Assuntos
Luto , Criança , Pesar , Morte Parental/psicologia , Adaptação Psicológica , Adolescente , Transtornos Reativos da Criança/diagnóstico , Transtornos Reativos da Criança/psicologia , Comunicação , Emoções , Cuidados Paliativos na Terminalidade da Vida/psicologia , Humanos , Controle Interno-Externo , Relações Pais-Filho , Fatores de Risco , Apoio Social , Resultado do TratamentoAssuntos
Serviços de Saúde da Criança/normas , Reforma dos Serviços de Saúde/organização & administração , Serviços de Saúde Materna/normas , Gestão da Qualidade Total/organização & administração , Criança , Inglaterra , Humanos , Cultura Organizacional , Inovação Organizacional , Medicina Estatal/organização & administraçãoRESUMO
The oversight of clinical research in the UK is currently in a state of flux. Discusses the quality assurance problems that have arisen in the management of research and the protection of the rights of human participants. Contrasts clinical governance and regulatory approaches to research quality assurance and performs a critical analysis of the Department of Health (England) Research Governance Framework (RGF) to see where it falls within the continuum. Highlights the implications for UK hospitals engaged in clinical research through the presentation of a case study in implementing the RGF. Concludes by suggesting the priority areas that need to be addressed and invites further debate regarding the merits of a clinical governance or regulatory approach to research quality assurance.
Assuntos
Pesquisa Biomédica/normas , Controle de Qualidade , Medicina Estatal , Pesquisa Biomédica/organização & administração , Reino UnidoRESUMO
A novel ATP-sensitive potassium channel (K(ATP)) channel agonist, BPDZ 154 (6,7-dichloro-3-isopropylamino-4H-1,2,4-benzothiadiazine 1,1-dioxide), was synthesized, and its effects on insulin-secreting cells were evaluated using electrophysiology, (86)Rb(+) and (45)Ca(2+) efflux, and RIA determinations of insulin secretion. BPDZ 154, an analog of diazoxide, inhibited both glucose-induced insulin secretion from isolated perifused islets and the secretion of insulin induced by glucose and tolbutamide. These effects were mediated by the activation of ATP-sensitive potassium channels because BPDZ 154 induced a concentration-dependent increase in channel activity that was inhibited by the sulfonylurea tolbutamide and the imidazoline efaroxan. In beta-cells isolated from patients with either nontypical hyperinsulinism (preserved K(ATP) channel function) or from the control areas of the pancreas of patients with focal hyperinsulinism, BPDZ 154 activated K(ATP) channels and was found to be more effective and less readily reversible than diazoxide. By contrast, it was not possible to activate K(ATP) channels by either diazoxide or BPDZ 154 in beta-cells from patients with hyperinsulinism as a consequence of defects in K(ATP) channel function. In beta-cells isolated from a patient with pancreatic insulinoma, K(ATP) channels were readily recorded and modulated by BPDZ 154. These data suggest that BPDZ 154 or BPDZ 154-like compounds may have therapeutic potential in the treatment of certain forms of hyperinsulinism.