Postgraduate medicine
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Postgraduate medicine · May 2014
Randomized Controlled Trial Comparative StudyThe impact of weight loss on weight-related quality of life and health satisfaction: results from a trial comparing canagliflozin with sitagliptin in triple therapy among people with type 2 diabetes.
Type 2 diabetes mellitus (T2DM) is primarily a self-managed disease in which self-care behaviors play an important role in achieving optimal outcomes. Because self-care does not result in immediate tangible or noticeable benefits, adherence to such a regimen can be confusing, difficult, and frustrating. ⋯ In this study, we explored the impact of the average weight loss amount demonstrated with canagliflozin treatment on improvement in 3 patient-relevant outcomes that have been linked to performance of healthy behaviors and better outcomes in T2DM: weight-related quality of life, as measured by the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire, and satisfaction with physical health and emotional health, as measured by the Current Health Satisfaction Questionnaire (CHES-Q), using data from a previously reported study. Weight loss of an amount demonstrated in clinical trials of canagliflozin was associated with improvements in weight-related quality of life and satisfaction with physical and emotional health, concepts shown to be important to the persistent and consistent performance of healthy behaviors.
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Postgraduate medicine · May 2014
Clinical TrialComparison of midazolam and propofol for sedation in pediatric diagnostic imaging studies.
This study aims to compare the efficacy of propofol and midazolam in terms of adverse effect potentials and to determine the appropriate strategy for pediatric procedural sedation. ⋯ Propofol seems to be more effective, achieve the appropriate sedation level more quickly, and provide a faster onset of sedation than midazolam in pediatric procedural sedation and analgesia. Propofol is preferred for imaging studies (computed tomography and magnetic resonance imaging) to reduce the occurrence of undesired motion artefacts. Although both drugs are safe to use for sedation before pediatric imaging procedures, propofol is preferred with appropriate preparation.
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Postgraduate medicine · May 2014
Safety and tolerability of canagliflozin in patients with type 2 diabetes mellitus: pooled analysis of phase 3 study results.
Canagliflozin is a sodium glucose cotransporter 2 inhibitor developed for treating type 2 diabetes mellitus (T2DM). ⋯ The safety/tolerability profile of canagliflozin 100 and 300 mg over 26 weeks was assessed using an integrated analysis of data pooled from 4 placebo-controlled, phase 3 studies representing a broad range of patients with T2DM (N = 2313; mean age, 56.0 years; glycated hemoglobin [HbA1c], 8.0%; body mass index, 32.1 kg/m2; estimated glomerular filtration rate, 88.1 mL/min/1.73 m2) on various prespecified background diabetes mellitus treatments. Safety/tolerability evaluations included adverse event (AE) reporting, with additional data collection prespecified for selected AEs, and assessments of renal-related, lipid, and other safety laboratory parameters.
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Postgraduate medicine · May 2014
Health care provider management of patients with type 2 diabetes mellitus: analysis of trends in attitudes and practices.
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. ⋯ 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.
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Postgraduate medicine · May 2014
Physician adherence to ACR gout treatment guidelines: perception versus practice.
In October 2012, the American College of Rheumatology (ACR) published recommendations for chronic gout treatment goals and pharmacotherapy. ⋯ Although adherence with ACR guidelines is higher among rheumatologists than PCPs in treating patients with gout, overall adherence could be improved by both specialties.