Background

ConclusionHealth professional resilience is multifaceted, combining discrete personal traits alongside personal, social, and workplace features. A measure for health professional resilience should be developed and validated that may be used in future quantitative research to measure the effect of an intervention to promote it.

Aims: To evaluate whether the survival rates of patients with heart failure (HF) in the community are better than those with a diagnosis of the 4 most common cancers in men and women in a contemporary primary care cohort in Scotland. Methods and Results:The data were obtained from the Primary Care Clinical Informatics Unit from a database of 1.75 million people registered with 393 general practices in Scotland. Sex-specific survival modeling was undertaken using Cox proportional hazards models, adjusted for potential confounders. A total of 56,658 patients were eligible to be included in the study with 147,938 person years follow up (median follow up 2.04 years). In men, heart failure (reference group; 5yrs survival 37.7%) had worse mortality outcomes than patients with prostate cancer (HR 0.61, 95%CI 0.57-0.65; 5yrs survival 49.0%), and bladder cancer (HR 0.88, 95%CI 0.81-0.96; 5yrs survival 36.5%), but better than lung cancer (HR 3.86, 95%CI 3.65-4.07; 5yrs survival 2.8%) and colorectal cancer (HR 1.23 95%CI 1.16-1.31; 5 yrs survival 25.9%). In women, patients with HF (reference group; 5yrs survival 31.9%) had worse mortality outcomes than patients with breast cancer (HR 0.55 95%CI 0.51-0.59; 5yrs survival 61.0%), but better outcomes than lung cancer (HR 3.82, 95%CI 3.60-4.05; 5yrs survival 3.6%), ovarian cancer (HR 1.98, 95%CI 1.80-2.17; 5yrs survival 19%) and colorectal cancer (HR 1.21, 95%CI 1.13-1.29; 5yrs survival 28.4%). Conclusions:Despite advances in management, heart failure remains as 'malignant' as some of the common cancers in both men and women.3

Help4Mood is acceptable to some patients receiving treatment for depression although none used it as regularly as intended. Changes in depression symptoms in individuals who used the system regularly reached potentially meaningful levels.

Background: Functional somatic symptoms and disorders are common and complex phenomena involving both bodily and brain processes. They pose major challenges across medical specialties. These disorders are common and have significant impacts on patients' quality of life and healthcare costs. Main body: We outline five problems pointing to the need for a new classification: (1) developments in understanding aetiological mechanisms; (2) the current division of disorders according to the treating specialist; (3) failure of current classifications to cover the variety of disorders and their severity (for example, patients with symptoms from multiple organs systems); (4) the need to find acceptable categories and labels for patients that promote therapeutic partnership; and (5) the need to develop clinical services and research for people with severe disorders. We propose 'functional somatic disorders' (FSD) as an umbrella term for various conditions characterised by persistent and troublesome physical symptoms. FSDs are diagnosed clinically, on the basis of characteristic symptom patterns. As with all diagnoses, a diagnosis of FSD should be made after considering other possible somatic and mental differential diagnoses. We propose that FSD should occupy a neutral space within disease classifications, favouring neither somatic disease aetiology, nor mental disorder. FSD should be subclassified as (a) multisystem, (b) single system, or (c) single symptom. While additional specifiers may be added to take account of psychological features or co-occurring diseases, neither of these is sufficient or necessary to make the diagnosis. We recommend that FSD criteria are written so as to harmonise with existing syndrome diagnoses. Where currently defined syndromes fall within the FSD spectrumand also within organ system-specific chapters of a classificationthey should be afforded dual parentage (for example, irritable bowel syndrome can belong to both gastrointestinal disorders and FSD). Conclusion: We propose a new classification, 'functional somatic disorder', which is neither purely somatic nor purely mental, but occupies a neutral space between these two historical poles. This classification reflects both emerging aetiological evidence of the complex interactions between brain and body and the need to resolve the historical split between somatic and mental disorders.