Transdisciplinarity in strategic decisions for oncological treatments

The current models for equity and access to new oncological treatments are under strain due to the economic and demographic crisis in Europe as well as the rising costs of innovative drugs. Cancer treatment needs a model of patient-centered care in which an interdisciplinary care plan, based on evidence-based practice is essential for patient wellbeing. Physicians should be focused in the doctor-patient relationship and informed consent is important, especially when new medicines are prescribed. Related with informed consent, there is therapeutic privilege. Moreover, utilitarianism and social justice have to be considered without compromising human dignity and the principle of economy cannot be ignored in the provision of public services. An interdisciplinary approach is essential for the new oncological drugs approval. Therefore, transdisciplinary decision between civil society, pharmaceuticals, healthcare professionals and policy makers is essential in order to assure quality, access to innovation and equity in oncological care.info:eu-repo/semantics/acceptedVersio

Impact of the economic crisis in the approval of new oncological drugs:the Portuguese paradigm

Background: The European crisis lead to funding restrains in healthcare, already under pressure due to the ageing of the population and the increase of demands from innovation. Portugal is the paradigm of the European crisis since has both an economic and demographic crisis. The researchers aimed to evaluate the impact of economic restrains in Portugal for access and reimbursement of new oncological drugs. Methodology: A qualitative approach was used, supported by 27 formal, tape recorded, semi-structured interviews to representatives of the different healthcare stakeholders and policymakers. The content analysis with semantic associations through co-occurrence analysis were done with the support of Tropes® software. Results: The results of the content analysis showed that economic restrains are leading to a policy of cost control with lower prices and reduced access to innovation; an excessive delay in the approval of new drugs; lack of transparency; serious limitations and inequity between hospitals. Contractual boundaries to national prescription was established and agreements with pharmaceuticals were made. Changes in the reimbursement process are being implemented with an increase of risk sharing mechanisms and implementation of a new system of health technological evaluation (SINATS). Treatment protocols are also being revised and public hospitals are trying to increase the number of clinical trials but there is still much bureaucracy. In this qualitative approach, the following factors with impact on survival were identified: Innovation and technological development, government funding, the price of drugs and type of oncological diseases. Conclusions: The economic crisis is leading to a very serious problem of inequity. However, it is also an opportunity for a structural reform. In Portugal, an attempt of reform is being made with the implementation of SINATS since it is important to distinguish molecules that effectively bring added value. In order to consider the strategic vision in which the patient is the center of all efforts, the process of reimbursement approval for new medicines should be faster, more transparent and interdisciplinary. Moreover, the decisions must be done triangulating evidence based medicine, economics, health policy and ethical and legal issues. For National Health Service sustainability, efficiency and efficacy, clinical and economic reassessments must be done after market introduction of new medicines, with subsequent renegotiations.info:eu-repo/semantics/publishedVersio

Metabolic network reconstruction of the central carbon metabolism of Enterococcus faecalis

The profound advance in experimental high throughput techniques (generally referred to as “omics techniques”) has enabled the analysis of a large number of components within a living cell. The vast amount of data obtained from the different “omics” (genomics, proteomics, fluxomics, metabolomics, transcriptomics) demands the use of bioinformatics tools. These methods comprise the development of comparative tools and maintenance of databases for the analysis of genomics data, in addition to the construction of models for the analysis and integration of data in a system-wide approach. Enterococcus faecalis is a Gram-positive bacterium that is getting more attention due to its “two-face” behavior. This natural inhabitant of the mammalian gastrointestinal tract is also an opportunist pathogen responsible for urinary tract infections, nosocomial infections, bacteremia and infective endocarditis. Besides, its intrinsic physiological properties such as inherent antibiotic resistance and exceptional ability to adapt to harsh conditions provide this organism with an enormous advantage in the infection processes. Here, we propose to reconstruct the genome scale metabolic network of the central carbon metabolism of Enterococcus faecalis using genome sequencing information available on different databases as well as proteomics and metabolomics data. The first metabolic model generated for this bacterium will allow correlating metabolite levels and fluxes which enables identification of key control points in its metabolism. As it has been previously shown for other organisms, the metabolic network reconstruction may serve as a valuable tool to predict the phenotypic behaviour under various genetic and environmental conditions

Genome scale metabolic network reconstruction of pathogen – Enterococcus faecalis

Enterococcus faecalis is a Gram-positive bacterium that is getting more attention due to its “two-face” behavior. This natural inhabitant of the gastrointestinal mammalian tract is also an opportunist pathogen responsible for urinary tract infections, nosocomial infections, bacteremia and infective endocarditis (1). Since the metabolic reconstruction of Haemophilus influenzae was published in 1999 (2), many other researchers have focused their attention into the possibilities that the new era of genome-scale metabolic models could bring to the scientific scene, both in prokaryotic and eukaryotic organisms

Genome-scale metabolic network of the central carbon metabolism of Enterococcus faecalis

The profound advance in experimental high throughput techniques (generally referred to as omics techniques) has enabled the analysis of a large number of components within a living cell. The vast amount of data obtained from the different omics (genomics, proteomics, fluxomics, metabolomics, transcriptomics) demands the use of bioinformatics tools. These methods comprise the development of comparative tools and maintenance of databases for the analysis of genomics data, in addition to the construction of models for the analysis and integration of data in a system-wide approach. Enterococcus faecalis is a gram-positive bacterium that is getting more attention due to its two-face behavior. This natural inhabitant of the mammalian gastrointestinal tract is also an opportunist pathogen responsible for urinary tract infections, nosocomial infections, bacteremia and infective endocarditis. Besides, its intrinsic physiological properties such as inherent antibiotic resistance and exceptional ability to adapt to harsh conditions provide this organism with an enormous advantage in the infection processes. Here, we propose to reconstruct the genome scale metabolic network of the central carbon metabolism of Enterococcus faecalis using genome sequencing information available on different databases as well as proteomics and metabolomics data. The first metabolic model generated for this bacterium will allow correlating metabolite levels and fluxes which enables identification of key control points in its metabolism. As it has been previously shown for other organisms, the metabolic network reconstruction may serve as a valuable tool to predict the phenotypic behaviour under various genetic and environmental conditions.Supported by a PhD grant from the FCT (Portuguese Science Foundation): SFRH/BD/47016/2008 and funding from HRC (Health Research Council of New Zealand)

Metabolic network reconstruction of the pathogen Enterococcus faecalis

Enterococcus faecalis is a Gram-positive bacterium with a low G_C content in its genomic DNA. This natural inhabitant of the gastrointestinal mammalian tract is also an opportunist pathogen responsible for urinary tract infections, nosocomial infections, bacteremia and infective endocarditis. E. faecalis normally grows as a commensal organism in the gut, but it possesses very subtle virulence traits that are not easily identified. Besides, its intrinsic physiologic properties such as inherent antibiotic resistance and exceptional ability to adapt to harsh conditions provide this organism with an enormous advantage in the infection processes. Recognizing the medical importance of this bacterium, The Institute for Genomic Research has undertaken the genome sequencing of E. faecalis strain V583 and based on that, the first genome-scale metabolic model of E.faecalis will be reconstructed. To support the reconstruction, high throughput techniques, generally referred to as omics techniques (genomics, proteomics, fluxomics, metabolomics and transcriptomics) will provide data of different levels to validate, test and sustain the robustness of the model. The different levels of data will comprise genome, metabolite, protein and flux profiles. The first metabolic model generated for this bacterium will allow correlating metabolite levels and fluxes which enables identification of key control points in its metabolism. As it has been previously shown for other organisms, the metabolic network reconstruction may serve as a valuable tool to predict the phenotypic behaviour under various genetic and environmental conditions