The pathophysiology of demyelination and the ionic basis of nerve conduction in multiple sclerosis: an overview.

Multiple sclerosis (MS) affects young adults during the prime of life, complicating child-rearing and work-related activities, often resulting in significant disability. New treatment options are rapidly becoming available. Persons with MS and their families rely on nurses to provide current and accurate information. Neuroscience nurses are increasingly challenged to keep abreast of new treatments and research and the scientific bases for them. In response to this need, nurses must develop a basic understanding of the proposed etiology of MS as well as of the pathophysiology of demyelination and the ionic basis of nerve conduction.

Development of new faculty in higher education.

Faculty development programs in nursing, as well as in other disciplines, are needed to respond to changing expectations about the quality of undergraduate education, student populations, decreasing resources, and widespread use of technology in education. Problems facing new and senior faculty center on these changing demands. Preparing faculty to use technology in teaching is especially important. The problem of diminishing resources for faculty development must be balanced with the overwhelming need for faculty education in this changing environment.

Copolymer-1 in the treatment of multiple sclerosis.

Recent research in the treatment of multiple sclerosis (MS) has yielded new therapies. Specifically, copolymer-1, a mixture of synthetic polypeptides composed of four amino acids has been effective in reducing relapse rates and disability in patients with relapsing-remitting MS. In a two-year multicenter, randomized, double-blind, placebo-controlled trial of 251 patients, copolymer-1 was shown to reduce relapses by an average of 29% when compared with placebo. Sustained disability was also slightly reduced in the copolymer-1-treated group. The results of the clinical trial indicate that copolymer-1 positively alters the course of relapsing-remitting MS. With the present availability of copolymer-1, nurses are challenged to maintain current knowledge of nursing implications, interventions, patient education and goals for treatment.

Rheumatoid arthritis antirheumatic drug trials: effects of a standardized instructional videotape on the reliability of observer-dependent outcome measures.

AIMS: A study was designed to assess the effects of a standardized instructional videotape on reducing interobserver variability for several commonly used observer-dependent outcome measures. METHODS: During a single day, six rheumatologists independently examined six patients with rheumatoid arthritis (RA) in a predetermined order using a Latin square design, before and after viewing a standardized videotape demonstrating 13 examination techniques. Reliability coefficients were calculated based on the variance components of the analysis of variance (ANOVA) table. RESULTS: Prestandardization reliability coefficients were >0.80 for all measures and remained above 0.80 following standardization. CONCLUSIONS: It is usually assumed that serial measurement in clinical trials should be performed by the same assessor because of concern regarding interobserver variability. However, the high levels of prestandardization interobserver reliability observed in this study indicate that, for these variables, serial measurements in a clinical trial could be made by different assessors, assuming they were equally skilled. This observation has important implications for outcome measurement in RA clinical trials. Although high levels of prestandardization reliability precluded the demonstration of any significant effect, we speculate that the videotape might be effective in training less-experienced assessors. Reductions in observer variability have the potential to diminish sample size requirements for RA antirheumatic drug studies. The use of a videotape to achieve this goal offers cost and convenience advantages over one-on-one training procedures, and this method should be further assessed in less-experienced assessors.

Ankylosing spondylitis antirheumatic drug trials: Effects of a standardized instructional viddeotape on the reliability of observer-dependent outcome measures.

AIMS: A study was designed to assess the effects of a standardized instruction videotape on reducing interobserver variability for several commonly used observer-dependent outcome measures. METHODS: During a single day, six rheumatologists independently examined six patients with ankylosing spondylitis (AS) in a predetermined order using a Latin square design, before and after viewing a standardized videotape demonstrating 14 examination techniques. Reliability coefficients were calculated based on the variance components of the analysis of variance (ANOVA) table. RESULTS: Prestandardization reliability coefficients were <0.80 for three measures. Following standardization 12 reliability coefficients exceeded 0.80. For the majority of measures prestandardization reliability coefficients were high and no further improvement in reliability could be demonstrated. For one measure of cervical extension, but not another, an important and beneficial effect in reliability was noted. It was not possible to achieve adequate reliability in the performance of the chest excursion measurement. CONCLUSIONS: It is usually assumed that serial measurement in clinical trials should be performed by the same assessor because of concern regarding interobserver variability. However, the high levels of prestandardization interobserver reliability observed in this study indicate that for these variables serial measurements in a clinical trial could be made by different assessors, assuming they were equally skilled. This observation has important implications for outcome measurement in AS clinical trials. Although high levels of prestandardization reliability precluded the demonstration of any significant effect, we speculate that the videotape might be effective in training less experienced assessors. Nevertheless, an alternative approach to standardization may be required for the chest excursion measurement. Reductions in observer variability have the potential to diminish sample size requirements for AS antirheumatic drug studies. The use of a videotape to achieve this goal offers cost and convenience advantages over one-on-one training procedures, and this method should be further assessed in a group of less experienced assessors.

A comparative study of auranofin, gold sodium thiomalate, and D-penicillamine in rheumatoid arthritis: a progress report.

We compared auranofin (AF) in a single blind multi-centre study with gold sodium thiomalate and D-penicillamine in the treatment of rheumatoid arthritis. Adult patients with disease duration 6-60 months without previous treatment with gold salts with persistent active disease, were included. Thirty-nine patients, 13 in each treatment group, have so far been entered. Cumulative toxicity data and some results of efficacy assessments in those completing 9 months of treatment are presented. AF is very well tolerated, judgment concerning efficacy must await the end of the trial.

Antitrypsin activity and enzyme inhibitors in the rheumatoid joint.

Proteolytic enzyme inhibitor activity has been measured in the rheumatoid knee by 2 different techniques. The inactivation rate of trypsin injected into the joint in 13 patients was compared with synovial fluid levels of alpha-1-antitrypsin (apha 1AT), alpha-2-macroglobulin (alpha 2M) and trypsin inhibitory capacity (TIC). The lack of correlation and the fact that an inverse relationship was shown between the T1/2 to inactivation and joint damage suggests that additional mechanisms are involved in the inactivation of destructive enzymes. Serum levels of alpha 1AT and TIC were elevated in 36 rheumatoid arthritis (RA) patients when compared with control values and RA synovial fluid inhibitor levels elevated by comparison with osteoarthritic figures. The synovial fluid alpha 1AT and TIC correlated with the activity of the lysosomal enzyme beta-acetyl glucosaminidase (beta AGA) but only trace amount of neutral protease activity was detected probably because of the large concentration of inhibitors present. The deficient Pi phenotype MZ was rarely encountered.