Notes

Increased plasma tv's D-dimer levels tend to be associated with chance of long term incident venous thromboembolism.
All participants enjoyed the training and experienced low levels of muscle soreness/discomfort. The training program improved passive/active ankle ROM in all participants; however, improvements did not translate to improvements in walking for all participants.

Walking backward and downhill is a safe and feasible training modality for people with MS with ankle contractures. Clinical outcomes (greater passive/active ankle ROM) after this eccentric exercise training were evident. However, translation to clinically meaningful changes in walking function requires further examination.
Walking backward and downhill is a safe and feasible training modality for people with MS with ankle contractures. Clinical outcomes (greater passive/active ankle ROM) after this eccentric exercise training were evident. However, translation to clinically meaningful changes in walking function requires further examination.
Patients with a compromised immune system are at risk for converting from latent tuberculosis infection (LTBI) to active tuberculosis (TB) infection. Multiple sclerosis (MS) therapies may put individuals with LTBI at higher risk of TB.

Patients at the Beth Israel Deaconess Medical Center MS Clinic were screened for TB as part of routine testing with the QuantiFERON-TB Gold In-Tube (QFT-GIT) assay (Cellestis Ltd) from 2013 to 2017. Patients were tested either before or during immunomodulatory therapy.

Four of 222 patients (1.8%; 95% CI, 0.1%-3.6%) had positive QFT-GIT results; three patients had risk factors for TB, having emigrated from TB-endemic countries or worked in the health care industry. Twenty-eight of 222 patients (12.6%) had an indeterminate assay result, and 75.0% of these occurred in patients taking dimethyl fumarate. Fingolimod, natalizumab, or anti-CD20 treatments showed 0% to 7.7% indeterminate results.

The prevalence of LTBI was 1.8% in the Beth Israel Deaconess Medical Center MS Clinh rate of lymphopenia in virtually all patients.
The expanding population of older adults with multiple sclerosis (MS) likely experiences many of the same benefits of physical activity (PA) as younger and middle-aged adults with MS. However, participation in PA is exceedingly low in this segment of the MS population. This study examined variables from social cognitive theory (SCT) as correlates of PA in older adults with MS to inform the subsequent development of behavioral interventions.

Older adults with MS (≥60 years of age, N = 180) completed an online survey including demographic and clinical characteristics, SCT variables (exercise self-efficacy, exercise goal setting, social support, and outcome expectations), and PA (total PA [TPA] and moderate-to-vigorous PA [MVPA]).

Bivariate correlation analyses indicated that all SCT variables were significantly associated with TPA and MVPA (all
≤ .001). Hierarchical linear regression analyses indicated that disability status was a significant correlate of TPA (
= -0.48,
= 0.23) and MVPA (
= -0.44,
= 0.19) in step 1; disability and self-efficacy were significant correlates of TPA (disability
= -0.20, self-efficacy
= 0.59,
= 0.50) and MVPA (disability
= -0.16, self-efficacy
= 0.60,
= 0.47) in step 2; and disability, self-efficacy, and exercise goal setting were significant correlates of TPA (disability
= -0.21, self-efficacy
= 0.50, exercise goal setting
= 0.14,
= 0.55) and MVPA (disability
= -0.17, self-efficacy
= 0.51, exercise goal setting
= 0.15,
= 0.51) in step 3.

These results suggest that behavioral interventions focusing on self-efficacy and exercise goal setting as targets from SCT may be appropriate for increasing PA in older adults with MS.
These results suggest that behavioral interventions focusing on self-efficacy and exercise goal setting as targets from SCT may be appropriate for increasing PA in older adults with MS.
Clinical pharmacists are uniquely positioned to assist with the complexities of medication management for patients with multiple sclerosis (MS). The objective was to describe clinical pharmacy services provided, as well as provider satisfaction with and perceived impact of incorporating a clinical pharmacist in MS patient care.

The study consisted of a retrospective medical record review and a provider survey conducted in an outpatient neurology clinic at an academic medical center. Between April 2017 and June 2018, electronic medical records of patients with documented interventions by a pharmacist were reviewed to describe clinical pharmacy services provided to patients with MS. A voluntary, anonymous survey was distributed to neurology providers to evaluate provider satisfaction with and perceived impact of clinical pharmacist involvement in MS patient care.

There were 64 patients identified with 378 documented interventions made by clinical pharmacists. Pharmacist interventions were mostly related to facilitating medication access (n = 208), pretreatment screening (n = 57), patient counseling (n = 51), and providing drug information (n = 43). All nine providers surveyed indicated that facilitating medication access, counseling patients, and managing drug interactions were moderately or very important clinical pharmacy services. Furthermore, all providers surveyed strongly agreed that pharmacist involvement decreased time to therapy initiation and provider time spent on medication management.

Clinical pharmacists play an integral role in MS patient care, particularly with facilitating medication access. Prospective studies are needed to further evaluate the contribution of clinical pharmacists in MS patient care.
Clinical pharmacists play an integral role in MS patient care, particularly with facilitating medication access. Prospective studies are needed to further evaluate the contribution of clinical pharmacists in MS patient care.
Fatigue is the most disabling symptom in patients with multiple sclerosis (MS). Although there is no standard tool to evaluate fatigue in clinical settings, the Fatigue Impact Scale (FIS), Fatigue Severity Scale (FSS), and Multidimensional Assessment of Fatigue (MAF) scale are popular instruments for this purpose. The aim of this study was to compare the psychometric properties of the Persian versions of these scales.

One hundred thirty adult patients with MS and 60 controls participated in this study. They completed the scales on two occasions 3 days apart. Reproducibility and internal consistency were evaluated as intraclass correlation coefficients (ICCs) and Cronbach α. Convergent validity was assessed by evaluating the association of the fatigue scales with age, sex, Expanded Disability Status Scale (EDSS) score, disease duration, and sleep quality. Dimensionality was evaluated using confirmatory factor analysis. Acceptability and known-group validity were investigated. The effect size of each scale was computed.

The ICC of all instruments was 0.99. Internal consistency was 0.97 for the MAF scale, 0.93 for FSS, and 0.83 for FIS. The instruments showed moderate-to-good correlations with Pittsburgh Sleep Quality Index, EDSS score, and disease duration. Acceptability was acceptable. The FIS had three dimensions, and the FSS and MAF scale were unidimensional. All scales were able to discriminate patients with MS from controls.

The Persian version of the MAF scale seems to be the most suitable instrument to evaluate fatigue in patients with MS based on its time efficiency, effect size, and detailed data about various aspects of fatigue.
The Persian version of the MAF scale seems to be the most suitable instrument to evaluate fatigue in patients with MS based on its time efficiency, effect size, and detailed data about various aspects of fatigue.
It is estimated that there are more than 100,000 people in the United Kingdom who have multiple sclerosis (MS). Z-YVAD-FMK supplier Patient experience and outcome are improved by access to a specialist nursing service. The aim of this study was to perform demand modeling to understand the need for MS nursing interventions, and thus inform modeling of the future UK MS nursing workforce.

Existing national data and specific workload and service data were collected from 163 MS specialist nurses who completed a questionnaire on activity and complexity of work both done and left undone.

Data were received from across all of the United Kingdom. Twenty-nine percent of respondents were specialist nurses in the field for 3 years or less. Unpaid overtime was regularly performed by 83.4% of respondents. The MS specialist nurse was part of all areas of the patient journey. Areas of work left undone were psychological interventions, physical assessments, social interventions/benefits, and recommending or prescribing medications.

The current recommended caseload of 358 people with MS per full-time equivalent seems to be too high, with a considerable amount of work left undone, particularly psychosocial care. Factors such as travel time, complexity of caseload, changing drug therapies, and societal issues such as the benefits system contributed to driving demand/workload.
The current recommended caseload of 358 people with MS per full-time equivalent seems to be too high, with a considerable amount of work left undone, particularly psychosocial care. Factors such as travel time, complexity of caseload, changing drug therapies, and societal issues such as the benefits system contributed to driving demand/workload.Current trends in climate change indicate that the impact on the most vulnerable systems will increase. Urban areas, which concentrate population, economic activity and infrastructures, are sometimes at high-risk locations. Yet they are to be considered as vulnerable systems in need of harmonized structures supporting their efforts towards mitigating climate effects and/or adapting their territories to them. One current structure is the Covenant of Mayors for Climate and Energy (CoM) initiative, tackling in a global and harmonized way local adaptation to climate change. Do CoM cities that developed acceptable climate change adaptation plans have similar characteristics? It is still unclear which might be the drivers or key attributes potentially leading to successful planning within the initiative. In this paper, we explore attributes of the first 51 cities that have submitted their adaptation plans to CoM, in order to identify common elements among accepted plans. Therefore, our hypothesis is that there must be attributes determining the acceptance of adaptation plans. In order to do so, the cities were classified as compliant and non-compliant with the CoM principles. Fisher's and Kolmogorov-Smirnov tests were applied to identify attributes that are statistically different between both groups. Results show that the engagement of multiple stakeholders and citizens, particularly at the local level, might significantly facilitate the acceptance of adaptation plans in the initiative. We also found that the benefits of stakeholder and citizen engagement could be greater in small municipalities because citizens and stakeholders have more opportunities to participate.First introduced in early 2000s, the accountable care organization (ACO) is designed to lower health care costs while improving quality of care and has become one of the most important coordinated care technologies in the United States. In this research, we use the Medicare fee-for-service claims data from 2009-2014 to estimate the heterogeneous effects of Medicare ACO programs on hospital admissions across hospital referral regions (HRRs) and provider groups. To conduct our analysis, a model for a difference-in-difference (DID) study is embellished in multiple ways to account for intricacies and complexity with the data not able to be accounted for using existing models. Of particular note, we propose a Gaussian mixture model to account for the inability to observe the practice group affiliation of physicians if the organization they worked for did not become an ACO, which is needed to ensure appropriate partitioning of variation across the different units. The results suggest that the ACO programs reduced the rate of readmission to hospital, that the ACO program may have reduced heterogeneity in readmission rates, and that the effect of joining an ACO varied considerably across medical groups.
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