系统与复杂性思维在全科医学文献中的应用：综合历史叙事性回顾。
Systems and complexity thinking in the general practice literature: an integrative, historical narrative review.
机构信息
Department of General Practice, Newcastle University, Newcastle, New South Wales, Australia.
出版信息
Ann Fam Med. 2014 Jan-Feb;12(1):66-74. doi: 10.1370/afm.1593.
PURPOSE
Over the past 7 decades, theories in the systems and complexity sciences have had a major influence on academic thinking and research. We assessed the impact of complexity science on general practice/family medicine.
METHODS
We performed a historical integrative review using the following systematic search strategy: medical subject heading [humans] combined in turn with the terms 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.
目的
在过去的 70 年里，系统和复杂性科学理论对学术思想和研究产生了重大影响。我们评估了复杂性科学对普通科/家庭医学的影响。
方法
我们采用以下系统搜索策略进行历史综合回顾：主题词[人类]与复杂适应系统、非线性动力学、系统生物学和系统理论相结合，限于普通科/家庭医学，并在 2010 年 12 月前发表。共检索到 16242 篇文章，其中 49 篇发表在普通科/家庭医学期刊上。手工检索和滚雪球检索又检索到 35 篇。经过全文审查，我们纳入了 56 篇专门讨论系统科学和普通/家庭实践的文章。
结果
普通科/家庭医学在 4 个阶段与新兴的系统和复杂性理论接触。1995 年以前，文章倾向于探索普通的现象学普通科/家庭医学经验。1995 年至 2000 年期间，文章描述了这一学科的复杂适应性本质。2000 年至 2005 年期间发表的文章侧重于描述医疗实践的系统动力学。2005 年后，文章越来越多地将广泛的复杂科学理论应用于医疗保健、医疗改革和医学的未来。
结论
本历史回顾描述了普通科/家庭医学与复杂适应系统理论的发展，并展示了系统科学如何更准确地反映该学科的哲学和身份。分析表明，普通科/家庭医学首先通过有意识地重新组织其边界和范围来接受系统理论，然后才应用经验工具。未来的研究应集中于将非线性动力学和经验建模应用于患者护理，以及组织和发展当地实践，参与社区发展，并影响医疗改革。
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