Title : Rehabilitative services through the view of Personalized and Precision Medicine (PPM) to secure the precision surgery outcome: Centers for surgery and post-operational reha-bilitation of the next step generation
Abstract:
Despite an increasing focus on PPM (Personalized and Precision Medicine)-guided approach-es in daily healthcare services, their application in a rehabilitation context remains unexplored. To achieve the implementation of PPM concept into the post-operative rehabilitation related practice, it is necessary to create a fundamentally new strategy making Precision Surgery (PS) and PS-associated Personalized Rehabilitation (PR) (PS-PR) as a new ap-approach to health care that customizing patients’ medical treatment according to their own genetic information. This new combinatorial and evidence-based approach is the result of increased knowledge of the human genome and phenome and ways this information can be applied by surgeons and physicians in the medical and surgical management of their patients. In this sense, a patient’s genotype can yield important information concerning disease systems-related susceptibility and the effectiveness of medications, therefore guiding specific, targeted imaging, treatment and rehabilitative therapies.
PPM-guided rehabilitation today is an emerging framework that aims to tailor rehabilitation interventions based on individual patient needs, functional goals, and real-world data in-sights. Whilst assessing the current landscape of PPM-guided rehabilitation, highlighting key opportunities must be addressed to enhance efficiency, effectiveness, and equity in rehabilitation care. Their perspective emphasizes the importance of standardization, interdisciplinary collaboration, genomics, and patient engagement, advocating for a more integrated and technologically advanced approach to rehabilitation medicine.
For instance, sepsis is a systemic inflammatory response to infection, being the most common cause of death in intensive care patients. So, the treatments may need to be adapted to the continuous and rapid changes of the disease, making it challenging to identify a single target. In this sense, identifying drug-response phenotypes by examining interactions be-tween phenotypes and sepsis therapies is a priority for intensive care practitioners and surgeons.
The remarkable progress in the field of sepsis and its complications can be attributed to the latest advances in OMIC-technologies and sepsis modeling, together with a better under-standing of the immunopathology, biology and epidemiology of sepsis syndrome. The focus of the biodesign driven translational research and applications is nowadays on the interplay between therapies, pathogens, and the host. Regarding the pathogen-inducer, microbiologic diagnostic approaches are discussed, as well as multi-targeted (combinatorial) treatment, since sepsis is certainly the sum of multiple host-microbial interactions.Other topics include the disruption of host immune system and the use of specific biomarkers in sepsis management and patient stratification.
Among the latest innovations in the field, for instance, ImmunoSep, illustrating the advanced innovations in personalized immunotherapy and developing a next-generation theranostics platform for the individualized targeted immunotherapy, aims at significantly improving the treatment outcome of sepsis in individual patients.
PPM-guided rehabilitation seeks to improve care for individuals by identifying personalized treatments that enhance both the efficacy and efficiency of care. Rapid advances in artificial intelligence (AI) and data-driven methodologies stand to greatly enhance PPM-guided rehabilitation methods, particularly when paired with clinical expertise and patient-driven goals. Although AI has been successfully integrated into healthcare, the dynamic, multi-faceted, complex nature of rehabilitation require a different approach than standard predictive mod-els.
Along with canonical Precision Surgery (PS), PS-PR is most likely to play a great role in post-operative PR management and treatment. And we are entering an era of rapidly evolving transformation in translational and clinical research as it relates to medical practice, and a shifting paradigm of standardized health care in which detailed genetic and molecular in-formation regarding a patient’s conditions is being used for PS-PR-based manipulations.
Meanwhile, a lack of the medical guidelines has been identified by the majority of respond-ers as the predominant barrier for adoption, indicating a need for the development of best practices and guidelines to support the implementation of PS-PR! So, coordination of all health care stakeholders has become more important than ever to unite surgeons, pathologists, physicians and payers to work with Big Pharma and Biotech to develop prod-ucts, services, and coverage policies that would improve patient outcomes and lower overall health care costs for institutions that put personalized regimens in place. This is the reason for developing global scientific, clinical, social, and educational projects in the area of PS-PR to elicit the content of the new branch and to stress the impact and benefits of the latter.
We are offering a new view on the management of PPM in sepsis-related PS-PR which, to our mind, strongly stresses the need to discuss the management of PS-PR on an individual basis in an interdisciplinary context, in order to offer the best possible surgical, therapeutic and rehabilitative approach. In this sense, the infrastructure of the Center for Precision Sur-gery & Personalized Rehabilitation (CPSPR) should have, at least, four essential components: 1) genomic/molecular data acquisition and storage, 2) integration of genomic diagnostic testing and targeted imaging, 3) research focused on functional genomic targets, and 4) de-velopment and informed use of targeted therapies of actionable genes. Moving forward, clear and centralized consensus on actionable genes is needed.
We will promote educational programs in PS-PR and encourage more basic scientists, clinical scientists, surgeons, pathologists, and physicians to participate in PS-PR in the different phas-es of the model, with the ultimate goal being to significantly improve healthcare quality by utilizing personal genomic-phenomics-related information to guide choice of rehabilitative treatment and restoration.
Keywords: Personalized & precision medicine, rehabilitation, surgery, intensive care, hospital hetworks
