China
Africa
Explore chapters and articles related to this topic
Disenchantment with current pain management
Published in Stephen Buetow, Rethinking Pain in Person-Centred Health Care, 2020
In restricting professional autonomy, the development of clinical guidelines and standardized protocols for pain management, including opioid prescribing and monitoring,22 has done nothing to alleviate this problem. Push-back from clinicians can take place through clinical inertia23 or therapeutic inertia as “the failure to initiate or intensify therapy in a timely manner according to evidence-based clinical guidelines.”24 However, therapeutic inertia can also signify a state of creative inertia in the context of the impulse of modern health systems to continue to look to innovations in science and technology to furnish freedom from pain.
Adiposity-based Chronic Disease a New Diagnostic Term
Published in James M. Rippe, Lifestyle Medicine, 2019
Michael G. Flynn, Krauss Jeffrey
The growing and worldwide epidemic of obesity is among the highest intervention priorities in health care. A number of important lifestyle factors have been identified in addition to the individualization of dietary patterns and physical activity. Unfortunately, a slow rate of success coupled with therapeutic inertia on local and national scales require new ways to regard the problem. ABCD is a new diagnostic term that incorporates not only body weight and BMI, which is all that current obesity definitions and interventions rely on, but also healthy and unhealthy distributions and secretory functions of body fat. This broader conceptualization of this metabolic problem permits a better understanding of pathophysiology, analysis of current evidence, and formulation of effective interventions. Future directions in this field may yield the incorporation of body scanning for adipose distribution assessment and broad molecular testing to identify multiple adipokine abnormalities in the pathologic state of ABCD.1
2018 ESC/ESH Guidelines for the Management of Arterial Hypertension
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
Bryan Williams, Giuseppe Mancia, Wilko Spiering, Enrico Agabiti Rosei, Michel Azizi, Michel Burnier, Denis L. Clement, Antonio Coca, Giovanni de Simone, Anna F. Dominiczak, Thomas Kahan, Felix Mahfoud, Josep Redon, Luis M. Ruilope, Alberto Zanchetti, Mary Kerins, Sverre E. Kjeldsen, Reinhold Kreutz, Stéphane Laurent, Gregory Y.H. Lip, Richard McManus, Krzysztof Narkiewicz, Frank Ruschitzka, Roland E. Schmieder, Evgeny Shlyakhto, Konstantinos P. Tsioufis, Victor Aboyans, Ileana Desormais
Although no RCT has compared major cardiovascular outcomes between initial combination therapy and monotherapy, observational evidence suggests that the time taken to achieve BP control is an important determinant of clinical outcomes, especially in higher risk patients, with a shorter time to control associated with lower risk [344]. Furthermore, there is evidence from the more general hypertensive population that, compared with patients on initial monotherapy, those who start treatment with a two-drug combination exhibit more frequent BP control after 1 year [341,345]. This is probably because initial combination treatment is associated with a better long-term adherence to the prescribed treatment regimen [346] and because initial two-drug administration prevents therapeutic inertia (i.e. reluctance or failure to upgrade treatment from one to more drugs when BP is uncontrolled) [347]. Studies from very large hypertension cohorts in usual care have shown that initial combination treatment results in reduced treatment discontinuation and a lower risk of cardiovascular events than initial monotherapy followed by the traditional stepped-care approach [312,346]. The usual-care settings for these studies may be especially relevant to study the true impact of treatment strategies on adherence and therapeutic inertia, because this can be difficult to replicate in a conventional RCT in which the motivation of the clinical staff and patients, and the monitoring of treatment, are very different from usual care. In this regard, the outcome of these real-life studies of the impact of initial combination therapy on adherence, BP control, and cardiovascular outcomes may be especially relevant [348].
Hierarchical modeling of blood pressure determinants and outcomes following valsartan treatment in hypertensive patients with known comorbidities: pooled analysis of six prospective real-world studies including 11,999 patients
Published in Current Medical Research and Opinion, 2021
Nimer Alkhatib, Diana Sun, Kris Denhaerynck, Dina Hamarneh, Yoleen Van Camp, Lorenzo Villa, Heidi Brié, Stefaan Vancayzeele, Karen MacDonald, Ivo Abraham
Patients seen by the same physician are affected by that particular physician’s knowledge, experience and practice patterns, among other factors. This was evident from the proportions of variance in BP values at ∼90 days attributable to a physician class effect: 22% for SBP and 25% for DBP – with the remaining 78% and 75% attributable to variation in patients. At the physician level, number of years in practice was consistently associated with worse BP outcomes. This possibly indicates that younger physicians are more likely to intensify therapy when observing poor BP outcomes. In contrast, older colleagues may exhibit therapeutic inertia12: failure to initiate or intensify BP therapy when indicated due to overestimation of the care provided, use of “soft” reasons to avoid intensification of therapy, and lack of education, training and practice organization aimed at achieving therapeutic goals13. However, Redon et al. have argued that factors explaining therapeutic inertia are not completely understood14.
Real-world outcomes of treatment with insulin glargine 300 U/mL versus standard-of-care in people with uncontrolled type 2 diabetes mellitus
Published in Current Medical Research and Opinion, 2020
Nick Freemantle, Didac Mauricio, Andrea Giaccari, Timothy Bailey, Ronan Roussel, Denise Franco, Baptiste Berthou, Valerie Pilorget, Jukka Westerbacka, Zsolt Bosnyak, Mireille Bonnemaire, Anna M. G. Cali, My-Liên Nguyên-Pascal, Alfred Penfornis, Manuel Perez-Maraver, Jochen Seufert, Sean D. Sullivan, John Wilding, Carol Wysham, Melanie Davies
Therapeutic inertia is a global unmet medical need, one that the ADA and EASD are seeking to address in their recent consensus report. In both REACH and REGAIN, no differences in glycemic control or hypoglycemia outcomes were seen between treatment arms over 12 months. However, the suboptimal basal insulin titration seen in both trials reflects considerable therapeutic inertia, limiting the ability to compare outcomes between the newer basal insulin (Gla-300) and SoC basal insulin arms. Results from REACH and REGAIN show that, in addition to appropriate insulin therapy, more dedicated basal insulin titration support using evidence-based algorithms may be required for patients and healthcare providers in order to help patients with uncontrolled T2DM to achieve glycemic targets. These studies also highlight the importance of appropriate patient selection and treatment. Appropriate titration of Gla-300 and other second-generation basal insulin analogues may be required to realize their potential clinical benefits of decreasing the risk of hypoglycemia versus older basal insulins.
Dyslipidaemia in the elderly: to treat or not to treat?
Published in Expert Review of Clinical Pharmacology, 2018
Niki Katsiki, Genovefa Kolovou, Pablo Perez-Martinez, Dimitri P. Mikhailidis
Therapeutic inertia refers to the situation when, although therapeutic targets based on clinical guidelines are not attained, physicians fail to modify treatment (either initiation or intensification of drug therapy), with the patients remaining untreated or undertreated [276]. Therapeutic inertia represents an important factor that hampers the treatment of CVD risk factors including hypertension, dyslipidemia, and T2DM [277–279]. Especially in the elderly population, physicians may be more reluctant to initiate or intensify drug therapies due to the fear of side effects. Greater clinical inertia leads to poorer outcomes in terms of morbidity and mortality as well as to increased costs [280,281]. Such clinical practice may significantly increase the risk of CVD in both primary and secondary prevention settings [281,282]. Only one study evaluated therapeutic inertia in terms of blood pressure control in the elderly [283]. Further research is needed in this field.