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Clayton A, Alam S, Hoskins E, Cherian S, Iyer S. Evaluation of a Quality Measure for Multiple Sclerosis Care: Disease-Modifying Therapy Initiation at the University of North Carolina's Outpatient Neurology Clinic. Int J MS Care 2024; 26:247-253. [PMID: 39268507 PMCID: PMC11391097 DOI: 10.7224/1537-2073.2023-069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is a neurological condition leading to significant disability and challenges to quality of life. To slow progression and reduce relapses, it is critical to rapidly initiate disease-modifying therapy (DMT) after diagnosis. Patient demographics may play a role in timely DMT initiation. Financial barriers may also result in delays in DMT access. METHODS This retrospective, single-center, cross-sectional study included patients seen at a neurology clinic at a large academic medical center for an initial evaluation of MS between January 1, 2022, and June 30, 2022. As an indicator of the quality of care, the primary study outcome was whether patients were offered DMT initiation on their first clinic visit. Secondary outcomes evaluated the time to DMT initiation, including differences in care based on demographic factors and financial coverage. RESULTS Of the 49 eligible individuals studied, 45 (91.8%) were offered DMT at their initial MS visit. Descriptive statistics appeared to demonstrate that demographic factors did not impact whether DMT was offered. However, the majority of patients experienced access barriers relating to prior authorization requirements (80.0%) and/or the need for co-pay assistance (52.0%). CONCLUSIONS DMT was appropriately offered to a majority of patients at their initial MS visit, regardless of demographic considerations. No offer of DMT and delays in initiation were primarily due to the need for imaging and specialty referrals, as well as financial barriers. Medication assistance teams may play a crucial role in limiting delays and financial hurdles associated with insurance coverage and co-pay assistance.
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Affiliation(s)
- Alissa Clayton
- From the Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC
| | - Sidrah Alam
- From the Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC
| | - Emily Hoskins
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
| | - Seena Cherian
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York City, NY
| | - Stephanie Iyer
- From the Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC
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Voigt I, Fischer S, Proschmann U, Konofalska U, Richter P, Schlieter H, Berger T, Meuth SG, Hartung HP, Akgün K, Ziemssen T. Consensus quality indicators for monitoring multiple sclerosis. THE LANCET REGIONAL HEALTH. EUROPE 2024; 40:100891. [PMID: 38585674 PMCID: PMC10998202 DOI: 10.1016/j.lanepe.2024.100891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 04/09/2024]
Abstract
Multiple sclerosis (MS) as a chronic, degenerative autoimmune disease of the central nervous system has a longitudinal and heterogeneous course with increasing treatment options and risk profiles requiring constant monitoring of a growing number of parameters. Despite treatment guidelines, there is a lack of strategic and individualised monitoring pathways, including respective quality indicators (QIs). To address this, we systematically developed transparent, traceable, and measurable QIs for MS monitoring. Through literature review, expert discussions, and consensus-building, existing QIs were identified and refined. In a two-stage online Delphi process involving MS specialists (on average 53 years old and with 25 years of professional experience), the QIs were evaluated for content, clarity, and intelligibility, resulting in a set of 24 QIs and checklists to assess the quality of care. The final QIs provide a structured approach to document, monitor, and enhance the quality of care for people with MS across their treatment journey.
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Affiliation(s)
- Isabel Voigt
- Center of Clinical Neuroscience, Department of Neurology, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, Dresden 01307, Germany
| | - Stefanie Fischer
- Center of Clinical Neuroscience, Department of Neurology, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, Dresden 01307, Germany
| | - Undine Proschmann
- Center of Clinical Neuroscience, Department of Neurology, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, Dresden 01307, Germany
| | - Urszula Konofalska
- Center of Clinical Neuroscience, Department of Neurology, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, Dresden 01307, Germany
| | - Peggy Richter
- Research Group Digital Health, Faculty of Business and Economics, TUD Dresden University of Technology, Dresden 01062, Germany
| | - Hannes Schlieter
- Research Group Digital Health, Faculty of Business and Economics, TUD Dresden University of Technology, Dresden 01062, Germany
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
| | - Sven G. Meuth
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, Düsseldorf 40225, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, Düsseldorf 40225, Germany
| | - Katja Akgün
- Center of Clinical Neuroscience, Department of Neurology, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, Dresden 01307, Germany
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, Dresden 01307, Germany
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Tryfonos C, Chrysafi M, Papadopoulou SK, Vadikolias K, Spanoudaki M, Mentzelou M, Fotiou D, Pavlidou E, Gkouvas G, Vorvolakos T, Michailidis A, Bisbinas A, Alexatou O, Giaginis C. Association of Mediterranean diet adherence with disease progression, quality of life and physical activity, sociodemographic and anthropometric parameters, and serum biomarkers in community-dwelling older adults with multiple sclerosis: a cross-sectional study. Aging Clin Exp Res 2024; 36:73. [PMID: 38492093 PMCID: PMC10944396 DOI: 10.1007/s40520-024-02712-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 01/23/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) constitutes a chronic inflammatory and degenerative demyelinating disease, which can progressively lead to a broad range of sensorimotor, cognitive, visual, and autonomic function symptoms, independently of patient' age. However, the clinical studies that examine the role of dietary patterns against disease progression and symptomatology remain extremely scarce, especially concerning Mediterranean diet (MD) in the subgroup age of older adults with MS. AIMS The present study aimed to investigate the potential impact of MD compliance in disease progression and symptoms severity as well as quality of life and physical activity of community-dwelling older adults with MS. METHODS This is a cross-sectional conducted on 227 older adults with no history of other severe disease. Relevant questionnaires were applied to collect sociodemographic and anthropometric factors by face-to face interviews between patients and qualified personnel. Serum biomarkers were retrieved by patients' medical records. RESULTS Higher MD compliance was independently associated with younger patients' age, lower risk of overweight/obesity and abdominal obesity, decreased disease progression and higher muscle mass, as well as greater physical activity, better quality of life, and adequate serum ferritin and albumin levels CONCLUSIONS: MD may exert beneficial effects in older adults with MS. Future strategies and policies are highly recommended to inform both the general population and the older patients with MS for the beneficial effects of MD in preventing MS and in improving or even slowing down the disease progression and symptoms severity of MS.
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Affiliation(s)
- Christina Tryfonos
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400, Lemnos, Myrina, Greece
| | - Maria Chrysafi
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400, Lemnos, Myrina, Greece
| | - Sousana K Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, Thessaloniki, Greece
| | - Konstantinos Vadikolias
- Department of Neurology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Spanoudaki
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, Thessaloniki, Greece
- Clinical Dietetics and Nutritional Department, 424 General Military Hospital, Thessaloníki, Greece
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400, Lemnos, Myrina, Greece
| | - Dimitrios Fotiou
- Department of Neurology, School of Medicine, Aristoteleio University of Thessaloniki, Thessaloníki, Greece
| | - Eleni Pavlidou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400, Lemnos, Myrina, Greece
| | - Georgios Gkouvas
- Clinical Dietetics and Nutritional Department, 424 General Military Hospital, Thessaloníki, Greece
| | - Theofanis Vorvolakos
- Department of Geriatric Psychiatry, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Alexia Bisbinas
- University General Hospital of Thessaloniki AHEPA, Thessaloníki, Greece
| | - Olga Alexatou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400, Lemnos, Myrina, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400, Lemnos, Myrina, Greece.
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Henderson K, Reihm J, Koshal K, Wijangco J, Miller N, Sara N, Doyle M, Mallory A, Sheridan J, Guo CY, Oommen L, Feinstein A, Mangurian C, Lazar A, Bove R. Pragmatic phase II clinical trial to improve depression care in a real-world diverse MS cohort from an academic MS centre in Northern California: MS CATCH study protocol. BMJ Open 2024; 14:e077432. [PMID: 38401894 PMCID: PMC10895222 DOI: 10.1136/bmjopen-2023-077432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/25/2024] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION Depression occurs in over 50% of individuals living with multiple sclerosis (MS) and can be treated using many modalities. Yet, it remains: under-reported by patients, under-ascertained by clinicians and under-treated. To enhance these three behaviours likely to promote evidence-based depression care, we engaged multiple stakeholders to iteratively design a first-in-kind digital health tool. The tool, MS CATCH (Care technology to Ascertain, Treat, and engage the Community to Heal depression in patients with MS), closes the communication loop between patients and clinicians. Between clinical visits, the tool queries patients monthly about mood symptoms, supports patient self-management and alerts clinicians to worsening mood via their electronic health record in-basket. Clinicians can also access an MS CATCH dashboard displaying patients' mood scores over the course of their disease, and providing comprehensive management tools (contributing factors, antidepressant pathway, resources in patient's neighbourhood). The goal of the current trial is to evaluate the clinical effect and usability of MS CATCH in a real-world clinical setting. METHODS AND ANALYSIS MS CATCH is a single-site, phase II randomised, delayed start, trial enrolling 125 adults with MS and mild to moderately severe depression. Arm 1 will receive MS CATCH for 12 months, and arm 2 will receive usual care for 6 months, then MS CATCH for 6 months. Clinicians will be randomised to avoid practice effects. The effectiveness analysis is superiority intent-to-treat comparing MS CATCH to usual care over 6 months (primary outcome: evidence of screening and treatment; secondary outcome: Hospital Anxiety Depression Scale-Depression scores). The usability of the intervention will also be evaluated (primary outcome: adoption; secondary outcomes: adherence, engagement, satisfaction). ETHICS AND DISSEMINATION University of California, San Francisco Institutional Review Board (22-36620). The findings of the study are planned to be shared through conferences and publishments in a peer-reviewed journal. The deidentified dataset will be shared with qualified collaborators on request, provision of CITI and other certifications, and data sharing agreement. We will share the results, once the data are complete and analysed, with the scientific community and patient/clinician participants through abstracts, presentations and manuscripts. TRIAL REGISTRATION NUMBER NCT05865405.
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Affiliation(s)
- Kyra Henderson
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Jennifer Reihm
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Kanishka Koshal
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Jaeleene Wijangco
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Nicolette Miller
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Narender Sara
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Marianne Doyle
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Alicia Mallory
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Judith Sheridan
- Patient Stakeholder, University of California San Francisco, San Francisco, California, USA
| | - Chu-Yueh Guo
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Lauren Oommen
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Christina Mangurian
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Ann Lazar
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Riley Bove
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
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Woelfle T, Bourguignon L, Lorscheider J, Kappos L, Naegelin Y, Jutzeler CR. Wearable Sensor Technologies to Assess Motor Functions in People With Multiple Sclerosis: Systematic Scoping Review and Perspective. J Med Internet Res 2023; 25:e44428. [PMID: 37498655 PMCID: PMC10415952 DOI: 10.2196/44428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/19/2022] [Accepted: 05/04/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Wearable sensor technologies have the potential to improve monitoring in people with multiple sclerosis (MS) and inform timely disease management decisions. Evidence of the utility of wearable sensor technologies in people with MS is accumulating but is generally limited to specific subgroups of patients, clinical or laboratory settings, and functional domains. OBJECTIVE This review aims to provide a comprehensive overview of all studies that have used wearable sensors to assess, monitor, and quantify motor function in people with MS during daily activities or in a controlled laboratory setting and to shed light on the technological advances over the past decades. METHODS We systematically reviewed studies on wearable sensors to assess the motor performance of people with MS. We scanned PubMed, Scopus, Embase, and Web of Science databases until December 31, 2022, considering search terms "multiple sclerosis" and those associated with wearable technologies and included all studies assessing motor functions. The types of results from relevant studies were systematically mapped into 9 predefined categories (association with clinical scores or other measures; test-retest reliability; group differences, 3 types; responsiveness to change or intervention; and acceptability to study participants), and the reporting quality was determined through 9 questions. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. RESULTS Of the 1251 identified publications, 308 were included: 176 (57.1%) in a real-world context, 107 (34.7%) in a laboratory context, and 25 (8.1%) in a mixed context. Most publications studied physical activity (196/308, 63.6%), followed by gait (81/308, 26.3%), dexterity or tremor (38/308, 12.3%), and balance (34/308, 11%). In the laboratory setting, outcome measures included (in addition to clinical severity scores) 2- and 6-minute walking tests, timed 25-foot walking test, timed up and go, stair climbing, balance tests, and finger-to-nose test, among others. The most popular anatomical landmarks for wearable placement were the waist, wrist, and lower back. Triaxial accelerometers were most commonly used (229/308, 74.4%). A surge in the number of sensors embedded in smartphones and smartwatches has been observed. Overall, the reporting quality was good. CONCLUSIONS Continuous monitoring with wearable sensors could optimize the management of people with MS, but some hurdles still exist to full clinical adoption of digital monitoring. Despite a possible publication bias and vast heterogeneity in the outcomes reported, our review provides an overview of the current literature on wearable sensor technologies used for people with MS and highlights shortcomings, such as the lack of harmonization, transparency in reporting methods and results, and limited data availability for the research community. These limitations need to be addressed for the growing implementation of wearable sensor technologies in clinical routine and clinical trials, which is of utmost importance for further progress in clinical research and daily management of people with MS. TRIAL REGISTRATION PROSPERO CRD42021243249; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=243249.
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Affiliation(s)
- Tim Woelfle
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Lucie Bourguignon
- Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Johannes Lorscheider
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Yvonne Naegelin
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
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Grant JG, Rapport LJ, Darling R, Waldron-Perrine B, Bernitsas E. Incremental validity of brief and abbreviated neuropsychological tests toward predicting functional outcomes in multiple sclerosis. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-11. [PMID: 36773023 DOI: 10.1080/23279095.2023.2176766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE This study examined the relationships among functional outcomes and performance on standard-length and abbreviated cognitive screening measures for multiple sclerosis (MS). METHOD 72 adults with MS underwent neurological examination and cognitive screening. They completed standard-length and abbreviated versions of tests from the Minimal Assessment of Cognitive Function in MS (MACFIMS), the abbreviated aMACFIMS, and the Brief International Cognitive Assessment for MS (BICAMS). Functional outcomes included neurological disability, physical and psychological dysfunction, and employment status. RESULTS Concordance of impairment classifications was examined between standard-length and abbreviated tests using logistic regression and ROC curve analyses. Overall, the abbreviated test versions showed a broad range of concordance with impairment classifications made using the full-length tests. Processing speed was the strongest correlate of neurological disability and employment status; immediate recall was the strongest predictor of subjective physical dysfunction. Test performance provided unique value toward predicting neurological disability and employment status, but not physical and psychological dysfunction. CONCLUSIONS The findings replicate some support for abbreviated tests in MS assessment, although caveats regarding loss of validity associated with abbreviation remain. The findings extend prior research showing that abbreviated tests of processing speed and immediate recall can provide unique predictive information regarding objective functional outcomes.
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Affiliation(s)
- Jeremy G Grant
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Lisa J Rapport
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Rachel Darling
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Brigid Waldron-Perrine
- Department of Physical Medicine & Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA
| | - Eva Bernitsas
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
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Graves JS, Ganzetti M, Dondelinger F, Lipsmeier F, Belachew S, Bernasconi C, Montalban X, van Beek J, Baker M, Gossens C, Lindemann M. Preliminary validity of the Draw a Shape Test for upper extremity assessment in multiple sclerosis. Ann Clin Transl Neurol 2022; 10:166-180. [PMID: 36563127 PMCID: PMC9930424 DOI: 10.1002/acn3.51705] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/15/2022] [Accepted: 11/05/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To validate the smartphone sensor-based Draw a Shape Test - a part of the Floodlight Proof-of-Concept app for remotely assessing multiple sclerosis-related upper extremity impairment by tracing six different shapes. METHODS People with multiple sclerosis, classified functionally normal/abnormal via their Nine-Hole Peg Test time, and healthy controls participated in a 24-week, nonrandomized study. Spatial (trace accuracy), temporal (mean and variability in linear, angular, and radial drawing velocities, and dwell time ratio), and spatiotemporal features (trace celerity) were cross-sectionally analyzed for correlation with standard clinical and brain magnetic resonance imaging (normalized brain volume and total lesion volume) disease burden measures, and for capacity to differentiate people with multiple sclerosis from healthy controls. RESULTS Data from 69 people with multiple sclerosis and 18 healthy controls were analyzed. Trace accuracy (all shapes), linear velocity variability (circle, figure-of-8, spiral shapes), and radial velocity variability (spiral shape) had a mostly fair/moderate-to-good correlation (|r| = 0.14-0.66) with all disease burden measures. Trace celerity also had mostly fair/moderate-to-good correlation (|r| = 0.18-0.41) with Nine-Hole Peg Test performance, cerebellar functional system score, and brain magnetic resonance imaging. Furthermore, partial correlation analysis related these results to motor impairment. People with multiple sclerosis showed greater drawing velocity variability, though slower mean velocity, than healthy controls. Linear velocity (spiral shape) and angular velocity (circle shape) potentially differentiate functionally normal people with multiple sclerosis from healthy controls. INTERPRETATION The Draw a Shape Test objectively assesses upper extremity impairment and correlates with all disease burden measures, thus aiding multiple sclerosis-related upper extremity impairment characterization.
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Affiliation(s)
- Jennifer S. Graves
- Department of NeurosciencesUniversity of California San DiegoSan DiegoCaliforniaUSA
| | | | | | | | | | | | - Xavier Montalban
- Department of Neurology‐Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat)Hospital Universitari Vall d'HebronBarcelonaSpain
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Identification of cognitive impairment, depression, and fatigue among multiple sclerosis patients in a large comprehensive care center: A mixed-methods, qualitative study. Mult Scler Relat Disord 2022; 68:104117. [PMID: 36037754 DOI: 10.1016/j.msard.2022.104117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/30/2022] [Accepted: 08/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite studies suggesting a high prevalence of cognitive impairment, depression, and fatigue (CDF) among patients with multiple sclerosis (MS), standardized CDF tools are used infrequently in clinical practice, potentially resulting in underdiagnosis. We documented the use of standardized tools to identify CDF in MS and sought to understand provider attitudes toward the tools and their use. METHODS This mixed-methods study analyzed electronic health records (EHRs) from a large US urban MS center to determine the frequency and types of CDF screenings and numbers of MS treatment encounters (January 2018-December 2019). Participants included neurologists and nurse practitioners with ≥30 eligible patients and a convenience sample of adult MS patients (≥18 years) with at least outpatient encounters during the study period. Semistructured provider interviews (n = 6; the principal investigator and 1 provider were excluded) were conducted, transcribed, coded, and analyzed to characterize screening patterns. Assessments included proportions of encounters and patients who had standardized CDF screenings, positive screening results, and documentation of a treatment recommendation, as well as provider attitudes toward tools and reported barriers and facilitators for use. Bivariate analysis was used to evaluate the relationship between screening rates and patient and provider covariates for groups with sufficient sample size (n = 30). RESULTS The final population included 260 unique patients, 489 outpatient encounters, and 8 providers. Of 260 patients (75% female, 83% aged <65 years), 24% (n = 63) were screened with a depression tool. Only 2% (n = 4) were screened with a tool measuring cognitive impairment, and none were screened with a tool measuring fatigue. Screening rates varied little by provider type. Higher depression screening rates were associated with white race (difference: 13.2%; 95% CI: 2.8-23.5%; P = .01), ≤2 visits during the study period (difference: 7.6%; 95% CI: 0.6-14.5%; P = .03), and provider experience >10 years (difference: 14.6%; 95% CI: 3.5-25.8%; P = .01). Lack of support staff and perception of limited treatment options were commonly cited barriers to standardized screening in provider interviews. The higher rate of depression screening is likely driven by institutional culture and priorities. CONCLUSION Providers recognize the importance of CDF to patients, despite infrequent use of standardized screening. Integrating screening into institutional practices may enable ongoing tracking of assessment scores and provide a more comprehensive and longitudinal picture of symptom progression.
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Holm SP, Wolfer AM, Pointeau GH, Lipsmeier F, Lindemann M. Practice effects in performance outcome measures in patients living with neurologic disorders – A systematic review. Heliyon 2022; 8:e10259. [PMID: 36082322 PMCID: PMC9445299 DOI: 10.1016/j.heliyon.2022.e10259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/05/2021] [Accepted: 08/05/2022] [Indexed: 10/26/2022] Open
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Spain R. Approach to Symptom Management in Multiple Sclerosis With a Focus on Wellness. Continuum (Minneap Minn) 2022; 28:1052-1082. [PMID: 35938657 DOI: 10.1212/con.0000000000001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article describes an approach to symptom management in people with multiple sclerosis (MS), emphasizing healthy lifestyles and evidence-based treatments. RECENT FINDINGS Growing evidence supports healthy nutrition, exercise, and emotional well-being (wellness) as foundational for MS symptom management. A stepped approach starts with healthy lifestyle practices and adds nonpharmacologic, pharmacologic, and procedural-based therapies balancing levels of evidence, risks, and potential benefits. The growing availability of cannabis and widespread use of dietary supplements in self-management of MS symptoms raise both therapeutic promises and challenges. SUMMARY Wellness approaches for MS symptom management foster self-reliance and should be reinforced early and often. Recognition of symptom clusters and medical comorbidities helps limit polypharmacy.
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Tardo LM, McCreary M, Majeed H, Greenberg BM. Determining Prevalence of Depression and Covariates of Depression in a Cohort of Multiple Sclerosis Patients. J Cent Nerv Syst Dis 2022; 14:11795735221098143. [PMID: 35558003 PMCID: PMC9087231 DOI: 10.1177/11795735221098143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Depression is one of the most common symptoms experienced by multiple
sclerosis patients and may be secondary to the disease itself as well as
other variables such as age, disease severity and side effects of
treatment. Objective To determine if there is an association between disease modifying therapies
and depression rates based on PHQ9 scores in multiple sclerosis. Methods This was a retrospective chart review. Patients followed at the University of
Texas Southwestern Multiple Sclerosis and Neuroimmunology Clinic from 2017
to 2020 were included in this study. Patients’ most recent PHQ-9 scores were
used. The following data was extracted from patient charts: disease
modifying therapy, age, disease duration, gender, antidepressant use and
ambulatory status. Results Data from our study included 2611 individual PHQ-9 scores. The majority of
our patients were female and the mean age across all treatment groups was
50.37 years old. The median disease duration across all treatment groups was
12.74 years. Most patients in this cohort required no ambulatory assistance.
43.86% of patients were on antidepressants and use was correlated with a
higher PHQ9 score. The median PHQ 9 score across all treatment groups was 4
(Interquartile range = 7). Across treatment groups, patients on interferon
therapy had the lowest PHQ 9 scores with a median of 2. Conclusions Our study demonstrated that there were lower PHQ-9 scores among interferon
treatment group as compared to other disease modifying therapies and
non-treatment groups
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Affiliation(s)
- Lauren M. Tardo
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Morgan McCreary
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
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12
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Zaratin P, Vermersch P, Amato MP, Brichetto G, Coetzee T, Cutter G, Edan G, Giovannoni G, Gray E, Hartung HP, Hobart J, Helme A, Hyde R, Khan U, Leocani L, Mantovani LG, McBurney R, Montalban X, Penner IK, Uitdehaag BM, Valentine P, Weiland H, Bertorello D, Battaglia MA, Baneke P, Comi G. The agenda of the global Patient Reported Outcomes for Multiple Sclerosis (PROMS) Initiative: progresses and open questions. Mult Scler Relat Disord 2022; 61:103757. [DOI: 10.1016/j.msard.2022.103757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/14/2022] [Accepted: 03/20/2022] [Indexed: 11/25/2022]
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13
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Veillard D, Deburghgraeve V, Le Page E, Debouverie M, Wiertlewski S, Gallien P, Edan G. Developing tools to evaluate quality of care management for patients living with multiple sclerosis: An original French initiative. Rev Neurol (Paris) 2022; 178:722-731. [DOI: 10.1016/j.neurol.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/15/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022]
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14
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Yang Z, Pou-Prom C, Jones A, Banning M, Dai D, Mamdani M, Oh J, Antoniou T. Assessment of Natural Language Processing Methods for Ascertaining the Expanded Disability Status Scale Score From the Electronic Health Records of Patients With Multiple Sclerosis: Algorithm Development and Validation Study. JMIR Med Inform 2022; 10:e25157. [PMID: 35019849 PMCID: PMC8792771 DOI: 10.2196/25157] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/08/2021] [Accepted: 11/19/2021] [Indexed: 01/16/2023] Open
Abstract
Background The Expanded Disability Status Scale (EDSS) score is a widely used measure to monitor disability progression in people with multiple sclerosis (MS). However, extracting and deriving the EDSS score from unstructured electronic health records can be time-consuming. Objective We aimed to compare rule-based and deep learning natural language processing algorithms for detecting and predicting the total EDSS score and EDSS functional system subscores from the electronic health records of patients with MS. Methods We studied 17,452 electronic health records of 4906 MS patients followed at one of Canada’s largest MS clinics between June 2015 and July 2019. We randomly divided the records into training (80%) and test (20%) data sets, and compared the performance characteristics of 3 natural language processing models. First, we applied a rule-based approach, extracting the EDSS score from sentences containing the keyword “EDSS.” Next, we trained a convolutional neural network (CNN) model to predict the 19 half-step increments of the EDSS score. Finally, we used a combined rule-based–CNN model. For each approach, we determined the accuracy, precision, recall, and F-score compared with the reference standard, which was manually labeled EDSS scores in the clinic database. Results Overall, the combined keyword-CNN model demonstrated the best performance, with accuracy, precision, recall, and an F-score of 0.90, 0.83, 0.83, and 0.83 respectively. Respective figures for the rule-based and CNN models individually were 0.57, 0.91, 0.65, and 0.70, and 0.86, 0.70, 0.70, and 0.70. Because of missing data, the model performance for EDSS subscores was lower than that for the total EDSS score. Performance improved when considering notes with known values of the EDSS subscores. Conclusions A combined keyword-CNN natural language processing model can extract and accurately predict EDSS scores from patient records. This approach can be automated for efficient information extraction in clinical and research settings.
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Affiliation(s)
- Zhen Yang
- Data Science and Advanced Analytics, Unity Health Toronto, Toronto, ON, Canada
| | - Chloé Pou-Prom
- Data Science and Advanced Analytics, Unity Health Toronto, Toronto, ON, Canada
| | - Ashley Jones
- Division of Neurology, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Michaelia Banning
- Data Science and Advanced Analytics, Unity Health Toronto, Toronto, ON, Canada
| | - David Dai
- Data Science and Advanced Analytics, Unity Health Toronto, Toronto, ON, Canada
| | - Muhammad Mamdani
- Data Science and Advanced Analytics, Unity Health Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jiwon Oh
- Division of Neurology, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Tony Antoniou
- Data Science and Advanced Analytics, Unity Health Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, Unity Health Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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15
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Block VJ, Pitsch EA, Gopal A, Zhao C, Pletcher MJ, Marcus GM, Olgin JE, Hollenbach J, Bove R, Cree BAC, Gelfand JM. Identifying falls remotely in people with multiple sclerosis. J Neurol 2022; 269:1889-1898. [PMID: 34405267 PMCID: PMC8370664 DOI: 10.1007/s00415-021-10743-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 10/29/2022]
Abstract
BACKGROUND Falling is common in people with multiple sclerosis (MS) but tends to be under-ascertained and under-treated. OBJECTIVE To evaluate fall risk in people with MS. METHODS Ninety-four people with MS, able to walk > 2 min with or without an assistive device (Expanded Disability Status Scale (EDSS ≤ 6.5) were recruited. Clinic-based measures were recorded at baseline and 1 year. Patient-reported outcomes (PROs), including a fall survey and the MS Walking Scale (MSWS-12), were completed at baseline, 1.5, 3, 6, 9, and 12 months. Average daily step counts (STEPS) were recorded using a wrist-worn accelerometer. RESULTS 50/94 participants (53.2%) reported falling at least once. Only 56% of participants who reported a fall on research questionnaires had medical-record documented falls. Fallers had greater disability [median EDSS 5.5 (IQR 4.0-6.0) versus 2.5 (IQR 1.5-4.0), p < 0.001], were more likely to have progressive MS (p = 0.003), and took fewer STEPS (mean difference - 1,979, p = 0.007) than Non-Fallers. Stepwise regression revealed MSWS-12 as a major predictor of future falls. CONCLUSIONS Falling is common in people with MS, under-reported, and under-ascertained by neurologists in clinic. Multimodal fall screening in clinic and remotely may help improve patient care by identifying those at greatest risk, allowing for timely intervention and referral to specialized physical rehabilitation.
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Affiliation(s)
- Valerie J. Block
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Erica A. Pitsch
- grid.266102.10000 0001 2297 6811Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, USA
| | - Arpita Gopal
- grid.266102.10000 0001 2297 6811Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, USA
| | - Chao Zhao
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Mark J. Pletcher
- grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA ,grid.266102.10000 0001 2297 6811Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Gregory M. Marcus
- grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Jeffrey E. Olgin
- grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Jill Hollenbach
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Riley Bove
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Bruce A. C. Cree
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Jeffrey M. Gelfand
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
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16
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The evolution of multiple sclerosis in Spain over the last decade from the patient's perspective. Mult Scler Relat Disord 2022; 57:103355. [DOI: 10.1016/j.msard.2021.103355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022]
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17
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Hsu WY, Rowles W, Anguera JA, Anderson A, Younger JW, Friedman S, Gazzaley A, Bove R. Assessing Cognitive Function in Multiple Sclerosis With Digital Tools: Observational Study. J Med Internet Res 2021; 23:e25748. [PMID: 34967751 PMCID: PMC8759021 DOI: 10.2196/25748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/29/2021] [Accepted: 11/16/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Cognitive impairment (CI) is one of the most prevalent symptoms of multiple sclerosis (MS). However, it is difficult to include cognitive assessment as part of MS standard care since the comprehensive neuropsychological examinations are usually time-consuming and extensive. OBJECTIVE To improve access to CI assessment, we evaluated the feasibility and potential assessment sensitivity of a tablet-based cognitive battery in patients with MS. METHODS In total, 53 participants with MS (24 [45%] with CI and 29 [55%] without CI) and 24 non-MS participants were assessed with a tablet-based cognitive battery (Adaptive Cognitive Evaluation [ACE]) and standard cognitive measures, including the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test (PASAT). Associations between performance in ACE and the SDMT/PASAT were explored, with group comparisons to evaluate whether ACE modules can capture group-level differences. RESULTS Correlations between performance in ACE and the SDMT (R=-0.57, P<.001), as well as PASAT (R=-0.39, P=.01), were observed. Compared to non-MS and non-CI MS groups, the CI MS group showed a slower reaction time (CI MS vs non-MS: P<.001; CI MS vs non-CI MS: P=.004) and a higher attention cost (CI MS vs non-MS: P=.02; CI MS vs non-CI MS: P<.001). CONCLUSIONS These results provide preliminary evidence that ACE, a tablet-based cognitive assessment battery, provides modules that could potentially serve as a digital cognitive assessment for people with MS. TRIAL REGISTRATION ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618.
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Affiliation(s)
- Wan-Yu Hsu
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
| | - William Rowles
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
| | - Joaquin A Anguera
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
- Neuroscape, University of California, San Francisco, CA, United States
- Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Annika Anderson
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
| | - Jessica W Younger
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
- Neuroscape, University of California, San Francisco, CA, United States
| | - Samuel Friedman
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
| | - Adam Gazzaley
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
- Neuroscape, University of California, San Francisco, CA, United States
- Department of Psychiatry, University of California, San Francisco, CA, United States
- Department of Physiology, University of California, San Francisco, CA, United States
| | - Riley Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
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18
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Veillard D, Le Page E, Epstein J, Wiertlewski S, Gallien P, Hamonic S, Debouverie M, Edan G. Evaluation of the quality of the care pathway for patients with multiple sclerosis in France: Results of an original study of a cohort of 700 patients. Rev Neurol (Paris) 2021; 178:580-590. [PMID: 34893353 DOI: 10.1016/j.neurol.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/17/2021] [Accepted: 09/24/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Evaluating the quality of the care pathway for patients with chronic diseases, such as multiple sclerosis (MS), is an important issue. Process indicators are a recognized method for evaluating professional practices. However, these tools have been little developed in the field of MS, and few data are available. The aim of this study was to describe, retrospectively, with validated indicators, the quality of the care pathway in a population-based cohort of 700 patients with the first manifestations of the disease occurring between January 1, 2000 and December 31, 2001 and during the first 10 years of disease. METHOD This assessment was based on 48 indicators specific to MS. The information required for the calculation of each indicator was collected from the source files of the 700 patients of the cohort. RESULTS Data for the 10 years of follow-up were collected for 80% of the patients. In total, 36 indicators were calculated. These results reveal that there is room for improvement, particularly in terms of the initial assessment, access to ophthalmological evaluation, employment, obtaining an evaluation of the need for rehabilitation and access to such care. CONCLUSION The results of this survey provide access to unprecedented new data in France, that professionals and patients can appropriate to improve the targeting of actions, to improve the quality of care further for patients with MS in France. We propose to continue this process by submitting, for discussion, a targeted list of updated indicators relating to changes in guidelines, and in issues concerning the quality of patient management.
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Affiliation(s)
- D Veillard
- Service d'épidémiologie et de santé publique, CHU, 35000 Rennes, France; Équipe d'accueil 3279, centre d'études et de recherche sur les services de santé, Aix-Marseille Université, 13000 Marseille, France.
| | - E Le Page
- Inserm, service de neurologie, Clinical Neuroscience Center CIC-P 1414, CHU, 35000 Rennes, France.
| | - J Epstein
- Service d'épidémiologie, clinique du centre hospitalier universitaire and Clinical Investigation Center CIC 1433, 54000 Nancy, France.
| | - S Wiertlewski
- Clinique neurologique, CHU de Nantes, 44000 Nantes, France.
| | - P Gallien
- Pôle de médecine physique et de rehabilitation Saint-Hélier, 35000 Rennes, France.
| | - S Hamonic
- Service d'épidémiologie et de santé publique, CHU, 35000 Rennes, France.
| | - M Debouverie
- Équipe d'accueil 4360 adaptation, mesure et évaluation en santé, approches interdisciplinaires, service de neurologie, université de Lorraine, CHU de Nancy, 54000 Nancy, France.
| | - G Edan
- Inserm, Clinical Neuroscience Centre, CIC-P 1414, Université de Rennes 1, 35000 Rennes, France.
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19
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Kraft AK, Berger K. Quality of Care for Patients With Multiple Sclerosis-A Review of Existing Quality Indicators. Front Neurol 2021; 12:708723. [PMID: 34421807 PMCID: PMC8374044 DOI: 10.3389/fneur.2021.708723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The care of patients with multiple sclerosis (MS) calls for a lifelong guidance and treatment and results in a high resource utilization. Therefore, strategies for the assessment and improvement of the care process are crucial. Quality indicators have become a widely used instrument to determine quality in many areas of the healthcare system. The currently available sets of indicators for the quality of MS care are summarized in this review. Methods: A literature search was conducted for reports that include statements on quality indicators for the care of people with MS. For the determination of the strength of the underlying evidence of the identified publications appropriate criteria of the PRISMA and AGREE-Statements were used. A further prioritization of the eligible indicators was based on the internal grading by the initial authors. Results: Of the 465 included records in the search, 6 sources were finally identified, 3 demonstrating a high and the others a medium strength of evidence. In total, these six reports described 226 quality indicators for the treatment of MS. Of them, 147 were further included in the assessment due to the scope of this article. Among the 101 indicators that originated from reports with a high strength of evidence, 6 also had a high initial internal grading. These six identified quality indicators describe five important characteristics of a high-quality care of MS. Conclusion: The search led to a scientifically evident set of six quality indicators for the assessment of care for patients with MS. These should be seen as starting points in the development of comprehensive sets of quality indicators in MS that addresses the individual objective of their use.
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Affiliation(s)
- Anna Kristina Kraft
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
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20
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Montalban X, Graves J, Midaglia L, Mulero P, Julian L, Baker M, Schadrack J, Gossens C, Ganzetti M, Scotland A, Lipsmeier F, van Beek J, Bernasconi C, Belachew S, Lindemann M, Hauser SL. A smartphone sensor-based digital outcome assessment of multiple sclerosis. Mult Scler 2021; 28:654-664. [PMID: 34259588 PMCID: PMC8961252 DOI: 10.1177/13524585211028561] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Sensor-based monitoring tools fill a critical gap in multiple sclerosis (MS)
research and clinical care. Objective: The aim of this study is to assess performance characteristics of the
Floodlight Proof-of-Concept (PoC) app. Methods: In a 24-week study (clinicaltrials.gov: NCT02952911), smartphone-based active
tests and passive monitoring assessed cognition (electronic Symbol Digit
Modalities Test), upper extremity function (Pinching Test, Draw a Shape
Test), and gait and balance (Static Balance Test, U-Turn Test, Walk Test,
Passive Monitoring). Intraclass correlation coefficients (ICCs) and age- or
sex-adjusted Spearman’s rank correlation determined test–retest reliability
and correlations with clinical and magnetic resonance imaging (MRI) outcome
measures, respectively. Results: Seventy-six people with MS (PwMS) and 25 healthy controls were enrolled. In
PwMS, ICCs were moderate-to-good (ICC(2,1) = 0.61–0.85) across tests.
Correlations with domain-specific standard clinical disability measures were
significant for all tests in the cognitive (r = 0.82,
p < 0.001), upper extremity function (|r|=
0.40–0.64, all p < 0.001), and gait and balance domains
(r = −0.25 to −0.52, all p < 0.05;
except for Static Balance Test: r = −0.20,
p > 0.05). Most tests also correlated with Expanded
Disability Status Scale, 29-item Multiple Sclerosis Impact Scale items or
subscales, and/or normalized brain volume. Conclusion: The Floodlight PoC app captures reliable and clinically relevant measures of
functional impairment in MS, supporting its potential use in clinical
research and practice.
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Affiliation(s)
- Xavier Montalban
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jennifer Graves
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA
| | - Luciana Midaglia
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain and Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Patricia Mulero
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Stephen L Hauser
- UCSF Weill Institute for Neurosciences and Department of Neurology, University of California San Francisco, San Francisco, CA, USA
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21
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Lakin L, Davis BE, Binns CC, Currie KM, Rensel MR. Comprehensive Approach to Management of Multiple Sclerosis: Addressing Invisible Symptoms-A Narrative Review. Neurol Ther 2021; 10:75-98. [PMID: 33877583 PMCID: PMC8057008 DOI: 10.1007/s40120-021-00239-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune inflammatory disease of the central nervous system, leading to neurodegeneration and manifesting as a variety of symptoms. These can include "invisible" symptoms, not externally evident to others, such as fatigue, mood disorders, cognitive impairments, pain, bladder/bowel dysfunction, sexual dysfunction, and vision changes. Invisible symptoms are highly prevalent in people living with MS, with multifactorial etiology and potential to impact the disease course. Patient experiences of these symptoms include both physical and psychosocial elements, which when unaddressed negatively influence many aspects of quality of life and perception of health. Despite the high impact on patient lives, gaps persist in awareness and management of these hidden symptoms. The healthcare provider and patient author experiences brought together here serve to raise the profile of invisible symptoms and review strategies for a team-based approach to comprehensive MS care. We summarize the current literature regarding the prevalence and etiology of invisible symptoms to convey the high likelihood that a person living with MS will contend with one or more of these concerns. We then explore how open communication between people living with MS and their care team, stigma mitigation, and shared decision-making are key to comprehensive management of invisible symptoms. We recommend validated screening tools and technological advancements that may be incorporated into MS care to regularly monitor these symptoms, offering insight into how healthcare providers can both educate and listen to patients, with the goal of improved patient quality of life. By pairing clinical knowledge with an understanding and consideration of the patient perspective, providers will be equipped to foster a patient-centered dialogue that encourages shared decision-making. Invisible symptoms of MS.
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Affiliation(s)
- Lynsey Lakin
- The Neurology Group, 9120 Haven Ave, Rancho Cucamonga, CA, USA
- Comprehensive MS Center, The University of California Riverside, 3390 University Ave, Suite 100, Riverside, CA, USA
| | - Bryan E Davis
- Comprehensive MS Center, The University of California Riverside, 3390 University Ave, Suite 100, Riverside, CA, USA
| | - Cherie C Binns
- Accelerated Cure Project/iConquerMS, 187 Robinson Street, Wakefield, RI, USA
| | - Keisha M Currie
- Currie Consultancy Agency LLC., 11 M. R. Watson Court, Eastover, SC, USA
| | - Mary R Rensel
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
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22
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Dujari S, Gummidipundi S, He Z, Gold CA. Administration of Dexamethasone for Bacterial Meningitis: An Unreliable Quality Measure. Neurohospitalist 2021; 11:101-106. [PMID: 33791051 DOI: 10.1177/1941874420969556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To validate the use of administrative data to identify patients with bacterial meningitis and quantify the rate of dexamethasone administration as defined in the American Academy of Neurology Inpatient and Emergency Care Quality Measurement Set. Methods The Vizient Clinical Data Base and Resource Manager was used to identify patients with International Classification of Diseases, Tenth Revision (ICD-10) codes for bacterial meningitis from October 2015 to June 2019. Chart review was performed on patients identified at a single quaternary-care hospital. The positive predictive value (PPV) of Vizient was determined. Demographic, clinical, and laboratory data were assessed using descriptive statistics. Results Of all hospitals that submitted complete data to Vizient during the study period, a median of 19 patients per hospital had ICD-10 codes for bacterial meningitis in the 45-month period. We identified 79 patients using Vizient at our institution of whom 69 had a diagnosis of bacterial meningitis confirmed by chart review (PPV = 87%). 15 patients were eligible to receive dexamethasone per the quality measurement set. Six of these patients (40%) received dexamethasone. Conclusion It is feasible to use the Vizient Clinical Data Base and Resource Manager to identify patients with bacterial meningitis. Due to low prevalence across multiple institutions and high rate of exclusion criteria at our institution, this study suggests that the rate of dexamethasone administration in bacterial meningitis may be an unreliable indicator of quality of care provided by inpatient neurologists. The creation of a registry for hospitalized neurology patients could enhance development of future quality measures.
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Affiliation(s)
- Shefali Dujari
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
| | | | - Zihuai He
- Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
| | - Carl A Gold
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
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23
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Katzan IL, Lapin B, Griffith S, Jehi L, Fernandez H, Pioro E, Tepper S, Crane PK. Somatic symptoms have negligible impact on Patient Health Questionnaire-9 depression scale scores in neurological patients. Eur J Neurol 2021; 28:1812-1819. [PMID: 33715277 DOI: 10.1111/ene.14822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE There is concern that the Patient Health Questionnaire-9 (PHQ-9) depression scale may be impacted by the presence of somatic symptoms (differential item functioning [DIF]) in patients with neurological conditions. We evaluated the PHQ-9 for the presence and impact of DIF in large clinical samples of neurological patients. METHODS We conducted a cross-sectional study of patients seen at the Cleveland Clinic Cerebrovascular, Headache, Movement Disorder, and Neuromuscular clinics who completed the PHQ-9 and patient-reported disease severity measures as part of standard care between 29 July 2008 and 21 February 2013. We evaluated PHQ-9 items for DIF with respect to disease-specific severity for each condition. Salient DIF impact was characterized as a difference between DIF-adjusted and unadjusted PHQ-9 scores. RESULTS Included in the study were 2112 patients with stroke, 8221 with migraine, 440 with amyotrophic lateral sclerosis (ALS), and 5022 with Parkinson disease (PD). Several PHQ-9 items demonstrated DIF with respect to disease-specific severity, although salient DIF was present in very few patients (stroke, n = 0; migraine, n = 1; ALS, n = 13; PD, n = 1). CONCLUSIONS PHQ-9 items function consistently across disease severity, with salient levels of DIF impact found only for a very small proportion of people. These results suggest that the PHQ-9 provides a consistent measure of depression severity among people with neurological conditions associated with somatic symptoms that overlap with depression.
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Affiliation(s)
- Irene L Katzan
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brittany Lapin
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sandra Griffith
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lara Jehi
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hubert Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Erik Pioro
- Neuromuscular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stewart Tepper
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul K Crane
- Division of General Internal Medicine, University of Washington, Seattle, Washington, USA
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Hsieh K, Fanning J, Frechette M, Sosnoff J. Usability of a Fall Risk mHealth App for People With Multiple Sclerosis: Mixed Methods Study. JMIR Hum Factors 2021; 8:e25604. [PMID: 33749609 PMCID: PMC8080269 DOI: 10.2196/25604] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/20/2021] [Accepted: 02/22/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic, neurodegenerative disease that causes a range of motor, sensory, and cognitive symptoms. Due to these symptoms, people with MS are at a high risk for falls, fall-related injuries, and reductions in quality of life. There is no cure for MS, and managing symptoms and disease progression is important to maintain a high quality of life. Mobile health (mHealth) apps are commonly used by people with MS to help manage their health. However, there are limited health apps for people with MS designed to evaluate fall risk. A fall risk app can increase access to fall risk assessments and improve self-management. When designing mHealth apps, a user-centered approach is critical for improving use and adoption. OBJECTIVE The purpose of this study is to undergo a user-centered approach to test and refine the usability of the app through an iterative design process. METHODS The fall risk app Steady-MS is an extension of Steady, a fall risk app for older adults. Steady-MS consists of 2 components: a 25-item questionnaire about demographics and MS symptoms and 5 standing balance tasks. Data from the questionnaire and balance tasks were inputted into an algorithm to compute a fall risk score. Two iterations of semistructured interviews (n=5 participants per iteration) were performed to evaluate usability. People with MS used Steady-MS on a smartphone, thinking out loud. Interviews were recorded, transcribed, and developed into codes and themes. People with MS also completed the System Usability Scale. RESULTS A total of 3 themes were identified: intuitive navigation, efficiency of use, and perceived value. Overall, the participants found Steady-MS efficient to use and useful to learn their fall risk score. There were challenges related to cognitive overload during the balance tasks. Modifications were made, and after the second iteration, people with MS reported that the app was intuitive and efficient. Average System Usability Scale scores were 95.5 in both iterations, representing excellent usability. CONCLUSIONS Steady-MS is the first mHealth app for people with MS to assess their overall risk of falling and is usable by a subset of people with MS. People with MS found Steady-MS to be usable and useful for understanding their risk of falling. When developing future mHealth apps for people with MS, it is important to prevent cognitive overload through simple and clear instructions and present scores that are understood and interpreted correctly through visuals and text. These findings underscore the importance of user-centered design and provide a foundation for the future development of tools to assess and prevent scalable falls for people with MS. Future steps include understanding the validity of the fall risk algorithm and evaluating the clinical utility of the app.
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Affiliation(s)
- Katherine Hsieh
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States.,Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Mikaela Frechette
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Jacob Sosnoff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States.,Department of Physical Therapy and Rehabilitation Sciences, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States
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Messinis L, Bakirtzis C, Kosmidis MH, Economou A, Nasios G, Anyfantis E, Konitsiotis S, Ntoskou A, Peristeri E, Dardiotis E, Grigoriadis N, Gourzis P, Papathanasopoulos P. Symbol Digit Modalities Test: Greek Normative Data for the Oral and Written Version and Discriminative Validity in Patients with Multiple Sclerosis. Arch Clin Neuropsychol 2021; 36:117-125. [PMID: 32385488 DOI: 10.1093/arclin/acaa028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/18/2020] [Accepted: 04/02/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The purpose of this study was to generate normative data on the Symbol Digits Modalities Test (SDMT) for the written and oral versions in the Greek adult population. We also investigated the test's validity in discriminating the performance of healthy adults from two groups of adults diagnosed with relapsing remitting (RRMS) and secondary progressive (SPMS) multiple sclerosis. METHOD The sample consisted of 609 healthy men and women between the ages of 18 and 65. All participants were monolingual native Greek adult speakers. Each healthy participant was administered either the written (n = 460) or oral (n = 149) versions of the SDMT. Discriminant validity was examined by comparing 35 healthy participants who had completed the oral version of the SDMT to 35 age - and education-matched RRMS and SPMS patients. RESULTS Linear regression models explained between 36% and 55% of the variance in the SDMT oral and written version scores. Age was the strongest predictor of difference in SDMT written and oral version performance, followed by education that also accounted for a further proportion of the SDMT variance. On the contrary, gender was found not to contribute significantly to the variance in the SDMT for either the written or the oral versions. As a result, age- and education-adjusted norms were generated. Regarding the tests discriminative validity, we found that both MS patient groups scored significantly lower than the healthy group. CONCLUSIONS This is the first study to provide comprehensive normative data for the SDMT in the adult population in Greece, impacting the future practice of neuropsychological assessment in this country.
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Affiliation(s)
- Lambros Messinis
- Neuropsychology Section, Departments of Neurology and Psychiatry, University Hospital of Patras and University of Patras Medical School, Patras, Greece
| | - Christos Bakirtzis
- B'Department of Neurology and the MS Center, AHEPA University Hospital, Central Macedonia, Thessaloniki, Greece
| | - Mary Helen Kosmidis
- Laboratory of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Greece
| | - Alexandra Economou
- Department of Psychology, School of Philosophy, University of Athens, Athens, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Emmanouil Anyfantis
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece.,Department of Neurology, University of Ioannina Medical School, Ioannina, Greece
| | - Spiridon Konitsiotis
- Department of Neurology, University of Ioannina Medical School, Ioannina, Greece
| | - Aikaterini Ntoskou
- Rehabilitation Unit for Patients with Spinal Cord Injury, "Demetrios and Vera Sfikas" Department of Medicine, University of Patras Medical School, Patras, Greece
| | - Eleni Peristeri
- Department of Neurology, University of Thessaly Medical School, Larissa, Greece
| | - Efthymios Dardiotis
- Department of Neurology, University of Thessaly Medical School, Larissa, Greece
| | - Nikolaos Grigoriadis
- B'Department of Neurology and the MS Center, AHEPA University Hospital, Central Macedonia, Thessaloniki, Greece
| | - Phillipos Gourzis
- Department of Psychiatry, University of Patras Medical School, Patras, Greece
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Consequences of Insurance Denials Among U.S. Patients Prescribed Repository Corticotropin Injection for Acute Exacerbations of Multiple Sclerosis. Neurol Ther 2020; 10:149-167. [PMID: 33170434 PMCID: PMC8140003 DOI: 10.1007/s40120-020-00219-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Repository corticotropin injection (RCI; Acthar® Gel) is indicated for the treatment of acute exacerbations of multiple sclerosis (MS) in adults. Despite the well-documented clinical and economic benefits of RCI, many patients are denied use of the therapy by third-party payers. This study aims to understand the demographic and clinical characteristics of MS relapse patients who received a prescription for RCI from their physicians and then were either approved or denied treatment by their insurers. The study compares measurable clinical outcomes and healthcare resource utilization (HCRU) between approved and denied cohorts. Methods A retrospective analysis of adults experiencing MS relapse from January 2015 to December 2018 was conducted using a de-identified open-source claims database [Symphony Health Integrated Dataverse® (IDV)]. Patients were identified using ICD codes for MS and considered to have relapsing/remitting type according to established claims-based methodology. Clinical characteristics and HCRU were analyzed during the year preceding (“baseline”) and the year following (“follow-up”) each patient’s index date, defined as the date of a patient’s first approved RCI claim (for patients with ≥ 1 approved claim) or first denied RCI claim (for patients with only denied claims). Baseline characteristics were reported with unadjusted differences and p values indicating the significance of characteristics between the two cohorts. For outcomes, match-adjusted results were reported using propensity matching to account for underlying differences between cohorts. Results The study sample included 1902 MS relapse patients with at least one claim for RCI. At baseline, approved patients were slightly older compared to denied patients (mean age 48.0 vs. 47.2), had higher rates of hemiplegia/paraplegia (6.7% vs. 3.3%), greater mobility impairment (17% vs. 11.5%), more exacerbation episodes (66.2% vs. 59.9%), and a higher number of physical therapy/rehab claims (23.5 vs. 14.0), respectively. Outcomes among the matched sample show an increased use of corticosteroids for patients denied access to RCI compared to approved patients (51.1% vs. 42.4%), more exacerbation episodes (36.6% vs. 28.2%), and an increased number of physical therapy/rehab claims (11.5% vs. 9.9%), respectively. Conclusion The results of this study may aid providers and payers in evaluating scenarios where RCI may be beneficial and improve quality of care for patients experiencing MS relapse.
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Kamalabadi YM, Sedigh SS, Abbaslou M. The relationship between DMFT index and cognitive impairment: A descriptive cross-sectional study. J Family Med Prim Care 2020; 9:4317-4322. [PMID: 33110852 PMCID: PMC7586545 DOI: 10.4103/jfmpc.jfmpc_90_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/12/2020] [Accepted: 04/18/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Cognitive disorders are characterized by major impairments in functions such as memory, judgment, language and attention. One of the tests used to assess these disorders is called the Montreal Cognitive Assessment Test, which is one of the most recent tests known in this field. DMFT index is the most important dental index for evaluation of decayed, missing and filled teeth. Since alteration or damage to the sensory function of teeth can cause changes in chewing function and different levels of cognitive disorders. The objective of this study was to determine the relationship of DMFT index with cognitive disorders in people aged 25-55 in Rafsanjan in 2019. Materials and Methods This cross-sectional study was performed on 350 patients chosen by simple random sampling within age range of 25-55 years, referred to Rafsanjan Dental School in 2019. Patients' demographic information was recorded and each was given a consent form and also Montreal Cognitive Assessment Test. Dental examination regarding decayed, missing and filled teeth was then carried out by a dentist and The DMFT index was recorded. Data were then analyzed by SPSS version 21; P value less than 0.05 was considered as significant level. Results Data showed that the MOCA index had a negative significant relationship with DMFT (P = 0.001) and age (P = 0.001) and had a significant positive relationship with education (P = 0.001), but it had no significant relationship with gender (P = 0.853), time of last dental appointment (P = 0.231) and place of residence (P = 0.428). The effect of age (P = 0.67) and gender (P = 0.525) on the relationship of DMFT and MOCA was not significant. But the effect of education (P = 0.001), place of residence (P = 0.0003) and time of last dental appointment (P = 0.002) on it was significant. Conclusion The results of this study showed that the relationship between DMFT index and cognitive disorders was significant and the higher the score of this index, the more severe cognitive disorders.
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Affiliation(s)
| | - Somaye Salari Sedigh
- Department of Periodontology, School of Dentistry, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Sico JJ, Sarwal A, Benish SM, Busis NA, Cohen BH, Das RR, Finsilver S, Halperin JJ, Kelly AG, Meunier L, Phipps MS, Thirumala PD, Villanueva R, von Gaudecker J, Bennett A, Shenoy AM. Quality improvement in neurology. Neurology 2020; 94:982-990. [DOI: 10.1212/wnl.0000000000009525] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/30/2020] [Indexed: 01/06/2023] Open
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Wallin MT, Whitham R, Maloni H, Jin S, Duckart J, Haselkorn J, Culpepper WJ. The Multiple Sclerosis Surveillance Registry: A Novel Interactive Database Within the Veterans Health Administration. Fed Pract 2020; 37:S18-S23. [PMID: 32341633 PMCID: PMC7182245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To demonstrate the infrastructure and utility of an interactive health system database for multiple sclerosis (MS), we present the MS Surveillance Registry (MSSR) within the US Department of Veterans Affairs (VA). BACKGROUND Disease specific databases can be helpful in the management of neurologic conditions but few are fully integrated into the electronic health record and linked to health system data. Creating a consistent information technology (IT) architecture and with ongoing support within disease specific registries has been a challenge. METHODS Building the MSSR was initiated by an iterative process with an IT team and MS health care providers. A common registry platform shared by other VA disease specific registries (eg, traumatic brain injury and cancer) was used to develop the IT infrastructure. MS cases were entered online into the MS Assessment Tool at selected MS Centers of Excellence (MSCoE) clinics in the US. Other large VA databases linked to MSSR are reviewed. Patient demographic and clinical characteristics were compared and contrasted with the broader VA population and other US registry populations. RESULTS We have enrolled 1,743 patients with MS in the MSSR through fiscal year 2019 from selected MS regional programs in the VA MSCoE network. The mean age of patients was 56.0 years, with a 2.7 male:female ratio. Among those with definite MS, the mean European Database for MS Disability Score was 4.7 and 75% had ever used an MS disease modifying therapy. A summary electronic dashboard was developed for health care providers to easily access demographic and clinical data for individuals and groups of patients. Data on comorbid conditions, pharmacy and prosthetics utilization, outpatient clinic visits, and inpatient admission were documented for each patient. CONCLUSIONS The MSSR is a unique electronic database that has enhanced clinical management of MS and serves as a national source for clinical outcomes.
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Affiliation(s)
- Mitchell T Wallin
- is the Director of the VA Multiple Sclerosis Center of Excellence (MSCoE)-East and Associate Professor of Neurology, George Washington University School of Medicine in Washington, DC. is Professor Emeritus of Neurology at Oregon Health and Science University in Portland. is the Clinical Director of the VA MSCoE-East in Washington, DC. is a Statistician and Data Analyst at VA MSCoE-East in Baltimore, Maryland. is a Health System Specialist at the VA Office of Inspector General in Portland. is the Director of the VA MSCoE-West and a Professor of Physical Medicine and Rehabilitation at the University of Washington School of Medicine and Public Health in Seattle. is the Director of the Veterans Health Administration Epidemiology Program and Director of Epidemiology and Informatics at VA MSCoE-East and an Adjunct Associate Professor of Neurology at the University of Maryland School of Medicine in Baltimore
| | - Ruth Whitham
- is the Director of the VA Multiple Sclerosis Center of Excellence (MSCoE)-East and Associate Professor of Neurology, George Washington University School of Medicine in Washington, DC. is Professor Emeritus of Neurology at Oregon Health and Science University in Portland. is the Clinical Director of the VA MSCoE-East in Washington, DC. is a Statistician and Data Analyst at VA MSCoE-East in Baltimore, Maryland. is a Health System Specialist at the VA Office of Inspector General in Portland. is the Director of the VA MSCoE-West and a Professor of Physical Medicine and Rehabilitation at the University of Washington School of Medicine and Public Health in Seattle. is the Director of the Veterans Health Administration Epidemiology Program and Director of Epidemiology and Informatics at VA MSCoE-East and an Adjunct Associate Professor of Neurology at the University of Maryland School of Medicine in Baltimore
| | - Heidi Maloni
- is the Director of the VA Multiple Sclerosis Center of Excellence (MSCoE)-East and Associate Professor of Neurology, George Washington University School of Medicine in Washington, DC. is Professor Emeritus of Neurology at Oregon Health and Science University in Portland. is the Clinical Director of the VA MSCoE-East in Washington, DC. is a Statistician and Data Analyst at VA MSCoE-East in Baltimore, Maryland. is a Health System Specialist at the VA Office of Inspector General in Portland. is the Director of the VA MSCoE-West and a Professor of Physical Medicine and Rehabilitation at the University of Washington School of Medicine and Public Health in Seattle. is the Director of the Veterans Health Administration Epidemiology Program and Director of Epidemiology and Informatics at VA MSCoE-East and an Adjunct Associate Professor of Neurology at the University of Maryland School of Medicine in Baltimore
| | - Shan Jin
- is the Director of the VA Multiple Sclerosis Center of Excellence (MSCoE)-East and Associate Professor of Neurology, George Washington University School of Medicine in Washington, DC. is Professor Emeritus of Neurology at Oregon Health and Science University in Portland. is the Clinical Director of the VA MSCoE-East in Washington, DC. is a Statistician and Data Analyst at VA MSCoE-East in Baltimore, Maryland. is a Health System Specialist at the VA Office of Inspector General in Portland. is the Director of the VA MSCoE-West and a Professor of Physical Medicine and Rehabilitation at the University of Washington School of Medicine and Public Health in Seattle. is the Director of the Veterans Health Administration Epidemiology Program and Director of Epidemiology and Informatics at VA MSCoE-East and an Adjunct Associate Professor of Neurology at the University of Maryland School of Medicine in Baltimore
| | - Jonathan Duckart
- is the Director of the VA Multiple Sclerosis Center of Excellence (MSCoE)-East and Associate Professor of Neurology, George Washington University School of Medicine in Washington, DC. is Professor Emeritus of Neurology at Oregon Health and Science University in Portland. is the Clinical Director of the VA MSCoE-East in Washington, DC. is a Statistician and Data Analyst at VA MSCoE-East in Baltimore, Maryland. is a Health System Specialist at the VA Office of Inspector General in Portland. is the Director of the VA MSCoE-West and a Professor of Physical Medicine and Rehabilitation at the University of Washington School of Medicine and Public Health in Seattle. is the Director of the Veterans Health Administration Epidemiology Program and Director of Epidemiology and Informatics at VA MSCoE-East and an Adjunct Associate Professor of Neurology at the University of Maryland School of Medicine in Baltimore
| | - Jodie Haselkorn
- is the Director of the VA Multiple Sclerosis Center of Excellence (MSCoE)-East and Associate Professor of Neurology, George Washington University School of Medicine in Washington, DC. is Professor Emeritus of Neurology at Oregon Health and Science University in Portland. is the Clinical Director of the VA MSCoE-East in Washington, DC. is a Statistician and Data Analyst at VA MSCoE-East in Baltimore, Maryland. is a Health System Specialist at the VA Office of Inspector General in Portland. is the Director of the VA MSCoE-West and a Professor of Physical Medicine and Rehabilitation at the University of Washington School of Medicine and Public Health in Seattle. is the Director of the Veterans Health Administration Epidemiology Program and Director of Epidemiology and Informatics at VA MSCoE-East and an Adjunct Associate Professor of Neurology at the University of Maryland School of Medicine in Baltimore
| | - William J Culpepper
- is the Director of the VA Multiple Sclerosis Center of Excellence (MSCoE)-East and Associate Professor of Neurology, George Washington University School of Medicine in Washington, DC. is Professor Emeritus of Neurology at Oregon Health and Science University in Portland. is the Clinical Director of the VA MSCoE-East in Washington, DC. is a Statistician and Data Analyst at VA MSCoE-East in Baltimore, Maryland. is a Health System Specialist at the VA Office of Inspector General in Portland. is the Director of the VA MSCoE-West and a Professor of Physical Medicine and Rehabilitation at the University of Washington School of Medicine and Public Health in Seattle. is the Director of the Veterans Health Administration Epidemiology Program and Director of Epidemiology and Informatics at VA MSCoE-East and an Adjunct Associate Professor of Neurology at the University of Maryland School of Medicine in Baltimore
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Abstract
PURPOSE OF REVIEW This article discusses the prevalence, identification, and management of multiple sclerosis (MS)-related symptoms and associated comorbidities, including complications that can present at all stages of the disease course. RECENT FINDINGS The impact of comorbidities on the outcome of MS is increasingly recognized. This presents an opportunity to impact the course and outcome of MS by identifying and treating associated comorbidities that may be more amenable to treatment than the underlying inflammatory and neurodegenerative disease. The identification of MS-related symptoms and comorbidities is facilitated by brief screening tools, ideally completed by the patient and automatically entered into the patient record, with therapeutic suggestions for the provider. The development of free, open-source screening tools that can be integrated with electronic health records provides opportunities to identify and treat MS-related symptoms and comorbidities at an early stage. SUMMARY Identification and management of MS-related symptoms and comorbidities can lead to improved outcomes, improved quality of life, and reduced disease activity. The use of brief patient-reported screening tools at or before the point of care can facilitate identification of symptoms and comorbidities that may be amenable to intervention.
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Clinical instrument to retrospectively capture levels of EDSS. Mult Scler Relat Disord 2019; 39:101884. [PMID: 31865272 DOI: 10.1016/j.msard.2019.101884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Expanded Disability Status Scale (EDSS), a common outcome measure in Multiple Sclerosis (MS), is obtained prospectively through a direct standardized evaluation. The objective of this study is to develop and validate an algorithm to derive EDSS scores from previous neurological clinical documentation. METHODS The algorithm utilizes data from the history, review of systems, and physical exam. EDSS scores formally obtained from research patients were compared to captured EDSS (c-EDSS) scores. To test inter-rater reliability, a second investigator captured scores from a subset of patients. Agreement between formal and c-EDSS scores was assessed using a weighted kappa. Clinical concordance was defined as a difference of one-step in EDSS (0.5) and functional system (1.0) scores. RESULTS Clinical documentation from 92 patients (EDSS range 0.0-8.5) was assessed. Substantial agreement between the c-EDSS and formal EDSS (kappa 0.80; 95% CI 0.74-0.86) was observed. The mean difference between scores was 0.16. The clinical concordance was 78%. Near-perfect agreement was found between the two raters (kappa 0.89; 95% CI 0.84-0.95). The mean inter-rater difference in c-EDSS was 0.23. CONCLUSIONS This algorithm reliably captures EDSS scores retrospectively with substantial correlation with formal EDSS and high inter-rater agreement. This algorithm may have practical implications in clinic, MS research and clinical trials.
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Silva MDCND, Cavalcanti DBA. Avaliação da qualidade de vida em portadores de esclerose múltipla: impacto da fadiga, ansiedade e depressão. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/17005426042019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo do estudo foi avaliar a percepção da qualidade de vida em pacientes com esclerose múltipla (EM) e verificar se há associação com fadiga, ansiedade e depressão. Trata-se de um estudo transversal com amostra composta por 100 indivíduos com diagnóstico de EM cadastrados no Centro de Referência para Atenção ao Paciente Portador de Doença Desmielinizante do Hospital da Restauração. Foram aplicadas: a escala de determinação funcional da qualidade de vida na EM (Defu), a escala modificada do impacto da fadiga (MFIS-BR) e a escala hospitalar de ansiedade (HAD-a) e depressão (HAD-d). Os pacientes com a forma clínica primariamente progressiva apresentaram pior percepção da qualidade de vida (66,90±3,47) quando comparados às formas secundariamente progressivas (71,65±5,92) e remitente-recorrente (79,00±6,62), com diferença estatística significativa (p<0,001). Houve forte correlação positiva entre os escores da Defu e da MFIS-BR (r=0,84), e forte correlação negativa entre Defu e HAD-a (r=−0,85) e Defu e HAD-d (r=−0,82). A diminuição da percepção da qualidade de vida em pacientes com EM é mais crítica nas formas progressivas da doença e tem associação com a presença de fadiga, depressão e ansiedade.
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Baldassari LE, Nakamura K, Moss BP, Macaron G, Li H, Weber M, Jones SE, Rao SM, Miller D, Conway DS, Bermel RA, Cohen JA, Ontaneda D, McGinley MP. Technology-enabled comprehensive characterization of multiple sclerosis in clinical practice. Mult Scler Relat Disord 2019; 38:101525. [PMID: 31759186 DOI: 10.1016/j.msard.2019.101525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/08/2019] [Accepted: 11/13/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Objective and longitudinal measurements of disability in patients with multiple sclerosis (MS) are desired in order to monitor disease status and response to disease-modifying and symptomatic therapies. Technology-enabled comprehensive assessment of MS patients, including neuroperformance tests (NPTs), patient-reported outcome measures (PROMs), and MRI, is incorporated into clinical care at our center. The relationships of each NPT with PROMs and MRI measures in a real-world setting are incompletely studied, particularly in larger datasets. OBJECTIVES To demonstrate the utility of comprehensive neurological assessment and determine the association between NPTs, PROMs, and quantitative MRI measures in a large MS clinical cohort. METHODS NPTs (processing speed [PST], contrast sensitivity [CST], manual dexterity [MDT], and walking speed [WST]) and physical disability-related PROMs (Quality of Life in Neurological Disorders [Neuro-QoL], Patient Determined Disease Steps [PDDS], and Patient-Reported Outcomes Measurement Information System Global-10 [PROMIS-10] physical) were collected as part of routine clinical care. Fully-automated MRI analysis calculated T2-lesion volume (T2LV), whole brain fraction (WBF), thalamic volume (TV), and cervical spinal cord cross-sectional area (CA) for brain MRIs completed within 3 months of a clinic visit during which NPTs and PROMs were assessed. Spearman's rank correlation coefficients evaluated the cross-sectional associations of NPTs with PROMs and MRI measures. Linear regression was utilized to determine which combination of clinical characteristics, patient demographics, MRI measures, and PROMs best cross-sectionally explained each NPT result. RESULTS 997 unique patients (age 47.7 ± 11.4 years, 71.8% female) who underwent assessments over a 2-year period were included. Correlations among NPTs and PROMs were moderate. PST correlations were strongest for Neuro-QoL upper extremity (NQ-UE) (Spearman's rho = 0.43) and lower extremity (NQ-LE) (0.47). CST correlations were strongest for NQ-UE (0.33), NQ-LE (0.36), and PDDS (-0.31). MDT correlations were strongest for NQ-UE (-0.53), NQ-LE (-0.54), and PDDS (0.53). WST correlations were strongest for PDDS (0.64) and NQ-LE (-0.65). NPTs also had moderate correlations with MRI metrics, the strongest of which were observed with PST (with T2LV (-0.44) and WBF (0.49)). Spearman's rho for other NPT-MRI correlations ranged from 0.23 to 0.36. Linear regression identified age, disease duration, PROMIS-10 physical, NQ-UE, NQ-LE, T2LV and WBF as significant cross-sectional explanatory variables for PST (adjusted R2=0.46). For CST, significant variables included age and NQ-LE (adjusted R2 = 0.30). For MDT, significant variables included PDDS, PROMIS-10 physical, NQ-UE, NQ-LE, T2LV, and WBF (adjusted R2=0.37). For WST, significant variables included sex, PDDS, NQ-LE, T2LV, and CA (adjusted R2=0.39). CONCLUSIONS Impaired performance on NPTs correlated with worse physical disability-related PROMs and MRI disease severity, but the strongest cross-sectional explanatory variables for each NPT component varied. This study supports the use of comprehensive, objective quantification of MS status in clinical and research settings. Future longitudinal analyses can determine predictors of treatment response and disability worsening.
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Affiliation(s)
- Laura E Baldassari
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Kunio Nakamura
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Brandon P Moss
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Gabrielle Macaron
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Hong Li
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - Malory Weber
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Stephen E Jones
- Imaging Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Stephen M Rao
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, OH, United States
| | - Deborah Miller
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Devon S Conway
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Robert A Bermel
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Jeffrey A Cohen
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Marisa P McGinley
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States.
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Martínez-Ginés M, García-Domínguez J, Sarmiento M, Maurino J. Spanish cultural adaptation of the short version of the Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ-23). NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Martínez-Ginés M, García-Domínguez J, Sarmiento M, Maurino J. Adaptación cultural al español del cuestionario sobre las dificultades para trabajar con esclerosis múltiple. Versión corta de 23 ítems (MSWDQ-23). Neurologia 2019; 34:611-614. [DOI: 10.1016/j.nrl.2017.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 01/17/2017] [Indexed: 10/19/2022] Open
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Foster NL, Bondi MW, Das R, Foss M, Hershey LA, Koh S, Logan R, Poole C, Shega JW, Sood A, Thothala N, Wicklund M, Yu M, Bennett A, Wang D. Quality improvement in neurology: Mild cognitive impairment quality measurement set. Neurology 2019; 93:705-713. [PMID: 31534026 DOI: 10.1212/wnl.0000000000008259] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/30/2019] [Indexed: 02/03/2023] Open
Affiliation(s)
- Norman L Foster
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Mark W Bondi
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Rohit Das
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Mary Foss
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Linda A Hershey
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Steve Koh
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Rebecca Logan
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Carol Poole
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Joseph W Shega
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Ajay Sood
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Niranjan Thothala
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Meredith Wicklund
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Melissa Yu
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - Amy Bennett
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
| | - David Wang
- From the Center for Alzheimer's Care, Imaging and Research, Department of Neurology (N.L.F.), University of Utah, Salt Lake City; Department of Psychiatry (M.W.B., S.K.), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System (M.W.B.), CA; Department of Neurology (R.D., R.L.), University of Texas Southwestern Medical Center, Dallas; Alzheimer's Association (M.F., C.P.), Chicago, IL; Department of Neurology (L.A.H.), University of Oklahoma Health Sciences Center, Oklahoma City; University of Central Florida College of Medicine (J.W.S.), Lake Nona; VITAS Healthcare (J.W.S.), Miami, FL; AMITA Health Neurosciences Institute (A.S.), Elk Grove Village, IL; Department of Medicine (N.T.), Good Samaritan Hospital, Vincennes, IN; Department of Neurology (M.W.), Barrow Neurological Institute, Phoenix, AZ; Alzheimer's Disease and Memory Disorders Clinic, Department of Neurology (M.Y.), Baylor College of Medicine, Houston, TX; American Academy of Neurology (A.B.), Minneapolis, MN; Neurology Department (D.W.), University of Illinois College of Medicine at Peoria; and OSF Saint Francis Medical Center Comprehensive Stroke Center (D.W.), Peoria, IL
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Rae-Grant AD. Incorporating Clinical Practice Guidelines and Quality Measures Into High-Quality Cost-Effective Care for Patients With Multiple Sclerosis. Continuum (Minneap Minn) 2019; 25:845-849. [DOI: 10.1212/con.0000000000000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Turning Feed-forward and Feedback Processes on Patient-reported Data into Intelligent Action and Informed Decision-making. Med Care 2019; 57 Suppl 5 Suppl 1:S31-S37. [DOI: 10.1097/mlr.0000000000001088] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hudgens S, Schüler R, Stokes J, Eremenco S, Hunsche E, Leist TP. Development and Validation of the FSIQ-RMS: A New Patient-Reported Questionnaire to Assess Symptoms and Impacts of Fatigue in Relapsing Multiple Sclerosis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:453-466. [PMID: 30975397 DOI: 10.1016/j.jval.2018.11.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 10/05/2018] [Accepted: 11/11/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES A new patient-reported outcome (PRO) instrument to measure fatigue symptoms and impacts in relapsing multiple sclerosis (RMS) was developed in a qualitative stage, followed by psychometric validation and migration from paper to an electronic format. METHODS Adult patients with relapsing-remitting multiple sclerosis (RRMS) were interviewed to elicit fatigue-related symptoms and impacts. A draft questionnaire was debriefed in cognitive interviews with further RRMS patients, and revised. Content confirmation interviews were conducted with patients with progressive-relapsing multiple sclerosis (PRMS) and relapsing secondary-progressive multiple sclerosis (RSPMS). Psychometric analyses used data from adult patients with different RMS subtypes and matched non-RMS controls in a multicenter, observational study. After item reduction, the final instrument was migrated to a smartphone (eDiary) and usability was confirmed in interviews with additional adult RMS patients. RESULTS The qualitative stage included 37 RRMS, 5 PRMS, and 5 RSPMS patients. Saturation of concepts was reached during concept elicitation. Cognitive interviews confirmed that participants understood the instructions, items, and response options of the instrument-named FSIQ-RMS-as intended. Psychometric validation included 164 RMS and 74 control patients. Internal consistency and test-retest reliability were demonstrated. The symptoms domain discriminated along the RMS symptom-severity continuum and between patients and controls. Patients were able to attribute fatigue-related symptoms to RMS. Usability and conceptual equivalence of the eDiary were confirmed (n = 10 participants). CONCLUSIONS With 7 symptom items and 13 impact items (in 3 impacts subdomains: physical, cognitive and emotional, and coping) after item reduction, the FSIQ-RMS is a comprehensive, valid, and reliable measure of fatigue-related symptoms and impacts in RMS patients.
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Affiliation(s)
| | - René Schüler
- Global Market Access & Pricing, Actelion, Singapore
| | | | | | - Elke Hunsche
- Global Market Access & Pricing, Actelion, Allschwil, Switzerland
| | - Thomas P Leist
- Comprehensive Multiple Sclerosis Center, Thomas Jefferson University, Philadelphia, PA, USA
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Decavel P, Sagawa Y. Gait quantification in multiple sclerosis: A single-centre experience of systematic evaluation. Neurophysiol Clin 2019; 49:165-171. [DOI: 10.1016/j.neucli.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 12/24/2018] [Accepted: 01/08/2019] [Indexed: 01/14/2023] Open
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Claire Simon K, Hentati A, Rubin S, Franada T, Maurer D, Hillman L, Tideman S, Szela M, Meyers S, Frigerio R, Maraganore DM. Successful utilization of the EMR in a multiple sclerosis clinic to support quality improvement and research initiatives at the point of care. Mult Scler J Exp Transl Clin 2018; 4:2055217318813736. [PMID: 30559971 PMCID: PMC6293369 DOI: 10.1177/2055217318813736] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Many physicians enter data into the electronic medical record (EMR) as unstructured free text and not as discrete data, making it challenging to use for quality improvement or research initiatives. OBJECTIVES The objective of this research paper was to develop and implement a structured clinical documentation support (SCDS) toolkit within the EMR to facilitate quality initiatives and practice-based research in a multiple sclerosis (MS) practice. METHODS We built customized EMR toolkits to capture standardized data at office visits. Content was determined through physician consensus on necessary elements to support best practices in treating patients with demyelinating disorders. We also developed CDS tools and best practice advisories within the toolkits to alert physicians when a quality improvement opportunity exists, including enrollment into our DNA biobanking study at the point of care. RESULTS We have used the toolkit to evaluate 541 MS patients in our clinic and begun collecting longitudinal data on patients who return for annual visits. We provide a description and example screenshots of our toolkits, and a brief description of our cohort to date. CONCLUSIONS The EMR can be effectively structured to standardize MS clinic office visits, capture data, and support quality improvement and practice-based research initiatives at the point of care.
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Affiliation(s)
| | - Afif Hentati
- Department of Neurology, NorthShore University HealthSystem, USA
| | - Susan Rubin
- Department of Neurology, NorthShore University HealthSystem, USA
| | - Tiffani Franada
- Department of Neurology, NorthShore University HealthSystem, USA
| | - Darryck Maurer
- Health Information Technology, NorthShore University HealthSystem, USA
| | - Laura Hillman
- Health Information Technology, NorthShore University HealthSystem, USA
| | - Samuel Tideman
- Department of Neurology, NorthShore University HealthSystem, USA
| | - Monika Szela
- Department of Neurology, NorthShore University HealthSystem, USA
| | - Steven Meyers
- Department of Neurology, NorthShore University HealthSystem, USA
| | - Roberta Frigerio
- Department of Neurology, NorthShore University HealthSystem, USA
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Bakirtzis C, Ioannidis P, Messinis L, Nasios G, Konstantinopoulou E, Papathanasopoulos P, Grigoriadis N. The Rationale for Monitoring Cognitive Function in Multiple Sclerosis: Practical Issues for Clinicians. Open Neurol J 2018; 12:31-40. [PMID: 30008964 PMCID: PMC6008981 DOI: 10.2174/1874205x01812010031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/14/2018] [Accepted: 05/07/2018] [Indexed: 11/22/2022] Open
Abstract
About half of patients with multiple sclerosis exhibit cognitive impairment which negatively affects their quality of life. The assessment of cognitive function in routine clinical practice is still undervalued, although various tools have been proposed for this reason. In this article, we describe the potential benefits of implementing cognitive assessment tools in routine follow -ups of MS patients. Early detection of changes in cognitive performance may provide evidence of disease activity, could unmask depression or medication side-effects and provide suitable candidates for cognitive rehabilitation. Since apathy and cognitive deficiencies are common presenting symptoms in Progressive Multifocal Leukoencephalopathy, we discuss the utility of frequent monitoring of mental status in multiple sclerosis patients at increased risk. In addition, we propose a relevant algorithm aiming to incorporate a systematic evaluation of cognitive function in every day clinical practice in multiple sclerosis.
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Affiliation(s)
- Christos Bakirtzis
- The Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Ioannidis
- The Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lambros Messinis
- Department of Neurology, Neuropsychology Section, University of Patras Medical School, Patras, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, Higher Educational Institute of Epirus, Ioannina, Greece
| | - Elina Konstantinopoulou
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Nikolaos Grigoriadis
- The Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Katzan IL, Thompson NR, Dunphy C, Urchek J, Lapin B. Neurologic provider views on patient-reported outcomes including depression screening. Neurol Clin Pract 2018; 8:86-92. [PMID: 29708224 DOI: 10.1212/cpj.0000000000000438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 10/04/2017] [Indexed: 11/15/2022]
Abstract
Background We sought to assess neurologic provider satisfaction with the systematic electronic collection of patient-reported outcome measures (PROMs) for both disease-specific measures and depression screening (Patient Health Questionnaire [PHQ-9]). Methods A web-based survey was sent to 299 staff physicians and advanced practice providers on the staff email list of a large group neurologic practice, of whom 206 used the PROM system. The survey consisted of 11 questions with Likert response options regarding perceived usefulness of PROM collection; usefulness of PROM data for clinical care, quality, and research activities according to provider age group and type; and perceived usefulness between disease-specific information and the PHQ-9 depression screen. Results Of those who use the PROM system, 73.3% (151/206) responded. PROM collection was useful for patient care (strongly agree or agree 59.6%), research (strongly agree or agree 68.5%), and to a lesser extent, quality improvement (strongly agree or agree 48.6%). Providers aged 66-75 years believed PROM data were less useful for research (p < 0.01). PROM collection affected patient interactions or clinical management (always or usually 34.6% for disease-specific information and 31.3% for the PHQ-9). Responses were similar concerning perceived clinical usefulness (strongly agree or agree 67.3%) for center-selected disease-specific PROMs and the mandated PHQ-9 (69.8%). Conclusions Providers favorably viewed systematic electronic collection of PROMs in neurologic patients. A mandated depression screening was perceived as favorably as center-selected disease-specific information and should be considered when implementing PROMs in neurologic practice.
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Affiliation(s)
- Irene L Katzan
- Neurological Institute Center for Outcomes Research & Evaluation (ILK, NRT, BL), and Clinical Systems Office (ILK, CD, JU), Cleveland Clinic, OH
| | - Nicolas R Thompson
- Neurological Institute Center for Outcomes Research & Evaluation (ILK, NRT, BL), and Clinical Systems Office (ILK, CD, JU), Cleveland Clinic, OH
| | - Cheryl Dunphy
- Neurological Institute Center for Outcomes Research & Evaluation (ILK, NRT, BL), and Clinical Systems Office (ILK, CD, JU), Cleveland Clinic, OH
| | - John Urchek
- Neurological Institute Center for Outcomes Research & Evaluation (ILK, NRT, BL), and Clinical Systems Office (ILK, CD, JU), Cleveland Clinic, OH
| | - Brittany Lapin
- Neurological Institute Center for Outcomes Research & Evaluation (ILK, NRT, BL), and Clinical Systems Office (ILK, CD, JU), Cleveland Clinic, OH
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Krieger SC. New Approaches to the Diagnosis, Clinical Course, and Goals of Therapy in Multiple Sclerosis and Related Disorders. Continuum (Minneap Minn) 2018; 22:723-9. [PMID: 27261678 DOI: 10.1212/con.0000000000000324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The diagnosis, categorization, and treatment of multiple sclerosis (MS) and other demyelinating diseases have shifted over the past decade, and many of the fundamental principles of MS pathogenesis and clinical course are being rewritten. Fundamental issues include selecting the right disease-modifying therapy for someone with active disease and how, or even if, patients with purely progressive MS should be treated. This article provides an overview and introduction to the current thinking in MS diagnosis and therapy with an emphasis on the data-driven and proactive approach that has come to define the current state of the art.
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Abstract
PURPOSE OF REVIEW This article provides an evidence-based approach to the management of patients with early relapsing multiple sclerosis (MS). RECENT FINDINGS Numerous clinical trials have shown the role of disease-modifying therapies in reducing relapses and new MRI lesions in patients with relapsing MS. Many of these trials also show the ability of these agents to delay disability progression, and a few suggest that disease-modifying therapies may slow brain atrophy in relapsing MS; however, very few suggest that disease-modifying therapies can improve symptoms or disability. The therapeutic armamentarium of disease-modifying therapies includes five interferon formulations, two versions of glatiramer acetate, mitoxantrone, natalizumab, fingolimod, teriflunomide, dimethyl fumarate, and alemtuzumab. SUMMARY Although multiple disease-modifying therapies exist, the risks of these vary markedly, head-to-head comparator trials are limited, and no prospective biomarkers for treatment efficacy exist; therefore, choosing a disease-modifying therapy for an individual patient with MS is a difficult decision. This difficulty is compounded by limitations in predicting a patient's disease course, and the risk tolerance of the patient and opinions of the care partner need to be factored into the decision analysis as well. After a disease-modifying therapy is chosen, vigilance for clinical or radiographic breakthrough disease is very important, as this may suggest a suboptimal response to the chosen therapy. Furthermore, the role of symptom management and wellness should always remain part of the approach to the patient with MS.
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Abstract
Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS) and the most widespread nontraumatic cause of disability in young adults around the world. MS occurs in people of all ages, races, and ethnicities. MS is characterized by clinical symptoms resulting from lesions in the brain, spinal cord, or optic nerves that can affect balance, gait, and fall risk. Lesions accumulate over time and occur in different areas of the CNS causing symptoms that include weakness, spasticity, and fatigue, as well as changes in sensation, coordination, vision, cognition, and bladder function. Thus, it is not surprising that imbalance, gait dysfunction, and falls are common in people with MS. The overwhelming majority have abnormalities of postural control and gait even early in the disease course. In all, 50-80% have balance and gait dysfunction and over 50% fall at least once each year. Balance dysfunction in MS is conceptualized as three interrelated problems: decreased ability to maintain position, limited and slowed movement towards limits of stability, and delayed responses to postural displacements and perturbations. In addition, functional balance performance may be affected by impaired dual-task integration. Walking changes in MS include reduced gait speed, impaired walking balance, and reduced walking-related physical activity. Falls in people with MS are associated with injuries, reduced participation, and increased fear of falling. A wide and growing range of rehabilitation and medical interventions are available to address the changes in balance, gait, and fall risk associated with MS.
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Affiliation(s)
- Michelle H Cameron
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States.
| | - Ylva Nilsagard
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
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Baldassari LE, Salter AR, Longbrake EE, Cross AH, Naismith RT. Streamlined EDSS for use in multiple sclerosis clinical practice: Development and cross-sectional comparison to EDSS. Mult Scler 2017; 24:1347-1355. [DOI: 10.1177/1352458517721357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The Expanded Disability Status Scale (EDSS) is the standard measure of disability in multiple sclerosis clinical trials. The EDSS has limited application in the clinical setting due to required completion time and scoring complexity. Systematically recording an objective, simplified, less time-intensive, and neurologist-derived disability score would be beneficial for patient care. Objective: To develop and validate a streamlined version of the Expanded Disability Status Scale (sEDSS) for clinical monitoring. Methods: The EDSS was modified by eliminating maneuvers with no impact on function, consolidating redundancies, and simplifying scoring. This sEDSS was refined and preliminarily validated using a pilot cohort of 102 patients. Subsequently, the sEDSS was retrospectively validated using 968 patients from the CombiRx trial. We evaluated correlation and agreement between each functional system as well as the overall sEDSS and EDSS. Results: The sEDSS correlated strongly with the EDSS, both overall (Spearman’s rho = 0.93) and for each functional system (Spearman’s rho 0.65–0.97). Correlation was slightly lower for functional systems where scoring was modified for consolidation and simplification. Conclusion: The sEDSS had strong agreement and correlation with the existing EDSS and can provide a useful measure of disability in clinical practice.
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Affiliation(s)
- Laura E Baldassari
- John L. Trotter Multiple Sclerosis Center, Department of Neurology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA/Division of Neuroimmunology, Department of Neurology, University of Utah Health, Salt Lake City, UT, USA
| | - Amber R Salter
- Division of Biostatistics, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Erin E Longbrake
- John L. Trotter Multiple Sclerosis Center, Department of Neurology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA/Department of Neurology, School of Medicine, Yale University, New Haven, CT, USA
| | - Anne H Cross
- John L. Trotter Multiple Sclerosis Center, Department of Neurology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Robert T Naismith
- John L. Trotter Multiple Sclerosis Center, Department of Neurology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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Tintoré M, Alexander M, Costello K, Duddy M, Jones DE, Law N, O’Neill G, Uccelli A, Weissert R, Wray S. The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction. Patient Prefer Adherence 2017; 11:33-45. [PMID: 28053511 PMCID: PMC5189708 DOI: 10.2147/ppa.s115090] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Managing multiple sclerosis (MS) treatment presents challenges for both patients and health care professionals. Effective communication between patients with MS and their neurologist is important for improving clinical outcomes and quality of life. METHODS A closed-ended online market research survey was used to assess the current state of MS care from the perspective of both patients with MS (≥18 years of age) and neurologists who treat MS from Europe and the US and to gain insight into perceptions of treatment expectations/goals, treatment decisions, treatment challenges, communication, and satisfaction with care, based on current clinical practice. RESULTS A total of 900 neurologists and 982 patients completed the survey, of whom 46% self-identified as having remitting-relapsing MS, 29% secondary progressive MS, and 11% primary progressive MS. Overall, patients felt satisfied with their disease-modifying therapy (DMT); satisfaction related to comfort in speaking with their neurologist and participation in their DMT decision-making process. Patients who self-identified as having relapsing-remitting MS were more likely to be very satisfied with their treatment. Top challenges identified by patients in managing their DMT were cost, side effects/tolerability of treatment, and uncertainty if treatment was working. Half of the patients reported skipping doses, but only 68% told their health care provider that they did so. CONCLUSION Several important differences in perception were identified between patients and neurologists concerning treatment selection, satisfaction, expectations, goals, and comfort discussing symptoms, as well as treatment challenges and skipped doses. The study results emphasize that patient/neurologist communication and patient input into the treatment decision-making process likely influence patient satisfaction with treatment.
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Affiliation(s)
- Mar Tintoré
- Multiple Sclerosis Centre of Catalonia, Hospital Vall d’Hebron, Barcelona, Spain
- Correspondence: Mar Tintoré, Multiple Sclerosis Centre of Catalonia, Hospital Vall d’Hebron EUI 2ª Pl, Ps. Vall d’Hebron, 119-129, 08035 Barcelona, Spain, Tel +34 93 274 6202, Fax +34 93 274 6084, Email
| | | | | | - Martin Duddy
- Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - David E Jones
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Nancy Law
- Nancy Law Consulting LLC, Parker, CO, USA
| | | | - Antonio Uccelli
- Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Robert Weissert
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Sibyl Wray
- Hope Neurology Multiple Sclerosis Center, Knoxville, TN, USA
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Newsome SD, Aliotta PJ, Bainbridge J, Bennett SE, Cutter G, Fenton K, Lublin F, Northrop D, Rintell D, Walker BD, Weigel M, Zackowski K, Jones DE. CME/CNE Article: A Framework of Care in Multiple Sclerosis, Part 1: Updated Disease Classification and Disease-Modifying Therapy Use in Specific Circumstances. Int J MS Care 2016; 18:314-323. [PMID: 27999526 DOI: 10.7224/1537-2073.2016-051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Activity Available Online: To access the article, post-test, and evaluation online, go to http://www.cmscscholar.org. TARGET AUDIENCE The target audience for this activity is physicians, physician assistants, nursing professionals, and other health-care providers involved in the management of patients with multiple sclerosis (MS). LEARNING OBJECTIVES Apply new information about MS to a comprehensive individualized treatment plan for patients with MSIntegrate the team approach into long-term planning in order to optimize rehabilitation care of patients with MSAccreditation Statement: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Consortium of Multiple Sclerosis Centers (CMSC), Nurse Practitioner Alternatives (NPA), and Delaware Media Group. The CMSC is accredited by the ACCME to provide continuing medical education for physicians. The CMSC designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Nurse Practitioner Alternatives (NPA) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. NPA designates this enduring material for 1.0 Continuing Nursing Education credit. Laurie Scudder, DNP, NP, has served as Nurse Planner for this activity. She has disclosed no relevant financial relationships. Disclosures: Francois Bethoux, MD, Editor in Chief of the International Journal of MS Care (IJMSC), has served as Physician Planner for this activity. He has received royalties from Springer Publishing and has received intellectual property rights from Biogen. Laurie Scudder, DNP, NP, has served as Nurse Planner for this activity. She has disclosed no relevant financial relationships. Scott D. Newsome, DO, MSCS (author), has served on scientific advisory boards for Biogen, Genentech, Novartis, and Genzyme, and has performed contracted research (institution received funds) for Biogen, Genentech, and Novartis. Philip J. Aliotta, MD, MSHA, CHCQM, FACS (author), has served on speakers' bureaus for Astellas Pharma, Actavis, Augmenix, and Allergan and has performed contracted research for Allergan. Jacquelyn Bainbridge, PharmD (author), has disclosed no relevant financial relationships. Susan E. Bennett, PT, DPT, EdD, NCS, MSCS (author), has served on speakers' bureaus for Acorda Therapeutics, Biogen, and Medtronic; has received consulting fees from and performed contracted research for Acorda Therapeutics; and is chair of the Clinical Events Committee at Innovative Technologies. Gary Cutter, PhD (author), has participated on Data and Safety Monitoring Committees for AMO Pharma, Apotek, Gilead Pharmaceuticals, Horizon Pharmaceuticals, Modigenetech/Prolor, Merck, Merck/Pfizer, Opko Biologics, Neuren, Sanofi-Aventis, Reata Pharmaceuticals, Receptos/Celgene, Teva Pharmaceuticals, NHLBI (Protocol Review Committee), and NICHD (OPRU Oversight Committee); has received consulting fees from and/or served on speakers' bureaus and scientific advisory boards for Cerespir, Genzyme, Genentech, Innate Therapeutics, Janssen Pharmaceuticals, Klein-Buendel Incorporated, MedImmune, Medday, Nivalis, Novartis, Opexa Therapeutics, Roche, Savara, Somahlution, Teva Pharmaceuticals, Transparency Life Sciences, and TG Therapeutics; and is President of Pythagoras, Inc., a private consulting company located in Birmingham, AL. Kaylan Fenton, CRNP, APNP, MSCN (author), has disclosed no relevant financial relationships. Fred Lublin, MD (author), has received consulting fees/fees for non-CME/CE activities from Bayer HealthCare Pharmaceuticals, Biogen, EMD Serono, Novartis, Teva Neuroscience, Actelion, Sanofi/Genzyme, Acorda, Questcor/Mallinckrodt, Roche/Genentech, MedImmune, Osmotica, Xenoport, Receptos/Celgene, Forward Pharma, Akros, TG Therapeutics, AbbVie, Toyama, Amgen, Medday, Atara Biotherapeutics, Polypharma, Pfizer, Johnson & Johnson, Revalesio, Coronado Bioscience, and Bristol-Myers Squibb; has served on speakers' bureaus for Genentech/Roche and Genzyme/Sanofi; has performed contracted research for Acorda, Biogen, Novartis, Teva Neuroscience, Genzyme, Xenoport, and Receptos; is the co-chief editor of Multiple Sclerosis and Related Disorders; and has an ownership interest in Cognition Pharmaceuticals. Dorothy Northrop, MSW, ACSW (author), has disclosed no relevant financial relationships. David Rintell, EdD (author), has received consulting fees from Novartis and has served as a patient education speaker for Teva Neuroscience. He started as a salaried employee of Sanofi Genzyme in November 2015. Dr. Rintell's work on this project was completed before he became a salaried employee of Sanofi Genzyme.Bryan D. Walker, MHS, PA-C (author), has served on scientific advisory boards for EMD Serono and Sanofi Genzyme and owns stock in Biogen. Megan Weigel, DNP, ARNP-C, MSCN (author), has received consulting fees from Mallinckrodt, Genzyme, and Genentech, and has served on speakers' bureaus for Bayer Corp, Acorda Therapeutics, Teva Neuroscience, Biogen, Mallinckrodt, Genzyme, Novartis, and Pfizer. Kathleen Zackowski, PhD, OTR, MSCS (author), has performed contracted research for Acorda Therapeutics. David E. Jones, MD (author), has received consulting fees from Biogen and Novartis, and has performed contracted research for Biogen. One anonymous peer reviewer for the IJMSC has performed contracted research (institution received funds) for Novartis, Chugai, and Biogen. Another reviewer has received consulting fees and served on speakers' bureaus for Biogen, Sanofi Genzyme, Genentech, EMD Serono, and Novartis. The third reviewer has disclosed no relevant financial relationships. Lori Saslow, MS (medical writer), has disclosed no relevant financial relationships. The staff at the IJMSC, CMSC, NPA, and Delaware Media Group who are in a position to influence content have disclosed no relevant financial relationships. Note: Disclosures listed for authors are those applicable at the time of their work on this project and within 12 months previously. Financial relationships for some authors may have changed in the interval between the time of their work on this project and publication of the article. Funding/Support: Funding for the Framework of Care consensus conference was provided by the Consortium of Multiple Sclerosis Centers, Mallinckrodt Pharmaceuticals, and Mylan Pharmaceuticals. Method of Participation: Release Date: December 1, 2016 Valid for Credit Through: December 1, 2017 In order to receive CME/CNE credit, participants must: Review the CME/CNE information, including learning objectives and author disclosures.Study the educational content.Complete the post-test and evaluation, which are available at http://www.cmscscholar.org. Statements of Credit are awarded upon successful completion of the post-test with a passing score of >70% and the evaluation. There is no fee to participate in this activity. Disclosure of Unlabeled Use: This CME/CNE activity may contain discussion of published and/or investigational uses of agents that are not approved by the FDA. CMSC, NPA, and Delaware Media Group do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of CMSC, NPA, or Delaware Media Group. Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any medications, diagnostic procedures, or treatments discussed in this publication should not be used by clinicians or other health-care professionals without first evaluating their patients' conditions, considering possible contraindications or risks, reviewing any applicable manufacturer's product information, and comparing any therapeutic approach with the recommendations of other authorities.
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