Friday, 20 January 2017

#NeuroSpeak: MS Trust's Health Professionals Web Resources

Healthcare professionals working in MS may find the MS Trust's new web resource helpful #NeuroSpeak

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Health Professionals Web Resources
Here at the MS Trust we are always working to ensure that people with MS and the specialist health professionals who support them have access to up-to-date, relevant, accurate and useful information. Recently, we've been working with health professionals to look into the information resources currently used, and where there may be gaps. Many thanks to everyone who has been involved in this project and those who completed our survey.

A few topics emerged that professionals wanted more information on, so we decided to send a reminder about the resources we already provide in those areas. We believe the following resources will prove useful to MS health professionals, and support them in their professional development and in providing quality care to people with MS.
Writing an effective business case
We have recently updated a page on our website about capacity planning and writing a good business case, featuring highlights from our guide to writing an effective business case and our capacity planning tool, which are available in full on request.

Understanding commissioning and funding flows in MS services in England
This is a vastly complex subject, but can be hugely beneficial to understand when making a case for service improvement/development. We've created a straightforward, practical guide to funding flows in MS services in England.

Sharing examples of innovative practice
We have recently put together a resource for health professionals highlighting opportunities to implement change in MS services. Featured on this webpage are a number of examples of innovative practice from MS teams across the UK (and the opportunity to add to this list yourself) and suggestions for small steps you can implement to help take forward the action statements from MS Forward View.

Developing an effective, responsive and efficient relapse service
In the summer of 2016, we sent every MS nurse a copy of our guide Eight steps to improving your relapse service: a guide to best practice for MS specialist nurses, which explained relapses, discussed the clinical management of relapses, and set out our 'eight steps' needed to deliver an effective relapse service. We also hoped that this resource may be useful for other MS health professionals and GPs.
Auditing your service with a user survey
The MS Trust offers all UK MS nurse and therapist teams the chance to use this survey through a free service whereby we take away most of the work involved.  By taking part, you will receive a valuable presentation giving evidence of the benefits of your service to patients along with service users' experiences and suggestions for improvement.

Improving the efficiency of disease modifying drug provision
As part of MS Forward View, we looked at the DMD pathway in MS and investigated how capacity may be created in this area of MS care. This report provides a detailed explanation of the current workload associated with DMDs and how this impacts MS teams, models how this workload may develop in future and where capacity may be freed up in this pathway. 
Improving services for people with advanced MS
Another area of MS services we looked at as part of MS Forward View was care for people with advanced MS. Recently, concerns have arisen that this was an aspect of care that was often difficult for teams to fully implement as demands on MS services in general continue to rise. This report outlines the findings of our work on this area, and our recommendations for how services can better meet the needs of people with advanced MS.  

Other resources you may find useful
We hope you find these resources useful, let us know if you have feedback on any of them – we're keen to hear what you think.   
All the best, 
Health Professionals Programme Team  
Multiple Sclerosis Trust
Spirella Building, Bridge Road, Letchworth Garden City, Hertfordshire, SG6 4ET
Phone: 01462 476700  |  Email:

Irish Medical Pot......You Will You Will You Will.

Crowley D, Collins C, Delargy I, Laird E, Van Hout MC. Irish general practitioner attitudes toward decriminalisation and medical use of cannabis: results from a national survey. Harm Reduct J. 2017; 14(1):4. doi: 10.1186/s12954-016-0129-7.


Governmental debate in Ireland on the de facto decriminalisation of cannabis and legalisation for medical use is ongoing. A cannabis-based medicinal product (Sativex®) has recently been granted market authorisation in Ireland. This unique study aimed to investigate Irish general practitioner (GP) attitudes toward decriminalisation of cannabis and assess levels of support for use of cannabis for therapeutic purposes (CTP).


General practitioners in the Irish College of General Practitioner (ICGP) database were invited to complete an online survey. Anonymous data yielded descriptive statistics (frequencies, percentages) to summarise participant demographic information and agreement with attitudinal statements. Chi-square tests and multi-nominal logistic regression were included.


The response rate was 15% (n = 565) which is similar to other Irish national GP attitudinal surveys. Over half of Irish GPs did not support the decriminalisation of cannabis (56.8%). In terms of gender, a significantly higher proportion of males compared with females (40.6 vs. 15%; p < 0.0001) agreed or strongly agreed with this drug policy approach. A higher percentage of GPs with advanced addiction specialist training (level 2) agreed/strongly agreed that cannabis should be decriminalised (54.1 vs. 31.5%; p = 0.021). Over 80% of both genders supported the view that cannabis use has a significant effect on patients' mental health and increases the risk of schizophrenia (77.3%). Over half of Irish GPs supported the legalisation of cannabis for medical use (58.6%). A higher percentage of those who were level 1-trained (trained in addiction treatment but not to an advanced level) agreed/strongly agreed cannabis should be legalised for medical use (p = 0.003). Over 60% agreed that cannabis can have a role in palliative care, pain management and treatment of multiple sclerosis (MS). In the regression response predicator analysis, females were 66.2% less likely to agree that cannabis should be decriminalised, 42.5% less likely to agree that cannabis should be legalised for medical use and 59.8 and 37.6% less likely to agree that cannabis has a role in palliative care and in the treatment of multiple sclerosis (respectively) than males.


The majority of Irish GPs do not support the present Irish governmental drug policy of decriminalisation of cannabis but do support the legalisation of cannabis for therapeutic purposes. Male GPs and those with higher levels of addiction training are more likely to support a more liberal drug policy approach to cannabis for personal use. A clear majority of GPs expressed significant concerns regarding both the mental and physical health risks of cannabis use. Ongoing research into the health and other effects of drug policy changes on cannabis use is required.

The Dáil (Irish Government) has passed a bill to make cannabis available in Ireland for medicinal use.
The Irish Government had said it would not oppose the legislation.
It aims to legalise and regulate cannabis products used for medical purposes.

What do Doctors think?....Do Doctors think:-)

The title pays homage to "FatherTed" an Irish Comedy about Priests in a Parish on an Island. So there was a survey amongst Irish GPs about whether support decriminalization for therapeutic us of cannabis. In the US there is a growing number of states that support growing for medical consumption, will Ireland so the same way. 

Well it seem they could not give a feck for doing surveys as there was only 15% who replied, but most though decriminalization was not the way to go, most though it could be bad for you, but there was some support for medical use. 

What we have been trying to do is to exploit the benefit that cannabis has to offer, without the side effect so we can create a pharmaceutical medicine and move the science away from the recreational cannabis users

GA...Today's mechanism.

Ahn YH, Jeon SB, Chang CY, Goh EA, Kim SS, Kim HJ, Song J, Park EJ.Glatiramer acetate attenuates the activation of CD4+ T cells by modulating STAT1 and -3 signaling in glia.
Sci Rep. 2017 Jan 17;7:40484

Interactions between immune effector cells of the central nervous system appear to directly or indirectly influence the progress/regression of multiple sclerosis (MS). Here, we report that glial STAT1 and -3 are distinctively phosphorylated following the interaction of activated lymphocytes and glia, and this effect is significantly inhibited by glatiramer acetate (GA), a disease-modifying drug for MS. GA also reduces the activations of STAT1 and -3 by MS-associated stimuli such as IFNγ or LPS in primary glia, but not neurons. Experiments in IFNγ- and IFNγ receptor-deficient mice revealed that GA-induced inhibitions of STAT signaling are independent of IFNγ and its receptor. Interestingly, GA induces the expression levels of suppressor of cytokine signaling-1 and -3, representative negative regulators of STAT signaling in glia. We further found that GA attenuates the LPS-triggered enhancement of IL-2, a highly produced cytokine in patients with active MS, in CD4+ T cells co-cultured with glia, but not in CD4+ T cells alone. Collectively, these results provide that activation of glial STATs is an essential event in the interaction between glia and T cells, which is a possible underlying mechanism of GA action in MS. These findings provide an insight for the development of targeted therapies against MS

Is it really a new mechanism? 

Not really as GA has always been inhibiting T cells hasn't it?

STAT1 and STAT3 are transcription factor i.e. they affect the production levels of proteins from the DNA.

The study says that GA reduces the effect of the STATS in response to  interferon gamma and LPS. LPS is lipopolysaccharide a sugar like molecule on bacteria...So this implies that MS is caused by bacteria!. 

They examine the effect of this case it is usually a mix of microGLIA and astroGLIA but they do experiments in single cell types too.

It states "All animal procedures were performed according to the ARRIVE guidelines". However the ARRIVE guidelines are a reporting guideline, not a how to do experiments guideline.

So it shows how good the referees and editors are:-)

However, is this real?  Why because the glatiramer acetate was from a chemical supply company and not the real McCoy.  So is this generic any good.

COI : None

Thursday, 19 January 2017

#ClinicSpeak & #BrainHealth: online rating sites - good or bad?

Is your MS centre ready for open online reviews? #ClinicSpeak #BrainHealth

For the last year I have been promoting the concept of an msAdvisor for the field to help promote the 'Brain Health: Time Matters' policy document and to get adoption of the MS management principles we are promoting as part of the initiative. Therefore the following perspective piece in this week's NEJM is very timely. It is clear the US healthcare system is way ahead of the game with several online rating sites already established. The article describes some of the many issues linked to online rating sites. My personal opinion is that they need to offer disease-specific ratings. Why? Each disease has specific issues that are unique to that disease. In the case of MS this could for example refer to the use of MRI, or not, to monitor the disease, allowing pwMS access to their own results, etc. I don't want the msAdvisor to be used to 'name and shame' people and centres, but rather as a tool to nudge or encourage the adoption of 'best practice' as defined by peers. The app could also be used to educate and help pwMS self-manage their disease. The tool could also be used as an information resource. The app would have the ability to keep reviews anonymous and for a 'neutral moderator'.

What I would like to hear from you is the msAdvisor an app you would use? Do you think we should develop it? If, yes what content should we include in it?

Vivian Lee. Transparency and Trust — Online Patient Reviews of Physicians. N Engl J Med 2017; 376:197-199.

....... After years of academic debate over the role and value of patient-satisfaction scores and reviews of health care providers,1,2 Yelp, the online powerhouse of documenting customer satisfaction, is forcing the issue. With more than 102 million customer reviews to date, 6% of them in the health care arena, Yelp easily dwarfs longer-standing commercial physician-review sites such as Healthgrades and Vitals....

....... A recent analysis used natural language processing tools to evaluate 17,000 Yelp reviews of 1352 hospitals and showed that they revealed information similar to that covered by 7 of the 11 categories of patient satisfaction included in the Hospital Consumer Assessment of Healthcare Providers and Systems survey (HCAHPS), along with 12 categories not included in the HCAHPS, such as costs, billing, and scheduling......

....... I believe patient reviews and feedback can serve three main goals. First, like the peer-level perspectives on consumer products and services posted on Amazon, TripAdvisor, and Yelp, reviews of physicians or hospitals can help patients make more informed consumer decisions. Publicly available reviews can help address information asymmetry in the health care market and increase patients’ confidence in their own decisions. Collectively, by making clear their preference for higher-performing systems, patients can become a market force driving quality and value in health care.....

...... Second, patient reviews offer clinicians valuable performance feedback for learning and improving, both individually and across a system. Receptivity to performance feedback, which depends heavily on physicians’ acceptance of the data’s validity, facilitates a culture of continuous learning and patient-centeredness......

....... Third, health care systems and physicians who voluntarily share patient-review data visibly foster a spirit of trust with patients and the community. Patient reviews offer the opportunity to improve health care delivery while strengthening the provider–patient relationship......

Digesting Science in Bournemouth

I had the great pleasure of travelling to Bournemouth last weekend to help the Dorset MS Service deliver a Digesting Science event for their families.

The event was held in the incredibly well kitted out MS Society Osborne Centre in local West Parley. I was very impressed at the facilities in this centre and the programme of events that the branch runs to support people with and affected by MS. 

The families that took part enjoyed learning about how MS affects eye-sight, bladder function, walking, how we treat MS and how to prevent MS. The hands on activities were enjoyed by children aged between 5 and 12 years old and the feedback on the event was hugely positive. Thank you to everyone who came along to make the morning such a success.

Special thanks to Rod Slip for having us and Claire Williams and her colleagues from the Dorset MS Team based at Poole Hospital Michelle, Kirsty and Hannah for such great organisation ….and for the cake!

If you would like to host a Digesting Science event, please get in touch: booking (at) The kits can be sent to you free of charge and we can support you to deliver the event in your area.

The next London based Digesting Science event is in Whitechapel on Saturday the 25th March. More information here and how to book.