Individual Therapeutic Goals Research Articles

Farmakoterapija hroničnog nekancerskog bola kod odraslih

Chronic non-cancer pain (CNCP) in adults is one of the most common reasons for which patients seek medical help. Chronic pain is present in about 20% of the world's adult population and as a global health problem requires greater attention from every society. Chronic pain has a negative impact not only on the individual but by increasing costs, directly on the health system and indirectly on the economy of the whole society. Its adequate treatment is a human right, and every healthcare system must ensure it. In this regard, great progress has been made with the implementation of chronic pain in the revised ICD-11, which will contribute to changing health policy and focusing more attention on the prevention and treatment of chronic pain worldwide. Integrative pharmacological and nonpharmacological therapeutic approaches with the patient in focus (patient-centric approach) have the strongest evidence of effectiveness; because they reduce not only the intensity of pain but also improve physical, psychological, and social functionality and increase patient satisfaction. Individually tailored balanced pharmacological approaches for different phenotypes of chronic pain (nociceptive, neuropathic, nociplastic) involve the use of nonselective and selective non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, antidepressants, anticonvulsants, other adjuvant therapies and opioid analgesics. These pharmacological approaches based on mechanisms, intensity of pain, and comorbidities, contribute to the optimization of individual therapeutic goals and the maximization of safety and quality of life of persons being treated. Liberalization of opioid prescription in CNCP and inadequate selection and follow-up of patients have contributed to opioid prescription reaching epidemic proportions in the USA, Canada, and some Western European countries and led to the phenomenon of medicalization, iatrogenesis, and fatal outcomes, i.e. opioid crisis. The U.S. Centers for Disease Control (CDC, 2022) guideline for opioid prescribing is summarized in 12 key recommendations based on strong evidence and related to initiation of opioid therapy, opioid selection, dose determination, duration of therapy, monitoring, and assessment of potential side effects from the use of opioids.

Clinical Approaches to the Three-Dimensional Endodontic Obturation Protocol for Teeth with Periapical Bone Lesions

Knowledge of dental anatomy and the three-dimensional principles of debridement, sterilization and obturation is necessary for effective root canal treatment. The chemo–mechanical preparation of the root canal biomechanically significantly reduces the number of microorganisms present. However, research has demonstrated that microorganisms frequently persist. The antimicrobial effect of the irrigants is essential to their biological function. Several obturation techniques are currently available, the selection of which depends on the canal’s morphology and the individual therapeutic goals of each instance. New sealing materials and methods for regenerative root canal obturation are enhancing and improving the predictability of three-dimensional (3D) sealing procedures. Epoxy sealers and gutta-percha are currently employed by clinicians as the gold standard in obturation procedures. The most recent developments in endodontic sealing materials are related to bioceramic sealers. Reports indicate that bioceramic sealers are biocompatible, harmless, hydrophilic, expandable and antibacterial. In the therapy of teeth with periapical lesions, not only the effective treatment of the root canal system but also the quality of the used sealer are of particular importance. Regenerative processes in the bone lesion are potentiated by the action of the sealer due to its highly biocompatible, non-toxic, aluminum-free and antibacterial capabilities. This paper discusses sophisticated root canal sealing materials and contemporary filling techniques in the regenerative therapy protocol for teeth with periapical bone lesions.

Innovative technologies in the management of diabetes mellitus: prevention of hypoglycemia

One of the strategies for preventing hypoglycemia, along with structured patient education and the use of modern hypoglycemic agents, is self-control of glycemia with the achievement of individual therapeutic goals. Frequently recurring hypoglycemic episodes are associated with impaired recognition of hypoglycemia and increase the risk of severe hypoglycemia up to six times. Prevention of the development of severe hypoglycemia may be of key importance for the prevention of adverse cardiovascular events and the risk of sudden death in patients with diabetes mellitus. Repeated hypoglycemic episodes can lead to impaired recognition of hypoglycemia, as a result of which a lower blood glucose level is necessary for the development of clinical symptoms of hypoglycemia. The use of individual glucose meters is currently relevant, despite the active introduction into clinical practice of continuous monitoring of glycemia and flash monitoring. ccording to the Russian “Algorithms of specialized medical care for patients with diabetes mellitus”, patients are recommended to conduct self-monitoring using individual glucose meters at least 4 times a day when using continuous monitoring of glycemia in real time and at least 2 times a day when using flash monitoring of glycemia to assess accuracy and / or calibration monitoring data and in order to resolve the issue of correction of ongoing therapy. The desire for strict and adequate self-control dictates the need to use the latest means of glycemia control – intelligent glucose meters with high accuracy, ease of use and reliability of blood glucose measurements. The introduction of intelligent technologies – “smart” glucose meters using a mobile application, with the functions of “no coding”, “second chance”, data transmission to the attending physician – makes it possible to carry out remote monitoring, providing more effective management of diabetes mellitus.

International classification of functioning, disability and health (ICF) in daily clinical practice: Structure, benefits and limitations

IntroductionThe diagnosis of intellectual disability (ID) alone does not predict the level of required care, functional outcomes or limitations in social and occupational participation. The International Classification of Functioning, Disability and Health (ICF) is a taxonomy of health and health-related domains. It provides a common language and framework for describing the level of functioning of a person within their unique environment. Furthermore, it helps to describe health problems of a person in line with the International Classification of Diseases (ICD-10).ObjectiveIntroducing the ICF taxonomy exemplary in the care of individuals with ID and mental health problems in Germany.MethodComparison of the ICF’s comprehensive multidisciplinary approach to assess an individual’s level of functioning and care in relation to assessing the needs of persons with ID based on clinical experience.ResultsThe ICF provides a standardised assessment instrument to determine individual functional needs for the care, rehabilitation and societal integration of individuals with disabilities, which is a statutory requirement in many European countries.ConclusionUsing the ICF for the assessment and management of patients with chronic health conditions, mental disorders and ID can help to accurately define individual therapeutic goals and monitor functional outcomes. A comprehensive narrative description of the patient’s functional status and clinical needs is comparatively time-consuming, requires greater effort by the assessing clinician and carries a higher risk of omission of pertinent functional domains; furthermore, a single ICF item confers little additional benefit to the patient in terms of the treatment or care they subsequently receive.DisclosureNo significant relationships.

A systematic review of the clinical effectiveness of monitoring patients with diabetes mellitus using individual blood glucose meters with function of transmitting measurements via gsm channel or via the internet

BACKGROUND: In recent years, there has been an active introduction of telecommunication technologies in various spheres of scientific and practical knowledge, including medicine. Diabetes mellitus (DM) is one of the most common chronic non-communicable diseases requiring constant monitoring of the patients condition. For telemedicine monitoring of patients with DM, glucose self-monitoring devices with the option of transmitting patients measurements via GSM channel or via the Internet have been developed.
 AIM: To evaluate the clinical effectiveness of telemedicine observation of patients with DM using individual glucose self-monitoring devices with option of transmitting patients measurements via a GSM channel or via the Internet.
 MATERIALS AND METHODS: Publications about clinical trials were searched in PubMed. The search, selection and evaluation of the methodological quality of clinical trials were carried out by two independent researchers. Clinical trials were included in the review if the clinical efficacy of remote monitoring of patients with DM using individual glucose self-monitoring devices with the option of transmitting the results of measurements taken by the patient via a GSM channel or via the Internet was evaluated in comparison with traditional observation methods.
 RESULTS: As a result of the systematic search, 10 original randomized controlled trials (RCTs) with different methodological quality were selected. It was found that the use of remote technologies for 12 months does not affect the level of glycated hemoglobin, however, it allows to increase the frequency of achieving individual therapeutic goals in patients with type 2 DM. In addition, it was found that the use of remote technologies allows to reduce the frequency of outpatient visits of patients with type 2 DM, but does not reduce the length of hospitalization and the frequency of an emergency calls of these patients.
 CONCLUSION: Thus, evidence was obtained of the potential therapeutic benefits of remote observation of patients with diabetes based on data from foreign clinical studies. Based on the results obtained, a Russian clinical trial of this medical technology can be recommended.

Patterns of Change in Collaboration Are Associated with Baseline Characteristics and Predict Outcome and Dropout Rates in Treatment of Multi-Problem Families. A Validation Study.

Objective: The present study validates the Multi-Problem Family (MPF)-Collaboration Scale), which measures the progress of goal directed collaboration of patients in the treatment of families with MPF and its relation to drop-out rates and treatment outcome.Method: Naturalistic study of symptom and competence-related changes in children of ages 4–18 and their caregivers.Setting: Integrative, structural outreach family therapy.Measures: The data of five different groups of goal directed collaboration (deteriorating collaboration, stable low collaboration, stable medium collaboration, stable high collaboration, improving collaboration) were analyzed in their relation to treatment expectation, individual therapeutic goals (ITG), family adversity index, severity of problems and global assessment of a caregiver’s functioning, child, and relational aspects.Results: From N = 810 families, 20% displayed stable high collaboration (n = 162) and 21% had a pattern of improving collaboration. The families with stable high or improving collaboration rates achieved significantly more progress throughout therapy in terms of treatment outcome expectancy (d = 0.96; r = 0.43), reaching ITG (d = 1.17; r = 0.50), family adversities (d = 0.55; r = 0.26), and severity of psychiatric symptoms (d = 0.31; r = 0.15). Furthermore, families with stable high or improving collaboration maintained longer treatments and had a bigger chance of finishing the therapy as planned. The odds of having a stable low or deteriorating collaboration throughout treatment were significantly higher for subjects who started treatment with low treatment expectation or high family-related adversities.Conclusion: The positive outcomes of homebased interventions for multi-problem families are closely related to “stable high” and an “improving” collaboration as measured with the MPF-Collaboration Scale. Patients who fall into these groups have a high treatment outcome expectancy and reduce psychological stress. For therapeutic interventions with multi-problem families it seems beneficial to maintain a stable high collaboration or help the collaboration, e.g., by fostering treatment expectation.

Síndrome metabólica, componentes e fatores associados em adultos de 40 anos ou mais de um município da Região Sul do Brasil

Resumo Objetivo Estimar a prevalência de síndrome metabólica (SM), de seus componentes e fatores associados em adultos de 40 anos ou mais. Métodos Estudo transversal, de base populacional, com 1.180 residentes em um município brasileiro de médio porte da Região Sul. Realizaram-se entrevistas domiciliares, avaliações antropométricas e exames laboratoriais. A SM foi definida de acordo com o critério harmonizado de 2009. Foram analisadas variáveis sociodemográficas, comportamentais e de utilização de serviços de saúde. Utilizaram-se o teste de qui-quadrado, exato de Fisher e teste de Wald na análise de múltiplos fatores pela regressão de Poisson. Resultados Entre os entrevistados, 959 (81,3%) realizaram exames laboratoriais e medidas antropométricas. A prevalência de SM foi de 53,7%, mais elevada em mulheres e em idades mais avançadas. A presença de cinco componentes da SM foi observada em 12% dos participantes (15,8% mulheres e 7,3% homens). Após ajustes, apenas a idade se associou à SM. Conclusão A elevada prevalência de SM e de seus componentes, distinta em cada sexo e grupo etário, aponta a necessidade de ações de enfrentamento com abordagens coletivas e estabelecimento de metas terapêuticas individuais.

Importance of Geriatric Syndromes in Older Patients with Diabetes with de novo Insulin Treatment: The VEGAS Study.

AimsThe VEGAS study was conducted to evaluate representative data of de novo insulin-treated older patients with type 2 diabetes in the outpatient setting in Germany.MethodsIn this prospective, multicenter, non-interventional observational study, a nationwide written survey was carried out among practitioners (02/2011–06/2011). Older patients, aged ≥70 years, starting de novo insulin therapy, were documented.ResultsData from 4,858 patients from about 500 centers (mean age: 78.2 ± 5.4 years; mean glycosylated hemoglobin [HbA1c]: 70 ± 14.2 mmol/mol [8.6 ± 1.3 %]) were collected. The mean target HbA1c value was 55 ± 6.6 mmol/mol (7.2 ± 0.6 %). 91.1 % of geriatric patients were multi-morbid. 96.2 % showed at least one physical or psychological geriatric syndrome. Most of the patients were notably impaired according to their age. Conventional insulin therapy and basal-supported oral therapy were the most frequently planned treatment regimens (39.1 and 31.1 %). Important factors in the selection of the insulin treatment regimen were an efficient HbA1c decrease (65.6 %), easy administration (55.7 %), and also a patient’s ability to self-administer insulin (38.5 %). De novo insulin treatment increased care requirements (22.7 %). 22.3 % of the relatives were scheduled to receive special training. Specific training programs for older patients with diabetes were planned in only 7.3 % of cases.ConclusionsThe data demonstrate the high prevalence of geriatric syndromes during de novo insulin treatment. Individual therapeutic goals and regimes are based on practicability, in particular, the receipt of autonomy and the care requirement. Diabetes education with adapted programs is currently under-represented. Important factors for the choice of an insulin treatment regimen were an efficient HbA1c decrease, easy administration, and a patient’s ability for self-administration.Electronic supplementary materialThe online version of this article (doi:10.1007/s40801-015-0014-9) contains supplementary material, which is available to authorized users.

"Kinect-ing" with clinicians: a knowledge translation resource to support decision making about video game use in rehabilitation.

Microsoft's Kinect for Xbox 360 virtual reality (VR) video games are promising rehabilitation options because they involve motivating, full-body movement practice. However, these games were designed for recreational use, which creates challenges for clinical implementation. Busy clinicians require decision-making support to inform game selection and implementation that address individual therapeutic goals. This article describes the development and preliminary evaluation of a knowledge translation (KT) resource to support clinical decision making about selection and use of Kinect games in physical therapy. The knowledge-to-action framework guided the development of the Kinecting With Clinicians (KWiC) resource. Five physical therapists with VR and video game expertise analyzed the Kinect Adventure games. A consensus-building method was used to arrive at categories to organize clinically relevant attributes guiding game selection and game play. The process and results of an exploratory usability evaluation of the KWiC resource by clinicians through interviews and focus groups at 4 clinical sites is described. Subsequent steps in the evaluation and KT process are proposed, including making the KWiC resource Web-based and evaluating the utility of the online resource in clinical practice.

Pediatric traumatic brain injury: an update

The developing brain is particularly vulnerable to traumatic brain injury (TBI), leading to frequent disability or death. This article is an update of the pediatric specificities of TBI management. We review the evidences with regards to general management and therapeutic goals to prevent secondary injuries in pediatric TBI patients. Recent controversies in neurocritical care, such as multimodal neuromonitoring, hyperventilation, barbiturate coma, hypothermia, and decompressive surgery, are also highlighted. Many therapeutic modalities in pediatric TBI have a low level of evidence. Further research is needed to establish clear resuscitation goals. Universal objectives may not be suitable for all patients; intensive neuromonitoring may help in identifying individual therapeutic goals and guiding the selection of treatments.

Evidence-based patient information in diabetes.

Patient education in diabetes has been successful in training and motivating patients to assume a more active and independent role in monitoring and treating their disease resulting in an improvement of patient-orientated outcomes. Traditionally, diabetes education has mainly aimed at increasing patient compliance to physician-defined therapeutic goals and treatment strategies. To strengthen their rights and autonomy, patients need to become more involved in medical decision making with respect to their individual therapeutic goals, such as HbA1c and blood pressure, body weight, etc., as well as choosing whether they pursue these goals. The importance of patient participatation is particularly relevant to Type 2 diabetes. Even perfect, long-term therapeutic co-operation will not eliminate diabetic complications, only reduce the risk of developing them. The benefits, lack of benefits and unwanted effects of various interventions need to be communicated to the patient in an unbiased manner, so that he/she can make an informed choice with regard to different therapeutic goals and strategies. In diabetes, ways of presenting patients with unbiased information to enable them to make such informed decisions are not yet available. We present ways of how this might be achieved using data provided by the UKPDS. The concept of patient participation in medical decision making represents a fundamental challenge for the future development of diabetes care.

Therapeutic goals and indications: psychotherapy patient's self-reports during diagnostic assessment

Although individual therapeutic goals are considered to be important factors motivating patients to engage in therapeutic work, they have gained little attention in empirical research. In the present study, patients were given a questionnaire containing 24 therapeutic goals which could be rated according to their subjective relevance on a 5-point scale. N = 152 patients (mean age 34.5 years, 59.2% female) who presented at a university psychotherapy outpatient department to attend a diagnostic interview participated in the study. "To solve my problems" and "to get relief from my complaints" were the goals that were rated as most important. Goals pertaining to mental health such as more contentness and calmness, self-assertion and insight scored high, too. Three rational scales were constructed: 1. insight, 2. sociability, and 3. self-assertion. These scales were correlated with both patients' causal attributions and therapy expectations in plausible ways. However, the general strength of intercorrelations point of the conception patients goals were not very succinct at the time of the intake interview. Indication groups regarding specific therapeutic measures did not differ with respect to therapy goals. Only the general decision whether to recommend a psychotherapeutic intervention or not seemed to be influenced by patients' therapeutic aims.

Differential indications for thyroid gland operation

Although the case for thyroid surgery is based on morphologic and physiologic criteria, it is mainly based on individual therapeutic goals. The goals are influenced by various biographic, medical and personal facts and by many environmental conditions. Thus, there is no rationale for cataloguing indications. With the euthyroid goitre the indication for surgery is usually given by the size of the thyroid gland, especially since it has become clear in various studies that with drug therapy the achievable size reduction is rather small. With Graves' disease the pros and cons of the three main methods, surgery, medical treatment or radioiodine, have to be considered in each case. Surgery is mainly indicated when the goal is a rapid and reliable normalization of the hormonal status. Thyroid autonomy is a clear-cut case for radioiodine. Only isolated autonomous nodules can equally well be treated by surgery. In addition, a case for surgery is given when besides the autonomy a large goitre is present. A special indication is iodine-induced thyrotoxicosis that cannot be normalized by medical treatment. All kinds of thyroid carcinoma, with very few exceptions, usually have to be operated on as the first choice.

Some Ethical Issues in Feminist-Oriented Therapeutic Groups for Women

Review of the origins of group psychotherapy reveals concerns with social as well as with personal "psychopathology." Thus, group processes have been mobilized for curative or change purposes for ideological as well as individual therapeutic goals. Psychopolitical as well as personal change are the goals for some groups. The ethical problem stems from a persistent assumption that the group's processes are inherently benign and curative and beneficial to individual participants. A more sophisticated understanding takes into account their essential neutrality and their potential use (or abuse) for purposes of ideological persuasion that may or may not be personally therapeutic. As in other ethically implicated issues in the psychotherapies, the question becomes one of treatment versus exploitation, or therapy for the individual versus recruitment on behalf of a cause.