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BACKGROUND: Alone, administrative data poorly identifies patients with palliative care needs. OBJECTIVE: To identify patients with uncommon, yet devastating, illnesses using a combination of administrative data and natural language processing (NLP). DESIGN/SETTING: Retrospective cohort study using the electronic medical records of a healthcare network totaling over 2500 hospital beds. We sought to identify patient populations with two unique disease processes associated with a poor prognosis: pneumoperitoneum and leptomeningeal metastases from breast cancer. MEASUREMENTS: Patients with pneumoperitoneum or leptomeningeal metastasis from breast cancer were identified through administrative codes and NLP. RESULTS: Administrative codes alone resulted in identification of 6438 patients with possible pneumoperitoneum and 557 patients with possible leptomeningeal metastasis. Adding NLP to this analysis reduced the number of patients to 869 with pneumoperitoneum and 187 with leptomeningeal metastasis secondary to breast cancer. Administrative codes alone yielded a 13% positive predictive value (PPV) for pneumoperitoneum and 25% PPV for leptomeningeal metastasis. The combination of administrative codes and NLP achieved a PPV of 100%. The entire process was completed within hours. CONCLUSIONS: Adding NLP to the use of administrative codes allows for rapid identification of seriously ill patients with otherwise difficult to detect disease processes and eliminates costly, tedious, and time-intensive manual chart review. This method enables studies to evaluate the effectiveness of treatment, including palliative interventions, for unique populations of seriously ill patients who cannot be identified by administrative codes alone.

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INTRODUCTION: This study originated from patients' demands that they be better informed and that their meningioma diagnosis be considered serious. Meningioma are brain tumours that represent about 30% of all primary brain tumours. In 90% of the cases, they are non-cancerous. The objective was to identify whether educational intervention by nurses would have a positive impact on transition. METHOD: The study lasted 12 months and included two groups: intervention and control. Intervention involved the verbal and written delivery of answers to frequently asked questions, as well as patient follow-up for six weeks post-surgery. Nurses were available during the preparation for discharge, as well as the follow-up call 48-72 hours later. RESULTS: Educational nursing care had no demonstrable effect. DISCUSSION: Differences between the groups might have influenced the effect of educational intervention. Our results suggest certain lines of thought as to the doses of information that should be given based on stages of care and individual particularities.

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Resulting from a system-wide launch of an academic-service partnership that united a research-intensive School of Nursing and a tertiary healthcare system, neuroscience nurses used a team-based approach in mentoring undergraduate nursing students in neuroscience nursing. They linked their team approach to the Institute of Medicine's Future of Nursing report and American Association of Neuroscience Nurses' (2012) strategic plan to prepare neuroscience nurses for the future. Using case reports containing both the mentors' and students' perspective, we showcase sophomore nursing students' development in neuroscience nursing with focus on their developing skills in competency, leadership, and collaboration. Results from this implementation phase include improved reliability in performing undergraduate neurological assessments; developing competency in collaborating with the health team using a culturally sensitive approach; beginning leadership in managing a patient with seizures; and collaborating with families in patient-family-focused care. Evaluation of the effectiveness of this mentored approach to clinical undergraduate nursing education will focus on confidence building for students and mentors.

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A cross-sectional predictive design was used to study the relationships among recovery symptoms, mood state, and physical functioning and to identify predictors of physical functioning in patients who underwent surgery for brain tumor at the first follow-up visit (2 weeks) after hospital discharge. The sample included 88 patients who were 18 years or older, had full level of consciousness, and underwent first-time surgery for brain tumor without other adjuvant treatments from a tertiary hospital in Bangkok, Thailand. Descriptive statistics, Pearson product-moment correlation coefficient, and multiple regression were used for data analysis. The results revealed that most participants were women (75%) with an average age of 45.18 ± 11.49 years, having benign brain tumors (91%) and pathological results as meningioma (48.9%). The most common recovery symptoms were pain (mean = 3.2, SD = 2.6) and sleep disturbance (mean = 3.1, SD = 3.0). As for mood state, the problem of confusion was found the most (mean = 4.6, SD = 2.7). The physical functioning problem found the most was work aspect (mean = 66.3, SD = 13.3). Recovery symptoms had positive relationships with physical functioning and mood state (r = .406, .716; p < .01), respectively. At the same time, mood state had positive relationships with physical functioning (r = .288, p < .01). Recovery symptoms, total mood disturbance, fatigue, and vigor were statistically significant predictors of physical functioning and could explain variance of postoperative physical functioning in these patients at 2 weeks after discharge by 35%. Total mood disturbance was the strongest predictor of physical functioning followed by vigor, fatigue, and recovery symptom, respectively. Interventions to improve physical functioning in postoperative brain tumor patients during home recovery should account for not only recovery symptom management but also mood state.

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Cancer in the central nervous system can arise from a primary brain tumor and metastasize to the brain or to the leptomeninges, leading to leptomeningeal metastasis (LM). LM also is called leptomeningeal carcinomatosis and carcinomatous meningitis. When LM occurs, signs and symptoms include headache, nausea, vomiting, lumbar back pain, and stiff or painful neck; LM also may lead to mental disturbances and seizures. Nursing care of patients with LM requires an understanding of neurologic anatomy and physiology, along with associated treatments and complications. Treatment of LM may involve intrathecal or, more likely, intraventricular chemotherapy. Very little has been written about appropriate care of patients with LM. The purpose of this article is to review the literature, summarize clinical care recommendations, and construct evidence-based guidelines for the administration of intraventricular chemotherapy and the care and monitoring of patients with LM.

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Leptomeningeal metastases typically have been a rare complication of systemic cancers. The incidence is increasing for cancers of the breast and lung, primarily because of more effective treatment modalities and longer survival. Presentation consists of multiple symptoms related to areas in the central nervous system, including the brain, cranial nerves, and spinal nerve roots. Diagnosis is made by magnetic resonance imaging with contrast enhancement and cerebral spinal fluid pathology. Treatment frequently involves combination therapy with radiation and intrathecal chemotherapy. Outcomes are poor, with short survival of six weeks to six months. Nurses play a key role in the care of patients with leptomeningeal metastases. Nursing care for this patient population includes baseline assessment and monitoring for changes in central nervous system function, symptom management, chemotherapy administration, education about the disease and treatment, identification of psychosocial issues, and assessment of coping strategies of patients and families.

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PURPOSE/OBJECTIVES: To review neoplastic meningitis and the nursing implications for the intrathecal administration of chemotherapy. DATA SOURCES: Published research and educational manuscripts, books, conference proceedings, and personal experience. DATA SYNTHESIS: Standard treatment for neoplastic meningitis includes radiotherapy to the neuraxis to palliate symptomatic disease, intrathecal chemotherapy to eradicate cancer cells in the cerebrospinal axis, and systemic chemotherapy. Intrathecal liposomal cytarabine (DepoCyt), a novel lipid-encapsulated chemotherapeutic agent, prolongs tumor exposure to cytotoxic levels of cytarabine, improves patient response rates, and prolongs time to clinical progression. CONCLUSIONS: DepoCyt prolongs the half-life of cytarabine in the central nervous system, resulting in improved patient response to therapy and delayed disease progression. IMPLICATIONS FOR NURSING PRACTICE: The clinical success of DepoCyt treatment depends on effective implementation of the treatment regimen, attentiveness to patient and family education, and adverse-event management.

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Stereotactic biopsy procedures, in which a computer-based, three-dimensional-image-guided system accurately locates patients' brain tumors, are relatively new diagnostic methods. Complications from stereotactic biopsy procedures are minimal compared with open craniotomy procedures because they are performed with local anesthesia. Perioperative nurses should have knowledge of and be trained in stereotactic biopsy procedures to ensure optimal care for patients undergoing these procedures.

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Surgical resection of meningiomas may require removal of involved dura mater. Dural closure then requires the use of a dura mater substitute. Serious complications have been reported in patients with dural grafts. Understanding host-graft interaction and the potential for development of complications years after duraplasty aids in the delivery of comprehensive care to patients with in situ synthetic dura mater grafts.

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In spite of over 100 years of surgical experience with the brain tumor, meningioma, it continues in many cases to be a challenge. Although benign by nature, meningiomas may be difficult to resect and a small percentage may recur. Surgical intervention is the treatment of choice for complete abolition of the tumor. Following surgery, astute nursing care is required to promote physiological stability while monitoring for life-threatening complications.

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A meningioma is an intracranial tumor arising from the coverings (meninges) of the brain. One of the first intracranial tumors successfully removed, the meningioma is considered the most common of all nongliomatous tumors, accounting for approximately 15 to 20% of all intracranial tumors. Occurring more than twice as often in women than men, meningiomas usually present between the third and sixth decades of life. It is imperative for nurses who work with neurosurgery patients to easily recognize and accurately assess specific characteristics of different brain tumors. Discussion in this article includes origin, signs and symptoms for various locations, diagnostic testing, medical treatment and nursing interventions for patients with meningiomas.

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In this article three intracranial tumors are described including signs, symptoms and radiologic findings. Two of the more common tumor types are discussed--meningioma and astrocytoma, along with one less common type, the germinoma. The germinoma with its less common features provides an interesting comparison. Each tumor is exemplified using case presentations. The neuroscience nurse, in understanding the mechanisms by which these tumors manifest themselves, will be better able to predict treatment, outcome and correlate nursing care as necessary.

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The care of the patient with meningeal carcinomatosis is not unlike the care of any other patient. Despite varying symptomatology, the nurse views the patient holistically. The nurse helps the patient and family adjust to a disease process which at present, shows a gradual deterioration of function even with current therapy.

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