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Polymorbid patient

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https://www.readbyqxmd.com/read/29123431/comparative-quality-measures-of-emergency-care-an-outcome-cockpit-proposal-to-survey-clinical-processes-in-real-life
#1
Susanne Burgemeister, Alexander Kutz, Antoinette Conca, Thomas Holler, Sebastian Haubitz, Andreas Huber, Ulrich Buergi, Beat Mueller, Philipp Schuetz
Background: Benchmarking of real-life quality of care may improve evaluation and comparability of emergency department (ED) care. We investigated process management variables for important medical diagnoses in a large, well-defined cohort of ED patients and studied predictors for low quality of care. Methods: We prospectively included consecutive medical patients with main diagnoses of community-acquired pneumonia, urinary tract infection (UTI), myocardial infarction (MI), acute heart failure, deep vein thrombosis, and COPD exacerbation and followed them for 30 days...
2017: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/29120542/-nocturia-in-aged-patient-in-practice
#2
Alexandre Da Costa, Mirabelle Ishida, Rachid Akrour, Grégoire Mary-Heck, Nuno Grilo, Brigitte Schurch, Pierre Olivier Lang
Nocturia is defined as the complaint that the individual has to wake at night to urinate. In older persons, this urinary functional disorder is most often of multifactorial origin and/or the symptom (sometimes the unique one) of a chronic disease. Nocturia is very annoying and its impact on health and quality of life is related to the disturbance of sleep cycles. In aged patients, who are often polymorbide and polymedicated, the interaction between nocturia and geriatric syndromes as well as comorbidities has to be more particularly underlined...
November 8, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/29091930/self-administered-vitamin-d-status-predictor-older-adults-are-able-to-use-a-self-questionnaire-for-evaluating-their-vitamin-d-status
#3
Cedric Annweiler, Anastasiia Kabeshova, Alix Callens, Marie-Liesse Paty, Guillaume T Duval, Michael F Holick
BACKGROUND: The 16-item Vitamin D Status Predictor (VDSP) questionnaire helps to identify, without resorting to a blood test, older adults with low vitamin D concentrations. Our objective was to determine whether a self-administered VDSP was concordant with the VDSP administered by a physician, and to examine the concordance of every single item of the VDSP. METHODS: A total of 349 older in- and outpatients (mean, 83.2±7.2years; 59% female) were consecutively recruited in the geriatric ward of the University Hospital of Angers, France...
2017: PloS One
https://www.readbyqxmd.com/read/28948801/-invagination-in-an-adult-as-a-rare-cause-of-acute-abdomen-2-case-reports
#4
J Majernik, D Bis, T Kriegler, P Hanousek, T Vltavský, V Ninger
The authors present two cases of intestinal invagination in adult patients. The first case is an 84-year-old polymorbid female patient indicated for acute surgical revision due to ileus with a finding of invagination in the sigmoid area, with no evidence of an organic cause. The second case, an 80-year-old polymorbid female patient, was indicated for acute surgical revision also due to ileus with a finding of invagination on the small intestine and with a proven neuroendocrine tumor. Unlike invagination in childhood where its cause is usually unknown[1,7], intestinal invagination is relatively rare in adults and it is mostly due to an organic cause, most frequently a benign tumor of the small intestine[2]...
2017: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
https://www.readbyqxmd.com/read/28934791/a-practical-guide-for-treatment-of-pain-in-patients-with-systemic-mast-cell-activation-disease
#5
Stefan Wirz, Gerhard J Molderings
Systemic mast cell activation disease (MCAD, a subclass of mastocytosis), which has a prevalence of around 17% (at least in the German population), is characterized by accumulation of genetically altered dysfunctional mast cells with abnormal release of these cells' mediators. Since mast cells affect functions in potentially every organ system, often without causing abnormalities in routine laboratory or radiologic testing, this disease has to be considered routinely in the differential diagnosis of patients with chronic multisystem polymorbidity of a generally inflammatory and allergic theme...
September 2017: Pain Physician
https://www.readbyqxmd.com/read/28802519/espen-guidelines-on-nutritional-support-for-polymorbid-internal-medicine-patients
#6
Filomena Gomes, Philipp Schuetz, Lisa Bounoure, Peter Austin, María Ballesteros-Pomar, Tommy Cederholm, Jane Fletcher, Alessandro Laviano, Kristina Norman, Kalliopi-Anna Poulia, Paula Ravasco, Stephane M Schneider, Zeno Stanga, C Elizabeth Weekes, Stephan C Bischoff
BACKGROUND & AIMS: Polymorbidity (also known as multimorbidity) - defined as the co-occurrence of at least two chronic health conditions - is highly prevalent, particularly in the hospitalized population. Nonetheless, clinical guidelines largely address individual diseases and rarely account for polymorbidity. The aim of this project was to develop guidelines on nutritional support for polymorbid patients hospitalized in medical wards. METHODS: The methodology used for the development of the current project follows the standard operating procedures for ESPEN guidelines...
July 24, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28754053/complex-decision-making-in-patients-with-dementia-in-an-internal-medicine-department
#7
Ladislav Kabelka
With the increase of polymorbidity, extending life expectancy and improving treatment options for chronic diseases, the care for dementia is moving into other areas of medicine. The length and quality of life with advanced dementia is directly dependent on the quality of medical and nursing care, early detection and treatment of complications, nutritional support and palliative care plan. Significant is also the support for family carers. The key coordinators of care for patients with dementia are general practitioners (GPs), geriatricians, psychiatrists, and an increasingly important role play internists...
October 2017: Annals of Palliative Medicine
https://www.readbyqxmd.com/read/28728198/-nutrition-of-polymorbid-patients-data-or-opinions
#8
REVIEW
Mathias Plauth
Polymorbidity and old age are rather the rule than the exception in hospitalised patients. Malnutrition is common in such patients and should be identified by appropriate screening and assessment measures in order to devise a nutrition plan and act accordingly. Unlike in the UK or The Netherlands, malnutrition screening and nutrition teams are not mandatory for German hospitals. Malnutrition and, in particular, sarcopenia are indicators of a nutrition associated risk or increased morbidity and mortality. Malnutrition can affect patients of any medical discipline and, therefore, is managed most efficiently by the interdisciplinary and multiprofessional nutrition team...
July 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28480974/comorbidities-and-medications-of-patients-with-chronic-hepatitis-c-under-specialist-care-in-the-uk
#9
Benjamin Hudson, Alex J Walker, William L Irving
Designing services with the capacity and expertise to meet the needs of the chronic hepatitis C (CHC) population in the era of direct acting antivirals (DAAs), and widening access to such treatments, requires detailed understanding of the characteristics and healthcare needs of the existing patient population. In this retrospective analysis of data from the National HCV Research UK Biobank between March 2012 and October 2014, the characteristics of the CHC population currently under specialist care in the UK were evaluated-with specific focus upon use of medications, adverse lifestyle choices, and comorbidities...
December 2017: Journal of Medical Virology
https://www.readbyqxmd.com/read/28452726/-nesfatin-1-activity-in-patients-with-essential-hypertension-and-prediabetes-type-2-diabetes
#10
O Kovalyova, T Ashcheulova, A Demydenko, M Vizir, O Kochubiei
Essential hypertension (EH) is one of the important problems and comorbidity negatively affects the prognosis of the disease. Substantial thing is investigation of metabolic substances that influence the carbohydrate profile. Aim - investigation of the nesfatin-1 activity in patients with Essential hypertension and prediabetes/type2 diabetes. 83 patients with EH were examined and divided into groups according to dysglicemia and abdominal obesity. Significant increasing of nesfatin-1 in patients with EH 7,81±0,26 ng/ml was found comparing to controls 4,54±0,13 ng/ml, p<0,05...
February 2017: Georgian Medical News
https://www.readbyqxmd.com/read/28386499/total-knee-arthroplasty-in-severe-valgus-osteoarthritis-excellent-early-results-in-a-90-year-old-patient-with-a-valgus-deformity-of-47%C3%A2
#11
Petros Ismailidis, Rolf Kernen, Sebastian Andreas Mueller
Grade III valgus deformity (tibiofemoral alignment > 20°) is present in only 0.5% of patients receiving total knee arthroplasty. Furthermore, cases with a valgus deformity exceeding 40° are even rarer. Since they mostly affect elderly, polymorbid patients, successful outcome means a great challenge. We report on a case of a 90-year-old patient with a valgus deformity of 47°. The patient was preoperatively restricted to a wheel chair, unable to walk, and only able to stand for a few seconds. The maximal knee flexion was 100°, and there was an extension deficit of 15°...
2017: Case Reports in Orthopedics
https://www.readbyqxmd.com/read/28382662/successful-targeted-treatment-of-mast-cell-activation-syndrome-with-tofacitinib
#12
Lawrence B Afrin, Roger W Fox, Susan L Zito, Leo Choe, Sarah C Glover
Mast cell (MC) activation syndrome (MCAS) is a collection of illnesses of inappropriate MC activation with little to no neoplastic MC proliferation, distinguishing it from mastocytosis. MCAS presents as chronic, generally inflammatory multisystem polymorbidity likely driven in most by heterogeneous patterns of constitutively activating mutations in MC regulatory elements, posing challenges for identifying optimal mutation-targeted treatment in individual patients. Targeting commonly affected downstream effectors may yield clinical benefit independent of upstream mutational profile...
August 2017: European Journal of Haematology
https://www.readbyqxmd.com/read/28054112/-surgical-treatment-of-colorectal-carcinoma-in-the-elderly
#13
J Schuld, M Glanemann
Colorectal carcinoma is one of the most frequent tumor entities worldwide. The treatment of elderly and mostly polymorbid patients is an outstanding challenge in view of the demographic change with a continuously aging community. Due to the demographic changes the numbers of elderly (>65 years) and very old (≥80 years) patients are steadily increasing in surgical cohorts. This has resulted in higher morbidity and mortality rates in comparison to younger patients, with increased wound healing and cardiovascular complications but with comparable numbers of anastomotic insufficiency...
February 2017: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
https://www.readbyqxmd.com/read/28009313/character-and-frequency-of-the-variations-of-co-and-polymorbid-syntropic-extrahepatic-lesions-and-their-dependence-on-the-hepatopulmonary-syndrome-severity-degree-in-cirrhotic-patients
#14
O Abrahamovych, M Abrahamovych, S Tolopko, O Fayura, M Ferko
In this study, we comprehensively examined 93 patients with liver cirrhosis, selected in a randomized manner, with the preliminary stratification by the presence of hepatopulmonary syndrome with the aim to study the nature and frequency of extrahepatic syntropic lesions of organs and systems and their dependence on the severity of lung injury that is necessary for the appointment of the most effective individualized comprehensive treatment. The results of our calculations showed that with the increasing of the hepatopulmonary syndromeseverity degree, the nature and the frequency of the syntropic co- and polymorbid functional and organic extrahepatic lesions of the organs and body systems was significantly (p<0...
November 2016: Georgian Medical News
https://www.readbyqxmd.com/read/27488941/impact-of-preoperative-antithrombotic-therapy-on-blood-management-after-implantation-of-primary-total-knee-arthroplasty
#15
Lukas Leitner, Ewald Musser, Norbert Kastner, Jörg Friesenbichler, Daniela Hirzberger, Roman Radl, Andreas Leithner, Patrick Sadoghi
Red blood cell concentrates (RCC) substitution after total knee arthroplasty (TKA) is correlated with multifold of complications and an independent predictor for higher postoperative mortality. TKA is mainly performed in elderly patients with pre-existing polymorbidity, often requiring permanent preoperative antithrombotic therapy (PAT). The aim of this retrospective analysis was to investigate the impact of demand for PAT on inpatient blood management in patients undergoing TKA. In this study 200 patients were retrospectively evaluated after TKA for differences between PAT and non-PAT regarding demographic parameters, preoperative ASA score > 2, duration of operation, pre-, and intraoperative hemoglobin level, and postoperative parameters including amount of wound drainage, RCC requirement, and inpatient time...
2016: Scientific Reports
https://www.readbyqxmd.com/read/27352588/-integration-of-a-palliative-care-approach-in-the-management-patients-with-polymorbidity
#16
Sophie Pautex, Catherine Weber
The number of patients with multimorbidity is steadily increasing due to medical progress and increased life expectancy. A palliative approach may be offered to some of these patients. It includes the detection and management of somatic and mental symptoms, the management of social and spiritual problems, the anticipation of care and support of the relatives. Its main goal is to improve patient's quality of life and reduce interventions that are unnecessary, or undesired by patients themselves.
May 11, 2016: Revue Médicale Suisse
https://www.readbyqxmd.com/read/27123730/-pain-management-in-geriatric-patients
#17
REVIEW
Jürgen Eiche, Florian Schache
Pains belong to the most frequent reasons for a doctor's visit. In elderly people, it is the result of progressive degenerative processes (e. g. , arthrosis, Osteoarthritis, degenerative spinal changes) and a higher prevalence of cancer disease to a further increase of the patients who suffer unnecessarily from pains. By the increasing polymorbidity (e.g. diabetes mellitus, vascular disease) and a declining immune competence, the prevalence of polyneuropathy and post-herpetic neuralgia rises. Insufficiently treated chronic or periodically returning pain can lead to serious interferences of the physical, cognitive and social everyday competence and therefore to a limited quality of life...
April 2016: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/27012973/often-seen-rarely-recognized-mast-cell-activation-disease-a-guide-to-diagnosis-and-therapeutic-options
#18
REVIEW
Lawrence B Afrin, Joseph H Butterfield, Martin Raithel, Gerhard J Molderings
Mast cell (MC) disease has long been thought to be just the rare disease of mastocytosis (in various forms, principally cutaneous and systemic), with aberrant MC mediator release at symptomatic levels due to neoplastic MC proliferation. Recent discoveries now show a new view is in order, with mastocytosis capping a metaphorical iceberg now called "MC activation disease" (MCAD, i.e. disease principally manifesting inappropriate MC activation), with the bulk of the iceberg being the recently recognized "MC activation syndrome" (MCAS), featuring inappropriate MC activation to symptomatic levels with little to no inappropriate MC proliferation...
2016: Annals of Medicine
https://www.readbyqxmd.com/read/26978608/-features-of-polymorbidity-in-cardiac-and-gastroenterologic-patients-from-a-therapeutic-clinic
#19
Yu A Nikolaev, E V Sevostyanova, I M Mitrofanov, V Ya Polyakov, N A Dolgova
AIM: To examine the incidence of polymorbidity (PM) and changes in its rates in 2003 to 2011 in cardiac and gastroenterologic patients living in the Novosibirsk Region and the Republic of Sakha (Yakutia) in accordance with gender, occupation, and residence. SUBJECTS AND METHODS: The dynamics of PM rates was analyzed in 13 496 patients who had been examined and treated at the Cardiology and Gastroenterology Departments, Therapeutic Clinic, Research Institute of Experimental and Clinical Medicine (Novosibirsk), 2003-2011...
2016: Terapevticheskiĭ Arkhiv
https://www.readbyqxmd.com/read/26945264/hemopericardium-under-dabigatran-for-stroke-prevention-in-atrial-fibrillation
#20
Claudia Stöllberger, Maria Heger, Josef Finsterer
Spontaneous hemopericardium is a complication of anticoagulant therapy with not only vitamin-K-antagonists, but also with nonvitamin-K-antagonist oral anticoagulants. We report a polymorbid 75-year old male under a therapy with dabigatran, valsartan, amlodipine, nicorandil, furosemide, atorvastatin, bisoprolol, metformin, tizanidine, pantoprazole, and tramadol. He suffered from chest pain for 4 months. Coronary angiography showed only ectatic coronary arteries. He started taking nonsteroidal anti-inflammatory drugs...
March 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
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