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

Pharmacy Clinical health science

Pharmacy is the clinical health science that links medical science with chemistry and it is charged with the discovery, production, disposal, safe and effective use, and control of medications and drugs. The practice of pharmacy requires excellent knowledge of drugs, their mechanism of action, side effects, interactions, mobility and toxicity. At the same time, it requires knowledge of treatment and understanding of the pathological process. Some specialties of pharmacists, such as that of clinical pharmacists, require other skills, e.g. knowledge about the acquisition and evaluation of physical and laboratory data.

Health informatics Applications of information processing concepts and machinery in medicine

Health informatics is the field of science and engineering that aims at developing methods and technologies for the acquisition, processing, and study of patient data, which can come from different sources and modalities, such as electronic health records, diagnostic test results, medical scans. The health domain provides an extremely wide variety of problems that can be tackled using computational techniques.

Electronic health record Digital collection of patient and population electronically stored health information

An electronic health record (EHR) is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.

Adverse drug reaction Medical condition

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 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 drug event (ADE) refers to any unexpected and inappropriate occurrence at the time a drug is used, whether or not associated with the administration of the drug. An ADR is a special type of ADE in which a causative relationship can be shown. ADRs are only one type of medication-related harm, as harm can also be caused by omitting to take indicated medications.

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. If it results from an unsuitable or incorrect dosage or procedure, this is called a medical error and not a complication. 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. Adverse effects can also be caused by placebo treatments . 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.

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.

Pharmacotherapy is therapy using pharmaceutical drugs, as distinguished from therapy using surgery, radiation, movement, or other modes. Among physicians, sometimes the term medical therapy refers specifically to pharmacotherapy as opposed to surgical or other therapy; for example, in oncology, medical oncology is thus distinguished from surgical oncology. Pharmacists are experts in pharmacotherapy and are responsible for ensuring the safe, appropriate, and economical use of pharmaceutical drugs. The skills required to function as a pharmacist require knowledge, training and experience in biomedical, pharmaceutical and clinical sciences. Pharmacology is the science that aims to continually improve pharmacotherapy. The pharmaceutical industry and academia use basic science, applied science, and translational science to create new pharmaceutical drugs.

In medicine, an indication is a valid reason to use a certain test, medication, procedure, or surgery. There can be multiple indications to use a procedure or medication. An indication can commonly be confused with the term diagnosis. A diagnosis is the assessment that a particular [medical] condition is present while an indication is a reason for use. The opposite of an indication is a contraindication, a reason to withhold a certain medical treatment because the risks of treatment clearly outweigh the benefits.

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.

Pharmaceutical care is the direct, responsible provision of medication-related care for the purpose of achieving definite outcomes that improve a patient’s quality of life.

Drug discovery and development requires the integration of multiple scientific and technological disciplines. These include chemistry, biology, pharmacology, pharmaceutical technology and extensive use of information technology. The latter is increasingly recognised as Pharmacoinformatics. Pharmacoinformatics relates to the broader field of bioinformatics.

Health information technology (HIT) is health technology, particularly information technology, applied to health and health care. It supports health information management across computerized systems and the secure exchange of health information between consumers, providers, payers, and quality monitors. Based on an often-cited 2008 report on a small series of studies conducted at four sites that provide ambulatory care – three U.S. medical centers and one in the Netherlands – the use of electronic health records (EHRs) was viewed as the most promising tool for improving the overall quality, safety and efficiency of the health delivery system.

Drug therapy problems (DTPs) represent the categorization and definition of clinical problems related to the use of medications or "drugs" in the field of pharmaceutical care. In the course of clinical practice, DTPs are often identified, prevented, and/or resolved by pharmacists in the course of medication therapy management, as experts on the safety and efficacy of medications, but other healthcare professionals may also manage DTPs.

ICU Medical, Inc. is a San Clemente, California-based company with global operations that develops, manufactures, and sells medical technologies used in vascular therapy, oncology, and critical care applications.

Fast Healthcare Interoperability Resources is a standard describing data formats and elements and an application programming interface (API) for exchanging electronic health records (EHR). The standard was created by the Health Level Seven International (HL7) health-care standards organization.

Joseph Antony Cafazzo is a Canadian biomedical engineer, educator, and researcher.

Specialty drugs or specialty pharmaceuticals are a recent designation of pharmaceuticals that are classified as high-cost, high complexity and/or high touch. Specialty drugs are often biologics—"drugs derived from living cells" that are injectable or infused. They are used to treat complex or rare chronic conditions such as cancer, rheumatoid arthritis, hemophilia, H.I.V. psoriasis, inflammatory bowel disease and hepatitis C. In 1990 there were 10 specialty drugs on the market, in the mid-1990s there were fewer than 30, by 2008 there were 200, and by 2015 there were 300. Drugs are often defined as specialty because their price is much higher than that of non-specialty drugs. Medicare defines any drug for which the negotiated price is $670 per month or more, as a specialty drug which is placed in a specialty tier that requires a higher patient cost sharing. Drugs are also identified as specialty when there is a special handling requirement or the drug is only available via a limited distributions network. By 2015 "specialty medications accounted for one-third of all spending on drugs in the United States, up from 19 percent in 2004 and heading toward 50 percent in the next 10 years", according to IMS Health, which tracks prescriptions. According to a 2010 article in Forbes, specialty drugs for rare diseases became more expensive "than anyone imagined" and their success came "at a time when the traditional drug business of selling medicines to the masses" was "in decline". In 2015 analysis by The Wall Street Journal suggested the large premium was due to the perceived value of rare disease treatments which usually are very expensive when compared to treatments for more common diseases.

Artificial intelligence in healthcare Overview of the use of artificial intelligence in healthcare

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IBM Watson Health is a digital tool that helps clients facilitate medical research, clinical research, and healthcare services, through the use of artificial intelligence, data, analytics, cloud computing, and other advanced information technology. It is a division of the International Business Machines Corporation, (IBM), an American multinational information technology company headquartered in Armonk, New York.

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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