Identification Of Possible Solutions Research Articles

The concept and features of the settlement of investment disputes under the legislation of the Republic of Kazakhstan

Relevance. The relevance of the study is determined by the fact that investment activity serves as one of the most important factors for the formation of an effective economic system, and litigation in this category of disputes is one of the innovations in the legal sphere of Kazakhstan and has no analogues in the post-Soviet space. Purpose. The objectives of this study are a theoretical analysis of the content of investment disputes, the procedure for resolving this category of disputes and identifying potential issues that may undermine the efficiency of dispute resolution. Methodology. Among the main methodological approaches used in the investigation are theoretical, functional, and dogmatic approaches, along with the method of induction, legal hermeneutics, the method of synthesis and others. Results. The study revealed that the characteristic features of investment disputes are the competition, confrontation, and interaction of private and public law categories. Notably, among the main categories of investment disputes were those involving the implementation of an investment project, and disputes related to the termination of investment activities and the admission of an investment; each category was defined and considered to have its own specific characteristics. As part of a detailed analysis, a judicial panel of the Supreme Court of the Republic of Kazakhstan was reviewed, which has jurisdiction over investment disputes involving large investors and appellate review of this category of disputes with other investors. Many conflicts and gaps in the current Kazakh and international framework have been identified. Conclusions. The practical value of the findings provided is the detailed analysis of the inherent issues and the identification of possible solutions aimed at improving the efficiency of investment litigation. Keywords: investment activity; Supreme Court; harmonisation of legislation; investment ombudsman; jurisdiction

The concept and features of the settlement of investment disputes under the legislation of the Republic of Kazakhstan

Relevance. The relevance of the study is determined by the fact that investment activity serves as one of the most important factors for the formation of an effective economic system, and litigation in this category of disputes is one of the innovations in the legal sphere of Kazakhstan and has no analogues in the post-Soviet space. Purpose. The objectives of this study are a theoretical analysis of the content of investment disputes, the procedure for resolving this category of disputes and identifying potential issues that may undermine the efficiency of dispute resolution. Methodology. Among the main methodological approaches used in the investigation are theoretical, functional, and dogmatic approaches, along with the method of induction, legal hermeneutics, the method of synthesis and others. Results. The study revealed that the characteristic features of investment disputes are the competition, confrontation, and interaction of private and public law categories. Notably, among the main categories of investment disputes were those involving the implementation of an investment project, and disputes related to the termination of investment activities and the admission of an investment; each category was defined and considered to have its own specific characteristics. As part of a detailed analysis, a judicial panel of the Supreme Court of the Republic of Kazakhstan was reviewed, which has jurisdiction over investment disputes involving large investors and appellate review of this category of disputes with other investors. Many conflicts and gaps in the current Kazakh and international framework have been identified. Conclusions. The practical value of the findings provided is the detailed analysis of the inherent issues and the identification of possible solutions aimed at improving the efficiency of investment litigation. Keywords: investment activity; Supreme Court; harmonisation of legislation; investment ombudsman; jurisdiction

Analysis of the implementation of the cluster approach in the Russian economy in modern conditions

The Russian economy is currently under significant pressure from various challenges that determine the need for an appropriate response, the basis of which is the intensification of innovative development, primarily in priority sectors. The effectiveness of innovation processes is largely determined by the existing infrastructure that provides the necessary traffic of innovative ideas at all stages from generation to implementation to end users. In this regard, the urgency of creating the necessary structural solutions that ensure the interaction of participants in innovation processes, among which the cluster is one of the priorities, is increasing. Domestic practice shows that active state support for the creation and functioning of clusters is not proportional to the achieved result, which determines the need to identify existing "bottlenecks" in the implementation of the cluster approach in Russia, leveling the efforts made, and identification of possible solutions. The purpose of the article is to identify the main trends and specifics of the cluster approach implemented in the Russian economy, and to identify the most important directions of its development, taking into account existing needs. Based on the data analysis, the dynamics and structure of clusters created in our country are determined, including in the context of regional differentiation, specific features of clusters functioning on the territory of our state are identified. Based on practical cases, the necessity of transformation of the cluster approach is justified, characterized by a shift in emphasis from the territorial aspect to the sectoral one. Thus, the scientific novelty of the presented research is the confirmation of the existing readiness and need for the development of the cluster approach implemented in Russian practice, and the shift of focus towards the sectoral aspect, in connection with which the role of the so-called national clusters is justified and their classification into sectoral and intersectoral clusters is proposed, which will contribute to achieving higher and faster results of innovative development of the Russian economy

461 Developing a Carer-Led Intervention Supporting older people and their carers with Medicines Management through pathways of care using interviews: a qualitative service evaluation

Abstract Introduction Previous studies have shown that informal carers involved in assisting with patients’ medicines have considerable knowledge about patients’ usual medication management (1). This could be helpful for healthcare professionals (HCPs) in secondary care caring for such patients and facilitate their safe discharge. However, carer involvement is often lost during patients’ hospital admissions, as carers report feeling excluded from decisions surrounding patients’ medicines management (2). Aim To assess the opinions of HCPs, patients and carers on strategies in place for HCPs to (i) identify informal carers during patients’ hospital admissions and (ii) aid communication between HCPs and carers with regards to medicines management during an inpatient stay and after discharge. Methods Semi-structured interviews were conducted with HCPs (doctors, nurses, pharmacists, occupational therapist and physiotherapist), adult patients, and their unpaid carers assisting with medication at home. Participants were recruited from three elderly care wards at one London teaching hospital. HCPs were approached directly; patients and carers were recruited with assistance from ward HCPs. Interviews explored participants’ opinions on current and potential methods for HCPs to identify informal carers, as well as how communication between HCPs and carers about medicines management could be improved. Interviews were transcribed verbatim and analysed using thematic analysis. Results Sixteen interviews were conducted. Thirteen participants provided demographic data, eight identified as female and five as male. Six identified as white British, one as Indian and one as Asian. A number of barriers to effective identification of carers were identified. Some HCP and carer participants were unaware of the carer’s identification lanyard provided by the hospital, which could help identify patients’ informal carers. Carers and HCPs suggested information about who assisted with medicines was not always passed between different HCPs, and that this should be on a central record that is assessed by all HCPs. Carers expressed the need to be kept updated on changes to medicines throughout the patient’s stay. Carers and HCPs made suggestions to improve this, including having a central point of contact to update carers during a patient’s hospital admission, having ‘five minute update’ discussions throughout admission, and involving carers in multidisciplinary interactions. Finally, carers suggested having access to written information about medication changes, especially before discharge. Carers and HCPs also identified lack of post-discharge follow up communication. Some HCPs and carers proposed community teams lead on follow-up, but HCPs highlighted the need for a clear referral process between secondary and primary care. Other carers and HCPs suggested the HCP teams looking after the patient during admission should follow-up with patient and carer shortly after discharge. Conclusion A strength of this service evaluation was identification of possible solutions to the problems identified. By asking about the personal experience of patients and carers, we identified suggestions for improvement. The main limitation is potential lack of generalisability, as interviews were only conducted at one hospital. The findings will be used to inform the development of a tool to improve communication and carer involvement in the medicines management process during an inpatient admission and after discharge.

China policy on Taiwan against the backdrop of the Russia-Ukraine War

The relevance of the study is conditioned by the transformational trends in globalisation policy as a result of russia’s full-scale invasion of Ukraine, especially in the political relations of the People’s Republic of China with Taiwan, which is one of the most important aspects of international security. The purpose of the study is to identify the characteristic features of the Taiwan issue. The following methodological approaches were used: functional, dogmatic, logical analysis, synthesis, deduction, method of legal hermeneutics, etc. The study found that political relations between China and Taiwan are largely determined by the party affiliation of the latter’s leadership. Parallels were drawn between China-Taiwan and russia-Ukraine relations, which are associated with the asymmetry of relations between the two countries. It was found that the russia-Ukraine war serves as a factor that will have a further impact on the development and resolution of the conflict between Taiwan and China. The possibility of resolving the China-Taiwan war will depend on the results of the russia-Ukraine war and the reaction of the international community, especially the United States of America, which is Taiwan’s main ally. The study results showed that the factor that will help reduce the likelihood of China’s intervention against Taiwan is Ukraine’s victory in the russia-Ukraine war; another factor is the active role of the international community in countering russian aggression If the United States and Europe take a passive stance, this will act as a factor that will increase the tension between China and Taiwan The practical value of the findings allows for a causal analysis of the Taiwan issue and the identification of possible solutions to the conflict against the backdrop of the russia-Ukraine war

Energy Transition Scenarios for Energy Poverty Alleviation: Analysis of the Delphi Study

Energy poverty is a phenomenon that is affecting an increasing number of EU citizens. It occurs when people are unable to buy enough energy to meet their needs at a socially acceptable level. Despite the many efforts and measures taken to prevent this negative phenomenon, the looming energy crisis could exacerbate it. On the one hand, efforts towards energy transition are intended to prevent this phenomenon, but on the other hand, inadequate restraint on the energy market may lead to its escalation. Various scenarios need to be analysed to ensure that the risks associated with energy shortages do not lead to even greater levels of energy poverty, with negative consequences for societies, economies, and the environment. Using a scenario approach and expert research, as well as mathematical–statistical tools, the article presents possible scenarios related to the implementation of measures affecting energy transformation and the transition to renewable energy sources in economies. These measures can change the phenomenon of energy poverty. The results of the analysis conducted in the article showed that there is a relationship between the increase in GDP per capita and the degree of energy consumption from renewable sources. In addition, there is a negative correlation between the degree of use of energy from renewable sources and the problem of energy poverty, especially in countries with a relatively lower level of GDP per capita. The current economic and political situation requires research in this area and the identification of possible solutions, as energy poverty is becoming a major social problem. The measures taken to promote sustainable development in an energy crisis situation might not be able to be implemented in a highly satisfactory manner.

Physiological and molecular characterization of the late ripening stages in Mangifera indica cv Keitt

Mango is heavily affected by rapid off-tree ripening progression with an excessive fruit softening that eventually limits its marketability. The comprehension of the physiological events occurring in the post-climacteric/senescent phase can contribute to the identification of possible solutions for the improvement of shelf life. In this study, the ripening process of mangoes cv Keitt was monitored for two weeks in a simulated commercial shelf life, after shipping from Brazil to Italy, measuring both ripening-associated parameters (firmness, soluble solid content, ethylene production) and non-destructive method based on Vis/NIR spectroscopy (the ripening index IAD). Moreover, the expression pattern of thirteen genes related to different ripening aspects such as ethylene biosynthesis (ACS, ACO), perception (ETR, ERS) and signaling (EIN2, ERF), in combination with genes responsible for cell wall metabolism (PG14, PG21, EXP, PEL, CEL) and carotenoids accumulation (PSY, NCED) were assessed. The results highlighted a specific gene signature characterizing the post-climacteric softening and the senescence onset. Moreover, the non-destructive IAD has proven to be an effective non-destructive monitoring system of the fruit ripening in mango.

ОБГРУНТУВАННЯ СТРУКТУРИ СИСТЕМИ ПІДТРИМКИ ПРИЙНЯТТЯ РІШЕНЬ НА СПРОЩЕННЯ КОНТРОЛЬНИХ ПРОЦЕДУР У ПУНКТАХ ПРОПУСКУ

The article is devoted to the substantiation of the structure of the decision support system for the simplification of control procedures at road checkpoints across the state border. As a result of the research, the structure of the decision support system for simplification of control procedures at road checkpoints is proposed. The structure is based on the analysis of the border control process at road checkpoints and technological features of its simplification, analysis of decision support models for the organization and technology of border control simplification, as well as analysis of problematic aspects of their implementation and identification of possible solutions. The article substantiates that the basis of the database management system models of the studied decision support system should be a model for determining the need for simplification of border control at road checkpoints, a model for determining the duration of simplification of border control and a model for selecting appropriate control actions for individuals and vehicles. queues. The basis of the database management system of the studied decision support system should be databases relating to the situation at the checkpoint, which changes dynamically over time, the characteristics of the queue of vehicles, tactical and technical characteristics of those vehicles from which the queue may be formed. car checkpoint, departmental database "Gart - 1 P", a database concerning the rules of crossing the state border, a database of information signs of offenses at the state border and risk profiles.

Waiting times in emergency departments: a resource allocation or an efficiency issue?

BackgroundIn recent years, the flow of patients to the Emergency Departments (ED) of Western countries has steadily increased, thus generating overcrowding and extended waiting times. Scholars have identified four main causes for this phenomenon, related to: continuity of primary care services; availability of specific clinical pathways for chronic patients; ED’s personnel endowment; organization of the ED. This study aims at providing a logical diagnostic framework to support managers in investigating specific solutions to be applied to their EDs to cope with high ED waiting times. The framework is based on the ED waiting times and ED admission rate matrix. It was applied to the Tuscan EDs as illustrative example.MethodsTo provide the factors to be analyzed once the EDs are positioned into the matrix, a list of issues has been identified. The matrix was applied to Tuscan EDs. Data were collected from the Tuscan performance evaluation system, integrated with specific data on Tuscan EDs’ personnel. The Tuscan EDs matrix, the descriptive statistics for each quadrant and the Spearman’s rank correlation analysis among waiting times, admission rates and a set of performance indicators were conducted to help managers to read the phenomena that they need to investigate.ResultsThe combined reading of the correlations and waiting times-admission rates matrix shows that there are no optimal rules for all the EDs in managing admission rates and waiting times, but solutions have to be found considering mixed and personalized strategies.ConclusionsThe waiting times-admission rates matrix provides a tool able to support managers in detecting the problems related to the management of ED services. In particular, using this matrix, healthcare managers could be facilitated in the identification of possible solutions for their specific situation.

Analysis of the Integration of Wind Energy Generation in the National Transmission System (NTS)

Background/Objectives: A case study is presented where a 1.432 MW wind power connection with DFIG (doubly-fed induction generator) technology is analyzed in the stability of the National Transmission System (NTS). Hence, the STN’s database from 2017 is used in DIgSILENT with different demand scenarios and their respective generation dispatch units. Methods/Statistical Analysis: A scan was executed on the flaws in circuits close to the connection of wind energy parks in La Guajira by calculating the percentage of events that generate the disconnection of wind turbines due to voltage sags and swells. The stability in frequency in response to these generation losses is also analyzed. Findings: Regarding the contingencies that were simulated, the outcome was seen in overshoot events of wind turbines due to transitory peaks in voltage during flaws that could not be solved with external reactive compensation. The stability in frequency related to these overshoots is greatly affected on disconnections higher than 400 MW. After verifying the reactive power injection from the converter of the DFIG model in DIgSILENT based on the compliance with electrical parameters supplied by manufacturers, 58% did not meet these technical specifications so a wind turbine model is necessary to grasp the internal operation of the converter. Conclusion: This allows the identification of possible solutions to stability issues that contribute to the operational and regulatory changes to define technical technology-related requirements and the connection of wind turbines in Colombia. Keywords: DFIG Wind Turbine, DIgSILENT, Stability, Voltage Supportability, Wind Energy

Utilisation des bases de données médico-administratives du Québec pour des études en santé mentale : opportunités, défis méthodologiques et limites – cas de la dépression chez les personnes diabétiques

The use of medico-administrative databases for studies on mental health issues is very common because of the large number of people in these databases and the possibility to carry out long-term studies. Several challenges, such as identifying people with a disease of interest or being exposed to a risk factor, have to be overcome through validation studies to ensure an optimal use of these resources. Moreover, limits (lack of certain relevant information) and the coverage of about 40% of Quebec's population by the public drug plan are to be considered in the interpretation and generalization of research results based on these data sources. In the specific case of depression, we used these databases to determine the incidence of depression among diabetic individuals in Quebec. This required the use of a previously validated algorithm (validated in another province) that we modified to define and identify the cases of depression in the RAMQ databases. We observed an incidence of depression of 9.47 persons years over a follow-up of 8 years. Finally, we assessed the impact of depression on adherence and persistence with antidiabetic drugs as well as the factors that affect patients' use of these drugs. Our results suggest that depression has a negative impact on the use of antidiabetic drugs and allow the identification of possible solutions.

WATERSTORY ILE

Background: Sustainable management of the municipal water supply is a priority issue in the policy agenda of Maui County, Hawaii. The Maui Economic Development Board launched the WaterStory initiative to educate residents about the determinants and history of Maui’s water resource development. A System Dynamics model was developed and coupled with a user interface to create WATERSTORY, an interactive learning environment (ILE). Purpose: The purpose of this study was to analyze the benefits of WATERSTORY for the identification and assessment of sustainable water management policies in Maui. Method: WATERSTORY is a System Dynamics-based ILE that shows the cross-sectoral impacts of users’ decisions. Both, the simulation model and the ILE resulted from group modeling and ILE testing sessions. Results: The development of the WATERSTORY ILE facilitated the involvement of local communities in the discussion of water management problems and identification of possible solutions. Conclusions: The study suggests that developing a simple ILE is essential in raising the interest of a wide audience involved in sustainable development policy making. After stakeholders gain confidence in the benefit of the ILE, it becomes easier to integrate simulation exercises into planning processes at national, regional and local levels.

The Mateiaș limestone quarry (Southern Carpathians): changes in spatial extent and local perception on the related environmental issues

The various natural resources and the industrialization policies implemented during the communist regime have resulted in the opening of many mines and quarries, inclunding the Mount Mateiaș exploitation. The aim of this study is to give warning against open pit mining, which has a direct and conspicuous impact on landscape dynamics and the cultural-historical value of Mount Mateiaș. The research methodology consisted in field observations, accomplished during the period 2009-2012, the analysis of limestone quarry expansion by using GIS techniques, and the application of a semi-structured interview, the results of which were processed subsequently in QSR-Nvivo 10. The analysis and processing of cartographic materials highlighted that during the interval 1979-2012 strip mining has dramatically altered the topography (by excavation works, land leveling, access road construction, accelerated slope erosion, collapses, torrential erosion etc.). These add to other processes and phenomena that have a negative impact on the environment (soil loss, massive deforestations, air pollution with suspended particles etc.). Despite these realities, most people living in the neighborhood of Mount Mateiaș (the Valea Mare-Pravaț, Dragoslavele, Stoenești and Câmpulung communes) deem that quarrying is vital for the development of local communities. Under the circumstances, the only economically productive and ecollogically protective measure advanced by the authors is the identification of possible solutions for the restauration of the quarry, given that limestone exploitation will not end in the medium term. Last, but not least, we suggest that the results of the present investigation be included in the pre- feasibility and feasibility studies of a potential future rehabilitation.

Will integration help systems deal with health care reform effectively?

PurposeThe purpose of this paper is to discuss the impact of demographic pressures on health and social care services and provide readers with a simple way of assessing their impact on local organisations.Design/methodology/approachThe major forces affecting health systems are identified and the likely impact discussed.FindingsIt is likely that between 4 and 8 per cent of existing budgets need to be released to deal effectively with increasing demand over the next decade. Systems that work in an integrated way are more likely to achieve this.Practical implicationsBy developing a quick numerical model, it is possible to assess the viability and effectiveness of proposed strategies.Originality/valueThe paper provides a quick way to think about the major forces affecting strategy enabling the reader to contribute to the identification of possible solutions.

Applied social research and action priorities for adaptation to climate change and rainfall variability in the rainfed agricultural sector of Zimbabwe

Climate change and rainfall variability poses serious risks to rainfed farming communities in the semi-dry agro-ecological zones of Zimbabwe. Its impacts include erratic and unpredictable seasonal rainfall, floods and cyclones. These impacts are more magnified in marginal rainfed agricultural areas characterized by low and erratic precipitation leading to low and unpredictable levels of crop production. Adaptation to these impacts is increasingly being advocated as a more sustainable response that enhances livelihoods. Through an examination of key debates from climate-science scholars, this paper examines the social research and action priorities that can be pursued in order to build the resilience of rural communities who rely on rainfed agriculture for their livelihoods. The paper examines the nature of adaptation processes and subsequently identifies research themes, action priorities and approaches that can generate more robust responses to climate change at various levels. The study found out that despite the weaknesses identified in Zimbabwean water and agricultural policies, there are a number of specific actions that researchers, policy-makers and communities can take to enhance adaptation capacity. Systematic assessment of rural risk and vulnerability and participatory identification of possible solutions can enable the rural poor to get better access to options, assets and the services they require to improve their livelihoods. This also enables the identification and improvement of more adaptation options that the farmers themselves have already been trying out for many years.

Reflections on the National Patient Safety Agency's database of medical errors

Reflections on the National Patient Safety Agency's database of medical errors

Rural energy consumption and land degradation in a post-Soviet setting – an example from the west Pamir mountains in Tajikistan

The sustainable use of energy resources in semi-arid rural mountain areas is a common but still unresolved problem, often resulting in environmental degradation. In a post-Soviet setting the identification of possible solutions poses specific challenges. This study aimed at (1) investigating the current energy supply and consumption patterns at household and village levels in the western Tajik Pamirs, (2) analysing the implications for land degradation and natural resource management, and (3) proposing recommendations for sustainable energy use, taking into consideration the peculiarities of the Soviet heritage. For this, a participatory and multi-level stakeholder approach was applied. Data was collected through comparative in-depth case-studies at household level and through participatory land degradation assessments. The study revealed that the close interlinkage between local energy resource use and land degradation leads to a paradoxical situation in present energy consumption. The scarcer the local energy resource base, the higher the overall energy consumption at household level appears to be. It can further be concluded that since 1991 energy consumption patterns in the Tajik Pamirs have become comparable to patterns in semi-arid rural mountain regions of developing countries. Like many countries in the South, the Tajik Pamirs suffer from chronic energy scarcity, unsatisfactory supply of modern energy carriers and unsustainable use of local biomass fuels, leading to land degradation. This calls for a reassessment of the energy policy orientation for Tajikistan.

Coiled-Tubing Operations in the Panna Field Offshore Western India

This article, written by Assistant Technology Editor Karen Bybee, contains highlights of paper SPE 100149, "Operability Challenges During Coiled-Tubing (CT) Well Intervention: Panna Field Case Histories From Western India Offshore," by S. Kale, SPE, and R. Proctor, SPE, BJ Services Co., and S. Paliwal, SPE, and S. Nayak, SPE, BG E&P India Ltd., prepared for the 2006 SPE/ICoTA Coiled Tubing and Well Intervention Conference and Exhibition, The Woodlands, Texas, 4-5 April. Coiled tubing (CT) was used in well interventions offshore western India. Well completions are open hole, open hole with tail pipe, and cased hole with swell packers. CT entry was essential to operate sliding sleeves installed in the completions. The full-length paper documents case studies and reviews attempted solutions such as bottomhole-assembly (BHA) excitation tools and contact-friction reducers to extend reach and increase downhole force. Introduction Located off the west coast of India, the target reservoir in the Panna field is a limestone layer. Horizontal wells have been drilled and completed in the field since 1997. The main difference between the wells completed in the late 1990s and current wells is the horizontal-section length. Challenges associated with CT operations can be considered as logistical and technical. The main logistical challenges include limited crane capacity and deck space for CT rig up. Technical challenges include limited CT downhole force. Because of logistical challenges, the preferred CT size cannot be used on most platforms. Logistical Challenges Panna field has two types of platforms, one with nine slots and the other with 15 slots. The nine-slot platforms have limited deck space and crane capacity. Larger CT sizes such as 1 3/4-in.-outside-diameter (OD) pipe cannot be rigged up on nine- slot platforms but can be used on the 15-slot platforms. Two memory-production-logging (PL) campaigns were undertaken on the 15-slot platforms. Because of limited deck space on some platforms, fluid-pumping and nitrogen equipment, tanks, and mixing equipment were offloaded to a dedicated supply boat as required. This presented the logistical challenge of timing the operations to boat availability and tide conditions. Technical Challenges The two most important technical challenges faced by the team were CT-reach prediction and identification of possible solutions to meet well-intervention objectives. The objectives of well interventions in late-1990s completions were acid stimulation and memory PL. Current completions require sliding-sleeve manipulation, acid stimulation, and PL. Accurate CT-entry predictions require use of a CT simulator. In addition, the engineer using the simulator must have a thorough understanding of the modeling parameters and analysis process.

Adherence to disease-modifying therapy in multiple sclerosis: Part II.

Multiple sclerosis (MS) is a chronic, debilitating disease for which there is no cure; however, the recent introduction of injectable immunomodulating agents has reduced the rate of relapsing episodes and possibly slowed the progression of the disease. These disease-modifying agents are recommended by the National MS Society, but their true potential cannot be realized if patients do not accept them and healthcare professionals do not promote them. Since MS has an unpredictable course, and treatments can produce side effects, adherence to the recommended therapy is a complex and challenging issue. Improved understanding of the obstacles to adherence and the identification of possible solutions should be of value to nurses, who have numerous opportunities to encourage patients to initiate and continue therapy. Part I of this article, published in the September/October 2001 issue of Rehabilitation Nursing, described the particular problems of treatment adherence in MS. Part II proposes that the transtheoretical model of behavior change can be a useful tool in achieving both patient acceptance and treatment goals. This model is founded upon the concept that readiness for change is crucial, and that attempts at intervention should be sensitive to the patients' changing conditions and states of mind.

Adherence to disease-modifying therapy in multiple sclerosis: Part I.

Multiple sclerosis (MS) is a chronic, debilitating disease for which there is no cure. However, the recent introduction of injectable immunomodulating agents has made it possible to reduce the frequency of relapsing episodes and to possibly slow its progression. The use of these agents is recommended by the National MS Society, however, their true potential cannot be realized if patients do not accept them and healthcare professionals do not promote them. Because MS is unpredictable, and treatments can produce side effects, ensuring adherence to the recommended therapy is a complex and challenging issue. A better understanding of the obstacles to adherence, and the identification of possible solutions, should be of value to nurses, who have numerous opportunities to encourage patients to initiate and continue therapy. This article, which is in two parts, describes the particular problems of treatment adherence, and proposes that the transtheoretical model of behavior change can be useful in achieving treatment goals in MS and in other chronic disease states. This model is based upon the concept that a patient's "readiness for change" is crucial, and that attempts at intervention should be sensitive to the patient's changing conditions and state of mind. Nurses who work with patients with MS and other chronic diseases can apply the model to help their patients accept and adhere to the demands of ongoing treatment.