Multiple Chronic Comorbidities Research Articles

Physiotherapists' Treatment Strategies and Delineation of Areas of Responsibility for People With Musculoskeletal Conditions and Comorbidities in Private Physiotherapy Practice: A Qualitative Study.

Patients with multiple chronic conditions, for example, musculoskeletal conditions and comorbidities, often receive inadequate and sometimes even contradictory care. Physiotherapists are well qualified to manage patients with musculoskeletal conditions and comorbidities due to their education and experience with rehabilitation; however, it is unknown which challenges they face when treating these patients. To identify challenges, treatment strategies, and delineations of areas of responsibility among physiotherapists working in private physiotherapy practice when treating people with musculoskeletal conditions and comorbidities. Qualitative study using focus group discussions and participant observations of 13 physiotherapists working in Danish private physiotherapy clinics. Grounded theory was applied to guide the analysis. Two major themes emerged from the focus groups and the observations (1) The necessity of adapting management to the patients and their treatment trajectory; (2) The dilemma of overall responsibility for coordinating care. The physiotherapists described different elements of adapting their management, including being challenged on time, taking extra care of the patient, and having to adjust to a fluctuating course of treatment. The dilemma in coordinating care concerned whether the responsibility should lie with the physiotherapist, other healthcare professionals, or the patients, and whether to treat only the condition on the referral or to treat all the conditions the patient had. Physiotherapists use adapted strategies for diagnosing and treating patients with musculoskeletal conditions and comorbidities and are uncertain about the overall responsibility for coordinating care and whether they should focus on the index condition alone or also the other comorbidities the patient has.

Lessons Learnt from the Management of Severe COVID-19 Disease in a 93-year-old with Chronic Co-Morbidities at a Resource-constrained Centre in Nigeria – A Retrospective Single Case Study

Introduction: Severe COVID-19 infection is associated with significant mortality in the elderly. This is even more so, when the elderly patient with the disease also has multiple chronic co-morbidities, and is resident in a resource-constrained area.
 Aims/ Objectives: To outline management strategies employed, and important lessons learnt from the successful management of a case of severe COVID-19 disease in a 93-year-old with chronic co-morbidities in a resource-limited setting.
 Methods: We utilized a simple COVID-19 severity categorization algorithm on presentation, to assign the index patient to the appropriate COVID-19 disease severity class and subsequently employed patient’s serial, weekly clinical and laboratory parameters to guide a multi-specialty management protocol.
 Results: A 93-year-old man was referred to a tertiary hospital in Enugu during the second wave of the COVID-19 pandemic, with a 5-day-history of high grade fever, severe fatigue, and altered sensorium. He had been living with diabetes for 48years; recently had worsening glycemic control, and was yet to pass urine in the previous 12hours. He was also being managed conservatively for prostate carcinoma. Examination revealed signs of severe pneumonia and he was drowsy, dehydrated, and had asterixis. A diagnosis of acute kidney injury from septicemia, following community acquired pneumonia and possibly urinary tract infection was made, with COVID-19 infection as a differential. Samples were collected for laboratory investigations while he was recommended for intensive care unit admission for further care. Para-enteral broad spectrum antibiotics, intravenous fluid therapy, intranasal oxygen therapy, basal-bolus-insulin-regimen, and anti-coagulation prophylaxis were instituted. Following laboratory investigation results which included a positive COVID-19 test (clinically categorized as severe disease), severe systemic inflammation, evidence of uro-tract infection, intravascular thrombosis and severe renal impairment, the Nephrology, Infectious disease, Urology teams were invited to co-manage the patient alongside the Endocrinologists. After 27days of collaborative care, patient was discharged with resolution of his symptoms and signs.
 Conclusion: Multi-specialty collaborative care improves patients’ outcome even in the face of severe COVID-19 with associated co-morbidities in elderly patients. Severity stratification ensures life-saving timely care for severe COVID-19 disease.

Funding Life-Extension Research.

While the worldwide trend in life expectancy continues to increase slightly overall, the trend for the last few decades in developed countries is that more people are spending more years in poor health with multiple chronic comorbidities. These chronic conditions in aging populations consume high proportions of national healthcare budgets. The relatively young field of longevity research, after accumulating insights into the mechanisms of aging and producing dramatic laboratory demonstrations of life extension in some organisms, is entering the translational phase. This phase, through clinical trials, will confirm or refute the "geroscience hypothesis" that drugs can change the trajectory of the processes of aging within cells, and ultimately in living humans. At the same time, traditional funding patterns do not favor such visionary "moonshot" research, which, despite the potential for ultimately providing benefits for everyone, offers little prospect for rapid return on investment and high probabilities for early phase failure. New radical funding strategies incentivizing innovation will have to be called into play.

Case Study Presenting Remarkable Improvements of all Parameters in a Long-Term T2DM Patient with Multiple Chronic Comorbidities by Sugar fit’s -Tech/Ai-Driven Platform with Daily Personalised Life Coaching and Expert Medical Advice

Background: Type 2 diabetes mellitus (T2DM) is not only one of the leading causes of mortality, but its impact on healthcare costs and burden is becoming unsustainable each year. The quality of life and life expectancy are both significantly impacted by this chronic metabolic condition. To help control their blood glucose levels, patients with T2DM adhere to a self-management regimen as instructed by a professional. Various technological options are available now to help self-management. Methods: Here, we present a case of a 64-year-old female with insulin-dependent type 2 diabetes mellitus, multiple co-morbidities, depression, confined to her room, and inability to walk for about a year. After six months of the Sugar fit approach with daily-personalized life coaching, expert medical advice, tech-enabled, AI-driven model, she showed tremendous improvement in every parameter. Results: Before joining sugar fit, the patient was on 44 units of rapid insulin and 18 units of long-acting and oral anti-diabetic medications. The patient’s Hba1c at baseline was 8%; six months later, it is 6.8% with all rapid and long insulin stopped and oral meds essentially the same as before. She has reduced creatinine from 1.88 to 1.37 and triglycerides from 1015 to 448, respectively. Her BP medications have been reduced to 50%. She walks for 2 km every day and is socially active with resolved depression. She has lost 3 kgs of weight and 3 inches of waist circumference. Conclusions: The findings indicate that a tech-enabled, AI-driven model with intensive, personalized coaching, lifestyle modification, and expert physician guidance has shown remarkable results even in this particularly complicated case. The findings indicate that the personalized and individualized frequent lifestyle coaching and expert physician opinion enabled by superior technology and AI-driven Insights resulted in marked improvement of all parameters and significant medication reductions even in Diabetes of long duration with comorbidities

Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children

ObjectiveTo identify risk factors for severe disease in children hospitalised for SARS-CoV-2 infection.DesignMulticentre retrospective cohort study.Setting18 hospitals in Canada, Iran and Costa Rica from 1 February 2020 to 31 May...

Consumer workarounds during the COVID-19 pandemic: analysis and technology implications using the SAMR framework.

ObjectiveTo understand the nature of health consumer self-management workarounds during the COVID-19 pandemic; to classify these workarounds using the Substitution, Augmentation, Modification, and Redefinition (SAMR) framework; and to see how digital tools had assisted these workarounds.Materials and MethodsWe assessed 15 self-managing elderly patients with Type 2 diabetes, multiple chronic comorbidities, and low digital literacy. Interviews were conducted during COVID-19 lockdowns in May–June 2020 and participants were asked about how their self-management had differed from before. Each instance of change in self-management were identified as consumer workarounds and were classified using the SAMR framework to assess the extent of change. We also identified instances where digital technology assisted with workarounds.ResultsConsumer workarounds in all SAMR levels were observed. Substitution, describing change in work quality or how basic information was communicated, was easy to make and involved digital tools that replaced face-to-face communications, such as the telephone. Augmentation, describing changes in task mechanisms that enhanced functional value, did not include any digital tools. Modification, which significantly altered task content and context, involved more complicated changes such as making video calls. Redefinition workarounds created tasks not previously required, such as using Google Home to remotely babysit grandchildren, had transformed daily routines.Discussion and ConclusionHealth consumer workarounds need further investigation as health consumers also use workarounds to bypass barriers during self-management. The SAMR framework had classified the health consumer workarounds during COVID, but the framework needs further refinement to include more aspects of workarounds.

Clinical and Microbiological Characteristics of Neonates with Candidemia and Impacts of Therapeutic Strategies on the Outcomes.

Neonatal candidemia is associated with significant morbidities and a high mortality rate. We aimed to investigate the clinical characteristics of Candida bloodstream infections in neonates and the impact of therapeutic strategies on the outcomes. We identified all the neonates with candidemia from a medical center in Taiwan over an 18-year period (2003–2021) and analyzed them. Clinical isolates were confirmed by DNA sequencing, and antifungal susceptibility testing was performed. The prognostic factors associated with clinical treatment failure (30-day, all-cause mortality and persistent candidemia > 72 h after antifungal agents) and in-hospital mortality were analyzed using logistic regression modeling. A total of 123 neonates with 139 episodes of candidemia were included in the study. The median (IQR) gestational age and birth weight of the neonates with candidemia were 29.0 (26.0–35.0) weeks and 1104.0 (762.0–2055) g, respectively. The most common Candida spp. was Candida albicans (n = 57, 41.0%), followed by C. parapsilosis (n = 44, 31.7%), Candida guilliermondii (n = 12, 8.6%), and C. glabrata (n = 11, 7.9%). The overall susceptibility to fluconazole was 81.3%, and the resistant rates against other antifungal agents were less than 3%. The cumulative mortality rate at 7 and 30 days after the first episode of candidemia was 11.3% and 32.3%, respectively. The overall in-hospital mortality rate was 42.3%. The treatment outcomes did not change over the study period and were not affected by delayed initiation of antifungal agents. Multivariate analysis showed that delayed catheter removal (odds ratio [OR], 5.54; 95% confidence interval [CI]: 1.93–15.86, p = 0.001), septic shock (OR, 7.88; 95% CI: 2.83–21.93, p < 0.001), and multiple chronic comorbidities (OR, 8.71; 95% CI: 1.82–41.81, p = 0.007) were independently associated with the final in-hospital mortality. We concluded that the overall mortality of neonatal candidemia has remained consistently high over the past decade. Prompt early catheter removal and an aggressive treatment strategy for neonatal candidemia with septic shock would be critical to improving patient outcomes.

Chronic Complications of Diabetes

Diabetes is a chronic condition that afflicts over 450 million people worldwide. Diabetes can lead to the development of multiple chronic comorbidities, such as microvascular, macrovascular, and neuropathic complications. Furthermore, diabetes is the leading cause for many of these complications, such as blindness, peripheral arterial disease, and kidney disease. Many of these conditions can go unnoticed for many years until they become more severe and are no longer reversible. This article will provide an evidence-based review of the background, prevention, and screening for many of the complications of diabetes.

Vaccine-preventable disease hospitalized patients with heart failure with reduced ejection fraction.

BackgroundOver five million Americans suffer from heart failure (HF), and this is associated with multiple chronic comorbidities and recurrent decompensation. Currently, there is an increased incidence in vaccine‐preventable diseases (VPDs). We aim to investigate the impact of HF with reduced ejection fraction (HFrEF) in patients hospitalized with VPDs.HypothesisPatient with HFrEF are at higher risk for VPDs and they carry a higher risk for in‐hospital complications.MethodsRetrospective analysis from all hospital admissions from the 2016‐2018 National Inpatient Sample (NIS) using the ICD‐10CM codes for patients admitted with a primary diagnosis of VPDs with HFrEF and those without reduced ejection fraction. Outcomes evaluated were in‐hospital mortality, length of stay (LOS), healthcare utilization, frequency of admissions, and in‐hospital complications. Multivariate regression analysis was conducted to adjust for confounders.ResultsOut of 317 670 VPDs discharges, we identified 12 130 (3.8%) patients with HFrEF as a comorbidity. The most common admission diagnosis for VPDs was influenza virus (IV) infection (75.0% vs. 64.1%; p < .01), followed by pneumococcal pneumonia (PNA) (13% vs. 9.4%; p < .01). After adjusting for confounders, patients with HFrEF had higher odds of having diagnosis of IV (adjusted [aOR], 1.42; p < .01) and PNA (aOR, 1.27; p < .01). Patients with VPDs and HFrEF had significantly higher odds of mortality (aOR, 1.76; p < .01), LOS, respiratory failure requiring mechanical ventilation, and mechanical ventilation for less than 96 h.ConclusionInfluenza and PNA were the most common VPDs admitted to the hospital in patients with a concomitant diagnosis of HFrEF. They were associated with increased mortality and in‐hospital complications.

Methods for home-based self-applied polysomnography: the Multicenter AIDS Cohort Study.

Study ObjectivesAlong with multiple chronic comorbidities, sleep disorders are prevalent in people living with human immunodeficiency virus (HIV) infection. The goal of this study was to establish methods for assessing sleep quality and breathing-related disorders using self-applied home polysomnography in people with and without HIV.MethodsSelf-applied polysomnography was conducted on 960 participants in the Multicenter AIDS Cohort Study (MACS) using the Nox A1 recorder to collect data on the frontal electroencephalogram (EEG), bilateral electrooculograms, and a frontalis electromyogram during sleep. Breathing patterns were characterized using respiratory inductance plethysmography bands and pulse oximetry. Continuous recordings of the electrocardiogram were also obtained. All studies were scored centrally for sleep stages and disordered breathing events.ResultsSuccessful home polysomnography was obtained in 807 of 960 participants on the first attempt and 44 participants on the second. Thus, a successful polysomnogram was obtained in 851 (88.6%) of the participants. Reasons for an unsuccessful study included less than 3 h of data on oximetry (34.6%), EEG (28.4%), respiratory inductance plethysmography (21.0%), or two or more of these combined (16.0%). Of the successful studies (N = 851), signal quality was rated as good, very good, or excellent in 810 (95.2%). No temporal trends in study quality were noted. Independent correlates of an unsuccessful study included black race, current smoking, and cocaine use.ConclusionsHome polysomnography was successfully completed in the MACS demonstrating its feasibility in a community cohort. Given the burden of in-lab polysomnography, the methods described herein provide a cost-effective alternative for collecting sleep data in the home.

Aspiration pneumonia.

The growing population of older people worldwide represents a great challenge for health systems. The elderly are at increased risk of infectious diseases such as pneumonia, which is associated with increased morbidity and mortality related mainly to age-related physiological changes in the immune system (immunosenescence), the presence of multiple chronic comorbidities, and frailty. In pneumonia, microaspiration is recognized as the main pathogenic mechanism; while macroaspiration which refers to the aspiration of a large amount of oropharyngeal or upper gastrointestinal content passing through the vocal cords and trachea into the lungs is identified as “aspiration pneumonia”. Although there are strategies for the prevention and management of patients with pneumonia that have been shown to be effective in older people with pneumonia, more research is needed on aspiration pneumonia, its risk factors and outcomes, especially since there are no specific criteria for its diagnosis and consequently, the studies on aspiration pneumonia include heterogeneous populations.

Abstract 13656: Outcomes of Vaccine Preventable Diseases and Heart Failure With Reduced Ejection Fraction

Background: Over five million Americans suffer from Heart Failure (HF), and this is associated with multiple chronic comorbidities and recurrent decompensations. Currently, there is an increased incidence of vaccine-preventable diseases (VPDs). We aim to investigate the impact of VPDs on hospitalization outcomes in patients with heart failure with reduced ejection fraction (HFrEF). Methods: A retrospective analysis from all hospital admissions from the 2016-2018 National Inpatient Sample (NIS) using the ICD-10CM codes for patients admitted with a primary diagnosis of VPDs with HFrEF and those without reduced ejection fraction. Outcomes evaluated were in-hospital mortality, length of stay (LOS), health care utilization, frequency of admissions, and in-hospital complications. Multivariate regression analysis was conducted to adjust for confounders. Results: Out of 317,670 VPDs discharges, we identified 12,130 (3.8%) patients with HFrEF as comorbidity. The most common admission diagnosis for VPDs was influenza virus (IV) infection (75.0% vs 64.1%; P:&lt;0.01), followed by Pneumococcal pneumonia (PNA) (13% vs 9.4%; P:&lt;0.01). After adjusting for confounders, patients with HFrEF had higher odds of being admitted due to a diagnosis of IV (aOR 1.42; P:&lt;0.01) and PNA (aOR 1.27; P:&lt;0.01). Patients with VPDs and HFrEF had significantly higher odds of mortality (aOR 1.76; P:&lt;0.01), LOS, respiratory failure requiring mechanical ventilation, and mechanical ventilation for less than 96 hours. Conclusion: Influenza and PNA were the most common VPDs admitted to the hospital in patients with HFrEF. They were associated with increased mortality and in-hospital complications.

What Is Frailty? Perspectives from Chinese Clinicians and Older Immigrants in New Zealand

This qualitative study explores the meanings of frailty held by Chinese New Zealanders and Chinese health care professionals with the aim of identifying commonalities as well as potential differences. Two guided focus groups with Mandarin and Cantonese speaking older adults (n = 10), one individual interview with a English speaking older Chinese, and one focus group with Chinese New Zealand health care professionals (n = 7) were held to obtain views on frailty in older adults, followed by transcribing and a thematic qualitative analysis. Three main themes emerged: (1) Frailty is marked by ill-health, multiple chronic and unstable medical comorbidities, and is a linked with polypharmacy; (2) Frailty can involve physical weakness, decline in physical function such as reduced mobility or poor balance, and declining cognitive function; and (3) Frailty is associated with psychological and social health including depression, reduced motivation, social isolation, and loss of confidence. The perspectives of frailty that emerged are congruent with a multi-dimensional concept of frailty that has been described in both Chinese and non-Chinese medical research literature.

Real-time, simulation-enhanced interprofessional education in the care of older adults with multiple chronic comorbidities: a utilization-focused evaluation

Background: Interprofessional education (IPE) is a curricular requirement for all healthcare professional education standards. To foster learning about, from and with each other, consistent with the Interprofessional Education Consortium’s Core Competencies, many graduate schools are integrating interprofessional (IP) simulation experiences throughout their educational curricula, providing multiple opportunities for health professional students to collaborate and practice together. High-fidelity, real-time simulations help students from diverse professional backgrounds to apply their classroom learning in realistic clinical situations, utilize mobile technology to access clinical decision support (CDS) software, and receive feedback in a safe setting, ensuring they are practice-ready upon graduation.

Real-time, simulation-enhanced interprofessional education in the care of older adults with multiple chronic comorbidities: a utilization-focused evaluation.

Interprofessional education (IPE) is a curricular requirement for all healthcare professional education standards. To foster learning about, from and with each other, consistent with the Interprofessional Education Consortium's Core Competencies, many graduate schools are integrating interprofessional (IP) simulation experiences throughout their educational curricula, providing multiple opportunities for health professional students to collaborate and practice together. High-fidelity, real-time simulations help students from diverse professional backgrounds to apply their classroom learning in realistic clinical situations, utilize mobile technology to access clinical decision support (CDS) software, and receive feedback in a safe setting, ensuring they are practice-ready upon graduation. New York University Rory Meyers College of Nursing (NYU) and Long Island University College of Pharmacy (LIU) partnered for two consecutive years to create, coordinate and implement two interprofessional educational simulations involving patients with chronic cardiovascular disease. A utilization-focused evaluation of high-fidelity, simulation-enhanced IPE (Sim-IPE) was implemented to assess students' IP competencies before and after their participation in the IPE-simulation and their overall satisfaction with the experience. The Interprofessional Collaborative Competency Attainment Survey (ICCAS), a reliable instrument, was administered to both doctor of pharmacy students and primary care advanced practice nursing students before and after each simulation experience. Additionally, student satisfaction surveys were administered following the IPE-simulation. Aggregated means revealed statistically significant improvements in each of the six domains including communication, collaboration, roles and responsibilities, collaborative patient/family approach, conflict resolution and team functioning. Student ratings revealed positive experiences with the IPE-simulations. High-fidelity, real-time IPE-simulation is a powerful pedagogy to help graduate students from different professional backgrounds practice applying IP competencies in simulated experiences. Quality improvement studies and research studies are needed to assess the impact of high-fidelity, real-time simulations throughout graduate curricula with different types of patients to improve coordinated, team approaches to treatment.

Development and validation of an aetiology in delirium diagnostic support tool.

recognition of the multifactorial causes of delirium represents a clinical challenge. to develop and show proof of principle of a diagnostic support tool (DST) for identification of causes of delirium. stage 1-development of the aetiology in delirium-diagnostic support tool (AiD-DST); stage 2-validation of the AiD-DST against reference standard diagnosis, based on clinical assessment from two independent consultant geriatricians. a series of eight steps AiD-DST were formulated by an expert group to identify possible causes of delirium. Forty inpatients admitted to a general medical unit with a consultant physician/geriatrician diagnosis of delirium were recruited, consented and reviewed against the AiD-DST. Mean age was 85.1 (standard deviation 7.9) years and 26 (65%) of participants were female. Participants had multiple chronic co-morbidities [median Charlson Comorbidity Index 7; interquartile range (IQR 6-9)] and median number of medications was 8 (IQR 6-11.75). Median number of causes of delirium detected on AiD-DST was 3 (IQR 3-4) versus 5 (IQR 3-6) using the reference standard diagnosis, with sensitivity of 88.8% (95% confidence interval, 81.6-93.9%) and specificity of 71.8% (63-79.5%). the aetiology in delirium DST shows promise in the identification of cause(s) in delirium.

Gastrointestinal bleeding from gangliocytic paraganglioma treated with palliative radiotherapy: a case report

: Gangliocytic paraganglioma (GP) is a rare neuroendocrine tumor typically found in the second part of the duodenum. The rarity of this tumor has not allowed development of treatment guidelines. The mainstay of treatment involves endoscopic or surgical resection. Adjuvant chemotherapy or radiation have been utilized in a few cases. Gastrointestinal bleeding from GP treated with radiotherapy has not been described in the literature. The case described is of a patient presenting with a 6-month history of hematochezia and a one week history of fatigue. An esophagogastroduodenoscopy (EGD) was performed demonstrating a 3-cm periampullary, non-obstructing mass with areas of ulceration and oozing. Pathology from biopsy samples showed trabeculae and cords of epithelioid cells bordered by S-100 positive spindled cells consistent with paraganglioma as well as scattered “large cells” without typical ganglion cell morphology. GP was favored versus other neuroendocrine carcinomas given its classic location in the second part of duodenum, presentation with bleeding, and the morphological pattern of paraganglioma. This patient was a poor surgical candidate and at high risk of perioperative mortality due to multiple chronic comorbidities and poor functional capacity. It was decided to administer fourteen courses of 35 Gray (Gy) palliative radiotherapy to control the patient’s gastrointestinal (GI) bleeding. Surveillance EGD was performed after his tenth treatment which showed no further areas of oozing along the mass. From his first to his last radiotherapy session, his hemoglobin improved from 7.5 to 8.9 g/dL without further episodes of hematochezia. One week after his discharge, the patient died from cardiac arrest. Radiotherapy may be useful in controlling GI bleed secondary to GP in a palliative setting.

Incidence, Characteristics, and Outcome of COVID-19 in Adults on Kidney Replacement Therapy: A Regionwide Registry Study.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection disproportionally affects frail, elderly patients and those with multiple chronic comorbidities. Whether patients on RRT have an additional risk because of their specific exposure and complex immune dysregulation is controversial. To describe the incidence, characteristics, and outcomes of SARS-CoV-2 infection, we conducted a prospective, multicenter, region-wide registry study in adult patients on RRT versus the general population from March 2 to May 25, 2020. This study comprised all patients undergoing RRT in the Flanders region of Belgium, a country that has been severely affected by coronavirus disease 2019 (COVID-19). At the end of the epidemic wave, crude and age-standardized cumulative incidence rates of SARS-CoV-2 infection were 5.3% versus 2.5%, respectively, among 4297 patients on hemodialysis, and 1.4% versus 1.6%, respectively, among 3293 patients with kidney transplants (compared with 0.6% in the general population). Crude and age-standardized cumulative mortality rates were 29.6% versus 19.9%, respectively, among patients on hemodialysis, and 14.0% versus 23.0%, respectively, among patients with transplants (compared with 15.3% in the general population). We found no excess mortality in the hemodialysis population when compared with mean mortality rates during the same 12-week period in 2015-2019 because COVID-19 mortality was balanced by lower than expected mortality among uninfected patients. Only 0.18% of the kidney transplant population died of SARS-CoV-2 infection. Mortality associated with SARS-CoV-2 infection is high in patients on RRT. Nevertheless, the epidemic's overall effect on the RRT population remained remarkably limited in Flanders. Calculation of excess mortality and age standardization provide a more reliable picture of the mortality burden of COVID-19 among patients on RRT.

Evaluation of the Efficacy of Probiotics (MCP® BCMC® Strains) Treating Constipation in Elderly Patients with Multiple Chronic Co-Morbidities: A Randomized Control Trial.

To evaluate the impact of a microbial cell preparation (MCP®) (Hexbio®; comprising MCP® BCMC® strains) on stool frequency, consistency, and constipation-related symptoms in elderly patients with multiple chronic medical conditions. Randomised control trial. Medical outpatient and medical/surgical in-patient unit in single tertiary center. Patients aged ≥ 60 years who experience constipation and have multiple chronic medical conditions. Participants with constipation were blindly randomized into either a treatment (MCP® BCMC® strains) or a placebo group. The treatment was administered twice daily. Gastrointestinal symptoms and stool habits were assessed over a week during the intervention via the use of a questionnaire and stool diary. Stool frequency was seen to be higher and the improvement in stool consistency was more significant in the treatment group than in the placebo group (p =<0.001). A significant improvement in symptoms was demonstrated in patients who received MCP® BCMC® strains,specifically with respect to straining (p = < 0.001) and a sensation of incomplete evacuation (p = < 0.001). reduction in anorectal blockage symptoms and the need for manual stool evacuation was also demonstrated, but this finding was not statistically significant. Significant adverse events were not observed. An improvement in stool frequency and consistency was reported in elderly patients with chronic medical conditions following the administration of MCP® BCMC® strains.

Changes in chronic medication adherence, costs, and health care use after a cancer diagnosis among low-income patients and the role of patient-centered medical homes.

Approximately 40% of patients with cancer also have another chronic medical condition. Patient-centered medical homes (PCMHs) have improved outcomes among patients with multiple chronic comorbidities. The authors first evaluated the impact of a cancer diagnosis on chronic medication adherence among patients with Medicaid coverage and, second, whether PCMHs influenced outcomes among patients with cancer. Using linked 2004 to 2010 North Carolina cancer registry and claims data, the authors included Medicaid enrollees who were diagnosed with breast, colorectal, or lung cancer who had hyperlipidemia, hypertension, and/or diabetes mellitus. Using difference-in-difference methods, the authors examined adherence to chronic disease medications as measured by the change in the percentage of days covered over time among patients with and without cancer. The authors then further evaluated whether PCMH enrollment modified the observed differences between those patients with and without cancer using a differences-in-differences-in-differences approach. The authors examined changes in health care expenditures and use as secondary outcomes. Patients newly diagnosed with cancer who had hyperlipidemia experienced a 7-percentage point to 11-percentage point decrease in the percentage of days covered compared with patients without cancer. Patients with cancer also experienced significant increases in medical expenditures and hospitalizations compared with noncancer controls. Changes in medication adherence over time between patients with and without cancer were not determined to be statistically significantly different by PCMH status. Some PCMH patients with cancer experienced smaller increases in expenditures (diabetes) and emergency department use (hyperlipidemia) but larger increases in their inpatient hospitalization rates (hypertension) compared with non-PCMH patients with cancer relative to patients without cancer. PCMHs were not found to be associated with improvements in chronic disease medication adherence, but were associated with lower costs and emergency department visits among some low-income patients with cancer.