Strategies to Improve Therapeutic Compliance in General Medicine

2019 ◽  
Vol 1 (1) ◽  
pp. 31-39
Author(s):  
Jose Luis Turabian
Keyword(s):  
Therapeutic Alliance ◽  
General Medicine ◽  
Daily Practice ◽  
Point Of View ◽  
Strict Sense ◽  
Shared Decision ◽  
Chronic Patient ◽  
Drug Reactions ◽  
Self Monitoring ◽  
Building Trust

Within the framework where overlap therapeutic alliance, patient-centred consultation and shared decision-making, the strategies to increase compliance during the consultation in general medicine are inserted. A strategy is, in a strict sense, an organized, formalized and oriented procedure to obtain a clearly established goal. Its application in daily practice requires the improvement of procedures and techniques whose detailed choice and design are the responsibility of the doctor. To achieve the goal of improving compliance in general medicine, within this model of patient-centred medicine / therapeutic alliance / shared decisions, a number of strategies can be cited: 1) Establish rapport and continuity of care that allows building trust; 2) Ensure confidentiality; 3) Sensitive exploration of adverse drug reactions and prevention of their effects on compliance; 4) Simplify the therapeutic regimen; 5) Self-monitoring; 6) Avoid giving the impression that the drug replaces the need for changes in habits (such as diet, exercise and smoking cessation); 7) Know the patient's agenda, explore perceptions of the disease, and assess the importance that the patient attaches to compliance, and their confidence in achieving it; this also includes understand and tolerate that the chronic patient sometimes gets tired and abandons the treatment that is necessary; 8) Involve the patient in the decision; and, 9) Motivational Interviewing and negotiation of therapeutic objectives, although they seem minimal from doctor point of view. Finally, it must be remembered that the patient always has the last word to accept our indications or not.

The Revolutionizing of the Revolution

2017 ◽  
Author(s):  
R. R. Palmer
Keyword(s):  
French Revolution ◽  
Point Of View ◽  
Strict Sense ◽  
French Government ◽  
Thing In Itself ◽  
Set Up ◽  
The Moment ◽  
The French Revolution ◽  
The Revolution

In 1792, the French Revolution became a thing in itself, an uncontrollable force that might eventually spend itself but which no one could direct or guide. The governments set up in Paris in the following years all faced the problem of holding together against forces more revolutionary than themselves. This chapter distinguishes two such forces for analytical purposes. There was a popular upheaval, an upsurge from below, sans-culottisme, which occurred only in France. Second, there was the “international” revolutionary agitation, which was not international in any strict sense, but only concurrent within the boundaries of various states as then organized. From the French point of view these were the “foreign” revolutionaries or sympathizers. The most radical of the “foreign” revolutionaries were seldom more than advanced political democrats. Repeatedly, however, from 1792 to 1799, these two forces tended to converge into one force in opposition to the French government of the moment.

scholarly journals THU0647-HPR SHARED DECISION MAKING AMONGST RHEUMATOLOGISTS IN TRAINING IN THE NETHERLANDS: WHERE DO WE STAND?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 568.2-568
Author(s):  
L. Kranenburg ◽  
M. Dankbaar ◽  
N. Basoski ◽  
W. Van den Broek ◽  
J. Hazes
Keyword(s):  
Decision Making ◽  
The Netherlands ◽  
Shared Decision Making ◽  
Online Survey ◽  
Daily Practice ◽  
Clear Understanding ◽  
Shared Decision ◽  
Professional Activities ◽  
Self Evaluation ◽  
The Subject

Background:The training curriculum for rheumatologists in training in the Netherlands describes competences and entrusted professional activities (EPA) to monitor the progress in learning. However, this training program does not discuss training of Shared Decision Making. As the basis for shared care and patient participation is made during these years, the question arises how rheumatologist in training think about Shared Decision Making and how they use this in daily practice.Objectives:Inventory of vision, experience and self-evaluation of skills related to Shared Decision Making amongst rheumatologists in training in the Netherlands in order to identify barriers in the implementation of Shared Decision Making in daily practice.Methods:Qualitative data was collected from on online survey amongst rheumatologists in training who were registered in January 2018 by the Dutch Society of Rheumatology.Results:Forty-two rheumatologists in training from various years of training responded (60%). Respondents think that Shared Decision Making is important. A third applies Shared Decision Making on a regular basis in daily practice. Self rating of skills for Shared Decision Making varies from sufficient to good. However, respondents are uncertain about their performance due to a lack of feedback and unclearness of the concept. They indicate that Shared Decision Making is not possible for all patients and find it difficult to assess whether the patient has a clear understanding of the options. Patient’s preferences are discussed only by 33% of the doctors on a regular basis when starting new treatment.Conclusion:Rheumatologists in training agree on the importance of Shared Decision Making, but are uncertain about their performance. Unclearness of the concept is described as a known barrier in literature1,2and is frequently mentioned by respondents. Rheumatologist in training indicate that not all patients are fit for Shared Decision Making. Regarding the limited training on the subject this could also be a misjudgment of patients preferences and lack of experience how to deal with different patient types. There is a clear plea for more training and feedback on the subject. Training should be integrated in the curriculum focusing on how to assess patients preferences and how to apply Shared Decision Making also for patients who indicate to leave decisions up to their doctor.References:[1]van Veenendaal, H.et al.Accelerating implementation of shared decision-making in the Netherlands: An exploratory investigation.Patient Educ Couns101, 2097-2104 (2018).[2]Legare, F., Ratte, S., Gravel, K. & Graham, I. D. Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions.Patient Educ Couns73, 526-535 (2008).Disclosure of Interests:Laura Kranenburg Grant/research support from: Pfizer and UCB for the development of the Reuma App, a tool to support selfmanagement for patients. This is not used for the research related to the submitted abstract., Mary Dankbaar: None declared, Natalja Basoski: None declared, Walter Van den Broek: None declared, Johanna Hazes: None declared

eHealth in cardiac rehabilitation

2020 ◽  
pp. 171-176
Author(s):  
Ines Frederix ◽  
Paul Dendale
Keyword(s):  
Cardiac Rehabilitation ◽  
Progress Monitoring ◽  
Care Delivery ◽  
Cost Effective ◽  
Daily Practice ◽  
Point Of View ◽  
Successful Implementation ◽  
Sustained Delivery ◽  
Definition Of

TeleCR is an innovative and (cost-)effective preventive care delivery strategy that can overcome the challenges associated with traditional centre-based cardiac rehabilitation (CR). This chapter describes how it can be implemented in daily practice. From an organizational point of view, it implies a shift in traditional and operational workflows and reorganization of the (non-)human resources for care delivery. The establishment of a well-coordinated tele-team, the definition of clear goals, profound progress monitoring and follow-up, and the creation of an environment that promotes sustained delivery of teleCR are paramount. Tackling the current legal and technological challenges is another prerequisite for successful implementation.

scholarly journals P330 Inflammatory Bowel Disease (IBD) patients frequently report adverse drug reactions during biologic therapy: A multicentre, prospective, patient-reported pharmacovigilance monitoring system

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S319-S319 ◽  
Author(s):  
P THOMAS ◽  
R West ◽  
M Russel ◽  
J Jansen ◽  
J van Lint ◽  
...  
Keyword(s):  
Healthcare Provider ◽  
Monitoring System ◽  
Adverse Drug Reactions ◽  
Daily Practice ◽  
Drug Reactions ◽  
Therapeutic Consequences ◽  
Treatment Optimisation ◽  
Patient Reported ◽  
High Level ◽  
System Organ

Abstract Background The use of biologicals has improved the treatment of IBD but the understanding of adverse drug reactions (ADRs) and the knowledge of patients’ perception on ADRs is poor. Patient-reporting may provide more insight in the extent and burden of ADRs in daily practice which in turn can lead to treatment optimisation. This study aimed to assess systematic patient-reported ADRs during biological therapy in IBD patients. Methods This multicentre, prospective, event monitoring study enrolled adult Crohn’s disease (CD) and ulcerative colitis (UC) patients treated with a biological between 1 January 2017 and 31 December 2018. Patients completed bimonthly comprehensive web-based questionnaires regarding indication and use of, description of biological induced ADRs, follow-up of previous ADRs, experienced burden of the ADR using a 5-point Likert scale, contact with a healthcare provider and therapeutic consequences due to the ADR. Patient-reported ADRs were MedDRA coded by trained pharmacovigilance assessors. MedDRA is a multi-hierarchical dictionary used to code reported ADRs into specific unambiguous terms (preferred terms). Preferred terms are subsequently grouped into high-level terms, high-level group terms and system organ classes. In total there are 26 system organ classes. Results In total, 182 patients in 4 centres (female 51%, mean (standard deviation) age 42.2 (14.2) years, CD 77%) were included and completed 750 questionnaires. At baseline, 49% used an immunomodulator (43% thiopurines, 6% methotrexate), while biologicals were documented as follows: 59% infliximab, 30% adalimumab, 9% vedolizumab, 1% ustekinumab. At least one ADR was reported by 50% of the participants, and 233 ADRs were reported in total with a median reported ADRs per participant of 2 (interquartile range, 1–3). Fatigue (n = 26), headache (n = 20), injection site reactions (n = 16) and arthralgia (n = 12) were most commonly reported, with a mean burden of 3.31, 1.63, 2.55 and 3.33, and a correlation in time with the administration of the biologic was described in 58%, 85%, 81% and 8% in these ADRs, respectively. Participants contacted a healthcare provider in 62% of all ADRs. In two out of 90 patients who reported an ADR, the biological was discontinued. Conclusion We established a patient-reported pharmacovigilance monitoring system and participants in this study frequently reported ADRs due to biologicals. Fatigue and arthralgia resulted in the highest burden. This reporting system may provide more understanding of patient-experienced ADRs which may ultimately lead to increased adherence of therapy and improved quality of life.

Contributo allo studio dell'ereditarietà della S. di Marfan. Descrizione di un albero genealogico di quattro generazioni con un matrimonio fra consanguinei affetti

1959 ◽  
Vol 8 (4) ◽  
pp. 455-482 ◽  
Author(s):  
L. Capotorti ◽  
R. Gaddini De Benedetti ◽  
P. Rizzo
Keyword(s):  
Cardiac Involvement ◽  
Autosomal Dominant ◽  
General Medicine ◽  
Severe Form ◽  
Point Of View ◽  
Sufficient Evidence ◽  
Continuous Increase ◽  
General Picture ◽  
Ectopia Lentis ◽  
Skeletal Malformations

SUMMARYThe AA. have studied the pedigree of a family with Marfan's Syndrome (M.S.) including 90 persons of four generations. 37 subjects were examined both from a general and from an ophcalmological point of view. Furthermore reliable informations have been obtained about 13 more subjects related with them. Out of the total of 50 persons about whom the A A. have gathered sufficient evidence, 22 turned out to be affected by « ectopia lentis », 20 by various skeletal malformations, all of them included in the general picture of M.S. In 5 more cases some signs of cardiac involvement have been found. The percentage of affected subjects in the whole family was 40%, whereas the hereditary transmission of this syndrome appeared to be typical of a presumably single autosomal dominant character.This is the first report in the literature of a consanguineous marriage between two subjects both affected by M.S. Out of 9 children who were born from this couple, 4 presented the M.S. (2 of them in a particularly severe form), 3 died during infancy, one was a stillborn and only one was a healthy individual.The number of cases of this syndrome described in the medical literature is in continuous increase. Furthermore the growing prominence it is assuming in general medicine, owing to the skeletal, cardiac and vascular anomalies, stimulates to a more thorough knowledge of its hereditary transmission, in the hope of achieving a useful social prophylaxis.

Assessing and Improving the Accuracy of In-Service Teachers’ Perceptions of Daily Practice

1996 ◽  
Vol 15 (3) ◽  
pp. 297-318 ◽  
Author(s):  
Tom Sharpe ◽  
Rob Spies ◽  
Dick Newman ◽  
Donna Spickelmier-Vallin
Keyword(s):  
Daily Practice ◽  
Single Subject ◽  
Self Monitoring ◽  
Teachers Perceptions ◽  
Behavioral Systems ◽  
Instructional Procedures ◽  
Monitoring Accuracy ◽  
Videotape Feedback ◽  
Positive Effect ◽  
Education Process

This paper describes the effects of two instructional strategies on (a) the accuracy of self-monitoring by in-service teachers, and (b) the resulting changes in their daily teaching practices. Independent recordings of teacher and student practices were first compared to teacher self-ratings. Two self-monitoring instructional procedures were then introduced to determine their effectiveness in improving the accuracy of the teachers’ self-perceptions of their classroom practices. A single-subject A-B-A-C design was used to document procedural effectiveness. Results indicated (a) the utility of a behavioral systems observational approach for describing daily classroom activity; (b) the superior effectiveness of verbal and videotape feedback, when compared to verbal only, in facilitating self-monitoring accuracy; and (c) a positive effect of improved self-monitoring accuracy on teacher and student practices related to subject matter learning. Results suggest incorporating the use of self-monitoring accuracy as a facilitating component to the teacher education process.

Gynecologic Oncologist Perspective About ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer

2017 ◽  
Vol 27 (4) ◽  
pp. 826-831 ◽  
Author(s):  
Polat Dursun ◽  
Ali Ayhan
Keyword(s):  
Endometrial Cancer ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Daily Practice ◽  
Consensus Conference ◽  
Point Of View ◽  
Great Effort ◽  
Care Providers ◽  
Nccn Guidelines ◽  
Huge Impact

AbstractESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer was simultaneously published in 3 prestigious journals and is sure to have a huge impact on the clinical practice of gynecologic oncology community and other gynecologic cancer care providers.It is a tremendous report representative of great effort. Hovewer, as practicing gynecologic oncologists, endometrial carcinoma is the most common clinical entity encountered in our routine daily practice; as such, we find some of the report confusing and object to some of its findings, as detailed in this brief report.We also attempted to summarize the differences between the well-known NCCN guidelines and the ESMO-ESGO-ESTRO Consensus Conference guidelines and try to give the point of view of gynecologic oncologic perspective. It is obvious that differences in the management of endometrial carcinomas will continue to be debated by the scientific community.

An Integrity Management Strategy Based on Flexible Risers Conceived to Be Self-Monitored

2007 ◽  
Author(s):  
Marcelo Brack ◽  
Sergio Roberto Alves Mendes ◽  
Rodrigo Cesar Lancelotti Campos ◽  
Luiz Antonio Lobianco e Souza
Keyword(s):  
Management Strategy ◽  
Relevant Information ◽  
Gas Production ◽  
Point Of View ◽  
Flexible Pipe ◽  
Self Monitoring ◽  
Basic Premise ◽  
Oil Companies ◽  
Integrity Management ◽  
Operation Phase

Many of the current practices applied for offshore production managing emphasize those aspects related to the efficiency of oil & gas production and exportation. Nowadays, due not only to the inherent technical challenges associated to deep-water applications but also to the increasing importance of the HSE aspects and requirements faced by the industry, a crescent demand to implement a philosophy which focalizes safety, reliability and integrity of their subsea flowing systems is taking place. The handling of monitored data in order to help the pipe operator to control fluid transportation throughout flexible pipes is an old practice performed by Petrobras and other oil companies in the world. However, the idea of acquiring a product which has been conceived, designed and manufactured with both intrinsic monitoring and expert systems is a recent idea. The tendency of the main flexible pipe manufactures is normally to face the problem from the traditional point of view: those systems are considered dissociated one from the other and as appendices to be installed, in the field, after system connection and start-up. Experience demonstrates that the installation of those systems during the operation phase has a number of limitations, restrictions, and associated problems. The main objective of this paper is to present an integrity management strategy based on the concept of the self-monitored flexible riser. Self-monitoring is understood as the own capacity of a product (flexible pipe and components with built-in devices) to acquire data about itself and make use of data from the internal and external environments, during its service life. Monitored data is then processed in order to generate relevant information for the fluid transportation business. The basic premise is to select, during product conception phase, some key-parameters to be further monitored, during the operation phase. The selection is determined by technical criteria depending on the potential failure mechanisms and modes related to the particularities of each different application.

Fundamental Demands on the Construction of a Theoretical Object of Strictly Scientific Empirical Studies of Literature

1989 ◽  
Vol 7 (2) ◽  
pp. 131-144 ◽  
Author(s):  
Edmund Nierlich
Keyword(s):  
Data Acquisition ◽  
Social Practice ◽  
Empirical Studies ◽  
Point Of View ◽  
Strict Sense ◽  
Narrow Sense ◽  
Political Decision ◽  
Practical Action ◽  
Object Theory ◽  
Object Of Knowledge

When we start out from the assumption that theories can never adequately represent an unknowable realm of stimulators of our senses, this implies the construction even of the objects themselves of scientific empirical theories, which is here taken to be wholly dependent on practically relevant explanatory purposes for the advancement of practical capacities only. This also means that explanatory empirical theories alone can be scientific empirical theories in a strict sense, whereas descriptive empirical theories, as implying the assumption of some fundamental substance-construct, may only be justified within science insofar as they fulfill an adequate service function of some required data acquisition. This article, being also based on the constructivist point of view that there is no independent object of knowledge at all, consists for a large part in a sketch of a sequence of object-constructs as resulting from different and successively more effective ways of making attempts at survival in the evolution of mankind and the development of its social practice. The object-construct of scientific empirical explanatory theories as the latest of them is here conceived as empirical practical quasi-action with the function of enabling new know-that for the improvement of practical capacities in various fields of our highly specified practice. As special kinds of empirical practical quasi-actions for a future fruitful construction of objects of scientific empirical explanatory theories are here proposed: process (in a narrow sense), origination of meaning, and origination of a practical action. It must be understood as a “political” decision when the author intends to develop an object-theory of scientific empirical studies of literature as that of originations of a kind of communicative cooperative practical actions.

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