Current Issue : January - March Volume : 2013 Issue Number : 1 Articles : 7 Articles
Two major trends have developed in pediatric bioethics: family-centered care and increased recognition of emerging\r\nautonomy through legal and policy entrenched rights. The different foci of their corresponding health care delivery\r\nmodels (ââ?¬Å?family-centeredââ?¬Â or ââ?¬Å?patient-/child-centeredââ?¬Â) create the potential for conflict in the context of seeking consent\r\nto research or, as will be presented, the possibility of integration. Given the state of current bioethical principles and\r\nlegal holdings, the pediatric patient should ultimately be the primary focus of ethical consideration and, at least in the\r\ncontext of dissenting to research, the childââ?¬â?¢s autonomous wishes should reign. However, in recognizing and supporting\r\na childââ?¬â?¢s emerging autonomy, the family context should also be respected and taken into account. This discussion\r\narticulates the values underpinning these two important trends in pediatric health care delivery, and proposes a model\r\nfor obtaining consent for pediatric research in the current context....
Adherence to long-term therapy for chronic illnesses in developed countries averages only 50%. Patients’ non-adherence to drug therapy is a major problem for society as it is associated with reduced health outcomes. This study aims to determine the impact of medication adherence among socio-economic classes in type 2 diabetes patients on the cost of diabetes (COD) estimates. This is a prospective, observational, and cross sectional study conducted at three centers for upper, middle and lower class patients (n = 612). Adherence was significantly lower for medicines not felt to be improving or directly needed to lower blood glucose levels. (5.7 vs 6.3 days out of 7, P < 0.004). Among patients on more than three drugs 77% was adherent with all but one or two medicines. Adherence to insulin was significantly more than adherence to oral hypoglyceamic drugs (6.1 vs 5.5 days out of 7, P <0.005). Estimating an average of 18.8% non-adherence, there will be a reduction of Rs.123.48 monthly (1481.76 yearly) from the drug acquisition cost which translates to a reduction of 13.2% of the total Cost-of-Diabetes (COD). Drug acquisition costs increased fivefold for patients with more than two co-morbidities....
Is the incidence of orchidoma in the elderly on the rise?\r\nThe subject is discussed apropos of two cases. The data relative to the frequency and incidence of orchidoma in\r\nthe elderly is discussed and The New York Memorial Series of Dean and Dean, the series of The Institute of Urology\r\nof London of Collins and Pugh as well as the series of the VAMC, Phoenix are reviewed, and the differences are\r\nstudied statistically and arithmetically.\r\nIt is concluded that the incidence of orchidoma in the elderly seems to be on the rise; it is compelling and\r\nobligatory that this fact retain our attention in the differential diagnosis of scrotal masses in the elderly....
Objective: To assess parentsââ?¬â?¢ opinions about their participation in the longitudinal, multicenter study - The\r\nEnvironmental Determinants of Diabetes in the Young (TEDDY) consortium.\r\nMethods: A survey was given to parents who had been in the study for = 1 year. Parents rated the importance\r\nof different reasons for staying in TEDDY and how well different study components were working. Parents were also\r\nasked if they had suggestions for making TEDDY better and if they ever had thought of leaving TEDDY and if so,\r\nwhy.\r\nResults: Out of the 3336 eligible families, 2000 completed the survey (59.1%); most (77.6%) were mothers.\r\nSurvey completion was more common in European than US TEDDY sites and was associated with greater maternal\r\neducation, more accurate perceptions about their childââ?¬â?¢s risk of type 1 diabetes, longer participation in TEDDY and\r\nexcellent attendance at TEDDY visits. ââ?¬Å?Having someone watching the child for development of T1DMââ?¬Â was most\r\nimportant reason given for staying in the study; other important reasons included ââ?¬Å?Helping science discover causes\r\nof diabetesââ?¬Â and ââ?¬Å?Getting childââ?¬â?¢s antibody resultsââ?¬Â. Most parents were very satisfied with the different components\r\nof TEDDY and had not thought of leaving the study. A minority (24%) of parents acknowledged some thoughts of\r\nleaving TEDDY and cited the blood draws, being too busy/not having enough time, the demanding protocol, and food\r\ndiaries as their reasons for considering leaving.\r\nConclusions: The study highlights factors important for successful implementation of demanding, longitudinal\r\nprotocols. Friendly, devoted, skilled and knowledgeable staff with continuity makes the family comfortable. Keeping\r\nparents involved and informed on study progress is essential as is making procedures as smooth and painless as\r\npossible. Although the study is international the survey results were convergent across countries suggesting that the\r\nresults have relevance to other similar studies to retain study participants....
Stem cell biology and important advancements and limitations with respect to their prospective use in regeneration therapies in various human diseases such as a Myocardial infarction. This can occurs when a coronary artery has been blocked by thrombus, and its existing therapeutic drugs are thrombolytic, antiplatelet drugs and angiotensin-converting enzyme inhibitors. Adult stem cells, generally accepted the each organ of our body is in balance between degradation and repair. Fetal stem cells can be transplanted into the infracted heart and improved cardiac function through increased neovascularisation. Genetic markers or dyes were used to track the cells in vivo, the engrafted cells partly expressed endothelial and CMC marker proteins. Along with an overview of the basics of their biology, we discuss here their potential nature as components of the vascular wall, and the prospects for their use in local and systemic transplantation and gene therapy....
Paracetamol is an important drug in the category of analgesic & antipyretic used in treatment of acute pain, But yet many of us know little pharmacokinetics. The determination of pharmacokinetics of the drug is the determination of absorption, distribution, metabolism and excretion (ADME) time course of drug and how it is related to pharmacological activity of drug such as its therapeutic and toxic activity. The determination of drug concentration in saliva as an alternative body fluid for pharmacokinetic determination is widely accepted now days. It is mainly suitable for geriatric and pediatric patient as it can be collected easily with minimal patient discomfort and obtained on multiple occasions. The determination of drug concentration in saliva has been employed for therapeutic drug monitoring and measurement of various pharmacokinetic parameters, which can provide knowledge of patient-specific pharmacokinetic parameters leading to improved therapy. The present study was undertaken to evaluate the pharmacokinetics of model drug in saliva when administered in different media like water, milk, juice and to measure the concentration in the saliva in healthy volunteers....
Background: The difficulties of recruiting and retaining African women in biomedical research cannot be\r\noveremphasized. Despite the epidemiologic and gender distribution of the burden of diseases in Africa, women scarcely\r\nparticipate in biomedical research especially in clinical trials. This paper critically examines the challenges involved in\r\nrecruiting and retaining African women in clinical trials using a pilot study in Nigeria.\r\nMethods: We carried out a pilot study through self-administered semi-structured questionnaire on knowledge,\r\nconstraints and willingness by women to participate in clinical trials. Females attending outpatient obstetrics and\r\ngynecology clinics in Nigeria were the participants. The data collected was converted to numerical values for generation\r\nof statistic analysis.\r\nResults: Out of the 200 questionnaires distributed, 172 were returned anonymously representing 86% response\r\nrate, which were used in the data analysis. Eighty-two (47.7%) were willing to participate depending on the type of trials\r\nwhile 60 (35%) were concerned about monetary compensation. Most of the respondents (p < 0.05) were of the opinion\r\nthat their husbands and families must be in support before they could participate.\r\nDiscussion and Conclusion: This study has shown that knowledge and education play important role in motivating\r\nwomen to participate in clinical trials in Africa while family attachments and cultural barrier is an impediment to their\r\nparticipation. This calls for an awareness campaign to emphasize not only the necessity for women participation in\r\nclinical trial but also the establishment of adequate protective and educative measures for those willing to participate in\r\na male dominated society like Nigeria....
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