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Clinical inertia

Sverre Kjeldsen
There is a whole armament of good drugs for treatment of hypertension including diuretics, calcium antagonist, angiotensin receptor antagonists and angiotensin converting enzyme inhibitors. Secondary drugs mostly used for special indications include beta-blockers, alpha-blockers, mineralocorticoid receptor antagonists (aldosterone antagonists), renin-inhibitors, centrally acting drugs, direct vasodilators and others.A variety of new drugs targeting different pressor mechanism exist and have partly been studies experimentally but will unlikely make it to clinical use in human hypertension...
September 2016: Journal of Hypertension
Dorairaj Prabhakaran
Among individuals with established CVD, multiple medications (aspirin, blood pressure lowering drugs and statins) are required to manage CVD and it is well established that non adherence to prescribed treatments is substantial in the long term. Such discontinuation of CV-preventive medications and low adherence rates has been shown to affect the success of CVD prevention efforts. In low- and middle income countries only less than 20% patients receive recommended therapy for CVD prevention, but even in high-income countries treatment coverage in the community is only about 50% in those with heart disease and 35% in those with stroke...
September 2016: Journal of Hypertension
Chan Joo Lee, Sungha Park
Despite improvements in hypertension awareness and treatment, the blood pressure (BP) control rate still remains at around 50%. One of the major determinants of low BP control results from therapeutic inertia of the physician and suboptimal compliance of the patients. Home BP self-measurement and monitoring improves patients' awareness and helps the management of hypertension. Recent technological advances are allowing for accurate measurement and telemonitoring of home BP, with a number of randomized clinical trials demonstrating the efficacy of telemonitoring for BP control...
September 2016: Pulse (Basel, Switzerland)
Jennifer L Schroeck, James Ford, Erin L Conway, Kari E Kurtzhalts, Megan E Gee, Krista A Vollmer, Kari A Mergenhagen
PURPOSE: Insomnia is problematic for older adults. After behavioral modifications fail to show adequate response, pharmacologic options are used. The pharmacokinetics of agents used to treat insomnia may be altered. This review focuses on the safety and efficacy of medications used to treat insomnia. METHODS: A literature search of Medline, PubMed, and Embase was conducted (January 1966-June 2016). It included systematic reviews, randomized controlled trials, observational studies, and case series that had an emphasis on insomnia in an older population...
October 14, 2016: Clinical Therapeutics
J A Divisón Garrote
It is clear that clinical measurements of blood pressure can lead to errors in the diagnostic process and follow-up of patients with hypertension. Scientific societies recommend other measurement methods, such as home measurements and outpatient monitoring. Outpatient monitoring might be the golden standard but, nowadays has an important limitation-its availability. Home measurements solve 80-90% of the doubts of the diagnostic process and follow-up of patients with hypertension, and its higher availability and acceptance by the patient are clear...
October 10, 2016: Hipertensión y Riesgo Vascular
Kamlesh Khunti, David Millar-Jones
Achieving tight glycaemic control early following the diagnosis of type 2 diabetes is key to optimising clinical outcomes, yet many patients and clinicians are reluctant to initiate and intensify insulin therapy. Reasons for this arise primarily from a lack of time, clinical expertise and patient understanding. However, meaningful progress can be achieved with self-management educational programmes soon after diagnosis. Clinician education and training, along with easy-to-use and well-tolerated therapies (for example, those carrying a low risk of hypoglycaemia and/or avoiding weight gain), may also increase the likelihood of patient adherence...
October 7, 2016: Primary Care Diabetes
Rhys D Brady, Brian L Grills, Jarrod E Church, Nicole C Walsh, Aaron C McDonald, Denes V Agoston, Mujun Sun, Terence J O'Brien, Sandy R Shultz, Stuart J McDonald
Concomitant traumatic brain injury (TBI) and long bone fracture are commonly observed in multitrauma and polytrauma. Despite clinical observations of enhanced bone healing in patients with TBI, the relationship between TBI and fracture healing remains poorly understood, with clinical data limited by the presence of several confounding variables. Here we developed a novel trauma model featuring closed-skull weight-drop TBI and concomitant tibial fracture in order to investigate the effect of TBI on fracture healing...
September 29, 2016: Scientific Reports
Takeshi Mochizuki, Koichiro Yano, Katsunori Ikari, Kosei Kawakami, Ryo Hiroshima, Naoko Koenuma, Mina Ishibashi, Toshikatsu Shirahata
OBJECTIVE: The objective of this study was to perform a hip structure analysis (HSA) of teriparatide (TPTD) treatment in women with postmenopausal osteoporosis. METHODS: The study included 96 patients with postmenopausal osteoporosis and received 20 μg TPTD daily. HSA was performed by dual-energy X-ray absorptiometry. RESULTS: The percent changes from baseline for the cross-sectional moment of inertia, section modulus, buckling ratio, and femoral strength index based on HSA results were 9...
December 2016: Journal of Orthopaedics
George Triadafilopoulos
BACKGROUND: The precise aetiology of chronic bloating remains poorly understood and underlying gastroparesis, small bowel bacterial overgrowth and colonic inertia may, individually or collectively, play a role. AIMS: In this retrospective cohort analysis of symptomatic patients with chronic persistent bloating, we determined the clinical utility of wireless motility capsule and lactulose breath test in further defining the underlying aetiology for functional bloating...
2016: BMJ Open Gastroenterology
Mathilde Cohen, Dominique Cazals-Hatem, Henri Duboc, Jean-Marc Sabate, Simon Msika, Anne Lavergne Slove, Yves Panis, Benoit Coffin
AIM: Subtotal colectomy is the treatment of last resort in patients with severe colonic inertia (SCI) refractory to laxatives. Some studies have reported hypoplasia of the interstitial cells of Cajal (ICC) using a semi-quantitative analysis. The aims of this study were first to investigate if semi-quantitative or morphometry is better at the quantification of colonic ICC and secondly to determine whether there is a relationship between the number of ICC and the severity of constipation...
September 14, 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Kim L Lavoie, Joshua A Rash, Tavis S Campbell
Widespread acceptance of evidence-based medicine has led to the proliferation of clinical practice guidelines as the primary mode of communicating current best practices across a range of chronic diseases. Despite overwhelming evidence supporting the benefits of their use, there is a long history of poor uptake by providers. Nonadherence to clinical practice guidelines is referred to as clinical inertia and represents provider failure to initiate or intensify treatment despite a clear indication to do so. Here we review evidence for the ubiquity of clinical inertia across a variety of chronic health conditions, as well as the organizational and system, patient, and provider factors that serve to maintain it...
September 7, 2016: Annual Review of Pharmacology and Toxicology
Nella Bieszk, Shannon L Reynolds, Wenhui Wei, Cralen Davis, Pravin Kamble, Claudia Uribe
BACKGROUND: Clinical inertia, which has been defined as the recognition of a problem with a patient's management but failing to act, is a concern in type 2 diabetes (T2D) because it places the patient at risk of diabetes-related complications. Despite managed care organizations making significant investment in this area, little is known about the impact of educational programs aimed at aligning patients and their physicians with diabetes guidelines and thus overcoming clinical inertia...
September 2016: Journal of Managed Care & Specialty Pharmacy
Nella Bieszk, Shannon L Reynolds, Wenhui Wei, Cralen Davis, Pravin Kamble, Claudia Uribe
BACKGROUND: Clinical inertia, which has been defined as the recognition of a problem with a patient's management but failing to act, is a concern in type 2 diabetes (T2D) because it places the patient at risk of diabetes-related complications. Despite managed care organizations making significant investment in this area, little is known about the impact of educational programs aimed at aligning patients and their physicians with diabetes guidelines and thus overcoming clinical inertia...
September 2016: Journal of Managed Care & Specialty Pharmacy
Adalberto Serrano, Vicente Pascual
INTRODUCTION: The clinical inertia in the screening and treatment of patients at high or very high cardiovascular risk leads to the failure to achieve LDLc targets in this population. The aim of the DIANA study was to determine the opinion of doctors about the screening for dyslipidaemia, the usual practice, and the differences between Primary Care physicians and other specialties. MATERIAL AND METHODS: A questionnaire, using the modified Delphi method, included four blocks on dyslipidemic patients with impaired glucose metabolism...
August 16, 2016: Semergen
Elisa Evangelista, Lucie Barateau, Yves Dauvilliers
Excessive sleepiness is a common problem, defined by a complaint of excessive daytime sleepiness almost daily with an inability to stay awake and alert dosing periods at sleep, with episodes of irresistible sleep need or drowsiness or non-intentional sleep, or by a night's sleep time overly extended often associated with sleep inertia. This sleepiness is variable in terms of phenotype and severity to be specified by the out-patient clinic. It is considered to be chronic beyond three months and often responsible for significant functional impairment of school and professional performance, of the accidents and cardiovascular risk...
June 2016: La Revue du Praticien
William H Polonsky, Robert R Henry
At least 45% of patients with type 2 diabetes (T2D) fail to achieve adequate glycemic control (HbA1c <7%). One of the major contributing factors is poor medication adherence. Poor medication adherence in T2D is well documented to be very common and is associated with inadequate glycemic control; increased morbidity and mortality; and increased costs of outpatient care, emergency room visits, hospitalization, and managing complications of diabetes. Poor medication adherence is linked to key nonpatient factors (eg, lack of integrated care in many health care systems and clinical inertia among health care professionals), patient demographic factors (eg, young age, low education level, and low income level), critical patient beliefs about their medications (eg, perceived treatment inefficacy), and perceived patient burden regarding obtaining and taking their medications (eg, treatment complexity, out-of-pocket costs, and hypoglycemia)...
2016: Patient Preference and Adherence
Kevin M Pantalone, Brian J Wells, Kevin M Chagin, Flavia Ejzykowicz, Changhong Yu, Alex Milinovich, Janine M Bauman, Michael W Kattan, Swapnil Rajpathak, Robert S Zimmerman
OBJECTIVE: "Clinical inertia" has been used to describe the delay in the intensification of type 2 diabetes treatment among patients with poor glycemic control. Previous studies may have exaggerated the prevalence of clinical inertia by failing to adequately monitor drug dose changes and nonmedication interventions. This project evaluated the intensification of diabetes therapy and hemoglobin A1c (A1C) goal attainment among patients with newly diagnosed type 2 diabetes when metformin monotherapy failed...
September 2016: Diabetes Care
James R Goodwin, Ashley E Cannaday, Holly G Palmeri, Aldo Di Costanzo, Lauren L Emberson, Richard N Aslin, Andrew J Berger
Functional near-infrared spectroscopy (fNIRS) research to date has tended to publish group-averaged rather than individual infant data due to normative basic research goals. Acquisition of individual infant time courses holds interest, however, both for cognitive science and particularly for clinical applications. Infants are more difficult to study than adults as they cannot be instructed to remain still. In addressing this, upright infants pose several associated complications for the researcher. We identified and optimized the factors that affect the quality of fNIRS data from individual 6- to 9-month-old infants exposed to a visual stimulation paradigm...
July 2016: Neurophotonics
K Stinkens, B Peene, C Mathieu
INTRODUCTION: The treatment of patients with type 2 diabetes mellitus remains challenging, as it goes beyond adequate glycemic control, in particular addressing weight, blood pressure and other contributors to cardiovascular disease. In addition, the progressive nature of type 2 diabetes mellitus demands the intensification and combination of glucose lowering therapies. In many patients, there is a clinical inertia for the initiation of insulin therapy, leading to failure in reaching glycemic targets in many patients...
September 2016: Expert Opinion on Biological Therapy
Avivit Cahn, William T Cefalu
Type 2 diabetes is a progressive disorder characterized by increasing hyperglycemia and the need to gradually intensify therapy in order to achieve and maintain glycemic control. Early initiation of combination therapy has been proposed as an approach to achieve glycemic goals earlier and delay the deterioration of glycemic control and with possible better preservation of β-cell function. We discuss in this article the pros and cons of this approach, focusing on individuals with HbA1c at diagnosis of 7.5-9...
August 2016: Diabetes Care
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