australasian neuroscience nurses association Issue 3 November 2005

australasian neuroscience nurses association Issue 3, November 2005 Brainstem www. anna. asn. au I know that she is already busily planning next years conference, which will see us heading up to tropical Queensland in Cairns. Bring it on! Tracy taking the surf rider challenge The end of the year and all of the festivities that comes with it is fast approaching. This will be our last BRAINSTEM for 2005 and on behalf of the Executive team we wish you a safe and merry Christmas and prosperous New Year. The month of September saw 100 ANNA members come together on the Gold Coast for our annual scientific meeting (conference). It was great to see so many members (both old and new) participate in the sharing of neuroscience knowledge and to network with fellow colleagues. The diversity of the papers presented was fantastic, with many areas relevant to neuroscience nursing being addressed. Congratulations to all of the presenters, in particular our prize winners, Tim O’Maley, Suzy Goodman and Lucy Bailey. Cheryl will have more about the conference in her report, but I can sum it up by saying it was educational and fun (particularly the beach theme dinner). If you want to see what ANNA members got up to visit the ANNA website. As you will know we ran several competitions through the year with the winners being announced at the conference. Congratulations to the following winners: 33 rd member to renew for 2005 -2006 – Rebecca Burke Most members recruited during the week of ANND in May – Royal North Shore Hospital, Sydney. ANND celebration competition – Sydney West Area Health Service. Cheryl (our friendly conference convener) did a fantastic job organising and coordinating the conference. The great success of the conference, which was evident from the evaluation responses, was possible because of her dedication to every detail in ensuring the conference met the needs of ANNA members. Inside this issue • Presidents report • Conference news • WFNN News • State news • Membership • 2005 AGM minutes • Brainstem Evaluations Special features: • John Shead Biography • Huntington’s Disease • Onyx Our membership numbers have shown a steady rise over the year, which is pleasing to see. It is the members that strengthen our association and we thank you for your support in continuing to promote ANNA and recruit new members. We welcome to the Federal Executive Karen Tuqiri as Treasurer. We look forward to Karen joining the team and working together for the association.

A Message from your Friendly Conference Convener As I pack away the folder for conference 2005 and label the 2006 folder I feel that you the members deserve to read a somewhat bias report on the 33 rd Annual Scientific Meeting. Legends Hotel, Gold Coast QLD: September 15 th – 17 th 2005 was the place to be according to @ 100 enthusiastic ‘ANNA’ members. ‘On the Terrace’ with a drink in one hand old friendships were reunited and new ones started as delegates mingled amongst their neuroscience colleagues. Tracy Desborough welcomed all to our annual meeting and the networking continued. 34 members submitted abstracts for posters and oral presentations, these submissions allowed the program to reflect the diversity that Neuroscience Nursing represents. Congratulations to our Prize winners, all gave outstanding presentations representing the work they do for Neuroscience patients: Tonnie Koenen Prize: Tim O’Maley (QLD) Neurosurgical Society Australasia (NSA) Prize: Suzy Goodman (VIC) Poster Prize: Kylie Wright (NSW) First Time Presenter: Lucy Bailey (QLD) Congratulations to all presenters (oral and poster) and moderators who expressed interest in participating at a very successful conference, I thank you and look forward to your support next year.

I also look forward to the inundation of abstract submissions we get when I post the call for abstracts!! Remember the conference program can only be as good as its content, which is up to you the members. So if you want a longer program or a more diverse program start thinking about your abstract submission for next year now! And tell your colleagues. As you know there is more to a conference than just absorbing and sharing knowledge, what about the social side or in conference language ‘networking opportunities’. The conference dinner is an event that will be hard to beat, how many people have now taken up surfing lessons or visited a chiropractor? ? ? How much fun was the mechanical surf board and the dance floor both activities proved that nurses are very talented people!! I am sure there are story’s being told around neuro wards about who was the most talented on the surf (Charmaine). Thank you all for a great night. Thank you for attending and supporting our conference it is always great to see our members come together each year and share their experiences. I look forward to seeing you all next year. Bye for now Your Friendly Conference Convener Cheryl Trudinger PS: See you in Cairns, September 14 th – 16 th 2006

A tribute to John Shead - a biography There is a beautiful saying…. Some people come into our lives and quickly go. Some stay awhile, leave footprints on our hearts. And we are never, ever the same. For those who had the privilege of having met and known John Shead, would agree that John has left footprints in our hearts. John’s recent sudden and tragic passing had a profound effect on all staff, across all disciplines throughout Westmead Hospital. It goes without saying that John’s prescience within the hospital was always obvious and highly valued, and now his absence has left an equally obvious void and sense of immeasurable loss for many, many people. John had been on the staff at Westmead for some twenty years and as such he had become an integral and much loved part of Westmead Hospital. John fulfilled many professional roles during his time, starting back in 1979 as a registered nurse. In 1981, John completed his midwifery training and stayed on staff thereafter. John subsequently ventured in to the world of Neural Sciences (some would say he took his job a bit too literally, as demonstrated by his shaved bald head!) After he successfully did the Neurological Course at Westmead, John went on to become the Nurse Unit Manager of the Neuro High Dependency Unit (D 5 b), before later becoming the Clinical Nurse Consultant in Neural Sciences. At one stage, John had completed more postgraduate courses at Westmead than any other nurse. In the last couple of years, John embraced the opportunity of a change in career direction and successfully fulfilled the role of Acting Facility Planner with the Maintenance and Facility department. This role assisted in raising the profile even higher and wider amongst the Westmead Hospital community and like his clinical career he took little time in proving what a highly valuable asset he was to the service. John dedicated almost half his lifetime to Westmead and he has left behind an indelible legacy. Many people were probably unaware of the extent of his great work and commitment, to both his clinical specialty and the nursing profession in general. John was a regular and popular lecturer on Neuro specialty on local, national and international level. John was the epitome of the ‘quiet achiever’, who got on with the job, always doing the best job possible. One of John’s greatest achievements was his outstanding ability as a teacher and mentor. Thank you to Angela Lownie and Kate Murphy from the Western Area Health Service, Sydney for providing this contribution

The 2005 World Congress on Huntington’s Disease – Impetus for change Reported by Angela Lownie The 2005 World Congress on Huntington Disease was held at the Midland Hotel, Manchester from 10 – 13 th September 2005. The program and abstracts have been published as Supplement l. V in the Journal of neurology, neurosurgery and psychiatry (Oct 2005, Vol 76). Along with 492 other participants, I spent the 2. 5 days absorbing what scientists, clinicians, and medical researchers from the fields of genetics, epidemiology, biochemistry, neurology, psychiatry, psychology, nursing, and general medicine, from every corner of the globe had to say about their work in understanding and overcoming, this baffling hereditary condition. Also there were care managers, administrators, and representatives of HD affected families through their local organizations, meeting together for an historic first time. The high- powered work for a cure or treatments to slow down the progress of the disease are truly astonishing and would take an article on their own to discuss. Suffice it to say that collaborative international research papers spoke (amongst many others) of efforts to regulate the toxicity of mutant Huntington (Rubinsztein et al; of the role of dopamine in restoring cortical function in HD mice (Cummings et al); of evidence of the role of m. RNA dysfunction in producing pathology (Hodges et al); preliminary results of clinical trials of human striatal tissue transplant (Dunnett – Brain repair group); investigation of the effects of miraxion (motor features), memantine (cognitive impairment), coenzyme Q (functional decline) and investigation of any impact on disease course (minocycline) as well as Creatine, Phenylbutyrate, Ethyl. EPA, Rosagiline, Citicoline, Lamotrigine, MPEP and Amantidine. I was fortunate to have the opportunity to attend, assisted by a much appreciated Professional Development Scholarship from ANNA. With my service director, neurologist Dr Elizabeth Mc. Cusker, I presented a poster “Ten years of Huntington Disease outreach service in New South Wales” on the 2 nd day with eleven others under the heading of Clinical Care and Management. In spite of the rather crowded display space, I had several conversations with other participants during the hour long poster viewing session regarding the functioning of our service. I particularly enjoyed discussions regarding late stage residential care with team members from the Netherlands working in a 70 bed specialist residential unit “Overduin, “ in Katwijk. By comparison to my previous experience a few years ago, it was pleasing to find an increasing number of papers and posters targeting care and management issues at this key event. Posters from the Leicester Partnership Trust (UK), Nottingham (UK), Russia, and the Netherlands (as mentioned), presented work with common threads to ours. Once again, we were happy that our work in this area compares favorably when viewed from the International standpoint. However, it was the in-depth conversations with nurses such as Dr Elizabeth Almquist from Sweden regarding their work on assessing nursing interventions and strategies for aggressive behaviour, and Steve Smith from the University of East Anglia who used the conference to launch his book “Huntington’s Disease – a Nursing Guide – Applying the Roper, Logan and Tierney Model of Nursing, ” that provided the greatest benefit. An excellent paper by administrator jim pollard and psychologist R. M. Stein, “accommodating the cognitive phenotype : a challenge to nursing homes and considerations for care was the final impetus to animated conversations which resulted in plans to launch the first international network of non medical professionals in HD. Some last minute drafting late into the night and we had a document, outlining the aims and plans, to disseminate to the participants at the last plenary session. It is hoped that this network might be a force for change with regard to the noticeable lack of research by allied health therapists and nurses. The next congress will be in dresden, Germany in 2007, and it would be wonderful to be able to report on some collaborative endeavors to that meeting. Interested nurses and allied health staff can join through contacting me (angela_lownie@wsahs. Nsw. Gov. Au) or Steve smith (steve. Smith@uea. Ac. Uk) or Jim pollard (jpollard@comcast. Net)

What is Huntington's Disease? • Huntington's disease (HD) results from genetically programmed degeneration of brain cells, called neurons, in certain areas of the brain. This degeneration causes uncontrolled movements, loss of intellectual faculties, and emotional disturbance. HD is a familial disease, passed from parent to child through a mutation in the normal gene. Each child of an HD parent has a 50 -50 chance of inheriting the HD gene. If a child does not inherit the HD gene, he or she will not develop the disease and cannot pass it to subsequent generations. A person who inherits the HD gene will sooner or later develop the disease. Whether one child inherits the gene has no bearing on whether others will or will not inherit the gene. Some early symptoms of HD are mood swings, depression, irritability or trouble driving, learning new things, remembering a fact, or making a decision. As the disease progresses, concentration on intellectual tasks becomes increasingly difficult and the patient may have difficulty feeding himself or herself and swallowing. The rate of disease progression and the age of onset vary from person to person. A genetic test, coupled with a complete medical history and neurological and laboratory tests, help physician's diagnose HD. Presymptomic testing is available for individuals who are at risk for carrying the HD gene. In 1 to 3 percent of individuals with HD, no family history of HD can be found. • How is HD Diagnosed? • The great American folk singer and composer Woody Guthrie died on October 3, 1967, after suffering from HD for 13 years. He had been misdiagnosed, considered an alcoholic, and shuttled in and out of mental institutions and hospitals for years before being properly diagnosed. His case, sadly, is not extraordinary, although the diagnosis can be made easily by experienced neurologists. A neurologist will interview the individual intensively to obtain the medical history and rule out other conditions. A tool used by physicians to diagnose HD is to take the family history, sometimes called a pedigree or genealogy. It is extremely important for family members to be candid and truthful with a doctor who is taking a family history. The doctor will also ask about recent intellectual or emotional problems, which may be indications of HD, and will test the person's hearing, eye movements, strength, coordination, involuntary movements (chorea), sensation, reflexes, balance, movement, and mental status, and will probably order a number of laboratory tests as well. People with HD commonly have impairments in the way the eye follows or fixes on a moving target. Abnormalities of eye movements vary from person to person and differ, depending on the stage and duration of the illness. The discovery of the HD gene in 1993 resulted in a direct genetic test to make or confirm a diagnosis of HD in an individual who is exhibiting HD-like symptoms. Using a blood sample, the genetic test analyzes DNA for the HD mutation by counting the number of repeats in the HD gene region. Individuals who do not have HD usually have 28 or fewer CAG repeats. Individuals with HD usually have 40 or more repeats. A small percentage of individuals, however, have a number of repeats that fall within a borderline region • • • Is there any treatment? • Physicians prescribe a number of medications to help control emotional and movement problems associated with HD. Most drugs used to treat the symptoms of HD have side effects such as fatigue, restlessness, or hyperexcitability. It is extremely important for people with HD to maintain physical fitness as much as possible, as individuals who exercise and keep active tend to do better than those who do not. What is the prognosis? • • At this time, there is no way to stop or reverse the course of HD. Now that the HD gene has been located, investigators are continuing to study the HD gene with an eye toward understanding how it cause disease in the human body. • What research is being done? • Scientific investigations using electronic and other technologies enable scientists to see what the defective gene does to various structures in the brain and how it affects the body's chemistry and metabolism. Laboratory animals are being bred in the hope of duplicating the clinical features of HD so that researchers can learn more about the symptoms and progression of HD. Investigators are implanting fetal tissue in rodents and nonhuman primates with the hope of understanding, restoring, or replacing functions typically lost by neuronal degeneration in individuals with HD. Related areas of investigation include excitotoxicity (over stimulation of cells by natural chemicals found in the brain), defective energy metabolism (a defect in the mitochondria), oxidative stress (normal metabolic activity in the brain that produces toxic compounds called free radicals), tropic factors (natural chemical substances found in the human body that may protect against cell death).

western Australia This year has been a disappointing one for the WA Branch, attendances at our sessions have Increasingly we have seen the been variable and often poor – a reflection of our busy lives I guess. neurosurgical nurses engage less with the Association hence the focus I also think there a number of on non surgical topics to encourage other organizations that compete attendance from the more active neurological nurses. for the neuroscience nurses including the MSNA, Parkinson’s Our fundraising film night had great special interest group, potential but unfortunately with only Rehabilitation Nurses group etc. We all know membership fees are 35 tickets sold the potential wasn’t realized but we did make $122. 50 costly and with family and other profit. The biscuit sales were non commitments people make existent. choices and I believe this negatively impacts on our No members expressed an interest in membership. attending the ANNA symposium but I understand Catherine Bucholz and Jo On the bright side we have held Mc. Phee (ex members non financial) some excellent educational from SJOG attended with hospital sessions including sessions on funding which is fantastic. The WCN Cognition, MS, Stroke and the research done by the Parkinson’s is being held in Sydney in November Nurse Consultant on carers. Other and I think this may have distracted opportunities available to Members some members unable to attend both. have been the TCD workshop, the Trigeminal Neuralgia presentation After 10 years as State Delegate for WA I am not seeking nomination this and the MS Awareness Week year. Having restarted the branch in forums. 1995 and facilitating a number of significant achievements – including several seminars which were videotaped, the Professional Standards for Neuroscience Nurses adopted nationally and the introduction of National Neuroscience Nurses Day. I believe it is time to hand over to new blood. Since leaving the hospital system I have found it increasingly difficult both time wise and with networking as it is harder to access people generally of site. Several key players have also changed positions and / or left the system and this has added to the difficulties faced in generating interest and participation. I would like to thank Lee for her work as secretary over the last 12 months and Robyn for the great work she did before that. I would also like to thank that core of people who have attended the meetings and helped with organising speakers and events especially Harriet, Meg and Gill. I would be happy to provide support to the new position holders if necessary and hope that the branch can be regenerated here in WA. Sue Shapland State Delegate WA Branch ANNA September 2005

new south wales queensland Dear NSW members and Australasia members: The NSW branch held one of our most successful ever AGMs prior to the annual conference. We were very lucky to be supported by Medtronic and to have an educational presentation on the management of Hydrocephalus prior to the meeting. At the AGM we welcomed Brianna Beattie to the NSW - Executive as our weblinks assistant. Brianna is from Royal North Shore Hospital and she will be working with Anita Lloyd from Australasia to maintain the links on our Webpage. In addition to this new member we welcome Nicole Morley to the Executive. At our next meeting we will be outlining Nicole's new role - more of this in the next Brainstem and Hemisphere News (the NSW newsletter coordinated by Kylie Wright). Sadly I need to advise members that the NSW - Secretary, Ms Heidi Evans, will be retiring from her role after 5 years as our State Secretary. Never an easy task, Heidi has helped us immeasurably with keeping our meetings organised, minuted and allowing us to use her own database for membership information - in conjunction with that used by Australasia. I would like to thank her for commitment to ANNA and for all her efforts. A calendar will be going out to NSW members shortly to advise of planned events over the rest of the financial year but before you get your Christmas events all planned - Royal North Shore Hospital our hosting an ANNA evening on the Wednesday 30 th November 2005 from 5. 30 - 8. 30 pm. Refreshments are provided and the meeting will take place in the Main Block, Level 13 Boardroom, Royal North Shore Hospital on the Pacific Highway at St. Leonards. The contact person for this event is Anne Mac. Leod on 9926 8074 or amacleod@nsccahs. health. nsw. gov. au. The program for the evening is: Onyx, Thrombolysis, Research in Action and a Brain Bee Trivia Quiz. Anne requests that members and non-members attend and RSVP by 23 rd November (especially to assist with catering). Registration and payment may be made on the night. Hope to see you there and for those members who are not in the metropolitan area who would like to be involved in an education event - please contact me at: maureen. edgtton@swsahs. nsw. gov. au Maureen Edgtton-Winn Liverpool Hospital I hope that all the members who attended the conference enjoyed it. I have had some very positive feedback from m colleagues here at the Princess Alexandra Hospital. I was in the UK and therefore unable to attend. In August, we were guests of the Wesley Hospital, Brisbane for an excellent informative presentation by Dr Peter Silburn on Deep Brain Stimulation in the treatment of Parkinson Disease. The next meeting, which will be held on the 30 th November is sponsored by Novartis Pharmaceuticals and held in Romeos’s Italian Restaurant, Spring Hill. It will feature Professor Mervyn Eadie presenting an update on epilepsy. Contact me for further information as space is limited. I am continuing to send out journal articles by email, so any Queensland member who does not receive them, please let me know as this means I either don’t have your email address or I have the wrong address. Any members who are unable to attend meetings are encouraged to send in items for discussion or requests for support. Sue Day Ph: 07 3240 2137 Email: sue_day@health. qld. gov. au Australian Nurse Practitioner “Supporting advanced nursing practice” Association 2005 Report The Australian Nurse Practitioner Association (ANPA) was officially formed in 2003. The association aims to support and encourage advanced nursing practice across specialties. Members are committed to having a positive influence over the clinical care and outcomes of all patients and their families. Currently the association has representatives from 5 states and 2 territories throughout Australia. Membership has grown dramatically throughout the year. The Inaugural Conference was held in October 2005 in Canberra, ACT. Attendance exceeded expectations with 170 delegates. Delegates included Nurse Practitioners, aspiring Nurse Practitioners, academics and other health professionals who support advanced nursing practice. This exciting and historic occasion provided opportunities for all those involved to share knowledge, expertise and commitment to clinical excellence Delegates were also able to discuss future directions and plans for advanced nursing practice. Keynote speaker was Prof Donna Diers. Prof Diers delivered a very inspiring address sharing experiences and lessons learnt in the development of advance nursing role development. More information can be found at: www. nursepractitioners. org. au Rochelle Firth Nurse Practitioner- Neurosurgery Australian Nurse Practitioner Association- Treasurer

Earlier in the year we asked you for your thoughts on your association newsletter. Here are the results, and I hope that this issue starts to reflect what you the members want And just as a gentle reminder contributions from you the members is greatly appreciated – we would love to know what is going on in the world of neurosciences and hope that your good work is shared amongst your professional peers 1. Could you please rate the following aspects of brainstem currently Excellent Quality of Publication Very Good Satisfactory 67% 33% Poor Frequency of Publication 8% 42% 25% Conference Information 17% 58% 17% 8% Membership information 17% 58% 8% 17% Clinical Content 8% 26% 33% Professional Issues 8% 17% 58% 17% Association Information/Update 16% 42% 25% 17% 50% 33% 17% Educational Opportunities Comments: Much improved after the facelift The format is good Very Informative Inclusion of articles by community nurses and carer organisations to keep us informed and updated An article on research stats on beneficial outcomes of early rehabilitation. Invitations to physio’s and OT’s to contribute articles to “Brainstem”. Have a particular interest in brain tumours A research article on common co-morbidities in neurological. Pt’s would be of interest.

3. Please indicate whether you would like to see any of the following in future editions of Brainstem? Yes No Unsure Member profiles 60% 20% Unit profiles 70% 10% 30% General Professional Issues 100% Educational opportunities 100% A clinical theme eg Stroke, Neurosurg 80% State Delegate Updates 80% Clinical Issues 90% 10% Conference Updates 80% 10% Job advertisements 70% 20% 10% Product information 70% 30% 20% What other area’s would you like to see covered in Brainstem? WFNN Corner – used to have in journal few years ago Current trial (clinical trials) Different types of neuro illness. I would like clinical relevant data included-maybe a topic an edition. All covered in above Educational Opportunities Journal review: paragraph review Link page reviewed. Any other comments/ suggestions? Many thanks for this facelift of brainstem A job well done I like brainstem to be in a newsletter format, with the journal focus on clinical issues. More clinical based information for current practicing nurses- this will include people not able to attend conferences. Appreciate all the work people put in to get brainstem published. Issue 2 is a great improvement from all previous issues.

noticeboard Following this years AGM, several decisions need to be highlighted to members: • membership rates shall be for a 12 month period i. e. if you applied in march, renewals will be expected in march the next year - pro rata rates will no longer apply. Each member will receive reminder renewals once the 12 month period has passed RNSH ANNA Education Evening • ANNA Exec and state delegates will have the discretion to distribute all members with appropriate notices via email This education evening will be focusing on interventional neuroradiological techniques, primarily the use of thrombolysis in stroke and onyx for the treatment of aneurysms and AVMs. Royal North Shore Hospital November 30 th 630 pm – 830 pm Further information: Anne Macleod Light refreshments and supper will be provided Q I have an issue with taking the size of the pupil when doing GCS. I knew that I should take the size of the pupil before shining light, but often many people misunderstand as to take the size of the pupil after shining light. Colleagues on my ward all think that it should be the "post" one rather than the "pre" one. Could you guys tell me which is the correct one? ? As much as possible, can you also send me journal articles to support the say, so that I can show it to my colleague? ? Articles that I have found generally talk about the different types of response of pupils towards light but they don't describe how to take the size of the pupil trivia Let everyone know about your education evenings and advertise in Brainstem! Send information at least 2 months before the event, including event, date, venue, contact details Send information to Rochelle Mc. Knight Email: annaexecutive@bigpond. com. au Fax: 02 9439 9029 Mail: PO Box 6, Artarmon, NSW 1570 Australia A When we assess pupil size it is the resting pupil size, that is before the light is shone in the pupil. The references for this include Joanne Hickey: The Clinical Practice of Neurological and Neurosurgical Nursing, 5 th edition and another useful journal article: Shah, S (1999). Neurological Assessment: Nursing Standard, 13 (22), 49 -56

The aims of this conference will be: ØTo highlight the timeframe for acute stroke care ØTo discuss innovations in stroke management and research ØTo promote new initiatives on stroke care ØTo provide the latest information on best practice in stroke ØTo provide a forum for stroke clinicians to share information ØTo raise awareness of rehabilitation concepts in stroke ØTo highlight rehabilitation practices by allied health ØTo raise community awareness of stroke üThe Organising Committee request presentation ideas from prospective presenters & participants to make this conference relevant and informative for all stroke clinicians. üJust give us your ideas on what you would like to hear more of. üThis is a call for your suggestions! üThe call for abstracts will be sent out in the near future based on your responses of what YOU want to hear about. We have provided the organising committees aims of the conference to help guide you. üPlease send your ideas by the 31. 10. 05 to: Conference Secretariat: Louise Pitney Conference Action Pty Ltd, PO Box 576, Crows Nest, NSW AUSTRALIA 1585 Tel: 02 9437 9333 Fax: 02 9901 4586 Email: louise@conferenceaction. com. au

ANNA is continuing to recruit new association members! It is always encouraging to see so many new memberships in the mail On behalf of ANNA, the executive would like to welcome the following new members. Kerri Reeves The Canberra Hospital ACT Justyne Anderson St Vincents Public Hospital - Sydney NSW Penny Bisaro Prince of Wales Hospital NSW Nghia Bui St Vincents Public Hospital - Sydney NSW Renee Craig Royal North Shore Hospital NSW Wendy Cutler Royal Prince Alfred Hospital NSW Regina Edwards Prince of Wales Hospital NSW Lauren Farmer St George Public Hospital NSW Meredith Ford Royal North Shore Hospital NSW Linda Maree Gesell John Hunter Hospital NSW Alison Harris Wyong Hospital NSW Philip Herbert Royal North Shore Hospital NSW Jane Maree Hunter Central Coast Health NSW Tracy Kelly Prince of Wales Hospital NSW Steve Klekacroski St George Public Hospital NSW Simon Latham Royal Prince Alfred Hospital NSW Christina Mills North Shore Private Hospital NSW Sandra Morgan NSW Colette Patteson North Shore Private Hospital NSW Danni Phillips Nepean Hospital NSW Daniel Troitsin Royal North Shore Hospital NSW Dallas Tucker Nepean Hospital NSW Christine Turner The Sutherland Hospital NSW Kim Milners St George Hospital NSW Meena Sharma Liverpool Health Service NSW Kathryn Bergan Nepean Hospital NSW Fiona Wade Westmead Children's Hospital NSW A reminder to members to notify the Association promptly of change of address, we have been receiving increasing numbers of returns of late. If you have Email addresses please let the executive know - by emailing us and we will then be in a position to electronically mail you all relevant association documentation.

Marcia Greenaway Auckland City Hospital, Operating Rooms NZ-Nth Anna Kreft Starship Children's Hospital Auckland NZ-Nth Ben Mc. Intyre Auckland City Hospital NZ-Nth David Moxon Canterbury District Health Board NZ-Nth Kathryn Robinson Starship Children's Hospital Auckland NZ-Nth Mabeline Siaw Canterbury Health Board, New Zealand NZ-Nth Nathan Hood Christchurch Hospital NZ-Sth Melissa Burton Princess Alexandria Hospital QLD Jacqueline Clare Cameron Royal Brisbane Hospital QLD Sarah Day Royal Brisbane Hospital QLD Sharmaine Denise Hoera Gold Coast Hospital QLD Rosina Mc. Keen Gold Coast Hospital QLD Lorraine Barbara Retallick Gold Coast Hospital QLD Jasmin Abdulhakeem Boxhill Hospital VIC Suzanne De Lange Monash Medical Centre VIC Natalie Derry St Vincent's Private Hospital - Melbourne VIC Darren Mac. Gregor Alfred Hospital VIC Patricia O'Donoghue St Vincent's & Mercy Private Hospital VIC Joahnne Ramos Royal Children's Hospital, Melbourne VIC Cheryl Schlosser Sir Charles Gairdner Hospital WA Membership renewals are now overdue with names of unfinancial members now removed from our active membership lists and from future mail outs. If you have colleagues who are concerned at their current financial status please advise them to contact the executive for clarification.

What the? ? ? Onyx, a new As a result of high blood flow and pressure imbalances, Intracranial arterio-venous malformations (AVM) are at risk of hemorrhage, or rupture, which can lead to stroke, severe disability and even death. They often represent a complex clinical problem in regards to treatment, the choice of treatment and the technical difficulties related to treatment. embolization material Treatment options for AVMs include catheter -based therapies, surgery, radiation therapy, or a combination of these treatments. Catheter-based treatments involve the delivery of embolic materials to occlude, or block, the abnormal blood vessels comprising the AVM. Onyx is a liquid embolic material that is delivered by neurovascular specialists through micro catheters directly into a vascular defect, such as a brain aneurysm or AVM, in a very controlled manner. After delivery of the embolic material, it stays in liquid form until it comes into contact with blood or other aqueous solutions. Once contact is made, Onyx begins to precipitate, changing from liquid to a solid thereby sealing off the vessels in the AVM from blood flow and reducing the risk of rupture. Endovascular embolization can reduce the size and vascularity of the AVM, thereby facilitating safer and easier surgical resection Opaque – can be seen radiologically Slow injection for exact placement. Non-adhesive – easy injection with microcatheters Disadvantages Vascular toxicity, vasospasm & necrosis. By-products of Onyx are released by lungs producing an unpleasant smell. Cost: approx. $2000 per vial Post insertion of onyx, the AVM no longer has a blood supply

Annual General Meeting Minutes 17 th September, 2005 Legends Hotel, Gold Coast, QLD Attendance: Tracy Desborough, Sharon Eriksson, Cheryl Trudinger, Jennifer Blundell, Suzy Goodman, Carley Mills, Rochelle Mc. Knight, Joanne Mc. Loughlin, Terri Pinkis, Tania Heywood, Sue de Lange, Phillipa Balfour, Kellie Mc. Intosh, Helen Houridis, Brianna Beattie, Allison O’Dea, Saskia Baaijens, Ros Nicholson, Karen O’Malley, Tim O’Malley, Barbara Lester, Lynette Wallace, Dallas Tucker, Sharryn Byers, Michael Sham, Anne Mac. Leod, Rochelle Firth, Vicki Evans, Jeanne Barr, Rosey Merheb, Mary Wyer, Penny Bayliss, Nerolie Lyle, Karen Tuqiri, 1. Apologies: Angela, Maureen Edgtton-Winn, Sue Day, Denise Le Lievre, Jane Henry, Joan Johnson, Sue Astegno, Brooke Lederman, Jill Stow, Naomi Moody, Eithnie Irving, Mary Lomas 2. Proxies: 3. Chair: Tracy Desborough 4. Confirmation of previous minutes: Lynette Wallace Seconded: Sharryn Byers 5. Tabling of Reports Content 5. 1 President Report Since the change of executive, we have been meeting monthly to look at the processes; Financial transactions, journal production, recruitment and retention strategies of members, benefits for members increasing the educational content of Brainstem, Strategies to improve the communication between the Executive and the State Delegates We plan to review again these strategies at the end of the year. Thank you to the Executive and State Delegates for their enthusiasm. Received and tabled 5. 2 NSW Report Action 6. Business arising Content Action 6. 1 Standards of Neuroscience Nursing Standards were mailed out early in the year. The Case studies were omitted accidentally, but will be printed and mailed out as an amendment within the month. RM to mail out case studies 6. 2 Affiliation with the College of Nursing With the change in Executive, this has not been followed up. This is essentially a branch initiative and will be forwarded to NSW to follow up 6. 3 EBSCO Publishing ANNA has formalised the contract with EBSCO. Members will be informed in Brainstem further information JB to submit a short contribution re: EBSCO contract for Brainstem 7. Election of Office Bearers Content Action 7. 1 Treasurer Position • Nomination – Karen Tuqiri • Proposed – Sharon Eriksson • Seconded – Tracy Desborough • Accepted unanimously

8. New Business Content Actions 8. 1 Affiliation with the NSA ANNA now consists of more than just neurosurgical nurses – neurology, stroke, Parkinson's disease, ms, mnd The Exec raised the idea of not following the NSA and to look at becoming a stand alone independent conference. Concerns highlighted include sponsorship support; there are still a few nurses that stay on from the ANNA conference for the NSA. There was a suggestion to encourage neurologists to present at future conferences TD/SE to follow up 8. 2 Dual Membership There are competing bodies for professional organisations. The Exec would like to investigate the idea of having dual membership, targeting other organisations e. g. operating room nurses, spinal, rehab, ACCCN, Radiology Discussion around benefits which included: Members receiving a discount from combined membership; Advertising to affiliation members ANNA conference delegate rates; Shared resources during conferences leading to a meeting that encompasses all areas within neurosciences 8. 3 Email Correspondence The Exec proposed to the members the idea of ANNA business being emailed. Accepted unanimously 8. 4 Receipting Processes are being addressed in regards to the receipting of transactions and the timing. These will continue to be addressed with the change over of the role. 8. 5 AJON JB reports that there have been difficulties in obtaining contributions, but the Journal is in print. Suggested journal article content: case studies/ clinical updates; Abstracts; Themes JB is developing an article package which will include guidelines for article structure JB will also develop a guideline package for reviewers. Interested reviewers would look at 1 - 2 papers per year 9. Business without notice Content 9. 1 Membership pro rata rates Following discussion at the State delegate Meeting, the Exec would like to propose a standard 12 month membership. It was discussed that the pro rata rates were quite confusing to members. State delegates will be notified of unfinancial members regularly for follow up Meeting closed: 1550 Next meeting: Cairns September 2006 Actions

WORLD FEDERATION OF NEUROSCIENCE NURSES 2005 Update Following a successful 9 th Congress, Barcelona- Spain, plans for the 10 th Congress are under way. The location of the next congress has yet to be decided. To ensure the quality, efficiency and support for congress preparations it was decided that prospective host countries were to provide submissions for consideration. Submissions are due at the end of 2005 and congress location for 2009 will be announced at the beginning of 2006. A Membership, Education, Research Committee (MERC) has been formed. This is to ensure ongoing development and opportunities for neuroscience nurses. It is expected that the MERC will prove to be extremely valuable in the growth of WFNN and its members. There has been further development in the Nurse Exchange Program with a proposed sponsorship contract from Johnson and Johnson. Details are still being finalised however this program will create wonderful opportunities for neuroscience nurses to exchange practices and ideas. Ongoing information will be updated on the web site: www. wfnn. nu Rochelle Firth Nurse Practitioner- Neurosurgery WFNN- Secretary PO Box 6, Artarmon NSW 1570 AUSTRALIA annaexecutive@bigpond. com. au phone: 9926 7527 fax: 02 9439 9029 President Tracy Desborough tdesborough@doh. health. nsw. gov. au Phone: (02) 43 947 679 Treasurer Karen Tuqiri Karen. Tuqiri@sesiahs. health. nsw. gov. au Vice President Sharon Eriksson Sharonmaree. eriksson@sesiahs. health. nsw. gov. au Secretary Rochelle Mc. Knight annaexecutive@bigpond. com. au Phone: (02) 9926 7527 Phone: (02) 9382 8113 Conference Convener Cheryl Trudinger Cheryl. Trudinger@sesiahs. health. nsw. gov. au Phone: (02) 9382 3802 Journal Editor Jenni Blundell jblundel@nursing. usyd. edu. au