共查询到20条相似文献,搜索用时 0 毫秒
1.
Mara E. Murray Horwitz Molly A. Fisher Christine A. Prifti Janet W. Rich-Edwards Christina D. Yarrington Katharine O. White Tracy A. Battaglia 《Journal of general internal medicine》2022,37(4):912
Several common adverse pregnancy outcomes can reveal subclinical or latent cardiovascular disease (CVD) risk, transiently exposed through the physiologic stress of pregnancy. The year after pregnancy may be a singular opportunity to identify and initiate treatment for CVD risk, even before the onset of traditional CVD risk factors. However, clinical guidance regarding CVD risk management after adverse pregnancy outcomes is lacking. We therefore conducted a systematic review of US clinical practice guidelines and professional society recommendations to inform primary care–based CVD risk management after adverse pregnancy outcomes. We identified 13 relevant publications. While most recommendations were based on limited or weak evidence, we identified several areas of consensus. First, individuals with an adverse pregnancy outcome associated with future CVD are likely to benefit from CVD risk assessment—accompanied by education, counseling, and support for lifestyle modification—beginning within the first postpartum year. Second, among clinicians, clear and consistent documentation about adverse pregnancy outcomes and recommended follow-up is important to coordinate care after pregnancy. In addition, patients need to be informed about their pregnancy complications and associated CVD risks, so that they can make informed health care and lifestyle decisions. Finally, in general, CVD prevention in the year after an adverse pregnancy outcome focuses on lifestyle modification, reserving pharmacotherapy for the highest-risk patients and those with traditional CVD risk factors. While postpartum lifestyle interventions show promise for reducing CVD risk after adverse pregnancy outcomes, continued research to determine the optimal content, timing, and long-term effects of such interventions is needed.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07149-x. 相似文献
2.
3.
4.
5.
Donna M. Zulman MD MS Steven M. Asch MD MPH Susana B. Martins MD MSc Eve A. Kerr MD MPH Brian B. Hoffman MD Mary K. Goldstein MD MS 《Journal of general internal medicine》2014,29(3):529-537
Multimorbidity—the presence of multiple chronic conditions in a patient—has a profound impact on health, health care utilization, and associated costs. Definitions of multimorbidity in clinical care and research have evolved over time, initially focusing on a patient’s number of comorbidities and the associated magnitude of required care processes, and later recognizing the potential influence of comorbidity characteristics on patient care and outcomes. In this article, we review the relationship between multimorbidity and quality of care, and discuss how this relationship may be mediated by the degree to which conditions interact with one another to generate clinical complexity (comorbidity interrelatedness). Drawing on established theoretical frameworks from cognitive engineering and biomedical informatics, we describe how interactions among conditions result in clinical complexity and may affect quality of care. We discuss how this comorbidity interrelatedness influences the value of existing quality guidelines and performance metrics, and describe opportunities to quantify this construct using data widely available through electronic health records. Incorporating comorbidity interrelatedness into conceptualizations of multimorbidity has the potential to enhance clinical and research efforts that aim to improve care for patients with multiple chronic conditions. 相似文献
6.
7.
Abstract The disease trajectory in chronic obstructive pulmonary disease (COPD) is characterised by a progressive decline in overall function, loss of independence and reduction of health-related quality of life. Although the symptom burden is high and care is often demanding, patients’ and informal carers’ experiences in living with advanced COPD are seldom described. This study sought to explore patients’ and informal carers’ experiences in living with advanced COPD and to understand their awareness about palliative care provision in advanced COPD. About 20 patients and 20 informal carers were recruited in a respiratory care service in Southern Switzerland. Semistructured individual interviews with participants were conducted on clinic premises and audio-recorded. Interviews lasted between 35 and 45?min. Data were analysed using thematic analysis. Living day to day with COPD, psychosocial dimension of the disease and management of complex care were the main themes identified. Patients and informal carers reported a range of psychological challenges, with feelings of guilt, discrimination and blame. Most of the participants had no knowledge of palliative care and healthcare services did not provide them with any information about palliative care approaches in advanced COPD. The reported psychological challenges may influence the relationship between patients, informal carers and healthcare professionals, adding further complexity to the management of this long-term condition. Further research is needed to explore new ways of managing complex care in advanced COPD and to define how palliative care may be included in this complex care network. 相似文献
8.
9.
Neil Yager Krishnakumar Hongalgi Mikhail Torosoff 《Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital》2022,49(5)
BackgroundPatients with chronic kidney disease are underrepresented in registries and in randomized trials of coronary artery disease management. To investigate effects of chronic kidney disease on outcomes of nonemergent percutaneous coronary intervention in patients with left main or left main–equivalent coronary artery disease, we analyzed data from the New York State Percutaneous Coronary Intervention Registry during the calendar year 2015, involving 2,956 elective percutaneous coronary intervention cases. Outcomes of percutaneous coronary intervention in patients with various degrees of chronic kidney disease and stable left main or left main–equivalent coronary artery disease were compared.MethodsOnly patients with left main or left main–equivalent coronary artery disease and elective percutaneous coronary intervention were included in the study cohort. Patients with acute coronary syndromes within 24 hours of the index percutaneous coronary intervention, patients reported to be in shock, and patients with prior coronary artery bypass surgery were excluded from the study cohort.ResultsIn this cohort, stage 4 or 5 chronic kidney disease, current congestive heart failure, and left main disease remained statistically significant predictors of post–percutaneous coronary intervention mortality.ConclusionOur findings in this large, statewide cohort indicate that advanced kidney disease is associated with markedly increased post–nonemergent percutaneous coronary intervention mortality. 相似文献
10.
Hiroyuki Seto Naoto Ishimaru Jun Ohnishi Yohei Kanzawa Takahiro Nakajima Toshio Shimokawa Yuichi Imanaka Saori Kinami 《Internal medicine (Tokyo, Japan)》2022,61(16):2417
Objective This study evaluated the effectiveness of a multidisciplinary team deprescribing intervention to reduce polypharmacy and potentially inappropriate medications (PIMs) in elderly orthopedic inpatients. Methods In this single-center retrospective observational study, orthopedic inpatients ≥75 years old and prescribed ≥6 different medications were enrolled as participants. Interventions comprised multidisciplinary team-led polypharmacy screening and suggestions regarding deprescribing any unnecessary medications during hospital stays. The primary outcome was reduction in the mean number of regular medicines and PIMs. Secondary outcomes included falls, delirium, and other adverse events during hospitalization as well as emergency department visits or unplanned hospital admissions within six months after discharge. Results After propensity score matching, 184 patients (intervention group, n=92; control group, n=92) were included in the analysis. The mean patient age was 83 years old. The mean number of prescribed medications and PIMs at admission were similar in both groups. The mean change in the number of regular medicines was -1.4 [standard deviation (SD), 2.3] in the intervention group and +0.2 (SD, 1.8) in the control group (p<0.001). The mean change in the number of PIMs was -0.5 (SD, 0.9) in the intervention group and +0.1 (SD, 0.8) in the control group (p<0.001). In-hospital adverse events other than falls and delirium were significantly less common in the deprescribing intervention group than in the control group. Conclusion Deprescribing intervention by our multidisciplinary team seems to have been effective in reducing the number of prescribed medicines and PIMs in elderly orthopedic inpatients, with some accompanying reduction in certain adverse events. 相似文献
11.
Effect of Primary Care‐Based Memory Clinics on Referrals to and Wait‐Time for Specialized Geriatric Services 下载免费PDF全文
Linda Lee MD Loretta M. Hillier MA Jane McKinnon Wilson MSc Susie Gregg MSc OT Karim Fathi DipHI Cathy Sturdy Smith BA MSc Matt Smith MB BCh MSc 《Journal of the American Geriatrics Society》2018,66(3):631-632
12.
Incidence of Physical Disability Related to Musculoskeletal Disorders in the Elderly: Results From a Primary Care–Based Registry 下载免费PDF全文
Juan A. Jover Cristina Lajas Leticia Leon Loreto Carmona Jose A. Serra Agustin Reoyo Luis Rodriguez‐Rodriguez Lydia Abasolo for the Acute Physical Disability in the Elderly Group 《Arthritis care & research》2015,67(1):89-93
13.
Guideline‐Recommended Medications and Physical Function in Older Adults with Multiple Chronic Conditions 下载免费PDF全文
Gail McAvay PhD Heather G. Allore PhD Andrew B. Cohen MD PhD Danijela Gnjidic PhD Terrence E. Murphy PhD Mary E. Tinetti MD 《Journal of the American Geriatrics Society》2017,65(12):2619-2626
14.
15.
Candace H. Feldman Cameron Speyer Rachel Ashby Bonnie L. Bermas Shamik Bhattacharyya Eliza Chakravarty Brendan Everett Elizabeth Ferucci Aimee O. Hersh Francisco M. Marty Joseph F. Merola Rosalind Ramsey‐Goldman Brad H. Rovin Mary Beth Son Laura Tarter Sushrut Waikar Jinoos Yazdany Joel S. Weissman Karen H. Costenbader 《Arthritis care & research》2021,73(1):146-157
16.
17.
18.
19.
20.
Periodontitis as a Modifiable Risk Factor for Dementia: A Nationwide Population‐Based Cohort Study 下载免费PDF全文
Yao‐Tung Lee MD Hsin‐Chien Lee MD MPH Chaur‐Jongh Hu MD Li‐Kai Huang MD Shu‐Ping Chao MD Chia‐Pei Lin MD Emily Chia‐Yu Su PhD Yi‐Chen Lee DrHS Chu‐Chieh Chen PhD 《Journal of the American Geriatrics Society》2017,65(2):301-305