Journal of evaluation in clinical practice
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Clinical inertia, defined as a delay in treatment intensification, is prevalent in people with diabetes. Treatment intensification rates are as low as 37.1% in people with haemoglobin A1c (HbA1c) values >7%. Intensification by addition of medication therapy may take 1.6 to more than 7 years. Clinical inertia increases the risk of cardiovascular events. The primary objective was to evaluate rates of clinical inertia in people whose diabetes is managed by both pharmacists and primary care providers (PCPs). Secondary objectives included characterizing types of treatment intensification, HbA1c reduction, and time between treatment intensifications. ⋯ Pharmacist involvement in diabetes management may reduce the clinical inertia patients may otherwise experience in the primary care setting.
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Little is known about which medical providers, other than neurologists, are involved in the care of neurologic conditions. We aimed to describe the current distribution of outpatient neurologic care by provider type. ⋯ PCPs perform more neurologic visits than neurologists. With the anticipated increased demand for neurologic care, strategies to optimize neurologic care delivery could consider expanding access to neurologists as well as supporting PCP care for neurologic conditions.
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Non-adherence is a major problem among patients with chronic diseases. Community pharmacists are ideally positioned to detect non-adherence and to provide patient-centred interventions. ⋯ Pharmacist-led intervention can improve LLM adherence, but its influence on clinical outcomes, including lipid level control, remains to be clarified.
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Clinical reasoning lies at the heart of medical practice and has a long research tradition. Nevertheless, research is scattered across diverse academic disciplines with different research traditions in a wide range of scientific journals. This polyphony is a source of conceptual confusion. ⋯ Our work seeks to bring into awareness implicit assumptions of the ongoing clinical reasoning research and to hopefully open much needed channels of communication between the different research communities involved in clinical reasoning research in the field.
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As the recent literature has growing concerns about research replicability and the misuse and misconception of P-values, the fragility index (FI) has been an attractive measure to assess the robustness (or fragility) of clinical study results with binary outcomes. It is defined as the minimum number of event status modifications that can alter a study result's statistical significance (or non-significance). Owing to its intuitive concept, the FI has been applied to assess the fragility of clinical studies of various specialties. However, the FI may be limited in certain settings. As a relatively new measure, more work is needed to examine its properties. ⋯ Our findings may help clinicians properly use the FI and appraise the reliability of a study's conclusion.