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Clinical inertia

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https://www.readbyqxmd.com/read/29094260/comparison-among-recommendations-for-the-management-of-arterial-hypertension-issued-by-last-us-canadian-british-and-european-guidelines
#1
Christina Antza, Ioannis Doundoulakis, Stella Stabouli, Vasilios Kotsis
Guidelines for the management of hypertension have been issued by different hypertension societies or organizations. Despite many similarities one can identify major differences in the diagnosis, management and treatment of the hypertensive patients among ESH/ESC, NICE, Canadian and NJC8 guidelines. Differences that can be identified are in the definition of hypertension in the elderly population, the optimal blood pressure targets in different hypertensive populations such as patients with diabetes and chronic kidney disease patients and the choose of the initial and appropriate antihypertensive agent depending on comorbidities of the treated population...
November 1, 2017: High Blood Pressure & Cardiovascular Prevention: the Official Journal of the Italian Society of Hypertension
https://www.readbyqxmd.com/read/29083969/personalized-care-and-the-role-of-insulin-as-a-vehicle-to-optimizing-treatments-in-diabetes-care
#2
Nella Bieszk, Michael Grabner, Wenhui Wei, John Barron, Ralph Quimbo, Tingjian Yan, Beth Biel, James W Chu
BACKGROUND: In patients with type 2 diabetes (T2D) with poor glycemic control, there is an unmet need for treatment optimization involving the initiation and/or intensification of insulin therapy, which is often delayed because of clinical inertia. Educational initiatives that target patients and physicians might be one way to address this need. OBJECTIVE: To evaluate the effectiveness of educational materials mailed to physicians and their patients in affecting initiation of insulin therapy and other health care outcomes...
November 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29066518/apathy-a-neurocircuitry-model-based-on-frontotemporal-dementia
#3
REVIEW
Simon Ducharme, Bruce H Price, Bradford C Dickerson
Apathy is a symptom shared among many neurological and psychiatric disorders. However, the underlying neurocircuitry remains incompletely understood. Apathy is one of the core features of behavioural variant frontotemporal dementia (bvFTD), a neurodegenerative disease presenting with heterogeneous combinations of socioaffective symptoms and executive dysfunction. We reviewed all neuroimaging studies of apathy in frontotemporal dementia (FTD) attempting to refine a neurocircuitry model and inform clinical definitions...
October 24, 2017: Journal of Neurology, Neurosurgery, and Psychiatry
https://www.readbyqxmd.com/read/29053215/the-identification-of-barriers-to-insulin-therapy-and-approaches-for-overcoming-them
#4
REVIEW
D Russell-Jones, F Pouwer, K Khunti
Poor glycaemic control in type 2 diabetes (T2D) is a global problem despite the availability of numerous glucose-lowering therapies and clear guidelines for T2D management. Tackling clinical or therapeutic inertia, where the person with diabetes and/or their healthcare providers do not intensify treatment regimens despite this being appropriate, is key to improving patients' long-term outcomes. This gap between best practice and current level of care is most pronounced when considering insulin regimens, with studies showing that insulin initiation/intensification is frequently and inappropriately delayed for several years...
October 20, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/29049076/fatigue-risk-management-the-impact-of-anesthesiology-residents-work-schedules-on-job-performance-and-a-review-of-potential-countermeasures
#5
Lily R Wong, Erin Flynn-Evans, Keith J Ruskin
Long duty periods and overnight call shifts impair physicians' performance on measures of vigilance, psychomotor functioning, alertness, and mood. Anesthesiology residents typically work between 64 and 70 hours per week and are often required to work 24 hours or overnight shifts, sometimes taking call every third night. Mitigating the effects of sleep loss, circadian misalignment, and sleep inertia requires an understanding of the relationship among work schedules, fatigue, and job performance. This article reviews the current Accreditation Council for Graduate Medical Education guidelines for resident duty hours, examines how anesthesiologists' work schedules can affect job performance, and discusses the ramifications of overnight and prolonged duty hours on patient safety and resident well-being...
October 17, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29044066/color-vision-abnormalities-in-type-ii-diabetes-sankara-nethralaya-diabetic-retinopathy-epidemiology-and-molecular-genetics-study-ii-report-no-2
#6
Laxmi Gella, Rajiv Raman, Vaitheeswaran Kulothungan, Swakshyar Saumya Pal, Suganeswari Ganesan, Sangeetha Srinivasan, Tarun Sharma
PURPOSE: The purpose of this study is to assess color vision abnormalities in a cohort of subjects with type II diabetes and elucidate associated risk factors. METHODS: Subjects were recruited from follow-up cohort of Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study I. Six hundred and seventy-three eyes of 343 subjects were included from this population-based study. All subjects underwent detailed ophthalmic evaluation, including the Farnsworth-Munsell 100 hue test...
October 2017: Indian Journal of Ophthalmology
https://www.readbyqxmd.com/read/29033057/clinical-inertia-versus-overtreatment-in-glycaemic-management
#7
Kamlesh Khunti, Melanie J Davies
No abstract text is available yet for this article.
October 9, 2017: Lancet Diabetes & Endocrinology
https://www.readbyqxmd.com/read/29017373/clinical-considerations-for-use-of-insulin-degludec-insulin-aspart-in-japanese-patients
#8
Takahisa Hirose, Takuya Awata, Yuiko Yamamoto, Mads Peter Hemmingsen
Co-formulation of basal and bolus insulin components provides a simpler regimen for patients with type 2 diabetes than separate basal-bolus treatment. However, conventional premixed insulin products include a suboptimal protaminated basal component that requires resuspension prior to injection. Insulin degludec/insulin aspart (IDegAsp) is the first soluble co-formulation of a basal insulin with an ultra-long duration of action (IDeg) and a rapid-acting bolus insulin (IAsp) in a single injection. Areas covered: In this review, the authors summarize findings from pre-clinical studies and the clinical trial program and provide guidance for the initiating and switching of IDegAsp in different patient populations...
October 11, 2017: Expert Opinion on Biological Therapy
https://www.readbyqxmd.com/read/28993141/therapeutic-inertia-amongst-general-practitioners-with-interest-in-diabetes
#9
Samuel Seidu, Tun Than, Deb Kar, Amrit Lamba, Pam Brown, Azhar Zafar, Rizwan Hussain, Ahmed Amjad, Mathew Capehorn, Elizabeth Martin, Kevin Fernando, Jim McMoran, David Millar-Jones, Shahzada Kahn, Nigel Campbell, Richard Brice, Rahul Mohan, Mukesh Mistry, Naresh Kanumilli, Joan St John, Richard Quigley, Colin Kenny, Kamlesh Khunti
INTRODUCTION: As the therapeutic options in the management of type 2 diabetes increase, there is an increase confusion among health care professionals, thus leading to the phenomenon of therapeutic inertia. This is the failure to escalate or de-escalate treatment when the clinical need for this is required. It has been studied extensively in various settings, however, it has never been reported in any studies focusing solely on primary care physicians with an interest in diabetes. This group is increasingly becoming the focus of managing complex diabetes care in the community, albeit with the support from specialists...
October 6, 2017: Primary Care Diabetes
https://www.readbyqxmd.com/read/28971278/a-systematic-review-of-wearable-systems-for-cancer-detection-current-state-and-challenges
#10
Partha Pratim Ray, Dinesh Dash, Debashis De
Rapid growth of sensor and computing platforms have introduced the wearable systems. In recent years, wearable systems have led to new applications across all medical fields. The aim of this review is to present current state-of-the-art approach in the field of wearable system based cancer detection and identify key challenges that resist it from clinical adoption. A total of 472 records were screened and 11 were finally included in this study. Two types of records were studied in this context that includes 45% research articles and 55% manufactured products...
October 2, 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/28945701/american-pediatric-society-s-2017-john-howland-award-acceptance-lecture-a-tale-of-two-toxicants-childhood-exposure-to-lead-and-tobacco
#11
REVIEW
Michael Weitzman
This article summarizes the presentation of the 2017 Howland Award to Michael Weitzman, MD at the Annual Pediatric Academic Society Meetings. It summarizes the remarkable advances in understanding the effects and pathways of exposure of the 2 most common and pernicious of our nation's child environmental exposures, namely lead and tobacco. It also summarizes the profound effect of the translation of these findings into prudent and effective clinical and public health policies such that exposure to both has dramatically decreased over the past 40 years due to the tenacious activities of pediatricians, other child-related professionals, government agencies at all levels, and the American Academy of Pediatrics...
September 25, 2017: Pediatric Research
https://www.readbyqxmd.com/read/28919840/leptin-independently-predicts-development-of-sepsis-and-its-outcome
#12
Sofie Jacobsson, Peter Larsson, Göran Johansson, Margareta Norberg, Göran Wadell, Göran Hallmans, Ola Winsö, Stefan Söderberg
BACKGROUND: Sepsis is a life-threatening condition and obesity is related to the clinical outcome. The underlying reasons are incompletely understood, but the adipocyte derived hormones leptin and adiponectin may be involved. METHODS: Patients aged 18 years or more with documented first time sepsis events were included in a nested case-referent study if they had participated in previous health surveys. Two matched referents free of known sepsis were identified...
2017: Journal of Inflammation
https://www.readbyqxmd.com/read/28915897/development-of-a-complex-intervention-to-promote-appropriate-prescribing-and-medication-intensification-in-poorly-controlled-type-2-diabetes-mellitus-in-irish-general-practice
#13
Mark E Murphy, Molly Byrne, Atieh Zarabzadeh, Derek Corrigan, Tom Fahey, Susan M Smith
BACKGROUND: Poorly controlled type 2 diabetes mellitus (T2DM) can be seen as failure to meet recommended targets for management of key risk factors including glycaemic control, blood pressure and lipids. Poor control of risk factors is associated with significant morbidity, mortality and healthcare costs. Failure to intensify medications for patients with poor control of T2DM when indicated is called clinical inertia and is one contributory factor to poor control of T2DM. We aimed to develop a theory and evidence-based complex intervention to improve appropriate prescribing and medication intensification in poorly controlled T2DM in Irish general practice...
September 16, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28871238/overcoming-therapeutic-inertia-in-multiple-sclerosis-care-a-pilot-randomized-trial-applying-the-traffic-light-system-in-medical-education
#14
Gustavo Saposnik, Jorge Maurino, Angel P Sempere, Maria A Terzaghi, Christian C Ruff, Muhammad Mamdani, Philippe N Tobler, Xavier Montalban
BACKGROUND: Physicians often do not initiate or intensify treatments when clearly warranted, a phenomenon known as therapeutic inertia (TI). Limited information is available on educational interventions to ameliorate knowledge-to-action gaps in TI. OBJECTIVES: To evaluate the feasibility and efficacy of an educational intervention compared to usual care among practicing neurologists caring for patients with multiple sclerosis (MS). METHODS: We conducted a pilot double-blind, parallel-group, randomized clinical trial...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28870498/drug-adherence-in-hypertension
#15
REVIEW
M Burnier
Blood pressure control remains unsatisfactory in all countries of the world with at best 60% of treated hypertensive patients reaching recommended therapeutic goals. Several factors have been identified which may explain why the rate of blood pressure control remains low. Among them, one can cite medical inertia and a poor adherence to drug therapies. In the absence of new drugs to control blood pressure, drug adherence has become a major issue in the management of hypertensive patients. Numerous studies have demonstrated that the major problem is the lack of persistence followed by a poor day to day execution of the prescribed regimens...
September 1, 2017: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/28866091/variation-in-sodium-intake-and-intra-individual-change-in-blood-pressure-in-chronic-kidney-disease
#16
Chetna M Pathak, Joachim H Ix, Cheryl A M Anderson, Tyler B Woodell, Gerard Smits, Martha S Persky, Geoffrey A Block, Dena E Rifkin
OBJECTIVE: In the kidney disease clinic setting, higher-than-usual blood pressure is often ascribed to recent dietary sodium indiscretion. While clinical trials demonstrate a clear relationship between salt intake and blood pressure on the population level, it is uncertain whether real-world variation in sodium intake within individual chronic kidney disease (CKD) patients is associated with fluctuations in blood pressure. METHODS: We analyzed data from the Phosphorus Normalization Trial, in which participants with CKD eating their usual diets completed at least three 24-hour urine collections over 9 months, from which we measured sodium...
August 30, 2017: Journal of Renal Nutrition
https://www.readbyqxmd.com/read/28862799/initiating-therapy-in-patients-newly-diagnosed-with-type-2-diabetes-combination-therapy-vs-a-stepwise-approach
#17
REVIEW
Eugenio Cersosimo, Eric L Johnson, Christina Chovanes, Neil Skolnik
There is clear evidence that achieving glycaemic targets reduces the risk of developing complications as a result of type 2 diabetes (T2D). Many patients, however, continue to have suboptimal glycaemic control because of issues that include unclear advice on how to achieve these targets as well as clinical inertia. The two management approaches recommended for patients newly diagnosed with T2D are stepwise and combination therapy, each of which has advantages and disadvantages. Stepwise therapy may result in good patient adherence and allow greater individualization of therapy, and minimization of side effects and cost, and so may be appropriate for patients who are closer to goal...
September 1, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28844490/decalogue-of-the-spanish-society-of-arteriosclerosis-to-reduce-therapeutic-inertia
#18
Mariano Blasco, Pablo Pérez-Martínez, Carlos Lahoz
Therapeutic inertia (TI) is defined as the failure of the physician to initiate or intensify a treatment when the therapeutic goal has not been achieved. TI can be of 2types: inertia due to lack of prescription of drugs and inertia in the absence of control of a risk factor. The consequences of TI are poor control of risk factors, an increase in potentially preventable events and an increase in costs. There are factors of the doctor himself, the patient and the care organization that determine the presence of TI...
August 24, 2017: Clínica e Investigación en Arteriosclerosis
https://www.readbyqxmd.com/read/28834075/therapeutic-inertia-in-the-treatment-of-hyperglycaemia-in-patients-with-type-2-diabetes-a-systematic-review
#19
Kamlesh Khunti, Marilia B Gomes, Stuart Pocock, Marina V Shestakova, Stéphane Pintat, Peter Fenici, Niklas Hammar, Jesús Medina
AIMS: Therapeutic inertia, defined as the failure to initiate or intensify therapy in a timely manner according to evidence-based clinical guidelines, is a key reason for uncontrolled hyperglycaemia in patients with type 2 diabetes. The aims of this systematic review were to identify how therapeutic inertia in the management of hyperglycaemia was measured and to assess its extent over the past decade. MATERIALS AND METHODS: Systematic searches for articles published from January 1, 2004 to August 1, 2016 were conducted in MEDLINE and Embase...
August 22, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28789568/temporal-trends-in-the-use-of-antiplatelet-therapy-in-patients-with-acute-coronary-syndromes
#20
María Asunción Esteve-Pastor, Juan Miguel Ruíz-Nodar, Esteban Orenes-Piñero, José Miguel Rivera-Caravaca, Miriam Quintana-Giner, Andrea Véliz-Martínez, Antonio Tello-Montoliu, Vicente PerniasEscrig, Miriam Sandín Rollán, Nuria Vicente-Ibarra, Manuel Jesús MacíasVillanego, Elena Candela Sánchez, Luna Carrillo Alemán, Teresa Lozano, Mariano Valdés, Francisco Marín
BACKGROUND: Current clinical guidelines of acute coronary syndromes (ACS) recommend the use of potent antiplatelet therapy, prasugrel or ticagrelor, because both drugs consistently reduce cardiovascular events. PURPOSE: The aim of this study was to examine temporal changes in the use of optimal antiplatelet therapy in patients with ACS. METHODS: A total of 1717 consecutive patients admitted for ACS in 3 tertiary hospitals from February 2014 to December 2015 were enrolled...
January 1, 2017: Journal of Cardiovascular Pharmacology and Therapeutics
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