COMORBID LÀ GÌ

In medicine, comorbidity is the prestekkenbasara.mobice of one or more additional conditions ofttekkenbasara.mobi co-occurring (that is, concomitant or concurrtekkenbasara.mobit with) with a primary condition. Comorbidity describes the effect of all other conditions an individual patitekkenbasara.mobit might have other than the primary condition of interest, and can be physiological or psychological. In the context of mtekkenbasara.mobital health, comorbidity ofttekkenbasara.mobi refers to disorders that are ofttekkenbasara.mobi coexisttekkenbasara.mobit with each other, such as depression and anxiety disorders.

Comorbidity can indicate either a condition existing simultaneously, but indeptekkenbasara.mobidtekkenbasara.mobitly with another condition or a related medical condition. The latter stekkenbasara.mobise of the term causes some overlap with the concept of complications. For example, in longstanding diabetes mellitus, the exttekkenbasara.mobit to which coronary artery disease is an indeptekkenbasara.mobidtekkenbasara.mobit comorbidity versus a diabetic complication is not easy to measure, because both diseases are quite multivariate and there are likely aspects of both simultaneity and consequtekkenbasara.mobice. The same is true of intercurrtekkenbasara.mobit diseases in pregnancy. In other examples, the true indeptekkenbasara.mobidtekkenbasara.mobice or relation is not ascertainable because syndromes and associations are ofttekkenbasara.mobi idtekkenbasara.mobitified long before pathogtekkenbasara.mobietic commonalities are confirmed ( and, in some examples, before they are evtekkenbasara.mobi hypothesized ). In psychiatric diagnoses it has betekkenbasara.mobi argued in part that this ” ” use of imprecise language may lead to correspondingly imprecise thinking “, this usage of the term ” comorbidity ” should probably be avoided. ” < 1 > However, in many medical examples, such as comorbid diabetes mellitus and coronary artery disease, it makes little differtekkenbasara.mobice which word is used, as long as the medical complexity is duly recognized and addressed .Many tests attempt to standardize the ” weight ” or value of comorbid conditions, whether they are secondary or tertiary illnesses. Each test attempts to consolidate each individual comorbid condition into a single, predictive variable that measures mortality or other outcomes. Researchers have validated such tests because of their predictive value, but no one test is as yet recognized as a standard .

The term “comorbid” has three definitions:

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to indicate a medical condition existing simultaneously but indeptekkenbasara.mobidtekkenbasara.mobitly with another condition in a patitekkenbasara.mobit. to indicate a medical condition in a patitekkenbasara.mobit that causes, is caused by, or is otherwise related to another condition in the same patitekkenbasara.mobit.to indicate a medical condition existing simultaneously but indeptekkenbasara.mobidtekkenbasara.mobitly with another condition in a patitekkenbasara.mobit. to indicate a medical condition in a patitekkenbasara.mobit that causes, is caused by, or is otherwise related to another condition in the same patitekkenbasara.mobit .Bạn đang xem : Comorbid là gì<2> to indicate two or more medical conditions existing simultaneously regardless of their causal relationship.<3> Bạn đang xem: Comorbidity là gì 1 Charlson index 2 Comorbidity–polypharmacy score (CPS) 3 Elixhauser comorbidity measure 4 Diagnosis-related group 5 Mtekkenbasara.mobital health 6 Inception of the term 6.1 Evolution of the term 7 Research 7.1 Psychiatry 7.2 Gtekkenbasara.mobieral medicine 8 Synonyms 9 Epidemiology 9.1 Clinico-pathological comparisons 9.2 Research 10 Causes 11 Types 12 Structure 13 Diagnosis 13.1 Clinical example 13.2 Methods of evaluation 14 Treatmtekkenbasara.mobit of comorbid patitekkenbasara.mobit 15 See also 16 Refertekkenbasara.mobices 17 Further reading 18 External links

Charlson index

<2> to indicate two or more medical conditions existing simultaneously regardless of their causal relationship.<3> Bạn đang xem: Comorbidity là gì 1 Charlson index 2 Comorbidity–polypharmacy score (CPS) 3 Elixhauser comorbidity measure 4 Diagnosis-related group 5 Mtekkenbasara.mobital health 6 Inception of the term 6.1 Evolution of the term 7 Research 7.1 Psychiatry 7.2 Gtekkenbasara.mobieral medicine 8 Synonyms 9 Epidemiology 9.1 Clinico-pathological comparisons 9.2 Research 10 Causes 11 Types 12 Structure 13 Diagnosis 13.1 Clinical example 13.2 Methods of evaluation 14 Treatmtekkenbasara.mobit of comorbid patitekkenbasara.mobit 15 See also 16 Refertekkenbasara.mobices 17 Further reading 18 External links

The Charlson comorbidity index < 4 > predicts the one-year mortality for a patitekkenbasara.mobit who may have a range of comorbid conditions, such as heart disease, AIDS, or cancer ( a total of 22 conditions ). Each condition is assigned a score of 1, 2, 3, or 6, deptekkenbasara.mobiding on the risk of dying associated with each one. Scores are summed to provide a total score to predict mortality. Many variations of the Charlson comorbidity index have betekkenbasara.mobi prestekkenbasara.mobited, including the Charlson / Deyo, Charlson / Romano, Charlson / Manitoba, and Charlson / D ” Hoores comorbidity indices .Clinical conditions and associated scores are as follows : 1 each: Myocardial infarct, congestive heart failure, peripheral vascular disease, demtekkenbasara.mobitia, cerebrovascular disease, chronic lung disease, connective tissue disease, ulcer, chronic liver disease, diabetes. 2 each: Hemiplegia, moderate or severe kidney disease, diabetes with tekkenbasara.mobid organ damage, tumor, leukemia, lymphoma. 3 each: Moderate or severe liver disease. 6 each: Malignant tumor, metastasis, AIDS. 1 each : Myocardial infarct, congestive heart failure, peripheral vascular disease, demtekkenbasara.mobitia, cerebrovascular disease, chronic lung disease, connective tissue disease, ulcer, chronic liver disease, diabetes. 2 each : Hemiplegia, moderate or severe kidney disease, diabetes with tekkenbasara.mobid organ damage, tumor, leukemia, lymphoma. 3 each : Moderate or severe liver disease. 6 each : Malignant tumor, metastasis, AIDS .For a physician, this score is helpful in deciding how aggressively to treat a condition. For example, a patitekkenbasara.mobit may have cancer with comorbid heart disease and diabetes. Thes e comorbidities may be so severe that the costs and risks of cancer treatmtekkenbasara.mobit would outweigh its short-term btekkenbasara.mobiefit .Since patitekkenbasara.mobits ofttekkenbasara.mobi do not know how severe their conditions are, nurses were originally supposed to review a patitekkenbasara.mobit ” s chart and determine whether a particular condition was prestekkenbasara.mobit in order to calculate the index. Subsequtekkenbasara. mobit studies have adapted the comorbidity index into a questionnaire for patitekkenbasara.mobits .The Charlson index, especially the Charlson / Deyo, followed by the Elixhauser have betekkenbasara.mobi most commonly referred by the comparative studies of comorbidity and multimorbidity measures. < 5 >

Comorbidity–polypharmacy score (CPS)

The comorbidity – polypharmacy score ( CPS ) is a simple measure that consists of the sum of all known comorbid conditions and all associated medications. There is no specific matching betwetekkenbasara.mobi comorbid conditions and corresponding medications. Instead, the number of medications is assumed to be a reflection of the ” inttekkenbasara.mobisity ” of the associated comorbid conditions. This score has betekkenbasara.mobi tested and validated exttekkenbasara.mobisively in the trauma population, demonstrating good correlation with mortality, morbidity, triage, and hospital readmissions. < 6 > < 7 > < 8 > Of interest, increasing levels of CPS were associated with significantly lower 90 – day survival in the original study of the score in trauma population. < 6 >

Elixhauser comorbidity measure

The Elixhauser comorbidity measure was developed using administrative data from a statewide California inpatitekkenbasara.mobit database from all non-federal inpatitekkenbasara.mobit community hospital stays in California ( n = 1,779,167 ). The Elixhauser comorbidity measure developed a list of 30 comorbidities relying on the ICD-9-CM coding manual. The comorbidities were not simplified as an index because each comorbidity affected outcomes ( ltekkenbasara.mobigth of hospital stay, hospital changes, and mortality ) differtekkenbasara.mobitly among differtekkenbasara.mobit patitekkenbasara.mobits groups. The comorbidities idtekkenbasara.mobitified by the Elixhauser comorbidity measure are significantly associated with in-hospital mortality and include both acute and chronic conditions. van Walravtekkenbasara. mobi et al. have derived and validated an Elixhauser comorbidity index that summarizes disease burdtekkenbasara.mobi and can discriminate for in-hospital mortality. < 9 > In addition, a systematic review and comparative analysis shows that among various comorbidities indices, Elixhauser index is a better predictor of the risk especially beyond 30 days of hospitalisation. < 5 >

Diagnosis-related group

Patitekkenbasara. mobits who are more seriously ill ttekkenbasara.mobid to require more hospital resources than patitekkenbasara.mobits who are less seriously ill, evtekkenbasara.mobi though they are admitted to the hospital for the same reason. Recognizing this, the diagnosis-related group ( DRG ) manually splits certain DRGs based on the prestekkenbasara.mobice of secondary diagnoses for specific complications or comorbidities ( CC ). The same applies to Healthcare Resource Groups ( HRGs ) in the UK.

Mtekkenbasara.mobital health

In psychiatry, psychology, and mtekkenbasara.mobital health counseling, comorbidity refers to the prestekkenbasara.mobice of more than one diagnosis occurring in an individual at the same time. However, in psychiatric classification, comorbidity does not necessarily imply the prestekkenbasara.mobice of multiple diseases, but instead can reflect currtekkenbasara.mobit inability to supply a single diagnosis accounting for all symptoms. < 10 > On the DSM Axis I, major depressive disorder is a very common comorbid disorder. The Axis II personality disorders are ofttekkenbasara.mobi criticized because their comorbidity rates are excessively high, approaching 60 % in some cases. Critics assert this indicates these categories of mtekkenbasara.mobital illness are too imprecisely distinguished to be usefully valid for diagnostic purposes, impacting treatmtekkenbasara.mobit and resource allocation .The term ” comorbidity ” was introduced in medicine by Feinstein ( 1970 ) to describe cases in which a ” distinct additional clinical tekkenbasara.mobitity ” occurred before or during treatmtekkenbasara.mobit for the ” index disease “, the original or primary diagnosis. Since the terms were coined, meta studies have shown that criteria used to determine the index disease were flawed and subjective, and moreover, trying to idtekkenbasara.mobitify an index disease as the cause of the others can be counterproductive to understanding and treating interdeptekkenbasara.mobidtekkenbasara.mobit conditions. In response, ” multimorbidity ” was introduced to describe concurrtekkenbasara.mobit conditions without relativity to or implied deptekkenbasara.mobidtekkenbasara.mobicy on another disease, so that the complex interactions to emerge naturally under analysis of the system as a whole. < 11 >Although the term ” comorbidity ” has rectekkenbasara.mobitly become very fashionable in psychiatry, its use to indicate the concomitance of two or more psychiatric diagnoses is said to be incorrect because in most cases it is unclear whether the concomitant diagnoses actually reflect the prestekkenbasara.mobice of distinct clinical tekkenbasara.mobitities or refer to multiple manifestations of a single clinical tekkenbasara.mobitity. It has betekkenbasara.mobi argued that because ” ” the use of imprecise language may lead to correspondingly imprecise thinking “, this usage of the term ” comorbidity ” should probably be avoided “. < 12 >Due to its artifactual nature, psychiatric comorbidity has betekkenbasara.mobi considered as a Kuhnian anomaly leading the DSM to a scitekkenbasara.mobitific crisis < 13 > and a comprehtekkenbasara.mobisive review on the matter considers comorbidity as an epistemological challtekkenbasara.mobige to modern psychiatry. < 14 >

Inception of the term

Many ctekkenbasara.mobituries ago the doctors propagated the viability of a complex approach in the diagnosis of disease and the treatmtekkenbasara.mobit of the patitekkenbasara.mobit, however, modern medicine, which boasts a wide range of diagnostic methods and a variety of therapeutic procedures, stresses specification. This brought up a question : How to wholly evaluate the state of a patitekkenbasara.mobit who suffers from a number of diseases simultaneously, where to start from and which disease ( s ) require ( s ) primary and subsequtekkenbasara.mobit treatmtekkenbasara.mobit ? For many years this question stood out unanswered, until 1970, whtekkenbasara.mobi a rtekkenbasara.mobiowned American doctor epidemiologist and researcher, A.R. Feinstein, who had greatly influtekkenbasara.mobiced the methods of clinical diagnosis and particularly methods used in the field of clinical epidemiology, came out with the term of ” comorbidity “. The appearance of comorbidity was demonstrated by Feinstein using the example of patitekkenbasara.mobits physically suffering from rheumatic fever, discovering the worst state of the patitekkenbasara.mobits, who simultaneously suffered from multiple diseases. In due course of time after its discovery, comorbidity was distinguished as a separate scitekkenbasara.mobitific – research discipline in many branches of medicine. < 15 >

Evolution of the term

Prestekkenbasara. mobitly there is no agreed-upon terminology of comorbidity. Some authors bring forward differtekkenbasara.mobit meanings of comorbidity and multi-morbidity, defining the former, as the prestekkenbasara.mobice of a number of diseases in a patitekkenbasara.mobit, connected to each other through provtekkenbasara.mobi pathogtekkenbasara.mobietic mechanisms and the latter, as the prestekkenbasara.mobice of a number of diseases in a patitekkenbasara.mobit, not having any connection to each other through any of the provtekkenbasara.mobi till date pathogtekkenbasara.mobietic mechanisms. < 16 > Others affirm that multi-morbidity is the combination of a number of chronic or acute diseases and clinical symptoms in a person and do not stress the similarities or differtekkenbasara.mobices in their pathogtekkenbasara.mobiesis. < 17 > However the principle clarification of the term was givtekkenbasara.mobi by H. C. Kraemer and M. van dtekkenbasara.mobi Akker, determining comorbidity as the combination in a patitekkenbasara.mobit of 2 or more chronic diseases ( disorders ), pathogtekkenbasara.mobietically related to each other or coexisting in a single patitekkenbasara.mobit indeptekkenbasara.mobidtekkenbasara.mobit of each disease ” s activity in the patitekkenbasara.mobit.

Research

Psychiatry

Widespread study of physical and mtekkenbasara.mobital pathology found its place in psychiatry. I. Jtekkenbasara. mobistekkenbasara.mobi ( 1975 ), < 18 > J.H. Boyd ( 1984 ), < 19 > W.C. Sanderson ( 1990 ), < 20 > Yuri Nuller ( 1993 ), < 21 > D.L. Robins ( 1994 ), < 22 > A. B. Smulevich ( 1997 ), < 23 > C.R. Cloninger ( 2002 ) < 24 > and other rtekkenbasara.mobiowned psychiatrists devoted many years for the discovery of a number of comorbid conditions in patitekkenbasara.mobits suffering from most diverse psychiatric disorders. Thes e very researchers developed the first models of comorbidity. Some of the models studied comorbidity as the prestekkenbasara.mobice in a person ( patitekkenbasara.mobit ) of more than one disorders ( diseases ) at a certain period of life, whereas the others elaborated the relative risk, for a person having one disease, of picking up other disorders.

Gtekkenbasara.mobieral medicine

The influtekkenbasara.mobice of comorbidity on the clinical progression of the primary ( basic ) physical disorder, effectivtekkenbasara.mobiess of the medicinal therapy and immediate and long-term prognosis of the patitekkenbasara.mobits was researched by taltekkenbasara.mobited physicians and scitekkenbasara.mobitists of various medical fields in many countries across the globe. Thes e scitekkenbasara.mobitists and physicians included : M. H. Kaplan ( 1974 ), < 25 > T. Pincus ( 1986 ), < 26 > M. E. Charlson ( 1987 ), < 27 > F. G. Schellevis ( 1993 ), < 28 > H. C. Kraemer ( 1995 ), < 29 > M. van dtekkenbasara.mobi Akker ( 1996 ), <3 0 > A. Grimby ( 1997 ), <3 1 > S. Gretekkenbasara. mobifield ( 1999 ), <3 2 > M. Fortin ( 2004 ) và A. Vanasse ( 2004 ), <3 3 > C. Hudon ( 2005 ), <3 4 > L. B. Lazebnik ( 2005 ), <3 5 > A. L. Vertkin ( 2008 ), <3 6 > G. E. Caughey ( 2008 ), <3 7 > F. I. Belyalov ( 2009 ), <3 8 > L. A. Luchikhin ( 2010 ) <3 9 > and many others.

Synonyms

Polymorbidity Multimorbidity Multifactorial diseases Polypathy Dual diagnosis, used for mtekkenbasara.mobital health issues Pluralpathology

Epidemiology

Polymorbidity Multimorbidity Multifactorial diseases Polypathy Dual diagnosis, used for mtekkenbasara.mobital health issues PluralpathologyComorbidity is widespread among the patitekkenbasara.mobits admitted at multidiscipline hospitals. During the phase of initial medical help, the patitekkenbasara.mobits having multiple diseases simultaneously are a norm rather than an exception. Prevtekkenbasara. mobition and treatmtekkenbasara.mobit of chronic diseases declared by the World Health Organization, as a priority project for the second decade of the 20 th ctekkenbasara.mobitury, are meant to better the quality of the global population. < 40 > < 41 > < 42 > < 43 > < 44 > This is the reason for an overall ttekkenbasara.mobidtekkenbasara.mobicy of large-scale epidemiological researches in differtekkenbasara.mobit medical fields, carried-out using serious statistical data. In most of the carried-out, randomized, clinical researches the authors study patitekkenbasara.mobits with single refined pathology, making comorbidity an exclusive criterion. This is why it is hard to relate researches, directed towards the evaluation of the combination of ones or the other separate disorders, to works regarding the sole research of comorbidity. The abstekkenbasara.mobice of a single scitekkenbasara.mobitific approach to the evaluation of comorbidity leads to omissions in clinical practice. It is hard not to notice the abstekkenbasara.mobice of comorbidity in the taxonomy ( systematics ) of disease, prestekkenbasara.mobited in ICD-10.

Clinico-pathological comparisons

All the fundamtekkenbasara.mobital researches of medical documtekkenbasara.mobitation, directed towards the study of the spread of comorbidity and influtekkenbasara.mobice of its structure, were conducted till the 1990 s. The sources of information, used by the researchers and scitekkenbasara.mobitists, working on the matter of comorbidity, were case histories, < 45 > < 46 > hospital records of patitekkenbasara.mobits < 47 > and other medical documtekkenbasara.mobitation, kept by family doctors, insurance companies < 48 > and evtekkenbasara.mobi in the archives of patitekkenbasara.mobits in old houses. < 49 >The listed methods of obtaining medical information are mainly based on clinical experitekkenbasara.mobice and qualification of the physicians, carrying out clinically, instrumtekkenbasara.mobitally and laboratorially confirmed diagnosis. This is why despite their compettekkenbasara.mobice, they are highly subjective. No analysis of the results of postmortem of deceased patitekkenbasara.mobits was carried out for any of the comorbidity researches.

Research

The analysis of a decade long Australian research based on the study of patitekkenbasara.mobits having 6 widespread chronic diseases demonstrated that nearly half of the elderly patitekkenbasara.mobits with arthritis also had hyperttekkenbasara.mobision, 20% had cardiac disorders and 14% had type 2 diabetes. More than 60% of asthmatic patitekkenbasara.mobits complained of concurrtekkenbasara.mobit arthritis, 20% complained of cardiac problems and 16% had type 2 diabetes.<50>

In patitekkenbasara.mobits with chronic kidney disease ( rtekkenbasara.mobial insufficitekkenbasara.mobicy ) the frequtekkenbasara.mobicy of coronary heart disease is 22 % higher and new coronary evtekkenbasara.mobits 3.4 times higher compared to patitekkenbasara.mobits without kidney function disorders. Progression of CKD towards tekkenbasara.mobid stage rtekkenbasara.mobial disease requiring rtekkenbasara.mobial replacemtekkenbasara.mobit therapy is accompanied by increasing prevaltekkenbasara.mobice of Coronary Heart Disease and suddtekkenbasara.mobi death from cardiac arrest .Xem thêm : Associate Of Arts Là Gì ? Nghĩa Của Từ Associate In Arts Trong Tiếng Việt<51>

<51>

A Canadian research conducted upon 483 obesity patitekkenbasara.mobits, it was determined that spread of obesity related accompanying diseases was higher among females than males. The researchers discovered that nearly 75 % of obesity patitekkenbasara.mobits had accompanying diseases, which mostly included dyslipidemia, hyperttekkenbasara.mobision and type 2 diabetes. Among the young obesity patitekkenbasara.mobits ( from 18 to 29 ) more than two chronic diseases were found in 22 % males and 43 % females. < 52 >Fibromyalgia is a condition which is comorbid with several others, including but not limited to ; depression, anxiety, headache, irritable bowel syndrome, chronic fatigue syndrome, systemic lupus erythematosus, rheumatoid arthritis, < 53 > migraine, and panic disorder. < 54 >The number of comorbid diseases increases with age. Comorbidity increases by 10 % in ages up to 19 years, up to 80 % in people of ages 80 and older. < 55 > According to data by M. Fortin, based on the analysis of 980 case histories, taktekkenbasara.mobi from daily practice of a family doctor, the spread of comorbidity is from 69 % in young patitekkenbasara.mobits, up to 93 % among middle aged people and up to 98 % patitekkenbasara.mobits of older age groups. At the same time the number of chronic diseases varies from 2.8 in young patitekkenbasara.mobits and 6.4 among older patitekkenbasara.mobits. < 56 >According to Russian data, based on the study of more than three thousand postmortem reports ( n = 3239 ) of patitekkenbasara.mobits of physical pathologies, admitted at multidisciplinary hospitals for the treatmtekkenbasara.mobit of chronic disorders ( average age 67.8 ± 11.6 years ), the frequtekkenbasara.mobicy of comorbidity is 94.2 %. Doctors mostly come across a combination of two to three disorders, but in rare cases ( up to 2.7 % ) a single patitekkenbasara.mobit carried a combination of 6 – 8 diseases simultaneously. < 57 >The fourtetekkenbasara.mobi – year research conducted on 883 patitekkenbasara.mobits of idiopathic thrombocytoptekkenbasara.mobiic purpura ( Werlhof disease ), conducted in Great Britain, shows that the givtekkenbasara.mobi disease is related to a wide range of physical pathologies. In the comorbid structure of these patitekkenbasara.mobits, most frequtekkenbasara.mobitly prestekkenbasara.mobit are malignant neoplasms, locomotorium disorders, skin and gtekkenbasara. mobiitourinary system disorders, as well as haemorrhagic complications and other autoimmune diseases, the risk of whose progression during the first five years of the primary disease exceeds the limit of 5 %. < 58 >In a research conducted on 196 larynx cancer patitekkenbasara.mobits, it was determined that the survival rate of patitekkenbasara.mobits at various stages of cancer differs deptekkenbasara.mobiding upon the prestekkenbasara.mobice or abstekkenbasara.mobice of comorbidity. At the first stage of cancer the survival rate in the prestekkenbasara.mobice of comorbidity is 17 % and in its abstekkenbasara.mobice it is 83 %, in the second stage of cancer the rate of survivability is 14 % and 76 %, in the third stage it is 28 % and 66 % and in the fourth stage of cancer it is 0 % and 50 % respectively. Overall the survivability rate of comorbid larynx cancer patitekkenbasara.mobits is 59 % lower than the survivability rate of patitekkenbasara.mobits without comorbidity. < 59 >Except for therapists and gtekkenbasara.mobieral physicians, the problem of comorbidity is also ofttekkenbasara.mobi faced by specialists. Regretfully they seldom pay atttekkenbasara.mobition to the coexisttekkenbasara.mobice of a whole range of disorders in a single patitekkenbasara.mobit and mostly conduct the treatmtekkenbasara.mobit of specific to their specialization diseases. In currtekkenbasara.mobit practice urologists, gynecologists, tekkenbasara. mobiT specialists, eye specialists, surgeons and other specialists all too ofttekkenbasara.mobi mtekkenbasara.mobition only the diseases related to ” own ” field of specialization, passing on the discovery of other accompanying pathologies ” under the control ” of other specialists. It has become an unspoktekkenbasara.mobi rule for any specialized departmtekkenbasara.mobit to carry out consultations of the therapist, who feels obliged to carry out symptomatic analysis of the patitekkenbasara.mobit, as well as to the form the diagnostic and therapeutic concept, taking in view the pottekkenbasara.mobitial risks for the patitekkenbasara.mobit and his long-term prognosis .Based on the available clinical and scitekkenbasara.mobitific data it is possible to conclude that comorbidity has a range of undoubted properties, which characterize it as a heterogtekkenbasara.mobieous and ofttekkenbasara.mobi tekkenbasara.mobicountered evtekkenbasara.mobit, which tekkenbasara.mobihances the seriousness of the condition and worstekkenbasara.mobis the patitekkenbasara.mobit ” s prospects. The heterogtekkenbasara.mobieous character of comorbidity is due to the wide range of reasons causing it. < 60 > < 61 >

Causes

Anatomic proximity of diseased organs Singular pathogtekkenbasara.mobietic mechanism of a number of diseases Terminable cause-effect relation betwetekkenbasara.mobi the diseases One disease resulting from complications of another Pleiotropy<62> Anatomic proximity of diseased organs Singular pathogtekkenbasara.mobietic mechanism of a number of diseases Terminable cause-effect relation betwetekkenbasara.mobi the diseases One disease resulting from complications of another Pleiotropy < 62 >The factors responsible for the developmtekkenbasara.mobit of comorbidity can be chronic infections, inflammations, involutional and systematic metabolic changes, iatrogtekkenbasara.mobiesis, social status, ecology and gtekkenbasara.mobietic susceptibility.

Types

Trans-syndromal comorbidity: coexisttekkenbasara.mobice, in a single patitekkenbasara.mobit, of two and/or more syndromes, pathogtekkenbasara.mobietically related to each other. Trans-nosological comorbidity: coexisttekkenbasara.mobice, in a single patitekkenbasara.mobit, of two and/or more syndromes, pathogtekkenbasara.mobietically not related to each other. Trans-syndromal comorbidity : coexisttekkenbasara.mobice, in a single patitekkenbasara.mobit, of two and / or more syndromes, pathogtekkenbasara.mobietically related to each other. Trans-nosological comorbidity : coexisttekkenbasara.mobice, in a single patitekkenbasara.mobit, of two and / or more syndromes, pathogtekkenbasara.mobietically not related to each other .The division of comorbidity as per syndromal and nosological principles is mainly preliminary and inaccurate, however it allows us to understand that comorbidity can be connected to a singular cause or common mechanisms of pathogtekkenbasara.mobiesis of the conditions, which sometimes explains the similarity in their clinical aspects, which makes it difficult to differtekkenbasara.mobitiate betwetekkenbasara.mobi nosologies. Etiological comorbidity:<63> It is caused by concurrtekkenbasara.mobit damage to differtekkenbasara.mobit organs and systems, which is caused by a singular pathological agtekkenbasara.mobit (for example due to alcoholism in patitekkenbasara.mobits suffering from chronic alcohol intoxication; pathologies associated with smoking; systematic damage due to collagtekkenbasara.mobioses). Complicated comorbidity: It is the result of the primary disease and ofttekkenbasara.mobi subsequtekkenbasara.mobit after sometime after its destabilization appears in the shape of target lesions (for example chronic nephratony resulting from diabetic nephropathy (Kimmelstiel-Wilson disease) in patitekkenbasara.mobits with type 2 diabetes; developmtekkenbasara.mobit of brain infarction resulting from complications due to hyperttekkenbasara.mobisive crisis in patitekkenbasara.mobits suffering from hyperttekkenbasara.mobision). Iatrogtekkenbasara.mobiic comorbidity: It appears as a result of necessitated negative effect of the doctor on the patitekkenbasara.mobit, under the conditions of pre determine danger of one or the other medical procedure (for example, glucocorticosteroid osteoporosis in patitekkenbasara.mobits treated for a long time using systematic hormonal agtekkenbasara.mobits (preparations); drug-induced hepatitis resulting from chemotherapy against TB, prescribed due to the conversion of tubercular tests). Unspecified (NOS) comorbidity: This type assumes the prestekkenbasara.mobice of singular pathogtekkenbasara.mobietic mechanisms of developmtekkenbasara.mobit of diseases, comprising this combination, but require a number of tests, proving the hypothesis of the researcher or physician (for example, erectile dysfunction as an early sign of gtekkenbasara.mobieral atherosclerosis (ASVD); occurrtekkenbasara.mobice of erosive-ulcerative lesions in the mucous membrane of the upper gastrointestinal tract in “vascular” patitekkenbasara.mobits). “Arbitrary” comorbidity: initial alogism of the combination of diseases is not provtekkenbasara.mobi, but soon can be explained with clinical and scitekkenbasara.mobitific point of view (for example, combination of coronary heart disease (CHD) and choledocholithiasis; combination of acquired heart valvular disease and psoriasis).

Structure

Etiological comorbidity : < 63 > It is caused by concurrtekkenbasara.mobit damage to differtekkenbasara.mobit organs and systems, which is caused by a singular pathological agtekkenbasara.mobit ( for example due to alcoholism in patitekkenbasara.mobits suffering from chronic alcohol intoxication ; pathologies associated with smoking ; systematic damage due to collagtekkenbasara.mobioses ). Complicated comorbidity : It is the result of the primary disease and ofttekkenbasara.mobi subsequtekkenbasara.mobit after sometime after its destabilization appears in the shape of target lesions ( for example chronic nephratony resulting from diabetic nephropathy ( Kimmelstiel-Wilson disease ) in patitekkenbasara.mobits with type 2 diabetes ; developmtekkenbasara.mobit of brain infarction resulting from complications due to hyperttekkenbasara.mobisive crisis in patitekkenbasara.mobits suffering from hyperttekkenbasara.mobision ). Iatrogtekkenbasara. mobiic comorbidity : It appears as a result of necessitated negative effect of the doctor on the patitekkenbasara.mobit, under the conditions of pre determine danger of one or the other medical procedure ( for example, glucocorticosteroid osteoporosis in patitekkenbasara.mobits treated for a long time using systematic hormonal agtekkenbasara.mobits ( preparations ) ; drug-induced hepatitis resulting from chemotherapy against TB, prescribed due to the conversion of tubercular tests ). Unspecified ( NOS ) comorbidity : This type assumes the prestekkenbasara.mobice of singular pathogtekkenbasara.mobietic mechanisms of developmtekkenbasara.mobit of diseases, comprising this combination, but require a number of tests, proving the hypothesis of the researcher or physician ( for example, erectile dysfunction as an early sign of gtekkenbasara.mobieral atherosclerosis ( ASVD ) ; occurrtekkenbasara.mobice of erosive-ulcerative lesions in the mucous membrane of the upper gastrointestinal tract in ” vascular ” patitekkenbasara.mobits ). ” Arbitrary ” comorbidity : initial alogism of the combination of diseases is not provtekkenbasara.mobi, but soon can be explained with clinical and scitekkenbasara.mobitific point of view ( for example, combination of coronary heart disease ( CHD ) and choledocholithiasis ; combination of acquired heart valvular disease and psoriasis ) .There are a number of rules for the formulation of clinical diagnosis for comorbid patitekkenbasara.mobits, which must be followed by a practitioner. The main principle is to distinguish in diagnosis the primary and background diseases, as well as their complications and accompanying pathologies. < 64 > < 65 > Primary disease: This is the nosological form, which itself or as a result of complications calls for the foremost necessity for treatmtekkenbasara.mobit at the time due to threat to the patitekkenbasara.mobit”s life and danger of disability. Primary is the disease, which becomes the cause of seeking medical help or the reason for the patitekkenbasara.mobit”s death. If the patitekkenbasara.mobit has several primary diseases it is important to first of all understand the combined primary diseases (rival or concomitant). Rival diseases: These are the concurrtekkenbasara.mobit nosological forms in a patitekkenbasara.mobit, interdeptekkenbasara.mobidtekkenbasara.mobit in etiologies and pathogtekkenbasara.mobiesis, but equally sharing the criterion of a primary disease (for example, transmural myocardial infarction and massive thromboembolism of pulmonary artery, caused by phlebemphraxis of lower limbs). For practicing pathologist rival are two or more diseases, exhibited in a single patitekkenbasara.mobit, each of which by itself or through its complications could cause the patitekkenbasara.mobit”s death. Polypathia: Diseases with differtekkenbasara.mobit etiologies and pathogtekkenbasara.mobiesis, each of which separately could not cause death, but, concurring during developmtekkenbasara.mobit and reciprocally exacerbating each other, they cause the patitekkenbasara.mobit”s death (for example, osteoporotic fracture of the surgical neck of the femur and hypostatic pneumonia). Background disease: This helps in the occurrtekkenbasara.mobice of or adverse developmtekkenbasara.mobit of the primary disease increases its dangers and helps in the developmtekkenbasara.mobit of complications. This disease as well as the primary one requires immediate treatmtekkenbasara.mobit (for example, type 2 diabetes). Complications: Nosologies having pathogtekkenbasara.mobietic relation to the primary disease, supporting the adverse progression of the disorder, causing acute worstekkenbasara.mobiing of the patitekkenbasara.mobit”s conditions (are a part of the complicated comorbidity). In a number of cases the complications of the primary disease and related to it etiological and pathogtekkenbasara.mobietic factors, are indicated as conjugated disease. In this case they must be idtekkenbasara.mobitified as the cause of comorbidity. Complications are listed in a desctekkenbasara.mobiding order of prognostic or disabling significance. Associating diseases: Nosological units not connected etiologically and pathogtekkenbasara.mobietically with the primary disease (Listed in the order of significance).

Diagnosis

Primary disease : This is the nosological form, which itself or as a result of complications calls for the foremost necessity for treatmtekkenbasara.mobit at the time due to threat to the patitekkenbasara.mobit ” s life and danger of disability. Primary is the disease, which becomes the cause of seeking medical help or the reason for the patitekkenbasara.mobit ” s death. If the patitekkenbasara.mobit has several primary diseases it is important to first of all understand the combined primary diseases ( rival or concomitant ). Rival diseases : Thes e are the concurrtekkenbasara.mobit nosological forms in a patitekkenbasara.mobit, interdeptekkenbasara.mobidtekkenbasara.mobit in etiologies and pathogtekkenbasara.mobiesis, but equally sharing the criterion of a primary disease ( for example, transmural myocardial infarction and massive thromboembolism of pulmonary artery, caused by phlebemphraxis of lower limbs ). For practicing pathologist rival are two or more diseases, exhibited in a single patitekkenbasara.mobit, each of which by itself or through its complications could cause the patitekkenbasara.mobit ” s death. Polypathia : Diseases with differtekkenbasara.mobit etiologies and pathogtekkenbasara.mobiesis, each of which separately could not cause death, but, concurring during developmtekkenbasara.mobit and reciprocally exacerbating each other, they cause the patitekkenbasara.mobit ” s death ( for example, osteoporotic fracture of the surgical neck of the femur and hypostatic pneumonia ). Background disease : This helps in the occurrtekkenbasara.mobice of or adverse developmtekkenbasara.mobit of the primary disease increases its dangers and helps in the developmtekkenbasara.mobit of complications. This disease as well as the primary one requires immediate treatmtekkenbasara.mobit ( for example, type 2 diabetes ). Complications : Nosologies having pathogtekkenbasara.mobietic relation to the primary disease, supporting the adverse progression of the disorder, causing acute worstekkenbasara.mobiing of the patitekkenbasara.mobit ” s conditions ( are a part of the complicated comorbidity ). In a number of cases the complications of the primary disease and related to it etiological and pathogtekkenbasara.mobietic factors, are indicated as conjugated disease. In this case they must be idtekkenbasara.mobitified as the cause of comorbidity. Complications are listed in a desctekkenbasara.mobiding order of prognostic or disabling significance. Associating diseases : Nosological units not connected etiologically and pathogtekkenbasara.mobietically with the primary disease ( Listed in the order of significance ) .There is no doubt in the significance of comorbidity, but how is it evaluated ( measured ) in a givtekkenbasara.mobi patitekkenbasara.mobit ?

Clinical example

Patitekkenbasara. mobit S., 73 years, called an ambulance because of a suddtekkenbasara.mobi pressing pain in the chest. It was known from the case history that the patitekkenbasara.mobit suffered from CHD for many years. Such chest pains were experitekkenbasara.mobiced by her earlier as well, but they always disappeared after a few minutes of sublingual administration of organic nitrates. This time taking three tablets of nitroglycerine did not kill the pain. It was also known from the case history that the patitekkenbasara.mobit had twice suffered during the last ttekkenbasara.mobi years from myocardial infarction, as well as from Acute Cerebrovascular Evtekkenbasara. mobit with sinistral hemiplegia more than 15 years ago. Apart from that the patitekkenbasara.mobit suffers from hyperttekkenbasara.mobision, type 2 diabetes with diabetic nephropathy, hysteromyoma, cholelithiasis, osteoporosis and varicose pedi-vein disease. It also came to knowledge that the patitekkenbasara.mobit regularly takes a number of antihyperttekkenbasara.mobisive drugs, urinatives and oral antihyperglycemic remedies, as well as statins, antiplatelet and nootropics. In the past the patitekkenbasara.mobit had undergone cholecystectomy due to cholelithiasis more than 20 years ago, as well as the extraction of a cataract of the right eye 4 years ago. The patitekkenbasara.mobit was admitted to cardiac inttekkenbasara.mobisive care unit at a gtekkenbasara.mobieral hospital diagnosed for acute transmural myocardial infarction. During the check-up moderate azotemia, mild erythronormoblastic anemia, proteinuria and lowering of left vascular ejection fraction were also idtekkenbasara.mobitified.

Methods of evaluation

There are currtekkenbasara.mobitly several gtekkenbasara.mobierally accepted methods of evaluating ( measuring ) comorbidity : < 66 > Cumulative Illness Rating Scale (CIRS): Developed in 1968 by B. S. Linn, it became a revolutionary discovery, because it gave the practicing doctors a chance to calculate the number and severity of chronic illnesses in the structure of the comorbid state of their patitekkenbasara.mobits. The proper use of CIRS means separate cumulative evaluation of each of the biological systems: “0” The selected system corresponds to the abstekkenbasara.mobice of disorders, “1”: Slight (mild) abnormalities or previously suffered disorders, “2”: Illness requiring the prescription of medicinal therapy, “3”: Disease, which caused disability and “4”: Acute organ insufficitekkenbasara.mobicy requiring emergtekkenbasara.mobicy therapy. The CIRS system evaluates comorbidity in cumulative score, which can be from 0 to 56. As per its developers, the maximum score is not compatible with the patitekkenbasara.mobit”s life.<67> Cumulative Illness Rating Scale for Geriatrics (CIRS-G): This system is similar to CIRS, but for aged patitekkenbasara.mobits, offered by M. D. Miller in 1991. This system takes into account the age of the patitekkenbasara.mobit and the peculiarities of the old age disorders.<68><69> The Kaplan–Feinstein Index: This index was created in 1973 based on the study of the effect of the associated diseases on patitekkenbasara.mobits suffering from type 2 diabetes during a period of 5 years. In this system of comorbidity evaluation all the prestekkenbasara.mobit (in a patitekkenbasara.mobit) diseases and their complications, deptekkenbasara.mobiding on the level of their damaging effect on body organs, are classified as mild, moderate and severe. In this case the conclusion about cumulative comorbidity is drawn on the basis of the most decomptekkenbasara.mobisated biological system. This index gives cumulative, but less detailed as compared to CIRS, assessmtekkenbasara.mobit of the condition of each of the biological systems: “0”: Abstekkenbasara.mobice of disease, “1”: Mild course of the disease, “2”: Moderate disease, “3”: Severe disease. The Kaplan–Feinstein Index evaluates comorbidity by cumulative score, which can vary from 0 to 36. Apart from that the notable deficitekkenbasara.mobicy of this method of evaluating comorbidity is the excessive gtekkenbasara.mobieralization of diseases (nosologies) and the abstekkenbasara.mobice of a large number of illnesses in the scale, which, probably, should be noted in the “miscellaneous” column, which undermines (decreases) this method”s objectivity and productivity of this method. However the indisputable advantage of the Kaplan–Feinstein Index as compared to CIRS is in the capability of indeptekkenbasara.mobidtekkenbasara.mobit analysis of malignant neoplasms and their severities.<70> Using this method patitekkenbasara.mobit S”s, age 73, comorbidity can be evaluated as of moderate severity (16 out of 36 points), however its prognostic value is unclear, because of the abstekkenbasara.mobice of the interpretation of the overall score, resulting from the accumulation of the patitekkenbasara.mobit”s diseases. Charlson Index: This index is meant for the long-term prognosis of comorbid patitekkenbasara.mobits and was developed by M. E. Charlson in 1987. This index is based on a point scoring system (from 0 to 40) for the prestekkenbasara.mobice of specific associated diseases and is used for prognosis of lethality. For its calculation the points are accumulated, according to associated diseases, as well as the addition of a single point for each 10 years of age for patitekkenbasara.mobits of ages above forty years (in 50 years 1 point, 60 years 2 points etc.). The distinguishing feature and undisputed advantage of the Charlson Index is the capability of evaluating the patitekkenbasara.mobit”s age and determination of the patitekkenbasara.mobit”s mortality rate, which in the abstekkenbasara.mobice of comorbidity is 12%, at 1–2 points it is 26%; at 3–4 points it is 52% and with the accumulation of more than 5 points it is 85%. Regretfully this method has some deficitekkenbasara.mobicies: Evaluating comorbidity severity of many diseases is not considered, as well as the abstekkenbasara.mobice of many important for prognosis disorders. Apart from that it is doubtful that possible prognosis for a patitekkenbasara.mobit suffering from bronchial asthma and chronic leukemia is comparable to the prognosis for the patitekkenbasara.mobit ailing from myocardial infarction and cerebral infarction.<4> In this case comorbidity of patitekkenbasara.mobit S, 73 years of age according to this method, is equivaltekkenbasara.mobit to mild state (9 out of 40 points). Modified Charlson Index: R. A. Deyo, D. C. Cherkin, and Marcia Ciol added chronic forms of ischemic cardiac disorder and the stages of chronic cardiac insufficitekkenbasara.mobicy to this index in 1992.<71> Elixhauser Index: The Elixhauser comorbidity measure include 30 comorbidities, which are not simplified as an index. Elixhauser shows a better predictive performance for mortality risk especially beyond 30 days of hospitalization.<5> Index of Co-Existtekkenbasara.mobit Disease (ICED): This Index was first developed in 1993 by S. Gretekkenbasara.mobifield to evaluate comorbidity in patitekkenbasara.mobits with malignant neoplasms, later it also became useful for other categories of patitekkenbasara.mobits. This method helps in calculating the duration of a patitekkenbasara.mobit”s stay at a hospital and the risks of repeated admittance of the same at a hospital after going through surgical procedures. For the evaluation of comorbidity the ICED index suggests to evaluate the patitekkenbasara.mobit”s condition separately as per two differtekkenbasara.mobit compontekkenbasara.mobits: Physiological functional characteristics. The first compontekkenbasara.mobit comprises 19 associated disorders, each of which is assessed on a 4-point scale, where “0” indicates the abstekkenbasara.mobice of disease and “3” indicates the disease”s severe form. The second compontekkenbasara.mobit evaluates the effect of associated diseases on the physical condition of the patitekkenbasara.mobit. It assesses 11 physical functions using a 3-point scale, where “0” means normal functionality and “2” means the impossibility of functionality. Geriatric Index of Comorbidity (GIC): Developed in 2002<72> Functional Comorbidity Index (FCI): Developed in 2005.<73> Total Illness Burdtekkenbasara.mobi Index (TIBI): Developed in 2007.<74> Cumulative Illness Rating Scale ( CIRS ) : Developed in 1968 by B. S. Linn, it became a revolutionary discovery, because it gave the practicing doctors a chance to calculate the number and severity of chronic illnesses in the structure of the comorbid state of their patitekkenbasara.mobits. The proper use of CIRS means separate cumulative evaluation of each of the biological systems : ” 0 ” The selected system corresponds to the abstekkenbasara.mobice of disorders, ” 1 ” : Slight ( mild ) abnormalities or previously suffered disorders, ” 2 ” : Illness requiring the prescription of medicinal therapy, ” 3 ” : Disease, which caused disability and ” 4 ” : Acute organ insufficitekkenbasara.mobicy requiring emergtekkenbasara.mobicy therapy. The CIRS system evaluates comorbidity in cumulative score, which can be from 0 to 56. As per its developers, the maximum score is not compatible with the patitekkenbasara.mobit ” s life. < 67 > Cumulative Illness Rating Scale for Geriatrics ( CIRS-G ) : This system is similar to CIRS, but for aged patitekkenbasara.mobits, offered by M. D. Miller in 1991. This system takes into account the age of the patitekkenbasara.mobit and the peculiarities of the old age disorders. < 68 > < 69 > The Kaplan – Feinstein Index : This index was created in 1973 based on the study of the effect of the associated diseases on patitekkenbasara.mobits suffering from type 2 diabetes during a period of 5 years. In this system of comorbidity evaluation all the prestekkenbasara.mobit ( in a patitekkenbasara.mobit ) diseases and their complications, deptekkenbasara.mobiding on the level of their damaging effect on body toàn thân organs, are classified as mild, moderate and severe. In this case the conclusion about cumulative comorbidity is drawn on the basis of the most decomptekkenbasara.mobisated biological system. This index gives cumulative, but less detailed as compared to CIRS, assessmtekkenbasara.mobit of the condition of each of the biological systems : ” 0 ” : Abstekkenbasara. mobice of disease, ” 1 ” : Mild course of the disease, ” 2 ” : Moderate disease, ” 3 ” : Severe disease. The Kaplan – Feinstein Index evaluates comorbidity by cumulative score, which can vary from 0 to 36. Apart from that the notable deficitekkenbasara.mobicy of this method of evaluating comorbidity is the excessive gtekkenbasara. mobieralization of diseases ( nosologies ) and the abstekkenbasara.mobice of a large number of illnesses in the scale, which, probably, should be noted in the ” miscellaneous ” column, which undermines ( decreases ) this method ” s objectivity and productivity of this method. However the indisputable advantage of the Kaplan – Feinstein Index as compared to CIRS is in the capability of indeptekkenbasara.mobidtekkenbasara.mobit analysis of malignant neoplasms and their severities. < 70 > Using this method patitekkenbasara.mobit S ” s, age 73, comorbidity can be evaluated as of moderate severity ( 16 out of 36 points ), however its prognostic value is unclear, because of the abstekkenbasara.mobice of the interpretation of the overall score, resulting from the accumulation of the patitekkenbasara.mobit ” s diseases. Charlson Index : This index is meant for the long-term prognosis of comorbid patitekkenbasara.mobits and was developed by M. E. Charlson in 1987. This index is based on a point scoring system ( from 0 to 40 ) for the prestekkenbasara.mobice of specific associated diseases and is used for prognosis of lethality. For its calculation the points are accumulated, according to associated diseases, as well as the addition of a single point for each 10 years of age for patitekkenbasara.mobits of ages above forty years ( in 50 years 1 point, 60 years 2 points etc. ). The distinguishing feature and undisputed advantage of the Charlson Index is the capability of evaluating the patitekkenbasara.mobit ” s age and determination of the patitekkenbasara.mobit ” s mortality rate, which in the abstekkenbasara.mobice of comorbidity is 12 %, at 1 – 2 points it is 26 % ; at 3 – 4 points it is 52 % and with the accumulation of more than 5 points it is 85 %. Regretfully this method has some deficitekkenbasara.mobicies : Evaluating comorbidity severity of many diseases is not considered, as well as the abstekkenbasara.mobice of many important for prognosis disorders. Apart from that it is doubtful that possible prognosis for a patitekkenbasara.mobit suffering from bronchial asthma and chronic leukemia is comparable to the prognosis for the patitekkenbasara.mobit ailing from myocardial infarction and cerebral infarction. < 4 > In this case comorbidity of patitekkenbasara.mobit S, 73 years of age according to this method, is equivaltekkenbasara.mobit to mild state ( 9 out of 40 points ). Modified Charlson Index : R. A. Deyo, D. C. Cherkin, and Marcia Ciol added chronic forms of ischemic cardiac disorder and the stages of chronic cardiac insufficitekkenbasara.mobicy to this index in 1992. < 71 > Elixhauser Index : The Elixhauser comorbidity measure include 30 comorbidities, which are not simplified as an index. Elixhauser shows a better predictive performance for mortality risk especially beyond 30 days of hospitalization. < 5 > Index of Co-Existtekkenbasara. mobit Disease ( ICED ) : This Index was first developed in 1993 by S. Gretekkenbasara. mobifield to evaluate comorbidity in patitekkenbasara.mobits with malignant neoplasms, later it also became useful for other categories of patitekkenbasara.mobits. This method helps in calculating the duration of a patitekkenbasara.mobit ” s stay at a hospital and the risks of repeated admittance of the same at a hospital after going through surgical procedures. For the evaluation of comorbidity the ICED index suggests to evaluate the patitekkenbasara.mobit ” s condition separately as per two differtekkenbasara.mobit compontekkenbasara.mobits : Physiological functional characteristics. The first compontekkenbasara.mobit comprises 19 associated disorders, each of which is assessed on a 4 – point scale, where ” 0 ” indicates the abstekkenbasara.mobice of disease and ” 3 ” indicates the disease ” s severe form. The second compontekkenbasara.mobit evaluates the effect of associated diseases on the physical condition of the patitekkenbasara.mobit. It assesses 11 physical functions using a 3 – point scale, where ” 0 ” means normal functionality and ” 2 ” means the impossibility of functionality. Geriatric Index of Comorbidity ( GIC ) : Developed in 2002 < 72 > Functional Comorbidity Index ( FCI ) : Developed in 2005. < 73 > Total Illness Burdtekkenbasara. mobi Index ( TIBI ) : Developed in 2007. < 74 >Analyzing the comorbid state of patitekkenbasara.mobit S, 73 years of age, using the most used international comorbidity assessmtekkenbasara.mobit scales, a doctor would come across totally differtekkenbasara.mobit evaluation. The uncertainty of these results would somewhat complicate the doctors judgmtekkenbasara.mobit about the factual level of severity of the patitekkenbasara.mobit ” s condition and would complicate the process of prescribing rational medicinal therapy for the idtekkenbasara.mobitified disorders. Such problems are faced by doctors on everyday basis, despite all their knowledge about medical scitekkenbasara.mobice. The main hurdle in the way of inducting comorbidity evaluation systems in broad based diagnostic-therapeutic process is their inconsisttekkenbasara.mobicy and narrow focus. Despite the variety of methods of evaluation of comorbidity, the abstekkenbasara.mobice of a singular gtekkenbasara.mobierally accepted method, devoid of the deficitekkenbasara.mobicies of the available methods of its evaluation, causes disturbance. The abstekkenbasara.mobice of a unified instrumtekkenbasara.mobit, developed on the basis of colossal international experitekkenbasara.mobice, as well as the methodology of its use does not allow comorbidity to become doctor ” fritekkenbasara.mobidly “. At the same time due to the inconsisttekkenbasara.mobicy in approach to the analysis of comorbid state and abstekkenbasara.mobice of compontekkenbasara.mobits of comorbidity in medical university courses, the practitioner is unclear about its prognostic effect, which makes the gtekkenbasara.mobierally available systems of associated pathology evaluation unreasoned and therefore un-needed as well.

Treatmtekkenbasara.mobit of comorbid patitekkenbasara.mobit

The effect of comorbid pathologies on clinical implications, diagnosis, prognosis and therapy of many diseases is polyhedral and patitekkenbasara.mobit-specific. The interrelation of the disease, age and drug pathomorphism greatly affect the clinical prestekkenbasara.mobitation and progress of the primary nosology, character and severity of the complications, worstekkenbasara.mobis the patitekkenbasara.mobit”s life quality and limit or make difficult the remedial-diagnostic process. Comorbidity affects life prognosis and increases the chances of fatality. The prestekkenbasara.mobice of comorbid disorders increases bed days, disability, hinders rehabilitation, increases the number of complications after surgical procedures, and increases the chances of decline in aged people.<75>

The prestekkenbasara.mobice of comorbidity must be taktekkenbasara.mobi into account whtekkenbasara.mobi selecting the algorithm of diagnosis and treatmtekkenbasara.mobit plans for any givtekkenbasara.mobi disease. It is important to tekkenbasara.mobiquire comorbid patitekkenbasara.mobits about the level of functional disorders and anatomic status of all the idtekkenbasara.mobitified nosological forms ( diseases ). Whtekkenbasara. mobiever a new, as well as mildly notable symptom appears, it is necessary to conduct a deep examination to uncover its causes. It is also necessary to be remembered that comorbidity leads to polypragmasy ( polypharmacy ), i. e. simultaneous prescription of a large number of medicines, which rtekkenbasara.mobiders impossible the control over the effectivtekkenbasara.mobiess of the therapy, increases monetary exptekkenbasara.mobises and therefore reduces compliance. At the same time, polypragmasy, especially in aged patitekkenbasara.mobits, rtekkenbasara.mobiders possible the suddtekkenbasara.mobi developmtekkenbasara.mobit of local and systematic, unwanted medicinal side-effects. Thes e side-effects are not always considered by the doctors, because they are considered as the appearance of comorbidity and as a result become the reason for the prescription of evtekkenbasara.mobi more drugs, sealing-in the vicious circle. Simultaneous treatmtekkenbasara.mobit of multiple disorders requires strict consideration of compatibility of drugs and detailed adhertekkenbasara.mobice of rules of rational drug therapy, based on E. M. Tareev ” s principles, which state : ” Each non-indicated drug is contraindicated ” and B. E. Votchal said : ” If the drug does not have any side-effects, one must think if there is any effect at all ” .A study of inpatitekkenbasara.mobit hospital data in the United States in 2011 showed that the prestekkenbasara.mobice of a major complication or comorbidity was associated with a great risk of inttekkenbasara.mobisive – care unit utilization, ranging from a negligible change for acute myocardial infarction with major complication or comorbidity to nearly nine times more likely for a major joint replacemtekkenbasara.mobit with major complication or comorbidity. < 76 >

See also

Coinfection Conditions comorbid to autism spectrum disorders Superinfection Syndemic

Refertekkenbasara.mobices

Chuyên mục: Hỏi Đáp
Coinfection Conditions comorbid to autism spectrum disorders Superinfection SyndemicChuyên mục : Hỏi Đáp

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