Adults' experience of living with multimorbidity: a qualitative systematic review protocol.

OBJECTIVE: The objective of the review is to synthesize the qualitative research literature on the experiences of adults living with multimorbidity. INTRODUCTION: Persons living with two or more chronic health conditions, known as multimorbidity, is a global health problem in countries of all income levels. Multimorbidity presents an ever-increasing resource and financial burden for health care systems and similarly challenges those living with multiple health conditions because of the complexity of their health and treatment requirements. Overall, persons with multimorbid conditions experience a high risk of mortality and a lower quality of life. Understanding the adult experience of multimorbidity is important for creating and implementing health care that meets the needs of individuals living with the burden of multiple chronic health conditions. INCLUSION CRITERIA: The systematic review will include published peer-reviewed and unpublished English-language studies from 2000 to 2020 that provide qualitative evidence of adults' (18+ years of age) experiences of living with multimorbidity. METHODS: CINAHL with full text, Cochrane, MEDLINE, Embase, PsycINFO, Consumer Health Database, Scopus, and ScienceDirect journals and books will be searched. Reference lists of included studies will also be cross-checked with search outcomes to identify additional studies. Sources of gray literature will also be searched for unpublished studies. The critical appraisal of selected studies and the extraction of data will be independently undertaken by two reviewers using JBI methods. The findings will be pooled using meta-aggregation to produce comprehensive synthesized findings. A ConQual Summary of Findings will also be presented. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020152038.

Two patients with daptomycin induced eosinophilic pneumonia with different presentations and treatment.

We present two cases of daptomycin-induced eosinophilic pneumonia with characteristic chest x ray, CT scan and bronchoalveolar lavage (BAL) findings. It is not a commonly seen complication of Daptomycin but when it happens, it could cause a diagnostic and treatment dilemma. Patients could present acutely with hypoxic respiratory failure or a less dramatic chronic presentation is also possible. Our two patients presented with acute hypoxic respiratory failure and presentation resembles that of an infectious etiology. Diagnosis is confirmed by bronchoscopy with BAL in one of them and the other was treated empirically as the clinical and radiologic presentation was typical. Treatment includes removal of the offending agent, daptomycin. Corticosteroids are used if symptoms are severe and can result in rapid clinical improvement. There is no agreed upon dose and duration of steroids and we suggest a long taper of steroids for patients who present with severe symptoms and a short course steroid for patients with milder symptoms.