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Clinical inertia

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
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)...
March 14, 2018: Reproduction in Domestic Animals, Zuchthygiene
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...
March 13, 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
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...
March 9, 2018: Diabetes Research and Clinical Practice
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
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
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
M H Kuizenga, P J Colin, K M E M Reyntjens, D J Touw, H Nalbat, F H Knotnerus, H E M Vereecke, M M R F Struys
BACKGROUND: Neural inertia is defined as the tendency of the central nervous system to resist transitions between arousal states. This phenomenon has been observed in mice and Drosophila anaesthetized with volatile anaesthetics: the effect-site concentration required to induce anaesthesia in 50% of the population (C50 ) was significantly higher than the effect-site concentration for 50% of the population to recover from anaesthesia. We evaluated this phenomenon in humans using propofol or sevoflurane (both with or without remifentanil) as anaesthetic agents...
March 2018: British Journal of Anaesthesia
Mark Peyrot, Timothy S Bailey, Belinda P Childs, Gérard Reach
INTRODUCTION: Type 2 diabetes mellitus (T2D) is a growing global epidemic. Due to the progressive nature of the disease, many people with T2D require insulin at some point, most commonly a long-acting (basal) insulin to assist with 24-hour control of glucose levels. OBJECTIVE: This opinion paper provides an overview of considerations for primary care providers (PCPs) in intensifying the treatment regimen when basal insulin therapy is inadequate. RESULTS: Control of mealtime hyperglycemia, in addition to fasting hyperglycemia, has been shown to be crucial in reaching A1c goals of <7...
February 12, 2018: Current Medical Research and Opinion
Matthew Fuller-Tyszkiewicz, Ben Richardson, Vivienne Lewis, Josh Smyth, Isabel Krug
The present study evaluated the relation of key features of state body dissatisfaction experiences - inertia, instability from moment-to-moment, and average level across time-points - to trait body dissatisfaction and/or eating disorder risk. Participants included 161 women who completed measures of trait body dissatisfaction and disordered eating pathology, and then completed reported state body dissatisfaction and contextual influences (binge eating, dietary restraint, exercise, and appearance comparison behaviors) 6 times daily for 7 days...
February 1, 2018: Body Image
Michelle Mocarski, Jason Yeaw, Victoria Divino, Mitch DeKoven, German Guerrero, Jakob Langer, Brian Larsen Thorsted
BACKGROUND: Clinical inertia in type 2 diabetes mellitus (T2DM) refers to the failure of clinicians to intensify therapy when indicated. Many T2DM patients remain suboptimally controlled after initiating basal insulin. OBJECTIVE: To examine the prevalence of patients treated with basal insulin but in poor glycemic control (hemoglobin A1c [A1c] ≥ 7%) after initiation and subsequent treatment intensification patterns and glycemic outcomes in a real-world setting...
November 16, 2017: Journal of Managed Care & Specialty Pharmacy
Rosana C Gomes, Elaine C O Guirro, Adriana C Gonçalves, Jayme A Farina Junior, Luiz O Murta Junior, Rinaldo R J Guirro
INTRODUCTION: Severe burns benefit from skin grafting, and grafting surgery is of great importance in the treatment of these injuries. As a result, there is formation of an additional wound at the donor site, which is painful and susceptible to infection. However, the therapeutic approach to these problems at donor sites for skin grafting is insufficiently explored in the literature. AIM: To evaluate electrical stimulation of the donor sites of burn patients treated by grafting surgery...
February 2, 2018: Burns: Journal of the International Society for Burn Injuries
L Westover, G Faulkner, C Flores-Mir, W Hodgetts, D Raboud
In this paper we present the development of the Advanced System for Implant Stability Testing (ASIST) for application to natural teeth. The ASIST uses an impact measurement combined with an analytical model of the system and surrounding support to provide a measure of the interface stiffness. In this study, an analytical model is developed for a single-rooted natural tooth allowing the ASIST to estimate the stiffness characteristics of the periodontal ligament (PDL). The geometry and inertia parameters of the tooth model are presented in two ways: (1) using full CT scans of the individual tooth and (2) using an approximate geometry model with estimates of only the tooth length and diameter...
February 1, 2018: Journal of Biomechanics
Consuelo Artero-López, Verónica V Márquez-Hernández, María Teresa Estevez-Morales, Genoveva Granados-Gámez
AIMS AND OBJECTIVES: To assess the existence of therapeutic inertia in the nursing care of patients with urinary incontinence during the patient's time in hospital, together with the socio-demographic and professional variables involved. BACKGROUND: Inertia in care is a problem which appears in the nursing care process. Actions related to inertia can be attributed to not adhering to protocols, clinical guidelines and the lack of prevention measures which have undesirable effects on the efficiency of care...
February 3, 2018: Journal of Clinical Nursing
Nathaniel A Sowa, Philip Jeng, Amy M Bauer, Joseph M Cerimele, Jürgen Unützer, Yuhua Bao, Lydia Chwastiak
OBJECTIVE: This study examined whether psychiatric case review was associated with depression medication modification in a large implementation program of collaborative care for depression in safety-net primary care clinics. METHODS: Registry data were examined from an implementation of the collaborative care model in Washington State. A total of 14,960 adults from 178 primary care clinics who initiated care between January 1, 2008, and September 30, 2014, and who had a baseline Patient Health Questionnaire-9 (PHQ-9) score of 10 or higher were included...
February 1, 2018: Psychiatric Services: a Journal of the American Psychiatric Association
Emilio Márquez-Contreras, Nieves Martell-Claros, Sara Márquez-Rivero, Enrique Hermida-Campa, Carmen Gracia-Diez, Eugenio Sanchez-López, Vicente Gil-Guillén
OBJECTIVE: To assess the efficacy of a mixed intervention, educational and reminder calendar of the intake, as a strategy to improve therapeutic adherence with dabigatran in patients with non-valvular atrial fibrillation (NVAF). METHODS: Prospective, longitudinal, multicenter study, carried out in 110 specialized healthcare centers in Spain. 726 patients treated with dabigatran prescribed for stroke prevention were included. A cluster randomization was performed based on two groups: 1) Control Group (CG) as usual clinical practice and Intervention Group (IG) with a mixed strategy: a) Healthcare education and b) Use of a reminder calendar for taking the anticoagulant medication...
January 31, 2018: Current Medical Research and Opinion
Yuki Fujihara, Helen E Huetteman, Ting-Ting Chung, Melissa J Shauver, Kevin C Chung
BACKGROUND: Following the publication of high level evidence demonstrating that corticosteroid inject is not an effective treatment for lateral epicondylitis, a reduction in the rate of corticosteroid injection would be expected. We aimed to clarify the current clinical practice pattern for lateral epicondylitis and to identify which factors hinder or encourage the introduction of evidence into clinical practice. METHODS: In this administrative claims analysis, we used the 2009 to 2015 Truven MarketScan databases...
January 12, 2018: Plastic and Reconstructive Surgery
Andrzej Marcinkiewicz, Michał Plewka, Wojciech Hanke, Paweł Kałużny, Marta Wiszniewska, Agnieszka Lipińska-Ojrzanowska, Jolanta Walusiak-Skorupa
BACKGROUND: Due to high prevalence, insufficient recognition and ineffectual treatment, hypertension (HT) still remains a major medical and socio-economic problem. There is a real necessity to develop effective prophylaxis for cardiovascular disorders (CVD), based on strategies which support compliance during long-term therapy. The Polish scheme of occupational health services (OHS) with mandatory periodical employee check-ups creates a unique opportunity for effective HT prophylaxis...
January 19, 2018: Kardiologia Polska
Anna Beth Barton, Daniel E Okorodudu, Hayden B Bosworth, Matthew J Crowley
BACKGROUND: Treatment nonadherence and clinical inertia perpetuate poor cardiovascular disease (CVD) risk factor control. Telemedicine interventions may counter both treatment nonadherence and clinical inertia. INTRODUCTION: We explored why a telemedicine intervention designed to reduce treatment nonadherence and clinical inertia did not improve CVD risk factor control, despite enhancing treatment adherence versus usual care. METHODS: In this analysis of a randomized trial, we studied recipients of the 12-month telemedicine intervention...
January 17, 2018: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
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
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