Pharmacocybernetics

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Pharmacocybernetics (also known as pharma-cybernetics, cybernetic pharmacy and cyberpharmacy) is an upcoming field that describes the science of supporting drugs and medications use through the application and evaluation of informatics and internet technologies, so as to improve the pharmaceutical care of patients. [1] It is an interdisciplinary field that integrates the domains of medicine and pharmacy, computer sciences (informatics, cybernetics, interactive digital media, human-computer-environment interactions) and psychological sciences to design, develop, apply and evaluate technological innovations which improve drugs and medications management, as well as prevent or solve drug-related problems.

Contents

Terminology

"Pharmaco" originates from the Greek word "pharmakon", which means drugs or poisons; [2] while "cybernetics" originates from the Greek word "kubernetes", which means "the art of steering". [3] Norbert Wiener first defined cybernetics as the science or study of "control and communication in the animal and the machine". [3] [4] Since then, the American Society for Cybernetics has further described this field as "the design or discovery and application of principles of regulation and communication". [4]

Cybernetics has been applied to many fields, such as anthropology, sociology, systems theory, psychology, biology, computer science and engineering. The defining characteristic of a cybernetic system is its relationship between endogenous goals and the external environment. [5] In the 1970s, cybernetics was applied in healthcare as a means of setting positive outcome goals for patients who were not satisfied with their plastic surgeries. [6] The emergence of "new cybernetics" or "second-order cybernetics" further expanded this concept to include the interactions between cybernetic systems and the people interacting with them, as well as to society as a whole. [7]

Cybernetics also includes the concept of "cyberspace", which is described by the science fiction author William Gibson as a virtual representation of information in varying states of accessibility that is linked to various people and organizations in his book Neuromancer. [8] [9] [10] This concept is also reiterated in the movie "The Matrix" and its sequels, which revolves around Neo (Keanu Reeves), a computer programmer, who lives in a simulated matrix world created by sentient machines but perceived by humans as reality. The term "cyberspace" is now used ubiquitously to describe anything that is associated with computers, informatics and internet technologies, and also user experiences through interactions with these technologies.

Context

The increased popularity of informatics and internet technologies in healthcare has led to the development of various software, tools and applications for healthcare professionals and patients to improve pharmaceutical care and health-related outcomes. Pharmacoinformatics (or pharmacy informatics) is a field within e-health that targets drug-related problems through the use of informatics and internet technologies. [11] Pharmacocybernetics goes one step further by merging the science of technology with human-computer-environment interactions, so that technological innovations can be designed, developed, applied and evaluated in relation to supporting medicines and drugs use, as well as to reduce or prevent drug-related problems. Pharmacocybernetic approaches target patient care and safety, and they take into account the flow of information and knowledge between users and cybernetic systems or the environment, the actions taken by users to achieve their goals, user interactivity, as well as feedback. [1] This field requires clinical knowledge and experience, as well as advanced skills and expertise to deal with technologies and human-computer-environment interactions in relation to the management of medicines and drug therapies. [1]

Pharmaceutical care involves the identification, solving and prevention of medication/drug-related problems with regards to patients' drug therapies. [12] These problems are classified into various categories, which differ slightly between the American and European systems.

The American Society of Health-System Pharmacists classifies drug-related problems into eight major categories: [12]

The Pharmaceutical Care Network Europe classifies them by problems and causes: [13]

Classification by problems:

Classification by causes:

The rapid adoption of cybermedicine has led to several other associated medication/drug-related problems. [11] These include:

Pharmacocybernetics approaches target the whole digital healthcare innovation cycle from identifying the healthcare problem, designing, developing, applying and evaluating the technological innovations that aim to address these drug-related problems. These technological innovations tend to be based on user-centered, experience-centered and activity-centered designs.

Types of environments

The types of environments that are relevant to pharmacocybernetics approaches follow Urie Bronfenbrenner’s Ecological Systems Theory. [1] [14] These environments, when applied to healthcare (for example, when a patient with a chronic disease searches the internet for information regarding his drug therapy), are as follows:

Pharmacocybernetic maxims

Four pharmacocybernetic maxims have been defined for designers and developers of pharmaco-informatics tools and applications that provide information on medications and drug therapies. [1] [15] [16] These design principles are in relation to:

  1. Quality of drug information: The quality of the drug information provided by the tool/application should be accurate and evidence based. Its content should follow that from appropriate sources, such as research articles, established drug databases and drug package information.
  2. Quantity of drug information: The tool/application should provide adequate content regarding the medication or drug therapy so that its users have enough knowledge to minimize the likelihood of drug-related problems.
  3. Relation to target audiences: The medication- or drug-related content provided by the tool/application should be relevant to its target audience and clarify their doubts.
  4. Manner of data presentation: The information provided by the tool/application should be presented in a clear manner that avoids ambiguity and misinterpretation.

Related Research Articles

<span class="mw-page-title-main">Pharmacy</span> Clinical health science

Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links health sciences with pharmaceutical sciences and natural sciences. The professional practice is becoming more clinically oriented as most of the drugs are now manufactured by pharmaceutical industries. Based on the setting, pharmacy practice is either classified as community or institutional pharmacy. Providing direct patient care in the community of institutional pharmacies is considered clinical pharmacy.

<span class="mw-page-title-main">Health informatics</span> Computational approaches to health care

Health informatics is the study and implementation of computer structures and algorithms to improve communication, understanding, and management of medical information. It can be viewed as a branch of engineering and applied science.

<span class="mw-page-title-main">Adverse drug reaction</span> Harmful, unintended result of medication

An adverse drug reaction (ADR) is a harmful, unintended result caused by taking medication. ADRs may occur following a single dose or prolonged administration of a drug or may result from the combination of two or more drugs. The meaning of this term differs from the term "side effect" because side effects can be beneficial as well as detrimental. The study of ADRs is the concern of the field known as pharmacovigilance. An adverse event (AE) refers to any unexpected and inappropriate occurrence at the time a drug is used, whether or not the event is associated with the administration of the drug. An ADR is a special type of AE in which a causative relationship can be shown. ADRs are only one type of medication-related harm. Another type of medication-related harm type includes not taking prescribed medications, known as non-adherence. Non-adherence to medications can lead to death and other negative outcomes. Adverse drug reactions require the use of a medication.

An adverse effect is an undesired harmful effect resulting from a medication or other intervention, such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. The term complication is similar to adverse effect, but the latter is typically used in pharmacological contexts, or when the negative effect is expected or common. If the negative effect results from an unsuitable or incorrect dosage or procedure, this is called a medical error and not an adverse effect. Adverse effects are sometimes referred to as "iatrogenic" because they are generated by a physician/treatment. Some adverse effects occur only when starting, increasing or discontinuing a treatment. Using a drug or other medical intervention which is contraindicated may increase the risk of adverse effects. Adverse effects may cause complications of a disease or procedure and negatively affect its prognosis. They may also lead to non-compliance with a treatment regimen. Adverse effects of medical treatment resulted in 142,000 deaths in 2013 up from 94,000 deaths in 1990 globally.

Combination therapy or polytherapy is therapy that uses more than one medication or modality. Typically, the term refers to using multiple therapies to treat a single disease, and often all the therapies are pharmaceutical. 'Pharmaceutical' combination therapy may be achieved by prescribing/administering separate drugs, or, where available, dosage forms that contain more than one active ingredient.

eHealth describes healthcare services which are supported by digital processes, communication or technology such as electronic prescribing, Telehealth, or Electronic Health Records (EHRs). The use of electronic processes in healthcare dated back to at least the 1990s. Usage of the term varies as it covers not just "Internet medicine" as it was conceived during that time, but also "virtually everything related to computers and medicine". A study in 2005 found 51 unique definitions. Some argue that it is interchangeable with health informatics with a broad definition covering electronic/digital processes in health while others use it in the narrower sense of healthcare practice using the Internet. It can also include health applications and links on mobile phones, referred to as mHealth or m-Health. Key components of eHealth include electronic health records (EHRs), telemedicine, health information exchange, mobile health applications, wearable devices, and online health information. These technologies enable healthcare providers, patients, and other stakeholders to access, manage, and exchange health information more effectively, leading to improved communication, decision-making, and overall healthcare outcomes.

Computerized physician order entry (CPOE), sometimes referred to as computerized provider order entry or computerized provider order management (CPOM), is a process of electronic entry of medical practitioner instructions for the treatment of patients under his or her care.

A clinical decision support system (CDSS) is a health information technology that provides clinicians, staff, patients, and other individuals with knowledge and person-specific information to help health and health care. CDSS encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools include computerized alerts and reminders to care providers and patients, clinical guidelines, condition-specific order sets, focused patient data reports and summaries, documentation templates, diagnostic support, and contextually relevant reference information, among other tools. CDSSs constitute a major topic in artificial intelligence in medicine.

<span class="mw-page-title-main">Personalized medicine</span> Medical model that tailors medical practices to the individual patient

Personalized medicine, also referred to as precision medicine, is a medical model that separates people into different groups—with medical decisions, practices, interventions and/or products being tailored to the individual patient based on their predicted response or risk of disease. The terms personalized medicine, precision medicine, stratified medicine and P4 medicine are used interchangeably to describe this concept, though some authors and organizations differentiate between these expressions based on particular nuances. P4 is short for "predictive, preventive, personalized and participatory".

Pharmacotherapy, also known as pharmacological therapy or drug therapy, is defined as medical treatment that utilizes one or more pharmaceutical drugs to improve ongoing symptoms, treat the underlying condition, or act as a prevention for other diseases (prophylaxis).

Health is the state of complete physical, mental, and social well-being and a positive concept emphasizing social and personal resources, as well as physical capacities. This article lists major topics related to personal health.

Imaging informatics, also known as radiology informatics or medical imaging informatics, is a subspecialty of biomedical informatics that aims to improve the efficiency, accuracy, usability and reliability of medical imaging services within the healthcare enterprise. It is devoted to the study of how information about and contained within medical images is retrieved, analyzed, enhanced, and exchanged throughout the medical enterprise.

Pharmaceutical care is a pharmacy practice model developed in the 1990s that describes patient-centered medication management services performed by pharmacists.

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<span class="mw-page-title-main">Cybernetics</span> Transdisciplinary field concerned with regulatory and purposive systems

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<span class="mw-page-title-main">Artificial intelligence in healthcare</span> Overview of the use of artificial intelligence in healthcare

Artificial intelligence in healthcare is the application of artificial intelligence (AI) to copy human cognition in the analysis, presentation, and understanding of complex medical and health care data, or to exceed human capabilities by providing new ways to diagnose, treat, or prevent disease. Specifically, AI is the ability of computer algorithms to arrive at approximate conclusions based solely on input data.

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References

  1. 1 2 3 4 5 Yap, KY; Chuang, X; Lee, AJM; Lee, RZ; Lim, L; Lim, JJ; Nimesha, R (2009). "Pharmaco-cybernetics as an interactive component of pharma-culture: empowering drug knowledge through user-, experience- and activity-centered designs". International Journal of Computer Science Issues. 3: 1–13.
  2. ↑ Stedman TL. Stedman's Medical Dictionary. 28th ed. Baltimore, Maryland: Lippincott Williams & Wilkins; 2005.
  3. 1 2 Pangaro P. "Getting started" guide to cybernetics. Available at: http://pangaro.com/published/cyber-macmillan.html.
  4. 1 2 American Society for Cybernetics. Foundations - the subject of cybernetics: defining 'cybernetics'. Available at: http://www.asc-cybernetics.org/foundations/definitions.htm.
  5. ↑ Corning, PA (1996). "Synergy, cybernetics, and the evolution of politics". International Political Science Review. 17 (1): 91–119. doi:10.1177/019251296017001006. S2CID   143822151.
  6. ↑ 'Psycho-cybernetics' Author. Plastic surgeon tries to heal 'inner scars'. Los Angeles Times 1973, 2 November; Sect. Part 1-A: B5-1.
  7. ↑ Geyer, F (1995). "The challenge of sociocybernetics". Kybernetes: The International Journal of Systems & Cybernetics. 24 (4): 6–32. doi:10.1108/03684929510089321.
  8. ↑ Adams, PC (1997). "Cyberspace and virtual places". Geographical Review. 87 (2): 155–171. doi:10.2307/216003. JSTOR   216003.
  9. ↑ Trappl R. The cybernetics and systems revival: Paper presented at: 14th European Meeting on Cybernetics and Systems Research (EMCSR'98); 14–17 April 1998; University of Vienna, Austrian Society for Cybernetic Studies.
  10. ↑ Gibson W. Neuromancer (Special 20th Anniversary Edition). Hardcover ed: Ace Books; 2004.
  11. 1 2 Yap, KY; Chan, A; Chui, WK (2009). "Improving pharmaceutical care in oncology by pharmacoinformatics: the evolving role of informatics and the internet for drug therapy". Lancet Oncology. 10 (10): 1011–1019. doi:10.1016/S1470-2045(09)70104-4. PMID   19796753.
  12. 1 2 "ASHP statement on pharmaceutical care". American Journal of Hospital Pharmacy. 50 (8): 1720–1723. 1993. doi:10.1093/ajhp/50.8.1720.
  13. ↑ Pharmaceutical Care Network Europe. PCNE classification for drug-related problems v6.2. Available at: http://www.pcne.org/sig/drp/documents/PCNE%20classification%20V6-2.pdf.
  14. ↑ Paquette D, Ryan J. Bronfenbrenner’s Ecological Systems Theory. Available at: "Archived copy" (PDF). Archived from the original (PDF) on 2007-09-28. Retrieved 2007-09-28.{{cite web}}: CS1 maint: archived copy as title (link).
  15. ↑ Yap, KY; Lim, KJ (2012). "Merging the old with the new: a cybermedicine marriage for oncology interactions with traditional herbal therapies and complementary medicines". Tang - International Journal of Genuine Traditional Medicine. 2 (2): e18. doi: 10.5667/tang.2012.0004 .
  16. ↑ Chan, A; Yap, KY (2010). "Detection and management of oncology drug interactions: Can we do better?". Maturitas. 65 (3): 181–182. doi:10.1016/j.maturitas.2009.12.001. PMID   20036470.
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