Evaluations on fitness-to-drive of individuals with multiple sclerosis (MS) usually involve the administration of several physical, visual, and cognitive tests. In some instances, a practical road test is also administered. The use of several tests, many of which are only remotely driving-related, increases the time, cost, and human resources involved in the evaluation process, and sometimes lead to erroneous decisions. In this study, we investigated the usefulness of using a short battery of a few highly predictive tests to predict fitness-to-drive of individuals with MS. Fortyfour individuals with relapsing-remitting MS (age = 46 ± 11 years, 37 females) and Expanded Disability Status Scale values between 1 and 7 were administered selected physical, visual and cognitive tests including the Stroke Driver Screening Assessment (SDSA) battery. Performance on 12 cognitive and three visual tests were significantly associated with participants' performance on a practical road test. The Stroop Color test, Direction, Compass, and Road Sign Recognition tests from the SDSA, and the Speed of Processing test from Useful Field of View test battery together explained 59% of the variance and predicted the pass or fail outcome on the road test with 91% accuracy, 70% sensitivity, and 97% specificity. The five psychometric/off-road tests, which together can be administered in less than 45 minutes, cost approximately $150, and is 91% accurate, can be used as a screening battery. Those who pass should be further tested on-road to finally decide their fitness-to-drive while those of fail should be further evaluated, trained, or advised on alternative transportation means. Future studies are needed to confirm and validate the findings in this study.

ImportanceRetinal vein occlusion is the second most common retinal vascular disease. Bevacizumab was demonstrated in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) to be noninferior to aflibercept with respect to visual acuity in study participants with macular edema due to central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO) following 6 months of therapy. In this study, the cost-utility of bevacizumab vs aflibercept for treatment of CRVO is evaluated.ObjectiveTo investigate the relative cost-effectiveness of bevacizumab vs aflibercept for treatment of macular edema associated with CRVO or HRVO.Design, Setting, and ParticipantsThis economic evaluation study used a microsimulation cohort of patients with clinical and demographic characteristics similar to those of SCORE2 participants and a Markov process. Parameters were estimated and validated using a split-sample approach of the SCORE2 population. The simulated cohort included 5000 patients who were evaluated 100 times, each with a different set of characteristics randomly selected based on the SCORE2 trial. SCORE2 data were collected from September 2014 October 2019, and data were analyzed from October 2019 to July 2021.InterventionsBevacizumab (followed by aflibercept among patients with a protocol-defined poor or marginal response to bevacizumab at month 6) vs aflibercept (followed by a dexamethasone implant among patients with a protocol-defined poor or marginal response to aflibercept at month 6).Main Outcomes and MeasuresIncremental cost-utility ratio.ResultsThe simulation demonstrated that patients treated with aflibercept will have an expected cost $18 127 greater than those treated with bevacizumab in the year following initiation. When coupled with the lack of clinical superiority over bevacizumab (ie, patients treated with bevacizumab had a gain over aflibercept in visual acuity letter score of 4 in the treated eye and 2 in the fellow eye), these results demonstrate that first-line treatment with bevacizumab dominated aflibercept in the simulated cohort of SCORE2 participants. At current price levels, aflibercept would be considered the preferred cost-effective option only if treatment restored the patient to nearly perfect health.Conclusions and RelevanceWhile there will be some patients with CRVO-associated or HRVO-associated macular edema who will benefit from first-line treatment with aflibercept rather than bevacizumab, given the minimal differences in visual acuity outcomes and large cost differences for bevacizumab vs aflibercept, first-line treatment with bevacizumab is cost-effective for this condition.

No abstract

This interview took place in May of 2007. Our intention was to hold a conversation two years after the passing of Michael White, based on the interview published in JST in 2009 (Duvall & Young, 2009). In keeping with the narrative tradition of telling, re-tellings, and re-tellings of re-tellings, we held three conversations on that day. The first conversation involved Jim, a faculty member in the doctoral program in family therapy at Nova Southeastern University, Paul, also a faculty member, and Marcela, who is completing her doctoral work and who has published and presented internationally on narrative issues. Witnessing this conversation, and subsequently reflecting on it, were Michelle, a doctoral student working on her dissertation about narrative approaches with families of perpetrators of crimes, Corinne, who is completing her dissertation on outsider witness practices with adolescent girls in a school setting, and Olivia, a doctoral student who is approaching the dissertation phase. The first group then responded briefly to this reflection. The introduction to the conversation with Duvall, Young, and White concludes with: "We were particularly interested in Michael's notion of keeping faith, staying true to those important sentiments, learnings, and circumstances in life that clarify what is important that we give value to" (p. 1). The idea of keeping faith forms the primary path for this conversation. But, as with most conversations, many excursions were made down unexpected side-paths. We are sure that if we held The authors would like to thank Maria Shields for her assistance in transcribing this conversation.