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1.
J Med Eng Technol ; 42(5): 381-388, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30324856

RESUMO

Patients with a spinal cord injury above the 6th thoracic vertebrae may be prone to autonomic dysreflexia (AD) in response to bladder stimulus associated with a urodynamics investigation. It is essential that these patients are managed carefully in the urodynamics clinic in order to prevent life-threatening hypertension and bradycardia. Part of this management is the measurement and manual recording of pulse rate (PR) and non-invasive blood pressure (NIBP), alongside the standard urodynamics data set. The purpose of recording these additional data is to identify the characteristic drop in PR and rise in NIBP that indicates the onset of AD. This technical note describes the development of a novel, in-house constructed interface that allows PR and NIBP to be recorded alongside the standard urodynamics data set, using a commonly available vital signs monitor and urodynamics workstation.


Assuntos
Pressão Sanguínea , Frequência Cardíaca , Monitorização Fisiológica/instrumentação , Urodinâmica , Disreflexia Autonômica/diagnóstico , Disreflexia Autonômica/fisiopatologia , Humanos
2.
Acta Vet Scand ; 60(1): 64, 2018 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-30373607

RESUMO

BACKGROUND: The trigeminocardiac reflex (TCR) is a brainstem reflex that may be observed in anaesthesia during surgical procedures stimulating the intracranial or peripheral portion of the trigeminal nerve. The peripheral TCR is divided into the oculocardiac reflex and the maxillomandibulocardiac reflex based on the affected sensory branches of the trigeminal nerve. In veterinary medicine the oculocardiac reflex has been described, however the maxillomandibulocardiac reflex has never been reported. CASE PRESENTATION: A 5-year-old male Epagneul Breton was presented for surgical management of an upper lip mass. During surgery, a sudden severe bradycardia and a decrease in systemic arterial blood pressure developed. The occurrence of a maxillomandibulocardiac reflex was suspected on the basis of the temporary link between surgical stimulation and haemodynamic changes. Three doses of atropine were given before starting a dopamine infusion due to lack of response. The dopamine infusion normalized heart rhythm and blood pressure. The dog recovered uneventfully and he was discharged 24 h later with a sinus rhythm and no sign of recurrence of arrhythmias. CONCLUSION: The TCR is a rare but potentially life-threatening complication of procedures involving the sensory areas innervated by the three branches of the trigeminal nerve and it may cause bradycardia with hypotension. The use of a ß1-adrenergic receptor agonist such as dopamine may be indicated in cases of a refractory response to the conventional treatment with atropine.


Assuntos
Disreflexia Autonômica/veterinária , Doenças do Cão/cirurgia , Neoplasias Labiais/veterinária , Nervo Trigêmeo , Animais , Disreflexia Autonômica/diagnóstico , Diagnóstico Diferencial , Cães , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/veterinária , Neoplasias Labiais/cirurgia , Masculino
3.
BMC Med ; 16(1): 53, 2018 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-29650001

RESUMO

BACKGROUND: Autonomic dysreflexia is a severe and potentially life-threatening condition in patients with spinal cord injury, as it can lead to myocardial ischemia, brain hemorrhage, or even death. Urodynamic investigation is the gold standard to assess neurogenic lower urinary tract dysfunction due to spinal cord injury and reveal crucial pathological findings, such as neurogenic detrusor overactivity. However, neurogenic detrusor overactivity and urodynamic investigation are known to be leading triggers of autonomic dysreflexia. Therefore, we aimed to determine predictors of autonomic dysreflexia in individuals with spinal cord injury during urodynamic investigation. METHODS: This prospective cohort study included 300 patients with spinal cord injuries and complete datasets of continuous non-invasive cardiovascular monitoring, recorded during same session repeat urodynamic investigation. We used logistic regression to reveal predictors of autonomic dysreflexia during urodynamic investigation. RESULTS: We found that level of injury and presence of neurogenic detrusor overactivity were the only two independent significant predictors for autonomic dysreflexia during urodynamic investigation. A lesion at spinal segment T6 or above (odds ratio (OR) 5.5, 95% CI 3.2-9.4) compared to one at T7 or below, and presence of neurogenic detrusor overactivity (OR 2.7, 95% confidence interval (CI) 1.4-4.9) were associated with a significant increased odds of autonomic dysreflexia during urodynamic investigation. Both odds persisted after adjustment for age, sex, and completeness and stage of injury (adjusted OR (AOR) 6.6, 95% CI 3.8-11.7, and AOR 2.2, 95% CI 1.1-4.5, respectively). Further stratification by lesion level showed level-dependent significantly increased adjusted odds of autonomic dysreflexia, i.e., from C1-C4 (AOR 16.2, 95% CI 5.9-57.9) to T4-T6 (AOR 2.6, 95% CI 1.3-5.2), compared to lesions at T7 or below. CONCLUSIONS: In patients with neurogenic lower urinary tract dysfunction due to spinal cord injury, autonomic dysreflexia is independently predicted by lesion level and presence of neurogenic detrusor overactivity. Considering the health risks associated with autonomic dysreflexia, such as seizures, stroke, retinal bleeding, or even death, we recommend both continuous cardiovascular monitoring during urodynamic investigation in all spinal cord-injured patients with emphasis on those with cervical lesions, and appropriate neurogenic detrusor overactivity treatment to reduce the probability of potentially life-threatening complications. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01293110 .


Assuntos
Disreflexia Autonômica/diagnóstico , Urodinâmica/fisiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
4.
World Neurosurg ; 108: 988.e1-988.e5, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28782691

RESUMO

BACKGROUND: Spinal cord transection is a radical but effective treatment for highly selective cases of symptomatic spinal retethering in paraplegic spina bifida patients. Autonomic dysreflexia (AD) is a potentially life-threatening syndrome involving a dysregulated sympathetic discharge reflex commonly seen following cervical and high thoracic spinal cord injury, leading to a disconnect between autonomic pathways above and below the lesion that can lead to severe complications including uncontrolled hypertension, bradycardia, stroke, and potentially death. Herein we present a case in which a paraplegic spina bifida patient presenting with symptomatic spinal retethering experienced autonomic dysreflexia following an elective spinal cord transection. CASE DESCRIPTION: A 51-year-old male with a history of complex spina bifida presented with an active cerebrospinal fluid leak. Physical examination revealed a thin covering of abnormal epidermis over the large placode. Magnetic resonance imaging revealed a large myelomeningocele defect with posterior element defects spanning from L2 to the sacrum with evidence of tethering. The patient underwent an intradural transection of the spinal cord with a "blind-pouch" closure of the dura at the level of T12/L1. Postoperatively, the patient developed intermittent episodes of hypertension, bradycardia, headaches, altered mental status, severe perspiration, and red flushing of the upper torso, face, and arms. The diagnosis of AD was made clinically and managed with a positive response to a combination of beta- and alpha-blockade along with patient education on avoidance of common AD triggers. At 5-year follow-up the patient has continued to do well on medication. CONCLUSION: This case highlights a potential major side effect from elective transection of the spinal cord. If unrecognized and untreated, AD can cause significant distress and morbidity. We hope this first case report serves to supplement existing data and aid in future surgical and medical decision-making.


Assuntos
Disreflexia Autonômica/etiologia , Procedimentos Cirúrgicos Eletivos , Complicações Pós-Operatórias , Medula Espinal/cirurgia , Disrafismo Espinal/cirurgia , Disreflexia Autonômica/diagnóstico , Disreflexia Autonômica/tratamento farmacológico , Diagnóstico Diferencial , Seguimentos , Humanos , Masculino , Meningomielocele/complicações , Meningomielocele/diagnóstico por imagem , Meningomielocele/cirurgia , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Disrafismo Espinal/complicações , Disrafismo Espinal/diagnóstico por imagem
5.
PM R ; 9(10): 1047-1050, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28366524

RESUMO

The life expectancy of persons with spinal cord injury (SCI) is increasing due to advances in medicine and technology. As a result, there is a higher incidence of age-associated illnesses in this population. Degenerative joint disease is a common age-associated illness that causes pain and thus, in persons with SCI above the T6 level, can serve as a noxious stimulus to trigger autonomic dysreflexia (AD). This is a case report of severe bilateral hip osteoarthritis (OA) causing unyielding AD in a person with tetraplegia leading to bilateral girdle stone surgeries. Hip OA as an etiology for AD has not previously been reported and is important to recognize as this population continues to age and to develop age-associated diseases. LEVEL OF EVIDENCE: V.


Assuntos
Disreflexia Autonômica/complicações , Multimorbidade , Osteoartrite do Quadril/complicações , Quadriplegia/complicações , Disreflexia Autonômica/diagnóstico , Disreflexia Autonômica/reabilitação , Vértebras Cervicais/lesões , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/cirurgia , Quadriplegia/diagnóstico , Quadriplegia/reabilitação , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/diagnóstico
6.
J Spinal Cord Med ; 40(2): 170-174, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-26507254

RESUMO

OBJECTIVES: We aimed to investigate whether autonomic dysreflexia (AD) develops during urodynamic investigation in patients with spinal cord injury (SCI) with neurological level below thoracic (T) 6 together with the frequency and related factors for AD development. STUDY DESIGN: Prospective study. METHODS: The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) of 51 SCI patients with a neurological level below T6 were measured and recorded at the beginning and every two minutes during the filling phase of the urodynamic study. The changes between the SBP, DBP and HR values at the beginning and end of the filling phase were analyzed. RESULTS: Autonomic dysreflexia developed only in one of the 51 patients included into the study. The BP of this patient increased from 105/76 mmHg to 145/102 mmHg and the HR dropped from 88 beats/minute (bpm) to 69 bpm together with development of the AD symptoms. The patient was a 47-year-old male with a neurological level at T8. A significant difference was found between the mean SBP and the mean DBP values at the beginning and end of the filling phase. CONCLUSIONS: Although rare, AD can be seen during urodynamic investigation in patients with a neurological level below T6, especially when close to the T6 level. Therefore, we suggest that the patients with a neurological level below T6 and especially closer to T6 level should be followed-up in terms of development of AD. The clinicians should take into account the HR values in addition to the the SBP and DBP values at follow-ups.


Assuntos
Disreflexia Autonômica/diagnóstico , Traumatismos da Medula Espinal/complicações , Adolescente , Adulto , Disreflexia Autonômica/etiologia , Pressão Sanguínea , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/diagnóstico , Urodinâmica
7.
J Neurotrauma ; 34(3): 559-566, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27573583

RESUMO

Cardiovascular disease is one of the leading causes of morbidity and mortality in the spinal cord injury (SCI) population. SCI may disrupt autonomic cardiovascular homeostasis, which can lead to persistent hypotension, irregular diurnal rhythmicity, and the development of autonomic dysreflexia (AD). There is currently no software available to perform automated detection and evaluation of cardiovascular autonomic dysfunction(s) such as those generated from 24 h ambulatory blood pressure monitoring (ABPM) recordings in the clinical setting. The objective of this study is to compare the efficacy of a novel 24 h ABPM Autonomic Dysfunction Detection Software against manual detection and to use the software to demonstrate the relationships between level of injury and the degree of autonomic cardiovascular impairment in a large cohort of individuals with SCI. A total of 46 individuals with cervical (group 1, n = 37) or high thoracic (group 2, n = 9) SCI participated in the study. Outcome measures included the frequency and severity of AD, frequency of hypotensive events, and diurnal variations in blood pressure and heart rate. There was good agreement between the software and manual detection of AD events (Bland-Altman limits of agreement = ±1.458 events). Cervical SCI presented with more frequent (p = 0.0043) and severe AD (p = 0.0343) than did high thoracic SCI. Cervical SCI exhibited higher systolic and diastolic blood pressure during the night and lower heart rate during the day than high thoracic SCI. In conclusion, our ABPM AD Detection Software was equally as effective in detecting the frequency and severity of AD and hypotensive events as manual detection, suggesting that this software can be used in the clinical setting to expedite ABPM analyses.


Assuntos
Disreflexia Autonômica/diagnóstico , Monitorização Ambulatorial da Pressão Arterial/normas , Índice de Gravidade de Doença , Software/normas , Traumatismos da Medula Espinal/diagnóstico , Adulto , Disreflexia Autonômica/epidemiologia , Disreflexia Autonômica/fisiopatologia , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/epidemiologia , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Pressão Sanguínea/fisiologia , Monitorização Ambulatorial da Pressão Arterial/métodos , Vértebras Cervicais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/fisiopatologia , Vértebras Torácicas , Fatores de Tempo
8.
Spinal Cord ; 55(2): 216-222, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27618973

RESUMO

STUDY DESIGN: Single-group pre-/post-test with 3- and 6-month follow-ups. OBJECTIVES: To test the effects of the 'ABCs of AD' educational module on immediate and longer-term changes in paramedics' knowledge and beliefs about using the autonomic dysreflexia clinical practice guidelines (AD-CPGs). SETTING: Canada. METHODS: A total of 119 paramedics completed an AD knowledge test and measures of attitudes, perceived control, self-efficacy, social pressure from patients and health-care professionals, and intentions to use the AD-CPGs before and 1 week, 3 months and 6 months after viewing 'ABCs of AD'. RESULTS: There were significant improvements in AD knowledge, attitudes and social pressure from patients to use the AD-CPGs from baseline to 1 week, 3 months and 6 months post viewing (all P<0.001). Self-efficacy and intentions increased 1 week post viewing (P<0.001), but returned to baseline levels at 3 and 6 months (P>0.05). There was no change in perceived control or social pressure from health-care professionals. AD knowledge and beliefs explained 50-61% of the variance in intentions to use the AD-CPGs. Attitudes, social pressure from patients and perceived behavioural control were significant unique predictors of intentions at all time points (P<0.05); AD knowledge was a significant predictor at 6 months only (P=0.048). No other predictors were significant. CONCLUSION: 'ABCs of AD' has immediate and sustained effects on paramedics' knowledge of attitudes toward and perceived pressure from patients to use the AD-CPGs. Updates to paramedic patient care guidelines and standards are needed to increase paramedics' perceived control and self-efficacy to implement the guidelines, and their intentions to use the AD-CPGs. SPONSORSHIP: Canadian Institutes of Health Research (2011-CIHR- 260877).


Assuntos
Pessoal Técnico de Saúde/educação , Disreflexia Autonômica/terapia , Gerenciamento Clínico , Conhecimentos, Atitudes e Prática em Saúde , Internet , Guias de Prática Clínica como Assunto , Adulto , Pessoal Técnico de Saúde/normas , Disreflexia Autonômica/diagnóstico , Disreflexia Autonômica/epidemiologia , Feminino , Seguimentos , Humanos , Internet/normas , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Guias de Prática Clínica como Assunto/normas
9.
J Plast Surg Hand Surg ; 50(1): 44-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26450444

RESUMO

BACKGROUND: Patients with spinal cord injury (SCI) requiring reconstructive surgery, particularly for pressure ulcers, are ubiquitous in Plastic and Reconstructive Surgery practices. Much of the current literature focuses on operative techniques, antibiotic indications, sitting protocols, and dressing and bedding choices. METHODS: This paper reviews normal neuroanatomy, outlines changes in neurophysiology observed in spinal cord injury, and addresses concepts related to perioperative care that are highly relevant but often under-emphasised. RESULTS: Vascular disturbances such as autonomic dysreflexia and orthostatic hypotension are dangerous phenomena occurring in this patient population that, if not properly recognised and treated, may result in complications such as haematoma, flap loss, inadequate tissue perfusion, and death. The management of spasticity, deep venous thrombosis, and perioperative pain are also relevant and discussed in this paper. CONCLUSION: A basic understanding of these concepts is essential for the Plastic Surgeon involved in the care of patients with SCI and pressure ulcers, particularly before and after debridement or reconstruction.


Assuntos
Assistência Perioperatória , Traumatismos da Medula Espinal/complicações , Disreflexia Autonômica/diagnóstico , Disreflexia Autonômica/etiologia , Disreflexia Autonômica/prevenção & controle , Humanos , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/etiologia , Hipotensão Ortostática/prevenção & controle , Espasticidade Muscular/etiologia , Espasticidade Muscular/prevenção & controle , Manejo da Dor , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle
10.
Clin Auton Res ; 25(5): 293-300, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26280219

RESUMO

OBJECTIVE: There is a dearth of literature on the treatment of chronic recurrent autonomic dysreflexia (AD), a well-known complication of spinal cord injury that can have life-threatening implications. This study sought to identify clinical practices regarding the treatment of AD, both acute and recurrent, in patients with spinal cord injury (SCI). METHODS: Online survey regarding AD management in SCI composed of 11 questions designed to obtain information on respondent characteristics, AD treatment options, and causes of AD. SETTING: Veterans Administration health care system. PARTICIPANTS: Veterans Health Administration National SCI Staff Physicians were sent an electronic email to participate in the anonymous web-based survey. INTERVENTION: None applicable. RESULTS: The response rate was 52%. The most commonly prescribed medications for minor and severe acute manifestations of AD were nitrates. For recurrent AD, clonidine was the most commonly prescribed medication. INTERPRETATION: Anti-hypertensive medications continue to be the mainstay in the management of both acute and chronic recurrent AD. Current literature is lacking in prospective randomized controlled trials investigating the relative efficacy of AD interventions. Evidence-based practice guidelines are necessary to improve clinical care.


Assuntos
Disreflexia Autonômica/diagnóstico , Disreflexia Autonômica/prevenção & controle , Médicos , Guias de Prática Clínica como Assunto/normas , Inquéritos e Questionários , Disreflexia Autonômica/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicos/tendências , Estudos Prospectivos , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/terapia
12.
Minerva Urol Nefrol ; 67(2): 85-90, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25598399

RESUMO

AIM: This study aims to explore the risk factors associated with autonomic dysreflexia (AD) reflex during cystolitholapaxy and increase the awareness of urologists on the dangerous reaction of AD in patients with spinal cord injury (SCI). METHODS: Data of 89 SCI patients with bladder stone who underwent cystolitholapaxy were retrospectively analyzed. Patients were divided into two groups according to the presence or absence of AD. Risk factors may associated with AD during the endoscopic procedure were analyzed by comparing clinical and operative features between the two groups. RESULTS: Of the 89 patients, 31 (34.83%) developed AD during the procedure. The patients who developed AD had larger stones (4.58±1.26 cm vs. 3.75±1.15 cm, P<0.01), more stones (2.29±0.86 vs. 1.74±0.81, P<0.01), and greater injury (83.87% vs. 41.38%, above T6, P<0.01) than those who did not develop AD. The patients who developed AD suffered higher irrigation (83.55± 13.05 cm vs. 77.47±10.91 cm, P<0.05) and longer operation time (60.65±17.78 min vs. 49.31±14.31 min, P<0.01) than those who did not develop AD. The AD group also received local anesthetics to a larger extent compared with non-AD group, which more often had spinal anesthesia. CONCLUSION: The patients who developed AD during the procedure had larger stones, more stone number, injury level more often above T6, higher hydraulic irrigation height, and longer operation time compared with the patients who did not develop AD. Urologists should pay extra care when performing cystolitholapaxy on individuals with these features.


Assuntos
Anestésicos Locais/efeitos adversos , Disreflexia Autonômica/etiologia , Litotripsia/efeitos adversos , Traumatismos da Medula Espinal/complicações , Cálculos da Bexiga Urinária/terapia , Adulto , Disreflexia Autonômica/diagnóstico , Cistoscopia/métodos , Feminino , Humanos , Litotripsia/métodos , Masculino , Duração da Cirurgia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Traumatismos da Medula Espinal/diagnóstico , Resultado do Tratamento , Cálculos da Bexiga Urinária/complicações
13.
Am J Hypertens ; 28(2): 173-81, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24990527

RESUMO

BACKGROUND: This study determined whether the Autonomic Dysfunction Following Spinal Cord Injury (ADFSCI) questionnaire, a measure of self-reported frequency and severity of symptoms during hypo- and hypertensive episodes, correlates with blood pressure (BP) instability. In addition, test-retest reliability of the ADFSCI questionnaire was assessed. METHODS: Thirty individuals with spinal cord injury (SCI) (aged 42±12 years; level of lesion = C3-L1; American Spinal Injury Association Impairment Scale = A-C; lesion duration = 1 month to 30 years after injury) participated in this study. Twenty-four-hour ambulatory BP monitoring (ABPM) was used to assess BP instability. ABPM recorded systolic BP (SBP), diastolic BP (DBP), and heart rate at 15-minute intervals during the daytime and 1-hour intervals during the nighttime. Test-retest reliability was performed by completion of the ADFSCI questionnaire on 2 occasions (i.e., 9±4 days in between). RESULTS: Individuals with SCI who self-reported autonomic dysreflexia (AD) episodes showed significantly higher SBP coefficient of variation (CV) (14%) and more AD events (n = 11) than individuals who reported never having AD symptoms (CV = 9%; AD events = 1). Both the number of AD events over the 24-hour period and the BP variability (SBP CV) were significantly related to the patients' self-reported total AD score (rho = 0.522, P = 0.005; rho = 0.584, P = 0.001, respectively) and daily AD frequency (rho = 0.553, P = 0.003; rho = 0.586, P = 0.001, respectively). Conversely, no significant correlations existed between the number of hypotensive events over the 24-hour period and self-reported frequency and severity in the ADFSCI questionnaire. CONCLUSIONS: This study provides evidence that ABPM offers a strong clinical basis for documenting and understanding BP instability, such as AD, and related symptoms in individuals with SCI.


Assuntos
Disreflexia Autonômica/diagnóstico , Hipertensão/diagnóstico , Hipotensão/diagnóstico , Traumatismos da Medula Espinal/fisiopatologia , Adolescente , Adulto , Idoso , Disreflexia Autonômica/etiologia , Disreflexia Autonômica/fisiopatologia , Monitorização Ambulatorial da Pressão Arterial , Feminino , Frequência Cardíaca , Humanos , Hipertensão/etiologia , Hipertensão/fisiopatologia , Hipotensão/etiologia , Hipotensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Traumatismos da Medula Espinal/complicações , Inquéritos e Questionários , Adulto Jovem
15.
J Spinal Cord Med ; 37(5): 598-607, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25055849

RESUMO

CONTEXT/OBJECTIVE: Despite availability of clinical practice guidelines (CPGs), gaps in autonomic dysreflexia (AD) knowledge and practice persist. A free, online educational module, the "ABCs of AD", was developed to improve knowledge of the AD-CPGs among emergency healthcare personnel. We examine short-term changes in paramedic and nurse trainees' knowledge of, and social cognitions towards using, the AD-CPGs following module completion. DESIGN: Pre-post. METHODS: Thirty-four paramedic and nurse trainees from two training programs in Canada completed measures immediately before and after viewing the online "ABCs of AD" module. OUTCOME MEASURES: AD knowledge test; Theory of Planned Behavior social cognition questionnaire; module feedback survey. RESULTS: Paired samples t-tests revealed significant increases in participants' AD knowledge test scores (M ± SDpre = 9.00 ± 2.46, M ± SDpost = 12.03 ± 4.07, P < 0.001; d = 0.84). Prior to viewing the module, participants reported positive social cognitions for using the AD-CPGs (all Ms ≥ 4.84 out of 7). From pre- to post-module, no significant changes were seen in participants' social cognitions for using the AD-CPGs. Participants' average module viewing time was 36.73 ± 24.17 minutes (range 8-90 minutes). There was a decline in viewing from the first to the last module sections, with only half of participants viewing all six sections. CONCLUSION: Knowledge alone is insufficient for clinical behavior change; as such, social cognitive determinants of behavior should be explicitly targeted in future iterations of the module to increase the likelihood of increased use of the AD-CPGs. To engage viewers across all module sections, the "ABCs of AD" module should include supplementary learning strategies, such as interactive quizzes and peer-to-peer interaction.


Assuntos
Pessoal Técnico de Saúde/educação , Disreflexia Autonômica/diagnóstico , Disreflexia Autonômica/terapia , Instrução por Computador/métodos , Educação em Enfermagem/métodos , Guias de Prática Clínica como Assunto , Instrução por Computador/estatística & dados numéricos , Currículo , Avaliação Educacional/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Internet , Masculino , Sistemas On-Line , Ontário , Projetos Piloto , Adulto Jovem
16.
Urol Clin North Am ; 41(3): 445-52, ix, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25063601

RESUMO

Neurogenic lower urinary tract dysfunction (NLUTD) affects many patients and requires close monitoring. Initial studies establishing patients at risk for upper tract disease revealed that high detrusor leak point pressures were predictive of upper tract disease. Urodynamics in patients with NLUTD have specific challenges. Initial studies in patients after an acute injury should be delayed until after the spinal shock phase. In children with spinal dysraphism, studies should be done early to established potential risk. The goals are maintaining low bladder pressures, decreasing risk of infection, and maintaining continence.


Assuntos
Sintomas do Trato Urinário Inferior/diagnóstico , Bexiga Urinaria Neurogênica/diagnóstico , Algoritmos , Disreflexia Autonômica/diagnóstico , Disreflexia Autonômica/fisiopatologia , Monitorização Ambulatorial da Pressão Arterial , Eletromiografia , Humanos , Rim/fisiopatologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/fisiopatologia , Bexiga Urinária/fisiopatologia , Urodinâmica
18.
Eur J Pediatr ; 173(12): 1683-4, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24535713

RESUMO

UNLABELLED: The scope of paediatric autonomic disorders is not well recognised, and paediatricians seem to be generally unaware of the complexity and diversity of their clinical manifestations. We report a 12-year-old boy presenting with hypertensive encephalopathy caused by autonomic dysreflexia. CONCLUSION: This observation emphasises the importance of the recognition of this rare autonomic disorder, which can have potentially life-threatening neurological complications.


Assuntos
Disreflexia Autonômica/complicações , Pressão Sanguínea , Encefalopatia Hipertensiva/etiologia , Traumatismos da Medula Espinal/complicações , Disreflexia Autonômica/diagnóstico , Vértebras Cervicais , Criança , Diagnóstico Diferencial , Seguimentos , Humanos , Encefalopatia Hipertensiva/diagnóstico , Encefalopatia Hipertensiva/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Traumatismos da Medula Espinal/diagnóstico , Vértebras Torácicas
20.
Spinal Cord ; 51(11): 863-7, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24060768

RESUMO

STUDY DESIGN: Retrospective chart review. OBJECTIVE: To compare autonomic dysreflexia (AD) severity during urodynamics and cystoscopy in individuals with spinal cord injury (SCI). SETTING: Outpatient urological clinic. METHODS: Demographic and clinical data were collected from charts of individuals with SCI who had blood pressure (BP) monitoring during urological procedures. Cardiovascular parameters were collected at baseline and during the various stages of two examinations. RESULTS: A total of 21 SCI individuals (mean age 49.4 years) who underwent both procedures developed episodes of AD. The majority of individuals had cervical SCI (85.7%). The median duration of injury was 183 months (ranging from 3 to 530 months). There was statistically more of an increase (P=0.039) in systolic BP during cystoscopy (67.1±33.8 mm Hg) in comparison with urodynamics (51.8±21.8 mm Hg). The BP response during episodes of AD was more pronounced in individuals with more than 2 years post SCI than with less than 2 years post SCI during both urodynamics and cystoscopy (P=0.047 and P=0.010, respectively). CONCLUSION: Even though cystoscopy filled the bladder to lesser volumes than did urodynamics (150 ml vs 500 ml), during cystoscopy the individuals developed greater changes in systolic BP, indicating that stimulation of the urethra/prostate/internal sphincter region probably is a more potent stimulus of AD than just the filling of the bladder. The severity of AD also increased with time post SCI during both procedures. Considering the high incidence of silent episodes of AD during the urological procedures, it is recommended that monitoring of cardiovascular parameters during these procedures be routinely performed.


Assuntos
Disreflexia Autonômica/fisiopatologia , Pressão Sanguínea/fisiologia , Cistoscopia/efeitos adversos , Traumatismos da Medula Espinal/fisiopatologia , Urodinâmica/fisiologia , Adulto , Disreflexia Autonômica/diagnóstico , Cistoscopia/métodos , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Traumatismos da Medula Espinal/complicações , Bexiga Urinária/fisiopatologia , Adulto Jovem
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