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Clinical inertia

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https://www.readbyqxmd.com/read/27917770/evaluating-point-of-care-testing-for-glycosylated-haemoglobin-in-public-sector-primary-care-facilities-in-the-western-cape-south-africa
#1
R Mash, A Ugoagwu, C Vos, M Rensburg, R Erasmus
BACKGROUND: Diabetes mellitus contributes significantly to the burden of disease in South Africa (SA). Monitoring of glycaemic control with glycosylated haemoglobin (HbA1c) is recommended, even though current laboratory-based testing does not support immediate clinical decision-making. OBJECTIVES: To evaluate the costs and consequences for quality of care by introducing point-of-care (POC) testing for HbA1c for patients with type 2 diabetes at community health centres in Cape Town, SA...
December 1, 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/27887708/pulsatile-gonadotropin-releasing-hormone-therapy-in-persistent-amenorrheic-weight-recovered-anorexia-nervosa-patients
#2
Natacha Germain, Anaïs Fauconnier, Jean-Philippe Klein, Amélie Wargny, Yadh Khalfallah, Chrysoula Papastathi-Boureau, Bruno Estour, Bogdan Galusca
OBJECTIVE: To compare hormonal and clinical responses to GnRH pulsatile treatment in weight-recovered anorexia nervosa patients (Rec-AN) with persistent functional hypothalamic amenorrhea (HA) vs. in patients with secondary and primary HA. DESIGN: Retrospective, observational, ambulatory study. SETTING: University hospital. PATIENT(S): Forty-one women: 19 Rec-AN (body mass index >18.5 kg/m(2) without menses recovery), 15 secondary HA without any eating disorders patients (SHA), and 7 primary HA patients (PHA)...
November 22, 2016: Fertility and Sterility
https://www.readbyqxmd.com/read/27831597/pharmacological-management-of-dyslipidemia-in-high-and-very-high-cardiovascular-risk-patients
#3
V Pascual Fuster
Dyslipaemia is one of the main risk factors in the development of cardiovascular diseases. Currently, there are different alternatives available (amongst which statins occupy a pre-eminent place), to optimise the treatment of patients at high or very high cardiovascular risk. Despite this, the percentage of patients that achieve good lipid control is low. The causes of the mismatch with proposed objectives include lack of patient adherence and therapeutic inertia. This review uses available evidence and the latest clinical guides as a basis to assess the pharmacological treatment of dyslipaemia in patients with a background of arteriosclerotic vascular disease, diabetes, chronic kidney disease, cardiovascular risk at ≥5% calculated by SCORE and familial hypercholesterolaemia...
December 2016: Revista Española de Sanidad Penitenciaria
https://www.readbyqxmd.com/read/27823802/in-vivo-observations-and-in-vitro-experiments-on-the-oral-phase-of-swallowing-of-newtonian-and-shear-thinning-liquids
#4
S Mowlavi, J Engmann, A Burbidge, R Lloyd, P Hayoun, B Le Reverend, M Ramaioli
In this study, an in vitro device that mimics the oral phase of swallowing is calibrated using in vivo measurements. The oral flow behavior of different Newtonian and non-Newtonian solutions is then investigated in vitro, revealing that shear-thinning thickeners used in the treatment of dysphagia behave very similar to low-viscosity Newtonian liquids during active swallowing, but provide better control of the bolus before the swallow is initiated. A theoretical model is used to interpret the experimental results and enables the identification of two dynamical regimes for the flow of the bolus: first, an inertial regime of constant acceleration dependent on the applied force and system inertia, possibly followed by a viscous regime in which the viscosity governs the constant velocity of the bolus...
October 17, 2016: Journal of Biomechanics
https://www.readbyqxmd.com/read/27796904/strategies-for-diabetes-management-using-newer-oral-combination-therapies-early-in-the-disease
#5
REVIEW
Joel Zonszein, Per-Henrik Groop
INTRODUCTION: The duration of uncontrolled type 2 diabetes mellitus (T2DM) can adversely impact small and large vessels, eventually leading to microvascular and macrovascular complications. Failure of therapeutic lifestyle changes, monotherapy, and clinical inertia contribute to persistent hyperglycemia and disease progression. The aim was to review the complex pathophysiology of type 2 diabetes and how different oral agents can be used effectively as first-line therapy in combination with metformin, as well as in patients not achieving glycemic goals with metformin therapy...
December 2016: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/27792661/treatment-intensification-for-hypertension-in-us-ambulatory-medical-care
#6
Lin Mu, Kenneth J Mukamal
BACKGROUND: Hypertension is widely prevalent yet remains uncontrolled in nearly half of US hypertensive adults. Treatment intensification for hypertension reduces rates of major cardiovascular events and all-cause mortality, but clinical inertia remains a notable impediment to further improving hypertension control. This study examines the likelihood and determinants of treatment intensification with new medication in US ambulatory medical care. METHODS AND RESULTS: Using the nationally representative National Ambulatory Medical Care Survey (2005-2012) and National Hospital Ambulatory Medical Care Survey (2005-2011), we identified adult primary care visits with diagnosed hypertension and documented blood pressure exceeding goal targets and assessed the weighted prevalence and odds ratios of treatment intensification by initiation or addition of new medication...
October 22, 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27754162/pl-03-3-the-future-development-of-drug-therapy-for-hypertension
#7
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
https://www.readbyqxmd.com/read/27754010/sp-03-1-polypill-strategy-to-improved-adherence
#8
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
https://www.readbyqxmd.com/read/27752479/the-role-of-home-blood-pressure-telemonitoring-for-blood-pressure-control
#9
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)
https://www.readbyqxmd.com/read/27751669/review-of-safety-and-efficacy-of-sleep-medicines-in-older-adults
#10
REVIEW
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...
November 2016: Clinical Therapeutics
https://www.readbyqxmd.com/read/27745830/-outpatient-blood-pressure-monitoring-is-not-always-necessary
#11
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
https://www.readbyqxmd.com/read/27727005/clinical-inertia-to-insulin-initiation-and-intensification-in-the-uk-a-focused-literature-review
#12
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
https://www.readbyqxmd.com/read/27682431/closed-head-experimental-traumatic-brain-injury-increases-size-and-bone-volume-of-callus-in-mice-with-concomitant-tibial-fracture
#13
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
https://www.readbyqxmd.com/read/27656075/hip-structure-analysis-by-dxa-of-teriparatide-treatment-a-24-month-follow-up-clinical-study
#14
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
https://www.readbyqxmd.com/read/27648298/utility-of-wireless-motility-capsule-and-lactulose-breath-testing-in-the-evaluation-of-patients-with-chronic-functional-bloating
#15
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
https://www.readbyqxmd.com/read/27627028/evaluation-of-interstitial-cells-of-cajal-in-patients-with-severe-colonic-inertia-requiring-surgery-a-clinical-pathological-study
#16
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
https://www.readbyqxmd.com/read/27618738/changing-provider-behavior-in-the-context-of-chronic-disease-management-focus-on-clinical-inertia
#17
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
https://www.readbyqxmd.com/read/27579824/-act-on-threes-paradigm-for-treatment-intensification-of-type-2-diabetes-in-managed-care-results-of-a-randomized-controlled-study-with-an-educational-intervention-targeting-improved-glycemic-control
#18
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
https://www.readbyqxmd.com/read/27574744/-act-on-threes-paradigm-for-treatment-intensification-of-type-2-diabetes-in-managed-care-results-of-a-randomized-controlled-study-with-an-educational-intervention-targeting-improved-glycemic-control
#19
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
https://www.readbyqxmd.com/read/27542912/-opinion-from-physicians-on-the-need-for-dyslipidemia-screening-in-cardiovascular-risk-similarities-and-differences-between-primary-care-and-other-specialties-the-diana-study
#20
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
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