Elaboration of the preliminary Rheumatoid Arthritis Impact of Disease (RAID) score: a EULAR initiative.

BACKGROUND: Current response criteria in rheumatoid arthritis (RA) usually assess only three patient-reported outcomes (PROs): pain, functional disability and patient global assessment. Other important PROs such as fatigue are not included. OBJECTIVE: To elaborate a patient-derived composite response index for use in clinical trials in RA, the RA Impact of Disease (RAID) score. METHODS: Ten patients identified 17 domains or areas of health relevant for inclusion in the score, then 96 patients (10 per country in 10 European countries) ranked these domains in order of decreasing importance. The seven most important domains were selected. Instruments were chosen for each domain after extensive literature research of psychometric properties and expert opinion. The relative weight of each of the domains was obtained from 505 patients who were asked to "distribute 100 points" among the seven domains. The average ranks of importance of these domains were then computed. RESULTS: The RAID score includes seven domains with the following relative weights: pain (21%), functional disability (16%), fatigue (15%), emotional well-being (12%), sleep (12%), coping (12%) and physical well-being (12%). Weights were similar across countries and across patient and disease characteristics. Proposed instruments include the Health Assessment Questionnaire and numerical ratings scales. CONCLUSION: The preliminary RAID score is a patient-derived weighted score to assess the impact of RA. An ongoing study will allow the final choice of questionnaires and assessment of validity. This score can be used in clinical trials as a new composite index that captures information relevant to patients.

Use of routine laboring epidurals at Naval hospitals: a physician survey.

Physicians and patients have complained about a lack of laboring epidurals at Naval hospitals. In order to assess this situation, a survey was mailed to all physicians specializing in obstetrics and gynecology (OB) and family practice who were stationed at Naval hospitals in the United States and abroad. Respondents were queried regarding the availability of routine laboring epidurals (RLEs) at their hospitals, as well as their attitudes toward the use of RLEs. RLEs were reported to be available for most patients who might benefit at OB teaching hospitals but not at other Naval hospitals. Most physicians stated that patients complained about a lack of RLEs and that the patient could obtain one at a civilian hospital in the area. Most physicians, especially OBs, had favorable attitudes regarding the use of RLEs and would employ them if available. The discussion includes how the Department of Defense has taken steps toward making epidurals available to all military women and dependents.