RESUMO
The term "biobanking" is often misapplied to any collection of human biological materials (biospecimens) regardless of requirements related to ethical and legal issues or the standardization of different processes involved in tissue collection. A proper definition of biobanks is large collections of biospecimens linked to relevant personal and health information (health records, family history, lifestyle, genetic information) that are held predominantly for use in health and medical research. In addition, the International Organization for Standardization, in illustrating the requirements for biobanking (ISO 20387:2018), stresses the concept of biobanks being legal entities driving the process of acquisition and storage together with some or all of the activities related to collection, preparation, preservation, testing, analysing and distributing defined biological material as well as related information and data. In this review article, we aim to discuss the basic principles of biobanking, spanning from definitions to classification systems, standardization processes and documents, sustainability and ethical and legal requirements. We also deal with emerging specimens that are currently being generated and shaping the so-called next-generation biobanking, and we provide pragmatic examples of cancer-associated biobanking by discussing the process behind the construction of a biobank and the infrastructures supporting the implementation of biobanking in scientific research.
Assuntos
Bancos de Espécimes Biológicos , Pesquisa Biomédica , Medicina de Precisão , Manejo de Espécimes , Acreditação , Bancos de Espécimes Biológicos/classificação , Bancos de Espécimes Biológicos/ética , Bancos de Espécimes Biológicos/legislação & jurisprudência , Bancos de Espécimes Biológicos/normas , Pesquisa Biomédica/classificação , Pesquisa Biomédica/ética , Pesquisa Biomédica/legislação & jurisprudência , Pesquisa Biomédica/normas , Guias como Assunto , Humanos , Formulação de Políticas , Medicina de Precisão/classificação , Medicina de Precisão/ética , Medicina de Precisão/normas , Manejo de Espécimes/classificação , Manejo de Espécimes/ética , Manejo de Espécimes/normas , Participação dos Interessados , Terminologia como AssuntoRESUMO
Diabetes has become a major burden of healthcare expenditure. Diabetes management following a uniform treatment algorithm is often associated with progressive treatment failure and development of diabetic complications. Recent advances in our understanding of the genomic architecture of diabetes and its complications have provided the framework for development of precision medicine to personalize diabetes prevention and management. In the present review, we summarized recent advances in the understanding of the genetic basis of diabetes and its complications. From a clinician's perspective, we attempted to provide a balanced perspective on the utility of genomic medicine in the field of diabetes. Using genetic information to guide management of monogenic forms of diabetes represents the best-known examples of genomic medicine for diabetes. Although major strides have been made in genetic research for diabetes, its complications and pharmacogenetics, ongoing efforts are required to translate these findings into practice by incorporating genetic information into a risk prediction model for prioritization of treatment strategies, as well as using multi-omic analyses to discover novel drug targets with companion diagnostics. Further research is also required to ensure the appropriate use of this information to empower individuals and healthcare professionals to make personalized decisions for achieving the optimal outcome.
Assuntos
Diabetes Mellitus/classificação , Diabetes Mellitus/terapia , Gerenciamento Clínico , Medicina de Precisão/classificação , Medicina de Precisão/métodos , Diabetes Mellitus/diagnóstico , Humanos , Farmacogenética/classificação , Farmacogenética/métodos , Fatores de RiscoAssuntos
Medicina Ambiental/classificação , Nível de Saúde , Medicina de Precisão/classificação , Sociobiologia/classificação , Terminologia como Assunto , Meio Ambiente , Comportamentos Relacionados com a Saúde , Disparidades nos Níveis de Saúde , Humanos , Características de Residência , Fatores de Risco , Comportamento SocialRESUMO
Analysis of interactions between professionals and patients with chronic diseases reveals a space invested by professional expertise in which APA teachers occupy their own distinctive position..
Assuntos
Terapia por Exercício/legislação & jurisprudência , Ocupações em Saúde/legislação & jurisprudência , Medicina de Precisão , Exercício Físico , Terapia por Exercício/educação , Terapia por Exercício/normas , Ocupações em Saúde/classificação , Ocupações em Saúde/educação , Ocupações em Saúde/normas , Humanos , Guias de Prática Clínica como Assunto , Medicina de Precisão/classificação , Medicina de Precisão/normas , Padrões de Referência , Terminologia como Assunto , Recursos HumanosAssuntos
Diabetes Mellitus/terapia , Terapia de Alvo Molecular , Medicina de Precisão , Bases de Dados Genéticas , Diabetes Mellitus/genética , Perfilação da Expressão Gênica , Predisposição Genética para Doença , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Terapia de Alvo Molecular/métodos , Terapia de Alvo Molecular/tendências , Farmacogenética , Medicina de Precisão/classificação , Medicina de Precisão/métodos , Medicina de Precisão/tendências , Terminologia como Assunto , Terapias em Estudo/métodosRESUMO
STUDY OBJECTIVE: To test the feasibility and effectiveness of an individualized Medication Assessment and Planning (iMAP) program integrated within a primary care practice on the number and prevalence of medication-related problems (MRPs) and acute health services utilization, defined as combined hospitalizations and emergency department visits. DESIGN: Six-month, prospective, observational pilot study. SETTING: Community-based primary care medical practice. PATIENTS: Convenience sample of 64 patients aged 65 years and older who were taking at least five medications. INTERVENTION: Each patient was enrolled in the iMAP program-a collaborative, multifaceted intervention facilitated by a clinical pharmacist whereby patients receive comprehensive medication therapy management at baseline and 3 and 6 months as part of routine clinical care. MEASUREMENTS AND MAIN RESULTS: MRPs were assessed and recommendations proposed using the previously published MRP classification tool; physician acceptance of recommendations served to validate the assessments. There was a significant reduction in mean number of MRPs/patient (4.2 at baseline vs 1.0 at 6 mo, p<0.0001) when adjusted for number of medications, race, and pharmacist. The prevalence of MRPs at 6 months compared with baseline was also significant (p<0.0008). Acute health services utilization was assessed by medical record abstraction. The 64 patients experienced a rate of 8.3 events/100 person-months (64 total events) during the 12-month prestudy period. During the 6-month study period, the same patients experienced 5.4 events/100 person-months (20 total events). Thus, we noted a reduction in acute health services utilization of 35%. Physicians were enthusiastically supportive of iMAP. CONCLUSION: iMAP has the potential to address a significant and timely issue affecting older adults and primary care practices: the burden of managing and continuously monitoring multiple medications in medically complex older adults. A more rigorous evaluation of iMAP is warranted and planned to demonstrate sustained effectiveness and cost-benefit.