The patient
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Patient characteristics and attitudes can affect how patients react to the physician's communication style, and this reaction can then influence consultation outcomes. ⋯ Male hostile sexist patients perceive a female physician's nonverbal communication as less patient-centered and this negatively affects their expectation of positive outcomes from the consultation.
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Patients who undergo major surgery are at risk for perioperative morbidity and mortality. It would be appropriate to initiate advance care planning with patients prior to surgery, but surgeons may experience difficulty initiating such conversations. Rather than focus on changing clinician behavior, advance care planning decision aids can be an innovative vehicle to motivate advance care planning among surgical patients and their families. ⋯ This environmental scan will demonstrate principles of patient-centered outcomes research, and it will exemplify a pioneering approach for reviewing complex interventions. Anticipated limitations are that information will be gathered from a small sample of patients and families, and that potentially relevant information could also be missing from the environmental scan due to the inclusion/exclusion criteria. Outcomes from the environmental scan will inform future patient-centered research to develop and evaluate a new decision aid.
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Impairments in work productivity and daily activities contribute to the burden of rheumatoid arthritis (RA). It is thus essential to use an instrument assessing both work and daily activity impairments when studying the full impact of RA on individuals. The Work Productivity and Activity Impairment (WPAI) questionnaire is such an instrument. ⋯ The WPAI:RA questionnaire is now linguistically validated in 20 new languages [Czech (Czech Republic), Dutch (Belgium), English (Canada and UK), French (Belgium, Canada and France), German (Germany), Hungarian (Hungary), Italian (Italy), Polish (Poland), Portuguese (Brazil), Romanian (Romania), Russian (Russia and Ukraine), Spanish (Argentina, Mexico, Spain and US) and Ukrainian (Ukraine)]. The WPAI:RA questionnaire shows good content validity. It can thus be used in multi-country clinical trials to assess RA-related impact on the patients' ability to work and perform daily activities.
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Little information exists on the understanding and management of painful diabetic peripheral neuropathy (pDPN) between patients and healthcare practitioners (HCPs). ⋯ Not only do misperceptions exist on the cause and management of pDPN among patients and HCPs, but there are additional disparities between the patient and HCP perspectives. These results suggests a need for (1) educational initiatives on pDPN that target patients and HCPs, and (2) initiating improved dialogue between patients and their HCPs for discussing appropriate management of pDPN that is distinct from treatment of the underlying diabetes.
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Multicenter Study
Psychometric evaluation of the Cushing's Quality-of-Life questionnaire.
Cushing's disease (CD) is a rare disorder of chronic hypercortisolism due to an adrenocorticotropic hormone (ACTH)-secreting pituitary corticotroph adenoma. Because hypercortisolism symptoms are wide ranging, it is important to assess a variety of outcomes including both clinical factors, such as cortisol levels, and health-related quality of life (HR-QOL), to better understand the severity and impact of CD on patients and the potential efficacy of CD treatment. Pasireotide, a somatostatin analog that targets somatostatin receptors on the pituitary adenoma, is under development as a treatment for CD. A phase III clinical trial was conducted to investigate its safety and efficacy in patients with CD. In this trial, HR-QOL was assessed with the Cushing's Quality-of-Life (CushingQOL) questionnaire, specifically developed and validated in patients with Cushing's syndrome. ⋯ This study provided evidence within the context of a longitudinal design that the CushingQOL questionnaire is a reliable, valid, and responsive instrument for the assessment of HR-QOL in adults with CD in accordance with recommendations set forth by regulatory agencies in the USA and Europe.