The ethics of using COVID-19 host genomic information for clinical and public health decision-making: A survey of US health professionals.

Several genetic variants linked to COVID-19 have been identified by host genomics researchers. Further advances in this research will likely play a role in the clinical management and public health control of future infectious disease outbreaks. The implementation of genetic testing to identify host genomic risk factors associated with infectious diseases raises several ethical, legal, and social implications (ELSIs).

Management of Uncertainty in Everyday Pediatric Care.

Medicine is filled with uncertainty. Clinicians may experience uncertainty due to limitations in their own or existing medical knowledge. Uncertainty can be scientific, practical, or personal, and may involve issues related to probability, ambiguity, and complexity.

How to "Do Ethics" in Pediatrics Practice: A Framework for Addressing Everyday Ethics Issues.

Pediatricians have a fiduciary responsibility to advocate for the best interests of their patients. They accomplish this through the therapeutic alliance with the patient and their parent. In everyday clinical medicine, the pediatrician may be faced with challenging situations.

Establishing Goals of Care in Serious and Complex Pediatric Illness.

An increasing number of children are living for months and years with serious/complex illness characterized by long-term prognostic uncertainty, intensive interactions with medical systems, functional limitations, and often home medical technologies that shape the child's and family's quality of life. These families face many medical decision points that require intentional and iterative discussions about goals of care. Threats to cohesive goals of care include prognostic uncertainty, diffusion of medical responsibility, individual family context, and blended goals of care.

Pediatrician as Advocate and Protector: An Approach to Medical Neglect for Children with Medical Complexity.

For children with medical complexity (CMC), gaps in medical care can result in significant harm. When concerns for medical neglect arise for CMC, pediatricians may experience ethical challenges in attempting to simultaneously avoid harm, promote well-being, respect family goals and values, and maintain a positive therapeutic relationship. This article proposes an ethics-guided approach to identifying and addressing underlying modifiable risk factors for medical neglect through collaboration with family caregivers and other stakeholders (eg, medical providers, school staff, and community resources).

Everyday Ethics in Ambulatory Pediatrics: Cases and Applications.

This article presents three clinical scenarios that might be encountered in ambulatory pediatrics. The framework for ethical analysis presented by Dr Hughes in a separate article in this issue of the Journal is used to examine these clinical scenarios and demonstrate application of the framework. The three cases involve a physician being asked by parents to write a letter for better housing that would require the doctor to be dishonest; parents who decline to have their 8-month-old daughter vaccinated; and a physician who believes contraception is a sin and therefore would not prescribe it to a sexually active 17-year-old girl.

The Imperative of Ethics in Everyday Clinical Pediatrics.

Clinical ethics is the dimension of bioethics devoted to analyzing competing values and obligations in clinical care, seeking the optimal balance between competing duties. Competence in clinical ethics is particularly important in our current scientific and social environment, where disharmony and challenges between value systems are common and the medical profession suffers from self-imposed risks to integrity and coherence. The ability to bring ethical analysis into the challenges of everyday clinical practice is a crucial component in resolving values conflicts and protecting the clinician-patient relationship that is the heart of our profession.

Parent Perspectives on the Child Experience of Pediatric Home Ventilation via Tracheostomy.

Background And Objective: Parents facing the decision of whether to initiate pediatric mechanical ventilation via tracheostomy ("home ventilation") report wanting information about what to expect for life at home for their child. The study objective is to explore parent descriptions of the child experience of home ventilation to increase awareness for clinicians in the inpatient setting caring for these children.

Methods: Semistructured interviews were conducted using purposive sampling of parents with children who initiated home ventilation within the previous 5 years from 3 geographically diverse academic medical centers.

Addressing Health Disparities in Pediatric Eye Care for School-Age Children: A Call to Action.

Disparities in access to pediatric eye care among school-age children pose significant challenges to their health and well-being; addressing these disparities will necessitate coordination across multiple systems. Although vision screenings are mandated in most US states, differences persist in terms of who receives screenings and subsequent follow-up care. Racial, ethnic, and socioeconomic factors exacerbate the issue, with potential ramifications of unaddressed eye problems on learning performance and the risk of widening preexisting educational disparities.

Exploring the use of self-management strategies for antiretroviral therapy adherence among women with HIV in the Miami-Dade County Ryan White Program.

Women with HIV (WWH) face increased difficulties maintaining adherence to antiretroviral therapy (ART) due to a variety of demographic and psychosocial factors. To navigate the complexities of ART regimens, use of strategies to maintain adherence is recommended. Research in this area, however, has largely focused on adherence interventions, and few studies have examined self-reported preferences for adherence strategies.

Post-epidemic health system recovery: A comparative case study analysis of routine immunization programs in the Republics of Haiti and Liberia.

Large-scale epidemics in resource-constrained settings disrupt delivery of core health services, such as routine immunization. Rebuilding and strengthening routine immunization programs following epidemics is an essential step toward improving vaccine equity and averting future outbreaks. We performed a comparative case study analysis of routine immunization program recovery in Liberia and Haiti following the 2014-16 West Africa Ebola epidemic and 2010s cholera epidemic, respectively.

Identifying Children in Foster Care and Improving Foster Care Documentation in Primary Care.

Background: Children and youth in foster care (CYFC) are a population with special healthcare needs, and the American Academy of Pediatrics has healthcare standards to care for this population, but implementation challenges include identifying clinic patients in foster care (FC). Documentation of FC status in the Electronic Health Record (EHR) can support the identification of CYFC to tailor care delivery. Therefore, we aimed to improve the percentage of CYFC with problem list (PL) documentation of FC status from 20% to 60% within 12 months.

Surgeon Information-Sharing, Parent Verbal Engagement, and Parent Knowledge of Pediatric Adenotonsillectomy.

Objective: We characterize clinician information-sharing and parent verbal engagement during pediatric adenotonsillectomy consultations and evaluate whether these behaviors relate to disease-specific knowledge for parents of children with obstructive sleep-disordered breathing (OSDB).

Study Design: Mixed-methods sequential explanatory analysis.

Setting: Outpatient otolaryngology clinics.

Does the Quality of Behavior Change Counseling in Routine HIV Care Vary According to Topic and Demand?

HIV clinicians face increasing time constraints. Our objective was to describe the prevalence and quality of behavior change counseling within routine HIV visits and to explore whether clinicians may provide lower quality counseling when facing increased counseling demands. We audio-recorded and transcribed encounters between 205 patients and 12 clinicians at an urban HIV primary care clinic.

Simulation for communication training in neonatology.

Communication skills training is a core competency for neonatal-perinatal medicine (NPM) fellows, yet many neonatology fellowship programs do not have formal communication skills curricula. Since the late 1990s, experiential learning that includes role-play and simulation has become the standard for communication training. NPM fellows who receive simulation-based communication skills training report greater comfort with difficult conversations in the NICU.

Ethics of Adaptive Designs for Randomized Controlled Trials.

Over recent decades, adaptive trial designs have been used more and more often for clinical trials, including randomized controlled trials (RCTs). This rise in the use of adaptive RCTs has been accompanied by debates about whether such trials offer ethical and methodological advantages over traditional, fixed RCTs. This study examined how experts on clinical trial methods and ethics believe that adaptive RCTs, compared to fixed ones, affect the ethical character of clinical research.

Ethically cleared to launch?

Rules are needed for human research in commercial spaceflight.