scholarly journals Implementing Personalized Medicine in COVID-19 in Andalusia: An Opportunity to Transform the Healthcare System

2021 ◽  
Vol 11 (6) ◽  
pp. 475
Author(s):  
Joaquín Dopazo ◽  
Douglas Maya-Miles ◽  
Federico García ◽  
Nicola Lorusso ◽  
Miguel Ángel Calleja ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Clinical Practice ◽  
Personalized Medicine ◽  
Local Level ◽  
Individual Variability ◽  
Response To Therapy ◽  
Control Measures ◽  
Response To Treatment ◽  
Specific Patient

The COVID-19 pandemic represents an unprecedented opportunity to exploit the advantages of personalized medicine for the prevention, diagnosis, treatment, surveillance and management of a new challenge in public health. COVID-19 infection is highly variable, ranging from asymptomatic infections to severe, life-threatening manifestations. Personalized medicine can play a key role in elucidating individual susceptibility to the infection as well as inter-individual variability in clinical course, prognosis and response to treatment. Integrating personalized medicine into clinical practice can also transform health care by enabling the design of preventive and therapeutic strategies tailored to individual profiles, improving the detection of outbreaks or defining transmission patterns at an increasingly local level. SARS-CoV2 genome sequencing, together with the assessment of specific patient genetic variants, will support clinical decision-makers and ultimately better ways to fight this disease. Additionally, it would facilitate a better stratification and selection of patients for clinical trials, thus increasing the likelihood of obtaining positive results. Lastly, defining a national strategy to implement in clinical practice all available tools of personalized medicine in COVID-19 could be challenging but linked to a positive transformation of the health care system. In this review, we provide an update of the achievements, promises, and challenges of personalized medicine in the fight against COVID-19 from susceptibility to natural history and response to therapy, as well as from surveillance to control measures and vaccination. We also discuss strategies to facilitate the adoption of this new paradigm for medical and public health measures during and after the pandemic in health care systems.

scholarly journals SALIVA AND SALIVAOMICS IN THE DIAGNOSIS OF ORAL AND SYSTEMIC DISEASES: A REVIEW

2021 ◽  
pp. 8-12
Author(s):  
Sherly Ruth ◽  
Koduri Sridevi ◽  
Buduru Krishnaveni ◽  
Nalli Prasanth Kumar ◽  
Katru Sreekar ◽  
...  
Keyword(s):  
Health Care ◽  
Early Detection ◽  
Patient Care ◽  
Disease Diagnosis ◽  
Response To Therapy ◽  
Response To Treatment ◽  
Systemic Diseases ◽  
Early Disease ◽  
Early Disease Detection ◽  
Salivary Diagnostics

The quest for novel strategies in early disease detection and response to therapy is an essential ongoing process in health care setups.Along with other body fluids such as blood,mucus,urine,semen and vaginal fluids;saliva can also be considered for the detection of the disease.The Salivary diagnostics is a dynamic field that is being incorporated as part of disease diagnosis, clinical monitoring and for making important clinical decisions for patient care. This review presents the translational value of saliva as a credible clinical diagnostic biofluid in detection, early detection of the various diseases and response to treatment.

scholarly journals COVID-19 Outbreaks in Settings With Precarious Housing Conditions in Germany: Challenges and Lessons Learned

2021 ◽  
Vol 9 ◽  
Author(s):  
Ruth Zimmermann ◽  
Navina Sarma ◽  
Doris Thieme-Thörel ◽  
Katharina Alpers ◽  
Tanja Artelt ◽  
...  
Keyword(s):  
Public Health ◽  
Disease Transmission ◽  
Residential Buildings ◽  
Local Level ◽  
Lessons Learned ◽  
Control Measures ◽  
Sequencing Analysis ◽  
Housing Conditions ◽  
Health Measures ◽  
The City

Two COVID-19 outbreaks occurred in residential buildings with overcrowded housing conditions in the city of Göttingen in Germany during May and June 2020, when COVID-19 infection incidences were low across the rest of the country, with a national incidence of 2.6/100,000 population. The outbreaks increased the local incidence in the city of Göttingen to 123.5/100,000 in June 2020. Many of the affected residents were living in precarious conditions and experienced language barriers. The outbreaks were characterized by high case numbers and attack rates among the residents, many asymptomatic cases, a comparatively young population, and substantial outbreak control measures implemented by local authorities. We analyzed national and local surveillance data, calculated age-, and gender-specific attack rates and performed whole genome sequencing analysis to describe the outbreak and characteristics of the infected population. The authorities' infection control measures included voluntary and compulsory testing of all residents and mass quarantine. Public health measures, such as the general closure of schools and a public space as well as the prohibition of team sports at local level, were also implemented in the district to limit the outbreaks locally. The outbreaks were under control by the end of June 2020. We describe the measures to contain the outbreaks, the challenges experienced and lessons learned. We discuss how public health measures can be planned and implemented through consideration of the needs and vulnerabilities of affected populations. In order to avoid coercive measures, barrier-free communication, with language translation when needed, and consideration of socio-economic circumstances of affected populations are crucial for controlling infectious disease transmission in an outbreak effectively and in a timely way.

scholarly journals Personalized medicine in Brazil: a new paradigm, old problems

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Claudia Pavani ◽  
Guilherme Ary Plonski
Keyword(s):  
Public Health ◽  
Health Care ◽  
Personalized Medicine ◽  
Clinical Studies ◽  
Research Method ◽  
New Technologies ◽  
High Income ◽  
Public Health Care ◽  
Content Type

Purpose Personalized medicine (PM) encompasses a set of procedures, technologies and medications; the term became more prominent from the 2000s onwards and stems from the mapping of the human genome. The purposes of this study were to analyse the development stage of the process of technological innovation for PM and the obstacles that prevent PM from being adopted in the public health system in Brazil. Design/methodology/approach As a research method, this paper opts for a case study carried out at the Hospital das Clínicas, which belongs to São Paulo Medical School. In total, 22 in-depth interviews were carried out at the hospital to identify current practices in PM, future prospects and barriers imposed to the adoption of PM technologies in public health. Findings Personalized or precision medicine is already a reality for a small portion of the Brazilian population and is gradually gaining ground in public health care. One finding is that such changes are occurring in a disjointed manner in an incomplete and under development health innovation system. The analysis pointed out that the obstacles identified in Brazil are the same as those faced by high-income countries such as regulation, lack of clinical studies and need to adapt clinical studies to PM. They appear in all stages of the innovation cycle, from research to widespread use. Research limitations/implications The research method was a case study, so the findings cannot be extrapolated to other contexts. A limited number of professionals were interviewed, their opinions may not reflect those of their organizations. Originality/value There are several studies that discuss how health-care systems in high-income countries could incorporate these new technologies, but only a few focuses on low or middle-income countries such as Brazil.

scholarly journals Building a Digital Tool for the Adoption of the World Health Organization’s Antenatal Care Recommendations: Methodological Intersection of Evidence, Clinical Logic, and Digital Technology (Preprint)

2019 ◽  
Author(s):  
Samira M Haddad ◽  
Renato T Souza ◽  
Jose Guilherme Cecatti ◽  
Maria Barreix ◽  
Tigist Tamrat ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Clinical Practice ◽  
Decision Support ◽  
Antenatal Care ◽  
Digital Systems ◽  
World Health ◽  
Evidence Based ◽  
Data Dictionary ◽  
The World

BACKGROUND One of the key mandates of the World Health Organization (WHO) is to develop guidelines, defined as “a document containing recommendations for clinical practice or public health policy.” Guidelines represent the global standard for information sources shaping clinical practice and public health policies. Despite the rigorous development process and the value of guidelines for setting standards, implementing such standards within local contexts and at the point of care is a well-documented challenge. Digital technologies enable agile information management and may facilitate the adaptation of guidelines to diverse settings of health services delivery. OBJECTIVE The objective of this paper is to detail the systematic and iterative process involved in transforming the WHO Antenatal Care (ANC) guidelines into a digital decision-support and patient-record application for routine use in primary health care settings, known as the WHO digital ANC module. METHODS The WHO convened a team of clinical and digital health experts to develop the WHO digital ANC module as a tool to assist health care professionals in the implementation of WHO evidence-based recommendations for pregnant women. The WHO digital ANC module’s creation included the following steps: defining a minimum viable product (MVP), developing clinical workflows and algorithms, algorithm testing, developing a data dictionary, and the creation of a user interface or application development. The overall process of development took approximately 1 year to reach a stable prototype and to finalize the underlying content requirements of the data dictionary and decision support algorithms. RESULTS The first output is a reference software reflecting the generic WHO ANC guideline content, known as the WHO digital ANC module. Within it, all actionable ANC recommendations have related data fields and algorithms to confirm whether the associated task was performed. WHO recommendations that are not carried out by the health care worker are saved as pending tasks on a woman’s health record, and those that are adequately fulfilled trigger messages with positive reinforcement. The second output consists of the structured documentation of the different components which contributed to the development of the WHO digital ANC module, such as the data dictionary and clinical decision support workflows. CONCLUSIONS This is a novel approach to facilitate the adoption and adaptation of recommendations through digital systems at the health service delivery level. It is expected that the WHO digital ANC module will support the implementation of evidence-based practices and provide information for monitoring and surveillance; however, further evidence is needed to understand how the WHO digital ANC module impacts the implementation of WHO recommendations. Further, the module’s implementation will inform the WHO’s ongoing efforts to create a pathway to adaptive and integrated (Smart) Guidelines in Digital Systems to improve health system quality, coverage, and accountability.

scholarly journals Can innovative digital collaborations help overcome barriers to intersectoral collaboration?

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Nordström ◽  
B Kumar
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Systems ◽  
Local Level ◽  
National Level ◽  
Migrant Health ◽  
Intersectoral Collaboration ◽  
Professional Networks ◽  
Care Systems

Abstract Issue Health in all policies is desirable, but moving from the silos approach is a challenge for health care systems. New health policies require more cooperation and broader collaboration between governmental, private and volunteer sector, as well as across professions. Though it is key to implementation of national policies and long-term public health work at the local level, intersectoral collaboration remains elusive. Professionals working with public health and migrant health across Norway often work independently of each other and other sectors. Description of the Problem Evaluation of the Norwegian network for migrant friendly hospitals showed that with the opportunity to meet and share experiences, participants used the new knowledge and network in developing their practice and organisation of services. They experienced greater support to challenge status quo in their institutions. However, fear of making the network “too big to handle” is a barrier to creating intersectoral network. In a recent survey (2017), health personnel ask for digital solutions for finding resources and support in their practice to give better health care to immigrant patients. Results The newly (2020) knowledge HUB part of JAHEE actions brings stakeholders together at the local, regional and national level, ensuring access to the same knowledge, increase evidence based decisions among stakeholders when choosing interventions on the local, regional and national level, including sharing of good practices and promising initiatives at a national level so that they can be replicated. Lessons Professional networks that are coordinated and collaborative are important for development of services and implementation of measures for migrant health. However, expanding them across sectors and fields may create challenges. Combining sectoral networks with a common digital platform may overcome some of these challenges. Key messages Exploiting the potential of collaborative digital solutions may help overcome some barriers to intersectoral approach to migrant health. Coordinated collaborative professional networks can support the participants in developing their practice and organisation of services for migrants.

scholarly journals Building a Digital Tool for the Adoption of the World Health Organization’s Antenatal Care Recommendations: Methodological Intersection of Evidence, Clinical Logic, and Digital Technology

10.2196/16355 ◽  
2020 ◽  
Vol 22 (10) ◽  
pp. e16355
Author(s):  
Samira M Haddad ◽  
Renato T Souza ◽  
Jose Guilherme Cecatti ◽  
Maria Barreix ◽  
Tigest Tamrat ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Clinical Practice ◽  
Decision Support ◽  
Antenatal Care ◽  
Digital Systems ◽  
World Health ◽  
Evidence Based ◽  
Data Dictionary ◽  
The World

Background One of the key mandates of the World Health Organization (WHO) is to develop guidelines, defined as “a document containing recommendations for clinical practice or public health policy.” Guidelines represent the global standard for information sources shaping clinical practice and public health policies. Despite the rigorous development process and the value of guidelines for setting standards, implementing such standards within local contexts and at the point of care is a well-documented challenge. Digital technologies enable agile information management and may facilitate the adaptation of guidelines to diverse settings of health services delivery. Objective The objective of this paper is to detail the systematic and iterative process involved in transforming the WHO Antenatal Care (ANC) guidelines into a digital decision-support and patient-record application for routine use in primary health care settings, known as the WHO digital ANC module. Methods The WHO convened a team of clinical and digital health experts to develop the WHO digital ANC module as a tool to assist health care professionals in the implementation of WHO evidence-based recommendations for pregnant women. The WHO digital ANC module’s creation included the following steps: defining a minimum viable product (MVP), developing clinical workflows and algorithms, algorithm testing, developing a data dictionary, and the creation of a user interface or application development. The overall process of development took approximately 1 year to reach a stable prototype and to finalize the underlying content requirements of the data dictionary and decision support algorithms. Results The first output is a reference software reflecting the generic WHO ANC guideline content, known as the WHO digital ANC module. Within it, all actionable ANC recommendations have related data fields and algorithms to confirm whether the associated task was performed. WHO recommendations that are not carried out by the health care worker are saved as pending tasks on a woman’s health record, and those that are adequately fulfilled trigger messages with positive reinforcement. The second output consists of the structured documentation of the different components which contributed to the development of the WHO digital ANC module, such as the data dictionary and clinical decision support workflows. Conclusions This is a novel approach to facilitate the adoption and adaptation of recommendations through digital systems at the health service delivery level. It is expected that the WHO digital ANC module will support the implementation of evidence-based practices and provide information for monitoring and surveillance; however, further evidence is needed to understand how the WHO digital ANC module impacts the implementation of WHO recommendations. Further, the module’s implementation will inform the WHO’s ongoing efforts to create a pathway to adaptive and integrated (Smart) Guidelines in Digital Systems to improve health system quality, coverage, and accountability.

scholarly journals Methicillin-ResistantStaphylococcus aureus: A Public Health Issue with Economic Consequences

2007 ◽  
Vol 18 (1) ◽  
pp. 27-34 ◽  
Author(s):  
Mireille Goetghebeur ◽  
Pierre-Alexandre Landry ◽  
Donald Han ◽  
Colin Vicente
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Cost ◽  
Epidemiological Data ◽  
Economic Consequences ◽  
Control Measures ◽  
Cost Driver ◽  
Cost Data ◽  
Health Issue ◽  
Public Health Issue

BACKGROUND: Methicillin-resistantStaphylococcus aureus(MRSA) has become endemic worldwide in hospitals, and community-associated MRSA is spreading into the community at large.OBJECTIVES: To estimate the current cost of MRSA in Canada and to assess the magnitude of this public health issue.METHODS: An extensive review of the literature was conducted to gather epidemiology, health care resource utilization and cost data for MRSA in Canadian settings. The current MRSA burden was estimated using available cost data and the most recent epidemiology data.RESULTS: The rate of MRSA in Canadian hospitals increased from 0.46 to 5.90 per 1000 admissions between 1995 and 2004, while community-associated MRSA continued to spread into the community. Patients harbouring MRSA required prolonged hospitalization (average 26 days of isolation per patient), special control measures, expensive treatments and extensive surveillance. Total cost per infected MRSA patient averaged $12,216, with hospitalization being the major cost driver (81%), followed by barrier precautions (13%), antimicrobial therapy (4%) and laboratory investigations (2%). The most recent epidemiological data, combined with available cost data, suggest that direct health care cost attributable to MRSA in Canada, including cost for management of MRSA-infected and-colonized patients and MRSA infrastructure, averaged $82 million in 2004 and could reach $129 million in 2010.CONCLUSION: MRSA is a costly public health issue that needs to be tackled if the growing burden of this disease in Canadian hospitals and in the community is to be limited.

scholarly journals Quadmester-wise comparison of disease transmission dynamics of COVID-19 among health care workers in Kannur district, Kerala

2021 ◽  
Vol 8 (5) ◽  
pp. 2481
Author(s):  
Ameena Subair Raheela ◽  
Sajish Chandran ◽  
Deepak Rajan ◽  
Preetha Muduvana
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Disease Transmission ◽  
Local Level ◽  
Control Measures ◽  
Transmission Dynamics ◽  
Work Place ◽  
Cross Sectional ◽  
Indirect Contact ◽  
Care Workers

Background: Health-care workers (HCWs) may get infected by direct or indirect contact with infected patients or other HCWs or from the community as well, depending on the phase through which pandemic progresses. Knowledge about the disease transmission dynamics as the pandemic advances is a need so that appropriate monitoring, prevention and control measures for HCWs can be implemented at local level. The main objective of this study was quadmester-wise comparison of disease transmission dynamics of COVID-19 among HCWs in Kannur district.Methods: A cross-sectional study was carried out among HCWs reported positive for SARS-CoV-2 in Kannur district, Kerala. COVID-19 positive HCWs reported in the district were consolidated and contacted over phone and details were collected using a semi-structured questionnaire. Data were entered into microsoft excel and analysed using statistical package for social sciences (SPSS) trial version. Chi-square test was used to compare differences observed in the two groups and binary logistic regression was done to pick out the significant predictors of variability in disease transmission among the two groups.Results: Total respondents in the first and second quadmester were 243 and 1665, respectively. Factors like gender, clinical features, source of infection, family as source and type of duty taken were found to be statistically significant for the disease transmission dynamics among HCWs.Conclusions: As the pandemic advances, irrespective of the type of work place, self-reporting and regular testing of HCWs will help to check HCWs from getting infected and spreading the disease.

scholarly journals Personalized medicine: consequences for drug research and therapy

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Thorsten Ruppert ◽  
Sabine Sydow ◽  
Günter Stock
Keyword(s):  
Health Care ◽  
Personalized Medicine ◽  
Diagnostic Tests ◽  
Molecular Mechanisms ◽  
Drug Research ◽  
Treatment Success ◽  
Molecular Medicine ◽  
Patient Specific ◽  
New Paradigm ◽  
Specific Patient

In drug research, a serious transformation has taken place. With increasing knowledge gained from molecular medicine, it became possible to refine and develop new therapies based on the molecular mechanisms of diseases. Medicine and drug development have seen a paradigm shift which can be characterized with the catchword “personalized medicine”, also called “stratified medicine” or “precision medicine”. Personalized medicine is based on defined tandems of therapeutic agents and diagnostic tests. With this addition to the regular medical examination of the patient, specific patient characteristics are determined. The results of such diagnostic tests are then decisive for the choice of therapy or control of the effectiveness of the chosen treatment. The benefit of personalized medicine for the patient is the higher probability of treatment success as well as improved effectiveness and reduced / avoided side effects. Health insurance systems and the public may have the advantage that the health funds can be used more efficiently on this basis. This new paradigm requires also a new debate on the remuneration in health care. In order to bring personalized therapies to patients as quickly as possible, all players in health care should work together to address the challenges associated with personalized medicine.

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