PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “multimorbidity”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 145 records · Page 8Linked to original sources
PubMed2004

[Treatment options for bladder disorders in the aged].

Urinary incontinence in the elderly is caused primarily by multiple factors such as physiologic changes of old age connected with multimorbidity and functional deficiencies, polypharmacology, psychosociological influences as well as conditions of the milieu. All these factors have to be carefully considered for therapy to be effective. Continence should be the goal of such therapy. Active participation in daily life can also be achieved by using auxiliary devices to improve the impaired quality of life. Temporary incontinence demands the search for its cause, while chronic incontinence calls for a differentiated form of therapy according to the kind of incontinence encountered. Conservative treatment consists of behavior therapy, such as toilet-(habit)-training and pelvic floor exercises. The use of drugs and auxiliary devices are equally important.

Aged↗
PubMed2006

[A new method for standardized diagnosis following renal transplantation. Ultrasound with contrast enhancement].

Ultrasound (US) imaging is an important diagnostic tool following renal transplantation. Unfortunately, due to the heterogeneity of the recipients and their multimorbidity, imaging procedures in the early phase after kidney transplantation are difficult and of limited use. We performed a study to evaluate the use of a contrast enhancer for US examination as a standardized method in the follow-up of kidney transplant recipients.The study included 40 recipients: 32 were examined on the 5th to 7th day following transplantation and 8 patients at the time when clinically suspicious findings occurred (acute rejection, tumor, acute tubular necrosis). Following the intravenous application of the contrast medium, pictures were taken during the arterial and parenchymatous phase and compared with conventional B-mode and power Doppler pictures of the same visual plane. Three examiners assessed different parameters of the transplant organ (max. vascularized area, suspected hematomas, tumors, rejection, acute tubular necrosis). Findings were confirmed by histological results of a biopsy if rejection, tumor, or acute tubular necrosis were suspected. Application of ultrasound contrast medium significantly increased visualization of the vascularized kidney area. Also, US findings in the follow-up after acute rejection therapy corresponded with the clinical course; 19 hematomas could be detected with contrast medium compared to only 9 without. With contrast medium a perfusion deficit was detectable in three patients compared to one patient with power Doppler US. Also, US contrast medium helped to detect tumor vascularization in two patients in whom conventional sonography suspected no abnormality. Ultrasound contrast medium enhancement is a reproducible, reliable, and easy to apply method which is superior to conventional sonography in the follow-up after kidney transplantation. This method is also helpful to detect and control acute rejections and to better visualize hematomas, deficits of perfusion, and tumors.

Adolescent↗
PubMed2001

[Radiotherapy of urothelial carcinomas of the urinary bladder].

Radiotherapy of bladder cancer is a locally effective therapeutic approach. It is increasingly becoming part of the multimodal protocols aimed at the preservation of both organ and organ function. In this context, it is an alternative to cystectomy. The addition of chemotherapy to radiotherapy enhances the curative potential of this non-surgical approach and may be useful especially in older, multimorbid patients. If chemotherapy can not be applied, the use of radiotherapy alone is reasonable, although in advanced tumors the results are disappointing. After the transurethral resection of bladder cancer, postoperative radiotherapy should be considered in muscle-invasive cancer as well as when other negative prognostic factors occur. The prerequisites for an effective, minimally toxic, state of the art radiotherapy are a subtle treatment-planning procedure and an accurate delivery of the radiation.

Carcinoma, Transitional Cell↗
PubMed2002

[Therapy of rheumatoid cubarthritis].

With the progression of rheumatoid arthritis (RA),more than half of the patients develop an affliction of the elbow.Cub arthritis has to be regarded as a part of systemic rheumatoid disease. Thus, the indication for operative treatment depends not only on local changes but is determined by the pattern of all affected joints, the activity of the basic rheumatic disease as well as the effect of physical therapy and medication. The complexity of the rheumatic disease, which typically affects many joints, demands an individual therapeutic plan that can only be developed and accomplished successfully when rheumatologists, rheumatoid surgeons and other specialists cooperate. In cases of recurrent cub arthritis,in spite of adequate medication, synoviorthesis or synovectomy should be performed. This may relieve pain and swelling,however if lesions of the cartilage already exist,progressive joint destruction cannot be prevented. Arthroscopic surgery of the elbow provides all of the known advantages of minimal traumatisation. In RA,it is used mainly when there is ligament laxity in late synovectomies eventually combined with arthroscopically assisted resection of caput radii. In contrast to monoarticular diseases in RA,the adjoining bursa olecrani, neighbouring joints and nerve entrapment syndromes also require treatment. The treatment for advanced cub arthritis is arthroplasty. Due to progress in the development of elbow endoprotheses, the range of indications for resection (interposition) arthroplasty has increased. It is now preferred mainly in younger patients with ankylosing arthritis. Rheumatoid changes in the bone and soft tissue impede the implantation of artificial joints and require time consuming and precise preparation techniques. When choosing either an unconstrained or semi-constrained prosthesis,one has to bear in mind the actual ligament stability and its often unpredictable changes during the course of the disease.Perioperative measures, postoperative care and therapy is made even more difficult due to the involvement of several joints, often extensive permanent medication, secondary lesions such as ldquo;corticoid skin" and in most cases the multimorbidity of patients after many years of chronic disease. When comparing elbow surgery in osteoarthritis and RA,we found that patients with RA clearly required more elaborate surgery and more extensive perioperative and postoperative care.

Arthritis, Rheumatoid↗
PubMed2003

[Microsurgery of acquired degenerative lumbar spinal stenosis. Bilateral over-the-top decompression through unilateral approach].

Degenerative lumbar spinal stenosis is diagnosed with an increasing incidence. Clinical and radiological signs of progression often result in a significant decrease in the patient's quality of life. The indication for surgical treatment follows the spectrum of clinical symptoms. In cases with "structural" spinal stenosis and predominant "leg symptoms" such as neurogenic claudication and/or radicular symptoms, decompressive types of surgery are indicated. However, due to the multimorbidity of the mostly elderly patients, the surgical risk should be as low as possible whereas the surgical efficacy should be as high as possible. We describe a microsurgical technique, which can achieve a bilateral decompression of the central and lateral lumbar spinal canal through a unilateral surgical approach. In a consecutive series of 275 patients, a significant increase in standing time and walking distance could be attained. The surgical complication rate was low. A complete decompression of the spinal canal with preservation of the "tension band" of the posterior spinal column could be achieved. Although this type of surgery is adequate for patients with "predominantly leg symptoms" only, low back pain improved as well in nearly 50% of the patients. However, in cases with dynamic spinal stenosis and/or disturbed curvature with predominant low back pain, a combination of the described procedure with stabilizing surgery (spinal fusion, dynamic fixation etc.) is recommended.

Adult↗
PubMed1996

[Microsurgical transconjunctival approach to the orbits. Initial retrospective analysis of experiences with the transconjunctival approach in 15 patients. Clinical and surgical aspects].

The authors report 4-year follow-up results for their first 15 consecutive tumor patients, who underwent transconjunctival surgery of their orbital lesions without muscle dissection. Presentation, natural history, management, surgical appraisal of the transconjunctival approach and its indications are discussed. At follow-up, 14 of the patients showed excellent cosmetic and functional results. Our experience with the transconjunctival approach in the past 4 years suggests that this approach remains a useful modality, with good intraoperative visibility and minimal postoperative scar formation, for managing selected patients with space-occupying lesions located in the inferior medial and basal compartment of the orbit. Not suitable for the transconjunctival approach are deep intraconal lesions (orbital apex) and extraconal superior lesions. The rare problems with the transconjunctival approach have included temporary eye muscle injury with ophthalmoplegia postoperatively. More recently, the use of the transconjunctival approach has allowed surgeons to reduce cosmetic failures, functional deficits and deformities of the orbit. Because of its low risks, the absence of postoperative bleeding, and the absence of prolongation of hospitalization or immobilization of the patients, the transconjunctival approach is a successful procedure, especially in elderly multimorbid patients.

Adolescent↗
PubMed1997

[Fornix reconstruction in ocular pemphigoid with Goretex surgical membrane].

UNLABELLED: After separation of symblepharons in ocular pemphigoid, transplantation of nasal or bucal mucosa is recommended to prevent recurrent lid fusion; however, it is not always successful. BACKGROUND: An 86-year-old patient was referred to our eye clinic because of trichiasis in ocular pemphigoid. In the right eye, the only functional eye, fusion of the lower lid and the globe was present. There was severe trichiasis with multiple lesions of the cornea and beginning neovascularization. The left eye showed complete fusion of the lid fissure and neovascularization of the cornea. To prevent the right eye from suffering the fate of the left, we tried to find a simple surgical method that could easily be performed on the multimorbid patient. METHOD: Under parabulbar anesthesia we separated the lower lid from the globe until free passive motility of the lower lid was achieved. A cut-to-size piece of Gore-Tex surgical membrane was prepared and fixated with resorbable u-sutures on the inner lid. The membrane was left in place for 4 weeks until suture lysis. A silicone tube, which was transitorily fixed to the outer lower lid, had an additional ectropionizing effect. Three months later, lower-lid ectropion surgery was performed, combined with tarsectomy to obtain a long-term effect. RESULT: Six months later the lower-lid fornix had stabilized, and the lid and globe had good motility. The corneal lesions had healed. CONCLUSION: The use of 0.1 mm membrane prevents penetration of cell because of the microstructure. Similar to the "bare sclera" technique, which is used in selected cases in strabismus or pterygium surgery, the inner lid and sclera were epithelialized separately from the remaining conjunctiva. The surgical membrane prevented recurrence of the symblepharon. We think the presented technique is an easy, quick method of preventing recurrence of lid fusion after separation of symblepharons.

Aged↗
PubMed2006

Health care in seniority: crucial questions and challenges from the perspective of health services research.

This paper gives an updated outlook on geriatric health care in Germany and on research demands with particular respect to advanced-age patients with multimorbidity. The paper is written from the perspective of health services research and addresses selected topics such as primary care, palliative care, health policies and patient orientation. It is pointed out that the structure of services and processes of health care delivery is not compatible with the complex demands of the target group, and that the priorities of improvement strategies may differ among the various professional groups involved (e. g. primary care physicians as generalists and palliative and geriatric experts as specialists). Furthermore, it is argued that the current incentives for establishing integrated health care may not be adequate to ensure that sustainable changes are made in the long term.

Aged↗
PubMed1999

Ageing and the cardiovascular system.

Heart disease is the most common cause of death in elderly people. Cardiovascular aging is a continuous and irreversible process. It has a decline rate that varies among individuals and can be modulated by three conceptually different influences, namely, physiological changes due to the passage of time, adaptive sequeles of previous diseases or surgery in younger life, and influence of the individual lifestyle or their own cardiovascular risk factors. The main practical consequences of aging processes are a progressive change in the morphological, functional, and semiological characteristics of the cardiovascular system and an increase in the number of age-related cardiovascular disorders. The main morphological cardiovascular changes with aging happen in the structure of cardiac tissue and chambers, in the conduction system, and in the coronary arteries. But the cardiac function at rest in healthy elderly persons is adequate to meet the body's need. A normal or almost normal cardiac output in the elderly is to be maintained by increasing the stroke volume and the ejection fraction due to an augmented cardiac filling (preload). Atypical clinical pictures are very common in elderly patients with cardiovascular disease. For example, non-cardiac symptoms are the often presenting features. Concerning the treatment of cardiovascular diseases in the elderly, the clinician needs to consider age-related factors as multimorbidity and disabilities, the possible side effects and/or interactions due to pharmacodynamic or/and pharmacocinetic changes. And he has to take into account the social and financial situation of his patient.

Aged↗
PubMed2000

[Fundamentals of dentistry for geriatric rehabilitation--an introduction to geriatric dentistry].

The percentage of aged and very old people in the total population is increasing rapidly in industrialized countries. This is an important change which, in particular, affects the areas of dentistry and oral medicine. The problems that this older population group face need to be given more attention and need to be brought more into the forefront of dental and oral medicine. The percentage of the dentate population has increased in Germany, due to the high standard of the dental care. The percentage of the edentulous population has therefore decreased. It has become necessary for those who care for the elderly to adjust to caring for the dentate patient, as opposed to edentulous patient. It is important for all professions involved in the treatment and care of geriatric patients to have an awareness of the basic fundamentals of geriatric dentistry within general rehabilitation. Doctors in particular need to be given training in the detection of caries, peridontal diseases, and denture problems. They should feel confident working with the dentist and his team as partners in the rehabilitation treatment. It is especially important that geriatric hospitals have experience in dentistry and oral hygiene, so that damage to life-long well cared for teeth can be prevented, and so that poor oral hygiene during a hospital stay does not result in dental problems. Dentists and their teams will have to adjust to the treatment of aged and multimorbidic patients. More discussion is also necessary between dentists involved in all areas of geriatric medicine, geriatric dentistry, and geriatric dental public health.

Aged↗
PubMed2000

[Motivation or burden?--Illness and health in the elderly from the historical perspective].

Medical theories and practices concerning illness and health in old age as well as several aspects of society that do influence the aging process are described from a historical perspective integrating classical antiquity, middle ages, and modern times. From the present state of research it is distinguished between "primary illnesses in old age" and chronical diseases which might principally also begin in younger ages but take a different course in old age. Even if the frequency of disease and multimorbidity is increasing, negative stereotypes of the aging process have to be invalidated. Advances in medical sciences are a good pre-condition for increasing physical and mental health in old age.

Aged↗
PubMed2000

[Utilization of medical services and medication intake of patients over 60 in Germany--health related, social structure related, socio-demographic and subjective factors].

In a community sample of 394 elderly aged 61 years and older from East and West Germany, diseases, contacts with general practitioners and specialists, the use of medicine, attitudes regarding health and illness, the subjective health, psychic problems, social support, social integration, social burden, and socio-demographic variables were assessed. Based on these data the determinants for the contact of physicians and the use of medicine were analyzed. The results confirmed the frequency of multimorbidity in the elderly; on average we found three different diseases at the same time for each person. In nearly 10% of the sample we found seven diagnoses existing at the same time. 88% had contact with a general practitioner at least once a year, 97% had contact either with a general practitioner or with a specialist once a year. 55.8% took at least one medicine each day. The number of diseases existing at the same time was the most determining variable for the contact of physicians and the use of medicine. Furthermore, the elderly had more contact with physicians and took more medicine if they thought they were susceptible to diseases in a high degree, and if they rated their own health as poor. Fewer contacts with physicians and a lower use of medicine were found in those elderly that rated health behavior as little useful, that had low control beliefs regarding their own health, and that experienced only a low degree of health-related limitations in their everyday life. Furthermore, we found a higher use of medicine if there was little social support. There were no significant age-related or sex-related differences regarding the contact of practitioners or the use of medicine.

Aged↗
PubMed2001

[Is the ICIDH (International Classification of Impairments, Disabilities and Handicaps) suitible for geriatric rehabilitation?].

The International Classification of Impairments, Disabilities, and Handicaps (ICIDH), a manual of disease consequences issued by WHO, at present exists in two versions. ICIDH-1, issued in 1980, has been under revision since 1993. This revision process will result in a more sophisticated and more comprehensive ICIDH-2 in 2001. The ICIDH, based on the biopsychosocial disease model, describes disease consequences in three dimensions: Structural and functional body impairments. Disabilities (ICIDH-1) or restrictions of activities (ICIDH-2) in activities of daily living. Handicaps (ICIDH-1) or participation limitations (ICIDH-2) in social integration. In the field of geriatrics ICIDH is also helpful as a coherent conceptual framework and reference manual to determine and code the disabilities and handicaps with regard to daily living competence. Geriatric assessment instruments are no alternative, but complementary to the ICIDH. In view of the high frequency of geriatric patients with multimorbidity, i.e. multiple impairments, disabilities, and handicaps, the utility of the ICIDH in geriatric care is highly dependent on the flexible application of this classification system.

Activities of Daily Living↗
PubMed2003

[Evaluating the first German diagnosis-related groups (G-DRG) in cardiological patients: problems in the correct medical and economic grouping].

About three years ago, the German Government initiated a complete change in the reimbursement system for costs of the in-hospital treatment of patients. A commission of representatives from every component of the German health system decided to adapt the Australian refined Diagnosis Related Groups (AR-DRG system). The AR-DRG system was selected as it would fit best to the German system and because of its high flexibility and preciseness reflecting severity of diseases and treatments. In October 2002, the first German Diagnosis Related Groups (G-DRGs) were calculated from the data of about 116 hospitals. These data now allow first analyses in how far a correct and precise grouping of patients in specific hospital settings is indeed performed and corresponds to the actual costs. Thus, we thoroughly calculated all costs for material and personnel during the in-hospital stay for each patient discharged during the first 4 months of 2002 from our cardiological department. After performing the grouping procedure for each patient, we analyzed in how far inhomogeneous patient distribution in the DRGs occurred and which impact this had on costs and potential reimbursements. Several different problems were identified which should be outlined in this work regarding three G-DRGs: costs of patients who received an implantable cardioverter defibrillator (F01Z) were markedly influenced by multimorbidity and additional expensive interventions which were not reflected by this G-DRG. Use of numerous catheters and expensive drugs represented a major factor for costs in patients with coronary angioplasty in acute myocardial infarction (F10Z) but seemed to be not sufficiently included in the cost weight. A specific area of patient management in our department is high frequency ablation of tachyarrhythmias which is included in other percutaneous interventions (F19Z). Complex procedures such as ablation of ventricular tachycardia or new innovative procedures as ablation of atrial fibrillation were associated with high costs leading to inadequate reimbursement. Furthermore, problems in the associated codes for diseases and procedures became apparent. Opportunities for future optimization such as specific new DRGs, splitting of DRGs, or the impact of changes in reimbursement for high-outliers were discussed.

Angioplasty, Balloon↗
PubMed2005

[Management of diabetes mellitus in patients with angiopathies].

Nowadays, about 6-8% of the German population suffers from diabetes mellitus mostly type 2 but in patients with angiopathies about 30% have known diabetes and a further 30% have newly diagnosed diabetes or impaired glucose tolerance. Therefore diagnosis and therapy of glucose impairment play a central role for management of these patients. The antidiabetic therapy for secondary prevention of cardiovascular disease has to be embedded in a multifactorial concept with management of hypertension, hyperlipidemia and hypercoagulability. The management of diabetes following guidelines is a stepwise therapy with lifestyle interventions (diet, exercise) and oral drugs or insulin. Metformin has shown favorable outcome in overweight patients if aware of side effects; insulin is a safe drug in multimorbid patients and with planned interventions or operations. We are awaiting the results of multiple endpoint studies with newer antidiabetic drugs which may change our current concept of management of diabetes mellitus in these patients in the near future.

Clinical Trials as Topic↗
PubMed1999

[Hybrid technique for myocardial revascularization: value of combined minimal invasive bypass technique (MIDCAB) with interventional therapy (PTCA)].

BACKGROUND: Minimally invasive direct coronary artery bypass (MIDCAB) grafting without cardiopulmonary bypass (CPB) through an anterolateral minithoracotomy has become a promising therapeutical option especially in multimorbid, elderly and reoperative patients with single vessel disease. However, this procedure precludes complete revascularization in multivessel disease because the minithoracotomy limits the surgical access either to anterior or lateral or posterior vessels of the beating heart. To expand the benefits of the MIDCAB concept to patients with multivessel disease, new interdisciplinary approaches have recently been introduced. METHODS: Since December 1996, 26 patients (21 male, 5 female, mean age 56.6 +/- 18.8 years) underwent a "hybrid" revascularization performed as a primary MIDCAB procedure for grafting of the left anterior descending artery (LAD) with the left internal mammary artery (LIMA) followed by staged angioplasty and stenting of additional coronary lesions. RESULTS: After MIDCAB grafting, the postoperative course was uneventful in all patients. Coronary re-angiography after a median of 7 days revealed patent and functioning LIMA grafts in all patients. Applying subsequent percutaneous transluminal coronary angioplasty (PTCA) and occasional stenting (n = 8), a total of 31 lesions were treated successfully. Procedure related complications did not occur. All patients remained angina-free and no stress electrocardiographic changes were recorded. CONCLUSION: Our preliminary results of a "hybrid" approach to myocardial revascularization suggest that this concept is a safe and effective approach of complete revascularization for selected patients with multivessel involvement. Especially elderly and reoperative patients with significant comorbidity may benefit from hybrid procedures avoiding cardiopulmonary bypass and midsternotomy.

Adult↗
PubMed2006

[The elder patient with a rheumatic disease and comorbidities. Aspects of rheumatology in an ageing population].

Elder patients with comorbidities are a rapidly growing population for in- and outpatient care. Diagnosis, treatment and integrated care are challenges which are only met by a multidisciplinary approach, which includes specialists from different medical professions and health professionals. A high number of comorbidities are a risk factor for drug interactions and fragmentisation of patient care between different medical disciplines. This is in particular relevant for patients with rheumatic diseases. So far it is not known whether treatment strategies such as the aim of remission induction in RA can be transferred as it is to the care of elder patients. Moreover, the safety and effectiveness of drugs used for the treatment of rheumatology patients has not yet been intensively studied. To meet the challenge of the care of a growing group of elder and multimorbid patients with rheumatic diseases, the reimbursement systems for in- and outpatient care must be adapted to allow multidisciplinary approaches. A concept for such a multidisciplinary procedure for inpatients with rheumatic diseases is introduced.

Activities of Daily Living↗