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Article ; Online: Children of COVID-19: pawns, pathfinders or partners?

Larcher, Victor / Brierley, Joe

2020 Volume 46, Issue 8, Page(s) 508–509

Abstract: Countries throughout the world are counting the health and socioeconomic costs of the COVID-19 pandemic, including the strategies necessary to contain it. Profound consequences from social isolation are beginning to emerge, and there is an urgency about ... ...

Abstract	Countries throughout the world are counting the health and socioeconomic costs of the COVID-19 pandemic, including the strategies necessary to contain it. Profound consequences from social isolation are beginning to emerge, and there is an urgency about charting a path to recovery, albeit to a 'new normal' that mitigates them. Children have not suffered as much from the direct effects of COVID-19 infection as older adults. Still, there is mounting evidence that their health and welfare are being adversely affected. Closure of schools has been a critical component of social isolation but has a far broader impact than the diminution of educational opportunities, as important as these are. Reopening of schools is therefore essential to recovery, with some countries already tentatively implementing it. Children's interests are vital considerations in any recovery plan, but the question remains as to how to address them within the context of how society views children; should they be regarded as pawns, pathfinders or partners in this enterprise?
MeSH term(s)	Adult ; Adverse Childhood Experiences ; Betacoronavirus ; Bioethical Issues ; COVID-19 ; Child ; Child Health ; Child Welfare ; Coronavirus Infections/complications ; Coronavirus Infections/virology ; Cost-Benefit Analysis ; Humans ; Pandemics/ethics ; Pneumonia, Viral/complications ; Pneumonia, Viral/virology ; Public Health ; Public Opinion ; Quarantine ; SARS-CoV-2 ; Schools ; Social Change ; Social Isolation
Keywords	covid19
Language	English
Publishing date	2020-06-05
Publishing country	England
Document type	Journal Article
ZDB-ID	194927-5
ISSN	1473-4257 ; 0306-6800
ISSN (online)	1473-4257
ISSN	0306-6800
DOI	10.1136/medethics-2020-106465
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Article ; Online: Children of COVID-19

Larcher, Victor / Brierley, Joe

Journal of Medical Ethics

pawns, pathfinders or partners?

2020 Volume 46, Issue 8, Page(s) 508–509

Abstract	Countries throughout the world are counting the health and socioeconomic costs of the COVID-19 pandemic, including the strategies necessary to contain it. Profound consequences from social isolation are beginning to emerge, and there is an urgency about charting a path to recovery, albeit to a ‘new normal’ that mitigates them. Children have not suffered as much from the direct effects of COVID-19 infection as older adults. Still, there is mounting evidence that their health and welfare are being adversely affected. Closure of schools has been a critical component of social isolation but has a far broader impact than the diminution of educational opportunities, as important as these are. Reopening of schools is therefore essential to recovery, with some countries already tentatively implementing it. Children’s interests are vital considerations in any recovery plan, but the question remains as to how to address them within the context of how society views children; should they be regarded as pawns, pathfinders or partners in this enterprise?
Keywords	Health Policy ; Arts and Humanities (miscellaneous) ; Issues, ethics and legal aspects ; Health(social science) ; covid19
Language	English
Publisher	BMJ
Publishing country	uk
Document type	Article ; Online
ZDB-ID	194927-5
ISSN	1473-4257 ; 0306-6800
ISSN (online)	1473-4257
ISSN	0306-6800
DOI	10.1136/medethics-2020-106465
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Children of COVID-19: pawns, pathfinders or partners?

Larcher, Victor / Brierley, Joe

J Med Ethics

Abstract	Countries throughout the world are counting the health and socioeconomic costs of the COVID-19 pandemic, including the strategies necessary to contain it. Profound consequences from social isolation are beginning to emerge, and there is an urgency about charting a path to recovery, albeit to a 'new normal' that mitigates them. Children have not suffered as much from the direct effects of COVID-19 infection as older adults. Still, there is mounting evidence that their health and welfare are being adversely affected. Closure of schools has been a critical component of social isolation but has a far broader impact than the diminution of educational opportunities, as important as these are. Reopening of schools is therefore essential to recovery, with some countries already tentatively implementing it. Children's interests are vital considerations in any recovery plan, but the question remains as to how to address them within the context of how society views children; should they be regarded as pawns, pathfinders or partners in this enterprise?
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #534936
Database	COVID19

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Book ; Online: Children of COVID-19

Larcher, Victor / Brierley, Joe

pawns, pathfinders or partners?

2020

Abstract	Countries throughout the world are counting the health and socioeconomic costs of the COVID-19 pandemic, including the strategies necessary to contain it. Profound consequences from social isolation are beginning to emerge, and there is an urgency about charting a path to recovery, albeit to a ‘new normal’ that mitigates them. Children have not suffered as much from the direct effects of COVID-19 infection as older adults. Still, there is mounting evidence that their health and welfare are being adversely affected. Closure of schools has been a critical component of social isolation but has a far broader impact than the diminution of educational opportunities, as important as these are. Reopening of schools is therefore essential to recovery, with some countries already tentatively implementing it. Children’s interests are vital considerations in any recovery plan, but the question remains as to how to address them within the context of how society views children; should they be regarded as pawns, pathfinders or partners in this enterprise?
Keywords	Current controversy ; covid19
Language	English
Publishing date	2020-08-01 00:00:00.0
Publisher	BMJ Publishing Group Ltd
Publishing country	us
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Adolescent autonomy revisited: clinicians need clearer guidance.

Brierley, Joe / Larcher, Victor

Journal of medical ethics

2016 Volume 42, Issue 8, Page(s) 482–485

Abstract: In 1996, Brazier and Bridge raised the question 'is adolescent autonomy truly dead and buried' following judicial decisions which had seemed to reverse the Gillick-inspired trend for greater child autonomy in healthcare. Subsequent decisions by the ... ...

Abstract	In 1996, Brazier and Bridge raised the question 'is adolescent autonomy truly dead and buried' following judicial decisions which had seemed to reverse the Gillick-inspired trend for greater child autonomy in healthcare. Subsequent decisions by the courts have reinforced the view that those below 18 years in England and Wales remain children with limited rights to refuse treatment compared with adults. This is at variance with the daily experience of those working with young people who increasingly seek to actively involve them in making freely informed decisions about their healthcare, in accordance with the principles enunciated in the UN Convention of the Rights of the Child and the UK Children Acts. We review the derivation of the law in England and Wales in this area, in the light of another recent family court judgement enforcing treatment on a 'competent' child without his or her consent and ask: 'How can the Common Law and the ethical practice of those caring for young people have diverged so far?' Either young people can decide whether to have a recommended treatment, or they cannot. Given Ian McEwan's book, the Children Act, has stimulated wider social debate in this area might this be an opportune moment to seek public policy resolution with regards to healthcare decision making by young people? We argue that events since the Gillick case have underlined the need for a comprehensive review of legal policy and practice in this area. While absolute autonomy and freedom of choice are arguably inconsistent with the protection rights that society has agreed are owed to children, healthcare practitioners need clarity over the circumstances in which society expects that autonomous choices of adolescents can be overridden.
MeSH term(s)	Adolescent ; Decision Making/ethics ; England ; Female ; Humans ; Informed Consent/legislation & jurisprudence ; Mental Competency/legislation & jurisprudence ; Minors/legislation & jurisprudence ; Personal Autonomy ; Public Policy ; Wales
Language	English
Publishing date	2016-03-21
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	194927-5
ISSN	1473-4257 ; 0306-6800
ISSN (online)	1473-4257
ISSN	0306-6800
DOI	10.1136/medethics-2014-102564
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Article ; Online: FPR2 DNA Aptamers for Targeted Therapy of Wound Repair.

de Arriba, María Del Carmen / Fernández, Gerónimo / Chacón-Solano, Esteban / Mataix, Manuel / Martínez-Santamaría, Lucía / Illera, Nuria / Carrión-Marchante, Rebeca / Martín, María Elena / Larcher, Fernando / González, Victor M / Del Río, Marcela / Carretero, Marta

The Journal of investigative dermatology

2022 Volume 142, Issue 8, Page(s) 2238–2248.e8

Abstract: Chronic wounds represent a major health problem worldwide. Some of the available therapies based on recombinant proteins usually fail owing to the hostile environment found at the wound bed. Aptamers appear as an attractive alternative to recombinant ... ...

Abstract	Chronic wounds represent a major health problem worldwide. Some of the available therapies based on recombinant proteins usually fail owing to the hostile environment found at the wound bed. Aptamers appear as an attractive alternative to recombinant factors owing in part to their stability, sensitivity, specificity, and low-cost production. In this study, the Cell-Systematic Evolution of Ligands by EXponential Enrichment technology was employed to generate aptamers that specifically recognize and modulate the function of the FPR2, a receptor expressed in a variety of cells involved in wound repair. Three aptamers were obtained that specifically bound to FPR2 stable transfectants generated in HaCaT cells. The targeted aptamers were shown to act as FPR2 agonists in different in vitro functional assays, including wound healing assays, and elicited a similar pattern of response to that obtained with other known FPR2 peptide agonists, such as the human LL37 cathelicidin. We have also obtained in vivo evidence for the prohealing activities of one of these FPR2 aptamers in a skin-humanized mouse model developed by us, previously shown to accurately recreate the main phases of physiological human wound repair process. In conclusion, we provide evidence of the potential therapeutic value of FPR2 aptamers for cutaneous repair.
MeSH term(s)	Animals ; Aptamers, Nucleotide ; Humans ; Ligands ; Mice ; Receptors, Formyl Peptide/agonists ; Receptors, Formyl Peptide/genetics ; Receptors, Formyl Peptide/metabolism ; Receptors, Lipoxin/agonists ; Receptors, Lipoxin/genetics ; Receptors, Lipoxin/metabolism ; Wound Healing
Chemical Substances	Aptamers, Nucleotide ; FPR2 protein, human ; Ligands ; Receptors, Formyl Peptide ; Receptors, Lipoxin
Language	English
Publishing date	2022-01-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80136-7
ISSN	1523-1747 ; 0022-202X
ISSN (online)	1523-1747
ISSN	0022-202X
DOI	10.1016/j.jid.2021.12.026
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Article: Ethical, Cultural, Social, and Individual Considerations Prior to Transition to Limitation or Withdrawal of Life-Sustaining Therapies.

Kirsch, Roxanne E / Balit, Corrine R / Carnevale, Franco A / Latour, Jos M / Larcher, Victor

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

2018 Volume 19, Issue 8S Suppl 2, Page(s) S10–S18

Abstract: As part of the invited supplement on Death and Dying in the PICU, we reviewed ethical, cultural, and social considerations for the bedside healthcare practitioner prior to engaging with children and families in decisions about limiting therapies, ... ...

Abstract	As part of the invited supplement on Death and Dying in the PICU, we reviewed ethical, cultural, and social considerations for the bedside healthcare practitioner prior to engaging with children and families in decisions about limiting therapies, withholding, or withdrawing therapies in a PICU. Clarifying beliefs and values is a necessary prerequisite to approaching these conversations. Striving for medical consensus is important. Discussion, reflection, and ethical analysis may determine a range of views that may reasonably be respected if professional disagreements persist. Parental decisional support is recommended and should incorporate their information needs, perceptions of medical uncertainty, child's condition, and their role as a parent. Child's involvement in decision making should be considered, but may not be possible. Culturally attuned care requires early examination of cultural perspectives before misunderstandings or disagreements occur. Societal influences may affect expectations and exploration of such may help frame discussions. Hospital readiness for support of social media campaigns is recommended. Consensus with family on goals of care is ideal as it addresses all parties' moral stance and diminishes the risk for superseding one group's value judgments over another. Engaging additional supportive services early can aid with understanding or resolving disagreement. There is wide variation globally in ethical permissibility, cultural, and societal influences that impact the clinician, child, and parents. Thoughtful consideration to these issues when approaching decisions about limitation or withdrawal of life-sustaining therapies will help to reduce emotional, spiritual, and ethical burdens, minimize misunderstanding for all involved, and maximize high-quality care delivery.
MeSH term(s)	Child ; Critical Illness/psychology ; Critical Illness/therapy ; Culturally Competent Care ; Decision Making ; Female ; Humans ; Intensive Care Units, Pediatric/standards ; Male ; Parents/psychology ; Patient Participation/psychology ; Social Media ; Terminal Care/standards ; Withholding Treatment/ethics
Language	English
Publishing date	2018-08-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2052349-X
ISSN	1947-3893 ; 1529-7535
ISSN (online)	1947-3893
ISSN	1529-7535
DOI	10.1097/PCC.0000000000001488
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Article ; Online: Simplified PADUA renal (SPARE) nephrometry score validation and long-term outcomes after robot-assisted partial nephrectomy.

Rosiello, Giuseppe / Piazza, Pietro / Puliatti, Stefano / Mazzone, Elio / Amato, Marco / Tames, Victor / Farinha, Rui / De Groote, Ruben / Berquin, Camille / Develtere, Dries / Sinatti, Celine / Larcher, Alessandro / Capitanio, Umberto / D'Hondt, Frederiek / Schatteman, Peter / Briganti, Alberto / Montorsi, Francesco / De Naeyer, Geert / Mottrie, Alexandre

Urologic oncology

2021 Volume 40, Issue 2, Page(s) 65.e1–65.e9

Abstract: Background: International guidelines suggest the use of anatomic scores to predict surgical outcomes after partial nephrectomy (PN). We aimed at validating the use of Simplified PADUA Renal (SPARE) nephrometry score in robot-assisted PN (RAPN).: ... ...

Abstract	Background: International guidelines suggest the use of anatomic scores to predict surgical outcomes after partial nephrectomy (PN). We aimed at validating the use of Simplified PADUA Renal (SPARE) nephrometry score in robot-assisted PN (RAPN). Materials and methods: Three hundred and sixty-eight consecutive RAPN patients were included. Primary endpoints were overall complications, postoperative acute kidney injury (AKI) and TRIFECTA achievement. Secondary endpoint was estimated glomerular filtration rate (eGFR) decrease at last follow-up. Multivariable logistic and linear regression models were used. Results: Of 368 patients, 229 (62%) vs. 116 (31%) vs. 23 (6.2%) harboured low- vs. intermediate- vs. high-risk renal mass, according to SPARE classification. SPARE score predicted higher risk of overall complications (Odds ratio [OR]: 1.23, 95%CI 1.09-1.39; P < 0.001), and postoperative AKI (OR: 1.20, 95%CI 1.08-1.35; P < 0.01). Moreover, SPARE score was associated with lower TRIFECTA achievement (OR: 0.89, 95%CI 0.81-0.98; P = 0.02). Predicted accuracy was 0.643, 0.614 and 0.613, respectively. After a median follow-up of 40 (IQR: 21-66) months, eGFR decrease ranged from -7% in low-risk to -17% in high-risk SPARE. Conclusions: SPARE scoring system predicts surgical success in RAPN patients. Moreover, SPARE score is associated with eGFR decrease at long-term follow-up. Thus, the adoption of SPARE score to objectively assess tumor complexity prior to RAPN may be preferable.
MeSH term(s)	Aged ; Female ; Humans ; Kidney Neoplasms/surgery ; Male ; Middle Aged ; Nephrectomy/methods ; Nephrotomy/methods ; Prospective Studies ; Robotic Surgical Procedures/methods ; Robotics/methods ; Treatment Outcome
Language	English
Publishing date	2021-11-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	1336505-8
ISSN	1873-2496 ; 1078-1439
ISSN (online)	1873-2496
ISSN	1078-1439
DOI	10.1016/j.urolonc.2021.09.021
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Article ; Online: Knee Donor Site Morbidity Following Harvest of Medial Femoral Trochlea Osteochondral Flaps for Carpal Reconstruction.

Windhofer, Christian / Wong, Victor W / Larcher, Lorenz / Paryavi, Ebrahim / Bürger, Heinz K / Higgins, James P

The Journal of hand surgery

2016 Volume 41, Issue 5, Page(s) 610–614.e1

Abstract: Purpose: This study examines donor site morbidity associated with the medial femoral trochlea (MFT) when used as a donor site for vascularized osteochondral flaps for reconstruction of challenging carpal defects such as proximal pole scaphoid nonunion ... ...

Abstract	Purpose: This study examines donor site morbidity associated with the medial femoral trochlea (MFT) when used as a donor site for vascularized osteochondral flaps for reconstruction of challenging carpal defects such as proximal pole scaphoid nonunion and advanced Kienböck disease. Methods: The retrospective study population included all patients who had undergone MFT flap harvest for scaphoid or lunate reconstruction. Chart review, patient questionnaires, and validated knee function assessment tools were used: International Knee Documentation Committee Subjective Knee Form scores ranged from 0 (maximal disability) to 100 (no disability). Western Ontario and McMaster Universities osteoarthritis index scores ranged from 0% (no disability) to 100% (maximal disability). Magnetic resonance imaging and radiographs were obtained on the donor knee on the majority of patients. Results: Questionnaire response rate was 79% (45 of 57 patients). Average patient age was 35 ± 11 years (range, 19-70 years). Average postoperative follow-up was 27 ± 17 months (range, 9-108 months). The indication for MFT flap reconstruction was scaphoid nonunion in 30 patients and Kienböck disease in 15 patients. All 45 patients had a stable knee on examination. Magnetic resonance and radiographic imaging obtained on 35 patients exhibited no pathological changes. Average duration of postoperative pain was 56 ± 59 days (range, 0-360 days); average duration until patients reported the knee returning to normal was 90 ± 60 days (range, 14-360 days). Forty-three of 44 patients would have the same surgery again if needed; overall satisfaction with the surgery was rated as 5 ± 1 (range, 2-5) on a scale from 0 (no satisfaction) to 5 (maximal satisfaction). Average International Knee Documentation Committee score was 96 ± 9 (range, 56.3-100) and the average Western Ontario and McMaster Universities score was 6% ± 16% (range, 0%-68%). Conclusions: Medial femoral trochlea osteochondral flap harvest results in minimal donor site morbidity in the majority of patients. Symptoms are time limited. Intermediate-term follow-up demonstrates excellent results in subjective outcome measures. Type of study/level of evidence: Therapeutic IV.
MeSH term(s)	Adult ; Aged ; Carpal Bones/injuries ; Carpal Bones/surgery ; Female ; Fractures, Ununited/surgery ; Humans ; Knee Joint/physiology ; Male ; Middle Aged ; Osteonecrosis/surgery ; Range of Motion, Articular ; Retrospective Studies ; Surgical Flaps ; Tissue and Organ Harvesting/adverse effects ; Transplant Donor Site ; Young Adult
Language	English
Publishing date	2016-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	605716-0
ISSN	1531-6564 ; 0363-5023
ISSN (online)	1531-6564
ISSN	0363-5023
DOI	10.1016/j.jhsa.2016.01.015
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Article: Core competencies for clinical ethics committees.

Larcher, Victor / Slowther, Anne-Marie / Watson, Alan R

Clinical medicine (London, England)

2010 Volume 10, Issue 1, Page(s) 30–33

Abstract: Clinical ethics committees (CECs) are increasing in number in the UK and have mostly developed in response to local interest, as opposed to being mandated as in the USA. However, there is no regulatory framework for UK CECs with no defined educational ... ...

Abstract	Clinical ethics committees (CECs) are increasing in number in the UK and have mostly developed in response to local interest, as opposed to being mandated as in the USA. However, there is no regulatory framework for UK CECs with no defined educational requirements or specification of core competencies for their members. The UK Clinical Ethics Network has consulted extensively with its members to set out, for the first time in the UK, the core competencies necessary for the provision of clinical ethics support. Recommendations for educational and membership requirements for CECs have also been made. Given the appropriate resources the standards proposed can be appropriately evaluated and are consistent with principles of ethical governance.
MeSH term(s)	Clinical Competence ; Ethics Committees, Clinical ; Ethics, Medical/education ; Humans ; United Kingdom ; United States
Language	English
Publishing date	2010-04-19
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2048646-7
ISSN	1473-4893 ; 1470-2118
ISSN (online)	1473-4893
ISSN	1470-2118
DOI	10.7861/clinmedicine.10-1-30
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