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John lantos

John D Lantos
No abstract text is available yet for this article.
March 13, 2018: Journal of Pediatrics
Johan Bester, Maya Sabatello, Clara D M van Karnebeek, John D Lantos
A 38-year-old woman is diagnosed with Li-Fraumeni syndrome, an autosomal dominant genetic condition that predisposes to a variety of cancers. The woman has an 11-year-old daughter. The geneticist recommends that the child be tested for the Li-Fraumeni genetic variant. The mother is concerned about the impact of testing and diagnosis on Karen's psychological well-being. She describes Karen as "highly strung" and as "a worrier." The child has been diagnosed with an anxiety disorder and is managed by a psychologist for counseling...
March 13, 2018: Pediatrics
Laurel Willig, Erin Paquette, D Micah Hester, Bradley A Warady, John D Lantos
A 3-month-old boy with failure to thrive was referred to a nephrology clinic after a diagnostic workup for failure to thrive revealed a serum urea nitrogen level of 95 mg/dL and creatinine level of 3.6 mg/dL. A renal ultrasound revealed marked bilateral hydronephrosis with little remaining renal cortex in either kidney. A voiding cystourethrogram revealed evidence of posterior urethral valves. The child had no evident comorbidities. Fulguration of the valves was successfully performed but did not lead to improvement in kidney function...
February 28, 2018: Pediatrics
Maya Sabatello, Annie Janvier, Eduard Verhagen, Wynne Morrison, John Lantos
No abstract text is available yet for this article.
March 2018: American Journal of Bioethics: AJOB
John Lantos
This paper discusses the inevitable ambiguity of the language that we use to describe events that are rare and emotionally devastating. A search for precision in such circumstances may distract from more important issues. Neither families nor doctors need more precise language. Instead, they need more trust, more emotional transparency, and a recognition by doctors of the tragic nature of the decision they face.
2018: Perspectives in Biology and Medicine
Manya J Hendriks, John D Lantos
There is an inconsistency in the ways that doctors make clinical decisions regarding the treatment of babies born extremely prematurely. Many experts now recommend that clinical decisions about the treatment of such babies be individualized and consider many different factors. Nevertheless, many policies and practices throughout Europe and North America still appear to base decisions on gestational age alone or on gestational age as the primary factor that determines whether doctors recommend or even offer life-sustaining neonatal intensive care treatment...
January 25, 2018: Bioethics
Marije Brouwer, Christopher Kaczor, Margaret P Battin, Els Maeckelberghe, John D Lantos, Eduard Verhagen
Voluntary active euthanasia for adults at their explicit request has been legal in Belgium and the Netherlands since 2002. In those countries, acceptance of the practice for adults has been followed by acceptance of the practice for children. Opponents of euthanasia see this as a dangerous slippery slope. Proponents argue that euthanasia is sometimes ethically appropriate for minors and that, with proper safeguards, it should be legally available in appropriate circumstances for patients at any age. In this Ethics Rounds, we asked philosophers from the United States and the Netherlands, and a Dutch pediatrician, to discuss the ethics of legalizing euthanasia for children...
February 2018: Pediatrics
Arpana Iyengar, Sanjiv Lewin, John D Lantos
Poor families without health insurance present unique challenges for pediatricians who want to do what is best for the children who are their patients. Families are often willing to make tremendous sacrifices to pay for recommended and needed medical care. Physicians may have to decide whether, or how strongly to, recommend expensive treatments, especially when any good outcomes associated with such treatments are not guaranteed. How should we balance the considerations of justice and of the child's best interest with the grim realities facing poor families? In this article, we present a case from a tertiary care hospital in India in which doctors and parents struggled to figure out the best options for a young man with end stage renal disease...
January 2018: Pediatrics
Helen Lee, Peter Milgrom, Colleen E Huebner, Philip Weinstein, Wylie Burke, Erika Blacksher, John D Lantos
Early childhood caries (ECC) is the single most common chronic childhood disease. In the treatment of ECC, children are often given moderate sedation or general anesthesia. An estimated 100 000 to 250 000 pediatric dental sedations are performed annually in the United States. The most common medications are benzodiazepines, opioids, local anesthetics, and nitrous oxide. All are associated with serious adverse events, including hypoxemia, respiratory depression, airway obstruction, and death. There is no mandated reporting of adverse events or deaths, so we don't know how often these occur...
December 2017: Pediatrics
John Lantos
No abstract text is available yet for this article.
November 2017: American Journal of Bioethics: AJOB
Mark Kuczewski, John D Lantos, Zarna Patel
No abstract text is available yet for this article.
January 2018: Pediatrics
Ryan M Antiel, Alan W Flake, Christopher A Collura, Mark P Johnson, Natalie E Rintoul, John D Lantos, Farr A Curlin, Jon C Tilburt, Stephen D Brown, Chris Feudtner
OBJECTIVES: The ethics of maternal-fetal surgery involves weighing the importance of potential benefits, risks, and other consequences involving the pregnant woman, fetus, and other family members. We assessed clinicians' ratings of the importance of 9 considerations relevant to maternal-fetal surgery. METHODS: This study was a discrete choice experiment contained within a 2015 national mail-based survey of 1200 neonatologists, pediatric surgeons, and maternal-fetal medicine physicians, with latent class analysis subsequently used to identify groups of physicians with similar ratings...
December 2017: Pediatrics
John D Lantos
The SUPPORT study (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments), sponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development to evaluate different oxygen saturation targets for extremely premature babies, led to a national controversy that was surprisingly public, intense, and polarizing. This article describes the study design, the study outcomes, and the key issues. I conclude that the controversy was based on two different views of the clinical investigator...
October 30, 2017: Seminars in Fetal & Neonatal Medicine
Donald Cochran, Sarosh Saleem, Sumaira Khowaja-Punjwani, John D Lantos
There are more migrants, refugees, and immigrants adrift in the world today than at any time in the recent past. Doctors and hospitals must care for people from many different cultures, countries, and religious backgrounds. We sometimes find our own deeply held beliefs and values challenged. In this "Ethics Rounds," we present a case in which a Pakistani immigrant family faces a tragic medical situation and wants to deal with it in ways that might be normative in their own culture but are aberrant in ours. We asked the American doctors and 2 Pakistani health professionals to think through the issues...
November 2017: Pediatrics
Ryan M Antiel, Farr A Curlin, John D Lantos, Christopher A Collura, Alan W Flake, Mark P Johnson, Natalie E Rintoul, Stephen D Brown, Chris Feudtner
BACKGROUND: While prenatal surgery historically was performed exclusively for lethal conditions, today intrauterine surgery is also performed to decrease postnatal disabilities for non-lethal conditions. We sought to describe physicians' attitudes about prenatal surgery for lethal and non-lethal conditions and to elucidate characteristics associated with these attitudes. METHODS: Survey of 1200 paediatric surgeons, neonatologists and maternal-fetal medicine specialists (MFMs)...
October 10, 2017: Journal of Medical Ethics
Brian Carter, Manuel Brockman, Jeremy Garrett, Angie Knackstedt, John Lantos
In most children's hospitals, there are very few ethics consultations, even though there are many ethically complex cases. We hypothesize that the reason for this may be that hospitals develop different mechanisms to address ethical issues and that many of these mechanisms are closer in spirit to the goals of the pioneers of clinical ethics than is the mechanism of a formal ethics consultation. To show how this is true, we first review the history of collaboration between philosophers and physicians about clinical dilemmas...
October 3, 2017: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
Cécile Rousseau, B Heidi Ellis, John D Lantos
Parents, educators, law enforcement officials, and health professionals are all concerned about the violent radicalization of adolescents. Health professionals may be called on to assess teenagers regarding the risk that they will become dangerous. We present a case in which a psychiatrist is asked to do a forensic evaluation of a young adolescent who said troubling things and had some concerning posts on his Facebook page. The evaluation reveals things about both the young boy and his community.
October 2017: Pediatrics
Sosha Chaney, John D Lantos
A poor, African-American mother describes the difficulties that she has in getting a comprehensive medical evaluation for her child in an Emergency Room. Eventually, she finds the care and the caring that she needs at a medical clinic in a community health center.
August 14, 2017: Current Problems in Pediatric and Adolescent Health Care
Sumaira Khowaja-Punjwani, Charlotte Smardo, Monica Rita Hendricks, John D Lantos
Nearly 20% of nurses leave their first job within a year of being hired. Many do so because they perceive the work environment to be unhealthy or nonsupportive. Nurse turnover is costly. When new nurses leave within 3 years of being hired, it costs the hospital $64 000, over and above salaries, to replace them. One of the hallmarks of an unhealthy work environment is poor communication between doctors and nurses. We present a case in which a nurse advocates for a young mother by questioning the doctor. She is reprimanded for doing so...
September 2017: Pediatrics
M Denise Dowd, John D Lantos
Children living in poverty in the United States in 2016 face a devastating combination of psychological problems. Their neighborhoods are often violent. They have no place to get healthy food. It is not safe to play outside, even on playgrounds. The children who grow up in this environment, not surprisingly, have many adverse childhood experiences (ACEs). ACEs cause toxic stress. Toxic stress leads to long-term physical and psychological problems. For many pediatricians, children's hospitals, civic leaders, and public health officials, it is difficult to know how to intervene...
August 11, 2017: Current Problems in Pediatric and Adolescent Health Care
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