Whole Systems Research Research Articles

Study on WSR-based community healthy food distribution design method

While new types of consumer services emerge to fulfill people's diverse requirements, one of the most pressing societal concerns is how to improve the health of the elderly and allow them to live their golden years in good physical and mental health. This research is based on the Whole Systems Research (WSR) method, which expands and improves the theoretical research field of delivery service. The planning and service process of healthy diet opens up new service content and service system for the logistics and delivery industry; the research results of this paper are based on the innovation of systematic service model in three levels: physical, physical, and human, which can broaden the service model for related logistics enterprises and new retail market. The research results of this paper, which are based on the innovation of systematic service model from physical and human levels, can broaden the marketing mode and funding source for related logistics enterprises and new retail market; the overall research process and the application of research method can provide theoretical reference for related research institutions.

Effects of shiatsu on the health-related quality of life of a person with secondary progressive multiple sclerosis: A mixed methods N-of-1 trial within a whole systems research case study

IntroductionMultiple Sclerosis (MS) is a chronic neurological disorder with high prevalence in Finland. Most people with MS will develop Secondary-Progressive MS (SPMS) over time. People with MS report lower than the average Health-Related Quality of Life (HRQoL) and use Complementary and Alternative Medicine (CAM) for their symptoms. Personalised interventions such as shiatsu have an insufficient evidence base. The n-of-1 trial is a promising study design for personalised interventions in chronic conditions but has not little used in CAM research. The aim was to investigate if shiatsu affects the HRQoL of a person with SPMS. MethodsSix-periods counterbalanced mixed-methods n-of-1 trial within a Whole Systems Research (WSR) case study was used. The short version of the MSQLI, data collected from a semi-structured interview and case notes were used to assess the effect of the treatment. The collected data analysed quantitatively and qualitatively and synthesised as a descriptive case study. ResultsThe study was able to document improvements in spasticity, bowel function, fatigue, pain, sleep and relaxation. No adverse events occurred. Preliminary estimations of the onset and wash-out of shiatsu effects were inferred. Advantages and drawbacks of the design are discussed to improve future applicability. ConclusionsShiatsu was able to improve some domains of the HRQoL of the specific person with SPMS. It was a safe treatment with no adverse events. Mixed methods n-of-1 trial within a WSR case study was an appropriate design for the study.

Convergent Points for Conventional Medicine and Whole Systems Research: A User's Guide.

Value-based health care has emerged as a manifestation of the conventional medicine community's awareness of the overlapping needs to both better incorporate patient centeredness into practice and research paradigms and further develop a systemic approach to cost reduction. The origins of the whole systems research (WSR) movement date to the late 1990s, when the U.S. Congress legislated appropriation of funds to stimulate the U.S. National Institutes of Health to evaluate popular traditional, complementary, and integrative medicine (TCIM) practices. Questions immediately arose over how well these forms of practice could be measured through standard randomized controlled trials, and the WSR community began to articulate and adapt innovative methodologies for evaluating TCIM interventions. This column explores the potential impact of WSR methods and exemplars on the clinical practice and research communities seeking to successfully implement and measure the complexities of value-based health care. Four potentially cross-talking themes are specifically discussed: complex behaviorally focused interventions, patient-centered outcomes, team-based care, and resilience and well-being. The time is ripe for clinicians and investigators to capitalize on methodologies, exemplars, and learnings from the WSR literature toward improving care, developing more robust research strategies, and furthering the dialogue between the TCIM and conventional medicine communities.

The pursuit of interdisciplinary whole systems energy research: Insights from the UK Energy Research Centre

Interdisciplinary whole systems research (WSR) is attracting increasing interest as a way to address to complex societal challenges such as sustainable energy. However, WSR typically involves challenging research elements (radical disciplinary scope, integrative knowledge production and transdisciplinary design), which are seen by some as intellectually and institutionally flawed. Drawing on the interdisciplinary studies literature, this paper considers WSR strategy and practice in the UK Energy Research Centre (UKERC) over its first two phases (2004–14) and compares UKERC to other similar UK-based initiatives. WSR strategy and practice face a number of tensions: integration versus diversity, stability versus flexibility and independence versus engagement. The emphasis in UKERC was on integration in the first phase and diversity and flexibility in the second phase – a pattern largely imposed by funders, assessors and stakeholders, rather than by internal strategy. Though granted ambitious remits, WSR is often funded, practised and assessed in the margins of disciplinary based research systems, rather than as a distinctive research form. There is a need to better attend to the choices and trade-offs involved in WSR strategy and practice, drawing on the experiences of UKERC and other initiatives. As a guide, the paper introduces a number of interdisciplinary WSR archetypes.

A Community of Healing: Psychosocial Functions of Integrative Medicine Perceived by Oncology Patients/Survivors, Healthcare Professionals, and CAM Providers

ObjectiveA whole systems research approach was used to explore the psychosocial functions attributed to an Integrative Medicine oncology program. Field research was conducted at a cancer clinic to answer the following questions: (1) what meanings do the participants attribute to the Integrative Medicine oncology program; (2) what contributes to sustaining the Integrative Medicine program; and (3) what role does the Integrative Medicine program play in the lives of the participants. MethodsParticipant observation and in-depth interviews were conducted at a community-based cancer clinic that offers various complementary modalities along with conventional cancer treatments. ParticipantsThe data were obtained from a total of 23 participants including cancer patients/survivors, caregivers, volunteers who provided the complementary therapies, and healthcare professionals at the clinic. ResultsResults indicated that the Integrative Medicine program had three major psychosocial functions for those involved. Participants viewed the Integrative Medicine program as a place (1) to exchange health/medical information and learn from others' experiences and expertise, (2) to give and receive emotional support, and (3) for the individual to act on his/her transformed new identity and new life goals through serving others. ConclusionsThe results illustrate the positive psychosocial impacts an Integrative Medicine program may bring to individuals involved in it and suggest the value of using a whole systems research (WSR) approach to Integrative Medicine research.

The Peter Brojde Lung Cancer Centre: A Model of Integrative Practice

The generally poor prognosis and poor quality of life for lung cancer patients have highlighted the need for a conceptual model of integrative practice. Although the philosophy of integrative oncology is well described, conceptual models that could guide the implementation and scientific evaluation of integrative practice are lacking. The present paper describes a conceptual model of integrative practice in which the philosophical underpinnings derive mainly from integrative oncology, with important contributions from Traditional Chinese Medicine (TCM) and the discipline of nursing. The conceptual model is described in terms of its purpose, values, concepts, dynamic components, scientific evidence, clinical approach, and theoretical underpinnings. The model argues that these components delineate the initial scope and orientation of integrative practice. They serve as the needed context for evaluating and interpreting the effectiveness of clinical interventions in enhancing patient outcomes in lung cancer at various phases of the illness. Furthermore, the development of relevant and effective integrative clinical interventions requires new research methods based on whole-systems research. An initial focus would be the identification of interrelationship patterns among variables that influence clinical interventions and their targeted patient outcomes.

Thinking Inside the Box: Simple Methods to Evaluate Complex Treatments

We risk ignoring cheaper and safer medical treatments because they cannot be patented, lack profit potential, require too much patient-contact time, or do not have scientific results. Novel medical treatments may be difficult to evaluate for a variety of reasons such as patient selection bias, the effect of the package of care, or the lack of identifying the active elements of treatment. Whole Systems Research (WSR) is an approach designed to assess the performance of complete packages of clinical management. While the WSR method is compelling, there is no standard procedure for WSR, and its implementation may be intimidating. The truth is that WSR methodological tools are neither new nor complicated. There are two sequential steps, or boxes, that guide WSR methodology: establishing system predictability, followed by an audit of system element effectiveness. We describe the implementation of WSR with a particular attention to threats to validity (Shadish, Cook, & Campbell, 2002; Shadish & Heinsman, 1997). DOI:10.2458/azu_jmmss_v2i1_menke

Whole Systems Research Becomes Real: New Results and Next Steps

Cheryl Ritenbaugh: The term “whole-systems research” was coined in 2002 on the basis of systems such as Chinese medicine and homeopathy, whose traditions not only included particular treatment modalities such as acupuncture or homeopathic remedies, but also diagnosis and patient–practitioner interactions, techniques for changing patient behavior, and other complementary and alternative approaches to healing. It grew from the realization that the conventional randomized controlled trial (RCT) was probably insufficient for obtaining a more holistic idea of the magnitude of impact of these interventions and how they worked.

Chinese Medicine and Biomodulation in Cancer Patients—Part One

Traditional Chinese Medicine (tcm) may be integrated with conventional Western medicine to enhance the care of patients with cancer. Although tcm is normally implemented as a whole system, recent reductionist research suggests mechanisms for the effects of acupuncture, herbs, and nutrition within the scientific model of biomedicine. The health model of Chinese medicine accommodates physical and pharmacologic interventions within the framework of a body-mind network. A Cartesian split does not occur within this model, but to allow for scientific exploration within the restrictions of positivism, reductionism, and controls for confounding factors, the components must necessarily be separated. Still, whole-systems research is important to evaluate effectiveness when applying the full model in clinical practice. Scientific analysis provides a mechanistic understanding of the processes that will improve the design of clinical studies and enhance safety. Enough preliminary evidence is available to encourage quality clinical trials to evaluate the efficacy of integrating tcm into Western cancer care.

Chiropractic Care for Nonmusculoskeletal Conditions: A Systematic Review with Implications for Whole Systems Research

(1) To evaluate the evidence on the effect of chiropractic care, rather than spinal manipulation only, on patients with nonmusculoskeletal conditions; and (2) to identify shortcomings in the evidence base on this topic, from a Whole Systems Research perspective. Systematic review. Databases included were PubMed, Ovid, Mantis, Index to Chiropractic Literature, and CINAHL. Search restrictions were human subjects, peer-reviewed journal, English language, and publication before May 2005. All randomized controlled trials (RCTs) were evaluated using the Scottish Intercollegiate Guidelines Network (SIGN) and Jadad checklists; a checklist developed from the CONSORT (Consolidated Standards of Reporting Trials) guidelines; and one developed by the authors to evaluate studies in terms of Whole Systems Research (WSR) considerations. The search yielded 179 papers addressing 50 different nonmusculoskeletal conditions. There were 122 case reports or case series, 47 experimental designs, including 14 RCTs, 9 systematic reviews, and 1 a large cohort study. The 14 RCTs addressed 10 conditions. Six RCTs were rated "high" on the 3 conventional checklists; one of these 6 was rated "high" in terms of WSR considerations. (1) Adverse effects should be routinely reported. For the few studies that did report, adverse effects of spinal manipulation for all ages and conditions were rare, transient, and not severe. (2) Evidence from controlled studies and usual practice supports chiropractic care (the entire clinical encounter) as providing benefit to patients with asthma, cervicogenic vertigo, and infantile colic. Evidence was promising for potential benefit of manual procedures for children with otitis media and elderly patients with pneumonia. (3) The RCT design is not necessarily incompatible with WSR. RCTs could improve generalizability by basing protocols on usual practice. (4) Case reports could contribute more to WSR by increasing their emphasis on patient characteristics and patient-based outcomes. (5) Chiropractic investigators, practitioners, and funding agencies should increase their attention to observational designs.

Complementary and alternative medicine whole systems research: Beyond identification of inadequacies of the RCT

Complementary and alternative medicine (CAM) often consists of whole systems of care (such as naturopathic medicine or traditional Chinese medicine (TCM)) that combine a wide range of modalities to provide individualised treatment. The complexity of these interventions and their potential synergistic effect requires innovative evaluative approaches. Model validity, which encompasses the need for research to adequately address the unique healing theory and therapeutic context of the intervention, is central to whole systems research (WSR). Classical randomised controlled trials (RCTs) are limited in their ability to address this need. Therefore, we propose a mixed methods approach that includes a range of relevant and holistic outcome measures. As the individual components of most whole systems are inseparable, complementary and synergistic, WSR must not focus only on the "active" ingredients of a system. An emerging WSR framework must be non-hierarchical, cyclical, flexible and adaptive, as knowledge creation is continuous, evolutionary and necessitates a continuous interplay between research methods and "phases" of knowledge. Finally, WSR must hold qualitative and quantitative research methods in equal esteem to realize their unique research contribution. Whole systems are complex and therefore no one method can adequately capture the meaning, process and outcomes of these interventions.

The development of an applied whole-systems research methodology in health and social service research: A Canadian and United Kingdom collaboration

This paper provides a description of a 'whole system' research model developed in Canada and adapted for use in the United Kingdom. The model tests the assumption that service utilization across the whole system is driven by a complex mix of psychosocial factors, rather than disease characteristics, of the population and, second, that proactive, integrated and communitybased packages of care are equally or more effective and less expensive than fragmented services. The methodology uses large-scale, cross-sectional surveys of a diverse range of population groups accessing health and social services. Data were collected on measures of psychosocial resource, functional ability and service utilization. The relationship between psychosocial resources, functional ability and service utilization is analysed. This paper describes the research model, the theories informing the model and the application of the model to two diverse population groups: patients with chronic obstructive pulmonary disease and single parents on welfare. The article concludes by acknowledging that multi-agency approaches to evaluation using measures of patient need and healthcare outcomes which do not privilege the contribution of any one agency are required to test the cost-effectiveness of inter-agency working. This paper describes the early experiences of replicating this methodology in a UK context in order to test the findings for their generalizability to that context.