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Purpose: Shared decision-making is critical in multiple sclerosis (MS) due to the uncertainty of the disease trajectory over time and the large number of treatment options with differing efficacy, safety and administration characteristics. The aim of this study was to assess patients' decisional conflict regarding the choice of a disease-modifying therapy and its associated factors in patients with mid-stage relapsing-remitting multiple sclerosis (RRMS). Methods: A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS (2017 revised McDonald criteria) and disease duration of 3 to 8 years were included. The level of uncertainty experienced by a patient when faced with making a treatment choice was assessed using the 4-item Decisional Conflict Scale. A battery of patient-reported and clinician-rated measures was administered to obtain information on symptom severity, illness perception, illness-related uncertainty, regret, MS knowledge, risk taking behavior, preferred role in the decision-making process, cognition, and self-management. Patients were recruited during routine follow-up visits and completed all questionnaires online using electronic tablets at the hospital. A multivariate logistic regression analysis was conducted. Results: A total of 201 patients were studied. Mean age (Standard deviation) was 38.7 (8.4) years and 74.1% were female. Median disease duration (Interquartile range) was 6.0 (4.0-7.0) years. Median EDSS score was 1.0 (0-2.0). Sixty-seven (33.3%) patients reported a decisional conflict. These patients had lower MS knowledge and more illness uncertainty, anxiety, depressive symptoms, fatigue, subjective symptom severity, a threatening illness perception, and poorer quality of life than their counterparts. Lack of decisional conflict was associated with MS knowledge (Odds ratio [OR]=1.195, 95% CI 1.045, 1.383, p=0.013), self-management (OR=1.049, 95% CI 1.013, 1.093, p=0.018), and regret after a healthcare decision (OR=0.860, 95% CI 0.756, 0.973, p=0.018) in the multivariate analysis. Conclusion: Decisional conflict regarding the selection of a disease-modifying therapy was a common phenomenon in patients with mid-stage RRMS. Identifying factors associated with decisional conflict may be useful to implement preventive strategies that help patients better understand their condition and strengthen their self-management resources.
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Introduction: The Spasticity-Plus Syndrome (SPS) in multiple sclerosis (MS) refers to a combination of spasticity and other signs/symptoms such as spasms, cramps, bladder dysfunction, tremor, sleep disorder, pain, and fatigue. The main purpose is to develop a user-friendly tool that could help neurologists to detect SPS in MS patients as soon as possible. Methods: A survey research based on a conjoint analysis approach was used. An orthogonal factorial design was employed to form 12 patient profiles combining, at random, the eight principal SPS signs/symptoms. Expert neurologists evaluated in a survey and a logistic regression model determined the weight of each SPS sign/symptom, classifying profiles as SPS or not. Results: 72 neurologists participated in the survey answering the conjoint exercise. Logistic regression results of the survey showed the relative contribution of each sign/symptom to the classification as SPS. Spasticity was the most influential sign, followed by spasms, tremor, cramps, and bladder dysfunction. The goodness of fit of the model was appropriate (AUC = 0.816). Concordance between the experts' evaluation vs. model estimation showed strong Pearson's (r = 0.936) and Spearman's (r = 0.893) correlation coefficients. The application of the algorithm provides with a probability of showing SPS and the following ranges are proposed to interpret the results: high (> 60%), moderate (30-60%), or low (< 30%) probability of SPS. Discussion: This study offers an algorithmic tool to help healthcare professionals to identify SPS in MS patients. The use of this tool could simplify the management of SPS, reducing side effects related with polypharmacotherapy.
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Background: Hopelessness is a risk factor for depression and suicide. There is little information on this phenomenon among patients with relapsing-remitting multiple sclerosis (RRMS), one of the most common causes of disability and loss of autonomy in young adults. The aim of this study was to assess state hopelessness and its associated factors in early-stage RRMS. Methods: A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS, a disease duration ≤ 3 years, and an Expanded Disability Status Scale (EDSS) score of 0-5.5 were included. The State-Trait Hopelessness Scale (STHS) was used to measure patients´ hopelessness. A battery of patient-reported and clinician-rated measurements was used to assess clinical status. A multivariate logistic regression analysis was conducted to determine the association between patients' characteristics and state hopelessness. Results: A total of 189 patients were included. Mean age (standard deviation-SD) was 36.1 (9.4) years and 71.4% were female. Median disease duration (interquartile range-IQR) was 1.4 (0.7, 2.1) years. Symptom severity and disability were low with a median EDSS (IQR) score of 1.0 (0, 2.0). A proportion of 65.6% (n=124) of patients reported moderate-to-severe hopelessness. Hopelessness was associated with older age (p=0.035), depressive symptoms (p=<0.001), a threatening illness perception (p=0.001), and psychological and cognitive barriers to workplace performance (p=0.029) in the multivariate analysis after adjustment for confounders. Conclusion: Hopelessness was a common phenomenon in early-stage RRMS, even in a population with low physical disability. Identifying factors associated with hopelessness may be critical for implementing preventive strategies helping patients to adapt to the new situation and cope with the disease in the long term.
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Introducción: En los últimos años ha crecido el interés de especialistas no radiólogos por la ecografía de tiroides. Desde nuestro punto de vista como especialistas en imagen, en este artículo repasaremos los puntos de partida que estos especialistas deben de tener en cuenta antes de enfrentarse a la tarea de integrar la ecografía en su práctica diaria. Material y método: Hemos realizado una búsqueda bibliográfica en la base de datos Pubmed. Nos hemos basado asimismo en documentación disponible en la Web de sociedades de imagen médica como la Sociedad Española de Ultrasonografía (SEUS) y el American College of Radiology (ACR). Discusión: Tratamos varios puntos esenciales. En primer lugar, describimos como ha de ser el proceso ecográfico en sentido amplio. Después, abordamos aspectos técnicos básicos que es imprescindible conocer. Finalmente, nos centramos en la interpretación de las imágenes, para lo cual, explicamos el estudio sistemático de la glándula y abordamos brevemente la patología tiroidea más frecuente, el nódulo tiroideo bajo la perspectiva del sistema TIRADS y la enfermedad tiroidea difusa. Conclusión: La ecografía es actualmente una técnica accesible para muchas especialidades. Entre ellos el otorrinolaringólogo puede beneficiarse en su práctica diaria. Es importante, sin embargo, contar con programas de formación y ser rigurosos al realizarla, con correcto archivo de las imágenes y realización de informes. En la valoración del nódulo tiroideo, el sistema ACR-TIRADS es útil para sistematizar su manejo. La ecografía es también útil en la detección de enfermedad tiroidea difusa. (AU)
Introduction: In the past few years, many non-radiologist physicians have developed interest in thyroid ultrasonography (US). In this paper, as diagnostic imaging experts, we would like to assess the starting points that these non-radiologists should bear in mind before facing the challenge of includ-ing US in their daily clinical practice. Material and methods: We made a systematic narrative review with bibliographic research on Pubmed. We consulted documents on websites from medical imaging societies such as Sociedad Española de Ultrasonidos (SEUS) and the American College of Radiology. Discussion: We ́ve treated some key topics. First, we ́ve described how the US process should be carried out in a broader sense. Then, we ́ve address some basic technical aspects that should be mastered. Finally, we ́ve focussed on imaging interpretation. We ́ve described a sytematic approach of the thyroid gland US examination, and we ́ve briefly discussed the most common thyroid diseases: the thyroid nodule under the TIRADS system perspective, and diffuse thyroid disease. Conclusions: US is nowadays an available imaging technique for non-radiologists, such as the ENT surgeon. However, it ́s important to rely on training programmes and to perform it rigorously, with appropriate imaging archiving and reporting. ACR-TIRADS system is useful to assess thyroid nodules because it allows us to systematize the decision-making process. US is also useful to detect diffuse thyroid disease. (AU)
Subject(s)
Humans , Ultrasonography , Diagnostic Imaging , Thyroid Nodule , Research ReportABSTRACT
BACKGROUND/PURPOSE: Congenital anomalies of the inferior vena cava (IVC) are infrequent conditions. Most are asymptomatic and incidentally discovered. However, their recognition may sometimes have relevant clinical and therapeutic implications. The purpose of this report is to emphasize the importance of accurate identification and to assess the utility of three-dimensional contrast-enhanced magnetic resonance angiography (3D contrast-enhanced MRA) in their evaluation. METHODS: We retrospectively evaluated the 3D contrast-enhanced MRA of 21 patients in whom an IVC anomaly was found. RESULTS: Five of these anomalies concerned the hepatic and prerenal segments, seven were located in the renal segment, and finally, the last nine concerned the postrenal segment. CONCLUSION: IVC anomalies are uncommon conditions which may sometimes have important clinical implications. 3D contrast-enhanced MRA is a good method not only to identify them, but also to depict them accurately and safely.
Subject(s)
Imaging, Three-Dimensional , Magnetic Resonance Angiography , Vena Cava, Inferior/abnormalities , Vena Cava, Inferior/pathology , Adolescent , Adult , Child , Child, Preschool , Contrast Media , Female , Gadolinium DTPA , Humans , Male , Middle Aged , Renal Veins/abnormalities , Renal Veins/pathology , Retrospective StudiesABSTRACT
Living donor liver transplantation is increasingly being used to help compensate for the increasing shortage of cadaveric liver grafts. However, the extreme variability of the hepatic vascular systems can impede this surgical procedure. Evaluation of potential living donors was conducted in which a two-detector-row computed tomographic (CT) scanner was used to obtain arterial phase and portal dominant phase images following the intravenous injection of contrast material, after which three-dimensional maximum-intensity-projection and volume-rendered images were created. The vascular anatomy was evaluated, with special attention given to the origin and course of the artery to segment IV and the presence of variants, especially those considered relative or absolute contraindications for donation, those requiring reconstruction, or those potentially altering the surgical approach. In addition, graft and remnant liver volumes were determined and the liver parenchyma evaluated. Multidetector CT is proving to be valuable in the evaluation of potential living liver donors, contributing to donor safety and providing comprehensive information about the hepatic vascular anatomy, the liver parenchyma, and graft and remnant liver volume. This information is critical in choosing the most suitable potential donor, in surgical planning, and in obtaining an optimal graft that maintains the balance between blood supply and venous drainage.
