ABSTRACT
Corticosteroid management for patients with sarcoidosis requires the need for close monitoring to detect and manage any complications that may arise during treatment.
ABSTRACT
Cystic fibrosis (CF) is the most common life-limiting genetic disease in Caucasian patients. Continued advances have led to improved survival, and adults with CF now outnumber children. As our understanding of the disease improves, new therapies have emerged that improve the basic defect, enabling patient-specific treatment and improved outcomes. However, recurrent exacerbations continue to lead to morbidity and mortality, and new pathogens have been identified that may lead to worse outcomes. In addition, new complications, such as CF-related diabetes and increased risk of gastrointestinal cancers, are creating new challenges in management. For patients with end-stage disease, lung transplantation has remained one of the few treatment options, but challenges in identifying the most appropriate patients remain.
Subject(s)
Aminophenols/administration & dosage , Cystic Fibrosis Transmembrane Conductance Regulator/genetics , Cystic Fibrosis/diagnosis , Cystic Fibrosis/therapy , Disease Management , Quinolones/administration & dosage , Adult , Aminopyridines/administration & dosage , Benzodioxoles/administration & dosage , Child , Chronic Disease , Combined Modality Therapy , Comprehension , Cystic Fibrosis/epidemiology , Cystic Fibrosis Transmembrane Conductance Regulator/drug effects , Disease Progression , Drug Approval , Female , Genetic Predisposition to Disease/epidemiology , Humans , Lung Transplantation/methods , Male , Prognosis , Risk Assessment , Severity of Illness Index , Survival Analysis , United States , United States Food and Drug AdministrationSubject(s)
Cystic Fibrosis , Neoplasms , Organ Transplantation , Postoperative Complications/therapy , Survivors/statistics & numerical data , Comorbidity , Cystic Fibrosis/complications , Cystic Fibrosis/epidemiology , Cystic Fibrosis/therapy , Disease Progression , Humans , Neoplasms/diagnosis , Neoplasms/epidemiology , Neoplasms/therapy , Organ Transplantation/adverse effects , Organ Transplantation/methods , Patient Care Management/methods , Prevalence , Severity of Illness IndexSubject(s)
Critical Care/statistics & numerical data , Intensive Care Units/statistics & numerical data , Aged , Critical Care/methods , Critical Care/organization & administration , Female , Humans , Intensive Care Units/organization & administration , Male , Middle Aged , Pennsylvania , Prospective Studies , Racial Groups/statistics & numerical data , Time Factors , WorkforceABSTRACT
Improving the management of potential organ donors in the intensive care unit could meet an important public health goal by increasing the number and quality of transplantable organs. However, randomized clinical trials are needed to quantify the extent to which specific interventions might enhance organ recovery and outcomes among transplant recipients. Among several barriers to conducting such studies are the absence of guidelines for obtaining informed consent for such studies and the fact that deceased organ donors are not covered by extant federal regulations governing oversight of research with human subjects. This article explores the underexamined ethical issues that arise in the context of donor management studies and provides ethical guidelines and suggested regulatory oversight mechanisms to enable such studies to be conducted ethically. We conclude that both the respect that is traditionally accorded to the prior wishes of the dead and the possibility of postmortem harm support a role for surrogate consent of donors in such randomized controlled trials. Furthermore, although recipients will often be considered human subjects under federal regulations, several ethical arguments support waiving requirements for recipient consent in donor management randomized controlled trials. Finally, we suggest that new regulatory mechanisms, perhaps linked to existing regional and national organ donation and transplantation infrastructures, must be established to protect patients in donor management studies while limiting unnecessary barriers to the conduct of this important research.
Subject(s)
Biomedical Research/ethics , Informed Consent/ethics , Informed Consent/legislation & jurisprudence , Tissue Donors/ethics , Tissue Donors/supply & distribution , Tissue and Organ Procurement/organization & administration , Cadaver , Critical Illness/mortality , Female , Humans , Intensive Care Units , Male , Needs Assessment , Organ Transplantation/ethics , Organ Transplantation/legislation & jurisprudence , Presumed Consent/ethics , Presumed Consent/legislation & jurisprudence , Randomized Controlled Trials as Topic , Tissue Donors/legislation & jurisprudence , Tissue and Organ Procurement/ethics , Tissue and Organ Procurement/legislation & jurisprudence , Tissue and Organ Procurement/methods , Total Quality Management , United StatesABSTRACT
Various clinical populations display atypical volume asymmetry of language structures and also the auditory M100 source. Although such atypical volume asymmetries have also been observed in autism, M100 source asymmetries have not yet been investigated. We examined M100 asymmetry in autism and its relationship with language functioning. Evoked neural activity to a 1 kHz tone was recorded using whole-cortex 151-channel magnetoencephalography in three groups of individuals. A single-dipole model identified the M100 generator in auditory cortex in each hemisphere. Healthy adults and control children displayed the expected right-sided M100 anteriority, whereas children with autism showed no such asymmetry. An association was found between language functioning and the degree of asymmetry across the two groups of children, suggesting a possible relationship between functional-structural asymmetry and language ability.
Subject(s)
Auditory Perception/physiology , Autistic Disorder/physiopathology , Brain/physiopathology , Evoked Potentials, Auditory , Functional Laterality , Language , Acoustic Stimulation , Adolescent , Adult , Aging , Auditory Cortex/physiopathology , Brain Mapping , Child , Female , Humans , Language Tests , Magnetoencephalography , Male , Middle Aged , Young AdultABSTRACT
While magnetoencephalography (MEG) is of increasing utility in the assessment of pediatric patients with seizure disorders, this reflects only a part of the clinical potential of the technology. Beyond epilepsy, a broad range of developmental psychiatric disorders require the spatial and temporal resolution of brain activity offered by MEG. This article reviews the application of MEG in the study of auditory processing as an aspect of language impairment in children. Specifically, the potential application of MEG is elaborated in autism spectrum disorders (ASD), a devastating disorder with prevalence of 1 in 150. Results demonstrate the sensitivity of MEG for detection of abnormalities of auditory processing in ASD ('electrophysiological signatures') and their clinical correlates. These findings offer promise for the comprehensive assessment of developmental neuropsychiatric disorders.
