应用于慢病共存的最小破坏性医学研究进展

目的 综述最小破坏性医学（minimally disruptive medicine,MDM）的研究现况及进展,以期为减轻慢病共存患者治疗负担提供理论依据。方法 以“最小破坏性医学”作为知网数据库和万方数据库检索词,以“Minimally disruptive medicine”作为 PubMed 数据库的检索词,查阅文献,就MDM的概念、四项基本原则、照护模型、临床实施的工具及策略进行综述。结果 MDM是针对慢病共存治疗负担发展而来,已形成完善详细的应用基本原则及照护模型,MDM发展而成的工具及策略,临床已开始应用,效果良好。结论 MDM对减轻慢病共存患者治疗负担具有积极作用,值得进行深入研究推广。     

Multimorbidity and quality of life: Systematic literature review and meta-analysis

Multimorbidity is typically defined as the co-existence of two or more chronic diseases within an individual. Its prevalence is highest among the elderly, with poor quality of life (QoL) being one of the major consequences. This study aims to: (1) understand the relationship between multimorbidity and QoL or health-related quality of life (HRQoL) through systematic literature review; (2) explore the strength of this association by conducting the first meta-analysis on the subject.Following PRISMA, Medline/PubMed, Embase, CINAHL and PsycINFO were searched for studies published through September 1st, 2018. Original studies with clear operationalization of multimorbidity and validated QoL (or HRQoL) measurement were retained. For random-effect meta-analysis, a minimum of three studies with the same multimorbidity tool (e.g. number of diseases or equal comorbidity index) and the same QoL tool were required. Number of diseases was most common and the only measure on which meta-analysis was carried out. The outcome of interest was the linear regression slope between increasing number of diseases and QoL. Heterogeneity was explored with meta-regression. Out of 25,890 studies initially identified, 74 studies were retained for systematic review (total of 2,500,772 participants), of which 39 were included in the meta-analysis. The mean decrease in HRQoL per each added disease, depending on the scale, ranged from: −1.55% (95%CI: −2.97%, −0.13%) for the mental component summary score of pooled SF-36, -12 and -8 scales to −4.37% (95%CI: −7.13%, −1.61%) for WHOQoL-BREF physical health domain. Additional studies considering severity, duration and patterns of diseases are required to further clarify this association.     

The association of multimorbidity with healthcare expenditure among the elderly patients in Beijing,China

ObjectivesTo add evidence to the relationship between multimorbidity and healthcare expenditure.MethodsThe study population comprised patients aged ≥60 in Beijing, covered by the Urban Employee Basic Medical Insurance (UEBMI) (N = 30,774). Multimorbidity was measured with 33 chronic conditions confirmed by doctors. Multivariate linear regression was performed.ResultsThe prevalence of multimorbidity was 82% among elderly patients in Beijing and was higher in older and female patients. About 95% of the healthcare expenditure on the 33 conditions was spent on multimorbid patients. In the multivariate analysis, after inclusion of demographic characteristics, disease severity, and health facility level, the expenditure increased significantly with the number of chronic conditions. After further including condition types, the coefficients of the number of conditions were much lower than those in previous models. The expenditure on patients with two and three conditions was 3.4 times (95% CI: 3.2–3.7) and 5.3 times (95% CI: 4.7–6.0) higher than that on patients with a single condition, respectively; however, the expenditure did not significantly increase after three conditions.ConclusionsMultimorbidity is common among elderly patients in Beijing and consumes the majority of the healthcare resources. The health delivery system in China and other low- and middle-income countries needs to pay more attention to multimorbidity.     

Systematic review on the use of anticholinergic scales in poly pathological patients

PurposeAnticholinergic drugs may increase the risk of cognitive and functional disorders in older patients. There are anticholinergic scales on which said risk is estimated. The objectives of this study are: to identify the scales described in literature that are applicable to polypathological patients and analyze their clinical outcomes.Material and methodsA systematic review was performed. Data sources were MEDLINE, EMBASE and Web of Science which were consulted until August 2014. Inclusion criteria: (1) studies that specify the list of drugs, describe the methodology for their elaboration and how they calibrate the anticholinergic potential and (2) studies that use the scales identified as a tool to measure exposure to anticholinergic drugs in polypathological patients or those with similar characteristics. The main differences between the scales and main results on cognitive, functional and mortality status were collected.Results25 articles were included. 10 scales were identified. For their preparation, 8 were based on literature about drugs with anticholinergic activity and/or previously published scales as well as expert opinions. Exposure to anticholinergic drugs has been linked to cognitive disorders (basically measured with Anticholinergic Risk Scale (ARS), Anticholinergic Cognitive Burden Scale (ACB) and Drug Burden Index (DBI)) and functional scale (with ARS and DBI). However, there is no clear relationship with mortality. The Anticholinergic Drug Scale was the only one that obtained no association with any of the variables studied.ConclusionsThere is a great variety of scales published and applied to older patients. The clinical results are different depending on the scale used which is probably due to the different methodology in their elaboration.     

Supporting older people with multimorbidity: The care burden of home health-care assistants in Ireland

The treatment burden inherent in self-managing multiple chronic conditions (multimorbidity) is recognized, but there has been little examination of the care burden experienced by paid home health-care assistants (HCAs) who support older people with multimorbidity. Focus groups were conducted with HCAs in Ireland and data were coded using a thematic analysis approach. Care burden of HCAs was linked with lack of knowledge and information, poor communication, insufficient time and resources, gaps in medication support and work-related stress. Strategies are required to reduce the care burden of HCAs, who are essential stakeholders supporting growing numbers of older people with multimorbidity.     

Multimorbidity of overweight and obesity alongside anxiety and depressive disorders in individuals with spinal cord injury

ObjectiveTo compare the prevalence of anxiety/depression and overweight/obesity (Aim 1) and the multimorbidity of these conditions (Aim 2) in a sample of adults with and without spinal cord injury (SCI). Aim 3 was to examine whether overweight/obese individuals with SCI differ on the prevalence of anxiety/depressive disorders compared to non-overweight/obese individuals with SCI.DesignRetrospective cohort study.ParticipantsIndividuals ≥16 years old who had patient encounters between January 1, 2011, and February 28, 2018. In total, 761 598 individuals were included, of which 3136 had SCI.Main Outcome MeasuresIndividuals were identified as diagnosed with SCI, anxiety and/or depressive disorders, and overweight/obesity using the International Classification of Diseases.ResultsAge-adjusted odds ratios (ORs) were calculated using logistic regression. In contrast to non-SCI individuals, those with SCI had increased odds of anxiety disorders (OR: 3.58, 95% CI [3.29–3.90]), depressive disorders (OR: 4.33, 95% CI [3.95–4.74]), and overweight/obesity (OR: 3.08, 95% CI [2.80–3.38]). Pertaining to multimorbidity, individuals with SCI had increased odds of having overweight/obesity alongside anxiety disorders (OR: 4.30, 95% CI [3.71–4.98]) and overweight/obesity alongside depressive disorders (OR: 4.69, 95% CI [4.01–5.47]) compared to those without SCI. Individuals with SCI who were diagnosed as overweight/obese had increased odds of having anxiety disorders (OR: 2.54, 95% CI [2.06–3.13]), and depressive disorders (OR: 2.70, 95% CI [2.18–3.36]), relative to non-overweight/obese individuals with SCI.ConclusionsThis work is among the first to find evidence that individuals with SCI are at heightened odds of overweight/obesity alongside anxiety and/or depressive disorders. This early work holds clinical implications for treating these interrelated comorbidities in SCI.     

中国10个地区成年人共病流行特征分析

目的:描述中国成年人的共病流行情况及其长期变化,以及常见的共病模式。方法:本研究纳入参与中国慢性病前瞻性研究第二次重复调查的25 033人,利用研究对象参加2004-2008年基线调查和2013-2014年第二次重复调查时采集的信息进行分析。根据自报疾病史、现场体格检查及血液样本检测等信息定义了13种慢性病或健康问题,...     

Aging with HIV in the ART era

In the current era of therapy for human immunodeficiency virus (HIV), life expectancy for persons living with HIV (PLWH) approaches that of the general population. This newly prolonged survival among PLWH is associated with an increased prevalence of comorbidities due to the inflammation, immune activation and immune senescence associated with HIV infection. Higher prevalence of tobacco and alcohol use, co-infection with viral hepatitis and traditional cardiovascular risk factors such as hypertension and hyperlipidemia contribute as well. In this review, we hope to describe the current comorbidities occurring among PLWH and bring increased awareness for conditions that may otherwise not be considered given the younger age at time of presentation.     

The Update on Instruments Used for Evaluation of Comorbidities in Total Hip Arthroplasty

IntroductionIt is a well-established fact that concomitant diseases can affect the outcome of total hip arthroplasty (THA). Therefore, careful preoperative assessment of a patient''s comorbidity burden is a necessity, and it should be a part of routine screening as THA is associated with a significant number of complications. To measure the multimorbidity, dedicated clinical tools are used.MethodsThe article is a systematic review of instruments used to evaluate comorbidities in THA studies. To create a list of available instruments for assessing patient''s comorbidities, the search of medical databases (PubMed, Web of Science, Embase) for indices with proven impact on revision risk, adverse events, mortality, or patient''s physical functioning was performed by two independent researchers.ResultsThe initial search led to identifying 564 articles from which 26 were included in this review. The measurement tools used were: The Charlson Comorbidity Index (18/26), Society of Anesthesiology classification (10/26), Elixhauser Comorbidity Method (6/26), and modified Frailty Index (5/26). The following outcomes were measured: quality of life and physical function (8/26), complications (10/26), mortality (8/26), length of stay (6/26), readmission (5/26), reoperation (2/26), satisfaction (2/26), blood transfusion (2/26), surgery delay or cancelation (1/26), cost of care (1/26), risk of falls (1/26), and use of painkillers (1/26). Further research resulted in a comprehensive list of eleven indices suitable for use in THA outcomes studies.ConclusionThe comorbidity assessment tools used in THA studies present a high heterogeneity level, and there is no particular system that has been uniformly adopted. This review can serve as a help and an essential guide for researchers in the field.