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This article is intended as a guide to help improve and perfect your knee examination technique for the MRCS examination. The knee is a joint frequently assessed in the MRCS OSCE, due to the presence of reliable clinical signs in the chronic patient, who can easily attend for repeated examinations. The article will guide the reader through important aspects of the history and physical examination and how these can inform the clinical reasoning process and subsequent diagnosis and management.

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.

Background The cascade of care of the hepatitis C are complex. The diagnosis of active infection in the same serum sample would simplify the process establishing a rapid access for patients to treatment. Our objective was to estimate the impact on healthcare and economic outcomes of the diagnosis of chronic infection in one-step diagnosis compared to standard diagnosis in Andalusia (8.39 million people). Methods A decision tree was developed to estimate the referral of patients with chronic infection, loss of follow-up, access to treatment and costs of the diagnosis of the infection, for both processes. The unit costs (€, 2018) of the health resources (medical visits, antibodies, viral load and genotype), without considering the pharmacological cost, were obtained from public sources in Andalusia. Results Of the total estimated population (269,526 patients), 1389 patients would be referred to the specialised care in the one-step diagnosis and 1063 in de standard diagnosis, being treated 1320 and 1009, respectively. In one-step diagnosis, no negative viral loud patient would be referred to specialist versus 540 with standard diagnosis. One-step diagnosis would generate a cost saving of €184,928 versus standard diagnosis (€15,671,493 vs €15,856,421). When compared one-step diagnosis to standard diagnosis, the savings per patient with positive viral load referred to specialist would be €3634 (€11,279 vs €14,923). Conclusion The one-step diagnosis will achieve an increase in diagnosed patients, will increase the access of chronic patient to treatment and will generate cost savings, demonstrating its efficiency in the system in Andalusia.

Chronic patients could benefit from the technological advances, but the clinical approaches for this kind of patients are still limited. This paper describes a system for chronic patients monitoring both, in home and external environments. For this purpose, we used novel technologies as big data, cloud computing and internet of things (IoT). Additionally, the system has been validated for three use cases: cardiovascular disease (CVD), hypertension (HPN) and chronic obstructive pulmonary disease (COPD), which were selected for their incidence in the population. This system is innovative within e-health, mainly due to the use of a big data architecture based on open-source components, also it provides a scalable and distributed environment for storage and processing of biomedical sensor data. The proposed system enables the incorporation of non-medical data sources in order to improve the self-management of chronic diseases and to develop better strategies for health interventions for chronic and dependents patients. Spanish Ministry of Science and Innovation through the National Programme for Research Aimed at the Challenges of Society (IPHealth, TIN-2013-47153-C3-1). 2.934 JCR (2021) Q3, 60/109 Health Care Sciences & Services 0.652 SJR (2021) Q2, 45/104 Health Informatics No data IDR 2021 UEM

We describe the technological development of a web platform named CHRONIC-PHARMA that integrates three prescription support tools for patients with chronic diseases: Anticholinergic Burden Calculator (ABC), LESS-CHRON criteria and TRIGGER-CHRON. They focus on the optimization and evaluation of pharmacotherapy in patients with chronic diseases, resulting in a useful, single platform that can facilitate the review of pharmacotherapy and improve the safety of chronically ill patients. This is achieved by estimating and reducing the anticholinergic risk (ABC), detecting opportunities for deprescribing drugs and monitoring its success (LESS-CHRON criteria), as well as calculating the risk of adverse drug events (TRIGGER-CHRON). The platform is freely accessible online (https://chronic-pharma.com/) as well as through a mobile application, and therefore easily accessible among the healthcare community.

Therapeutic education plays an important role in nursing education in terms of knowledge and skills. Indeed, the support of the chronic patient represents a new challenge for the caregiver and requires a change in his or her posture. Thus, he may have to collaborate with the expert patient, who is now fully recognised as a care partner. Sharing experience with a student from a Parisian nursing training institute, himself an expert patient.

International Diabetes Federation said that there is 5% of Indian population agonizes from diabetes, and it will rise to 123 million by 2040, also one study reveals that three Indians in ten suffered from hypertension and 89% of Indian population suffered from stress. There are various parameters which will impact on the medical health of a patient, and music is one of them. Emotions of individual by changing the timbre will affect by raga as said by ancient Indian classical musical experts some decades ago. Due to advancement in technology and day-by-day increasing work pressure on a human being due to competitions, there is need of an hour to improve health and reduces stress by other traditional way. This review work explores raga music therapy as scientifically the traditional way of medicine. A pilot study reveals that the raga music therapy will enhance health of diabetics, low BP, high BP, and stress of chronic disease patients. At the end mobile app development process flow is explained on the similar concept which may greatly help in improvement of different chronic patients’ health.

Background When novel treatments prove to be better than conventional therapy there is a need for effective introduction, both for cost-effectiveness and to minimize patient suffering. Effective implementation is a challenge in patients with chronic diseases who may be treated both in primary care and/or specialist clinics. Studies have shown that introduction is often unnecessary delayed. Our aims were to develop a model for systematic introduction and to test the feasibility of this model on a new treatment of a chronic disease. We also investigated how such an approach would be received by the patients. Methods The systematic introduction approach is a seven step procedure; Step 1 - define a few main criteria for the specific therapy, Step 2 – primary scan patients with the one or two main criteria using computerised medical records, databases or clinical registries, Step 3 – identify patients applying the other predefined criteria, Step 4 - evaluate if any examinations or laboratory test updates are required, Step 5 - summon identified patients to the clinic with an information letter, Step 6 – discuss treatment with the patient and prescribe to appropriate patients, Step 7 – follow-up on initiated therapy and evaluate the applied process. The model was tested in a case study during introduction of the new drug sacubitril-valsartan in a heart failure population. Patient experiences with the approach were investigated in an interview study with general inductive approach using qualitative content analysis. Results By applying the systematic introduction approach in the case study, 76 out of 1924 patients were identified to be eligible for sacubitril-valsartan and summoned to the clinic to discuss treatment. The content analysis resulted in three final categories of how the model was received by the patients; A good approach , Role of the information letter , and Trust in care . Conclusions The systematic introduction approach ensures that strict criteria are used in the selection process and that a treatment can be implemented in eligible patients within a specified population with limited resources and time. The model was effective in our case study and maintained the patient’s confidence in health care.

Over the last 2 decades, advances in the diagnosis and management of pituitary diseases have made it possible to attain an endocrine "cure"in a large proportion of patients. In other words, tumors can be excised or controlled with drugs, mass effects of the lesion on surrounding structures can be solved, and pituitary deficiencies can be substituted with all relevant hormones. While this is considered a satisfactory outcome for health care providers, patients often suffer from an aftermath of prior endocrine dysfunction exposure, with irreversible effects, both physically and psychologically, which have a great impact on their everyday life. Diagnostic delay, often of several years, adds a negative impact on health perception. This affects their social, professional, and family domains and determines their future life. Understanding that this may occur is important, and health care providers should offer information to prepare the patient for this difficult journey, especially in the case of acromegaly, Cushing disease, or hypopituitarism. In order to maintain a good quality of life (QoL) in the long-term, patients need to adapt to this new situation, something that may be difficult, since they often cannot continue with all the activities and rhythm they used to do. Depression is often the consequence of maladaptation to the new situation, leading to impaired QoL. © 2020 S. Karger AG, Basel. All rights reserved.

espanolRESUMEN El proceso de envejecimiento y las enfermedades cronicas implican cambios vitales en el adulto mayor que suponen, en muchas ocasiones, acontecimientos estresantes que derivan en un malestar psicologico y un deterioro de la calidad de vida. La vejez es una etapa caracterizada por sentimientos de perdidas y disminucion de capacidades funcionales y afectivas. Se investiga la serenidad como estrategia de afrontamiento en relacion con el apoyo psicologico y emocional para mejorar las capacidades del adulto mayor para afrontar los problemas o dificultades que conllevan las consecuencias del envejecimiento. Objetivo: Analizar el concepto de serenidad en relacion con el apoyo psicologico y emocional del paciente cronico. Metodologia: Revision de la bibliografia. La busqueda se realizo en PubMed, CINAHL, Cochrane Library y Medline. Se acoto al periodo 1999-2017, incluyendo aquellos estudios que solo aplican el concepto de serenidad para la promocion de la salud mental. Resultados: De los 40 estudios revisados, 8 hacian referencia al envejecimiento y la cronicidad; 15 a trastornos afectivos en la cronicidad; 13 al apoyo emocional y psicologico en el paciente mayor cronico, y 4 a la serenidad y cuidado enfermero. Posteriormente al analisis se identificaron tres temas relacionados: apoyo emocional en la cronicidad, concepto de serenidad y bienestar psiquico y emocional, definiendo atributos y niveles de serenidad, apoyo emocional en la cronicidad. Conclusiones: El concepto de serenidad puede representar una herramienta que fomente el bienestar psiquico y emocional del paciente mayor cronico, ayudando a aceptar y manejar la situacion de salud. Resulta necesaria una mayor evidencia cientifica sobre el concepto y su uso en los profesionales enfermeros. EnglishABSTRACT The aging process and chronic diseases involve vital changes in the elderly that, in many cases, involve stressful events that lead to psychological discomfort and a deterioration in the quality of life. Old age is a stage characterized by feelings of loss and decreased functional and affective abilities. Serenity is investigated as a coping strategy in relation to psychological and emotional support to improve the abilities of the elderly to face the problems or difficulties that entail the consequences of aging. Objective: To analyze the concept of serenity in relation to the psychological and emotional support of the chronic patient. Methodology: Review of the literature. The search was performed in PubMed, CINAHL, Cochrane Library, Medline. The 1999-2017 period was included, including those studies that only apply the concept of serenity for the promotion of mental health. Results: Of the 40 studies reviewed, 8 referred to aging and chronicity; 15 to affective disorders in the chronicity; 13 to emotional and psychological support in the chronically elderly patient; 4 to serenity and nursing care. Three related topics were identified: emotional support in chronicity, the concept of serenity and psychic and emotional well-being, defining attributes and levels of serenity, emotional support in chronicity. Conclusions: The serenity can represent a tool that promotes the psychic and emotional well-being of the chronic elderly patient, helping to accept and manage the health situation. Greater scientific evidence on the concept and its use in nursing professionals is necessary.

The Healthing solution aims to satisfy various needs that are currently manifested in health processes as the prevention, treatment and monitoring of chronic diseases. These limits are related to the difficulties existing in the healthcare area in facing the serious problem of improper hospitalization and the absence of a care network for the treatment of chronic diseases. The management of a Pathway Diagnostic Therapeutic Care (PDTA) represents today the most complete and long-term monitoring of chronic diseases, planning controls and specialized exams to patients suffering of chronic illness. However, the evolution of the pathology follows dynamics that are not generic for all patients. In to accompany the individual patient in his process of care, is necessary to monitor daily both the PDTA and pharmacological intake plans and relation with electromedicals. Therefore, the present Healthing solution besides being a valid instrument for the chronic patient, easy to use and with simple modalities of use, represents a monitoring and video-consultation tool for physicians, the healthcare and care worker who are in care more patients. The advantages of this solution, differently from other telemedicine platforms are: monitoring the progress of one or more PDTAs in which the individual patient is involved; checking the adherence of care plans (pharmacological and electro-medical surveys) and customize them based on the clinical observations; analyzing over time the variability of the risk index of comorbidity, that is the co-presence of several pathologies, which is a common tendency in the chronic course.

La Insuficiencia Venosa Crónica es una patología progresiva, la cual es más prevalente entre el sexo femenino. Ciertos estudios demuestran que la enfermedad venosa altera la movilidad, el sueño, provoca efecto psicológico negativo y una disminución de la calidad de vida del paciente. Se presenta el caso clínico de una paciente de 65 años con diver-sas patologías, entre ellas Insuficiencia Venosa Cónica, que presenta baja adherencia terapéutica, sobrepeso, problemas de autoimagen, disconfort y déficit de conocimientos. El objetivo planteado fue proporcionar cuidados enfermeros que aporten al paciente conocimientos sobre su enfermedad, aumenten la adherencia terapéutica a su tratamien-to y mejoren su autoimagen y confort. Gracias a una adecuada planificación de cuidados, la paciente expresó gran satisfacción tras ampliar sus conocimientos y habilidades de autocuidado. Además presentó cambios significativos en su piel, mostró mejoría en su descanso y mayor aceptación hacia su imagen. Como conclusión, la educación para la salud en el paciente crónico es esencial para lograr un adecuado automanejo de su enfermedad y, así, aumentar la satisfacción con su proceso de salud.

Background Electronic health records may present laboratory test results in a variety of ways. Little is known about how the usefulness of different visualizations of laboratory test results is influenced by the complex and varied process of clinical decision making. Objective The purpose of this study was to investigate how clinicians access and utilize laboratory test results when caring for patients with chronic illness. Methods We interviewed 10 attending physicians about how they access and assess laboratory tests when following up patients with chronic illness. The interviews were audio-recorded, transcribed verbatim, and analyzed qualitatively. Results Informants preferred different visualizations of laboratory test results, depending on what aspects of the data they were interested in. As chronic patients may have laboratory test results that are permanently outside standardized reference ranges, informants would often look for significant change, rather than exact values. What constituted significant change depended on contextual information (e.g., the results of other investigations, intercurrent diseases, and medical interventions) spread across multiple locations in the electronic health record. For chronic patients, the temporal relations between data could often be of special interest. Informants struggled with finding and synthesizing fragmented information into meaningful overviews. Conclusion The presentation of laboratory test results should account for the large variety of associated contextual information needed for clinical comprehension. Future research is needed to improve the integration of the different parts of the electronic health record.

For the prevention and management of diseases in chronic patients, attention has been directed at ubiquitous healthcare systems in order to reduce medical expenses and provide high-quality medical services at different places, including hospitals and homes. In this paper, a ubiquitous healthcare system has been proposed in order to care for a chronic patient, to be used by a nurse or a care professional at the patient’s residence. It comprises a portable bio-signal acquisition device, smartphone application, and ubiquitous health server. The smartphone application collects the patient information, including lifelog and the bio-signals from the device, and transfers the patient information through bio-signals to the ubiquitous health server. The ubiquitous health server monitors the bio-signals with the help of lifelog, analyzes the patient’s health state, and alerts medical staff on symptoms of any illness. The proposed system collects five types of bio-signals from patients using the acquisition device, automatically monitors and analyzes their bio-data with lifelog, displays the state of their health as determined by the analysis, using graphical representation, such that the doctor can understand the patient’s condition and undertake an appropriate medical treatment procedure.

This study aims to identify satisfaction levels of adult chronic patients regarding the care they received at the hospital. The descriptive and cross-sectional study was conducted at Cukurova University Faculty of Medicine Balcali Hospital between 01.08.2016-31.10.2016. The sample consisted of 910 patients. The data was collected with “Personal Information Form” and "Patient Assessment of Chronic Illness Care (PACIC)." The data were analyzed via IBM 20.0 program. Ethical committee approval, permission from the institution and verbal consent from the patients were obtained for the study. The average age of the participants was 50.88±16.55. The average hospitalization duration was 9.22±11.55 days. It was indicated that 38% of the respondents have cardiovascular diseases, 94.6% use a kind of medication,91.7% have their medications on time, 85.5% take recommended dosages, 45.5% know the name and the number of the medication they take. The average score for chronic patient care evaluation scale was 3.11±0.74. When the subscales of the scale are analyzed, it was found that the average score for patient participation subscale is 3.75±0.93, decision-making support subscale is 3.46±3.33, target-setting subscale is 2.95±0.78, problem-solving subscale is 3.28±0.97 and monitoring/coordination subscale is 2.51±1.03. Significant correlations were found between the respondents’ education level and health education with their evaluations of chronic care. It was indicated that the patients’ satisfaction with the nursing care is medium, the highest average scores are in decision-making subscale while the average score for monitoring/coordination subscale is the lowest. In order to raise the satisfaction levels of chronic patients regarding nursing care, chronic patient care should be prioritized in organized education and on-the-job training for nurses. By emphasizing the importance of monitoring and coordinating the patients, better management of chronic diseases can be achieved. Article DOI: https://dx.doi.org/10.20319/lijhls.2017.32.3850 This work is licensed under the Creative Commons Attribution-Non-commercial 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc/4.0/ or send a letter to Creative Commons, PO Box 1866, Mountain View, CA 94042, USA.

Pulmonary hypertension (PH) is a complex, life-threatening disease. Development of pulmonary hypertension centers is recommended by pulmonary hypertension best practice guidelines and patient organizations to successfully care for patients. However, very little is published on the characteristics of these centers or the daily management required to care for this complex patient population. This article, written by nurses who have extensive experience in managing patients with pulmonary hypertension, details the collaboration and workflows needed at a pulmonary hypertension center. Cohesive management among PH team members, patients, and caregivers is required for the long-term and successful care of patients. PH centers should have individual team members with clearly defined functional roles, policies and procedures that outline how to address the challenges of managing patients, effective communication between outpatient and inpatient teams, and well-educated staff to accurately diagnose and manage treatments, including accessing pulmonary arterial hypertension medications. Education of patients, concurrent with the support of caregivers and healthcare providers, plays a vital role in improving patients’ understanding of their disease state and treatment options that best suit their lifestyle. PH team members assist patients in developing self-care skills to better recognize and respond to worsening symptoms and manage medication side effects to improve patient outcomes. Defining collaborative care, work flows, and characteristics of a pulmonary hypertension center is essential to optimize care in this complex, chronic patient population. Actelion Pharmaceuticals US, Inc.

The doctor-patient relationship tends to reconfigure. The chronic patient is recognised for the ability to perform certain healthcare activities, but also for a type of expertise related to his or her personal experience with illness. However, what are the individual and collective benefits of this expertise? How is it enhanced by connected medical systems?

Hypothyroidism affects up to 5% of the general population, with a further estimated 5% being undiagnosed. Over 99% of affected patients suffer from primary hypothyroidism. Worldwide, environmental iodine deficiency is the most common cause of all thyroid disorders, including hypothyroidism, but in areas of iodine sufficiency, Hashimoto’s disease (chronic autoimmune thyroiditis) is the most common cause of thyroid failure. Hypothyroidism is diagnosed biochemically, being overt primary hypothyroidism defined as serum thyroid-stimulating hormone (TSH) concentrations above and thyroxine concentrations below the normal reference range. Symptoms of hypothyroidism are non-specific and include mild to moderate weight gain, fatigue, poor concentration, depression, and menstrual irregularities, while the consequences of untreated or under-treated hypothyroidism include cardiovascular disease and increased mortality. Levothyroxine has long been the main tool for treating hypothyroidism and is one of the world’s most widely prescribed medicines. In adults with overt hypothyroidism, levothyroxine is usually prescribed at a starting dose of 1.6 µg/kg/day, which is then titrated to achieve optimal TSH levels (0.4–4.0 mIU/L), according to the therapeutic target. We here summarise the history of levothyroxine and discuss future issues regarding the optimal treatment of hypothyroidism. Because nearly one-third of patients with treated hypothyroidism still exhibit symptoms, it is important that levothyroxine is used more appropriately to achieve maximum benefit for patients. In order to ensure this, further research should include more accurate assessments of the true prevalence of hypothyroidism in the community, optimisation of the levothyroxine substitution dose, proper duration of treatment, and identification of patients who may benefit from combination therapy with levothyroxine plus levotriiodothyronine. Funding: Merck. Plain Language Summary: Plain language summary available for this article.

To explore the perception of normality in life experienced by patients with chronic heart failure.A hermeneutic phenomenological study was conducted.Individual conversational interviews were held with 20 outpatients with chronic heart failure between March 2014-July 2015. Van Manen's phenomenology of practice method was used for data analysis.From the analysis, four main themes emerged: (a) Accepting my new situation; (b) Experiencing satisfaction with life; (c) Continuing with my family, social and work roles; and (d) Hiding my illness from others.The present study makes a novel contribution to understanding the importance of the perception of normality in the lives of patients with chronic heart failure. It was found that patients need to incorporate this health experience into their lives and reach a 'new normal', thus achieving well-being. Several factors were identified that can help promote this perception in their lives; therefore, nursing interventions should be designed to help develop scenarios encouraging this normalization process.Although the implications of having a sense of normality or experiencing 'normalization' of the illness process in life have been studied in other chronic patient populations, no studies to date have examined how patients with chronic heart failure experience this phenomenon in their lives. For the first time, the results of this research prove that the perception of normality is a key aspect in the experience of living with chronic heart failure.目的: 探讨慢性心力衰竭患者对生活常态的认知。 设计: 进行诠释现象学研究。 方法: 2014年3月至2015年7月对20例慢性心力衰竭门诊患者进行单独访谈。数据分析采用Van Manen的现象学实践方法。 结果: 分析得出四个主题:(a)接受新环境;(b)体验对生活的满意;(c)继续担任其家庭、社会和工作角色;(d)隐藏病情。 结论: 本研究对理解慢性心力衰竭患者生活中正常状态的重要性做出了新的贡献。研究发现,患者需要将这种健康体验融入其生活并达到一种“新常态”,从而获得幸福。有几个因素可以帮助他们在生活中提升这种认知;因此,护理干预的设计应有助于开发鼓励这一正常化过程的情景。 影响: 虽然在其他慢性病患者中已经研究了在生活中有正常感觉或经历疾病过程“正常化”的含义,但迄今为止还没有研究调查慢性心力衰竭患者在生活中如何经历这种现象。本研究的结果首次证明,正常的感觉是慢性心力衰竭患者生活经验中的一个关键方面。.

Background Within the programmes of continuous care of the complex chronic patient (CCP), there are initiatives to improve adherence and continuity of care. Most frequent is dispensing medication upon discharge. A discharge finite medication (FM) programme for complex chronic diseases (DMCDP) was implemented in the continuity care unit of internal medicine (UCA) in our hospital. Purpose Evaluate the DMCDP from our hospital. Material and methods FM is defined as drugs that the patient doesn’t have and whose estimated duration of treatment is less than 30 days. A prospective observational study was designed with all patients classified as CCP admitted to the UCA during the first 6 months of 2018, to compare cost and number of doses dispensed (DD) between the community pharmacy (CP) system vs the DMCDP programme. An Excel database was created. Variables: age, sex, medication dispensed, therapeutic group, indication, duration and days until end of treatment, units dispensed and saved vs CP more adjusted to treatment presentation, estimated cost in CP according to Remedios, cost of hospital dispensation and opportunity cost. All data were analysed with XLS Stat for descriptive statistics. Tools: history of primary care, electronic prescription, medication bag, informative interview on admission and discharge, medication sheet at discharge, hourly chart, FM in unit doses with posology until the end of treatment and in daily kits dated for medications with variable posology such as descending corticoid patterns. Remedios data base. Results Sixty-six patients were studied. Age 83 (44–98) years. All patients had at least seven medical prescriptions: 100% of admissions were reconciled and interviewed on admission and discharge. Thirty-four (47.2%) patients required FM according to discharge medical prescription to finish initiated hospital treatments for anticoagulation (78%), respiratory infection (ABR) (14%), urinary infection (3%), other infections (4%) and hepatic encephalopathy (1%). Medication DD avoided were: systemic corticosteroids (59.3%), antibacterial (34.7%) and antithrombotic antihaemorragic (4.7%). Cost savings in medication for the national health system (88.27%). Pathologies’ greatest savings were AC (78%) and ABR(14%). The biggest problem on admission and discharge was lack of time. Conclusion A discharge medication programme led by a hospital pharmacist, reinforces understanding and compliance for each patient, decreases the risk failure due to lack of adherence, knowledge or accessibility problems. In addition, it promotes rational use, since dispensing of the exact units reduces the possibility of future self-medication at home. References and/or acknowledgements Jago-Byrne MM-C, et al. (GPI) discharge management: safer discharges and improved information. Int J Clin Pharma 2011;71:1–10. (http://statements.eahp.eu/sites/default/files/resources/GPI%204.2–4.3–4.4.pdf) No conflict of interest.

[Resumen] INTRODUCCIÓN: La epidemia de las enfermedades crónicas se ve avivada hoy por factores poderosos que afectan a todas las regiones del mundo: el envejecimiento demográfico, la urbanización rápida y no planificada, y la mundialización de modos de vida malsanos. Son una de las principales causas de muerte en España y producen un elevado gasto sanitario, debido a las frecuentes reagudizaciones que precisan ingreso hospitalario, las complicaciones o la dependencia derivada de todo ello. OBJETIVO: Conocer los nuevos modelos de atención multidisciplinar al paciente crónico y las intervenciones de enfermería más eficaces. DESARROLLO: Se realizó una búsqueda bibliográfica en las principales bases de datos del ámbito de las ciencias de la salud. Se incluyeron en la búsqueda todos los artículos publicados desde el año 2009 en lengua española e inglesa y con disponibilidad de texto completo. La aplicación de la estrategia de búsqueda dio como resultado 1416 artículos de los que se descartaron 1404 por no cumplir los criterios de inclusión, quedando finalmente 12 para analizar. CONCLUSIÓN: Se precisa realizar estudios que confirmen la eficacia y reducción de costes derivados de las intervenciones de enfermería. Se pone de manifiesto la aparición de nuevos modelos de abordaje al paciente crónico complejo, EPA, EGC, o recursos como la teleasistencia que junto con la atención de enfermería en AP con un modelo renovado obtiene mejores resultados realizando visitas domiciliarias. [Resumo] INTRODUCIÓN: A epidemia de enfermidades crónicas está agora alimentada por poderosos factores que afectan a todas as rexións do mundo: o envellecemento demográfico, a rápida e non planificada urbanización e a globalización de estilos de vida non saudables. Son unha das principais causas de morte en España e producen un elevado gasto sanitario, debido ás frecuentes exacerbacións que requiren a admisión hospitalaria, complicacións ou dependencia derivadas de todo isto. OBXETIVO: Coñecer os novos modelos de atención multidisciplinar para o paciente pluripatolóxico crónico e as intervencións de enfermaría máis eficaces. DESENVOLVEMENTO: Realizouse unha busca bibliográfica nas principais bases de datos do campo das ciencias da saúde. Na procura incluíronse todos os artigos publicados desde 2009 en castelán e inglés e dispoñibilidade de texto completo. A aplicación da estratexia de busca resultou en 1416 artigos dos cales 1404 foron descartados por non cumprir os criterios de inclusión e 12 quedaron finalmente para analizar. CONCLUSIÓN: Necesítanse estudos para confirmar a eficacia e a redución dos custos derivados das intervencións de enfermería. A aparición de novos modelos de achegamento ao paciente crónico complexo, EPA, EGC ou recursos como a teleasistencia que xunto co coidado de enfermería en PC cun modelo renovado obteñen mellores resultados a través de visitas a domicilio [Abstract] INTRODUCTION: The epidemic of chronic diseases is now stoked by powerful factors that affect all regions of the world: demographic aging, rapid and unplanned urbanization, and the globalization of unhealthy lifestyles. They are one of the main causes of death in Spain and produce a high health expenditure, due to the frequent exacerbations that require hospital admission, complications or dependence derived from all this. OBJETIVE: To know the new models of multidisciplinary care for the chronic pluripathologic patient and the most effective nursing interventions. DEVELOPING: A bibliographic search was carried out in the main databases of the field of health sciences. All articles published since 2009 in Spanish and English and with full text availability were included in the search. The application of the search strategy resulted in 1416 articles of which 1404 were discarded for not meeting the inclusion criteria, and 12 were finally left to analyze. CONCLUSION: Studies are needed to confirm the effectiveness and reduction of costs derived from nursing interventions. The emergence of new models of approach to the complex chronic patient, EPA, EGC, or resources such as telecare that together with the nursing care in PC with a renewed model obtains better results by conducting home visits Traballo fin de grao (UDC.ENFC). Enfermaría. Curso 2018/2019

Taking patient experience as a basis, this paper introduces a theoretical framework, to capture insights leading to new technological healthcare solutions. Targeting a recently diagnosed type 1 diabetes child and her mother (the principal caregiver), the framework showed its potential with effective identification of meaningful insights in a generative session. The framework is based on the patient experience across the continuum of care. It identifies insights from the patient perspective: capturing patients' emotional and cognitive responses, understanding agents involved in patient experience, uncovering pain moments, identifying their root causes, and/or prioritizing actions for improvement. The framework deepens understanding of the patient experience by providing an integrated and multi-leveled structure to assist designers to (a) empathise with the patient and the caregiver throughout the continuum of care, (b) understand the interdependencies around the patient and different agents and (c) reveal insights at the interaction level.

Made available in DSpace on 2019-10-04T12:36:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-01-01 Background: Unilateral spatial neglect (USN) is the prevalent feature in patients with right-sided stroke. It is diagnosed through the behavior inattention test (BIT) and has a negative impact on patients affecting both their functional capacity and quality of life. Objective: Here, we aimed to evaluate the impact of USN on the quality of life of patients in the chronic phase of stroke. Methods: This is a cross-sectional study with stroke patients with USN. After confirming the presence of stroke through neuroimaging examinations and of USN through the BIT, patients' quality of life was evaluated by using the EUROQOL scale. Spearman's correlation was used to validate the correlation between patients' USN and quality of life, with a p

Background: In today’s world, chronic diseases are predominant health problems and cause heavy burden on society; therefore early diagnosis and even prediction of the disease is a way to reduce this burden. In this project, we tried to use recommender system to predict which other diseases a chronic patient is susceptible for. Methods: In this study, through a dynamic recommender system, we evaluated patients’ treatment destiny during the time. Results: It was shown that our method increased accuracy and reduced error compared with other recommendation methods in disease prediction. Conclusion: Compared to current usual methods, in our method we used previous patients’ characteristics as one of the factorization variables to predict destiny of future patients. Furthermore, using this method, we can predict which complication or disease the patient would suffer from first in future. Therefore, we can manage policies toward disease burden reduction by implementing prevention programs.

The autonomy of chronic patients in Iranian hospitals is challenged by impaired functioning resulting from chronic illness, a negative image in society, and effects related to hospitalization. Comprehensive interviews and observations of 34 patients, nurses, and physicians were performed to assess the autonomy of chronic patients in Iran. Conceptualization, constant comparison, and the combination of data resulted in the identification of 5 main categories related to autonomy: welcoming paternalism, self-expression, self-proof, shared decision making, and self-determination. Authority scrambling was a central category describing chronic patients’ perceptions of their autonomy during hospitalization. These patients sought to maintain their independence despite serious threats to their autonomy.

Treatment adherence is a key health behavior in chronic patients. This study investigates the mediating role of perceived social support in the relationship between perceived self-efficacy and adherence to treatment. The sample is composed of 202 chronic patients living in Spain. Stratified random sampling was used to select participants based on the variables age group and type of disease. As predicted, patient self-efficacy is associated with lower levels of nonadherence as well as greater perceived social support. The results show that self-efficacy has a significant direct effect and an indirect effect (through social support and satisfaction with support) on patient adherence, specifically regarding diet and exercise. This study contributes to understand the processes underlying increased levels of nonadherence to treatment in people with lower self-efficacy and less social support. The results are discussed in terms of their contribution to future intervention programs for improving adherence to treatment in chronic patient groups.

Palliative care in Romania is a relatively new emerging field. Challenges of this specialty, its uniqueness and the several problems posed by a particular category of patients, the chronically ill patients, make this medical specialty a particularly complex one in certain situations, requiring a multidisciplinary team well-prepared in terms of theory and practice. Unlike in the case of most medical specialties, particular emphasis is laid on the “human” side of medical care, this specialty introducing the concept of “total pain”.

The existence of good coordination between the different levels of care is an essential factor in the development of quality and efficient healthcare. The primary care physician is fundamental in the secondary prevention of cardiovascular disease and the close collaboration between primary care and cardiology is a key factor in the control of cardiovascular disease. The CAPaCERES project (AP-Cardiology Collaboration in Caceres) aims to improve the coordination between primary care and cardiology from the perspective of mutual knowledge and the improvement of communication between the professionals who develop it, and with that to improve the quality of care chronic patient with cardiovascular disease.

In the e-Health learning area, the use of chronic patient context has become very important given the increase in the number of individuals who suffer from these diseases and the unavailability of medications. Specifically, chronic kidney failure is one of the diseases that goes undetected and undiagnosed until it is well advanced. The need for preventive prediction remains an essential task for the well-being of patients at risk. In this paper, we aim to explore the added value of using ontology-based prediction, focusing on Linear SVM, to deal with Chronic Kidney Disease Problems.

Hepatitis B virus (HBV) causes significant global health problems despite the presence of a potential vaccine. HBV chronic cases are increasing rapidly in developing countries like Bangladesh. Here, we report the complete genome sequence of an HBV genotype C strain isolated from a chronic patient identified at an outdoor hospital section.

Background: Provision of care to patients with chronic diseases at their homes remains a great challenge for modern health care systems. Smartphone applications are indicated as one of the strategies that could improve care delivery to this group of patients. The aim of this study is to investigate the feasibility and usability of a proprietary application with a messaging service used by a primary care team attending chronic patients mainly at their homes. Methods: A Cross-sectional pilot study of a smartphone application to communicate amongst clinicians. Primary care practices in Tona, Spain, were recruited during a period from January to December 2016. Clinicians used WhatsICS to communicate during their home visits for 12 months. We studied the patterns of use, response time and types of communication. To explore barriers and enablers, semi-structured interviews were conducted with selected nurses, social worker and general practitioners. Results: Two nurses, two practitioners and a social worker were recruited and more than 1,000 hours of communication were recorded on 163 patients, generating 5820 communication events. Nurses initiated the majority of communications (59.79%); these communications were mainly for the purpose of receiving instructions from practitioners and for coordination (66.6%). The communications were made on weekdays, from Monday to Friday, and between 7:30 a.m. and 9:30 p.m. (99.73%). Participants felt that WhatsICS helped streamline and improve home-based care. Conclusions: WhatsICS is safe technologically and accepted as a communication tool for professionals. This study establishes the basis for future implementations of this tool to improve the care of chronic patients at home through smartphones.

This narrative presents my personal reflections as a medical anthropology researcher, and my journey as a chronic patient suffering for 30 years from ulcerative colitis. My surgeon promised me "a new life" after recommending a total colectomy 20 years ago. Indeed, a new life did begin following surgery, but I find I must renegotiate the challenges and rewards of this new life nearly every day.

Recent studies reported enhanced performance on language tasks induced by transcranial direct current stimulation (tDCS) in patients with aphasia. One chronic patient with non-fluent aphasia received 20 sessions of a verb anomia training combined with off-line bihemispheric tDCS applied to the dorsolateral prefrontal cortex (DLPFC) - anodal tDCS over left DLPFC plus cathodal tDCS over right DLPFC. A significant improvement in verb naming was observed at all testing times (4, 12, 24, and 48 weeks from post-entry/baseline testing) for treated and untreated verbs. Our findings show beneficial effects of verb anomia training in combination with tDCS in chronic aphasic patient, suggesting a long-lasting effect of this treatment.

Due to social, economic and cultural changes, there has been a transformation of Health Services around the world. A new figure has emerged from this: the Active Patient, more responsible, with more information and willing to change his life as a chronic patient. In order to respond to this new situation, several countries have established initiatives such as self-reliance programmes for chronic patients. The aim of this article is to underline the Expert Patient Programme Catalonia(®) and to explain its operation and the results obtained up until now. The purpose of this program is to improve the experience of chronic disease by patients, from meetings in which an expert patient provides his knowledge and experiences to a group of patients with the same disease, with the aim of promoting changes in habits and lifestyles that improve the quality of life and the coexistence of the person with his chronic process.

Sepsis syndrome includes an immediate inflammatory, or innate immune, response to infection that may be followed by mild or severe organ failure, excessive or depressed inflammation, survival, or death in more than 25% of patients. Research in animal models indicates that excessive inflammation increases early mortality, and targeted anti-inflammatory therapies reliably decrease mortality (1). Unfortunately, targeting inflammatory pathways in human clinical trials has not reduced patient mortality. Possible explanations for lack of response in humans include the heterogeneity of the sepsis syndrome in terms of cause and patient responses: micro-organism, site of infection, chronic patient illness, genomic program of inflammation, or timing of therapy in relation to onset of infection (2). An important element for future clinical trials will be to better characterize patients and match with one or more therapies most likely to reduce mortality.

Low-income Hispanics are often identified as especially at risk for common chronic conditions like diabetes and are targeted for aggressive screening and treatment. Anthropologists and other social scientists have extensively explored barriers and facilitators to the management of chronic illnesses in minority populations but have not yet considered the impact of recently lowered diagnostic and treatment thresholds on such groups. In this paper, we critically review recent changes in diabetes, hypertension, and high cholesterol diagnostic and treatment standards that have dramatically increased the number of people being treated for these conditions. Drawing on an ethnographic study of chronic illness management in two Hispanic-serving clinics in the Midwest, we examine how these new standards are being applied and consider the resulting health care challenges their patients face. Our analysis leads us to question the value of promoting narrowly defined treatment goals, particularly when patients lack reliable access to the health care resources these goals require. While improving the health of low-income Hispanics is a worthwhile goal, it is important to consider whether these efforts may be promoting over-diagnosis and over-treatment, drawing them into an expensive chronic patient role with uncertain benefit.

Purpose – Reports on quality of life (QOL) measures for forensic patients are severely limited. The present paper aims to consider how to assess chronic patient's well‐being and to identify and evaluate the content validity of measures used to assess health‐related QOL in psychosis.Design/methodology/approach – A review was undertaken to gather information on the different QOL measures from relevant databases, exploring their strengths and weaknesses.Findings – Results from the review indicate a broad range of assessment tools are used in practice, although very few have been used in forensic settings. A preference for subjective tools is emerging, in addition to patient rated scales as opposed to clinician rated scales.Originality/value – The application of QOL measures in the forensic population is of particular interest and a relatively new area of study, thus of value to practicing clinicians. It is hoped that the use of appropriate tools will enhance understanding of the treatment and service needs f...

A historian of aging, privileged to work with an interdisciplinary team of caregivers and researchers in a division of geriatric and palliative care of a major medical school and teaching hospital, discovers that his history of chronic illnesses secures him a useful role as a humanistic patient who helps clinicians to respond to the concerns, fears, and needs of aging Boomers.

A health care protocol for a chronic disease contains a set of actions that describe how the patient should treat his/her disease outside the hospital. The patient and possibly his healthcare team should follow the protocol in order to control the evolution of the chronic disease. The main problems are that (i) the patient can't interact and integrate in the protocol the expertise he acquired during his daily life with the disease and (ii) the health care team doesn't know how the protocol is concretely followed. Our main contribution in this paper is an approach for integrating the patient's expertise knowledge expressed in textual or verbal form, and representing this expertise with an ontological paradigm.

Purpose: The aim of this study is to explore and understand the experience of the adaptation process among family caregivers in hospitals, who have an active presence in hospital and are essential in ensuring proper patient care. Methods: A qualitative phenomenological approach was used to gain a deeper understanding of caregivers' lived experiences. Data were collected using in-depth interviews to explore six caregivers' experiences of hospitalization. Results: The caregivers' accounts highlight the different determining factors in the transition process of a chronically ill patient's family caregiver during the patient's time in hospital. The most important themes emerging from the analysis were the importance of cultural beliefs and attitudes, meaning of the situation, caregiver's training and knowledge, socio-economic status and the hospital as a community. These categories can be analyzed using transitions theory. Conclusions: The most important conclusion is that the hospital in this study was not designed to accommodate caregivers, and the mechanisms used to meet caregivers' needs endanger their privacy, health, and coexistence in the hospital's rooms. Transitions theory provides a holistic understanding of the experience of the family caregiver.

Purpose The aim of this study is to explore and understand the experience of the adaptation process among family caregivers in hospitals, who have an active presence in hospital and are essential in ensuring proper patient care. Methods A qualitative phenomenological approach was used to gain a deeper understanding of caregivers' lived experiences. Data were collected using in-depth interviews to explore six caregivers' experiences of hospitalization. Results The caregivers' accounts highlight the different determining factors in the transition process of a chronically ill patient's family caregiver during the patient's time in hospital. The most important themes emerging from the analysis were the importance of cultural beliefs and attitudes, meaning of the situation, caregiver's training and knowledge, socio-economic status and the hospital as a community. These categories can be analyzed using transitions theory. Conclusions The most important conclusion is that the hospital in this study was not designed to accommodate caregivers, and the mechanisms used to meet caregivers' needs endanger their privacy, health, and coexistence in the hospital's rooms. Transitions theory provides a holistic understanding of the experience of the family caregiver.

Objetivo: Analizar-identificar las causas que producen Manejo Inefectivo del Régimen Terapéutico en pacientes crónicos de consulta de enfermería. Metodología: Estudio descriptivo, cuantitativo y cualitativo. Análisis descriptivo, cuantitativo, cualitativo e inferencial (prueba de la Ji-cuadrado y test ANOVA). En el análisis cualitativo se etiquetaron los resultados en cuatro categorías: Conocimientos y habilidades del usuario. Motivación y dificultades para cuidarse. Apoyo familiar y social. Relación con el equipo sanitario. Resultados: Participaron 25 pacientes en el estudio cuantitativo y 6 en el cualitativo. Presentan una media de 4 patologías, siendo las más prevalentes Diabetes (80%), Obesidad (76%), HTA (68%), EPOC (12%), Cardiopatías y otros procesos (20%). En el análisis de las entrevistas, los mayores problemas fueron: incumplimiento de dieta y ejercicio físico. Al apoyo familiar le conceden un valor importante y ponderan positivamente la relación con el equipo sanitario. Conclusión: el personal sanitario debe asumir la existencia de pacientes no cumplidores, y establecer las medidas necesarias para detectarlos. Objective: Analyze-identify the underlying causes of IHTR in chronic patients attending nursing consultation. Methods: Descriptive study, quantitatively and qualitatively. Descriptive analysis, quantitatively, qualitatively and analytic statistical as the Chi-square proof and the ANOVA test. In the qualitatively analysis the results were tag in four categories: User Knowledge and Ability. Motivation and difficulties for self-healing. Family and social support. Sanitary Staff relation. Results: 25 patients took part in the quantitatively study, and 6 in the qualitatively one. They show an average of 4 chronic pathologies, being the most prevalent: Diabetes (80%), Obesity (76%), AHT (68%), COPD (12%), Heart Diseases and other processes (20%). In the analysis of the interviews, the biggest problems were the failure of diet and physical exercise. They give a high value to the family support; and they are pleased with the sanitary staff relations. Conclusions: The Sanitary Staff must assume the existence of non-compliant patients, and they must establish the steps to detect it.

As part of the actions implemented by the Mexican government, to address chronic diseases most prevalent in the country, since 2008 the Ministry of Health launched the Medical Specialty Units Chronic Disease (UNEMES EC), which under Model "Prevention Clinic" provides care to patients referred to the first level and reagents for the treatment of diabetes mellitus, hypertension, overweight or obesity, metabolic syndrome and dyslipidemia. In this model converge several components: the medical-pharmacological care focused on disease control, prevention and early detection of complications, an education process for users and involving a multidisciplinary team composed of medical specialists, registered nurses, nutrition, psychology and social work and administrative staff; trained specifically for patient care and involve your family. Moreover, within primary care actions performed early detection, providing interventions to the population in risk detected. The extension component of good practice to the primary care level, provides training and advice to staff referral units. To implement the model in the 100 units in operation, were trained for multidisciplinary team, to publicize the operational model, define processes, responsibilities and made use of electronic medical record HAD doc care for these diseases. Through an exploratory qualitative study for five years consulting and continuous monitoring by various media was given, supervisory visits were conducted, with a charter application of structured, weighted and interviews with team members and executives program. Development in the implementation of the model. Results: The results show that there is a correlation between the proposed theoretical model and operating model, with good clinical integration within the team resulting in comprehensive, multidisciplinary care to patients and their families is given, highlighting satisfaction users. 3 World Congress on Integrated Care, Mexico City, Mexico, 19-21 November, 2015 International Journal of Integrated Care – Volume 15, 17 Nov – URN:NBN:NL:UI:10-1-117372 – http://www.ijic.org The findings to identify difficulties at various levels for the insertion and articulation of this model in the continuum of care. At the national level, although this protocolized the care of these patients in the UNEMES EC, there is a lack of regulations on the articulation of these units with primary and secondary, to allow proper transit of chronic patient care, according to their clinical need . Statewide, the difficulties are related on the one hand mechanisms job instability personnel serving in these units, and on the other, monitoring mechanisms and oriented to meeting targets assessment, rather than an integrated factor analysis approach that contribute to non-compliance with them and the dilution of responsibilities. At the national level, a lack of knowledge, adoption of the model and dilution of responsibilities, leading to greater disruption at this level and operational fragmentation was detected. Conclusion: As a result of these structural difficulties, UNEMES EC should make additional efforts to achieve care coverage, trigger actions model and achieve its objective of contributing to slow the trend of major chronic diseases. Conference abstract Spanish Como parte de las acciones que implemento el Estado Mexicano, para atender las enfermedades cronicas de mayor prevalencia en el pais, a partir del ano 2008 la Secretaria de Salud puso en marcha las Unidades de Especialidades Medicas de Enfermedades Cronicas (UNEMEs EC), que bajo el Modelo de “Prevencion Clinica” otorga atencion a pacientes referidos del primer nivel y reactivos al tratamiento de diabetes mellitus, hipertension arterial, sobrepeso u obesidad, sindrome metabolico y dislipidemias. En este modelo confluyen varios componentes: la atencion medico-farmacologica enfocada al control del padecimiento, la prevencion y deteccion oportuna de complicaciones, un proceso educativo para los usuarios y, la participacion de un equipo multidisciplinario integrado por medicos especialistas, licenciados en enfermeria, nutricion, psicologia y trabajo social y personal administrativo; entrenado ex profeso para atender al paciente e involucrar a su familia. Ademas, dentro de sus acciones de atencion primaria realiza deteccion oportuna, otorgando intervenciones a la poblacion en riesgo detectada. El componente de extension de buenas practicas hacia el primer nivel de atencion, brinda capacitacion y asesoria al personal de unidades de referencia. Para la implementacion del modelo en las 100 unidades funcionando, para se capacito al equipo multidiciplinario, para dar a conocer el modelo operativo, definir los procesos, responsabilidades y uso del expediente clinico electronico hecho had doc para la atencion de estas enfermedades. A traves de un estudio exploratorio de caracter cualitativo, por cinco anos se dio asesoria y monitoreo continuo por diferentes medios de comunicacion, se realizaron visitas de supervision, con aplicacion de una cedula estructurada, ponderada y con entrevistas con los integrantes del equipo y directivos del programa. Desarrollo en la implementacion del modelo. Resultados: Los resultados muestran que existe una concordancia entre el modelo teorico planteado y el modelo operativo, con buena integracion clinica al interior del equipo que se traduce en atencion integral y multidisciplinaria que se otorga a los pacientes y sus familias, resaltando la satisfaccion de los usuarios. Los hallazgos permiten identificar dificultades en diversos niveles para la insercion y articulacion de este modelo en el continuo de atencion. En el nivel nacional, si bien esta protocolizado la atencion de estos pacientes en las UNEMEs EC, se carece de normatividad sobre la articulacion de estas unidades con las de atencion primaria y secundaria, que permita el transito adecuado del paciente cronico, segun su necesidad clinica. A nivel estatal, las dificultades estan relacionadas por un lado con mecanismos de inestabilidad laboral del personal que atiende en estas unidades, y por otro, a mecanismos de seguimiento y evaluacion orientada al cumplimiento de metas, mas que a un enfoque integrado de analisis de factores que contribuyen al no cumplimiento de las mismas y a la dilucion de responsabilidades. En el nivel jurisdiccional se detecto una falta de conocimiento, adopcion del modelo y dilucion de responsabilidades, lo que genera a ese nivel mayor desarticulacion y fragmentacion operativa. 3 World Congress on Integrated Care, Mexico City, Mexico, 19-21 November, 2015 International Journal of Integrated Care – Volume 15, 17 Nov – URN:NBN:NL:UI:10-1-117372 – http://www.ijic.org Conclusion: Como consecuencia de estas dificultades estructurales, las UNEMEs EC deberan realizar esfuerzos adicionales para lograr la cobertura de atencion, disparador de las acciones del modelo y lograr su objetivo de contribuir a desacelerar la tendencia de las principales enfermedades cronicas.

Current systematic reviews yielded relatively small efficacy effect sizes of different psychopharmacological agents compared to placebo. It seems that these effect sizes have decreased compared to earlier meta-analyses. We speculate about factors explaining the decrease of effect size such as lower methodological requirements for earlier randomised controlled trials, but in particular enormous methodological problems of current trials such as chronic patient populations, exclusion of severely ill patients by the protocols, sponsoring by the pharmaceutical industry and so-called professional patients. A few examples from general medicine are used to illustrate that the effect sizes of other medications are often also surprisingly small. Psychotropic drugs are efficacious, but they need to be prudently applied according to evidence-based criteria.