Background. Recently, ocrelizumab (Ocrevus®) was approved for the treatment of primary progressive multiple sclerosis (PPMS) based on data from the ORATORIO clinical trial. Real-world data about the ...clinical effectiveness of ocrelizumab has yet to be gathered. Objective. The aim of this study was to provide data about the clinical effectiveness of ocrelizumab for patients diagnosed with PPMS in a real-world setting. Methods. We conducted a retrospective cohort study of all patients with PPMS who started ocrelizumab treatment (n=21) in St. Antonius Hospital (Utrecht/Nieuwegein, the Netherlands) between April 2018 and December 31, 2018. Primary outcome was pre- versus post-ocrelizumab disability worsening rate (from 96 weeks prior to first ocrelizumab administration up to 24 weeks post first ocrelizumab administration). Results. Disability worsening rate while on treatment significantly differed (lower) from disability worsening rate in pre-treatment period (Z=−2.81, p≤.01). Three out of 17 patients showed a clinically relevant improvement in disability status after treatment start. Conclusion. Ocrelizumab can stabilize disability progression in patients with PPMS. Some patients even showed a clinically relevant improvement in disability status. Further research should help to identify which patients benefit most from ocrelizumab.
•There is need for consensus on the most important outcomes for Multiple Sclerosis.•A standard outcome set facilitates value-based care for Multiple Sclerosis.•Four domains: disease activity, ...symptoms, functional status and quality of life.•Multi-applicable set: monitoring, benchmarking, informing patients, research, etc.•Included outcome measures are freely available and easy to administer.
Currently, outcomes of Multiple Sclerosis (MS) are not standardized and it is unclear which outcomes matter most to people living with MS. A consensus between patients and healthcare professionals on which outcomes to measure and how, would facilitate a move towards value-based MS care.
to develop an internationally accepted, patient-relevant Standard Outcome Set for MS (S.O.S.MS).
A mixed-method design was used, including a systematic literature review, four patient focus groups (n=30) and a RAND-modified Delphi process with seventeen MS experts of five disciplines from seven countries (the Netherlands, United States of America, Portugal, Ireland, India, New Zealand, Switzerland and Turkey).
A standard outcome set for MS was defined, consisting of fourteen outcomes divided in four domains: disease activity (n=3), symptoms (n=4), functional status (n=6), and quality of life (n=1). For each outcome, an outcome measure was selected and the measurement protocol was defined. In addition, seven case-mix variables were selected.
This standard outcome set provides a guideline for measuring outcomes of MS in clinical practice and research. Using this set to monitor and (inter)nationally benchmark real-world outcomes of MS can support improvement of patient value and ultimately guide the transition towards value-based MS care.
Single-spin asymmetries for pions and charged kaons are measured in semi-inclusive deep-inelastic scattering of positrons and electrons off a transversely nuclear-polarized hydrogen target. The ...dependence of the cross section on the azimuthal angles of the target polarization (ϕS) and the produced hadron (ϕ) is found to have a substantial sin(ϕ+ϕS) modulation for the production of π+, π− and K+. This Fourier component can be interpreted in terms of non-zero transversity distribution functions and non-zero favored and disfavored Collins fragmentation functions with opposite sign. For π0 and K− production the amplitude of this Fourier component is consistent with zero.
The momentum and helicity density distributions of the strange quark sea in the nucleon are obtained in leading order from charged-kaon production in deep-inelastic scattering on the deuteron. The ...distributions are extracted from spin-averaged K± multiplicities, and from K± and inclusive double-spin asymmetries for scattering of polarized positrons by a polarized deuterium target. The shape of the momentum distribution is softer than that of the average of the u¯ and d¯ quarks. In the region of measurement 0.02<x<0.6 and Q2>1.0 GeV2, the helicity distribution is zero within experimental uncertainties.
To promote quality improvement in Dutch mental health care, it is imperative to line up methods of quality improvement with daily care practice. In value-based healthcare the joint vision of medical ...professionals and patients is leading in the design and execution of care improvements.
To demonstrate the value of value-based care.
Description of a practical example of the application of value based healthcare in mental healthcare, including a practical example of value-based improvement of patient care.
A multidisciplinary improvement team was formed, consisting of patients and employees who were involved in the depression care pathway. The team determined important outcomes of care from the patient's perspective, and successfully executed several improvement initiatives.
The bottom-up approach of value-based healthcare is in line with day-to-day care practice and provides opportunities for effectively improving the quality of mental health care.
Value-based healthcare has been introduced in 2006. Ten years later, this concept is adopted by a growing number of healthcare organizations. However, little is known about the practical ...implementation of value-based healthcare within hospitals. While working on the implementation of value-based healthcare in Dutch heart care, physicians are confronted with three main challenges that still need to be addressed to make value-based healthcare successful. First, it will require a shift in our thinking to actually use outcomes as drivers for quality improvement instead of as end points in scientific studies. Secondly, it will require tools for linking outcomes to quality of care processes enabling quicker and continuous improvement cycles. Finally, platforms are needed where benchmarking on outcomes is connected to an open learning and sharing environment where physicians can discuss good care delivery practices.
Longitudinal double-spin asymmetries of charged hadrons with high transverse momentum
p
T
have been measured in electroproduction using the H
ermes
detector at H
era
. Processes involving gluons in ...the nucleon have been enhanced relative to others by selecting hadrons with
p
T
typically above 1 GeV. In this kinematic domain the gluon polarization has been extracted in leading order making use of the model embedded in the Monte Carlo Generator P
ythia
6.2. The gluon polarization obtained from single inclusive hadrons in the
p
T
range 1 GeV <
p
T
< 2.5 GeV using a deuterium target is
at a scale
and
. For different final states and kinematic domains, consistent values of
have been found within statistical uncertainties using hydrogen and deuterium targets.
A series of semi-inclusive deep-inelastic scattering measurements on deuterium, helium, neon, krypton, and xenon targets has been performed in order to study hadronization. The data were collected ...with the HERMES detector at the DESY laboratory using a 27.6 GeV positron or electron beam. Hadron multiplicities on nucleus
A relative to those on the deuteron,
R
A
h
, are presented for various hadrons (
π
+
,
π
−
,
π
0
,
K
+
,
K
−
,
p, and
p
¯
) as a function of the virtual-photon energy
ν, the fraction
z of this energy transferred to the hadron, the photon virtuality
Q
2
, and the hadron transverse momentum squared
p
t
2
. The data reveal a systematic decrease of
R
A
h
with the mass number
A for each hadron type
h. Furthermore,
R
A
h
increases (decreases) with increasing values of
ν (
z), increases slightly with increasing
Q
2
, and is almost independent of
p
t
2
, except at large values of
p
t
2
. For pions two-dimensional distributions also are presented. These indicate that the dependences of
R
A
π
on
ν and
z can largely be described as a dependence on a single variable
L
c
, which is a combination of
ν and
z. The dependence on
L
c
suggests in which kinematic conditions partonic and hadronic mechanisms may be dominant. The behaviour of
R
A
π
at large
p
t
2
constitutes tentative evidence for a partonic energy-loss mechanism. The
A-dependence of
R
A
h
is investigated as a function of
ν,
z, and of
L
c
. It approximately follows an
A
α
form with
α
≈
0.5
–
0.6
.
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