A Guide to Monitoring and Achieving Asthma Control in Children Younger Than 5 Years
Supplement to Consultant for Pediatricians -- September 2009
Supported by an educational grant from AstraZeneca
A Guide to Monitoring and Achieving Asthma Control in Children Younger Than 5 Years
Kevin R. Murphy, MD
Boys Town National Research Hospital
Michael H. Mellon, MD
Southern California Permanente Medical Group
Diagnosing and treating asthma in preschool-aged children is challenging and requires ongoing monitoring of asthma control. Asthma control reflects the degree to which asthma risks, symptoms, and limitations are minimized and goals of therapy are met. Both clinicians and caregivers have a role in monitoring a child's asthma control. The Test for Respiratory and Asthma Control in Kids (TRACK™) is a new validated and easy-to-administer caregiver-completed questionnaire that can be used to aid caregivers and clinicians in evaluating respiratory control in children younger than 5 years with respiratory symptoms consistent with asthma.
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Current Issues in the Management of Type 2 Diabetes
Supplement to Consultant -- July 2009 Vol 49 No 7
Supported by an educational grant from Novo Nordisk, Inc
Current Issues in the Management of Type 2 Diabetes
Steven Edelman, MD
University of California, San Diego
The threat of diabetes looms larger than ever as obesity rates rise because of the availability of low-cost “junk” foods and increasingly sedentary lifestyles. The incidence and prevalence of diabetes are high and rising: recent data indicate that the disease has been diagnosed in 23.6 million people in the United States (7.8% of the population), with 1.6 million new adult cases each year. Despite effective treatments, approximately 44% of patients still fail to achieve the American Diabetes Association target of hemoglobin A1c levels lower than 7%.
The need to educate patients about diabetes risk factors, natural history, and treatment options is thus greater than ever, but at a time when health care providers are increasingly stretched for time and resources. We cannot ignore the fact that while current diabetes treatments can delay the onset and progression of the disease, their limitations may also reduce their acceptability. Novel therapies that address these shortcomings are urgently needed.
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Type 2 Diabetes: Limitations of Current Therapies
Athena Philis-Tsimikas, MD
Scripps Whittier Diabetes Institute, La Jolla, CA
Type 2 diabetes is a chronic disease associated with numerous microvascular and macrovascular complications. It affects millions of persons worldwide, posing an enormous socioeconomic burden. A growing body of evidence shows that comorbidities are greatly reduced when adequate glycemic control is achieved. Unfortunately, despite the variety of therapies currently available, the majority of patients do not achieve glycemic goals. Recent evidence demonstrating that diabetes progression can be stopped or even reversed with early and aggressive intervention, and the advent of therapies that address several of the mechanisms of diabetes pathophysiology, offers much promise for the future. This review article will identify the direct and indirect limitations of current type 2 diabetes therapies, and will explore new ways in which these limitations can be overcome. Novel therapies that address these shortcomings are urgently needed.
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Safety and Effectiveness of Modern Insulin Therapy:
The Value of Insulin Analogs
Stephen Brunton, MD
Cabarrus Family Medicine Residency Program, Charlotte, NC
Great improvements have been made to insulin preparations over the years, including the development of insulin analogs, which were designed to overcome the disadvantages of traditional human insulins in the treatment of type 1 and type 2 diabetes. Insulin analogs more closely mimic the physiological insulin profile and are therefore associated with an improved balance between glycemic control and tolerability. They are also associated with a lower risk of hypoglycemia, less weight gain, and greater treatment flexibility than human insulins. These benefits, in combination with new insulin delivery devices, such as pens, have greatly improved patients’ treatment satisfaction and medication adherence, leading to improvements in clinical outcome. This article reviews the advantages of insulin analogs over human insulin for the treatment of type 1 and type 2 diabetes.
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Addressing Barriers to Timely Intensification of Diabetes Care:
The Relationship Between Clinical Inertia and Patient Behavior
Davida F. Kruger, MSN, APN-BC, BC-ADM
Henry Ford Medical Center, Detroit, MI
Geralyn R. Spollett, MSN, ANP, CDE
Yale University School of Medicine, New Haven, CT
Evidence has shown that effective blood glucose control can reduce long-term diabetes complications, and a plethora of clinical guidelines have recommended glycemic targets. Yet many patients with diabetes have poor glycemic control, which may be caused by a number of factors including clinical inertia: the failure to initiate or augment therapy when it is clinically indicated. This article will examine how health care providers and patients can work together to address the issue of clinical inertia and improve patients’ willingness to accept appropriate
treatment changes.
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Insulin Intensification: A Patient-Centered Approach
Martin J. Abrahamson, MD
Harvard Medical School, Boston, MA
Diabetes mellitus is the most common metabolic abnormality, and the disease is growing at an alarming rate—there are currently an estimated 24 million people living with the condition in the United States. Ninety percent of people with diabetes have type 2 diabetes, which is most often caused by a combination of insulin resistance and β-cell dysfunction. Type 2 diabetes is now seen at all ages, including childhood and adolescence. As a result, physicians typically begin treating patients with diabetes at a younger age and are involved in their care for many years. It is therefore important to understand the natural history of the disease and how best to treat it with the increasing variety of medications that are available.
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Striking the Right Balance: The Residual Risk of Coronary Artery Disease
Supplement to Consultant -- November 2008 Vol 48 No 12
Supported by an educational grant from Abbott Laboratories
CME activity sponsored by The Chatham Institute. Exp Date: November 2009
Striking the Right Balance: The Residual Risk of Coronary Artery Disease
Frank M. Sacks, MD
Harvard School of Public Health
Vera Bittner, MD, MSPH
University of Alabama at Birmingham
David S. Kountz, MD, FACP
Robert Wood Johnson Medical School
Michael Miller, MD, FACC, FAHA
University of Maryland
Elevated low-density lipoprotein cholesterol (LDL-C) is a well-established independent risk factor for coronary artery disease and is the principal lipid target for risk reduction. Statins lower LDL and other apo B–containing lipoproteins, thereby leading to a 20% to 35% reduction in major cardiovascular events, but do not comprehensively address the multiple lipid abnormalities of atherogenic dyslipidemia
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Parkinson Disease
Supplement to Consultant -- September 2008 Vol 48 No 10
Supported by Boehringer Ingelheim Pharmaceuticals
Parkinson Disease in Primary Practice: Keys to Diagnosis and Management
H. James Brownlee, MD
University of South Florida College of Medicine
More than 1 million Americans older than 60 years have Parkinson disease (PD). Diagnosis is clinical and based on the history and physical findings. The 4 cardinal motor symptoms are bradykinesia, resting tremor, muscle rigidity, and a gait disorder. The stereotypic PD tremor is a "pill-rolling" movement of the fingers and thumb with the arm at rest in the lap.
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Dopamine Agonists in Parkinson Disease: Special Focus on Pramipexole
Theresa A. Zesiewicz, MD, FAAN
University of South Florida College of Medicine
Dopamine receptor agonists have played an important role in antiparkinsonian therapy since the first ergoline derivative was introduced in 1974. The non-ergoline dopamine agonists, developed later to provide the benefits of the ergolines with fewer side effects, are currently used as both monotherapy and as adjunctive therapy to treat symptoms of Parkinson disease (PD), to postpone the onset of levodopa therapy, to delay the development and minimize the severity of levodopa’s complications, and to reduce the dosage of levodopa.
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Respiratory Syncytial Virus: Best Practices for Prevention and Treatment
Dianne S. Charsha, RN, MSN, NNP-BC
Cooper University Hospital
A number of methods may be employed to prevent the spread of respiratory syncytial virus (RSV), including simple hand washing, screening of visitors to neonatal ICUs, and appropriate isolation and cohorting of infected infants. These standards of care must also be transferred to the home. Treatments such as acetaminophen, bronchodilators, and the antiviral agent, ribavirin, are available to treat symptoms of infection. Pharmacological prophylaxis with palivizumab and RSV intravenous immunoglobulin may be used in specific at-risk patients.
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