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ObjectiveDispersion, or variability in an individual’s performance across multiple tasks at a single assessment visit, has been associated with cognitive dysfunction (CD) in many neurodegenerative and neurodevelopmental disorders. We aimed to compute a dispersion score using neuropsychological battery (NB) tests and determine its association with CD in patients with SLE.MethodsCD was defined as a z-score of ≤−1.5 on ≥2 domains of the NB. To compute a type of dispersion score known as the intraindividual SD (ISD), the SD of age-adjusted and sex-adjusted z-scores was calculated for each visit in each patient. To estimate the association between ISD and cognitive status (CD and non-CD), we used multilevel logistic regression, adjusting for clinically important covariates.ResultsA total of 301 adult patients with SLE completed the NB at baseline, 187 of whom were reassessed at 6 months and 189 at 12 months. CD was observed in 35.2% of patients at baseline, 27.8% at 6 months and 28.0% at 12 months. Prior to covariate adjustment, the mean ISD for non-CD was 1.10±0.31 compared with 1.50±0.70 for CD. After adjusting for ethnicity, education, employment, socioeconomic status and anxiety/depression, there was a statistically significant association between ISD and CD (OR for one-unit increase in ISD: 13.56, 95% CI 4.80 to 38.31; OR for 1/10th-unit increase in ISD: 1.30, 95% CI 1.17 to 1.44). Findings were valid across multiple sensitivity analyses.ConclusionThis is the first study to show that patients with SLE who were classified as having CD by the NB had more variability across the NB tests (ie, higher ISD score) compared with those who were not classified as having CD.

Objectives To examine the longitudinal relationship between incidence of diagnosed chronic disease and work status and hours worked. Methods A dynamic cohort approach was taken to construct our study sample using the Canadian National Population Health Survey. Participant inclusion criteria included being employed and without a chronic health condition in the survey cycle prior to diagnosis, and participation in consecutive surveys following diagnosis. Each respondent was matched with up to 5 respondents without a diagnosed health condition. The direct and indirect associations between chronic disease and work status and hours worked following diagnosis were examined using probit and linear regression path models. Separate models were developed for arthritis, back problems, diabetes, hypertension and heart disease. Results We identified 799 observations with a diagnosis of arthritis, 858 with back pain, 178 with diabetes, 569 with hypertension and 163 with heart disease, which met our selection criteria. An examination of total effects at time 1 and time 2 showed that, excluding hypertension, chronic disease diagnosis was related to work loss. The time 2 effect of chronic disease diagnosis on work loss was mediated through time 1 work status. With the exception of heart disease, an incident case of chronic disease was not related to changes in work hours among observations with continuous work participation. Conclusions Chronic disease can result in work loss following diagnosis. Research is required to understand how modifying occupational conditions may benefit employment immediately after diagnosis.

IntroductionIllicit opioid use has become a national crisis in Canada, with over 65 000 people seeking treatment for opioid use disorder (OUD) in Ontario and British Columbia alone. Medication-assisted treatment (MAT) is a common treatment for OUD. There is substantial variability in treatment outcomes used to evaluate effectiveness of MAT, making it difficult to establish clinically and scientifically relevant treatment effect. Furthermore, patients are often excluded from the process of determining these outcomes. The primary objective of this review is to examine outcomes currently used to measure MAT effectiveness and to identify patient-relevant outcomes to enhance effectiveness of treatment options. This review refers to patient-important outcomes as those outcomes patients consider important to or markers of treatment success.Methods and analysisMEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Cochrane Library, Cochrane Clinical Trials Registry, National Institutes for Health Clinical Trials Registry and WHO International Clinical Trials Registry Platform databases will be searched. We will search databases from inception to the date the search is ran. Studies of interest include those evaluating the effectiveness of MAT for patients with OUD, with or without consultation with patients regarding what they consider to be important as an indicator of treatment success. Results will be analysed using thematic analysis and qualitative analysis where possible. This will result in comprehensive synthesis of all outcomes and measures found related to OUD treatment effectiveness.Ethics and disseminationWe are collaborating with Canadian Addiction Treatment Centres which provide MAT to patients with OUD who will participate in disseminating study results. Dissemination strategies will involve sharing study results through workshops, presentations, peer-reviewed publications, study reports, community presentations and resources in primary care settings.PROSPERO registration numberCRD42018095553.

Background Lack of standardization of outcome measures limits the usefulness of clinical trial evidence to advance clinical practice and improve health. Agreement on a core set of outcome measures to be reported in all trials could address this problem. Over the past two decades the Outcome Measures in Rheumatology (OMERACT) international consensus initiative has successfully developed core sets for many rheumatologic conditions but its expanding scope called for clarification and update of its underlying conceptual framework and working process. Objectives To formulate a conceptual framework for outcome measurement across health conditions in rheumatology and to establish an explicit process to develop core sets. Methods Literature searches, iterative consensus process (internet-based surveys, small and large group processes) of stakeholders including patients, health professionals and methodologists within and outside rheumatology. Results The framework comprises three core “Areas”: Death, Life Impact and Pathophysiologic Manifestations; with a fourth strongly recommended: Resource Use. The process of core set development for a health condition starts by selecting core Domains within the Areas (‘core domain set’). This requires literature searches, involvement of all relevant stakeholders — especially patients — and one or more consensus process. Next, developers select at least one applicable measurement instrument for each core Domain. Applicability means that the instrument must be Truthful (face, content and construct validity), Discriminative (between situations of interest) and Feasible (understandable, acceptable (time and monetary) costs). Depending on the quality of the instruments stakeholders formulate either a preliminary or a final ‘core outcome measurement set’. In the OMERACT 11 consensus conference in May 2012, 96% of voting participants (n=125) endorsed the model and process. Conclusions OMERACT has established a strongly endorsed, generic framework including a process to develop core outcome measurement sets for rheumatology, that is likely to be useful in other areas of health care as well. Acknowledgements Caroline Terwee, Leanne Idzerda, Reuben Escorpizo, Annelies Boonen, Susan Magasi, Ian Sinha, Paula Williamson, Jane Blazeby, Gerold Stucki who gave valuable advice on this abstract; all survey participants. Disclosure of Interest None Declared