TGI Friday! Our weekly round-up of recently published research abstracts | 9 May 2014

May 9, 2014

From Health and Quality of Life Outcomes, 30 April 2014. Full text available.

A comparison of health status in patients meeting alternative definitions for chronic fatigue syndrome/myalgic encephalomyelitis

Samantha C Johnston, Ekua W Brenu, Sharni L Hardcastle, Teilah K Huth,
Donald R Staines and Sonya M Marshall-Gradisnik

Abstract (provisional)


Several diagnostic definitions are available for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) that varies significantly in their symptom criteria. This pilot study was conducted to determine whether simple biological and clinical measures differed between CFS/ME patients meeting the 1994 Centres for Disease Control and Prevention (CDC) criteria, the International Consensus Criteria (ICC), as well as healthy controls.


A total of 45 CFS/ME patients and 30 healthy controls from the South East Queensland region of Australia provided a blood sample, reported on their current symptoms, as well as aspects of their physical and social health using the Short-Form Health Survey (SF-36),
and the World Health Organisation Disability Adjustment Schedule 2.0 (WHO DAS 2.0). Differences were examined using independent sample testing.


Patients fulfilling the ICC definition reported significantly lower scores (p < 0.05) for physical functioning, physical role, bodily pain, and social functioning than those that only fulfilled the 1994 CDC definition. ICC patients reported significantly greater (p < 0.05) disability across all domains of the WHO DAS 2.0.CONCLUSIONSThese preliminary findings suggest that the ICC identifies a distinct subgroup found within patients complying with the 1994 CDC definition, with more severe impairment to their physical and social functioning.

From BMC Family Practice, 7 March 2014 (open access article).

Overcoming the barriers to the diagnosis and management of chronic fatigue syndrome/ME in primary care: a meta synthesis of qualitative studies

Kerin Bayliss(1*), Mark Goodall(2), Anna Chisholm(3), Beth Fordham(3), Carolyn Chew-Graham(4), Lisa Riste(1), Louise Fisher(5), Karina Lovell(6), Sarah Peters(7) and Alison Wearden(7)
* Corresponding author: Kerin Bayliss
1) Institute of Population Health, University of Manchester, Manchester, UK
2) Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
3) Institute of Inflammation and Repair, University of Manchester, Manchester, UK
4) Primary Care and Health Sciences and National School for Primary Care Research, Keele University, Keele, UK
5) National School for Primary Care Research, University of Manchester, Manchester, UK
6) School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
7) School of Psychological Sciences, University of Manchester, Manchester, UK



The NICE guideline for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) emphasises the need for an early diagnosis in primary care with management tailored to patient needs. However, GPs can be reluctant to make a diagnosis and are unsure how to manage people with the condition.


A meta synthesis of published qualitative studies was conducted, producing a multi-perspective description of barriers to the diagnosis and management of CFS/ME, and the ways that some health professionals have been able to overcome them. Analysis provided second-order interpretation of the original findings and developed third-order constructs to provide recommendations for the medical curriculum.


Twenty one qualitative studies were identified. The literature shows that for over 20 years health professionals have reported a limited understanding of CFS/ME. Working within the framework of the biomedical model has also led some GPs to be sceptical about the existence of the condition. GPs who provide a diagnosis tend to have a broader, multifactorial, model of the condition and more positive attitudes towards CFS/ME. These GPs collaborate with patients to reach agreement on symptom management, and use their therapeutic skills to promote self care.


In order to address barriers to the diagnosis and management of CFS/ME in primary care, the limitations of the biomedical model needs to be recognised. A more flexible bio-psychosocial approach is recommended where medical school training aims to equip practitioners with the skills needed to understand, support and manage patients and provide a pathway to refer for specialist input.

From Expert Review of Clinical Immunology, 1 May 2014 2014 May 1. [Epub ahead of print]

Spectrum of mast cell activation disorders.

Petra AI1, Panagiotidou S, Stewart JM, Conti P, Theoharides TC.
Department of Molecular Physiology and Pharmacology, Molecular Immunopharmacology and Drug Discovery Laboratory, Tufts University School of Medicine and Tufts Medical Center, 136 Harrison Avenue, Boston, MA, USA.


Mast cell (MC) activation disorders present with multiple symptoms including flushing, pruritus, hypotension, gastrointestinal complaints, irritability, headaches, concentration/memory loss and neuropsychiatric issues.

These disorders are classified as: cutaneous and systemic mastocytosis with a c-kit mutation and clonal MC activation disorder, allergies, urticarias and inflammatory disorders and mast cell activation syndrome (MCAS), idiopathic urticaria and angioedema. MCs are activated by IgE, but also by cytokines, environmental, food, infectious, drug and stress triggers, leading to secretion of multiple mediators.

The symptom profile and comorbidities associated with these disorders, such as chronic fatigue syndrome and fibromyalgia, are confusing. We propose the use of the term ‘spectrum' and highlight the main symptoms, useful diagnostic tests and treatment approaches.

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