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Medication adherence among patients with prostate cancer prescribed luteinizing hormone-releasing hormone agonists in England: Primary results from a real-world, retrospective cohort study. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02532-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
Oral health is a critical part of overall health. The current COVID-19 pandemic has highlighted the importance of oral health. In this article, we describe how dental practice has been impacted by COVID-19, identify the public health response to COVID-19, and explain the gradual resumption of dental care after the initial disruption due to the pandemic. Finally, we discuss how long-standing health disparities in oral health have been exacerbated by the current pandemic.
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Can Parents Restrict Access to Their Adolescent's Voice?: Deciding About a Tracheostomy. Pediatrics 2021; 147:peds.2021-050358. [PMID: 33785636 DOI: 10.1542/peds.2021-050358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 11/24/2022] Open
Abstract
Parents are the default decision-makers for their infants and children. Their decisions should be based on the best interests of their children. Differing interpretations of children's best interests may be a source of conflict. Providers' biased evaluations of patients' quality of life may undermine medicine's trustworthiness. As children mature, they should participate in medical decision-making to the extent that is developmentally appropriate. In this month's Ethics Rounds, physicians, a philosopher, and a lawyer consider parents' demand, supported by the hospital's legal department, that their 17-year-old son be excluded from a potentially life-and-death medical decision.
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Abstract
Increasing use of social media by patients and clinicians creates opportunities as well as dilemmas for pediatricians, who must recognize the inherent ethical and legal complexity of these communication platforms and maintain professionalism in all contexts. Social media can be a useful tool in the practice of medicine by educating both physicians and patients, expanding access to health care, identifying high-risk behaviors, contributing to research, promoting networking and online support, enhancing advocacy, and nurturing professional compassion. At the same time, there are confidentiality, privacy, professionalism, and boundary issues that need to be considered whenever potential interactions occur between physicians and patients via social media. This clinical report is designed to assist pediatricians in identifying and navigating ethical issues to harness the opportunities and avoid the pitfalls of social media.
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Transitioning from Adolescence to Adulthood with Autism Spectrum Disorder: An Overview of Planning and Legal Issues. Psychiatr Clin North Am 2020; 43:723-733. [PMID: 33127004 DOI: 10.1016/j.psc.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The transition to adulthood is complex. It is defined by many objective and subjective milestones. Transition from adolescence to young adulthood is challenging for both neurotypical individuals and individuals with autism spectrum disorders. However, for autistic individuals, this transition is even more complicated and poses a range of legal and ethical considerations. This article discusses how existing legal and social constructs may exacerbate rather than diminish barriers and access for autistic adults and identifies current and potential legal and policy solutions to reducing current systemic barriers. This article ultimately supports a supported decision-making model for autistic adolescents transitioning into adulthood.
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Professional Obligations of Clinicians and Institutions in Pediatric Care Settings during a Public Health Crisis: A Review. J Pediatr 2020; 224:10-15. [PMID: 32585238 PMCID: PMC7308757 DOI: 10.1016/j.jpeds.2020.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 11/24/2022]
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The Ethics of Creating a Resource Allocation Strategy During the COVID-19 Pandemic. Pediatrics 2020; 146:peds.2020-1243. [PMID: 32366610 DOI: 10.1542/peds.2020-1243] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease 2019 pandemic has affected nearly every aspect of medicine and raises numerous moral dilemmas for clinicians. Foremost of these quandaries is how to delineate and implement crisis standards of care and, specifically, how to consider how health care resources should be distributed in times of shortage. We review basic principles of disaster planning and resource stewardship with ethical relevance for this and future public health crises, explore the role of illness severity scoring systems and their limitations and potential contribution to health disparities, and consider the role for exceptionally resource-intensive interventions. We also review the philosophical and practical underpinnings of crisis standards of care and describe historical approaches to scarce resource allocation to offer analysis and guidance for pediatric clinicians. Particular attention is given to the impact on children of this endeavor. Although few children have required hospitalization for symptomatic infection, children nonetheless have the potential to be profoundly affected by the strain on the health care system imposed by the pandemic and should be considered prospectively in resource allocation frameworks.
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Like Autism, Representation Falls on a Spectrum. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:4-5. [PMID: 32223638 DOI: 10.1080/15265161.2020.1735871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Transitioning from Adolescence to Adulthood with Autism Spectrum Disorder: An Overview of Planning and Legal Issues. Child Adolesc Psychiatr Clin N Am 2020; 29:399-408. [PMID: 32169269 DOI: 10.1016/j.chc.2019.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The transition to adulthood is complex. It is defined by many objective and subjective milestones. Transition from adolescence to young adulthood is challenging for both neurotypical individuals and individuals with autism spectrum disorders. However, for autistic individuals, this transition is even more complicated and poses a range of legal and ethical considerations. This article discusses how existing legal and social constructs may exacerbate rather than diminish barriers and access for autistic adults and identifies current and potential legal and policy solutions to reducing current systemic barriers. This article ultimately supports a supported decision-making model for autistic adolescents transitioning into adulthood.
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Enhancing shared decision making in assisted reproductive technologies through the use of multimedia platforms for informed consent. Fertil Steril 2018; 110:1267-1268. [PMID: 30503121 DOI: 10.1016/j.fertnstert.2018.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 09/24/2018] [Indexed: 11/28/2022]
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Distinguishing between law and ethics. J Am Dent Assoc 2018; 149:1005-1006. [PMID: 30497572 DOI: 10.1016/j.adaj.2018.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 11/15/2022]
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What's in a Name? The Ethical Importance of Respecting a Patient's "Unexplained" Medical Concerns. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:1-2. [PMID: 29697331 DOI: 10.1080/15265161.2018.1461467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Abstract
The hospice philosophy embraces palliative care for the terminally ill, for whom quality of life is the central focus of comfort care management. Often, caregivers hesitate or simply do not elect to extend oral care for patients nearing the end of life, due to difficulties encountered in patient compliance, a sense of futility in doing so, staff time constraints in prioritizing care, underfunding, or a lack of education as to how and why such care should be delivered to the hospice patient. This article aims to show physiological and psychosocial reasons why the hospice patient has a need for properly and regularly implemented oral care and why dental professionals have an ethical responsibility to address the current void that exists in hospice-centered oral care. Varying viewpoints are discussed regarding the need for oral health monitoring and maintenance in both the capable patient with capacity and in the patient who lacks capacity and is totally dependent, yet who exhibits no particular signs of oral distress nor desire for hygiene measures. Consideration is given to family dynamics in such care. Oral care of the elderly patients and terminally ill is sorely lacking, and dental educators are challenged to cultivate in students a sense of professional duty toward caring for the vulnerable elderly patients. Dental professionals should create initiatives in developing, promoting, and implementing an appropriate standard of oral care for the hospice patient.
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Abstract
This is a very delicate age for Cameron, with his eighteenth birthday looming like a big exit sign. Should I establish guardianship? Am I limiting his independence if I do? Am I putting him at risk if I don't? Will he be able to earn a meaningful living and be able to support himself? If not, are there supports available for him, aside from me? These questions weigh heavy on my mind, as time seems to speed up the older Cameron gets. I am encouraged by the pride Cameron shows in his independence, and hope that pride continues to grow, along with his independence.
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Integrating Social Justice for Health Professional Education: Self-reflection, Advocacy, and Collaborative Learning. ACTA ACUST UNITED AC 2015. [DOI: 10.18785/ojhe.1101.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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A preclinical evaluation of the PI3K alpha/delta dominant inhibitor BAY 80-6946 in HER2-positive breast cancer models with acquired resistance to the HER2-targeted therapies trastuzumab and lapatinib. Breast Cancer Res Treat 2014; 149:373-83. [DOI: 10.1007/s10549-014-3239-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 12/10/2014] [Indexed: 01/08/2023]
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Conducting research on social media--is Facebook like the public square? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2014; 14:63-65. [PMID: 25229596 DOI: 10.1080/15265161.2014.947825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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WITHDRAWN: Initiation of the Society for Assisted Reproductive Technology Donor Egg Registry: a report from the Donor Egg Registry Task Force. Fertil Steril 2013:S0015-0282(13)02969-5. [PMID: 24268055 DOI: 10.1016/j.fertnstert.2013.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/08/2013] [Accepted: 08/12/2013] [Indexed: 11/29/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Growing up with autism: challenges and opportunities of parenting young adult children with autism spectrum disorders. Narrat Inq Bioeth 2012; 2:207-211. [PMID: 24406889 DOI: 10.1353/nib.2012.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Frozen embryos: a life-saving option. Fertil Steril 2008; 90:849.e15-6. [DOI: 10.1016/j.fertnstert.2007.07.1374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Revised: 07/25/2007] [Accepted: 07/25/2007] [Indexed: 10/22/2022]
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Who is the parent in cloning? HOFSTRA LAW REVIEW 2003; 27:533-55. [PMID: 12650149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
In July 1996, a sheep named Dolly was born in Scotland. What makes Dolly's birth noteworthy is that she is the result of the first successful cloning attempt using the nucleus of an adult cell. The technique that led to Dolly's birth involved transferring the nucleus of a mammary cell from an adult sheep to the enucleated egg cell of an unrelated sheep with gestation occurring in a third sheep. The possibility of applying this technique to human reproduction raised concerns worldwide with several countries moving for an immediate bans on human cloning. In the United States, President Clinton requested that the National Bioethics Advisory Commission ("NBAC"), a multidisciplinary group composed of scientists, lawyers, educators, theologians, and ethicists study the implications of cloning and issue recommendations. The Commission consulted other scientists, ethicists, theologians, lawyers, and citizens with interests in this advancing technology and concluded that, "at this time it is morally unacceptable for anyone in the public or private sector, whether in a research or clinical setting, to attempt to create a child using somatic cell nuclear transfer cloning." This Article was included in a larger work prepared at the request of, and submitted to the Commission by, law professor Lori B. Andrews. Cloning through nuclear transfer will change the way we create and define families. This Article explores how existing law relating to parentage, surrogacy, egg donation, and artificial insemination may apply in the cloning context to clarify the parent-child relationship established through cloning.
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Lawsuits against IRBs: accountability or incongruity? THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2001; 29:220-228. [PMID: 11508198 DOI: 10.1111/j.1748-720x.2001.tb00342.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Pressure is mounting to hold researchers and research institutions accountable for the protection of human subjects. When subjects or their family members believe they have been injured, they are increasingly willing to file lawsuits. Recent cases indicate that institutional review boards (IREs) and their members may be pulled more and more into the legal fray.On September 17, 1999, 18-year-old Jesse Gelsinger died while participating in research conducted by the University of Pennsylvania's Institute for Gene Therapy. Gelsinger was involved in a Phase I clinical trial testing a new approach to treatment of ornithine transcarbamylase deficiency (OTC), a rare metabolic disorder. Although infants affected by the severe form of OTC die shortly after birth, Gelsinger suffered from a relatively mild form. It appears undisputed that the cause of Gelsinger's death was not the disorder itself, but multiple organ system failure triggered by the virus used to carry new genetic material into his system.
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Less is more: the risks of multiple births. The Institute for Science, Law, and Technology Working Group on Reproductive Technology. Fertil Steril 2000; 74:617-23. [PMID: 11020494 DOI: 10.1016/s0015-0282(00)00713-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To review the medical, social, and financial risks caused by the birth of multiples that need to be addressed in policy and practice. RESULT(S) Many risks of multiple births are described in the literature. The medical risks to the offspring include death, low birth weight, deformational plagiocephaly, and other physical and mental disabilities. Risks to the women include premature labor, premature delivery, pregnancy-induced hypertension, toxemia, gestational diabetes, and vaginal-uterine hemorrhage. Children born in multiples face difficulty socializing, developmental delays, and behavioral problems, whereas their parents risk exhaustion, depression, and anxiety. In addition to personal costs faced by families, society often bears the financial costs of overburdened hospitals, caps on insurance and/or inability of parents to cover expenses. CONCLUSION(S) Multiple births present potential acute and long-term medical risks to the pregnant woman and her children. However, more long-term follow-up research and more research on outcomes with higher-order multiples are needed. In designing practices and policies to improve the success of IVF while reducing the risk of multiples, it is important to balance the many interests involved. At a minimum, providers and patients need to be educated about the risks of multiple gestation so that steps can be taken to prevent adverse outcomes.
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Adoption, reproductive technologies, and genetic information. HEALTH MATRIX (CLEVELAND, OHIO : 1991) 1999; 8:125-51. [PMID: 10182215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Cloning position paper of the IIT Institute for Science, Law and Technology Working Group on Reproductive Technologies. SOUTHERN CALIFORNIA INTERDISCIPLINARY LAW JOURNAL 1998; 8:87-101. [PMID: 15085833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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