Advancing Precision Medicine: A Review of Innovative In Silico Approaches for Drug Development, Clinical Pharmacology and Personalized Healthcare.

The landscape of medical treatments is undergoing a transformative shift. Precision medicine has ushered in a revolutionary era in healthcare by individualizing diagnostics and treatments according to each patient's uniquely evolving health status. This groundbreaking method of tailoring disease prevention and treatment considers individual variations in genes, environments, and lifestyles. The goal of precision medicine is to target the "five rights": the right patient, the right drug, the right time, the right dose, and the right route. In this pursuit, in silico techniques have emerged as an anchor, driving precision medicine forward and making this a realistic and promising avenue for personalized therapies. With the advancements in high-throughput DNA sequencing technologies, genomic data, including genetic variants and their interactions with each other and the environment, can be incorporated into clinical decision-making. Pharmacometrics, gathering pharmacokinetic (PK) and pharmacodynamic (PD) data, and mathematical models further contribute to drug optimization, drug behavior prediction, and drug-drug interaction identification. Digital health, wearables, and computational tools offer continuous monitoring and real-time data collection, enabling treatment adjustments. Furthermore, the incorporation of extensive datasets in computational tools, such as electronic health records (EHRs) and omics data, is also another pathway to acquire meaningful information in this field. Although they are fairly new, machine learning (ML) algorithms and artificial intelligence (AI) techniques are also resources researchers use to analyze big data and develop predictive models. This review explores the interplay of these multiple in silico approaches in advancing precision medicine and fostering individual healthcare. Despite intrinsic challenges, such as ethical considerations, data protection, and the need for more comprehensive research, this marks a new era of patient-centered healthcare. Innovative in silico techniques hold the potential to reshape the future of medicine for generations to come.

Community-Based Organizations Leading Research Efforts: Preliminary Findings from the Chicagoland CEAL Program's COVID-19 Vaccine Uptake and Intention Survey.

BACKGROUND: To foster community engaged research in the communities most impacted by COVID-19, the National Institutes of Health (NIH) formed 21 teams of Community Engagement Alliance Against COVID-19 Disparities (CEAL). The national CEAL initiative developed a Common Survey to investigate attitudes and behaviors to the COVID-19 vaccine and clinical trials. This article describes survey implementation at the Chicagoland CEAL Program (CCP). METHODS: This community-based participatory research project was the result of a strong collaboration between academic institutions, and a community-based non-profit health equity-focused partner organization. The survey implementation was developed and refined with strong input from CHWs, participants, and staff in the partner organizations and institutions. Survey data were collected with Qualtrics, a web-based survey tool. RESULTS: Survey implementation resulted in data collection for 852 participants during the period 12/18/2021-02/18/2023. Excluding participants on the basis of missing data resulted in a sample of 690, 601 of which (87.10%) indicated that they had received at least one dose or intended to get vaccinated. Overall, 54 (7.83%) respondents reported that they had not received the vaccine and were not planning to. CONCLUSION: Hard to reach populations present two unique challenges in emerging infectious disease events. Reaching populations vulnerable to poor outcomes with vaccines was essential to addressing the COVID-19 pandemic. Additionally, learning about barriers and hesitancy toward vaccine uptake is difficult in these communities. CCP's partnership of five academic institutions, a community research center, and a community-based non-profit health equity-focused organization shows what is possible when traditional models of research and inquiry are reconsidered for community-based participatory research. Results shown here are drawn from a collaboratively designed and implemented survey, collected in person, with over 90% completion.

A Review of the Lidocaine in the Perioperative Period.

This review analyzes the controversies surrounding lidocaine (LIDO), a widely recognized local anesthetic, by exploring its multifaceted effects on pain control in the perioperative setting. The article critically analyzes debates about lidocaine's efficacy, safety, and optimal administration methods. While acknowledging its well-documented analgesic attributes, the text highlights the ongoing controversies in its application. The goal is to provide clinicians with a comprehensive understanding of the current discourse, enabling informed decisions about incorporating lidocaine into perioperative protocols. On the other hand, emphasizes the common uses of lidocaine and its potential role in personalized medicine. It discusses the medication's versatility, including its application in anesthesia, chronic pain, and cardiovascular diseases. The text recognizes lidocaine's widespread use in medical practice and its ability to be combined with other drugs, showcasing its adaptability for individualized treatments. Additionally, it explores the incorporation of lidocaine into hyaluronic acid injections and its impact on pharmacokinetics, signaling innovative approaches. The discussion centers on how lidocaine, within the realm of personalized medicine, can offer safer and more comfortable experiences for patients through tailored treatments.

Estresse ocupacional dos enfermeiros de urgência e emergência de um hospital público de Teresina (PI) / Occupational stress among emergency and urgent care nurses at a public hospital in Teresina, Piaui, Brazil

INTRODUÇÃO: Nos serviços de urgência e emergência, o número de profissionais acometidos pelo estresse ocupacional é bastante elevado e tem gerado grande preocupação para a gestão hospitalar. Entre os profissionais de saúde com maior exposição ao estresse ocupacional, os enfermeiros encontram-se como os mais afetados. OBJETIVO: Verificar o nível de estresse ocupacional dos enfermeiros pela Escala Bianchi na unidade de urgência e emergência de um hospital público de Teresina, Piauí. MÉTODOS: Estudo transversal descritivo realizado nos meses de novembro de 2016 a janeiro de 2017 em um hospital público de urgências e emergência de Teresina, Piauí. A amostra foi composta de 20 enfermeiros que exercem suas funções nas salas vermelha, amarela, verde e estabilização. Os dados foram coletados utilizando a Escala Bianchi de Stress. Os dados foram inseridos em bancos de dados e processados no software Statistical Package for the Social Sciences, versão 23.0, e foram calculadas estatísticas descritivas. RESULTADOS: A amostra foi eminentemente feminina (75%), com faixa etária entre 31 e 40 anos (65%), sendo que a maioria apresentava entre 6 e 10 anos (60%) de graduado em enfermagem, 90% com pós-graduação e 70% desenvolvem as atividades na unidade de emergência há mais de 6 anos. Os enfermeiros obtiveram escore individual de estresse entre 2,4 e 5,25. O nível médio de estresse com escore global foi 3,46 com destaque ao domínio A. CONCLUSÃO: Foi possível constatar que as relações interpessoais nos serviços de urgência e emergência podem ser uma das causas do estresse ocupacional entre os profissionais.

BACKGROUND: The number of emergency and urgent care providers with occupational stress is quite large and is a source of concern for hospital managers. Nurses are the professional category most affected among workers exposed to occupational stress. OBJECTIVE: To investigate the level of occupational stress among emergency and urgent care nurses at a public hospital in Teresina, Piaui, Brazil, by means of the Bianchi Stress Questionnaire. METHODS: Cross-sectional descriptive study conducted from November 2016 through January 2017 at a public emergency and urgency care hospital in Teresina. The sample comprised 20 nurses allocated to the department red, yellow, green and stabilization zones. Data were collected by means of the Bianchi Stress Questionnaire (BSQ), fed to a database and processed using software Statistical Package for the Social Sciences version 23.0. Analysis consisted of descriptive statics. RESULTS: Participants were predominantly female (75%) within age range 31 to 40 years old (65%); most had graduated 6 to 10 years earlier (60%), 90% had attended graduate education and 70% had worked at the department for more than 6 years. The global stress score ranged from 2.4 to 5.25, mean 3.46; the highest stress level corresponded to BSQ domain A. CONCLUSION: Interpersonal relationships in emergency and urgent care departments might be a cause of occupational stress among workers.

Vinculação e trabalho na assistência social: vivenciando um CRAS / Bond and work in social assistance: experiencing the social Assistance Reference Center (CRAS) / Vinculación y trabajo em la assistencia social: probando um CRAS

Entendemos que o trabalho do psicólogo no campo da assistência social pode ser concebido como processo político inventivo e dinâmico que não se cristaliza em uma posição cientificista - a fim de meramente classificar e diagnosticar disfuncionalidades. A partir disso, este artigo propõe discutir a atuação profissional do psicólogo no SUAS. Através da extensão universitária em um CRAS do Município de Cariacica/ES - tendo os registros de diário de campo como material de análise -, percebeu-se a potência do trabalho na formação de rede, na formação continuada, que comparecem como modos de resistência capazes de fomentar espaços públicos de luta por direitos. A ideia de vínculo presente na política de assistência social, também foi alvo das análises: diante de um trabalho no qual o objetivo é fortalecer vínculos, vincular-se é algo indispensável. Mesmo diante de um cenário de sucateamento dos serviços socioassistenciais, o maior recurso ainda são os afetos. (AU)

Acknowledging the psychologist work in social assistance context might formulated as a political, inventive and dynamic process that does not set in a scientific position- in order to only classify and diagnose dysfunctionalities. From that, this article proposes to discuss the professional performance of the psychologist in SUAS. Through the university extension program in the CRAS of Cariacica/ES - using the field journal records as analysis material - it was noticed the power of the network activity and the continued academic education potentials, which appear as resistance capable of fomenting public spaces for the struggle for rights. The bond conception that lies in the social assistance policy was also an analysis target: considering a work in which the aim is to strengthen ties bind up becomes indispensable. Faced in a scenario of social assistance services impoverishment the greatest resource is still the affections. (AU)

Entendimos que el trabajo del psicólogo en el campo de la asistencia social puede seer diseñado como um processo politico ocurrente y dinámico que no cristaliza en una posición científica, a fin de hacer clasificación y diagnóstico de la disfuncionalidad. De ahí, este artículo propone discutir la atuación del profesional psicólogo no SUAS. Desde la extensión universitaria en una unidad del CRAS del Municipio de Cariacia/ES - teniendo todos los registros del diario de campo como material de análisis , percibimos la potencia del trabajo en la formación de la red, en la formación de continuidad, que exhiben como modo de resistencia capaz de fomentar espacios públicos de lucha por derechos. La idea de vinculo vigente en la politica de asistencia social, también fue un alvo de analisis: delante de un trabajo cuál el objetivo es fortalecer vínculaciones, tener vínculo com algo es indispensable. Mismo delante de un escenario de servicios dañados socioasistenciais, el mayor recurso aun sea el afecto. (AU)

Consenso brasileiro multi-institucional de pacientes sobre medicamentos biossimilares / Brazilian patients multi-institutional consensus on biosimilar drugs

Objetivo: O presente trabalho tem como objetivo emitir um consenso de diversas associações de pacientes sobre os produtos biossimilares. Métodos: O consenso foi produzido em reunião presencial com 15 representantes de 11 diferentes associações de pacientes. Previamente ao encontro, realizou- -se exercício Delphi contemplando 12 diferentes tópicos referentes a medicamentos biossimilares, sendo os temas de menor concordância selecionados para aulas informativas. Posteriormente, os participantes reuniram-se para discussão dos temas e elaboração do consenso. Resultados: O consenso concentrou-se em torno de oito temas gerais: nomenclatura, farmacovigilância, mercado nacional, RDC nº 55/2010, extrapolação de indicações, substituição automática, intercambialidade e estudos clínicos. Conclusões: Os medicamentos biossimilares representam avanço referente ao acesso à terapia biológica devido, especialmente, à competitividade econômica. Todavia, sua utilização deve ser respaldada por exercícios clínicos apropriados ­ exercício de biossimilaridade ­, respeitando a autonomia do prescritor e sempre apoiado em metodologias apropriadas de farmacovigilância.

Objective: This paper aims to publish a consensus from diverse patient associations on biossimilar drugs. Methods: The consensus was produced in a live meeting that gathered 15 representatives from 11 different patient associations. Previously to the meeting a Delphi exercise was elaborated contemplating 12 different subjects regarding biosimilar drugs. The subjects with smaller agreement were chosen to be discussed in informative lectures. Posteriorly, the attendants discussed the subjects and elaborated the consensus. Results: The consensus focused on eight different general subjects: nomenclature, pharmacovigilance, national Market, RDC nº 55/2010, extrapolation of controindications, automatic substitution, interchangeability, clinical trials. Conclusions: Biosimilar drugs represent progress regarding the access to biologic treatment, especially due to its economic competitiveness. However, its use must be supported by proper clinical trials ­ biosimilarity exercise ­ respecting the prescritor autonomy and counting on solid pharmacovigilance methods.