Bringing complexity into clinical practice: An internistic approach

Corazza, Gino Roberto; Formagnana, Pietro; Lenti, Marco Vincenzo

doi:10.1016/j.ejim.2018.11.009

Cited by 57 publications

(57 citation statements)

References 77 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In our study, the vast majority of patients (86%) had to consult at least two different specialist physicians before a definitive diagnosis was made. An excessive fragmentation of care may contribute per se to diagnostic delay and to poorer patient management, as was hypothesised in other settings . Haematologists made a correct diagnosis with a median diagnostic delay of 1 month, compared to a median of 6 months for gastroenterologists.…”

Section: Discussionmentioning

confidence: 95%

Determinants of diagnostic delay in autoimmune atrophic gastritis

Lenti

Miceli

Cococcia

et al. 2019

Aliment Pharmacol Ther

Self Cite

View full text Add to dashboard Cite

Background: Autoimmune atrophic gastritis (AAG) is characterised by a wide clinical spectrum that could delay its diagnosis.Aims: To quantify the diagnostic delay in patients suffering from AAG and to explore possible risk factors for longer diagnostic delay. Methods:Consecutive patients with AAG evaluated at our gastroenterological outpatient clinic between 2009 and 2018 were included. Diagnostic delay was estimated as the time lapse occurring between the appearance of the first likely symptoms, laboratory alterations, and other clues indicative of AAG and the final diagnosis.Patient-dependent and physician-dependent diagnostic delays were also assessed.Multivariable regression models were fitted.Results: 291 patients with AAG (mean age at diagnosis 61 ± 15 years; F:M ratio = 2.3:1) were included. The median overall diagnostic delay was 14 months (interquartile range [IQR] 4-41). Factors associated with longer median overall diagnostic delay were female sex (17 months, IQR 5-48), having a previous misdiagnosis (36 months, IQR 17-125) and a history of infertility/miscarriages (33 months, IQR 8-120), whereas a higher level of education was associated with longer patient-dependent diagnostic delay (4 months, IQR 1-12). First evaluation by a gastroenterologist was associated with a median longer diagnostic delay (6 months, IQR 2-15) compared to an internist (3 months, IQR 3-31) and a haematologist (1 month, IQR 0-2). Age, socioeconomic or marital status did not affect the diagnostic delay.Conclusions: AAG is burdened by substantial diagnostic delay, especially in female patients, and due to lack of awareness, particularly among gastroenterologists.Uncommon vitamin B12 deficiency-related manifestations are overlooked and may prolong the diagnostic delay.

show abstract

Section: Discussionmentioning

confidence: 95%

Determinants of diagnostic delay in autoimmune atrophic gastritis

Lenti

Miceli

Cococcia

et al. 2019

Aliment Pharmacol Ther

Self Cite

View full text Add to dashboard Cite

show abstract

“…Building further on the important foundation of CGA and frailty, adding a dynamical dimension through resilience measurements may offer a way forward in personalizing the prediction and management of recovery . Quantitative tools to dynamically measure resilience can complement CGA‐based clinical intuitions and hence boost clinical resilience management .…”

Section: Added Value Of the Resilience Conceptmentioning

confidence: 99%

“…59 Building further on the important foundation of CGA and frailty, adding a dynamical dimension through resilience measurements may offer a way forward in personalizing the prediction and management of recovery. 19 Quantitative tools to dynamically measure resilience can complement CGA-based clinical intuitions and hence boost clinical resilience management. 4,9 In this review, two crucial leads for developing such tools and expanding our capacity to manage the resilience of individual patients are advocated: first, performing multiple repeated measurements around a stressor can provide insight about the patient's dynamic responses to stressors; and, second, linking psychological and physiological subsystems can provide insight into dynamic interactions involved in a resilient response.…”

Section: Added Value Of the Resilience Conceptmentioning

confidence: 99%

Resilience in Clinical Care: Getting a Grip on the Recovery Potential of Older Adults

Gijzel

Whitson

Leemput

et al. 2019

J American Geriatrics Society

View full text Add to dashboard Cite

Background Geriatricians are often confronted with unexpected health outcomes in older adults with complex multimorbidity. Aging researchers have recently called for a focus on physical resilience as a new approach to explaining such outcomes. Physical resilience, defined as the ability to resist functional decline or recover health following a stressor, is an emerging construct. Methods Based on an outline of the state‐of‐the‐art in research on the measurement of physical resilience, this article describes what tests to predict resilience can already be used in clinical practice and which innovations are to be expected soon. Results An older adult's recovery potential is currently predicted by static tests of physiological reserves. Although geriatric medicine typically adopts a multidisciplinary view of the patient and implicitly performs resilience management to a certain extent, clinical management of older adults can benefit from explicitly applying the dynamical concept of resilience. Two crucial leads for advancing our capacity to measure and manage the resilience of individual patients are advocated: first, performing multiple repeated measurements around a stressor can provide insight about the patient's dynamic responses to stressors; and, second, linking psychological and physiological subsystems, as proposed by network studies on resilience, can provide insight into dynamic interactions involved in a resilient response. Conclusion A big challenge still lies ahead in translating the dynamical concept of resilience into clinical tools and guidelines. As a first step in bridging this gap, this article outlines what opportunities clinicians and researchers can already exploit to improve prediction, understanding, and management of resilience of older adults. J Am Geriatr Soc 67:2650–2657, 2019

show abstract

“…Comorbidity is one of the major factors contributing to patients' complexity, leading to a more difficult therapeutic approach, especially when it is associated with frailty. Physicians often have to face with multimorbid patients and this could be due to the spreading of unhealthy lifestyle and to the longer life expectancy (81). Moreover, comorbidity worsens the prognosis of IBD per se, increasing the likelihood of drug-to-drug interaction.…”

Section: Comorbiditiesmentioning

confidence: 99%

Preventing Infections by Encapsulated Bacteria Through Vaccine Prophylaxis in Inflammatory Bowel Disease

et al. 2020

Self Cite

View full text Add to dashboard Cite

Inflammatory bowel disease (IBD), which comprises ulcerative colitis and Crohn's disease, is an immune-mediated, chronic-relapsing, disabling disorder which is associated with increased mortality and poor patients' quality of life. Patients with IBD are at increased risk of infections for many reasons. In fact, IBD often requires a lifelong immunosuppressive and/or biologic therapy, both commonly associated with respiratory and opportunistic infections, but also gastrointestinal, urinary tract infections, and sepsis. Moreover, impaired spleen function has been found in a considerable proportion of IBD patients, further increasing the risk of developing infections sustained by encapsulated bacteria, such as S. pneumoniae, H. influenzae, and N. meningitidis. Finally, comorbidities and surgery represent additional risk factors for these patients. Despite the availability of vaccinations against the most common serotypes of encapsulated bacteria, uncertainties still exist regarding a proper vaccination strategy and the actual effectiveness of vaccinations in this particular setting. Aim of this narrative review is to focus on the broad topic of vaccinations against encapsulated bacteria in IBD patients, discussing the clinical impact of infections, predisposing factors, vaccinations strategies, and unmet research and clinical needs.

show abstract

Bringing complexity into clinical practice: An internistic approach

Cited by 57 publications

References 77 publications

Determinants of diagnostic delay in autoimmune atrophic gastritis

Determinants of diagnostic delay in autoimmune atrophic gastritis

Resilience in Clinical Care: Getting a Grip on the Recovery Potential of Older Adults

Preventing Infections by Encapsulated Bacteria Through Vaccine Prophylaxis in Inflammatory Bowel Disease

Contact Info

Product

Resources

About