The Structure and Function of the Retina in Multiple Sclerosis

Background: Multiple sclerosis (MS) is a complex heterogenous autoimmune inflammatory disease with a prolonged and variable time course. The visual system is frequently implicated, either as the presenting symptom, or, with advancement of the disease. This has been documented in the literature with changes in visual acuity (VA) that are accompanied by functional changes in the optic nerve, measured with the visual evoked potential (VEP) and possible retrograde degeneration involving the retinal ganglion cells in the retina, measured with the pattern reversal electroretinogram (PERG). However, inflammatory episodes may be clinical or subclinical in nature and may go unrecognised. Originating from the same embryological origins, the effect of inflammation in MS on the on the retina is less well known. The research hypothesis was that there is a measurable difference in the function of retinal cells in patients with newly diagnosed multiple sclerosis, suggestive of inflammatory retinopathy compared to healthy controls. The overall aim was to investigate any differences in the electrophysiological function of the visual pathway of patients newly diagnosed with MS compared to healthy controls. Methods: The visual system is explored with clinical (VA), electrophysiology (VEP and electroretinography (ERG – pattern and flash) and structural (OCT) measures, in patients presenting with symptoms suggestive of MS to a specialist service. This prospective case control study investigates the visual pathway at the earliest stage of the disease to look for differences in structure and function between patients and healthy volunteers that might serve as a biomarker in the future. Results: There were a number of variables that were significantly different between the two groups, logistic regression analysis found that VA (p 0.038) and VEP P100 peak-time (p 0.014) from the right eye as significant. Dividing the participants by prolongation of the VEP P100 peak-time as defined in clinical practice, found a number of ERG amplitude variables as well as VA that were consistently different between the groups regardless of symptoms. Conclusion: The study confirms optic nerve involvement in MS with VEP and VA abnormalities consistent with the literature in this cohort. Additionally, VA and some ERG amplitude variables were significantly reduced in participants with MS, when grouped according to VEP P100 peak-time, suggesting inner and outer retinal changes. Further work would be required to confirm these findings. No OCT structural changes were found in any of the analysis that included the macula thickness, ganglion cell layer or retinal nerve fibre layer. Keywords: multiple sclerosis (MS), visual evoked potential (VEP), pattern electroretinogram (PERG), electroretinogram (ERG), optical coherence tomography (OCT

Sleep disturbance in dementia or mild cognitive impairment: a realist review of general practice

Background: Sleep disturbance (SD) is a prevalent condition among people living with dementia (PLwD) or mild cognitive impairment (MCI). Its assessment and management within primary care is complex due to the comorbidities, older age and cognitive impairment typical of this patient group. Aim: This study aimed to explore how primary care clinicians assess, understand, and manage SD for PLwD or MCI; if and why such initiatives work; and how people and their carers experience SD and its treatment. Design and setting: A realist review of existing literature was conducted in 2022. Methods: Six bibliographic databases were searched. Context-Mechanism-Outcome Configurations (CMOCs) were developed and refined. Results: Sixty records were included from 1,869 retrieved hits and 19 CMOCs were developed. Low awareness of and confidence in the treatment of SD among primary care clinicians and service users, combined with time and resource constraints, meant that identifying SD was difficult and not prioritised. Medication was perceived by clinicians and service users as the primary management tool, resulting in inappropriate or long-term prescription. Rigid nursing routines in care homes were reportedly not conducive to good quality sleep. Conclusion: In primary care, SD among PLwD or MCI is not adequately addressed. Over-reliance on medication, under-utilisation of non-pharmacological strategies, and inflexible care home routines were reported due to low confidence and resource constraints. This does not constitute effective and person-centred care. Future work should consider ways to tailor the assessment and management of SD to the needs of individuals and their informal carers without overstretching services

Understanding primary care diagnosis and management of sleep disturbance for people with dementia or mild cognitive impairment: a realist review protocol

INTRODUCTION: The increasingly ageing population is associated with greater numbers of people living with dementia (PLwD) and mild cognitive impairment (MCI). There are an estimated 55 million PLwD and approximately 6% of people over 60 years of age are living with MCI, with the figure rising to 25% for those aged between 80 and 84 years. Sleep disturbances are common for this population, but there is currently no standardised approach within UK primary care to manage this. Coined as a 'wicked design problem', sleep disturbances in this population are complex, with interventions supporting best management in context. METHODS AND ANALYSIS: The aim of this realist review is to deepen our understanding of what is considered 'sleep disturbance' in PLwD or MCI within primary care. Specifically, we endeavour to better understand how sleep disturbance is assessed, diagnosed and managed. To co-produce this protocol and review, we have recruited a stakeholder group comprising individuals with lived experience of dementia or MCI, primary healthcare staff and sleep experts. This review will be conducted in line with Pawson's five stages including the development of our initial programme theory, literature searches and the refinement of theory. The Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) quality and reporting standards will also be followed. The realist review will be an iterative process and our initial realist programme theory will be tested and refined in response to our data searches and stakeholder discussions. ETHICS AND DISSEMINATION: Ethical approval is not required for this review. We will follow the RAMESES standards to ensure we produce a complete and transparent report. Our final programme theory will help us to devise a tailored sleep management tool for primary healthcare professionals, PLwD and their carers. Our dissemination strategy will include lay summaries via email and our research website, peer-reviewed publications and social media posts. PROSPERO REGISTRATION NUMBER: CRD42022304679

Old World Meets New World: Growth of Kansas City Cuisine

Professor Andrea Broomfield, PhD., discusses the history of Kansas City cuisine during the Kansas Cowboy Jubilee held at Johnson County Community College, September 30, 2017. The Kansas Studies Institute at JCCC promotes research and teaching on the culture, history, economics and natural environment of Kansas