Clinical Inertia

Clinical practice guidelines were initially developed within the context of evidence-based medicine with the goal of putting medical research findings into practice. However, physicians do not always follow them, even when they seem to apply to the particular patient they have to treat. This phenomenon, known as clinical inertia, represents a significant obstacle to the efficiency of care and a major public health problem, the extent of which is demonstrated in this book. An analysis of its causes shows that it stems from a discrepancy between the objective, essentially statistical nature of evidence-based medicine on the one hand and the physician’s own complex, subjective view (referred to here as “medical reason”) on the other. This book proposes a critique of medical reason that may help to reconcile the principles of evidence-based medicine and individual practice. The author is a diabetologist and Professor of Endocrinology, Diabetology and Metabolic Diseases at Paris 13 University. He has authored several books, including one to be published by Springer (Philosophy and Medicine series) under the title: The Mental Mechanisms of Patient Adherence to Long Term Therapies, Mind and Care. , Diabetology and Metabolic Diseases at the Paris 13-University. He has also published Pourquoi Se soigne-t-on, Enquête sur la rationalité morale de l’observance (2007), Clinique de l’Observance, L’Exemple des diabètes (2006), and Une théorie du soin, Souci et amour face à la maladie (2010). An English adaptation of the first book is published by Springer (Philosophy and Medicine) under the title: The Mental Mechanisms of Patient Adherence to Long Term Therapies, Mind and Care.

v. 1. Research findings -- v. 2. Concepts and methodology -- v. 3. Implementation issues -- v. 4. Programs, tools and products.

For over 30 years, the stepped care approach has been used in the management and treatment of hypertension. This approach advocates the use of initial monotherapy to reach the desired blood pressure, and the subsequent use of additional drugs with complementary modes of action, until the target BP is achieved. However, current control rates for hypertension suggest that such an approach may be outdated and no longer effective in the management of hypertension. Clinical trials have shown that more than 50% of patients require a combination of drug therapies to achieve their target BP. Some proponents of combination therapy have argued that the risk of adverse side effects and non-compliance will be lower than that compared to monotherapy, which initially requires higher doses to be administered to be effective. Consequently, there have been increasing calls of the necessity for a much more combined approach in the treatment of hypertension. Adding to this, Combination Therapy in Hypertension will cover current control rates of blood pressure worldwide, the benefits of monotherapy and combination therapy, examine the effectiveness, risk of adverse effects, compliance, and cost of the available therapies and will also include information on relevant outcome studies.

Healthcare information technologies are now routinely deployed in a variety of healthcare contexts. These contexts differ widely, but the smooth integration of IT systems is crucial, so the design, implementation, and evaluation of safe, effective, efficient and easy to adopt health informatics involves careful consideration of both human and organizational factors. This book presents the proceedings of the Context Sensitive Health Informatics (CSHI) conference, held in Copenhagen, Denmark, in August 2013. The theme of this year’s conference is human and sociotechnical approaches. The Human Factors approach is distinctly design-driven and aims to optimize performance, safety and users’ sense of well-being associated with their use of a system through the application of user-centered systems design and evaluation. The papers and presentations included here are grouped under the topics: patients and IT; usability test and evaluation; work tasks and related contexts; human factors and simulation; and context and systems design, and outline theories and models for studying contextual issues and insights related to how health information technologies can be better designed to accommodate different healthcare contexts. Healthcare organizations, health policy makers and regulatory bodies globally are starting to acknowledge this essential role of human and organizational factors for safe and effective health information technology. This book will be of interest to all those involved in improving the quality of healthcare worldwide.

Diabetes has become a worldwide health problem, the global estimated prevalence approaches ten percent and the burden of this disease in terms of morbidity and mortality is unprecedented. The advances acquired through the knowledge of the mechanisms of the disease and the variety of therapeutic approaches contrast with the inability of private and public health systems in underdeveloped and even developed countries to achieve the goals of treatment. This paradox has been described in many sources: the surge of scientific advances contrast with an unprecedented amount of human suffering. Thus, a patient centered and an evidence based approach with the capacity to produce measurable clinical and economic outcomes is required. The purpose of this textbook is multiple: to offer a comprehensive resource covering all aspects of outpatient management; to address diabetes as a health problem from an epidemiological, economic and clinical perspective; to discuss the role of social determinants of health on the worldwide increase in diabetes; to highlight the challenges and obstacles in providing adequate care; and to outline a multidisciplinary approach to management in which medical visits retain their importance as part of a team comprising the patient, his or her family and a multidisciplinary group of health professionals who are able to move beyond the traditional approach of diabetes as a disease and greatly improve outcomes.

In this issue of Critical Care Nursing Clinics, guest editor and Heart Failure and Valve Coordinator Nicole Jones, APRN, CNS, brings her considerable expertise to the topic of Heart Failure and Transcatheter Aortic Valve Replacement. Critical care nurses are vital to improving patient outcomes and the delivery of quality care in patients with heart failure, including recent emphases on the in-patient admission, faster diagnosis of acute or decompensated heart failure, in-patient management in an appropriate care environment, and planned discharge. In this issue, top experts in the field provide current updates in both the clinical care of the heart failure patient as well as nursing interventions to improve outcomes. Contains 12 relevant, practice-oriented topics including patient symptom perceptions and lay consultations prior to hospitalization with HF and how clinicians can improve care; barriers to heart failure treatment optimization; the role of telemedicine in improving GDMT for heart failure patients during a pandemic; nurse-led anesthesia for TAVR or other TAVR patient care improvements; TAVR efficiency/screening and care pathways for improving efficiency while maintaining outcomes; and more. Provides in-depth clinical reviews on heart failure and transcatheter aortic valve replacement, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

In the past few decades a revolution in our approach to treating type 2 diabetes has occurred following the recognition that the condition is caused by multiple defects. A range of new treatments are now available, with many more forthcoming, utilising differing mechanisms of action that allow targeted and more effective therapy of this multifactorial disease than ever before. The increasing requirement in the UK to move much of diabetes practice into the community requires much more detailed knowledge of the condition by GPs and practice nurses. In this bespoke book, the authors aim to show how new mechanisms of glucose control and advances in treatments arising from this can tailor treatment to the individual in primary care. This book incorporates the recently published ADA/EASD guidelines and the 2015 update from the National Institute for Health and Clinical Excellence (NICE). Essential reading for the multi-professional diabetes care team, this book should also be of interest to hospital specialists in training.

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