Factors affecting adherence to disease-modifying therapies in multiple sclerosis: systematic review

People with multiple sclerosis (MS) face challenges adhering to disease-modifying drug (DMD) treatment. Poor adherence to treatment reduces its clinical effectiveness which can adversely impact disease progression, MS-related hospitalisation, and mortality rates. Understanding the barriers to adherence is essential to addressing these issues in clinical practice and a consolidation of the literature had not yet been carried out. A systematic search was carried out using the electronic databases PsycINFO, and PubMed (Medline) using the search terms treatment compliance or treatment adherence and multiple sclerosis or MS. Studies included adults, with a diagnosis of relapsing–remitting MS (RRMS) (sample > 80% RRMS), taking a DMD. The studies used an adequate measurement of treatment adherence and analysed possible factors associated with adherence. A total of 349 studies were retrieved, of which 24 were considered eligible for inclusion. Overall adherence rates of the included studies ranged from 52 to 92.8%. Narrative synthesis revealed the most prevalent factors associated with adherence were age, gender, depression, cognition, treatment satisfaction, injection-site reactions, and injection anxiety. There was contradictory evidence for disability in association with treatment adherence. The findings should be used to inform the development of targeted patient support programs which improve treatment compliance. The review also highlights the opportunities for advancing research into treatment adherence in MS.

Bermain Terapeutik Clay Menurunkan Tingkat Kecemasan Pada Anak Usia Prasekolah Saat Tindakan Injeksi

ABSTRACT: PLAYING CLAY THERAPEUTIC REDUCES ANXIETY LEVELS IN PRE-SCHOOL AGE DURING INJECTION ACTION Background: Many children who are hospitalized have anxiety. The child's anxiety was caused by the injection. Anxiety in children is characterized by a refusal reaction, the child is afraid of the treatment given, the child often cries and is not cooperative with health workers. For this reason, clay therapy is given, where playing can make children happier and more comfortable so that stress and tension can be avoided.Objective: To determine the effect of clay therapy on anxiety levels in preschool children during injection in the Orchid room of dr. Soeselo Slawi.Research Methods: This type of research is quantitative, quasi experimental design with one group pretest and posttest design approach. The sample in this study were 20 preschool children. The instrument used was an observation sheet to determine anxiety using the Spence Children Anxiety Scale. Data analysis was univariate (frequency distribution) and bivariate (Wilxocon test).Results: The results of the Wilcoxon test using a computer program at an error rate of 5% (ρ - 0.05) were obtained ρ value = 0.002 so that ρ value <ρ namely (0.002 <0.05) which means that Ha is accepted and it means that there is an effect of playing therapeutic clay on the level of anxiety in preschool children during the injection in the Anggrek room RSUD dr. Soeselo Slawi.Conclusion: there is an effect of playing therapeutic clay on the level of anxiety in preschool children during the injection in the Orchid room at RSUD dr. Soeselo Slawi. The recommendation from this study is that clay can be given to preschoolers to reduce anxiety during injection. Keywords: Play, Clay, Injection, Anxiety INTISARI: BERMAIN TERAPEUTIK CLAY MENURUNKAN TINGKAT KECEMASAN PADA ANAK USIA PRASEKOLAH SAAT TINDAKAN INJEKSI Latar Belakang : Anak yang dirawat di rumah sakit banyak yang mengalami kecemasan. Kecemasan pada anak tersebut disebabkan saat tindakan injeksi. Kecemasan pada anak ditandai dengan reaksi menolak, anak takut terhadap pengobatan yang diberikan, anak sering menangis dan tidak kooperatif pada petugas kesehatan. Untuk itu, diberikan terapi clay, dimana bermain dapat menjadikan diri anak lebih senang dan nyaman sehingga adanya stress dan ketegangan dapat dihindarkan.Tujuan : Mengetahui pengaruh terapi clay terhadap tingkat kecemasan pada anak usia prasekolah saat tindakan injeksi di ruang Anggrek RSUD dr. Soeselo Slawi.Metode Penelitian : Jenis penelitian kuantitatif, rancangan quasi experimental design dengan pendekatan one group pretest and posttest design. Sampel dalam penelitian ini adalah anak usia prasekolah sebanyak 20 responden. Instrumen yang digunakan adalah lembar observasi untuk mengetahui kecemasan dengan menggunakan Spence Children Anxiety Scale. Analisis data secara univariat (distribusi frekuensi) dan bivariate (wilxocon test).Hasil : Hasil dari uji Wilcoxon test dengan menggunakan program komputer pada tingkat kesalahan 5% (ρ – 0.05) di peroleh ρ value = 0.002 sehingga ρ value < ρ yaitu (0.002 < 0.05) yang berarti Ha diterima dan artinya ada pengaruh bermain terapeutik clay terhadap tingkat kecemasan pada anak usia prasekolah saat tindakan injeksi di ruang Anggrek RSUD dr. Soeselo Slawi.Kesimpulan : ada pengaruh bermain terapeutik clay terhadap tingkat kecemasan pada anak usia prasekolah saat tindakan injeksi di ruang Anggrek RSUD dr. Soeselo Slawi.Rekomendasi dari penelitian ini adalah clay dapat diberikan pada anak usia prasekolah untuk mengurangi kecemasan saat tindakan injeksi. Kata Kunci : Bermain, Clay, Injeksi, Kecemasan

Patient Preferences with Regard to Laser versus Intravitreal Injections in the Treatment of Diabetic Macular Edema

Purpose. To identify treatment preferences of patients with diabetic macular edema (DME) having undergone laser and intravitreal injections. Methods. Patients with DME who received lasers and injections were surveyed, measuring preferences toward specific treatments. 66/210 diabetic patients met the criteria for our survey assessing preference for lasers and/or injections, incorporating demographics and treatment preference questions. Outcome measures included treatment preference (laser or injections), how often patients are willing to be treated, and how much vision they will sacrifice to avoid being treated every month. Results. 66 patients completed the survey. The mean diabetes duration was 20.7 years, the mean retina follow-up was 4.4 years, and patients received a mean of 4.82 lasers and 4.86 injections. 56% preferred injections, 33% preferred laser, and 11% had no preference. Regarding treatment effectiveness, 38% found no difference, 36% chose laser, and 25% chose injections. Regarding anxiety, 56% reported injection anxiety. While 50% versus 38% reported that laser was easier than injections. 91% would give up zero lines on the eye chart, and 76% would come in 12 times yearly for treatment to maintain vision. Conclusion. Patients with DME have no profound preference regarding laser versus intravitreal injections but prefer aggressive treatment and are unwilling to sacrifice vision for less visits.

Effect of hydro-alcoholic extract of Ziziphus spina-christi against scopolamine-induced anxiety in rats

<p class="Abstract">The aim of this study was to observe the effect of <em>Ziziphus spina-christi</em> extract against anxiety related behavior induced by scopolamine. Rats were randomly divided into six groups, each group consists of eight rats. Vehicle group received distilled water, negative control received scopolamine (1 mg/kg) and positive control received diazepam (1 mg/mL). Experimental groups received <em>Z. spina-christi</em> extract (50, 100 and 200 mg/kg IP) 30 min after scopolamine injection. Anxiety related behaviors were assessed using the elevated plus maze. The rotarod test was used to evaluate motor coordination. Administration of <em>Z. spina-christi</em> extract (200 mg/kg) significantly increased the time spent in the open arm of elevated plus maze. The extract also reduced the percentage of closed arms entries and time spent in the closed arms. Different concentration of <em>Z. spina-christi</em> extract didn’t affect motor coordination and balance. Hydro-alcoholic extract of <em>Z. spina-christi</em> significantly ameliorate scopolamine-induced anxiety.</p><p><strong>Video clip</strong></p><p><a href="https://youtube.com/v/LTHNppf_Euo">Elevated plus maze</a>: 1 min 58 sec </p>

The Stress and Mood Management Program for Individuals With Multiple Sclerosis

Multiple Sclerosis presents not only physical challenges, but emotional challenges as well. Many people with MS suffer from depression, anxiety and stress. Problems with mood and stress can interfere with relationships with others, reduce ability to meet obligations at work and at home, and substantially worsen overall quality of life. The stress and mood management program described in this book is backed by research and has proven effective in clinical trials. Based on the principles of cognitive-behavioral therapy (CBT), one of the most effective therapeutic techniques available for combating depression and anxiety, this program can help manage stress and improve well-being. It provides ways to learn skills for identifying and challenging your unhelpful thoughts, as well as how to motivate to reengage in pleasant activities. It also covers treatment modules that can be modified to specific MS-related problems. Choices include modules on managing symptoms like fatigue, pain, and cognitive problems, and improving communication and assertiveness skills, among others. It also provides a module on self-injection anxiety.

Module 7: Self-Injection Anxiety Counseling (SIAC)

This chapter describes an optional treatment module on self-injection anxiety counselling (SIAC). This module is designed for patients who have needle anxiety and who rely on self-injection for the management of their illness. It presents basic information about self-injection anxiety, cognitive impairment, the anxiety response, subjective units of distress (SUDS) rating, the use of hierarchies, systematic desensitization, unhelpful thoughts, the actual injection process, and relapse prevention.