Development and validation of the Treatment Related Impact Measure of Weight (TRIM-Weight)

<p>Abstract</p> <p>Background</p> <p>The use of prescription anti-obesity medication (AOM) is becoming increasingly common as treatment options grow and become more accessible. However, AOM may not be without a wide range of potentially negative impacts on patient functioning and well being. The Treatment Related Impact Measure (TRIM-Weight) is an obesity treatment-specific patient reported outcomes (PRO) measure designed to assess the key impacts of prescription anti-obesity medication. This paper will present the validation findings for the TRIM-Weight.</p> <p>Methods</p> <p>The online validation battery survey was administered in four countries (the U.S., U.K., Australia, and Canada). Eligible subjects were over age eighteen, currently taking a prescription AOM and were currently or had been obese during their life. Validation analyses were conducted according to an <it>a priori </it>statistical analysis plan. Item level psychometric and conceptual criteria were used to refine and reduce the preliminary item pool and factor analysis to identify structural domains was performed. Reliability and validity testing was then performed and the minimally importance difference (MID) explored.</p> <p>Results</p> <p>Two hundred and eight subjects completed the survey. Twenty-one of the 43 items were dropped and a five-factor structure was achieved: Daily Life, Weight Management, Treatment Burden, Experience of Side Effects, and Psychological Health. <it>A-priori </it>criteria for internal consistency and test-retest coefficients for the total score and all five subscales were met. All pre-specified hypotheses for convergent and known group validity were also met with the exception of the domain of Daily Life (proven in an ad hoc analysis) as well as the 1/2 standard deviation threshold for the MID.</p> <p>Conclusion</p> <p>The development and validation of the TRIM-Weight has been conducted according to well-defined principles for the creation of a PRO measure. Based on the evidence to date, the TRIM-Weight can be considered a brief, conceptually sound, valid and reliable PRO measure.</p

Barriers to Initiating Insulin in Type 2 Diabetes Patients: Development of a New Patient Education Tool to Address Myths, Misconceptions and Clinical Realities

PURPOSE: The purpose of this study was to identify patient beliefs as well as clinical realities about insulin that may be barriers to type 2 diabetes patients initiating insulin treatment when recommended by their physician. This information was then used to develop a clinically relevant, cross-culturally valid patient education tool with the goal of providing unbiased, medically informative statements addressing these barriers. METHODS: Thirteen focus groups were conducted in five countries (Germany, Sweden, The Netherlands, UK, and USA) to collect qualitative data on attitudes about insulin therapy from type 2 diabetes patients aged 18 or older whose physician had recommended initiating insulin treatment in the past 6 months (n = 87). Additionally, a panel of four clinical experts was interviewed to ascertain obstacles they experience in initiating insulin with their patients. RESULTS: On the basis of the interview data, the ten questions that asked about the most important barriers were generated. The clinical expert panel then generated clinically accurate and unbiased responses addressing these concerns, and the educational tool “Questions about Starting Insulin: Information on the Myths, Misconceptions and Clinical Realities about Insulin” was drafted. The draft tool was pilot tested in a group of patients and finalized. CONCLUSIONS: Patient misconceptions, as well as some clinical realities, about insulin treatment and diabetes can influence the decision to initiate insulin treatment and ultimately impact disease management. The educational tool developed through this study was designed to help patients who are deciding whether or not to initiate insulin therapy as recommended by their physician, and facilitate patient–health-care provider interactions

Le FORUM, Vol. 39 No. 3

https://digitalcommons.library.umaine.edu/francoamericain_forum/1046/thumbnail.jp

Understanding and assessing the impact of treatment in diabetes: the Treatment-Related Impact Measures for Diabetes and Devices (TRIM-Diabetes and TRIM-Diabetes Device)

<p>Abstract</p> <p>Purpose</p> <p>Diabetes is a debilitating illness requiring lifelong management. Treatments can be varied in terms of mode of administration as well as type of agent. Unfortunately, most patient reported outcome measures currently available to assess the impact of treatment are specific to diabetes type, treatment modality or delivery systems and are designed to be either a HRQoL or treatment satisfaction measure. To address these gaps, the Treatment Related Impact Measure-Diabetes and Device measures were developed. This paper presents the item development and validation of the TRIM Diabetes/Device.</p> <p>Methods</p> <p>Patient interviews were conducted to collect the patient perspective and ensure high content validity. Interviews were hand coded and qualitatively analyzed to identify common themes. A conceptual model of the impact of diabetes medication was developed and preliminary items for the TRIM-Diabetes/Device were generated and cognitively debriefed. Validation data was collected via an on-line survey and analyzed according to an a priori statistical analysis plan to validate the overall score as well as each domain. Item level criteria were used to reduce the preliminary item pool. Next, factor analysis to identify structural domains was performed. Reliability and validity testing was then performed.</p> <p>Results</p> <p>One hundred and five patients were interviewed in focus groups, individual interviews and for cognitive debriefing. Five hundred seven patients participated in the validation study. Factor analysis identified seven domains: Treatment Burden, Daily Life; Diabetes Management; Psychological Health; Compliance and Device Function and Bother. Internal consistency reliability coefficients of the TRIM-Diabetes/Device ranged from 0.80 and 0.94. Test-retest reliability of the TRIM-Diabetes/Device ranged from 0.71 to 0.89. All convergent and known groups validity hypotheses were met for the TRIM-Diabetes/Device total scores and sub-scales.</p> <p>Conclusion</p> <p>Validation is an ongoing and iterative process. These findings are the first step in that process and have shown that both the TRIM-Diabetes and the TRIM-Diabetes Device have acceptable psychometric properties. Future research is needed to continue the validation process and examine responsiveness and the validity of the TRIM-Diabetes/Device in a clinical trial population.</p

La culture du viol dans le discours juridique : soigner ses mots pour combattre les violences sexuelles

Une agression sexuelle est-elle : (1) un abus sexuel ; (2) une aventure sexuelle ; (3) une erreur de jeunesse ; (4) une déviance ; (5) aucune de ces réponses? S’y retrouver n’est pas toujours facile quand on cherche à dénoncer les violences sexuelles. Dans une société marquée par la culture du viol, les préjugés inconscients peuvent nous inciter à euphémiser, romantiser, érotiser, excuser, et même encourager les violences à caractère sexuel. Le présent article offre une perspective langagière sur les violences sexuelles en examinant les biais, stéréotypes et mythes sur le viol qui s’infiltrent dans le discours juridique. Nous traitons de termes qui banalisent les violences sexuelles, comme « abus sexuel », « voler un baiser », « caresse » et « inconduite ». Nous analysons également les propos blâmant les victimes, les expressions sexistes qui trahissent une vision du viol comme une « perte de contrôle », l’invisibilisation des hommes violents, ainsi que l’altérisation et la pathologisation des agresseurs. En examinant la culture du viol spécifiquement sous l’angle du langage ou du discours, nous fournissons aux juristes de nouveaux outils pour avancer dans la lutte contre les violences faites aux femmes. </jats:p

Méthodologie et pratique de l'analyse de la caricature : le mccarthyisme et le New York Times, 1950-1954

This study of caricature in the press has two main objectives : to describe the sociopolitical representation of McCarthyism in the caricatures published in the New York Times between 1950 and 1954 and to suggest a general model in the analysis of the semiolinguistic modes of representation that are the mean of communication of all caricatures.Cette étude de la caricature de presse poursuit deux objectifs : montrer ce qu'ont été les représentations socio-politiques du mccarthysme dans les caricatures publiées par le New York Times de 1950 à 1954 et proposer un modèle général pour l'analyse des modes sémio-linguistiques de représentation par lesquels toute caricature communique.Este estudio de la caricatura de prensa persigue dos objetivos : mostrar lo que han sido las representaciones socio-políticas del mccarthismo en las caricaturas publicadas por el New York Times de 1950 a 1954, y proponer un modelo general para el análisis de las formas semio-linguísticas de representación a través de las cuales toda caricatura comunica .Lessard Denis, Mercier Suzanne. Méthodologie et pratique de l'analyse de la caricature : le mccarthyisme et le New York Times, 1950-1954. In: Communication Information, volume 3 n°3,1981. pp. 52-97