Gender and the experience of mental health expert witness testimony.

Mental health expert witness testimony involves complex tasks, and the capacity to perform under pressure is a fundamental skill of a forensic professional. In this context, it is important to understand the nuances of the provision of expert witness testimony. There have been several efforts to examine gender bias across legal and medical systems. Despite these reviews, little is known about how men and women differ or are similar with regard to performing expert witness functions. The purpose of this pilot study was to examine whether the testimony experiences of psychiatry and psychology experts vary by gender. Differences across certain domains, such as the sense of never experiencing anxiety and the sense of one's impact on case outcome were seen across genders. Few other gender-based differences in the experience of providing expert witness testimony were seen. Although the findings of this study raise further questions, they highlight some of the important subtleties noted in forensic practice and the work of the expert witness. In future studies, researchers should continue to explore these findings on the influence of gender and expand to consider culture and race as additional factors in the experience of expert witness testimony. As forensic professional practice evolves, it is important to understand unique aspects of forensic practice, to improve training of forensic experts, and to assist forensic experts in anticipating what they may experience related to the provision of expert testimony.

Surgical parathyroidectomy versus cinacalcet therapy: in the management of secondary hyperparathyroidism.

OBJECTIVES: The aim of this study was to compare the clinical effectiveness of surgery with calcimimetics as treatment strategies for managing the biochemical abnormalities that characterize secondary hyperparathyroidism (2HPTH), resistant to optimal conventional therapy in patients with end-stage renal failure (ESRF). STUDY DESIGN: A historical cohort study. SETTING: Maxillofacial Department, Morriston Hospital, Swansea, United Kingdom. SUBJECTS AND METHODS: Fifty-four patients with 2HPTH resistant to optimal conventional medical management were studied. One cohort of 20 patients was treated with surgical parathyroidectomy, the other cohort of 34 patients with cinacalcet. Serum parathyroid hormone (PTH) and bone profile were measured before and at monthly intervals after intervention. RESULTS: Both cohorts were comparable in their demographic profile, pretreatment comorbidities, baseline PTH, and bone profile. In all 20 surgical patients, the 1-week postoperative PTH had decreased by 97% (P < .001); in the medical cohort after 4 months of daily cinacalcet, the PTH decreased by 48% (P < .001) from baseline. This reduction was maintained at 18 months. In all but 1 surgical patient, alkaline phosphatase (ALP) decreased to normal levels, whereas on cinacalcet, there was no statistically significant reduction. Patients who underwent parathyroidectomy had a more significant decrease in PTH (P < .001) and ALP (P < .0014) than did patients on cinacalcet therapy. All patients managed surgically who complained of preoperative symptoms of pruritis and bone pain expressed complete resolution or significant improvement after parathyroidectomy (P < .001, P < .003, respectively). CONCLUSION: Surgery was superior to "medical" parathyroidectomy in controlling PTH and ALP.