Assessing patient PREFERence between the dulaglutide pen and the semaglutide pen: A crossover study (PREFER).

AIM: When selecting treatments for type 2 diabetes (T2D), it is important to consider not only efficacy and safety, but also other treatment attributes that have an impact on patient preference. The objective of this study was to examine preference between injection devices used for two weekly GLP-1 receptor agonists. MATERIALS AND METHODS: The PREFER study was an open-label, multicentre, randomized, crossover study assessing patient preference for dulaglutide and semaglutide injection devices among injection-naïve patients receiving oral medication for type 2 diabetes. After being trained to use each device, participants performed all steps of injection preparation and administered mock injections into an injection pad. Time-to-train (TTT) for each device was assessed in a subset. RESULTS: There were 310 evaluable participants (48.4% female; mean age, 60.0 years; 78 participants in the TTT subgroup). More participants preferred the dulaglutide device than the semaglutide device (84.2% vs. 12.3%; P < 0.0001). More participants perceived the dulaglutide device to have greater ease of use (86.8% vs. 6.8%; P < 0.0001). After preparing and using the devices, more participants were willing to use the dulaglutide device (93.5%) than the semaglutide device (45.8%). Training participants to use the dulaglutide device required less time than the semaglutide device (3.38 vs. 8.14 minutes; P < 0.0001). CONCLUSIONS: Participants with type 2 diabetes preferred the dulaglutide injection device to the semaglutide injection device. If patients prefer a device, they may be more willing to use the medication, which could result in better health outcomes. Furthermore, a shorter training time for injection devices may be helpful in busy clinical practice settings.

Effects of incidental positive emotion and cognitive reappraisal on affective responses to negative stimuli.

Previous studies have identified two powerful ways to regulate emotional responses to a stressor: experiencing incidental positive emotions and using cognitive reappraisal to reframe the stressor. Several cognitive and motivational theories of positive emotion support the formulation that incidental positive emotions may facilitate cognitive reappraisal. To test the separate and interacting effects of positive emotions and cognitive reappraisal, we first adapted an established picture-based reappraisal paradigm by interspersing blocks of positive emotion inducing and neutral pictures. Across two pre-registered studies (Studies 1, 2), reappraisal effectively decreased self-reported negative emotions and increased self-reported positive emotions; however, experiencing incidental positive emotions did not facilitate reappraisal success. In another preregistered study (Study 3), we employed a more powerful positive emotion induction via virtual reality (VR), used a social stress anticipation task, and instructed participants to reappraise the anticipated stressor positively. Although there was a robust effect of the positive emotion induction (relative to the neutral induction) on feeling more positive emotions throughout stress anticipation, the results again indicated that incidental positive emotions did not facilitate cognitive reappraisal. We propose that incidental positive emotions and cognitive reappraisal may constitute separate pathways of influence when regulating one's responses to negative events.

Psychosocial functioning in pediatric heart transplant recipients and their families.

Across pediatric organ transplant populations, patient and family psychosocial functioning is associated with important health-related outcomes. Research has suggested that pediatric heart transplant recipients and their families are at increased risk for adverse psychosocial outcomes; however, recent investigation of psychosocial functioning in this population is lacking. This study aimed to provide a contemporary characterization of psychosocial functioning in pediatric heart transplant recipients and their families. Associations between psychosocial function, demographic variables, and transplant-related variables were investigated. Fifty-six parents/guardians of pediatric heart transplant recipients completed a comprehensive psychosocial screening measure during transplant follow-up clinic visits. Descriptive statistics, correlational analyses, and independent samples t tests were performed. Forty percent of pediatric heart transplant recipients and their families endorsed clinically meaningful levels of total psychosocial risk. One-third of patients presented with clinically significant psychological problems per parent report. Psychosocial risk was unassociated with demographic or transplant-related factors. Despite notable improvements in the survival of pediatric heart transplant recipients over the past decade, patients and families present with sustained psychosocial risks well beyond the immediate post-transplant period, necessitating mental health intervention to mitigate adverse impact on health-related outcomes.

A prospective evaluation of short-term dysphagia after transoral robotic surgery for squamous cell carcinoma of the oropharynx.

BACKGROUND: Transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) has been associated with improved long-term dysphagia symptomatology compared with chemoradiation. Dysphagia in the perioperative period has been inadequately characterized. The objective of this study was to characterize short-term swallowing outcomes after TORS for OPSCC. METHODS: Patients undergoing TORS for OPSCC were enrolled prospectively. The Eating Assessment Tool 10 (EAT-10) was used as a measure of swallowing dysfunction (score >2) and was administered on postoperative day (POD) 1, 7, and 30. Patient demographics, weight, pain level, and clinical outcomes were recorded prospectively and focused on time to oral diet, feeding tube placement, and dysphagia-related readmissions. RESULTS: A total of 51 patients were included with pathologic T stages of T1 (n = 24), T2 (n = 20), T3 (n = 3), and Tx (n = 4). Self-reported preoperative dysphagia was unusual (13.7%). The mean EAT-10 score on POD 1 was lower than on POD 7 (21.5 vs 26.6; P = .005) but decreased by POD 30 (26.1 to 12.2; P < .001). Forty-seven (92.1%) patients were discharged on an oral diet, but 57.4% required compensatory strategies or modification of liquid consistency. Ninety-eight percent of patients were taking an oral diet by POD 30. There were no dysphagia-related readmissions. CONCLUSION: This prospective study shows that most patients who undergo TORS experience dysphagia for at least the first month postoperatively, but nearly all can be started on an oral diet. The dysphagia-associated complication profile is acceptable after TORS with a minority of patients requiring temporary feeding tube placement. Aggressive evaluation and management of postoperative dysphagia in TORS patients may help prevent dysphagia-associated readmissions. Cancer 2017;123:3132-40. © 2017 American Cancer Society.

Optimizing the Use of Discharge Medication Lists in Nursing Facilities.

OBJECTIVE: To highlight the need to optimize the use of discharge medication lists in nursing facilities. SETTING: In January 2014, the care transitions (CT) pharmacists at Frederick Memorial Hospital, Frederick, Maryland, began a pilot project in which they identified and followed high-risk patients transitioning from hospital to nursing facility and from nursing facility to home. PRACTICE DESCRIPTION: This pilot project served as a needs assessment to identify opportunities to improve patients' transition from nursing facility to home with the goal of reducing hospital readmissions. PRACTICE INNOVATION: One of the enormous opportunities that were immediately recognized was the nursing facility discharge medication list. MAIN OUTCOME MEASUREMENTS: The CT pharmacists found that patients had difficulty deciphering and understanding the medication lists. RESULTS: By reviewing the elements of existing medication lists, the CT pharmacists identified 11 components of a nursing facility discharge medication list that would increase patient safety and potentially reduce medication-related hospital readmissions. These elements include the capability of electronically generating a medication list that includes both brand and generic medication names with accurate indications in layperson terms. The ideal discharge medication list would also be patient-specific and remove irrelevant information and take into consideration patients' age, vision, and health literacy. CONCLUSION: With the upcoming implementation of the nursing facility value-based purchasing program, nursing facilities may soon receive incentives to improve their medication management systems at discharge.

Optimizing the Use of Discharge Medication Lists in Nursing Facilities.

OBJECTIVE: To highlight the need to optimize the use of discharge medication lists in nursing facilities. SETTING: In January 2014, the care transitions (CT) pharmacists at Frederick Memorial Hospital, Frederick, Maryland, began a pilot project in which they identified and followed high-risk patients transitioning from hospital to nursing facility and from nursing facility to home. PRACTICE DESCRIPTION: This pilot project served as a needs assessment to identify opportunities to improve patients' transition from nursing facility to home with the goal of reducing hospital readmissions. PRACTICE INNOVATION: One of the enormous opportunities that were immediately recognized was the nursing facility discharge medication list. MAIN OUTCOME MEASUREMENTS: The CT pharmacists found that patients had difficulty deciphering and understanding the medication lists. RESULTS: By reviewing the elements of existing medication lists, the CT pharmacists identified 11 components of a nursing facility discharge medication list that would increase patient safety and potentially reduce medication-related hospital readmissions. These elements include the capability of electronically generating a medication list that includes both brand and generic medication names with accurate indications in layperson terms. The ideal discharge medication list would also be patient-specific and remove irrelevant information and take into consideration patients' age, vision, and health literacy. CONCLUSION: With the upcoming implementation of the nursing facility value-based purchasing program, nursing facilities may soon receive incentives to improve their medication management systems at discharge.

Transitional Care Units: Expanding the Role of Pharmacists Providing Patient Care.

OBJECTIVE: To describe two innovative practice models that expand pharmacy services within a nursing facility's transitional care unit (TCU) to meet the needs of patients transitioning to subacute or community care. SETTING: TCU in a hospital-based vs. a community-based facility. PRACTICE DESCRIPTION: The two TCUs involved in these practices differ in that one is hospital-owned and the other is community-based and run by a nonprofit organization. Patients involved in the models are those who have been admitted to the TCU from a hospital and will eventually return home to the community. PRACTICE INNOVATION: Pharmacy services beyond the federally required, monthly drug regimen review are described, including pharmacist-conducted medication reconciliation, which identifies the drugs the patient is taking on admission and those prescribed before discharge from the TCU. Post-TCU discharge follow-up is also provided via telephone call or home visit. MAIN OUTCOME MEASUREMENTS: Description of practice models. RESULTS: Timely medication reconciliation and review on TCU admission is key to safe medication use during transitions of care. Incorporating pharmacy students and residents can promote awareness of the service. Partnerships with health systems and colleges or schools of pharmacy can provide financial support of these innovative practice models. CONCLUSION: Pharmacist-driven medication reconciliation and review can improve medication safety across transitions of care involving TCUs. Research is needed to evaluate the impact of these models on outcomes before they are replicated.

Acute and chronic impact of cardiovascular events on health state utilities.

BACKGROUND: Cost-utility models are frequently used to compare treatments intended to prevent or delay the onset of cardiovascular events. Most published utilities represent post-event health states without incorporating the disutility of the event or reporting the time between the event and utility assessment. Therefore, this study estimated health state utilities representing cardiovascular conditions while distinguishing between acute impact including the cardiovascular event and the chronic post-event impact. METHODS: Health states were drafted and refined based on literature review, clinician interviews, and a pilot study. Three cardiovascular conditions were described: stroke, acute coronary syndrome (ACS), and heart failure. One-year acute health states represented the event and its immediate impact, and post-event health states represented chronic impact. UK general population respondents valued the health states in time trade-off tasks with time horizons of one year for acute states and ten years for chronic states. RESULTS: A total of 200 participants completed interviews (55% female; mean age = 46.6 y). Among acute health states, stroke had the lowest utility (0.33), followed by heart failure (0.60) and ACS (0.67). Utility scores for chronic health states followed the same pattern: stroke (0.52), heart failure (0.57), and ACS (0.82). For stroke and ACS, acute utilities were significantly lower than chronic post-event utilities (difference = 0.20 and 0.15, respectively; both p < 0.0001). CONCLUSIONS: Results add to previously published utilities for cardiovascular events by distinguishing between chronic post-event health states and acute health states that include the event and its immediate impact. Findings suggest that acute versus chronic impact should be considered when selecting scores for use in cost-utility models. Thus, the current utilities provide a unique option that may be used to represent the acute and chronic impact of cardiovascular conditions in economic models comparing treatments that may delay or prevent the onset of cardiovascular events.

The (mal) adaptive value of mid-adolescent dating relationship labels.

The aim of this study was to explore adolescent dating relationships through the prism of high school girls' narratives. We probed the contexts and meanings associated with different forms of dating to better understand the developmental significance of romantic relationships during adolescence. Cross-sectional, in-depth semi-structured interviews were conducted with 20 high school females. The analytic approach was phenomenological and grounded in the narratives rather than based on an a priori theoretical framework. Interviews were digitally recorded, transcribed verbatim by research staff and entered into ATLAS.ti 6, a qualitative data-management software package, prior to analysis. Teen relationships were found to vary along a Dis-Continuum from casual hookups to "official" boyfriend/girlfriend. There was a lack of consensus, and much ambiguity, as to the substantive meaning of different relationships. Labeling dating relationships seem to facilitate acquisition of important developmental needs such as identity, affiliation, and status, while attempting to manage cognitive dissonance and emotional disappointments. Findings underscore the confusion and complexity surrounding contemporary adolescent dating. Adolescent girls are using language and social media to assist them in meeting developmental goals. Sometimes their dating labels are adaptive, other times they are a cause of stress, or concealment of unmet needs and thwarted desires. Programs focused on positive youth development need to resonate with the realities of teens' lives and more fully acknowledge the complicated dynamics of teen dating relationships and how they are formalized, publicized and negotiated.

Impact of caregiver and parenting status on time trade-off and standard gamble utility scores for health state descriptions.

BACKGROUND: The purpose of this study was to examine the effect of caregiver status on time trade-off (TTO) and standard gamble (SG) health state utility scores. Respondents were categorized as caregivers if they reported that either children or adults depended on them for care. METHODS: This study was a secondary analysis of data from three studies in which general population samples rated health state descriptions. Study 1: UK; four osteoarthritis health states. Study 2: UK; three adult ADHD health states. Study 3: US; 16 schizophrenia health states. All three studies included time trade-off assessment. Study 1 also included standard gamble. Descriptive statistics were calculated to examine willingness to trade in TTO or gamble in SG. Utilities for caregivers and non-caregivers were compared using t-tests and ANCOVA models. RESULTS: There were 364 respondents including 106 caregivers (n = 30, 47, and 29 in Studies 1, 2, and 3) and 258 non-caregivers. Most caregivers were parents of dependent children (78.3%). Compared to non-caregivers, caregivers had more responses at the ceiling (i.e., utility = 0.95), indicating less willingness to trade time or gamble. All utilities were higher for caregivers than non-caregivers (mean utility difference between groups: 0.07 to 0.16 in Study 1 TTO; 0.03 to 0.17 in Study 1 SG; 0.06 to 0.10 in Study 2 TTO; 0.11 to 0.22 in Study 3 TTO). These differences were statistically significant for at least two health states in each study (p < 0.05). Results of sensitivity analyses with two caregiver subgroups (parents of dependent children and parents of any child regardless of whether the child was still dependent) followed the same pattern as results of the primary analysis. The parent subgroups were generally less willing to trade time or gamble (i.e., resulting in higher utility scores) than comparison groups of non-parents. CONCLUSIONS: Results indicate that caregiver status, including being a parent, influences responses in time trade-off health state valuation. Caregivers (i.e., predominantly parents) were less willing than non-caregivers to trade time, resulting in higher utility scores. This pattern was consistent across multiple health states in three studies. Standard gamble results followed similar patterns, but with less consistent differences between groups. It may be useful to consider parenting/caregiving status when collecting, interpreting, or using utility data because this demographic variable could influence results.

Development and testing of a disease-specific health literacy measure in kidney transplant patients.

CONTEXT: Health literacy affects a patient's ability to navigate through the system of care for late-stage kidney disease, including evaluation, waiting, and recovering from kidney transplant. OBJECTIVES: To develop and provide a preliminary evaluation of a knowledge and decision-making capacity tool, which is a component of health literacy. DESIGN: Cross-sectional design with purposive sampling. SETTING: Vascular access, dialysis, and outpatient transplant clinics. METHODS: A Decision-Making Capacity Assessment Tool (DMCAT) was developed and administered to 127 adults at different stages in the kidney care process. RESULTS: The DMCAT tool is positively and significantly correlated to the other 2 previously validated instruments and accounts for more variance than the other 2 tools in the regression models. We found significant differences in patients' health literacy and decision-making capacity related to their stage of care. Decision-making capacity appeared to be an important component of health literacy and should be considered as health care providers tailor care to meet patients' needs.

Physician Perceptions of Dose Escalation for Type 2 Diabetes Medications in the United States.

INTRODUCTION: Medications used to treat type 2 diabetes (T2D) often require dose escalation to optimize effectiveness. Physician and patient perceptions of treatment characteristics of T2D medications have previously been examined, but little is known about perceptions of escalation to the optimal dose for each patient. This study examined physicians' perceptions of dose escalation for medications used to treat T2D. METHODS: Data on dose escalation and other factors influencing decision-making for treatment of T2D were collected via an online survey of endocrinologists and primary care physicians in the USA. RESULTS: The sample included 501 physicians (348 primary care physicians and 153 endocrinologists). Dose escalation was not frequently considered by physicians as a primary factor keeping patients' from reaching treatment goals (mentioned as a factor by only 7.6% of the sample) or a barrier to prescribing T2D medication (16.2%). Factors more likely to keep patients from reaching treatment goals included an unhealthy diet (86.6%) and medication adherence (77.4%). The most common reasons that physicians reported for escalating dose levels were the need for better glycemic control (reported by 89.8% of the sample), ability to decrease the total number of medications by increasing the dose of one medication (39.9%), and the need for the patient to lose weight (39.3%). Data reported by primary care physicians and endocrinologists followed similar patterns. CONCLUSIONS: Although common with T2D treatments, escalating the dose of T2D medication was not perceived by physicians to be a significant barrier to attaining treatment goals or prescribing medication. Multiple factors contribute to the decision to escalate the dose of T2D medication.

In early phases of initiating medication treatment for a patient with type 2 diabetes (T2D), it is common for physicians to increase from a lower initial dose to a higher end dose to maximize treatment benefit. This process is known as dose escalation. The purpose of this study was to examine physicians' perceptions of dose escalation for medications used to treat T2D. An online survey was designed to identify reasons why physicians in the US may choose to escalate or not escalate a dose of medication for T2D. In addition, physicians were asked about factors that keep patients from reaching treatment goals to identify whether the requirement for dose escalation is perceived to be a common barrier to successful treatment. The sample included 501 physicians (348 primary care, 153 endocrinologists). Dose escalation was not frequently considered to be a primary factor keeping patients' from reaching treatment goals or a barrier to prescribing medication for T2D. Dose escalation decisions are complex, driven by a range of factors such as glycemic control medication tolerability, the patient's body mass index, treatment guidelines, comorbidities, characteristics of the patient's entire treatment regimen, and potential cardiovascular benefits.

Inability to move one's face dampens facial expression perception.

Humans rely heavily on facial expressions for social communication to convey their thoughts and emotions and to understand them in others. One prominent but controversial view is that humans learn to recognize the significance of facial expressions by mimicking the expressions of others. This view predicts that an inability to make facial expressions (e.g., facial paralysis) would result in reduced perceptual sensitivity to others' facial expressions. To test this hypothesis, we developed a diverse battery of sensitive emotion recognition tasks to characterize expression perception in individuals with Moebius Syndrome (MBS), a congenital neurological disorder that causes facial palsy. Using computer-based detection tasks we systematically assessed expression perception thresholds for static and dynamic face and body expressions. We found that while MBS individuals were able to perform challenging perceptual control tasks and body expression tasks, they were less efficient at extracting emotion from facial expressions, compared to matched controls. Exploratory analyses of fMRI data from a small group of MBS participants suggested potentially reduced engagement of the amygdala in MBS participants during expression processing relative to matched controls. Collectively, these results suggest a role for facial mimicry and consequent facial feedback and motor experience in the perception of others' facial expressions.

Repression of TRIM13 by chromatin assembly factor CHAF1B is critical for AML development.

Acute myeloid leukemia (AML) is an aggressive blood cancer that stems from the rapid expansion of immature leukemic blasts in the bone marrow. Mutations in epigenetic factors represent the largest category of genetic drivers of AML. The chromatin assembly factor CHAF1B is a master epigenetic regulator of transcription associated with self-renewal and the undifferentiated state of AML blasts. Upregulation of CHAF1B, as observed in almost all AML samples, promotes leukemic progression by repressing the transcription of differentiation factors and tumor suppressors. However, the specific factors regulated by CHAF1B and their contributions to leukemogenesis are unstudied. We analyzed RNA sequencing data from mouse MLL-AF9 leukemic cells and bone marrow aspirates, representing a diverse collection of pediatric AML samples and identified the E3 ubiquitin ligase TRIM13 as a target of CHAF1B-mediated transcriptional repression associated with leukemogenesis. We found that CHAF1B binds the promoter of TRIM13, resulting in its transcriptional repression. In turn, TRIM13 suppresses self-renewal of leukemic cells by promoting pernicious entry into the cell cycle through its nuclear localization and catalytic ubiquitination of cell cycle-promoting protein, CCNA1. Overexpression of TRIM13 initially prompted a proliferative burst in AML cells, which was followed by exhaustion, whereas loss of total TRIM13 or deletion of its catalytic domain enhanced leukemogenesis in AML cell lines and patient-derived xenografts. These data suggest that CHAF1B promotes leukemic development, in part, by repressing TRIM13 expression and that this relationship is necessary for leukemic progression.

When looking 'hot' means not feeling cold: Evidence that self-objectification inhibits feelings of being cold.

Self-objectification, the internalization of an observer's appearance-based perspective of one's body, has been theorized and demonstrated to reduce body awareness among women. In this field study, we propose self-objectification as the mechanism to explain the oft-observed phenomenon where women wearing little clothing appear unbothered by cold weather, positing that self-objectification obstructs women's feelings of cold. We surveyed women outside nightclubs on cold nights, assessed self-objectification, and asked participants to report how cold they felt. Anonymous photos were taken and coded for amount of skin exposure. We hypothesized that self-objectification would moderate the relationship between clothing coverage and reports of feeling cold. Our hypothesis was supported: women low in self-objectification showed a positive, intuitive, relationship between skin exposure and perceptions of coldness, but women more highly focused on their appearance did not feel colder when wearing less clothing. These findings offer support for the relationship between self-objectification and awareness of bodily sensations in the context of a naturalistic setting. We discuss implications of these findings, and also consider limitations, an alternative explanation, and directions for future research.

Patient Perceptions of and Preferences Between Characteristics of Injectable Diabetes Treatments.

INTRODUCTION: The administration of medications targeting type 2 diabetes mellitus (T2D) has evolved over time. As injection delivery systems continue to evolve, it is necessary to understand patients' perceptions of currently available treatments. The objective of this study was to examine the patient perspective of injectable treatment for T2D and identify characteristics of these treatments that are most important to patients. METHODS: Data were collected via an online survey study with a sample of individuals in the UK and US who were treated for T2D with injectable medication. The survey was designed to elicit perceptions of the treatment process for injectable glucagon-like peptide 1 (GLP-1) receptor agonists and insulin. RESULTS: The sample included 504 participants (251 UK, 253 US). Approximately half (50.4%) were treated with a GLP-1 receptor agonist and half (49.6%) were treated with insulin. Respondents were presented with a list of 17 characteristics of injectable medication and asked to indicate which were most important to them. Respondents most frequently selected confidence in administering the correct dose (n = 300, 59.5%); ease of selecting the correct dose (n = 268, 53.2%); overall ease of using the injection device (n = 239, 47.4%); frequency of injections (n = 223, 44.2%); and ease of carrying the device when necessary to inject away from home (n = 190, 37.7%). Characteristics least frequently cited as important included dose escalation (n = 79, 15.7%); handling the needle (n = 74, 14.7%); connectivity to an electronic device (n = 70, 13.9%); and the time required to prepare and inject each dose (n = 62, 12.3%). CONCLUSION: Results of this survey suggest that patients prioritize some attributes of injectable treatments over others. These findings may have implications for clinical practice and development of injection devices.

The psychometric validation of the OAB family impact measure (OAB-FIM).

AIMS: Although overactive bladder (OAB) impacts patient health-related quality of life, the impact of OAB on family members is not known. Presently, no validated instruments exist to assess family impact, thus we examined the psychometric properties of a new instrument, the overactive bladder family impact measure (OAB-FIM). METHODS: Dyads of OAB patient-family members and control patient-family members were recruited from clinics. Family members (spouses, significant others, or daughters) completed the 32-item draft OAB-FIM. Patients completed the overactive bladder questionnaire (OAB-q) and the patient perception of bladder condition (PPBC). Both patients and family members completed two validated relationship measures. Item and exploratory factor analyses were performed to determine subscale structure; reliability and validity were assessed. RESULTS: One hundred ninety-three patient-family member dyads (163 OAB, 30 control) participated. OAB patients were mostly women (82%); the control group was younger with fewer women (53%). Family members were predominantly men (OAB, 58%; control, 52%), and control family members were younger than OAB family members. Thirteen items were deleted from the draft OAB-FIM based on item performance and factor structure based on exploratory factor analyses, leaving 19-items in the final OAB-FIM. Four subscales (Irritation, Activities, Travel, Concern) were derived for use among all family members; two additional subscales (Sleep, Sex) were derived for use with spouses/significant others. The OAB-FIM discriminated between OAB and control family members with OAB family members demonstrating significant impact (all P < 0.0001). Internal consistency reliability (Cronbach's alpha >0.70) and 2-week test-retest reliability (intraclass correlation coefficients >0.73) were high for all subscales. Concurrent validity of the OAB-FIM was demonstrated through statistically significant (P < 0.001) Spearman correlations with the OAB-q (0.35-0.58) and the PPBC (0.31-0.56). The OAB-FIM also demonstrated known-groups validity, distinguishing between family members of OAB patients and family members of control patients. CONCLUSIONS: This study supports the reliability and validity of a new measure to assess the impact of OAB on family members and demonstrates that family members are affected by another's medical condition.

Resilience training for functioning adults: program description and preliminary findings from a pilot investigation.

It has previously been asserted that the construct of resilience holds great promise for diverse high-risk populations and that resilience may be an attribute that can be acquired through training. A rich body of literature suggests the strengths that comprise resilience. This paper describes a resilience training program based upon the identified strengths of resilience and provides additional preliminary data from a pilot investigation which lend support to the idea that resilience can be acquired through training. Suggestions for future research are provided.

Patient Preferences and Health State Utilities Associated with Mealtime Insulin Concentrations Among Patients with Diabetes in Italy.

INTRODUCTION: Standard concentration (100 units/mL) mealtime insulin is frequently used to treat patients with type 1 (T1D) and type 2 diabetes (T2D). A more concentrated version of the medication (200 units/mL) has been available in Italy since 2016. This concentrated version is bioequivalent to the standard version and delivers the same amount of medication but in half the volume of liquid. The purpose of this study was to examine patient preferences and estimate health state utilities associated with standard and concentrated rapid-acting mealtime analog insulin. METHODS: Participants with T1D and T2D in Italy valued two health states in time trade-off interviews. The descriptions of diabetes and treatment in the two health states were identical, differing only in terms of insulin concentration (e.g., half as much liquid for the same dose, less effort needed to press the injection button, and fewer injection pens required with concentrated insulin). To ensure participants understood the health states, they were shown a short video illustrating the differences between concentrations. RESULTS: A total of 217 participants completed the interviews (49.8% male; mean age 56.1 years; 109 from Milan; 108 from Rome; 12.0% T1D; 88.0% T2D). When asked which health state they preferred, 98.2% responded the concentrated version, 0.9% said the standard version, and 0.9% had no preference. Mean [standard deviation (SD)] utilities rounded to three decimals were 0.892 (0.099) for the concentrated version and 0.884 (0.101) for the standard version. The mean (SD; p value) utility difference between the standard and concentrated rapid-acting insulin was 0.007 (0.019; p < 0.0001). CONCLUSIONS: Findings from this study provide insight into patient preferences associated with concentration of rapid-acting insulin. Although the difference in utility is small, patients consistently preferred the concentrated formulation over the standard insulin, and for some patients this difference had an impact on utility valuations. These results suggest that the concentration of rapid-acting insulin should be considered because it could affect treatment preference and quality of life. FUNDING: Eli Lilly and Company.

Patient-Reported Outcomes and Impact of Type 2 Diabetes: A Cross-Sectional Study in the Kingdom of Saudi Arabia.

BACKGROUND: The Kingdom of Saudi Arabia (KSA) has the second highest prevalence of type 2 diabetes mellitus (T2DM) in the Middle East. There is a paucity of research on the experiences and treatment preferences of patients with T2DM in KSA. This study explored Saudi patients' health-related quality of life, eating habits, experiences during Ramadan, and preference between two glucagon-like peptide-1 receptor agonist (GLP-1 RA) treatment devices. METHODS: A cross-sectional, observational study was conducted in three cities in KSA. Participants completed sociodemographic and clinical forms, EQ-5D-5L, Impact of Weight on Self-Perceptions, and a diabetes treatment survey. Participants also viewed instructional videos on GLP-1 RA injection devices and indicated their device preference. RESULTS: Of the 310 participants, 53% were male. The mean age was 43 years (range: 30.0-75.0), duration since diabetes diagnosis was 6.3 years (range: 0.2-27.1), the most commonly reported last HbA1c level was between ≥7.1% and 8% (45%). The mean EQ-5D-5L index score was 0.90, with some participants reporting problems with pain/discomfort (34.5%) and usual activities (33.2%). Patients reported a low-to-moderate impact of weight on self-perception. In preparation for Ramadan, participants sought physician advice on diabetes management (37%) and/or increased checks of their blood glucose (37%). After watching the videos, 89% (n=277) of participants indicated a device preference, with significantly more preferring the dulaglutide device (n=186, 67%) over the semaglutide device (n=91, 33%) (p<0.0001). CONCLUSION: This study indicates that T2DM has a significant social, emotional, and behavioral impact on the lives of patients in KSA.