How Should Clinicians Weigh the Benefits and Harms of Discussing Politicized Topics that Influence Their Individual Patients\u27 Health?

Health implications of politically charged phenomena are particularly difficult for physicians to discuss with their patients and communities. Addressing climate change and its associated health effects involves trade-offs between health and economic prosperity, necessitating that physicians weigh the potential benefits and risks of discussing climate change health effects. We argue that the potential benefits of physician communication and advocacy ultimately outweigh the potential risks. Therefore, physicians should be supported in their efforts to educate their patients and communities about climate change health effects. Furthermore, democratic deliberation could prove helpful in addressing disagreements among physicians within a practice about such politicized health topics

A Study of Recent Research on the Concept of Holy War in the Old Testament

The main purpose of this thesis is to gain a general overview of recent scholarship in the area of Holy War in the Old Testament. Holy War is a problem for the Christian for at least two reasons. First, the concept of holy War in the Old Testament is often a major point used in stressing the discontinuity between the Old Testament and the New Testament. Contrasts are set up between the Old Testament as a book of Law and the New Testament as a book of Gospel. The Old Testament is seen as containing a primitive form of religion that later evolved into the love concepts of Sweet Jesus. As a result, Holy War, along with most of the Old Testament is, I believe, either ignored or spiritualized by the majority of Christianity today. In order to avoid this, the Christian must come to grips with the problem” of the relevance of Holy War ideology for Christian ethics and warfare today. Secondly, the misuse of the concept of Holy War throughout Christian history to justify just wars, Crusades and other political stances has been a major point of critique from outside the Church against the Christian faith

Doing Research on the Ethics of Doing Research

In the previous issue of Critical Care Chenaud and colleagues found that most intensive care unit patients who had given informed consent for their participation in a clinical trial could not recall either the purpose of the trial or its related risks several days later. These findings should remind us that informed consent is a process, not an event, but they should not be interpreted to mean that recall is, of itself, a useful criterion for evaluating either the validity or the quality of the informed consent process. On an entirely separate note, the decision of the authors not to obtain informed consent for this study itself raises interesting questions about the ethics of doing research on the ethics of doing research

Informed consent and research design in critical care medicine

marking the progress that has been made in ensuring respect for human rights both within and beyond the context of medical research [1]. Today, many journal editors will refuse to consider manuscripts that have not undergone formal review by an independent committee, and virtually none will publish results that were procured without the explicit informed consent of the subjects. In one sense, therefore, the bioethics movement of the past several decades seems to have scored a resounding victory. In another sense, however, the rapid pace of medical research and the increasing effectiveness of medical interventions have only intensified the ethical dilemmas that physicians encounter in clinical research. The intensive care environment, in particular, has several characteristics that provide especially difficult challenges to the standar

Genetic variation in CRHR1 is associated with short-term respiratory response to corticosteroids in preterm infants at risk for bronchopulmonary dysplasia.

BackgroundBronchopulmonary dysplasia (BPD) is an orphan disease and advances in prevention and treatment are lacking. The clinical efficacy of systemic corticosteroid therapy to reduce the severity of lung disease and BPD is highly variable. Our objective was to assess whether candidate SNPs in corticosteroid metabolism and response genes are associated with short-term phenotypic response to systemic corticosteroids in infants at high risk for BPD.MethodsPharmacogenetic analysis of data from a large randomized controlled trial (TOLSURF) in infants treated with dexamethasone or hydrocortisone using multivariate linear regression. The primary outcome was a change in respiratory severity score (RSS, mean airway pressure x FiO2) at day 7 of corticosteroid treatment.Resultsrs7225082 in the intron of CRHR1 is significantly associated with the magnitude of decrease in RSS 7 days after starting treatment with systemic corticosteroid (meta-analysis P = 2.8 × 10-4). Each T allele at rs7225082 is associated with a smaller absolute change in RSS at day 7, i.e., less response to systemic corticosteroids.ConclusionsGenetic variability is associated with corticosteroid responsiveness with regard to respiratory status in preterm infants. Identification of genetic markers of corticosteroid responsiveness may allow for therapeutic individualization, with the goal of optimizing the risk-to-benefit ratio for an individual child

Inhaled nitric oxide in premature infants: effect on tracheal aspirate and plasma nitric oxide metabolites.

ObjectiveInhaled nitric oxide (iNO) is a potential new therapy for prevention of bronchopulmonary dysplasia and brain injury in premature infants. This study examined dose-related effects of iNO on NO metabolites as evidence of NO delivery.Study designA subset of 102 premature infants in the NO CLD trial, receiving 24 days of iNO (20 p.p.m. decreasing to 2 p.p.m.) or placebo, were analyzed. Tracheal aspirate (TA) and plasma samples collected at enrollment and at intervals during study gas were analyzed for NO metabolites.ResultiNO treatment increased NO metabolites in TA at 20 and 10 p.p.m. (1.7- to 2.3-fold vs control) and in plasma at 20, 10, and 5 p.p.m. (1.6- to 2.3-fold). In post hoc analysis, treated infants with lower metabolite levels at entry had an improved clinical outcome.ConclusioniNO causes dose-related increases in NO metabolites in the circulation as well as lung fluid, as evidenced by TA analysis, showing NO delivery to these compartments