Polypharmacy in Multiple Sclerosis: Current Knowledge and Future Directions.

Polypharmacy, or the daily use of five or more medications, is well documented in older adults and linked to negative outcomes such as medication errors, adverse drug reactions, and increased healthcare utilization. Like older adults, people with multiple sclerosis (PwMS) are susceptible to polypharmacy, owing to the variety of treatments used to address individual multiple sclerosis (MS) symptoms and other comorbidities. Between 15-65% of PwMS meet criteria for polypharmacy; in this population, polypharmacy is associated with increased reports of fatigue, subjective cognitive impairment, and reduced quality of life.

Use of the Sport Concussion Assessment Tool 5 (SCAT5) in professional hockey, part 2: which components differentiate concussed and non-concussed players?

Objectives: To examine the utility of Sport Concussion Assessment Tool (SCAT5) subcomponents in differentiating physician diagnosed concussed players from controls.

Methods: We evaluated 1924 professional hockey players at training camp using the National Hockey League (NHL) Modified SCAT5 prior to the 2018-2019 season. Over the course of the season, 314 English-speaking players received SCAT5 evaluations within 1 day of a suspected concussive event.

Use of the Sport Concussion Assessment Tool 5 (SCAT5) in professional hockey, part 1: cross-cultural normative data.

Objectives: This paper provides comprehensive normative data stratified by language preference and age on the components of the National Hockey League (NHL) Sport Concussion Assessment Tool 5 (SCAT5) in a multilingual sample of professional ice hockey players and compares the findings from a paper form of the NHL SCAT5 with an electronic (App) version of the tool.

Methods: A total of 1924 male NHL and American Hockey League (AHL) players (ages 17-41) were assessed during preseason medical evaluations (baseline); 1881 were assessed with the NHL SCAT5 App via tablet and 43 received the paper version of the NHL Modified SCAT5.

Results: No significant differences between the App and paper modes of administration emerged in a subsample of English preference players.

Motivational Interviewing to Encourage Quit Attempts Among Smokers Not Ready to Quit: A Trial-Based Economic Analysis.

Introduction: This study used data from a randomized controlled trial evaluating the efficacy of motivational interviewing (MI) relative to health education (HE) and brief advice (BA) to encourage quit attempts and cessation in order to determine their relative cost-effectiveness.

Aims And Methods: Urban community residents (n = 255) with low desire to quit smoking were randomized to MI, HE, or BA which differed in communication style and/or number of treatment sessions. Incremental cost-effectiveness ratios were used to compare the intensive interventions (MI and HE) to BA for facilitating quit attempts and smoking cessation.

Testing the hybrid battery approach to evaluating sports-related concussion in the National Hockey League: A factor analytic study.

There has been an increased interest in the use of "Hybrid" neuropsychological test batteries to evaluate neurocognitive functioning prior to and following sports-related concussion. Typically, these test batteries include a combination of traditional "paper and pencil" (P&P) and computerized measures. The National Hockey League (NHL) employs a Hybrid approach consisting of ImPACT and a brief battery of P&P measures.

Behavioral economic demand for medications and its relation to clinical measures in multiple sclerosis.

Multiple sclerosis (MS) is a neurodegenerative disorder that causes a wide range of symptoms, which, if left untreated, worsen over time. Despite the availability of effective medications, however, many MS patients fail to take their medications. One possibility is that these patients fail to follow through on treatment recommendations because they do not value these treatments-despite their effectiveness.

Reasons for nonadherence and response to treatment in an adherence intervention trial for relapsing-remitting multiple sclerosis patients.

Objectives: To explore whether patients in an adherence trial who appeared not to take disease modifying therapy (DMT) for avoidance reasons could be reliably identified, by observational coding, for their main reason of not taking DMT. To determine whether reason groups could be distinguished by clinical and self-report psychological characteristics and intervention outcomes.

Method: Participants were multiple sclerosis patients (N = 78, 88.

Probability discounting of treatment decisions in multiple sclerosis: associations with disease knowledge, neuropsychiatric status, and adherence.

Rationale: Patients weigh risks and benefits when making treatment decisions. Despite this, relatively few studies examine the behavioral patterns underpinning these decisions. Moreover, individual differences in these patterns remain largely unexplored.

How patients with multiple sclerosis weigh treatment risks and benefits.

Objective: Although the effectiveness and risks of multiple sclerosis (MS) therapies are established, relatively little is known about how these benefits and risks are perceived and weighed by patients. This risk-benefit trade-off is important for clinicians, industry, and regulators to consider when determining which therapies to develop, approve for clinical use, and recommend to individual patients. The primary objective of the present study was to describe individual differences in how MS patients weigh risks and benefits when making treatment decisions.

Discontinuing Treatment Against Medical Advice: The Role of Perceived Autonomy Support From Providers in Relapsing-Remitting Multiple Sclerosis.

Background: Long-term medication adherence is problematic among patients with chronic medical conditions. To our knowledge, this was the first study to examine factors associated with nonadherence among patients with relapsing-remitting multiple sclerosis who discontinue disease-modifying treatments against medical advice.

Purpose: To examine differences in perceived provider autonomy support between disease-modifying treatment-adherent relapsing-remitting multiple sclerosis patients and relapsing-remitting multiple sclerosis patients who discontinued disease-modifying treatments against medical advice.

Determining reliable change on the modified fatigue impact scale (5-item version).

Background: Fatigue is prevalent in Multiple Sclerosis (MS), but little research indicates how to best quantify changes in fatigue over time.

Objective: Evaluate reliable change on the abbreviated Modified Fatigue Impact Scale (MFIS-5) in MS patients.

Methods: One-hundred sixty eight MS patients completed the MFIS-5 at baseline and follow-up as part of two larger studies.

On how patients with multiple sclerosis weigh side effect severity and treatment efficacy when making treatment decisions.

Although effective disease-modifying treatments (DMTs) are available for individuals suffering from multiple sclerosis (MS), many patients fail to take their recommended medications. Unlike medications that provide immediate relief from existing symptoms, DMTs decrease the probability of future symptoms (i.e.

Baseline predictors of DMT reinitiation among patients with multiple sclerosis following an MI-CBT intervention.

Patients with multiple sclerosis (MS) are often nonadherent to their disease modifying therapy (DMT). While recent studies demonstrate enhanced DMT adherence following intervention grounded in motivational interviewing (MI), little is known about how to address DMT reinitiation among MS patients who have prematurely discontinued DMT against medical advice and do not intend to reinitiate. We examined baseline predictors of DMT reinitiation among patients with MS who discontinued medications against medical advice following a telephone-based MI and Cognitive Behavioral Therapy (MI-CBT) intervention.

Health Literacy and Medication Adherence Among Patients Treated in a Free Health Clinic: A Pilot Study.

Background: A patient's health literacy is not routinely assessed during visits with a health care provider. Since low health literacy is a risk factor for poor health outcomes, assessing health literacy should be considered as part of the standard medical workup.

Objectives: To evaluate the health literacy levels and medication adherence of patients treated by pharmacists in both the general medicine and the chronic care clinics at an urban free health clinic.

Articulation time does not affect speeded cognitive performance in multiple sclerosis.

Objective And Background: Cognitive test performance by individuals with multiple sclerosis (MS) may be biased because of MS-related speech problems. The purpose of this study was to compare articulation and pause durations between individuals with MS and controls on cognitive tests requiring an oral response.

Method: As part of a neuropsychological assessment, 41 patients with MS and 23 controls completed oral forms of 2 timed cognitive tests that are commonly used in MS.

Polypharmacy in multiple sclerosis: relationship with fatigue, perceived cognition, and objective cognitive performance.

Objective: Patients with multiple sclerosis (MS) commonly use a variety of medications to slow disease progression, alleviate symptoms, and treat comorbid conditions. Polypharmacy has been linked to adverse outcomes in other patient groups, but has not been studied extensively in MS. We investigated the impact of polypharmacy on fatigue, objective neuropsychological performance, and subjective cognitive impairment in a sample of patients with MS.