Beyond diagnosis: rising to the multimorbidity challenge

Mangin, Dee; Heath, Iona; Jamoulle, Marc

doi:10.1136/bmj.e3526

Cited by 137 publications

(125 citation statements)

References 14 publications

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“…Support that focuses more on the person than on the disease and the range of variation that this entails has been called for [33]. Our findings demonstrate that the multi-disciplinary co-ordinated approach taken by the EPIOC service is appropriate for meeting the health needs of users through a holistic approach in the provision of powered mobility.…”

Section: Resultsmentioning

confidence: 77%

“…In our study, these cases resulted in referral onwards to the primary care team for further medical management. Although evidence is lacking to support the difficult clinical decisions needed to inform best rehabilitation practice for those with multiple health conditions [33], it is recommended that taking specific precautions could prevent some deaths in MS [32].…”

Section: Comorbiditiesmentioning

confidence: 99%

“…Such decisions are made, not only in the best interests of the user but also recognising user and carer preferences. Taking into account the comorbidity and the complications of MS and disability avoids the dangers of ''siloing'' users into a single diagnostic group [33] and the potential additional costs for failing to account for disease severity [41] and any additional impairments.…”

Section: Ambiguities Of Classificationmentioning

confidence: 99%

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Problematic clinical features of powered wheelchair users with severely disabling multiple sclerosis

Souza

Frank

2014

Disability and Rehabilitation

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Purpose: The aim of this study is to describe the clinical features of powered wheelchair users with severely disabling multiple sclerosis (MS) and explore the problematic clinical features influencing prescription. Method: Retrospective review of electronic and case note records of recipients of electric-powered indoor/outdoor powered wheelchairs (EPIOCs) attending a specialist wheelchair service between June 2007 and September 2008. Records were reviewed by a consultant in rehabilitation medicine, data systematically extracted and entered into a computer database. Further data were entered from clinical records. Data were extracted under three themes; demographic, diagnostic, clinical and wheelchair factors. Results: Records of 28 men mean age 57 (range 37-78, SD 12) years and 63 women mean age 57 (range 35-81, SD 11) years with MS were reviewed a mean of 64 (range 0-131) months after receiving their wheelchair. Twenty two comorbidities, 11 features of MS and 8 features of disability were thought to influence wheelchair prescription. Fifteen users were provided with specialised seating and 46 with tilt-in-space seats. Conclusions: Our findings suggest that people with severe MS requiring an EPIOC benefit from a holistic assessment to identify problematic clinical features that influence the prescription of the EPIOC and further medical and therapeutic interventions. ä Implications for RehabilitationPeople with multiple sclerosis (MS), referred for an EPIOC, require a full clinical assessment to identify problematic clinical features that are potentially treatable and/or can be accommodated through specialised seating and tilt. The beneficial effects of TIS should be considered for all EPIOC users with MS and particularly for those with comorbidity Poorly controlled spasticity, when identified in people with MS, should be managed through positioning in the chair, pressure-relieving cushion and referral for medical management.

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Section: Resultsmentioning

confidence: 77%

Section: Comorbiditiesmentioning

confidence: 99%

Section: Ambiguities Of Classificationmentioning

confidence: 99%

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Problematic clinical features of powered wheelchair users with severely disabling multiple sclerosis

Souza

Frank

2014

Disability and Rehabilitation

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“…The four actions are in reality all the daily activities of a family doctor. Family doctors are used to address multiple problems during an encounter (34). As continuity and longitudinality are foundational for family practice, prevention is naturally embedded in daily contacts.…”

Section: The Task Of the Family Doctor Includes Naturally The Four Fimentioning

confidence: 99%

Quaternary prevention, an answer of family doctors to overmedicalization

Jamoulle

2015

Int J Health Policy Manag

104

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In response to the questioning of Health Policy and Management (HPAM) by colleagues on the role of rank and file family physicians in the same journal, the author, a family physician in Belgium, is trying to highlight the complexity and depth of the work of his colleagues and their contribution to the understanding of the organization and economy of healthcare. It addresses, in particular, the management of health elements throughout the ongoing relationship of the family doctor with his/her patients. It shows how the three dimensions of prevention, clearly included in the daily work, are complemented with the fourth dimension, quaternary prevention or prevention of medicine itself, whose understanding could help to control the economic and human costs of healthcare.

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“…These factors increase the chance of skin breakdown and complicate treatment. [2][3][4] Furthermore, because LTC residents have multiple chronic diseases and may have increased medication burden, 5,6 wounds that may been healable in younger populations are deemed as maintenance or unhealable wounds. 7 Vital to supporting wound healing, current best practice guidelines for treating pressure injuries recommend off-loading pressure, reducing friction and sheer forces, appropriate debridement, proper nutrition, infection Funding Source: This study was not funded by any research grants or funding agencies.…”

Section: Introductionmentioning

confidence: 99%

The Use of a No-sting Barrier Film Treatment Protocol Compared to Routine Clinical Care for the Treatment of Stage 1 and 2 Pressure Injuries in Long-term Care

Chan

Siu

2015

Journal of the American College of Clinical Wound Specialists

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Pressure injuries increase morbidity and mortality in geriatric patients by 400%. Residents in long-term care (LTC) are at high risk of developing pressure injuries because of limited mobility, poor nutritional status, impaired cognition, and incontinence. This study aims to determine whether a no-sting barrier film (NSBF) treatment protocol is more effective than current physician practices for treating stage 1 and 2 pressure injuries in LTC. A retrospective cohort study of 129 residents from one LTC facility was performed after a six-month implementation trial of a NSBF treatment protocol. The six-month incidence rate of stage 1 and 2 pressure injuries was 9% and 38% respectively. There was a statistically significant reduction in healing time in those treated with the NSBF protocol. In summary, the NSBF protocol reduces healing time of stage 1 and 2 pressure injuries; this protocol could be easily incorporated into existing pressure injury treatment strategies in LTC.

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Beyond diagnosis: rising to the multimorbidity challenge

Cited by 137 publications

References 14 publications

Problematic clinical features of powered wheelchair users with severely disabling multiple sclerosis

Problematic clinical features of powered wheelchair users with severely disabling multiple sclerosis

Quaternary prevention, an answer of family doctors to overmedicalization

The Use of a No-sting Barrier Film Treatment Protocol Compared to Routine Clinical Care for the Treatment of Stage 1 and 2 Pressure Injuries in Long-term Care

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