Autonomic dysreflexia and telehealth.

With the rapid expansion of telehealth lines in the United States and the establishment of provincially funded lines in Canada, a growing number of people use this convenient approach to establish their initial health needs and to pursue self-care. Telehealth providers, for the most part, rely on electronic protocols to offer triaging and advice. Unfortunately, standard protocols are misleading when a premorbid health condition such as a spinal cord injury is present. Symptoms such as a headache, diaphoresis or an elevated blood pressure, which are common occurrences in the general population, may indicate an emergency situation, namely autonomic dysreflexia (AD), when a mid-thoracic and higher spinal cord lesion is present. Since there is no available electronic protocol on AD, this emergency health condition is not recognized by the telehealth provider and may put the caller at risk of serious morbidity or even death. In this article, the authors present the clinical features of AD, the precipitating factors and the nursing management of an episode. The merits and pitfalls of electronic protocols are reviewed and an algorithm is presented to assist telehealth providers in recognizing AD.

Concordance in goal setting between patients with multiple sclerosis and their rehabilitation team.

OBJECTIVE: To determine the concordance between patients with multiple sclerosis and their clinical team members on the identification of goals for an inpatient rehabilitation stay. DESIGN: Prospective cohort study of patients admitted for rehabilitation in an adult inpatient neurospinal unit at a Rehabilitation Centre in Ottawa, Canada. Twenty-seven patients (11 men and 16 women, mean age of 45.3 yrs) with either a laboratory or a clinically supported diagnosis of multiple sclerosis. Patients rated 55 goals from a preexisting list, indicating the importance of each goal to be addressed during the inpatient stay. The goals fell into five broad domains of health/medical issues, daily activities, mobility, community life, and personal well-being. Patients also identified their five most important individual goals. In a separate session, the clinical team also rated the 55 goals in relation to each patient and identified an independent list of the five most important rehabilitation goals. Main outcome measures included concordance between patient and team ratings in the identification of goals, ratings of the likelihood of success of achieving each goal, and ratings of the amount of change required to realize a minimal clinically important difference. RESULTS: The patients and the team agreed on an average of 1.7 of the patient's five top-rated goals. Compared with the team, patients gave higher importance ratings to goals within the health/medical, mobility, and daily activities domains. They also considered that a greater average improvement would be required to achieve a meaningful benefit, and they gave higher ratings of the likelihood of success in achieving their selected goals. CONCLUSION: Patients with multiple sclerosis and clinical team members do not necessarily agree on specific goals for a rehabilitation stay. Patients may also have greater expectations than clinicians with respect to the amount of improvement and the likelihood of achieving their goals.