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In sickness and in health : disease and disability in contemporary America
The increasing importance of sickness and disability data across health-related disciplines is the focus of this concise but comprehensive resource. It reviews the basics of morbidity at the population level by defining core concepts, analyzing why morbidity has overtaken mortality as central to demographic study, and surveying ways these data are generated, accessed, and measured.
Book
Correction: Mortality and morbidity in wild Taiwanese pangolin (Manis pentadactyla pentadactyla)
[This corrects the article DOI: 10.1371/journal.pone.0198230.].
Journal Article
DEVELOPING A SCALE TO MEASURE NEGLECT SEVERITY: THE HEALTH-RELATED SEVERITY IN ELDER NEGLECT SCALE
Abstract
Caregiver neglect in older persons can vary dramatically in severity, with differential impact on an older adult’s health. Assessing severity is critical for research and clinical practice but has received focus until recently. To address this gap, we developed a scale to describe the health-related severity of elder neglect using an expert consensus method. In development, the experts conceptualized severity as: (1) the level of risk that neglectful behaviors would cause morbidity or mortality and (2) related timeframe. Additionally, the experts recommended that the scale identify risk for future neglect. The scale was designed iteratively, and, after finalization, we assessed face and construct validity. The final scale was found to have validity. It has 5 levels: not present, not present / potential risk, present / mild, present / moderate, present / severe. Each level has a description to guide assessment. For example, present / mild is described as: “caregiving behaviors not optimal, with potential to create morbidity, but low concern for immediate danger,” present / moderate is: “caregiving behaviors with significant potential to create morbidity within the next 4 weeks,” and present / severe is “caregiving behaviors creating immediate danger of morbidity or mortality -- insufficient access to shelter, food, medication – with alternative living situation or ED visit / hospitalization recommended.” The description of not present / potential risk is: “though neglect not currently occurring, factors present that raise concern for future neglect risk.” Assessing neglect severity using this scale may improve understanding of the phenomenon and inform intervention.
Journal Article
PO148 Shortfall in mssn coverage in west essex associated with lack of specialist ms care for people with significant ms related morbidity – a service evaluation of ms care in west essex ccg
IntroductionMultiple Sclerosis (MS) is a neurological condition requiring multidisciplinary input to optimise patient outcomes. NICE recommends everyone with MS have regular reviews with an MSSN.1,2 The MS Society estimates a prevalence of 490 people with MS in West Essex served by a 0.8 WTE MS nurse, against the recommended caseload of 358 per whole time MS nurse.3 MethodsIn collaboration with the MS Trust GEMSS team, a survey was sent out to collect data on the quality of MS care. 265 patients where surveyed with 114 (43%) responses.ResultsOf the 114 responders, 68.1% reported significant disability. 58% of patients had seen an MSSN in the last year compared to the GEMSS team average of 78%.167% saw a neurologist, but 14% had not seen any healthcare professional about their MS. Patients who had not seen a MSSN in the last year reported significant MS-related morbidity.Discussion42% of patients had not seen an MSSN in the last year and reported significant MS-related morbidity including isolation, lack of confidence and medication anxiety. Additional MSSN input is needed to support these patients.ReferencesFindings from the MS trust GEMSS MS specialist nurse evaluation project. Letchworth: MS Trust 2015. NICE quality standard MS2016.Modelling sustainable caseloads for MSSN: Report on a consensus process led by the MS trust. British Journal of Neuroscience Nursing2014;10(6):274–80.
Journal Article
Correction: The WHO Maternal Near-Miss Approach and the Maternal Severity Index Model (MSI): Tools for Assessing the Management of Severe Maternal Morbidity
Download corrected item. https://doi.org/10.1371/annotation/ca8ccfaa-71c2-4bb8-8b15-121af175a43f.s001.cn Citation: Souza JP, Cecatti JG, Haddad SM, Parpinelli MA, Costa ML, Katz L, et al. (2013) Correction: The WHO Maternal Near-Miss Approach and the Maternal Severity Index Model (MSI): Tools for Assessing the Management of Severe Maternal Morbidity.
Journal Article
Correction: Changes in inequality of childhood morbidity in Bangladesh 1993–2014: A decomposition analysis
[This corrects the article DOI: 10.1371/journal.pone.0218515.].[This corrects the article DOI: 10.1371/journal.pone.0218515.].
Journal Article
PLD.38 Major Obstetric Haemorrhage in a Tertiary Maternity Unit in Scotland: Review of Practice and Future Implications
Background The incidence of major obstetric haemorrhage (MOH), defined as ≥2.5 litres of blood loss, is rising. It is a leading cause of significant maternal morbidity.1 Objectives To review the management of MOH in a tertiary maternity unit, compare practice against recommended guidelines1 and suggest changes for improving future practice. Method Retrospective review of case notes for 6 months (Jan 2013 to June 2013) in Princess Royal Maternity Unit, Glasgow. Results There were 28 patients with MOH in the 6 month period, reflecting an incidence of 9.70 per 1000 births. A consultant obstetrician was less likely to be present overnight 0100–0900 (4 out of 8 patients), when compared to 0900–1700 (5 out of 7 patients) and 1700–0100 (12 out of 13 patients). A significant number of patients (5 out of 28) received more than the recommended 3.5L of intravenous fluids before receiving blood.1 There were 7 patients (25%) which could be identified as “high risk” before labour – all of which were identified in the antenatal period. A detailed action plan of management was recorded antenatally in 6 out of these 7 and followed in 5 out of the 7 patients. Conclusion The unit has been effective in identifying and planning for “high risk” patients. However, there is room for improvement in our management of MOH, such as improving consultant presence and early initiation of blood transfusion. Reference Scottish Confidential Audit of Severe Maternal Morbidity, 9th Annual Report (2011)
Journal Article
The SELFIE project on Integrated Care for Persons with Multi-Morbidity: framework, promising programmes, financing, and evaluation
The rise of multi-morbidity constitutes a serious challenge in the organisation of care and requires successful integration to counter the threat of fragmentation. The EU Horizon2020-funded project ‘Sustainable Integrated Care Models for Multi-Morbidity: Delivery, Financing and Performance’ (SELFIE) aims to increase the knowledge-base on integrated care for multi-morbidity. During this session four presentations on initial findings will be presented. First, (1) a conceptual framework for integrated care for multi-morbidity will be presented that was developed on the basis of an extensive scoping review and workshops with stakeholders. The framework was subsequently used to describe 17 promising integrated care programmes for multi-morbidity in the 8 SELFIE partner countries. (2) The overarching barriers and facilitators to their implementation will be presented. Next, (3) the different financial and payment schemes applied in these programmes will be described and compared. Lastly, (4) the planned Multi-Criteria Decision Analysis evaluations will be presented.
Journal Article
Predictive Ability of Comorbidity Indices for Surgical Morbidity and Mortality: a Systematic Review and Meta-analysis
Background
Several contemporary risk stratification tools are now being used since the development of the Charlson Comorbidity Index (CCI) in 1987. The purpose of this systematic review and meta-analysis was to compare the utility of commonly used co-morbidity indices in predicting surgical outcomes.
Methods
A comprehensive review was performed to identify studies reporting an association between a pre-operative co-morbidity measurement and an outcome (30-day/in-hospital morbidity/mortality, 90-day morbidity/mortality, and severe complications). Meta-analysis was performed on the pooled data.
Results
A total of 111 included studies were included with a total cohort size 25,011,834 patients. The studies reporting the 5-item Modified Frailty Index (mFI-5) demonstrated a statistical association with an increase in the odds of in-hospital/30-day mortality (OR:1.97,95%CI: 1.55–2.49,
p
< 0.01). The pooled CCI results demonstrated an increase in the odds for in-hospital/30-day mortality (OR:1.44,95%CI: 1.27–1.64,
p
< 0.01). Pooled results for co-morbidity indices utilizing a scale-based continuous predictor were significantly associated with an increase in the odds of in-hospital/30-day morbidity (OR:1.32, 95% CI: 1.20–1.46,
p
< 0.01). On pooled analysis, the categorical results showed a higher odd for in-hospital/30-day morbidity (OR:1.74,95% CI: 1.50–2.02,
p
< 0.01). The mFI-5 was significantly associated with severe complications (Clavien-Dindo ≥ III) (OR:3.31,95% CI:1.13–9.67,
p
< 0.04). Pooled results for CCI showed a positive trend toward severe complications but were not significant.
Conclusion
The contemporary frailty-based index, mFI-5, outperformed the CCI in predicting short-term mortality and severe complications post-surgically. Risk stratification instruments that include a measure of frailty may be more predictive of surgical outcomes compared to traditional indices like the CCI.
Journal Article