Miles, A. & Mezzich, J.E. (2011). The care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern clinical practice. International Journal of Person Centered Medicine 1 (2) 207-222

2014 ◽  
Vol 2 (1) ◽  
pp. 54
Author(s):  
Lillian Geza Rothenberger
Keyword(s):  
Clinical Practice ◽  
Patient Care ◽  
Evidence Base ◽  
Scientific Data ◽  
Research Progress ◽  
Inclusion Criteria ◽  
Study Results ◽  
The Individual ◽  
Medical Disciplines ◽  
Person Centered Approach

In recent years, there has undoubtedly been an “over-reliance on science” that has led to an unedifying “scientistic medicine” in patient care of most if not all medical disciplines [1]. Although I would not go so far as to say that these circumstances may lead to “an ethical and moral chaos within clinical practice,” I agree with Miles and Mezzich that “while it is imperative that medicine must be actively and continuously informed by science, science cannot function as the base of medicine.” Evidence generated by clinical or, in the early beginnings of research progress, even non-clinical trials can be very helpful, but to impose study results uncritically upon the individual patient would mean to neglect this person’s individuality. The individual needs may, for example, not be consistent with the inclusion criteria of the very study used as the evidence base for the treatment. I therefore welcome, then, the article by Miles and Mezzich, which discusses the need for a more critical reflection on scientific data before or within clinical use and the demand for more humanity in patient care in terms of a person-centered approach.

scholarly journals Physicians’ requirements and expectations of future Artificial Intelligence applications for healthcare – a web-based survey in German university hospitals (Preprint)

2020 ◽  
Author(s):  
Oliver Maassen ◽  
Sebastian Fritsch ◽  
Julia Gantner ◽  
Saskia Deffge ◽  
Julian Kunze ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Clinical Practice ◽  
Patient Care ◽  
Biomedical Research ◽  
Positive Attitude ◽  
Patient Data ◽  
University Hospitals ◽  
Web Based ◽  
Wide Range ◽  
Medical Disciplines

BACKGROUND The increasing development of artificial intelligence (AI) systems in medicine driven by researchers and entrepreneurs goes along with enormous expectations for medical care advancement. AI might change the clinical practice of physicians from almost all medical disciplines and in most areas of healthcare. While expectations for AI in medicine are high, practical implementations of AI for clinical practice are still scarce in Germany. Moreover, physicians’ requirements and expectations of AI in medicine and their opinion on the usage of anonymized patient data for clinical and biomedical research has not been investigated widely in German university hospitals. OBJECTIVE Evaluate physicians’ requirements and expectations of AI in medicine and their opinion on the secondary usage of patient data for (bio)medical research e.g. for the development of machine learning (ML) algorithms in university hospitals in Germany. METHODS A web-based survey was conducted addressing physicians of all medical disciplines in 8 German university hospitals. Answers were given on Likert scales and general demographic responses. Physicians were asked to participate locally via email in the respective hospitals. RESULTS 121 (39.9%) female and 173 (57.1%) male physicians (N=303) from a wide range of medical disciplines and work experience levels completed the online survey. The majority of respondents either had a positive (130/303, 42.9%) or a very positive attitude (82/303, 27.1%) towards AI in medicine. A vast majority of physicians expected the future of medicine to be a mix of human and artificial intelligence (273/303, 90.1%) but also requested a scientific evaluation before the routine implementation of AI-based systems (276/303, 91.1%). Physicians were most optimistic that AI applications would identify drug interactions (280/303, 92.4%) to improve patient care substantially but were quite reserved regarding AI-supported diagnosis of psychiatric diseases (62/303, 20.5%). 82.5% of respondents (250/303) agreed that there should be open access to anonymized patient databases for medical and biomedical research. CONCLUSIONS Physicians in stationary patient care in German university hospitals show a generally positive attitude towards using most AI applications in medicine. Along with this optimism, there come several expectations and hopes that AI will assist physicians in clinical decision making. Especially in fields of medicine where huge amounts of data are processed (e.g., imaging procedures in radiology and pathology) or data is collected continuously (e.g. cardiology and intensive care medicine), physicians’ expectations to substantially improve future patient care are high. However, for the practical usage of AI in healthcare regulatory and organizational challenges still have to be mastered.

scholarly journals The clinical assessment of acts of violence: mental mechanisms and subjectivity

2019 ◽  
Vol 26 (3) ◽  
pp. 135-144 ◽  
Author(s):  
Rajan Nathan ◽  
Peter Wilson
Keyword(s):  
Risk Assessment ◽  
Risk Management ◽  
Clinical Practice ◽  
Clinical Assessment ◽  
Clinical Utility ◽  
Individual Case ◽  
Evidence Base ◽  
Routine Clinical Practice ◽  
Factors Associated ◽  
The Individual

SUMMARYApproaches to assessing violence in clinical practice have been influenced by developments in the field of risk assessment. As a result, there has been a focus on identifying and describing factors associated with violence. However, a factor-based approach to assessing violence in individual cases has limited clinical utility. In response, the benefits of a formulation-based approach have been promoted. This approach is enhanced by an understanding of the specific mental mechanisms that increase the likelihood of violence in the individual case. Although there is an empirical evidence base for mental mechanisms associated with violence, this literature has not been distilled and synthesised in a way that informs routine clinical practice. In this article the authors present the key mechanisms that are known to be associated with violence in a way that is relevant to the clinical assessment of violence and, in turn, can inform clinical and risk management.

On what basis should we select treatment in clinical psychiatry: a question too obvious to ask?

2019 ◽  
Vol 28 (2) ◽  
pp. 202-205
Author(s):  
Sam Restifo ◽  
Lemuel Y H Tan
Keyword(s):  
Mental Illness ◽  
Clinical Practice ◽  
Treatment Planning ◽  
Clinical Psychiatry ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Research Evidence ◽  
Conceptual Models ◽  
Evidence Base ◽  
Medical Disciplines

Objective: Given the differences between our profession and the broader set of medical disciplines, a review of the factors to be considered in treatment planning was conducted. Conclusion: Treatment planning in psychiatry is inherently more complicated than in other medical disciplines for various reasons including: a broader range of conceptual models of mental illness and treatment; greater complexities around nosology and diagnosis; the greater limitations of the research evidence base and clinical practice guidelines; and the more substantial impacts of patients’ subjectivity and contextual aspects. Diagnosis is generally neither a sufficient nor necessarily the most useful criterion for treatment planning in psychiatry, with a number of other considerations to help guide treatment being outlined.

scholarly journals Developing a research framework to inform an evidence base for person-centered medicine: keeping the person at the centre

2013 ◽  
Vol 1 (2) ◽  
pp. 336 ◽  
Author(s):  
Corinne Reid
Keyword(s):  
Clinical Practice ◽  
Evidence Based Practice ◽  
Evidence Base ◽  
Evidence Based ◽  
Research Framework ◽  
Humanistic Medicine ◽  
A Priority ◽  
Person Centered Approach ◽  
Evidence Generation

Person-centered medicine exists at the intersect of science and humanism and has the dual goals of relational and evidence-based practice. In the operationalization of humanistic medicine the development of a sympathetic and facilitative research framework is, then, a priority. The person-centric research framework is proffered as one such model and will be described in this paper with a view to eliciting discussion about the essential qualities of a person-centered approach to evidence generation. This framework has been emergent from the clinical practice of the author and builds upon other pioneering work in this field. It is operationalized as a practitioner-informed philosophy of the conceptualisation, practice and interpretation of research.

THE ROLE OF PHAGE THERAPY IN THE FORMATION OF THE INTESTINAL MICROECOSYSTEM

2020 ◽  
pp. 183-191
Author(s):  
Gladkov S.F. ◽  
Perevoshchikova N.K. ◽  
Chernykh N.S. ◽  
Pichugina Yu.S. ◽  
Surkova M.A.
Keyword(s):  
Intestinal Microbiota ◽  
Allergic Diseases ◽  
Evidence Base ◽  
Immunological Tolerance ◽  
Convincing Evidence ◽  
Selective Decontamination ◽  
Genetic Characteristics ◽  
Treatment And Prevention ◽  
Intestinal Infections ◽  
The Individual

The current adverse situation associated with the presence of a pandemic of allergic diseases is due to the lack of a scientifically based concept of treatment and prevention. The increased interest of researchers from different countries in the formation of immunological tolerance by modeling the intestinal microbiota is of high importance. Methods of influence on the microbial communities of the child's intestine should be as delicate as possible, taking into account the individual genetic characteristics of the microecosystem and the possibility of anaphylaxis. Until now, probiotic drugs have been widely used to correct dysbiosis, but data is gradually accumulating that there is no convincing evidence base for their use for the treatment and prevention of atopy. The use of bacteriophages is very relevant and one of the promising, actively studied areas of correction of intestinal biocenosis today, which are an alternative to antibiotic and probiotic medications. Selective decontamination of representatives of opportunistic flora, as the main factor in the implementation of the atopic phenotype, makes it possible to preserve and accelerate the formation of a unique and individual composition of the intestinal microbiota of the child, which can form an immunoregulatory balance. More than a century of experience in the use of bacteriophages indicates the safety of their use. Today, bacteriophages are actively used in various fields of practical medicine − obstetrics-gynecology, perinatology, urology, pediatric otorhinolaryngology, in the treatment of purulent-septic and intestinal infections. In some cases, bacteriophages are very effective against antibiotic-resistant pathogens. The active personalized use of bacteriophages in real clinical practice will make it possible to solve a number of serious, long-standing health problems in the Russian Federation and to win a world priority in this direction.

scholarly journals Symptom Cluster-Matching Antidepressant Treatment: A Case Series Pilot Study

2021 ◽  
Vol 14 (6) ◽  
pp. 526
Author(s):  
Sławomir Murawiec ◽  
Marek Krzystanek
Keyword(s):  
Depressive Symptoms ◽  
Pilot Study ◽  
Antidepressant Treatment ◽  
Case Series ◽  
Symptom Cluster ◽  
Study Results ◽  
Cluster Matching ◽  
The Individual ◽  
Meta Analyses ◽  
Effectiveness Studies

Despite treating depression with antidepressants, their effectiveness is often insufficient. Comparative effectiveness studies and meta-analyses show the effectiveness of antidepressants; however, they do not provide clear indications as to the choice of a specific antidepressant. The rational choice of antidepressants may be based on matching their mechanisms of action to the symptomatic profiles of depression, reflecting the heterogeneity of symptoms in different patients. The authors presented a series of cases of patients diagnosed with depression in whom at least one previous antidepressant treatment was shown to be ineffective before drug targeted symptom cluster-matching treatment (SCMT). The presented pilot study shows for the first time the effectiveness of SCMT in the different clusters of depressive symptoms. All the described patients obtained recovery from depressive symptoms after introducing drug-targeted SCMT. Once validated in clinical trials, SCMT might become an effective and rational method of selecting an antidepressant according to the individual profile of depressive symptoms, the mechanism of their formation, and the mechanism of drug action. Although the study results are preliminary, SCMT can be a way to personalize treatment, increasing the likelihood of improvement even in patients who meet criteria for treatment-resistant depression.

scholarly journals How to objectively assess and observe maladaptive pain behaviors in clinical rehabilitation: a systematic search and review

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Florian Naye ◽  
Chloé Cachinho ◽  
Annie-Pier Tremblay ◽  
Maude Saint-Germain Lavoie ◽  
Gabriel Lepage ◽  
...  
Keyword(s):  
Back Pain ◽  
Clinical Practice ◽  
Critical Appraisal ◽  
Inclusion Criteria ◽  
Clinical Criteria ◽  
Affective Factors ◽  
Pain Behaviors ◽  
Observation Methods ◽  
Critical Appraisal Tool ◽  
Secondary Objective

Abstract Background Cognitive-affective factors influence the perception of pain and disability. These factors can lead to pain behaviors (PB) that can persist and become maladaptive. These maladaptive PB will further increase the risk of chronicity or persistence of symptoms and disability. Thus, clinicians must be prepared to recognize maladaptive PB in a clinical context. To date, in the context of assessment in a rehabilitation setting, PB in clinical settings are poorly documented. The main objective of this study was to identify direct observation methods and critically appraise them in order to propose recommendations for practice. As a secondary objective, we explored and extracted the different observable PB that patients could exhibit and that clinicians could observe. Methods We conducted a comprehensive review on four databases with a generic search strategy in order to obtain the largest range of PB. For the first objective, a two-step critical appraisal used clinical criteria (from qualitative studies on barriers to implement routine measures) and psychometric criteria (from Brink and Louw critical appraisal tool) to determine which observation methods could be recommended for clinical practice. For the second objective, we extracted PB found in the literature to list potential PB that patients could exhibit, and clinicians could observe. Results From the 3362 retrieved studies, 47 met the inclusion criteria for the first objective. The clinical criteria allowed us to select three observation methods. After the psychometric step, two observation methods were retained and recommended for clinical practice: the Behavioral Avoidance Test-Back Pain (BAT-Back) and the Pain Behaviour Scale (PaBS). For the second objective, 107 studies met the inclusion criteria. The extraction of the PB allowed us to list a large range of PB and classify the data in 7 categories of PB. Conclusion Our results allowed us to recommend two observation methods for clinical practice. However, these methods have limitations and are validated only in chronic low back pain populations. With the extraction of PB presented in the literature, we contribute to better prepare clinicians to recognize PB in all patients who are experiencing pain.

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