The RPSG continues to expand and invites health professionals to gain opportunities provided by social media networks to improve the health of their patients by facilitating and getting involved in 'real' discussions.

Background: People with multiple sclerosis (MS) are susceptible to severe COVID-19 outcomes. They were included as a priority group for the Australian COVID-19 vaccine roll-out in early 2021. However, vaccine hesitancy remains a complex barrier to vaccination in this population group, which may be partly related to disease relapse concerns following COVID-19 vaccination. This study examined the COVID-19 vaccination status, intent, hesitancy, and disease-related beliefs in people with MS. Methods: An online survey was conducted with people with MS receiving care at two Australian health services between September and October 2021. It collected sociodemographic and disease-specific characteristics and responses to validated scales that assessed vaccine hesitancy and general and MS-related vaccine beliefs. Results: Of the 281 participants [mean age 47.7 (SD 12.8) years; 75.8% females], most (82.9%) had received at least one COVID-19 vaccine dose. Younger participants were less likely to be vaccinated, as were those within 1–5 years of disease duration. After controlling for age, disease duration was not associated with vaccination status. Unvaccinated participants were more likely to report less willingness to receive the COVID-19 vaccine, higher vaccine complacency and lower vaccine confidence, greater MS-related vaccine complacency, and higher MS and treatment interaction concerns. Conclusions: People with MS reported a high vaccination rate, despite general and MS-specific COVID-19 vaccine concerns. Greater MS-specific concerns were reported by those who indicated that their MS was not well-controlled and their MS impacted their daily activities. By understanding the factors that influence vaccine hesitancy and their interplay with MS disease course and treatment concerns, this can inform tailored interventions and educational messages to address these concerns in people with MS. Clinicians, governments, and community organisations are key partners in delivering these interventions and messages, as ongoing booster doses are needed for this vulnerable population.

Multiple sclerosis (MS) is a chronic, neurodegenerative disease with a reported 10.4% increase in global prevalence between 1990 and 2016, to over 2.2 million cases. 1,2 While there is no cure for MS, disease-modifying therapies (DMTs), 3,4 reduce annualized relapse rates by 18.0% to 66.0% 5,6 and disability progression by 12.0% to 41.0%. 6 Optimal medication adherence is crucial to maximize drug efficacy and reduce unnecessary healthcare expenditure. However, World Health Organization 7 data estimates approxmimately 50% of people with chronic diseases experience suboptimal medication adherence. Medication adherence in MS is no exception. Adherence rates for selfinjectable DMTs are reported as between 41% to 88% across varying measurement types, 8 and between 30% to 60% of people with MS discontinue self-injectable DMTs within two years. [9][10][11] The introduction of oral DMTs has not resolved the problem. A study assessing one-year adherence and persistence to oral DMTs-fingolimod (FTY), teriflunomide (TFN), and dimethyl fumarate (DMF)-reported that the adherence rate, measured by proportion of days covered (PDC), was less than 80% in 24.6% to 46.9% of participants with discontinuation rates between 25.6% to 50.3%. 12 Studies consistently showed an increased likelihood of suboptimal medication adherence or discontinuation with increasing treatment durations. [13][14][15] Medication adherence is "The extent to which a patient acts in accordance with the prescribed interval, and dose of a dosing regimen." 16 Persistence is "The duration of time from initiation to discontinuation of therapy." 16 Discontinuation is the cessation of therapy, which may be initiated by either the clinician or patient. 17 Suboptimal medication adherence may be intentional or unintentional. Intentional suboptimal adherence has been linked to perceived inefficacy, 18 cost, 19 and medication side effects. Side effects vary by DMT, but they may include fatigue, headache, nausea, or diarrhea. Specific to route of administration, injectable DMTs may incur injection site reactions and needle phobia. 3 Forgetting is the most common unintentional reason for suboptimal medication adherence. Factors such as physical disability, cognitive impairment, and depression-all common in MS patients-contribute to medication adherence difficulties. 3,18 Medication adherence may be assessed objectively, using, for example, pharmacy records, or via patient self-report.Two previous systematic reviews have been undertaken addressing medication adherence and persistence to selfadministered injectable DMTs in people with MS, 8,15 both of which predated studies that assessed medication adherence and persistence in oral DMTs. Two recent reviews of oral DMT adherence and discontinuation rates did not compare oral and injectable DMTs to quantify whether oral ABSTRACT BACKGROUND: Medication adherence is critical for the realization of pharmacotherapy benefits and reduced healthcare expenditure. Studies have shown up to 60% of people with Multiple sclerosis (MS) exper...

DESCRIPTIONA 75-year-old woman presented reporting of feeling generally unwell. She had a history of cervical cancer, radiation enteritis and chronic urinary tract obstruction managed with a long-term urinary catheter. She was hypovolaemic and her urine was strikingly purple in colour (see figure 1) and malodourous. Urine dipstick was positive for nitrites and leucocytes; inflammatory markers were raised; and subsequent urine culture grew Escherichia coli, Klebsiella pneumoniae and Morganella morganii. She was treated with intravenous antibiotics and fluid resuscitation, her urinary catheter was changed, and the urine returned to a normal colour over 24 h.Discolouration of the urine may indicate significant pathology, and visual inspection of the urine should form part of routine clinical examination. The purple urinary bag syndrome was first described in 1978 and refers to the rare but potentially alarming phenomenon of the urine and catheter bag turning purple in response to urinary tract infection.1 It usually occurs in elderly patients with long-term urinary catheters. Intestinal bacteria metabolise tryptophan to indole, which is absorbed and conjugated to indoxyl sulfate (IS). IS is excreted in the urine where it may be converted to indigo (blue) and indirubicin (red) by indoxyl sulfatase and phosphatase enzymes. Indigo and indirubicin precipitate on to the catheter and catheter bag together as an intense purple colour.2 The syndrome occurs due to high levels of IS in the urine and the presence of bacteria that are capable of producing these enzymes: E. coli, K. pneumoniae, Providencia stuartii and Providencia rettgeri, Proteus mirabilis, and M. morganii. Learning points▸ Visual inspection of the urine should form part of routine clinical examination. ▸ Purple discolouration of the urine and catheter bag signifies urinary tract infection with organisms capable of producing indoxyl sulfatase and phosphatase enzymes.Competing interests None. Patient consent Obtained.Provenance and peer review Not commissioned; externally peer reviewed. REFERENCES

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