Bioethics and Medical Ethics Commons^™

Integrated Dna Copy Number And Expression Profiling Identifies Igf1r As A Prognostic Biomarker In Pediatric Osteosarcoma, Aaron M Taylor, Jiayi M Sun, Alexander Yu, Horatiu Voicu, Jianhe Shen, Donald A Barkauskas, Timothy J Triche, Julie M Gastier-Foster, Tsz-Kwong Man, Ching C Lau

Center for Medical Ethics and Health Policy Staff Publications

Osteosarcoma is a primary malignant bone tumor arising from bone-forming mesenchymal cells in children and adolescents. Despite efforts to understand the biology of the disease and identify novel therapeutics, the survival of osteosarcoma patients remains dismal. We have concurrently profiled the copy number and gene expression of 226 osteosarcoma samples as part of the Strategic Partnering to Evaluate Cancer Signatures (SPECS) initiative. Our results demonstrate the heterogeneous landscape of osteosarcoma in younger populations by showing the presence of genome-wide copy number abnormalities occurring both recurrently among samples and in a high frequency. Insulin growth factor receptor 1 (IGF1R) is a …

Therapeutic Targeting Of Macrophage Plasticity Remodels The Tumor-Immune Microenvironment, Hee-Jin Jang, Hyun-Sung Lee, Wendong Yu, Maheshwari Ramineni, Cynthia Y Truong, Daniela Ramos, Taylor Splawn, Jong Min Choi, Sung Yun Jung, Ju-Seog Lee, Daniel Y Wang, Joel M Sederstrom, Massimo Pietropaolo, Farrah Kheradmand, Christopher I Amos, Thomas M Wheeler, R Taylor Ripley, Bryan M Burt

Center for Medical Ethics and Health Policy Staff Publications

Although the majority of patients with advanced lung adenocarcinoma (LUAD) are eligible to receive immune checkpoint blockade, approximately 80% of these tumors are resistant to this therapeutic approach. Insights at the single-cell level into mechanisms that drive LUAD tumorigenesis and the relationship of LUAD histologic heterogeneity to response to immune checkpoint blockade could help identify biomarkers and potential combinational approaches to improve immunotherapy efficacy. Here we used a genetically engineered mouse model that replicates the development of human LUAD through a spectrum of pre-invasive to invasive adenocarcinoma histologic subtypes. A systems onco-immunology approach of integrating the analytical power and unique, …

An Updated Assessment Of 43,110 Patients Enrolled In The Childhood Cancer Research Network: A Children’S Oncology Group Report, Austin L Brown, Pagna Sok, Michael E Scheurer, Karen R Rabin, Erin L Marcotte, Douglas S Hawkins, Logan G Spector, Philip J Lupo

Center for Medical Ethics and Health Policy Staff Publications

Background: The Childhood Cancer Research Network (CCRN) was established by the Children's Oncology Group (COG) as a resource for epidemiologic studies of childhood cancer. The objective of this study was to evaluate the representativeness of CCRN and identify factors associated with enrollment.

Method: The number of US childhood patients with cancer diagnosed < 20 years of age enrolled in CCRN (2008-2015) was compared to expected counts, calculated from Surveillance, Epidemiology, and End Results incidence rates and US Census population estimates. Observed-to-expected ratios and corresponding 95% confidence intervals (CI) were estimated across sex, race, diagnosis age, calendar year, and cancer diagnosis groups. Multivariable linear regression models were generated to evaluate the association between open COG phase 3 therapeutic trials and CCRN enrollment rates.

Result: The 43,110 cases enrolled in CCRN represented 36% of the expected childhood cancers diagnosed from 2008 to 2015 (N = 120,118). CCRN enrollment ratios [95% CI] were highest among males (0.38 [95% CI, 0.37-0.38]), non-Hispanics (0.35 [95% CI, 0.35-0.36]), and those diagnosed from 1 to 4 years …

Pharmacists Role In Preventing Drug Abuse, Renae L. Wilson

College of Pharmacy Student Research

In 2019, there were approximately 332,000 pharmacists active in the US workforce, Data USA, 2019. A survey of 1,700 American adults, discovered, that 34% of Americans still rely on healthcare providers such as pharmacists, for information in relation their health, KRC Research, 2018. Pharmacists are one of the three most trusted health care professions and were found to be the second most trusted source for health information by Americans in 2005. Blendon et al., 2006 found, that information from pharmacist was trusted by 67%, of participants in their survey. One of the oaths pledged by pharmacist is, ‘ …

Actionable Tumor Alterations And Treatment Protocol Enrollment Of Pediatric And Young Adult Patients With Refractory Cancers In The National Cancer Institute-Children's Oncology Group Pediatric Match Trial, D Williams Parsons, Katherine A Janeway, David R Patton, Cynthia L Winter, Brent Coffey, P Mickey Williams, Sinchita Roy-Chowdhuri, Gregory J Tsongalis, Mark Routbort, Nilsa C Ramirez, Lauren Saguilig, Jin Piao, Todd A Alonzo, Stacey L Berg, Elizabeth Fox, Douglas S Hawkins, Jeffrey S Abrams, Margaret Mooney, Naoko Takebe, James V Tricoli, Nita L Seibel, Nci-Cog Pediatric Match Team

Center for Medical Ethics and Health Policy Staff Publications

Purpose: The National Cancer Institute-Children's Oncology Group Pediatric MATCH trial aimed to facilitate evaluation of molecular-targeted therapies in biomarker-selected cohorts of childhood and young adult patients with cancer by screening tumors for actionable alterations.

Patients and methods: Tumors from patients age 1-21 years with refractory solid tumors, lymphomas, or histiocytic disorders were subjected to cancer gene panel sequencing and limited immunohistochemistry to identify actionable alterations for assignment to phase II treatment arms. The rates of treatment arm assignment and enrollment were compared between clinical and demographic groups.

Results: Testing was completed for 94.7% of tumors submitted. Actionable alterations were detected …

Phase Ii Study Of Selumetinib In Children And Young Adults With Tumors Harboring Activating Mitogen-Activated Protein Kinase Pathway Genetic Alterations: Arm E Of The Nci-Cog Pediatric Match Trial, Olive S Eckstein, Carl E Allen, P Mickey Williams, Sinchita Roy-Chowdhuri, David R Patton, Brent Coffey, Joel M Reid, Jin Piao, Lauren Saguilig, Todd A Alonzo, Stacey L Berg, Nilsa C Ramirez, Alok Jaju, Joyce Mhlanga, Elizabeth Fox, Douglas S Hawkins, Margaret M Mooney, Naoko Takebe, James V Tricoli, Katherine A Janeway, Nita L Seibel, D Williams Parsons

Center for Medical Ethics and Health Policy Staff Publications

Purpose: The NCI-COG Pediatric MATCH trial assigns patients age 1-21 years with relapsed or refractory solid tumors, lymphomas, and histiocytic disorders to phase II studies of molecularly targeted therapies on the basis of detection of predefined genetic alterations. Patients with tumors harboring mutations or fusions driving activation of the mitogen-activated protein kinase (MAPK) pathway were treated with the MEK inhibitor selumetinib.

Methods: Patients received selumetinib twice daily for 28-day cycles until disease progression or intolerable toxicity. The primary end point was objective response rate; secondary end points included progression-free survival and tolerability of selumetinib.

Results: Twenty patients (median age: 14 …

Assessing Smoking Status And Risk Of Sars-Cov-2 Infection: A Machine Learning Approach Among Veterans, Alice B S Nono Djotsa, Drew A Helmer, Catherine Park, Kristine E Lynch, Amir Sharafkhaneh, Aanand D Naik, Javad Razjouyan, Christopher I Amos

Center for Medical Ethics and Health Policy Staff Publications

The role of smoking in the risk of SARS-CoV-2 infection is unclear. We used a retrospective cohort design to study data from veterans' Electronic Medical Record to assess the impact of smoking on the risk of SARS-CoV-2 infection. Veterans tested for the SARS-CoV-2 virus from 02/01/2020 to 02/28/2021 were classified as: Never Smokers (NS), Former Smokers (FS), and Current Smokers (CS). We report the adjusted odds ratios (aOR) for potential confounders obtained from a cascade machine learning algorithm. We found a 19.6% positivity rate among 1,176,306 veterans tested for SARS-CoV-2 infection. The positivity proportion among NS (22.0%) was higher compared …

Fair Allocation Of Scarce Therapies For Coronavirus Disease 2019 (Covid-19), Govind C. Persad, Monica E. Peek, Seema K. Shah

Sturm College of Law: Faculty Scholarship

The US Food and Drug Administration (FDA) has issued emergency use authorizations (EUAs) for monoclonal antibodies (mAbs) for nonhospitalized patients with mild or moderate coronavirus disease 2019 (COVID-19) disease and for individuals exposed to COVID-19 as postexposure prophylaxis. EUAs for oral antiviral drugs have also been issued. Due to increased demand because of the Delta variant, the federal government resumed control over the supply and asked states to ration doses. As future variants (e.g., the Omicron variant) emerge, further rationing may be required. We identify relevant ethical principles (i.e., benefiting people and preventing harm, equal concern, and mitigating health inequities) …

Is A Video Worth A Thousand Words?, Laura Kolbe, Ryan H Nelson, Joelle Robertson-Preidler, Olivia Schuman, Inmaculada De Melo-Martín

Faculty and Staff Publications

Bodily imagery elicits strong affective responses and is highly salient, potentially altering viewers' decision making. When clinicians engage surrogates in video calls showing the patient's body, several competing ethical issues must be considered. On the one hand, surrogates may require visual information to make informed decisions, and video technology closes crucial information gaps. On the other, video technology puts an increased amount of control in the hands of clinicians over how the patient's condition is perceived. This article explores some situations that can result in manipulation due to the affective impact of bodily images and the potential for selectivity and …

Provider Perceptions Of Telehealth And In-Person Exposure And Response Prevention For Obsessive-Compulsive Disorder, Andrew D Wiese, Kendall N Drummond, Madeleine N Fuselier, Jessica C Sheu, Gary Liu, Andrew G Guzick, Wayne K Goodman, Eric A Storch

Center for Medical Ethics and Health Policy Staff Publications

Until recently, psychotherapies, including exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD), have primarily been delivered in-person. The COVID-19 pandemic required OCD providers delivering ERP to quickly transition to telehealth services. While evidence supports telehealth ERP delivery, limited research has examined OCD provider perceptions about patient characteristics that are most appropriate for this modality, as well as provider abilities to identify and address factors interfering with effective telehealth ERP. In the present study, OCD therapists (N = 113) rated the feasibility of delivering telehealth ERP relative to in-person for different (1) patient age-groups, (2) levels of OCD severity, and …

A Validation Framework For Somatic Copy Number Detection In Targeted Sequencing Panels, Raghu Chandramohan, Jacquelyn Reuther, Ilavarasi Gandhi, Horatiu Voicu, Karla R Alvarez, Sharon E Plon, Dolores H Lopez-Terrada, Kevin E Fisher, D Williams Parsons, Angshumoy Roy

Center for Medical Ethics and Health Policy Staff Publications

Somatic copy number alterations (SCNAs) in tumors are clinically significant diagnostic, prognostic, and predictive biomarkers. SCNA detection from targeted next-generation sequencing panels is increasingly common in clinical practice; however, detailed descriptions of optimization and validation of SCNA pipelines for small targeted panels are limited. This study describes the validation and implementation of a tumor-only SCNA pipeline using CNVkit, augmented with custom modules and optimized for clinical implementation by testing reference materials and clinical tumor samples with different classes of copy number variation (CNV; amplification, single copy loss, and biallelic loss). Using wet-bench and in silico methods, various parameters impacting CNV …

The Role Of An Inpatient Hospice And Palliative Clinical Pharmacist In The Interdisciplinary Team, Jetavia Jones Moody, Ivy O Poon, Ursula K Braun

Center for Medical Ethics and Health Policy Staff Publications

Palliative care is a specialized health care service for individuals with serious illness at any stage and can be provided in any setting. Current national consensus developed by palliative care experts recommends the inclusion of pharmacists in an interdisciplinary team (IDT) to provide quality palliative care. However, national registry data report that less than 10% of inpatient palliative teams in the U.S. have a clinical pharmacist. Clinical pharmacists have an impactful role in palliative patients' quality of life by optimizing symptom management, deprescribing, and providing education to the palliative care team as well as patients and their families. In this …

Breast Cancer Diagnosis And Treatment During The Covid-19 Pandemic In A Nationwide, Insured Population, Jennifer L Caswell-Jin, Maryam N Shafaee, Lan Xiao, Mina Liu, Esther M John, Melissa L Bondy, Allison W Kurian

Center for Medical Ethics and Health Policy Staff Publications

Purpose: The early months of the COVID-19 pandemic led to reduced cancer screenings and delayed cancer surgeries. We used insurance claims data to understand how breast cancer incidence and treatment after diagnosis changed nationwide over the course of the pandemic.

Methods: Using the Optum Research Database from January 2017 to March 2021, including approximately 19 million US adults with commercial health insurance, we identified new breast cancer diagnoses and first treatment after diagnosis. We compared breast cancer incidence and proportion of newly diagnosed patients receiving pre-operative systemic therapy pre-COVID, in the first 2 months of the COVID pandemic and in …

A Novel, De Novo Intronic Variant In Pogz Causes White-Sutton Syndrome, Ashanta Merriweather, David R Murdock, Jill A Rosenfeld, Hongzheng Dai, Shamika Ketkar, Lisa Emrick, Sarah Nicholas, Richard A Lewis, Undiagnosed Diseases Network, Carlos A Bacino, Daryl A Scott, Brendan Lee, Vernon Reid Sutton, Lorraine Potocki, Lindsay C Burrage

Center for Medical Ethics and Health Policy Staff Publications

White-Sutton syndrome (WHSUS), which is caused by heterozygous pathogenic variants in POGZ, is characterized by a spectrum of intellectual disabilities and global developmental delay with or without features of autism spectrum disorder. Additional features may include hypotonia, behavioral abnormalities, ophthalmic abnormalities, hearing loss, sleep apnea, microcephaly, dysmorphic facial features, and rarely, congenital diaphragmatic hernia (CDH). We present a 6-year-old female with features of WHSUS, including CDH, but with nondiagnostic clinical trio exome sequencing. Exome sequencing reanalysis revealed a heterozygous, de novo, intronic variant in POGZ (NM_015100.3:c.2546-20T>A). RNA sequencing revealed that this intronic variant leads to skipping of exon 18. …

Health Equity In Medicine, Tracy Macintosh, Barbara L. Gracious, Jeremy R. Brooks, Graig Donini

HCA Healthcare Journal of Medicine

Healthcare disparities exist when, due to racial, ethnic, or gender identity differences linked to social, economic or environmental factors, certain populations lack equitable access to quality healthcare and insurance coverage. Such disparities across history carry profound future implications that we have only begun to contemplate as a profession. This special issue of the HCA Healthcare Journal of Medicine examines the critical issue of health equity in medicine and how the medical community can advance health equity through inclusive behavior and interactions in clinical and educational settings, and our communities.

Psychosocial Considerations For The Child With Rare Disease: A Review With Recommendations And Calls To Action., Leslee Belzer, Margaret Wright, Emily J. Goodwin, Mehar N. Singh, Brian S. Carter

Manuscripts, Articles, Book Chapters and Other Papers

Rare diseases (RD) affect children, adolescents, and their families infrequently, but with a significant impact. The diagnostic odyssey undertaken as part of having a child with RD is immense and carries with it practical, emotional, relational, and contextual issues that are not well understood. Children with RD often have chronic and complex medical conditions requiring a complicated milieu of care by numerous clinical caregivers. They may feel isolated and may feel stigmas in settings of education, employment, and the workplace, or a lack a social support or understanding. Some parents report facing similar loneliness amidst a veritable medicalization of their …

Yes, The Mda Stands For Something, Michael G. Maihofer Dds

The Journal of the Michigan Dental Association

In the President's address, Dr. Maihofer responds to concerns about the MDA's relevance, outlining four key points that emphasize its commitment to ethical dentistry, continuous education, advocacy, and adapting to changing professional needs. He highlights the MDA's role in opposing dental therapy, advocating for tax repeals, and promoting diversity, equity, and inclusion. Dr. Maihofer encourages member participation, emphasizing the collective strength of the MDA community. The address expresses gratitude to various contributors, including predecessor Dr. Steve Meraw, President-elect Dr. Vince Benivegna, the Board of Trustees, MDA staff, volunteers, and his wife, Denise.

Exploring Moral Permissibility Of Nurse Participation In Limited Resuscitation, Felicia Stokes

Electronic Theses and Dissertations

This dissertation offers a novel approach to support nurses when they face conflict between clinicians and families or alternate decision-makers over potentially inappropriate end-of-life goals of care. This dissertation will provide a normative analysis of the moral permissibility of limited resuscitation, with arguments supported by analyses of families’ and nurses’ perspectives and actions in the EoL decision-making process. Limited resuscitation is a cardiopulmonary resuscitation effort where full pharmacologic and mechanical intervention is not used, or the length of the resuscitative effort is shortened. It is typically associated with deception because it is performed without the knowledge of patients and families. …

A Bioethics Critique Of The Healthcare System In Nigeria: Personal Dignity And Human Solidarity, Cyprian Duru

Electronic Theses and Dissertations

Life is a sacred gift, an indivisible good with an inherent dignity and value. Despite its uniqueness, fragility, vulnerability, and limitations, it remains the most interesting, attractive, and exciting thing one can possess. These attributes invoke a deep sense of respect to life. Recently, science and biotechnology have astonished the world, as they continue to disorient human consciousness on new set of ethical issues. In effect, life is seriously exposed to the perspectives of modern science and technology. Thus, President George W. Bush warns that the powers of science are morally neutral, capable for good and bad purposes. In …

Narrative Authority: A Narrative-Based Multicultural Ethics To Overcome Western Biases In The Current Models Of Care, Fahmida Hossain

Electronic Theses and Dissertations

Technological advances and globalization are transforming healthcare dramatically. But unfortunately, current medical practices remain blind to their multicultural patients’ varied worldviews and norms, especially in the West. As a result, patients often find themselves isolated, anxious, and resentful.

All the humanistic models in the current literature view the individual as a unique and autonomous being and, in turn, provide practices to access and recognize the patient’s personhood. These models—Narrative Medicine, Narrative Ethics, and Ethics of Care—attempt to catch sight of the individual, the person’s situation, and some semblance of the person’s story before diagnosing or offering prescriptions. However, all these …

The Contribution Of Ethical Governance Of Artificial Intelligence & Machine Learning In Healthcare, Tina Nguyen

Electronic Theses and Dissertations

With the Internet Age and technology progressively advancing every year, the usage of Artificial Intelligence (AI) along with Machine Learning (ML) algorithms has only increased since its introduction to society. Specifically, in the healthcare field, AI/ML has proven to its end-users how beneficial its assistance has been. However, despite its effectiveness and efficiencies, AI/ML has also been under scrutiny due to its unethical outcomes. As a result of this, two polarizing views are typically debated when discussing AI/ML. One side believes that AI/ML usage should continue regardless of its unsureness, while the other side argues that this technology is too …

Undergraduate Holocaust Education And Biomedical Ethics: What's The Connection?, Tatiana Thompson

Psychology Department Student Scholarship

This poster represents the research results of two studies used to examine Holocaust education in undergraduate colleges and universities.

Everyday Ethics And Equity At The Bedside, Shika Kalevor, Angie Knackstedt

Research Days

Background: Traditional bioethics training, although important, may not be completely suited to the nursing role. In contrast to traditional clinical ethics, which focuses on healthcare dilemmas, everyday ethics focuses on routine clinical encounters between clinicians, patients, and families and may be better suited to help nurses address issues such as bias and racism at the bedside.

Objectives/Goal: This study aims to provide a data-backed approach to ethics education for nurses as it pertains to improvements in the understanding of Diversity, Equity, & Inclusion (DEI) efforts in healthcare. This study also provides an opportunity for the field of bioethics to provide …

Pre-Medical Student Concerns Regarding Applying To Medical School During Covid-19 Pandemic, Rachel Connell

Posters

INTRODUCTION
Over the last two years, the COVID-19 pandemic has altered the system processes of medical education. The primary goal of this study is to identify themes regarding the concerns of pre-medical students in the 2020-2021 application cycle through qualitative analysis of www.studentdoctor.net medical school admission forum posts in order to contribute to the limited literature available on this relatively novel topic.

Death Exposure Influence On Medical Students’ Attitudes Toward End-Of-Life Care, Sara J. Barlow, Nelia Alfonso, Jason A. Wasserman

Posters

INTRODUCTION
Advance directives help guide individuals and their families in making end-of-life decisions that physicians must respect and carry out on behalf of patients to provide optimal care that aligns with their wishes. The facilitation of end-of-life care and the application of advance directives are impacted by physicians’ attitudes and knowledge regarding this topic. Current studies focus on the perspective that practicing physicians have toward advance directives. Our goal is to examine the end-of-life preferences of medical students at Oakland University William Beaumont (OUWB) School of Medicine before and after clinical exposure to better appreciate how and when opinions regarding …

Understanding The State Of Lgbtqia+ Healthcare And Support In Camden County, Sayan Basu, Sana Farhat, Cindy Capps, Ali Harb

Rowan-Virtua Research Day

4.5% of American adults identify as lesbian, gay, or bisexual and about 1.4 million adults identify as transgender.

This demographic is impacted by many social determinants of health and health disparities, particularly for transgender patients.

33% of LGBTQIA+ patients ranging from a pool of 28,000 surveyed patients have had a negative experience with their health providers, and 8% of them had to educate their physicians about their needs due to physicians’ lack of knowledge about this demographic.

Research suggests that there is a reluctance to access mental health services in the LGBTQIA+ community due to homophobia,, difficulties disclosing sexual and …

Literature Review: Incidentalomas In Emergency Medicine - How Often Are They Reported And Are Patients Informed?, Mohammad Rattu, James Espinosa, Alan Lucerna, James Lee

Rowan-Virtua Research Day

The purpose of this proposed study is to look at the rate of incidental findings on CT scan in a community hospital setting, as well as to look at the rate of documentation of communication of the findings to the patient and referral for follow-up to primary care or to a specialty follow-up.

The Influence Of Blm And The Death Of George Floyd On Medical And Pre-Med Students And Their Views On Institutional Racism, Asia Susko, Jason A. Wasserman

Posters

INTRODUCTION
Racial inequalities present in medical education in a multitude of ways, including basing disease prevalence on majority populations and using images that disproportionately represent white patients. George Floyd’s death was not only a sentinel event of police violence, but underscored broader systemic racism, including medicine’s potential for complicity. This study highlights the perspectives of premedical and medical students in light of George Floyd’s death and the Black Lives Matter movement. Their views help elaborate ways to better support students and staff of color in medical education.

Emergency Department Recidivism Due To Skin Lesions Among The Homeless Population, Kylee Jb Kus, Jason A. Wasserman

Posters

INTRODUCTION
Ample research supports the correlation between homelessness and poor health generally. Individuals experiencing homelessness face a higher risk of dermatological health problems due to exposure and sanitation concerns and comprise a disproportionately large share of emergency department (ED) visits. This study assesses whether and how the interaction between homelessness and dermatological health contributes to ED recidivism.

The Divergence Of Medical Ethics And State Laws Regarding Life Sustaining Treatment, Hannah Vandusen, Jason A. Wasserman

Posters

INTRODUCTION
Research reveals that cardiopulmonary resuscitation (CPR) rarely leads to prolonged survival in patients with chronic illnesses in whom death is expected in the relative near-term. There is strong ethical consensus favoring a physician’s right to refuse to provide CPR when it is physiologically futile or medically inappropriate. State laws governing medical treatment, however, sometimes diverge from this guidance. This study examines laws related to life sustaining treatment, analyzing both physician and surrogate authority in decision making about resuscitation orders in the national context.