Abstract:
OBJECTIVE:To identify attitudes and practices of endocrinologists (ENDOs), family practitioners (FPs), internists (IMs), primary care nurse practitioners (NPs), physician assistants (PAs), certified diabetes educators (CDEs), retail pharmacists (R-PHs), and hospital pharmacists (H-PHs) with respect to type 2 diabetes mellitus (T2DM) management; to compare current study data with results from a similar 2011 study. METHODS:A nominal group technique focus group identified barriers to optimal management of patients with T2DM. Five case-vignette surveys were created, 1 for each group of health care professionals (HCPs): ENDOs; FPs and IMs; NPs and PAs; CDEs; and R-PHs and H-PHs. Surveys were tailored to each group. Versions were as similar as possible to each other and to the 2011 surveys to facilitate comparisons. Questions assessed guideline familiarity; knowledge of insulin formulations, glucagon-like peptide-1 (GLP-1) receptor agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors; patterns of referral to ENDOs and CDEs; as well as cultural barriers and communication barriers. Surveys were distributed by e-mail/fax to a nationally representative, random sample of US HCPs during January and February 2013. RESULTS AND CONCLUSIONS:Notable shifts from 2011 included NPs' increased familiarity with American Diabetes Association (ADA) guidelines; FPs, IMs, NPs, and PAs continued comfort with prescribing long-acting basal insulin but less with basal-bolus, Neutral Protamine Hagedorn insulin alone, or human premixed insulin; increased pharmacists' comfort in discussing long-acting basal insulin; increased likelihood that FPs will refer patients with recurrent hypoglycemia unable to achieve target glycated hemoglobin level to an ENDO; and continued incorporation of insulin and incretins into treatment regimens. The trends suggest gaps in perception, knowledge, and management practices to be addressed by education. Most HCPs lack confidence in using insulin regimens more complex than long-acting insulin alone. All providers need education on T2DM management guidelines, differences between GLP-1 agonists and DPP-4 inhibitors, and how to intensify therapy for patients not reaching goal blood glycemic level with use of multiple agents. Pharmacists might benefit from education on glycemic treatment goals.
journal_name
Postgrad Medjournal_title
Postgraduate medicineauthors
Williamson C,Glauser TA,Burton BS,Schneider D,Dubois AM,Patel Ddoi
10.3810/pgm.2014.05.2764subject
Has Abstractpub_date
2014-05-01 00:00:00pages
145-60issue
3eissn
0032-5481issn
1941-9260journal_volume
126pub_type
杂志文章abstract::Contrary to popular belief, hypoglycemia is an infrequently encountered condition and its presence is questionable until confirmed by appropriate tests. In ambulatory patients, blood glucose levels obtained during intake of a normal diet are more reliable than those obtained during a glucose tolerance test. If the blo...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1987.11700028
更新日期:1987-11-01 00:00:00
abstract:OBJECTIVE:This study aims to compare the effectiveness of insulin glargine 300 U/mL (Gla-300) with its accompanying patient support program with that of other basal insulin and available patient support programs in patients with type 2 diabetes (T2D) in a real-world setting in terms of achieving HEDIS (Healthcare Effec...
journal_title:Postgraduate medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1080/00325481.2016.1241663
更新日期:2016-11-01 00:00:00
abstract::Common variable immunodeficiency (CVID) is readily considered in patients presenting with recurrent sino-pulmonary infections, however this disease has a broad range of clinical manifestations and diagnosis can be delayed by several years. We present the case of a 44-year-old postpartum female who presented with nause...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2016.1199250
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:To describe the efficacy and safety of adjunctive aripiprazole, olanzapine, and quetiapine for major depressive disorder. DATA SOURCES:Published registration study reports, supplemented by clinical trial synopses as disclosed by manufacturers and product labeling. STUDY SELECTION:All available reports of st...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2010.07.2174
更新日期:2010-07-01 00:00:00
abstract::Anemia of chronic disease (ACD) is a prevalent condition commonly observed in patients with chronic infections, cancer, trauma, and inflammatory disorders. In this article, Dr Andrews examines new research findings that enhance the understanding of the pathophysiologic mechanisms of ACD. After a brief review of iron h...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.11.2004.suppl36.250
更新日期:2004-11-01 00:00:00
abstract::The chronic pain syndrome differs from chronic pain. The syndrome is a psychologic stress state that can produce physical-type illness, often with musculoskeletal manifestations. It tends to strike the "worried well," by nature hysterical, depressed, hypochondriacal, and dependent. Standard medical, surgical, and psyc...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1981.11715917
更新日期:1981-11-01 00:00:00
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
pub_type: 杂志文章
doi:10.1080/00325481.1988.11700368
更新日期:1988-08-01 00:00:00
abstract::Throughout history, societies have circumscribed certain forms of intimacy in the family setting. Transgression has been punished by force of ecclesiastical rules and government statutes. However, no single definition of incest is widely accepted, as the degree of kinship in which marriage is allowed and the age of co...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1989.11700738
更新日期:1989-06-01 00:00:00
abstract::Rheumatoid arthritis can cause joint erosion and deformity, pain, stiffness, and decreased function and range of motion. Early diagnosis is crucial to prevent permanent joint damage. In this article, Drs Williams and Fye discuss articular and extra-articular manifestations of rheumatoid arthritis as well as the evolvi...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2003.11.1525
更新日期:2003-11-01 00:00:00
abstract::Farming is a dangerous life-style and occupation for children and adults. Dangerous situations are taken in stride and considered part of life on a family farm. Regulatory and educational programs and funding have been minimal in the United States. Physicians have been a major force in accident-prevention efforts in o...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1991.11701013
更新日期:1991-08-01 00:00:00
abstract:BACKGROUND:Point-of-care testing (POCT) is widely used to measure blood glucose levels in people with diabetes, although its use in measuring glycated hemoglobin (HbA1c) levels is less common, perhaps due to perceived performance issues and access to the technology. METHODS:Forty blood samples were analyzed in duplica...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2013.05.2664
更新日期:2013-05-01 00:00:00
abstract::As sex, drugs, and rock 'n' roll have given way to STDs, HIV, and AIDS, adolescent sex has become an increasingly high-risk behavior. Dr Kay strongly believes that primary care physicians can have a prominent role in educating teens and their parents about the consequences of premature sexual activity and in promoting...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1995-06-01 00:00:00
abstract::Human sexuality is a lifelong process with biologic, psychosocial, and moral consequences. During adolescence, coping with sexual feelings and controlling sexual drive become urgent tasks that are made more difficult by today's society. Recent studies document a dramatic increase in the frequency of sexual activity am...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1982.11716039
更新日期:1982-04-01 00:00:00
abstract::Patients with protracted depression respond well to long-term maintenance antidepressant therapy. A precise diagnosis is a prerequisite to therapeutic decisions. Diagnosis may be missed and treatment inadequate if symptoms are attributed solely to aging or to life's circumstances. Proper dosage is determined by the pa...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1989.11700579
更新日期:1989-02-01 00:00:00
abstract::Even modest alcohol ingestion can increase the risk of steatosis, and long-term, excessive consumption can lead to alcoholic hepatitis and eventually cirrhosis. Most patients with clinically significant alcoholic liver disease have histologic findings typical of all three conditions. The only clearly beneficial treatm...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1998.04.462
更新日期:1998-04-01 00:00:00
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journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2017.1292107
更新日期:2017-05-01 00:00:00
abstract::Primary care physicians play a pivotal role in the early identification of patients with COPD. Early diagnosis, along with aggressive intervention, is the only way that the increasing morbidity and mortality of COPD can be reversed. Any patient with a history of smoking should undergo evaluation for the possibility of...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2002.06.1225
更新日期:2002-06-01 00:00:00
abstract::Views and clinical practice on hormone replacement therapy (HRT) for postmenopausal women have varied widely over the last several decades. The 1990s showed a dramatic decline in prescribing and only recently are prescription rates increasing again. Use of HRT is first line for women suffering from the symptoms of men...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2017.1334507
更新日期:2017-08-01 00:00:00
abstract::Systolic dysfunction of the heart represents a state of "prerenal" azotemia, in which the excess of total body salt and water is redistributed to venous and interstitial fluid compartments. This results in a diminished effective circulating blood volume and thereby decreases tissue perfusion. The kidneys perceive the ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-06-01 00:00:00
abstract::Because new drugs continue to be developed, physicians treating patients with type 2 diabetes have a wide range of agents from which to choose. The newest class, the thiazolidinediones (TZDs), should be a mainstay of treatment for most patients with type 2 diabetes, because these agents reduce insulin resistance as we...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:2003-05-01 00:00:00
abstract::Stenosis in the right common iliac artery of a 61-year-old man was manifested as pain in the right leg and foot and cyanosis of the second and third toes. Dilatation of the lesion was performed using a Grüntzig catheter; arteriography and measurement of femoral artery pressure confirmed a successful result. The patien...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1980.11715543
更新日期:1980-09-01 00:00:00
abstract::It is often difficult to determine the true extent of a burn, but most small thermal burns can be easily evaluated and managed by primary care physicians. In this article, the authors review the characteristics of different types of burns, describe those that require treatment in a burn center, and discuss appropriate...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1995-05-01 00:00:00
abstract::Preview Management of otitis media in children is a controversial matter: The basic questions of why, in whom, and how it should be treated are undergoing continual reassessment. In this article, Drs Shapiro and Bluestone provide answers to these and other questions, such as Why is treatment of acute otitis media just...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1995.11945992
更新日期:1995-05-01 00:00:00
abstract::Although low-dose oral corticosteroid therapy cannot be considered remittive, it has earned a place in the therapeutic armamentarium for rheumatoid arthritis. Major clinical trials of a group using corticosteroid compared with a control group have not been done since the 1950s. One of these three large trials showed s...
journal_title:Postgraduate medicine
pub_type: 临床试验,杂志文章,评审
doi:10.1080/00325481.1987.11700016
更新日期:1987-10-01 00:00:00
abstract::The esophageal obturator airway is a relatively new addition to equipment for emergency resuscitation. It is simple to use after minimal training and can be inserted quickly without laryngoscopic visualization. Problems are uncommon. ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1980.11715374
更新日期:1980-02-01 00:00:00
abstract::While a wide variety of thyroid function tests are currently available, all are sometimes abnormal in patients without thyroid disease. To interpret test results properly, the clinician needs to be aware of factors altering thyroid function tests. In every instance, the clinician needs to begin by asking whether the p...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1989-04-01 00:00:00
abstract::An exploratory subgroup analysis of a prospective, randomized, double-blind, forced-titration study comparing the efficacy and safety of once-daily olmesartan medoxomil (OM) and losartan potassium (LOS) in patients with stage 1 or stage 2 hypertension is reported. After a 3- to 4-week placebo run-in period, eligible p...
journal_title:Postgraduate medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.3810/pgm.2012.05.2549
更新日期:2012-05-01 00:00:00
abstract::Despite cervical cancer being considered a preventable disease, it still remains the second most common malignancy in women worldwide, with a higher incidence in underdeveloped countries. Human papillomavirus (HPV) is considered the causative agent of cervical cancer. The major mechanisms through which HPV contributes...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2008.11.1928
更新日期:2008-11-01 00:00:00
abstract::Patients "lucky" enough to have a nondisabling transient ischemic attack as a warning sign of impending stroke deserve the best possible prophylactic treatment in an attempt to avert that catastrophe. Dr Edmeads provides a step-by-step discussion of diagnostic studies and therapeutic regimens that help avoid stroke in...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1992.11701427
更新日期:1992-08-01 00:00:00
abstract::Although leprosy is increasing in incidence in the United States, it is confined almost entirely to immigrants from developing countries and their close contacts. While the clinical disease has not changed, leprosy has diffused more widely throughout the United States as a result of migration. Primary care physicians ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1985.11698955
更新日期:1985-04-01 00:00:00