A Novel Tool to Improve Shared Decision Making and Adherence in Multiple Sclerosis: Development and Preliminary Testing.

Background. Most people with multiple sclerosis (MS) want to be involved in medical decision making about disease-modifying therapies (DMTs), but new approaches are needed to overcome barriers to participation. Objectives. We sought to develop a shared decision-making (SDM) tool for MS DMTs, evaluate patient and provider responses to the tool, and address challenges encountered during development to guide a future trial. Methods. We created a patient-centered design process informed by image theory to develop the MS-SUPPORT SDM tool. Development included semistructured interviews and alpha and beta testing with MS patients and providers. Beta testing assessed dissemination and clinical integration strategies, decision-making processes, communication, and adherence. Patients evaluated the tool before and after a clinic visit. Results. MS-SUPPORT combines self-assessment with tailored feedback to help patients identify their treatment goals and preferences, correct misperceptions, frame decisions, and promote adherence. MS-SUPPORT generates a personal summary of their responses that patients can share with their provider to facilitate communication. Alpha testing (14 patients) identified areas needing improvement, resulting in reorganization and shortening of the tool. MS-SUPPORT was highly rated in beta testing (15 patients, 4 providers) on patient-provider communication, patient preparation, adherence, and other endpoints. Dissemination through both patient and provider networks appeared feasible. All patient testers wanted to share the summary report with their provider, but only 60% did. Limitations. Small sample size, no comparison group. Conclusions. The development process resulted in a patient-centered SDM tool for MS that may facilitate patient involvement in decision making, help providers understand their patients' preferences, and improve adherence, though further testing is needed. Beta testing in real-world conditions was critical to prepare the tool for future testing and inform the design of future studies.

Understanding people.

In democratic societies moving towards increased participation, it is more important than ever that the values, thoughts, understanding, attitudes and behaviours of the communities and public that we serve are properly and proportionately included in the evidence base for decision-making around risk, particularly when it comes to food. Not to do so undermines our trustworthiness and our licence to operate as regulators and is likely to compromise the quality and effectiveness of our communication. Moreover, each risk has its own characteristics that will affect how it is perceived and how it should be managed. This article sets out some of the ways that social research strategies, usually harnessing the direct input of citizens, contribute to the evidence base used for risk analysis and includes some practical examples of methods that have been used by the Food Standards Agency in England, Wales and Northern Ireland.

Communicating to and engaging with the public in regulatory science.

This paper presents selected highlights from the 'Engaging with society' session of EFSA's third Scientific Conference 'Science, Food and Society' (Parma, Italy, 18-21 September 2018). The social dimension for scientific advisory bodies largely concerns science communication and public engagement. The political, economic and technological transformation of contemporary societies is challenging conventional structures and approaches in these areas. The disintermediation of communication and the proliferation of misinformation, it is argued, herald the onset of the post-truth society. A better understanding of the way individuals consume information today has led to the development of tools to guide mediators such as journalists and communication specialists in countering these trends. Public engagement can reinforce confidence in regulatory bodies and potentially contribute to the quality of the scientific process. Scientific advisory bodies in Europe have created strategies and mechanisms to engage the public that are designed to increase transparency and representativeness. To be effective, several engagement mechanisms are needed, although factors such as resource constraints, institutional culture and public/stakeholder attitudes may limit their development. In conclusion, a more vigorous role for social research is needed to place scientific risk assessment within broader socio-economic and political contexts. Social science expertise can help to define more impactful public information strategies and to explore the potential opportunities that engaged stakeholders and citizens can make to sustain and strengthen regulatory science.

Liquid Nitrogen Cryotherapy Treatment of Herpes Simplex Epithelial Keratitis.

A retrospective case series was performed in a university setting for all patients with herpes simplex epithelial keratitis who underwent liquid nitrogen cryotherapy from 2012-2015. Outcome measure was clinical evidence of resolution of epithelial keratitis in the cornea with re-epithelialization. All cases of epithelial keratitis showed partial and complete resolution at day 1 and week 1 respectively. Liquid nitrogen cryotherapy is a safe and effective treatment for herpes epithelial keratitis comparable to other published studies.

Toxicity of topical ophthalmic anesthetics.

INTRODUCTION: Topical ocular anesthetics are generally well tolerated in clinical settings but have great potential for abuse if used by patients at home. This abuse can lead to significant ocular complications. Topical ocular anesthetic abuse can lead to superficial punctate keratitis, persistent epithelial defects, stromal/ring infiltrates, corneal edema, endothelial damage and ocular inflammation, even when used in a dilute concentration. Patient characteristics may include a healthcare association and/or psychiatric illness. In these instances, patients often do not admit to anesthetic use and are often initially treated for acanthamoeba keratitis. Local anesthetics are thought to cause direct toxicity to the corneal epithelium, stroma and endothelium. This in turn may lead to release of antigens and from there an inflammatory response in the form of infiltrate and edema. It is thought that preservatives in anesthetics may play a further role in toxicity. AREAS COVERED: The authors provide a brief history on topical ocular anesthetics and review the most recent literature on reported ocular toxicities of topical anesthetics. EXPERT OPINION: Practitioners must maintain high suspicion for topical ocular anesthetic abuse to identify it early. Topical ocular anesthetic abuse is often misdiagnosed as acanthamoeba keratitis. Early identification is one of the most important factors for a successful outcome. It is also imperative to give proper alternative pain control to avoid topical anesthetic abuse.