The organisation of physiotherapy for people with multiple sclerosis across Europe: a multicentre questionnaire survey.

BACKGROUND: Understanding the organisational set-up of physiotherapy services across different countries is increasingly important as clinicians around the world use evidence to improve their practice. This also has to be taken into consideration when multi-centre international clinical trials are conducted. This survey aimed to systematically describe organisational aspects of physiotherapy services for people with multiple sclerosis (MS) across Europe. METHODS: Representatives from 72 rehabilitation facilities within 23 European countries completed an online web-based questionnaire survey between 2013 and 2014. Countries were categorised according to four European regions (defined by United Nations Statistics). Similarities and differences between regions were examined. RESULTS: Most participating centres specialized in rehabilitation (82 %) and neurology (60 %), with only 38 % specialising in MS. Of these, the Western based Specialist MS centres were predominately based on outpatient services (median MS inpatient ratio 0.14), whilst the Eastern based European services were mostly inpatient in nature (median MS inpatient ratio 0.5). In almost all participating countries, medical doctors - specialists in neurology (60 %) and in rehabilitation (64 %) - were responsible for referral to/prescription of physiotherapy. The most frequent reason for referral to/prescription of physiotherapy was the worsening of symptoms (78 % of centres). Physiotherapists were the most common members of the rehabilitation team; comprising 49 % of the team in Eastern countries compared to approximately 30 % in the rest of Europe. Teamwork was commonly adopted; 86 % of centres based in Western countries utilised the interdisciplinary model, whilst the multidisciplinary model was utilised in Eastern based countries (p = 0.046). CONCLUSION: This survey is the first to provide data about organisational aspects of physiotherapy for people with MS across Europe. Overall, care in key organisational aspects of service provision is broadly similar across regions, although some variations, for example the models of teamwork utilised, are apparent. Organisational framework specifics should be considered anytime a multi-centre study is conducted and results from such studies are applied.

Cohort Study Comparing the Berg Balance Scale and the Mini-BESTest in People Who Have Multiple Sclerosis and Are Ambulatory.

BACKGROUND: The Berg Balance Scale (BBS) is a balance measure commonly used for people with multiple sclerosis (MS). The Mini-BESTest is an alternative based on balance systems. OBJECTIVE: The study objective was to compare the BBS and the Mini-BESTest for sensitivity to change, likelihood ratios for walking aid use and falls, and associations with clinical variables in people who have MS and are ambulatory. DESIGN: This was a cohort study with measurements before and after exposure to 8 weeks of routine physical therapy intervention. METHODS: For 52 participants who had a primary diagnosis of MS and who were independently mobile, with or without an aid, demographic details and a history of falls and near falls were collected. Participants completed the Mini-BESTest, Multiple Sclerosis Impact Scale-29, Multiple Sclerosis Walking Scale-12, BBS, Modified Fatigue Impact Scale, and Six-Minute Walk Test. RESULTS: No participant started with a baseline Mini-BESTest maximum score of 28, whereas 38.5% (n=20) started with a baseline BBS maximum score of 56. Statistically significant changes in the Mini-BESTest score (X̅=5.31, SD=3.5) and the BBS score (X̅=1.4, SD=1.9) were demonstrated. Effect sizes for the Mini-BESTest and the BBS were 0.70 and 0.37, respectively; standard response means for the Mini-BESTest and the BBS were 1.52 and 0.74, respectively. Areas under the receiver operating characteristic curves for the Mini-BESTest and the BBS were 0.88 and 0.77, respectively, for detecting mobility device use and 0.88 and 0.75, respectively, for detecting self-reported near falls. The Mini-BESTest had a higher correlation for each secondary measure than did the BBS. LIMITATIONS: This study involved a sample of convenience; 61% of the participants did not use a walking aid. The order of testing was not randomized, and fall status was obtained through retrospective recall. CONCLUSIONS: The Mini-BESTest had a lower ceiling effect and higher values on responsiveness tests. These findings suggest that the Mini-BESTest may be better at detecting changes in balance in people who have MS, are ambulatory, and have relatively little walking disability.

Evaluating holistic needs assessment in outpatient cancer care--a randomised controlled trial: the study protocol.

INTRODUCTION: People living with and beyond cancer are vulnerable to a number of physical, functional and psychological issues. Undertaking a holistic needs assessment (HNA) is one way to support a structured discussion of patients' needs within a clinical consultation. However, there is little evidence on how HNA impacts on the dynamics of the clinical consultation. This study aims to establish (1) how HNA affects the type of conversation that goes on during a clinical consultation and (2) how these putative changes impact on shared decision-making and self-efficacy. METHODS AND ANALYSIS: The study is hosted by 10 outpatient oncology clinics in the West of Scotland and South West England. Participants are patients with a diagnosis of head and neck, breast, urological, gynaecological and colorectal cancer who have received treatment for their cancer. Patients are randomised to an intervention or control group. The control group entails standard care--routine consultation between the patient and clinician. In the intervention group, the patient completes a holistic needs assessment prior to consultation. The completed assessment is then given to the clinician where it informs a discussion based on the patient's needs and concerns as identified by them. The primary outcome measure is patient participation, as determined by dialogue ratio (DR) and preponderance of initiative (PI) within the consultation. The secondary outcome measures are shared decision-making and self-efficacy. It is hypothesised that HNA will be associated with greater patient participation within the consultation, and that shared decision-making and feelings of self-efficacy will increase as a function of the intervention. ETHICS AND DISSEMINATION: This study has been given a favourable opinion by the West of Scotland Research Ethics Committee and NHS Research & Development. Study findings will be disseminated through peer-reviewed publications and conference attendance. TRAIL REGISTRATION NUMBER: Clinical Trials.gov NCT02274701.

The assessment of mood in adults who have severe or profound mental retardation.

Empirical literature examining the emotional lives of adults with severe and profound mental retardation is limited. One area to have received attention is mood. It is proposed that the utility of assessment of mood extends beyond psychiatric diagnosis to issues such as the appraisal of quality of life for individuals with limited or no expressive language. Two themes related to the assessment of mood are evident in contemporary literature. First, attempts have been made to clarify presentation of affective disorders, especially depression, and to improve assessment of depressive symptomatology in adults with mental retardation. A review of current methods for assessing depression indicates significant problems with reliability and validity. There is a need to develop appropriate assessment methods for use in relation to adults with severe and profound mental retardation who are unable to self-report and behavioral methodology might be useful in this respect. Second, there is an emerging argument that presentation of depression in adults with mental retardation, particularly in individuals with severe disabilities, includes challenging behaviors, referred to as "atypical symptoms." Methodological and conceptual issues related to this argument warrant closer examination. Finally, it is noted that research drawing on more rigorous methodology is required to interpret the emotional states of individuals with severe and profound mental retardation.

Bacteria--Mast Cell Interactions in Inflammatory Disease.

Chronic inflammatory diseases of the gastrointestinal tract such as ulcerative colitis and Crohn's disease are characterized by mast cell proliferation and secretion of inflammatory mediators. The determinant(s) responsible for stimulating mast cells in the intestinal mucosa is not known. We investigated the interaction of mast cells with type 1 fimbriated Escherichia coli, an opportunistic pathogen and a constituent of the normal indigenous microflora of the gut. Unlike a mutant derivative deficient in the FimH subunit of the fimbriae or nonfimbriated E. coli, type 1 fimbriated E. coli adhered avidly to mast cells. As a consequence of this interaction, the mast cells phagocytozed and killed adherent bacteria. The mast cell bactericidal activity involved generation of superoxide anion and acidification of phagocytic vacuoles. In addition, many of the mast cells had degranulated and released inflammatory mediators such as histamine. These observations have implications both for normal host defense and for the initiation and perpetuation of inappropriate inflammatory responses in the gastrointestinal tract.

Preliminary analysis of the psychometric properties of the Mood, Interest & Pleasure Questionnaire (MIPQ) for adults with severe and profound learning disabilities.

OBJECTIVE: There are few reliable and valid methods for assessing emotional constructs in adults with severe and profound learning disabilities who are unable to self report. The aims of this study were to develop an informant questionnaire on affect for use in relation to adults with severe and profound learning disabilities and to examine its psychometric properties. METHOD: The Mood, Interest & Pleasure Questionnaire (MIPQ) is a 25-item Likert scale questionnaire with two subscales (mood and interest & pleasure). The MIPQ and the Aberrant Behavior Checklist were completed on 53 participants with severe or profound learning disabilities, who were partly or non-verbal. Of these, 23 participants (43%) were included in an examination of test-retest and inter-rater reliability of the MIPQ. RESULTS: Reliability of the MIPQ was good for subscales and total score: test-retest and inter-rater reliability coefficients for the total score were .87 and .76, respectively. Internal consistency was excellent (.94). A significant correlation between the MIPQ total score and the Aberrant Behavior Checklist's 'lethargy, social withdrawal' subscale provided preliminary evidence of construct validity (r (48) = -.59, p < .001). CONCLUSIONS: A preliminary analysis of the psychometric properties of the MIPQ is encouraging and further validation of the measure is warranted. The measure might be used to examine depression in people with severe and profound learning disabilities as well as in investigations of issues such as quality of life.

Photoinduced C-N bond cleavage in 2-azido-1,3-diphenyl-propan-1-one derivatives: photorelease of hydrazoic acid.

Photolysis of 3-azido-1,3-diphenyl-propan-1-one (1a) in toluene yields 1,3-diphenyl-propen-1-one (2), whereas irradiation of 3-azido-2,2-dimethyl-1,3-diphenyl-propan-1-one (1b) results in the formation of mainly 2,2-dimethyl-1,3-diphenyl-propan-1-one. Laser flash photolysis (308 nm) of 1a,b in acetonitrile reveals a transient absorption (lambda max = approximately 310 nm) due to the formation of radicals 4a and 4b, respectively, which have lifetimes of approximately 14 micros at ambient temperature. TD-DFT calculations (B3LYP/6-31+G(d)) reveal that the first and second excited states of the triplet ketone (T1K (n,pi*) and T2K (pi,pi*)) in azide 1a are almost degenerate, at approximately 74 and 76 kcal/mol above the ground state (S0), respectively. Similarly, azide 1b has T1K and T2K 75 and 82 kcal/mol above S0, respectively. The calculated transition state for cleaving the C-N bond is located 71 and 74 kcal/mol above S0 in azides 1a and 1b, respectively. The calculated bond dissociation energies for breaking the C-N bond are 55 and 58 kcal/mol for azides 1a and 1b, respectively, making C-N bond breakage accessible from T1K in azides 1 at ambient temperature. In comparison, the irradiation of azides 1 in argon matrices at 14 K lead to the formation of the corresponding triplet alkyl nitrenes (1-n), via intramolecular energy transfer from T2K. The characterization of 1-n was supported by isotope labeling, IR spectroscopy, and molecular modeling.