Critical advances in the evaluation and development of clinical care

Miles, Andrew; Grey, Joseph E; Polychronis, Andreas; Melchiorri, C

doi:10.1046/j.1365-2753.2002.00367.x

Cited by 44 publications

(56 citation statements)

References 61 publications

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“…Now, following these 22 years of intensive philosophical and clinical argumentation [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76] , there are indications of a final recognition by the EBM community of the inescapable complexity of clinical practice which mandates a need to embrace and maintain the human dimension of medical care. Certainly, medicine has witnessed no less than four serial reconstitutions of the EBM philosophy and method since the publication of the initial EBM thesis to date.…”

Section: Patient-centered Care (Pcc)mentioning

confidence: 99%

Science, Humanism, Judgement, Ethics: Person-Centered Medicine as an Emergent Model of Modern Clinical Practice / Наука, Гуманизм, Преценка, Этика, Пациент. Гуманизм В Медицина - Новая Модель В Современн Ой Клинической Практике

Miles¹

2013

Folia Medica

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The Medical University of Plovdiv (MUP) has as its motto 'Committed to humanity". But what does humanity in modern medicine mean? Is it possible to practise a form of medicine that is without humanity? In the current article, it is argued that modern medicine is increasingly being practised in a de-personalised fashion, where the patient is understood not as a unique human individual, a person, but rather as a subject or an object and more in the manner of a complex biological machine. Medicine has, it is contended, become distracted from its duty to care, comfort and console as well as to ameliorate, attenuate and cure and that the rapid development of medicine's scientific knowledge is, paradoxically, principally causative. Signal occurrences in the 'patient as a person' movement are reviewed, together with the emergence of the evidence-based medicine (EBM) and patientcentered care (PCC) movements. The characteristics of a model of medicine evolving in response to medicine's current deficiencies -person-centered healthcare (PCH) -are noted and described. In seeking to apply science with humanism, via clinical judgement, within an ethical framework, it is contended that PCH will prove to be far more responsive to the needs of the individual patient and his/her personal circumstances than current models of practice, so that neither a reductive anatomico-pathological, disease-centric model of illness (EBM), nor an aggressive patient-directed, consumerist form of care (PCC) is allowed continued dominance within modern healthcare systems. In conclusion, it is argued that PCH will enable affordable advances in biomedicine and technology to be delivered to patients within a humanistic framework of clinical practice that recognises the patient as a person and which takes full account of his/her stories, values, preferences, goals, aspirations, fears, worries, hopes, cultural context and which responds to his/her psychological, emotional, spiritual and social necessities in addition to his/her physical needs. MUP, in assimilating such arguments and introducing person-centered medicine teaching into the University, is engaged in a notable and laudable initiative which will function as a salutary example to other medical schools within Europe and elsewhere.

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Section: Patient-centered Care (Pcc)mentioning

confidence: 99%

Science, Humanism, Judgement, Ethics: Person-Centered Medicine as an Emergent Model of Modern Clinical Practice / Наука, Гуманизм, Преценка, Этика, Пациент. Гуманизм В Медицина - Новая Модель В Современн Ой Клинической Практике

Miles¹

2013

Folia Medica

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“…Assumptions are made about the proportion of patients with a given medical condition that should receive a specific recommended treatment. But it is almost impossible to calculate what is the correct proportion of patients with that condition for whom the therapy is indicated because trials, with their ‘unrepresentative populations in highly controlled experimental environments’ [1] can never tell us this .…”

Section: Surveysmentioning

confidence: 99%

Translation of clinical trials into clinical practice

Julian

2004

Journal of Internal Medicine

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The results of well-conducted clinical trials should be translated into practice but there is good evidence that this is not happening. There are a number of reasons for this -ignorance of doctors and patients, uncertainty as to the applicability of trials to individual patients, indolence and inefficiency on the part of practitioners, and financial considerations. More attention needs to be paid to correct all these factors.

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“…It is believed that establishing evidence‐based strategies can effectively contribute to better outcomes and more effective use of resources (see Miles & Lugen 1996; Miles et al. 2002).…”

Section: Introductionmentioning

confidence: 99%

Strategies for ensuring effective surveillance in post‐transplant patients: practical organization and clinical evaluation

Jurewicz

Miles

2004

Evaluation Clinical Practice

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Results of renal transplantation have improved steadily over the years. This article reviews the current status of patient and graft survival and discusses major causes of mortality and renal allograft failure. Review of recent literature demonstrates that the traditional enemies of transplantation, acute rejection and opportunistic infections are no longer major problems facing transplantation. Chronic graft nephropathy and death with functioning graft due to cardiovascular disease are the main challenges in the current era. An impact of an early graft thrombosis, recurrent renal disease and post-transplant malignancies are also reviewed. Chronic graft nephropathy is examined in a context of differences between two calcineurin inhibitors, cyclosporin microemulsion and tacrolimus. Strategies of post-transplant surveillance are suggested.

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Critical advances in the evaluation and development of clinical care

Cited by 44 publications

References 61 publications

Translation of clinical trials into clinical practice

Strategies for ensuring effective surveillance in post‐transplant patients: practical organization and clinical evaluation

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