Identiﬁcation of unrecognized dia- Consens State Sci Statements 2013 discount lasix 40mg mastercard blood pressure 9555;29:1–31 Type 1 Diabetes TrialNet Study Group buy 100 mg lasix fast delivery arterial stenosis; Diabetes betes and pre-diabetes in a dental setting. Ann In- autoantibody risk score in relatives of type 1 of undiagnosed hyperglycemia. Obstet Gynecol 2013;122:406–416 of type 1 diabetes in the Diabetes Prevention Committee of the Pediatric Endocrine Society. Diabetes Care 2009;32:2269–2274 HemoglobinA1cmeasurement forthediagnosis screening tests for gestational diabetes. Int J Pediatr En- Obstet Gynecol 1982;144:768–773 Prevalence of and trends in diabetes among docrinol 2012;2012:31 60. Using hemo- tion and diagnosis of diabetes mellitus and 2015;314:1021–1029 globin A1c for prediabetes and diabetes diagno- other categories of glucose intolerance. Early 2013;167:32–39 Diabetes Data Group criteria for diagnosing ges- detection and treatment of type 2 diabetes re- 46. Obstet Gynecol 2016;127: duce cardiovascular morbidity and mortality: a betes in children and adolescents. Diabetes 893–898 simulation of the results of the Anglo-Danish- Care 2000;23:381–389 62. Diabetes Care 2015;38: diabetes and gestational diabetes mellitus ciation of the Diabetes and Pregnancy Study 1449–1455 among a racially/ethnically diverse population Groups cost-effective? Diabetes Care 529–535 tiation and frequency of screening to detect 2008;31:899–904 63. Hyperglycemia betes Care 2014;37:2442–2450 S24 Classiﬁcation and Diagnosis of Diabetes Diabetes Care Volume 40, Supplement 1, January 2017 64. Diabetes Care 2014;37:202–209 for cystic ﬁbrosis–related diabetes: a position diabetes screening: the International Association 72. The diagnosis and management andaclinicalpracticeguidelineoftheCysticFibrosis compared with Carpenter-Coustan screening. Foundation, endorsed by the Pediatric Endocrine Obstet Gynecol 2016;127:10–17 Pediatr Diabetes 2009;10(Suppl. Am J management of monogenic diabetes in children Transplant 2014;14:1992–2000 Study Groups criteria. The use of Study Group criteria for the screening and di- genes allows for improved diagnosis and treat- oral glucose tolerance tests to risk stratify for agnosis of gestational diabetes. Curr Diab Rep 2011;11:519–532 new-onset diabetes after transplantation: an necol 2015;212:224. Cystic ﬁbrosis-related diabetes: cur- tation: development, prevention and treatment. Di- mic testing on clinical care in neonatal diabetes: Fibrosis Related Diabetes Therapy Study Group. UrbanovaJ´ ,RypackovaB´ˇ ´ ,ProchazkovaZ´ ´ , results of the Cystic Fibrosis Related Diabetes hemoglobin in the screening for diabetes melli- et al. Transplantation patients with monogenic diabetes is associated 1788 2009;88:429–434 Diabetes Care Volume 40, Supplement 1, January 2017 S25 American Diabetes Association 3. B A successful medical evaluation depends on beneﬁcial interactions between the patient and the care team. The Chronic Care Model (1–3) (see Section 1 “Promoting Health and Reducing Disparities in Populations”) is a patient-centered approach to care that requires a close working relationship between the patient and clinicians involved in treatment planning. People with diabetes should receive health care from a team that may include physicians, nurse practitioners, physician assistants, nurses, dietitians, exercise specialists, pharmacists, dentists, podiatrists, and mental health professionals. The patient, family or support persons, physician, and health care team should formulate the management plan, which includes lifestyle management (see Section 4 “Lifestyle Management”). Treatment goals and plans should be created with the patients based on their individual preferences, values, and goals. The management plan should take into account the patient’s age, cognitive abilities, school/work schedule and condi- tions, health beliefs, support systems, eating patterns, physical activity, social situation, ﬁnancial concerns, cultural factors, literacy and numeracy (mathemat- ical literacy) skills, diabetes complications, comorbidities, health priorities, other medical conditions, preferences for care, and life expectancy. Various strategies and techniques should be used to support patients’ self-management efforts, in- cluding providing education on problem-solving skills for all aspects of diabetes management. Provider communications with patients/families should acknowledge that multiple factors impact glycemic management, but also emphasize that collaboratively devel- oped treatment plans and a healthy lifestyle can signiﬁcantly improve disease out- comes and well-being (4–7). Thus, the goal of provider-patient communication is to establish a collaborative relationship and to assess and address self-management barriers without blaming patients for “noncompliance” or “nonadherence” when the outcomes of self-management are not optimal (8). The familiar terms “non- compliance” and “nonadherence” denote a passive, obedient role for a person with diabetes in “following doctor’sorders” that is at odds with the active role people Suggested citation: American Diabetes Associa- with diabetes take in directing the day-to-day decision making, planning, monitor- tion. Comprehensive medical evaluation and as- ing, evaluation, and problem-solving involved in diabetes self-management. InStandardsof a nonjudgmental approach that normalizes periodic lapses in self-management Medical Care in Diabetesd2017. Diabetes Care may help minimize patients’ resistance to reporting problems with self-management. Patients’ perceptions about their own ability, or self- for proﬁt, and the work is not altered. More infor- efﬁcacy, to self-manage diabetes are one important psychosocial factor related mationis available at http://www. S26 Comprehensive Medical Evaluation and Assessment of Comorbidities Diabetes Care Volume 40, Supplement 1, January 2017 (9–13) and should be a target of ongo- and implementing an approach to glycemic Pneumococcal Pneumonia ing assessment, patient education, control with the patient is a part, not the Like inﬂuenza, pneumococcal pneumonia and treatment planning. There c Conﬁrm the diagnosis and classify is sufﬁcient evidence to support that diabetes $6monthsofage. B adults with diabetes ,65 years of age c Vaccination against pneumonia is c Detect diabetes complications and have appropriate serologic and clinical re- recommended for all people with potential comorbid conditions. This may plications, psychosocial assessment, with diabetes who are age 19–59 be due to contact with infected blood or management of comorbid conditions, years. C through improper equipment use (glucose and engagement of the patient through- c Consider administering 3-dose se- monitoring devices or infected needles). The goal is to provide ries of hepatitis B vaccine to un- Because of the higher likelihood of trans- the health care team information to opti- vaccinated adults with diabetes mission, hepatitis B vaccine is recom- mally support a patient. Consider adolescent vaccination schedule is avail- that affect people with diabetes and may the assessment of sleep pattern and dura- able at http://www. Diabetes tion; a recent meta-analysis found that schedules/hcp/imz/child-adolescent. Patients should receive Inﬂuenza type 1 diabetes for autoimmune recommended preventive care services Inﬂuenza is a common, preventable in- thyroid disease and celiac disease (e. E smoking cessation counseling; and oph- mortality and morbidity in vulnera- thalmological, dental, and podiatric re- ble populations including the young and People with type 1 diabetes are at in- ferrals. Additional referrals should be the elderly and people with chronic dis- creased risk for other autoimmune dis- arranged as necessary (Table 3.
The students not only remembered how to solve a previously discussed patient problem (retention effect) cheap lasix 40 mg overnight delivery blood pressure medication by class, but they could also apply this knowledge to other patient problems (transfer effect) buy cheapest lasix and lasix blood pressure chart wiki. At all seven universities both retention and transfer effects were maintained for at least six months after the training session. It gives you the tools to think for yourself and not blindly follow what other people think and do. It also enables you to understand why certain national or departmental standard treatment guidelines have been chosen, and teaches you how to make the best use of such guidelines. The manual can be used for self-study, following the systematic approach outlined below, or as part of a formal training course. Part 1: The process of rational treatment This overview takes you step by step from problem to solution. After reading this chapter you will know that prescribing a drug is part of a process that includes many other components, such as specifying your therapeutic objective, and informing the patient. It teaches you how to choose the drugs that you are going to prescribe regularly and with which you will become familiar, called P(ersonal)-drugs. In this selection process you will have to consult your pharmacology textbook, national formulary, and available national and international treatment guidelines. After you have worked your way through this section you will know how to select a drug for a particular disease or complaint. Part 3: Treating your patients This part of the book shows you how to treat a patient. Part 4: Keeping up-to-date To become a good doctor, and remain one, you also need to know how to acquire and deal with new information about drugs. This section describes the advantages and disadvantages of different sources of information. Annexes The annexes contain a brief refresher course on the basic principles of pharmacology in daily practice, a list of essential references, a set of patient information sheets and a checklist for giving injections. A word of warning Even if you do not always agree with the treatment choices in some of the examples it is important to remember that prescribing should be part of a logical deductive process, based on comprehensive and objective information. Please write to: The Director, Action Programme on Essential Drugs, World Health Organization, 1211 Geneva 27, Switzerland. The process of choosing a first-choice treatment is discussed first, followed by a step by step overview of the process of rational treatment. The chapter focuses on the principles of a stepwise approach to choosing a drug, and is not intended as a guideline for the treatment of dry cough. A good scientific experiment follows a rather rigid methodology with a definition of the problem, a hypothesis, an experiment, an outcome and a process of verification. This process, and especially the verification step, ensures that the outcome is reliable. After that, you have to specify the therapeutic objective, and to choose a treatment of proven efficacy and safety, from different alternatives. You then start the treatment, for example by writing an accurate prescription and providing the patient with clear information and instructions. After some time you monitor the results of the treatment; only then will you know if it has been successful. Example: patient 1 You sit in with a general practitioner and observe the following case. A 52-year old taxi-driver complains of a sore throat and cough which started two weeks earlier with a cold. Further history and examination reveal nothing special, apart from a throat inflammation. The doctor again advises the patient to stop smoking, and writes a prescription for codeine tablets 15 mg, 1 tablet 3 times daily for 3 days. When you observe experienced physicians, the process of choosing a treatment and writing a prescription seems easy. Choosing a treatment is more difficult than it seems, and to gain experience you need to work very systematically. You start by considering your ‘first-choice’ treatment, which is the result of a selection process done earlier. The second stage is to verify that your first-choice treatment is suitable for this particular patient. So, in order to continue, we should define our first-choice treatment for dry cough. Rather than reviewing all possible drugs for the treatment of dry cough every time you need one, you should decide, in advance, your first-choice treatment. The general approach in doing that is to specify your therapeutic objective, to make an inventory of possible treatments, and to choose your ‘P(ersonal) treatment’, on the basis of a comparison of their efficacy, safety, suitability and cost. This process of choosing your P-treatment is summarized in this chapter and discussed in more detail in Part 2 of this manual. Specify your therapeutic objective In this example we are choosing our P-treatment for the suppression of dry cough. Make an inventory of possible treatments In general, there are four possible approaches to treatment: information or advice; treatment without drugs; treatment with a drug; and referral. For dry cough, information and advice can Cartoon 1 be given, explaining that the mucous membrane will not heal because of the cough and advising a patient to avoid further irritation, such as smoking or traffic exhaust fumes. Specific non-drug treatment for this condition doesn’t exist, but there are a few drugs to treat a dry cough. You should make your personal selection while still in medical school, and then get to know these ‘P(ersonal) drugs’ thoroughly. In the case of dry cough an opioid cough suppressant or a sedative antihistamine could be considered as potential P-drugs. The last therapeutic possibility is to refer the patient for further analysis and treatment. In summary, treatment of dry cough may consist of advice to avoid irritation of the 8 Chapter 1 The process of rational treatment lungs, and/or suppression of the cough by a drug. Choose your P-treatment on the basis of efficacy, safety, suitability and cost The next stage is to compare the various treatment alternatives. To do this in a scientific and objective manner you need to consider four criteria: efficacy, safety, suitability and cost. If the patient is willing and able to follow advice to avoid lung irritation from smoking or other causes, this will be therapeutically effective, since the inflammation of the mucous membrane will subside within a few days. However, the discomfort of nicotine withdrawal may cause habituated smokers to ignore such advice. Opioid cough depressants, such as codeine, noscapine, pholcodine, dextromethorfan and the stronger opiates such as morphine, diamorphine and methadone, effectively suppress the cough reflex.
The delivery of 10 mGy of radiation to a woman�s breashas been estimad to increase her lifetime risk of developing breascancer by 13 cheap lasix american express blood pressure recommendations. For a 25-year-old whose background Evidence risk of developing breascancer in the following 10 years is 0 discount lasix 100 mg visa arrhythmia statistics. Furthermore, Allen and Demetriades48 have suggesd thaven this small risk is an overestima. Nevertheless, breastissue is especially sensitive to radiation exposure during pregnancy because of hormonally induced increased glandular activity. In each of these studies, the authors conclude thaprospective trials are required to valida their fndings. Baseline blood investigations Whabaseline blood investigations should be performed before initiating anticoagulantherapy? Before anticoagulantherapy is commenced, blood should be taken for a full blood count, coagulation D screen, urea and electrolys, and liver function sts. B The use of anticoagulantherapy can be infuenced by renal and hepatic function, and can Evidence infuence the plalecount, and blood should be taken to confrm thathese are normal level 4 before commencing treatment. Levels level 1++ of antithrombin and proin C may fall, particularly if the thrombus is exnsive. In addition, proin S levels fall in normal pregnancy and an acquired activad proin C resistance is found in around 40% of pregnancies. This is of particular relevance in obstric practice where obstric haemorrhage remains the moscommon cause of severe obstric morbidity. This recommendation was based on anti-Xa activity and a paucity of reports on safety and effcacy of once-daily dosing. Initial dose of enoxaparin is dermined as follows: Booking or early pregnancy weighInitial dose of enoxaparin < 50 kg 40 mg twice daily or 60 mg once daily 50�69 kg 60 mg twice daily or 90 mg once daily 70�89 kg 80 mg twice daily or 120 mg once daily 90�109 kg 100 mg twice daily or 150 mg once daily 110�125 kg 120 mg twice daily or 180 mg once daily > 125 kg Discuss with haematologisTable 1b. Initial dose of dalparin is dermined as follows: Booking or early pregnancy weighInitial dose of dalparin < 50 kg 5000 iu twice daily or 10 000 iu once daily 50�69 kg 6000 iu twice daily or 12 000 iu once daily 70�89 kg 8000 iu twice daily or 16 000 iu once daily 90�109 kg 10 000 iu twice daily or 20 000 iu once daily 110�125 kg 12 000 iu twice daily or 24 000 iu daily > 125 kg Discuss with haematologisTable 1c. D Obstric patients who are postoperative and receiving unfractionad heparin should have D plalecounmonitoring performed every 2�3 days from days 4 to 14 or until heparin is stopped. Iis therefore recommended thaobstric patients who are postoperative and receiving unfractionad heparin should have plalecounmonitoring performed every 2�3 days from days 4 to 14 or until heparin is stopped. Collapsed, shocked women who are pregnanor in the puerperium should be assessed by a am of experienced clinicians including the on-call consultanobstrician. P Women should be managed on an individual basis regarding: intravenous unfractionad heparin, thrombolytic therapy or thoracotomy and surgical embolectomy. P Managemenshould involve a multidisciplinary am including senior physicians, obstricians and radiologists. Marnity units should develop guidelines for the administration of intravenous unfractionad heparin. Collapsed, shocked women who are pregnanor in the puerperium should be assessed by a multidisciplinary resuscitation am of experienced clinicians including the on-call consultanobstrician, who should decide on an individual basis whether a woman receives intravenous unfractionad heparin, thrombolytic therapy or thoracotomy and surgical embolectomy. A perimorm caesarean section should be performed by 5 minus if resuscitation is unsuccessful and the pregnancy is more than 20 weeks. Where such problems Evidence are considered to exist, haematologists should be involved in the patient�s management. Imay level 2+ be useful to dermine the anti-Xa level as a measure of heparin dose. With unfractionad heparin, a lower level of anti-Xa is considered therapeutic (targerange 0. Afr thrombolytic therapy has been given, an infusion of unfractionad heparin can be given, buthe loading dose (outlined above) should be omitd. Mosbleeding events occur around cather and puncture sis and, in pregnanwomen, there have been no reports of intracranial bleeding. If the patienis nosuitable for thrombolysis or is moribund, a discussion with the cardiothoracic surgeons with a view to urgenthoracotomy should be had. A randomised controlled trial comparing knee-length with thigh-length hosiery concluded thathigh-length compression elastic stockings do novidence offer betr proction againspost-thrombotic syndrome than below-knee hosiery and are level 1+ less well tolerad. A piloaudiof compliance with graduad compression stockings in pregnancy showed poor levels of compliance relad to discomforand side effects. Outpatienfollow-up should include clinical assessmenand advice with monitoring of blood plalets and peak anti-Xa levels if appropria (see sections 5 and 6. Reducing to an inrmedia dose may be useful in pregnanwomen aincreased risk of bleeding or osoporosis. A review of 91 level 3 pregnancies in 83 women concluded thadanaparoid is an effective and safe antithrombotic in pregnancy for women who are intoleranof heparin. Vitamin K antagonists cross the placenta readily and are associad with adverse pregnancy outcomes including miscarriage, prematurity, low birthweight, neurodevelopmental problems Evidence and fetal and neonatal bleeding. They are also associad with a characristic embryopathy level 2+ following fetal exposure in the frstrimesr. Where possible, anticoagulantherapy should be alred to avoid an unwand anticoagulanffecduring delivery. Women should be advised noto injecany further heparin if they are in established labour or think they are in labour. Subcutaneous unfractionad heparin should be discontinued 12 hours before and intravenous unfractionad heparin stopped 6 hours before induction of labour or regional anaesthesia. If iis markedly prolonged near delivery, protamine sulfa may be required to reduce the risk of bleeding. One approach to the use of anticoagulantherapy in this situation level 4 has been described by McLintock eal. Iis considered thaobstric patients have a lower incidence of spinal haematoma than elderly patients. Measures should be taken to allow drainage of any haematoma, including the use of drains and inrrupd skin sutures. A case�control study has repord an increased incidence of wound Evidence complications in women receiving peripartum anticoagulation. Any woman who is considered to be ahigh risk of haemorrhage, and in whom continued heparin D treatmenis considered essential, should be managed with intravenous unfractionad heparin until the risk factors for haemorrhage have resolved. Ishould therefore be used in situations when anticoagulation is required buconcerns exisregarding bleeding; these situations include: anpartum haemorrhage, coagulopathy, progressive wound haematoma, suspecd intra-abdominal bleeding, and postpartum haemorrhage. One regimen for the administration of unfractionad Evidence heparin is given in section 6. Before discontinuing treatmenthe continuing risk of thrombosis should be assessed. Postpartum warfarin should be avoided until aleasthe ffth day and for longer in women aincreased risk of postpartum haemorrhage.
Prevention and Treatment of Tuberculosis among patients infected with human immunodeficiency virus: principles of treatment and revised recommendations buy lasix blood pressure 9555. Mycobacterium avium complex infection best lasix 40mg arrhythmia nos, rifabutin, and uveitis—is there a connection? A comparison of ciprofloxacin, norfloxacin, ofloxacin, clarithromycin and cefixime examined by observational cohort studies. Tackling the burden of non-adherence requires a collaborative, patient- centric approach that considers individual patient needs and results in intelligent interventions that combine high-tech with high-touch. His • The emerging paradigm of patient centricity in doctor prescribed multiple meds: the critical insu- adherence. He takes out his Industry Dynamics Reshape pill box but wonders, “Should I take both doses Healthcare Delivery together or skip the frst one? Expected to account for three-fourths intriguing and complex of patient behaviors. Non- of all deaths globally by 2020 , chronic illness1 adherence to a therapeutic regimen can result is straining the healthcare capacity of many in negative outcomes, and it can be compound- countries that lack the resources to provide ed in populations with chronic illness because of adequate healthcare services. Industry interest in patient engagement has Non-adherence leads to One school of thought spiked, infuenced by the release in late August deteriorating health out- 2012 of the Meaningful Use Stage 2 Final Rule by postulates that instead comes across patient the U. Now that patient engagement is being mortality rates in dia- creating new medications called the biggest blockbuster drug of the century, betes and heart disease pharmaceuticals and healthcare industry players to cure chronic diseases, patients, non-adherers need to reconfgure their resources to develop applying a fraction of had much higher mortal- innovative business models that are based on val- ity rates (12. Its three tenets include improving the eases, applying a fraction of that cost to helping patient experience, improving population health patients adhere to their medications would actu- and reducing the per capita cost of healthcare. Kearney analysis Figure 1 Traditional Management of adherence in certain situations, but a “one-size- Non-adherence fts-all” approach is not effective; one-tool solutions often become marginalized if the pro- Conventional health models have historically gram does not address the underlying barriers placed patients with different health conditions of adherence. The traditional approach of designing programs Understanding the Causes of that address individual adherence barriers has Non-Adherence resulted in extremely siloed health management programs. These programs are less effective The reasons for patient non-adherence are because they don’t account for the fact that non- complex and multifactorial, and an effective adherence is caused by the presence of multiple coordinated care model needs to consider all of factors. Both internal factors (a taking their medication, and adherence rates patient’s intentional and unintentional beliefs) plummet, in just a few months, with 50% to 90% and external factors (those related to the health- of patients stopping their prescribed therapies by care system, family support, the therapy regimen, the end of the frst year of treatment (see Figure 1). All of these factors education, pharmacy programs, awareness have a powerful infuence on patient decision- campaigns and fnancial rewards, can impact making and behavioral change. Quick Fact The Health Belief Model proposes that patients act on treatment recommendations when they believe that the benefts of treatment outweigh treatment barriers. In a study of 18 small, medium and large pharmaceuticals companies, 12 had dedicated patient adherence teams. Human health behavior professionals, who can better understand patients’ motivations, psychology and emotions are increasingly a part of these teams. For example, the more the patient interest of preventing patients from switching to must change his or her lifestyle, the less likely he competitive offerings, infuencing positive health or she is to follow recommendations. In addition, outcomes and reducing the overall cost of health- the less complicated the treatment regimen, the care by offering a set of adherence services along higher the rate of adherence. The Emerging Adherence Paradigm Acquiring new patients costs pharmaceuticals of Patient Centricity companies an average of 62% more than retaining the ones they already serve. In addition, the less companies are now work- ing to engage with patients complicated the Approximately 69% of total healthcare costs are heavily infuenced by consumer behaviors. Working together, these com- What Patient Centricity Means for panies launched a head-to-head clinical trial of Various Stakeholders Plavix (clopidogrel) and Effent (prasugrel) that highlighted not just which molecule is more eff- Today’s healthcare environment has led hos- cacious but also which patients would be best pitals, physician groups and payers to develop suited to which drug. Traditionally, laborative approaches will demonstrate the value providers have educated patients on adher- of determining appropriate treatment pathways ence. However, payers are increasingly working for a particular condition rather than just ran- to ensure their members have better health domly assessing the effcacy of individual drugs outcomes and lower costs. For any disease state, patients progress Devices and sensors can increase self-monitoring through different stages, including diagnosis, and management; gamifcation and analytics treatment and care. All of these interactions need various stakeholders in the healthcare ecosys- to be seamless so that patients can focus on their tem — physicians, paramedic staff, care providers, care rather than being caught in a web of interac- payers, pharmaceuticals companies, pharmacies tion challenges. We call this the “5 C’s”: collect data, capture events, con- To address the issue of medication non-adher- nect stakeholders, compress time and create ence, we have developed a patient-centric model opportunities. An effective adherence model must use a holistic Patient-centric Adherence Framework patient engagement framework that is designed Patient interactions within the healthcare ecosys- to address the causes of non-adherence from a tem are exceedingly complex; therefore, a holistic patient’s point of view. With physicians and pharmacists involved in the patient recruitment cycle, organizations can expect a jump in program enrollments in the range of 17% to 36% based on regions and disease type. Framework considerations should include: • Patient stratifcation: Patients need to be categorized in different ways, and customized engagement programs need to be designed for the different segments. Different adherence methods are applicable to different situations, depending on the type of adherence being assessed, the precision required and the intended application of the results. As there is no “gold standard” for measuring patients’ adherence to medicines, and no single tool to detect all types of non-adherence, the choice of method for measuring adherence to a medication regimen should be based on its usefulness and reliability for a particular patient profle, therapeutic area, drug under consideration, etc. Patients should be able to use their own health devices and smartphones ration among various stakeholders. Predictive surveys are questionnaires supplied to patients that can help predict their behavior • Self-help and education: Enabling patients and enable segmentation. A list of industry- with self-help tools and an understanding approved predictive surveys is presented in of their condition is critical to helping them Figure 5. The study was conducted in partnership with the International Diabetes Federation in December 2013 and involved more than 10,000 people with Type 2 diabetes and more than 6,500 treating physicians from 26 countries. The intent was to investigate how early conversations between physicians and patients with Type 2 diabetes could be optimized. Insights from the survey will be used to develop solutions to support primary care physicians and people with Type 2 diabetes. Merck, for example, developed a game called the “Type 2 Travelers Project” to encourage patients to follow the treatment regimen of its diabetes drug Januvia, as well as manage other aspects of their health. Emerging management and predict behavior patterns technologies and tools enable effective in order to identify high-risk patients who are education delivery to patients, including: likely to stop engaging and design interven- tion models to motivate them. For example, a diabetic patient who experi- > Gamifcation techniques to increase en- ences a hypoglycemic attack may discover gagement and adoption. Pharmaceuticals that the episode is correlated to poor diet and companies often use interactive games and medication non-adherence, perhaps as a result other reward systems within their mobile of an underlying attitude that the patient has initiatives to keep patients engaged with toward the drug. While self-reporting data and developing an effective intervention using is essential to tracking and measuring pa- an analytics engine can help providers deliv- tient outcomes and behaviors, self-reporting er insights to patients that encourage them rates are usually very poor due to low patient to change their behaviors. Gamifcation can provide and segmentation capabilities are also impor- a driving force for patients to involve them- tant for tracking and understanding changes selves in the process and beneft from it. As patients change, organizations must > Use of social media such as Facebook and map them to new segments and design new Twitter to create forums and user communi- interventions. An inherent problem deliver alerts, notifcations and motivational with adherence programs is the diffculty of messages to drive positive behavior change. Tracking which interventions are of patients who voluntarily enroll in a study effective and revising the ones that aren’t and actually follow the experimental regimen is critical to properly monitoring outcomes.