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1.
J Law Med ; 26(4): 825-830, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31682360

RESUMO

Independent medical experts provide reports in clinical negligence claims brought against doctors and other health care professionals. They are asked to provide an opinion on whether the doctor has breached their duty of care to the patient, commonly described as the "Bolam Principle". By the time a patient litigates against a health care professional, the clinical sequence and outcome are known. Experts provide their opinions with the benefit of this knowledge. To determine whether knowledge of the outcome affects the expert's opinion, 42 independent general practice experts were asked to indicate whether a general practitioner had breached their duty of care in six clinical case scenarios. 21 were told the clinical outcome. Experts who knew the outcome were less likely to support the general practitioner's course of action, although this did not reach statistical significance. General practitioners demonstrated considerable "dove" or "hawk" variability when giving opinions on the same scenario.


Assuntos
Imperícia , Prova Pericial , Humanos
2.
Sud Med Ekspert ; 62(5): 9-12, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31626187

RESUMO

The aim of the study is an analysis of the significant problems of legal regulation and procedure in the administration and conduct of forensic medical examinations of living persons. The authors, based on an analysis of the opinions of scientists, specialists and legal and forensic experts, draw conclusions and make suggestions aimed at improving forensic examinations in the conduct of these types of investigations.


Assuntos
Prova Pericial , Medicina Legal , Humanos
6.
Arch Endocrinol Metab ; 63(5): 456-461, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31482953

RESUMO

The indolent evolution of low-risk papillary thyroid microcarcinoma (mPTC) in adult patients and the consequences of thyroidectomy require a revision of the management traditionally recommended. Aiming to spare patients unnecessary procedures and therapies and to optimize the health system in Brazil, we suggest some measures. Fine-needle aspiration of nodules ≤ 1 cm without extrathyroidal extension on ultrasonography should be performed only in nodules classified as "very suspicious" (i.e., high suspicion according to ATA, high risk according to AACE, TI-RADS 5) and in selected cases [age < 40 years, nodule adjacent to the trachea or recurrent laryngeal nerve (RLN), multiple suspicious nodules, presence of hypercalcitoninemia or suspicious lymph nodes]. Active surveillance (AS) rather than immediate surgery should be considered in adult patients with low-risk mPTC. Lobectomy is the best option in patients with unifocal low-risk mPTC who are not candidates for AS because of age, proximity of the tumor to the trachea or RLN, or because they opted for surgery. The same applies to patients who started AS but had a subsequent surgical indication not due to a suspicion of tumor extension beyond the gland or multicentricity. Molecular tests are not necessary to choose between AS and surgery or, in the latter case, between lobectomy and total thyroidectomy. The presence of RAS or other RAS-like mutations or BRAFV600E or other BRAF V600E-like mutations should not modify the management cited above; however, the rare cases of mPTC exhibiting high-risk mutations, like in the TERT promoter or p53, are not candidates for AS.


Assuntos
Carcinoma Papilar/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Biópsia por Agulha Fina , Carcinoma Papilar/cirurgia , Prova Pericial , Humanos , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia
7.
Stud Health Technol Inform ; 264: 898-902, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438054

RESUMO

The evaluation of the validity of a knowledge-based system is of great importance during its development. It determines whether the system represents the experts' knowledge correctly. This is highly important, but also particularly difficult, if the expert knowledge is not explicit, but only implicit and tacit. In the following the validity's evaluation of a system for education of caregiving relatives is presented. To evaluate the system's knowledge delivery strategy against the experts' opinion, several fictious characters were created. The evaluation revealed inconsistencies in the knowledge base. After resolving these, the experts' opinion is represented to a large extent by the system. Nevertheless, the used evaluation approach is not capable of detecting all inconsistencies. Therefore, a strong need of a system's learning capacity to integrate feedback from a larger group of real caregiving relatives exists. In addition, a rule-based component, representing disease specific knowledge, should be implemented.


Assuntos
Bases de Conhecimento , Conhecimento , Prova Pericial , Aprendizagem
8.
Acta Psychol (Amst) ; 198: 102890, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31319279

RESUMO

Non-experts are unduly attracted to explanations of scientific phenomena that contain irrelevant reductive language (e.g., explanations of biological phenomena that mention chemistry; Hopkins, Weisberg, & Taylor, 2016). To determine if expertise would reduce this reasoning error, the current study recruited individuals with graduate-level training in six scientific fields and in philosophy (N = 580) and asked them to judge explanations for phenomena from those fields. Like the novices in Hopkins et al. (2016), scientists' ratings of bad explanations were influenced by reductive information when viewing phenomena from outside their field of expertise, but they were less likely to show this bias when reasoning about their own field. Higher levels of educational attainment did improve detection of bad explanations. These results indicate that advanced training in science or logic can lead to more accurate reasoning about explanations, but does not mitigate the reductive allure effect.


Assuntos
Tomada de Decisões/fisiologia , Prova Pericial/métodos , Julgamento/fisiologia , Lógica , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
11.
Sud Med Ekspert ; 62(2): 15-18, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31213585

RESUMO

The present study addresses the complicated borderline problems facing researchers of human images obtained with the use of photographic and videotechnical means and methods that imply the necessity of the combined application of the knowledge of different aspects of forensic medical and criminalistics expertises. The fundamental principles of comprehensive investigations and expertises are defined. The theoretical substantiation is provided for the performance of the combined forensic medical expertises and forensic facial reconstruction based on the concrete examples from expert practice. Special attention is given to the schedule and conduction of such examinations. It is demonstrated that only the joint analysis of all characteristic features revealed by different specialists allows for a definitive expert conclusion of evidentiary value.


Assuntos
Medicina Legal/normas , Aparência Física , Prova Pericial , Humanos
12.
Sud Med Ekspert ; 62(2): 48-51, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31213592

RESUMO

The objective of the analysis of the situational expertises performed during criminal investigations consists of the confirmation (or refutation) of a concrete version of the situation of interest, the possibility of trace formation, and the availability of facts awaiting interpretation from the medical perspective. The present study was carried out with the use of such methods as recording facts, conditions, and circumstances of the versions of the event being investigated, measurements, description, comparison, experiment, modeling, mathematical and cybernetic simulation as well as euristic technologies. The concrete expertise described in the present publication revealed the possibility of the evaluation of the appearance of specific traces associated with a given situation. The author proposes the recommendation for the preparation and performance of such expertises with special reference to the algorithm of the investigator's actions. The results of the study can be useful not only for the experts and investigators but also for other specialists in such fields as criminal sciences, surveillance operations, forensic expert and criminal intelligence.


Assuntos
Algoritmos , Crime , Prova Pericial/normas , Humanos
13.
Cancer Treat Rev ; 77: 1-10, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31163334

RESUMO

Surgical resection of pancreatic cancer offers a chance of cure, but currently only 15-20% of patients are diagnosed with resectable disease, while 30-40% are diagnosed with non-metastatic, unresectable locally advanced pancreatic cancer (LAPC). Treatment for LAPC usually involves systemic chemotherapy, with the aim of controlling disease progression, reducing symptoms and maintaining quality of life. In a small proportion of patients with LAPC, primary chemotherapy may successfully convert unresectable tumours to resectable tumours. In this setting, primary chemotherapy is termed 'induction therapy' rather than 'neoadjuvant'. There is currently a lack of data from randomized studies to thoroughly evaluate the benefits of induction chemotherapy in LAPC, but Phase II and retrospective data have shown improved survival and high R0 resection rates. New chemotherapy regimens such as nab-paclitaxel + gemcitabine and FOLFIRINOX have demonstrated improvement in overall survival for metastatic disease and shown promise as neoadjuvant treatment in patients with resectable and borderline resectable disease. Prospective trials are underway to evaluate these regimens further as induction therapy in LAPC and preliminary data indicate a beneficial effect of FOLFIRINOX in this setting. Further research into optimal induction schedules is needed, as well as guidance on the patients who are most suitable for induction therapy. In this expert opinion article, a panel of surgeons, medical oncologists and gastrointestinal oncologists review the available evidence on management strategies for LAPC and provide their recommendations for patient care, with a particular focus on the use of induction chemotherapy.


Assuntos
Neoplasias Pancreáticas/tratamento farmacológico , Quimioterapia Adjuvante , Prova Pericial , Humanos , Quimioterapia de Indução , Terapia Neoadjuvante , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Behav Sci Law ; 37(3): 313-328, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31157923

RESUMO

This is an illustrative article rather than a research study. We offer opinions and recommendations about what we view as unfortunate clinician testimony in suicide-related malpractice cases, testimony that - inadvertently or not - supports or encourages inadequate care of suicidal patients. The principles apply to both psychiatrists and non-psychiatrists, although the former appear more often in our work. We particularly consider the roles and testimony, in court or at deposition, of psychiatrists, whether as defendants, expert witnesses, or fact witnesses. We cite examples of what we view as poor, disingenuous, dishonest and even dangerous testimony that we believe moves the profession toward unsafe patient care. The examples illustrate what we (and sometimes others) describe as normalization of deviance, pre-suit puffery, self-serving defendant testimony, expert pride supplanting testimonial responsibility, expert arrogance, expert parroting of attorney suggestions, witness ignorance and avoiding facts, unconscious expert bias, inexperience thwarting justice, misleading use of terms such as "predictability," and expert witnesses who lack the direct-care experience that jurisdictions often require in order to opine about defendant clinicians' day-to-day patient care. The examples often reveal concerns beyond the category chosen, and should not be expected to convey all of the facts of a particular case.


Assuntos
Prova Pericial/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Suicídio/legislação & jurisprudência , Comportamento Perigoso , Humanos , Encaminhamento e Consulta/legislação & jurisprudência
15.
New Microbiol ; 42(3): 176-180, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31157400

RESUMO

IgM-enriched immunoglobulins (e-IgM) may be useful in patients with severe acute bacterial infections. The evidence for the administration of e-IgM is not extensive and a definitive consensus has never been reached on its best use in patients with acute infections as well as in critically ill patients. However, the official indication in several countries, including Italy, is quite wide and mainly refers to supportive treatment of patients with acute severe bacterial infections. A multidisciplinary meeting of Italian Experts in Infectious Diseases, Anesthesia and Critical Care, Pneumology, Microbiology and Oncohaematology aimed to produce a statement on the best practical methodological score that could improve the use of e-IgM in patients with different infections, variable severity of disease and etiology. The Expert Panel reviewed the literature and the available guidelines, discussed the experience and eventually proposed to adapt the PIRO score to the practical methodological needs of a simple tool that could guide the administration of e-IgM.


Assuntos
Infecções Bacterianas , Imunoglobulina M , Imunoglobulinas Intravenosas , Infecções Bacterianas/terapia , Prova Pericial , Humanos , Imunoglobulina M/administração & dosagem , Itália , Sepse/terapia
16.
Crit Rev Oncol Hematol ; 138: 190-206, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31092376

RESUMO

The presence of an epidermal growth factor receptor (EGFR) mutation is associated with higher incidence of brain metastases in patients with non-small cell lung cancer (NSCLC); however, patients with synchronous brain metastases at diagnosis have generally been excluded from clinical trials. As there is limited clinical evidence for managing this patient population, a multidisciplinary group of Spanish medical and radiation oncologists, and neuro-oncologist with expertise treating brain metastases in lung cancer patients met with the aim of reaching and developing an expert opinion consensus on the management of patients with EGFR mutated NSCLC with brain metastases. This consensus contains 26 recommendations and 20 conclusion statements across 21 questions in 7 areas, as well as a first-line treatment algorithm.


Assuntos
Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/terapia , Carcinoma Pulmonar de Células não Pequenas/secundário , Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Neoplasias Encefálicas/genética , Carcinoma Pulmonar de Células não Pequenas/genética , Consenso , Receptores ErbB/genética , Prova Pericial , Feminino , Humanos , Incidência , Neoplasias Pulmonares/genética , Mutação
17.
Rev Chil Pediatr ; 90(1): 52-59, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31095219

RESUMO

INTRODUCTION: Parental discipline is a topic frequently asked for advice by those who consult health professionals. It is related to parenting styles and has been scientifically studied regarding its effective ness and impact on children. OBJECTIVE: To describe the subjective theories about parental discipline present in recommendations made by doctors and psychologists in books for parents in Spanish. Ma terial and Method: Thirteen books with advice for parents, written in Spanish by healthcare profes sionals published between 2000 and 2017 were analyzed. Data analysis was performed using Groun ded Theory procedures adapted for the study of subjective theories, through open and axial coding. In addition, thematic codification was made to describe the cases, identifying subjective mottos and subjective theories for each case, which at the same time were grouped into superordinate subjective theories. RESULTS: The data were grouped into three general subjective theories about parental dis cipline in the books analyzed. These subjective theories differ from one another in the importance attributed to authority, punishment, and the necessity of parental discipline. CONCLUSION: There are differences in parental discipline among the books. There is little scientific evidence on the subjective theories of the books. Results differ from historical analyses of these publications in other cultural and temporal contexts. The importance of developing practical guidelines on parental discipline ba sed on evidence to guide parents by health professionals is highlighted.


Assuntos
Desenvolvimento Infantil , Bem-Estar da Criança , Poder Familiar/psicologia , Teoria Psicológica , Punição/psicologia , Adolescente , Atitude do Pessoal de Saúde , Criança , Pré-Escolar , Estudos Transversais , Prática Clínica Baseada em Evidências , Prova Pericial , Teoria Fundamentada , Humanos , América Latina , Literatura , Pesquisa Qualitativa , Espanha
18.
Qual Life Res ; 28(9): 2565-2578, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31102155

RESUMO

PURPOSE: Our purpose was to create a content domain framework for delirium severity to inform item development for a new instrument to measure delirium severity. METHODS: We used an established, multi-stage instrument development process during which expert panelists discussed best approaches to measure delirium severity and identified related content domains. We conducted this work as part of the Better ASsessment of ILlness (BASIL) study, a prospective, observational study aimed at developing and testing measures of delirium severity. Our interdisciplinary expert panel consisted of twelve national delirium experts and four expert members of the core research group. Over a one-month period, experts participated in two rounds of review. RESULTS: Experts recommended that the construct of delirium severity should reflect both the phenomena and the impact of delirium to create an accurate, patient-centered instrument useful to interdisciplinary clinicians and family caregivers. Final content domains were Cognitive, Level of consciousness, Inattention, Psychiatric-Behavioral, Emotional dysregulation, Psychomotor features, and Functional. Themes debated by experts included reconciling clinical geriatrics and psychiatric content, mapping symptoms to one specific domain, and accurate capture of unclear clinical presentations. CONCLUSIONS: We believe this work represents the first application of instrument development science to delirium. The identified content domains are inclusive of various, wide-ranging domains of delirium severity and are reflective of a consistent framework that relates delirium severity to potential clinical outcomes. Our content domain framework provides a foundation for development of delirium severity instruments that can help improve care and quality of life for patients with delirium.


Assuntos
Delírio/diagnóstico , Delírio/psicologia , Índice de Gravidade de Doença , Cuidadores , Prova Pericial , Feminino , Humanos , Masculino , Estudos Prospectivos , Qualidade de Vida/psicologia
19.
J Forensic Sci ; 64(6): 1687-1692, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31116432

RESUMO

Two hundred prosecuting attorneys completed a survey concerning priorities in taking on animal cruelty cases and the factors that help or hinder prosecuting such cases. Respondents commented on the priority given such cases. Questions also addressed specific kinds of evidence that had been used to decide whether to take on a cruelty case and were used in court. Results showed that prosecutors most frequently relied upon "traditional" sources of evidence, including detailed medical and crime scene reports and good quality photographic evidence. Other sources of forensic evidence such as DNA, computer forensics, forensic accounting, blood, and trace evidence were rarely employed. Veterinary forensic evidence, including forensic necropsies and detailed medical reports, was viewed as an important factor by a majority of prosecutors in deciding whether to accept a case for prosecution and in achieving a successful outcome, but a need for additional training for investigators was indicated.


Assuntos
Bem-Estar do Animal/legislação & jurisprudência , Crime/legislação & jurisprudência , Animais , Prova Pericial , Ciências Forenses , Humanos , Polícia , Inquéritos e Questionários , Estados Unidos , Médicos Veterinários
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