https://nova.newcastle.edu.au/vital/access/ /manager/Index ${session.getAttribute("locale")} 5 https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:35919 Wed 29 Jan 2020 13:18:20 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:47736 Wed 25 Jan 2023 15:07:51 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:55324 Wed 15 May 2024 15:39:44 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:27834 Wed 11 Apr 2018 18:16:09 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:7808 Wed 11 Apr 2018 17:19:05 AEST ]]> https://nova.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://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:4501 Wed 11 Apr 2018 12:16:19 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:29728 Wed 11 Apr 2018 10:02:55 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:55104 Wed 10 Apr 2024 08:51:35 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:49761 Tue 30 May 2023 20:16:33 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:50435 Tue 25 Jul 2023 19:08:26 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:43482 Tue 20 Sep 2022 11:16:21 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:52586 Tue 17 Oct 2023 15:56:55 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:35472  90% and MW 60%), self-rated health and rates of acute problems (red alerts) requiring prompt intervention were similar in both groups. Typical presentations were different in the two groups with IPCC presenting with age-related multimorbidity problems and MW with a cluster of pain, depression, and drug and alcohol problems in the context of psychosocial and environmental problems with many more instances of not coping (pink alerts). PaJR was well received with very low dropout rates in either group. This approach identified problems, generally amenable to intervention, but many psychosocial problems, particularly in MW, were challenging to solve within existing health service structures and resources. In conclusion supporting complex health journeys through conversations using lay care guides and an adaptive systems approach is feasible in at least two very different settings and patient groups.]]> Tue 13 Aug 2019 12:27:16 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:36802 Tue 07 Jul 2020 09:48:42 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:52126 Thu 28 Sep 2023 15:11:11 AEST ]]> https://nova.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://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:35915 Thu 16 Jan 2020 15:10:09 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:35914 Thu 16 Jan 2020 14:56:08 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:32648 needs of patients, providers and communities, and ultimately results in declining effectiveness and efficiency of the health care system as well as the health of the wider community. A needs-focused complex-adaptive health system can be represented by the 'healthcare vortex' model; how to build a needs-focused complex-adaptive health system is illustrated by Eastern Deanery AIDS Relief Program approaches in the poor neighbourhoods of Nairobi, Kenya. Findings and conclusions: A small group of nurses and community health workers focused on the care of terminally ill HIV/AIDS patients. This work identified additional problems: tuberculosis (TB) was underdiagnosed and undertreated, a local TB-technician was trained to run a local lab, a courier services helped to reach all at need, collaboration with the Ministry of Health established local TB and HIV treatment programmes and philanthropists helped to supplement treatment with nutrition support. Maternal-to-child HIV-prevention and adolescent counselling services addressed additional needs. The 'theory of the healthcare vortex' indeed matches the 'empery of the real world experiences'. Locally developed and delivered adaptive, people-centred health systems, a bottom-up community and provider initiated approach, deliver highly effective and sustainable health care despite significant resource constraints.]]> Thu 14 Apr 2022 11:04:06 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:7567 Sat 24 Mar 2018 08:42:03 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:7885 Sat 24 Mar 2018 08:41:36 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:8262 Sat 24 Mar 2018 08:40:36 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:8370 Sat 24 Mar 2018 08:39:46 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:7468 Sat 24 Mar 2018 08:38:48 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:7516 Sat 24 Mar 2018 08:38:30 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:7021 Sat 24 Mar 2018 08:37:56 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:8164 Sat 24 Mar 2018 08:36:04 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:13245 Sat 24 Mar 2018 08:16:00 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:10951 Sat 24 Mar 2018 08:14:15 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:11094 Sat 24 Mar 2018 08:13:24 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:11208 Sat 24 Mar 2018 08:12:44 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:11091 Sat 24 Mar 2018 08:12:04 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:11168 Sat 24 Mar 2018 08:08:30 AEDT ]]> https://nova.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://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:20476 Sat 24 Mar 2018 07:59:02 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:19861 Sat 24 Mar 2018 07:57:04 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:21227 Sat 24 Mar 2018 07:53:01 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:19352 Sat 24 Mar 2018 07:52:00 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:5404 Sat 24 Mar 2018 07:43:56 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:304 Sat 24 Mar 2018 07:42:24 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:29003 Sat 24 Mar 2018 07:41:20 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:29002 Sat 24 Mar 2018 07:41:20 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:29005 Sat 24 Mar 2018 07:41:20 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:29004 Sat 24 Mar 2018 07:41:19 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:29001 formal approach to understanding the real world through a simplified external and explicit representation of a mental model which can be manipulated and tested, before being implemented back into the real world. Mikulecky described the underlying mental processes as summarised in Fig. 6.1.]]> Sat 24 Mar 2018 07:41:18 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:28999 Sat 24 Mar 2018 07:41:18 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:35537 resilire, means “bouncing back”—should bouncing back be understood literally or rather metaphorically in the context of health, illness, dis‐ease, and disease? This essay examines ecological, physiological, personal, and health system perspectives inherent in the concept of resilience. It emerges that regardless of the level of aggregation, resilience is a systems property—it is as much a property of each of the subsystems of network physiology, the person, and the health care delivery system as it is a property of the health system as a whole. Given the interdependencies between people, their internal and external environments, and the health service system, strengthening resilience, ie, the ability to positively adapt to challenges and changing circumstances, will require a broad‐based public discourse: “How can we strengthen resilience and health for the benefit of people and society at large”.]]> Mon 26 Aug 2019 12:33:10 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:35536 Mon 26 Aug 2019 12:12:04 AEST ]]> https://nova.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://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:49763 Mon 24 Jul 2023 17:47:11 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:35381 health—defined as a personal experiential state—back at the center to achieve a seamlessly integrated health system. The health vortex model offers a tangible framework to guide the redesign of health systems that make health the driver in the pursuit of achieving highly integrated, constantly adapting health systems that meet the needs of the person/patient. The good physician treats the disease; the great physician treats the patient who has the disease. William Osler]]> Mon 22 Jul 2019 16:00:17 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:53901 Mon 22 Jan 2024 15:03:36 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:49436 Mon 15 May 2023 13:51:13 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:49240 Mon 08 May 2023 10:14:24 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:55081 Mon 08 Apr 2024 14:09:44 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:32647 Mon 02 Jul 2018 16:18:14 AEST ]]> https://nova.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://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:21299 Fri 30 Oct 2015 15:12:22 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:39214 dynamic complex-adaptive state defines a new paradigm, and outlines ways of translating these expanded understandings to clinical practice, future research, and health system design.]]> Fri 27 May 2022 11:16:36 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:35365 Fri 23 Aug 2019 16:38:42 AEST ]]> https://nova.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 ]]>