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https://www.readbyqxmd.com/read/29221453/the-extra-cost-of-comorbidity-multiple-illnesses-and-the-economic-burden-of-non-communicable-diseases
#1
Sébastien Cortaredona, Bruno Ventelou
BACKGROUND: The literature offers competing estimates of disease costs, with each study having its own data and methods. In 2007, the Dutch Center for Public Health Forecasting of the National Institute for Public Health and the Environment provided guidelines that can be used to set up cost-of-illness (COI) studies, emphasising that most COI analyses have trouble accounting for comorbidity in their cost estimations. When a patient has more than one chronic condition, the conditions may interact such that the patient's healthcare costs are greater than the sum of the costs for the individual diseases...
December 8, 2017: BMC Medicine
https://www.readbyqxmd.com/read/29220099/supportive-palliative-care-should-be-integrated-into-routine-care-for-paediatric-patients-with-life-limiting-kidney-disease
#2
REVIEW
Julia Thumfart, Tobias Reindl, Cornelia Rheinlaender, Dominik Müller
AIM: Paediatric palliative care is no longer restricted to patients with cancer and has been extended to patients with other chronic conditions, such as cystic fibrosis or neuromuscular disorders. This review focused on the current state of palliative care for children and adolescents with chronic kidney disease (CKD). METHOD: We assessed the literature on CKD published up to August 2017. All the papers, except one from 1996, were published this century. This review discusses the role that palliative care plays in the process of decision-making and explores the possibilities of implementing palliative care into the routine therapy of affected patients and providing support for their families...
December 8, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/29202104/a-health-profile-of-senior-aged-women-veterans-a-latent-class-analysis-of-condition-clusters
#3
Margaret E Gonsoulin, Ramon A Durazo-Arvizu, Karen M Goldstein, Guichan Cao, Qiuying Zhang, Dharani Ramanathan, Denise M Hynes
Background and Objectives: This study characterizes the multiple morbidities experienced by senior-aged women Veterans so that the Veterans Health Administration (VHA) and other healthcare systems may be better prepared to meet the healthcare needs of this growing cohort. Research Design and Methods: Using the VHA's Corporate Data Warehouse (CDW), we conducted a retrospective observational study of the 38,597 female veteran patients who were at least sixty-five years old and received care in the VHA during 2013 and 2014...
September 1, 2017: Innovation in Aging
https://www.readbyqxmd.com/read/29176633/epidemiology-and-predictors-of-ntm-pulmonary-infection-in-taiwan-a-retrospective-five-year-multicenter-study
#4
Hung-Ling Huang, Meng-Hsuan Cheng, Po-Liang Lu, Chin-Chung Shu, Jann-Yuan Wang, Jann-Tay Wang, Inn-Wen Chong, Li-Na Lee
Multicenter, longitudinal studies on nontuberculous mycobacteria (NTM) pulmonary infection (PI) are lacking. This study provides a 5-year epidemiological overview of NTM-PI in Taiwan and investigated its predictors. The clinical relevance of each respiratory NTM isolate in six hospitals between 2008 and 2014 was determined according to current guidelines. Recurrent episodes were judged by serial bacteriological results. New episodes of NTM-PI and pulmonary colonization (PC) occurring since 2010 were analyzed...
November 24, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29176352/new-science-and-treatment-paradigms-for-atopic-dermatitis
#5
James G Dinulos, Alyssa Trickett, Caroline Crudele
PURPOSE OF THE REVIEW: The prevalence of atopic dermatitis is increasing in industrialized countries for unclear reasons. One theory centers on reduced exposure to microbes during infancy and childhood. Alterations in the epidermal permeability barrier, place certain patients at risk for the immunological dysfunction seen in atopic dermatitis. This review examines current research pertaining to the epidermal permeability barrier, the cutaneous microbiome, and the immunology of atopic dermatitis...
November 15, 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/29153618/advantages-of-a-prospective-multidisciplinary-approach-in-transcatheter-aortic-valve-implantation-eight-years-of-experience
#6
Cátia Costa, Rui Campante Teles, João Brito, José Pedro Neves, Henrique Mesquita Gabriel, Miguel Abecassis, Regina Ribeiras, João Abecasis, Tiago Nolasco, Maria da Conceição Furstenau, Nélson Vale, António Tralhão, Sérgio Madeira, João Mesquita, Carla Saraiva, Rita Calé, Manuel Almeida, Ana Aleixo, Miguel Mendes
INTRODUCTION: Aortic stenosis is the most prevalent type of valvular disease in Europe. Surgical aortic valve replacement (SAVR) is the standard therapy, while transcatheter aortic valve implantation (TAVI) is an alternative in patients at unacceptably high surgical risk. Assessment by a heart team is recommended by the guidelines but there is little published evidence on this subject. The purpose of this paper is to describe the experience of a multidisciplinary TAVI program that began in 2008...
November 15, 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/29142786/extraordinary-clinical-benefit-to-sequential-treatment-with-targeted-therapy-and-immunotherapy-of-a-braf-v600e-and-pd-l1-positive-metastatic-lung-adenocarcinoma
#7
Shuyu D Li, Annia Martial, Alexa B Schrock, Jane J Liu
Background: The treatment algorithm for metastatic non-small cell lung cancers (NSCLCs) has been evolving rapidly due to the development of new therapeutic agents. Although guidelines are provided by National Comprehensive Cancer Network (NCCN) for treatment options according to biomarker testing results, sequentially applying the three main modalities (chemotherapy, targeted therapy and immunotherapy) remains an ad hoc practice in clinic. In light of recent FDA approval of dabrafenib and trametinib combination for metastatic NSCLCs with BRAF V600E mutation, one question arises due to insufficient clinical data is if the targeted therapy should be used before immunotherapy in patients with both BRAF V600E and PD-L1 expression...
2017: Experimental Hematology & Oncology
https://www.readbyqxmd.com/read/29141805/treating-depression-in-multiple-sclerosis-with-antidepressants-a-brief-review-of-clinical-trials-and-exploration-of-clinical-symptoms-to-guide-treatment-decisions
#8
REVIEW
Nabeela Nathoo, Aaron Mackie
Depression is a common comorbidity in patients with multiple sclerosis (MS). Those with MS and concurrent depression have poorer quality of life and are also less likely to be compliant with disease-modifying treatment, which may ultimately affect their MS disease course. Treating depression in MS with pharmacological agents can improve not only depression, but may also impact the MS disease course. However, no guidelines exist around treating depression in MS. Few randomized-controlled trials using antidepressants in MS exist...
November 2017: Multiple Sclerosis and related Disorders
https://www.readbyqxmd.com/read/29136014/treatment-guidelines-and-early-loss-from-care-for-people-living-with-hiv-in-cape-town-south-africa-a-retrospective-cohort-study
#9
Ingrid T Katz, Richard Kaplan, Garrett Fitzmaurice, Dominick Leone, David R Bangsberg, Linda-Gail Bekker, Catherine Orrell
BACKGROUND: South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4+ threshold of ≤200 cells/μl to providing ART for all people living with HIV (PLWH) as of September 2016. We evaluated the association of programmatic changes in ART eligibility with loss from care, both prior to ART initiation and within the first 16 weeks of starting treatment, during a period of programmatic expansion to ART treatment at CD4+ ≤ 350 cells/μl...
November 2017: PLoS Medicine
https://www.readbyqxmd.com/read/29122151/biologic-therapy-for-atopic-dermatitis-moving-beyond-the-practice-parameter-and-guidelines
#10
Mark Boguniewicz
Atopic dermatitis (AD), a common chronic pruritic inflammatory skin disease, impacts the quality of life of patients and caregivers and has become a global health problem. It is increasingly recognized as a disease not only of children but also of adults who may have a persistent or relapsing course from childhood or who develop new-onset adult disease. Besides well-established atopic comorbidities, associations with a number of nonatopic comorbidities have been reported. AD is characterized by both immune dysregulation and epidermal barrier dysfunction...
November 2017: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/29110763/clinical-genetic-testing-for-apol1-are-we-there-yet
#11
REVIEW
Bessie A Young, Stephanie Malia Fullerton, James G Wilson, Kerri Cavanaugh, Erika Blacksher, Clarence Spigner, Jonathan Himmelfarb, Wylie Burke
End-stage renal disease (ESRD) disproportionately affects African Americans, who are two to four times more likely than European Americans to develop ESRD. Two independent variants of the apolipoprotein L1 (APOL1) gene, G1 and G2, have been associated with a 7- to 10-fold greater risk of developing nondiabetic ESRD in African Americans. Those who inherit two risk variants (G1/G1, G2/G2, or G1/G2) are also more likely to develop ESRD at a younger age and to have progression of chronic kidney disease. Currently, it is not known what proportion of persons with high-risk genotypes will develop ESRD in the general population, the exact mechanism of injury for APOL1-related risk, its relation to environmental exposures, or whether patients with comorbid conditions are more likely to develop ESRD...
November 2017: Seminars in Nephrology
https://www.readbyqxmd.com/read/29101989/acr-appropriateness-criteria-%C3%A2-radiologic-management-of-central-venous-access
#12
Colette M Shaw, Shrenik Shah, Baljendra S Kapoor, Thomas R Cain, Drew M Caplin, Khashayar Farsad, M-Grace Knuttinen, Margaret H Lee, Joseph J McBride, Jeet Minocha, Elizabeth V Robilotti, Paul J Rochon, Richard Strax, Elrond Y L Teo, Jonathan M Lorenz
Obtaining central venous access is one of the most commonly performed procedures in hospital settings. Multiple devices such as peripherally inserted central venous catheters, tunneled central venous catheters (eg, Hohn catheter, Hickman catheter, C. R. Bard, Inc, Salt Lake City UT), and implantable ports are available for this purpose. The device selected for central venous access depends on the clinical indication, duration of the treatment, and associated comorbidities. It is important for health care providers to familiarize themselves with the types of central venous catheters available, including information about their indications, contraindications, and potential complications, especially the management of catheters in the setting of catheter-related bloodstream infections...
November 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/29090189/a-method-of-decision-analysis-quantifying-the-effects-of-age-and-comorbidities-on-the-probability-of-deriving-significant-benefit-from-medical-treatments
#13
Stephen P Fitzgerald, Nigel G Bean, Ravi P Ruberu
BACKGROUND: The external validity, or generalizability, of trials and guidelines has been considered poor in the context of multiple morbidity. How multiple morbidity might affect the magnitude of benefit of a given treatment, and thereby external validity, has had little study. OBJECTIVE: To provide a method of decision analysis to quantify the effects of age and comorbidity on the probability of deriving a given magnitude of treatment benefit. DESIGN: We developed a method to calculate probabilistically the effect of all of a patient's comorbidities on their underlying utility, or well-being, at a future time point...
2017: Journal of Comorbidity
https://www.readbyqxmd.com/read/29076113/a-knowledge-modeling-approach-to-integrate-multiple-clinical-practice-guidelines-to-provide-evidence-based-clinical-decision-support-for-managing-comorbid-conditions
#14
Samina Abidi
Clinical management of comorbidities is a challenge, especially in a clinical decision support setting, as it requires the safe and efficient reconciliation of multiple disease-specific clinical procedures to formulate a comorbid therapeutic plan that is both effective and safe for the patient. In this paper we pursue the integration of multiple disease-specific Clinical Practice Guidelines (CPG) in order to manage co-morbidities within a computerized Clinical Decision Support System (CDSS). We present a CPG integration framework-termed as COMET (Comorbidity Ontological Modeling & ExecuTion) that manifests a knowledge management approach to model, computerize and integrate multiple CPG to yield a comorbid CPG knowledge model that upon execution can provide evidence-based recommendations for handling comorbid patients...
October 26, 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/29064270/women-have-a-worse-prognosis-and-undergo-fewer-coronary-angiographies-after-out-of-hospital-cardiac-arrest-than-men
#15
Matilde Winther-Jensen, Christian Hassager, Jesper Kjaergaard, John Bro-Jeppesen, Jakob H Thomsen, Freddy K Lippert, Lars Køber, Michael Wanscher, Helle Søholm
BACKGROUND: Out-of-hospital cardiac arrest is more often reported in men than in women. OBJECTIVES: We aimed to assess sex-related differences in post-resuscitation care; especially with regards to coronary angiography, percutaneous coronary intervention, mortality and functional status after out-of-hospital cardiac arrest. METHODS: We included 704 consecutive adult out-of-hospital cardiac arrest-patients with cardiac aetiology in the Copenhagen area from 2007-2011...
February 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29063553/contributions-from-the-2016-literature-on-clinical-decision-support
#16
V Koutkias, J Bouaud
Objectives: To summarize recent research and select the best papers published in 2016 in the field of computerized clinical decision support for the Decision Support section of the IMIA yearbook. Methods: A literature review was performed by searching two bibliographic databases for papers related to clinical decision support systems (CDSSs). The aim was to identify a list of candidate best papers from the retrieved papers that were then peer-reviewed by external reviewers. A consensus meeting of the IMIA editorial team finally selected the best papers on the basis of all reviews and section editor evaluation...
August 2017: Yearbook of Medical Informatics
https://www.readbyqxmd.com/read/29042813/rehabilitation-management-of-low-back-pain-it-s-time-to-pull-it-all-together
#17
Yannick Tousignant-Laflamme, Marc Olivier Martel, Anand B Joshi, Chad E Cook
In the past, rehabilitation research initiatives for low back pain (LBP) have targeted outcome enhancement through personalized treatment approaches, namely through classification systems (CS). Although the use of CS has enhanced outcomes, common management practices have not changed, the prevalence of LBP is still high, and only selected patients meet the CS profile, namely those with a nociceptive context. Similarly, although practice guidelines propose some level of organization and occasionally a timeline of care provision, each mainly provides best practice for isolated treatment approaches...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/29019063/statin-prescribing-in-the-elderly-special-considerations
#18
REVIEW
M Leya, N J Stone
PURPOSE OF REVIEW: Our aim was to examine the current evidence behind prescribing statins to individuals over 65 years of age with emphasis on those older than 75. Individuals over 75 years of age may often have multiple comorbidities and take many medications. Additionally, they are often underrepresented in randomized controlled trials (RCTs) of statins in older populations. While results of RCTs demonstrate the benefit of statin therapy in both primary and secondary prevention patients, clinicians must more carefully consider adverse effects and drug-drug interactions before prescribing statin therapy as well as determining the intensity in older individuals...
October 11, 2017: Current Atherosclerosis Reports
https://www.readbyqxmd.com/read/28979888/high-dose-rate-salvage-interstitial-brachytherapy-a-case-based-guide-to-the-treatment-of-therapeutically-challenging-recurrent-vulvar-cancer
#19
Kelly Eileen Hughes, Christopher M McLaughlin, Emma C Fields
Vulvar cancer is a rare gynecological malignancy with incidence rates steadily increasing over the past 10 years. Despite aggressive treatment, recurrent disease is common. Vulvar cancer recurrence poses a significant therapeutic challenge as most patients have been previously treated with surgery and/or radiation limiting the options for additional treatment. There are no consensus guidelines for the treatment of recurrent disease. Current literature supports the use of salvage interstitial brachytherapy...
2017: Frontiers in Oncology
https://www.readbyqxmd.com/read/28922931/an-exploratory-decision-tree-analysis-to-predict-physical-activity-compliance-rates-in-breast-cancer-survivors
#20
Raheem J Paxton, Lingfeng Zhang, Changshuai Wei, Daniel Price, Fan Zhang, Kerry S Courneya, Ioannis A Kakadiaris
BACKGROUND: The study of physical activity in cancer survivors has been limited to one cause, one effect relationships. In this exploratory study, we used recursive partitioning to examine multiple correlates that influence physical activity compliance rates in cancer survivors. METHODS: African American breast cancer survivors (N = 267, Mean age = 54 years) participated in an online survey that examined correlates of physical activity. Recursive partitioning (RP) was used to examine complex and nonlinear associations between sociodemographic, medical, cancer-related, theoretical, and quality of life indicators...
September 19, 2017: Ethnicity & Health
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