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Clinical inertia

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https://www.readbyqxmd.com/read/28638444/understanding-the-barriers-and-improving-care-in-type-2-diabetes-brazilian-perspective-in-time-to-do-more-in-diabetes
#1
Sérgio Vencio, Päivi M Paldánius, Matthias Blüher, Daniel Giannella-Neto, Rafael Caiado-Vencio, W David Strain
BACKGROUND: Type 2 diabetes mellitus (T2DM) is a complex disease, particularly in a continental country like Brazil. We attempted to understand and evaluate the perceptions and routines of Brazilians with T2DM and physicians, compared with other countries. METHODS: We compared the results from a 20-min online survey in Brazil with simultaneously collated data from India, Japan, Spain, UK and USA. RESULTS: In total, 652 adults with T2DM and 337 treating physicians were enrolled, of whom 100 patients and 55 physicians were from Brazil...
2017: Diabetology & Metabolic Syndrome
https://www.readbyqxmd.com/read/28634455/fertilizing-a-patient-engagement-ecosystem-to-innovate-healthcare-toward-the-first-italian-consensus-conference-on-patient-engagement
#2
Guendalina Graffigna, Serena Barello, Giuseppe Riva, Mariarosaria Savarese, Julia Menichetti, Gianluca Castelnuovo, Massimo Corbo, Alessandra Tzannis, Antonio Aglione, Donato Bettega, Anna Bertoni, Sarah Bigi, Daniela Bruttomesso, Claudia Carzaniga, Laura Del Campo, Silvia Donato, Silvia Gilardi, Chiara Guglielmetti, Michele Gulizia, Mara Lastretti, Valeria Mastrilli, Antonino Mazzone, Giovanni Muttillo, Silvia Ostuzzi, Gianluca Perseghin, Natalia Piana, Giuliana Pitacco, Gianluca Polvani, Massimo Pozzi, Livio Provenzi, Giulia Quaglini, Mariagrazia Rossi, Paola Varese, Natalia Visalli, Elena Vegni, Walter Ricciardi, A Claudio Bosio
Currently we observe a gap between theory and practices of patient engagement. If both scholars and health practitioners do agree on the urgency to realize patient engagement, no shared guidelines exist so far to orient clinical practice. Despite a supportive policy context, progress to achieve greater patient engagement is patchy and slow and often concentrated at the level of policy regulation without dialoguing with practitioners from the clinical field as well as patients and families. Though individual clinicians, care teams and health organizations may be interested and deeply committed to engage patients and family members in the medical course, they may lack clarity about how to achieve this goal...
2017: Frontiers in Psychology
https://www.readbyqxmd.com/read/28611850/use-of-the-kalman-filter-for-aortic-pressure-waveform-noise-reduction
#3
Frank Lam, Hsiang-Wei Lu, Chung-Che Wu, Zekeriya Aliyazicioglu, James S Kang
Clinical applications that require extraction and interpretation of physiological signals or waveforms are susceptible to corruption by noise or artifacts. Real-time hemodynamic monitoring systems are important for clinicians to assess the hemodynamic stability of surgical or intensive care patients by interpreting hemodynamic parameters generated by an analysis of aortic blood pressure (ABP) waveform measurements. Since hemodynamic parameter estimation algorithms often detect events and features from measured ABP waveforms to generate hemodynamic parameters, noise and artifacts integrated into ABP waveforms can severely distort the interpretation of hemodynamic parameters by hemodynamic algorithms...
2017: Computational and Mathematical Methods in Medicine
https://www.readbyqxmd.com/read/28596248/examining-the-language-and-behavioural-profile-in-ftd-and-als-ftd
#4
Jennifer A Saxon, Jennifer C Thompson, Matthew Jones, Jennifer M Harris, Anna Mt Richardson, Tobias Langheinrich, David Neary, David Ma Mann, Julie S Snowden
BACKGROUND: A proportion of patients with behavioural variant frontotemporal dementia (bvFTD) develop amyotrophic lateral sclerosis (ALS). It is currently unknown whether the behavioural and cognitive syndrome in bvFTD with ALS (ALS-FTD) is indistinguishable from that of bvFTD alone. METHODS: A retrospective cohort of 241 patients with clinical diagnoses of bvFTD (n=185) or ALS-FTD (n=56) was examined with respect to behavioural, cognitive and neuropsychiatric symptoms...
June 8, 2017: Journal of Neurology, Neurosurgery, and Psychiatry
https://www.readbyqxmd.com/read/28574631/starry-aims-to-overcome-knowledge-translation-inertia-the-standards-for-reporting-implementation-studies-stari-guidelines
#5
Christopher R Carpenter, Hilary Pinnock
In 2007, Academic Emergency Medicine hosted a Consensus Conference on "Knowledge Translation in Emergency Medicine" with the objective of identifying high-yield research priorities for the concept of moving from evidence to action.(1) Patients often fail to receive care that aligns with quality indicators, and the Institute of Medicine has estimated that on average 17 years pass before just 14% of effective interventions reach the bedside.(2-4) Equally important is the concept that de-implementing wasteful, inefficient, or outdated clinical approaches frequently require more time and effort than is available, so the trajectory of bedside decision-making often yields to the status quo...
June 2, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28557468/differentiating-the-everyday-emotion-dynamics-of-borderline-personality-disorder-from-major-depressive-disorder-and-bipolar-disorder
#6
Malek Mneimne, William Fleeson, Elizabeth Mayfield Arnold, R Michael Furr
A major barrier to the understanding of emotion dynamics in borderline personality disorder (BPD) lies in its substantial comorbidity with major depressive disorder (MDD) and bipolar disorder (BD). Whereas BPD has often been characterized in terms of dynamic emotional processes, including instability, reactivity, and inertia, its substantial comorbidity with MDD and BD makes it difficult to discern the specificity of these dynamics. To differentiate the emotion dynamics of BPD from those of MDD and BD, an experience sampling study of 38 participants with BPD, 15 participants with MDD, 14 participants with BD, and 62 healthy controls obtained reports of interpersonal challenges and emotions 5 times daily for 2 weeks...
May 29, 2017: Personality Disorders
https://www.readbyqxmd.com/read/28531841/positive-affective-functioning-in-anhedonic-individuals-daily-life-anything-but-flat-and-blunted
#7
V E Heininga, E van Roekel, J J Ahles, A J Oldehinkel, A H Mezulis
BACKGROUND: Anhedonia, the decreased interest and pleasure, is often described as 'flat' or 'blunted' positive affect (PA). Yet, little is known about PA functioning in anhedonic individuals' daily lives. The current study investigates PA reactivity to pleasurable experiences in anhedonia together with its relevant temporal dynamics (i.e., variability, instability, and inertia), and expands current knowledge by exploring the role of arousal therein. METHODS: Using the Experience Sampling Method (ESM), we collected 90 assessments of real-life PA experiences across 30 days in 18-24 year old individuals with anhedonia (N=69) and without anhedonia (N=69)...
April 21, 2017: Journal of Affective Disorders
https://www.readbyqxmd.com/read/28524340/effectiveness-and-clinical-inertia-in-patients-with-antidiabetic-therapy
#8
Manuel Enrique Machado-Duque, Adriana Carolina Ramírez-Riveros, Jorge Enrique Machado-Alba
AIMS: To establish the effectiveness of antidiabetic therapy and the frequency of clinical inertia in the management of type 2 diabetes mellitus in Colombia. METHODS: A cross-sectional study with follow-up of patients who had been treated for at least 1 year and were receiving medical consultation for antidiabetic treatment. Effectiveness was established when haemoglobin-A1c levels were <7% and when clinical inertia was reached, which was defined as no therapeutic modifications despite not achieving management controls...
May 19, 2017: International Journal of Clinical Practice
https://www.readbyqxmd.com/read/28524123/-a-clinical-and-neuropsychological-study-of-patients-before-and-after-resection-of-third-ventricle-colloid-cysts
#9
S B Buklina, A N Konovalov, D I Pitskhelauri, M A Shkarubo, A A Poddubskaya, M V Kolycheva
The literature lacks studies of cognitive impairments in large groups of patients after resection of third ventricle colloid cysts. AIM: To evaluate cognitive impairments in patients before and after resection of third ventricle colloid cysts. MATERIAL AND METHODS: We performed a clinical and neuropsychological study of 52 patients with third ventricle colloid cysts using the Luria method (1962). Forty three patients were examined before and after cyst resection in the early postoperative period (three patients in this group were also examined in a long-term period of 3-7 months after surgery)...
2017: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
https://www.readbyqxmd.com/read/28499512/the-organ-transplant-imperative
#10
REVIEW
Wil L Santivasi, Jacob J Strand, Paul S Mueller, Thomas J Beckman
More than 120,000 US patients were listed for solid organ transplants in 2016. Although data are scarce, we suspect that many of these patients will die while awaiting transplant and without engaging in goals-of-care discussions with their physicians. The challenges of addressing goals of care in patients with malignancy, end-stage renal disease, and heart failure have been studied. However, there is sparse literature on addressing goals of care throughout the dynamic process of transplant assessment and listing...
May 10, 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28432748/future-challenges-and-therapeutic-opportunities-in-type-2-diabetes-changing-the-paradigm-of-current-therapy
#11
REVIEW
D R Owens, L Monnier, A H Barnett
Most algorithms for type 2 diabetes mellitus (T2DM) do not recommend treatment escalation until glycated haemoglobin (HbA1c) fails to reach the recommended target of 7% (53 mmol/mol) within approximately 3 months on any treatment regimen ('treat to failure'). Clinical inertia and/or poor adherence to therapy contribute to patients not reaching glycaemic targets when managed according to this paradigm. Clinical inertia exists across the entire spectrum of anti-diabetes therapies, although it is most pronounced when initiating and optimizing insulin therapy...
April 21, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28427405/ceiling-effect-in-emr-system-assimilation-a-multiple-case-study-in-primary-care-family-practices
#12
Marie-Claude Trudel, Josianne Marsan, Guy Paré, Louis Raymond, Ana Ortiz de Guinea, Éric Maillet, Thomas Micheneau
BACKGROUND: There has been indisputable growth in adoption of electronic medical record (EMR) systems in the recent years. However, physicians' progress in using these systems has stagnated when measured with maturity scales. While this so-called ceiling effect has been observed and its consequences described in previous studies, there is a paucity of research on the elements that could explain such an outcome. We first suggest that in the context of EMR systems we are in presence of a "tiered ceiling effect" and then we show why such phenomenon occurs...
April 20, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28413969/optimizing-the-management-of-uncontrolled-hypertension-what-do-triple-fixed-dose-drug-combinations-add
#13
Costas Thomopoulos, Georgios Katsimagklis, Stefanos Archontakis, Georgios Skalis, Thomas Makris
Fixed-dose triple drug combinations represent one of the latest innovations of pharmacotherapy for hypertension (HT). They combine a traditional renin-angiotensin system blocker, a diuretic and a calcium channel blocker. The main benefit is the simplification of treatment regimen because 3 different agents are combined at different doses in a single pill. Improving adherence to treatment partly explains why this kind of combination may effectively reduce blood pressure (BP). BP lowering by a single-pill triple-drug combination can be approximately predicted, by using appropriate formulas described in previous meta-analysis of randomized trials...
April 14, 2017: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/28395917/-compliance-with-recommendations-in-secondary-prevention-of-stroke-in-primary-care
#14
Carmen Tamayo-Ojeda, Neus Parellada-Esquius, Betlem Salvador-González, Pilar Ángeles Oriol-Torón, M Dolores Rodríguez-Garrido, Dolores Muñoz-Segura
OBJECTIVE: Knowing compliance with secondary prevention recommendations of stroke in primary care and to identify factors associated with compliance. DESIGN: Multi-centre cross-sectional. SETTING: Health primary care centres in a metropolitan area (944,280 inhabitants). PARTICIPANTS: Patients aged 18years and over with ischemic brain disease diagnosis prior to 6months before the study. MAIN MEASUREMENTS: Clinical history records of demographic variables, risk factors and cardiovascular comorbidity, drugs, blood pressure values (BP), LDL-cholesterol and medical visits by doctor and nurses after the event...
April 7, 2017: Atencion Primaria
https://www.readbyqxmd.com/read/28379024/-comments-on-current-guidelines-of-type-2-diabetes-mellitus-treatment
#15
Emil Martinka
In an effort to facilitate the widest possible application of recent findings in diabetology and the related medical fields, with regard to characteristics of medicines and current possibilities of using modern procedures, but also to their limitations due to the financial capacities of health insurance companies, SDS innovates its therapeutic recommendations for the treatment of diabetes mellitus on a regular basis. The most recent recommendations were issued by SDS in August 2016. The review discusses and describes several factors which the authors considered during their preparation: (1) Compliance with the findings of evidence-based medicine, compliance with reference recommendations (therapeutic recommendations ADA/EASD), compliance with summary characteristics of active substances in the treatment of diabetes mellitus and approved possibilities of their use, and compliance with indica-tive restrictions (IO) which define medical and economic conditions for health insurance covered treatment...
2017: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/28375658/empagliflozin-linagliptin-single-pill-combination-therapy-for-patients-with-type-2-diabetes-mellitus
#16
Rajeev Kumar Jain
Type 2 diabetes mellitus (T2DM) is typically progressive, with sequential addition of therapies often needed to address increasing hyperglycemia over the disease course. Using treatments in combination may be preferred to sequential addition, as a means of providing a more rapid clinical response and potentially avoiding clinical inertia. In such cases, a single-pill combination can help to reduce pill burden. Although various single-pill combinations of oral glucose-lowering agents are available, empagliflozin/linagliptin was the first approved combination of a sodium glucose co-transporter 2 (SGLT2) inhibitor with a dipeptidyl peptidase 4 (DPP-4) inhibitor in the United States...
April 2017: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/28324932/an-ict-and-mobile-health-integrated-approach-to-optimize-patients-education-on-hypertension-and-its-management-by-physicians-the-patients-optimal-strategy-of-treatment-post-pilot-study
#17
Fabio Albini, Xiaoqiu Liu, Camilla Torlasco, Davide Soranna, Andrea Faini, Renata Ciminaghi, Ada Celsi, Matteo Benedetti, Antonella Zambon, Marco di Rienzo, Gianfranco Parati
INTRODUCTION: Uncontrolled hypertension is largely attributed to unsatisfactory doctor's engagement in its optimal management and to poor patients' compliance to therapeutic interventions. ICT and mobile Health solutions might improve these conditions, being widely available and providing highly effective communication strategies. OBJECTIVE: To evaluate whether ICT and mobile Health tools are able to improve hypertension control by improving doctors' engagement and by increasing patients' education and involvement, and their compliance to lifestyle modification and prescribed drug therapy...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28298899/decision-making-in-multiple-sclerosis-the-role-of-aversion-to-ambiguity-for-therapeutic-inertia-among-neurologists-discutir-ms
#18
Gustavo Saposnik, Angel P Sempere, Daniel Prefasi, Daniel Selchen, Christian C Ruff, Jorge Maurino, Philippe N Tobler
OBJECTIVES: Limited information is available on physician-related factors influencing therapeutic inertia (TI) in multiple sclerosis (MS). Our aim was to evaluate whether physicians' risk preferences are associated with TI in MS care, by applying concepts from behavioral economics. DESIGN: In this cross-sectional study, participants answered questions regarding the management of 20 MS case scenarios, completed 3 surveys, and 4 experimental paradigms based on behavioral economics...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28279950/insuonline-an-electronic-game-for-medical-education-on-insulin-therapy-a-randomized-controlled-trial-with-primary-care-physicians
#19
Leandro Arthur Diehl, Rodrigo Martins Souza, Pedro Alejandro Gordan, Roberto Zonato Esteves, Izabel Cristina Meister Coelho
BACKGROUND: Most patients with diabetes mellitus (DM) are followed by primary care physicians, who often lack knowledge or confidence to prescribe insulin properly. This contributes to clinical inertia and poor glycemic control. Effectiveness of traditional continuing medical education (CME) to solve that is limited, so new approaches are required. Electronic games are a good option, as they can be very effective and easily disseminated. OBJECTIVE: The objective of our study was to assess applicability, user acceptance, and educational effectiveness of InsuOnline, an electronic serious game for medical education on insulin therapy for DM, compared with a traditional CME activity...
March 9, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28271251/efficacy-and-safety-of-metformin-and-sitagliptin-based-triple-antihyperglycemic-therapy-strategy-a-multicenter-randomized-controlled-non-inferiority-clinical-trial
#20
RANDOMIZED CONTROLLED TRIAL
Wen Xu, Yiming Mu, Jiajun Zhao, Dalong Zhu, Qiuhe Ji, Zhiguang Zhou, Bin Yao, Anhua Mao, Samuel S Engel, Bin Zhao, Yan Bi, Longyi Zeng, Xingwu Ran, Juming Lu, Linong Ji, Wenying Yang, Weiping Jia, Jianping Weng
Despite the current guideline's recommendation of a timely stepwise intensification therapy, the "clinical inertia", termed as the delayed treatment intensification, commonly exists in the real world, which may be partly due to the relatively little substantial evidence and no clear consensus regarding the efficacy and safety of triple oral agents in patients inadequately controlled with dual therapy. In this clinical trial performed in 237 centers in China, 5,535 type 2 diabetic patients inadequately controlled by previous therapies were treated with a stable metformin/sitagliptin dual therapy for 20 weeks...
March 2017: Science China. Life Sciences
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