Implementing core outcomes in kidney disease: report of the Standardized Outcomes in Nephrology (SONG) implementation workshop

There are an estimated 14,000 randomized trials published in chronic kidney disease. The most frequently reported outcomes are biochemical endpoints, rather than clinical and patient-reported outcomes including cardiovascular disease, mortality, and quality of life. While many trials have focused on optimizing kidney health, the heterogeneity and uncertain relevance of outcomes reported across trials may limit their policy and practice impact. The international Standardized Outcomes in Nephrology (SONG) Initiative was formed to identify core outcomes that are critically important to patients and health professionals, to be reported consistently across trials. We convened a SONG Implementation Workshop to discuss the implementation of core outcomes. Eighty-two patients/caregivers and health professionals participated in plenary and breakout discussions. In this report, we summarize the findings of the workshop in two main themes: socializing the concept of core outcomes, and demonstrating feasibility and usability. We outline implementation strategies and pathways to be established through partnership with stakeholders, which may bolster acceptance and reporting of core outcomes in trials, and encourage their use by end-users such as guideline producers and policymakers to help improve patient-important outcomes

Investing in people The labour market impact of human resource interventions funded under the 1994-1999 Cummunity Support Framework in Ireland

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Myosteatosis is associated with poor physical fitness in patients undergoing hepatopancreatobiliary surgery

Background: body composition assessment, measured using single computed tomography (CT) slide at L3 level, and aerobic physical fitness, objectively measured using cardiopulmonary exercise testing (CPET), are each independently used for perioperative risk assessment. Sarcopenia (i.e. low skeletal muscle mass), myosteatosis (i.e. low skeletal muscle radiation attenuation) and impaired objectively measured aerobic fitness (reduced oxygen uptake) have been associated with poor post-operative outcomes and survival in various cancer types. However, the association between CT body composition and physical fitness has not been explored. In this study, we assessed the association of CT body composition with selected CPET variables in patients undergoing hepatobiliary and pancreas surgery.Methods: a pragmatic prospective cohort of 123 patients undergoing hepatobiliary and pancreas surgery were recruited. All patients underwent preoperative CPET. Preoperative CT-scans were analysed using a single CT-slice at L3 level to assess skeletal muscle mass, adipose tissue mass and muscle radiation attenuation. Multivariate linear regression was used to test the association between CPET variables and body composition. Main outcomes were oxygen uptake at anaerobic threshold ( O2 at AT), oxygen uptake at peak exercise ( O2 peak), skeletal muscle mass and skeletal muscle radiation attenuation (SM-RA).Results: of 123 patients recruited (77 males (63%), median age 66.9± 11.7, median BMI 27.3± 5.2), 113 patients had good quality abdominal CT-scans available and were included. Of the CT-body composition variables, SM-RA had the strongest correlation with O2 peak (r = 0.57, p <0.001) and O2 at AT (r = 0.45, p <0.001) while skeletal muscle mass was only weakly associated with O2 peak (r = 0.24, p <0.010). In multivariate analysis, only SM-RA was associated with O2 Peak (B = 0.25, 95%-CI 0.15-0.34, p <0.001, R2 = 0.42) and O2 at AT (B = 0.13, 95%-CI 0.06-0.18, p <0.001, R2 = 0.26).Conclusions: there is a positive association between preoperative CT SM-RA and preoperative physical fitness ( O2 at AT and at Peak). This study demonstrates that myosteatosis, and not sarcopenia, is associated with reduced aerobic physical fitness. Combining both myosteatosis and physical fitness variables may provide additive risk stratification accuracy and guide interventions during the perioperative period