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Advances in Managing Multiple Sclerosis

Advances in Managing Multiple Sclerosis

According to recent estimates, about 400,000 people in the United States live with multiple sclerosis (MS). There are other conditions that are now known to be distinct from the disease but may be misdiagnosed as MS. Typically, MS can be associated with fatigue, impaired vision, problems with balance and walking, numbness or pain, tremor, and other sensory and physical changes. “With MS, the symptoms are unpredictable and vary from person to person,” explains Mark S. Freedman, MD. “Some patients may experience abnormal fatigue and episodes of numbness and tingling, whereas others lose balance and muscle coordination. All patients with MS will have unique characteristics and symptoms, making treatment challenging.” Disease-Modifying Therapy Some drugs treat symptoms of MS whereas others modify the disease by altering the course of its progression, Dr. Freedman says. “With disease-modifying therapy, the goal is to reduce MS attacks, decrease the number of lesions seen on MRI, and slow or prevent disease progression.” Several therapies have been approved by the FDA to treat MS, some that are taken orally and others that are injected. The National Multiple Sclerosis Society recommends that patients diagnosed with relapsing MS and those whose disease is currently active consider beginning treatment with disease-modifying therapy as early as possible, as these medications lose efficacy as the disease advances. “It can be challenging for patients to take disease-modifying medications over a long period of time,” Dr. Freedman says, “but it’s important that they understand the role of these therapies in their overall MS treatment plan.” Patients must also be made aware of the obstacles that can interfere with adherence to treatment plans. The...
Wanted: Older Adults in Cancer Trials

Wanted: Older Adults in Cancer Trials

Studies have shown that older adults account for most of the cancer diagnoses and deaths that occur in the United States and make up the majority of cancer survivors. More than 50% of cancers in the U.S. occur in people aged 65 and older, a demographic that is expected to grow exponentially in the coming years. However, the evidence base for treating this patient group is lacking. In addition, few policy initiatives have targeted the lack of evidence on older adults with cancer. “Older adults are largely underrepresented in clinical trials, and it’s rare when these trials are designed specifically for older adults,” says Arti Hurria, MD. “This patient population tends to have different experiences and outcomes with cancer treatment than younger counterparts. We’re also expecting a doubling of the U.S. population that is 65 and older, and we project a 67% increase in cancer incidence among this age group. These data emphasize the importance of involving older adults in clinical trials so that we can optimize treatment for these patients.” In response to this issue, the American Society of Clinical Oncology (ASCO) recently released landmark recommendations to improve the evidence base for treating older adults with cancer. The call-to-action statement was developed by ASCO’s Cancer Research Committee and published in the Journal of Clinical Oncology. It made five overarching recommendations to improve the evidence base for treating older adults with cancer (Table). Improving Trial Designs The first recommendation from ASCO is to use clinical trials to improve the evidence base for treating older adults. There is growing recognition that eligibility criteria in clinical trials could be relaxed without...
Examining Information Sharing Preferences

Examining Information Sharing Preferences

Research has shown that older patients often share control over decision-making and personal health information with family members or friends in order to manage medical care issues. However, it can be challenging for clinicians to balance helping patients and their caregivers work collaboratively to manage health information and decision-making while simultaneously respecting the preferences, privacy, and priorities of patients. To help patients manage their healthcare, patient portals have been developed that connect patients with their healthcare records and oftentimes directly with their clinicians through secure messaging. While portals can be helpful, they may not account for all privacy preferences and offer little guidance on when patients would like to bring their families or caregivers into the fold. Examining Attitudes & Needs In previous research, studies have shown that older patients often want control over the privacy of their health information in electronic medical records, but little is known about how this control relates to family dynamics and the use of patient portals. As reported in  JAMA Internal Medicine, Bradley H. Crotty, MD, MPH, and colleagues sought to identify how elderly patients (older than 75) and their family caregivers approached sharing of health information. “This is an issue that many physicians will encounter, but there has not been much research on the topic,” says Dr. Crotty. For the study, investigators recruited participants from the Information Sharing Across Generations (InfoSAGE) Living Laboratory. InfoSAGE is an ongoing study of the information needs of elderly patients and families within a network of senior housing in the Massachusetts area. Participants joined one of 10 discussion groups to explore the issues. Group discussions were then...
The CDI Burden in Surgery

The CDI Burden in Surgery

Despite increased national attention, the incidence of Clostridium difficile infection (CDI) and its associated financial and human costs continue to grow. In fact, the problem has become so critical that CMS would no longer reimburse hospitals for claims associated with this potentially preventable infection if it is acquired during the hospital stay. There are also concerns that new strains of the infection may cause resistance to traditional antibiotic regimens. Recent data have also shown that the burden of CDI is increasing among surgical patients. This is concerning given that surgical care accounts for about 40% to 50% of all hospital stays and healthcare dollars. “Surgery patients frequently receive prophylactic antibiotics and have longer inpatient hospital exposure,” explains Zaid M. Abdelsattar, MD, MSc. Previous reports on how CDI affects surgical patients has been limited by the use of administrative data and failure to capture cases diagnosed after discharge, and reports from single-center studies. A Large-Scale Analysis In a study published in Infection Control & Hospital Epidemiology, Dr. Abdelsattar and colleagues conducted a large-scale analysis of patients with postoperative CDI after 40 different surgeries at 52 academic and community hospitals for a period of about 1 year. The purpose of the analysis—which included more than 35,000 patients in total—was to identify CDI risk factors and determine the impact of the infection on resource utilization. According to the results, only about 0.5% of the study group developed CDI after surgery, but postoperative CDI rates varied significantly between surgical procedures. Three surgical groups had higher adjusted odds ratios (aOR) of postoperative CDI: Lower-extremity amputations: aOR,3.5. Gastric or esophageal operations: aOR, 2.1. Bowel resection...
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