Heart failure (HF) remains a leading cause of morbidity and mortality worldwide, despite advancements in guideline-directed medical therapies (GDMTs). A major obstacle to optimal HF management is clinical inertia, defined as the failure of health care providers to initiate or intensify therapy when indicated. This review examined the current state, contributing factors, and strategies for overcoming clinical inertia in HF. Studies have revealed substantial treatment gaps, with sub-optimal prescription rates and dosing of GDMT classes, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor-neprilysin inhibitors, β-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors. These treatment gaps persist over time and are associated with increased patient mortality and hospitalizations as well as reduced quality of life. Multiple factors contribute to clinical inertia, including patient-related factors (medication adherence and treatment understanding), provider-related factors (guideline familiarity, concerns regarding side effects, complex treatment decision-making), and health care system-related factors (fragmented care models and quality assessment frameworks). Strategies for overcoming clinical inertia involve patient empowerment through education and shared decision-making, provider education and clinical decision support tools, and redesigning HF care delivery. Specialized HF management systems, multidisciplinary collaboration, remote monitoring, and digital tools can promote guideline adherence. Continuous quality improvement by integrating research and practice is also essential. Addressing clinical inertia requires a multifaceted approach targeting patients, providers, and health care systems. By implementing targeted strategies, health care systems can bridge the evidence-practice gap, optimize GDMT utilization, and ultimately improve outcomes for this vulnerable patient population.

Heart failure (HF) remains a leading cause of morbidity and mortality worldwide, despite advancements in guideline-directed medical therapies (GDMTs). A major obstacle to optimal HF management is clinical inertia, defined as the failure of health care providers to initiate or intensify therapy when indicated. This review examined the current state, contributing factors, and strategies for overcoming clinical inertia in HF. Studies have revealed substantial treatment gaps, with sub-optimal prescription rates and dosing of GDMT classes, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor-neprilysin inhibitors, β-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors. These treatment gaps persist over time and are associated with increased patient mortality and hospitalizations as well as reduced quality of life. Multiple factors contribute to clinical inertia, including patient-related factors (medication adherence and treatment understanding), provider-related factors (guideline familiarity, concerns regarding side effects, complex treatment decision-making), and health care system-related factors (fragmented care models and quality assessment frameworks). Strategies for overcoming clinical inertia involve patient empowerment through education and shared decision-making, provider education and clinical decision support tools, and redesigning HF care delivery. Specialized HF management systems, multidisciplinary collaboration, remote monitoring, and digital tools can promote guideline adherence. Continuous quality improvement by integrating research and practice is also essential. Addressing clinical inertia requires a multifaceted approach targeting patients, providers, and health care systems. By implementing targeted strategies, health care systems can bridge the evidence-practice gap, optimize GDMT utilization, and ultimately improve outcomes for this vulnerable patient population.

[Objective]Although warm-tube moxibustion is easy-to-use in acupuncture therapy, the timing of moxa removal varies among practitioners. In the present study, we used near infrared spectroscopy (NIRS) to compare effects of different durations of moxibustion stimulation on improvement in local circulation as measured by changes in blood oxygenation dynamics in muscle tissue.
[Methods]Twelve healthy adults underwent warm-tube moxibustion with a single cone applied to the upper right shoulder region;measurements of tissue blood oxygenation dynamics (ΔOxy-Hb, ΔTotal-Hb) were obtained at intervals of 0.5 s. Control measurements were first taken for 15 min without intervention (Control);then, subjects received moxibustion 2 min after the start of measurement and had the moxa removed at the following time points: 30 s after patients experienced heat pain (Removal 30, moxibustion group); 45 s after heat pain (Removal 45, moxibustion group);or did not have the moxa removed (Continuous moxibustion group). These 4 different conditions were compared. Additionally, we determined the burning temperature of moxa and the skin temperature and intensity of heat pain sensation at the site of moxibustion.
[Results]Compared with the Control, the Removal 30, Removal 45, and Continuous moxibustion groups had significant increases in ΔOxy-Hb, ΔTotal-Hb, and skin temperature, with no significant differences among the moxibustion groups. No significant difference in the intensity of heat pain sensation was observed among the moxibustion groups. All moxibustion groups began to show rapid increases in both ΔTotal-Hb and ΔOxy-Hb around the time when subjects began to feel heat pain, suggesting that the axon reflex evoked by noxious stimuli of heat pain increased blood volume and arterial blood flow.
[Conclusion]Hemodynamic improvement in muscle tissue through the use of continuous warm-tube moxibustion for 30 s or longer after the occurrence of heat pain was confirmed.

Liverpool Care Pathway (LCP) Japanese version was implemented to electronic medical chart (FUJITSU HOPE/EGMAIN-FX®). The processes were needed as follows; preparation of each templates (criteria for use of the LCP/initial assessment, ongoing assessment, and care after death), preparation of pathway/regimen, incorporation of the templates to the pathway and approval in our hospital clinical pathway committee. One problem we encountered was whether to choose an Excel or a template format for each assessment sheet, and the template format was selected as it presented us with a higher degree of convenience, since each field can be expanded into a table on the screen without scrolling and there is little limitation in the letters of the valiance records that can be used in the template format. The complexity of the three records, “the pathway”, “SOAP & focus” for recording opioid use, and “the progress sheet” for recording vital signs, in addition to the inability to expand enough to capture the same field and show changes in the daily pathway over time through night and day work shifts remain a challenge and need to be improved in the future.

In order to obtain certain basic data to be used in planning a physical training program for archers, we examined physical constitution and fitness tests on 5 members of each sex in a university archery club (19 to 22 years old), after checking the actual bow weights they usually used. Parallele to these examinations we made the subjects shoot 6 arrows using actual bow weights of 32, 42 and 51 lbs (male) or 25, 35 and 45 lbs (female) and run a distance of 30 meters to fetch the arrows (Exp. I) . We also made the same subjects shoot 24 (Exp. IIa) or 6 arrows (Exp. IIb) without running to recover the arrows. The energy consumption levels during the experiments and at rest were recorded. The data were analyzed with various parameters. The results are as follows:
1. As regards body heights, body weights and girths of chest, there were no differences between our subjects and healthy Japanese of the same age except that our female subjects were heavier than normal.
2. The heart rates of both sexes increased in number immediately after shooting and remained during the shooting stage. After the shooting, heart rate decreased, quickly returning to the rest level at 2 minutes after shooting.
3. Energy requirements of both sexes increased with an increase in actual bow weights. When compared to experiment I and ha, experiment I showed greater value in energy requirements than that in experiment IIa, although the numbers of shooting in ha was larger than that of experiment I.
4. In experiment I and ha, relative metabolic rates and Ea (energy of activity) increased linearly in proportion to increase in actual bow weight for both sexes.
5. Energy requirements for one shot calculated from the data of experiment IIa, were 0.47, 0.59 and 0.73 kcal for male and 0.27, 0.33 and 0.40 kcal for female, following the above actual bow weight orders, repectively. Energy requirements per 10kg of body weight for one shot were 0.08, 0.10, and 0.12 kcal for male and 0.05, 0.06 and 0.07 kcal for female. These values increased linearly in proportion to the increase in actual bow weights. Positive correlations were found at the correlation coefficient of 0.70 for male and 0.84 for female between actual bow weight and energy requirements for each one shot. These positive correlations were also found between actual bow weight and energy requirements per 10 kg of body weight for one shot, obtaining correlation coefficient of 0.68 for male and 0.77 for female.
6. As compared with actual measurements and total energy consumption which was calculated from products of energy requirement per one shot and the number of shots, both values were about the same for males, but in the case of females, the distances of both values were slightly greater than that of the males.
From these results, especially in the case of energy requirements per one shot, it is likely that the more real energy consumptions were easily estimated by shot numbers and energy requirements per one shot.

In order to obtain certain basic data to he used in planning a physical training program for archers, we carried out physical constitution and fitness tests on six male members of a university archery club (20 to 21 years), after checking the actual bow weights they usually used. Parallel to these examinations we made the subjects launch three shots and run a distance of 30 meters to and fro to recover the arrows. Their energy consumption during this training and at rest was measured to clarify the intensity of archery training. The results are as follows :
1) In body height and body weight there was no difference between our subjects and the Olympic candidates in a training session, however, it was evident that the former had a smaller girth of chest than the latter did.
2) As to physical strength, there was no difference between our subjects and the Olympic candidates, in other factors except in shoulder-arm muscles strength which the subjects were slightly weaker than the Olympic candidates.
3) A positive correlation was found between the actual bow weight and shoulderarm muscle strength of archers, and the correlation coefficient was +0.73 in push and +0.50 in pull.
4) As a result of a basal metabolism test, the mean value was 38.3 kcal/m2/hr, which corresponds approximately with the mean value calculated from the standard basal metabolic rate.
5) A positive correlation was found between the total energy consumption and body weight or surface area of archers, and the correlation coefficient was +0.73 in body weight and +0.76 in surface area. A negative correlation was found between the total energy consumption and a year of experience, obtaining correlation coefficient of -0.68.
6) A relative metabolic rate was obtained from the caloric consumption during training ; the highest value was 2.7 and the lowest 1.9, while the mean was 2.2.

It is recently observed that there is in a tendency toward obesity or deficiency of endurance to the physique among schoolchildren. Consequently there is much interest for exercise through our nation.
Noting these facts, we conducted experiments similar to those previously reported for getting basic data of body composition, by loading 28-days exercise on male rats on 8 percent and 20 percent casein diets.
1. The food intake of the exercise groups was smaller than that of the control in each pair. During the exercise period, food intake of group II also showed similar decreases to those in group I, however, during the rest period, food intakes increased as compared to those of the control. In comparison of caloric requirement for 1g increase of body weight, exercised rats showed higher calories than the control in exercise periods. In the rest period, however, these caloric values decreased as compared with the control.
2. For organ weight per 100g of body weight, significant difference was observed in the heart and kidneys. The gastrocnemius muscles showed almost similar values to the control. The liver and testes did not differ in the weights per 100g of fat free mass of body between the exercise and the control groups.
3. The water contents (%) in the carcasses of exercised rats each fed the 8% and 20% casein diets in group I and I' differed significantly when compared with the control animals, but there was no difference in the water contents of the organs of all groups.
4. In the case of exercised rats in groups I and I', body lipid contents (%) were significantly lower than that of the control group, irrespective of the protein levels in the diets. On the other hand, for rats fed the 8% casein diet in group II, there was no difference in lipid content (%) in the carcasses as compared with the control rats. In the 8% and 20% casein diet groups, lipid contents (%) in the liver of exercised rats in groups I and I' also decreased considerably compared with the control level. In group II, the lipid content in the liver recovered to the control level or had a tendency to increase slightly.
5. The differences of body weight between the control and the exercised rats in each group were nearly equal to the difference of the sum of body lipids and water contents in the whole body between the two groups. From these data, it was suggested that the differences of body weight in each group between the exercised and control rats could be explained as the changes of lipids and water contentes in the body.