Navigating choice in multiple sclerosis management

Linker, Ralf A.; Chan, Andrew

doi:10.1186/s42466-019-0005-5

Cited by 12 publications

(13 citation statements)

References 61 publications

(60 reference statements)

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“…2 The increasing number of treatment options also pose new challenges for neurologists, including when to start, switch and stop treatments, and other important issues around pregnancy. 3 Clinical guidelines and treatment labels provide a framework, but rarely provide specific, detailed information on real-life usage, and are of limited help for individual decision making. 3 This means that there are many unanswered questions about the practical use of these treatments.…”

Section: Introductionmentioning

confidence: 99%

“…2 The increasing number of treatment options also pose new challenges for neurologists, including when to start, switch and stop treatments, and other important issues around pregnancy. 3…”

Section: Introductionmentioning

confidence: 99%

“…3 Clinical guidelines and treatment labels provide a framework, but rarely provide specific, detailed information on real-life usage, and are of limited help for individual decision making. 3 This means that there are many unanswered questions about the practical use of these treatments.…”

Section: Introductionmentioning

confidence: 99%

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Expert opinion on the use of cladribine tablets in clinical practice

Sørensen

Centonze

Giovannoni

et al. 2020

Ther Adv Neurol Disord

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Background: Gaps in current product labels and a lack of detailed clinical guidelines leaves clinicians’ questions on the practical management of patients receiving cladribine tablets for the treatment of relapsing multiple sclerosis (MS) unanswered. We describe a consensus-based programme led by international MS experts with the aim of providing recommendations to support the use of cladribine tablets in clinical practice. Methods: A steering committee (SC) of nine international MS experts led the programme and developed 11 clinical questions concerning the practical use of cladribine tablets. Statements to address each question were drafted using available evidence, expert experiences and perspectives from the SC and an extended faculty of 33 MS experts, representing 19 countries. Consensus on recommendations was achieved when ⩾75% of respondents expressed an agreement score of 7–9, on a 9-point scale. Results: Consensus was achieved on 46 out of 47 recommendations. Expert-agreed practical recommendations are provided on topics including: the definition of highly active disease; patterns of treatment response and suboptimal response with cladribine tablets; management of pregnancy planning and malignancy risk, infection risk and immune function, and switching to and from cladribine tablets. Conclusion: These expert recommendations provide up-to-date relevant guidance on the use of cladribine tablets in clinical practice.

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Section: Introductionmentioning

confidence: 99%

“…2 The increasing number of treatment options also pose new challenges for neurologists, including when to start, switch and stop treatments, and other important issues around pregnancy. 3…”

Section: Introductionmentioning

confidence: 99%

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Expert opinion on the use of cladribine tablets in clinical practice

Sørensen

Centonze

Giovannoni

et al. 2020

Ther Adv Neurol Disord

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“…The rising number of DMTs with different safety and efficacy profiles make the decision-making process in MS more complex [ 8 ]. As previously shown by our group and others, therapeutic decisions in MS care are influenced by healthcare providers´ behavioral characteristics, personal perceptions and biases [ 9 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

Behavioral aspects of nurse practitioners associated with optimal multiple sclerosis care in Spain

et al. 2021

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Background Nurse practitioners (NPs) play a critical role in the multidisciplinary management of patients with multiple sclerosis (MS). Neurologists´ behavioral characteristics have been associated with suboptimal clinical decisions. However, limited information is available on their impact among NPs involved in MS care. The aim of this study was to assess nurses´ therapeutic choices to understand behavioral factors influencing their decision making process. Methods A non-interventional, cross-sectional, web-based study was conducted. NPs actively involved in the care of patients with MS were invited to participate in the study by the Spanish Society of Neurology Nursing. Participants answered questions regarding their standard practice and therapeutic management of seven simulated relapsing-remitting MS (RRMS) case scenarios. A behavioral battery was used to measure participants´ life satisfaction, mood, positive social behaviors, feeling of helpfulness, attitudes toward adoption of evidence-based innovations, occupational burnout, and healthcare-related regret. The outcome of interest was therapeutic inertia (TI), defined as the lack of treatment escalation when there is clinical and radiological evidence of disease activity. A score to quantify TI was created based on the number of simulated scenarios where treatment intensification was warranted. Results Overall, 331 NPs were invited to participate, 130 initiated the study, and 96 (29%) completed the study. The mean age (SD) was 44.6 (9.8) years and 91.7% were female. Seventy-three participants (76.0%) felt their opinions had a significant influence on neurologists´ therapeutic decisions. Sixteen NPs (16.5%) showed severe emotional exhaustion related to work and 13 (13.5%) had depressive symptoms. The mean (SD) TI score was 0.97 (1.1). Fifty-six of NPs showed TI in at least one case scenario. Higher years of nursing experience (p = 0.014), feeling of helpfulness (p = 0.014), positive attitudes toward innovations (p = 0.046), and a higher intensity of care-related regret (p = 0.021) were associated with a lower risk of TI (adjusted R2 = 0.28). Burnout was associated with higher risk of TI (p = 0.001). Conclusions Although NPs cannot prescribe MS treatments in Spain, their behavioral characteristics may influence the management of patients with RRMS. Continuing education and specific strategies for reducing occupational burnout may lead to better management skills and improve MS care.

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“…Pract. 1, 5 (2019) [ 3 ] doi:10.1186/s42466-019-0005-5 Review 2242 Dziewas et al Safety and clinical impact of FEES – results of the FEES-registry Neurol. Res.…”

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confidence: 99%

Neurological research and practice: the first year

Hacke

2020

Neurol. Res. Pract.

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One year ago, the first articles in Neurological Research and Practice (NRP), a new peer-reviewed open access online-only scientific Journal were published. Neurological Research and Practice is the official Journal of the German Neurological Society (Deutsche Gesellschaft für Neurologie (DGN)), one of the largest national neurological societies worldwide with more than 10,000 members. NRP was created by the leadership of the DGN as an international, English language publication with a broad thematic scope reflecting all clinical, translational and basic research aspects of neurology and neuroscience. We strive to provide a forum for clinicians and scientists working in all areas of neurology including, but not limited to, genetics, vascular diseases, critical care neurology, disorders of the spine, movement disorders, neuroimmunology, infections, neurooncology, epilepsy, neuroimaging and neuroradiology, and degenerative disorders. The Journal publishes Research Articles, Reviews, Clinical Trial Protocols, Guidelines, Standard Operating Procedures, Historical Articles and Reviews and Letters to the Editor. The announcement of the new Journal came at a time of great competition between neurology journals [1]. With the increasing numbers of journals offering different publishing options for authors, some of which are of quality and some so-called predator journals, it can be difficult to establish a serious, quality-oriented open access journal in this environment. One of the characteristics that distinguishes NRP from many other new journals is that we believe in a strict peer-review process and unlike other open access options we currently do not charge any publication fees, this cost is covered by the DGN. After 18 months of preparatory work, the first set of seven articles were published by the end of February 2019. Now, one year later, it seems to be a good time to review and reflect on the achievements of the first year of NRP.

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Navigating choice in multiple sclerosis management

Cited by 12 publications

References 61 publications

Expert opinion on the use of cladribine tablets in clinical practice

Expert opinion on the use of cladribine tablets in clinical practice

Behavioral aspects of nurse practitioners associated with optimal multiple sclerosis care in Spain

Neurological research and practice: the first year

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