Comorbidity and dementia: a scoping review of the literature.

BACKGROUND: Evidence suggests that amongst people with dementia there is a high prevalence of comorbid medical conditions and related complaints. The presence of dementia may complicate clinical care for other conditions and undermine a patient's ability to manage a chronic condition. The aim of this study was to scope the extent, range and nature of research activity around dementia and comorbidity. METHODS: We undertook a scoping review including all types of research relating to the prevalence of comorbidities in people with dementia; current systems, structures and other issues relating to service organisation and delivery; patient and carer experiences; and the experiences and attitudes of service providers. We searched AMED, Cochrane Library, CINAHL, PubMed, NHS Evidence, Scopus, Google Scholar (searched 2012, Pubmed updated 2013), checked reference lists and performed citation searches on PubMed and Google Scholar (ongoing to February 2014). RESULTS: We included 54 primary studies, eight reviews and three guidelines. Much of the available literature relates to the prevalence of comorbidities in people with dementia or issues around quality of care. Less is known about service organisation and delivery or the views and experiences of people with dementia and their family carers. There is some evidence that people with dementia did not have the same access to treatment and monitoring for conditions such as visual impairment and diabetes as those with similar comorbidities but without dementia. CONCLUSIONS: The prevalence of comorbid conditions in people with dementia is high. Whilst current evidence suggests that people with dementia may have poorer access to services the reasons for this are not clear. There is a need for more research looking at the ways in which having dementia impacts on clinical care for other conditions and how the process of care and different services are adapting to the needs of people with dementia and comorbidity. People with dementia should be included in the debate about the management of comorbidities in older populations and there needs to be greater consideration given to including them in studies that focus on age-related healthcare issues

Big data analytics to model scoring probability in basketball: the effect of shooting under high-pressure conditions

In this paper, we analyze the shooting performance of basketball players by examining factors that may generate high-pressure game situations. Using play-by-play data from the Italian "Serie A2" Championship 2015/2016 to build the model, we validate the main results using data from the Olympic Basketball Tournament \Rio 2016" to determine whether the identified relationships can be confirmed using data from players at a very different professional level. After a preliminary exploratory analysis, we (1) develop a multivariate model, based on the Classification And Regression Tree (CART) algorithm, to investigate how selected high-pressure situations, jointly considered, affect scoring probability, and propose new shooting performance measures; (2) investigate players' personal reactions to selected high-pressure game situations by introducing additional new measures, improving the indices currently used to measure the players' shooting performance. The results are interesting and easy to interpret with the aid of some insightful graphical representations. Our approach can be exploited by both scouts and coaches to understand important characteristics of players and, ultimately, to measure and enhance a team's performance

Dimensions of Patient-provider Communication and Diabetes Self-care in an Ethnically Diverse Population

BACKGROUND: Patient-provider communication is essential for effective care of diabetes and other chronic illnesses. However, the relative impact of general versus disease-specific communication on self-management is poorly understood, as are the determinants of these 2 communication dimensions. DESIGN: Cross-sectional survey. SETTING: Three VA heath care systems, 1 county health care system, and 1 university-based health care system. PATIENTS: Seven hundred fifty-two diabetes patients were enrolled. Fifty-two percent were nonwhite, 18% had less than a high-school education, and 8% were primarily Spanish-speaking. MEASUREMENTS AND MAIN RESULTS: Patients' assessments of providers' general and diabetes-specific communication were measured using validated scales. Self-reported foot care; and adherence to hypoglycemic medications, dietary recommendations, and exercise were measured using standard items. General and diabetes-specific communication reports were only moderately correlated (r = .35) and had differing predictors. In multivariate probit analyses, both dimensions of communication were independently associated with self-care in each of the 4 areas examined. Sociodemographically vulnerable patients (racial and language minorities and those with less education) reported communication that was as good or better than that reported by other patients. Patients receiving most of their diabetes care from their primary provider and patients with a longer primary care relationship reported better general communication. VA and county clinic patients reported better diabetes-specific communication than did university clinic patients. CONCLUSIONS: General and diabetes-specific communication are related but unique facets of patient-provider interactions, and improving either one may improve self-management. Providers in these sites are communicating successfully with vulnerable patients. These findings reinforce the potential importance of continuity and differences among VA, county, and university health care systems as determinants of patient-provider communication