COSCA (Core Outcome Set for Cardiac Arrest) in Adults : An Advisory Statement From the International Liaison Committee on Resuscitation

Cardiac arrest effectiveness trials have traditionally reported outcomes that focus on survival. A lack of consistency in outcome reporting between trials limits the opportunities to pool results for meta-analysis. The COSCA initiative (Core Outcome Set for Cardiac Arrest), a partnership between patients, their partners, clinicians, research scientists, and the International Liaison Committee on Resuscitation, sought to develop a consensus core outcome set for cardiac arrest for effectiveness trials. Core outcome sets are primarily intended for large, randomized clinical effectiveness trials (sometimes referred to as pragmatic trials or phase III/IV trials) rather than for pilot or efficacy studies. A systematic review of the literature combined with qualitative interviews among cardiac arrest survivors was used to generate a list of potential outcome domains. This list was prioritized through a Delphi process, which involved clinicians, patients, and their relatives/partners. An international advisory panel narrowed these down to 3 core domains by debate that led to consensus. The writing group refined recommendations for when these outcomes should be measured and further characterized relevant measurement tools. Consensus emerged that a core outcome set for reporting on effectiveness studies of cardiac arrest (COSCA) in adults should include survival, neurological function, and health-related quality of life. This should be reported as survival status and modified Rankin scale score at hospital discharge, at 30 days, or both. Health-related quality of life should be measured with >= 1 tools from Health Utilities Index version 3, Short-Form 36-Item Health Survey, and EuroQol 5D-5L at 90 days and at periodic intervals up to 1 year after cardiac arrest, if resources allow.Peer reviewe

Health outcomes in ankylosing spondylitis : an evaluation of patient-based and anthropometric measures.

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN042031 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

“Most of the professors were Men” - a qualitative study of female medical students’ perceptions of careers in academic medicine.

Background: Women remain underrepresented in academic medicine, particularly at higher grades. A gender-based disparity in attitudes towards academic medicine has been described in qualified clinicians but not explored in student populations. To explore the perspectives of female graduate entry medical (GEM) students with regards to future careers in academic medicine. Method: A qualitative study using focus groups, facilitated by two female undergraduate medical students. A semi-structured topic guide was developed with a primary focus was on gender. However, the influence of intersecting characteristics was also explored. Findings: Twenty-seven female students from years 2 to 4 of a single GEM school in the West Midlands participated in five focus groups (mean duration 47.2 mins; range 36-59 mins). Thematic analysis revealed seven themes: work-life balance, impact on clinical career progression, personal preferences, GEM specific concerns, role models, imposter syndrome, culture of academia. GEM-specific concerns of financial issues and the influence of previous experience were highlighted. The presence of imposter syndrome, routed in a lack of knowledge about careers, lack of self-confidence and feelings of not belonging was an important recurrent theme. Conclusions: Access to relevant and timely information, support, opportunities, and concordant mentors are essential requirements from the first year of medical school. Fear of discrimination and bias must be addressed across the academic journey. Future exploration of the impact of ethnicity, LGBTQ+ and disability on academic medicine careers is required

Using PROMs in healthcare. Who should be in the driving seat - policy makers, health professionals, methodologists or patients?

Editorial - No abstrac

Important factors to consider when treating children with chronic fatigue sndrome/myalgic encephalomyelitis (CFS/ME):perspectives of health professionals from specialist services

Background Paediatric Chronic Fatigue Syndrome (CFS)/Myalgic Encephalomyelitis (ME) is relatively common and disabling. Improving treatment requires the development of Patient Reported Outcome Measures (PROMs) that enable clinicians and researchers to collect patient-centred evidence on outcomes. Health professionals are well placed to provide clinical insight into the condition, its treatment and possible outcomes. This study aimed to understand the perspectives of specialist paediatric CFS/ME health professionals and identify outcomes that are clinically important. Methods Focus groups and interviews were held with 15 health professionals involved in the care of children with CFS/ME from the four largest specialist paediatric CFS/ME services in the NHS in England. A range of clinical disciplines were included and experience in paediatric CFS/ME ranged from 2 months to 25 years. Ten participants (67%) were female. Focus groups and interviews were recorded, transcribed verbatim and data were analysed using thematic analysis. Results All health professionals identified the impact of CFS/ME across multiple aspects of health. Health professionals described four areas used to assess the severity of the illness and outcome in children: 1) symptoms; 2) physical function; 3) participation (school, activities and social life); and 4) emotional wellbeing. They also described the complexity of the condition, contextual factors and considerations for treatment to help children to cope with the condition. Conclusions Clinically important outcomes in paediatric CFS/ME involve a range of aspects of health. Health professionals consider increases in physical function yet maintaining school functioning and participation more widely as important outcomes from treatment. The results are similar to those described by children in a recent study and will be combined to develop a new child-specific PROM that has strong clinical utility and patient relevanc

Assessing fatigue in adults with Axial Spondyloarthritis : a systematic review of the quality and acceptability of patient-reported outcome measures

Objective Evaluate the quality and acceptability of patient-reported outcome measures used to assess fatigue in patients with Axial Spondyloarthritis. Methods A two-stage systematic review of major electronic databases (1980-2017) to: 1) Identify measures; and 2) Identify evaluative studies. Study and measurement quality was evaluated following international standards. Measurement content was appraised against a conceptual model of RA-fatigue. Results From 387 reviewed abstracts, 23 articles provided evidence for nine fatigue-specific measures: six multi-item and three single-item. No axSpA-fatigue specific measure was identified. Evidence of reliability was limited, but acceptable for the Multi-dimensional Fatigue Inventory (internal consistency, test-retest) and Short Form 36-item Health Survey Vitality subscale (SF-36 VT) (internal consistency). Evidence of construct validity was moderate for the Functional Assessment of Chronic Illness Therapy-Fatigue and 10cm visual analogue scale, limited for the SF-36 VT, and not available for the remaining measures. Responsiveness was rarely evaluated. Evidence of measurement error, content validity or structural validity was not identified. Most measures provide a limited reflection of fatigue; the most comprehensive were the Multi-dimensional Assessment of Fatigue (MAF), MFI-20, FACIT-fatigue and Fatigue Severity Scale (FSS). Conclusion The limited content and often poor quality of the reviewed measures limits any clear recommendation for fatigue-assessment in this population; assessments should be applied with caution until further robust evidence is established. Well developed, patient-derived measures can provide essential evidence of the patient’s perspective to inform clinical research and drive tailored healthcare. The collaborative engagement of key stakeholders must seek to ensure that future fatigue assessment is relevant, acceptable and of high quality

Co-Occurrence and Characteristics of Patients With Axial Spondyloarthritis Who Meet Criteria for Fibromyalgia : Results From a UK National Register

The British Society for Rheumatology (BSR) Biologics Register in Ankylosing Spondylitis is funded by the BSR and they have receive funds for this from Pfizer, AbbVie and UCB. These companies receive advance copies of manuscripts and can provide comments but have no input into determining the topics for analysis, publication and no input into the work involved in this analysis. This analysis is part-funded by Arthritis Research UK (Grant No: 21378)Peer reviewedPublisher PD

Recommendations for exercise adherence measures in musculoskeletal settings: a systematic review and consensus meeting

Background: Exercise programmes are frequently advocated for the management of musculoskeletal disorders; however, adherence is an important pre-requisite for their success. The assessment of exercise adherence requires the use of relevant and appropriate measures, but guidance for appropriate assessment does not exist. The aim of this study was to recommend outcome measures of exercise adherence that have clinical and research utility in the musculoskeletal field. Methods: There were two key stages to the research. First, a systematic review of the availability, quality and acceptability of measures used to assess exercise adherence in musculoskeletal disorders; second, a consensus meeting. The systematic review was conducted in two phases and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure a robust methodology. Phase one identified all reproducible measures that have been used to assess exercise adherence in a musculoskeletal setting. Phase two identified published and unpublished evidence of the measurement and practical properties of identified measures. Study quality was assessed against the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. A shortlist of measures was produced for consideration during stage two: a meeting of relevant stakeholders (n=14) in the United Kingdom. During this meeting consensus on the most relevant and appropriate measures of exercise adherence for application in research and/or clinical practice settings was sought. Key findings: Our systematic review identified numerous measures which had been used as measures of exercise adherence within musculoskeletal research. Of these 36 were deemed reproducible. However, only six had been evaluated as specific measures of exercise adherence for musculoskeletal research: evidence of essential measurement and practical properties was mostly limited or not available. Assessment of relevance and comprehensiveness was largely absent and there was no evidence of patient involvement during the development of any measure. During the consensus process the stakeholders reached agreement that none of the measures were relevant, appropriate or acceptable for use in musculoskeletal clinical or research settings. Conclusions and recommendations: Numerous exercise adherence measures are currently used within musculoskeletal research. However, many of these measures were not originally developed for this purpose; many approaches are not reproducible; and evidence of essential measurement and practical properties was only identified for a limited number of measures. Moreover, substantial methodological and quality issues were identified in the development and evaluation of the six short-listed measures which reduces confidence in the ability of these measures to reliably and validly evaluate adherence to exercise. Furthermore key stakeholders unanimously agreed that these measures were not fit for purpose. Measures of exercise adherence must be clearly conceptualised. Future development and evaluation should seek to involve patients, clinicians and researchers as active collaborators and use credible methods to develop and evaluate an appropriate measure of exercise adherence

Children's experiences of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME):a systematic review and meta-ethnography of qualitative studies

Objective To synthesis the qualitative studies of children's experiences of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Design Systematic review and meta-ethnography. Background CFS/ME is an important disabling illness, with uncertain cause and prognosis. As a result, children with CFS/ME can find themselves living with greater uncertainty and stigma, exacerbating the impact of the condition. There is a growing body of qualitative research in CFS/ME, yet there has been no attempt to systematically synthesis the studies involving children. Methods Studies exploring the experiences of children diagnosed with CFS/ME, published or unpublished, using qualitative methods were eligible. MEDLINE, EMBASE, PsycINFO and CINAHL databases were searched as well as grey literature, reference lists and contacting authors. Quality assessment was done independently using the Critical Appraisal Skills Programme (CASP) checklist. Studies were synthesised using techniques of meta-ethnography. Results Ten studies involving 82 children with CFS/ME aged 8–18 were included. Our synthesis describes four third-order constructs within children's experiences: (1) disruption and loss: physical, social and the self; (2) barriers to coping: suspension in uncertainty, problems with diagnosis and disbelief; (3) facilitators to coping: reducing uncertainty, credible illness narratives, diagnosis and supportive relationships and (4) hope, personal growth and recovery. CFS/ME introduces profound biographical disruption through its effects on children's ability to socialise, perform school and therefore how they see their future. Unfamiliarity of the condition, problems with diagnosis and felt stigma prevent children from forming a new illness identity. Children adopt coping strategies such as building credible explanations for their illness. Conclusions Physical, social, emotional and self-dimensions of life should be included when treating and measuring outcomes from healthcare in paediatric CFS/ME. There is a need for greater recognition and diagnosis of childhood CFS/ME, specialist advice on activity management and improved communication between health and education providers to help children cope with their condition

The Artistic Talent of Msgr. Adam Muchtin

Adam Muchtin poznat je kao svećenik Riječke nadbiskupije, župnik i graditelj crkve na Donjoj Vežici, no u ovom radu analizira se njegovo manje poznato stvaralaštvo, ono likovno i to kroz likovni rad i teoriju koju je sam zapisao. Prvi dio članka posvećen je njegovom likovnom radu, točnije crtežu, slici i kiparstvu. Crtežu pristupa vrlo studiozno i kao pripremi za slike od kojih su najkvalitetniji prikazi Bogorodice i sv. Josipa. One se nalaze u crkvi sv. Terezije od Djeteta Isusa na Vežici i najbolje su njegovo likovno postignuće. Osim likovnog, estetskog segmenta njegovog rada, na radovima je vrlo očit i upečatljiv razlog stvaranja njegovih radova, a to je služba sakralne umjetnosti – slavljenje i veličanje Boga. U njegovim se radovima iščitava duboka vjera u Boga, ali i dobro poznavanje teorije umjetnosti, sakralnog prostora i liturgije. Stoga se drugi dio rada bavi analizom četiriju skripti (Kritika umjetnosti, Povijesni pregled razvoja kršćanske umjetnosti, Oprema crkve i Vrste i svojstva kamena, drva, kovina i boja) kojima se Muchtin služio za predavanja na Visokoj bogoslovskoj školi u Rijeci. Njima daje doprinos ovoj tematici na tragu Drugog vatikanskog koncila, a vrlo su aktualne i u današnjem vremenu, posebno skripta Oprema crkve.Adam Muchtin is known as a priest of the Archdiocese of Rijeka, pastor and builder of the church in Donja Vežica, but this paper analyses his lesser-known activity – in fine arts – through his own artistic creations and writings. The first part of the article is dedicated to his art work, more precisely to drawing, painting and sculpture. He approaches drawing very studiously and uses it as preparation for paintings, the best of which are the depictions of St. Mary and St. Joseph, considered his best artistic achievements and located in the church of St. Therese of the Child Jesus in Vežica. Apart from the artistic, aesthetic segment, his work manifests clearly the reason for his artistic creations, and that is the purpose of art – especially sacred art: the glorification and exaltation of God. In his works we read his deep faith in God, but also his good knowledge of art theory, sacral space and liturgy. Thus, the second part of the paper deals with the analysis of four scripts (“Art Critique”, “Historical Development of Christian Art”, “Church Equipment” and “Types and Properties of Stone, Wood, Metal and Colour”) used by Muchtin for lectures at the Theological School in Rijeka. They give large contribution to this subject, in the wake of the Second Vatican Council, and are very useful even today, especially the script “Church Equipment”