Read by QxMD icon Read

multiple comorbidities guidelines

Rajkumar Bharatia, Manoj Chitale, Ganesh Narain Saxena, Raman Ganesh Kumar, Chikkalingaiah, Abhijit Trailokya, Kalpesh Dalvi, Suhas Talele
INTRODUCTION: Hypertension (HTN), being a major risk factor for cardiovascular diseases (CVDs), is an important issue of medical and public health. High blood pressure (BP) is ranked as the third most important risk factor for attributable burden of disease in south Asia (2010). Hypertension (HTN) exerts a substantial public health burden on cardiovascular health status and healthcare systems in India. Uncontrolled hypertension among adults with hypertension is associated with increased mortality...
July 2016: Journal of the Association of Physicians of India
David Wheeler
Hypertension is the most prevalent complication of chronic kidney disease (CKD). Lowering high blood pressure slows progressive loss of kidney function and may also reduce the associated risk of cardiovascular complications, a common cause of premature death in CKD patients.Current International Guidelines produced by Kidney Disease: Improving Global Outcomes (KDIGO) acknowledges that no single BP target is optimal for all CKD patients, and encourages individualization of treatment depending on age, the severity of albuminuria and comorbidities...
September 2016: Journal of Hypertension
Emmanuel Forestier, Thibaut Fraisse, Claire Roubaud-Baudron, Christine Selton-Suty, Leonardo Pagani
The incidence of infective endocarditis (IE) rises in industrialized countries. Older people are more affected by this severe disease, notably because of the increasing number of invasive procedures and intracardiac devices implanted in these patients. Peculiar clinical and echocardiographic features, microorganisms involved, and prognosis of IE in elderly have been underlined in several studies. Additionally, elderly population appears quite heterogeneous, from healthy people without past medical history to patients with multiple diseases or who are even bedridden...
2016: Clinical Interventions in Aging
David Liu, Michael Dan, Sara Martinez Martos, Elaine Beller
A perioperative blood management program is one of a number of important elements for successful patient care in total knee arthroplasty (TKA) and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risk of blood transfusion whilst at the same time maximizing hemoglobin (Hb) in the postoperative period, leading to a positive effect on outcome and cost. An individualized strategy based on patient specific risk factors, anticipated blood loss and comorbidities are useful in achieving this aim...
September 2016: Knee Surgery & related Research
Akeem A Yusuf, Tanya Natwick, Winifred Werther, Diana Felici, Maya Mahue, Kenneth R Bridges, Yi Peng
OBJECTIVE: Population-based data on mortality and associated factors in patients with multiple myeloma (MM) are limited. We examined the association between all-cause mortality and demographic and clinical characteristics in newly diagnosed MM patients treated with guideline-recommended chemotherapeutic agents. RESEARCH DESIGN AND METHODS: This retrospective cohort analysis used Medicare 20% data to created a cohort of adult (aged ≥ 18 years) newly diagnosed MM patients who received chemotherapy 2008-2011 and had no MM diagnosis in the 12 months before the disease index date...
August 17, 2016: Current Medical Research and Opinion
Anouk Déruaz-Luyet, Adjua Alexandra N'Goran, Lilli Herzig
Multimorbidity is often synonym with complexity and generally implies multiple medical treatments. In many cases, treatment guidelines traditionally defined for single conditions are not easily applicable. Primary care for individuals with multimorbidity requires complex patient-centered care and good communication between the patient and the general practitioner (GP). This often includes prioritizing among the different chronic conditions. The burden related to multimorbidity from the GP and the patients' perspective, as well as the prioritization of care between in patients with multimorbidity, has not been studied extensively yet...
May 11, 2016: Revue Médicale Suisse
Mary Alissa Willis, Robert J Fox
PURPOSE OF REVIEW: Many therapeutic advances for relapsing-remitting multiple sclerosis (MS) have occurred in the past 25 years. Although similar advances in disease-modifying therapies have not been realized in progressive MS, many symptomatic therapeutic strategies can benefit patients with progressive MS. Few guidelines exist for management of patients with progressive MS. RECENT FINDINGS: The classification of progressive MS was revised in 2013 to include a description of inflammatory disease activity determined by clinical relapses or imaging findings...
August 2016: Continuum: Lifelong Learning in Neurology
Luke Rudmik, Yuan Xu, Edward Kukec, Mingfu Liu, Stafford Dean, Hude Quan
BACKGROUND: Pharmacoepidemiological research using administrative databases has become increasingly popular for chronic rhinosinusitis (CRS); however, without a validated case definition the cohort evaluated may be inaccurate resulting in biased and incorrect outcomes. The objective of this study was to develop and validate a generalizable administrative database case definition for CRS using International Classification of Diseases, 9th edition (ICD-9)-coded claims. METHODS: A random sample of 100 patients with a guideline-based diagnosis of CRS and 100 control patients were selected and then linked to a Canadian physician claims database from March 31, 2010, to March 31, 2015...
May 26, 2016: International Forum of Allergy & Rhinology
Christopher K Bichakjian, Thomas Olencki, Sumaira Z Aasi, Murad Alam, James S Andersen, Daniel Berg, Glen M Bowen, Richard T Cheney, Gregory A Daniels, L Frank Glass, Roy C Grekin, Kenneth Grossman, Susan A Higgins, Alan L Ho, Karl D Lewis, Daniel D Lydiatt, Kishwer S Nehal, Paul Nghiem, Elise A Olsen, Chrysalyne D Schmults, Aleksandar Sekulic, Ashok R Shaha, Wade L Thorstad, Malika Tuli, Marshall M Urist, Timothy S Wang, Sandra L Wong, John A Zic, Karin G Hoffmann, Anita Engh
Basal cell carcinoma (BCC) of the skin is the most common cancer, with a higher incidence than all other malignancies combined. Although it is rare to metastasize, patients with multiple or frequently recurring BCC can suffer substantial comorbidity and be difficult to manage. Assessment of risk is a key element of management needed to inform treatment selection. The overall management of BCC primarily consists of surgical approaches, with radiation therapy as an alternate or adjuvant option. Many superficial therapies for BCC have been explored and continue to be developed, including topicals, cryosurgery, and photodynamic therapy...
May 2016: Journal of the National Comprehensive Cancer Network: JNCCN
Nancy Delloiacono
Today's employers are hiring a more age-diverse workforce. As Americans work longer, age-related changes often create activity limitations. Musculoskeletal disorders affect many older workers heightening their risk of workplace injury. Compounded by multiple comorbidities, older workers will need occupational health nurses with expert knowledge to maintain safe and productive workplaces. Older workers do not experience as many injuries as younger workers, but when they are injured, recovery is longer. The author developed and conducted a survey of New Jersey occupational health nurses...
June 2016: Workplace Health & Safety
Joseph Finkelstein, Carol Friedman, George Hripcsak, Manuel Cabrera
Pharmacogenomic (PGx) testing has been increasingly used to optimize drug regimens; however, its potential in older adults with polypharmacy has not been systematically studied. In this hypothesis-generating study, we employed a case series design to explore potential utility of PGx testing in older adults with polypharmacy and to highlight barriers in implementing this methodology in routine clinical practice. Three patients with concurrent chronic heart and lung disease aged 74, 78, and 83 years and whose medication regimen comprised 26, 17, and 18 drugs, correspondingly, served as cases for this study...
2016: Pharmacogenomics and Personalized Medicine
Nathaniel Berman, M Carrington Reid, Jeanne Teresi, Joseph P Eimicke, Ronald Adelman
BACKGROUND: An increasing proportion of hemodialysis patients are ineligible for transplant. Often these patients are elderly, with multiple comorbidities and decreased functional status. Such patients may benefit from modified treatment goals to reduce symptom burden. OBJECTIVE: To demonstrate the feasibility of a trial of reduced-intensity treatment in nontransplantable patients with end-stage renal disease (ESRD). STUDY DESIGN: A 6-week study randomized patients to a reduced-intensity intervention versus usual care...
May 2016: Journal of Palliative Medicine
Ramsis F Ghaly, Alexei Lissounov, Kenneth D Candido, Nebojsa Nick Knezevic
BACKGROUND: Spinal cord stimulators (SCSs) are gaining increasing indications and utility in an expanding variety of clinical conditions. Complications and initial expenses have historically prevented the early use of SCS therapy despite ongoing efforts to educate and promote its utilization. At present, there exists no literature evidence of SCS implantation in a chronically anticoagulated patient, and neuromodulation manufacturers are conspicuously silent in providing warnings or recommendations in the face of anticoagulant use chronically...
2016: Surgical Neurology International
Donghao Lu, Therese M L Andersson, Katja Fall, Christina M Hultman, Kamila Czene, Unnur Valdimarsdóttir, Fang Fang
IMPORTANCE: Psychiatric comorbidities are common among patients with cancer. However, whether or not there is increased risk of mental disorders during the diagnostic workup leading to a cancer diagnosis was unknown. OBJECTIVE: To examine the relative risks of depression, anxiety, substance abuse, somatoform/conversion disorder, and stress reaction/adjustment disorder during the periods before and after cancer diagnosis compared with individuals without cancer. DESIGN, SETTING, AND PARTICIPANTS: Nationwide matched cohort study from January 1, 2001, to December 31, 2010, in a Swedish population and health registers...
September 1, 2016: JAMA Oncology
Anna L Parks, Margaret C Fang
The number of patients with atrial fibrillation (AF) who are of advanced age or have multiple comorbidities is expected to increase substantially. Older patients with AF generally gain a net benefit from anticoagulation. Guidelines typically recommend anticoagulation. There are multiple challenges in the safe use of anticoagulation in frail patients, including bleeding risk, monitoring and adherence, and polypharmacy. Although there are options for chronic oral anticoagulation, clinicians must understand the unique advantages and disadvantages of these medications when developing a management plan...
May 2016: Clinics in Geriatric Medicine
Avivit Cahn, Simona Cernea, Itamar Raz
Cardiovascular disease is the leading cause of mortality in patients with diabetes. Over the past 20 years multiple CV outcome studies have been conducted assessing the cardiovascular benefits of tight glycemic control or of particular glucose lowering agents. Improved glycemic control per-se failed to significantly reduce the risk of adverse cardiovascular outcomes in the short term, and it is only after >15 years that a reduction in adverse CV outcomes with tight glycemic control was perceived. Moreover tight glycemic control and increased attendant hypoglycemia led to increased mortality observed in the ACCORD trial...
March 2016: Reviews in Endocrine & Metabolic Disorders
Joel C Marrs, Angela M Thompson
Hypertension affects one-third of all females in the United States, with the prevalence increasing over a female's lifespan. The approach to treating females with hypertension varies depending on a female's age, race, comorbidities, and whether she is of child-bearing age or pregnant. It is important to factor in the safety and effectiveness of antihypertensive medications across these populations of females. Blood pressure target goals are the same in females as in males regardless of comorbidities or stage of life, with the exception of those females who are pregnant...
June 2016: Pharmacotherapy
Akira Yamasaki, Katsuyuki Tomita, Kazuhiro Kato, Kouji Fukutani, Hiroyuki Sano, Yuji Tohda, Eiji Shimizu
BACKGROUND: Asthma guidelines suggest stepping-down of inhaled corticosteroids (ICSs) when asthma is stable. OBJECTIVE: To determine outcomes of stepping-down and prediction of outcome after stepping-down of ICSs in controlled adult asthma. METHODS: We performed a retrospective study on 21-81 year-old hospital-based outpatients with asthma in Japan. Protocol for stepping-down of ICSs was performed according to the GINA guideline. Failure/success of stepping-down is judged as occurring exacerbation or not for stepping-down of ICSs...
2016: Patient Preference and Adherence
Helen Tam-Tham, Brenda Hemmelgarn, David Campbell, Chandra Thomas, Robert Quinn, Karen Fruetel, Kathryn King-Shier
BACKGROUND: Guideline committees have identified the need for research to inform the provision of conservative care for older adults with stage 5 chronic kidney disease (CKD) who have a high burden of comorbidity or functional impairment. We will use both qualitative and quantitative methodologies to provide a comprehensive understanding of barriers and facilitators to care for these patients in primary care. OBJECTIVES: Our objectives are to (1) interview primary care physicians to determine their perspectives of conservative care for older adults with stage 5 CKD and (2) survey primary care physicians to determine the prevalence of key barriers and facilitators to provision of conservative care for older adults with stage 5 CKD...
2016: Canadian Journal of Kidney Health and Disease
Ross D Feldman, Stewart B Harris, Robert A Hegele, J Geoffrey Pickering, Kenneth Rockwood
The primary prevention of atherosclerotic disease is on the basis of optimal management of the major risk factors. For the major risk factors of diabetes, hypertension, and dyslipidemia, management for most patients is on the basis of well developed and extensive evidence-based diagnostic and therapeutic guidelines. However, for a growing segment of the population who are at the highest risk for atherosclerotic disease (ie, older adults), the application of these guidelines is problematic. First, few studies that form the evidence base for these primary prevention guidelines actually include substantial numbers of elderly subjects...
May 2016: Canadian Journal of Cardiology
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"