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.

Introduction: This study examines the relationship between learning styles and outcomes of interprofessional education (IPE) through co-curricular learning for medical and welfare students.Method: To analyze changes over time, we utilized IPE evaluations of students from Nagasaki University School of Medicine and the Department of Comprehensive Community Care Services, Nagasaki Junshin Catholic University, who participated in either face-to-face or online classes.Results: The learning outcomes from medical and welfare perspectives in IPE significantly increased regardless of the learning style. As for the same perspective on students from each department, the value of many outcomes in face-to-face learning showed significant increases compared to online classes.Discussion: The learning outcomes of IPE in medical and welfare through online classes were considered to have achieved certain results. Additionally, differences in learning outcomes depending on the learning style were thought to be due to variations in understanding between the groups. It was suggested that long-term studies are necessary for effective co-curricular learning in the future.

Gastric adenocarcinoma of the fundic gland mucosa type (GA-FGM) was proposed as a new variant of gastric adenocarcinoma of the fundic gland type (GA-FG). However, at present, the influence of Helicobacter pylori and the speed of progression and degree of malignancy in GA-FGM remain unclear. Herein, we report the first case of intramucosal GA-FGM that was endoscopically observed before and after H. pylori eradication over 15 years. The lesion showed the same tumor size with no submucosal invasion and a low MIB-1 labeling index 15 years after its detection using endoscopy. The endoscopic morphology changed from 0-IIa before H. pylori eradication to 0-IIa+IIc and then 0-I after H. pylori eradication. These findings suggest that the unaltered tumor size reflects low-grade malignancy and slow growth, and that the endoscopic morphology is influenced by H. pylori eradication.

The populations of Asian countries are expected to age rapidly in the near future, with a dramatic increase in the number of heart failure (HF) patients also anticipated. The need for palliative and end-of-life care for elderly patients with advanced HF is currently recognized in aging societies. However, palliative care and active treatment for HF are not mutually exclusive, and palliative care should be provided to reduce suffering occurring at any stage of symptomatic HF after the point of diagnosis. HF patients are at high risk of sudden cardiac death from the early stages of the disease onwards. The decision of whether to perform cardiopulmonary resuscitation in the event of an emergency is challenging, especially in elderly HF patients, because of the difficulty in accurately predicting the prognosis of the condition. Furthermore, advanced HF patients are often fitted with a device, and device deactivation at the end of life is a complicated process. Treatment strategies should thus be discussed by multi-disciplinary teams, including palliative experts, and should consider patient directives to address the problems discussed above. Open communication with the HF patient regarding the expected prognosis, course, and treatment options will serve to support the patient and aid in future planning.
Aged ; Aging* ; Asian Continental Ancestry Group ; Cardiopulmonary Resuscitation ; Death, Sudden, Cardiac ; Diagnosis ; Emergencies ; Heart Failure* ; Heart* ; Humans ; Palliative Care ; Prognosis

BACKGROUND/AIMS: We aimed to evaluate whether the advanced techniques have influenced the minor papilla approach. METHODS: We studied the success rate of guide wire insertion by using ordinary techniques and advanced techniques (rendezvous method and precut method) in 30 patients via the minor papilla. We compared the selection of the access routes between before (52 patients) and after (28 patients) the introduction of the Soehendra stent retriever. RESULTS: In 19 out of 30 patients (63%), guide wire insertion via the minor papilla could be achieved by using ordinary techniques. In total, the guide wire could be inserted in 27 patients (90%) by using the advanced techniques. Before introduction of the Soehendra stent retriever, the major papilla approach was chosen in 38 cases (73%), and the minor papilla approach in 14 cases (27%). After introduction of the Soehendra stent retriever, the major papilla approach was used in 26 cases (93%) and the minor papilla in 2 cases (7%). The frequency of selecting the minor papilla approach has significantly decreased (p<0.05). CONCLUSIONS: The advanced techniques have contributed to the improvement of endoscopic approaches via the minor papilla, and decreased the frequency of selecting the minor papilla approach.
Humans ; Stents