Multidimensional Care Research Articles

Geriatric Assessment of Older Adults With Cancer During Acute Hospitalizations: Challenges and Opportunities.

Introduction Geriatrics is a discipline that covers all adult healthcare, and oncology is no exception. The global geriatric assessment process plays a crucial role, impacting research, funding, resource allocation, as well as therapeutic decision-making. Thus, greater knowledge of the epidemiology of the frailty and functionality of elderly patients with cancer will allow for the development of a global care strategy. This study aimed to assess the prevalence of geriatric conditions in elderly cancer patients admitted to a medical geriatric unit following unplanned hospitalisation. Methods A retrospective, single-centre cohort study was conducted of patients aged ≥ 75 with an active oncological disease who were admitted to a geriatric medicine unit over a two-year period. Results A total of 65 patients were included. The median age was 85 (IQR 81-88), and 86% were aged ≥ 80. A moderate-to-high functional dependence was found: 67.7% on ≥ 3 basic activities of daily living (Katz ≥ D), with the majority classified as severely dependent based on the Barthel Index (mean 49.0 ± 33.7). Frailty was found in 90.7%. A high prevalence of geriatric syndromes was observed: malnutrition (84.6%), polypharmacy (64.6%), urinary incontinence (58.5%) and pressure ulcers (33.8%). The mortality rate was 36.9% during hospitalisation and 13.8%, 30 days post-discharge. Conclusions The study revealed a high prevalence of geriatric conditions, emphasising the importance of comprehensive assessment in managing elderly patients at different stages of the disease. This multidimensional and multidisciplinary approach optimises patient care throughout admission, hospitalisation and discharge.

Patient Preferences in Metastatic Breast Cancer Care: A Scoping Review.

People with metastatic breast cancer (MBC) have diverse medical, physical, and psychosocial needs that require multidimensional care. Understanding patient preferences is crucial to tailor treatments, services, and foster patient-centered care. A scoping review was performed to summarize the current evidence on the preferences of people with MBC regarding their care to identify knowledge gaps and key areas for future research. The Embase, MEDLINE, CINAHL and PsycInfo databases were searched. Twenty studies enrolling 3354 patients met the study eligibility criteria. Thirteen quantitative studies, four mixed methods studies, and three qualitative studies were included. Seven studies captured healthcare provider perspectives; thirteen studies evaluated patient preferences relating specifically to cancer treatments; three studies evaluated preferences relating to supportive care; and four studies evaluated communication and decision-making preferences. The current literature evaluating MBC patient preferences is heterogeneous with a focus on cancer treatments. Future research should explore patient preferences relating to multidisciplinary, multi-modal care that aims to improve quality of life. Understanding MBC patient preferences regarding their comprehensive care can help tailor healthcare delivery, enhance the patient experience, and improve outcomes.

Multidisciplinary and multidimensional approaches to transplantation in children with rare genetic kidney diseases.

In this review, we describe the multidisciplinary, multidimensional care required to optimize outcomes for pediatric transplant recipients with rare genetic kidney diseases. Transplant success, recipient survival, and improvement in quality of life depend on collaboration between patients, families, and a team of specialists with medical, as well as nonmedical expertise. A multidisciplinary transplant team composed of experts from medicine, surgery, nursing, nutrition, social services, transplant coordination, psychology, and pharmacology, is now standard in most transplant centers and is critical to the success of a transplant. In addition to these professionals, other specialists, such as cardiologists, urologists, geneticists, metabolic disease specialists, occupational therapists, case management, child life, chaplain, and palliative care services, have a crucial role to play in the preparation, surgery, and follow-up care, especially when a pediatric patient has a rare genetic disorder leading to renal involvement, and the need for transplantation. In order to describe this multidisciplinary care, we divide the genetic renal diseases into five subgroups-metabolic and tubular disorders, glomerular diseases, congenital anomalies of the kidney and urinary tract, ciliopathies including cystic diseases, and miscellaneous renal conditions; and describe for each, the need for care beyond that provided by the standard transplant team members.

Children's Oncology Group's 2023 blueprint for research: Liver tumors.

Liver tumors account for approximately 1%-2% of all pediatric malignancies, with the two most common tumors being hepatoblastoma (HB) and hepatocellular carcinoma (HCC). Previous Children's Oncology Group studies have meaningfully contributed to the current understanding of disease pathophysiology and treatment, laying groundwork for the ongoing prospective international study of both HB and HCC. Future work is focused on elucidating the biologic underpinnings of disease to support an evolution in risk categorization, advancements in the multidimensional care required to treat these patients, and the discovery of novel therapies.

Psychometric evaluation of the Chinese version of the supportive care needs survey for caregivers of children with Paediatric cancer (SCNS-C-Ped-C).

To revise the Supportive Care Needs Survey for Partners and Caregivers of Cancer Patients (SCNS-P&C) and evaluate the psychometric properties of the Chinese Version of the Supportive Care Needs Survey for Caregivers of Children with Paediatric Cancer (SCNS-C-Ped-C) in caregivers of children with paediatric cancer. A cross sectional design was used. In this methodological research, the reliability and validity of the SCNS-C-Ped-C were measured by a questionnaire survey among 336 caregivers of children with paediatric cancer in China. The construct validity was evaluated by exploratory factor analysis and internal consistency was examined by Cronbach's alpha, split-half reliability, and corrected item-to-total correlation coefficients. The exploratory factor analysis revealed six factors consist of: Healthcare and Informational Needs, Daily Care and Communication Needs, Psychological and Spiritual Needs, Medical Service Needs, Economic Needs, and Emotional Needs, explaining 65.615% of the variance. The Cronbach's alpha was 0.968 at full scale and 0.603-0.952 on the six domains. The split-half reliability coefficient was 0.883 at full scale and 0.659-0.931 on the six domains. The SCNS-C-Ped-C demonstrated both reliability and validity. It can be used to evaluate multi-dimensional supportive care needs for caregivers of children with paediatric cancer in China.

A Realist Evaluation of Case Management Models for People with Complex Health Conditions Using Novel Methods and Tools-What Works, for Whom, and under What Circumstances?

Case management developed from a generalist model to a person-centred model aligned with the evidence-informed evolution of best practice people-centred integrated care. Case management is a multidimensional and collaborative integrated care strategy where the case manager performs a set of interventions/actions to support the person with a complex health condition to progress in their recovery pathway and participate in life roles. It is currently unknown what case management model works in real life for whom and under what circumstances. The purpose of this study was to answer these questions. The study methods used realistic evaluation framework, examined the patterns and associations between case manager actions (mechanisms), the person's characteristics and environment (context), and recovery (outcomes) over 10 years post severe injury. There was mixed methods secondary analysis of data extracted via in-depth retrospective file reviews (n = 107). We used international frameworks and a novel approach with multi-layered analysis including machine learning and expert guidance for pattern identification. The study results confirm that when provided, a person-centred case management model contributes to and enhances the person's recovery and progress towards participation in life roles and maintaining well-being after severe injury.Furthermore, the intensity of case management for people with traumatic brain injury, and the person-centred actions of advising, emotional and motivational support, and proactive coordination contribute to the person achieving their goals. The results provide learnings for case management services on the case management models, for quality appraisal, service planning, and informs further research on case management.

Alcohol abuse in older adults with type 2 diabetes mellitus in primary health care: a cross-sectional study.

This cross-sectional study aimed to analyze alcohol abuse in older adults with type 2 diabetes mellitus in primary health care. Household data were collected from March to October 2018 in the Family Health Strategy in Ribeirão Preto, São Paulo through face-to-face interviews with a form application. The pattern of alcohol consumption was estimated with the Alcohol Use Disorders Identification Test-C. A total of 338 older adults with type 2 diabetes mellitus participated, and 19.2% (95%CI 15.0-23.4) engaged in alcohol abuse. Among them, we observed a higher frequency of males (63.1%), aged 60 to 64 years (35.4%), economic class C (49.2%), 1-4 schooling years (53.8%), and multimorbidity (92.3%). There was a negative association between alcohol abuse and drug therapy adherence (PR = 0.55; 95%CI 0.36-0.86). The frequency of alcohol abuse and non-adherence to drug treatment among those with a high consumption pattern is troubling since it can lead to diabetes complications. Therefore, we underscore the importance of multidimensional elderly care and health education in primary care.

Healthcare professionals' perceived barriers in providing palliative care in primary care and nursing homes: a survey study.

Palliative care in primary care and nursing home settings is becoming increasingly important. A multidimensional palliative care approach, provided by a multiprofessional team, is essential to meeting patients' and relatives' values, wishes, and needs. Factors that hamper the provision of palliative care in this context have not yet been fully explored. To identify the barriers to providing palliative care for patients at home or in nursing homes as perceived by healthcare professionals. Cross-sectional survey study. A convenience sample of nurses, doctors, chaplains, and rehabilitation therapists working in primary care and at nursing homes in the Netherlands is used. The primary outcome is barriers, defined as statements with ⩾20% negative response. The survey contained 56 statements on palliative reasoning, communication, and multiprofessional collaboration. Data were analyzed using descriptive statistics. In total, 249 healthcare professionals completed the survey (66% completion rate). The main barriers identified in the provision of palliative care were the use of measurement tools (43%), consultation of an expert (31%), estimation of life expectancy (29%), and documentation in the electronic health record (21% and 37%). In primary care, mainly organizational barriers were identified, whereas in nursing homes, most barriers were related to care content. Chaplains and rehabilitation therapists perceived the most barriers. In primary care and nursing homes, there are barriers to the provision of palliative care. The provision of palliative care depends on the identification of patients with palliative care needs and is influenced by individual healthcare professionals, possibilities for consultation, and the electronic health record. An unambiguous and systematic approach within the multiprofessional team is needed, which should be patient-driven and tailored to the setting.

Consumo abusivo de álcool em idosos com diabetes mellitus tipo 2 da atenção primária à saúde: um estudo transversal

Abstract This cross-sectional study aimed to analyze alcohol abuse in older adults with type 2 diabetes mellitus in primary health care. Household data were collected from March to October 2018 in the Family Health Strategy in Ribeirão Preto, São Paulo through face-to-face interviews with a form application. The pattern of alcohol consumption was estimated with the Alcohol Use Disorders Identification Test-C. A total of 338 older adults with type 2 diabetes mellitus participated, and 19.2% (95%CI 15.0-23.4) engaged in alcohol abuse. Among them, we observed a higher frequency of males (63.1%), aged 60 to 64 years (35.4%), economic class C (49.2%), 1-4 schooling years (53.8%), and multimorbidity (92.3%). There was a negative association between alcohol abuse and drug therapy adherence (PR = 0.55; 95%CI 0.36-0.86). The frequency of alcohol abuse and non-adherence to drug treatment among those with a high consumption pattern is troubling since it can lead to diabetes complications. Therefore, we underscore the importance of multidimensional elderly care and health education in primary care.

Interdisciplinary Collaboration and Communication Among Doctors and Nurses in ICUs During the COVID-19 Pandemic and Their Importance in Professional Life Quality Improvement.

To investigate interdisciplinary cooperation and communication among doctors and nurses along with its role in improving the quality of their professional life, a cross-sectional survey was designed. The study was carried out from February to April 2021 through the application of an anonymous, structured, self-completed, closed-ended questionnaire in a convenience sample consisting of 110 healthcare professionals currently working in the intensive care units (ICUs) of three distinct hospitals (response rate: 76.4%). It was observed that medical personnel manifested a more positive stance toward interdisciplinary collaboration than nursing while women seemed to believe more than men that nurses' administrative skills are not valued enough by doctors. Nurses with limited work experience reported that doctors show scarce respect to nurses in the presence of patients' parents and companions while male nurses acknowledged more the provision of multidimensional care given to patients. Occupational stress, professional satisfaction, and burnout levels were mainly moderate across study participants.

Identifying, exploring and integrating the spiritual dimension in proactive care planning: A mixed methods evaluation of a communication training intervention for multidisciplinary palliative care teams

Background: Patients receiving palliative care value attention given to their spiritual needs. However, these needs often remain unexplored as healthcare professionals lack the skills to identify and explore them and to integrate this information into care plans. Aim: To evaluate the effects of an interactive communication training intervention for palliative care teams in order to identify and explore the spiritual dimension and integrate it in patients’ care plans. Design: A mixed methods pre-post study, including self-assessment questionnaires, evaluation of videos with simulated consultations (applied competence) and medical record review (implementation). Setting/participants: Three palliative care teams including nurses (N = 21), physicians (N = 14) and spiritual caregivers (N = 3). Results: The questionnaires showed an improvement on ‘Patient and family-centred communication’ of the End-of-life professional caregiver survey (+0.37, p < 0.01; the 8-item S-EOLC (+0.54, p < 0.01) and regarding the Spiritual Care Competence Scale, on the three subscales used (+0.27, p < 0.01, +0.29, p < 0.01 and +0.32, p < 0.01). Video evaluations showed increased attention being paid to patient’s aims and needs. The medical record review showed an increase in anticipation on the non-somatic dimension (OR: 2.2, 95% CI: 1.2–4.3, p < 0.05) and, using the Mount Vernon Cancer Network assessment tool, addressing spiritual issues (OR: 10.9, 95% CI: 3.7–39.5, p < 0.001). Conclusions: Our training intervention resulted in increased palliative care professionals’ competence in identifying and exploring patients’ spiritual issues, and their integration in multidimensional proactive palliative care plans. The intervention directly addresses patients’ spiritual concerns and adds value to their palliative care plans.

Self-Organizing Maps to Multidimensionally Characterize Physical Profiles in Older Adults.

The aim of this study is to automatically analyze, characterize and classify physical performance and body composition data of a cohort of Mexican community-dwelling older adults. Self-organizing maps (SOM) were used to identify similar profiles in 562 older adults living in Mexico City that participated in this study. Data regarding demographics, geriatric syndromes, comorbidities, physical performance, and body composition were obtained. The sample was divided by sex, and the multidimensional analysis included age, gait speed over height, grip strength over body mass index, one-legged stance, lean appendicular mass percentage, and fat percentage. Using the SOM neural network, seven profile types for older men and women were identified. This analysis provided maps depicting a set of clusters qualitatively characterizing groups of older adults that share similar profiles of body composition and physical performance. The SOM neural network proved to be a useful tool for analyzing multidimensional health care data and facilitating its interpretability. It provided a visual representation of the non-linear relationship between physical performance and body composition variables, as well as the identification of seven characteristic profiles in this cohort.

Life-Cycle Spatial Strategy for Multidimensional Health-Oriented Medical Care Community—From the Perspective of Sustainable Marketing

The aging population and the increasing number of sub-healthy people in all age groups in China have brought huge opportunities for related industries. From the perspective of marketing and consumer psychology, there is a great demand for health care properties, especially those that provide long-term medical care. Against this situation, almost all the leading real estate companies have entered this field and tried to occupy more market shares through different products and brand marketing sustainably. In this context, it is urgent to explore a comprehensive community model combining medical and nursing care that covers all stages of life, so as to promote the health of diverse populations. In China, existing research on the growth of medical care communities for sustainable needs started relatively late, and insufficient attention has been paid to the supply–demand linkage among psychological demand, health behavior, spatial bearing, and service supply. Taking Wuzhishan city for example, we deduce the Medical-Care Maslow’s Hierarchy of Needs System according to classical theories. Based on motivation theory and marketing strategy, a theoretical model of Health demand-behavior-facilities and Spatial Interaction (HBSI) mediated by healthy behavior is constructed. Then, expert group decision making processes and the Fuzzy Delphi Method (DFM) were used to screen 67 spatial impact factors of 14 categories in five dimensions, including life safety, physical health, mental health, social adaptation and resilience recovery, which fit users’ multi-dimensional health needs. Finally, to provide a spatial strategy reference for the construction of sustainable and adaptive medical caring communities, spatial planning strategies and guidelines are offered based on correlation analysis, so as to fit the changeable market pattern, meet the psychological expectations and life-cycle caring needs of consumers.

Functional Decline in COVID-19 Older Survivors Compared to Other Pneumonia Patients, a Case Control Study.

ObjectivesAmong patients over 75 years, little is known about functional decline due to COVID-19. The aim of this study was to explore this functional decline, compare to other infectious pneumonia.Design and SettingThis case-control study included all COVID-19 patients hospitalized from March to December 2020 in Acute Geriatric Ward in Nantes University Hospital matched 1/1 with patients with pneumonia hospitalized in geriatric department between March 2017 and March 2019 (controls) on sex, age. Functional decline was assessed at 3 month follow up as it is routinely done after hospitalization in geriatric ward. We performed multivariable analyses to compare clinical outcomes between patients with COVID-19 vs controls.Results132 pairs were matched on age (mean: 87 y-o), and sex (61% of women). In multivariable logistic regression analysis, there were no statistical significant association between COVID-19 infection and functional decline (OR=0.89 p=0.72). A statistical significant association was found between functional decline and Charlson comorbidity index (OR=1.17, p=0.039); prior fall (OR=2.08, p=0.012); malnutrition (OR=1.97, p=0.018); length of hospital stay (OR=1.05, p=0.002) and preadmission ADL(OR=1.25, p=0.049).ConclusionCOVID-19 does not seem to be responsible for a more frequent or severe functional decline than other infectious pneumonia in older and comorbid population after 3 month follow up. In this population, pneumonia is associated with functional decline in almost 1 in 2 cases. The individual preadmission frailty seems to be a more important predictor of functional decline, encouraging multidimensional care management for this population.Electronic Supplementary MaterialSupplementary material is available in the online version of this article at 10.1007/s12603-022-1845-1.

Food Insecurity Screening in a Pediatric Clinic: Findings on Documentation and Multidimensional Care Needs.

Background The American Academy of Pediatrics recommends routine screening and resource provision for food insecurity (FI). The authors describe documentation of FI, as well as social, developmental, and health care utilization characteristics, among patients with and without FI in a pediatric clinic. Methods This data-only case-control study describes patients with and without FI seen by pediatricians who identified at least 10 patients with FI between January 2019 and January 2020. Controls were seen by the same pediatrician on the same day, matched 2:1 with cases. Chart review identified FI documentation. Bivariate analyses were used to describe demographic, clinical, and health care utilization characteristics. Results The authors identified 74 patients with FI (cases) and 144 controls. Pediatricians documented FI in the medical record for 76% of patients identified with FI, although only 43% had FI in the problem list. There were no differences between cases and controls in the distribution of age or sex. A larger proportion of cases used the emergency department (25.7% vs 9.6%; p < 0.05), were Black (36.5% vs 15.3%; p < 0.05) or Hispanic (44.6% vs 18.8%; p < 0.05), utilized Medi-Cal (41.9% vs 16.7%; p < 0.05), had developmental delay (13.5% vs 4.2%; p < 0.05), received speech therapy (20.3% vs 4.9%; p < 0.05), or were referred to a social worker (37.8% vs 3.5%; p < 0.05). Discussion Our findings show inconsistent documentation of FI in medical records and that FI is associated with increased social, developmental, and health care utilization needs. Conclusion Further research is needed to assess the impact of documenting FI in patient charts.

Nurses' Views on Palliative Care and Death: A Qualitative Study

Giriş: Palyatif bakım yaşam kalitesini yükseltmeyi hedefleyen, çok boyutlu bir bakım yaklaşımıdır. Palyatif bakım sürecinde aktif rol alan hemşireler, bakım sürecinde pek çok güçlükle karşılaşmaktadır.Amaç: Bu araştırma ile, palyatif bakım kliniğinde çalışmakta olan hemşirelerin mesleki yaşam deneyimlerinin, palyatif bakım hemşirelik uygulamalarının ve ölüme bakış açılarının belirlenmesi amaçlanmıştır.Yöntem: Nitel çalışma deseninde yürütülen çalışmanın evrenini, bir eğitim araştırma hastanesinin palyatif bakım kliniğinde çalışmakta olan 13 hemşire oluşturmaktadır. Çalışma grubu seçilmemiş olup evrenin tamamına ulaşılmıştır. Çalışmanın verileri 15.01.2022- 15.02.2022 tarihleri arasında toplanmıştır. Toplanan veriler içerik analizi yöntemi ile değerlendirilip tematik kodlama yapılmıştır.Bulgular: Katılımcıların hepsinin kadın olduğu, yaş ortalamalarının 33,30±7,45 (min:23, max:47) olduğu belirlenmiştir. Hemşirelerin, meslekte çalışma yılı ortalamaları 10,92±7,80 (min:2, max:25), palyatif bakım kliniğinde çalışma süreleri 2,15±1,21 (min:1, max:5) yıl olarak belirlenmiştir. Verilerin betimleyici ve yorumlayıcı analizleri sonucunda 5 ana tema, 19 alt tema oluşturulmuştur. Belirlenen 5 ana tema başlıkları şu şekildedir: Palyatif bakım hemşirelik yaklaşımları, palyatif bakım veren hemşirelerin duygu ve düşünceleri, hemşirelerin ölüm algısı, ölmek üzere olan hastaya bakım veren hemşirelerin duygu ve düşünceleri ve hemşirelerin kişisel motivasyon kaynaklarıdır.Sonuç: Çalışmamızda hemşirelerin palyatif bakımda en çok hastaların yaşam kalitesini arttırmaya, öz bakım uygulamalarına ve semptom yönetimine odaklandıkları belirlenmiştir. Ayrıca hemşirelerin terminal dönemdeki hastaya bakım verme konusunda zorluk yaşadıkları belirlenmiştir. Bu kapsamda yaşamın son döneminde olan hastaya bakım verme ve sonrasında yas sürecinde aileye destek olma gibi konularda hemşirelere hizmet içi eğitimlerin verilmesi önerilmektedir.

Use of Cosmetic Facial Injectables After Facial Aesthetic Surgery.

Over the last 2 decades, both invasive and minimally invasive aesthetic procedures have proliferated. Aesthetic surgeons often recommend injectable treatments after cosmetic facial surgery for multiple reasons. However, literature is lacking on how cosmetic surgery affects postoperative facial injectable use. The aim of this study was to identify predictors of facial injectable use after cosmetic facial surgery. All adult patients operated on by a single surgeon between 2013 and 2021 were retrospectively reviewed. Patients who had any of the following cosmetic facial surgeries were included: rhytidectomy, blepharoplasty, rhinoplasty, or genioplasty. Patient demographics, clinical history, intraoperative factors, and use of cosmetic facial injectables (neurotoxin, facial fillers, deoxycholic acid, poly-l-lactic acid) were recorded. A total of 227 patients who underwent facial cosmetic surgery were reviewed, of whom 158 were included. Of these, 89 patients had rhytidectomy (56.3%), 112 had blepharoplasty (70.9%), 28 had rhinoplasty (17.7%), and 7 had genioplasty (4.4%). Injectables were administered to 44.3% of patients after their surgery (n = 73), compared with only 17.7% before surgery (n = 28) (P < 0.001). The most common postoperative injectables were neurotoxins (48.5%) and facial fillers (46.0%), followed by deoxycholic acid (2.7%) and poly-l-lactic acid (2.7%). Multivariate regression revealed factors positively correlated with future injectable use were index blepharoplasty or rhinoplasty, and history of preoperative neurotoxin injection (P < 0.05). Cosmetic facial injectables are an important consideration in achieving and maintaining optimal facial aesthetics. Their use, especially neurotoxins and facial fillers, has increased among patients postoperatively. These results highlight the contribution of injectable procedures in the context of multidimensional care for augmenting facial aesthetics.

Seeking the Light in Intensive Care Unit Sedation: The Optimal Sedation Strategy for Critically Ill Patients.

The clinical approach to sedation in critically ill patients has changed dramatically over the last two decades, moving to a regimen of light or non-sedation associated with adequate analgesia to guarantee the patient’s comfort, active interaction with the environment and family, and early mobilization and assessment of delirium. Although deep sedation (DS) may still be necessary for certain clinical scenarios, it should be limited to strict indications, such as mechanically ventilated patients with Acute Respiratory Distress Syndrome (ARDS), status epilepticus, intracranial hypertension, or those requiring target temperature management. DS, if not indicated, is associated with prolonged duration of mechanical ventilation and ICU stay, and increased mortality. Therefore, continuous monitoring of the level of sedation, especially when associated with the raw EEG data, is important to avoid unnecessary oversedation and to convert a DS strategy to light sedation as soon as possible. The approach to the management of critically ill patients is multidimensional, so targeted sedation should be considered in the context of the ABCDEF bundle, a holistic patient approach. Sedation may interfere with early mobilization and family engagement and may have an impact on delirium assessment and risk. If adequately applied, the ABCDEF bundle allows for a patient-centered, multidimensional, and multi-professional ICU care model to be achieved, with a positive impact on appropriate sedation and patient comfort, along with other important determinants of long-term patient outcomes.

Computational Complexity and Tort Deterrence

Standard formulations of the economic model of tort deterrence constitute the injurer as the unboundedly rational bad man. Unbounded rationality implies that the injurer can always compute the solution to his caretaking problem. This in turn implies that optimal liability rules can provide robust deterrence, for they can always induce the injurer to take socially optimal care. In this paper I examine the computational complexity of the injurer’s caretaking problem. I show that the injurer’s problem is computationally tractable when the precaution set is unidimensional or convex but that it is computationally intractable when the precaution set is multidimensional and discrete. One implication is that the standard assumptions of unidimensional and convex care, though seemingly innocuous, are pivotal to ensuring that tort law can provide robust deterrence. It is therefore important to recognize situations with multidimensional discrete care, where robust tort deterrence may not be possible.

A Review: Polypharmacy and Medication Adherence in Patients with COVID-19 Diseases

Surveys of community based elderly patients’ shows that 2 to 9 prescription medications on average are taken per day. By survey 57% of US women aged &gt;65 years took more than 4 prescription medication and 12% took more than 9 prescription medication. [1]On random day 8.3 % of the population were exposed to minor polypharmacy and 1.2% to major polypharmacy. The prevalence of polypharmacy increased with the age and from the age of 70 years, two third of all drug users were polypharmacy users. An elderly patient is at greater risk for adverse drug reactions and drug-drug interactions because the physiologic changes that occur with aging make the body more sensitive to the effects of medications. The burden of polypharmacy, may enhance the risk of morbidity and mortality, especially in cases of acute infections. The Middle East respiratory syndrome (MERS-CoV), severe acute respiratory syndrome (SARS-CoV), SARS- related coronavirus-2 (SARS-CoV-2), and corona virus disease (COVID-19) are members of the same family as coronavirus. Various studies reported that COVID-19 has a similar pathogenic potential to cause respiratory complications, disability, and death as SARS-CoV and MERS-CoV. Medication non-adherence includes delaying prescription fills, failing to fill prescriptions, cutting dosages, and reducing the frequency of administration. Non adherence with medication is a complex and multidimensional health care problem. The causes may be related to the patient, treatment, and/or health care provider.