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Mackay, widely recognized experts in autoimmunity and its pathophysiological and clinical aspects. This thoughtfully updated new edition takes into consideration important developments in basic and clinical science. This book will be a valuable resource to clinicians involved in the diagnosis and treatment of autoimmune diseases, to scientists who want to follow developments in the field, and to all those who enjoyed the previous edition.

Eibl, M.

The Autoimmune Diseases

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Thanks in advance for your time. Skip to content. Search for books, journals or webpages All Pages Books Journals. View on ScienceDirect. Editors: Noel Rose Ian Mackay. Hardcover ISBN: Imprint: Academic Press.

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Institutional Subscription. Free Shipping Free global shipping No minimum order. Gives a thorough and an important overview on the entire field, framing individual disease chapters with information that compares and contrasts each disorder and therapy Provides thorough, up-to-date information on specific diseases, along with clinical applications, in an easily found reference for clinicians and researchers interested in certain diseases Keeps readers abreast of current trends and emerging areas in the field Ensures that content is not only up-to-date, but applicable and relevant.

Basic and clinical scientists working in immunology, rheumatology and autoimmune diseases. Conclusion Acknowledgments Abbreviations References Chapter 9. The Graylyn conferees defined. Clinical research involves interactions with patients, diagnostic clinical materials or data, or populations in any of the following areas: 1 disease mechanisms etiopathogenesis ; 2 bi-directional integrative translational research; 3 clinical knowledge, detection, diagnosis and natural history of disease; 4 therapeutic interventions including clinical trials of drugs, biologics, devices and instruments; 5 prevention primary and secondary and health promotion; 6 behavioral research; 7 health services research, including outcomes, and cost-effectiveness; 8 epidemiology; and 9 community-based trials.

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This definition was adopted by the U. In response to this definition, those determined to carve out and distinguish research requiring direct interaction with living patients coined the term patient-oriented research. Another distinction is commonly made for translational research , which describes research that explores the applicability of the results of basic research to clinical care for example, in clinical trials, especially early Phase 1 or 2 trials.

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In addition, translational research may also include studies of how to facilitate the introduction of newly established clinical knowledge into broad clinical practice and the obstacles thereto, or it may describe studies of the clinical effectiveness or cost effectiveness of new knowledge applied in clinical practice across very large and diverse populations. Subsequently, others have carried this terminology further by designating T3 blocks and even T4 blocks. This terminology has become widely accepted.

Recent scientific advances have begun to set the stage for a dramatic transformation of our capacity to diagnose, prevent, and treat disease and disability. But accomplishing this transformation will not only require the translation and wide-scale application of these increasingly remarkable basic research advances into health care practice, but will also demand profound changes in individual and group behaviors.

The latter will not be achievable without substantially enhancing our understanding of individual and population behaviors, which in turn will require significantly greater investment in the. Sung, N. Crowley, Jr. Genel, P. Salber, L. Sandy, L. Sherwood, S. Johnson, V. Catanese, H. Tilson, K. Getz, E. Larson, D. Scheinberg, E. Reece, H. Slavkin, A.


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Dobs, J. Grebb, R. Martinez, A. Korn, and D. Central challenges facing the national clinical research enterprise. JAMA Health services research, which involves the study of the efficiency, effectiveness, and costs of health care practices and systems, has become indispensable to understanding and informing the future of health care.

This relentless growth in costs, coupled with the aging of the American population, the severe economic recession, and the sharply rising federal deficit, is placing great strains on the private-sector, state, and federal systems used to finance health care, including private employer-sponsored health insurance coverage and public insurance programs such as Medicare and Medicaid. Successive IOM reports have highlighted the unacceptably poor status of our health care system as a whole, the high frequency and costs of medical errors resulting as much from systemic as individual failures, the almost unique failure of the health care industry in comparison with other sectors of the U.

Another effort to highlight the quality of health care began in with the publication of a series of reports by the Agency for Healthcare Research and Quality AHRQ that address the state of health care from the perspective of quality and disparity. At this time it is difficult to estimate the impact of the Patient Protection and Affordable Care Health Care Reform Act on the opportunities and challenges in clinical research.

There are many factors contributing to the continued underdevelopment of the clinical research enterprise. These include: a the extra time and expense required for clinical research training along with the inherent complexity, difficulty, and costs of patient-oriented clinical research, and the challenges these pose in competing successfully for sponsored research support, especially from National Institutes of Health, 3 b the sharply declining ability to cross-subsidize clinical research from hospital and faculty clinical practice income as a result of the major changes wrought in health care financing over the past 20 years, c the debt burden that inclines many physicians in training to forgo clinical research careers for the more likely rewards of clinical practice, and finally, d the still uncertain status of the full spectrum of clinical research within the culture of the academic health center, where traditionally, basic science and clinical prowess have often been valued more highly than clinical research.

Notwithstanding this formidable array of deterrents, abundant anecdotal evidence indicates that physician-scientists who leave research careers often do so because of insufficient institutional support, a perceived lack of available mentors, licensure regulations, and role models and the attendant discouragement.

Background

The need for increased investment in clinical research has been increasingly recognized in diverse funding programs—public, private, and philanthropic—as well as in academic medical and health centers. Nevertheless, that this underinvestment continues is indicated by the remarkably small fraction of the total annual expenditures directed to health care that is invested in clinical research. Nathan and released in December Although NIH support of clinical research awards during.

Kotchen, T. Lindquist, A. Miller Sostek, R. Hoffmann, K.

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Malik, and B. Outcomes of National Institutes of Health peer review of clinical grant applications. Journal of Investigative Medicine, Dickler et al. Recommendation 1: Every future physician should receive a thorough education in the basic principles of translational and clinical research, both in medical school and during residency training.

Recommendation 2: The Liaison Committee on Medical Education LCME should add education in translational and clinical research to the requirements for medical school accreditation, and the Accreditation Council for Graduate Medical Education ACGME should embed understanding of translational and clinical research within its required core competencies. Recommendation 3: Training for translational and clinical investigators should comprise completion of an advanced degree with a thesis project or an equivalent educational experience , tutelage by an appropriate mentor, and a substantive postdoctoral training experience.

Recommendation 4: Sufficient support should be given to new junior faculty who are translational and clinical investigators to maximize their probability of success. Recommendation 5: Training in translational and clinical research should be accelerated through comprehensive re-structuring so that these scientists can become independent clinicians and investigators at the earliest possible time. Recommendation 6: Institutions, journals, the NIH, and other research sponsors should take steps to facilitate appropriate academic recognition of translational and clinical scientists for their contributions to collaborative research.

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Recommendation 7: The NIH should modify the K23 and K24 awards to enhance their value in supporting clinical and translational research training and mentoring. There are also other support mechanisms, most notably the Clinical and Translational Science Awards CTSAs , directed by the National Center for Research Resources NCRR and launched in , all of which are transforming the quality and quantity of support of physician-scientists in universities and academic health centers.

Much of the NIH funding for the CTSA has been recovered from closing down the General Clinical Research Centers GCRC program, begun in the s to create a national network of such centers, situated primarily in academic health centers, and targeted initially to support what was then cutting-edge studies of metabolic diseases in human research subjects.