https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)60240-2.pdf

Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study

Supplementary Table 9, column 'Edoxaban', row 'eGFR category', '95 mL/min' (page 15). The cell should be coloured green instead of yellow. It should also read "60 mg"instead of "60 mg (use with caution in 'supranormal' renal function)."In the above-indicated cell, a footnote has also been added to state: "Edoxaban should be used in patients with high creatinine clearance only after a careful evaluation of the individual thromboembolic and bleeding risk."Supplementary Table 9, column 'Edoxaban', row 'Dose reduction in selected patients' (page 16). The cell should read "Edoxaban 60 mg reduced to 30 mg once daily if any of the following: creatinine clearance 15-50 mL/min, body weight <60 kg, concomitant use of dronedarone, erythromycin, ciclosporine or ketokonazole"instead of "Edoxaban 60 mg reduced to 30 mg once daily, and edoxaban 30 mg reduced to 15mg once daily, if any of the following: creatinine clearance of 30-50 mL/min, body weight <60 kg, concomitant us of verapamil or quinidine or dronedarone."

/pdf/2020-esc-guidelines-for-the-diagnosis-and-management-of-38dpic1xu8.pdf

2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).

D iabetes mellitus is a chronic illness that requires continuing medical care and ongoing patient self-management education and support to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payers, and other interested individuals with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. Specifically titled sections of the standards address children with diabetes, pregnant women, and people with prediabetes. These standards are not intended to preclude clinical judgment or more extensive evaluation and management of the patient by other specialists as needed. For more detailed information about management of diabetes, refer to references 1–3. The recommendations included are screening, diagnostic, and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A large number of these interventions have been shown to be cost-effective (4). A grading system (Table 1), developed by the American Diabetes Association (ADA) andmodeled after existingmethods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E. These standards of care are revised annually by the ADA’s multidisciplinary Professional Practice Committee, incorporating new evidence. For the current revision, committee members systematically searched Medline for human studies related to each subsection and published since 1 January 2010. Recommendations (bulleted at the beginning of each subsection and also listed in the “Executive Summary: Standards of Medical Care in Diabetesd2012”) were revised based on new evidence or, in some cases, to clarify the prior recommendation or match the strength of the wording to the strength of the evidence. A table linking the changes in recommendations to new evidence can be reviewed at http:// professional.diabetes.org/CPR_Search. aspx. Subsequently, as is the case for all Position Statements, the standards of care were reviewed and approved by the ExecutiveCommittee of ADA’s Board ofDirectors, which includes health care professionals, scientists, and lay people. Feedback from the larger clinical community was valuable for the 2012 revision of the standards. Readers who wish to comment on the “Standards of Medical Care in Diabetesd2012” are invited to do so at http://professional.diabetes.org/ CPR_Search.aspx. Members of the Professional Practice Committee disclose all potential financial conflicts of interest with industry. These disclosures were discussed at the onset of the standards revisionmeeting. Members of the committee, their employer, and their disclosed conflicts of interest are listed in the “Professional PracticeCommitteeMembers” table (see pg. S109). The AmericanDiabetes Association funds development of the standards and all its position statements out of its general revenues and does not utilize industry support for these purposes.

https://www.science-open.com/document_file/bb04d9d0-b3df-4133-9494-e71e300f4279/PubMedCentral/bb04d9d0-b3df-4133-9494-e71e300f4279.pdf

Standards of Medical Care in Diabetes—2012

Given the functional interdependencies between the molecular components in a human cell, a disease is rarely a consequence of an abnormality in a single gene, but reflects the perturbations of the complex intracellular and intercellular network that links tissue and organ systems. The emerging tools of network medicine offer a platform to explore systematically not only the molecular complexity of a particular disease, leading to the identification of disease modules and pathways, but also the molecular relationships among apparently distinct (patho)phenotypes. Advances in this direction are essential for identifying new disease genes, for uncovering the biological significance of disease-associated mutations identified by genome-wide association studies and full-genome sequencing, and for identifying drug targets and biomarkers for complex diseases.

Network Medicine: A Network-Based Approach to Human Disease

25. Multiple Imputation for Nonresponse in Surveys. By D. B. Rubin. ISBN 0 471 08705 X. Wiley, Chichester, 1987. 258 pp. £30.25.

Multiple Imputation for Nonresponse in Surveys

Results In a sample of 3309 patients in the community, the prevalence of multimorbidity was 662% (95% CI: 645–678) in those >50 years of age Health care utilization and cost was significantly increased among patients with multimorbidity (P 4 conditions versus 0 conditions); hospital out-patient visits (P = 0001) (36 versus 06 for >4 conditions versus 0 conditions); hospital admissions (P = 001) [adjusted odds ratio (OR) of 451 for >4 conditions versus 0 conditions] and total health care costs (P 4c onditions versus 0 conditions) over the previous 12 months Conclusions Multimorbidity is very common in primary care and in a system with strong gatekeeping is associated with high health care utilization and cost across the health care system Interventions to address quality and cost associated with multimorbidity must focus on primary as well as secondary care

/pdf/the-prevalence-of-multimorbidity-in-primary-care-and-its-41f4pp825z.pdf

The prevalence of multimorbidity in primary care and its effect on health care utilization and cost

PURPOSE Many patients consulting in primary care have multiple conditions (multimorbidity). Aims of this review were to identify measures of multimorbidity and morbidity burden suitable for use in research in primary care and commu- nity populations, and to investigate their validity in relation to anticipated asso- ciations with patient characteristics, process measures, and health outcomes. METHODS Studies were identifi ed using searches in MEDLINE and EMBASE from inception to December 2009 and bibliographies. RESULTS Included were 194 articles describing 17 different measures. Commonly used measures included disease counts (n = 98), Chronic Disease Score (CDS) / RxRisk (n = 17), Adjusted Clinical Groups (ACG) System (n = 25), the Charlson index (n = 38), the Cumulative Index Illness Rating Scale (CIRS; n = 10) and the Duke Severity of Illness Checklist (DUSOI; n = 6). Studies that compared measures sug- gest their predictive validity for the same outcome differs only slightly. Evidence is strongest for the ACG System, Charlson index, or disease counts in relation to care utilization; for the ACG System in relation to costs; for Charlson index in relation to mortality; and for disease counts or Charlson index in relation to quality of life. Simple counts of diseases or medications perform almost as well as complex mea- sures in predicting most outcomes. Combining measures can improve validity. CONCLUSIONS The measures most commonly used in primary care and com- munity settings are disease counts, Charlson index, ACG System, CIRS, CDS, and DUSOI. Different measures are most appropriate according to the outcome of interest. Choice of measure will also depend on the type of data available. More research is needed to directly compare performance of different measures.

https://www.annfammed.org/content/annalsfm/10/2/134.full.pdf

Measures of multimorbidity and morbidity burden for use in primary care and community settings: A systematic review and guide

Fundamento y objetivo El SF-36 es uno de los cuestionarios de calidad de vida mas evaluados y utilizados. Se han desarrollado 2 componentes sumarios (fisico y mental) a partir de sus 8 dimensiones originales. Nuestro objetivo ha sido obtener los pesos espanoles para el calculo de los componentes sumarios del SF-36 y el SF-12, evaluar sus caracteristicas metricas y obtener las normas poblacionales de referencia. Material y metodo Se han utilizado muestras representativas de la poblacion espanola procedentes de 2 estudios transversales: «Encuesta domiciliaria sobre uso de drogas» (n = 9.151) e «Hipertension arterial y otros factores de riesgo en ancianos» (n = 3.004). Los pesos espanoles de los componentes sumarios del SF-36 y SF-12 se calcularon mediante analisis de componentes principales y regresion lineal multiple, respectivamente. Para evaluar la validez de constructo se compararon grupos conocidos y la fiabilidad se evaluo con coeficientes de consistencia interna. Resultados Los pesos espanoles obtenidos fueron muy similares a los de la version original norteamericana (correlacion > 0,9). Los items del SF-12 explicaron el 91% de la variancia de los componentes sumarios del SF-36. Todas las puntuaciones fueron inferiores (peores) en los grupos de mayor edad y mas desfavorecidos (p  Conclusiones Los componentes sumarios fisico y mental calculados con pesos espanoles son fiables y validos. Las normas de referencia para dichos sumarios facilitaran la interpretacion de los resultados de calidad de vida evaluada con los cuestionarios SF en estudios realizados en Espana.

Interpretación de los cuestionarios de salud SF-36 y SF-12 en España: componentes físico y mental

ORIGINALES Interpretación de los cuestionarios de salud SF-36 y SF-12 en España: componentes físico y mental

The umbrella term Patient Reported Outcomes (PRO) has been successfully proposed for instruments measuring perceived health outcomes, but its relationship to current conceptual models remains to be established. Our aim was to develop a classification system for PRO measures based on a valid conceptual model. We reviewed models and classification schemes of health outcomes and integrated them in a common conceptual framework, based on the models by Wilson and Cleary and the International Classification of Functioning (ICF). We developed a cross-classification system based on the minimum common set of consistent concepts identified in previous classifications, and specified categories based on the WHO International Classifications (ICD-10, and ICF). We exemplified the use of the classification system with selected PRO instruments. We identified three guiding concepts: (1) construct (the measurement object); (2) population (based on age, gender, condition, and culture); and (3) measurement model (dimensionality, metric, and adaptability). The application of the system to selected PRO measures demonstrated the feasibility of its use, and showed that most of them actually assess more than one construct. This classification system of PRO measures, based on a valid integrated conceptual model, should allow the classification of most currently used instruments and may facilitate a more adequate selection and application of these instruments.

/pdf/patient-reported-outcome-measures-a-model-based-11apoig3dl.pdf

Jose M Valderas

Papers

The prevalence of multimorbidity in primary care and its effect on health care utilization and cost

Measures of multimorbidity and morbidity burden for use in primary care and community settings: A systematic review and guide

Interpretación de los cuestionarios de salud SF-36 y SF-12 en España: componentes físico y mental

ORIGINALES Interpretación de los cuestionarios de salud SF-36 y SF-12 en España: componentes físico y mental

Patient reported outcome measures: a model-based classification system for research and clinical practice