Developing guidelines for ethical response to infectious disease outbreaks in Islamic Republic of Iran.

Background: Ethical considerations are important in pandemic preparedness and response, however, there is a noticeable scarcity of ethical codes that are tailored to disease outbreaks and health emergencies.

Aim: To document the development of guidelines for ethical management of infectious disease outbreaks in Islamic Republic of Iran, as a model for low- and middle-income countries.

Methods: We conducted a non-systematic scoping review on PubMed and Google Scholar for drafting the guidelines for ethical management of infectious disease outbreaks in Islamic Republic of Iran.

Supporting parents' emotional and mental health in the antenatal consultation.

Supporting parents' emotional and mental health is crucial during antenatal consultations, in which expectant parents often receive serious news about their infant and sometimes face complex antenatal or postnatal decision-making. Being considerate of the circumstances to mitigate barriers and stressors, utilizing clear and sensitive language, and personalizing counseling and decision-making to support parents' pluralistic values are strategies that individual neonatologists can use to promote parents' mental wellness in these encounters. Partnership with clinicians of other disciplines and professions in antenatal consultations can help in providing additional medical information and parent support; however, care must be coordinated within the team to ensure that confusing or conflicting counseling is avoided.

Mental health in pregnancy complicated by fetal anomaly: depression screening and referrals in a single fetal care center.

To quantify depression screening rates in a fetal care center, identify characteristics associated with screenings and identify mental health referral uptake rates STUDY DESIGN: This retrospective cohort study of 166 patients in a single fetal care center investigated patients screened during pregnancy with the Edinburgh Postnatal Depression Scale RESULTS: Patients screened positive for depression at a rate of 31.9% using 10 as the cut-off score at their first mental health consult following diagnosis. Patients with a prior mental health diagnosis and lacked insurance or had state insurance were more likely to screen positive.

Disability 4.0: bioethical considerations on the use of embodied artificial intelligence.

Robotics and artificial intelligence have marked the beginning of a new era in the care and integration of people with disabilities, helping to promote their independence, autonomy and social participation. In this area, bioethical reflection assumes a key role at anthropological, ethical, legal and socio-political levels. However, there is currently a substantial diversity of opinions and ethical arguments, as well as a lack of consensus on the use of assistive robots, while the focus remains predominantly on the usability of products.

The self-fulfilling prophecy in medicine.

This article first describes the mechanism of any self-fulfilling prophecy through discussion of its four conditions: credibility, employment, employment sensitivity, and realization. Each condition is illustrated with examples specific to the medical context. The descriptive account ends with the definition of self-fulfilling prophecy and an expansion on collective self-fulfilling prophecies.

Moral Distress and Pediatric Palliative Care.

Moral distress is a complex phenomenon whereby a person feels tension, constraint, or conflict with an action or circumstance because it goes against their individual or the perceived collective (e.g., community, organizational, or professional association's) moral stance.

What Do We Mean by Sharing of Patient Data? DaSH: A Data Sharing Hierarchy of Privacy and Ethical Challenges.

Background:  Clinical data sharing is common and necessary for patient care, research, public health, and innovation. However, the term "data sharing" is often ambiguous in its many facets and complexities-each of which involves ethical, legal, and social issues. To our knowledge, there is no extant hierarchy of data sharing that assesses these issues.

Oversight of Dual-Use Research: What Role for Ethics Committees?

The World Health Organization (WHO) addresses the governance of biorisks, including dual-use research, for countries. It emphasizes engaging multisectoral stakeholders such as governments, scientific bodies, health and research institutes, standard-setting organizations, funding bodies, and others. Ethics constitutes a key component of the framework.

The Ladder of Inference as a tool to reduce implicit bias in pediatric clinical practice.

Implicit bias in healthcare professionals is a widespread phenomenon that leads to worse healthcare outcomes for marginalized patient populations. One tool that can help providers identify when biases are impacting the clinical care they are providing and enable them to take corrective action in real time is the "Ladder of Inference" (LOI). The LOI is an instrument that elucidates the process by which we take in information about another person, filter that data through our own interests, needs, perspectives and biases, and then use it to draw conclusions about the individual.

Equity, inclusion and cultural humility: contemporizing the neonatal intensive care unit family-centered care model.

Existing NICU family centered care models lack the key elements of equity, inclusion and cultural humility. These models were conceived to support families during the stressful life event of an infant's NICU admission. Their development, however, occurred prior to recognition of the medical field's systematic shortcomings in providing equitable care and their impact on outcome disparities for marginalized communities; thus, they do not include cultural or equitable healthcare considerations.

Improving attitudes toward trauma-informed care in the neonatal intensive care unit through comprehensive multi-disciplinary education.

Objective: This study measured staff understanding and integration of trauma-informed care following comprehensive education.

Study Design: This mixed method design used the validated Attitudes Related to Trauma-Informed Care (ARTIC) scale and open-ended survey questions via REDCap optional surveys. Trauma-informed care education was made available to staff members in a level IV NICU.

Access to health care for Afghan immigrants and refugees: an ethico-legal analysis based on the Iranian health law system.

The right to health is an internationally recognized and established human right with a long history of appreciation, indicating that governments should guarantee the highest possible level of access to health and provide health-care serivces with no discrimination based on nationality, race, gender, language or religion. The present study explored this topic using an analytic-descriptive approach. We reviewed related laws, policies and other available documents with the aim to investigate the ethico-legal aspects of Afghan refugees' and immigrants' access to health care and the challenges in in this regard within the Iranian health law system.

Developing a community-led rare disease ELSI research agenda.

Background: Research priorities are best defined through engagement with communities who will be impacted by the research and have lived experience of the topics to be studied. We aimed to establish a pediatric rare disease community stakeholder group and empower them in (1) eliciting perspectives from affected families in the wider region and (2) synthesizing collective ideas into a research agenda focused on shared ethical, legal, and social implications (ELSI) across rare disease.

Methods: This two-year project utilized a community-centered approach to engage rare disease community members as equal partners in developing a research agenda for ELSI in rare disease.

Shared decision-making in pediatric palliative care.

Shared decision-making (SDM) with parents and adolescents is normative in pediatric practice in North America. In this article we discuss how it is applicable to the practice of pediatric palliative care (PPC). As PPC itself is exemplary of patient-and-family-centered care, it often uses a SDM approach in clarifying patient and family preferences, goals, and values.

COVID-19 and Biopolitics: An Essay on Iran.

In the intricate tapestry of Iran's geopolitical, cultural, and economic landscape, the COVID-19 pandemic catalysed profound changes. This essay delves into the multifaceted impact of the pandemic on Iranians' lives, dissecting the specific nuances shaped by the complex biopolitical environment. We unravel the subtle imprints of COVID-19 on the biopolitical discourse, exploring how it intricately intertwines with daily life, social interactions, and the nation's health system.

Preparing ethical review systems for emergencies: next steps.

Ethical review systems need to build on their experiences of COVID-19 research to enhance their preparedness for future pandemics. Recommendations from representatives from over twenty countries include: improving relationships across the research ecosystem; demonstrating willingness to reform and adapt systems and processes; and making the case robustly for better resourcing.

Exploring defensive medicine: examples, underlying and contextual factors, and potential strategies - a qualitative study.

Background: Medical errors, unsatisfactory outcomes, or treatment complications often prompt patient complaints about healthcare providers. In response, physicians may adopt defensive practices to mitigate objections, avoid complaints, and navigate lengthy trial processes or other potential threats. However, such defensive medicine (DM) practices can carry risks, including potential harm to patients and the imposition of unnecessary costs on both patients and the healthcare system.

Perceptions of Rapid Antiretroviral Therapy Initiation Among Participants of The Netherlands Cohort Study on Acute HIV Infection.

Starting antiretroviral therapy (ART) same-day, or as soon as possible after HIV diagnosis is advised in guidelines worldwide. Especially during acute HIV infection (AHI), rapid ART start may be more urgent because of a higher risk of transmission or symptoms of acute retroviral syndrome. During this phase, rapid ART start may have additional benefits for viral reservoir size and host immunity.

The extent of government intervention in the public health system and individual freedoms during the Covid-19 pandemic: a theoretical analysis.

The concept of individual freedom has complex and multifaceted dimensions that significantly affect the limits of permissible government interventions aimed at restricting such freedoms and maintaining public health. Therefore, the boundary between individual freedom and the social obligations of the government must be carefully clarified. During the Covid-19 pandemic, the need for such clarifications clearly increased.

Accompaniment and Bearing Witness: The Path Through Liminal Spaces in Healthcare.

Clinician-healers bear witness to suffering and accompany patients and families through the liminal spaces of an illness experience. Bearing witness to a patient's suffering is a form of attunement toward the ill or hospitalized person. Non-action, or , becomes illustrative of the empathy that develops as clinicians bear witness to the suffering of patients and families.

Buy-in and breakthroughs: the Overton window in neonatology for the resuscitation of extremely preterm infants.

To understand the future of neonatology, it is important to reflect upon the past and the factors that lead to significant advances in the field. In this article, we explore the evolving landscape of neonatology and the shifting practices in the resuscitation of extremely premature infants, with a particular focus on societal influences that have driven these changes. Using the political policy concept of an Overton Window, we explore how breakthroughs move from unthinkable to acceptable practice and how the increasing involvement of parents and their advocacy efforts have played a pivotal role in that progress.

Antiracism: An Ethical Imperative.

Pediatric ethicists hold a privileged position of influence within health care institutions. Such a position confers a corresponding responsibility to address barriers to the health and flourishing of all children. A major barrier to children's health is racism.

Perinatal palliative care in sub-Saharan Africa: recommendations for practice, future research, and guideline development.

Worldwide, sub-Saharan Africa has the highest burden of global neonatal mortality (43%) and neonatal mortality rate (NMR): 27 deaths per 1,000 live births. The WHO recognizes palliative care (PC) as an integral, yet underutilized, component of perinatal care for pregnancies at risk of stillbirth or early neonatal death, and for neonates with severe prematurity, birth trauma or congenital anomalies. Despite bearing a disproportionate burden of neonatal mortality, many strategies to care for dying newborns and support their families employed in high-income countries (HICs) are not available in low-and-middle-income countries (LMICs).