateral subthalamic nucleus deep brain stimulation, his Parkinson's symptoms have improved dramatically, and his motor complications are significantly improved.     

Jones-Hedman walker modification for C7 quadriplegic patient: case study in team cooperation

A 20-year-old man with C7 quadriplegia was admitted to a tertiary care rehabilitation facility 1.5 months after discharge from an acute care community hospital. The patient's goals were to improve his skills in activities of daily living to a level of maximum independence, and to walk. Although his high level of spinal cord injury made ambulation unlikely, an occupational therapist and a rehabilitation engineer, working together, devised a method to help the patient meet his ambulation goal. They modified an ordinary walker by fabricating polyvinyl chloride-acrylic alloy guards lined with foam to reduce palmar pressure. The patient was then able to use wrist and finger extension during walker advancement and was able to ambulate 300m with Craig-Scott orthosis. The case illustrates the importance of a skilled interdisciplinary team in a specialized center for management of spinal cord injured patients.     

Neuroleptic malignant syndrome in a patient with Parkinson's disease: a case study.

Neuroleptic malignant syndrome (NMS) is a potentially lethal condition that has been described in patients with idiopathic Parkinson's disease (PD) after long-term dopaminergic medications are suddenly stopped or moderately decreased. If patients with PD develop severe rigidity, stupor, and hyperthermia, L-Dopa withdrawal should be suspected and the dopaminergic drug restarted as soon as possible to prevent rhabdomyolysis and renal failure. Nurses who are knowledgeable about NMS can provide prompt identification of the PD patient's condition and prevent a potentially lethal cascade of symptoms.     

Managing catheter dysfunction for better patient outcomes: a team approach.

Vascular access is the leading cause of morbidity in the hemodialysis patient population. Arteriovenous fistulas (AVFs) have the lowest complication rate while catheters have the highest. Though significant effort is being made to increase the number of AVFs and lower the number of catheters, annual data show that the number of catheters is increasing. To improve vascular access-related patient outcomes, catheter dysfunction needs to be managed by a vascular access team using the CQI process that begins with a comprehensive algorithm for treatment.     

A team to ensure sensitive continuing care. Setting up a symptom control/support team.

The stress and responsibility associated with palliative care is demanding for patients and healthcare professionals. A symptom control/support team can act as a resource for all involved, offering advice on symptom control, counselling, education and bereavement follow-up.     

Breaking down barriers to treat a patient with a germinoma: a case study.

Germinomas are the most common type of germ cell tumor occurring commonly before the second decade of life. Because of the radiosensitivity of germinomas, traditional treatment following diagnosis has been conventional radiotherapy. The desire to defer radiotherapy to avoid the delayed neurocognitive effects has led researchers to investigate the use of up front chemotherapy. A major limitation in using chemotherapy for brain tumors has been the inability to deliver drugs across the blood brain barrier. The blood brain barrier consortium has developed chemotherapy protocols for patients with malignant brain tumors through the use of reversible osmotic opening of the blood brain barrier. While the patient is under general anesthesia, osmotic opening or disruption is achieved by a 30-second intracarotid infusion of mannitol. The mannitol infusion is followed by both intraarterial and intravenous chemotherapy. By administering chemotherapy in conjunction with blood brain barrier disruption, drug delivery to the tumor and the brain around tumor is increased.