Suchergebnisse

The exercise of allocating health resources under the responsibility of the Ministry of Health is strongly influenced both by the varied needs of the population and by the demands of health workers. What role can these different interests play in integrating new technologies in healthcare distribution? Pharmacogenomics, an emerging branch of pharmacology integrating data from the human genome project into the development process of the medicine, is perceived as a technology for personalising medicine. Its integration into drug development or prescription processes promises to minimise the occurrence of adverse side effects arising from the taking of medicines. Given the current allocation of resources, would it make sense for the Government of Quebec to invest in pharmacogenomics as a new tool for the development of medicinal products or a new way of medication for its population? We will address this issue using selection criteria dictated by Caulfield and its collaborators (2001) [1] to assess the relevance of public investment in the development of a genetic test, i.e. acceptability, utility, non-malfeasance and clear — at reasonable cost — benefit to the population. As genomics are close to genetics, these factors are applicable in our discussion. ; Health care resource allocation is a complex governmental task involving political decisions that are bound to be influenced by the various needs of the population and the demands of health professionals. What influence should these different interests have on the integration of new technologies into the health care system? Pharmacogenomics, a new field in the pharmacological sciences that integrates into the drug development process genomic information developed through the Human Genome Project, has been proposed as a technology that promises to make medical practices more personalized. Its integration in drug development or prescription processes could help reduce the risk of adverse drug reactions characteristic of pharmaceutical treatments. Considering the ...

L'exercice d'allocation de ressources en santé, relevant du Ministère de la santé, se voit fortement influencé autant par les besoins variés de la population que par les exigences des intervenants en santé. Quel rôle ces différents intérêts peuvent-ils jouer dans l'intégration de nouvelles technologies dans la distribution des soins de santé ? La pharmacogénomique, branche émergente de la pharmacologie intégrant les données issues du projet génome humain au processus de développement du médicament, est perçue comme une technologie qui permettrait de personnaliser la médecine. Son intégration aux processus de développement ou de prescription de médicaments promet de minimiser l'apparition d'effets secondaires néfastes découlant de la prise de médicaments. Serait-il alors judicieux pour le gouvernement du Québec, considérant la conjoncture actuelle d'allocation de ressources, d'investir dans la pharmacogénomique en tant que nouvel outil de développement du médicament ou nouveau mode pronostic de médication pour sa population ? Nous aborderons cette question à l'aide de critères de sélection dictés par Caulfield et ses collaborateurs (2001)[1] pour évaluer la pertinence de l'investissement public dans la mise sur pied d'un test génétique, soit l'acceptabilité, l'utilité, la non-malfaisance et la présence d'un bénéfice clair – à coût raisonnable – pour la population. La génomique avoisinant la génétique, ces facteurs s'avèrent applicables dans notre discussion. ; Health care resource allocation is a complex governmental task involving political decisions that are bound to be influenced by the various needs of the population and the demands of health professionals. What influence should these different interests have on the integration of new technologies into the health care system? Pharmacogenomics, a new field in the pharmacological sciences that integrates into the drug development process genomic information developed through the Human Genome Project, has been proposed as a technology that promises to make medical practices more personalized. Its integration in drug development or prescription processes could help reduce the risk of adverse drug reactions characteristic of pharmaceutical treatments. Considering the actual allocation of health care resources in Quebec, should the provincial government invest in the integration of pharmacogenomics as a new tool for drug development or drug specification? This question will be addressed using the criteria previously described by Caulfield and colleagues (2001) in order to assess the justification of public financing for genetic testing[1], i.e., moral acceptability, utility, safety and the requirement of a noticeable benefit at an acceptable cost for society. Given the proximity of the fields of genetics and genomics, these criteria are applicable to our discussion.

Les troubles cognitifs sont à la base du diagnostic de la maladied'Alzheimer, mais il persiste chez les patients des capacités préservéesqui leur permettent, potentiellement, de maintenir des activitésquotidiennes valorisantes. Les recherches se poursuivent pourcaractériser les processus (notamment contrôlés versus automatiques) quisont modifiés par la maladie, mais les épreuves de laboratoire ne rendentpas toujours compte du fonctionnement des patients dans leur milieuquotidien. La réhabilitation cognitive s'enracine dans les connaissancesneuropsychologiques, mais elle se doit d'être écologique. Elle combineune analyse systématique et parfois schématique des activités avecune évaluation des motivations et du comportement du patientdevant l'action. La mise au point de programmes de réhabilitation, deprocédures et d'outils d'adaptation et d'évaluation rencontre la difficultébien connue de devoir être utile au plus grand nombre mais aussi àchaque patient individuel.

Since the beginning of the COVID-19 pandemic, numerous studies have been conducted to identify interventions that could contribute to alleviating the burden it has caused. The Institut national d'excellence en santé et en services sociaux (INESSS) has played a key role in informing the government of Québec regarding the evaluation of specific pandemic-related interventions. This process took place in a context characterized by a sense of urgency to assess and recommend potential interventions that could save lives and reduce the effects of the disease on populations and healthcare systems, which increased the pressure on the regulatory agencies leading these evaluations. While some of the interventions examined were considered promising, results from COVID-19 studies often led to uncertainty regarding their efficacy or safety. Regulatory agencies evaluating the value of promising interventions thus face challenges in deciding whether these should be made available to the population, particularly when assessing their benefit-risk balance. To shed light on these challenges, we identified underlying ethical considerations that can influence such an assessment. A rapid literature review was conducted in February 2021, to identify the main challenges associated with the benefit-risk balance assessment of promising interventions. To reinforce our understanding of the underlying ethical considerations, we initiated a discussion among various social actors involved in critical thinking surrounding the evaluation of promising interventions, including ethicists, clinicians and researchers involved in clinical or public health practice, as well as patients and citizens. This discussion allowed us to create a space for exchange and mutual understanding among these various actors who contributed equally to the identification of ethical considerations. The knowledge and perspectives stemming from the scientific literature and those consulted were integrated in a common reflection on these ethical considerations. This allowed ...