Ethical considerations regarding classroom use of personal genomic information.

Rapidly decreasing costs of genetic technologies-especially next-generation sequencing-and intensifying need for a clinical workforce trained in genomic medicine have increased interest in having students use personal genomic information to motivate and enhance genomics education. Numerous ethical issues attend classroom/pedagogical use of students' personal genomic information, including their informed decision to participate, pressures to participate, privacy concerns, and psychosocial sequelae of learning genomic information. This paper addresses these issues, advocates explicit discussion of these issues to cultivate students' ethical reasoning skills, suggests ways to mitigate potential harms, and recommends collection of ethically relevant data regarding pedagogical use of personal genomic information.

Early intervention in pregnant women with elevated anxiety and depressive symptoms: efficacy of a cognitive-behavioral group program.

To examine whether a cognitive-behavioral group program among pregnant women with elevated levels of anxiety or depression may reduce anxious and depressive symptoms and has a positive impact on risk factors for anxiety disorders and depression. A total of 753 participants were recruited. After completion of the clinical standardized interview, 160 participants were randomized to an intervention group or a control condition.

Effect of dementia on the use of drugs for secondary prevention of ischemic heart disease.

Background. Dementia and cardiovascular disease (CVD) are frequently comorbid. The presence of dementia may have an effect on how CVD is treated.

Managing incidental genomic findings in clinical trials: fulfillment of the principle of justice.

Rafael Dal-Ré and colleagues discuss how incidental findings are likely to be viewed as potential benefits of research participation in genomics trials, and investigators should implement mechanisms to ensure provision of timely and appropriate care. Ensuring provision of such interventions in countries lacking a universal public health care system may prove challenging.

Laboratory informatics based evaluation of methylene tetrahydrofolate reductase C677T genetic test overutilization.

Background: Laboratory data can provide a wide range of information to estimate adherence to guidelines and proper utilization of genetic testing. The methylene tetrahydrofolate reductase (MTHFR) C677T variant has been demonstrated to have negligible utility in patient management. However, the testing of this variant remains pervasive.

"Everyday ethics" in the care of hospitalized older adults.

As the U.S. population ages, the proportion of hospitalized patients older than 65 years will continue to increase with a significant number likely to have some degree of cognitive impairment.

Ethical dimensions of disparities in depression research and treatment in the pharmacogenomic era.

Disparities in access to, and utilization of, treatment for depression among African-American and Caucasian elderly adults have been well-documented. Less fully explored are the multidimensional factors responsible for these disparities. The intersection of cultural constructs, socioeconomic factors, multiple levels of racism, and stigma attending both mental health issues and older age may help to explain disparities in the treatment of the depressed elderly.

Incidental findings in the use of DNA to identify human remains: an ethical assessment.

DNA analysis is increasingly used to identify the remains of victims of conflicts and disasters. This is especially true in cases where remains are badly damaged and fragmented, or where antemortem records are unavailable. Incidental findings (IFs)-that is, genetics-related information for which investigators were not looking-may result from these identification efforts employing DNA analysis.

In sport and social justice, is genetic enhancement a game changer?

The possibility of genetic enhancement to increase the likelihood of success in sport and life's prospects raises questions for accounts of sport and theories of justice. These questions obviously include the fairness of such enhancement and its relationship to the goals of sport and demands of justice. Of equal interest, however, is the effect on our understanding of individual effort, merit, and desert of either discovering genetic contributions to components of such effort or recognizing the influence of social factors on the development and exercise of individual effort.

The ethics and reality of rationing in medicine.

Rationing is the allocation of scarce resources, which in health care necessarily entails withholding potentially beneficial treatments from some individuals. Rationing is unavoidable because need is limitless and resources are not. How rationing occurs is important because it not only affects individual lives but also expresses society's most important values.

Practicing preventive ethics, protecting patients: challenges of the electronic health record.

Implementation of guidelines regarding breaches of electronic health information requires an anticipatory stance and physician and patient education regarding security and monitoring measures and methods of redress. Adopting a preventive ethics, rather than a crisis management, model may also increase physician awareness of how the information they choose to include and privilege within the health record may expose patients to added harms if not done mindfully.

Health disparities and healthcare reform.

Healthcare reform continues to be an issue facing the American people whether they are politicians, healthcare providers, healthcare administrators, or patients and their families. Questions that are being addressed focus on improving access, reducing costs, delivering quality care, and having a more equitable distribution of benefits and burdens. Those persons who experience health disparities are more negatively affected by the current healthcare system, underscoring the need for reform.

How confidential is confidential?

Violations of patient confidentiality occur all too frequently. Conversations about patients and their care can be heard throughout hospitals. Although these conversations are necessary to manage the care of patients, the breach of confidentiality is of concern because of where the discussions occur and what is being communicated in public places.

Outcomes Associated With Delirium in Older Patients in Surgical ICUs.

Background: We previously noted that older adults admitted to surgical ICUs (SICUs) are at high risk for delirium. In the current study, we describe the association between the presence of delirium and complications in older SICU patients, and describe the association between delirium occurring in the SICU and functional ability and discharge placement for older patients.

Methods: Secondary analysis of prospective, observational, cohort study.

The association between changes in health status and nursing home resident quality of life.

Purpose: Previous research on nursing home resident quality of life (QOL) has mainly been cross-sectional. This study examined the association between changes in QOL and changes in resident clinical factors.

Design And Methods: A longitudinal study of resident QOL was conducted in two nursing homes.

Disclosure issues in neuroscience research.

Issues of disclosure arise in neuroscientific research during the informed consent process, whenever incidental findings are identified, and when study results are generated. The possibility of disclosure of incidental findings and/or research results may raise informational expectations on the part of subjects and may alter a study's risk:benefit ratio. We recommend that the informed consent process address this potential consequence of research participation, and specify the conditions under which particular types of information will be offered, the conditions under which information may not be disclosed, and any provisions for helping subjects make sense of the information to be disclosed.

Role of the ethics committee: helping to address value conflicts or uncertainties.

This article addresses two basic questions about ethics committees: why we have them, and how they might be helpful to clinicians. Our answer to the first question is twofold. First, we suggest that legal, regulatory, and professional forces drove the development of ethics committees, particularly as an alternative to litigation.

Conflict of interest: nurses at risk!

Conflict of interest as it relates to healthcare is gaining increasing attention. Pharmaceutical companies and manufacturers that produce medical devices are coming under greater scrutiny because of the influence that their marketing practices may have on the patient management decisions made by healthcare professionals. The result is that healthcare agency administrators are developing conflict of interest policies and procedures for their professional employees.