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Side Quality

The role of practising physicians from patient point of view changed: instead of experts referring to you health care professional are looking for. Adherent care to meet this development, need medical analysis and control systems such as the adherence dashboard. The patients desire, not only about disease and treatment options, but also about the prescribed medications in detail to be informed, is now no more a trend, but a manifest trend. The practice management must meet this requirement. But before actionist measures be implemented, practitioners of the Status quo of their patient orientation should determine. A triadisch scale patient survey helps here.

It determines the General Praxisleistungs quality (Organization, care, practical atmosphere etc.) – the doctor patient communication quality (comprehensibility, dialog orientation, use of explanatory tools etc.), as well as – the drugs quality of advice (information about effects, Side effects, interactions, etc.). The survey Trias so that not only informs, to what extent the practice staff generally meets the requirements of patients, but also, how effective are the treatment and medication-related communication. The results summarized to an adherence dashboard (percentage values = achieved satisfaction in relation to the requirements), that indicates that the adherence promotion potential of all practical work. As a result, then concrete improvement approaches can be developed, an option that is extremely important for the therapy of chronically ill patients, such as hypertensive. The example of a doctor’s Office (see below!) listed in the figure indicates an acceptable practice management quality, but a little communication and a lower quality of drugs advice so that the adherence effect is total only slightly pronounced. In this practice, the probability of therapy crashes by patients is comparatively high. The topic: adherence initiative to 2014 the drug therapy, the unknown creature…

Direct Current Stimulation

tDCS stimuli change the memory of pain acute pain is treated with analgesics, according to WHO stages schema first with peripheral effective, later with weak and highest expression with strong opioids. The pain afferent, the “Inbox”area is influenced so to speak. The pharmacological range under the notion that a Molesta through pain not only by increased delivery of signal from the periphery, but also by weakening the efferent pain inhibition is conceivable extends for chronic pain. Finally it applies to deviate from the Descartes’schen thinking of a sole pain afferent and the no longer new knowledge to take into account that our perception of pain ultimately results from the balance of pain afferent minus the pulses filtered away by the efferent pain inhibition. The efferent pain inhibition can be improved by the use of serotonin – and norepinephrine-enriching drug, also by using CA channel modulators and NA channel blockers.

This is pain therapy already banal and one like it already hardly repeat, that the use of antidepressants and anticonvulsants pain therapeutic treatment is one of the Basic program. Anyone who knows the reality of primary medical care, know that is that not much has gotten around. Pain therapists explain the stubborn persistence of painful after occurring chronicity with the emergence of pain memory. The pain memory the result of Neuroplatizitat is neurophysiologisch, functional and micro-structurally alter the ability of the central nervous system, in the context of learning and to adapt. Neuro-plastic operations benefit us to the advantage, when it comes to learn repeated experiences and getting better and faster. Everyone is familiar with the examples of the violinist, whose brain representation for violin playing is increasing with increasing expertise and brings more and more in the fMRI fields “to the light”. There are also neuro plastic operations, to our detriment run maladaptive neuroplasticity. The memory of the pain is such a faulty construction due to neuroplasticity.

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