Referenzliteratur: Dynamische Gefäßanalyse (RVA, DVA), Statische Gefäßanalyse (SVA) 1. Dawczynski J, Mandecka A, Blum M, Müller UA, Ach T, Strobel J. [Endothelial Dysfunction of Central Retinal Vessels: A Prognostic Parameter for Diabetic Retinopathy?] Klin Monatsbl Augenheilkd. 2007 Nov;224(11):827-831 2. Bek T. Diabetic retinopathy: a review of the aarhus approach to studies on epidemiol
05-8 iomsn rev 11/12 rbORGANIZA
MULTIPLE SCLEROSIS NURSES
Multiple Sclerosis Nursing in 2004:
A Global Perspective
Hope and Health
How Can the MS Nurse
in MS Patients
a patient’s level of hopefulness, Ms.
ill-equipped to plan for the future.
patient’s emotional well-being.” The nurse also may help TABLE 1. NURSING MEASURES
to facilitate communication between the patient and THAT ENCOURAGE HOPE
Social isolation caused by bladder and bowel prob- lems may occur during the course of MS. “The nurse can provide practical solutions for managing problems that may interfere with social activities,” suggested Ms.
Morgante. “For example, self-catheterization techniques can be taught, drugs may be prescribed to assist with uri- • Help to savor the moment• Encourage socialization nary urgency and incontinence, and bowel habits can be regularized with a high-ﬁber diet and supplements, giv- ing the patient greater comfort and self-conﬁdence in so- “Most importantly, nurses inspire hope when they feel hopeful themselves,” concluded Ms. Morgante. Re-search shows that patients rely on the hopeful attitudesof the health care provider.5 sense of a future, which severely depressed patients may —Rosalee L. Blumer
lack,” said Ms. Morgante. However, hoping in the mo-ment or “taking it one day at a time” may be appropriate References
for MS patients whose fears and anxieties are focused on 1. Watson M, Haviland JS, Greer S, et al. Inﬂuence of psychological response on survival the future uncertainties surrounding the illness. One in breast cancer: a population-based cohort study. Lancet. 1999;354:1331-1336.
study4 found that hope shifts as individuals move 2. Fraser C, Morgante L, Hadjimichael O, Vollmer T. Predictors of adherence to Copaxonetherapy in individuals with relapsing-remitting MS. J Neurosci Nurs. 2001;33:231-239.
through an experience for long periods of time. “Hopesand dreams of recovering at some point in the future un- 3. Foote AW, Piazza D, Holcombe J, et al. Hope, self-esteem and social support in personwith multiple sclerosis. J Neurosci Nurs. 1990;22:155-159.
dergo a transition to focusing on one day at a time,” said 4. Fraser C. The experience of transition for a daughter caregiver of a stroke survivor. J Ms. Morgante. “The experience is reframed to a comfort- able place in the present, which promotes a sense of con- 5. Miller CM. The lived experience of relapsing multiple sclerosis: a phenomenological study. J Neurosci Nurs. 1997;29:294-304. Many MS patients express fear of becoming burdens to their family and friends, Ms. Morgante noted. “The Managing Spasticity in MS:
nurse can help the patient explore these feelings and pin-point key relationships that are vital to hope. Maintain- A Nurse’s Point of View
ing and strengthening these relationships are crucial to a Approximately one third of MS patients modify or elim- TABLE 2. PATIENT BEHAVIORS
inate daily activities as a result of spasticity.1 “Many life THAT REFLECT HOPE
functions can be affected by spasticity. It affects patients’ability to work, think, and learn, which affects self-image and conﬁdence,” said Danuta Gogol, RN, MA, LPC, during a workshop on the topic at the 2004 CMSC conference in “If someone experiences a great deal of spasticity, it takes a lot of energy for the person to move around and perform daily tasks,” explained Ms. Gogol, a clinical • Anticipates positive outcomes• Relates to family, friends, or caregivers in nurse specialist at the Mellen Center for MS at the Cleve- land Clinic in Ohio. Spasticity causes fatigue and may • Feels connected to a higher being; spirituality also cause difﬁculties with concentration. In addition, itcan have an impact on the entire family and tends to limit IOMSN Update
Physical and occupational therapy should be incor- TABLE 1. FACTORS THAT
porated into a patient’s treatment program when there is COMPLICATE SPASTICITY
any degree of spasticity, said Ms. Gogol. Techniques for • Fatigue, imbalance, lack of coordination, weakness energy conservation and optimization have been shown • Infection, injury, inﬂammation, constipation, other illnesses, to improve fatigue and other quality of life measures.2 Gait training, orthotics, bracing, and electrical stimula- • Medications (selective serotonin reuptake inhibitors, beta tion are also beneﬁcial. “MS nurses should work closely with physical and/or occupational therapists and pa- tients to get spasticity under control. This may reduce theamount of medication patients need to take,” she added. Spasticity is complicated by several factors, noted Ms.
Gogol (Table 1). “The condition can involve the entire There are a number of treatment choices available for body, which includes the upper and lower limbs, neck, spasticity (see Table 2). The ﬁrst line of therapy is usually back, abdomen, and pelvis.” Patients who experience oral baclofen (Lioresal®). Because baclofen may cause spasticity primarily in their legs may also experience spas- muscle weakness and sleepiness, it should be started ticity in other parts of the body, she noted.
slowly and given in titrated doses, noted Ms. Gogol. Thisis also true of most other medications that are used to Nonpharmacologic Treatments
treat spasticity. Anticonvulsants or antidepressants may Complementary and alternative methods of care can be be useful, she noted. Narcotics are sometimes used but used along with any pharmacologic measure to treat do not appear to be as effective. Nonsteroidal anti- spasticity, according to Ms. Gogol. Martial arts like tai chi inﬂammatory drugs can help to reduce pain as well as sometimes help to reduce spasticity by relaxing the mus- cles, she said, as do other activities such as energy work, “Patients tend to request steroids frequently because touch, massage, relaxation, and visualization. “We have many feel it improves spasticity,” Ms. Gogol pointed out.
patients who use acupuncture in combination with phar- However, it is probably best to cut down on the use of macologic treatments, which many ﬁnd helpful,” she re- steroids for spasticity because of the potential for adverse marked. Heat, cold, and water therapies are also used by effects. “It’s a good idea to minimize the use of steroids some patients. Although there is little clinical evidence for treating spasticity because MS patients may need to for alternative modalities, anecdotal evidence points to take them to treat exacerbations,” she advised.
their usefulness, she said. “It’s important to keep in mind For more severe cases of spasticity, baclofen is some- that these exercises may also worsen spasticity in some times administered using a surgically implanted pump.
cases. Patients seem to know what works best for them The Multiple Sclerosis Council for Clinical Practice and that’s what they should be doing.” Guidelines recommend intrathecal baclofen as an effec-tive treatment for patients with severe disability (anEDSS score of 7 or greater). 3 TABLE 2: ANTISPASTICITY
—Rosalee L. Blumer
1. Rizzo MA, Hadjimichael OC, Preiningerova J, Vollmer TL. Prevalence and treatment of spasticity reported by multiple sclerosis patients. Mult Scler. 2004;10:589-595.
2. Mathiowetz VG, Matuska KM, Finlayson M. Randomized clinical trial of an energy conservation course for persons with MS. Ninth Annual Meeting of the Americas Com-mittee for Treatment and Research in Multiple Sclerosis. Toronto. October 3, 2004. Avail- able at: http://18.104.22.168/actrims/abstracts.asp.
3. Multiple Sclerosis Council for Clinical Practice Guidelines. Evidence-based manage- ment strategies for spasticity treatment in multiple sclerosis. Consortium of Multiple Scle- IOMSN Update
tion, such as attacks, exacerbations, lesions, demyelination, MS School for Patients
axon, myelin, and atrophy, among others,” he said. “One of the main goals of the course is to deﬁne the important educational elements for newly diagnosed pa- Many newly diagnosed MS patients do not have a clear tients,” explained Ms. Eckert, who is Clinical Director of understanding of the disease or what the diagnosis the Lehigh Valley Hospital MS Center. Several key subject means for them. Although one-on-one sessions provide areas are addressed in the program (Table 1).
TABLE 1. TOPICS REVIEWED
there are several limitations to this ap- AT MS SCHOOL FOR PATIENTS
they have to spend with each patient.
bel” may be unable to process the information during an selling anything, patronizing, trying to control informa- ofﬁce visit, let alone think of questions to ask a clinician.
tion, and ‘doctor speak,’” Dr. Rae-Grant stressed. This In order to address the problems inherent in the type of interaction beneﬁts both the patients and the med- TABLE 2. MS SCHOOL
tion about the disease, Alexander D.
• Small groups (20 participants maximum) an “MS School for Patients.” They dis- “First of all, MS is a lifelong disorder, and those re- timidating. Groups of 20 participants or less offer a non- ceiving new diagnoses are in need of a good—and con- threatening, intimate environment, added Ms. Eckert sistent—introduction to the disease,” said Dr. Rae-Grant, (Table 2). “All newly diagnosed patients are encouraged who is Director of the MS Center and Chief of Neurology to attend.” She noted that the MS school is open to neu- at Lehigh Valley Hospital. “For instance, many words as- rology patients not afﬁliated with the MS center.
sociated with MS need deﬁning for this patient popula- —Rosalee L. Blumer
INTERESTED IN SHARING YOUR KNOWLEDGE
WITH THE WORLD? JOIN THE IOMSN!
The IOMSN is the only organization dedicated to the education of MS nurses around the world. If you wish to join the IOMSN, you can access it on the World Wide Web at www.iomsn.org, or contact the organization at: c/o Bernard W. Gimbel MS Comprehensive Care Center
Get Plastic Out Of Your Diet our foods—plastics, pesticides, growth hormones, irradiation, and microwave. This is clear from the mass of expert and citizen testimony against such technologies that In the interests of a healthy population, we regulatory agencies bend over backwards and have decided to re-print this well jump through flaming hoops to please their researched and irr