The article discusses the key aspects of the recently revised Medicare coverage policy for implantable cardioverter-defibrillators (ICDs) that require patients to participate in a shared decision ...making interaction with their physician or a designated non-physician practitioner before undergoing a primary prevention implantation. Some of the advantages and benefits of shared decision making are highlighted.
Unlike ventilator allocation, provision of CPR to patients cannot be practically adjudicated by a hospital-level triage team. How does the surge of patients with Covid-19 complicate standard CPR ...practices, and how can we best design crisis standards for inpatient CPR?
Patients with traumatic brain injury and stroke are typically unconscious or too impaired to make decisions about participation in clinical trials. How qualitatively dissimilar are the treatment ...groups (ie, medicine vs medicine, or medicine vs interventional or surgical procedure)? Simplified or staged approaches, for example, can provide transparency, allow an opportunity for control or refusal, and promote trust.4 These are all important ethical functions, and existing data suggest that consent processes have value to patients and surrogates even in the absence of complete understanding.5 The authors are right that the full range of ethically appropriate approaches to consent for research in traumatic brain injury and stroke has been underappreciated.
Novel approaches to advance the field of vaccinology must be investigated, and are particularly of importance for influenza in order to produce a more effective vaccine. A systematic review of human ...challenge studies for influenza was performed, with the goal of assessing safety and ethics and determining how these studies have led to therapeutic and vaccine development. A systematic review of systems biology approaches for the study of influenza was also performed, with a focus on how this technology has been utilized for influenza vaccine development.
The PubMed database was searched for influenza human challenge studies, and for systems biology studies that have addressed both influenza infection and immunological effects of vaccination.
Influenza human challenge studies have led to important advancements in therapeutics and influenza immunization, and can be performed safely and ethically if certain criteria are met. Many studies have investigated the use of systems biology for evaluating immune response to influenza vaccine, and several promising molecular signatures may help advance our understanding of pathogenesis and be used as targets for influenza interventions. Combining these methodologies has the potential to lead to significant advances in the field of influenza vaccinology and therapeutics.
Human challenge studies and systems biology approaches are important tools that should be used in concert to advance our understanding of influenza infection and provide targets for novel therapeutics and immunizations.
Patients who are comatose after cardiac arrest continue to be a challenge, with high mortality. Although there is an American College of Cardiology Foundation/American Heart Association Class I ...recommendation for performing immediate angiography and percutaneous coronary intervention (when indicated) in patients with ST-segment elevation myocardial infarction, no guidelines exist for patients without ST-segment elevation. Early introduction of mild therapeutic hypothermia is an established treatment goal. However, there are no established guidelines for risk stratification of patients for cardiac catheterization and possible percutaneous coronary intervention, particularly in patients who have unfavorable clinical features in whom procedures may be futile and affect public reporting of mortality. An algorithm is presented to improve the risk stratification of these severely ill patients with an emphasis on consultation and evaluation of patients prior to activation of the cardiac catheterization laboratory.
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