PURPOSE: The purpose of this study was to investigate the effects on critical thinking, problem solving, communication, confidence in nursing performance and learning satisfaction after simulation with problem-based learning. METHODS: This study used a non-equivalent control group no-synchronized design. Forty junior baccalaureate nursing students were recruited conveniently and assigned to the experimental (n=20) or control (n=20) group using time difference. The experimental group participated in lecture and simulation with problem-based learning on care for patients with autonomic dysreflexia while the control group received lecture and traditional practices. RESULTS: The experimental group presented significant improvement in critical thinking (Z=−2.10, p=.036), problem solving (t=3.36, p=.002), communication (t=2.32, p=.026), confidence in nursing performance (Z=−2.20, p=.028) and learning satisfaction (Z=−3.42, p=.001) compared with the control group. CONCLUSION: The results of this study indicated that simulation with problem-based learning is effective in improving critical thinking, problem solving, communication, confidence in nursing performance and learning satisfaction for nursing students.
Autonomic Dysreflexia* ; Humans ; Learning ; Nursing ; Problem Solving ; Problem-Based Learning* ; Students, Nursing ; Thinking

OBJECTIVE: To analyze the factors related to urinary tract infection (UTI) occurrence after an urodynamic study (UDS) in patients with spinal cord injury (SCI). METHODS: We retrospectively investigated the medical records of 387 patients with SCI who underwent UDS with prophylactic antibiotic therapy between January 2012 and December 2012. Among them, 140 patients met the inclusion criteria and were divided into two groups, UTI and non-UTI. We statistically analyzed the following factors between the two groups: age, sex, level of injury, SCI duration, spinal cord independence measure, non-steroidal anti-inflammatory drug use, diabetes mellitus, the American Spinal Injury Association impairment scale (AIS), lower extremity spasticity, a history of UTI within the past 4 weeks prior to the UDS, symptoms and signs of neurogenic bladder, urination methods, symptoms during the UDS and UDS results. RESULTS: Among the 140 study participants, the UTI group comprised 12 patients and the non-UTI group comprised 128 patients. On univariate analysis, a history of UTI within the past 4 weeks prior to the UDS was significant and previous autonomic dysreflexia before the UDS showed a greater tendency to influence the UTI group. Multivariable logistic regression analysis using these two variables showed that the former variable was significantly associated with UTI and the latter variable was not significantly associated with UTI. CONCLUSION: In patients with SCI, a history of UTI within the past 4 weeks prior to the UDS was a risk factor for UTI after the UDS accompanied by prophylactic antibiotic therapy. Therefore, more careful pre-treatment should be considered when these patients undergo a UDS.
Autonomic Dysreflexia ; Diabetes Mellitus ; Humans ; Logistic Models ; Lower Extremity ; Medical Records ; Muscle Spasticity ; Retrospective Studies ; Risk Factors ; Spinal Cord Injuries* ; Spinal Cord* ; Spinal Injuries ; Urinary Bladder, Neurogenic ; Urinary Tract Infections* ; Urinary Tract* ; Urination ; Urodynamics*

Transverse myelitis is an acute inflammatory lesion of the spinal cord resulting in motor, sensory, and autonomic dysfunction. Pregnancy increases risk of complications depending on the level of the spinal cord lesion. Hence, a multidisciplinary approach is needed during prenatal period. This is a case of IB, a 32 year-old primigravid, a known case of Transverse Myelitis, initially seen at ten weeks age of gestation. Prenatal course was managed accordingly. She underwent primary cesarean section for arrest cervical dilatation at 39 weeks, with an unremarkable post-operative course. There is an increased risk of preventable complications such as recurrent urinary tract infections, anemia, development of decubitus ulcers, premature labor and delivery and autonomic dysreflexia. It is imperative that during the prenatal period, the patient be monitored closely and referred to specialists for further management of these simple to fatal complications.

Human ; Female ; Adult ; Pregnancy ; Myelitis, Transverse ; Autonomic Dysreflexia ; Patients ; Urinary Tract Infections ; Anemia ; Pressure Ulcer ; Ulcer

No abstract available.
Autonomic Dysreflexia* ; Humans ; Manometry* ; Spinal Cord Injuries*

Autonomic dysreflexia is a clinical emergency syndrome of uncontrolled sympathetic output that can occur in patients who have a history of spinal cord injury. Despite its frequency in spinal cord injury patients, central nervous system complications are very rare. We report a man with traumatic high level incomplete spinal cord injury who suffered hypertensive right thalamic hemorrhage secondary to an episode of autonomic dysreflexia. Prompt recognition and removal of the triggering factor, the suprapubic catheter obstruction which led to hypertensive attack, the patient had a favorable functional outcome after the resorption of the hematoma and effective rehabilitation programme.
Autonomic Dysreflexia* ; Catheter Obstruction ; Central Nervous System ; Cerebral Hemorrhage* ; Emergencies ; Hematoma ; Hemorrhage ; Humans ; Rehabilitation ; Spinal Cord Injuries

Effective rehabilitation and assisted reproductive technology may increase the number of women considering pregnancy who have spinal cord injuries. It is important that obstetricians caring for these patients are aware of the specific problems related to spinal cord injuries. Autonomic dysreflexia is the most significant medical complication found in women with spinal cord injuries, and precautions should be taken to avoid stimuli that can lead to this potentially fatal complication. Women with spinal cord injuries may give birth vaginally, but when cesarean delivery is indicated, adequate anesthesia is needed. We report three cases of delivery in patients with spinal cord injury.
Anesthesia ; Autonomic Dysreflexia ; Female ; Humans ; Parturition ; Pregnancy ; Pregnant Women ; Reproductive Techniques, Assisted ; Spinal Cord ; Spinal Cord Injuries

OBJECTIVE: To describe the frequency and reasons for rehospitalization in patients with spinal cord injury (SCI) living in the community. METHOD: A total 388 patients with SCI living in community participated in the nationwide questionnaire-based study. A self-administered questionnaire was used. RESULTS: Of the 459 patients originally enrolled, 388 completed questionnaires, yielding response rate of 84.5%. The reasons for rehospitalization were SCI related complications (71.7%), periodic health evaluation (44.7%), and other causes (28.3%). The most frequent SCI related complications for rehospitalization were urinary tract infections (45.2%), pressure sores (39.7%), fever (18.3%), pain (18.3%), and autonomic dysreflexia (7.6%). The number of rehospitalized cases due to SCI related complication including urinary tract infection was significantly higher in complete SCI. Rehospitalization due to pressures sore was more frequent in people with paraplegia, male and complete injuries. CONCLUSION: In our study, 71.7% of patients with SCI experienced rehospitalization for SCI related complication after initial hospitalization. Urinary tract infection and pressure sores were the most common SCI related complications for rehospitalization.
Autonomic Dysreflexia ; Fever ; Hospitalization ; Humans ; Male ; Paraplegia ; Pressure Ulcer ; Surveys and Questionnaires ; Spinal Cord ; Spinal Cord Injuries ; Urinary Tract Infections

BACKGROUND: We determined the effect of spinal cord injury (SCI) on sevoflurane requirements and stress hormone responses, and sevoflurane concentration to block autonomic hyperreflexia (AHR) in SCI patients. METHODS: In the first series, sevoflurane concentrations to maintain bispectral index score (BIS) at 40-50 and stress hormone response were examined in 27 SCI patients undergoing surgery below the level of injury.Fifteen patients without SCI served as control.Measurements included end-tidal sevoflurane concentrations (ET(SEVO)), systolic blood pressure (SBP), heart rate (HR), catecholamines, vasopressin, and cortisol concentrations.In the second series, sevoflurane concentration to block AHR was examined in 31 SCI patients undergoing transurethral litholapaxy.When a patient developed an episode of AHR, the target sevoflurane concentration was maintained for 10 min, and then the procedure was repeated.Each target concentration was determined by up-down method based on SBP. RESULTS: During surgery, SBP, HR, and BIS were comparable between SCI and control.However, ETSEVO was significantly smaller in the SCI than the control.Plasma concentrations of norepinephrine, epinephrine and cortisol were significantly lower in the SCI than the control.SBP rose by 67 +/- 31 mmHg, whereas HR fell by 13 +/- 8 bpm during the 1st trial in the SCI (P < 0.01).Hypertensive events were associated with increases of norepinephrine concentrations.ETSEVO required to prevent AHR were 3.12% in 50% of patients, 3.83% in 95% of patients. CONCLUSIONS: SCI reduces the anesthetic requirement by 39%, and decreases stress hormone responses during surgery below the level of injury.To prevent AHR in 95% of SCI patients undergoing litholapaxy, ETSEVO 3.83% may be required.
Autonomic Dysreflexia ; Blood Pressure ; Catecholamines ; Epinephrine ; Heart Rate ; Humans ; Hydrocortisone ; Lithotripsy ; Methyl Ethers ; Mustard Compounds ; Norepinephrine ; Spinal Cord Injuries ; Vasopressins

PURPOSE: Plastic surgeons are responsible for the management of spinal cord injury patients with upper and lower extremity reconstruction, pressure sore, and wounds. Derailment of autonomic nervous systems caused by injury to the spinal cord may result in fatal autonomic dysreflexia. Autonomic dysreflexia is a syndrome of massive imbalance of reflex sympathetic discharge occurring in patients with spinal cord lesion above the splanchnic outflow(T6). It is characterized by a sudden onset and severe increase in blood pressure and is potentially life threatening. The other classic symptoms are headache, chest pain, sweating, and bradycardia. In order to lower the blood pressure, it is important to remove the noxious stimulus for autonomic dysreflexia. If such symptoms last for more than 15 minutes despite conservative interventions, antihypertension drugs are recommended. METHODS: In this case study, we report an autonomic dysreflexia case that developed in a 45 year-old tetraplegia patient with sacral pressure sore. When he got bladder irrigation, his blood pressure went up very high and his mentality became stuporous. He was sent to ICU for his blood pressure and mental care. ICU care made his vital sign stabilized and his mentality alert. RESULTS: After the patient underwent proper treatment like inotropic agent, he was transferred to the general ward and his pressure sore on sacral area was coveraged with gluteus maximus myocutaneous advancement flap. CONCLUSION: If treatment is not effective, the patients have to undergo sudden, severe hypertension, which can cause stroke or death. To provide safe and effective care, plastic surgeons should be able to recognize and treat autonomic dysreflexia.
Autonomic Dysreflexia* ; Autonomic Nervous System ; Blood Pressure ; Bradycardia ; Chest Pain ; Headache ; Humans ; Hypertension ; Lower Extremity ; Middle Aged ; Patients' Rooms ; Pressure Ulcer* ; Quadriplegia ; Reflex ; Spinal Cord ; Spinal Cord Injuries ; Stroke ; Stupor ; Sweat ; Sweating ; Urinary Bladder ; Vital Signs ; Wounds and Injuries

Autonomic dysreflexia is a syndrome of uninhibited sympathetic spinal reflexes in response to stimuli below the level of injury in the patients with high spinal lesions. During labor, it can cause uteroplacental vasoconstriction resulting in fetal distress or devastating maternal complications including retinal hemorrhage, cerebrovascular accident and hypertensive encephalopathy. Neuraxial blockade has proven to be an effective method to attenuate or prevent it. We present a case detailing the use of epidural analgesia in managing the delivery of a quadriplegic parturient with a history of autonomic dysreflexia.
Analgesia, Epidural* ; Autonomic Dysreflexia ; Fetal Distress ; Humans ; Hypertensive Encephalopathy ; Reflex ; Retinal Hemorrhage ; Spinal Cord Injuries* ; Spinal Cord* ; Stroke ; Vasoconstriction