Journal of Clinical Research

For more than 70 years, glucocorticoids have been used to treat autoimmune and inflammatory diseases because of their potent anti-inflammatory and immune-suppressive properties. The severity of their side effects, which include osteoporosis, muscle wasting, hyperglycaemia, and hypertension, as well as the occurrence of resistance to glucocorticoid therapy, limit their use. An overview of our current understanding of the mechanisms underlying glucocorticoid treatments therapeutic and side effects, as well as the decreased sensitivity observed in resistant patients, is provided in this Special Issue. In addition, research that aims to either prevent or treat glucocorticoid resistance or to develop novel glucocorticoid therapies with fewer side effects is highlighted. The calming impacts of glucocorticoids are interceded by an intracellular receptor, the glucocorticoid receptor (GR). A wealth of information regarding which cells are the primary targets of the therapeutic effects of glucocorticoids has been provided by research conducted over the course of the past two decades using cell type-specific GR knockout mice in conjunction with models of infectious, autoimmune, and inflammatory diseases. This appears to be the case for both the effects of the endogenous glucocorticoid corticosterone on immune function and the therapeutic effects of glucocorticoid drugs on the disease. When all of these studies are taken into account, it becomes clear that glucocorticoids may target a variety of immune system cells, including innate lymphoid cells, T- and B-cells, myeloid cells (granulocytes, macrophages, and dendritic cells), as well as non-immune cells like epithelial and stromal cells.

There is a pressing need for high-quality, effective means of designing, developing, presenting, implementing, evaluating and maintaining all types of clinical decision support capabilities for clinicians, patients and consumers. Using an iterative, consensus-building process we identified a rank-ordered list of the top 10 grand challenges in clinical decision support. This list was created to educate and inspire researchers, developers, funders and policy-makers. The list of challenges in order of importance that they be solved if patients and organizations are to begin realizing the fullest benefits possible of these systems consists of: improve the human computer interface disseminate best practices in CDS design, development and implementation; summarize patient-level information; prioritize and filter recommendations to the user create an architecture for sharing executable CDS modules and services combine recommendations for patients with co-morbidities prioritize CDS content development and implementation create internet-accessible clinical decision support repositories use free text information to drive clinical decision support mine large clinical databases to create new CDS.