Impact Of Comorbid Conditions Research Articles

HYPERTENSION IN THE ELDERLY: CHALLENGES IN MANAGEMENT AND TREATMENT

Hypertension is a prevalent and significant health issue among the elderly, contributing to increased risks of cardiovascular diseases, stroke, and kidney failure. Managing hypertension in older adults poses unique challenges due to age-related physiological changes, comorbidities, and polypharmacy. This review explores the complex pathophysiology of hypertension in the elderly, including age-related changes in vascular function and the impact of comorbid conditions. It examines the difficulties in diagnosing hypertension, such as variability in blood pressure readings, white coat syndrome, and masked hypertension, highlighting the need for accurate monitoring through home and ambulatory techniques. The review discusses current management strategies, emphasizing the importance of setting appropriate treatment goals, implementing lifestyle modifications, and utilizing pharmacological treatments, including new antihypertensive drugs and combination therapies. It also addresses challenges such as adverse drug reactions, medication adherence, and the management of polypharmacy. Recent advances, including innovations in drug delivery systems and digital health technologies, offer promising solutions for improving hypertension management. Future research directions include exploring precision medicine, understanding the role of the gut microbiome, and addressing health disparities. Clinicians are advised to adopt personalized treatment approaches, integrate technological tools, and address socioeconomic barriers to optimize hypertension management in the elderly. This review underscores the need for ongoing research and tailored strategies to improve outcomes and quality of life for older patients with hypertension.

The psychosocial and educational burden of obsessive-compulsive disorder in youth

BackgroundPediatric OCD is associated with functional impairment in multiple environments. However, relatively little is known about the impact of comorbid conditions, as well as OCD severity on psychosocial functioning in this population. Furthermore, most studies did not include a control sample, nor examined differences between children and adolescents. The goal of this investigation was to assess psychosocial functioning and its associations with age, symptom severity, and comorbid conditions in a large well characterized sample of pediatric OCD probands, and controls. MethodsParticipants included 117 pediatric OCD probands and 147 controls, that underwent a careful diagnostic process, and completed several questionnaires and interviews. ResultsResults revealed significant psychosocial impairments across multiple domains/settings, some of which were affected by symptom severity as well as by conduct related comorbidities and to a lesser extent affective disorders. In addition, different aspects of psychosocial impairments were found between children and adolescents. ConclusionThis study provides high resolution information regarding the types and extent of psychosocial dysfunction in youth with OCD, as well as its relationship with clinical and diagnostic correlates. It is recommended that evaluation and management of OCD in youth in research and clinical settings regularly include qualitative and semi-quantitative assessment of function across these domains.

From Mild Cognitive Impairment to Dementia: The Impact of Comorbid Conditions on Disease Conversion.

The conversion from mild cognitive impairment (MCI) to dementia is influenced by several factors, including comorbid conditions such as metabolic and vascular diseases. Understanding the impact of these comorbidities can help in the disease management of patients with a higher risk of progressing to dementia, improving outcomes. In the current study, we aimed to analyze data from a large cohort of MCI (n = 188) by principal component analysis (PCA) and cluster analysis (CA) to classify patients into distinct groups based on their comorbidity profile and to predict the risk of conversion to dementia. From our analysis, four clusters emerged. CA showed a significantly higher rate of disease progression for Cluster 1, which was predominantly characterized by extremely high obesity and diabetes compared to other clusters. In contrast, Cluster 3, which was defined by a lower prevalence of all comorbidities, had a lower conversion rate. Cluster 2, mainly including subjects with traumatic brain injuries, showed the lowest rate of conversion. Lastly, Cluster 4, including a high load of hearing loss and depression, showed an intermediate risk of conversion. This study underscores the significant impact of specific comorbidity profiles on the progression from MCI to dementia, highlighting the need for targeted interventions and management strategies for individuals with these comorbidity profiles to potentially delay or prevent the onset of dementia.

Factors Affecting the Safety Profile of Intravenous Levetiracetam Used for Controlling Seizures in Children: A Literature Review

The administration of intravenous levetiracetam (IV-LEV) serves as a significant therapeutic approach for managing seizures in pediatric patients. The major factors that are involved in the equation determinants contain pharmacokinetic parameters, such as dosage regimen, drug interactions, and patient-specific factors including age, weight, and underlying comorbidities. Furthermore, attention is given to potential adverse effects, including hypersensitivity reactions, renal impairment, and central nervous system manifestations. Clinical trials, observational studies, and pharmacovigilance data contribute to a comprehensive evaluation of the drug’s safety, shedding light on optimal dosing strategies and risk mitigation techniques. Understanding these intricate factors is paramount for healthcare providers to ensure efficacious seizure control while minimizing potential harms associated with IV-LEV administration in children. This abstract examines the multifaceted factors that influence the safety profile of IV-LEV in this vulnerable pediatric population. This literature review explores the various factors influencing the safety profile of intravenous levetiracetam (IV-LEV) in its application for seizure management in pediatric patients. Based upon a comprehensive analysis of peer-reviewed articles, clinical trials, and observational studies, the review synthesizes findings related to pharmacokinetic variables, dosage considerations, and potential drug interactions. Additionally, patient-specific determinants, encompassing age-related variations, weight-based dosing implications, and the impact of comorbid conditions, are critically evaluated.

Emergency department visits in Parkinson's disease: The impact of comorbid conditions

IntroductionOlder adults have complex, often overlapping, medical conditions requiring careful management that may lead to increased emergency department usage compared to younger adults. Parkinson's disease (PD), a progressive neurodegenerative disorder characterized by distinct motor and nonmotor features, frequently occurs with additional comorbid disease. Classifying comorbid conditions into clinical subgroups allows for further understanding of the heterogeneity in outcomes in patients with PD. The current study examines the reasons for emergency department (ED) visits in a cohort of patients with PD and identifies comorbidities that are potential risk factors for specific ED presenting conditions. MethodsUsing data from Optum's de-identified Integrated Claims-Clinical dataset years 2010–2018, patients with PD were identified based on ICD-9/10 diagnosis codes. We identified all ED visits occurring after the first observed diagnosis code for PD. Comorbid conditions were classified using the AHRQ Clinical Classification Software (CCS). We classified patients using Latent Class Analysis (LCA) and conducted multiple logistic regression models with the outcome of reason-for-visit to examine the associations with comorbidity-profile class, patient demographics, and socio-economic characteristics. ResultsThe most common reasons for ED admission were injuries such as fractures and contusions, diseases of the circulatory system, and general signs and symptoms, including abdominal pain, malaise, and fatigue. Comorbid medical conditions often observed in this patient population include depression, diabetes mellitus, and chronic pulmonary disease. Patients in the “Poorest Health” classification of the LCA had greater odds for ED admission for diseases related to the gastrointestinal system, musculoskeletal system, and injury/poisoning categories and reduced odds for admission for diseases of the circulatory system. DiscussionPatients with PD who present to the emergency department with injuries are more likely to be in poor health overall with a high comorbidity burden. Clarifying the complex medical needs of patients with PD is the first step to further individualize care, which may reduce ED visits in this population, improve quality of life, and lessen the footprint on the healthcare system.

Impact of Comorbid Conditions on Severity of Dengue Fever: A Comparative Study

Objective: to identify the comorbid conditions associated with an increased risk of severe Dengue in clinically diagnosed patients with Dengue viral infections.
 Study Design: Comparative cross sectional study.
 Place and Duration of Study: Dengue ward, Department of Medicine, Combined Military Hospital Lahore, from Oct to Nov 2021.
 Methodology: Three hundred patients with confirmed Dengue infection were enrolled in the study. These patients were divided into two groups: 150 patients with comorbids (diabetes mellitus, hypertension, ischemic heart disease) and 150 patients without comorbids. The impact of comorbid conditions on the severity of dengue fever was studied.
 Results: Seventy-three out of the 300 patients had Dengue Fever without warning signs, while 79 out of the 300 patients had Severe Dengue Fever. Almost half of the patients (148) 300 had Dengue Fever with warning signs. The mean age of participants is 45.62±14.06 years. Patients with diabetes mellitus were more likely to develop Dengue without warning signs. Patients with hypertension were more likely to develop severe Dengue.
 Conclusion: This study showed that comorbid conditions such as Diabetes and Hypertension are important risk factors for developing severe Dengue.

How dental teams can help patients with temporomandibular disorders receive general dental care: an international Delphi process.

Many patients with temporomandibular disorders (TMD) find it difficult to undergo dental care due to challenges caused by their condition, previous temporomandibular joint surgery or invasive dental procedures, and the impact of comorbid conditions. Managing routine dental care for some patients with TMD can be seen as challenging by some dental practitioners. The objective of this study was to work with patients experiencing TMD and clinicians to co-produce recommendations aimed at helping general dentists to provide routine dental care for patients with TMD. A modified Delphi process was used to co-produce recommendations. Six patients experiencing TMD, patient advocates and seven clinicians took part, including international TMD clinicians. Two meetings were held with patient participants, mediated by a trained facilitator. Recommendations suggested by patient participants were distributed to clinicians who were asked to add additional suggestions, but not to modify patients' recommendations unless to aid clarity. Additional themes were identified from the existing literature, and the recommendations were then reviewed by the International Network for Orofacial Pain and Related Disorders Methodology (INfORM) consortium. Recommendations were given to support patients before, during, and after dental treatment. Participants identified specific and practical recommendations to help patients with TMD receive routine dental care, but also emphasised the need for professionals to listen sensitively to patients' concerns and work with patients in an empathetic and non-judgmental way. These recommendations, co-developed with patients experiencing TMD, should help dental professionals to provide supportive general dental care for patients with TMD.

Cognitive Impairments in Patients with Bronchial Asthma.

The course of bronchial asthma can be accompanied by cognitive impairments. However, the relationship between cognitive dysfunction and asthma has not been fully revealed, nor has it been fully established what causes cognitive impairments in patients with asthma. There is an opinion that transient hypoxia and persistent systemic inflammation with insufficient control of bronchial asthma can be accompanied by neurotoxicity in relation to the hippocampus and indirectly lead to deterioration of cognitive functions. Comorbid conditions, such as obesity, allergic rhinitis, and depressive states can increase cognitive dysfunction in asthmatics. The review considers the pathophysiology of cognitive dysfunction in patients with bronchial asthma, as well as the impact of comorbid conditions on the cognitive status. This information will allow systematizing the available knowledge about the state of cognitive functions in asthma for timely detection and correction of their impairments and, ultimately, optimization of the management of these patients.

Cervical medial branch radiofrequency ablation and opioid usage: Cross sectional views at six months prior to and six months following procedure

BackgroundZygapophysial joint pain has a prevalence of up to 55% in patients suffering from neck pain. Interventional pain procedures are commonly used to treat facetogenic neck pain including cervical medial branch radiofrequency ablation (CMBRFA), which has been shown to effectively reduce pain. However, there is little research regarding its impact on opioid medication usage. ObjectiveWe aimed to evaluate changes in opioid medication usage after CMBRFA and impact of comorbid conditions on noted changes. DesignRetrospective observational study. MethodsFor patients undergoing CMBRFA between May 01, 2017 and May 31, 2020, the following data were collected: demographics, spinal level of procedure, history of prior neck surgery or pain procedures, presence of comorbid conditions, and opioid medication prescription data at 6 months before and after the procedure. Fisher’s exact tests were used for continuous variables due to inadequate sample for parametric tests. Multivariable analysis was used to assess independent predictive factors. ResultsA total of 140 patients underwent RFA during the 3-year study period. Fifteen percent (N = 21) of the cohort were on opioid medication pre-procedurally – of these, 71 % (N = 15) decreased opioid use post-procedurally which includes the 43 % (N = 9) who ceased opioid use completely. However, no statistically significant difference was noted between pre- and post-procedural MME. Of the 119 opioid-naïve patients, 16 % (N = 19) started opioids by 6 months following CMBRFA; this group was noted to have higher prevalence of anxiety and depression. ConclusionOpioid use, studied in isolation, is not a reliable measure to assess CMBRFA effectiveness. Psychologic considerations such as history of anxiety or depression are significant factors in opioid use and may influence procedure effectiveness. Opioid use patterns are multifaceted. Larger, future studies are needed to analyze post-procedure opioid use in the context of other factors such as pre-procedure opioid use, psychiatric comorbidities, and presence of multiple pain generators.

Impact of Comorbid Conditions on Healthcare Expenditure and Work-related Outcomes in Patients With Rheumatoid Arthritis.

To evaluate the effect of comorbid conditions on direct healthcare expenditure and work-related outcomes in patients with rheumatoid arthritis (RA). This is a retrospective analysis of the Medical Expenditure Panel Survey from 2006 to 2015 in 4967 adults with RA in the United States. Generalized linear models were used for healthcare expenditure and income, logistic models for employment status, and zero-inflated negative binomial models for absenteeism. Thirteen comorbid conditions were included as potential predictors of direct cost- and work-related outcomes. The models were adjusted for sociodemographic factors including sex, age, region, marital status, race/ethnicity, income, education, and smoking status. Patients with RA with heart failure (HF) had the highest incremental annual healthcare expenditure (US$8205, 95% CI $3683-$12,726) compared to those without the condition. Many comorbid conditions including hypertension (HTN), diabetes, depression, chronic obstructive pulmonary disease, cancer, stroke, and HF reduced the chance of patients with RA aged between 18-64 years being employed. Absenteeism of employed patients with RA was significantly affected by HTN, depression, disorders of the eye and adnexa, or stroke. On average, RA patients with HF earned US$15,833 (95% CI $4435-$27,231) per year less than RA patients without HF. Comorbid conditions in patients with RA were associated with higher annual healthcare expenditure, lower likelihood of employment, higher rates of absenteeism, and lower income. Despite its low prevalence, HF was associated with the highest incremental healthcare expenditure and the lowest likelihood of being employed compared to other common comorbid conditions.

S1180 Low Impact of Co-Morbid Conditions on the Diagnosis of Covert Hepatic Encephalopathy in a Cohort of 690 Patients With Cirrhosis

S1180 Low Impact of Co-Morbid Conditions on the Diagnosis of Covert Hepatic Encephalopathy in a Cohort of 690 Patients With Cirrhosis

Impact of comorbid conditions on disease-specific quality of life in older men and women with atrial fibrillation

Older persons with atrial fibrillation (AF) experience significant impairment in quality of life (QoL), which may be partly attributable to their comorbid diseases. A greater understanding of the impact of comorbidities on QoL could optimize patient-centered care among older persons with AF. To assess impairment in disease-specific QoL due to comorbid conditions in older adults with AF. Patients aged ≥ 65years diagnosed with AF were recruited from five medical centers in Massachusetts and Georgia between 2015 and 2018. At 1 year of follow-up, the Quality of Life Disease Impact Scale-for Multiple Chronic Conditions was used to provide standardized assessment of patient self-reported impairment in QoL attributable to 34 comorbid conditions grouped in 10 clusters. The mean age of study participants (n = 1097) was 75years and 48% were women. Overall, cardiometabolic, musculoskeletal, and pulmonary conditions were the most prevalent comorbidity clusters. A high proportion of participants (82%) reported that musculoskeletal conditions exerted the greatest impact on their QoL. Men were more likely than women to report that osteoarthritis and stroke severely impacted their QoL. Patients aged < 75years were more likely to report that obesity, hip/knee joint problems, and fibromyalgia extremely impacted their QoL than older participants. Among older persons with AF, while cardiometabolic diseases were highly prevalent, musculoskeletal conditions exerted the greatest impact on patients' disease-specific QoL. Understanding the extent of impairment in QoL due to underlying comorbidities provides an opportunity to develop interventions targeted at diseases that may cause significant impairment in QoL.

Impact of comorbidities on recurrence rates and survival in patients with endometrial cancer

Aim: Endometrial cancer (EC) is mostly seen in elderly population, the impact of comorbid conditions on clinical outcomes and survival of EC is a topic of increasing interest. The aim of this study was to determine the association of diabetes mellitus (DM), hypertension (HT) and metformin use with survival in patients with EC.Material and Methods: Clinical and tumor characteristics of 410 patients who underwent surgery for EC in our institution between 2006 and 2012 were reviewed. Demographic features, histological subtypes, stage, type of surgery, comorbidities, treatment modalities and patient outcomes in terms of relapse-free survival (RFS) and overall survival (OS) were assessed.Results: Median follow-up was 39 months. The presence of HT and DM were associated with overall survival after adjusted for age, disease stage and grade (HR for HT 2.88, p=0.055, HR for DM 2.01, p=0.045). Presence of either HT or DM (or both) was independently associated with lower rate of 5 years survival (HR 8.24, p=0.041). Metformin use was not associated with RFS or OS in whole patient population. However, among patients with diabetes, metformin use was associated with improved 5 years survival (p=0.024) but not with RFS (p=0.47).Conclusion: Our study showed DM and HT to be associated with increased mortality in patients with EC but no link was shown between presence of DM/HT and disease recurrence. Metformin might be the treatment of choice in patients with DM and EC, but beneficial effects are probably through metabolic effects rather than anticancer efficacy.

In-Hospital Morbidity and Mortality Among Acute Myeloid Leukemia Patients Admitted for Hematopoeitic Stem Cell Transplants between 2002-2014

Introduction: Acute myeloid leukemia (AML) is a disease with poor overall prognosis, about 4.3 per 100,000 men and women per year are diagnosed with AML with a deaths rate of 2.8 per 100,000. The incidence of AML increases with age which leads to an older population with multiple comorbidities and inferior prognosis. Hematopoietic stem cell transplant (HCT) remains the standard of care in most intermediate and high-risk AML patients. However, HCT puts these patients at risk of severe cytopenia, opportunistic infections, acute graft versus host disease and financial stress, especially in the early phases of transplant. The purpose of this study is to identify the annual trends in in-hospital mortality and morbidity associated with patients with AML admitted for HCT and impact of comorbid conditions on the likelihood of death during admission. Method Data was collected from the National Inpatient Sample from the years of 2002 to 2014. Admissions for HCT for acute myeloid leukemia patients were identified using a procedural clinical classification software code for bone marrow transplants in combination with ICD 9 codes for acute myeloid leukemia. Annual trends in mortality, hospital length of stay, and costs of admission were assessed with a linear regression analysis. Univariate logistic regression analysis was used to test for associations between chronic medical conditions and mortality among these patients. Co-morbid conditions were identified using the Agency for Healthcare Research and Quality comorbidity measures for underlying chronic conditions in patients in 2013 to 2014. Results: Between and including the years of 2002 to 2014, a total weighted estimate of transplants for acute myeloid leukemias in the United States totaled 31,811 (N=6,102). Annual transplants increased from 1,761 in 2002 to 3,030 in 2014. In-hospital mortality decreased from 8.4% in 2002 to 4.8% in 2014 (p=0.02). The mean length of stay remained unchanged from 32.8 days in 2002 to 32.7 days in 2014. Costs of admission increased from $226,280 to $474,106. In-hospital mortality in the years 2013 and 2014 were most strongly associated with comorbid conditions of congestive heart failure (Odds ratio (OR)=5.93), weight loss (OR=4.32), coagulopathy (OR=3.84), liver cirrhosis (OR=3.41). Any two of these conditions increased the OR to 8.34. Conclusions: HCTs have traditionally been associated with high upfront including in-hospital mortality. Our data demonstrates that in the last two decades mortality has been reduced by almost 50% while the length of hospital stay has not changed. This could be related to improvements in supportive care and better selection of conditioning regimens for the patients. It also shows that the costs of hospitalization has doubled. Congestive heart failure, weight loss, underlying coagulopathy and liver cirrhosis are most strongly associated with worse outcomes with any combination of these further potentiating risk of death. Careful selection of patients with special attention to the pre-existing comorbidities is the key to improving early outcomes in HCT. Consideration should also be given to expanding infrastructure to perform outpatient transplants to bend the cost curve. Disclosures No relevant conflicts of interest to declare.

Impact of comorbid conditions on outcomes of hip and knee replacement surgery: a systematic review and meta-analysis

ObjectiveTo systematically perform a meta-analysis of the association between different comorbid conditions on safety (short-term outcomes) and effectiveness (long-term outcomes) in patients undergoing hip and knee replacement surgery.DesignSystematic review and...

Comorbidities, Sociodemographic Factors, and Hospitalizations in Outpatients With Heart Failure and Preserved Ejection Fraction

Patients with heart failure and preserved ejection fraction (HFpEF) tend to be older and have a high co-morbidity burden. The impact of co-morbid conditions and sociodemographic risk factors on outcomes in these patients has not been quantified. We evaluated 445 consecutive outpatients with HFpEF, defined as established diagnosis of heart failure (HF) with left ventricular ejection fraction at presentation >40% and no previous left ventricular ejection fraction ≤40%. Patients with specific cardiomyopathies, congenital heart disease, primary right-sided disease, valvular disease, or previous advanced HF therapies were excluded. After 2 years, there were 44 deaths and 609 all-cause hospitalizations; of these, 260 (42.7%) were cardiovascular hospitalizations, including HF, and 173 (28.4%) were specifically for HF. The highest attributable risk for hospitalizations was associated with marital status (single, divorced, and widowed had higher hospitalization rates compared with married patients), hypoalbuminemia, diabetes, atrial fibrillation, and renal dysfunction. The proportion of hospitalizations potentially attributable to these factors was 66.6% (95% confidence interval [CI] 56.4 to 74.4) for all-cause hospitalizations, 76.9% (95% CI 65.2 to 84.6) for cardiovascular hospitalizations, and 83.0% (95% CI 70.3 to 90.3) for HF hospitalizations. For composite end points, the proportion was 46.9% (95% CI 34.0% to 57.3%) for death or all-cause hospitalization, 45.7% (95% CI 29.3% to 58.2%) for death or cardiovascular hospitalization, and 43.7% (95% CI 24.2% to 58.2%) for death or HF-related hospitalization. In conclusion, among outpatients with HFpEF, most hospitalizations could be attributed to co-morbidities and sociodemographic factors. Effects of HF therapies on hospitalizations and related end points may be difficult to demonstrate in these patients. Multidisciplinary approaches are more likely to impact hospitalizations in HFpEF.

Impact of comorbid conditions on participation in an organised colorectal cancer screening programme: a cross-sectional study

BackgroundThere is controversy regarding how comorbidity impacts on colorectal cancer screening, especially in the context of organised programmes. The aim of this study is to assess the effect of comorbidities on participation in the Barcelona population-based colorectal cancer screening programme (BCCSP).MethodsCross-sectional study carried out in ten primary care centres involved in the BCCSP. Individuals aged 50 to 69, at average risk of colorectal cancer, who were invited to participate in the first round of the faecal immunochemical test-based BCCSP were included (2011–2012). The main variable was participation in the BCCSP. Comorbidity was assessed by clinical risk group status. Other adjusting variables were age, sex, socioeconomic deprivation, visits to primary care, smoking, alcohol consumption and body mass index. Logistic regression models were used to test the association between participation in the programme and potential explanatory variables. The results were given as incidence rate ratios (IRR) and their 95% confidence intervals (CI).ResultsOf the 36,208 individuals included, 17,404 (48%) participated in the BCCSP. Participation was statistically significantly higher in women, individuals aged 60 to 64, patients with intermediate socioeconomic deprivation, and patients with more medical visits. There was a higher rate of current smoking, high-risk alcohol intake, obesity and individuals in the highest comorbidity categories in the non-participation group. In the adjusted analysis, only individuals with multiple minor chronic diseases were more likely to participate in the BCCSP (IRR 1.14; 95% CI [1.06 to 1.22]; p < 0.001). In contrast, having three or more dominant chronic diseases was associated with lower participation in the screening programme (IRR 0.76; 95% CI [0.65 to 0.89]; p = 0.001).ConclusionsHaving three or more dominant chronic diseases, was associated with lower participation in a faecal immunochemical test-based colorectal cancer screening programme, whereas individuals with multiple minor chronic diseases were more likely to participate. Further research is needed to explore comorbidity as a cause of non-participation in colorectal cancer screening programmes and which individuals could benefit most from colorectal cancer screening.

Febrile neutropenia in the nationwide inpatient sample: In-hospital outcomes and impact of cormobidities in 2007-2012.

e18103 Background: Febrile Neutropenia (FN) is associated with significant in-patient morbidity and mortality. The goal of this study is to describe the in-patient outcomes of febrile neutropenia as well as the impact of comorbid conditions through a large national dataset. Methods: Using the Nationwide Inpatient Sample (NIS) for years 2007-2012, FN was defined as ICD-9 codes 288.0x for a primary discharge diagnosis of neutropenia in conjunction with 780.61 and 780.6 for fever in cancer patients. Linear regression analysis assessed for annual trends in in-hospital mortality, length of stay (LOS), and cost of stay (COS). Seasonal variations in admission rates were evaluated using ANOVA. We employed univariate and multivariate logistic regression analysis to elucidate the relationship between common comorbid conditions and mortality. Results: Among 55,253 cancer patients (weighted N = 264,384) admitted with FN between 2007 and 2012, there is a mean decrease in LOS from 5.78 to 5.47 days (p &lt; 0.0001), an increase in COS from $33,939 to $41,395 (p &lt; 0.0001), and a 12-15% drop in hospital admissions in winter months. Mortality rate is unchanged annually (1.06-1.28%). Univariate analysis identified an increased risk of mortality associated with atrial fibrillation (OR = 4.06), coronary artery disease (OR = 2.09), congestive heart failure (OR 4.39), hypertension (1.20), COPD (OR 2.33) pancytopenia (OR 1.81), and adrenal insufficiency (OR 5.32). All remained significant on multivariate analysis, except hypertension and diabetes mellitus. Conclusions: Between 2007-2012, FN had a slight decrease in length of stay, unchanged in-patient mortality and a 22% increase in hospitalization costs. Our results are in line with recently presented analyses of the same database (Blood 2016 128:4762, Blood 2016 128:5904). Comorbid conditions are associated with higher in-patient mortality, with up to 5-fold increase for those with atrial fibrillation, congestive heart failure and adrenal insufficiency. Clinicians should consider the significant impact of such comorbidities. Additional vigilance and potentially prophylactic antibiotics following treatment should be considered in affected patients.

Rheumatoid Arthritis Comorbidity Index (RACI): Development and Validation of a New Comorbidity Index for Rheumatoid Arthritis Patients

Objective: Classify comorbidities with greatest impact on Rheumatoid Arthritis (RA) patients. Develop and validate a prospectively applicable comorbidity index for classifying RA patients according to their comorbid disorders which might impact alter their hospitalization and mortality risk. Methods: A weighted index which considers the number and impact of comorbid conditions was developed based on clinical registry of a cohort of 2029 patients with early RA monitored over 10-years. Logistic and Cox Regression analyses were implemented to estimate the risk of mortality. Regression coefficients were used to develop the index score. ROC curve for the invented index was used to evaluate the discriminating ability of the index and identify different cutoff values that can delineate patients at different stages for risk of death. Disease activity parameters were considered. Results: Comorbidities (18 conditions) were strongly associated with the 10-year death risk, and composed the RA-comorbidity index, include Cardiovascular (7 comorbidities), infection, osteoporotic fractures, falls risk, Depression/anxiety, functional status (HAQ >2), diabetes mellitus, steroid therapy >5 mg, DAS-28 >3.2), renal/liver/ lung disease and tumors. Considering the comorbidities number, the comorbidities adjusted relative risk were employed as weights to develop a weighted index. Validation using ROC curve revealed AUC of 97%. Conclusion: The RA-comorbidity index is a valid method for assessing risk of death in RA patients. The index enables the treating physician to include comorbidities valuation and treatment in their standard practice. It can be used to identify targets, predict resource utilization, and detect the potential targets for lowering high costs, by prospectively recognizing RA patients at high risk.

Exploring the effectiveness of combined mentalization-based group therapy and dialectical behaviour therapy for inpatients with borderline personality disorder - A pilot study.

Borderline personality disorder (BPD) is characterized by emotional instability, interpersonal dysfunction, and other features that typically develop before a background of insecure attachment and traumatic experiences. Dialectical behaviour therapy (DBT) has proven highly effective in reducing self-harm and improving emotion regulation, whereby problems concerning social cognition, which are also characteristic of BPD, may need additional approaches such as mentalization-based treatment (MBT). Here, we examined, in a pilot study, the effectiveness of MBT given adjunct to DBT, compared to DBT alone, in an inpatient sample with BPD, whereby mentalization was measured using a novel cartoon-based task. Both treatments were highly effective in reducing symptom severity. The combination of DBT and MBT was superior in reducing fearful attachment and in improving affective mentalizing. Mentalization-based treatment in combination with DBT may improve certain aspects of social cognitive skills and attachment security, as compared to DBT alone, although the exact mechanisms that led to these changes need to be studied further. Clinical implications Dialectical behaviour therapy (DBT) can usefully be combined with mentalization-based treatment (MBT). The combination of DBT and MBT reduces self-harm more than DBT alone. DBT plus MBT may lead to a reduction in fearful attachment and improvement of affective mentalizing. Short-term combinations of evidence-based borderline treatments may enrich psychiatric inpatient care. Therefore, such approaches deserve further research. Limitations The treatment condition was therapeutically more intense than the control condition. The study lacked a follow-up assessment. The impact of comorbid conditions on treatment response was not taken into account. Adherence to the manualized approach was not measured.