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Clinical inertia

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https://www.readbyqxmd.com/read/29329039/an-investigation-into-the-drivers-of-avolition-in-schizophrenia
#1
Gaurav Suri, Lindsey M Lavaysse, Gerald Young, Craig Moodie, Alen Tersakyan, James J Gross, David E Gard
Over a century of research has documented that avolition is a core symptom in schizophrenia. However, the drivers of avolition remain unclear. Conceptually, there are at least two potential mutually compatible drivers that could cause avolition in schizophrenia. First, people with schizophrenia might have differences in preferences that result in less goal-directed behavior than non-clinical populations (preference-differences). Second, people with schizophrenia might have difficulty translating their preferences into manifest behavior at rates similar to non-clinical populations (psychological-inertia)...
January 6, 2018: Psychiatry Research
https://www.readbyqxmd.com/read/29327445/don-t-just-do-something-stand-there-the-value-and-art-of-deliberate-clinical-inertia
#2
Gerben Keijzers, Louise Cullen, Diana Egerton-Warburton, Daniel M Fatovich
It can be difficult to avoid unnecessary investigations and treatments, which are a form of low-value care. Yet every intervention in medicine has potential harms, which may outweigh the potential benefits. Deliberate clinical inertia is the art of doing nothing as a positive response. This paper provides suggestions on how to incorporate deliberate clinical inertia into our daily clinical practice, and gives an overview of current initiatives such as 'Choosing Wisely' and the 'Right Care Alliance'. The decision to 'do nothing' can be complex due to competing factors, and barriers to implementation are highlighted...
January 12, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29322372/examination-of-patient-reported-outcomes-in-association-with-tnf-inhibitor-treatment-response-results-from-a-us-observational-cohort-study
#3
Cynthia J Larmore, Natalie N Boytsov, Carol L Gaich, Xiang Zhang, Andre B Araujo, Sabrina Rebello, Bob A Salim, George W Reed, Leslie R Harrold
INTRODUCTION: Implementation of a treat-to-target strategy is challenging when the patient and physician prioritize different goals. This study aimed to "translate" improvements in Clinical Disease Activity Index (CDAI) to concepts that resonate with patients (such as pain, fatigue, morning stiffness) by examining the association between changes in disease activity and patient-reported outcomes (PROs) in a national cohort of patients with rheumatoid arthritis (RA) initiating their first biologic treatment...
January 10, 2018: Rheumatology and Therapy
https://www.readbyqxmd.com/read/29322300/glycemic-control-in-type-2-diabetes-from-medication-nonadherence-to-residual-vascular-risk
#4
Dario Giugliano, Maria Ida Maiorino, Giuseppe Bellastella, Katherine Esposito
Despite the availability of many new treatment options for type 2 diabetes, the proportion of patients achieving the HbA1c target < 7.0% remains around 50%. We put forward the hypothesis that the unchanged HbA1c results, observed in the last decade in type 2 diabetes patients, are also a consequence of medication nonadherence and clinical inertia. Poor medication-taking behavior is usually defined as medication nonadherence and is responsible for uncontrolled hemoglobin A1c level in 23% of cases. Medication nonadherence may also affect clinical outcomes, as diabetic patients with good adherence (≥80%) had a significant 10% lower rate of hospitalization events and a significant 28% lower rate of all-cause mortality when compared with patients with poor adherence (<80%)...
January 10, 2018: Endocrine
https://www.readbyqxmd.com/read/29316149/measure-accurately-act-rapidly-and-partner-with-patients-map-improves-hypertension-control-in-medically-underserved-patients-care-coordination-institute-and-american-medical-association-hypertension-control-project-pilot-study-results
#5
Robert B Hanlin, Irfan M Asif, Gregory Wozniak, Susan E Sutherland, Bijal Shah, Jianing Yang, Robert A Davis, Sean T Bryan, Michael Rakotz, Brent M Egan
Measure Accurately, Act Rapidly, and Partner With Patients (MAP) is an evidence-based protocol implemented to improve hypertension control in a clinic for underserved patients (49.9% Medicaid and 50.2% black). Patients with hypertension seen during the year before intervention and with at least one visit during the 6-month intervention (N = 714) were included. If initial attended blood pressure (BP; standard aneroid manometer) was ≥140/≥90 mm Hg, unattended automated office BP was measured in triplicate and averaged (Measure Accurately) using an Omron HEM-907XL...
January 5, 2018: Journal of Clinical Hypertension
https://www.readbyqxmd.com/read/29277347/adherence-to-blood-pressure-and-glucose-recommendations-in-chronic-kidney-disease-hospital-inpatients-clinical-inertia-and-patient-adherence
#6
Fergus William Gardiner, Ezekiel Uba Nwose, Phillip Taderera Bwititi, Judith Crockett, Lexin Wang
AIMS: To determine the extent to which targets for blood pressure (BP) (<140.90 mmHg) and random blood glucose level (BGL) (<7.7 mmol/L) control in patients with chronic kidney disease (CKD) are achieved; and the extent clinical inertia affects BP and glucose control in CKD and diabetes mellitus (DM). METHODS: Data was collected from the 1st January 2015 until 31st December 2015 on key patient pathology, admission reason, final discharge diagnosis, and information concerning clinical guideline adherence...
December 16, 2017: Diabetes & Metabolic Syndrome
https://www.readbyqxmd.com/read/29250981/update-on-treatment-for-idiopathic-hypersomnia
#7
Elisa Evangelista, Régis Lopez, Yves Dauvilliers
Idiopathic hypersomnia (IH) is a poorly characterized orphan central disorder of hypersomnolence responsible for excessive daytime sleepiness (EDS), prolonged nighttime sleep and sleep inertia that often require long-term symptomatic stimulant medication. To date, no drug has currently the authorization for the treatment of IH patients worldwide. Areas covered: The authors reviewed data on pharmacological treatment of IH obtained from published literature (Medline/PubMed/Web of Science) and Clinicaltrial.gov database from 1997 to 2017...
January 3, 2018: Expert Opinion on Investigational Drugs
https://www.readbyqxmd.com/read/29250458/comparison-of-psychological-response-between-concussion-and-musculoskeletal-injury-in-collegiate-athletes
#8
Samantha Turner, Jody Langdon, George Shaver, Victoria Graham, Kelly Naugle, Thomas Buckley
The psychological response to musculoskeletal injuries has been well documented, however, research on the psychological response to concussion is limited. The Profile of Mood States (POMS) and the State-Trait Anxiety Inventory (STAI) have recently been used to assess the psychological recovery of concussions. Although some studies indicate that psychological response is different for musculoskeletal injuries and concussion, there is currently not enough information to indicate this difference occurs at specific clinical milestones...
2017: Sport, Exercise, and Performance Psychology
https://www.readbyqxmd.com/read/29220731/quantitative-texture-analysis-in-the-prediction-of-idh-status-in-low-grade-gliomas
#9
Asgeir Store Jakola, Yi-Hua Zhang, Anne J Skjulsvik, Ole Solheim, Hans Kristian Bø, Erik Magnus Berntsen, Ingerid Reinertsen, Sasha Gulati, Petter Förander, Torkel B Brismar
OBJECTIVES: Molecular markers provide valuable information about treatment response and prognosis in patients with low-grade gliomas (LGG). In order to make this important information available prior to surgery the aim of this study was to explore if molecular status in LGG can be discriminated by preoperative magnetic resonance imaging (MRI). PATIENTS AND METHODS: All patients with histopathologically confirmed LGG with available molecular status who had undergone a preoperative standard clinical MRI protocol using a 3T Siemens Skyra scanner during 2008-2015 were retrospectively identified...
December 5, 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/29220213/clinical-application-of-biparametric-mri-texture-analysis-for-detection-and-evaluation-of-high-grade-prostate-cancer-in-zone-specific-regions
#10
Xiang-Ke Niu, Zhi-Fan Chen, Lin Chen, Jun Li, Tao Peng, Xin Li
OBJECTIVE: The purpose of this study was to investigate the performance of biparametric MRI texture analysis (TA) in detecting and evaluating high-grade prostate cancer in zone-specific regions. MATERIALS AND METHODS: A retrospective study included 184 consecutively registered biopsy-naive patients in whom prostate cancer was suspected who were undergoing multiparametric prostate MRI. MR images were scored and evaluated by two readers using the Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) and biparametric MRI TA in separate sessions...
December 8, 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/29204859/improvement-in-diagnosis-and-treat-to-target-management-of-hyperuricemia-in-gout-results-from-the-gema-2-transversal-study-on-practice
#11
Fernando Perez Ruiz, Carlos A Sanchez-Piedra, Jesus T Sanchez-Costa, Mariano Andrés, Cesar Diaz-Torne, Mercedes Jimenez-Palop, Eugenio De Miguel, Carmen Moragues, Francisca Sivera
INTRODUCTION: The objective of the study was to evaluate changes regarding main European League Against Rheumatism (EULAR) recommendations on diagnosis and treatment of gout compared to a previous assessment. METHODS: The GEMA-2 (Gout Evaluation and MAnagement) is a transversal assessment of practice for gout by rheumatologists. Main outcome variables were improvement of the previous GEMA assessment regarding the rate of crystal-proven diagnosis and that reaching therapeutic serum urate target below 6 mg/dl at last visit...
December 4, 2017: Rheumatology and Therapy
https://www.readbyqxmd.com/read/29201367/services-aimed-at-achieving-desirable-clinical-outcomes-in-patients-with-chronic-kidney-disease-and-diabetes-mellitus-a-narrative-review
#12
REVIEW
Fergus William Gardiner, Ezekiel Uba Nwose, Phillip Taderera Bwititi, Judith Crockett, Lexin Wang
There is a large number of patients with chronic kidney disease (CKD), diabetes mellitus (DM), and hypertension (HT) but whether the targets on blood pressure (BP) control in patients with DM and/or CKD are met is not clear. This narrative review therefore investigated evidence on services aimed at achieving desirable clinical results in patients with CKD and DM, and HT in Australia. Literature pertaining to pathology diagnosis and management of these patients as well as the complexities in management were considered...
2017: SAGE Open Medicine
https://www.readbyqxmd.com/read/29094260/comparison-among-recommendations-for-the-management-of-arterial-hypertension-issued-by-last-us-canadian-british-and-european-guidelines
#13
Christina Antza, Ioannis Doundoulakis, Stella Stabouli, Vasilios Kotsis
Guidelines for the management of hypertension have been issued by different hypertension societies or organizations. Despite many similarities one can identify major differences in the diagnosis, management and treatment of the hypertensive patients among ESH/ESC, NICE, Canadian and NJC8 guidelines. Differences that can be identified are in the definition of hypertension in the elderly population, the optimal blood pressure targets in different hypertensive populations such as patients with diabetes and chronic kidney disease patients and the choose of the initial and appropriate antihypertensive agent depending on comorbidities of the treated population...
November 1, 2017: High Blood Pressure & Cardiovascular Prevention: the Official Journal of the Italian Society of Hypertension
https://www.readbyqxmd.com/read/29083969/personalized-care-and-the-role-of-insulin-as-a-vehicle-to-optimizing-treatments-in-diabetes-care
#14
Nella Bieszk, Michael Grabner, Wenhui Wei, John Barron, Ralph Quimbo, Tingjian Yan, Beth Biel, James W Chu
BACKGROUND: In patients with type 2 diabetes (T2D) with poor glycemic control, there is an unmet need for treatment optimization involving the initiation and/or intensification of insulin therapy, which is often delayed because of clinical inertia. Educational initiatives that target patients and physicians might be one way to address this need. OBJECTIVE: To evaluate the effectiveness of educational materials mailed to physicians and their patients in affecting initiation of insulin therapy and other health care outcomes...
November 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29066518/apathy-a-neurocircuitry-model-based-on-frontotemporal-dementia
#15
REVIEW
Simon Ducharme, Bruce H Price, Bradford C Dickerson
Apathy is a symptom shared among many neurological and psychiatric disorders. However, the underlying neurocircuitry remains incompletely understood. Apathy is one of the core features of behavioural variant frontotemporal dementia (bvFTD), a neurodegenerative disease presenting with heterogeneous combinations of socioaffective symptoms and executive dysfunction. We reviewed all neuroimaging studies of apathy in frontotemporal dementia (FTD) attempting to refine a neurocircuitry model and inform clinical definitions...
October 24, 2017: Journal of Neurology, Neurosurgery, and Psychiatry
https://www.readbyqxmd.com/read/29053215/identification-of-barriers-to-insulin-therapy-and-approaches-to-overcoming-them
#16
REVIEW
David Russell-Jones, Frans Pouwer, Kamlesh Khunti
Poor glycaemic control in type 2 diabetes (T2D) is a global problem despite the availability of numerous glucose-lowering therapies and clear guidelines for T2D management. Tackling clinical or therapeutic inertia, where the person with diabetes and/or their healthcare providers do not intensify treatment regimens despite this being appropriate, is key to improving patients' long-term outcomes. This gap between best practice and current level of care is most pronounced when considering insulin regimens, with studies showing that insulin initiation/intensification is frequently and inappropriately delayed for several years...
October 20, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/29049076/fatigue-risk-management-the-impact-of-anesthesiology-residents-work-schedules-on-job-performance-and-a-review-of-potential-countermeasures
#17
Lily R Wong, Erin Flynn-Evans, Keith J Ruskin
Long duty periods and overnight call shifts impair physicians' performance on measures of vigilance, psychomotor functioning, alertness, and mood. Anesthesiology residents typically work between 64 and 70 hours per week and are often required to work 24 hours or overnight shifts, sometimes taking call every third night. Mitigating the effects of sleep loss, circadian misalignment, and sleep inertia requires an understanding of the relationship among work schedules, fatigue, and job performance. This article reviews the current Accreditation Council for Graduate Medical Education guidelines for resident duty hours, examines how anesthesiologists' work schedules can affect job performance, and discusses the ramifications of overnight and prolonged duty hours on patient safety and resident well-being...
October 17, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29044066/color-vision-abnormalities-in-type-ii-diabetes-sankara-nethralaya-diabetic-retinopathy-epidemiology-and-molecular-genetics-study-ii-report-no-2
#18
Laxmi Gella, Rajiv Raman, Vaitheeswaran Kulothungan, Swakshyar Saumya Pal, Suganeswari Ganesan, Sangeetha Srinivasan, Tarun Sharma
PURPOSE: The purpose of this study is to assess color vision abnormalities in a cohort of subjects with type II diabetes and elucidate associated risk factors. METHODS: Subjects were recruited from follow-up cohort of Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study I. Six hundred and seventy-three eyes of 343 subjects were included from this population-based study. All subjects underwent detailed ophthalmic evaluation, including the Farnsworth-Munsell 100 hue test...
October 2017: Indian Journal of Ophthalmology
https://www.readbyqxmd.com/read/29033057/clinical-inertia-versus-overtreatment-in-glycaemic-management
#19
Kamlesh Khunti, Melanie J Davies
No abstract text is available yet for this article.
October 9, 2017: Lancet Diabetes & Endocrinology
https://www.readbyqxmd.com/read/29017373/clinical-considerations-for-use-of-insulin-degludec-insulin-aspart-in-japanese-patients
#20
Takahisa Hirose, Takuya Awata, Yuiko Yamamoto, Mads Peter Hemmingsen
Co-formulation of basal and bolus insulin components provides a simpler regimen for patients with type 2 diabetes than separate basal-bolus treatment. However, conventional premixed insulin products include a suboptimal protaminated basal component that requires resuspension prior to injection. Insulin degludec/insulin aspart (IDegAsp) is the first soluble co-formulation of a basal insulin with an ultra-long duration of action (IDeg) and a rapid-acting bolus insulin (IAsp) in a single injection. Areas covered: In this review, the authors summarize findings from pre-clinical studies and the clinical trial program and provide guidance for the initiating and switching of IDegAsp in different patient populations...
October 11, 2017: Expert Opinion on Biological Therapy
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