Nancy J. Holland

The Goldman Consensus statement on depression in multiple sclerosis

Background. In January 2002 the New York City Chapter of the National Multiple Sclerosis Society convened a panel of experts to review the issue of depressive affective disorders associated with multiple sclerosis (MS). This Consensus Conference was supported by a grant from the Goldman family of New York City. Results. The panel reviewed summaries of current epidemiologic, neurobiologic, and therapeutic studies having to do with depressive disorders among MS patient populations. Depressive disorders occur at high rates among patients with MS, and there is reason to believe that the immunopathology of the disease is involved in the clinical expression of affective disorders. The depressive syndromes of MS have a major, negative impact on quality of life for MS sufferers, but are treatable. At the present time, most MS patients with depression do not receive adequate recognition and treatment. Conclusions. The Goldman Consensus Conference Study Group provides recommendations for improved screening, diagnosis, and clinical management for depressive affective disorders among patients suffering from MS.

Use of Alternative Treatments by People with Multiple Sclerosis

The prevalence, predictors, and description of alternative treatment use among peo ple with multiple sclerosis (MS) have not been well studied despite interest and con cern about such use among health care professionals and people with MS. The goal of this study was to describe the prevalence of the use of specific alternative treatments by people with MS, the sociodemographic and disease characteristics of those most likely to use alternative treatments, perceived benefits and harms from use of these treatments, and the reasons for their use. Almost three-fifths of the study sample of 240 people diagnosed with MS from two chapters of the National Multiple Sclerosis Society had used alternative treatments. Most (90 percent) of those who had used al ternative treatments did so in combination with traditional treatments. Only 7.1 per cent used any treatments considered to be high risk or dangerous. The primary reason for using alternative treatments was to obtain relief from physical and psychological symptoms. Implications of these findings for health care professionals are discussed. Key Words: Multiple sclerosis—Alternative therapies—Complementary therapies— Alternative medical practices—Unconventional medicine.

Meeting the Needs of People with Primary Progressive Multiple Sclerosis, Their Families, and the Health-Care Community

Although major advances have been made in delaying or preventing progression for the relapsing forms of multiple sclerosis (MS), little progress has been made to date in disease management for primary progressive MS (PPMS). Treatment strategies are largely focused on managing the symptoms of the disease and providing counseling and other forms of psychosocial support. The nurse plays a major role in managing these patients. This article summarizes a collaborative effort by the National Multiple Sclerosis Society and the Multiple Sclerosis Association of America to analyze the needs of this patient population and respond with programs that will meet those needs. This approach to developing a needs assessment is broadly applicable to other patient populations.

Young Adults With Multiple Sclerosis: Management in the Home:

Multiple sclerosis (MS) strikes early in life and places heavy demands on the person with MS and his or her family—physically, emotionally, and financially. Comprehensive planning of home-based services, implemented by a multidisciplinary team of health care professionals, is critical to management of the disease, prevention of complications, and promotion of optimal health and quality of life. Home-based services are an important strategy in cost containment, decreasing hospital admissions, and avoiding premature and expensive nursing home placement. This article describes MS and its management and explores the benefits of home services and coordination of care for people with MS within the framework of long-term care needs, clinical management of the disease, and caregiver and family issues.

A Comparative Study of Impairment Ratings in Multiple Sclerosis Patients

&NA; The Kurtzke Scale has been recently modified and is known as the “Expanded Disability Status Scale” (EDSS). The score obtained by application of this scale has been used by physicians for many years to document and communicate the impairment level of their MS patients. Nursing staff of the Albert Einstein College of Medicine and Holy Name Hospital MS Centers in New York used a modified evaluation tool to score 50 patients. Agreement between nurses and physicians tended to occur at mid‐point and higher on the EDSS. Scores on the lower end of the EDSS reflect minimal physical impairment and are dependent upon subtleties in the neurological examination. A major conclusion is that nurse‐physician use of this scale is reasonable for individuals who are experiencing some degree of disability. Since this population is the one most commonly in contact with the healthcare system, MDRN utilization of the EDSS has certain specific beneficial applications.

Developing Proposals for Nursing Research

A nursing specialty research panel was assigned the task of developing research questions pertinent to the issue of bladder management and skin integrity in multiple sclerosis. Review of the literature highlighted a gap in nursing research specific to nursing practice. Surveying colleagues at other multiple sclerosis centers revealed an inconsistent practice pattern. We believe that urinary tract infections can lead to worsening of MS symptoms and that urinary retention is a common cause of urinary tract infections. The technique of intermittent-self-catheterization is taught to patients to decrease urinary retention. The first research question addresses recommendations for catheter reuse. Additionally, skin breakdown is frequently referred to as a complication of MS. We do not know the incidence and prevalence of skin breakdown in this population. Moreover, we do not know the specific risk factors for skin breakdown in MS clients. The Braden scale has been utilized to predict pressure ulcer risk in the geriatric population. The pressure ulcer study being planned by the MS nursing specialty panel intends to examine the utility of the Braden scale to predict skin breakdown in MS patients. Both studies will include patients with clinically definite multiple sclerosis from MS centers within the Consortium of Multiple Sclerosis Centers.

Book Reviews: Neuroscience Nursing—A Nursing Diagnosis Approach. Marilyn Mitchell. Appleton & Lange, Nor-walk, CT, 1988, 260 pp

course of MS, appearing in the early stages of the disease and increasing with physical disability. The question is raised whether &dquo;a structural or neurochemical brain lesion in MS may explain mood disorders.&dquo; The conclusion is that patients’ complaints of depression may be &dquo;an indication of severe progression of brain damage.&dquo; Because of the nature and style of the findings presented, the book as a whole will be of greatest use and