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People living with cardiac sarcoidosis (CS) are likely to have worse clinical outcomes and greater impairment on health-related quality of life (HRQoL) than other sarcoidosis manifestations. CS can result in a constellation of intrusive symptoms (such as palpitations, dizziness, syncope/pre-syncope, chest pain, dyspnoea, orthopnoea, or peripheral oedema) and/or life-threatening episodes, requiring consideration of invasive cardiac procedures for diagnosis and for the management of acute events. Additionally, the presence of multisystemic involvement and persistent non-specific sarcoidosis symptoms negatively affect HRQoL. A systematic review was undertaken to explore the impact of CS on HRQoL in adults with CS. Multiple bibliographic databases were searched for studies with HRQoL as primary or secondary outcomes in CS (PROSPERO registration: CRD42019119752). Data extraction and quality assessments were undertaken independently by two authors. From the initial 1609 identified records, only 11 studies included CS patients but none specifically reported HRQoL scores for CS patients. The average representation of CS patients was 14.5% within these cohorts (range 2-22%). The majority (73%) was conducted in single-centre tertiary care settings, and only one study (9%) included longitudinal HRQoL data. CS patients were among those sarcoidosis patients with impaired HRQoL and worse outcomes, requiring higher doses of sarcoidosis-specific therapy which contribute to further deterioration of HRQoL. Sarcoidosis studies do not incorporate stratified HRQoL scores for CS patients. While there is a need for longitudinal and multicentre studies assessing HRQoL outcomes in CS cohorts, the development of CS-specific tools is also needed.

People living with cardiac sarcoidosis (CS) are likely to have worse clinical outcomes and greater impairment on health-related quality of life (HRQoL) than other sarcoidosis manifestations. CS can result in a constellation of intrusive symptoms (such as palpitations, dizziness, syncope/pre-syncope, chest pain, dyspnoea, orthopnoea, or peripheral oedema) and/or life-threatening episodes, requiring consideration of invasive cardiac procedures for diagnosis and for the management of acute events. Additionally, the presence of multisystemic involvement and persistent non-specific sarcoidosis symptoms negatively affect HRQoL. A systematic review was undertaken to explore the impact of CS on HRQoL in adults with CS. Multiple bibliographic databases were searched for studies with HRQoL as primary or secondary outcomes in CS (PROSPERO registration: CRD42019119752). Data extraction and quality assessments were undertaken independently by two authors. From the initial 1609 identified records, only 11 studies included CS patients but none specifically reported HRQoL scores for CS patients. The average representation of CS patients was 14.5% within these cohorts (range 2-22%). The majority (73%) was conducted in single-centre tertiary care settings, and only one study (9%) included longitudinal HRQoL data. CS patients were among those sarcoidosis patients with impaired HRQoL and worse outcomes, requiring higher doses of sarcoidosis-specific therapy which contribute to further deterioration of HRQoL. Sarcoidosis studies do not incorporate stratified HRQoL scores for CS patients. While there is a need for longitudinal and multicentre studies assessing HRQoL outcomes in CS cohorts, the development of CS-specific tools is also needed.

Weight discrimination impacts the physical and psychological health outcomes for persons living with obesity. Non-White adults are also more likely to report weight discrimination than White adults. The specific effects of weight discrimination on the physical and psychological health of racial minorities and any potential disparities are unknown. No reviews, systematic or scoping, have been conducted on the associations between weight discrimination and health outcomes on varying racial and ethnic groups, specifically Black, Asian, and Hispanic Americans. This scoping review will be conducted in order to summarize current research and identify gaps in knowledge.

Additional file 1: Search strategy.

Background. Currently, pregnant women are screened using ultrasound at booking and around the middle of pregnancy. Ultrasound scans thereafter are performed for clinical indications only. Objectives. We sought to assess the case for offering universal late pregnancy ultrasound to all nulliparous women in the UK. The main questions addressed were to determine the diagnostic effectiveness of universal late pregnancy ultrasound to predict adverse outcome, and the cost effectiveness of either implementing universal ultrasound or conducting further research in this area. Design We performed diagnostic test accuracy reviews of five ultrasonic measurements in late pregnancy. We conducted cost effectiveness and value of information (VoI) analysis of screening for fetal presentation, screening for small for gestational age (SGA) fetuses and screening for large for gestational age (LGA) fetuses. We finally conducted a survey and a focus group to determine the willingness of women to participate in a future randomised trial. Data sources We searched Medline, EMBASE and the Cochrane library from inception. Review methods The protocol for the review was designed a priori and registered. Eligible studies were identified using key words with no restrictions for language or location. The risk of bias in studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Health economic modelling employed a decision tree analysed via Monte Carlo simulation. Health outcomes were from the fetal perspective and presented as quality-adjusted life years (QALYs). Costs were from the perspective of the public sector defined as the (English) NHS and costs of special educational needs. All costs and QALYs were discounted by 3.5% per annum and the reference case time horizon was 20 years. Results Umbilical artery Doppler, cerebro-placental ratio (CPR), severe oligohydramnios, and borderline oligohydramnios were all either non-predictive or weakly predictive of the risk of neonatal morbidity (summary positive likelihood ratios [LR+] between 1 and 2) and were all weakly predictive of the risk of delivering a SGA infant (summary LR+ between 2 and 4). Suspicion of fetal macrosomia is strongly predictive of the risk of delivering a large baby but it is only weakly – albeit statistically significantly – predictive of the risk of shoulder dystocia. Very few studies blinded the result of the ultrasound scan and most studies had high risk of bias through treatment paradox, ascertainment bias or iatrogenic harm. Health economic analysis indicated that universal ultrasound for fetal presentation only may be both clinically and economically justified on the basis of existing evidence. Universal ultrasound including fetal biometry was of borderline cost-effectiveness, and sensitive to assumptions. VoI analysis indicated that future research should be focused on the cost difference between IOL and expectant management. Limitations The primary literature on the diagnostic effectiveness of ultrasound in late pregnancy is weak. VoI analysis may have underestimated the uncertainty in the literature as it was focused on the internal validity of parameters, which is quantified, whereas the greatest uncertainty may be in the external validity to the research question, which is unquantified. Conclusions Universal screening for presentation at term may be justified on the basis of current knowledge. Universal screening for fetal growth disorders cannot currently be justified., The National Institute for Health Research Health Technology Assessment programme

Checklist of the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. (DOC 119 kb)

Univariate analysis: tier 1 and 2 not predictive of C-POMS summary score on D3, D5 and D8. (DOCX 20Â kb)