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Multimorbidity publication in leading medical journal

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By Søren T. Skou, Frances S. Mair, Martin Fortin,Bruce Guthrie, Bruno P. Nunes, J. Jaime Miranda, Cynthia M. Boyd, Sanghamitra Pati, Sally Mtenga, Susan M. Smith

An international, interdisciplinary group of researchers and clinicians from nine different countries across five continents recently completed a review on multimorbidity, which was published in Nature Reviews Disease Primers, a top five general medical journal (journal impact factor of 65) [1]. The review, called a Primer, provides a global overview of a specific medical field as well as outlining future directions and research questions. Primers provide clinicians and researchers around the world with an understanding of the epidemiology, mechanisms/pathophysiology, prevention, diagnosis, and treatment for a specific medical condition or concept.
The process leading to the publication of the multimorbidity Primer started in January 2021 when the authors drafted a pre-submission inquiry, which was sent to the journal. After this the journal invited us to prepare a manuscript for submission, which was sent for peer review and finally accepted after several rounds of revision and published in July 2022. We put a lot of work into writing the manuscript, but it was a very rewarding process as it gave us an opportunity to collaborate and review the latest literature on multimorbidity and develop ideas for future projects together.
The primer underlined the burden of multimorbidity on individuals, carers and society, especially in socioeconomically deprived communities. Furthermore, it highlighted the complex, interrelated and multilevel mechanisms involved in the development of multimorbidity, including aging, biological mechanisms, and broader socio-determinants of health. Evidence for prevention and treatment is still limited. While there is more literature on interventions there is still no clear evidence to guide clinical practice and policy. The Primer suggests that interventions for multimorbidity may be person-centred, complex and multifaceted, and among other things focus on psychosocial and behavioural factors. The Primer also highlighted the need for further research particularly in low- and middle-income countries. Finally, the Primer calls for a change in focus for clinical practice and training to become more multimorbidity focused along with a shift in healthcare to support proper prevention and management of multimorbidity.
To read more, you can find the full Primer for free here: https://rdcu.be/cRBzm
You will also be able to find an infographic associated with the Primer here: https://rdcu.be/cTqpw 
It provides a quick overview of the review findings for your clinical practice or workspace.

1 Multimorbidity. Skou ST, Mair FS, Fortin M, Guthrie B, Nunes BP, Miranda JJ, Boyd CM, Pati S, Mtenga S, Smith SM. Nat Rev Dis Primers. 2022 Jul 14;8(1):48. doi: 10.1038/s41572-022-00376-4.

Publications on multimorbidity January-April 2022

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By Martin Fortin

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Our search for papers on multimorbidity that were published during the period January-April 2022 has been completed. As in previous searches, we have prepared a PDF file that can be accessed following this link.
Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expressions “multiple chronic diseases” and “multiple long-term conditions” in PubMed (https://www.ncbi.nlm.nih.gov/pubmed), but we are sure that most publications on the subject are included in the list.
All references are also included in our library. Feel free to share with anyone interested in multimorbidity.

Publications on multimorbidity September-December 2021

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By Martin Fortin

Our search for papers on multimorbidity that were published during the period September-December 2021 has been completed. As in previous searches, we have prepared a PDF file that can be accessed following this link.

Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expressions “multiple chronic diseases” and “multiple long-term conditions” in PubMed (https://www.ncbi.nlm.nih.gov/pubmed), but we are sure that most publications on the subject are included in the list. All references are also included in our library. Feel free to share with anyone interested in multimorbidity.

A New Multimorbidity PhD Programme for Health Professionals

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By Frances Mair, Programme Director

A new Multimorbidity PhD programme for health professionals, funded by Wellcome Trust, has recently been launched in Scotland. The new PhD programme is led by the University of Glasgow in collaboration with the Universities of Dundee, Edinburgh and St Andrews, and aims to train a new generation of healthcare professionals with transferable skills for academic, clinical and policy roles, with a focus on generation of evidence that will enhance understanding of the determinants of multimorbidity and inform development of patient-focused interventions to improve care and outcomes. The PhD Fellows will be recruited from a range of clinical and health professional backgrounds and be offered exceptional opportunities for clinical research across a range of specialisms, from data science and epidemiology, to applied clinical research in a unique collaborative training environment. Our vision is to create a cohort of academic health professionals, including doctors, nurses, pharmacists, dentists, clinical psychologists and allied health professionals, for whom interdisciplinary and integrated thinking is the norm, with the skills to bridge research gaps and overcome the challenges posed by multimorbidity. Hosted in the Scottish societal context, where multimorbidity is a key health concern, but examining globally relevant problems, it will promote development of a critical mass of multimorbidity researchers empowered to find ways to prevent multimorbidity, discover pathways tractable to novel intervention and optimise management. The programme builds on the strengths of the partner institutions, to create a rich, multidisciplinary environment that will equip a new generation of researchers with a broad range of methodological skills that will enable them to promote new thinking on this complex topic. The programme has three research themes: Prevention and Management; Physical and Mental Health Multimorbidity and Polypharmacy with Inequalities as a cross-cutting theme.

Fellows will participate in a range of cohort-building activities aimed at developing a community and broadening understanding of research and interdisciplinary collaboration. Patient and Public Involvement (PPI) and Knowledge Exchange (KE) skill development are core elements of the planned development programme for Fellows. The Programme will be recruiting for new Fellows annually for the next 5 years, during this time we expect to support 34 Fellows, making this the largest Multimorbidity PhD Programme for Health Professionals globally. We have just recruited our first cohort of Fellows who will commence in November 2022. Further details of the programme and the types of research projects being offered can be found here: https://www.gla.ac.uk/colleges/mvls/graduateschool/multimorbidity/.

Challenges in multimorbidity research: lessons learned from the most recent randomized controlled trials in primary care

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By Martin Fortin, Moira Stewart, José Almirall, and Priscilla Beaupré

Patients with multimorbidity need a new kind of health care. Numerous rigorous studies using randomized controlled designs (RCTs) have been conducted to demonstrate effectiveness of interventions aimed at improving outcomes for patient with multimorbidity in primary care, but most of them have reported neutral effects or mixed results. Nevertheless, these studies offer a valuable source of information to learn from in order to pave the way for future research in this area in primary care.
We conducted a scoping review [1] to include current up-to-date state-of-the-art studies in primary care published from 2019 until 2021 in order to synthesize and analyze the most recent RCTs and to identify the factors that may have contributed to the success or lack of success. Special attention was given to four elements of the intervention: 1) its description and content; 2) the context in which it was deployed; 3) the evaluation design chosen to test the effectiveness, and 4) the intervention’s implementation.
Nine articles reporting on six RCTs studies were included in the review. The findings were mixed, with primary outcomes showing no differences between intervention and control groups in four of the six but differences in secondary outcomes in all six. All studies involved family practice patients but interventions took place at different sites, and the time between the beginning of the intervention and the time of evaluation of outcomes varied across studies. Authors reported issues regarding the need for training of care teams, the roles and composition of the teams, the selection of patients and implementation barriers of the complex interventions in trying contexts with not enough time for the changes required.
This scoping review identified several lessons on planning for future intervention studies on multimorbidity in primary care. Interdisciplinary teams as the basis for most interventions, while recommended, may need more support by policy and practice leadership to be successfully deployed and evaluated. The randomized controlled design may not be the best evaluation design given the complexity of the interventions; alternative designs should be considered in which qualitative components are included. Special attention should be given to outcome measures ensuring that they are better aligned to patient goals. Selection of patients was prone to bias toward the less needy and this may hamper the ability to document effectiveness and raises questions about equity in research. Implementation of the interventions needs special attention and enough time to gel.

1-Fortin M, Stewart M, Almirall J and Beaupré P (2022) Challenges in Multimorbidity Research: Lessons Learned From the Most Recent Randomized Controlled Trials in Primary Care. Front. Med. 9:815783. doi: 10.3389/fmed.2022.815783

Publications on multimorbidity May-August 2021

By Martin Fortin

Our search for papers on multimorbidity that were published during the period May-August 2021 has been completed. As in previous searches, we have prepared a PDF file that can be accessed following this link.

Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expression “multiple chronic diseases” in PubMed (https://www.ncbi.nlm.nih.gov/pubmed), but we are sure that most publications on the subject are included in the list.

All references are also included in our library. Feel free to share with anyone interested in multimorbidity.

Publications on multimorbidity January-April 2021

By Martin Fortin

Our search for papers on multimorbidity that were published during the period January-April 2021 has been completed. As in previous searches, we have prepared a PDF file that can be accessed following this link.

Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expression “multiple chronic diseases” in PubMed (https://www.ncbi.nlm.nih.gov/pubmed), but we are sure that most publications on the subject are included in the list.

All references are also included in our library. Feel free to share with anyone interested in multimorbidity.

Multimorbidity in the context of Neurodegenerative Disorders

By Rafael Linden

Dear colleagues,

The Frontiers Platform has launched a Research Topic, aimed at basic research, epidemiology, clinical, neuropathological and modelling studies in the field of Multimorbidity in the context of Neurodegenerative Disorders. We encourage authors to submit either Original Articles or Reviews on this subject.

I would appreciate should IRCMo help inform scientists interested in this subject, and we encourage submission of articles related with the field.

More information:
https://www.frontiersin.org/research-topics/17133/multimorbidity-in-the-context-of-neurodegenerative-disorders

Best regards,

Rafael Linden, M.D., Ph.D.
Associate Editor
Frontiers in Neuroscience

Professor of Neuroscience
Instituto de Biofísica Carlos Chagas Filho
Universidade Federal do Rio de Janeiro
Brasil

Publications on multimorbidity September-December 2020

By Martin Fortin

Our search for papers on multimorbidity that were published during the period September-December 2020 has been completed. As in previous searches, we have prepared a PDF file that can be accessed following this link.

Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expression “multiple chronic diseases” in PubMed (https://www.ncbi.nlm.nih.gov/pubmed), but we are sure that most publications on the subject are included in the list.

All references are also included in our library. Feel free to share with anyone interested in multimorbidity.

The “Journal of Comorbidity” changed to the “Journal of Multimorbidity and Comorbidity.”

By Martin Fortin

Formerly, we could find in the description of the Journal of Comorbidity that it published “original clinical and experimental research articles on the pathophysiology, diagnosis, prevention and management of patients with comorbidity/multimorbidity.” Now, in the description of the Journal of Multimorbidity and Comorbidity, one reads that it publishes the same type of articles on “comorbidity and multimorbidity.”

The change in the name of the journal and the change in the description from “comorbidity/multimorbidity” to “comorbidity and multimorbidity” may seem natural for those working on multimorbidity or those who are familiar with its meaning. However, for many who still consider both words as interchangeable, writing “comorbidity/multimorbidity” could have been seen as normal and the separation in “comorbidity and multimorbidity” could be seen as redundant.

In 1996, van den Akker and colleagues [1] pointed out the prevailing ambiguity around the use of both terms at that time, and suggested distinct definitions for them. Since then, there has been an increasing awareness about the difference between both terms and the importance of using them correctly. A benefit in using both terms adequately is that publications are then correctly classified, leading to an improvement in the quality of search queries and ultimately to better research.

However, although the first alert on the ambiguity in the use of the terms was published 25 years ago, it has taken a long time for the recognition of the difference between both terms and its effect in slowing down the advance of our knowledge on the subject. For example, in the National Library of Medicine of the National Institutes of Health (NIH), the term “multimorbidity” was a subheading under the Medical Subject Heading (MeSH) “comorbidity” until 2017. It was only in 2018 that the term “multimorbidity” appeared with the hierarchy of a MeSH.

In the editorial of the Journal of Multimorbidity and Comorbidity explaining the change in the name of the journal [2], it is well explained that multimorbidity and comorbidity are distinct concepts in research design, intervention development and healthcare delivery. However, there is not a universal recognition of this distinction yet.

We welcome the change in the name of the journal as another step in clarifying the use of the terms, hoping that it will contribute to our main goal which is to improve the health outcomes of our patients.

  1. van den Akker M, Buntinx F and Knottnerus JA. Comorbidity or multimorbidity: what’s in a name? A review of literature. Eur J Gen Pract 1996; 2: 65-70.
  2. Harrison C, Fortin M, van den Akker M, et al. Comorbidity versus multimorbidity: Why it matters. Journal of Multimorbidity and Comorbidity 2021; 11. Article first published online: March 2, 2021. DOI: https://doi.org/10.1177/2633556521993993.