Background: In pharmacotherapy, the achievement of a target clinical outcome requires a certain level of medication intake or adherence. Based on Haynes's early empirical definition of sufficient adherence to antihypertensive medications as taking ≥80% of medication, many researchers used this threshold to distinguish adherent from non-adherent patients. However, we propose that different diseases, medications and patient's characteristics influence the cut-off point of the adherence rate above which the clinical outcome is satisfactory (thereafter medication adherence threshold). Moreover, the assessment of adherence and clinical outcomes may differ greatly and should be taken into consideration. To our knowledge, very few studies have defined adherence rates linked to clinical outcomes. We aimed at investigating medication adherence thresholds in relation to clinical outcomes.Method: We searched for studies that determined the relationship between adherence rates and clinical outcomes in the databases PubMed, EmbaseⓇ and Web of Science™ until December 2017, limited to English-language. Our outcome measure was any threshold value of adherence. The inclusion criteria of the retrieved studies were (1) any measurement of medication adherence, (2) any assessment of clinical outcomes, and (3) any method to define medication adherence thresholds in relation to clinical outcomes. We excluded articles considered as a tutorial. Two authors (PB and IA) independently screened titles and abstracts for relevance, reviewed full-texts, and extracted items. The results of the included studies are presented qualitatively.Result: We analyzed 6 articles that assessed clinical outcomes linked to adherence rates in 7 chronic disease states. Medication adherence was measured with Medication Possession Ratio (MPR, n = 3), Proportion of Days Covered (PDC, n = 1), both (n = 1), or Medication Event Monitoring System (MEMS). Clinical outcomes were event free episodes, hospitalization, cortisone use, reported symptoms and reduction of lipid levels. To find the relationship between the targeted clinical outcome and adherence rates, three studies applied logistic regression and three used survival analysis. Five studies defined adherence thresholds between 46 and 92%. One study confirmed the 80% threshold as valid to distinguish adherent from non-adherent patients.Conclusion: The analyzed studies were highly heterogeneous, predominantly concerning methods of calculating adherence. We could not compare studies quantitatively, mostly because adherence rates could not be standardized. Therefore, we cannot reject or confirm the validity of the historical 80% threshold. Nevertheless, the 80% threshold was clearly questioned as a general standard.

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Depuis l’approche située de la sociologie française de l’action de Quéré et Ogien, articulée à la philosophie pragmatiste deweyenne, nos analyses de l’activité d’éducateurs spécialisés ainsi qu’une littérature plus large en analyse du travail mettent en évidence que la réflexivité des professionnels n’est pas suffisante pour rendre compte de la construction de l’intervention et de son intelligence. Définie par le modèle du praticien réflexif de Schön et ses dérivés comme un travail de mise à distance, d’analyse et de formalisation de leur pratique, elle alimente une conception négative et restreinte de la professionnalité. Notre recherche s’est déroulée dans une structure d’hébergement pour adolescents en rupture familiale qui se voit enjoindre par le politique la mise en place d’une nouvelle mission d’insertion. Malgré de nombreuses réunions et discussions informelles, l’activité échappe sans cesse à une formalisation. Depuis un modèle alternatif de professionnalité basé sur la notion d’enquête deweyenne, nos analyses des enquêtes pratiques des professionnels, à la fois immanentes et filées dans le temps, montrent que la construction de l’intervention exige un savoir-faire logé dans l’activité même, et ce même pour des pratiques dites de base. Elle exige incessamment de par les propriétés de l’action l’expérimentation d’ajustements qui font que la mise en œuvre de la mission ne relève pas d’une logique applicationniste. Cette approche conduit à une forme d’externalisation de la pensée dans l’activité, définissant la pratique comme le lieu même où se construit la connaissance, sans la subordonner à la réflexivité comme intelligence de nature intellectuelle additionnelle à la pratique.

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An acceptable degree of digital literacy has always been present among the pharmacy teaching staff in Basel, with PowerPoint being the main vehicle to present teaching materials in front of full or half classes. Because cell phones became inseparable from students over the past years, mobile voting (movo.ch) or e-quizzes (mentimeter.com) have been regularly used to hold the attention of all students during collective teaching. Moreover, e-assessment on iPad® with the software BeAxi (www.k2prime.com) was introduced in 2012 and is currently used for all evaluations and exams. Suddenly over the night of March 16, 2020, our university, as all universities around the world, had to transfer all courses to an online format and to empower lecturers to teach from their home. This paper offers one perspective for how this digitial experiment unfolded at the University of Basel in Basel, Switzerland.