The American journal of the medical sciences
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Review Case Reports
Spontaneous resolution of a cyst of the septum pellucidum.
Septum pellucidum cysts are rare clinical findings. Although their optimal treatment remains controversial, large cysts causing hydrocephalus or neural compression should be treated surgically. However, spontaneous resolution can also occur. ⋯ To the best of the authors' knowledge, this is only the third reported case of spontaneous resolution of a septum pellucidum cyst. This case suggests that a symptomatic septum pellucidum cyst is not an absolute indication for surgical treatment. A conservative approach with close follow-up with computerized tomography or magnetic resonance imaging is strongly recommended unless the cyst causes obvious hydrocephalus or progressive neurological deterioration.
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For as long as the federal regulations governing human subjects research have existed, the practice of informed consent has been attacked as culturally biased, legalistic, ritualistic and unevenly enforced. Its focus on meeting the regulatory requirements is seen as undermining a truly ethical process that produces informed and voluntary participation in medical research. ⋯ Study participants are asked to consent to future studies with unspecified aims, broad data sharing policies and ongoing uncertainties regarding confidentiality protections and the potential benefit of incidental genomic research findings. Because more research is conducted under these new conditions, the very nature of the researcher-subject relationship is shifting and will require new governance mechanisms to promote the original goals of informed consent.
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Major depressive disorder (MDD) is a common psychiatric illness affecting nearly 20% of adults in the United States at least once during their lifetime. MDD is frequently diagnosed and treated in the primary care setting. ⋯ This article presents an overview of diagnostic and treatment guidelines for MDD and focuses on challenges encountered by primary care physicians. The role of antidepressant medications, psychotherapy and nonpharmacologic interventions for the treatment of patients with MDD is described, and factors influencing treatment selection, such as adverse event profiles and patient characteristics, are examined.
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Informed consent is one of the great puzzles of modern medical research and practice. As Professor Henderson has argued in her article, there is ample reason to be concerned that many, and maybe all, of the goals announced for informed consent law and ethics have not been reached. In this article, I will review the goals that theorists and judges have assigned to the doctrine and discuss some of the evidence concerning the difficulties of meeting those goals. Finally, I will suggest some of the reasons that might account for our continued commitment to informed consent despite its difficulties.
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Equipoise is widely endorsed as a necessary requirement for ethical design and conduct of randomized controlled trials. Nevertheless, I argue in this article that the equipoise principle suffers from fundamental defects. In particular, equipoise provides flawed ethical guidance for placebo-controlled trials and for decisions to terminate trials early based on interim data relating to benefit. ⋯ Because of this mistaken therapeutic orientation, equipoise fails to adequately account for the central purpose of randomized trials in providing evidence sufficient to guide health policy decisions relating to licensing new treatments and insurance coverage. I conclude that it is time to dispense with equipoise. The principles of research ethics are sufficient to provide adequate guidance to protect subjects and to promote socially valuable research without any appeal to equipoise.