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Clinical inertia

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https://www.readbyqxmd.com/read/29773934/iglarlixi-a-new-once-daily-fixed-ratio-combination-of-basal-insulin-glargine-and-lixisenatide-for-the-management-of-type-2-diabetes
#1
Debbie Hinnen, Jodi Strong
Background: Patients with type 2 diabetes require treatment intensification to maintain glycemic control. Clinician reluctance, patient injection fears, hypoglycemia, weight gain, or other objections may lead to clinical inertia, whereby therapy is not intensified and patients live with uncontrolled hyperglycemia and increased risk for complications. Initiation of injectable therapy with a glucagon-like peptide (GLP)-1 receptor agonist and/or basal insulin is a recommended option for patients with type 2 diabetes inadequately controlled on one or more oral agents...
May 2018: Diabetes Spectrum: a Publication of the American Diabetes Association
https://www.readbyqxmd.com/read/29768945/pharmacist-impact-on-treatment-intensification-and-hemoglobin-a-1c-in-patients-with-type-2-diabetes-mellitus-at-an-academic-health-center
#2
Kevin Cowart, Karen Sando
BACKGROUND: Achievement of treatment goals for patients with type 2 diabetes mellitus (T2DM) is suboptimal. This is in part driven by a lack of treatment intensification when warranted, termed "clinical inertia." OBJECTIVES: To investigate time to treatment intensification and changes in A1C among pharmacist-physician managed (PPM) patients compared to usual medical care (UMC) in patients with T2DM. METHODS: Retrospective matched cohort study at 2 academic family medicine clinics...
January 1, 2018: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/29745439/cannabinoids-and-gastrointestinal-motility-pharmacology-clinical-effects-and-potential-therapeutics-in-humans
#3
REVIEW
M Camilleri
BACKGROUND: Cannabinoid agents and cannabis are frequently used for relief of diverse gastrointestinal symptoms. PURPOSE: The objective of this article is to increase the awareness of gastroenterologists to the effects of cannabinoids on gastrointestinal motility, as gastroenterologists are likely to encounter patients who are taking cannabinoids, or those with dysmotility that may be associated with cannabinoid mechanisms. The non-selective cannabinoid agonist, dronabinol, retards gastric emptying and inhibits colonic tone and phasic pressure activity...
May 10, 2018: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
https://www.readbyqxmd.com/read/29724145/elizabeth-usher-memorial-lecture-how-do-we-change-our-profession-using-the-lens-of-behavioural-economics-to-improve-evidence-based-practice-in-speech-language-pathology
#4
Patricia J McCabe
Evidence-based practice (EBP) is a well-accepted theoretical framework around which speech-language pathologists strive to build their clinical decisions. The profession's conceptualisation of EBP has been evolving over the last 20 years with the practice of EBP now needing to balance research evidence, clinical data and informed patient choices. However, although EBP is not a new concept, as a profession, we seem to be no closer to closing the gap between research evidence and practice than we were at the start of the movement toward EBP in the late 1990s...
May 3, 2018: International Journal of Speech-language Pathology
https://www.readbyqxmd.com/read/29693788/-what-the-hell-is-water-how-to-use-deliberate-clinical-inertia-in-common-emergency-department-situations
#5
Diana Egerton-Warburton, Louise Cullen, Gerben Keijzers, Daniel M Fatovich
Appropriate deliberate clinical inertia refers to the art of doing nothing as a positive clinical response. It includes shared decision-making to improve patient care with the use of clinical judgement. We discuss common clinical scenarios where the use of deliberate clinical inertia can occur. The insertion of peripheral intravenous cannulae, investigating patients with suspected renal colic and the investigation of low risk chest pain are all opportunities for the thoughtful clinician to 'stand there' and use effective patient communication to avoid low value tests and procedures...
April 25, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29690773/therapeutic-inertia-in-antiplatelet-therapy-in-patients-with-a-cardiovascular-event-attended-in-an-emergency-department
#6
José Antonio García-Macías, Antonio Palazón-Bru, María Ángeles Carbonell-Torregrosa, Miguel Navarro-Juan, Vicente Francisco Gil-Guillén
OBJECTIVE: As very few studies have assessed therapeutic inertia (TI) in antiplatelet therapy in patients in secondary cardiovascular prevention, we designed a study in our hospital emergency department to quantify its magnitude and its associated factors. METHODS: This descriptive cross-sectional observational study involved a sample of 223 patients with a history of cardiovascular disease and recommendation for antiplatelet therapy who attended the emergency department in a Spanish region in 2016...
April 25, 2018: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/29669893/-sost-deficiency-leads-to-reduced-mechanical-strains-at-the-tibia-midshaft-in-strain-matched-in-vivo-loading-experiments-in-mice
#7
Laia Albiol, Myriam Cilla, David Pflanz, Ina Kramer, Michaela Kneissel, Georg N Duda, Bettina M Willie, Sara Checa
Sclerostin, a product of the Sost gene, is a Wnt-inhibitor and thus negatively regulates bone accrual. Canonical Wnt/β-catenin signalling is also known to be activated in mechanotransduction. Sclerostin neutralizing antibodies are being tested in ongoing clinical trials to target osteoporosis and osteogenesis imperfecta but their interaction with mechanical stimuli on bone formation remains unclear. Sost knockout (KO) mice were examined to gain insight into how long-term Sost deficiency alters the local mechanical environment within the bone...
April 2018: Journal of the Royal Society, Interface
https://www.readbyqxmd.com/read/29662024/pkidb-a-curated-annotated-and-updated-database-of-protein-kinase-inhibitors-in-clinical-trials
#8
Fabrice Carles, Stéphane Bourg, Christophe Meyer, Pascal Bonnet
The number of protein kinase inhibitors (PKIs) approved worldwide continues to grow steadily, with 39 drugs approved in the period between 2001 and January 2018. PKIs on the market have been the subject of many reviews, and structure-property relationships specific to this class of drugs have been inferred. However, the large number of PKIs under development is often overlooked. In this paper, we present PKIDB (Protein Kinase Inhibitor Database), a monthly-updated database gathering approved PKIs as well as PKIs currently in clinical trials...
April 15, 2018: Molecules: a Journal of Synthetic Chemistry and Natural Product Chemistry
https://www.readbyqxmd.com/read/29651956/quantitative-vascular-evaluation-from-laboratory-experiments-to-point-of-care-patient-clinical-approach
#9
Ricardo L Armentano, Leandro J Cymberknop
To aid in patient-specific risk stratification and diagnosis, an assessment of arterial structural and functional changes associated to a vascular disease in both early and advanced stages have been proposed in order to limit the progression or revert vascular alterations. To this end, an interdisciplinary international partnership made up by research institutions from France, Argentina, Uruguay and Spain was established, with the objective of contributing to the evaluation and follow-up of factors involved in the physiopathology of cardiometabolic diseases and human aging...
April 13, 2018: Current Hypertension Reviews
https://www.readbyqxmd.com/read/29620816/introduction-to-basal-insulin-therapy-clinical-management-of-diabetes
#10
Jasmine D Gonzalvo
Diabetes is a series of metabolic conditions associated with many serious comorbidities, such as heart disease and stroke, peripheral arterial disease and lower-extremity amputations, retinopathy, nephropathy, and peripheral neuropathy. The American Diabetes Association, the American Association of Clinical Endocrinologists, and the International Diabetes Federation recommend that individuals with diabetes be as near to normoglycemic as possible. There are many glycemic management barriers among patients, such as cost, patient perceptions, and clinical inertia...
March 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29615967/therapeutic-inertia-in-the-new-landscape-of-multiple-sclerosis-care
#11
Gustavo Saposnik, Xavier Montalban
The landscape of multiple sclerosis (MS) treatment is constantly changing. Significant heterogeneity exists in the efficacy and risks associated with these therapies. Therefore, clinicians have the challenge to tailor treatment based on several factors (disease activity level, risk of progression, individual patient preferences and characteristics, personal expertise, etc.), to identify the optimal balance between safety and efficacy. However, most clinicians have limited education in decision-making and formal training in risk management...
2018: Frontiers in Neurology
https://www.readbyqxmd.com/read/29574875/editorial-diabetes-obesity-and-clinical-inertia-the-recipe-for-advanced-nash-authors-reply
#12
EDITORIAL
Y A Patel, C M Hunt
No abstract text is available yet for this article.
April 2018: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/29574870/editorial-diabetes-obesity-and-clinical-inertia-the-recipe-for-advanced-nash
#13
EDITORIAL
J Leey, K Cusi
No abstract text is available yet for this article.
April 2018: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/29547895/gout-state-of-the-art-after-a-decade-of-developments
#14
Tristan Pascart, Frédéric Lioté
This review article summarizes the relevant English literature on gout from 2010 through April 2017. It emphasizes that the current epidemiology of gout indicates a rising prevalence worldwide, not only in Western countries but also in Southeast Asia, in close relationship with the obesity and metabolic syndrome epidemics. New pathogenic mechanisms of chronic hyperuricaemia focus on the gut (microbiota, ABCG2 expression) after the kidney. Cardiovascular and renal comorbidities are the key points to consider in terms of management...
March 13, 2018: Rheumatology
https://www.readbyqxmd.com/read/29537114/blood-calcium-glucose-and-haematology-profiles-of-parturient-bitches-diagnosed-with-uterine-inertia-or-obstructive-dystocia
#15
B L Frehner, I M Reichler, S Keller, S Goericke-Pesch, O Balogh
Bitches with dystocia most often present with clinical signs of uterine inertia (UI). The aetiology of myometrial dysfunction in most of these cases is still not elucidated. We compared blood ionized calcium (iCa) and glucose concentrations in bitches diagnosed with primary UI (PUI, n = 14), secondary UI (SUI, n = 6) or obstructive dystocia (OD, n = 6), and we described their haematology profiles. Bitches diagnosed with UI had a patent birth canal and delivered no puppies yet (PUI) or only part of the whole litter (SUI)...
June 2018: Reproduction in Domestic Animals, Zuchthygiene
https://www.readbyqxmd.com/read/29536425/changing-patients-treatment-preferences-and-values-with-a-decision-aid-for-type-2-diabetes-mellitus-results-from-the-treatment-arm-of-a-randomized-controlled-trial
#16
Robert A Bailey, Alicia C Shillington, Qing Harshaw, Martha M Funnell, Jeffrey VanWingen, Nananda Col
INTRODUCTION: Failure to intensify treatment for type 2 diabetes mellitus (T2DM) when indicated, or clinical inertia, is a major obstacle to achieving optimal glucose control. This study investigates the impact of a values-focused patient decision aid (PDA) for T2DM antihyperglycemic agent intensification on patient values related to domains important in decision-making and preferred treatments. METHODS: Patients with poorly controlled T2DM who were taking a metformin-containing regimen were recruited through physicians to access a PDA presenting evidence-based information on T2DM and antihyperglycemic agent class options...
April 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/29530386/steroid-induced-hyperglycemia-an-underdiagnosed-problem-or-clinical-inertia-a-narrative-review
#17
REVIEW
Aldo Bonaventura, Fabrizio Montecucco
Corticosteroids are widely diffused drugs. An important side effect is the impairment of glycemic control both in patients with known diabetes and in normoglycemic ones potentially leading to steroid-induced diabetes mellitus (SIDM). In this review based on papers released on PubMed, MEDLINE, and EMBASE from January 2015 to October 2017, we summarized and discussed main updates about the definition, the diagnosis, and the pathophysiology of steroid-induced hyperglycemia (SIH), with a look to new therapies. Main alterations responsible for the diabetogenic effect of corticosteroids are a negative impact on insulin sensitivity along with a derangement on insulin secretion, explaining the typical post-prandial hyperglycemia linked to the promotion of gluconeogenesis...
May 2018: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/29492243/a-review-of-the-new-glp-1-receptor-agonist-basal-insulin-fixed-ratio-combination-products
#18
REVIEW
Wesley Nuffer, Ashley Guesnier, Jennifer M Trujillo
There have been several new treatment approaches established for the management of hyperglycemia in type 2 diabetes (T2D), with treatment guidelines listing both glucagon-like peptide 1 receptor agonists (GLP-1 RAs) and basal insulin therapies as considerations for patients who have failed to control their blood glucose with oral antidiabetic agents. New studies have highlighted the importance of initiating combination therapy earlier in the T2D disease process to avoid clinical inertia and prevent the long-term complications arising from uncontrolled diabetes...
March 2018: Therapeutic Advances in Endocrinology and Metabolism
https://www.readbyqxmd.com/read/29484568/usefulness-of-bisacodyl-testing-on-therapeutic-outcomes-in-refractory-constipation
#19
Edda Battaglia, Mario Grassini, Maria Pina Dore, Gabrio Bassotti
BACKGROUND: Although chronically constipated patients usually respond to medical treatment, there is a subgroup with scarce/no response, generally labeled as refractory or intractable. However, whether this lack of response is real or due to ancillary causes (suboptimal dosage, lack of compliance etc.) is unknown. AIMS: To see whether a pharmacologic test (bisacodyl colonic intraluminal infusion during manometric assessment) may predict the therapeutic outcome. METHODS: Data of patients undergoing 24/h colonic manometry for severe intractable constipation in whom the bisacodyl test (10 ml of drug dissolved into saline and injected through the more proximal recording port) had been carried out were retrieved and analysed, and correlations with the therapeutic outcome made...
February 26, 2018: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/29475800/macrovascular-disease-and-risk-factors-in-youth-with-type-1-diabetes-time-to-be-more-attentive-to-treatment
#20
REVIEW
Petter Bjornstad, Kim C Donaghue, David M Maahs
Cardiovascular disease remains the leading cause of mortality in patients with type 1 diabetes. Although cardiovascular disease complications are rare until adulthood, pathology and early markers can manifest in adolescence. Whereas advances have been made in the management of microvascular complications of type 1 diabetes, similar progress in reducing macrovascular complications has not been made. The reasons for the absence of progress remain incompletely understood, but most likely relate to the long time needed for cardiovascular disease to manifest clinically and hence for risk factor management to show a clinical benefit, thus allowing inertia to prevail for diagnosis and particularly for targeting risk factors...
February 20, 2018: Lancet Diabetes & Endocrinology
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