Background There is currently no consensus as to a standardized tool for frailty measurement in any patient population. In the solid-organ transplantation population, routinely identifying and quantifying frailty in potential transplant candidates would support patients and the multidisciplinary team to make well-informed, individualized, management decisions. The aim of this scoping review was to synthesise the literature regarding frailty measurement in solid-organ transplant (SOT) candidates. Methods A search of four databases (Cochrane, Pubmed, EMBASE and CINAHL) yielded 3124 studies. 101 studies (including heart, kidney, liver, and lung transplant candidate populations) met the inclusion criteria. Results We found that studies used a wide range of frailty tools (N = 22), including four ‘established’ frailty tools. The most commonly used tools were the Fried Frailty Phenotype and the Liver Frailty Index. Frailty prevalence estimates for this middle-aged, predominantly male, population varied between 2.7% and 100%. In the SOT candidate population, frailty was found to be associated with a range of adverse outcomes, with most evidence for increased mortality (including post-transplant and wait-list mortality), post-operative complications and prolonged hospitalisation. There is currently insufficient data to compare the predictive validity of frailty tools in the SOT population. Conclusion Overall, there is great variability in the approach to frailty measurement in this population. Preferably, a validated frailty measurement tool would be incorporated into SOT eligibility assessments internationally with a view to facilitating comparisons between patient sub-groups and national and international transplant services with the ultimate goal of improved patient care.

Chlamydia trachomatis results in tubal factor infertility in some women. Diagnosis of this tubal infertility is difficult and typically involves laparoscopy or hysterosalpingography to detect the tubal blockages. Numerous serological tests have been developed; however, they are presently not used for diagnosis without subsequent surgical investigation during the infertility investigation. This study aimed to develop a highly specific serological assay for chlamydial tubal factor infertility in women that could be used to recommend direct progression to in vitro fertilization (IVF) treatment for women who are positive. Women were recruited from a variety of settings including women seeking fertility treatment, sexual health and general practitioner (GP) consultations or antenatal care (n=259). The serological assay was developed using sera from a large group of women by using infertile microimmunofluorescence (MIF)-positive women with tubal damage as the positives compared to infertile or acute infection and/or fertile controls (negatives). The new multi-peptide ELISA was highly specific for the detection of tubal factor infertility (P=0.011) compared to another ELISA (P=0.022) and MIF (P=0.099). The sensitivity of the assay should be improved before clinical utility. Potentially, a two-step testing protocol could be used during the initial infertility investigation, where MIF followed by a highly specific ELISA could be used to recommend direct progression to IVF for women who are positive.

Objectives(1) Identify the healthcare settings in which goal attainment scaling (GAS) has been used as an outcome measure in randomised controlled trials. (2) Describe how GAS has been implemented by researchers in those trials.DesignScoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews approach.Data sourcesPubMed, CENTRAL, EMBASE and PsycINFO were searched through 28 February 2022.Eligibility criteriaEnglish-language publications reporting on research where adults in healthcare settings were recruited to a randomised controlled trial where GAS was an outcome measure.Data extraction and synthesisTwo independent reviewers completed data extraction. Data collected underwent descriptive statistics.ResultsOf 1,838 articles screened, 38 studies were included. These studies were most frequently conducted in rehabilitation (58%) and geriatric medicine (24%) disciplines/populations. Sample sizes ranged from 8 to 468, with a median of 51 participants (IQR: 30–96). A number of studies did not report on implementation aspects such as the personnel involved (26%), the training provided (79%) and the calibration and review mechanisms (87%). Not all trials used the same scale, with 24% varying from the traditional five-point scale. Outcome attainment was scored in various manners (self-report: 21%; observed: 26%; both self-report and observed: 8%; and not reported: 45%), and the calculation of GAS scores differed between trials (raw score: 21%; T score: 47%; other: 21%; and not reported: 66%).ConclusionsGAS has been used as an outcome measure across a wide range of disciplines and trial settings. However, there are inadequacies and inconsistencies in how it has been applied and implemented. Developing a cross-disciplinary practical guide to support a degree of standardisation in its implementation may be beneficial in increasing the reliability and comparability of trial results.PROSPERO registration numberCRD42021237541.