Patient-oriented Medicine Research Articles

Modern extemporaneous pharmaceutical manufacturing: problems and prospects

Relevance. Extemporaneous manufacturing of preparations is an important component of modern patient-oriented medicine. This article provides an analysis of regulatory documents regulating the manufacture of drugs in a pharmacy, identifies problems and weaknesses in rationing production, and proposes constructive ways to solve the problems presented.Methodology. When conducting the study, methods of content analysis, comparative and logical analysis, and observation were used.Results. This article provides a critical analysis of the legal framework regulating the extemporaneous production of drugs. Weaknesses in the regulation of pharmaceutical production of dosage forms have been identified. In particular, the following problems are presented: checking the doses of active pharmaceutical substances and assessing the compatibility of prescription ingredients; issues related to the expiration dates of extemporaneously manufactured medicinal products; and problems with regulating conditions for the manufacture of drugs in pharmacies. Difficulties in equipping pharmacies with small-scale mechanization and aspects of the provision of modern active pharmaceutical ingredients and excipients are reflected, and the potential of physicians in prescribing extemporaneous prescriptions is noted.Conclusion. The proposed solutions to the identified problems will allow extemporaneous production to a new, more advanced level and expand the capabilities of personalized medicine.

Стратегический анализ реализации пациент-ориентированного подхода к развитию здравоохранения Кузбасса

Achieving the strategic goals of the Russian Federation for preserving the population and ensuring the health and well-being of people requires an effective health care system that can provide necessary medical services and technologies and systematically train residents in healthy lifestyle and disease prevention. 
 This necessitates a transition to patient-oriented medicine based on strategizing, which will ensure the coordination of federal, departmental and regional programs aimed at improving the medical care quality and the population health. The article analyses legislative, regulatory, organizational documents and statistical data at the federal, regional and departmental levels. The authors perform analysis of healthcare statistical indicators in the Siberian Federal District and its subjects in dynamics; OTSW analysis on the strategizing methodology; comparative analysis of long-term healthcare development goals. The expediency of applying strategic planning and management in the transition to patient-oriented medicine is established; interrelations between strategies of different levels are discovered; region’s strategic objectives for the healthcare sector transformation and the conditions for their implementation effectiveness are defined. The authors consider possibilities of implementing a strategy for the patient-oriented medicine development in Kuzbass on the basis of region’s strengths, identify the threats and risks of not achieving strategic objectives and formulate the proposals for their reduction. The article confirms the importance of strategies’ coherence and proactivity within the appropriate priorities; argues the potential for the patient-oriented medicine development in Kuzbass.

Supporting elderly patients in strengthening their personal and spiritual health resources.

Care for the sick, including spiritual support is sometimes called holistic medicine. The term bio-psycho-social-spiritual model is sometimes used to describe this type of therapeutic approach patient-oriented medicine. This report indicates the importance of taking into account the spiritual aspect of life due to its beneficial impact on the coping resources activated and the patient's well-being. Existential and spiritual issues are on the verge of new clinical and research interest in medicine, especially in gerontology, oncology, and palliative care. Clinicians focus not only on symptom control but also on spiritual and existential issues such as spirituality, hope, and meaning. This paper reviews the topic of spirituality in the context of illness and end-of-life care trying to define spirituality within the context of health resources of the subject. Spirituality is perceived in two of its main components: faith/religious beliefs and spiritual well-being. Especially this second construct is reviewed and described as a health resource.

The concept of patient-oriented medicine and pharmacy

The article describes the concept of the development of patient-oriented medicine and pharmacy in the Russian Federation.

Co-axial printing of convoluted proximal tubule for kidney disease modeling

Despite the increasing incidence of kidney-related diseases, we are still far from understanding the underlying mechanisms of these diseases and their progression. This lack of understanding is partly because of a poor replication of the diseases in vitro, limited to planar culture. Advancing towards three-dimensional models, hereby we propose coaxial printing to obtain microfibers containing a helical hollow microchannel. These recapitulate the architecture of the proximal tubule (PT), an important nephron segment often affected in kidney disorders. A stable gelatin/alginate-based ink was formulated to allow printability while maintaining structural properties. Fine-tuning of the composition, printing temperature and extrusion rate allowed for optimal ink viscosity that led to coiling of the microfiber’s inner channel. The printed microfibers exhibited prolonged structural stability (42 days) and cytocompatibility in culture. Healthy conditionally immortalized PT epithelial cells and a knockout cell model for cystinosis (CTNS -/-) were seeded to mimic two genotypes of PT. Upon culturing for 14 days, engineered PT showed homogenous cytoskeleton organization as indicated by staining for filamentous actin, barrier-formation and polarization with apical marker α-tubulin and basolateral marker Na+/K+-ATPase. Cell viability was slightly decreased upon prolonged culturing for 14 days, which was more pronounced in CTNS -/- microfibers. Finally, CTNS -/- cells showed reduced apical transport activity in the microfibers compared to healthy PT epithelial cells when looking at breast cancer resistance protein and multidrug resistance-associated protein 4. Engineered PT incorporated in a custom-designed microfluidic chip allowed to assess leak-tightness of the epithelium, which appeared less tight in CTNS -/- PT compared to healthy PT, in agreement with its in vivo phenotype. While we are still on the verge of patient-oriented medicine, this system holds great promise for further research in establishing advanced in vitro disease models.

KAMPOmics: A framework for multidisciplinary and comprehensive research on Japanese traditional medicine

Traditional Japanese medicines, known as “Kampo medicines”, are pharmaceutical-grade multi-herbal treatments that are integrated within the modern medical system in Japan. Although basic and clinical research including placebo-controlled double-blind trials is attempting to clarify their effectiveness and mechanisms of action, such studies are seriously limited due to the multi-targeted, multi-component “long-tail” properties of Kampo medicines, which are fundamentally different from modern western therapeutics. However, recent progress in high-throughput analytical technology, coupled with an exponential increase in biomedical information on various levels from molecular biology to clinical “big” data, is enabling us to commence a multidisciplinary and comprehensive investigation of Kampo medicines based on multi-omics, bio-informatics, and systems biology. In addition to deriving an inclusive understanding of the benefits and mechanisms of Kampo medicines, “KAMPOmics” may lead to the development of new principles to control and treat diseases in a systems-oriented manner. Furthermore, elucidation of “sho” and “mibyo” – classical concepts of Kampo, which loosely approximate to the notions of “precise medicine” and “pre-symptomatic aberration”, respectively – may contribute to the development of patient-oriented medicine, an area attracting enormous growth and interest in contemporary medicine.

Primary care patients' perspectives on the use of non-pharmacological home remedies in Geneva: a cross-sectional study.

BackgroundHome remedies are anchored in patients’ everyday life, but their use in Western cultures remains scarcely explored. Our objectives were to investigate primary care patients’ perspectives and use of non-pharmacological home remedies in Geneva (Switzerland).MethodsIn spring 2020, we conducted a cross-sectional survey among adult primary care patients in randomly selected general practices (N = 15). Patients were recruited in the waiting rooms and asked to complete a questionnaire about their sociodemographic characteristics, their home remedy use, and their expectations and reasons for using (or not using) home remedies. We employed descriptive statistics to summarise the data and logistic regression adjusted for clustering within practices to explore associations between home remedy use and participants’ sociodemographic characteristics.ResultsThree hundred fourteen of three hundred ninety patients agreed to participate in the study (participation rate 80.5%). Home remedies were used by 64.4% of patients. The main reasons given were for preventive purposes (55.3%), self-care (41.0%), as an alternative to conventional medicine (40.5%) and to avoid or delay a medical consultation (38.5%). One-third of patients considered that it was the GP’s role to spontaneously inform them about home remedies (36.4%), another third considered that it was the GP’s role to inform them, but only upon specific request (32.3%), and the last third of patients declared that it was not the GP’s role to provide information about home remedies (30.3%). Patients living in an urban zone (adjusted OR 2.1; 95%CI 1.0–4.4; p 0.05) and those with a tertiary education background (adjusted OR 1.9; 95%CI 1.0–3.6; p 0.05) believed that it was their GP’s role to inform them about home remedies.ConclusionsHome remedies are used by a majority of primary care patients in Geneva. For a comprehensive and safe healthcare management in the context of patient-oriented medicine, more evidence-based research on efficacy and safety of home remedies as well as their place in primary care consultation is required.

Optimization of evidence-based research in the prevention and treatment of coronary heart disease with traditional Chinese medicine: A comprehensive review

Coronary heart disease (CHD) has severely impacted the lives and health of patients for ages. Although the modern methods used for the prevention and treatment of CHD have been increasingly perfected, clinical problems remain that require solutions. In the prevention and treatment of CHD with traditional Chinese medicine (TCM), great therapeutic advantages have been demonstrated. However, the expression of its advantages relies on scientific evidence-based research and evaluation, which require further optimization and improvement. Therefore, this review aims to comprehensively emphasize our understanding of the current deficiencies in TCM evidence-based studies and the necessity of adopting scientific evidence-based optimization methods for use in research. In this process, evidence should be produced in a standard manner, and the advantages of TCM patterns should be accurately stated because these factors contribute to efficient transformation and proper verification of the obtained evidence. Additionally, focusing on patient-oriented medicine and doctor–patient relationships is also essential. These methods are of great significance to prove the clinical efficacy of TCM and promote its development.

Structural Design Method for Constructions: Simulation, Manufacturing and Experiment

The development of additive manufacturing technology leads to new concepts for design implants and prostheses. The necessity of such approaches is fueled by patient-oriented medicine. Such a concept involves a new way of understanding material and includes complex structural geometry, lattice constructions, and metamaterials. This leads to new design concepts. In the article, the structural design method is presented. The general approach is based on the separation of the micro- and macro-mechanical parameters. For this purpose, the investigated region as a complex of the basic cells was considered. Each basic cell can be described by a parameters vector. An initializing vector was introduced to control the changes in the parameters vector. Changing the parameters vector according to the stress-strain state and the initializing vector leads to changes in the basic cells and consequently to changes in the microarchitecture. A medium with a spheroidal pore was considered as a basic cell. Porosity and ellipticity were used for the parameters vector. The initializing vector was initialized and depended on maximum von Mises stress. A sample was designed according to the proposed method. Then, solid and structurally designed samples were produced by additive manufacturing technology. The samples were scanned by computer tomography and then tested by structural loads. The results and analyses were presented.

Strukturen medizinischer Versorgungszentren in der ambulanten Versorgung – ein Zukunftsmodell für die Innere Medizin?

Since the early 2000s, legislators have allowed the establishment of medical care centers to supplement and increase the flexibility of medical cooperation models. Several legal changes in subsequent years were unable to prevent that, contrary to the original intention, almost 90% of the newly founded facilities were established in urban cores and medium-sized centers; that concentration processes and monopolization were encouraged; and that the freedom of choice for patients was restricted. In order to counter the risk of undermining the free exercise of the medical profession and the dictates of economics over patient-oriented medicine in the outpatient sector, corporations, scientific societies, and professional associations are demanding more transparency and narrower limits for non-physician capital investors. There are currently more than 3000 medical care centers in Germany employing around 20,000 physicians, many of whom are internal medicine specialists. Regionally networked medical care center structures combine the advantages of optimized patient care with the growing desire of the younger generation of physicians for flexible working conditions within employment. With increasing acceptance on the part of the medical profession, networked medical care centers are able to create local structures for the expansion of modern intersectoral care and, at the same time, can be available for outpatient specialist training in internal medicine.

Medical Progress from Bio-Psycho-Social Points of View Associated with Happiness of People

For the inaugural issue of the “Biomedical Science Journal (BSJ)” in Ciencia Scientific Publisher group, Ciencia in Spanish means science, learning, and knowledge. BSJ covers wider fields of biomedical science. Medical practice has bio-psycho-social aspects. This is characteristic of primary care (PC), integrative medicine (IM), and psychosomatic medicine (PSM). Among them, important concepts include ACCCC of PC, Hinohara-ism, and New Elderly Association (NEA) by Dr. Shigeaki Hinohara, patient-oriented medicine, evidence-based medicine (EBM), narrative-based medicine (NBM). The goal of the medicine would be the health of the body and soul with happiness. Subjective well-being can be evaluated by the Subjective Happiness Scale (SHS). Significant and meaningful reports in BSJ would be expected to contribute much to the happiness of people across the world.

Various Care Option of Integrative Medicine from the Viewpoint of Patient-Oriented Medicine

Authors and colleagues have managed Shikoku Island division of Integrative Medicine Japan (IMJ) and continued various activities. There were several important conferences in 2019 concerning Integrative Medicine (IM) and Complementary and Alternative Medicine (CAM). World Federation of Chinese Medicine Societies held the 4th cancer rehabilitation seminar in Nagoya, as cooperation with IMJ in May. There was annual congress of our Shikoku division in October, with 14 various lectures such as music therapy, chiropractic, rehabilitation, Hinohara-ism and so on. Annual IMJ congress was held at Kagoshima in December with 1000 attendees and 100 presentations. The keynote speech by Dr. Noriko Yoshida was impressive for remarkable projects, such as national health project, long life & treasure child project, music exercise therapy with traditional song and dance, centenarian research project, island health thalasso-tourism, and psychotherapy. Author gave comments about mindfulness originated from Budhism, Pythagoreanism from Pythagoras and Hinohara-ism from famous Japanese physician Shigeaki Hinohara. These philosophies have common aspect of patient-oriented medicine, which are crucial element for IM and CAM.

От пациентоориентированной медицины к 4п-медицине: семантический аспект тренда

The step-by-step guidelines for the formation, development and implementation of the direction defined as “patient-oriented medicine” in the scientific and practical segments of healthcare are presented. It reflects not only the historical aspect of this semantic plot, but also gives a characteristic of the diverse models of interaction between subjects – a doctor and a patient. The analysis of definitions of “patient-oriented medicine” in the framework of foreign and domestic scientific schools, as well as the analysis of the relationship of the pattern with the new concept of health care development – 4P-medicine is given. The structure of the 4R-medicine concept is characterized, the ideological implications of the prospects for its development are given. The legislative and organizational initiatives for the development of patient-oriented medicine are outlined.

Rehabilitation nutrition care for elderly people with sarcopenia and nutritional disorders

Complementary and Alternative Medicine (CAM) and Integrative Medicine (IM) have the characteristic aspect of patient-oriented medicine. Recent problems include elderly people with sarcopenia, frailty, nutritional disorder and daily rehabilitation. It has been evaluated by International Classification of Functioning, Disability and Health (ICF). A circulating process for rehabilitation nutrition care has five stages, which are Assessment/diagnostic reasoning, Diagnosis, Goal setting, Intervention, Monitoring. For goal setting, check list for SMART (Specific, Measurable, Achievable, Relevant, Time) is useful. Diagnosis of rehabilitation nutrition includes the presence or absence of malnutrition, sarcopenia, and deficiency or excess of nutrient intake. When a subject has sarcopenia, we had to check whether it should be improved and whether it can be improved. To prevent iatrogenic sarcopenia will bring the benefit preventing sarcopenia in the whole body, swallowing- and respiratory-related muscles.

PATIENT-CENTERED MEDICINE: BACKGROUND TO THE TRANSFORMATION AND COMPONENTS

Purpose of the study. To analyze the concept of creating patient-oriented medicine, the prerequisites for its emergence, the difficulties of introducing it into existing health systems based on foreign experience. Materials and methods. The main materials of the study were used sources of foreign literature, which presents the concept of patient-oriented medicine, analyzed the prerequisites for changing models of health care in the European Union, USA and Asia in accordance with the principles of patient-oriented medicine, as well as data on the components and levels of patient-oriented medicine in foreign countries Results. The analyzed literature quite fully describes the difficulties of introducing patient-oriented medicine into existing health care systems. Particular attention should be paid to a multidisciplinary approach, continuity at different levels of medical care and effective communication between the physician and the patient towards the integration of this model into clinical practice. The analysis of the availability of medical care in developed countries and its dependence on social status, ethnicity and disease of the patient. Conclusion. Patient-oriented medicine is a new model for planning, implementing and evaluating medical services, which is based on mutually beneficial partnerships between medical workers, patients and their families. Taking into account the current problems of domestic health care, the introduction of the patient-oriented model will significantly improve the quality of medical care provided to the population of our country. Globally, the implementation of the principles of this model is far from complete. In the Russian Federation, targeted work in this direction requires additional scientific research, systematization of available data, and development of new legal documents

Bronchiectasis: A Complex, Heterogeneous Disease

Most areas of respiratory medicine continue to use an Oslerian approach, based on signs and symptoms, in which the disease is the center of all activity. However, this paradigm is changing. Now that lung diseases have been recognized as heterogeneous and complex, we are moving toward more personalized, precise, patient-oriented medicine. The aim of this review was to define the current state of the knowledge on bronchiectasis, or, more accurately, the bronchiectasis syndrome, as a multidimensional, systemic, heterogeneous, complex disease. We explore the advances that have already been made, and above all the many steps that are still to be taken. We also propose some tools which might facilitate the application of these concepts in clinical practice, and help us continue our journey toward a more holistic view of this disease.

Las bronquiectasias: una enfermedad compleja y heterogénea

Most areas of respiratory medicine continue to use an Oslerian approach, based on signs and symptoms, in which the disease is the center of all activity. However, this paradigm is changing. Now that lung diseases have been recognized as heterogeneous and complex, we are moving towards more personalized, precise, patient-oriented medicine. The aim of this review was to define the current state of the knowledge on bronchiectasis, or, more accurately, the bronchiectasis syndrome, as a multidimensional, systemic, heterogeneous, complex disease. We explore the advances that have already been made, and above all the many steps that are still to be taken. We also propose some tools which might facilitate the application of these concepts in clinical practice, and help us continue our journey towards a more holistic view of this disease.

Quality of life as a target criterion in schizophrenia therapy

Consideration of quality of life has developed into an important concept of a patient-oriented medicine in the last 50 years. With it, it should be possible to capture the subjective experience of the patients and describe its different dimensions. Today, the quality of life as a patient-reported endpoint is also an integral part of the early benefit assessment under the German Drug Market Reorganization Act. In the treatment of schizophrenic patients, however, improvement in quality of life as an accepted target criterion has only been established with delay.

Extemporaneous formulations in Germany - relevance for everyday clinical practice.

Extemporaneous formulations broaden the spectrum of therapeutic options for topical treatment in particular and thus improve patient care. The latest amendment to the Regulation on the Operation of Pharmacies issued in 2012 brought about changes in prescribing and manufacturing practices. The aim of the present study was to assess the relevance of extemporaneous formulations in everyday clinical practice. We used data from the German Institute for Drug Use Evaluation (DAPI) to analyze the prescribing practice for compounded preparations in Germany between the fourth quarter of 2011 and the third quarter of 2014. In doing so, we determined the total cost associated with extemporaneous formulations covered by statutory health insurance funds in the outpatient setting. Approximately three out of ten prescriptions (30.54%) by German dermatologists during the observation period were extemporaneous formulations. While dermatologists make up only 2.7% of physicians working in the statutory health care system in Germany, they prescribe more than half of all compounded preparations (53.6%). Each dermatologist prescribed an average of 270.4 formulations per quarter; that number was 13.5 (1.3%) for all other medical specialties. On average, 1,983,687 extemporaneous formulations overall (1.3% of all prescriptions) were prescribed per quarter, corresponding to a total cost of €40,944,982 (0.55%). Apart from finished medicinal products, extemporaneous formulations play a key role in outpatient care. Based on the principles of evidence-based and patient-oriented medicine, the quality of compounded preparations and the prescribing practice of physicians (standardized vs. individual formulations) should be further investigated to optimize the quality of these preparations.

The relevance of the Hippocratic Oath to the ethical and moral values of contemporary medicine. Part I: The Hippocratic Oath from antiquity to modern times.

The present paper discusses the relevance and significance of the Hippocratic Oath to contemporary medical ethical and moral values. It attempts to answer the questions about some controversial issues related to the Oath. The text is divided in two parts. Part I discusses the general attributes and ethical values of the Oath, while Part II presents a detailed analysis of each passage of the Oath with regard to perennial ethical principles and moral values. Part I starts with the contribution of Hippocrates and his School of Cos to medicine. It continues by examining the moral dilemmas concerning physicians and patients in the Classical Times and in the Modern World. It also investigates how the Hippocratic Oath stands nowadays, with regard to the remarkable and often revolutionary advancements in medical practice and the significant evolution in medical ethics. Further, it presents the debate and the criticism about the relevance of the general attributes and ethical values of the Oath to those of modern societies. Finally, it discusses the endurance of the ethical values of the Hippocratic Oath over the centuries until today with respect to the physicians' commitment to the practice of patient-oriented medicine. Part I concludes with the Oath's historic input in the Judgment delivered at the close of the Nuremberg "Doctors' Trial"; this Judgement has become legally binding for the discipline in the Western World and was the basis of the Nuremberg Code. The ethical code of the Oath turned out to be a fundamental part of western law not only on medical ethics but also on patients' rights regarding research.