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https://www.readbyqxmd.com/read/28993287/effectiveness-of-certified-diabetes-educators-following-pre-approved-protocols-to-redesign-diabetes-care-delivery-in-primary-care-results-of-the-remedies-4d-trial
#1
Janice C Zgibor, Maura A Maloney, Markku Malmi, Anthony Fabio, Shihchen Kuo, Francis X Solano, Debra Tilves, Lichuan Tu, Mayer B Davidson
OBJECTIVE: To evaluate the changes in HbA1c, blood pressure, and LDLc levels in participants from practices where certified diabetes educators (CDEs) implemented standardized protocols to intensify treatment compared with those receiveing usual care. RESEARCH DESIGN AND METHODS: This clustered, randomized, clinical trial was implemented in community-based primary care practices. Fifteen primary care practices and 240 patients with type 2 diabetes were randomized to the intervention (n=175) or usual care (n=65)...
October 6, 2017: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/28964455/value-based-payments-and-incentives-to-improve-care-a-case-study-of-patients-with-type-2-diabetes-in-medicare-advantage
#2
Jesse Sussell, Kata Bognar, Taylor T Schwartz, Jason Shafrin, John J Sheehan, Wade Aubry, Dennis Scanlon
OBJECTIVES: To estimate the impact of increased glycated hemoglobin (A1C) monitoring and treatment intensification for patients with type 2 diabetes (T2D) on quality measures and reimbursement within the Medicare Advantage Star (MA Star) program. METHODS: The primary endpoint was the share of patients with T2D with adequate A1C control (A1C ≤ 9%). We conducted a simulation of how increased A1C monitoring and treatment intensification affected this end point using data from the National Health and Nutrition Examination Survey and clinical trials...
September 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28960144/blood-pressure-regulation-reviewing-evidence-for-interplay-between-common-dietary-sugars-and-table-salt
#3
Harry G Preuss, Dallas Clouatre, Anand Swaroop, Manashi Bagchi, Debasis Bagchi, Gilbert R Kaats
A popular concept is that the significant global progression in prevalence and intensification of elevated blood pressure (BP) levels is due in part to dietary indiscretions. Excess intake of several food sources causing overweight/obesity plays an important role in BP perturbations. However, certain nutrients are involved in ways other than via body fat accumulation, particularly table salt (sodium chloride) and popular refined carbohydrates like dietary sugars (sucrose, fructose, high fructose corn syrup)...
September 29, 2017: Journal of the American College of Nutrition
https://www.readbyqxmd.com/read/28945115/advances-in-immunotherapy-for-pediatric-acute-myeloid-leukemia
#4
Challice L Bonifant, Mireya Paulina Velasquez, Stephen Gottschalk
Achieving better disease control in patients diagnosed with acute myeloid leukemia (AML) has proven challenging. Overall survival has been impacted by addressing treatment related mortality with focused supportive care measures. Despite this improvement, it remains difficult to induce durable leukemia remissions despite aggressive chemotherapeutic regimens. The addition of hematopoietic stem cell transplants (HSCT) has allowed further treatment intensification and provided the benefit of graft-versus-leukemia (GVL) effect...
October 11, 2017: Expert Opinion on Biological Therapy
https://www.readbyqxmd.com/read/28942908/integrating-function-directed-treatments-into-palliative-care
#5
REVIEW
Andrea L Cheville, Melissa Morrow, Sean Robinson Smith, Jeffrey R Basford
The growing acceptance of palliative care has created opportunities to increase the use of rehabilitation services among populations with advanced disease, particularly those with cancer. Broader delivery has been impeded by the lack of a shared definition for palliative rehabilitation and a mismatch between patient needs and established rehabilitation service delivery models. We propose the definition that, in the advanced cancer population, palliative rehabilitation is function-directed care delivered in partnership with other clinical disciplines and aligned with the values of patients who have serious and often incurable illnesses in contexts marked by intense and dynamic symptoms, psychological stress, and medical morbidity to realize potentially time-limited goals...
September 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/28936586/role-of-structured-individual-patient-education-in-the-prevention-of-vascular-complications-in-newly-diagnosed-type-2-diabetes-the-individual-therapeutic-education-in-newly-diagnosed-type-2-diabetes-intend-randomized-controlled-trial
#6
Adriana Coppola, Livio Luzi, Tiziana Montalcini, Andrea Giustina, Carmine Gazzaruso
OBJECTIVE: Recent studies showed that a structured patient therapeutic education (PTE) may decrease both mortality and the development of diabetes complications. Nevertheless, no data are available in the literature on the impact of individual PTE on the complications in newly diagnosed type 2 diabetic patients. Aim of the present randomized controlled trial is to evaluate the impact of individual PTE on the occurrence of macrovascular complications in newly diagnosed type 2 diabetic patients when compared to usual care (UC) and group PTE...
September 21, 2017: Endocrine
https://www.readbyqxmd.com/read/28929083/emerging-therapies-for-stage-iii-non-small-cell-lung-cancer-stereotactic-body-radiation-therapy-and-immunotherapy
#7
REVIEW
Sameera S Kumar, Kristin A Higgins, Ronald C McGarry
The current standard of care for locally advanced non-small cell lung cancer (NSCLC) includes radiation, chemotherapy, and surgery in certain individualized cases. In unresectable NSCLC, chemoradiation has been the standard of care for the past three decades. Local and distant failure remains high in this group of patients, so dose escalation has been studied in both single institution and national clinical trials. Though initial studies showed a benefit to dose escalation, phase III studies examining dose escalation using standard fractionation or hyperfractionation have failed to show a benefit...
2017: Frontiers in Oncology
https://www.readbyqxmd.com/read/28912200/development-and-validation-of-electronic-quality-measures-to-assess-care-for-patients-with-transient-ischemic-attack-and-minor-ischemic-stroke
#8
Dawn M Bravata, Laura J Myers, Eric Cheng, Mathew Reeves, Fitsum Baye, Zhangsheng Yu, Teresa Damush, Edward J Miech, Jason Sico, Michael Phipps, Alan Zillich, Jason Johanning, Seemant Chaturvedi, Curt Austin, Jared Ferguson, Bailey Maryfield, Kathy Snow, Susan Ofner, Glenn Graham, Rachel Rhude, Linda S Williams, Greg Arling
BACKGROUND: Despite interest in using electronic health record (EHR) data to assess quality of care, the accuracy of such data is largely unknown. We sought to develop and validate transient ischemic attack and minor ischemic stroke electronic quality measures (eQMs) using EHR data. METHODS AND RESULTS: A random sample of patients with transient ischemic attack or minor ischemic stroke, cared for in Veterans Health Administration facilities (fiscal year 2011), was identified...
September 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28842139/daunorubicin-90-mg-m-2-in-acute-myeloid-leukemia-induction-increased-toxicity-in-young%C3%A2-patients
#9
Rodrigo Portugal, Renata Lyrio, Monique Loureiro, Kátia Urago, Johny Bard, Aline Borchardt, Márcia Garnica, Márcio Nucci
BACKGROUND: The combination of an anthracycline and cytosine arabinoside has been the standard induction therapy for acute myeloid leukemia for more than 3 decades. The clinical benefit of intensification of the daunorubicin dose to 90 mg/m(2) has been supported by randomized trials. Based on these promising results, in 2010 we changed our induction protocol of acute myeloid leukemia, increasing the dose of daunorubicin. PATIENTS AND METHODS: We retrospectively analyzed the treatment outcome of patients treated with high-dose daunorubicin (90 mg/m(2) on days 1-3) and cytosine arabinoside (200 mg/m(2)/day continuous infusion on days 1-7) compared with patients receiving 45 to 60 mg/m(2) of daunorubicin...
August 2017: Clinical Lymphoma, Myeloma & Leukemia
https://www.readbyqxmd.com/read/28830475/preoperative-intensity-modulated-radiotherapy-with-a-simultaneous-integrated-boost-combined-with-capecitabine-in-locally-advanced-rectal-cancer-short-term-results-of-a-multicentric-study
#10
Marco Lupattelli, Fabio Matrone, Maria Antonietta Gambacorta, Mattia Osti, Gabriella Macchia, Elisa Palazzari, Luca Nicosia, Federico Navarria, Giuditta Chiloiro, Vincenzo Valentini, Cynthia Aristei, Antonino De Paoli
BACKGROUND: Preoperative radiotherapy (RT) in combination with fluoropyrimidine-based chemotherapy (CT) is the standard of care in patients with locally advanced, T3-T4 N0-2, rectal cancer (LARC). Given the correlation between RT dose-tumor response and the prognostic role of the tumor regression grade (TRG), treatment intensification represents an area of active investigation. The aim of the study was to analyze the role of RT dose-intensification in the preoperative treatment of LARC in terms of feasibility, efficacy and toxicity...
August 22, 2017: Radiation Oncology
https://www.readbyqxmd.com/read/28828933/impact-of-timely-treatment-intensification-on-glycemic-goal-achievement-in-patients-with-type-2-diabetes-failing-metformin-monotherapy
#11
Rohan Mahabaleshwarkar, Megan Templin, Frank Gohs, Holly Mulder, Andrea DeSantis, Flavia Ejzykowicz, Swapnil Rajpathak, Nick Wilkins
Purpose The purpose of the study was to examine the association between timely treatment intensification (TTI) and glycemic goal achievement in patients with type 2 diabetes (T2D) failing metformin monotherapy (MM). Methods This study was set at a large integrated health care system in the United States. The study cohort included T2D patients aged 18 to 85 years who were on MM between January 2009 and September 2013 and had an uncontrolled glycated hemoglobin (A1C) reading (≥8%) after at least 3 months of MM (corresponding date was index date)...
October 2017: Diabetes Educator
https://www.readbyqxmd.com/read/28792170/consensus-on-basal-insulin-in-the-management-of-type-2-diabetes-which-when-and-how
#12
Samit Ghosal, Binayak Sinha, Anirban Majumder, Ashok Kumar Das, Awadhesh Kumar Singh, Biswajit Ghoshdastidar, Debasish Maji, Ghanshyam Goyal, Jagat Jyoti Mukherjee, Kalyan Kumar Gangopadhyay, Mathew John, Sanjay Chatterjee, Shalini Jaggi, Subir Ray, Sujoy Majumdar, Surendra Kumar Sharma
INTRODUCTION: Type 2 diabetes mellitus (T2DM) has attained epidemic proportions and continues to increase despite the availability of a number of oral antidiabetic medications and major advances made in insulin delivery since its discovery nearly a hundred years ago. One, amongst many other reasons responsible for the inability to achieve adequate glycaemic control in a substantial proportion of T2DM patients is the delayed initiation and inappropriate intensification of insulin treatment...
July 2017: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/28754263/clinical-inertia-and-its-impact-on-treatment-intensification-in-people-with-type-2-diabetes-mellitus
#13
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/28712978/local-radiotherapy-intensification-for-locally-advanced-non-small-cell-lung-cancer-a-call-to-arms
#14
REVIEW
Noah S Kalman, Elisabeth Weiss, Paul R Walker, Julian G Rosenman
Chemoradiotherapy, the standard of care for locally advanced non-small-cell lung cancer (NSCLC), often fails to eradicate all known disease. Despite advances in chemotherapeutic regimens, locally advanced NSCLC remains a difficult disease to treat, and locoregional failure remains common. Improved radiographic detection can identify patients at significant risk of locoregional failure after definitive treatment, and newer methods of escalating locoregional treatment may allow for improvements in locoregional control with acceptable toxicity...
June 16, 2017: Clinical Lung Cancer
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
#15
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/28689692/patient-and-provider-factors-affecting-clinical-inertia-in-patients-with-type-2-diabetes-on-metformin-monotherapy
#16
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/28671150/emerging-trends-of-nosocomial-pneumonia-in-intensive-care-unit-of-a-tertiary-care-public-teaching-hospital-in-western-india
#17
Rakesh Bhadade, Minal Harde, Rosemarie deSouza, Ashwini More, Ramesh Bharmal
BACKGROUND: Nosocomial pneumonia poses great challenge to an intensivist. Detailed information about hospital-acquired pneumonia (HAP) and ventilator-acquired pneumonia (VAP) is crucial for prevention and optimal management, thus improving quality Intensive Care Unit (ICU) care. Hence, we aimed to study the current trend of nosocomial pneumonia in ICU. MATERIALS AND METHODS: It was a prospective observational cohort study, conducted in the ICU of a tertiary care teaching public hospital over a period of 18 months...
July 2017: Annals of African Medicine
https://www.readbyqxmd.com/read/28656746/therapeutic-inertia-in-patients-treated-with-two-or-more-antidiabetics-in-primary-care-factors-predicting-intensification-of-treatment
#18
Manel Mata-Cases, Josep Franch-Nadal, Jordi Real, Mònica Gratacòs, Flora López-Simarro, Kamlesh Khunti, Dídac Mauricio
AIMS: To determine the patterns and predictors of treatment intensification in patients with type 2 diabetes on ≥2 non-insulin antidiabetic drugs (NIADs) and inadequate glycemic control in primary care in Catalonia, Spain. MATERIAL AND METHODS: Retrospective analysis using electronic medical records from patients with HbA1c ≥7% and a first prescription for a new NIAD or insulin recorded from January 2010 to December 2014. Therapeutic inertia was defined as no intensification if HbA1c ≥8% at baseline or during follow-up...
June 28, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28648964/factors-associated-with-prolonged-inaction-in-the-hypoglycaemic-treatment-in-people-with-non-insulin-dependent-type-2-diabetes-and-elevated-glycated-haemoglobin-a-registry-based-cohort-study
#19
Geert Goderis, Bert Vaes, Marjan Van den Akker, Steven Elli, Chantal Mathieu, Frank Buntinx, Séverine Henrard
AIMS: To assess factors associated with Prolonged Inaction (PI) in insulin-naïve patients with Type 2 Diabetes Mellitus (T2DM). PI was defined as the absence of treatment initiation or intensification for ≥12 months despite HbA1c >7% (53mmol/mol). METHODS: A retrospective cohort study was conducted based on data from Intego, a Flemish General Practice registry. The study period ranged from January 1, 2006 to December 31, 2013. Patients with insulin therapy before the start of the study period were excluded from the analysis...
June 22, 2017: Primary Care Diabetes
https://www.readbyqxmd.com/read/28618915/coronary-artery-disease-risk-stratification-and-patient-selection-for-more-aggressive-secondary-prevention
#20
François Schiele, Fiona Ecarnot, Romain Chopard
In patients with stable coronary artery disease, clinical outcomes are predominantly characterized by the consequences of atherosclerosis on the myocardium, but also by complications of atherosclerosis, notably recurrent acute coronary syndrome or stroke. Secondary prevention therapy is therefore key in this patient population. Intensification of secondary prevention therapy is possible, at the price of a therapeutic risk or a high cost, therefore justifying careful selection of patients with a high residual risk and low therapeutic risk...
June 2017: European Journal of Preventive Cardiology
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