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Clinical inertia

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https://www.readbyqxmd.com/read/28919840/leptin-independently-predicts-development-of-sepsis-and-its-outcome
#1
Sofie Jacobsson, Peter Larsson, Göran Johansson, Margareta Norberg, Göran Wadell, Göran Hallmans, Ola Winsö, Stefan Söderberg
BACKGROUND: Sepsis is a life-threatening condition and obesity is related to the clinical outcome. The underlying reasons are incompletely understood, but the adipocyte derived hormones leptin and adiponectin may be involved. METHODS: Patients aged 18 years or more with documented first time sepsis events were included in a nested case-referent study if they had participated in previous health surveys. Two matched referents free of known sepsis were identified...
2017: Journal of Inflammation
https://www.readbyqxmd.com/read/28915897/development-of-a-complex-intervention-to-promote-appropriate-prescribing-and-medication-intensification-in-poorly-controlled-type-2-diabetes-mellitus-in-irish-general-practice
#2
Mark E Murphy, Molly Byrne, Atieh Zarabzadeh, Derek Corrigan, Tom Fahey, Susan M Smith
BACKGROUND: Poorly controlled type 2 diabetes mellitus (T2DM) can be seen as failure to meet recommended targets for management of key risk factors including glycaemic control, blood pressure and lipids. Poor control of risk factors is associated with significant morbidity, mortality and healthcare costs. Failure to intensify medications for patients with poor control of T2DM when indicated is called clinical inertia and is one contributory factor to poor control of T2DM. We aimed to develop a theory and evidence-based complex intervention to improve appropriate prescribing and medication intensification in poorly controlled T2DM in Irish general practice...
September 16, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28871238/overcoming-therapeutic-inertia-in-multiple-sclerosis-care-a-pilot-randomized-trial-applying-the-traffic-light-system-in-medical-education
#3
Gustavo Saposnik, Jorge Maurino, Angel P Sempere, Maria A Terzaghi, Christian C Ruff, Muhammad Mamdani, Philippe N Tobler, Xavier Montalban
BACKGROUND: Physicians often do not initiate or intensify treatments when clearly warranted, a phenomenon known as therapeutic inertia (TI). Limited information is available on educational interventions to ameliorate knowledge-to-action gaps in TI. OBJECTIVES: To evaluate the feasibility and efficacy of an educational intervention compared to usual care among practicing neurologists caring for patients with multiple sclerosis (MS). METHODS: We conducted a pilot double-blind, parallel-group, randomized clinical trial...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28870498/drug-adherence-in-hypertension
#4
REVIEW
M Burnier
Blood pressure control remains unsatisfactory in all countries of the world with at best 60% of treated hypertensive patients reaching recommended therapeutic goals. Several factors have been identified which may explain why the rate of blood pressure control remains low. Among them, one can cite medical inertia and a poor adherence to drug therapies. In the absence of new drugs to control blood pressure, drug adherence has become a major issue in the management of hypertensive patients. Numerous studies have demonstrated that the major problem is the lack of persistence followed by a poor day to day execution of the prescribed regimens...
September 1, 2017: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/28866091/variation-in-sodium-intake-and-intra-individual-change-in-blood-pressure-in-chronic-kidney-disease
#5
Chetna M Pathak, Joachim H Ix, Cheryl A M Anderson, Tyler B Woodell, Gerard Smits, Martha S Persky, Geoffrey A Block, Dena E Rifkin
OBJECTIVE: In the kidney disease clinic setting, higher-than-usual blood pressure is often ascribed to recent dietary sodium indiscretion. While clinical trials demonstrate a clear relationship between salt intake and blood pressure on the population level, it is uncertain whether real-world variation in sodium intake within individual chronic kidney disease (CKD) patients is associated with fluctuations in blood pressure. METHODS: We analyzed data from the Phosphorus Normalization Trial, in which participants with CKD eating their usual diets completed at least three 24-hour urine collections over 9 months, from which we measured sodium...
August 30, 2017: Journal of Renal Nutrition
https://www.readbyqxmd.com/read/28862799/initiating-therapy-in-patients-newly-diagnosed-with-type-2-diabetes-combination-therapy-versus-a-stepwise-approach
#6
REVIEW
Eugenio Cersosimo, Eric L Johnson, Christina Chovanes, Neil Skolnik
There is clear evidence that achieving glycaemic targets reduces the risk of developing complications as a result of type 2 diabetes (T2D). Many patients, however, continue to have suboptimal glycaemic control due to issues that include unclear advice on how to achieve these targets as well as clinical inertia. The two management approaches recommended for patients newly diagnosed with T2D are stepwise and combination therapy, each of which has advantages and disadvantages. Stepwise therapy may result in good patient adherence and allow greater individualization of therapy, minimization of side effects, and cost, and so may be appropriate for patients who are closer to goal...
September 1, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28844490/decalogue-of-the-spanish-society-of-arteriosclerosis-to-reduce-therapeutic-inertia
#7
Mariano Blasco, Pablo Pérez-Martínez, Carlos Lahoz
Therapeutic inertia (TI) is defined as the failure of the physician to initiate or intensify a treatment when the therapeutic goal has not been achieved. TI can be of 2types: inertia due to lack of prescription of drugs and inertia in the absence of control of a risk factor. The consequences of TI are poor control of risk factors, an increase in potentially preventable events and an increase in costs. There are factors of the doctor himself, the patient and the care organization that determine the presence of TI...
August 24, 2017: Clínica e Investigación en Arteriosclerosis
https://www.readbyqxmd.com/read/28834075/therapeutic-inertia-in-the-treatment-of-hyperglycaemia-in-patients-with-type-2-diabetes-a-systematic-review
#8
REVIEW
Kamlesh Khunti, Marilia B Gomes, Stuart Pocock, Marina V Shestakova, Stéphane Pintat, Peter Fenici, Niklas Hammar, Jesús Medina
AIMS: Therapeutic inertia, defined as the failure to initiate or intensify therapy in a timely manner according to evidence-based clinical guidelines, is a key reason for uncontrolled hyperglycaemia in patients with type 2 diabetes. The aims of this systematic review were to identify how therapeutic inertia in the management of hyperglycaemia was measured and to assess its extent over the past decade. MATERIALS AND METHODS: Systematic searches for articles published from 1 January 2004 to 1 August 2016 were conducted in MEDLINE and Embase...
August 22, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28789568/temporal-trends-in-the-use-of-antiplatelet-therapy-in-patients-with-acute-coronary-syndromes
#9
María Asunción Esteve-Pastor, Juan Miguel Ruíz-Nodar, Esteban Orenes-Piñero, José Miguel Rivera-Caravaca, Miriam Quintana-Giner, Andrea Véliz-Martínez, Antonio Tello-Montoliu, Vicente PerniasEscrig, Miriam Sandín Rollán, Nuria Vicente-Ibarra, Manuel Jesús MacíasVillanego, Elena Candela Sánchez, Luna Carrillo Alemán, Teresa Lozano, Mariano Valdés, Francisco Marín
BACKGROUND: Current clinical guidelines of acute coronary syndromes (ACS) recommend the use of potent antiplatelet therapy, prasugrel or ticagrelor, because both drugs consistently reduce cardiovascular events. PURPOSE: The aim of this study was to examine temporal changes in the use of optimal antiplatelet therapy in patients with ACS. METHODS: A total of 1717 consecutive patients admitted for ACS in 3 tertiary hospitals from February 2014 to December 2015 were enrolled...
January 1, 2017: Journal of Cardiovascular Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28754263/clinical-inertia-and-its-impact-on-treatment-intensification-in-people-with-type-2-diabetes-mellitus
#10
REVIEW
G Reach, V Pechtner, R Gentilella, A Corcos, A Ceriello
Many people with type 2 diabetes mellitus (T2DM) fail to achieve glycaemic control promptly after diagnosis and do not receive timely treatment intensification. This may be in part due to 'clinical inertia', defined as the failure of healthcare providers to initiate or intensify therapy when indicated. Physician-, patient- and healthcare-system-related factors all contribute to clinical inertia. However, decisions that appear to be clinical inertia may, in fact, be only 'apparent' clinical inertia and may reflect good clinical practice on behalf of the physician for a specific patient...
July 25, 2017: Diabetes & Metabolism
https://www.readbyqxmd.com/read/28721085/ambulatory-and-home-blood-pressure-monitoring-gaps-between-clinical-guidelines-and-clinical-practice-in-singapore
#11
Sajita Setia, Kannan Subramaniam, Boon Wee Teo, Jam Chin Tay
PURPOSE: Out-of-office blood pressure (BP) measurements (home blood pressure monitoring [HBPM] and ambulatory blood pressure monitoring [ABPM]) provide important additional information for effective hypertension detection and management decisions. Therefore, out-of-office BP measurement is now recommended by several international guidelines. This study evaluated the practice and uptake of HBPM and ABPM among physicians from Singapore. MATERIALS AND METHODS: A sample of physicians from Singapore was surveyed between 8 September and 5 October 2016...
2017: International Journal of General Medicine
https://www.readbyqxmd.com/read/28719066/insights-into-optimal-basal-insulin-titration-in-type-2-diabetes-results-of-a-quantitative-survey
#12
Lori Berard, Mireille Bonnemaire, Marie Mical, Steve Edelman
AIMS: Basal insulin (BI) treatment initiation and dose titration in type 2 diabetes (T2DM) are often delayed. Such "clinical inertia" results in poor glycemic control and high risk of long-term complications. This survey aimed to determine healthcare professional (HCP) and patient attitudes to BI initiation and titration. METHODS: An online survey (July-August 2015) including HCPs and patients with T2DM in the USA, France and Germany. Patients were ≥18 years old and had been on BI for 6-36 months, or discontinued BI within the previous 12 months...
July 18, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28705697/overcoming-clinical-inertia-in-insulin-initiation-in-primary-care-for-patients-with-type-2-diabetes-24-month-follow-up-of-the-stepping-up-cluster-randomised-controlled-trial
#13
Jo-Anne Manski-Nankervis, John Furler, David O'Neal, Louise Ginnivan, Sharmala Thuraisingam, Irene Blackberry
AIM: To examine the two-year impact of Stepping Up, a general practice based model of care intervention for insulin initiation and titration in Australia. METHODS: 266 participants from 74 general practices participated in the Stepping Up cluster randomised controlled trial between 2012-2014. Control practices received training in the model of care on completion of the 12-month trial. Patients were followed for 24 months. Participant baseline characteristics, insulin and non-insulin medication use were summarised for each study group...
October 2017: Primary Care Diabetes
https://www.readbyqxmd.com/read/28698169/effectiveness-of-digital-medicines-to-improve-clinical-outcomes-in-patients-with-uncontrolled-hypertension-and-type-2-diabetes-prospective-open-label-cluster-randomized-pilot-clinical-trial
#14
Juan Frias, Naunihal Virdi, Praveen Raja, Yoona Kim, George Savage, Lars Osterberg
BACKGROUND: Hypertension and type 2 diabetes mellitus are major modifiable risk factors for cardiac, cerebrovascular, and kidney diseases. Reasons for poor disease control include nonadherence, lack of patient engagement, and therapeutic inertia. OBJECTIVE: The aim of this study was to assess the impact on clinic-measured blood pressure (BP) and glycated hemoglobin (HbA1c) using a digital medicine offering (DMO) that measures medication ingestion adherence, physical activity, and rest using digital medicines (medication taken with ingestible sensor), wearable sensor patches, and a mobile device app...
July 11, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28689692/patient-and-provider-factors-affecting-clinical-inertia-in-patients-with-type-2-diabetes-on-metformin-monotherapy
#15
Rohan Mahabaleshwarkar, Frank Gohs, Holly Mulder, Nick Wilkins, Andrea DeSantis, William E Anderson, Flavia Ejzykowicz, Swapnil Rajpathak, H James Norton
PURPOSE: Our aim was to determine the extent of clinical inertia and the associated patient and provider factors in patients with type 2 diabetes on metformin monotherapy (MM) at a large integrated health care system in the United States. METHODS: The study cohort included patients with type 2 diabetes aged 18 to 85 years, on MM between January 2009 and September 2013, who experienced MM failure (had an uncontrolled glycosylated hemoglobin [HbA1c] reading (≥8...
July 6, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/28681829/molecular-characterisation-of-uropathogenic-escherichia-coli-isolates-at-a-tertiary-care-hospital-in-south-india
#16
Arindam Chakraborty, Prabha Adhikari, Shalini Shenoy, Vishwas Saralaya
Uropathogenic Escherichia coli (UPEC) express a multitude of virulence factors (VFs) to break the inertia of the mucosal barrier of the urinary tract. The aim of the present study was undertaken to characterised the UPEC strains and to correlate carriage of specific virulence markers with different phylogroups and also to correlate these findings with clinical outcome of patients. A total of 156 non-repeated, clinically significant UPEC isolates were studied. Virulent genes were determined by two set of multiplex polymerase chain reaction (PCR)...
April 2017: Indian Journal of Medical Microbiology
https://www.readbyqxmd.com/read/28638444/understanding-the-barriers-and-improving-care-in-type-2-diabetes-brazilian-perspective-in-time-to-do-more-in-diabetes
#17
Sérgio Vencio, Päivi M Paldánius, Matthias Blüher, Daniel Giannella-Neto, Rafael Caiado-Vencio, W David Strain
BACKGROUND: Type 2 diabetes mellitus (T2DM) is a complex disease, particularly in a continental country like Brazil. We attempted to understand and evaluate the perceptions and routines of Brazilians with T2DM and physicians, compared with other countries. METHODS: We compared the results from a 20-min online survey in Brazil with simultaneously collated data from India, Japan, Spain, UK and USA. RESULTS: In total, 652 adults with T2DM and 337 treating physicians were enrolled, of whom 100 patients and 55 physicians were from Brazil...
2017: Diabetology & Metabolic Syndrome
https://www.readbyqxmd.com/read/28634455/fertilizing-a-patient-engagement-ecosystem-to-innovate-healthcare-toward-the-first-italian-consensus-conference-on-patient-engagement
#18
Guendalina Graffigna, Serena Barello, Giuseppe Riva, Mariarosaria Savarese, Julia Menichetti, Gianluca Castelnuovo, Massimo Corbo, Alessandra Tzannis, Antonio Aglione, Donato Bettega, Anna Bertoni, Sarah Bigi, Daniela Bruttomesso, Claudia Carzaniga, Laura Del Campo, Silvia Donato, Silvia Gilardi, Chiara Guglielmetti, Michele Gulizia, Mara Lastretti, Valeria Mastrilli, Antonino Mazzone, Giovanni Muttillo, Silvia Ostuzzi, Gianluca Perseghin, Natalia Piana, Giuliana Pitacco, Gianluca Polvani, Massimo Pozzi, Livio Provenzi, Giulia Quaglini, Mariagrazia Rossi, Paola Varese, Natalia Visalli, Elena Vegni, Walter Ricciardi, A Claudio Bosio
Currently we observe a gap between theory and practices of patient engagement. If both scholars and health practitioners do agree on the urgency to realize patient engagement, no shared guidelines exist so far to orient clinical practice. Despite a supportive policy context, progress to achieve greater patient engagement is patchy and slow and often concentrated at the level of policy regulation without dialoguing with practitioners from the clinical field as well as patients and families. Though individual clinicians, care teams and health organizations may be interested and deeply committed to engage patients and family members in the medical course, they may lack clarity about how to achieve this goal...
2017: Frontiers in Psychology
https://www.readbyqxmd.com/read/28611850/use-of-the-kalman-filter-for-aortic-pressure-waveform-noise-reduction
#19
Frank Lam, Hsiang-Wei Lu, Chung-Che Wu, Zekeriya Aliyazicioglu, James S Kang
Clinical applications that require extraction and interpretation of physiological signals or waveforms are susceptible to corruption by noise or artifacts. Real-time hemodynamic monitoring systems are important for clinicians to assess the hemodynamic stability of surgical or intensive care patients by interpreting hemodynamic parameters generated by an analysis of aortic blood pressure (ABP) waveform measurements. Since hemodynamic parameter estimation algorithms often detect events and features from measured ABP waveforms to generate hemodynamic parameters, noise and artifacts integrated into ABP waveforms can severely distort the interpretation of hemodynamic parameters by hemodynamic algorithms...
2017: Computational and Mathematical Methods in Medicine
https://www.readbyqxmd.com/read/28596248/examining-the-language-and-behavioural-profile-in-ftd-and-als-ftd
#20
COMPARATIVE STUDY
Jennifer A Saxon, Jennifer C Thompson, Matthew Jones, Jennifer M Harris, Anna Mt Richardson, Tobias Langheinrich, David Neary, David Ma Mann, Julie S Snowden
BACKGROUND: A proportion of patients with behavioural variant frontotemporal dementia (bvFTD) develop amyotrophic lateral sclerosis (ALS). It is currently unknown whether the behavioural and cognitive syndrome in bvFTD with ALS (ALS-FTD) is indistinguishable from that of bvFTD alone. METHODS: A retrospective cohort of 241 patients with clinical diagnoses of bvFTD (n=185) or ALS-FTD (n=56) was examined with respect to behavioural, cognitive and neuropsychiatric symptoms...
August 2017: Journal of Neurology, Neurosurgery, and Psychiatry
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