How Do Legal Experts Cope With Medical Reports and Forensic Evidence? The Experiences, Perceptions, and Narratives of Swiss Judges and Other Legal Experts.

Expert scientific knowledge, including medical knowledge, is relevant for the legal profession and can strongly influence rulings and sentencing in criminal law, civil law, and insurance law. The way in which this medical evidence is understood and evaluated thus has an impact both on individuals and on society as a whole. It enters legal procedures in various forms, for example, as expert witness statements and/or as a legal expert's own acquired medical knowledge. On the other hand, a legal expert may be confronted with expert medical opinions that differ in quality or content and thus have to decide which ones to follow. The aim of this qualitative study was to investigate legal experts' perceptions, experiences, and narratives regarding medical knowledge, particularly the skills and general knowledge used in their branch of the legal profession. A total of 51 semi-structured interviews with judges and prosecutors from different courts of law and from the public prosecutor's office in six different German-speaking (Zurich, Luzern, Aagrau, Obwalden, Nidwalden, Zug) and German/French-speaking (Bern) cantons of Switzerland were conducted, coded, and analyzed using Nvivo. We used a comparison thematic approach identifying common and new themes related to the research aims. Our findings suggest that Swiss judges and prosecutors believe that possessing and developing the skills and terminology required for processing medical information is important but complex, and time-consuming for their work. Additionally, several legal experts reported that their understanding of medical evidence was limited or even non-existent. Moreover, the acquisition of skills related to the assessment of medical reports and forensic evidence appeared to be unstructured. Participants reported having no formal instruction in how to evaluate or deal with medical knowledge. The sources they used to answer questions arising appeared to be in part problematic and non-standardized (internet, newspapers, etc.). Medical literature from peer-reviewed journals was used only rarely. The findings from this study suggest that law departments might wish to evaluate whether their graduates are sufficiently equipped with scientific literacy skills and appropriate skills to evaluate medical information for their later careers. At the same time, medical knowledge pertinent to forensics published in local legal journals may be more effective in reaching the legal expert audience than in medical journals.

Status quo of German-speaking medical students' attitudes toward and knowledge about central aspects of forensic psychiatry across four European countries.

While forensic psychiatry is of increasing importance in mental health care, limited available evidence shows that attitudes toward the discipline are contradictory and that knowledge about it seems to be limited in medical students. We aimed to shed light on this subject by analyzing medical students' central attitudes toward and their association with knowledge about forensic psychiatry as well as with socio-demographic and education-specific predictor variables. We recruited N = 1345 medical students from 45 universities with a German language curriculum across four European countries (Germany, Switzerland, Austria and Hungary) by using an innovative approach, namely snowball sampling via Facebook. Students completed an online questionnaire, and data were analyzed descriptively and multivariably by linear mixed effects models and multinomial regression. The results showed overall neutral to positive attitudes toward forensic psychiatry, with indifferent attitudes toward the treatment of sex offenders, and forensic psychiatrists' expertise in the media. Whereas medical students knew about the term 'forensic psychiatry', they showed a lack of specific medico-legal knowledge. Multivariable models on predictor variables revealed statistically significant findings with, however, small estimates and variance explanation. Therefore, further research is required along with the development of a refined assessment instrument for medical students to explore both attitudes and knowledge in forensic psychiatry.

Predicting Medical Students' Current Attitudes Toward Psychiatry, Interest in Psychiatry, and Estimated Likelihood of Working in Psychiatry: A Cross-Sectional Study in Four European Countries.

Psychiatry as a medical discipline is becoming increasingly important due to the high and increasing worldwide burden associated with mental disorders. Surprisingly, however, there is a lack of young academics choosing psychiatry as a career. Previous evidence on medical students' perspectives is abundant but has methodological shortcomings. Therefore, by attempting to avoid previous shortcomings, we aimed to contribute to a better understanding of the predictors of the following three outcome variables: current medical students' attitudes toward psychiatry, interest in psychiatry, and estimated likelihood of working in psychiatry. The sample consisted of N = 1,356 medical students at 45 medical schools in Germany and Austria as well as regions of Switzerland and Hungary with a German language curriculum. We used snowball sampling via Facebook with a link to an online questionnaire as recruitment procedure. Snowball sampling is based on referrals made among people. This questionnaire included a German version of the Attitudes Toward Psychiatry Scale (ATP-30-G) and further variables related to outcomes and potential predictors in terms of sociodemography (e.g., gender) or medical training (e.g., curriculum-related experience with psychiatry). Data were analyzed by linear mixed models and further regression models. On average, students had a positive attitude to and high general interest in, but low professional preference for, psychiatry. A neutral attitude to psychiatry was partly related to the discipline itself, psychiatrists, or psychiatric patients. Female gender and previous experience with psychiatry, particularly curriculum-related and personal experience, were important predictors of all outcomes. Students in the first years of medical training were more interested in pursuing psychiatry as a career. Furthermore, the country of the medical school was related to the outcomes. However, statistical models explained only a small proportion of variance. The findings indicate that particularly curriculum-related experience is important for determining attitudes toward psychiatry, interest in the subject and self-predicted professional career choice. We therefore encourage the provision of opportunities for clinical experience by psychiatrists. However, further predictor variables need to be considered in future studies.

Skills and compensation strategies in adult ADHD - A qualitative study.

OBJECTIVE: The primary objectives of this study were to investigate how adult patients with ADHD coped with their symptoms prior to diagnosis and treatment, what skills and compensation strategies they had developed and what their self-perceptions of these strategies were. METHODS: We used a qualitative approach to analyze interviews with 32 outpatients of a specialty care unit at a university hospital. RESULTS: Patients reported frequent use of diverse compensatory strategies with varying degrees of effectiveness. These were classified into five categories (organizational, motoric, attentional, social, psychopharmacological). In certain circumstances, ADHD symptoms were even perceived as useful. CONCLUSION: Before diagnosis and treatment, patients with ADHD may develop a variety of skills to cope with their symptoms. Several of these skills are perceived as helpful. Knowledge of self-generated coping strategies may help better understand patients and their histories and thus facilitate patient cooperation. Moreover, knowing ways in which such patients cope with their symptoms may help elucidate reasons for late or under-diagnosing of the disorder.

Duration of untreated psychosis/illness and brain volume changes in early psychosis.

The time period during which patients manifest psychotic or unspecific symptoms prior to treatment (duration of untreated psychosis, DUP, and the duration of untreated illness, DUI) has been found to be moderately associated with poor clinical and social outcome. Equivocal evidence exists of an association between DUP/DUI and structural brain abnormalities, such as reduced hippocampus volume (HV), pituitary volume (PV) and grey matter volume (GMV). Thus, the goal of the present work was to examine if DUP and DUI are associated with abnormalities in HV, PV and GMV. Using a region of interest (ROI) based approach, we present data of 39 patients from the Basel FePsy (Früherkennung von Psychosen, early detection of psychosis) study for which information about DUP, DUI and HV, PV and GMV data could be obtained. Twenty-three of them were first episode psychosis (FEP) and 16 at-risk mental state (ARMS) patients who later made the transition to frank psychosis. In unadjusted analyses, we found a significant positive correlation between DUP and PV in FEP patients. However, when adjusted for covariates, we found no significant correlation between DUP or DUI and HV, PV or GMV anymore. There only was a trend for decreasing GMV with increasing DUI in FEP. Our results do not comprehensively support the hypothesis of a "toxic" effect of the pathogenic mechanism underlying untreated psychosis on brain structure. If there is any effect, it might rather occur very early in the disease process, during which patients experience only unspecific symptoms.

Attitudes Toward Stimulant Treatment of Offspring of Adult Patients with Attention-Deficit/Hyperactivity Disorder.

AIM: The objective of this study was to investigate how adult patients with attention-deficit/hyperactivity disorder viewed the testing and use of stimulants in their children. METHODS: Using a qualitative approach, we interviewed 32 outpatients from a special care unit of a university hospital. RESULTS: Emerging themes centered around concerns about the right age to test children and opinions about stimulant treatment ranging from unreserved agreement to reluctance, as well as the need for a shared decision with the child. CONCLUSIONS: Our results suggest that better psychoeducational programs are needed, especially for adults with attention-deficit/hyperactivity disorder, in which long-term consequences of the disorder, areas of impairment, and possible treatment effects in their children are explained and concerns about unknown side effects and the right time to test and treat are addressed.

[Assessment of Functioning when Conducting Occupational Capacity Evaluations--What is "Evidence-Based"?]. / Funktionsbeschreibung in der Begutachtung der Arbeitsfähigkeit--Was ist "evidence-based"?

AIM: Occupational capacity evaluations have previously been subject to criticism for lacking in quality and consistency. To the authors' knowledge, there is no clear consensus on the best way to formally assess functioning within capacity evaluations. In this review we investigated different instruments that are used to assess functioning in occupational capacity evaluations. METHODS: Systematic review of the literature. RESULTS: Though several instruments that assess functional capacity were found in our search, a specific validated instrument assessing occupational capacity as part of a larger psychiatric evaluation was not found. The limitations of the existing instruments on assessing functional capacity are discussed. CONCLUSION: Medical experts relying on instruments to conduct functional capacity evaluations should be cognizant of their limitations. The findings call for the development and use of an instrument specifically designed to assess the functional and occupational capacity of psychiatric patients, which is also likely to improve the quality of these reports.

Sarcoma de partes blandas del adulto: características, presentación, y tratamiento de 107 pacientes en el Instituto Oncológico Luis Razetti / Sarcoma of the soft tissue of the adult: characteristic presentation, and treatment of 107 patients in the Institute Oncologic Luis Razetti

Presentamos las características históricas, clínicas y terapéuticas más importantes de 107 adultos con sarcoma de partes blandas estadio II-IV vistos en el Instituto Oncológico Luis Razetti, de 1980 a 1992. En general, la epidemiología y clínica de este tumor sólido mostró ser parecida a la de otras series publicadas en la literatura. La sobrevida total del grupo fue de 55 por ciento tras 5 años de observación y de 16 por ciento tras 10 años. El riesgo acumulado de eventos a los 5 años fue de 42 por ciento, y el riesgo de abandono, 65 por ciento. Un subgrupo vivio menos tiempo que otro. Las variables significativamente asociadas a este hallazgo fueron estadio, tipo y grado histológico, margenes de resección, y tipo de cirugía. El grupo tratado con quimioterapia registró más eventos que el grupo no tratado, pero probablemente se trata de una asociación no causal. Los resultados de ajuste y control de estas variables con técnicas multivariables serán motivo de un reporte posterior

Modelo discriminante en cáncer de mama con ganglios negativos: análisis multivariante para predecir falta de seguimiento, recaida y sobrevida en pacientes con cáncer de mama sin metástasis ganglionar en axila / Discriminante models in breast cancer with negative ganglia: multivariant analysis for predict continuation absence, relapse and to survive in patients with breast cancer without ganglia metastasis in axilla

En Venezuela muchas pacientes con cáncer de mama desaparecen después de un seguimiento insuficiente. Nuestros objetivos fueron identificar variables que identifiquen casos con cáncer de mama sin metástasis ganglionar axilar, con alta probabilidad de abandonar el seguimiento postoperatorio y alto riesgo de recaída a distancia. Construimos un modelo de regresión múltiple y un modelo discriminante para predecir sobrevida libre de recaída (SLR) y pérdidas al seguimiento. Las covariables usadas fueron edad, tamaño tumoral, grado tumoral, condición menstrual, receptores estrogénicos (RE), tipo de cirugía, radioterapia (RT), y tamoxifeno. Ninguna de las 62 pacientes recibió quimioterapia. La mediana del tamaño tumoral fue 2.3 cm y 73 por ciento tuvo un grado tumoral pobre-moderado. La mitad de la serie se perdió antes de cumplir 5 años de seguimiento. La SLR estimada a los 8 años fue de 55 por ciento. En los ensayos multivariantes, sólo RT estuvo significativamente asociada a la SRL (p=0.0007). Las mujeres que no recibieron RT tuvieron una tasa de abandono dos veces superior. Es probable que el grupo tratado con RT tuvo mayor motivación. El desconocimiento del grado tumoral o de RE no pareció incidir negativamente en el pronóstico de la serie pero restó precisión al modelo discriminante. Estas observaciones sugieren que las pacientes con este diagnóstico tratadas en el Instituto Oncológico Razetti necesitan ser mejor educadas y motivadas para así disminuir las tasas de abandono y mejorar el seguimiento