Publications by authors named "Ernest Butler"

22 Publications

  • Page 1 of 1

Effect of Disease-Modifying Therapy on Disability in Relapsing-Remitting Multiple Sclerosis Over 15 Years.

Neurology 2021 02 28;96(5):e783-e797. Epub 2020 Dec 28.

From CORe (T.K., I.D., S.S., C.M.), Department of Medicine, University of Melbourne; MS Centre (T.K., I.D., S.S., C.M.), Department of Neurology, Royal Melbourne Hospital, Australia; Karolinska Institute (T.S.), Stockholm, Sweden; Department of Neuroscience (T.S., V.J., A.v.d.W., O.S., H.B.), Central Clinical School, Monash University, Melbourne; Burnet Institute (T.S.), Melbourne, Australia; Department of Neurology and Center of Clinical Neuroscience (D.H., E.K.H.), General University Hospital and Charles University in Prague, Czech Republic; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; Hospital Universitario Virgen Macarena (G.I.), Sevilla, Spain; Department of Neuroscience, Imaging and Clinical Sciences (A.L.), University "G. d'Annunzio," Chieti; Department of Biomedical and Neuromotor Sciences (A.L.), University of Bologna, IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; Hopital Notre Dame (A.P., M.G., P.D.), Montreal; CHUM and Universite de Montreal (A.P., M.G., P.D.); CISSS Chaudière-Appalache (P.G.), Levis, Canada; Department of Neurology (V.J., A.v.d.W., O.S., H.B.), Alfred Hospital, Melbourne, Australia; Neuro Rive-Sud (F. Grand'Maison), Quebec, Canada; Department of Neuroscience (P.S., D.F.), Azienda Ospedaliera Universitaria, Modena, Italy; Isfahan University of Medical Sciences (V.S.), Isfahan, Iran; Amiri Hospital (R. Alroughani), Kuwait City, Kuwait; Zuyderland Ziekenhuis (R.H.), Sittard, the Netherlands; Medical Faculty (M. Terzi), 19 Mayis University, Samsun; KTU Medical Faculty Farabi Hospital (C.B.), Karadeniz Technical University, Trabzon, Turkey; School of Medicine and Public Health (J.L.-S.), University Newcastle; Department of Neurology (J.L.-S.), John Hunter Hospital, Newcastle, Australia; UOC Neurologia (E.P.), Azienda Sanitaria Unica Regionale Marche-AV3, Macerata, Italy; Cliniques Universitaires Saint-Luc (V.V.P.), Brussels, Belgium; University of Parma (F. Granella); C. Mondino National Neurological Institute (R.B.), Pavia; Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino (D.S.), Italy; Flinders University (M. Slee), Adelaide; Westmead Hospital (S.V.), Sydney, Australia; Nemocnice Jihlava (R. Ampapa), Czech Republic; University of Queensland (P.M.), Brisbane; Royal Brisbane and Women's Hospital (P.M.), Brisbane, Australia; Hospital Germans Trias i Pujol (C.R.-T.), Badalona, Spain; CSSS Saint-Jérôme (J.P.), Canada; Hospital Universitario Donostia (J.O.), Paseo de Begiristain, San Sebastián, Spain; Hospital Italiano (E.C.), Buenos Aires, Argentina; Brain and Mind Centre (M.B.), University of Sydney, Australia; INEBA-Institute of Neuroscience Buenos Aires (M.L.S.), Argentina; Hospital de Galdakao-Usansolo (J.L.S.-M.), Galdakao, Spain; Liverpool Hospital (S. Hodgkinson), Sydney, Australia; Jahn Ferenc Teaching Hospital (C.R.), Budapest, Hungary; Craigavon Area Hospital (S. Hughes), UK; Jewish General Hospital (F.M.), Montreal, Canada; Deakin University (C.S.), Geelong; Monash Medical Centre (E.B.), Melbourne, Australia; South East Trust (O.G.), Belfast, UK; Perron Institute (A.K.), University of Western Australia, Nedlands; Institute of Immunology and Infectious Diseases (A.K.), Murdoch University; Sir Charles Gairdner Hospital (A.K.), Perth, Australia; Department of Neurology (T.C.), Faculty of Medicine, University of Debrecen, Hungary; Bombay Hospital Institute of Medical Sciences (B.S.), Mumbai, India; St Vincents Hospital (N.S.), Fitzroy, Melbourne, Australia; Veszprém Megyei Csolnoky Ferenc Kórház zrt (I.P.), Veszprem, Hungary; Royal Hobart Hospital (B.T.), Australia; Semmelweis University Budapest (M. Simo), Hungary; Central Military Emergency University Hospital (C.-A.S.), Bucharest; Titu Maiorescu University (C.-A.S.), Bucharest, Romania; BAZ County Hospital (A.S.), Miskolc, Hungary; and Box Hill Hospital (H.B.), Melbourne, Australia.

Objective: To test the hypothesis that immunotherapy prevents long-term disability in relapsing-remitting multiple sclerosis (MS), we modeled disability outcomes in 14,717 patients.

Methods: We studied patients from MSBase followed for ≥1 year, with ≥3 visits, ≥1 visit per year, and exposed to MS therapy, and a subset of patients with ≥15-year follow-up. Marginal structural models were used to compare the cumulative hazards of 12-month confirmed increase and decrease in disability, Expanded Disability Status Scale (EDSS) step 6, and the incidence of relapses between treated and untreated periods. Marginal structural models were continuously readjusted for patient age, sex, pregnancy, date, disease course, time from first symptom, prior relapse history, disability, and MRI activity.

Results: A total of 14,717 patients were studied. During the treated periods, patients were less likely to experience relapses (hazard ratio 0.60, 95% confidence interval [CI] 0.43-0.82, = 0.0016), worsening of disability (0.56, 0.38-0.82, = 0.0026), and progress to EDSS step 6 (0.33, 0.19-0.59, = 0.00019). Among 1,085 patients with ≥15-year follow-up, the treated patients were less likely to experience relapses (0.59, 0.50-0.70, = 10) and worsening of disability (0.81, 0.67-0.99, = 0.043).

Conclusion: Continued treatment with MS immunotherapies reduces disability accrual by 19%-44% (95% CI 1%-62%), the risk of need of a walking aid by 67% (95% CI 41%-81%), and the frequency of relapses by 40-41% (95% CI 18%-57%) over 15 years. This study provides evidence that disease-modifying therapies are effective in improving disability outcomes in relapsing-remitting MS over the long term.

Classification Of Evidence: This study provides Class IV evidence that, for patients with relapsing-remitting MS, long-term exposure to immunotherapy prevents neurologic disability.
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http://dx.doi.org/10.1212/WNL.0000000000011242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884998PMC
February 2021

Real-world effectiveness of cladribine for Australian patients with multiple sclerosis: An MSBase registry substudy.

Mult Scler 2021 Mar 12;27(3):465-474. Epub 2020 Jun 12.

CORe, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia/Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia.

Background/objective: Observational clinical data from cladribine-treated patients with relapsing forms of multiple sclerosis (MS) were recorded in the Australian MS registry powered by the MSBase registry platform (5-year follow-up) and analysed to complement information from the pivotal cladribine clinical trials in MS.

Methods: A cohort of 90 cladribine-treated patients with follow-up data reported by treating physicians and recorded in the Australian MSBase registry (database lock February 2016) were examined. Clinical data included Expanded Disability Status Scale (EDSS) scores, relapses and other disease-modifying drugs (DMDs) administered before and after cladribine treatment.

Results: Mean age on starting cladribine was 47 years; mean age at MS onset was 34 years, and median baseline EDSS score was 5.25. Disability trajectories in patients with sufficient follow-up suggested an overall increasing trend prior to cladribine treatment which was reduced during the 2-year post-treatment. Approximately 80% of patients were EDSS progression-free, 65% remained relapse-free after 2 years and median time to next DMD was 1.7 years.

Conclusion: These observational data suggest a disease-modifying effect in this cohort of relapsing MS patients characterised by older and more disabled patients. Since these data represent a single-arm cohort, clinical trials and larger comparative post-marketing studies are needed to validate and extend these findings.
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http://dx.doi.org/10.1177/1352458520921087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897790PMC
March 2021

MS-SMART study: systematic sampling bias concerns.

Lancet Neurol 2020 06 26;19(6):479. Epub 2020 May 26.

School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia; Department of Neurology, Monash Health, Clayton, VIC, Australia.

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http://dx.doi.org/10.1016/S1474-4422(20)30152-6DOI Listing
June 2020

To treat or not to treat study: Comparative group inclusion considerations.

Mult Scler Relat Disord 2020 May 30;40:101976. Epub 2020 Jan 30.

Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria 3168, Australia; Department of Neurology, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia.

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http://dx.doi.org/10.1016/j.msard.2020.101976DOI Listing
May 2020

Epidemiology, symptomatology and treatment of patients with myasthenia gravis in an Australian hospital.

Intern Med J 2019 12;49(12):1537-1540

Department of Neurology, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia.

Myasthenia gravis (MG) is a disorder affecting neuromuscular transmission with heterogeneous manifestations and treatments. This study describes clinical features and management of MG patients at a metropolitan hospital in Australia. Overall findings were consistent with previously published data. However, frequency of intravenous immuno-globulin use was higher, reasons for which are explored. Management is best conducted through specialist clinics with necessary expertise and standardised treatment protocols.
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http://dx.doi.org/10.1111/imj.14662DOI Listing
December 2019

Importance of Coping in the Relationship Between Executive Function and Quality of Life in People with Multiple Sclerosis.

Int J MS Care 2019 Sep-Oct;21(5):201-206

Background: Maximizing quality of life (QOL) for people with multiple sclerosis (MS) is a primary focus of health care management professionals. Research has shown a relationship between QOL and a person's coping style and that coping provides an indirect link between cognition and stress, depression, and anxiety in MS. This research assessed whether coping moderates or mediates the relationship between executive function and QOL in people with MS.

Methods: We assessed 107 people with relapsing-remitting (n = 83) or secondary progressive (n = 24) MS using executive function tasks and self-report coping and QOL inventories.

Results: Coping strategies that mediated the relationship between executive function and QOL in people with MS included behavioral disengagement, acceptance, growth, and religion, while moderating strategies were denial, active, religion, adaptive, and total coping indices. Less cognitively demanding coping strategies that were related to QOL in people with poorer executive function included acceptance, growth, and religion, and maladaptive strategies associated with QOL were behavioral disengagement and denial.

Conclusions: These results suggest that lessening avoidant coping strategies and strengthening use of less cognitively demanding adaptive coping strategies may improve QOL in people with MS who experience deficits in executive function. Consideration should be given to the development of psychoeducation and interventions with this focus.
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http://dx.doi.org/10.7224/1537-2073.2018-029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6819018PMC
November 2019

Letter to the editor: FLOUX-PMS study sample considerations.

Mult Scler 2019 11 20;25(13):1819-1820. Epub 2019 Sep 20.

Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia.

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http://dx.doi.org/10.1177/1352458519876025DOI Listing
November 2019

Neuroprotective Benefits of Antidepressants in Multiple Sclerosis: Are We Missing the Mark?

J Neuropsychiatry Clin Neurosci 2019 3;31(4):289-297. Epub 2019 Apr 3.

From the Department of Psychological Sciences, Swinburne University, Melbourne, Australia (Grech); the Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia (Grech); the Melbourne School of Psychological Sciences, University of Melbourne, Australia (Grech, Hester); the Department of Neurology, Monash Health, Victoria, Australia (Butler); the Department of Imaging, Monash Health, Victoria, Australia (Stuckey); and the Department of Imaging, School of Clinical Sciences, Monash Health, Monash University, Victoria, Australia (Stuckey).

The potential of antidepressant medication to have a neuroprotective effect for people with multiple sclerosis (MS) has received increased interest in recent years. The possibility of antidepressants, particularly fluoxetine, for potential repurposing to treat primary progressive and secondary progressive MS is of interest as a result of the relative lack of disease-modifying medications for these subtypes. A number of animal studies have found positive results for a neuroprotective effect of antidepressant use in MS, with human studies showing mixed results. These human studies all have a significant limitation: they exclude people with moderate to severe depressive symptoms, a core symptom of MS beyond that of reactive depression. It is likely that reregulation of the common mechanisms in depression and MS, such as inflammation, serotonin, norepinephrine, glutamate and brain-derived neurotropic factor disruption, and hypothalamic-pituitary-thalamic axis dysregulation, are important to the neuroprotective value of antidepressant medication. Given that MS is known for its heterogeneity, the question might be less about whether antidepressant medication provides neuroprotective benefits to people with multiple sclerosis but for whom they provide benefits and whether we are designing studies that will detect a benefit. To answer these questions, studies must include people with MS and depressive symptoms as well as people with relapsing remitting and chronic subtypes.
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http://dx.doi.org/10.1176/appi.neuropsych.18070164DOI Listing
March 2020

Interferon-beta in multiple sclerosis causing thrombotic microangiopathy.

Intern Med J 2019 02;49(2):274-276

Department of Neuroscience, Monash Health, Melbourne, Victoria, Australia.

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http://dx.doi.org/10.1111/imj.14204DOI Listing
February 2019

Comparison of fingolimod, dimethyl fumarate and teriflunomide for multiple sclerosis.

J Neurol Neurosurg Psychiatry 2019 04 13;90(4):458-468. Epub 2019 Jan 13.

Central Clinical School, Monash University, Melbourne, Victoria, Australia.

Objective: Oral immunotherapies have become a standard treatment in relapsing-remitting multiple sclerosis. Direct comparison of their effect on relapse and disability is needed.

Methods: We identified all patients with relapsing-remitting multiple sclerosis treated with teriflunomide, dimethyl fumarate or fingolimod, with minimum 3-month treatment persistence and disability follow-up in the global MSBase cohort study. Patients were matched using propensity scores. Three pairwise analyses compared annualised relapse rates and hazards of disability accumulation, disability improvement and treatment discontinuation (analysed with negative binomial models and weighted conditional survival models, with pairwise censoring).

Results: The eligible cohorts consisted of 614 (teriflunomide), 782 (dimethyl fumarate) or 2332 (fingolimod) patients, followed over the median of 2.5 years. Annualised relapse rates were lower on fingolimod compared with teriflunomide (0.18 vs 0.24; p=0.05) and dimethyl fumarate (0.20 vs 0.26; p=0.01) and similar on dimethyl fumarate and teriflunomide (0.19 vs 0.22; p=0.55). No differences in disability accumulation (p≥0.59) or improvement (p≥0.14) were found between the therapies. In patients with ≥3-month treatment persistence, subsequent discontinuations were less likely on fingolimod than teriflunomide and dimethyl fumarate (p<0.001). Discontinuation rates on teriflunomide and dimethyl fumarate were similar (p=0.68).

Conclusion: The effect of fingolimod on relapse frequency was superior to teriflunomide and dimethyl fumarate. The effect of the three oral therapies on disability outcomes was similar during the initial 2.5 years on treatment. Persistence on fingolimod was superior to the two comparator drugs.
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http://dx.doi.org/10.1136/jnnp-2018-319831DOI Listing
April 2019

Target Coping Strategies for Interventions Aimed at Maximizing Psychosocial Adjustment in People with Multiple Sclerosis.

Int J MS Care 2018 May-Jun;20(3):109-119

Background: The experience of psychological distress is prevalent in people with multiple sclerosis (MS), including high levels of stress, anxiety, and depression. It has been shown that people with MS use less adaptive coping compared with healthy individuals. This study examined the ability of coping strategies to predict maladaptive and adaptive psychosocial outcomes across areas of stress, depression, anxiety, and quality of life (QOL) in people with MS.

Methods: 107 people with MS completed measures of depression (Beck Depression Inventory-II), anxiety (State-Trait Anxiety Inventory), QOL (Multiple Sclerosis Quality of Life-54), stress (Daily Hassles Scale), and coping (COPE inventory).

Results: Consistent with expectations, depression, frequency of stress, trait anxiety, and mental health QOL were predicted by adaptive and maladaptive coping styles. Severity of stressful events was predicted by maladaptive, but not adaptive, coping styles. Depression and mental health QOL were most prominently connected to coping use. Emotional preoccupation and venting showed the strongest relationship with poorer psychosocial outcomes, whereas positive reinterpretation and growth seemed to be most beneficial.

Conclusions: The results of this study highlight the importance of intervention programs targeting specific coping strategies to enhance psychosocial adjustment for people with MS.
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http://dx.doi.org/10.7224/1537-2073.2016-008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991507PMC
June 2018

Cladribine versus fingolimod, natalizumab and interferon β for multiple sclerosis.

Mult Scler 2018 10 31;24(12):1617-1626. Epub 2017 Aug 31.

Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia/Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia/Department of Neurology, Box Hill Hospital, Monash University, Melbourne, VIC, Australia.

Objective: This propensity score-matched analysis from MSBase compared the effectiveness of cladribine with interferon β, fingolimod or natalizumab.

Methods: We identified all patients with relapse-onset multiple sclerosis, exposure to the study therapies and ⩾1-year on-treatment follow-up from MSBase. Three pairwise propensity score-matched analyses compared treatment outcomes over 1 year. The outcomes were hazards of first relapse, disability accumulation and disability improvement events. Sensitivity analyses were completed.

Results: The cohorts consisted of 37 (cladribine), 1940 (interferon), 1892 (fingolimod) and 1410 patients (natalizumab). The probability of experiencing a relapse on cladribine was lower than on interferon ( p = 0.05), similar to fingolimod ( p = 0.31) and higher than on natalizumab ( p = 0.042). The probability of disability accumulation on cladribine was similar to interferon ( p = 0.37) and fingolimod ( p = 0.089) but greater than natalizumab ( p = 0.021). The probability of disability improvement was higher on cladribine than interferon ( p = 0.00017), fingolimod ( p = 0.0025) or natalizumab ( p = 0.00099). Sensitivity analyses largely confirmed the above results.

Conclusion: Cladribine is an effective therapy for relapse-onset multiple sclerosis. Its effect on relapses is comparable to fingolimod and its effect on disability accrual is comparable to interferon β and fingolimod. Cladribine may potentially associate with superior recovery from disability relative to interferon, fingolimod and natalizumab.
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http://dx.doi.org/10.1177/1352458517728812DOI Listing
October 2018

Quality of Acute Care and Long-Term Quality of Life and Survival: The Australian Stroke Clinical Registry.

Stroke 2017 04 3;48(4):1026-1032. Epub 2017 Mar 3.

From the Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., N.E.A.); Florey Institute Neuroscience and Mental Health, Heidelberg, University of Melbourne, Victoria, Australia (D.A.C., B.G., C.F.B., G.A.D.); College of Science, Health and Engineering, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia (N.A.L.); Occupational Therapy Department, Alfred Health, Prahran, Victoria, Australia (N.A.L.); Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, New South Wales (S.M.); Priority Research Centre for Translational Neurosciences Mental Health Research, University of Newcastle and Hunter Research Institute, New South Wales, Australia (C.R.L.); Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia (H.M.D., C.F.B.); Faculty of Medicine, The University of New South Wales, Sydney and St Vincent's Hospital, Darlinghurst, Australia (S.F.); National Stroke Foundation, Melbourne, Victoria, Australia (K.H.); University of Queensland, Brisbane, Australia (R.G., A.W.); Neurology Department, Royal Brisbane and Women's Hospital, Queensland, Australia (A.W.); Neurology Department, Gold Coast Hospital, Queensland, Australia (A.S.); Neurology Department, Peninsula Health, Frankston, Victoria, Australia (E.B.); Swan District Hospital and University of Western Australia, Perth, Australia (T.R.B.); South West Healthcare, Warrnambool, Victoria, Australia (P.G.); Neurology Department, Royal Hobart Hospital, Hobart, Tasmania, Australia (H.C.); The George Institute for Global Health, The University of Sydney, New South Wales, Australia (C.S.A.); and Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (C.S.A.).

Background And Purpose: Uncertainty exists over whether quality improvement strategies translate into better health-related quality of life (HRQoL) and survival after acute stroke. We aimed to determine the association of best practice recommended interventions and outcomes after stroke.

Methods: Data are from the Australian Stroke Clinical Registry during 2010 to 2014. Multivariable regression was used to determine associations between 3 interventions: received acute stroke unit (ASU) care and in various combinations with prescribed antihypertensive medication at discharge, provision of a discharge care plan, and outcomes of survival and HRQoL (EuroQoL 5-dimensional questionnaire visual analogue scale) at 180 days, by stroke type. An assessment was also made of outcomes related to the number of processes patients received.

Results: There were 17 585 stroke admissions (median age 77 years, 47% female; 81% managed in ASUs; 80% ischemic stroke) from 42 hospitals (77% metropolitan) assessed. Cumulative benefits on outcomes related to the number of care processes received by patients. ASU care was associated with a reduced likelihood of death (hazard ratio, 0.49; 95% confidence interval, 0.43-0.56) and better HRQoL (coefficient, 21.34; 95% confidence interval, 15.50-27.18) within 180 days. For those discharged from hospital, receiving ASU+antihypertensive medication provided greater 180-day survival (hazard ratio, 0.45; 95% confidence interval, 0.38-0.52) compared with ASU care alone (hazard ratio, 0.64; 95% confidence interval, 0.54-0.76). HRQoL gains were greatest for patients with intracerebral hemorrhage who received care bundles involving discharge processes (range of increase, 11%-19%).

Conclusions: Patients with stroke who receive best practice recommended hospital care have improved long-term survival and HRQoL.
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http://dx.doi.org/10.1161/STROKEAHA.116.015714DOI Listing
April 2017

Executive function is an important consideration for coping strategy use in people with multiple sclerosis.

J Clin Exp Neuropsychol 2017 Oct 16;39(8):817-831. Epub 2017 Jan 16.

a Melbourne School of Psychological Sciences , University of Melbourne , Parkville , VIC , Australia.

Introduction: Executive function deficits are prevalent in people with multiple sclerosis (PwMS), and PwMS use less adaptive coping than healthy controls. This cross-sectional study assessed whether there is a relationship between executive function and coping in PwMS.

Method: One hundred and seven participants with relapsing remitting or secondary progressive MS (n = 83 and 24, respectively; age M = 48.8 ± 11.1 years) completed measures of coping and executive function.

Results: A positive relationship was found between verbal fluency and use of active, emotional, and instrumental social support coping, and total executive function and substance abuse coping. There was a negative relationship between coping strategies and core (social support, acceptance, religion, restraint, and total coping), higher order (denial and humor), and total executive function indices (acceptance, religion, behavioral disengagement, denial, and total coping).

Conclusion: These directional differences provide support for the importance of specific executive functions in coping strategy utilization. Understanding these relationships will assist psychologists and neuropsychologists with patient psychoeducation, adaptive coping strategy intervention and management for PwMS with reduced executive function ability.
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http://dx.doi.org/10.1080/13803395.2016.1270907DOI Listing
October 2017

Strut-based accelerated partial breast irradiation: Report of treatment results for 250 consecutive patients at 5 years from a multicenter retrospective study.

Brachytherapy 2016 Nov - Dec;15(6):780-787. Epub 2016 Aug 12.

Arizona Breast Cancer Specialists, Scottsdale, AZ.

Purpose: This registry trial studied the long-term outcomes of women receiving accelerated partial breast irradiation (APBI) using strut-based applicators and reports on the local control, toxicity, and survival for the first 250 patients treated with this device.

Methods And Materials: Patients were treated using the strut-based brachytherapy device with conventional dose and fractionation of 34 Gy in 10 twice-daily fractions. Planning goals for the planning target volume were V > 90%, V < 50 cc, and V < 20 cc. Toxicity was graded based on the Common Terminology Criteria for Adverse Events v3.0. Recurrence rates were also calculated.

Results: Median followup was 59.5 months for the 250 patients. Grade 2 or higher adverse events at any time for hyperpigmentation, induration, erythema, telangiectasia, breast pain, seroma, and fat necrosis were 0.4%, 3.0%, 3.0%, 3.0%, 3.9%, 4.8%, and 1.3%, respectively. The median V was 97%, V was 95.1%, V was 28.7 cc, and V was 14.2 cc. For those patients with a less than a 5-mm or 3-mm-skin bridge, the median skin max doses were 272 and 289 cGy, respectively. The 4-year actuarial recurrence rates for true recurrence/marginal miss and ipsilateral breast tumor recurrence were 2.3% and 3.6%, respectively. The 4-year actuarial rates for overall survival, cause-specific survival, and disease-free survival were 97%, 98%, and 92%, respectively.

Conclusions: The strut-based applicator was designed to simplify APBI compared to interstitial brachytherapy. This report confirms excellent tumor control and survival with low toxicity and supports the evidence that brachytherapy has less normal tissue toxicity than APBI with external beam irradiation.
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http://dx.doi.org/10.1016/j.brachy.2016.07.002DOI Listing
July 2017

Coping mediates and moderates the relationship between executive functions and psychological adjustment in multiple sclerosis.

Neuropsychology 2016 Mar 30;30(3):361-376. Epub 2015 Nov 30.

Melbourne School of Psychological Sciences, University of Melbourne.

Objective: To identify the moderating and mediating relationship of different coping strategies between executive function and stress, depression and anxiety in people with multiple sclerosis (PwMS).

Method: Participants were 107 people with relapsing remitting or secondary progressive multiple sclerosis who were administered tasks of executive function and completed self-report measures of stress, depression, anxiety, and coping.

Results: An indirect relationship was found between executive function and psychosocial adjustment through maladaptive coping strategies: behavioral and mental disengagement, and substance abuse; adaptive coping strategies: acceptance, active, positive reinterpretation, and growth, as well as for an index of adaptive coping. In general, a relationship was found between better performance on tasks of executive function and psychosocial adjustment when adaptive coping strategies were low, as opposed to high, or maladaptive coping strategies were high, as opposed to low. Some unexpected findings are also discussed.

Conclusion: Executive function and psychosocial adjustment is mediated and moderated by coping strategies used by PwMS. Well-preserved executive function provides relative protection from poorer adjustment in the presence of high maladaptive or low adaptive coping. PwMS who perform poorly on tasks of executive function benefit from using less cognitively demanding adaptive coping strategies to enhance adjustment outcomes and further research in this area would be advantageous to underpin effective intervention strategies.
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http://dx.doi.org/10.1037/neu0000256DOI Listing
March 2016

Interferon beta-1a long-term therapy related to pulmonary arterial hypertension in multiple sclerosis patients.

Mult Scler 2016 10 12;22(11):1495-1498. Epub 2015 Nov 12.

Department of Neurosciences, Monash Health, Melbourne, VIC, Australia.

We report two patients with relapsing remitting multiple sclerosis (RRMS) on interferon (IFN) beta-1a treatment for more than 7 years who developed pulmonary arterial hypertension (PAH). Patient 1 developed severe PAH requiring lung transplantation. Histology showed typical proliferative lesions including plexiform lesions consistent with PAH. Patient 2 ceased IFN beta-1a, and their symptoms stabilised. Both cases highlight IFN beta-1a treatment as a potential risk factor for PAH. PAH needs to be considered as a diagnosis in patients on long-term IFN beta-1a treatment who develop new-onset respiratory symptoms.
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http://dx.doi.org/10.1177/1352458515618020DOI Listing
October 2016

A case of chronic inflammatory demyelinating polyneuropathy with reversible alternating diaphragmatic paralysis: case study.

Crit Ultrasound J 2015 Dec 21;7(1):16. Epub 2015 Oct 21.

Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia.

Respiratory failure requiring mechanical ventilation has been reported in patients with bilateral diaphragmatic paralysis due to CIDP. We report a case of CIDP that progressed to respiratory failure with normal chest radiography despite unilateral diaphragmatic paralysis. This manifestation would have been missed if ultrasound was not employed.
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http://dx.doi.org/10.1186/s13089-015-0033-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4614851PMC
December 2015

The effect of executive function on stress, depression, anxiety, and quality of life in multiple sclerosis.

J Clin Exp Neuropsychol 2015 26;37(5):549-62. Epub 2015 May 26.

a Melbourne School of Psychological Sciences , University of Melbourne , Parkville , VIC , Australia.

The experience of cognitive deficits and emotional dysfunction are prevalent in people with multiple sclerosis (PwMS), although research examining their interaction has provided inconsistent findings. The current study examined the ability of executive function to predict psychosocial adjustment in PwMS. One hundred and seven PwMS underwent cognitive assessment and completed measures of stress, depression, anxiety, and quality of life (QoL). There was limited support for a relationship. There was no relationship between objective cognitive tasks and state or trait anxiety, mental health QoL, overall QoL, or stress frequency. The only relationship with depression was found when the Beck Depression Inventory Fast-Screen was used, with a task of planning when the timing element was removed. A measure of error rates on a task of cognitive flexibility predicted physical health QoL, and severity, but not frequency, of stress was predicted by a task of working memory. The results of this study highlight the need for further research into the relationship between cognitive deficits and psychosocial adjustment because of the conflicting findings between studies and call for a common measurement framework for future investigation.
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http://dx.doi.org/10.1080/13803395.2015.1037723DOI Listing
March 2016

Partial breast irradiation: rationale and early results.

W V Med J 2006 Sep-Oct;102(5):10-3

Schiffler Cancer Center, Wheeling Hospital,Wheeling, West, Va, USA.

The purpose of this study is to introduce the concept of partial breast irradiation in the management of early stage breast cancer, and describe the early experience at treating patients at Schiffler Cancer Center at Wheeling Hospital in Wheeling, W.Va., with this new technology. A prospective analysis of the first 25 patients treated with breast brachytherapy, with detailed patient and tumor characteristics, will serve as a reference for further investigation into this technique. Results from this early experience will provide information that will further establish this technology as a feasible and appropriate treatment option for well-selected breast cancer patients.
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April 2007

Progressive ataxic gait disorder.

J Clin Neurosci 2007 Feb;14(2):153-7

Department of Medicine, Frankston Hospital, Peninsula Health, Frankston, Victoria, Australia.

Paraneoplastic cerebellar degeneration (PCD) is a well-described paraneoplastic syndrome. In patients with anti-Yo associated PCD, neurological symptoms precede the diagnosis of the underlying cancer in approximately 60% of cases. Ovarian, breast and other gynaecological malignancies are most frequently found as causative malignancies. Antitumour treatment should be commenced at an early stage of the disease. Identification of the tumour is a diagnostic challenge in many of these patients. In the case reported herein, a secondary tumour with unknown primary was suggested after detection of a pathological lymph node in the right axilla by a positron emission tomography scan. Microscopic examination of the ultrasound-guided resected tissue was a poorly differentiated adenocarcinoma strongly positive for the C-ERB 2 oncoprotein. A micro-invasive mammary carcinoma was unable to be localized, even with the aid of magnetic resonance mammography and axillary clearance. Intravenous gamma-globulin and steroid treatment and rehabilitation failed to influence the neurological symptoms. The present patient also demonstrated diffuse increase on the T2 signal in the cerebellum, which may provide a useful diagnostic clue in the assessment of PCD.
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http://dx.doi.org/10.1016/j.jocn.2005.11.037DOI Listing
February 2007

Effect of lidocaine on ovalbumin and egg albumin foam stability.

Appl Biochem Biotechnol 2003 ;105 -108:905-11

Chemical Engineering Department, Vanderbilt University, Nashville, TN 37235, USA.

Foam fractionation is a simple separation process that can remove and concentrate hydrophobic molecules such as proteins, surfactants, and organic wastes from an aqueous solution. Bovine serum albumin and ovalbumin have been widely used as model proteins due to their strong foaming potential and low price. Here, we study the effect of lidocaine on albumin foam, since drugs like lidocaine are known to bind with albumin. We observed that lidocaine not only enhances the amount of foam produced but also the stability of that foam as well. The foam stability was evaluated as the decay rate constant of the foam, determined from a change in height (or volume) of the foam over a given time period.
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http://dx.doi.org/10.1385/abab:108:1-3:905DOI Listing
August 2003