Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 13.482
Filtrar
1.
Int J Offender Ther Comp Criminol ; 67(1): 3-16, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35435024

RESUMO

There are cases in forensic psychiatric evaluations with inconclusive information or with important information missing. In such situations, when new information becomes available the judge may ask an expert to supplement his/her report in the light of new information. For the purpose of this study, we collected 42 supplemental evaluations written in the University Psychiatric Hospital Vrapce to determine possible factors which were associated with changes in supplemental evaluations. The following data were gathered: demographic data, types of criminal offenses, reasons for the supplement evaluation, court questions, and diagnoses. Changes in supplemental evaluations occured more often when the defendants were diagnosed with a personality disorder (PD) only, compared to those who had a PD with a comorbidity, especially substance use disorders. Defendants with the diagnosis of a substance use disorder were 63.7% less likely to have changed experts' evaluations. The evaluations remained the same when the reason for supplemental evaluations were new witnesses' testimonies. Considering the principle of economy of actions in a judiciary system, a more critical approach should be taken when the judge requests a supplemental report.


Assuntos
Transtornos Mentais , Transtornos Relacionados ao Uso de Substâncias , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Prova Pericial , Defesa por Insanidade , Psiquiatria Legal , Transtornos da Personalidade/diagnóstico , Medicina Legal , Transtornos Relacionados ao Uso de Substâncias/diagnóstico
2.
Vnitr Lek ; 68(7): 426-431, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36402566

RESUMO

Chronic kidney disease (CKD) affects 10% of the population of developed countries and significantly affects the population health. In addition to the well-known renoprotection tools slowing down the progression of CKD, SGLT2 inhibitors have been newly introduced into clinical practice based on the results of extensive studies, both in diabetics and non-diabetics. This expert opinion discusses the classification of CKD, current renoprotection options, and the recent role of SGLT2 inhibitors in the care of patients with CKD.


Assuntos
Médicos , Insuficiência Renal Crônica , Inibidores do Transportador 2 de Sódio-Glicose , Humanos , Nefrologistas , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Prova Pericial , Insuficiência Renal Crônica/terapia
3.
5.
Am J Orthod Dentofacial Orthop ; 162(4): 442, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36182206
6.
BMJ ; 379: o2386, 2022 10 03.
Artigo em Inglês | MEDLINE | ID: mdl-36191929
7.
Asian J Psychiatr ; 78: 103266, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36244295

RESUMO

OBJECTIVE: According to some recent evidence, suicide rate is higher in inpatients than in the general population around the world. However, suicide prevention strategies (SPS) are poorly focused and understood in medical settings. This study aimed to develop effective SPS and interventions in medical settings of Iran and provide evaluation checklists/procedures for them. METHODS: The study was performed in two steps, including literature review and expert opinions panel. In the first stage, we conducted a comprehensive literature review to find relevant suicide prevention programs, strategies, interventions, or any efforts to prevent suicide in the medical settings. In the second stage, an expert panel was arranged for developing effective and feasible SPS in medical settings. Data were analyzed through content analysis approach. RESULTS: Overall, 11 records were included in the literature review. SPS varied from staff training, safety plan and quality improvements, and prevention programs to therapy methods. Finally, in the second stage, the following seven major SPS were recommended by the expert panel: 1) Integration and application of obtained suicidal behavior data through evaluating medical records, 2) Screening and suicide risk assessment, 3) Staff training, 4) Quality improvement, 5) Follow-up of inpatients with high-risk behaviors, 6) Reducing stigma and improving public awareness, and 7) Follow-up of discharged high-risk inpatients. Also, 23 interventions within the strategies were presented. CONCLUSION: Given that SPS are poorly focused in medical settings, the practical framework that emerged in this study could be used to develop or advance SPS in various medical settings.


Assuntos
Prova Pericial , Suicídio , Humanos , Pacientes Internados , Suicídio/prevenção & controle , Ideação Suicida , Melhoria de Qualidade
8.
Forensic Sci Int ; 341: 111499, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36283276

RESUMO

Expert testimony is only admissible in common law if it will potentially assist the trier of fact to make a decision that they would not be able to make unaided. The present paper addresses the question of whether speaker identification by an individual lay listener (such as a judge) would be more or less accurate than the output of a forensic-voice-comparison system that is based on state-of-the-art automatic-speaker-recognition technology. Listeners listen to and make probabilistic judgements on pairs of recordings reflecting the conditions of the questioned- and known-speaker recordings in an actual case. Reflecting different courtroom contexts, listeners with different language backgrounds are tested: Some are familiar with the language and accent spoken, some are familiar with the language but less familiar with the accent, and others are less familiar with the language. Also reflecting different courtroom contexts: In one condition listeners make judgements based only on listening, and in another condition listeners make judgements based on both listening to the recordings and considering the likelihood-ratio values output by the forensic-voice-comparison system.


Assuntos
Voz , Reconhecimento Psicológico , Medicina Legal , Prova Pericial , Tecnologia
9.
Expert Rev Clin Immunol ; 18(10): 1033-1047, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36062811

RESUMO

INTRODUCTION: Generalized pustular psoriasis (GPP) is a rare, severe, clinically heterogeneous disease characterized by flares of widespread, noninfectious, macroscopically visible pustules that occur with or without systemic inflammation, and are associated with significant morbidity and mortality. Historically, GPP has been classified as a variant of psoriasis vulgaris (PV, or plaque psoriasis); however, accumulating evidence indicates that these are distinct conditions, requiring different treatment approaches. AREAS COVERED: In this perspective article we review evidence that supports the classification of GPP as distinct from PV. EXPERT OPINION: The histopathologic and clinical appearance of GPP is distinct from that of PV and fundamental differences exist between the two conditions in terms of genetic causes and expression-related mechanisms of disease development. GPP results from dysregulation of the innate immune system, with disruption of the interleukin (IL)-36 inflammatory pathway, induction of inflammatory keratinocyte responses, and recruitment of neutrophils. PV is driven by the adaptive immune system, with a key role played by IL-17. Considering GPP as a separate disease will enable greater focus on its specific pathogenesis and the needs of patients. Many treatments for PV have insufficient efficacy in GPP and a therapeutic approach developed specifically for GPP might lead to better patient outcomes.


Generalized pustular psoriasis (GPP) is a rare disease. During episodes of worsening disease, the immune system attacks the skin. This causes large areas of skin to become red and painful, pus-filled blisters suddenly form. Some people with GPP have a history of another, more common, skin condition called psoriasis vulgaris (PV). People with PV develop patches of scaly, itchy skin. In the past, GPP was classed as a type of PV and treated with the same medicines. However, these medicines do not work well in GPP. Researchers now understand more about what causes GPP and how it differs from PV. GPP can cause medical problems throughout the body, leading to life-threatening complications. This means that people with GPP often need urgent medical treatment in hospitals. People with PV are mostly treated outside of hospitals. Any other medical problems are not usually due to PV itself. Researchers have found several genes that are altered in people with GPP and PV, and they differ between the two diseases. For example, changes in a gene called IL36RN are common in GPP but are not seen in PV. The skin of people with these two diseases also looks different under a microscope. Knowing more about GPP and how it differs from PV will help people with GPP to be diagnosed more quickly. It will also help researchers to develop new medicines specifically for GPP, so people can receive better treatment in the future.


Assuntos
Doenças da Imunodeficiência Primária , Psoríase , Doença Aguda , Prova Pericial , Humanos , Interleucina-17/uso terapêutico , Interleucinas/genética , Queratinócitos/patologia , Psoríase/tratamento farmacológico
10.
Philos Ethics Humanit Med ; 17(1): 11, 2022 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-36127693

RESUMO

BACKGROUND: Healthcare is predicated on the use of biotechnology and medical technology, both of which are indispensable in diagnosis, treatment, and most aspects of patient care. It is therefore imperative that justifications for use of new technologies are appropriate, with the technologies working as advertised. In this paper, I consider philosophical accounts of how such justifications are made. METHODS: Critical philosophical reflection and analysis. RESULTS: I propose that justification in many prominent accounts is based on the designer's professional experience and on expert testimony. I argue, however, that professional designers are not in a position to justify a new biotechnology or medical device if the justification is based on testimony or past experience of presumably similar technologies. I argue (1) that similarity judgments offered by instantaneous experts cannot be viewed as contributing (epistemically) to evidential justification of new and unproven technologies; and (2) that designers and manufacturers cannot endorse a technology's effective function in a patient-care context until it has been successfully used in that context. CONCLUSION: I show that an expert's past professional experiences can never predict or justify the impact of a novel technology on human health. This is because any new technology leads to the introduction of new mechanisms with unprecedented functions. The new technology therefore needs to be studied in situ and justified as a newly created mechanism within the relevant healthcare setting. Ultimately, justifications of this type rely on the scientific community and society engaging in repeated experimentation and observation of the technology, and confirming its successful use.


Assuntos
Prova Pericial , Julgamento , Atenção à Saúde , Humanos
11.
Am J Ther ; 29(5): e500-e506, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36048564

RESUMO

BACKGROUND: Advances in drug therapy for inflammatory bowel disease (IBD) [Crohn disease and ulcerative colitis (UC)] have contributed to a decrease in the severity of these chronic and disabling conditions. STUDY QUESTION: What are the milestones of the changes in the expert approach to the pharmacological management of IBD in the past century? STUDY DESIGN: To determine the changes in the experts' approach to the management of regional ileitis and UC, as presented in a widely used textbook in the United States. DATA SOURCES: The chapters presenting the management of IBD in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020. RESULTS: No specific interventions existed from 1927 through 1942. The pharmacological management of IBD has had 3 slightly overlapping eras starting in 1943. During the first period (1943-1951), the medical management relied on antibiotics, primarily sulfonamides and chloramphenicol. In the second (1955-75), experts recommended the use of adrenocorticotropic hormone or corticosteroids and 5-aminosalicylate. In the third era, which commenced in 1979 and is continuing to date, the pharmacological interventions have been expanded and refined to include 5 main drug classes, 5-aminosalicylates (sulfasalazine, mesalamine, and olsalazine), corticosteroids (prednisone and budesonide), immunomodulators (azathioprine, 6-mercaptopurine, cyclosporine, and tofacitinib), biologics (infliximab adalimumab certolizumab pegol, and natalizumab), and antibiotics (metronidazole and ciprofloxacin). A consensus exists that the monoclonal antibodies again tumor necrosis factor alpha are cost-effective for induction and maintenance of clinical remission in both UC (golimumab) and Crohn disease (certolizumab pegol). The newer agents ustekinumab (a monoclonal antibody to the interleukin p40 subunit) and vedolizumab (a monoclonal antibody to the homing receptor integrin complex) have also performed well. CONCLUSIONS: The pharmacological management of IBD has been the focus of intense research and development in the past 60 years. The pillars of drug treatment have been 5-aminosalicylates and corticosteroids. Recent pharmacological innovations (immunomodulators and biologicals) constitute an encouraging paradigm shift in the treatment of UC and Crohn disease.


Assuntos
Colite Ulcerativa , Doença de Crohn , Doenças Inflamatórias Intestinais , Antibacterianos/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Certolizumab Pegol/uso terapêutico , Colite Ulcerativa/tratamento farmacológico , Doença de Crohn/tratamento farmacológico , Prova Pericial , Humanos , Doenças Inflamatórias Intestinais/tratamento farmacológico
12.
PLoS One ; 17(9): e0275316, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36178941

RESUMO

BACKGROUND: Science communication can provide people with more accurate information on pandemic health risks by translating complex scientific topics into language that helps people make more informed choices on how to protect themselves and others. During pandemics, experts in medicine, science, public health, and communication are important sources of knowledge for science communication. This study uses the COVID-19 pandemic to explore these experts' opinions and knowledge of what to communicate to the public during a pandemic. The research question is: What are the key topics to communicate to the public about health risks during a pandemic? METHOD: We purposively sampled 13 experts in medicine, science, public health, and communication for individual interviews, with a range of different types of knowledge of COVID-19 risk and communication at the national, regional and hospital levels in Norway. The interview transcripts were coded and analysed inductively in a qualitative thematic analysis. RESULTS: The study's findings emphasise three central topics pertaining to communication about pandemic health risk during the first year of the COVID-19 pandemic in Norway: 1) how the virus enters the human body and generates disease; 2) how to protect oneself and others from being infected; and 3) pandemic health risk for the individual and the society. CONCLUSION: The key topics emerging from the expert interviews relate to concepts originating from multiple disciplinary fields, and can inform frameworks for interprofessional communication about health risks during a pandemic. The study highlights the complexity of communicating pandemic messages, due to scientific uncertainty, fear of risk amplification, and heterogeneity in public health and scientific literacy. The study contributes with insight into the complex communication processes of pandemic health risk communication.


Assuntos
COVID-19 , Comunicação em Saúde , COVID-19/epidemiologia , Comunicação , Prova Pericial , Humanos , Pandemias , Saúde Pública
14.
Am J Gastroenterol ; 117(11): 1743-1752, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36148549

RESUMO

Common variable immunodeficiency (CVID) is the most common symptomatic primary immunodeficiency. It is characterized by impaired B-cell differentiation. Although patients can be diagnosed with CVID anytime during their lifetime, most patients have symptoms for 5-9 years before their diagnosis. The diagnosis of CVID starts with a detailed history focusing on the infectious and noninfectious manifestations of the disease. In patients who are suspected to experience CVID, quantitative immunoglobulins (Ig) should be checked to confirm the diagnosis. IgG should be at least 2 times less than the age-specific SD along with either a low IgA or IgM and with evidence of impaired vaccine response. CVID is usually associated with infectious and/or noninfectious conditions, the latter of which can be inflammatory, autoimmune, lymphoproliferative, or malignant, among other manifestations. Ig therapy has positively affected the disease course of patients with infectious complications but has limited effect on the noninfectious manifestations because the noninfectious complications are related to immune dysregulation involving B cells and T cells rather than primarily due to antibody deficiency. When the gastrointestinal (GI) system is involved, patients with CVID may display signs and symptoms that mimic several GI conditions such as celiac disease, pernicious anemia, or inflammatory bowel diseases. The inflammatory bowel disease-like condition is usually treated with steroids, 5-aminosalicylates, thiopurines, or biologic agents to control the inflammation. In this review, the clinical presentations, diagnostic considerations, and therapeutic options for GI manifestations of CVID will be discussed to facilitate the individualized management of these often-complex patients.


Assuntos
Doença Celíaca , Imunodeficiência de Variável Comum , Humanos , Imunodeficiência de Variável Comum/complicações , Imunodeficiência de Variável Comum/diagnóstico , Imunodeficiência de Variável Comum/terapia , Prova Pericial , Linfócitos B , Doença Celíaca/complicações
15.
16.
MMW Fortschr Med ; 164(14): 62-66, 2022 08.
Artigo em Alemão | MEDLINE | ID: mdl-35941455

RESUMO

If the patient is unable to appear in court due to illness, a certificate of incapacity to stand trial or travel (civil resp. criminal law) must be submitted. METHODS: Over a period of 2;2 years, 34 certificates submitted in the context of criminal or civil proceedings at 4 different district and regional courts were analyzed anonymously. RESULTS: Major deficiencies in the content of the certificates were revealed. As a rule, certificates were submitted without justification for the stated inability to stand trial, or certificates of incapacity for work were submitted instead. The role of the physician as an expert witness, which should enable the court to make an independent decision, was exercised only very occasionally. DISCUSSION: The deficiencies shown are probably due to uncertainties in the issuance of the certificates. It is important that the certificate contains a diagnosis, the underlying diagnostics, the type and probable duration of the assumed incapacity and a generally understandable, sufficient justification for this.


Assuntos
Prova Pericial , Humanos
17.
Sud Med Ekspert ; 65(4): 64-68, 2022.
Artigo em Russo | MEDLINE | ID: mdl-35947414

RESUMO

The objective of the study is to develop scientific criteria for the analytical and synthesizing part of the expert report on 'medical cases.' We studied 15 conclusions of expert panels. The following research methods were used: logical and analytical, logical and synthetic (generalization), comparative, systemic and analytical (analysis of relations between facts). For the first time, a new algorithm for the analytical and synthesizing part of the expert report was proposed; and also ways to improve the quality of forensic reports for all types of expert examinations, including those involving non-state forensic experts, were described. These improvements make the results of expert examinations and reviews more convenient and objective. They are intended for non-state forensic experts, attorneys who use them, and state forensic experts, including during the training and professional development.


Assuntos
Medicina Legal , Pessoal de Saúde , Atenção à Saúde , Prova Pericial , Humanos
18.
Unfallchirurgie (Heidelb) ; 125(10): 825-836, 2022 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-36045263

RESUMO

The following article is one component of a four-part series on the presentation and discussion of new assessment recommendations for disability compensation in private accident insurance. The introduction to the topic and the associated basics as well as the concept of the new draft of the assessment recommendations have already been published in the Der Unfallchirurg on 17 February 2022. The topic of the second part published here is the assessment recommendations for disability of the upper extremities within the compensation scheme.


Assuntos
Pessoas com Deficiência , Seguro de Acidentes , Avaliação da Deficiência , Prova Pericial , Humanos , Extremidade Superior
19.
Head Neck ; 44(11): 2528-2536, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35920353

RESUMO

BACKGROUND: Few studies have investigated the needs of head and neck surgery trainees and areas for improvement of fellowship programs. METHODS: We conducted a qualitative study by interviewing a nationally representative sample of program directors and national leaders in head and neck surgery. We asked about the current state and strengths of training; and areas for further improvement. All interviews were independently coded and analyzed by two reviewers. RESULTS: All experts (100%) believed that the current training provides a strong foundation and furthermore, a standardized curriculum is beneficial. Multidisciplinary training (80%), participation in tumor boards (75%), and a syllabus (60%) were the most frequently mentioned components. Most believed that a formal certification process would be beneficial (73%), though there was no consensus on the format. CONCLUSION: Experts in head and neck surgery are generally in favor of a standardized curriculum. Further discussions of a formal certification process might be warranted.


Assuntos
Oncologia Cirúrgica , Currículo , Prova Pericial , Bolsas de Estudo , Humanos , Pescoço , Determinação de Necessidades de Cuidados de Saúde
20.
Expert Rev Clin Pharmacol ; 15(8): 921-925, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35959655

RESUMO

INTRODUCTION: Lisdexamfetamine dimesylate (LDX) is a prodrug approved for attention deficit/hyperactivity disorder and for moderate-to-severe binge eating disorder in adults in some countries. AREA COVERED: We aimed to specify the abuse potential of LDX in adults, using a review of pharmacokinetic/pharmacodynamic (PK/PD), animal, clinical, and pharmaco-epidemiological studies, through a PubMed search since inception until May 2021 using the following keywords: "lisdexamfetamine AND ('misuse' OR 'abuse' OR 'diversion' OR 'addiction')". EXPERT OPINION: Most of the studies highlighted a longer Tmax than dexamphetamine leading to a delayed onset of effects and a decreased Cmax. These PK parameters were often associated with a diminished feeling of euphoria, in comparison to immediate-release dexamphetamine. The potential for abuse was also limited by the prodrug property of LDX, thus reducing the risk of misuse. Nevertheless, all the data were not convergent, as some authors reported similar Cmax for LDX and dexamphetamine and reinforcing properties with a dose-dependent effect. Epidemiological studies found that abuse rates of LDX were substantially lower than those of immediate-release dexamphetamine. Overall, although LDX abuse seems possible, we did not find evidence concerning current safety signal. However, more long-term pharmaco-epidemiological studies are still needed to confirm this finding.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Estimulantes do Sistema Nervoso Central , Pró-Fármacos , Animais , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/efeitos adversos , Prova Pericial , Dimesilato de Lisdexanfetamina/efeitos adversos , Pró-Fármacos/efeitos adversos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...