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This is a summary of a previously published paper: Joint Healthcare Professional and Patient Development of Communication Tools to Improve the Standard of MS Care. It describes a collaboration between people with multiple sclerosis (PwMS) and healthcare professionals (HCPs) to identify challenges in multiple sclerosis (MS) care and design tools to improve communication during consultations., (© 2023. The Author(s).)

There are different frameworks to describe how people make decisions. One framework, maximization, is an approach where individuals approach choices with a goal of finding the 'best' possible alternative. We sought to determine the relationship between maximization and patient reported disability in patients with hand problems. We performed a cross-sectional study of 119 patients who presented to a hand surgery clinic. Patients completed a questionnaire that included sociodemographics, QuickDASH, Decisional Conflict Scale, Pain Catastrophizing Scale, Patient Health Questionnaire, Health Anxiety Inventory and General Self-Efficacy. Maximization did not correlate with subjective disability in patients with hand problems. Depression, pain catastrophizing and a diagnosis of upper extremity fracture had the greatest independent association with disability.In patients presenting for an initial hand surgery consultation, maximization was not associated with variation in patient reported disability or symptoms of psychosocial disease. Alternative factors influencing patient decision-making and outcomes should be explored. (Journal of Surgical Orthopaedic Advances 29(2):106-111, 2020).

Introduction: Effective communication between patients and healthcare professionals (HCPs) is important to enhance outcomes in multiple sclerosis (MS). However, in practice, patients often report a disconnect in communication. Communication tools to aid patient-HCP communication have a long history of use in many chronic conditions. For example, symptom diaries have been shown to enhance outcomes in cancer, headache and sleep disorder management. MS in the 21st Century, a Steering Group of HCP specialists and patients with MS (PwMS), has created two communication tools designed for use by both patients and their HCPs., Methods: The Steering Group first identified prominent issues in patient-HCP communication through group discussions and survey data. Following this, a series of workshops led to the development of two communication tools as potential solutions to these identified issues in communication., Results: The two most prominent issues identified were HCP time constraints during appointments and the misalignment of patient and HCP priorities-the communication tools developed through the workshops were created to address these. The "myMS priorities" tool [see supplementary materials] is designed to maximize the use of consultation time while the "myMS commitments" tool [see supplementary materials] aims to improve patient-HCP shared decision-making., Conclusions: The MS in the 21st Century Steering Group adopted a broad, iterative and collaborative approach in the development of these tools to help ensure they would be as useful as possible to both HCPs and PwMS. These tools have been developed through shared patient-HCP expertise and are based on existing tools in other therapy areas as well as a review of the existing literature and data from MS in the 21st Century Steering Group surveys. The next steps will focus on the validation of these tools through testing them in real-world environments and clinical trials., Funding: Merck KGaA, Darmstadt, Germany.

Background: Patient engagement is vital in multiple sclerosis (MS) in order to optimise outcomes for patients, society and healthcare systems. It is essential to involve all stakeholders in potential solutions, working in a multidisciplinary way to ensure that people with MS (PwMS) are included in shared decision-making and disease management. To start this process, a collaborative, open environment between PwMS and healthcare professionals (HCPs) is required so that similarities and disparities in the perception of key areas in patient care and unmet needs can be identified. With this patient-centred approach in mind, in 2016 the MS in the 21st Century Steering Group formed a unique collaboration to include PwMS in the Steering Group to provide a platform for the patient voice., Methods: The MS in the 21st Century initiative set out to foster engagement through a series of open-forum joint workshops. The aims of these workshops were: to identify similarities and disparities in the perception and prioritisation in three key areas (unmet needs, the treatment burden in MS, and factors that impact patient engagement), and to provide practical advice on how the gaps in perception and understanding in these key areas could be bridged., Results: Combined practical advice and direction are provided here as eight actions: 1. Improve communication to raise the quality of HCP-patient interaction and optimise the limited time available for consultations. 2. Heighten the awareness of 'hidden' disease symptoms and how these can be managed. 3. Improve the dialogue surrounding the benefit versus risk issues of therapies to help patients become fully informed and active participants in their healthcare decisions. 4. Provide accurate, lucid information in an easily accessible format from reliable sources. 5. Encourage HCPs and multidisciplinary teams to acquire and share new knowledge and information among their teams and with PwMS. 6. Foster greater understanding and awareness of challenges faced by PwMS and HCPs in treating MS. 7. Collaborate to develop local education, communication and patient-engagement initiatives. 8. Motivate PwMS to become advocates for self-management in MS care., Conclusion: Our study of PwMS and HCPs in the MS in the 21st Century initiative has highlighted eight practical actions. These actions identify how differences and gaps in unmet needs, treatment burden, and patient engagement between PwMS and HCPs can be bridged to improve MS disease management. Of particular interest now are patient-centred educational resources that can be used during time-limited consultations to enhance understanding of disease and improve communication. Actively bridging these gaps in a joint approach enables PwMS to take part in shared decision-making; with improved communication and reliable information, patients can make informed decisions with their HCPs, as part of their own personalised disease management., (Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.)

We report the case of a patient with a central vein occlusion associated with perivenular whitening. The "en-face" spectral domain OCT precisely demonstrated the ischemic area. This case underscores the utility of the "en-face" mode in the follow-up CRVO., (Copyright © 2013. Published by Elsevier Masson SAS.)

We report a case of a late ethmoidal mucocele occurring after transpalpebral bony orbital decompression. A 39-year-old man presented with a recurrence of a right-sided proptosis without signs of orbital inflammation. The patient had undergone bilateral transpalpebral bony orbital decompression for dysthyroid orbitopathy 2 years prior. Orbital CT scan showed a large mucocele in the supero-lateral right ethmoidal sinus with lateral extension to the medial rectus. The patient was therefore referred to an ear, nose and throat (ENT) surgeon, who performed an anterior ethmoidectomy with marsupialization and drainage of the mucocele via an endoscopic approach. A complete postoperative resolution of proptosis was observed without recurrence of the mucocele to date, approximately 6 months postoperative. Sinus complications occurring after orbital decompression may include sinusitis, hematoma, imploding antrum syndrome and mucoceles. Recurrent proptosis secondary to an ethmoidal mucocele is a rare event after bony orbital decompression surgery, with only two cases reported in the international literature. Management requires ophthalmologic diagnosis and collaboration between the ophthalmologist and otorhinolaryngologist., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

A 17-year-old man was referred with a 6-month history of painless left inferior eyelid edema. Ophthalmic examination was normal except for the presence of a reddish conjunctiva in the left eye medial canthus. MRI demonstrated a 20-mm well-defined extraconical mass between the medial and inferior rectus muscle without destruction of the medial orbital wall. A low-grade myxofibrosarcoma was diagnosed on orbital biopsy. The tumor was locally excised, but the patient categorically refused left exenteration or conformal radiotherapy. He accepted to have annual clinical and radiologic checkup. To date, 2 years later, he has been followed up with no evidence of tumor recurrence. Orbital localization of myxofibrosarcoma is extremely rare, with only 2 cases reported in the literature. The differential diagnosis could be difficult: here, a fibromyxoid sarcoma and a myxoid variant of dedifferentiated liposarcoma have been especially discussed in terms of their histopathologic features. Risk of metastasis is related to the tumor grade. Management of these tumors associates surgery with orbital exenteration or globe-sparing approaches and postsurgical adjuvant radiation therapy.

Purpose: To evaluate the efficacy and efficiency of the new small anterior incision, small-incision dissection procedure (Frueh's procedure) for the correction of involutional and congenital blepharoptosis., Patients and Methods: This was a retrospective study to compare different parameters between Frueh's procedure and the traditional aponeurotic anterior approach in a group of 98 involutional blepharoptosis patients and between Frueh's procedure and Whitnall's sling in a group of 21 congenital blepharoptosis patients. The main criterion was recurrence requiring reintervention., Results: In the adult's group, the rate of reoperation was not significantly different for the two surgical procedures (p=0.82). In the children's group, the rate of reoperation was not significantly different for the two surgical procedures (p=0.3)., Discussion: In adults, compared with the traditional aponeurotic approach, Frueh's procedure for blepharoptosis correction is equally efficacious in correcting eyelid height, superior in producing desirable eyelid contour, and much quicker to perform. In children, Frueh's procedure is a good technique for mild and moderate blepharoptosis with a good levator function. However, Frueh's procedure in severe blepharoptosis with low levator function seems not to be as efficient as the traditional surgical techniques., Conclusion: This study confirms Frueh's procedure as a reference for the treatment of adults and children with blepharoptosis., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Purpose: To measure the peripapillary retinal nerve fiber layer thickness (RNFL thickness) in normal children using optical coherence tomography (OCT) and evaluate the effects of several factors on RNFL thickness, in order to complete results of other studies on this topic., Material and Method: One hundred and four eyes of 53 normal children were investigated using OCT (Stratus OCT 3, Carl Zeiss Meditec, Dublin, CA, USA) measuring the RNFL thickness. These 28 boys and 25 girls had a mean age of 9.68±3.02 years (range, 4-15 years) and a mean refraction in spherical equivalent of +1.79±2.11 diopters (range, -3.50-5.75). The effects of age, sex, and refraction on RNFL thickness were statistically analyzed with the SPSS Package (version 15, Chicago, IL, USA)., Results: RNFL thickness was 104.33±10.22 μm (range, 85.87-145.82). RNFL thickness was greatest inferiorly (132.99±16.36 μm) and superiorly (130.72±19.51 μm), thinner nasally (79.01±18.48 μm), and thinnest temporally (73.79±12.61 μm). In univariate regression analysis, age had no significant effect on refraction and RNFL thickness. In univariate and multivariate analysis, refraction had a significant effect only on temporal (p<0.001) RNFL thickness., Conclusion: OCT can be used to measure RNFL thickness in children. This study confirms normal children's RNFL thickness data, which can be useful to the clinician in evaluating and treating optic nerve disorders in children., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Purpose: To compare retinal nerve fiber layer (RNFL) measurements taken with OCT in normal, ocular hypertensive, and glaucomatous eyes of children 4-18 years old., Materials and Methods: The study included 181 eyes: 106 normal, 37 with ocular hypertension, and 38 with juvenile glaucoma. Diagnostic groups were classified based on intraocular pressure, optic nerve head appearance, visual field examination, and central corneal thickness measurement. RNFL measurements were taken using the Zeiss Stratus OCT., Results: The RNLF average thickness was 94.2 + or -13.2 microm in glaucomatous eyes, 105.4 + or - 6.8 microm in ocular hypertensive eyes, and 104.8 + or - 10.3 microm in normal eyes. RNFL average thickness, inferior thickness, and superior thickness showed statistically significant differences between normal and glaucomatous eyes (p<0.01) and between glaucomatous [corrected] and ocular hypertensive eyes (p<0.01). There was no difference found between normal and ocular hypertensive eye., Conclusion: OCT has already shown its diagnostic efficiency in adult glaucoma. This study shows that OCT is useful in childhood glaucoma diagnosis, helping to differentiate between ocular hypertension and beginning juvenile glaucoma., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)

A 47-year-old woman, physically active, presented with a history of progressive isolated right eye visual loss (20/200). Ophtalmological examination with Goldmann's perimetry showed a Marcus Gunn pupil, an optic disc temporal pallor and a central scotoma on the affected eye. CT scan and cerebral angiography demonstrated an abnormally wide and elongated (megadolichoectatic) intraorbital ophthalmic artery responsible for optic nerve compression in the optic canal. Pulse steroid therapy was chosen and allowed recuperation of right eye visual acuity to 20/20. A 3-months' follow-up was decided and to date, 1 year later, she fell back to 20/40 with a normal right eye visual field. The authors compare these clinical and radiological findings with intraorbital aneurysms and discuss the therapeutic options for this extremely rare form of vascular disease.

Objectives: To describe the surgical orthodontic technique of correcting transverse maxillary deficiency associated with nasal obstruction and malocclusion., Surgical Procedure: The surgical-orthodontic correction of transverse maxillary deficiency consists in an incomplete Le Fort I procedure, without down-fracture, associated with a sagittal palatal osteotomy. This procedure is called SARE (Surgically Assisted Rapid Expansion). A pre-fabricated orthodontic appliance is cemented to premolars and molars prior to the surgical procedure. The patient activates the appliance allowing a 1 mm widening a day up to 10 mm. A stabilisation phase is mandatory to avoid early relapse of the correction. This phase involves ossification of the midline osteotomy site., Results: A 22 year old female consulted for a chronic nasal obstruction. Previous treatments, medical and surgical (septoplasty) did not improve her symptoms. She presented with a typical transverse maxillary hypoplasia. She underwent a surgery with the technique described above. Nasal patency improvement was noted on the first post-operative day. This was confirmed by comparing pre and post-operative rhinomanometry. An orthodontic treatment followed for several months to stabilize the result., Discussion and Conclusion: Main advantages of this surgical intervention are to correct both the dental malocclusion and the nasal obstruction by widening the nasal floor and the maxillary arch. Post-operative period is mostly uneventful. It can take up to six months to achieve a good result that is why a strong collaboration has to exist between the surgeon, the orthodontist and the patient.

Introduction: We report a case of a patient with orbital pseudotumors associated with Riedel's thyroiditis. This association of unknown etiology may be related to idiopathic multifocal fibrosclerosis that includes retroperitoneal fibrosis, mediastinal fibrosis, sclerosing cholangitis, Riedel's thyroiditis, and orbital pseudotumors., Case Report: A 44-year-old woman was referred for a bilateral inflammatory malignant exophthalmos with progressive optical neuropathy (bilateral visual acuity<1/20). Imaging studies demonstrated bilateral exophthalmos (grade III) with compression of the both optic nerves by extensive tumoral infiltration. The general work-up showed a compressive goiter, with the histopathologic examination establishing the diagnosis of Riedel's thyroiditis. Orbital biopsy and antithyroid antibody testing were not contributive. Systemic corticosteroid associated with total thyroidectomy resulted in regression of the symptoms within 3 months., Discussion: The coexistence of bilateral orbital pseudotumor and Riedel's thyroiditis is the most common situation found for idiopathic multifocal fibrosclerosis. We discuss the differential diagnosis with thyroid-associated orbitopathy and orbital lymphoma. This observation is original because the diagnosis was reached by ophthalmic manifestation. The ophthalmologist should be able to identify this pathology to optimize the diagnostic and the therapeutic strategy., Conclusion: In case of exophthalmos, a complete assessment should be made, including radiological and histopathological orbital and thyroid work-up.

Paragangliomas of the cerebellopontine angle are exceptional tumours. We report two cases of paragangliomas of the cerebellopontine angle. To our knowledge, including these two cases, only five cases have been reported in the international literature. The emerging field of genetic study of these tumours will prove critical for their diagnosis and prognosis. The presence of paraganglioma in this area is explained by an abnormal embryologic migration of paraganglionic cells into the cerebellopontine angle, associated with tumorogenesis. These tumors can be associated with others cervico-facial tumours and to genomic abnormalities. The preoperative diagnosis of these tumours is very difficult, with clinical signs like hearing loss, vertigo and tinnitus are very ambiguous. Radiologic assessment of the cerebellopontine angle is also vague. The final diagnosis is only made possible peroperatively and by the post-operative histopathologic study. ENT and neurosurgeons should be awarded of the possible existence of paragangliomas of the cerebellopontine angle, and the necessity of a systemic and genetic assessment.

Tobacco use can lead to dependence, as indicated by withdrawal symptomatology during abstinence. In smokers, nicotine-free cigarettes suppress tobacco withdrawal, suggesting that non-nicotine stimuli may be relevant to tobacco dependence. This study examined non-nicotine factors in smokeless tobacco (SLT) withdrawal. SLT users used their own brand of SLT, nicotine-free SLT, or no SLT hourly in 3 approximately 4.5-hr sessions. Participant-rated measures of craving and desire to use SLT were elevated in the abstinence condition relative to the own-brand and nicotine-free conditions. Heart rate was significantly elevated in sessions in which participants' own brand was administered relative to the nicotine-free and abstinence conditions. These results support the notion that stimuli associated with tobacco use may have some withdrawal suppressing qualities, at least in the short term.

Since expired gas is not water-saturated (Ferrus et al., 1980, Respir. Physiol. 39: 367-381), its water content should depend on biological or environmental factors other than expired gas temperature. In order to verify this hypothesis, multiple linear regression relationships between MEH2O, the mass of water expired per litre of BTPS ventilated gas and respiratory frequency (f) or period (TR), tidal volume (VT), ventilation (V), temperature of inspired gas (TI), density of inspired gas mixture (rho I), partial pressure of water in inspired gas (PIH2O) were computed from 345 experiments performed on 7 subjects. This analysis shows that MEH2O is positively and significantly correlated to TI (0.22 mg . dm-3 . degrees C-1), to PIH2O (0.14 mg . dm-3 . Torr-1), and to TR (0.87 mg . dm3 . s-1). MEH2O is negatively and significantly correlated to f (-0.27 mg . dm-3(cy . min-1)-1) to rho I (-0.06 mg . dm-3(g . dm-3)-1) and to V (-0.09 mg . dm-3(dm3 . min-1)-1). There is no statistical correlation between MEH2O and VT. It is concluded that the respiratory water loss depends to a large degree on respiratory or environmental conditions. This dependence supports the previously published results suggesting that expired gas is not water saturated.

The temperatures (TI, TE) of inspired and expired gas and the mass of expired water (MEH2O) have been measured in four subjects at rest during mouth and nose breathing of dry air at room temperature. TI and TE were measured by copper-constantan thermocouples, MEH2O by freezing and ventilatory parameters by total body plethysmography. During mouth breathing, temperatures are significantly higher (TI = 28.1 degrees C, TE = 31.5 degrees C) and the amount of expired water larger (MEH2O = 27.8 mg dm-3 BTPS) than during nose breathing (TI = 24.8 degrees C; TE = 29.6 degrees C; MEH2O = 26.6 mg dm-3 BTPS). From these experimental data the appropriate computations show clearly that in humans, while either nose or mouth breathing, the expired air is not water saturated; the latent heat exchanges represent the larger part of the respiratory heat exchanges; the counter current expiratory heat recovery is imperfect; in terms of heat and water respiratory exchanges, no large difference exists between the oral and nasal routes. This last point is confirmed by the calculation of a difference less than 10% in the total respiratory heat losses between mouth and nose breathing.