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Ethics pediatrics

H Olschewski, J Behr, H Bremer, M Claussen, P Douschan, M Halank, M Held, M M Hoeper, S Holt, H Klose, S Krüger, T J Lange, F Reichenberger, D Skowasch, S Ulrich, H Wilkens, W Seeger
The 2015 European Guidelines on Pulmonary Hypertension did not cover only pulmonary arterial hypertension (PAH) but also some aspects of pulmonary hypertension (PH) associated with chronic lung disease. The European Guidelines point out that the drugs currently used to treat patients with PAH (prostanoids, endothelin receptor antagonists, phosphodiesterase-5 inhibitors, sGC stimulators) have not been sufficiently investigated in other forms of PH. Therefore, the European Guidelines do not recommend the use of these drugs in patients with chronic lung disease and PH...
October 2016: Deutsche Medizinische Wochenschrift
Diana Karpman, Peter Höglund
Orphan drugs designed to treat rare diseases are often overpriced per patient. Novel treatments are sometimes even more expensive for patients with ultra-rare diseases, in part due to the limited number of patients. Pharmaceutical companies that develop a patented life-saving drug are in a position to charge a very high price, which, at best, may enable these companies to further develop drugs for use in rare disease. However, is there a limit to how much a life-saving drug should cost annually per patient? Government interventions and regulations may opt to withhold a life-saving drug solely due to its high price and cost-effectiveness...
October 13, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Noor A A Giesbertz, Karen Melham, Jane Kaye, Johannes J M van Delden, Annelien L Bredenoord
Pediatric biobanking is considered important for generating biomedical knowledge and improving (pediatric) health care. However, the inclusion of children's samples in biobanks involves specific ethical issues. One of the main concerns is how to appropriately engage children in the consent procedure. We suggest that children should be involved through a personalized assent procedure, which means that both the content and the process of assent are adjusted to the individual child. In this paper we provide guidance on how to put personalized assent into pediatric biobanking practice and consider both the content and process of personalized assent...
October 12, 2016: BMC Medical Ethics
Maria Claudia Rodríguez, Perla Villamor, Tatiana Castillo
INTRODUCTION: Pain is a disease by itself and it's a public health concern of major implication in children, not just because of the emotional component of the child and his family, but also due to the potential morbidity and mortality involving it. A proper assessment of pain it's a challenge in the pediatric population, due to their lack of understanding and verbalization of hurt. Additionally, a satisfactory treatment of pediatric pain can be arduous due to a lack of clinical knowledge, insufficient pediatric research, and the fear to opioid side effects and addiction...
November 2016: International Journal of Pediatric Otorhinolaryngology
Evelyn Hsu, George V Mazariegos
Current literature and policy in pediatric liver allocation and organ procurement are reviewed here in narrative fashion, highlighting historical context, ethical framework, technical/procurement considerations and support for a logical way forward to an equitable pediatric liver allocation system that will improve pediatric wait-list and post-transplant outcomes without adversely affecting adults. Where available, varying examples of successful international pediatric liver allocation and split liver policy will be compared to current US policy to highlight potential strategies that can be considered globally...
October 5, 2016: Liver Transplantation
Caroline Petit, Adeline Samson, Satoshi Morita, Moreno Ursino, Jérémie Guedj, Vincent Jullien, Emmanuelle Comets, Sarah Zohar
The number of trials conducted and the number of patients per trial are typically small in paediatric clinical studies. This is due to ethical constraints and the complexity of the medical process for treating children. While incorporating prior knowledge from adults may be extremely valuable, this must be done carefully. In this paper, we propose a unified method for designing and analysing dose-finding trials in paediatrics, while bridging information from adults. The dose-range is calculated under three extrapolation options, linear, allometry and maturation adjustment, using adult pharmacokinetic data...
October 4, 2016: Statistical Methods in Medical Research
Hanh Nguyen-Thi-Bich, Huong Duong-Thi-Ly, Vu Thi Thom, Nhung Pham-Thi-Hong, Long Doan Dinh, Huong Le-Thi-Minh, Timothy John Craig, Sy Duong-Quy
INTRODUCTION: Fractional exhaled nitric oxide (FENO) is a biomarker of airway inflammation in asthma. The measurement of FENO is utilized to assist in the diagnosis and treatment of children with asthma, especially for those treated with inhaled corticosteroids. OBJECTIVES: The aims of this study were to evaluate the correlations between FENO and atopic status, blood eosinophil levels, FCER2 mutation, and asthma control in Vietnamese children. SUBJECTS AND METHODS: This was a prospective and descriptive study approved by the local Ethical Board...
2016: Journal of Asthma and Allergy
Nooshin Razani, Michael A Kohn, Nancy M Wells, Doug Thompson, Hanna Hamilton Flores, George W Rutherford
BACKGROUND: Contact with nature improves human health; stress reduction is a mediating pathway. Stay Healthy in Nature Everyday (SHINE) is a stress reduction and health promotion intervention for low-income families at an urban Federally Qualified Health Center. We plan to evaluate two service-delivery models for SHINE and present here the intervention design and evaluation protocol. METHODS: Behavioral change theory and environmental education literature informed the intervention...
September 29, 2016: Contemporary Clinical Trials
Karthik Narayanan Ramaswamy, Sunit Singhi, Muralidharan Jayashree, Arun Bansal, Karthi Nallasamy
OBJECTIVE: We compared efficacy of dopamine and epinephrine as first-line vasoactive therapy in achieving resolution of shock in fluid-refractory hypotensive cold septic shock. DESIGN: Double-blind, pilot, randomized controlled study. SETTING: Pediatric emergency and ICU of a tertiary care teaching hospital. PATIENTS: Consecutive children 3 months to 12 years old, with fluid-refractory hypotensive septic shock, were enrolled between July 2013 and December 2014...
September 23, 2016: Pediatric Critical Care Medicine
Koji Hashimoto, Masato Fujiki, Cristiano Quintini, Federico N Aucejo, Teresa Diago Uso, Dympna M Kelly, Bijan Eghtesad, John J Fung, Charles M Miller
Split liver transplantation (SLT), while widely accepted in pediatrics, remains underutilized in adults. Advancements in surgical techniques and donor-recipient matching, however, have allowed expansion of SLT from utilization of the right trisegment graft to now include use of the hemiliver graft as well. Despite less favorable outcomes in the early experience, better outcomes have been reported by experienced centers and have further validated the feasibility of SLT. Importantly, more than two decades of experience have identified key requirements for successful SLT in adults...
September 7, 2016: World Journal of Gastroenterology: WJG
Susanna Esposito, Rossana Tenconi, Valentina Preti, Elena Groppali, Nicola Principi
BACKGROUND: The concomitant incidence of cancer and pregnancy has increased in recent years because of the increase in maternal age at the time of the 1st pregnancy. The diagnosis of cancer in a pregnant woman causes ethical and therapeutic problems for both the patient and the physician. The main aim of this paper is to describe the available evidence concerning the short- and long-term neonatal impact of chemotherapy given to pregnant women. METHODS: The relevant publications in English were identified by a systematic review of MEDLINE and PubMed for the last 15 years...
September 2016: Medicine (Baltimore)
Nikki Keene Woods
There are many different professional stances on safe sleep and then there is the reality of caring for a newborn. There is a debate among professionals regarding safe sleep recommendations. The continum of recommendations vary from the American Academy of Pediatrics (AAP) Safe Sleep Guidelines to the bed-sharing recommendations from the Mother-Baby Behavioral Sleep Laboratory. The lack of consistent and uniform safe sleep recommendations from health professionals has been confusing for families but has more recently raised a real professional ethical dilemma...
September 22, 2016: Journal of Primary Care & Community Health
Clara Hartmanshenn, Megerle Scherholz, Ioannis P Androulakis
Personalized medicine strives to deliver the 'right drug at the right dose' by considering inter-person variability, one of the causes for therapeutic failure in specialized populations of patients. Physiologically-based pharmacokinetic (PBPK) modeling is a key tool in the advancement of personalized medicine to evaluate complex clinical scenarios, making use of physiological information as well as physicochemical data to simulate various physiological states to predict the distribution of pharmacokinetic responses...
October 2016: Journal of Pharmacokinetics and Pharmacodynamics
Amanda Martin, Kira Becker, Martina Darragh, James Giordano
BACKGROUND: Neuroethics describes several interdisciplinary topics exploring the application and implications of engaging neuroscience in societal contexts. To explore this topic, we present Part 3 of a four-part bibliography of neuroethics' literature focusing on the "ethics of neuroscience." METHODS: To complete a systematic survey of the neuroethics literature, 19 databases and 4 individual open-access journals were employed. Searches were conducted using the indexing language of the U...
2016: Philosophy, Ethics, and Humanities in Medicine: PEHM
K Martakis, K Czabanowska, P Schröder-Bäck
BACKGROUND: Ethics education rarely exists in pediatric resident curricula, although ethical conflicts are common in the clinical practice. Ethics education can prepare residents to successfully handle these conflicts. AIM: We searched for methods in teaching ethics to clinical and especially pediatric residents, and identified recurring barriers to ethics teaching and solutions to overcome them. DESIGN: Literature from 4 electronic databases with peer-reviewed articles was screened in 3 phases and analyzed...
September 2016: Klinische Pädiatrie
Jeffrey R Botkin
PURPOSE OF REVIEW: Developments in genetic test technologies enable a detailed analysis of the genomes of individuals across the range of human development from embryos to adults with increased precision and lower cost. These powerful technologies raise a number of ethical issues in pediatrics, primarily because of the frequent lack of clinical utility of genetic information, the generation of secondary results and questions over the proper scope of parental authority for testing. RECENT FINDINGS: Several professional organizations in the fields of genetics and pediatrics have published new guidance on the ethical, legal, and policy issues relevant to genetic testing in children...
September 6, 2016: Current Opinion in Pediatrics
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No abstract text is available yet for this article.
October 1, 2016: Archivos Argentinos de Pediatría
Paul E Croarkin, Alexander Rotenberg
This special issue surveys recent work and underscores the challenges of psychiatric brain stimulation research with child and adolescent populations. The field of child and adolescent psychopharmacology is replete with examples of potential pitfalls in the assumption that "children are little adults." Arguably, younger age portends more neurobiological and descriptive heterogeneity in research pursuits and clinical practice. For existing brain stimulation modalities, there are a paucity of translational models to design studies for youth and no well-studied dosing schemes...
September 2016: Journal of Child and Adolescent Psychopharmacology
Felipe Damiani, Gabriel Rada, Juan Cristóbal Gana, Pablo E Brockmann, Gigliola Alberti
INTRODUCTION: Adenotonsillar hypertrophy is the most important anatomical factor associated with obstructive sleep apnoea syndrome in children. The American Academy of Pediatrics recommends adenotonsillectomy as the first line of treatment. AT can reduce the apnoea hypopnoea index; however, its effect on long-term outcomes remains unclear. METHODS AND ANALYSIS: We will conduct an electronic search for randomised controlled trials in MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE...
2016: BMJ Open
Mark C Navin
Techniques from behavioral economics-nudges-may help physicians increase pediatric vaccine compliance, but critics have objected that nudges can undermine autonomy. Since autonomy is a centrally important value in healthcare decision-making contexts, it counts against pediatric vaccination nudges if they undermine parental autonomy. Advocates for healthcare nudges have resisted the charge that nudges undermine autonomy, and the recent bioethics literature illustrates the current intractability of this debate...
September 1, 2016: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
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