Abstract:
OBJECTIVES:Multimorbidity, defined as the presence of 2 or more chronic medical conditions in an individual, is associated with poorer health outcomes. Several multimorbidity measures exist, and the challenge is to decide which to use preferentially in predicting health outcomes. The study objective was to compare the performance of 5 count-based multimorbidity measures in predicting emergency hospital admission and functional decline in older community-dwelling adults attending primary care. SETTING:15 general practices (GPs) in Ireland. PARTICIPANTS:n=862, ≥70 years, community-dwellers followed-up for 2 years (2010-2012). Exposure at baseline: Five multimorbidity measures (disease counts, selected conditions counts, Charlson comorbidity index, RxRisk-V, medication counts) calculated using GP medical record and linked national pharmacy claims data. PRIMARY OUTCOMES:(1) Emergency admission and ambulatory care sensitive (ACS) admission (GP medical record) and (2) functional decline (postal questionnaire). STATISTICAL ANALYSIS:Descriptive statistics and measure discrimination (c-statistic, 95% CIs), adjusted for confounders. RESULTS:Median age was 77 years and 53% were women. Prevalent rates ranged from 37% to 91% depending on which measure was used to define multimorbidity. All measures demonstrated poor discrimination for the outcome of emergency admission (c-statistic range: 0.62, 0.65), ACS admission (c-statistic range: 0.63, 0.68) and functional decline (c-statistic range: 0.55, 0.61). Medication-based measures were equivalent to diagnosis-based measures. CONCLUSIONS:The choice of measure may have a significant impact on prevalent rates. Five multimorbidity measures demonstrated poor discrimination in predicting emergency admission and functional decline, with medication-based measures equivalent to diagnosis-based measures. Consideration of multimorbidity in isolation is insufficient for predicting these outcomes in community settings.
journal_name
BMJ Openjournal_title
BMJ openauthors
Wallace E,McDowell R,Bennett K,Fahey T,Smith SMdoi
10.1136/bmjopen-2016-013089subject
Has Abstractpub_date
2016-09-20 00:00:00pages
e013089issue
9issn
2044-6055pii
bmjopen-2016-013089journal_volume
6pub_type
杂志文章相关文献
BMJ Open文献大全abstract:OBJECTIVES:To investigate whether gestational age modifies the association of airway infections that result in hospital admission during the first year after birth, with subsequent asthma risk after age 5 years. SETTING:Hospital inpatients and a general population comparison group in Sweden followed for subsequent dia...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2013-004034
更新日期:2013-10-29 00:00:00
abstract:OBJECTIVES:The typical approach of survey data collection is to use interviewers who are not from the study site and do not know the participants, yet the implications of this approach on data quality have seldom been investigated. We examine the relationship between interviewer-respondent familiarity and selected fami...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-023069
更新日期:2019-01-21 00:00:00
abstract:INTRODUCTION:Persisting neurotropic viruses are proposed to increase the risk of dementia, but evidence of association from robust, adequately powered population studies is lacking. This is essential to inform clinical trials of targeted preventive interventions. METHODS AND ANALYSIS:We will carry out a comprehensive ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-016522
更新日期:2017-06-23 00:00:00
abstract:OBJECTIVE:To compare intrapartum and neonatal mortality in low-risk term women starting labour in midwife-led versus obstetrician-led care. STUDY DESIGN:We performed a propensity score matched study using data from our national perinatal register, completed with data from medical files. We studied women without major ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-018845
更新日期:2018-01-05 00:00:00
abstract:INTRODUCTION:Healthcare systems around the world are looking for solutions to the growing problem of mental disorders. RECOVER is the synonym for an evidence-based, stepped and cross-sectoral coordinated care service model for mental disorders. RECOVER implements a cross-sectoral network with managed care, comprehensiv...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-036021
更新日期:2020-05-04 00:00:00
abstract:OBJECTIVE:To determine whether valproate (VPA) monotherapy influences homocysteine metabolism in patients with epilepsy. DESIGN:Systematic review and meta-analysis. DATA SOURCES:We searched all articles in English through PubMed, Web of Science and EMBASE published up to August 2013 concerning the homocysteine levels...
journal_title:BMJ open
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmjopen-2014-004936
更新日期:2014-07-16 00:00:00
abstract:OBJECTIVES:This review was commissioned by WHO, South Africa-Country office because of an exponential increase in medical litigation claims related to patient safety in obstetrical care in the country. A rapid review was conducted to examine the effectiveness of quality improvement (QI) strategies on maternal and newbo...
journal_title:BMJ open
pub_type: 杂志文章,评审
doi:10.1136/bmjopen-2017-020170
更新日期:2018-07-06 00:00:00
abstract:OBJECTIVE:Canada is among the few countries in which e-cigarettes containing nicotine are prohibited. To date, there is little evidence on the prevalence and patterns of use of e-cigarettes in markets with product bans. The current study examines e-cigarette use among a sample of non-smokers and smokers in Canada. DES...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2015-007971
更新日期:2015-08-26 00:00:00
abstract:OBJECTIVE:To determine the association of the Martin Luther King Jr Hospital (MLK) closure on the distribution of admissions on adjacent trauma centres, and injury mortality rates in these centres and within the county. DESIGN:Observational, retrospective study. SETTING:Non-public patient-level data from the state of...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-011700
更新日期:2016-05-10 00:00:00
abstract:OBJECTIVE:A prospective evaluation of the effect of 2012 point-of-sale (PoS) display ban in supermarkets in England on perceived exposure to PoS displays, and on changes in susceptibility and smoking uptake among young people. DESIGN:Cohort study. SETTINGS:Seven schools in Nottinghamshire, England. PARTICIPANTS:1035...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2016-012451
更新日期:2017-01-23 00:00:00
abstract:BACKGROUND:Achilles tendon injuries give rise to substantial long-lasting morbidity and pose considerable challenges for clinicians and patients during the lengthy healing period. Current treatment strategies struggle to curb the burden of this injury on health systems and society due to lengthy rehabilitation, work ab...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmjopen-2017-018135
更新日期:2017-11-16 00:00:00
abstract:OBJECTIVES:University academic achievement may be inversely related to the performance of the secondary (high) school an entrant attended. Indeed, some medical schools already offer 'grade discounts' to applicants from less well-performing schools. However, evidence to guide such policies is lacking. In this study, we ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-020291
更新日期:2018-05-23 00:00:00
abstract:OBJECTIVES AND DESIGN:We identified a novel TRIM59 gene, as an early signal transducer in two (SV40Tag and Ras) oncogene pathways in murine prostate cancer (CaP) models. We explore its clinical applications as a multitumour marker detecting early tumorigenesis by immunohistochemistry (IHC). SETTING AND PARTICIPANTS:88...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2012-001410
更新日期:2012-10-08 00:00:00
abstract:OBJECTIVES:To conduct a systematic review to identify studies that describe factors and interventions at primary care practice level that impact on levels of utilisation of unscheduled secondary care. SETTING:Observational studies at primary care practice level. PARTICIPANTS:Studies included people of any age of eith...
journal_title:BMJ open
pub_type: 杂志文章,评审
doi:10.1136/bmjopen-2013-004746
更新日期:2014-05-23 00:00:00
abstract:INTRODUCTION:Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is widely used to support the most severe forms of cardiogenic shock (CS). Nevertheless, despite extracorporeal membrane oxygenation (ECMO) use, mortality still remains high (50%). Moderate hypothermia (MH) (33°C-34°C) may improve cardiac performan...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmjopen-2019-031697
更新日期:2019-10-14 00:00:00
abstract:OBJECTIVES:This study aimed to measure the burden of work-related upper limb amputation in Korea over a 10-year period and assess its trend. DESIGN:Ecological study. SETTING:National level data in Korea between 2004 and 2013. PARTICIPANTS:49 535 subjects who claimed Korea industrial accident compensation insurance d...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-032793
更新日期:2019-11-19 00:00:00
abstract:OBJECTIVES:For people with end-stage renal disease requiring haemodialysis, exercise can improve aspects of quality of life (QoL). However, the relative benefits and risks of different types of exercise in this population are unknown. Therefore, this pilot study aimed to evaluate the feasibility of a main study evaluat...
journal_title:BMJ open
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjopen-2016-012085
更新日期:2016-09-06 00:00:00
abstract:INTRODUCTION:Insomnia is a highly prevalent, often debilitating and economically burdensome sleep disorder with limited effective therapies. Few data are available to understand which of the therapeutic alternatives is the most effective for patients with insomnia, especially for Traditional Chinese Medicine (TCM). Chi...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmjopen-2015-008459
更新日期:2016-02-02 00:00:00
abstract:OBJECTIVES:Liver disease is a major cause of morbidity and mortality in sub-Saharan Africa, but its prevalence, distribution and aetiology have not been well characterised. We therefore set out to examine liver function tests (LFTs) and liver fibrosis scores in a rural African population. DESIGN:We undertook a cross-s...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-032890
更新日期:2020-03-31 00:00:00
abstract:INTRODUCTION:Osteoarthritis (OA) pathophysiology is driven in part by joint inflammation. Resveratrol has in vitro anti-inflammatory properties. We aim to assess the efficacy of oral resveratrol for knee pain at 3 months in people with knee OA. METHODS AND ANALYSIS:We will conduct a randomised double-blind placebo-con...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmjopen-2017-017652
更新日期:2017-09-29 00:00:00
abstract:OBJECTIVE:The Yale Global Tic Severity Scale (YGTSS) is the most commonly used clinician-rated evaluation tool for Tourette syndrome (TS), with established reliability and validity. This study aims to determine whether the YGTSS is a valid parent-reported assessment in the TS population. DESIGN:A prospective cohort st...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-034634
更新日期:2020-08-20 00:00:00
abstract:OBJECTIVES:To estimate the cost-effectiveness of a planned birth in a birth centre compared with alternative planned places of birth for low-risk women. In addition, a distinction has been made between different types of locations and integration profiles of birth centres. DESIGN:Economic evaluation based on a prospec...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-016960
更新日期:2017-09-11 00:00:00
abstract:OBJECTIVE:Japan Coma Scale (JCS) is a grading system used to evaluate disturbed consciousness in prehospital care settings. We aimed to identify the association between the JCS levels at the scene with in-hospital mortality, as well as the discrimination ability for the outcomes. DESIGN:A retrospective cohort study ba...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2019-029706
更新日期:2019-07-30 00:00:00
abstract:OBJECTIVES:To assess people's procedural preferences for making medical surrogate decisions, from the perspectives of both a potential surrogate and an incapacitated patient. DESIGN:Computer-assisted telephone interviews. Respondents were randomly assigned either the role of an incapacitated patient or that of a poten...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-022289
更新日期:2018-07-25 00:00:00
abstract:PURPOSE:Cardiovascular disease (CVD) is a major challenge to global health. The same epidemiological transition scenario is replayed as countries develop, but with variations based on environment, culture and ethnic mixture. The Baependi Heart Study was set up in 2005 to develop a longitudinal family-based cohort study...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-011598
更新日期:2016-10-21 00:00:00
abstract:OBJECTIVES:To support return to work (RTW) among cancer patients, a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy. The aim was to investigate RTW rates of cancer patients and to evaluate changes in work-...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2016-014746
更新日期:2017-06-15 00:00:00
abstract:INTRODUCTION:In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of nursing home care. How...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-015134
更新日期:2017-06-08 00:00:00
abstract:OBJECTIVES:To explore the views and experiences of patients on the care they have received while enrolled on the Northumberland High Risk Patient Programme (NHRPP). This programme involved case finding of frail patients using a multidisciplinary team (MDT)-led community case management programme, and support of patient...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-012019
更新日期:2016-09-09 00:00:00
abstract:INTRODUCTION:Pain is an expected and appropriate experience following traumatic musculoskeletal injury. By contrast, chronic pain and disability are unhelpful yet common sequelae of trauma-related injuries. Presently, the mechanisms that underlie the transition from acute to chronic disabling post-traumatic pain are no...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-017876
更新日期:2018-04-28 00:00:00
abstract:OBJECTIVES:To explore healthcare professionals (HCPs) experiences and challenges in diagnosing suspected lower limb cellulitis. SETTING:UK nationwide. PARTICIPANTS:20 qualified HCPs, who had a minimum of 2 years clinical experience as an HCP in the national health service and had managed a clinical case of suspected ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-034692
更新日期:2020-10-14 00:00:00