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Clinical inertia

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https://www.readbyqxmd.com/read/28183347/application-of-incident-command-structure-to-clinical-trial-management-in-the-academic-setting-principles-and-lessons-learned
#1
Penny S Reynolds, Mary J Michael, Bruce D Spiess
BACKGROUND: Clinical trial success depends on appropriate management, but practical guidance to trial organisation and planning is lacking. The Incident Command System (ICS) is the 'gold standard' management system developed for managing diverse operations in major incident and public health arenas. It enables effective and flexible management through integration of personnel, procedures, resources, and communications within a common hierarchical organisational structure. Conventional ICS organisation consists of five function modules: Command, Planning, Operations, Logistics, and Finance/Administration...
February 9, 2017: Trials
https://www.readbyqxmd.com/read/28155046/early-combination-therapy-with-oral-glucose-lowering-agents-in-type-2-diabetes
#2
Cristina Bianchi, Giuseppe Daniele, Angela Dardano, Roberto Miccoli, Stefano Del Prato
Despite the considerable burden of disease associated with type 2 diabetes mellitus (T2DM), most patients are not at, or are unable to achieve, recommended glycemic targets. This is partly because of the relentless progressive nature of the disease, but it may also be attributable to the current diabetes treatment paradigm. The recommended stepwise approach may lead to frequent early treatment failure with prolonged periods of elevated glucose as a consequence of clinical inertia and delays in achieving optimal glycemic control...
February 3, 2017: Drugs
https://www.readbyqxmd.com/read/28149842/inertia-based-microfluidic-capture-and-characterisation-of-circulating-tumour-cells-for-the-diagnosis-of-lung-cancer
#3
Dimple Y Chudasama, Daria V Freydina, Maxim B Freidin, Maria Leung, Angeles Montero Fernandez, Alexandra Rice, Andrew G Nicholson, Emmanouil Karteris, Vladimir Anikin, Eric Lim
BACKGROUND: Routine clinical application of circulating tumour cells (CTCs) for blood based diagnostics is yet to be established. Despite growing evidence of their clinical utility for diagnosis, prognosis and treatment monitoring, the efficacy of a robust platform and universally accepted diagnostic criteria remain uncertain. We evaluate the diagnostic performance of a microfluidic CTC isolation platform using cytomorphologic criteria in patients undergoing lung cancer surgery. METHODS: Blood was processed from 51 patients undergoing surgery for known or suspected lung cancer using the ClearBridge ClearCell FX system(TM) (ClearBridge Biomedics, Singapore)...
December 2016: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28113461/on-the-quantitative-potential-of-viscoelastic-response-visr-ultrasound-using-the-one-dimensional-mass-spring-damper-model
#4
Mallory R Selzo, Christopher J Moore, Md Murad Hossain, Mark Palmeri, Caterina M Gallippi
Viscoelastic Response (VisR) ultrasound is an acoustic radiation force (ARF)-based imaging method that fits induced displacements to a one-dimensional (1D) mass-spring-damper (MSD) model to estimate the ratio of viscous to elastic moduli, τ, in viscoelastic materials. Error in VisR τ estimation arises from inertia and acoustic displacement underestimation. These error sources are herein evaluated using finite element method (FEM) simulations, error correction methods are developed, and corrected VisR τ estimates are compared to true simulated τ values to assess VisR's relevance to quantifying viscoelasticity...
March 8, 2016: IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control
https://www.readbyqxmd.com/read/28109138/adaptations-in-the-microarchitecture-and-load-distribution-of-maternal-cortical-and-trabecular-bone-in-response-to-multiple-reproductive-cycles-in-rats
#5
Chantal Mj de Bakker, Allison R Altman-Singles, Yihan Li, Wei-Ju Tseng, Connie Li, X Sherry Liu
Pregnancy, lactation, and weaning result in dramatic changes in maternal calcium metabolism. In particular, the increased calcium demand during lactation causes a substantial degree of maternal bone loss. This reproductive bone loss has been suggested to be largely reversible, as multiple clinical studies have found that parity and lactation history have no adverse effect on postmenopausal fracture risk. However, the precise effects of pregnancy, lactation, and post-weaning recovery on maternal bone structure are not well understood...
January 21, 2017: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
https://www.readbyqxmd.com/read/28105580/pixel-based-dxa-derived-structural-properties-strongly-correlate-with-pqct-measures-at-the-one-third-distal-femur-site
#6
Alexander M Baker, David W Wagner, B Jenny Kiratli, Gary S Beaupre
While bone mineral density has been traditionally used to quantify fracture risk for individuals with spinal cord injuries, recent studies are including engineering measurements such as section modulus and cross sectional moment of inertia. These are almost exclusively calculated by peripheral QCT scanners which, unlike DXA scanners, are rarely found in clinical settings. Using fifty-four fresh frozen femora, we developed and validated a pixel-by-pixel method to calculate engineering properties at the distal femur using a Hologic QDR-1000 W DXA scanner and compared them against similar parameters measured using a Stratec XCT-3000 peripheral QCT scanner...
January 19, 2017: Annals of Biomedical Engineering
https://www.readbyqxmd.com/read/28098628/the-abcdef-bundle-science-and-philosophy-of-how-icu-liberation-serves-patients-and-families
#7
E Wesley Ely
Over the past 20 years, critical care has matured in a myriad of ways resulting in dramatically higher survival rates for our sickest patients. For millions of new survivors comes de novo suffering and disability called "the postintensive care syndrome." Patients with postintensive care syndrome are robbed of their normal cognitive, emotional, and physical capacity and cannot resume their previous life. The ICU Liberation Collaborative is a real-world quality improvement initiative being implemented across 76 ICUs designed to engage strategically the ABCDEF bundle through team- and evidence-based care...
February 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28095039/update-on-a-quality-initiative-to-overcome-clinical-inertia-in-the-postoperative-care-of-inpatients-with-diabetes-mellitus
#8
Curtiss B Cook, Heidi A Apsey, Elizabeth B Habermann, Amy E Glasgow, Janna C Castro, Richard T Schlinkert
No abstract text is available yet for this article.
January 17, 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28087182/multimorbidity-and-acute-heart-failure-in-internal-medicine
#9
F Martínez, L Martínez-Ibañez, G Pichler, A Ruiz, J Redon
AIMS: To analyse the characteristics of hospitalized patients for AHF, with special attention to the clustering of morbidities. METHODS AND RESULTS: Clinical records of patients, admitted in Internal Medicine due to AHF, during three years, were reviewed. The characteristics of patients-episodes were registered and key indicators of performance. Multiple correspondence analysis (MCA) was used to assess the distribution of morbidities. LR models were used to study clinical variables related with death or readmission...
January 5, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28069041/understanding-how-primary-care-practitioners-perceive-an-online-intervention-for-the-management-of-hypertension
#10
Katherine Bradbury, Katherine Morton, Rebecca Band, Carl May, Richard McManus, Paul Little, Lucy Yardley
BACKGROUND: In order to achieve successful implementation an intervention needs to be acceptable and feasible to its users and must overcome barriers to behaviour change. The Person-Based Approach can help intervention developers to improve their interventions to ensure more successful implementation. This study provides an example of using the Person-Based Approach to refine a digital intervention for hypertension (HOME BP). METHODS: Our Person-Based Approach involved conducting qualitative focus groups with practice staff to explore their perceptions of HOME BP and to identify any potential barriers to implementation of the HOME BP procedures...
January 9, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28064252/philosophical-provocation-the-lifeblood-of-clinical-ethics
#11
Laurence B McCullough
The daily work of the clinical ethics teacher and clinical ethics consultant falls into the routine of classifying clinical cases by ethical type and proposing ethically justified alternatives for the professionally responsible management of a specific type of case. Settling too far into this routine creates the risk of philosophical inertia, which is not good either for the clinical ethicist or for the field of clinical ethics. The antidote to this philosophical inertia and resultant blinkered vision of clinical ethics is sustained, willing exposure to philosophical provocation...
February 2017: Journal of Medicine and Philosophy
https://www.readbyqxmd.com/read/28053550/real-world-medication-persistence-and-outcomes-associated-with-basal-insulin-and-glucagon-like-peptide-1-receptor-agonist-free-dose-combination-therapy-in-patients-with-type-2-diabetes-in-the-us
#12
Jay Lin, Melissa Lingohr-Smith, Tao Fan
BACKGROUND: Free-dose combination treatment with basal insulin and short-acting glucagon-like peptide-1 receptor agonists (GLP-1 RAs) reduces hyperglycemia via complementary targeting of fasting and postprandial blood glucose levels, however, in the real world, due to injection burden and clinical inertia, the full efficacy may not be able to translate into clinical and economic benefits. OBJECTIVE: The aim of the study was to evaluate treatment persistence and associated outcomes in patients with type 2 diabetes (T2D) treated with a GLP-1 RA in free-dose combination with basal insulin...
2017: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/28034591/women-with-polycystic-ovary-syndrome-have-comparable-hip-bone-geometry-to-age-matched-control-women
#13
Laura E McBreairty, Gordon A Zello, Julianne J Gordon, Shani B Serrao, Roger A Pierson, Donna R Chizen, Philip D Chilibeck
Polycystic ovary syndrome (PCOS) is an endocrine disorder affecting women of reproductive age manifesting with polycystic ovaries, menstrual irregularities, hyperandrogenism, hirsutism, and insulin resistance. The oligomenorrhea and amenorrhea characteristic to PCOS are associated with low bone mineral density (BMD); conversely, the hyperandrogenism and hyperinsulinemia may elicit a protective effect on BMD. As bone geometric properties provide additional information about bone strength, the objective of this study was to compare measures of hip geometry in women with PCOS to a healthy female population...
December 26, 2016: Journal of Clinical Densitometry
https://www.readbyqxmd.com/read/28032429/under-treatment-of-type-2-diabetes-causes-and-outcomes-of-clinical-inertia
#14
REVIEW
Clifford J Bailey
AIMS: To assess the impact of clinical inertia on type 2 diabetes (T2D) care. METHODS: PubMed database search from January 2000 until December 2015. RESULTS: Clinical inertia, defined as resistance to initiate or intensify treatment in a patient not at the evidence-based glycated haemoglobin goal, is conservatively estimated to occur in at least 25% of patients with T2D. Consequently, many patients with diagnosed and treated T2D experience extended periods, in some cases years, of ineffectively controlled hyperglycaemia, potentially causing serious microvascular and macrovascular harm...
December 2016: International Journal of Clinical Practice
https://www.readbyqxmd.com/read/28008300/physicians-attitudes-toward-use-of-and-perceived-barriers-to-clinical-guidelines-a-survey-among-swiss-physicians
#15
Tanja Birrenbach, Simone Kraehenmann, Martin Perrig, Christoph Berendonk, Soeren Huwendiek
BACKGROUND: Little is known about the attitudes toward, use of, and perceived barriers to clinical guidelines in Switzerland, a country with no national guideline agency. Moreover, there is no available data on the objective assessment of guideline knowledge in Switzerland. Therefore, we conducted a study at a large university's Department of General Internal Medicine in Switzerland to assess physicians' attitudes toward, use of, perceived barriers to, and knowledge of clinical guidelines...
2016: Advances in Medical Education and Practice
https://www.readbyqxmd.com/read/27972204/flexibly-modelling-hba1c-progression-in-type-2-diabetes-to-estimate-the-impact-of-clinical-inertia-on-costs-and-quality-adjusted-life-years
#16
P McEwan, J Gordon, H Bennett, K Bergenheim, L Qin
No abstract text is available yet for this article.
November 2016: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
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
#17
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
#18
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)...
February 2017: Fertility and Sterility
https://www.readbyqxmd.com/read/27831597/pharmacological-management-of-dyslipidemia-in-high-and-very-high-cardiovascular-risk-patients
#19
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
#20
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...
December 8, 2016: Journal of Biomechanics
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