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      Apuntes sobre el enfoque de la complejidad y su aplicación en la salud Translated title: Notes on the approach to complexity and its application in the field of healthcare

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          Abstract

          La medicina en su esquema metodológico tradicional al igual que otras tantas disciplinas, ha tenido un enfoque basado en la mecánica de Descartes y Newton, por lo que en muchas ocasiones mantiene el esquema tradicional de causa-efecto basado en modelos de ecuaciones lineales, donde todo funciona como una maquinaria de forma predecible. En el presente trabajo se argumenta como el enfoque de los sistemas complejos fomenta una forma de actuación emergente, holista, transdisciplinar que integra técnicas y conocimientos de diversos campos. El artículo destaca como este enfoque ofrece las herramientas adecuadas para implementar los nuevos modelos necesarios. Se detallan algunas propiedades de los sistemas complejos con el fin de divulgar este enfoque en el sector de la salud. Para realizar este artículo se consultaron más de 50 fuentes bibliográficas y se realizaron entrevistas y consultas a especialistas. La teoría de la complejidad, proporciona al médico una gran capacidad de generar nuevas soluciones integradas a través de las conexiones históricas y sociales de cada localidad, para un conocimiento expandido; capacidad para el debate, la discusión, adaptación a los cambios y capacidad de desarrollar nuevas metas y estrategias.

          Translated abstract

          Like many other disciplines, the approach of the traditional methodological scheme of medicine has been based on Descartes and Newton´s system, therefore medicine keeps in many occasions the traditional cause-effect pattern based on linear equation models where everything operates in a predictable way like a piece of machinery. The present paper substantiated how the complex system approach encourages emerging, holistic, multidisciplinary way of acting that incorporates techniques and knowledge from several fields. The article stresses how this approach provides the suitable tools to implement new required models. Some properties of the complex systems were described in order to disseminate this type of approach in the healthcare sector. To write this article, a literature review was made, which comprised 50 sources and several interviews to specialists. The complexity theory provides the physician with great capacities of generating new comprehensive solutions through the historical and social relationships existing in each place, giving rise to broader knowledge, greater capacity for debate, discussion, adaptation to change and increased capabilities to develop new targets and strategies.

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          Most cited references26

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          Modelling disease outbreaks in realistic urban social networks.

          Most mathematical models for the spread of disease use differential equations based on uniform mixing assumptions or ad hoc models for the contact process. Here we explore the use of dynamic bipartite graphs to model the physical contact patterns that result from movements of individuals between specific locations. The graphs are generated by large-scale individual-based urban traffic simulations built on actual census, land-use and population-mobility data. We find that the contact network among people is a strongly connected small-world-like graph with a well-defined scale for the degree distribution. However, the locations graph is scale-free, which allows highly efficient outbreak detection by placing sensors in the hubs of the locations network. Within this large-scale simulation framework, we then analyse the relative merits of several proposed mitigation strategies for smallpox spread. Our results suggest that outbreaks can be contained by a strategy of targeted vaccination combined with early detection without resorting to mass vaccination of a population.
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            Dynamics in Action

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              Organizational interventions employing principles of complexity science have improved outcomes for patients with Type II diabetes

              Background Despite the development of several models of care delivery for patients with chronic illness, consistent improvements in outcomes have not been achieved. These inconsistent results may be less related to the content of the models themselves, but to their underlying conceptualization of clinical settings as linear, predictable systems. The science of complex adaptive systems (CAS), suggests that clinical settings are non-linear, and increasingly has been used as a framework for describing and understanding clinical systems. The purpose of this study is to broaden the conceptualization by examining the relationship between interventions that leverage CAS characteristics in intervention design and implementation, and effectiveness of reported outcomes for patients with Type II diabetes. Methods We conducted a systematic review of the literature on organizational interventions to improve care of Type II diabetes. For each study we recorded measured process and clinical outcomes of diabetic patients. Two independent reviewers gave each study a score that reflected whether organizational interventions reflected one or more characteristics of a complex adaptive system. The effectiveness of the intervention was assessed by standardizing the scoring of the results of each study as 0 (no effect), 0.5 (mixed effect), or 1.0 (effective). Results Out of 157 potentially eligible studies, 32 met our eligibility criteria. Most studies were felt to utilize at least one CAS characteristic in their intervention designs, and ninety-one percent were scored as either "mixed effect" or "effective." The number of CAS characteristics present in each intervention was associated with effectiveness (p = 0.002). Two individual CAS characteristics were associated with effectiveness: interconnections between participants and co-evolution. Conclusion The significant association between CAS characteristics and effectiveness of reported outcomes for patients with Type II diabetes suggests that complexity science may provide an effective framework for designing and implementing interventions that lead to improved patient outcomes.
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                Author and article information

                Journal
                rcsp
                Revista Cubana de Salud Pública
                Rev. cub. salud pública
                Centro Nacional de Información de Ciencias Médicas (La Habana, La Habana, Cuba )
                0864-3466
                1561-3127
                June 2010
                : 36
                : 2
                : 160-165
                Affiliations
                [01] Camagüey orgname. Universidad de Ciencias Médicas Carlos J. Finlay Cuba
                [02] La Habana orgnameEscuela Nacional de Salud Pública Cuba
                Article
                S0864-34662010000200010 S0864-3466(10)03600210
                db4d5ad6-55f9-4978-985c-0fcf0fe7fabb

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 03 December 2008
                : 23 March 2009
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 26, Pages: 6
                Product

                SciELO Cuba

                Self URI: Texto completo solamente en formato PDF (ES)
                Categories
                Debate

                Complex health systems,Sistemas complejos de salud,salud y complejidad,health and complexity

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