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At present, there is no internationally accepted set of core outcomes or measurement methods for epilepsy clinical practice. The International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group of experts in epilepsy, people with epilepsy, and their representatives to develop minimum sets of standardized outcomes and outcome measurement methods for clinical practice. Using modified Delphi consensus methods with consecutive rounds of online voting over 12 months, a core set of outcomes and corresponding measurement tool packages to capture the outcomes were identified for infants, children, and adolescents with epilepsy. Consensus methods identified 20 core outcomes. In addition to the outcomes identified for the ICHOM Epilepsy adult standard set, behavioral, motor, and cognitive/language development outcomes were voted as essential for all infants and children with epilepsy. The proposed set of outcomes and measurement methods will facilitate the implementation of the use of patient‐centered outcomes in daily practice. [ABSTRACT FROM AUTHOR]

At present, there is no internationally accepted set of core outcomes or measurement methods for epilepsy clinical practice. Therefore, the International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group of experts in epilepsy, people with epilepsy and their representatives to develop minimum sets of standardized outcomes and outcomes measurement methods for clinical practice that support patient–clinician decision‐making and quality improvement. Consensus methods identified 20 core outcomes. Measurement tools were recommended based on their evidence of strong clinical measurement properties, feasibility, and cross‐cultural applicability. The essential outcomes included many non‐seizure outcomes: anxiety, depression, suicidality, memory and attention, sleep quality, functional status, and the social impact of epilepsy. The proposed set will facilitate the implementation of the use of patient‐centered outcomes in daily practice, ensuring holistic care. They also encourage harmonization of outcome measurement, and if widely implemented should reduce the heterogeneity of outcome measurement, accelerate comparative research, and facilitate quality improvement efforts. [ABSTRACT FROM AUTHOR]

Objective It is recognised internationally that rural communities often experience greater barriers to accessing services and have poorer health outcomes compared to urban communities. In some settings, health disparities may be further exacerbated by mining activity, which can affect the social, physical and economic environment in which rural communities reside. Direct environmental health impacts are often associated with mining activity and are frequently investigated. However, there is evidence of broader, indirect health and well-being implications emerging in the literature. This systematic review examines these health and well-being outcomes in communities living in proximity to mining in high-income countries, and, in doing so, discusses their possible determinants. Methods Four databases were systematically searched. Articles were selected if adult residents in mining communities were studied and outcomes were related to health or individual or community-level well-being. A narrative synthesis was conducted. Results Sixteen publications were included. Evidence of increased prevalence of chronic diseases and poor self-reported health status was reported in the mining communities. Relationship breakdown and poor family health, lack of social connectedness and decreased access to health services were also reported. Changes to the physical landscape; risky health behaviours; shift work of partners in the mine industry; social isolation and cyclical nature of 'boom and bust' activity contributed to poorer outcomes in the communities. Conclusion This review highlights the broader health and well-being outcomes associated with mining activity that should be monitored and addressed in addition to environmental health impacts to support co-existence of mining activities and rural communities. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives The management of rheumatoid arthritis ( RA) usually entails regular hospital reviews with a specialist often when the patient is well rather than during a period of exacerbation. An alternative approach where patients initiate appointments when they need them can improve patient satisfaction and resource use whilst being safe. This service evaluation reports a system-wide implementation of a patient-initiated review appointment system called Direct Access ( DA) for people with RA. The aim was to establish the impact on patient satisfaction of the new system versus usual care as well as evaluate the implementation processes. Methods As all patients could not start on the new system at once, in order to manage the implementation, patients were randomly allocated to DA or to usual care. Instead of regular follow-up appointments, DA comprised an education session and access to a nurse-led telephone advice line where appointments could be accessed within two weeks. Usual care comprised routine follow-ups with the specialist. Data were collected on patient satisfaction, service use and outcomes of any contact to the advice line. Results Three hundred and eleven patients with RA were assessed as being suitable for DA. In terms of patient satisfaction, between-group differences were found in favour of DA for accessibility and convenience, ease of contacting the nurse and overall satisfaction with the service. Self-reported visits to the general practitioner were also significantly lower. DA resulted in a greater number of telephone contacts (incidence rate ratio = 1.69; 95% confidence interval 1.07 to 2.68). Hospital costs of the two different service models were similar. Mean waiting time for an appointment was 10.8 days Conclusion This service evaluation found that DA could be implemented and it demonstrated patient benefit in a real-world setting. Further research establishing the broader cost-consequences across the whole patient pathway would add to our findings. [ABSTRACT FROM AUTHOR]

Context Two widely used antithyroid drug ( ATD) regimes for Graves' disease ( GD) include the 'block & replace' (B&R) regime (a fixed high-dose of ATD combined with levothyroxine) and the 'titration' regime (a titrating dose of ATD). Anecdotally, it is believed that B&R is less prone to fluctuating thyroid function. Objective To study whether, in routine clinical practice, the B&R regime, compared with the titration regime, is associated with more stable thyroid function. Methods We retrospectively analysed case-records for 450 patients treated with ATDs for GD at a secondary care hospital. Exclusion criteria included treatment with ATDs for <6 months, thyrotoxicosis due to other causes, treatment with radioiodine or thyroidectomy and pregnancy. Results Two hundred and twenty three patients were treated with the B&R regime ('B&R group'), 149 with the titration regime ('titration group') and 78 with both regimes. The number of thyroid function tests ( TFTs) performed per year (mean( SD): 3·2(1·2) vs 3·4(1·5); adjusted mean difference = −0·4; 95% CI: −0·7 to −0·1; and P = 0·008) and the number of hospital clinic visits per year (mean ( SD): 2·9 (1·0) vs 3·2 (1·3); adjusted mean difference = −0·4; 95% CI: −0·7 to −0·2; and P = 0·002) were lower in the B&R group than the titration group. The number of abnormal TFT results per year was similar in the two groups (mean( SD): 1·8(1·3) vs 1·8(1·4); adjusted mean difference = 0·05; 95% CI: −0·3 to 0·4; and P = 0·74). Conclusions In this retrospective study, there was little evidence that patients under B&R have more stable thyroid function. Further data from prospective studies, however, are needed to confirm this finding. [ABSTRACT FROM AUTHOR]

The article focuses on the Pharmaceutical Benefits Scheme (PBS) urgently needs to update anti-epileptic drug prescribing restrictions that put patients and prescribers at risk; and mentions the three latest drugs listed on the PBS for third line use include perampanel, lacosamide and brivaracetam.