Multimorbidity—A manifestation of network disturbances? How to investigate? How to treat?

Miles, Andrew; Asbridge, Jonathan

doi:10.1111/jep.12723

Cited by 12 publications

(9 citation statements)

References 18 publications

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“…While we readily recognize the effect of inflammation in acute disease processes, the uncontrolled or over production of inflammation leading to chronic low-grade effects are clearly under-recognized in clinical practice. Inflammation as the driver of most “phenotypically defined” disease also clearly challenges the prevailing notion of multimorbidity as a construct of “multiple individual diseases” in the one person ( 59 , 165 – 173 ). Using the complex system's lens, inflammation is an inter-system communicator of distress as well as an indicator or target for addressing multiple chronic diseases.…”

Section: The Role Of Inflammation In Common Conditionsmentioning

confidence: 99%

Inflammation–Nature's Way to Efficiently Respond to All Types of Challenges: Implications for Understanding and Managing “the Epidemic” of Chronic Diseases

et al. 2018

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Siloed or singular system approach to disease management is common practice, developing out of traditional medical school education. Textbooks of medicine describe a huge number of discrete diseases, usually in a systematic fashion following headings like etiology, pathology, investigations, differential diagnoses, and management. This approach suggests that the body has a multitude of ways to respond to harmful incidences. However, physiology and systems biology provide evidence that there is a simple mechanism behind this phenotypical variability. Regardless if an injury or change was caused by trauma, infection, non-communicable disease, autoimmune disorders, or stress, the typical physiological response is: an increase in blood supply to the area, an increase in white cells into the affected tissue, an increase in phagocytic activity to remove the offending agent, followed by a down-regulation of these mechanisms resulting in healing. The cascade of inflammation is the body‘s unique mechanism to maintain its integrity in response to macroscopic as well as microscopic injuries. We hypothesize that chronic disease development and progression are linked to uncontrolled or dysfunctional inflammation to injuries regardless of their nature, physical, environmental, or psychological. Thus, we aim to reframe the prevailing approach of management of individual diseases into a more integrated systemic approach of treating the “person as a whole,” enhancing the patient experience, ability to a make necessary changes, and maximize overall health and well-being. The first part of the paper reviews the local immune cascades of pro- and anti-inflammatory regulation and the interconnected feedback loops with neural and psychological pathways. The second part emphasizes one of nature's principles at work—system design and efficiency. Continually overwhelming this finely tuned system will result in systemic inflammation allowing chronic diseases to emerge; the pathways of several common conditions are described in detail. The final part of the paper considers the implications of these understandings for clinical care and explore how this lens could shape the physician-patient encounter and health system redesign. We conclude that healthcare professionals must advocate for an anti-inflammatory lifestyle at the patient level as well as at the local and national levels to enhance population health and well-being.

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Section: The Role Of Inflammation In Common Conditionsmentioning

confidence: 99%

Inflammation–Nature's Way to Efficiently Respond to All Types of Challenges: Implications for Understanding and Managing “the Epidemic” of Chronic Diseases

et al. 2018

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“…Commentators' opinions on what the case studies contributed to healthcare chaplaincy and to the care of the patient in general were also sought. With reference to these criteria and the overall inclusion requirements, nine chaplains were subsequently selected for participation in the project and a range of commentators recruited, contributing cases and commentaries in the fields of paediatrics (chapters 1-5), psychiatry (chapters 6-10) and palliative care (chapters [11][12][13][14][15].…”

Section: Methodological Perspectivesmentioning

confidence: 99%

“…Regrettably, there appears at the time of writing little appetite within the WHO, as currently constituted, to embark on a revision of the current definition of health which would see key references to dynamics and spirituality included. It is true that a definitional consensus on how spirituality should be defined has yet to achieve international consensus [9][10][11] and it is likewise true that the field of complexity science in health is itself underdeveloped, though it is rapidly attracting greater interest and finding common ground with preceding theories [7,8,12]. But given the current epidemic of longterm co-and multimorbid, socially complex illnesses, identified not least by the WHO itself [13][14][15][16][17][18], and given that the importance of spiritual care as a dynamic part of modern approaches to the management of such conditions is increasingly acknowledged [19][20][21][22][23], a continued silence from the WHO on the need for a revision of its now essentially archaic definition of health remains difficult to understand.…”

Section: Introductionmentioning

confidence: 99%

George Fitchett & Steve Nolan, (eds.). (2015). Spiritual Care in Practice. Case Studies in Healthcare Chaplaincy. An Analysis, Commentary and the Implications for Person-Centered Healthcare. London: Jessica Kingsley Publishing. ISBN 978-84905-976-3

Miles¹

2017

EJPCH

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“…Within the latest Complexity Forum of the JECP, Miles and Asbridge highlight the overwhelming fixation of clinical practice, over the last century, with scientific progress in biomedicine and technology at the expense of a fixation with the context of such progress—the person of the patient. How, they ask, can we return to modern medicine and health care a preferential fixation with the destination of all biomedical and technological advance—the patient as a person who suffers?…”

Section: Introductionmentioning

confidence: 99%

“…As Miles and Asbridge outline, such high, yet entirely realisable ideals, were the basis, in 2014, of the creation of the European Society for Person Centered Healthcare (ESPCH), an international membership organisation that advocates a shift towards humanistic health care and which is currently engaged in the development of practical clinical models for the person‐centered health care of a wide range of specific clinical conditions. The authors describe how the development of such models, by their nature, takes full account of comorbidity and mutlimorbidity and how the ESPCH is developing associated clinical guidelines in an effort to assist clinicians and health care policymakers in ensuring that the ethical ideal of person‐centered health care becomes an operational reality.…”

Section: Introductionmentioning

confidence: 99%

From evidence‐based to evidence‐informed, from patient‐focussed to person‐centered—The ongoing “energetics” of health and social care discourse as we approach the Third Era of Medicine

Miles¹

2017

Evaluation Clinical Practice

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From evidence-based to evidence-informed, from patientfocussed to person-centered-The ongoing "energetics" of health and social care discourse as we approach the Third Era of MedicineThe current thematic issue of the JECP on EBM, the latest in a long line of such editions over 20 years, contributes a further set of insights and opinions on the place of scientific knowledge within the clinical consultation and as part of health services delivery more generally. Medicine, as the Journal has always insisted, is not a science, but rather a human endeavour with a moral character, which employs science, but which does not equate to it. This position of the JECP has historically earned it as many detractors as supporters, but the literature now indicates that a seismic shift is beginning to take place-a shift away from the scientistic reductionism of recent decades, towards the embrace of the complex and personal, not only within academic and clinical medicine but also within health and social care in addition. The Journal wholeheartedly welcomes this shift, viewing this commencement of an altered course and momentum as a "correction" to the distortions of medicine's integral character that followed an uncritical embrace of the initial definition of EBM, without a detailed analysis and prediction of its likely consequences-intended or otherwise. The JECP will continue to do all it can to progress this shift and to imbed this correction, thus fostering the associated benefits for patients and all of those who care for them. But what exactly is the character of this Modern medicine is undeniably a technical giant, yet in so many ways, it remains an ethical child. 9 In its continued focus on individual organ systems and superspecializations, it is neglecting its indispensable imperative to care, comfort, and console, concentrating preferentially on its duty to ameliorate, attenuate, and cure. 9 A continued averting of medicine's gaze away from the "patient as integral person,"and the maintenance of an understanding of the "patient as organism,"cannot but lead to what David Weatherall already sees as being extantmedicine as a failure. 3,9These things having been said, who would argue against the necessity of monitoring pathological disease processes within discreet anatomical loci as part of treatment approaches? Surely, nobody. To do so would be absurd. There is nothing wrong with clinical reductionism, per se, as long as the disease is seen as part of the person and not the person seen as part of the disease. Indeed, it is for this reason, that Aron, a clinical endocrinologist writing within the current issue, says this: "While we hold onto our magnifying glasses, we should not forget to reach for the 'minifying' lens which allows one to see a more whole picture." 10 Wise words indeed and ones with which the JECP fully accords.

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Multimorbidity—A manifestation of network disturbances? How to investigate? How to treat?

Cited by 12 publications

References 18 publications

Inflammation–Nature's Way to Efficiently Respond to All Types of Challenges: Implications for Understanding and Managing “the Epidemic” of Chronic Diseases

Inflammation–Nature's Way to Efficiently Respond to All Types of Challenges: Implications for Understanding and Managing “the Epidemic” of Chronic Diseases

George Fitchett & Steve Nolan, (eds.). (2015). Spiritual Care in Practice. Case Studies in Healthcare Chaplaincy. An Analysis, Commentary and the Implications for Person-Centered Healthcare. London: Jessica Kingsley Publishing. ISBN 978-84905-976-3

From evidence‐based to evidence‐informed, from patient‐focussed to person‐centered—The ongoing “energetics” of health and social care discourse as we approach the Third Era of Medicine

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