Graph theory enables drug repurposing - how a mathematical model can drive the discovery of hidden mechanisms of action.

We introduce a methodology to efficiently exploit natural-language expressed biomedical knowledge for repurposing existing drugs towards diseases for which they were not initially intended. Leveraging on developments in Computational Linguistics and Graph Theory, a methodology is defined to build a graph representation of knowledge, which is automatically analysed to discover hidden relations between any drug and any disease: these relations are specific paths among the biomedical entities of the graph, representing possible Modes of Action for any given pharmacological compound. We propose a measure for the likeliness of these paths based on a stochastic process on the graph. This measure depends on the abundance of indirect paths between a peptide and a disease, rather than solely on the strength of the shortest path connecting them. We provide real-world examples, showing how the method successfully retrieves known pathophysiological Mode of Action and finds new ones by meaningfully selecting and aggregating contributions from known bio-molecular interactions. Applications of this methodology are presented, and prove the efficacy of the method for selecting drugs as treatment options for rare diseases

Role of MDCT coronary angiography in the clinical setting: economic implications

PURPOSE:This study evaluated the incremental value and cost-effectiveness ratio of introducing coronary angiography (CA) with multidetector computed tomography (MDCT-CA) in the diagnostic management of patients with suspected coronary artery disease (CAD) compared with the traditional diagnostic workup.MATERIAL AND METHODS:Five hundred and fifty consecutive patients who underwent MDCT-CA between January 2009 and June 2011 were considered. Patients with atypical chest pain and suspected obstructive CAD were directed to one of two diagnostic pathways: the traditional protocol (examination, stress test, CA) and the current protocol (examination, stress test, MDCT-CA, and CA, if necessary). The costs of each protocol and for the individual method were calculated. Based on the results, the cost-effectiveness ratio of the two diagnostic pathways was compared. A third, modified, diagnostic pathway has been proposed with its relative cost-effectiveness ratio (examination, MDCT-CA, stress test, and CA, if necessary).RESULTS:Stress test vs. MDCT-CA had an accuracy of 66%, a sensitivity and specificity of 21% and 87%, respectively, and a positive (PPV) and negative (NPV) predictive value of 40% and 70%, respectively. Comparison between conventional CA (CCA) and MDCT-CA showed a sensitivity and specificity of 92% and 89%, respectively, a PPV and NPV of 89%, and an accuracy of 92%. The traditional protocol has higher costs than the second protocol: 1,645 euro against 322 euro (mean), but it shows a better cost-effectiveness ratio. The new proposed protocol has lower costs, mean 261 euro, with a better costeffectiveness ratio than the traditional protocol.CONCLUSIONS:The diagnostic protocol for patients with suspected CAD has been modified by the introduction of MDCT-CA. Our study confirms the greater diagnostic performance of MDCT-CA compared with stress test and its similar accuracy to CCA. The use of MDCT-CA to select patients for CCA has a favourable cost-effectiveness profile

Prácticas del enfermero en el contexto de la atención básica: scoping review

Objective: to identify and categorize the practices performed by nurses working in Primary Health Care and Family Health Strategy Units in light of responsibilities established by the profession’s legal and programmatic frameworks and by the Brazilian Unified Health System. Method: a scoping review was conducted in the following databases: LILACS, IBECS, BDENF, CINAHL and MEDLINE, and the Cochrane and SciELO libraries. Original research papers written by nurses addressing nursing practices in the primary health care context were included. Results: the review comprised 30 studies published between 2005 and 2014. Three categories emerged from the analysis: practices in the service; practices in the community; and management and education practices. Conclusion: the challenges faced by nurses are complex, as care should be centered on the population’s health needs, which requires actions at other levels of clinical and health responsibility. Brazilian nursing has achieved important advancements since the implementation of policies intended to reorganize work. There is, however, a need to shift work processes from being focused on individual procedures to being focused on patients so that an enlarged clinic is the ethical-political imperative guiding the organization of services and professional intervention.Objetivo: identificar e categorizar as práticas exercidas pelos enfermeiros junto às Unidades Básicas e às Equipes de Saúde da Família, à luz das atribuições previstas pelos marcos legais e programáticos da profissão e do Sistema Único de Saúde. Método: realizou-se uma revisão da literatura com o método scoping review, nas bases LILACS, IBECS, BDENF, CINAHL e MEDLINE, e nas bibliotecas Cochrane e SciELO. Incluíram-se artigos de pesquisa original, produzidos com enfermeiros, sobre as práticas de enfermagem no contexto dos cuidados de saúde primários. Resultados: a revisão abrangeu trinta estudos publicados entre 2005 e 2014. Da análise, resultaram três categorias: práticas no serviço, práticas na comunidade e práticas de gestão e formação. Conclusão: os desafios dos enfermeiros são complexos, posto que o cuidado deve estar centrado nas necessidades de saúde da população, o que remete à ação para outros níveis de responsabilidade clínica e sanitária. A enfermagem brasileira mostra importantes avanços desde a implantação das políticas de reorganização do trabalho. Necessita, entretanto, avançar no que se refere ao deslocamento dos processos de trabalho, focados em procedimentos individuais, para um processo mais voltado aos usuários, onde a clínica ampliada seja o imperativo ético-político da organização dos serviços e da intervenção profissional.Objetivo: identificar y categorizar las prácticas ejercidas por los enfermeros en las Unidades Básicas y los Equipos de Salud de la Familia, desde el punto de vista de las atribuciones previstas por los marcos legales y programáticos de la profesión y del Sistema Único de la Salud. Método: se realizó una revisión de la literatura con el método scoping review, en las bases LILACS, IBECS, BDENF, CINAHL y MEDLINE, y en las bibliotecas Cochrane y SciELO. Se incluyeron artículos de investigación original, producidos con enfermeros, sobre las prácticas de enfermería en el contexto de los cuidados de salud primarios. Resultados: la revisión abarcó treinta estudios publicados entre 2005 y 2014. Del análisis, resultaron tres categorías: prácticas en el servicio; prácticas en la comunidad; y, prácticas de administración y formación. Conclusión: los desafíos de los enfermeros son complejos, ya que el cuidado debe estar centrado en las necesidades de salud de la población, lo que conduce a la acción para otros niveles de responsabilidad clínica y sanitaria. La enfermería brasileña muestra importantes avances a partir de la implantación de las políticas de reorganización del trabajo. Necesita, entre tanto, avanzar en lo que se refiere al desplazamiento de los procesos de trabajo, enfocados en procedimientos individuales, para un proceso más dirigido a los usuarios, en donde la clínica ampliada sea el imperativo ético político de la organización de los servicios y de la intervención profesional.info:eu-repo/semantics/publishedVersio

O alcoolismo, suas causas e tratemento nas representacoes sociais de profissionais de Saude da Familia = Alcoholism, its causes and treatment in the social representations constructed by Brazilian Family Health professionals

Health sciences define alcoholism as a multifaceted syndrome. Guidelines for treatment include adoption of the harm reduction paradigm and the essential role of Primary Health Care (PHC) towards the wide range of alcohol problems. This research aimed at understanding the social representations of alcoholism constructed by Brazilian PHC professionals, working at Family Health Centers (FHC). We conducted semi-structured interviews with 40 graduated health professionals who worked in 11 different FHC located in a municipality in southeast Brazil. Data were treated with thematic content analysis. We highlight the following results: professionals objectified the alcoholic as a patient who did not search for treatment and/or who threatened the normal functioning of the FHC; professionals considered social and psychological factors as the main causes of alcoholism; they did not mention the concept of harm reduction, nor well-defined treatment protocols. The causal attribution and the representational field inherent to the social representations contributed to anchor alcoholism as a "plague" of poverty. The FHC were perceived simultaneously as important and impotent towards alcoholism. We conclude that the implementation of alcohol-related care strategies must consider the intergroup relations between professionals and patients

Role of coronary angiography MDCT in the clinical setting: changes of diagnostic workup and economic implications

Purpose: To assess the incremental value of MDCT- coronary angiography (MDCT-CA) in the diagnostic workup and cost management of patients with suspected coronary artery disease (CAD). Methods and Materials: 550 consecutive patients underwent MDCT-CA between 04/2008 and 07/2010. For each patient pre-test probability of CAD using Morise score was related to exercise test, MDCT-CA and CA. We calculated thereafter the incremental diagnostic value of stress test to MDCT-CA for each category of cardiovascular risk. The traditional diagnostic workup (without MDCT-CA) to the modified workup (with MDCT-CA) in terms of pre-test CAD probability\effectiveness and cost\effectiveness were compared. Results: The diagnostic performance of stress test had a sensitivity and specificity of 46.2% and 73.4% with PPV and NPV of 48 % and 72 %. MDCT-CA demonstrated a sensitivity of 100 %, a specificity of 94.7%, PPV of 96.7% and NPV of 100 %. According to Morise Score, in low pre-test probability, stress test accuracy resulted 30 %, in moderate pre-test 38 %, in high pre-test 45 % considering MDCT-CA as reference. The MDCT-CA modified diagnostic protocol offers an average increased diagnostic performance of 60 % compared with the traditional protocol, and an average cost saving of \u20ac 1323 per patient. Conclusions: MDCT-CA is the reference method for the non-invasive exclusion of critical coronary stenosis. Up to a low-medium CAD risk, the MDCT-CA diagnostic workup is the most cost-effective protocol, being superior to the traditional exercise ECG-based protocol