Combined dexamethasone suppression–corticotrophin-releasing hormone stimulation test in medication-free major depression and healthy volunteers

Background

The hypothalamic–pituitary–adrenal (HPA) axis is dysfunctional in a subgroup of mood disorders.

Methods

We compared cortisol and adrenocorticotropic hormone (ACTH) responses in major depression and healthy volunteers to the combined dexamethasone suppression–corticotrophin-releasing hormone stimulation (DEX–CRH) test. Unlike other published studies, the study patients were medication-free and the healthy volunteers did not have first-degree relatives with a mood or psychotic disorder. Demographics, DSM-IV diagnoses and other clinical parameters were evaluated in major depressive disorder (MDD) and healthy control groups. Participants received an oral dose of 1.5 mg dexamethasone at 11 pm the day before CRH administration. On the following day, at 3 pm, 100 µg of ovine CRH was infused. Blood samples for determination of cortisol and ACTH were collected every 15 min from 3 pm to 4:15 pm. Cortisol and ACTH responses were calculated as areas under the curve.

Results

Controlling for age, baseline (i.e., post-dexamethasone) ACTH levels were higher in depressed patients compared to controls (p=0.01). There was a trend for higher ACTH responses in depressed patients compared to the control group (p=0.08). In depressed patients, cortisol and ACTH responses correlated positively with age, duration of illness and number of hospitalizations.

Limitations

Because of the cross-sectional study design we can only evaluate the nature of potential HPA axis disturbances that were present in patients when they are acutely depressed.

Conclusions

Feedback inhibition of ACTH secretion by cortisol is compromised in MDD, and this is independent of an age effect on the HPA axis function.     

Copeptin during rest and exercise in major depression

Background

High vasopressin levels and a correlation between vasopressin and cortisol has been observed in patients with depression. The aim was to assess copeptin, the c-terminal of provasopressin, and the association between cortisol, adrenocorticotropic hormone (ACTH) and copeptin in patients with depression. Secondly, to examine the copeptin response to acute exercise and aerobic training.

Methods

Copeptin, ACTH, and cortisol were measured in 111 patients with depression and 57 controls at rest. Copeptin was also measured during exercise. The depressed patients were subsequently randomized to an aerobic training intervention or an exercise control intervention.

Results

The plasma level of copeptin in depressed subjects was 5.14 pg/ml (IQR 3.4–8.4) and 4.82 pg/ml (IQR 2.8–7.5) in healthy controls (p=.66). The association between copeptin and cortisol was.02 (95% CI –.44 to.48; p=.93) and the association between copeptin and ACTH was –.06 (95% CI –.17 to.05; p=.27). All associations were independent of depression status (p=.15). Aerobic exercise training did not influence copeptin levels at rest (p=.09) or the response to acute exercise (p=.574). Copeptin decreased at rest in response to aerobic training in participants with high compliance to the exercise intervention (p=.04).

Limitations

We did not measure plasma osmolality, which is a possible confounder in this study.

Conclusions

Copeptin levels are not elevated or associated to ACTH or cortisol in depressed patients. Aerobic exercise training decreased copeptin levels in high attenders only. This study does not support a role of copeptin or vasopressin in depression.     

Self- or parent report of (co-occurring) internalizing and externalizing problems,and basal or reactivity measures of HPA-axis functioning: A systematic evaluation of the internalizing-hyperresponsivity versus externalizing-hyporesponsivity HPA-axis hypothesis

Background

Previous research findings on the link between adolescents’ psychopathology and hypothalamic–pituitary–adrenal (HPA) axis activity have been heterogeneous.

Method

Adolescents (n = 211) with a preadolescent DSM-IV diagnosis participated in a lab-based social stress task. Saliva cortisol was assessed at awakening and during social stress. It was investigated if continuous measures of internalizing and externalizing problems and their interaction, using both self- and parent report, were associated with basal or reactivity measures of HPA-axis functioning

Results

During social stress, an enhanced total release of cortisol was associated with self-reported internalizing problems and a blunted total release of cortisol with self-reported externalizing problems. Post hoc analyses revealed that the association between enhanced cortisol output and internalizing problems held for boys but not for girls. Associations with morning cortisol measures were overall weak

Conclusions

Only in the context of stress, and particularly when based on self-report, blunted cortisol output was associated with externalizing and enhanced cortisol output with internalizing problems. Our broad approach demonstrates the importance of who reports on psychopathology, the use of dimensional measures of psychopathology, simultaneous analysis of internalizing and externalizing problems, and the use of awakening and social stress related measures of cortisol.     

Cross-cultural validation of the Patient–Practitioner Orientation Scale (PPOS)

Objectives

Translate, adapt and validate the Patient–Practitioner Orientation Scale (PPOS) for use in Brazil.

Methods

The PPOS was translated to Portuguese using a modified Delphi technique. The final version was applied to 360 participants. Reliability (test–retest and internal consistency) and construct validity (explanatory and confirmatory factor analysis) were assessed.

Results

Only two items did not reach pre-established criteria agreement in Delphi technique. In pre-testing, seven items were modified. Internal consistency (Cronbach's alpha = 0.605) and test–retest reliability (intraclass correlation coefficient = 0.670) were adequate. In explanatory factor analysis, one item did not achieve a loading factor, one item was considered factorially complex and two items were inconsistent with a priori factors. Confirmatory factor analysis provided an acceptable adjustment for the observed variables (χ²/df = 2.33; GFI = 0.91; AGFI = 0.89; CFI = 0.84; NFI = 0.75; NNFI = 0.81; RMSEA = 0.062 (p = 0.016) and SRMR = 0.065).

Conclusions

The Brazilian version PPOS (B-PPOS) showed acceptable validity and adequate reliability.

Practice implications

The use of the B-PPOS in national and cross-cultural studies may contribute to the evaluation and monitoring of the attitudes of doctors, medical students and patients toward their professional relationships in research and practice.     

Fibulin-5 (FBLN5) gene polymorphism is associated with pelvic organ prolapse

Objective

FBLN5 encodes a key protein of elastic fiber matrix assembly and function that contributes to maintaining pelvic support and plays the important role in the pathophysiology of pelvic organ prolapse (POP). The aim of the study was to investigate whether there is an association between common single-nucleotide polymorphisms (SNPs) of the FBLN5 gene and POP.

Study design

A total of eleven tag SNPs of the FBLN5 gene were genotyped using the polymerase chain reaction with confronting two-pair primers (PCR-CTPP) in 210 patients with POP (stages III–IV) and 292 controls with no even minimal POP.

Results

We revealed significant associations of tag SNPs rs2018736 and rs12589592 with POP. The top association signal was found for SNP rs2018736 (protective effect for the minor allele A) in the entire set: p = 0.0026, OR = 0.42, 95% CI: 0.24–0.75; in the stratum with pelvic floor trauma: p = 0.0018, OR = 0.27, 95% CI: 0.11–0.64; and in the stratum with fetal macrosomia: p = 0.013, OR = 0.14, 95% CI: 0.03–0.71. The results of the haplotype analyses were consistent with the single SNP analysis. In the strata without perineal trauma and fetal macrosomia effects were non-significant, possibly, due to the smaller effect sizes.

Conclusions

Current data provide, for the first time, strong evidence that common SNPs of the FBLN5 gene are associated with POP especially after pelvic floor injury.     

Higher cortisol levels at diurnal trough predict greater attentional bias towards threat in healthy young adults

Background

Attentional bias (AB), selective information processing towards threat, can exacerbate anxiety and depression. Despite growing interest, physiological determinants of AB are yet to be understood. We examined whether stress hormone cortisol and its diurnal variation pattern contribute to AB.

Methods

Eighty-seven healthy young adults underwent assessments for AB, anxious personality traits, depressive symptoms, and attentional function. Salivary cortisol was collected at three time points daily (at awakening, 30 min after awakening, and bedtime) for 2 consecutive days. We performed: (1) multiple regression analysis to examine the relationships between AB and the other measures and (2) analysis of variance (ANOVA) between groups with different cortisol variation patterns for the other measures.

Results

Multiple regression analysis revealed that higher cortisol levels at bedtime (p<0.001), an anxious personality trait (p=0.011), and years of education (p=0.036) were included in the optimal model to predict AB (adjusted R²=0.234, p<0.001). ANOVA further demonstrated significant mean differences in AB and depressive symptoms; individuals with blunted cortisol variation exhibited significantly greater AB and depression than those with moderate variation (p=0.037 and p=0.009, respectively).

Limitations

Neuropsychological assessment focused on attention and cortisol measurement at three time points daily.

Conclusions

We showed that higher cortisol levels at bedtime and blunted cortisol variation are associated with greater AB. Individuals who have higher cortisol levels at diurnal trough might be at risk of clinical anxiety or depression but could also derive more benefits from the attentional-bias-modification program.     

Patient-centered communication and prognosis discussions with cancer patients

Objective

To examine physician communication associated with prognosis discussion with cancer patients.

Methods

We conducted a study of physician–patient communication using trained actors. Thirty-nine physicians, including 19 oncologists and 20 family physicians participated in the study. Actors carried two hidden digital recorders to unannounced visits. We coded recordings for eliciting and validating patient concerns, attentive voice tone, and prognosis talk.

Results

Actor adherence to role averaged 92% and the suspected detection rate was 14%. In a multiple regression, eliciting and validating patient concerns (β = .40, C.I. = 0.11–0.68) attentiveness (β = .32, C.I. = 0.06–0.58) and being an oncologist vs. a family physician (β = .33, C.I. = 0.33–1.36) accounted for 46% of the variance in prognosis communication.

Conclusion

Eliciting and validating patient concerns and attentiveness voice tone is associated with increased discussion of cancer patient prognosis as is physician specialty.

Practice implications

Eliciting and validating patient concerns and attentive voice tone may be markers of physician willingness to discuss emotionally difficult topics. Educating physicians about mindful practice may increase their ability to collect important information and to attend to patient concerns.     

Effects of escitalopram on menopause-specific quality of life and pain in healthy menopausal women with hot flashes: A randomized controlled trial

Objective

To evaluate the effects of escitalopram 10–20 mg/day on menopause-related quality of life and pain in healthy menopausal women with hot flashes.

Study design

A double-blind, placebo-controlled randomized trial of escitalopram 10–20 mg/day vs. identical placebo was conducted among 205 women ages 40–62 years with an average of ≥4 daily hot flashes recruited at 4 clinical sites from July 2009 to June 2010.

Main outcome measures

The primary trial outcomes, reported previously, were the frequency and severity of vasomotor symptoms at 8 weeks. Here, we report on the pre-specified secondary endpoints of total and domain scores from the Menopause-Specific Quality of Life Questionnaire (MENQOL) and the pain intensity and interference scale (PEG).

Results

Outcome data were collected on 97% of randomized women and 87% of women took at least 70% of their study medication. Treatment with escitalopram resulted in significantly greater improvement in total MENQOL scores (mean difference at 8 weeks of −0.41; 95% confidence interval (CI) −0.71 to −0.11; p < 0.001), as well as Vasomotor, Psychosocial, and Physical domain scores with the largest difference seen in the Vasomotor domain (mean difference −0.75; 95% CI −1.28 to −0.22; p = 0.02). There was no significant treatment group difference for the Sexual Function domain. Escitalopram treatment resulted in statistically significant improvements in PEG scores compared to placebo (mean treatment group difference at 8 weeks of −0.33; 95% CI −0.81 to 0.15; p = 0.045).

Conclusions

Treatment with escitalopram 10–20 mg/day in healthy women with vasomotor symptoms significantly improved menopause-related quality of life and pain.     

Does health coaching change patients’ trust in their primary care provider?

Objective

To assess the impact of health coaching on patients’ in their primary care provider.

Methods

Randomized controlled trial comparing health coaching with usual care.

Participants

Low-income English or Spanish speaking patients age 18–75 with poorly controlled type 2 diabetes, hypertension and/or hyperlipidemia.

Main outcome measure

Patient trust in their primary care provider measured by the 11-item Trust in Physician Scale, converted to a 0–100 scale.

Analysis

Linear mixed modeling.

Results

A total of 441 patients were randomized to receive 12 months of health coaching (n = 224) vs. usual care (n = 217). At baseline, the two groups were similar to those in the usual care group with respect to demographic characteristics and levels of trust in their provider. After 12 months, the mean trust level had increased more in patients receiving health coaching (3.9 vs. 1.5, p = 0.47), this difference remained significant after adjustment for number of visits to primary care providers (adjusted p = .03).

Conclusions

Health coaching appears to increase patients trust in their primary care providers.

Practice Implications

Primary care providers should consider adding health coaches to their team as a way to enhance their relationship with their patients.     

Supportive care needs in patients with cardiovascular disorders

Objectives

Unmet medical needs are a focus in cardiovascular disorder (CVD) research. However, few studies have investigated patients’ perceived needs. The present study examined supportive care needs in patients with CVD and their relation to health characteristics.

Methods

In total 260 in-patients with CVD were consecutively assessed with the supportive care needs survey. Primarily, frequency and content of unmet needs were examined. Secondarily, CVD-diagnoses were compared and correlations with risk factors, treatment characteristics, mood-state and quality of life were analyzed.

Results

Supportive care needs were indicated by 21% of all patients: unmet health information (37%) and psychological (23%) needs were most frequent. The number of unmet needs did not differ between most CVD-diagnoses. Unmet needs were not related to cardiac risk factors. However, treatment characteristics (r = .17–.23, p < .01), anxiety (r = .44–.71, p < .01), depression (r = .38–.63, p < .01), physical (r = .21–.47, p < .01) and mental (r = .29–.65, p < .01) quality of life were associated with unmet needs.

Conclusions

Supportive care needs are common in patients with CVD. They are based on patients’ treatment characteristics, emotions and subjective well-being rather than on cardiac factors.

Practice implications

Needs assessments in patients with CVD could detect unmet needs, enhance patient education and communication and, therefore, effectively target patients’ perceived needs and medical needs.     

Haematology patients and the internet – The use of on-line health information and the impact on the patient–doctor relationship

Objective

Patients access on-line health information (OHI) to better understand their health. We aimed to determine which demographic factors influence OHI use. We also explored how OHI is used and subsequent implications to the patient–doctor relationship.

Methods

We distributed a self-administered questionnaire to 202 haematology out-patients.

Results

62.3% used the internet and 54.3% used OHI. Higher education, (P < 0.001, OR 34.62, 95% CI 5.20–230.66) and household incomes of £15 000–25 000 (P = 0.023 OR 4.8 95% CI 1.236–18.59) were positively associated with OHI use.Those reassured after reading OHI had improved trust in their specialist (P < 0.001, OR 52.1, 95% CI 12.3–221.1), improved confidence during consultations, (P < 0.001, OR 23.0, 95% CI 2.8–188.2) and were improved decisions makers (P = 0.008, OR 13.6, 95% CI 4.1–45.7). Those with increased trust in their haematologist also had improved confidence (P < 0.001, OR 6.2, 95% CI 2.2–17.3) and improved decision making ability (P < 0.001, OR 13.6, 95% CI 4.7–39.4). 74.6% of patients did not share OHI with their haematologist.

Conclusions

Two-thirds of participants were exposed directly or indirectly to OHI. OHI affects patients’ view of their health and influences behaviour during consultations.

Practice implications

Haematologists could facilitate patients using OHI by recommending high quality websites and act supportively when patients share OHI.     

A meta-analysis of nonrandomized effectiveness studies on outpatient cognitive behavioral therapy for adult anxiety disorders

Objective

The primary aim of this study was to assess the overall effectiveness of individual and group outpatient cognitive behavioral therapy (CBT) for adults with a primary anxiety disorder in routine clinical practice.

Method

We conducted a random effects meta-analysis of 71 nonrandomized effectiveness studies on outpatient individual and group CBT for adult anxiety disorders. Standardized mean gain effect sizes pre- to posttreatment, and posttreatment to follow-up are reported for disorder-specific symptoms, depression, and general anxiety. The mean dropout from CBT is reported.

Results

Outpatient CBT was effective in reducing disorder-specific symptoms in completer (d = 0.90–1.91) and intention-to-treat samples (d = 0.67–1.45). Moderate to large (d = 0.54–1.09) and small to large effect sizes (d = 0.42–0.97) were found for depressive and general anxiety symptoms posttreatment. Across all anxiety disorders, the weighted mean dropout rate was 15.06%. Posttreatment gains for disorder-specific anxiety were maintained 12 months after completion of therapy.

Conclusions

CBT for adult anxiety disorders is very effective and widely accepted in routine practice settings. However, the methodological and reporting quality of nonrandomized effectiveness studies must be improved.     

Associations between patient–provider communication and socio-cultural factors in prostate cancer patients: A cross-sectional evaluation of racial differences

Objective

To examine the association between socio-cultural factors and patient–provider communication and related racial differences.

Methods

Data analysis included 1854 men with prostate cancer from a population-based study. Participants completed an assessment of communication variables, physician trust, perceived racism, religious beliefs, traditional health beliefs, and health literacy. A multi-group structural equation modeling approach was used to address the research aims.

Results

Compared with African Americans, Caucasian Americans had significantly greater mean scores of interpersonal treatment (p < 0.01), prostate cancer communication (p < 0.001), and physician trust (p < 0.001), but lower mean scores of religious beliefs, traditional health beliefs, and perceived racism (all p values <0.001). For both African and Caucasian Americans, better patient–provider communication was associated with more physician trust, less perceived racism, greater religious beliefs (all p-values <0.01), and at least high school education (p < 0.05).

Conclusion

Socio-cultural factors are associated with patient–provider communication among men with cancer. No evidence supported associations differed by race.

Practice implication

To facilitate patient–provider communication during prostate cancer care, providers need to be aware of patient education levels, engage in behaviors that enhance trust, treat patients equally, respect religious beliefs, and reduce the difficulty level of the information.     

Physician eye contact and elder patient perceptions of understanding and adherence

Objective

To Examine physician eye contact (EC), patient understanding and adherence.

Methods

Secondary analysis of National Institute of Aging videotapes (N = 52) of physician–elder patients in two visit types: (1) routine (n = 20); (2) anxiety-provoking (n = 32) was conducted. Self-reports of understanding and adherence were used. History-taking segments were qualitatively and quantitatively analyzed for relationships between EC, understanding and adherence.

Results

Qualitative analysis showed: (1) two salient EC elements – frequency, type (brief or sustained) – and verbal synchronicity were commonly invoked; (2) conjoint unfolding of three communication elements – “looking, listening and talking” – may be salient for patient outcomes; (3) despite differing EC patterns in routine and anxiety provoking visits, statistical analyses showed patient understanding and adherence ratings were similar in the sample population comprising two visit types; no significant correlations between EC elements and understanding and adherence were found.

Conclusions

Salience of EC for patient-centered communication is shown in prior research. Present findings broaden the significance of EC by including verbal synchronicity. Methodological limitations may account for no significant correlations between EC and patient outcomes.

Practice implications

Using suggested framework for operationalizing EC elements, including verbally synchronous communication, may facilitate patient-centeredness and have positive implications for patient understanding and adherence.     

Patients’ trust in their physician—Psychometric properties of the Dutch version of the “Wake Forest Physician Trust Scale”

Objective

Aim was to investigate the psychometric properties of a Dutch version of the “Wake Forest Physician Trust Scale”, which intends to measure patients’ trust in their physician.

Methods

A random sample of internal medicine patients visiting the outpatient clinic completed the questionnaire (N = 201). Dimensionality, reliability and validity of the instrument were examined.

Results

The structure of the questionnaire was best explained by a unidimensional construct. Reliability was confirmed: internal consistency was high (α = .88), and mean item-total correlations were all above .40. Construct validity was indicated by patients’ trust in their physician correlating significantly and as hypothesized with (1) satisfaction with their physician (r = .64), (2) with the length of the patient–physician relationship (r = .28), (3) with their willingness to recommend their physician (r = .71) and (4) their unwillingness to switch their physician (r = .61).

Conclusion

The results suggest the Dutch version of the Wake Forest Physician Trust Scale to be a psychometrically sound instrument to assess patients’ interpersonal trust.

Practice implications

Trust is a key feature of the patient–physician relationship, yet has been scarcely researched in other than Anglophone cultures. An adequate Dutch trust questionnaire forms the first step to gaining more knowledge about patient–physician trust in another culture and health care setting.     

A prospective cohort study of menstrual symptoms and morbidity over 15 years following laparoscopic Filshie clip sterilisation

Objective

To observe the incidence of menstrual symptoms and relevant surgery after sterilisation.

Study design

1101 women sterilised with Filshie clips between 1983 and 2002 were assessed prospectively comparing menstrual symptomatology documented immediately before surgery and 5–14 years later by questionnaire.

Main outcome measures

Prevalence of menstrual dysfunction and subsequent surgery related to pre-operative menstrual symptoms and contraception.

Results

After excluding 232 (24%) of the 968 eligible women sent questionnaires whose address had changed, 573 of the remaining 735 women (78%) completed the questionnaire, 223 5–6 years after sterilisation, 175 after 7–9 years and 175 after 10–15 years; the respondents were demographically representative of the total population. Heavy periods increased from 9% before to 35% (P < 0.0001) after sterilisation, painful periods from 2% to 21% (P < 0.0001) and 6% had undergone hysterectomy or endometrial ablation. These findings were not influenced by the pre-sterilisation method of contraception but were inversely related to advancing age (P < 0.0002). The lowest rates of menstrual symptoms were reported 10–15 years after sterilisation.

Conclusion

Menstrual symptoms increased following Filshie clip sterilisation irrespective of pre-sterilisation symptoms and contraception. Whatever the causative mechanism, the progestogen-loaded intrauterine system (IUS), with similar efficacy but with improved menstrual symptoms, should be considered before sterilisation.     

Communication matters: The impact of communication and participation in decision making on breast cancer patients’ depression and quality of life

Objective

This study explored the impact of breast cancer patients’ experiences of physician–patient communication and participation in decision making on patient depression and quality of life three and six months after primary treatment.

Methods

Participants were 135 German breast cancer patients, recruited within a week after the beginning of treatment. Women were asked to complete a self-administered questionnaire at baseline and three and six months later.

Results

Patients who rated their level of information at baseline as high were less depressed after three (p = .010) and six months (p < .001) and experienced higher quality of life after three (p < .001) and six months (p = .049). Patients who participated as much as they had wanted were more satisfied with the decision making process (p < .001) and had lower depression scores three months later (p = .005). The level of participation itself (passive, collaborative, active) and the treatment type had no impact.

Conclusion

The findings reveal the significance of physician–patient communication and stress the meaning of baseline depression for later adjustment.

Practice implications

A high level of information and tailoring the involvement in decision making to patients’ desired level can help patients to better cope with their illness. Physicians should assess and treat depression early in cancer treatment.     

Évolution de la résistance aux antibiotiques de Pseudomonas aeruginosa dans un centre hospitalier universitaire entre 2002 et 2006

Aim of study

Monitor evolution of antibiotic resistance of Pseudomonas aeruginosa from 2002 to 2006 in our hospital to optimize antibiotherapy.

Patients and method

The infections/colonizations with P. aeruginosa have been identified by the hospital's informatic database. Bacteriological samples realized 48 hours after patient's admission was considered as nosocomial. A Cochran-Armitage test was conducted to assess the evolution of resistance.

Results

During this period, 2098 infections/colonizations with P. aeruginosa have been identified. Bacteriological samples (68.5%) were nosocomial. Among the β-lactam antibiotics, ceftazidime and imipenem were the most active (R = 16.8% and 15.2%, respectively), followed by piperacillin and piperacillin–tazobactam (R = 24.8%, 18.4%, respectively). Amikacin and tobramycin were more active than gentamicin (R = 19.9%; 22.2% and 40.6%, respectively). 28.9% of strains were resistant to ciprofloxacin. Nosocomial strains were significantly more resistant than non-hospital strains: ceftazidime: 17.9% versus 14.2%, p = 0.0346; ticarcillin–clavulanic acid: 47.5% versus 39.6%, p = 0.0009; piperacillin–tazobactam: 20.0% versus 14.8%, p = 0.0046; ciprofloxacin: 30.7% versus 25.2%, p = 0.0112. A significant increase in the resistance of nosocomial strains to ceftazidime, ticarcillin–clavulanic acid and piperacillin–tazobactam was noted. Resistance from non-hospital strains to fluoroquinolones, aminoglycosides, ceftazidime, piperacillin and ticarcillin–clavulanic acid decreased significantly.

Conclusion

P. aeruginosa is a predominantly nosocomial microorganism. There is a decrease of resistance for non-hospital strains. But the resistance of nosocomial strains to antibiotics widely prescribed in hospital is worrying.     

Impact of genetic polymorphisms on the pathogenesis of idiopathic achalasia: Association with IL33 gene variant

Aim

To investigate the association of single nucleotide polymorphisms (SNPs) of genes involved in the regulation of immune responses, IL33, IL1RL1, IL23R, and IL10, with idiopathic achalasia in an Italian cohort of patients.

Materials and methods

A panel of eleven polymorphisms were genotyped in 116 unrelated idiopathic achalasic patients and 371 healthy subjects, by using TaqMan genotyping assays.

Results

Significant differences of allele (P = 0.0065, OR = 1.59, CI = 1.14–2.22) and genotype (P = 0.0097, OR = 1.74, CI = 1.14–2.65) frequencies of the IL33 rs3939286 variant were found between achalasic patients and controls. No association of the other investigated SNPs was detected. No differences in genotype and allele distribution were found with respect to clinical characteristics of patients.

Conclusion

We provide for the first time an association between the risk of developing idiopathic achalasia and IL-33 variant, underling the role of cytokines and inflammatory mediators on the pathogenesis of the disease.     

Working alliance in communication skills training for oncology clinicians: A controlled trial

Objective

The aim of this study was to evaluate the impact of communication skills training (CST) on working alliance and to identify specific communicational elements related to working alliance.

Methods

Pre- and post-training simulated patient interviews (6-month interval) of oncology physicians and nurses (N = 56) who benefited from CST were compared to two simulated patient interviews with a 6-month interval of oncology physicians and nurses (N = 57) who did not benefit from CST. The patient–clinician interaction was analyzed by means of the Roter Interaction Analysis System (RIAS). Alliance was measured by the Working Alliance Inventory – Short Revised Form.

Results

While working alliance did not improve with CST, generalized linear mixed effect models demonstrated that the quality of verbal communication was related to alliance. Positive talk and psychosocial counseling fostered alliance whereas negative talk, biomedical information and patient's questions diminished alliance.

Conclusion

Patient–clinician alliance is related to specific verbal communication behaviors.

Practice implications

Working alliance is a key element of patient–physician communication which deserves further investigation as a new marker and efficacy criterion of CST outcome.