scholarly journals Examining Nurse Empathy for Infant Procedural Pain: Testing a New Video Measure

2011 ◽  
Vol 16 (4) ◽  
pp. 228-233 ◽  
Author(s):  
Margot Latimer ◽  
Philip Jackson ◽  
Celeste Johnston ◽  
Jocelyn Vine
Keyword(s):  
Self Report ◽  
Procedural Pain ◽  
Control Group ◽  
Control Groups ◽  
Cross Sectional ◽  
Research Reporting ◽  
Video Clips ◽  
Infant Pain ◽  
Repeated Pain ◽  
Video Program

BACKGROUND: Research reporting effective pain care strategies exists, yet it is not translated to care. Little is known about how repeated pain exposure has affected nurses’ ability to be empathetic and use their knowledge to provide evidence-based care. Concerns have been raised regarding the validity of self-report empathy instruments; therefore, a novel video program was developed for testing. It was hypothesized that those who viewed infants in painful and nonpainful states would have a measureable empathy (pain rating) response correlating to the level of pain expressed by the infants.OBJECTIVE: To validate the newly developed Empathy for Infant Pain video program (EIPvp) by determining whether nurse and non-nurse control groups’ pain scores of 24 video clips showing infants undergoing real medical procedures were equal.DESIGN: A descriptive cross-sectional video judgement study.METHODS: Fifty female participants (25 nurses and 25 allied health controls) were asked to score the infant procedural pain level displayed in the EIPvp using a visual analogue scale and a composite score of known infant pain cues. Participants also scored their own sensitivity to painful events.RESULTS: Participants rated the videos contained in the EIPvp similarly in three categories (no, low or high pain); however, there were consistent differences between groups within the categories. Nurses scored facial cues for all categories higher than the control group. Nurses scored their own pain in hypothetical situations and that of the infants consistently higher than the control group.CONCLUSION: The EIPvp yielded predictable responses from both the nurse and non-nurse control groups when scoring the pain expressed in the video clips. Nurses’ detection of pain more often than controls may have been an indication that they have greater knowledge of pain cues, or their empathy levels may have been different as a result of their exposure to, or their perceived relationship with, patients. The EIPvp was validated and has promising potential for training and research purposes.

Efektivitas Short Message Service Reminderterhadap Kepatuhan Konsumsi Tablet Besi pada Wanita Hamil

1970 ◽  
Vol 2 (3) ◽  
Author(s):  
Ermiati E ◽  
Imas Rafiyah ◽  
Devi Kusnanti
Keyword(s):  
Short Message Service ◽  
Self Report ◽  
Control Group ◽  
Short Message ◽  
Control Groups ◽  
Chi Square ◽  
Purposive Sampling ◽  
Message Service ◽  
Sms Reminder ◽  
Expectant Mothers

Anemia merupakan salah satu penyebab terjadinya perdarahan dan bisa mengakibatkan kematian pada ibu hamil. Suplementasi besi merupakan program pemerintah dalam mengatasi anemia pada wanita hamil dan beberapa wanita hamil masih ada yang belum patuh dalam mengkonsumsi tablet besi. Oleh karena itu, diperlukan sebuah metode yang bisa meningkatkan kepatuhan wanita hamil dalam mengonsumsi tablet besi yaitu dengan short message service (SMS) reminder. Penelitian ini bertujuan untuk mengidentifikasi efektivitas SMS reminderterhadap kepatuhan konsumsi tablet besi pada ibu hamil di (unit pelayanan terpadu) UPT Puskesmas Cibuntu Kota Bandung. Rancangan penelitian quasi experimentaldengan desain posttest-only with control group designdengan teknik pengambilan sampel yang digunakan adalah purposive sampling. Penelitian ini dilaksanakan dari bulan April–Mei tahun 2014 di Puskesmas X Kota Bandung. Sampel berjumlah 40 orang wanita hamil yang tidak patuh dalam mengonsumsi tablet besi yang dibagi menjadi 20 kelompok intervensi dan 20 kelompok kontrol. Data diperoleh melalui kuesioner dalam bentuk self report.Analisis data yang digunakan adalah analisis deskriptif dan uji chi square. Hasil penelitian menunjukkan sebagian besar kelompok intervensi 17 orang (85%) patuh dan sebagian besar kelompok kontrol 16 orang (80%) tidak patuh. Hasil analisis dengan menggunakan chi squaredidapatkan p(0.000) dengan taraf signifikan <0.05 sehingga dapat disimpulkan bahwa SMS reminder efektif terhadap kepatuhan konsumsi tablet besi pada wanita hamil dan bisa dijadikan bahan pertimbangan bagi pihak Puskesmas untuk menjalin kerjasama dengan pihak provideratau mengajukan dana ke Dinas Kesehatan untuk mengaktifkan SMS reminderdi Puskesmas.Kata kunci: Kepatuhan, SMS reminder,tablet besi, wanita hamil AbstractAnemia is one of the leading causes of hemorrhage during pregnancy, and it can cause death to expectant mothers. Iron supplementation is a government program to overcome anemia among expectant mothers, and some of the expectant mothers still do not obediently consume iron tablets. Therefore, to increase the obedience of the expectant mothers on consuming the iron tablets, SMS reminder is the appropriate method needed. This research aims to identify the effectiveness of SMS reminder to the obedience of iron tablets consumption among expectant mothers at UPT Puskesmas Cibuntu , Bandung. The research employed quasi-experimental design with posttest-only control group design using purposive sampling technique. The research was held on April–May 2014 at UPT Puskesmas Cibuntu, Bandung. Forty expectant mothers consuming iron tablets disobediently divided into 20 intervention groups and 20 control groups were taken as the samples. Questionnaire in form of self report was used to obtain data. In addition, descriptive analysis and chi square test were applied to analyze the data. The result of the research showed that 17 persons (85%) of intervention groups were mostly obedient, and 16 persons (80%) of control groups were mostly disobedient. From the analysis using chi square, it was found the difference of the obedience of iron tablets consumption after SMS reminder (p=0.00) had been delivered with significant level <0.05. Based on the result of this research, SMS reminder had an effective impact toward the obedience of iron tablets consumption among the expectant mothers. The result will be a good consideration for Puskesmas to cooperate with provider or proposed some funds to Dinas Kesehatan to activate SMS reminder.Key words:Expectant mothers, obedience, SMS reminder, iron tablets

scholarly journals Temporomandibular disorders in patients with early rheumatoid arthritis and at-risk individuals in the Dutch population: a cross-sectional study

RMD Open ◽  
2021 ◽  
Vol 7 (1) ◽  
pp. e001485
Author(s):  
Johanna M Kroese ◽  
Catherine M C Volgenant ◽  
Wim Crielaard ◽  
Bruno Loos ◽  
Dirkjan van Schaardenburg ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
At Risk ◽  
Early Rheumatoid Arthritis ◽  
Temporomandibular Disorders ◽  
Self Report ◽  
Joint Disease ◽  
Control Group ◽  
Healthy Controls ◽  
Cross Sectional ◽  
Pain Diagnosis

ObjectiveTo evaluate the prevalence of temporomandibular disorders (TMD) in patients with early rheumatoid arthritis (ERA) and individuals at-risk of RA.Methods150 participants were recruited in three groups (50 per group): (1) patients with ERA (2010 EULAR criteria) (2) at-risk individuals and (3) healthy controls. All participants were tested for seropositivity of rheumatoid factor and anticitrullinated protein antibodies. A possible TMD diagnosis was determined according to the standardised and validated diagnostic criteria for TMD (DC/TMD) in five categories: myalgia, arthralgia, articular disc displacement, degenerative joint disease and headache attributed to TMD. Results were tested for the prevalence of TMD (all categories combined) and TMD pain (myalgia and/or arthralgia). To investigate a possible role for bruxism, a probable sleep and/or awake bruxism diagnosis was determined based on self-report and several clinical features.ResultsThe prevalence of any TMD diagnosis did not differ between the three groups. However, at-risk individuals more often had a TMD-pain diagnosis than healthy controls (p=0.046). No such difference was found between the ERA group and the control group. However, within the ERA group, seronegative patients had a TMD-pain diagnosis more often than seropositive patients (4/12 (33%) vs 3/38 (8%), p=0.048). Participants with a TMD-pain diagnosis were more often diagnosed with probable sleep bruxism than those without a TMD-pain diagnosis.ConclusionThe prevalence of TMD pain is increased in individuals at-risk of RA and seronegative ERA patients, and is associated with bruxism signs and symptoms. These results suggest that health professionals should be alert to TMD pain in these groups.

scholarly journals Investigating the Effects of Brain Respiration on Children’s Behavior

2009 ◽  
Vol 4 (2) ◽  
pp. 46-61
Author(s):  
Geoffrey K. Leigh ◽  
Cynthia Robinson ◽  
Steven Bernard Hollingsworth
Keyword(s):  
Treatment Group ◽  
Self Report ◽  
Fifth Grade ◽  
Control Group ◽  
Control Groups ◽  
Teacher Observations ◽  
Fifth Grade Students ◽  
Math Scores ◽  
Reading And Math ◽  
Post Test

Building on the increasing number of programs designed to enhance brain development, a program developed in Korea, Brain Respiration, was adapted to a school in Nevada. Classes were offered twice weekly to a class of fourth and fifth grade students with control group classes assessed in the same school. Self-report surveys, teacher observations, and standardized reading and math scores were used to determine effects of the program on the students. Some differences were found in the pretest for the survey and the observation, with control groups scoring higher. There were differences in some post-test scores, with treatment group children scoring higher when differences did occur. There also were differences in the reading and math scores, with control groups scoring higher than the overall treatment group, but not higher when compared to those actively participating in the program. Such differences are discussed as well as other issues possibly influencing the effects.

scholarly journals Effectiveness of Cognitive Behavioral Therapy and Eye Movement Desensitization and Reprocessing in Child Victims of Domestic Violence

2019 ◽  
Author(s):  
Nasrin Jaberghaderi ◽  
Mansour Rezaei ◽  
Mitra Kolivand ◽  
Azita Shokoohi
Keyword(s):  
Domestic Violence ◽  
Cognitive Behavioral Therapy ◽  
Eye Movement ◽  
Behavioral Therapy ◽  
Self Report ◽  
Cognitive Behavioral ◽  
Individual Treatment ◽  
Control Group ◽  
Child Victims ◽  
Control Groups

Objective: This study was conducted to examine and compare the effectiveness of cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) in child victims of domestic violence (child physical abuse and/or witnessing parents’ conflicts). Method: A total of 139 girls and boys, aged 8-12 years, were randomly assigned into CBT (n = 40), EMDR (n = 40), or control groups (n=59). All children received up to 12 individual treatment sessions over 4–12 weeks. Blind assessment was done before and 2 weeks after the treatment and on a variety of teacher-parent-rated and self-report measures of posttraumatic symptomatology, depression, anxiety, and behavior problems. Results: CBT and EMDR were effective in ameliorating psychological sequelae of victims of domestic violence on the measured variables (p =.001). Comparison of the treatment and control groups suggested moderate to high practical significance in treatment groups vs controls. Conclusion: Both CBT and EMDR can help children to greatly recover from the outcomes of domestic violence in comparison with control group. Moreover, structured trauma treatments are strongly recommended and can be used for children

scholarly journals Relationship between serum iron level and febrile convulsion in children

2021 ◽  
Vol 62 (2) ◽  
pp. 112-118
Author(s):  
Ayşe Tuğba Kartal ◽  
Zeynep Çağla Mutlu
Keyword(s):  
Serum Iron ◽  
Febrile Convulsion ◽  
Blood Parameters ◽  
Control Group ◽  
Iron Level ◽  
Control Groups ◽  
Serum Iron Level ◽  
Cross Sectional ◽  
Reinforcing Factors ◽  
And Control

The aim of the present study was to evaluate the relationship between febrile convulsion, serum iron levels and whole blood parameters. This cross-sectional case-control study included patients aged 6 months-6 years-old brought to the department of pediatrics of Kütahya ParkHayat Hospital with febrile convulsions between January 2015 and December 2019. The patients were divided into two groups as: febrile with convulsions (study group; n= 47) and febrile without convulsions (control group; n= 35). Both groups were age and sex-matched. Some blood parameters such as mean serum iron, ferritin, Hb and MCV levels were used to compare the groups. Mean serum iron levels of the study and control groups were 33.7 ± 2.1 μg/dL and 56.3 ± 7.4 μg/dL (p<0.05), and serum ferritin levels were 27.3 ± 6.2 ng/mL and 31.1 ± 2.1 ng/ mL (p>0.05), respectively. Mean hemoglobin levels of the study and control groups were 10.6 ± 1.7 g/dL and 11.1 ± 1.4 g/dL (p <0.05), and mean MCV levels were 71.1 ± 1.2 fL and 73.2 ± 1.1 fL (p>0.05), respectively. In the light of the findings of this study, the low serum iron and ferritin levels may be reinforcing factors for developing febrile convulsion. However, multicentre studies with more patients are needed to reach a precise conclusion.

scholarly journals Immunological Microenvironment Alterations in Follicles of Patients With Autoimmune Thyroiditis

2021 ◽  
Vol 12 ◽  
Author(s):  
Ning Huang ◽  
Dandan Liu ◽  
Ying Lian ◽  
Hongbin Chi ◽  
Jie Qiao
Keyword(s):  
Follicular Fluid ◽  
Autoimmune Thyroiditis ◽  
Cross Sectional Study ◽  
Control Group ◽  
Control Groups ◽  
Cross Sectional ◽  
Thyroid Autoantibody ◽  
Inflammatory Cascade ◽  
Immune Imbalance ◽  
And Control

Autoimmune thyroiditis (AIT) is the most prevalent autoimmune endocrine disease, with a higher incidence in women than in men. Immunological abnormalities may lead to the impairment of ovarian folliculogenesis; however, whether the presence of AIT affects immunological microenvironment in follicles remains controversial. We performed a cross-sectional study including 122 patients, aged 20–40 years, who underwent IVF/ICSI treatment owing to isolated male or tube factor infertility. Patients were divided into AIT and control groups according to clinical presentation, thyroid function, and thyroid autoantibody measurements. Follicular fluid was collected and the distribution of cytokines/chemokines in follicular fluid was measured by flow cytometry using multiplex bead assays between the two groups. Based on differences in levels of intrafollicular chemokines and cytokines between the AIT and control groups, the relevant inflammatory cascade was further demonstrated. Among the 12 chemokines analyzed, three (CXCL9, CXCL10, and CXCL11) showed significantly elevated levels in the follicular fluid of patients with AIT. Among the 11 cytokines detected, compared with those in the control group, significantly higher levels of IFNγ were observed in patients with AIT. IFNγ dose-dependently stimulated the expression and secretion of CXCL9/10/11 in cultured primary granulosa cells. The percentage of CXCR3+ T lymphocytes was significantly elevated in the follicular microenvironment of patients with AIT. We concluded that the IFNγ-CXCL9/10/11-CXCR3+ T lymphocyte inflammatory cascade is activated in the follicular microenvironment of patients with AIT. These findings indicate that a considerable immune imbalance occurred in the follicular microenvironment of patients with AIT.

scholarly journals Musculoskeletal Symptoms among the Brick Kiln Workers of Kathmandu Valley

2017 ◽  
Vol 7 (1) ◽  
pp. 7-11
Author(s):  
Tanweer Mikrani ◽  
Naresh Manandhar ◽  
Sunil Kumar Joshi
Keyword(s):  
Exposed Group ◽  
Musculoskeletal Symptoms ◽  
Control Group ◽  
Kathmandu Valley ◽  
Control Groups ◽  
Brick Kiln ◽  
Musculoskeletal Problem ◽  
Cross Sectional ◽  
Brick Kilns ◽  
And Control

Background: Brick kilns may pose threat to the environment and health of the workers and people residing around them. Health problems related to brick kilns are musculoskeletal, respiratory, digestive system, nutritional and skin disorders. Objective of this study was to find out the prevalence of musculoskeletal symptoms (problems) among brick kiln workers of Kathmandu valley. Methods: A cross sectional study was conducted in the brick kilns of Kathmandu valley from February to April 2015. Two hundred (200) workers were selected randomly from the sampled brick kilns of Kathmandu Valley as the exposed group and the equal number of grocery vendors from the surroundings of the brick kilns was included as the control group in term of exposure to ergonomic hazards. The data was collected using Nordic Musculoskeletal Questionnaire. Results: A majority of the respondents were Hindu by religion. The mean age of exposed group was 30.75 years and 33.25 years for control group. Male female ratios were 2.39:1 and 1.94:1 in exposed and control groups respectively. The highest prevalence of musculoskeletal problem was found on Shoulders followed by Lower back, Knee and Neck for exposed group. Conclusion: All musculoskeletal problems were significantly different between exposed and control groups. Compared to the control groups, brick kiln workers had almost 8 times more likely to experience shoulder problem and 7 times more low back pain. All musculoskeletal symptoms at any time during last 12 months were found higher in exposed group compared to the control group, which was statistically significant.

scholarly journals Psychological and behavioural aspects in children and adolescents with congenital hypothyroidism diagnosed by neonatal screening: comparison between parents' and children's perceptions

2011 ◽  
Vol 164 (2) ◽  
pp. 269-276 ◽  
Author(s):  
Nicoletta Bisacchi ◽  
Milva Orquidea Bal ◽  
Laura Nardi ◽  
Ilaria Bettocchi ◽  
Graziana D'Addabbo ◽  
...  
Keyword(s):  
Congenital Hypothyroidism ◽  
Neonatal Screening ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Self Report ◽  
Control Group ◽  
Cross Sectional ◽  
Increased Risk ◽  
Group 2 ◽  
Behavioural Aspects

ObjectiveTo compare the psychological adjustment and behaviour of congenital hypothyroidism (CH) children and their parents with a control group.Study designA cross-sectional study was carried out with 84 CH subjects diagnosed by neonatal screening (range 2.7–18.6 years), subdivided into four age groups: group 1 (2–5 years); group 2 (6–10 years); group 3 (11–13 years); and group 4 (14–18 years) and was compared with an age-matched control group. Patients were assessed using two questionnaires: Child Behaviour Checklist for parents and Youth Self-Report for children over 11 years of age.ResultsIn groups 1, 3 and 4, total score (TS), internalising score (IS=problems within the self) and externalising score (ES=conflicts with other people) as reported by parents were not significantly different in CH patients and in controls. In group 2, parents of CH children showed values of TS (P<0.05), IS (P<0.05), ES (P<0.05) and scores on other scales significantly higher than controls. In self-reports of groups 3 and 4, the behavioural scales were not significantly different in CH patients and in controls.ConclusionsPaediatricians should be informed about the increased risk of the development of behavioural problems at primary school age in CH patients. At this age special attention should be paid to parental worries and anxiety. However, it can be reassuring for the patients and parents to know that the problems may be related to CH, and that they may spontaneously disappear.

scholarly journals Evaluation of Carotid Intima-Media Thickness in Sub-clinical Hypothyroid Patients

2018 ◽  
Vol 19 (2) ◽  
pp. 123
Author(s):  
Farhana Rahman ◽  
Fatema Sultana Haque ◽  
Shankar Kumar Biswas ◽  
Rubina Begum ◽  
Sadia Hossain ◽  
...  
Keyword(s):  
Rank Correlation ◽  
Intima Media Thickness ◽  
Control Group ◽  
Control Groups ◽  
College Hospital ◽  
Cross Sectional ◽  
Female Ratio ◽  
Media Thickness ◽  
The Mean ◽  
And Control

<p><strong>Objective:</strong> Endothelial dysfunction and atherosclerosis may be associated with subclinical hypothyroidism (SCH) in multiple ways. The intima-media thickness of the common carotid artery (CIMT) is an important parameter for early atherosclerotic change. Previously several studies addressed the association between SCH and CIMT. Some studies indicate that SCH might be related to increase CIMT, while other studies revealed no significant association.   The aim of the study was to further examine the relationship between CIMT and SCH patients in our own laboratory setting in Bangladesh.</p><p><strong>Patients and Methods: </strong>This cross sectional study was carried out at the Institute of Nuclear Medicine and Allied Sciences (INMAS), Dhaka Medical College Hospital Campus, Dhaka during the period of January 2016 to October 2016. The study included 56 consecutive patients. Out of 56 patients, 26 were in SCH group and 30 were in euthyroid control group. CIMT was measured in each subject via High resolution B-mode ultrasonography. Data were analyzed between these two groups in respect to age, sex, BMI, and mean CIMT.</p><p><strong>Results: </strong>Out of 56 subjects, 26 were SCH group and 30 were euthyroid control group. Male to female ratio was 3:23 and 9:21 in SCH and control groups respectively. The mean age was 30±7.4 and 32±8.7 years in SCH and control groups respectively. The mean BMI was 25.6±4.7 kg/m<sup>2</sup> in SCH and 25.1±4.1 kg/m<sup>2</sup> in control group. The mean CIMT was significantly (p≤0.05) higher in SCH group (Right-0.80±0.05 mm, Left-0.80±0.07 mm) than control group (Right-0.60±0.05 mm, Left- 0.61±0.05 mm). SCH group was further subdivided into two groups with a cut off value of serum TSH at 10 mIU/L.  The mean CIMT was significantly higher in SCH with TSH above 10 mIU/L than SCH group with TSH less than 10 mIU/L (p≤0.05). Pearson’s rank correlation test showed significant positive correlation between both CIMT and TSH values.</p><p><strong>Conclusion: </strong>Our study showed that CIMT was significantly higher in SCH group than euthyroid control group. The CIMT values were positively correlated with the TSH values. Therefore we may conclude that SCH is an independent risk factor for atherosclerosis  in addition to other  classical risk factors.</p><p>Bangladesh J. Nuclear Med. 19(2): 123-127, July 2016</p>

Assessment of serum zonulin as a marker of altered intestinal permeability in patients with multiple sclerosis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Prof.Dr. Ayman Mohamed Nassef ◽  
Lobna Mohamed ElNabil ◽  
Mohamed Mahmoud Fouad ◽  
Amira Ahmed Moussa
Keyword(s):  
Multiple Sclerosis ◽  
Intestinal Barrier ◽  
Control Group ◽  
P Value ◽  
University Hospitals ◽  
Control Groups ◽  
Cross Sectional ◽  
Progressive Group ◽  
And Control ◽  
Age And Sex

Abstract Background Here we enrolled patients into 3 groups: Relapsing remittent MS in relapse (RRMS) [N = 26], progressive MS (progressive) [N = 19] and relapsing remittent MS in remission (remission) [N = 18] Control group matching age and sex [N = 20] P-Value was &lt;0.001, which is significant in RRMS group in relation to progressive, remission and control groups. P-Value was 0.849, which is insignificant in progressive group in relation to remission group. P-Value was 0.584, which is insignificant in progressive group in relation to control group. P-Value was 0.973, which is insignificant in remission group in relation to control group. Aim of the Work To investigate the possible association between IP changes and MS through measurement serum zonulin in different population of MS for possible implication on treatment. Patients and Methods A. Subjects Type of the Study A case control observational cross sectional study Study Setting The Neurology department of Ain Shams University hospitals. Study Period 6 months to 1 year Study Population This study will enroll 92 subjects who will be divided into 4 groups; group 1 including 24patients with the diagnosis of relapsing remittent MS (RRMS) who are in relapse phase within one week from the time of sample withdrawal, group 2 including 24 patients with the diagnosis of RRMS who are in remission phase, group 3 including 24 patients with secondary progressive MS (SPMS) and group 4 including 20 age- and sex-matched healthy controls. Results In the RRMS group of this study, serum Zonulin varying between (12_ 93) with mean 28.692 and +\-22.894 SD. In the progressive group of this study, serum Zonulin varying between (2_ 18) with mean 8.021 and +\-3.866 SD. In the remission group of this study, serum Zonulin varying between (1.5_ 11) with mean 4.522 and +\-3.026 SD. In the control group of this study, serum Zonulin varying between (1.3_ 6) with mean 2.690 and +\-1.292 SD. P-Value was &lt;0.001, which is significant in RRMS group in relation to progressive, remission and control groups. P-Value was 0.849, which is insignificant in progressive group in relation to remission group. P-Value was 0.584, which is insignificant in progressive group in relation to control group. P-Value was 0.973, which is insignificant in remission group in relation to control group. Conclusion this study included 62 patients diagnosed as multiple sclerosis that are divided into 3 groups and serum Zonulin level was assessed in each group and the results were significant in the relapse group which indicates autoimmune theory of MS and link between gut barrier and CNS also illustrated the role of gut microbiota in the MS. It also supported disintegration of intestinal barrier during the attack of MS for further work up studies regarding oral medication in the acute attack of MS.

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