Olde Rikkert Marcel G M, van Zuijlen Paul P M, de Kleuver Marinus, van Reekum Ariëtte, Hoekstra Alfons G, Sloot Peter M A
Radboudumc, afd. Geriatrie, Nijmegen.
Contact: M.G.M. Olde Rikkert (
Ned Tijdschr Geneeskd. 2019 Aug 19;163:D3970.
Complexity of patient care is rapidly increasing as a consequence of rising numbers of patients with complex multimorbidity. Not just the patient as a whole, but also the networks of organs, tissues and cells are forming a complex adaptive system (CAS). A CAS is defined as a network of several components ('agents') with lots of mutual feedback loops between which there are circular causalities; the predictability of a CAS is limited by definition. However, current guidelines and evidence-based medicine assume that diseases and the medical interventions to address them are predictable. Physicians' brains are complex neural networks that are much better at dealing with complex situations than guidelines. In the near future, physicians will also get help from advanced computer simulation models that make better diagnostic analyses on the basis of detailed phenotyping and are more accurate when predicting possible courses of disease and treatment outcomes.
由于患有复杂多种疾病的患者数量不断增加，患者护理的复杂性正在迅速上升。不仅是患者整体，而且器官、组织和细胞网络也正在形成一个复杂适应系统（CAS）。复杂适应系统被定义为一个由多个组件（“主体”）组成的网络，这些组件之间存在大量相互反馈回路，其中存在循环因果关系；复杂适应系统的可预测性从定义上来说是有限的。然而，当前的指南和循证医学假定疾病以及针对疾病的医学干预是可预测的。医生的大脑是复杂的神经网络，在处理复杂情况方面比指南要好得多。在不久的将来，医生还将从先进的计算机模拟模型中获得帮助，这些模型基于详细的表型分析进行更好的诊断分析，并且在预测疾病可能进程和治疗结果时更加准确。
