Abstract:
BACKGROUND:In October 2012, the American College of Rheumatology (ACR) published recommendations for chronic gout treatment goals and pharmacotherapy. OBJECTIVES:Identify potential gaps between real-world chronic gout treatment, ACR guideline recommendations, and physicians' perceived guideline adherence by evaluating records of patients classified as having "higher" and "lower" guideline adherence as defined by the investigators. METHODS:A comprehensive quantitative survey was administered between February 11 and February 22, 2013, to physicians treating patients with gout; the survey included a patient record chart review informed by prior qualitative interviews. Eight criteria from the ACR gout management guidelines were used to compose the survey. To assess ACR guideline adherence, information from records of patients with chronic gout treated by primary care physicians (PCPs) and rheumatologists was scored from 0 (no adherence) to 8 (total adherence), in accordance with ACR guideline recommendations. Physicians also indicated how closely they believed patient treatment followed current guidelines on a 10-point scale. RESULTS:Of the 350 records of patients with chronic gout, all but 3 PCP patients were adherent on ≥ 1 guideline recommendation, but nearly all patients could be considered nonadherent, considering all potential recommendations. Patients with chronic gout treated by rheumatologists tended to be managed more closely to ACR guidelines than patients treated by PCPs (mean scores: rheumatologists 5.8/8 ± 1.7 vs 4.3/8 ± 1.7 for PCPs). Among patients classified as having "higher adherence" based on adherence scores, there was low adherence on first-line urate lowering therapy dose, acute prophylaxis dosing, and length of prophylaxis treatment. Among PCPs and rheumatologists, there was a disparity between how closely physicians believed patient treatment followed guidelines and actual adherence with ACR guidelines based on adherence scores. For 16.4% of patients treated by PCPs and 18.4% of patients seen by rheumatologists, physicians believed they closely followed ACR guidelines (score of 8-10/10) for each patient; but in actuality, adherence was lower. CONCLUSION:Although adherence with ACR guidelines is higher among rheumatologists than PCPs in treating patients with gout, overall adherence could be improved by both specialties.
journal_name
Postgrad Medjournal_title
Postgraduate medicineauthors
Oderda GM,Shiozawa A,Walsh M,Hess K,Brixner DI,Feehan M,Akhras Kdoi
10.3810/pgm.2014.05.2774subject
Has Abstractpub_date
2014-05-01 00:00:00pages
257-67issue
3eissn
0032-5481issn
1941-9260journal_volume
126pub_type
杂志文章abstract::Our review describes potential weight-altering effects of psychotropic medications (antipsychotics, antidepressants, anti-anxiety medications, mood stabilizers, sedative-hypnotics, medications for attention-deficit/hyperactivity disorder, and other psychotropic medications) and offers guidance on switching a medicatio...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2013.09.2706
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abstract::Physicians must be alert to the possibility of abuse within the family and home. They should be well prepared to help victims begin the transition to a safer environment. An awareness of the prevalence of abuse and a high index of suspicion are the most effective clinical tools for assisting victims of domestic violen...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1996.07.11
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abstract::Extracorporeal shock wave lithotripsy has become a valuable asset to the urologist and greatly benefits urologic stone patients. Eight years of clinical use have proven its clinical efficacy, with more than 400,000 successfully performed treatments worldwide. In a short period of time, ESWL has completely changed the ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1988.11700265
更新日期:1988-05-01 00:00:00
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journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2016.1120642
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abstract::Bulimia nervosa is a common eating disorder among women. Sociocultural and interpersonal pressures are thought to be highly influential in the development of the syndrome. An association with depression has also been suggested. Recognizing bulimia nervosa is usually difficult, because patients are hesitant to reveal t...
journal_title:Postgraduate medicine
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doi:10.1080/00325481.1988.11700368
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journal_title:Postgraduate medicine
pub_type: 杂志文章
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journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
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journal_title:Postgraduate medicine
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doi:10.1080/00325481.1981.11715861
更新日期:1981-09-01 00:00:00
abstract::Legg-Calvé-Perthes disease affects children, mostly boys, in the age range of 3 to 12 years. Severity and duration are quite variable. Catterall's classification of disease according to degree of femoral head involvement is of real prognostic value. Other factors of prognostic importance are loss of motion, metaphysea...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1976.11714449
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journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
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更新日期:1994-10-01 00:00:00
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journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1995-03-01 00:00:00
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pub_type: 杂志文章,评审
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journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1985.11698879
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pub_type: 杂志文章
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pub_type: 杂志文章,评审
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更新日期:1999-09-01 00:00:00
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journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1991.11700843
更新日期:1991-02-15 00:00:00
abstract::Review of: Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Eng J Med 2009; 361(11): 1045-1057. For acute coronary syndrome (ACS), a dual antiplatelet regimen comprised of treatment with aspirin and either P2Y12 adenosine diphosphate receptor antagonist...
journal_title:Postgraduate medicine
pub_type: 评论,杂志文章
doi:10.1080/00325481.2016.1118351
更新日期:2016-01-01 00:00:00
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doi:10.3810/pgm.09.2004.suppl34.206
更新日期:2004-09-01 00:00:00
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journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1979.11715218
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doi:10.1080/00325481.1995.11946003
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journal_title:Postgraduate medicine
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journal_title:Postgraduate medicine
pub_type: 杂志文章
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更新日期:1986-04-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:1980-09-01 00:00:00
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journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1985.11698867
更新日期:1985-02-01 00:00:00
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journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1983.11698326
更新日期:1983-01-01 00:00:00
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journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-12-01 00:00:00
abstract::Use of "designer drugs" has created a new dilemma for physicians. Generally, it is possible to recognize symptoms and signs of intoxication that fit a specific class of substances, such as amphetamine-like effects for the phenylethylamines and opioid effects for the fentanyl analogues. Designer compounds have crossed ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
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更新日期:1991-05-01 00:00:00