Review finds core outcome set uptake in new studies and systematic reviews needs improvement

OBJECTIVE

To review evidence about the uptake of core outcome sets (COS). A COS is an agreed standardized set of outcomes that should be measured and reported, as a minimum, in all clinical trials in a specific area of health or health care.

STUDY DESIGN AND SETTING

This article provides an analysis of what is known about the uptake of COS in research. Similarities between COS and outcomes recommended by stakeholders in the evidence ecosystem is reviewed, and actions taken by them to facilitate COS uptake described.

RESULTS

COS uptake is low in most research areas. Common facilitators relate to trialist awareness and understanding. Common barriers were not including in the development process all specialties who might use the COS, and the lack of recommendations for how to measure the outcomes. Increasingly, COS developers are considering strategies for promoting uptake earlier in the process, including actions beyond traditional dissemination approaches. Overlap between COS and outcomes in regulatory documents and health technology assessments is good. An increasing number and variety of organisations are recommending COS be considered.

CONCLUSION

We suggest actions for various stakeholders for improving COS uptake. Research is needed to assess the impact of these actions to identify effective evidence-based strategies.

Myocardial infarction in men and women under 65 years of age: no evidence of gender bias

We examined short and long term outcomes of MI in a consecutive series of 169 men and 50 women who were followed for an average of 3.5 years. Similar percentages of men and women were admitted to medical intensive care, received in-patient cardiac rehabilitation, quit smoking at one year, were still smoking, were taking a lipid lowering drug or had returned to work at one year, underwent coronary angiography at 3.5 years or had died by 3.5 years. The lack of gender difference in outcome may reflect an absence of gender bias in the management of men and women with MI in southwest Scotland.

Clinical and biochemical determinants of plasma lipid peroxide levels in type 2 diabetes

The enhanced risk and increased severity of atheroma in diabetes is well recognized but, as yet, incompletely explained. A cross-sectional study of vascular disease risk factors in a group of type 2 diabetic patients from South West Scotland has revealed an association between glycaemic control, assessed by HbAl level and plasma lipid peroxides measured by a specific high-performance liquid chromatography method. Duration of diabetes appeared to be a subsidiary contributor to lipid peroxidation. We suggest this evidence supports the importance of glycaemic control in modulating glyco-oxidative mechanisms probably crucial to production of diabetic complications. Atherosclerosis prevention in diabetes may hinge on exemplary simultaneous control of both hyperglycaemia and hyperlipidaemia.

Conflict between classifications based on free thyroxine and thyroid stimulating hormone concentrations in thyroxine-treated patients

The use of free thyroxine assay as the basis for monitoring patients on thyroxine replacement therapy was assessed. Patients with normal free thyroxine levels were divided into sub-groups on the basis of serum TSH levels. Of these, patients with normal TSH levels had higher serum free thyroxine and free 3,5,3'-triiodothyronine concentrations than patients with elevated TSH levels. No significant differences were seen in the level of duration of replacement therapy. Patients were almost equally divided between the high and normal TSH sub-groups. It was concluded that free thyroxine assay had little role to play in the monitoring of these patients.