https://ogma.newcastle.edu.au/vital/access/ /manager/Index ${session.getAttribute("locale")} 5 https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:49511 Wed 13 Mar 2024 09:24:26 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:7808 Wed 11 Apr 2018 17:19:05 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:14772 2 diseases) is a product of the design of health care systems which define health care need on the basis of disease status. So does the solution lie in an alternative model of healthcare? Discussion: Strengthening generalist practice has been proposed as part of the solution to tackling multi-morbidity. Generalism is a professional philosophy of practice, deeply known to many practitioners, and described as expertise in whole person medicine. But generalism lacks the evidence base needed by policy makers and planners to support service redesign. The challenge is to fill this practice-research gap in order to critically explore if and when generalist care offers a robust alternative to management of this complex problem. We need practice-based evidence to fill this gap. By recognising generalist practice as a ‘complex intervention’ (intervening in a complex system), we outline an approach to evaluate impact using action-research principles. We highlight the implications for those who both commission and undertake research in order to tackle this problem. Summary: Answers to the complex problem of multi-morbidity won’t come from doing more of the same. We need to change systems of care, and so the systems for generating evidence to support that care. This paper contributes to that work through outlining a process for generating practice-based evidence of generalist solutions to the complex problem of person-centred care for people with multi-morbidity.]]> Wed 11 Apr 2018 13:41:48 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:55104 Wed 10 Apr 2024 08:51:35 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:36802 Tue 07 Jul 2020 09:48:42 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:25646 learning by dividing) is no longer useful, the challenge for the future is to understand the big picture (learning by connecting). Diagnostic categorization needs to embrace a meta-learning approach open to human variability.]]> Thu 21 Oct 2021 12:53:18 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:35915 Thu 16 Jan 2020 15:10:09 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:7885 Sat 24 Mar 2018 08:41:36 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:8262 Sat 24 Mar 2018 08:40:36 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:8370 Sat 24 Mar 2018 08:39:46 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:7021 Sat 24 Mar 2018 08:37:56 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:10951 Sat 24 Mar 2018 08:14:15 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:11094 Sat 24 Mar 2018 08:13:24 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:11208 Sat 24 Mar 2018 08:12:44 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:11168 Sat 24 Mar 2018 08:08:30 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:21483 complex adaptive systems, nonlinear dynamics, systems biology, and systems theory, limited to general practice/family medicine and published before December 2010. A total of 16,242 articles were retrieved, of which 49 were published in general practice/family medicine journals. Hand searches and snowballing retrieved another 35. After a full-text review, we included 56 articles dealing specifically with systems sciences and general/family practice. Results: General practice/family medicine engaged with the emerging systems and complexity theories in 4 stages. Before 1995, articles tended to explore common phenomenologic general practice/family medicine experiences. Between 1995 and 2000, articles described the complex adaptive nature of this discipline. Those published between 2000 and 2005 focused on describing the system dynamics of medical practice. After 2005, articles increasingly applied the breadth of complex science theories to health care, health care reform, and the future of medicine. Conclusions: This historical review describes the development of general practice/family medicine in relation to complex adaptive systems theories, and shows how systems sciences more accurately reflect the discipline’s philosophy and identity. Analysis suggests that general practice/family medicine first embraced systems theories through conscious reorganization of its boundaries and scope, before applying empirical tools. Future research should concentrate on applying nonlinear dynamics and empirical modeling to patient care, and to organizing and developing local practices, engaging in community development, and influencing health care reform.]]> Sat 24 Mar 2018 08:03:35 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:21227 Sat 24 Mar 2018 07:53:01 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:5404 Sat 24 Mar 2018 07:43:56 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:29005 Sat 24 Mar 2018 07:41:20 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:23794 talk about things is the way we think about them. Currently, and in contrast to most other disciplines, medicine remains largely stuck in the simplistic "reductionist" scientific world view and is resisting the move to he complex dynamic "holistic" scientific world view.]]> Mon 24 Oct 2016 16:03:25 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:32647 Mon 02 Jul 2018 16:18:14 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:32646 within an individual in his or her socio-cultural environment. Networks include genomic, metabolomic, proteomic, neuroendocrine, immune and mitochondrial bioenergetic elements, as well as social, environmental and health care networks. Stress systems and other physiological mechanisms create feedback loops that integrate and regulate internal networks within the individual. Minor (e.g. daily hassles) and major (e.g. trauma) stressful life experiences perturb internal and social networks resulting in physiological instability with changes ranging from improved resilience to unhealthy adaptation and 'clinical disease'. Understanding 'multimorbidity' as a complex adaptive systems response to biobehavioural and socio-environmental networks is essential. Thus, designing integrative care delivery approaches that more adequately address the underlying disease processes as the manifestation of a state of physiological dysregulation is essential. This framework can shape care delivery approaches to meet the individual's care needs in the context of his or her underlying illness experience. It recognizes 'multimorbidity' and its symptoms as the end product of complex physiological processes, namely, stress activation and mitochondrial energetics, and suggests new opportunities for treatment and prevention. The future of 'multimorbidity' management might become much more discerning by combining the balancing of physiological dysregulation with targeted personalized biotechnology interventions such as small molecule therapeutics targeting specific cellular components of the stress response, with community-embedded interventions that involve addressing psycho-socio-cultural impediments that would aim to strengthen personal/social resilience and enhance social capital.]]> Mon 02 Jul 2018 16:18:12 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:21299 Fri 30 Oct 2015 15:12:22 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:35365 Fri 23 Aug 2019 16:38:42 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:38935 emergence of a coronavirus (SARS-CoV-2) with novel characteristics that made it highly infectious and particularly dangerous for an older age group and people with multiple morbidities brought our complex adaptive system (CAS) “society”—the economy, health systems, and individuals—to a virtual standstill. The COVID-19 pandemic—caused by SARS-Co-2—is a typical wicked problem¹—we did not see it coming, we experience its effects, and it challenges our entrained ways of thinking and acting. In our view, it is a classic example that demonstrates how suddenly changing dynamics can destabilize a system and tip it into an unstable state. COVID-19—rather than something else—turned out to be what we colloquially call the last straw that broke the camel's back or, put in system dynamics terms, what pushed our societal systems over a tipping point. When a system suddenly tips over, the linkages between most of its agents break, and a chaotic situation ensues. Chaotic states entail a high degree of uncertainty, a state in which previously proven interventions no longer maintain the status quo. The uncertainties triggered by COVID-19 have not only shown the fragility of health and national systems but also highlighted the intrinsic and tacit dynamics underpinning them. Most notable are the markedly different responses at the policy and community level. China drastically clamped down on all societal activities and rapidly built large new hospitals to deal with those fallen ill. Iceland rapidly tested every potential case. Sweden implemented limited social distancing measures. Italy hospitalized many mild cases in an environment of limited hospital resources, and the United States, for several weeks, denied that there is a significant problem. Each of these approaches has its own dynamics affecting individuals, communities, health systems, the economy, and the nation as a whole—new patterns emerge that become understandable with increasing knowledge (Figure 1). However, the long-term outcomes and effects on the system as a whole will only become evident over the next months and years.]]> Fri 11 Mar 2022 12:03:17 AEDT ]]>