{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T03:39:43Z","timestamp":1793417983060,"version":"4.5.0"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","license":[{"start":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T00:00:00Z","timestamp":1746748800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,5,9]]},"abstract":"<jats:sec>\n                    <jats:title>Rationale:<\/jats:title>\n                    <jats:p>As China enters an accelerated stage of global population aging, multimorbidity has emerged as a significant public health challenge. Current management strategies often focus primarily on index diseases, neglecting the complex interplay of multiple conditions in elderly patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient concerns:<\/jats:title>\n                    <jats:p>An 86-year-old female with multimorbidity, including diabetes, hypertension, and osteoporosis, sustained a femoral fracture. Following \u201cartificial bone replacement\u201d surgery, she experienced significant loss of consciousness with a drastic decline in hemoglobin from 110 to 39\u2009g\/L.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Diagnoses:<\/jats:title>\n                    <jats:p>The patient\u2019s femoral fracture triggered a cascade of complications, resulting in hypoglycemic coma, gastrointestinal bleeding, and acute cerebral infarction. Utilizing a multimorbidity framework, general practitioners hypothesized and subsequently confirmed nonocclusive mesenteric ischemia (NOMI) as the cause of bleeding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions:<\/jats:title>\n                    <jats:p>Management included timely interventions focused on addressing the underlying NOMI, specifically volume expansion and vasodilator therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes:<\/jats:title>\n                    <jats:p>Following the targeted interventions addressing both the primary conditions and complications, the patient recovered sufficiently to be discharged from the hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Lessons:<\/jats:title>\n                    <jats:p>This case underscores the importance of holistic approaches in clinical practice when managing elderly patients with multimorbidity. It demonstrates how multiple conditions can interact in a domino effect and highlights the value of considering less common diagnoses like NOMI in complex elderly patients with multiple comorbidities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/md.0000000000042004","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T21:00:17Z","timestamp":1747083617000},"page":"e42004","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Reflections on the domino effect of a patient with multimorbidity: A case report and literature review"],"prefix":"10.1097","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2401-0353","authenticated-orcid":false,"given":"Meizi","family":"Guo","sequence":"first","affiliation":[{"name":"Department of General practice, Shenzhen Hospital of Southern Medical University, Shenzhen, 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