Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Nephrology, Department of Medicine, McGill University, Montreal, Quebec, Canada.
Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands; AG10 Sex- and Gender-Sensitive Medicine, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany.
Kidney Int. 2023 Apr;103(4):674-685. doi: 10.1016/j.kint.2022.12.026. Epub 2023 Jan 31.
Precision medicine emerged as a promising approach to identify suitable interventions for individual patients with a particular health concern and at various time points. Technology can enable the acquisition of increasing volumes of clinical and "omics" data at the individual and population levels and support advanced clinical decision making. However, to keep pace with evolving societal realities and developments, it is important to systematically include sex- and gender-specific considerations in the research process, from the acquisition of knowledge to implementation. Building on the foundations of evidence-based medicine and existing precision medicine frameworks, we propose a novel evidence-based precision medicine framework in the form of the P3model, which considers individual sex-related (predictive [P1], preventive [P2], and personalized [P3] medicine) and gender-related (participatory [P4], psychosocial [P5], and percipient [P6] medicine) domains and their intersection with ethnicity, geography, and other demographic and social variables, in addition to population, community, and public dimensions (population-informed [P7], partnered with community [P8], and public-engaging [P9] medicine, respectively). Through its ability to contextualize and reflect on societal realities and developments, our model is expected to promote consideration of diversity, equity, and inclusion principles and, thus, enrich science, increase reproducibility of research, and ensure its social impact.
精准医学是一种很有前途的方法,可以识别特定健康问题的个体患者在不同时间点的合适干预措施。技术可以在个体和人群层面上获取越来越多的临床和“组学”数据,并支持先进的临床决策。然而,为了跟上不断变化的社会现实和发展,从知识获取到实施,在研究过程中系统地纳入性别特异性考虑因素非常重要。在循证医学和现有精准医学框架的基础上,我们提出了一种新的基于证据的精准医学框架,即 P3 模型,它考虑了个体相关的性别(预测[P1]、预防[P2]和个体化[P3]医学)和与性别相关的领域(参与性[P4]、心理社会[P5]和感知性[P6]医学)及其与种族、地理位置和其他人口统计学和社会变量的交叉,以及人口、社区和公共维度(人口知情[P7]、与社区合作[P8]和公众参与[P9]医学)。通过其对社会现实和发展进行情境化和反思的能力,我们的模型有望促进对多样性、公平性和包容性原则的考虑,从而丰富科学、提高研究的可重复性,并确保其社会影响。
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