61 research outputs found
sj-pdf-1-msj-10.1177_13524585231151953 – Supplemental material for A national case–control study investigating demographic and environmental factors associated with NMOSD
No full textSupplemental material, sj-pdf-1-msj-10.1177_13524585231151953 for A national case–control study investigating demographic and environmental factors associated with NMOSD by Dalia L Rotstein, Christina Wolfson, Robert Carruthers, Mark S Freedman, Sarah A Morrow, Liesly Lee, Jodie M Burton, Rosane Nisenbaum, Andrea Konig, Sandra Magalhaes and Ruth Ann Marrie in Multiple Sclerosis Journal</p
Association of No Evidence of Disease Activity With No Long-term Disability Progression in Multiple Sclerosis
No full textObjective: We conducted a systematic review and meta-analysis to evaluate the relationship between No Evidence of Disease Activity (NEDA) and no long-term disability progression on low and high efficacy therapy in relapsing-remitting multiple sclerosis (RRMS). Methods: MEDLINE, Embase, and the Cochrane Database were searched from January 1, 2006 to January 26, 2021. We selected studies which evaluated NEDA-3 (no relapse, new MRI lesion, or confirmed disability progression) at one or two years and had a minimum of four years' follow-up for determination of disability progression. Data were extracted by two independent reviewers and were meta-analyzed using a random effects model. Primary outcome of no disability progression was defined as no confirmed progression on the Expanded Disability Status Scale (EDSS) during follow-up. We assessed the odds ratio for no disability progression with NEDA vs. Evidence of Disease Activity (EDA). Positive predictive value of NEDA for no disability progression was summarized for studies with prevalence of no progression >80% vs. <80% separately. Results: We included 29 studies in our qualitative synthesis of which 27 (16 low efficacy, 11 high efficacy) were included in the meta-analysis (n=10,935 participants). Median follow-up was 5.6 years (IQR: 4.3, 8.0 years). The pooled odds ratios for no progression with NEDA-3 vs. EDA were 2.32 (95% CI: 1.58-3.42; I2=73%) for low efficacy therapy and 3.19 (1.86-5.47; I2=86%) for high efficacy therapy. Among studies with prevalence of no progression at follow-up >80%, the pooled positive predictive value for low efficacy therapy was 91% (95% CI: 89-93%) and for high efficacy therapy was 92% (95% CI: 88-94%). Among studies with prevalence of no progression <80%, the pooled positive predictive value for low efficacy therapy was 81% (95% CI: 75-86%) and for high efficacy therapy was 86% (95% CI: 80-90%). Conclusions: NEDA-3 is associated with no long-term disability progression in RRMS on both low and high efficacy therapies. Further studies of early composite outcome measures incorporating easily measurable biomarkers, and longer follow-up, may help to improve on prognostic value of NEDA-3 in RRMS
Association of NEDA-4 With No Long-term Disability Progression in Multiple Sclerosis and Comparison With NEDA-3: A Systematic Review and Meta-analysis
No full textBACKGROUND AND OBJECTIVES: No evidence of disease activity (NEDA)-4 has been suggested as a treatment target for disease-modifying therapy (DMT) in relapsing-remitting multiple sclerosis (RRMS). However, the ability of NEDA-4 to discriminate long-term outcomes in MS and how its performance compares with NEDA-3 remain uncertain. We conducted a systematic review and meta-analysis to evaluate (1) the association between NEDA-4 and no long-term disability progression in MS and (2) the comparative performance of NEDA-3 and NEDA-4 in predicting no long-term disability progression. METHODS: English-language abstracts and manuscripts were systematically searched in MEDLINE, Embase, and the Cochrane databases from January 2006 to November 2021 and reviewed independently by 2 investigators. We selected studies that assessed NEDA-4 at 1 or 2 years after DMT start and had at least 4 years of follow-up for determination of no confirmed disability progression. We conducted a meta-analysis using random-effects model to determine the pooled odds ratio (OR) for no disability progression with NEDA-4 vs EDA-4. For the comparative analysis, we selected studies that evaluated both NEDA-3 and NEDA-4 with at least 4 years of follow-up and examined the difference in the association of NEDA-3 and NEDA-4 with no disability progression. RESULTS: Five studies of 1,000 patients (3 interferon beta and 2 fingolimod) met inclusion criteria for both objectives. The median duration of follow-up was 6 years (interquartile range: 4–6 years). The prevalence of NEDA-4 ranged from 4.2% to 13.9% on interferon beta therapy and 24.9% to 25.1% on fingolimod therapy. The pooled OR for no long-term confirmed disability progression with NEDA-4 vs EDA-4 was 2.14 (95% confidence interval: 1.36–3.37; I(2) = 0). We did not observe any significant difference between NEDA-4 and NEDA-3 in the comparative analyses. DISCUSSION: In patients with RRMS, NEDA-4 at 1–2 years was associated with 2 times higher odds of no long-term disability progression, at 6 years compared with EDA-4, but offered no advantage over NEDA-3
Jealous Men but Evil Women: The Double Standard in Cases of Domestic Homicide
No full textIn 1989, Sarah Thornton killed her abusive husband with a knife, after years of abuse and threats to her daughter. She was convicted of murder and sentenced to life imprisonment. Also in 1989, Kiranjit Ahluwalia soaked her husband’s bedclothes with petrol and set them alight. He died from burns 10 days later, and she was subsequently convicted of murder and sentenced to life in prison.
In 1991, Joseph McGrail kicked his alcoholic common-law wife to death whilst she lay unconscious. He walked free from court, the judge telling him that “this lady would have tried the patience of a saint”. In 1992, Les Humes told a court that he “saw a red mist” after his wife admitted loving someone else. He fatally stabbed her whilst their teenage children struggled with him. He was convicted of manslaughter due to provocation and was imprisoned for 7 years.
Double standards in judicial processes are notorious. Chivalric justice is the case in which women are given lighter sentences for similar offences to men. This does not apply in the case of domestic homicide, where women are seen as evil and calculating when killing a spouse, men are seen as provoked beyond reason. Women who kill husbands do so with weapons that they need to acquire, men do it with their hands or weapons that are immediately available. So it is seems the defence of crime passionnel is reserved for men; women, it is implied, premeditate the murder of abusive husbands, and are justifiably punished. This paper explores the double standard in uxoricide vs. mariticide, and why it appears that killing a wife is justified and killing a husband is evi
Differences Between Systematic Reviews and Health Technology Assessments: A Trade-Off Between the Ideals of Scientific Rigor and the Realities of Policy Making
No full text
Where does the waiting list begin? A short review of the dynamics and organization of modern waiting lists
No full textWaiting for medical care is the by-product of system rationing, where demand exceeds supply. In this short report we expand on the conventional concept of the queue, by focusing on the regulation of demand and by incorporating a funnel and spout analogy. Real-world examples are used to illustrate the infancy of funnel or demand-side reform initiatives targeting the queue, and the suggestion is made that policy needs to address the concept of 'waiting' much earlier in the treatment cycle.Waiting lists Supply Demand Health systems System rationing
Three-Year Visual Field and Optical Coherence Tomography Outcome of Mog-IgG Optic Neuritis Without Corticosteroid Treatment
No full textMost patients with myelin oligodendrocyte glycoprotein-IgG optic neuritis (MOG-ON) present with significantly reduced visual function necessitating high-dose corticosteroid treatment. There is limited data on the natural history of acute MOG-ON without treatment. We report a case of severe MOG-ON not treated in the acute period with 3-year optical coherence tomography (OCT) and Humphrey visual field (HVF) outcomes
- …
