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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 which 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 that aim to improve drugs and medications management, as well as prevent or solve medication/drug-related problems.

Terminology

The term “pharmaco” comes from the Greek word “pharmakon”, which means drugs or poisons;[2] while the term “cybernetics” comes from the Greek word “kubernetes”, which means “the art of steering”.[3] The latter term was originally defined by Norbert Wiener as the science or study of “control and communication in the animal and the machine”.[3][4] On the other hand, the American Society for Cybernetics has described this area 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. In fact, the defining characteristic of a cybernetic system is its relationship between endogenous goals and the external environment.[5] This concept has been applied to healthcare since the 1970s 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”, whereby individuals build new knowledge through interactions with their environment, also implies that such systems are dependent on the individuals interacting with them, who in turn are also linked to society as a whole.[7]


The concept of “cyberspace” has been derived from the science of cybernetics as well. Originally coined by the science fiction author William Gibson through his book Neuromancer, this term describes a virtual representation of information in varying states of accessibility, which is linked to various people and organizations.[8][9][10] This concept was further reiterated in the movie “The Matrix” and its sequels, in which Neo (Keanu Reeves), a computer programmer, lived in a simulated matrix world created by sentient machines, but was perceived by humans as reality. The term “cyberspace” is now used ubiquitously to describe anything associated with computers, informatics and internet technologies, which inherently also incorporates our social experiences through our interactivity with these technologies.


Therefore, pharmacocybernetics not only describes the application and evaluation of technologies to support medicines and drugs use, but also takes 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]

Context

The advancement of informatics and internet technologies has led to the development of various software, tools and applications that can be used as aids by healthcare professionals and patients to improve pharmaceutical care and health-related outcomes. Such technologies are increasing in terms of popularity within the healthcare sector. Despite potential benefits, various issues have also surfaced from the use of such technologies, which can affect the quality of pharmaceutical care provided to patients. Pharmacoinformatics (or pharmacy informatics), a related field in e-health, targets medication/drug-related problems through the use of informatics and internet technologies.[11] However, 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 medication/drug-related problems. This field not only requires clinical knowledge and experience, but also the advanced skills and expertise to deal with technologies and human-computer-environment interactions in relation to the management of medicines and drug therapies.[1] Therefore, pharmacocybernetics approaches target the aspects of patient care and safety.

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]

  • Untreated indications
  • Medication use without indication
  • Failure to receive medications
  • Improper drug selections
  • Underdose
  • Overdose
  • Adverse drug reactions
  • Drug interactions


On the other hand, the Pharmaceutical Care Network Europe classifies them by problems and causes:[13]

Classification by problems:

  • Treatment effectiveness
  • Adverse reactions
  • Treatment costs
  • Other types of problems


Classification by causes:

  • Drug selection
  • Drug form
  • Dose selection
  • Treatment duration
  • Drug use/administration process
  • Logistics-related
  • Patient-related
  • Other causes


The rapid adoption of cybermedicine, which is the delivery of medical services through the internet, has led to several other associated medication/drug-related problems.[11] These include:

  • Digital dehumanization of the patient-practitioner relationship
  • Virtual conflicts of recommendation
  • Phenomenon of online self-prescribing


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. Technological innovations that are developed for this purpose tend to be based on user-centered, experience-centered and activity-centered designs.

Types of Environments in Pharmacocybernetics

The types of environments that are relevant to pharmacocybernetics approaches can be understood using 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), can be described as follows:

  • Microsystem (the patient’s immediate environment): The physical characteristics of the desktop or laptop, mouse sensitivity, or hardware and software faults that the patient experiences when performing the task.
  • Mesosystem (the relation between the patient’s immediate environments): Whether the patient carries out the task alone or in the company of others will affect his experiences, psychological state and behavior.
  • Exosystem (the external settings that indirectly affect but do not include the patient): When his family also understands his medical condition and drug therapy, they can provide encouragement and support which will prompt a sense of closeness experienced by the patient. This in turn may lead to improved medication compliance.
  • Macrosystem (cultural context of the patient): Sharing of his experiences with other similar patients on social networking channels may alleviate the stigma felt and positively influence and enhance the experiences of the patient.
  • Chronosystem (the time-space dimension over the patient’s course of life): As the patient gains more moral support in time from others with similar experiences, he can better adapt to life and may be motivated to improve his lifestyle and keep healthy.

The 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.

References

  1. ^ a b c d e Yap KY, Chuang X, Lee AJM, Lee RZ, Lim L, Lim JJ, Nimesha R. 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 2009; 3: 1-13.
  2. ^ Stedman TL. Stedman's Medical Dictionary. 28th ed. Baltimore, Maryland: Lippincott Williams & Wilkins; 2005.
  3. ^ a b Pangaro P. "Getting started" guide to cybernetics. Available at: http://pangaro.com/published/cyber-macmillan.html.
  4. ^ a b American Society for Cybernetics. Foundations - the subject of cybernetics: defining 'cybernetics'. Available at: http://www.asc-cybernetics.org/foundations/definitions.htm.
  5. ^ Corning PA. Synergy, cybernetics, and the evolution of politics. International Political Science Review 1996; 17(1): 91-119. DOI: 10.1177/019251296017001006
  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. The challenge of sociocybernetics. Kybernetes: The International Journal of Systems & Cybernetics 1995; 24(4): 6-32. DOI: 10.1108/03684929510089321
  8. ^ Adams PC. Cyberspace and virtual places. Geographical Review 1997; 87(2): 155-171.
  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. ^ a b Yap KY, Chan A, Chui WK. Improving pharmaceutical care in oncology by pharmacoinformatics: the evolving role of informatics and the internet for drug therapy. Lancet Oncology 2009; 10(10): 1011-1019. DOI: 10.1016/S1470-2045(09)70104-4 PMID: 19796753
  12. ^ a b American Society of Hospital Pharmacists. ASHP statement on pharmaceutical care. American Journal of Hospital Pharmacy 1993; 50: 1720-1723.
  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: http://pt3.nl.edu/paquetteryanwebquest.pdf.
  15. ^ Yap KY, Lim KJ. 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 2012; 2(2): e18. DOI: 10.5667/tang.2012.0004
  16. ^ Chan A, Yap KY. Detection and management of oncology drug interactions: Can we do better? Maturitas 2010; 65(3): 181-182. DOI: 10.1016/j.maturitas.2009.12.001 PMID: 20036470
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