Utilizing a participatory curriculum development approach for multidisciplinary training on the forensic medical evaluation of asylum seekers.

BACKGROUND: Clinicians play an important role in asylum applications through the forensic medical evaluation (FME). The lack of adequately trained and knowledgeable clinicians limits access to FME. Participatory curriculum development is a powerful tool that elevates voices of multiple stakeholders to generate innovation in FME education. The objective of this study was to conduct an interview-based curricular needs assessment of the core skills needed to perform safe and effective FME and the most effective teaching methods targeting multidisciplinary learners. METHODS: In accordance with a participatory curriculum development framework, we conducted semi-structured interviews of individuals in four key stakeholder groups that play an important role in FME: asylees, experienced educators, prospective learners, and attorneys. We used grounded theory, an inductive approach to the thematic coding of interview transcripts. RESULTS: Interview participants described the most important skills for performing FME and approaches to teaching these skills. Thematic saturation was reached at 13 interviews. Four major themes central to an FME curriculum were identified: (1) Core knowledge and technical skills to perform effective FME, (2) Practical skills in a trauma-informed approach to FME, (3) Mitigating secondary trauma and building resilience, and (4) Teaching approaches for multi-disciplinary learners. CONCLUSION: We conducted an interview-based study utilizing participatory curriculum development principles to investigate the most important skills to conduct safe and effective FME of asylum seekers. We found that experiential training that emphasizes the practice of skills in a multi-disciplinary environment is more aligned with stakeholder needs than existing frameworks built around one-way knowledge transfer.

Right congestive heart failure in domestic kitten (Felis domesticus) by dilation of the pulmonary veins and cardiomegali.

Background: Congestive heart failure (CHF) is a pathological state characterized by the incapability of the heart to properly perform its essential function of delivering blood to meet the metabolic demands of the body. Case Description: The present case report concerns a 3-month-old male domestic kitten, displaying symptoms including an enlarged abdomen, emaciation, dehydration, dyspnea, rhinorrhea, and infestation with scabies. This animal, weighing 0.7 kg displays a tabby bicolor pattern. The findings gleaned from the clinical evaluation revealed the presence of a murmur upon auscultation of the cardiac region. Upon conducting an ultrasound examination, it was determined that the abdominal cavity contained a fluid accumulation known as ascites. Conclusion: The findings from the radiographic evaluation indicate that feline Hiro exhibits ascites alongside cardiomegaly, in conjunction with discernible vascular modifications characterized by both enlargements of the pulmonary arteries and veins.

Can you be cured if the doctor disagrees? A case study of 27 prayer healing reports evaluated by a medical assessment team in the Netherlands.

THE SETTING: between 2015 and 2020 a medical assessment team evaluated 27 reports of prayer healing in the Netherlands. OBJECTIVES: Three research questions were formulated. What are the medical and experiential findings? Are there medically remarkable and/or unexplained healings? Which explanatory frameworks can help us understand the findings? METHODS: The reported healings were analyzed using both medical files and patient narratives, as part of a case study research design compiled by a multidisciplinary research team. An independent team of five medical consultants, representing different fields of expertise, evaluated the 27 case files. According to criteria these were selected from a larger group of 83 received reports. Experiential data was obtained by in-depth interviews and analyzed. Instances of healing could be classified as 'medically remarkable' or 'medically unexplained'. Subsequent analysis was transdisciplinary. RESULTS: Eleven of the 27 healings assessed were evaluated as 'medically remarkable', none were labelled as 'medically unexplained'. Recurring characteristics were common to some degree in all healings, whether 'medically remarkable' or not: a temporal connection with prayer, instantaneity and unexpectedness of healing, strong emotional and physical manifestations, and a sense of 'being overwhelmed' and transformed. The healings were invariably interpreted as acts of God. Positive effects have persisted for 5 to 33 years, with 2 relapses. CONCLUSIONS: Our findings on remarkable healings do not fit well in the traditional biomedical conceptual framework. All healings exhibited important non-medical aspects, whether or not they were assessed as medically remarkable. We need a broader multi-perspective approach in which all relevant data is considered to be valuable, both experiential and objective. This so-called horizontal epistemology may be helpful when trying to understand the findings, and it may bring about mutual understanding between patients, health practitioners and relevant disciplines.

Pre-Anesthetic Medical Evaluations: Criteria Considerations for Telemedicine Alternatives to Face to Face Visits.

BACKGROUND: The number of pre-anesthetic medical evaluations (PAMEs) being conducted in primary care is increasing. Due to the COVID-19 pandemic, the use of telemedicine has surged, providing a feasible way to conduct some of these visits. This study aimed to identify patient-related factors where a face to face (FTF) evaluation is indicated, measured by the need for pre-operative testing. METHODS: A retrospective chart review was conducted on patients age ≥ 18 years who had a PAME between January 2019-June 2020 at a rural primary care clinic in Southeast Minnesota. Data collected included age, gender, Charlson Comorbidity Index Score, medications, revised cardiac risk index (RCRI), smoking status, exercise capacity, body mass index, and pre-operative testing. Logistical regression modeling for odds ratios of outcomes was performed. RESULTS: 254 patients were included, with an average age of 64.1 years; 43.7% were female. Most were obese (mean BMI 31.6), non-smoking (93.7%) with excellent functional capacity (87.8% ≥ 5 METs). 76.8% of the planned surgeries were intermediate or high risk. 35.0% (n = 89) of visits resulted in medication adjustments and 76.7% (n = 195) in pre-operative testing. Age ≥ 65 years, ≥7 current medications, and diabetes all significantly increased the odds of requiring pre-operative testing (P < .05). CONCLUSIONS: This study was able to identify patient-related factors that increased the likelihood of requiring pre-operative testing. Patients who are age ≥ 65 years, ≥7 current medications, and those with diabetes could be scheduled for a FTF evaluation. Others could be scheduled for a telemedicine visit to minimize health-care exposures.

Characteristics and scope of humanitarian relief forensic medical evaluations for immigrant children in the US.

According to US Customs and Border Protection, over 473,000 family units and 76,000 unaccompanied children were apprehended in 2019, a multi-fold increase from previous years. Thus, the number of children who may be eligible for humanitarian relief has increased significantly. For those claiming humanitarian relief, forensic medical evaluations performed by health professionals can provide critical evidence to bolster claims. In this cross-sectional, nationwide survey-in which we sought to characterize specialties, forensic training, capacity, and scope of humanitarian relief evaluations for immigrant children under eighteen-years-old-only 28 providers, half of whom were Child Abuse Pediatricians, reported performing humanitarian relief evaluations. The most common reported type of humanitarian relief evaluation conducted was for asylum. We found that the current training for forensic medical evaluations for humanitarian relief in pediatrics is likely varied not well-defined, and not pediatric-specific. In order to protect the rights of children who are eligible for humanitarian relief, pediatric and family medicine forensic medical evaluation training standards and curricula need to be developed; validated humanitarian relief screening tools need to be tested and utilized; and residents and attending physicians, including specialists with expertise in forensic evaluations, need to be actively recruited to perform these evaluations in collaboration with legal aid organizations.

Evaluations of alleged torture and ill treatment in Thailand: A collection of forensic medical evidence by non-medical evaluators.

Forensic medical evidence plays a critical role in the investigation and documentation of torture and ill treatment, as well as in civil reparation cases and in state monitoring mechanisms, especially if conducted on a timely basis by qualified, impartial experts. Detainees in many countries, such as Thailand, face significant barriers to access medical personnel while in custody or independent, non-governmental or impartial forensic experts. This study summarizes an effective method of collecting forensic medical evidence of torture and ill treatment by non-medical evaluators under conditions of limited access to detainees. The aim of the study was to determine the feasibility to render an expert opinion based on such documentation. We reviewed 49 non-medical forensic evaluations of alleged torture and ill treatment conducted by 11 attorneys or legal representatives in Southern Thailand between March and October 2011. Forty-four non-medical evaluations (90%) had sufficient information for the authors to formulate an opinion between the alleged abuse and the documented findings and to make a statement as to the level of consistency between them. Of these 44 evaluations, the authors determined that in 28 (70%) cases, the documented findings were highly consistent with the alleged abuse and in 13 (30%) cases, the documented findings were consistent with the alleged abuse. The study shows that non-medical evaluations conducted by attorneys and legal advocates can be a resource when individuals are denied access to forensic medical expertise. The results of a non-medical evaluation interpreted by an expert can have great evidentiary value when courts are reluctant to entertain writs of protection, such as a habeas corpus, or when states are reluctant to meet their obligations to pursue formal forensic evaluations.