Podcasts about multimorbidity

How does multimorbidity impact the progression from psoriasis to psoriatic arthritis? Can early identification of chronic conditions help prevent psoriatic arthritis in high-risk patients?In this episode of Inside GRAPPA, host Dr. Mio Nakamura sits down with Dr. Paras Karmacharya, recipient of a GRAPPA Annual Pilot Research Grant. He presented his findings at the 2024 GRAPPA Annual in Seattle and shares his groundbreaking study with us on "Multimorbidity and Psoriasis as a Risk Factor for Psoriatic Arthritis." Dr. Karmacharya discusses his personal journey into psoriatic arthritis research, how his study leveraged the Rochester Epidemiology Project, and what the findings mean for the future of patient care. He also explores: ✔️ What multimorbidity really means in psoriatic disease ✔️ The connection between chronic conditions and psoriatic arthritis risk ✔️ How his study design helped uncover key insights ✔️ The clinical implications for screening, early intervention, and patient educationKey Takeaways

This study explores how environmental exposures (exposome)

Send us a textIntraventricular Hemorrhage and Survival, Multimorbidity, and Neurodevelopment.Rees P, Gale C, Battersby C, Williams C, Carter B, Sutcliffe A.JAMA Netw Open. 2025 Jan 2;8(1):e2452883. doi: 10.1001/jamanetworkopen.2024.52883.PMID: 39761048 As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

In this episode, we explore the unique challenges and considerations in treating older adults, focusing on the need for a different approach to care due to polypharmacy and multimorbidity. We delve into the complexities of managing these patients, emphasizing the importance of understanding frailty—how to assess, prevent, and address it. The discussion also covers late-onset rheumatoid arthritis, its distinction from rheumatoid arthritis, and why it often goes underdiagnosed and undertreated. We introduce the 5 M's framework; a geriatric care model that helps clinicians focus on what truly matters to older adults. Additionally, we address the role of palliative care in rheumatology, highlighting its importance beyond end-of-life care, and provide guidance on shared decision-making with older adults and their families to ensure patient-centered outcomes.   

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances discusses a recently published original research paper on apixaban and limiting aspirin for patients with atrial fibrillation, percutaneous coronary intervention, and multimorbidity.

DISCLAMER >>>>>>    The Ditch Lab Coat podcast serves solely for general informational purposes and does not serve as a substitute for professional medical services such as medicine or nursing. It does not establish a doctor/patient relationship, and the use of information from the podcast or linked materials is at the user's own risk. The content does not aim to replace professional medical advice, diagnosis, or treatment, and users should promptly seek guidance from healthcare professionals for any medical conditions.   >>>>>> The expressed opinions belong solely to the hosts and guests, and they do not necessarily reflect the views or opinions of the Hospitals, Clinics, Universities, or any other organization associated with the host or guests.       Disclosures: Ditch The Lab Coat podcast is produced by (Podkind.co) and is independent of Dr. Bonta's teaching and research roles at McMaster University, Temerty Faculty of Medicine and Queens University. Welcome to another episode of "Ditch the Lab Coat," the podcast where we critically explore the latest in medical science and healthcare with engaging discussions and a dose of skepticism. I'm your host, Dr. Mark Bonta, and today we have an insightful conversation lined up with our distinguished guest, Dr. Allan Detsky. Dr. Detsky, a professor at the University of Toronto and former Chief Physician at Sinai Health Systems, brings his extensive knowledge in evidence-based medicine, health policy, and clinical experience into our discussion.In this episode, we'll delve into the complex landscape of pain management and the opioid crisis, explore the future health challenges posed by climate change and societal shifts in civility, and critique the growing influence of unregulated health advice on social media. Dr. Detsky shares his candid views on the pharmaceutical industry's role in drug development, conflicts of interest, and the intricate relationship between lifestyle changes and medical advancements.We'll also discuss the limitations of evidence-based medicine, especially when it comes to treating patients with multiple conditions, and the challenges of applying clinical guidelines to real-world settings. Plus, stay tuned for an announcement about a website overhaul, launching in December, featuring expanded blog content for our curious listeners.Join us as we unravel these pressing issues and more, always questioning, always learning. "Ditch the Lab Coat" continues right now.00:00 - Podcast begins with healthcare insights from Dr. Alan Detsky.05:31 - Highlighting the role of randomized trials in improving evidence-based medicine.08:52 - Questioning the efficacy of zinc supplements for healthy young adults.10:27 - Clinical study results often fail to align with real patient demographics.16:57 - Lack of shared decision-making opportunities for hospitalized patients.19:22 - Discussing right-wing skepticism toward pharmaceutical companies, balanced with acknowledgment of their contributions.21:21 - Exploration of how pharmaceutical companies prioritize profits over public-interest-driven drug development.25:00 - Reflecting on personal and professional relationships with drug industry figures.30:43 - Increasing dependency on lifelong medications in healthcare.35:14 - Potential for AI to address systemic issues despite its resource demands.36:35 - Emphasizing the importance of verifying credentials to avoid unqualified healthcare professionals.

Multimorbidity poses a global challenge to healthcare delivery. This study aimed to describe the prevalence of multimorbidity, common disease combinations and outcomes in a contemporary cohort of patients undergoing major abdominal surgery.

In this episode Dr Ben Warner discusses multimorbidity, also known as multiple long-term conditions, with Professor Frances Mair. They discuss what multimorbidity is, how the concept differs from frailty and how the burden of treatment and health inequalities impact patients with multiple long-term conditions. Professor Frances Mair is the Norie Miller Professor of General Practice, Head of General Practice and Primary Care, and Director of a Wellcome funded Multimorbidity PhD Programme for Health Professionals at the University of Glasgow. She co-leads the NHS Research Scotland Primary Care Network, promoting research activity in primary care and is a member of the MRC Clinical Academic Research Partnerships Panel. Professor Mair is also an International Advisor to the Norwegian Primary Care Research Network and the Australian Translating Research Outcomes into the Primary Health Interface (TROPHI) Scientific Advisory Group as well as acting as a Visiting Professor at the University of Melbourne, Australia. Dr Ben Warner is a Respiratory Medicine Specialty Registrar with clinical and academic experience of global public health, having completed the LSHTM's East African Diploma in Tropical Medicine and then worked for 18 months in rural South Africa. He is currently undertaking a PhD in multimorbidity in Malawi as part of the Wellcome-funded Multimorbidity PhD Programme for Health Professionals with the University of Glasgow. Recording date: 20 February 2024 -- Useful Links -- https://www.bmj.com/content/339/bmj.b2803 https://www.nice.org.uk/guidance/ng56 https://doi.org/10.1016/S0140-6736(12)60240-2 https://www.gla.ac.uk/colleges/mvls/graduateschool/multimorbidity/ https://www.gla.ac.uk/schools/healthwellbeing/staff/francesmair/ -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: cme@rcpe.ac.uk

Intermittent fasting, anticoagulation decisions, heterogenous treatment effects, frailty in HF, the importance of the ECG, and industry conflicts are the topics John Mandrola, MD, covers this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Intermittent Fasting No, Intermittent Fasting Won't Kill You https://www.medscape.com/viewarticle/1000544 NEJM Paper on Time-Restricted Eating  https://www.nejm.org/doi/full/10.1056/NEJMoa2114833 JAMA TREAT Clinical Trial https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2771095 II. Stroke Prevention with OAC Shah Meta analysis of Vitamin K Agonists in AF https://www.ahajournals.org/doi/abs/10.1161/CIRCOUTCOMES.123.010269 III. Heterogenous Treatment Effects in Trials Pivotal CV Trials May Not Apply to Complex Patients https://www.medscape.com/viewarticle/989129 Analysis of 8 Trials of Multimorbidity and Treatment Response https://doi.org/10.1016/j.amjmed.2024.01.028 IV. Frailty and HF Circulation Outcomes: Multidomain Frailty and Mode of Death in HF  https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.123.010416 V. ECG in LBBB JAMA Cardiology: Revised Definition of LBBB  https://jamanetwork.com/journals/jamacardiology/fullarticle/2816973 VI. Industry Payments to Doctors JAMA: Payments to US Physicians by Specialty https://jamanetwork.com/journals/jama/fullarticle/2816900 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

TODAY ON THE ROBERT SCOTT BELL SHOW: Multimorbidity epidemic, Acetaminophen language delay, Parkinson's pesticides, Homeopathic Hit - Chimaphila Umbellata, Elderly antidepressants, Microwaved plastics, Food additive infertility, Toxic sewage fertilizer, Direct-to-consumer pharmaceutical advertising and MORE! https://robertscottbell.com/multimorbidity-epidemic-acetaminophen-language-delay-parkinsons-pesticides-homeopathic-hit-chimaphila-umbellata-elderly-antidepressants-microwaved-plastics-food-additive-infertility-toxic-s/

Søren Thorgaard Skou (PT, MSc, PhD) has vast experience within the field of osteoarthritis and other chronic conditions and has been the principal investigator of several high-quality randomized controlled trials on surgical and non-surgical treatment, one of which was published in The New England Journal of Medicine (impact factor of 79.26), the highest ranked of all general medical journals. Currently, he is the principal investigator of a randomized, controlled trial of meniscal surgery vs. exercise therapy and education for young people with a meniscal tear (DREAM) and a 5-year EU-funded project (MOBILIZE, grant agreement No 801790) with the overall aim of improving health in people with more than one chronic condition (i.e. multimorbidity) through personalized exercise therapy and education. Furthermore, he is the co-lead of Exercise First, a research program funded by Region Zealand aimed at developing, testing and implementing initaitives that support that the individual patient received the right prevention and treatment at the right time and to increase self-management using e-health.  He is one of the main architects and leader of the implementation of the highly successful treatment program Good Life With osteoArthritis in Denmark (GLA:D) for patients with knee and hip osteoarthritis. Furthermore, he is a recipient of a prestigious ERC Starting Grant from the European Research Council, and a postdoc grant and a Sapere Aude Research Talent Award from the Independent Research Fund Denmark.  --- Follow Professor Søren Skou on Twitter https://twitter.com/STSkou He is affiliated with both University of Southern Denmark and the research unit PROgrez at Slagelse Hospital, Denmark (@PROgrezDK) _____________________ This podcast episode is sponsored by Fibion Inc. | Better Sleep, Sedentary Behaviour and Physical Activity Research with Less Hassle --- Collect, store and manage SB and PA data easily and remotely - Discover ground-breaking Fibion SENS --- SB and PA measurements, analysis, and feedback made easy.  Learn more about Fibion Research --- Learn more about Fibion Sleep and Fibion Circadian Rhythm Solutions. --- Fibion Kids - Activity tracking designed for children. --- Collect self-report physical activity data easily and cost-effectively with Mimove. --- Explore our Wearables,  Experience sampling method (ESM), Sleep,  Heart rate variability (HRV), Sedentary Behavior and Physical Activity article collections for insights on related articles. --- Refer to our article "Physical Activity and Sedentary Behavior Measurements" for an exploration of active and sedentary lifestyle assessment methods. --- Learn about actigraphy in our guide: Exploring Actigraphy in Scientific Research: A Comprehensive Guide. --- Gain foundational ESM insights with "Introduction to Experience Sampling Method (ESM)" for a comprehensive overview. --- Explore accelerometer use in health research with our article "Measuring Physical Activity and Sedentary Behavior with Accelerometers ". --- For an introduction to the fundamental aspects of HRV, consider revisiting our Ultimate Guide to Heart Rate Variability. --- Follow the podcast on Twitter https://twitter.com/PA_Researcher Follow host Dr Olli Tikkanen on Twitter https://twitter.com/ollitikkanen Follow Fibion on Twitter https://twitter.com/fibion https://www.youtube.com/@PA_Researcher    

The following question refers to Section 10.1 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. The question is asked by Western Michigan University medical student and CardioNerds Intern Shivani Reddy, answered first by Boston University cardiology fellow and CardioNerds Ambassador Dr. Alex Pipilas, and then by expert faculty Dr. Ileana Pina.Dr. Pina is Professor of Medicine and Quality Officer for the Cardiovascular Line at Thomas Jefferson University, Clinical Professor at Central Michigan University, and Adjunct Professor of Biostats and Epidemiology at Case Western University. She serves as Senior Fellow and Medical Officer at the Food and Drug Administration's Center for Devices and Radiological Health.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #15 Mrs. Framingham is a 65-year-old woman who presents to her cardiologist's office for stable angina and worsening dyspnea on minimal exertion. She has a history of non-insulin dependent type 2 diabetes mellitus and hypertension. She is taking metformin, linagliptin, lisinopril, and amlodipine. Blood pressure is 119/70 mmHg. Labs are notable for a hemoglobin of 14.2 mg/dL, iron of 18 mcg/dL, ferritin 150 ug/L, transferrin saturation 15%, and normal creatine kinase. An echocardiogram shows reduced left ventricular ejection fraction of 25%. Coronary angiography shows obstructive lesions involving the proximal left anterior descending, left circumflex, and right coronary arteries. In addition to optimizing GDMT, which of the following are recommendations for changes in management? A Anticoagulation, percutaneous revascularization, and IV iron B A change in her diabetic regimen, percutaneous revascularization, and PO iron C A change in her diabetic regimen, surgical revascularization, and IV iron D A change in her diabetic regimen, medical treatment alone for CAD, and PO iron E Anticoagulation and surgical revascularization Answer #15 Explanation The correct answer is C – a change in her diabetic regimen, surgical treatment and IV iron. Multimorbidity is common in patients with heart failure. More than 85% of patients with HF also have at least 2 additional chronic conditions, of which the most common are hypertension, ischemic heart disease, diabetes, anemia, chronic kidney disease, morbid obesity, frailty, and malnutrition. These conditions can markedly impact patients' tolerance to GDMT and can inform prognosis. Not only was Mrs. F found with HFrEF (most likely due to ischemic cardiomyopathy), but she also suffers from severe multi-vessel coronary artery disease, hypertension, and non-insulin dependent type 2 diabetes mellitus. In addition to starting optimized GDMT for HF, specific comorbidities in the heart failure patient warrant specific treatment strategies. Mrs. Framingham would benefit from a change in her diabetic regimen, namely switching from linagliptin to an SGLT2 inhibitor (e.g., empagliflozin, dapagliflozin). In patients with HF and type 2 diabetes, the use of SGLT2i is recommended for the management of hyperglycemia and to reduce HF related morbidity and mortality (Class 1, LOE A). Furthermore, as she has diabetes, symptomatic severe multi-vessel CAD, and LVEF≤35%,

Tune in to hear Drs Stanley Cohen and Alexis Ogdie dive into new research on switching vs cycling medications in caring for patients with psoriatic arthritis, tight control in axSpA, and more. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/984265). The topics and discussions are planned, produced, and reviewed independently of the advertisers. This podcast is intended only for US healthcare professionals. Resources 1600: The Impact of Second-Line Therapeutic on Disease Control After Discontinuation of First Line TNF Inhibitor in Patients With PsA: Analysis From the CorEvitas Psoriatic Arthritis/Spondyloarthritis Registry https://www.eventscribe.net/2022/ACRConvergence/index.asp?presTarget=2189995 Cycling or Swap Biologics and Small Molecules in Psoriatic Arthritis: Observations From a Real-life Single Center Cohort https://pubmed.ncbi.nlm.nih.gov/33879661/ Baseline Disease Activity Predicts Achievement of cDAPSA Treatment Targets With Apremilast: Phase III Results in DMARD-naïve Patients With Psoriatic Arthritis https://pubmed.ncbi.nlm.nih.gov/35428720/ Etanercept and Methotrexate as Monotherapy or in Combination for Psoriatic Arthritis: Primary Results From a Randomized, Controlled Phase III Trial https://pubmed.ncbi.nlm.nih.gov/30747501/ EULAR 2023. European Congress of Rheumatology https://congress.eular.org/ GRAPPA Treatment Recommendations: 2021 Update https://pubmed.ncbi.nlm.nih.gov/35293339/ Special Article: 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis https://pubmed.ncbi.nlm.nih.gov/30499246/ Effect of a Treatment Strategy of Tight Control for Rheumatoid Arthritis (the TICORA Study): A Single-blind Randomised Controlled Trial https://pubmed.ncbi.nlm.nih.gov/15262104/ Aiming at Low Disease Activity in Rheumatoid Arthritis With Initial Combination Therapy or Initial Monotherapy Strategies: The BeSt Study https://pubmed.ncbi.nlm.nih.gov/17083767/ Long-term Follow-up of Patients in the TIght COntrol of Inflammation in Early Psoriatic Arthritis (TICOPA) Trial https://pubmed.ncbi.nlm.nih.gov/31504996/ Efficacy of a Tight-control and Treat-to-target Strategy in Axial Spondyloarthritis: Results of the Open-label, Pragmatic, Cluster-randomised TICOSPA Trial https://pubmed.ncbi.nlm.nih.gov/33958325/ ASAS Health Index: The "All in One" for Spondyloarthritis Evaluation? https://pubmed.ncbi.nlm.nih.gov/33004479/ Central Sensitization Has Major Impact on Quality of Life in Patients With Axial Spondyloarthritis https://pubmed.ncbi.nlm.nih.gov/35033996/ ASAS-EULAR Recommendations for the Management of Axial Spondyloarthritis: 2022 Update https://pubmed.ncbi.nlm.nih.gov/36270658/ Treatment of Ankylosing Spondylitis by Primary Care Physicians and Rheumatologists: A Retrospective Study in Three Health Systems https://acrabstracts.org/abstract/treatment-of-ankylosing-spondylitis-by-primary-care-physicians-and-rheumatologists-a-retrospective-study-in-three-health-systems/ Multimorbidity in Psoriasis as a Risk Factor for Psoriatic Arthritis: A Population-Based Study https://acrabstracts.org/abstract/multimorbidity-in-psoriasis-as-a-risk-factor-for-psoriatic-arthritis-a-population-based-study/ Comorbidities, Pain and Fatigue in Psoriatic Arthritis, Psoriasis and Healthy Controls: A Clinical Cohort Study https://pubmed.ncbi.nlm.nih.gov/33325531/

How do chronic diseases affect your patient's ability to get well from low back pain? On this episode, we analyze a new study highlighting how multimorbidity impacts the life of people struggling with low back pain. Episode Notes:Multimorbidity in patients with low back pain in Danish chiropractic practice: a cohort studyDesigned by a Podiatrist over 30 years ago after seeing similarities in many of the custom devices he was creating, PowerStep offers an affordable, same day solution that combines support and cushioning. Want to try a pair for yourself, click here for a free sample pair. with the code EBCPatient Pilot by The Smart Chiropractor is the fastest, easiest way to grow your practice on autopilot…without spending any money on advertising. Discover more and access our 3X ROI Guarantee here! ChiroMatchMakers specializes in DC and CA hiring. We have over 100 positions available right now with salaries starting at $85K. Discover the available positions today by clicking here. With Zingit, you can expect an average of 23 google reviews in a month, and a patient show rate of at least 94%. And that only scratches the surface of the value Zingit can bring to your practice. Click here to schedule a demo today and receive a $100 DoorDash Gift Card after completing your demo!Our members use research to GROW their practice. Are you interested in increasing your referrals? Discover the best chiropractic marketing you aren't currently using right here!

Dr. Caroline Ran discusses her paper, "Multimorbidity and Sickness Absence/Disability Pension in Cluster Headache Patients and Matched References: A Swedish Register-Based Study". Show references: https://n.neurology.org/content/early/2022/12/14/WNL.0000000000201685

Listen to a blog summary of a research paper published by Aging in Volume 14, Issue 24, entitled, "12-year evolution of multimorbidity patterns among older adults based on Hidden Markov Models." _______________________________________ Multimorbidity is a term that refers to living with two or more chronic diseases at the same time, and the prevalence of this phenomenon increases with age. In addition, humans tend to evolve and transition into distinct patterns of multimorbidity. These still ill-defined patterns of multimorbidity may offer a window of opportunity for researchers. Since the aging population continues to grow in many parts of the world, researchers are motivated to better understand these patterns and how they evolve and transition over time in order to develop interventions and therapeutics for healthier aging. However, this is a challenging task for several reasons. “Multimorbidity is associated with a higher risk of polypharmacy and decreased quality of life, and challenges the decision-making of clinicians that lack effective guidelines for the management and treatment of patients with cohexisting complex diseases [4].” While researchers have investigated multimorbidity, not all studies are created equal—rendering meta-analyses largely incongruent (thus far). One reason the evolution of multimorbidity patterns is so challenging to study is because most study designs are not powered to account for the dynamic nature of multimorbidity in old age. Another reason is that various studies use different lists of diseases. (Some studies include ten conditions or less and others include 200+ conditions.) Finally, most statistical methods used to organize data are not able to properly handle the complexity of multimorbidity. “Exploring how multimorbidity patterns evolve throughout people's lives and the time subjects remain within specific patterns is still an under-researched area [7, 8]. The understanding of how diseases cluster longitudinally in specific age groups would pave the way to the design of new prognostic tools, as well as new preventive and, eventually, therapeutic approaches.” Full blog - https://aging-us.org/2023/01/how-hidden-markov-models-can-help-elucidate-multimorbidity-in-aging/ DOI - https://doi.org/10.18632/aging.204395 Corresponding authors - Albert Roso-Llorach - aroso@idiapjgol.org, Amaia Calderón-Larrañaga - amaia.calderon.larranaga@ki.se Keywords - multimorbidity, older adults, longitudinal population-based study, aging, Hidden Markov Models About Aging-US Launched in 2009, Aging-US publishes papers of general interest and biological significance in all fields of aging research and age-related diseases, including cancer—and now, with a special focus on COVID-19 vulnerability as an age-dependent syndrome. Topics in Aging-US go beyond traditional gerontology, including, but not limited to, cellular and molecular biology, human age-related diseases, pathology in model organisms, signal transduction pathways (e.g., p53, sirtuins, and PI-3K/AKT/mTOR, among others), and approaches to modulating these signaling pathways. Please visit our website at https://www.Aging-US.com​​ and connect with us: SoundCloud - https://soundcloud.com/Aging-Us Facebook - https://www.facebook.com/AgingUS/ Twitter - https://twitter.com/AgingJrnl Instagram - https://www.instagram.com/agingjrnl/ YouTube - https://www.youtube.com/agingus​ LinkedIn - https://www.linkedin.com/company/aging/ Pinterest - https://www.pinterest.com/AgingUS/ For media inquiries, please contact media@impactjournals.com.

In part one of the two-part podcast series, recorded during the ECNP Congress in Vienna, PhD student Veerle van Gils and senior clinical scientist and psychologist Dr Silke Matura discuss the role of dysfunctional insulin signalling as modulator of mental and non-mental chronic diseases. They are both part of the PRIME (Prevention and Remediation of Insulin Multimorbidity in Europe) project trying to identify and specify the molecular mechanisms underlying insulin comorbidities. Views and opinions expressed in this podcast are those of the interviewee and do not necessarily reflect the official position of ECNP. The content of this podcast should not be used in any way as the basis for treatment decisions.

Søren Thorgaard Skou (PT, MSc, PhD) has vast experience within the field of osteoarthritis and other chronic conditions and has been the principal investigator of several high-quality randomized controlled trials on surgical and non-surgical treatment, one of which was published in The New England Journal of Medicine (impact factor of 79.26), the highest ranked of all general medical journals. Currently, he is the principal investigator of a randomized, controlled trial of meniscal surgery vs. exercise therapy and education for young people with a meniscal tear (DREAM) and a 5-year EU-funded project (MOBILIZE, grant agreement No 801790) with the overall aim of improving health in people with more than one chronic condition (i.e. multimorbidity) through personalized exercise therapy and education. Furthermore, he is the co-lead of Exercise First, a research program funded by Region Zealand aimed at developing, testing and implementing initaitives that support that the individual patient received the right prevention and treatment at the right time and to increase self-management using e-health.  He is one of the main architects and leader of the implementation of the highly successful treatment program Good Life With osteoArthritis in Denmark (GLA:D) for patients with knee and hip osteoarthritis. Furthermore, he is a recipient of a prestigious ERC Starting Grant from the European Research Council, and a postdoc grant and a Sapere Aude Research Talent Award from the Independent Research Fund Denmark.  --- Follow Professor Søren Skou on Twitter https://twitter.com/STSkou He is affiliated with both University of Southern Denmark and the research unit PROgrez at Slagelse Hospital, Denmark (@PROgrezDK) _____________________ This podcast episode is sponsored by Fibion Inc. | Better Sleep, Sedentary Behaviour and Physical Activity Research with Less Hassle --- Learn more about Fibion Sleep and Circadian Rhythm Solutions: https://sleepmeasurements.fibion.com/ --- Collect, store and manage SB and PA data easily and remotely - Discover ground-breaking Fibion SENS: https://sens.fibion.com/ --- SB and PA measurements, analysis, and feedback made easy.  Learn more about Fibion Research : fibion.com/research --- Fibion Kids - Activity tracking designed for children. https://fibionkids.fibion.com/ --- Collect self-report physical activity data easily and cost-effectively https://mimove.fibion.com/ --- Follow the podcast on Twitter https://twitter.com/PA_Researcher Follow host Dr Olli Tikkanen on Twitter https://twitter.com/ollitikkanen Follow Fibion on Twitter https://twitter.com/fibion https://www.youtube.com/@PA_Researcher

Follow Professor Søren Skou on Twitter https://twitter.com/STSkou He is affiliated with both University of Southern Denmark and the research unit PROgrez at Slagelse Hospital, Denmark (@PROgrezDK)

In this episode, hear Marta Boffito, MD, PhD, FRCP, and Julian Falutz, MD, FRCPC, discuss their approach to minimizing antiretroviral (ARV)-related intolerances in older patients with HIV, including:Consequences of polypharmacyDeprescribing ARV and non-ARV medicationsComplications associated with aging (eg, geriatric syndromes such as falls, frailty, multimorbidity)Mediations to avoid, such as anticholinergic medications, to minimize drug–drug interactions and risk of developing geriatric syndromesFaculty:Marta Boffito, MD, PhD, FRCPConsultant Physician/ProfessorHIV/ResearchChelsea and Westminster HospitalImperial College LondonLondon, United KingdomJulian Falutz, MD, FRCPCAssociate Professor of MedicineDepartment of MedicineMcGill University School of MedicineDirectorComprehensive HIV and Aging InitiativeChronic Viral Illness ServiceMcGillMontreal, Quebec, CanadaLink to full program:https://bit.ly/3PM3nYeFollow along with the slides at:https://bit.ly/3NpAYI1

In this episode, Dr. Yeh is joined by Claire Rosen, MD, from the Hospital of the University of Pennsylvania. They discuss her recent paper, which demonstrates that past medical history, specifically multimorbidity, influences the risk of adverse outcomes after emergency general surgery, from increased mortality to limited independence and function. When surgeons understand and communicate these risks, shared decision making is improved. Learn more about the Journal of the American College of Surgeons, a monthly peer-reviewed journal publishing original contributions on all aspects of surgery, including scientific articles, collective reviews, experimental investigations, and more. #JACSOperativeWord

This episode features Dr Richard Green (University of Surrey, Guildford, UK). Multimorbidity is increasing substantially worldwide, is associated with greater use of healthcare services, lower quality and quantity of life, and rises with age. Older people with multimorbidity are expected to become the main recipients of palliative care in the coming decades; however, there is limited evidence of their specific needs. Older people's voices are vital to understanding their own palliative care needs and priorities, but these voices are hampered by structural inequities in service provision. This is the first paper reporting on the expressed palliative care needs of community-dwelling older people with multimorbidity. The most common palliative care needs identified across need domains were pain, function, unhappiness, staying socially connected, future planning, person-centred care and having meaning and purpose in life. This paper highlights different priorities between the reported items in tools used to collect palliative care need and needs expressed by older people with multimorbidity. Further evidence is required to understand need to support service changes required to provide accessible, person-centred care to this underserved population. Multidimensional palliative care tools require refining to encompass complexity beyond the standard domains of palliative care. Community palliative care provision should involve the integration of care across sectors and recognise the diversity of needs across the continuum of living and dying well for older people with multimorbidity Full paper available from:     https://journals.sagepub.com/doi/full/10.1177/02692163221118230 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:  a.nwosu@lancaster.ac.uk If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:  a.nwosu@lancaster.ac.uk

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.09.26.509522v1?rss=1 Authors: Zhang, F., Chang, H., Schaefer, S. M., Gou, J. Abstract: Multimorbidity, co-occurrence of two or more chronic conditions, is one of the top priorities in global health research and has emerged as the gold standard approach to study disease accumulation. As aging underlies the development of many chronic conditions, surrogate aging biomarkers are not disease-specific and capture health at the whole person level, having the potential to improve our understanding of multimorbidity. Biological age has been examined in recent years as a surrogate biomarker to capture the process of aging. However, relatively few studies have investigated the relationship between biological age and multimorbidity. More research is needed to quantify biological age using a broad range of biological markers and multimorbidity based on a comprehensive set of chronic conditions. Brain age estimated by neuroimaging data and machine learning models is another surrogate aging biomarker predictive of a wide range of health outcomes. Little is known about the relationship between brain age and multimorbidity. To answer these questions, our study investigates whether elevated biological age and accelerated brain age are associated with an increased risk of multimorbidity using a large dataset from the Midlife in the United States (MIDUS) Refresher study. Ensemble learning is utilized to combine multiple machine learning models to estimate biological age using a comprehensive set of biological markers. Brain age is obtained using convolutional neural networks and neuroimaging data. Our study is the first to examine the relationship between accelerated brain age and multimorbidity and presents the first effort to test whether sex moderates the relationship between these surrogate aging biomarkers and multimorbidity. Furthermore, it is the first attempt to explore how biological age and brain age are related to multimorbidity in mental health. Our findings hold the potential to advance the understanding of the accumulation of physical and mental health conditions, which may contribute to new strategies to improve the treatment of multimorbidity and detection of at-risk individuals. Copy rights belong to original authors. Visit the link for more info Podcast created by PaperPlayer

In this episode we talk to Dr Simon Fraser who is a GP and associate professor of public health at the School of Primary Care, Population Sciences, and Medical Education at the University of Southampton. Paper: Change in treatment burden among people with multimorbidity: a follow-up survey https://doi.org/10.3399/BJGP.2022.0103 (https://doi.org/10.3399/BJGP.2022.0103) The extent to which treatment burden changes over time and which groups of people are likely to experience increases or decreases in treatment burden is not known. This study identified that a third of older adults with multimorbidity experienced an increase in treatment burden category (overall 9% moving to the ‘high' treatment burden category), and that living more than 10 minutes away from their GP – particularly for those with limited health literacy - was associated with an increase in treatment burden. Improving patient access to primary care services and enhancing health literacy may help to mitigate increases in treatment burden. Our revised single-item measure performed moderately, suggesting a brief measure of treatment burden consisting of more than one item may be required for use in practice.

In this podcast, Jonathan Appelbaum, MD, FACP, AAHIVS, summarizes the many medical challenges faced by aging people with HIV, including:Underrepresentation of older patients in medical researchConsequences of early experiences in the epidemic such as late HIV diagnosis and low CD4+ cell count nadir, incomplete or short-lived virologic suppression with early regimens, and toxicity associated with early antiretroviral agentsAdded challenges of multimorbidity and psychosocial challenges, especially mental health issues, loneliness, and social isolationThe need to provide care for the aging HIV population using a holistic approach Gaps in the current healthcare system in providing optimal care for aging people with HIVFaculty:Jonathan Appelbaum, MD, FACP, AAHIVSLaurie L. Dozier Jr, MD, Education DirectorProfessor of Internal MedicineChair, Department of Clinical SciencesFlorida State University College of MedicineTallahassee, FloridaLink to full program: https://bit.ly/3KkF4iZ

Welcome to a new Hot Topics Podcast from NB Medical with Dr Neal Tucker.  It's the summer holidays! We hope a little pressure is off at your practices and you might even get a break yourself.  In this podcast, we discuss the latest news including whether GPs simply aren't working hard enough and debate a £10 charge for DNAs.In research, we look at new data from JAMA suggesting patients are at increased risk of MI shortly after a flare of gout, a fantastic paper in the BJGP presenting data showing how it may be possible to improve early identification of colorectal cancer based on common symptoms and blood results, and more from the BJGP with qualitative research exploring the barriers to shared decision making in patients with multimorbidity. ReferencesJAMA Gout and acute CVDBJGP Early Identification of CRCBJGP Shared decision making and multimorbidity

In this episode, hear HIV activist Marc Thompson share his perspectives on aging with HIV including: His early experiences after receiving his diagnosisPersisting issues of the HIV epidemic including stigma and discriminationChanges in healthcare with the advent of HIV treatmentAdded issues of aging with HIV like polypharmacy, multimorbidity, and mental health concerns (eg, loneliness, social isolation)Actions needed to improve the path for the future: addressing opportunities to expand research, improve collaboration between HIV and other healthcare professionals and gain wisdom and knowledge from others aging with HIVPresenter:Marc ThompsonDirector, The Love TankLink to full program: https://bit.ly/3yIkntcYou can also join Marc Thompson and a panel of patient advocates and healthcare professionals in person or in a live simulcast as they discuss healthy aging with HIV at our live symposium at AIDS 2022 in Montreal, Quebec, Canada. They will discuss the challenges faced by older people with HIV, including medical and nonmedical issues, and specific challenges faced by subgroups of older patients such as women and patients in resource-limited settings.

3ヶ月ぶりの配信となります。おまたせしてごめんなさい。今回は富山からマルモ寿司先生をむかえて、多疾患併存～Multimorbidityについてお話をうかがいました。多疾患併存が現代においてなぜ重要なのか？どのようにアプローチするのか？多職種にとりくむためには？教育の枠組みは？などのテーマについて語り合いました。略語や専門用語が多いので、ぜひマルモ寿司先生の週間医学界新聞の連載をご参照ください。 ---------------------------------------------------------- 「ケースで学ぶマルチモビディティ」 https://www.igaku-shoin.co.jp/paper/archive/y2020/PA03367_05

Sex, Age and Race/Ethnic Differences in Multimorbidity in Lupus: Drs. Duarte and Mehta Hospitalization Trends in Patients with Psoriatic Arthritis: Dr. Olga Petryna Patient Reported Outcomes in axSpA: Dr. Swetha Alexander Pregnancy Outcomes in PsA, SpA, RA: Dr. Rachel Tate Guselkemab vs. Ustekinumab in PsA: Dr. Richard Conway Medication Preferences in Patients with Psoriatic Arthritis: Dr. Olga Petryna Dr. Michelle Petri - Urine Proteome Advances: What Do They Mean?

Sex, Age and Race/Ethnic Differences in Multimorbidity in Lupus: Drs. Duarte and Mehta Hospitalization Trends in Patients with Psoriatic Arthritis: Dr. Olga Petryna Patient Reported Outcomes in axSpA: Dr. Swetha Alexander Pregnancy Outcomes in PsA, SpA, RA: Dr. Rachel Tate Guselkemab vs. Ustekinumab in PsA: Dr. Richard Conway Medication Preferences in Patients with Psoriatic Arthritis: Dr. Olga Petryna Dr. Michelle Petri - Urine Proteome Advances: What Do They Mean?

CHEST November 2021, Volume 160, Issue 5 Joanne McPeake, PhD, and Hans Flaatten, MD, PhD, join CHEST Podcast Moderator Dominique Pepper, MD, to discuss multimorbidity and its relationship with long-term outcomes following critical care discharge. DOI: https://doi.org/10.1016/j.chest.2021.05.069 DOI: https://doi.org/10.1016/j.chest.2021.06.012

In this episode we speak to Dr Patrick Highton who is a Research Associate at the Diabetes Research Centre at the University of Leicester and also part of the NIHR Applied Research Collaboration East Midlands. Paper: Promoting physical activity through group self-management support for those with multimorbidity: a randomised controlled trial https://doi.org/10.3399/BJGP.2021.0172 (https://doi.org/10.3399/BJGP.2021.0172) People with multimorbidity typically display increased morbidity and mortality risk, driven in part by reduced levels of habitual physical activity. Disease self-management empowers patients to take more of an active role in their own healthcare and has shown promise in individual conditions, though this is under-researched in multimorbidity. This study investigated the impact of a targeted group-based disease self-management programme on habitual physical activity levels in people with multimorbidity. However, a slight decrease in physical activity levels was observed, suggesting that the intervention was ineffective, and that future research should target those at greatest need for physical activity intervention.

In this latest Hot Topics Podcast, Dr Neal Tucker reflects on the NHSE Rescue Package and asks if we are going to strike are we clear what we want general practice to be? Time for us to make up our minds.In research we look at multimorbidity clusters and consultation rates - how should this influence funding? Also a ray of hope for patients with heart failure and preserved ejection fraction with empagliflozin - but is it as good as it appears to be? And two papers on AF screening including implanting a mini-ECG machine in your chest wall. Sounds like a lot of effort, but does it help???ReferencesBJGP MM & Consultation RatesNEJM Empagliflozin & HFpEFLancet STROKESTOP study & ILR study

With Dong Zhao & Jing Liu, Beijing Anzhen Hospital, Beijing - China Link to EHJ paper Link to EHJ editorial  

Presenter:Javed Butler MD, MPH, MBAProfessor and ChairmanDepartment of MedicineUniversity of MississippiJackson, MississippiHeart Failure is a serious health concern amongst older adults, afflicting over 6 million Americans, the majority of whom are 65 years of age or older. It is the leading cause of hospitalization, morbidity, and mortality in this population. It is more challenging to diagnose and manage HF in older patients due to multiple factors including multimorbidity, polypharmacy, cognitive impairment, and frailty. Furthermore, clinicians struggle to remain up-to-date on key clinical trial data and recent guidelines on developing individualized treatment plans for patients. To improve outcomes for patients with HF, clinicians must be adept at recognizing its common signs or symptoms, conducting a thorough diagnostic evaluation, and developing a treatment plan that addresses the multiple challenges and complexities that this patient population faces. Here, we cover these key principles in a short, case-based teaching module.Follow along with the slideset located here:https://bit.ly/3EGHtBx

In this episode we talk to Professor Stewart Mercer who is a Professor of Primary Care and Multimorbidity at the Usher Institute, College of Medicine and Veterinary Medicine at the University of Edinburgh. Paper: Implementing social prescribing in primary care in areas of high socioeconomic deprivation: process evaluation of the ‘Deep End' community links worker programme https://doi.org/10.3399/BJGP.2020.1153 (https://doi.org/10.3399/BJGP.2020.1153) Social prescribing using primary care-based link workers is increasingly promoted across the four nations of the UK and elsewhere in the world, as a way of reducing health inequalities by better supporting people living in deprived areas. However, the evidence-base of effectiveness is limited, and there is very little information on how best to successfully implement a link worker approach in practice. This study reports on a process evaluation of the ‘Deep End' Links Worker Programme (LWP) over a two-year period, in seven general practices in deprived areas of Glasgow. Despite the programme being well-funded and well supported, the majority of practices involved had not fully integrated the LWP within the first two years. Implementing social prescribing and link workers within primary care at scale is unlikely to be a ‘quick fix' for mitigating health inequalities in deprived areas.

When 2 in every 3 people with a musculoskeletal condition also have at least one other underlying health condition, it’s time for rehabilitation clinicians to up our game in understanding complex health needs. Thankfully, Professor Søren Skou is here to help. Who is best placed to help patients manage their complex health needs? And is exercise—the veritable polypill—always the answer? Link to the START trial: https://pubmed.ncbi.nlm.nih.gov/33591346/

We meet our first guest, Clare Howard. Clare has worked in pharmacy since she was 16 and in the past was Deputy Chief Pharmaceutical Officer for NHS England. She is now the Medicines Optimisation Clinical Director for the Wessex Academic Health and Sciences Network. We discuss Clare's choice of Desert Island Drug, a book that has influenced her career and a song for the Aural Apothecary playlist. While making fun of Jamie we discuss polypharmacy, PINCER, multimorbidity as well as middle aged apathy.The paper we discuss is the Lancet paper ‘Epidemiology of multimorbidity and implications for healthcare, research and medical education' https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60240-2/fulltext. Clare's book choice was ‘Invisible Women'https://www.waterstones.com/book/invisible-women/caroline-criado-perez/9781784706289 and her song choice was ‘I can see clearly now' by Jonny Nash. You can see the Aural Apothecary playlist at https://open.spotify.com/user/steve.williams55/playlist/3OsWj4w8sxsvuwR9zMXgn5?si=iMh-pTPtQtWrM65wtXd9yQ. To get in touch follow us on Twitter @auralapothecary or email us at auralapothecarypod@gmail.com.

Polypharmacy in Older Adults: Practical Applications Alongside a Patient Case by: Timothy Nguyen, PharmD, BCPS, Elaine Wong, PharmD, BCPS and Francesco Ciummo, PharmD, BCCCP.   *********&&&&&&&&&&&**********&&&&&&&&&&***********&&&&&&&&&&&************&&&&&&&&&&************&&&&&&&&&&&**   "Multimorbidity and the associated use of multiple medicines (polypharmacy), is common in the older population. Despite this, there is no consensus definition for polypharmacy"(2017) . References: Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G. E. (2017). What is polypharmacy? A systematic review of definitions. BMC geriatrics, 17(1), 230. https://doi.org/10.1186/s12877-017-0621-2   Sharing knowledge and educating those in the community for a healthier stronger safer community. MOTTO: GUMBO We'll teach your Grandma, Uncles, Mama, Brothers, and Others (GUMBO) The book is complete.  It was written to help raise money for the Non-profit. "Casey and the Crawfish" will be sold starting in January 2019. Everyone can purchase from http://gumboeducation.com/casey-and-the-crawfish   BULLYING PREVENTION FOR NURSES - A REAL SOLUTION: CONTACT HOURS WILL BE AWARDED: Thanks again for your support.      

Commentary by Dr. Valentin Fuster

 Welcome to AiArthritis Voices 360. This episode join your host, Tiffany, as she and co-host Simon Stones discuss the prevalence and logistics of living with multiple conditions. Most health systems have moved away from a model where General Practitioners are managing all aspects of patient care to a model that places more emphasis on specialists and a depth of expertise in a specific disease. The downside to this is it has created a system where patients must be their own Care Coordinators, yet most have no experience or understanding of how to do this. What can be done to change the system? What can you do in the meantime to ensure that your health is not slipping through the cracks? Tune in to this week’s episode to find out. AiArthritis Voices 360 is produced by the International Foundation for Autoimmune and Autoinflammatory Arthritis. Visit us on the web at www.aiarthritis.org/podcast. Find us on twitter, instagram, or Facebook (@ifAiArthritis) or email us (podcast@aiarthritis.org) to have your seat at the table.    Show Notes: Episode 18 – “Living with Multiple Conditions” 00:52 - Tiffany welcomes listeners and co-host, Simon Stones01:58 - Today’s topic is living with multiple conditions02:20 – Tiffany’s primary diagnosis is Non-Radiographic Axial Spondyloarthritis, but she also has comorbidities such as Bechet’s Disease and possibly Sjogren’s Syndrome 03:25 - If you have been sick for a while without an explanation, a diagnosis can be a relief 04:27 - Simon was diagnosed with Juvenile Idiopathic Arthritis at age 3 and has no memory of his life before Arthritis07:06 - At 10, Simon was diagnosed with Slipped Capital Femoral Epiphyses 08:30 - Sometimes secondary conditions can be masked by the symptoms of the primary diagnosis, even when under the care of specialists09:23 - Patients assume that their specialists will catch new problems, but there is a high risk of new symptoms being dismissed as part of the existing diagnosis09:45 - Every patient is an expert in their own body and must advocate if they know their symptoms are something to be explored13:20 - In his teenage years, Simon’s diagnosis was modified to include Psoriatic Arthritis or Undifferentiated Axial Spondyloarthritis 14:50 - In the UK, no biologic therapies are approved for adults with JIA, so patients must have a new diagnosis so they can have access to medication15:32 - Managing multiple complex diagnoses in a complex medical system can be very complicated16:51 - Around 12 years old, Simon developed symptoms of Crohn’s Disease, but the symptoms and markers were attributed to his JlA diagnosis19:03 - Doctors may be reluctant to order tests that are unpleasant for pediatric patients. Parents may need to advocate strongly for their children if they believe something is wrong.26:02 - Medicine should be evidence-based and not vary wildly from one doctor to the next27:10 - A comorbidity is the presence of two related diseases (like Rheumatoid Arthritis and Cardiovascular Disease or Psoriatic Arthritis and Psoriasis) where one is the index disease*27:33 - Multimorbidity is the presence of multiple diseases without the presence of a specific index disease and requires more holistic treatment29:23: Some people will combine terminology of related diseases (ex: Lupus and Rheumatoid Arthritis = Rupus)29:40 - Multiple Autoimmune Syndrome (MAS) is a term many doctors and patients use to refer to the presence of 3 or more autoimmune diseases 30:56 - Simon read a study that asserted that 25% of the general population of rheumatology patients has 2 or more diseases, but Simon’s experience would suggest it may be much higher than that 33:13 - Gathering more data would be helpful34:52 - The actual rarity of having only one autoimmune disease impacts clinical trials because patients with comorbidities and multimorbidities are all excluded from clinical trials38:17 - When you have multiple diagnoses and multiple specialists, you may need to become your own coordinator of care39:04 - Pediatric specialists seem to be better about coordinating with each other, but adult specialists often rely on the patient to report what they have been told by their other specialists41:10 - If you are not advocating for yourself and managing your own care, you run the risk of important warning signs being missed41:55 - General practitioners used to be very involved in managing patient care across multiple specialities, but that is no longer happening42:43 - Healthcare systems now really could benefit from moving to a coordinated care model46:02 - Obtaining health records can be very difficult because patient data is the property of the hospital or doctor’s office instead of the patient49:40 - Patient advocates should unite to tackle the problem of inconsistent patient data and data ownership54:27 - The system needs to change, and it can result from grassroots efforts 55:00 - Decision-making processes about reforming the healthcare systems must include patient voices55:17 - Patients often have the best solutions to healthcare systemic problems because we know exactly what we need to make things work better and reduce waste56:13 - Tiffany thanks Simon for co-hosting today’s episode56:52 - If you have an opinion on this topic, IFAA wants to hear from you! 57:08 - If you would like to take a seat at the table, visit us on social medias @IfAiArthritis on all platforms or email us @ podcast@aiarthritis.org *An index disease is a primary or core disease with a significant impact on the development of a comorbidity 

We know that the number of people living with multiple health conditions is rising year on year, and yet training, guidelines, organisations and physical spaces in healthcare still largely focus on single diseases or organ systems. The means that patients in the NHS are often treated as if their conditions exist in isolation, and that their care lacks coordination, and isn't as good as it should be. To look at why patients with multiple conditions pose a challenge to the NHS, and what we can do to improve the care they receive, we're joined by Louella Vaughan, acute physician and senior clinical fellow at the Nuffield Trust Jihad Malasi, GP and clinical chair of Thanet CCG Rammya Mathew, GP and a quality improvement lead and columnist for The BMJ and David Oliver, consultant in geriatrics, clinical vice president of the RCP and columnist for The BMJ

Do all samples from suspected COVID-19 cases need to be sent directly to the CDC for testing? Find out about this and more in today's PV Roundup podcast.

Reference to paper: Whitty C.J.M.et al 2020 BMJ 2020;368:l6964 doi: 10.1136/bmj.l6964 (Published 6 January 2020) Link to paper: https://www.bmj.com/content/bmj/368/bmj.l6964.full.pdf For more blogs see here: https://www.3vh.org/essential-insights/category/paper-of-the-week/

Recap extravaganza 2019 featuring top pearls from our staff’s favorite episodes of 2019 and voicemails from Kashlak faculty, Dr. Avital O’Glasser (@aoglasser), Dr. Kimberly Manning (@gradydoctor), Dr. Renee Dversdal (@DrSonosRD) and The Curbsiders team. Topics include: HFpEF, the PARAGON-HF trial, Buprenorphine, Opioid Use Disorder, Cirrhosis, Coagulopathy, SBP, Hyperkalemia treatment, Multimorbidity, and how to think about NNT. Plus, the team shares a bunch of other favorite moments and random pearls! Upcoming shows: The next two weeks will feature REBOOT episodes with fresh intros from The Curbsiders team. Season 9 starts January 20, 2020 with a Lipid Update from Cardiologist Dr. Erin Michos (@ErinMichos) Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com Credits Produced by: Sarah Phoebe Roberts MPH and Chris Chiu MD, FACP, FAAP  Writer: Sarah Phoebe Roberts MPH Infographic: Sarah Phoebe Roberts MPH Cover Art: Kate Grant MBChB DipGUMed Hosts: Chris Chiu MD, FACP, FAAP; Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Chris Chiu MD, FACP, FAAP (audio), Matthew Watto MD, FACP (show notes) Time Stamps 00:00 Intro and disclaimer 04:25 Picks of the year*: The Expanse (TV show) -Chiu Man’s pick; Midsommar (film) -Paul’s pick; Point-of-care-ultrasound (ACP course at IM2020 in LA or AIUM courses with Dr. Renee Dversdal @DrSonosRD) -Matt’s pick; Sleep!!! -Stuart pick 08:37 Hyperkalemia Master Class Joel Topf MD 14:53 Multimorbidity Games with Josh Uy MD 21:54 Buprenorphine Master Master Class with Michael Fingerhood MD 27:50 Cirrhosis TIPS for Acute Complications with Scott Matherly MD 31:55 HFpEF with Clyde Yancy MD 39:50 Chronic pain, sickle cell disease, opioid tapers 43:13 Teaching in the Hospital 46:00 A quote from Paul Williams 47:35 Celebrity voicemails from Avital O’Glasser MD, Kimberly Manning MD,  and Renee Dversdal MD 51:55 Voicemails and favorite pearls from our Curbsiders team! 62:23 Outro Goal Listeners will recall some of the top pearls from Curbsiders episodes on cirrhosis, buprenorphine, HFpEF, multimorbidity and hyperkalemia. Links* The Expanse (TV show) -Chiu Man’s pick Midsommar (film) -Paul’s pick Point-of-care-ultrasound (ACP course at IM2020 in LA or AIUM courses with Dr. Renee Dversdal @DrSonosRD) -Matt’s pick Sleep!!! -Stuart pick *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Disclosures The Curbsiders report no relevant financial disclosures.  Citation Roberts SP, Chiu CJ, Williams PN, Brigham SK, Watto MF. “#190 Recap Extravaganza 2019”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. December 30, 2019.

Peter Bower Multimorbidity by NIHR

Learn how to approach the geriatric patient with multimorbidity and how to parse through and prioritize a mile-long problem list with Dr Josh Uy, master geriatrician at the University of Pennsylvania. We review different approaches to a clinic visit with a patient who takes fifteen daily medications with just as many chief complaints, all in a thirty minute (or less!) appointment time. We discuss what the term “multimorbidity” even means, how to ask about patient preferences and use them to inform the treatment plan, and what the evidence has to say about adjusting treatment goals of common conditions for individual patients. (Spoiler alert: It all depends on the patient, comorbid conditions and goals!)  Full show notes https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Producer: Nora Taranto MD  Writer:  Nora Taranto MD, Leah Witt MD  Infographic:  Leah Witt MD  Cover Art: Nora Taranto MD  Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Leah Witt MD, Paul Williams MD, FACP Editor: Matthew Watto MD, FACP; Clair Morgan Guest: Josh Uy MD Time Stamps 00:00 Pun, Intro, disclaimer, guest bio 04:30 Guest one-liner; Career advice;  Picks of the Week*: Unbroken (book), Down Dog Yoga (app); Check out Dimash’s music on YouTube; Off Your Rocker (TV show); Finishing Well to the Glory of God (book) 12:30 A case of multimorbidity; Where to start? 15:30 How to focus the visit; Lumping and the problem list; 18:20 Dr Uy’s framework for multimorbidity 28:08 Questions (scripts) for eliciting patient preferences 30:20 Hypertension; All cause mortality; Number needed to treat; The danger of adding blood pressure medications in the hospital, the Jenga analogy 35:30 How to frame  potentially ineffective treatments (e.g. statins for primary prevention of stroke) and align treatments with a patient and family’s goals 44:18 Dr Uy runs through common comorbid conditions and time to benefit starting with longevity minded (45:43); Palliative minded approach (47:50) 48:49 Afib, anticoagulation and falls; Cancer screening 54:30 Take Home Points *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Goal Listeners will develop an approach to managing older adults with multimorbidity in primary care   Learning objectives  After listening to this episode listeners will...  Define multimorbidity and its implications for triaging multiple chief complaints and chronic conditions Recognize the time frame to benefit of treatments for several chronic conditions Learn to ask patients about health care values and goals of care in order to optimize shared decision-making Identify the barriers to treating multimorbidity and strategize approaches for optimal primary care delivery for patients with multimorbidity Disclosures Dr Uy reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation Uy J, Taranto N, Witt LJ, Williams PN, Brigham SK, Watto MF. “#181 The Multimorbidity Games”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list November 4, 2019.

Ep. 17 Motivational Interviewing for Multimorbidity Glenn and Sebastian are happy to share our latest podcast with our guest, Kylie McKenzie, MAPS, FCCLP. Kylie is based outside of Melbourne Australia and is a Clinical Psychologist with more than eighteen years’ experience in a regional public hospital setting. Kylie’s clinical work, focused on mental health andRead more The post Ep. 17 Motivational Interviewing for Multimorbidity appeared first on Glenn Hinds.

Kimberly Casten, MD presents her original research Weakness and Inflammation Are Associated with Disability, Poor Cognition, and Multimorbidity in Older Adults. This episode is part of our Rehabilitation Science Series in which we explore the culture of research at our institution from resident projects to NIH grant work done by our research and clinical faculty. For more information about PM&R at Michigan Medicine please visit our website https://medicine.umich.edu/dept/pmr/education-training/physician-residency.

On today's podcast we talk with one of the national experts on multimorbidity, Melissa Wei. Dr. Wei is an Assistant Professor and physician researcher at the University of Michigan. In addition to destroying the lyrics to Bohemian rhapsody, we talk to Dr. Wei about how we should conceptualize multi morbidity, it's impact on older adults, and about her recent JAGS publication titled "Multimorbidity and Mental Health-Related Quality of Life and Risk of Completed Suicide."

History of the Calorie: https://nutritionj.biomedcentral.com/track/pdf/10.1186/1475-2891-6-44 Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC. National Academies Press. 2005 pp. 119–21. https://www.nap.edu/catalog/10490/dietary-reference-intakes-for-energy-carbohydrate-fiber-fat-fatty-acids-cholesterol-protein-and-amino-acids Ravussin E, Bogardus C. A brief overview of human energy metabolism and its relationship to essential obesity. Am J Clin Nutr. 1992; 55:S242S–45. https://www.ncbi.nlm.nih.gov/pubmed/1728837 Food and Nutrition Board. Dietary Reference Intakes for Energy, Carbohydrates, Fiber, Fat, Protein, and Amino Acids. Washington, DC: National Academy Press. 2002. https://www.nal.usda.gov/sites/default/files/fnic_uploads/energy_full_report.pdf Horton ES. Introduction: an overview of the assessment and regulation of energy balance in humans. Am J Clin Nutr. 1983; 38:972–77. 58. Jequier E, Acheson K, Schutz Y. Assessment of energy expenditure and fuel utilization in man. Ann Rev Nutr. 1987; 7:187–208. http://agris.fao.org/agris-search/search.do?recordID=US8501699 Galgani, J. E., Castro-Sepulveda, M., Pérez-Luco, C., & Fernández-Verdejo, R. (2018). Validity of predictive equations for resting metabolic rate in healthy humans. Clinical Science, 132(16), 1741–1751. doi:10.1042/cs20180317 https://www.ncbi.nlm.nih.gov/pubmed/29967004 Gropper, Sareen S.; Smith, Jack L.. Advanced Nutrition and Human Metabolism (Page 299). Cengage Textbook. Buchholz, A. C., Rafii, M., & Pencharz, P. B. (2001). Is resting metabolic rate different between men and women? British Journal of Nutrition, 86(06), 641. doi:10.1079/bjn2001471. https://www.ncbi.nlm.nih.gov/pubmed/11749674 Horton, T. J., Drougas, H., Brachey, A., Reed, G. W., Peters, J. C., & Hill, J. O. (1995). Fat and carbohydrate overfeeding in humans: different effects on energy storage. https://www.ncbi.nlm.nih.gov/pubmed/7598063/ Fabbri, Elisa et al. “Energy Metabolism and the Burden of Multimorbidity in Older Adults: Results From the Baltimore Longitudinal Study of Aging” journals of gerontology. Series A, Biological sciences and medical sciences vol. 70,11 (2014): 1297-303. Knuth ND, Johannsen DL, Tamboli RA, Marks-Shulman PA, Huizenga R, Chen KY, Abumrad NN, Ravussin E, Hall KD. Metabolic adaptation following massive weight loss is related to the degree of energy imbalance and changes in circulating leptin. Obesity (Silver Spring) 2014;22:2563–2569. https://onlinelibrary.wiley.com/doi/full/10.1002/oby.20900 De Cleva, R., Mota, F. C., Gadducci, A. V., Cardia, L., D’Andréa Greve, J. M., & Santo, M. A. (2018). Resting metabolic rate and weight loss after bariatric surgery. https://www.ncbi.nlm.nih.gov/pubmed/29628405 Bouchard C, Pérusse L, Dériaz O, et al. Genetic influences on energy expenditure in humans. Crit Rev Food Sci Nutr 1993;33:345–50. https://www.ncbi.nlm.nih.gov/pubmed/8357495 Westerterp-Plantenga, M. S., Nieuwenhuizen, A., Tome, D., Soenen, S., & Westerterp, K. R. (2009). Dietary protein, weight loss, and weight maintenance. Annual Review of Nutrition, 29, 21–41 https://www.ncbi.nlm.nih.gov/pubmed/19400750 Ravussin E., Lillioja S., Anderson T.E., Christin L., Bogardus C. Determinants of 24-hour energy expenditure in man. Methods and results using a respiratory chamber. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC423919/pdf/jcinvest00111-0160.pdf Stookey Jodi. Negative, Null and Beneficial Effects of Drinking Water on Energy Intake, Energy Expenditure, Fat Oxidation and Weight Change in Randomized Trials: A Qualitative Review. Nutrients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4728633/ LaForgia J., Withers R. T., Gore C. J. (2006). https://www.ncbi.nlm.nih.gov/pubmed/17101527/ Podcasts: goo.gl/X4H4z8 Email: info@barbellmedicine.com Newsletter: http://eepurl.com/cpqB3n

There are now a greater proportion of people living longer with more health conditions and taking new combinations of medicines. How can we adjust medical practice to deal with this? Professor David Haslam, Chair of NICE, explains why we need to address multimorbidity and how we are moving forward to overcome the challenges. Emily gives her personal experiences of managing multiple conditions and Dr James Larcombe explains how GPs deal with these complex situations on the field. Full NICE guidance: https://www.nice.org.uk/guidance/ng56

Commentary by Dr. Valentin Fuster

Dr. Dixon and Dr. Berezin discuss what policy makers can do regarding fentanyl and the evolving opioid epidemic, explore communication strategies to counter stigma and improve mental illness and substance use disorder policy, and document how the concept of multimorbidity is making its way into clinical practice. Articles may be viewed online at ps.psychiatryonline.org. We are conducting a listener survey. Please go to ps.psychiatryonline.org/podcast and select the link to the survey. It won’t take more than a few minutes to complete, and your feedback will remain anonymous. We appreciate your responses. Thank you.

Julia Ho in interview with Ross Upshur talks about her recent article “It’s a fight to get anything you need”—accessing care in the community from the perspectives of people with multimorbidity, published in the Open Access journal of Health Expectations.

This episode: Multimorbidity Presented by: Jo Preston (Consultant Geriatrician at St George's Hospital, London) and Iain Wilkinson (Consultant Geriatrician at East Surrey Hospital). A BigFings Media Production - www.bigfings.com

In the Autumn podcast Dr Madeline Lameris interviews Dr Nick Steel and Dr Alice Shiner about their article on managing multimorbidity in primary care. Dr David Scott, our resident psychiatry trainee, interviews Veronica Beckett, a sex therapist with Relate about sex therapy and  psychosexual disorders. Finally, Dr Tim Crossman, GP trainee, interviews Mr Tom Walker, Maxillofacial surgeon, about the use of Botox and Fillers and what they mean to us in primary care.

Multimorbidity presents a number of different challenges, for the patients living with the conditions, but also for the health professionals caring for them in systems that often are not designed with these more complex needs in mind. Emma Wallace, general practice lecturer, and Susan Smith, a professor of general practice at the Royal College of Surgeons in Ireland Medical School join us to discuss how to work within the system, and what their dream scenario for care would be. Read the full clinical review: http://www.bmj.com/content/350/bmj.h176