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Medical Experts (medical + expert)
Selected AbstractsPolygraph Evidence and Juror Judgments: The Effects of Corroborating Evidence,JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 5 2003Bryan Myers A total of 169 college freshman were presented with a mock transcript of a sexual assault trial. We varied both polygraph expert testimony indicating that the defendant was deceptive (polygraph/no polygraph) and testimony by a medical expert and eyewitness who further corroborated the defendant's guilt (corroborating evidence/no corroborating evidence). Whereas the presence of corroborating evidence influenced verdicts as well as probability of commission (PC) estimates regarding the defendant, evidence of a failed polygraph test did not significantly influence verdicts or PC estimates, nor did the presentation of polygraph evidence interact with the corroborating evidence. [source] Clinical teaching: maintaining an educational role for doctors in the new health care environmentMEDICAL EDUCATION, Issue 10 2000D Prideaux Context and objectives Good clinical teaching is central to medical education but there is concern about maintaining this in contemporary, pressured health care environments. This paper aims to demonstrate that good clinical practice is at the heart of good clinical teaching. Methods Seven roles are used as a framework for analysing good clinical teaching. The roles are medical expert, communicator, collaborator, manager, advocate, scholar and professional. Results The analysis of clinical teaching and clinical practice demonstrates that they are closely linked. As experts, clinical teachers are involved in research, information retrieval and sharing of knowledge or teaching. Good communication with trainees, patients and colleagues defines teaching excellence. Clinicians can ,teach' collaboration by acting as role models and by encouraging learners to understand the responsibilities of other health professionals. As managers, clinicians can apply their skills to the effective management of learning resources. Similarly skills as advocates at the individual, community and population level can be passed on in educational encounters. The clinicians' responsibilities as scholars are most readily applied to teaching activities. Clinicians have clear roles in taking scholarly approaches to their practice and demonstrating them to others. Conclusion Good clinical teaching is concerned with providing role models for good practice, making good practice visible and explaining it to trainees. This is the very basis of clinicians as professionals, the seventh role, and should be the foundation for the further development of clinicians as excellent clinical teachers. [source] Effects of a distance learning program on physicians' opioid- and benzodiazepine-prescribing skillsTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 4 2006Deana Midmer BScN Abstract Introduction: Opioid misuse is common among patients with chronic nonmalignant pain. There is a pressing need for physicians to increase their confidence and competence in managing these patients. Methods: A randomized controlled trial of family physicians (N = 88) attending 1 of 4 continuing medical education events helped to determine the effectiveness of e-mail case discussions in changing physician behavior. Before random assignment, participants completed a pretest and attended a 3-hour didactic session on prescribing opioids and benzodiazepines. The intervention group participated in 10 weeks of e-mail case discussions, with designated participants responding to questions on cases. An addictions physician facilitated the discussion. Several months after the e-mail discussion, participants took part in a mock telephone consultation; a blinded researcher posing as a medical colleague asked for advice about 2 cases involving opioid and benzodiazepine prescribing. Using a checklist, the researcher recorded the questions asked and advice given by the physician. Results: On post-testing, both groups expressed greater optimism about treatment outcomes and were more likely to report using a treatment contract and providing advice about sleep hygiene. There were no significant differences between pretesting and post-testing between the groups on the survey. During the telephone consultation, the intervention group asked significantly more questions and offered more advice than the control group (odds ratio for question items, 1.27 [p = .03]; advice items, 1.33 [p = .01). Discussion: Facilitated by electronic mail and a medical expert, case discussion is an effective means of improving physician performance. Telephone consultation holds promise as a method for evaluating physicians' assessment and management skills. [source] AN AUDIT OF OPERATIVE NOTES: FACTS AND WAYS TO IMPROVE,ANZ JOURNAL OF SURGERY, Issue 9 2008Liviu P. Lefter Background: Accurate operation record keeping is an important element of risk management. Handwritten surgical notes are often produced as evidence in medico-legal malpractice cases and incomplete and illegible notes may be a source of weakness in a surgeon's defence. Therefore, we audited the surgical notes in a teaching hospital surgical department. Methods: During 1 week 190 operative notes were audited for patient identity details, preoperative diagnosis, operation title and details, CMB code, postoperative instruction and author of the note. The operative notes were assessed by a medico-legal lawyer and a medical expert to establish level of legibility and usefulness in a virtual court case. Results: Several operative notes were found incomplete (51.57%) missing important information as CMB code (13.68%), patient details (6.8%) preoperative diagnosis (6.31%), operation title (6.31%) and postoperative instruction (14.73%). Overall, only 92 notes were complete. Conclusion: This audit suggests that handwritten surgical notes generate several errors that could lead to confusion when notes are reviewed for further follow up or are produced as evidence in medico-legal disputes. [source] Reaction of mock jurors to testimony of a court appointed expertBEHAVIORAL SCIENCES & THE LAW, Issue 6 2000Joel Cooper Ph.D. A study was conducted to assess the impact of court appointed experts on the judgments of mock jurors. A civil proceeding was adopted for the experiment. Mock jurors heard testimony about a plaintiff's injury in an automobile accident. In some conditions, medical testimony for the plaintiff and defendant was provided by experts hired by each side. In other conditions, a medical expert appointed by the court testified in addition to the two adversarial experts. In one of these conditions, the court expert sided with the plaintiff; in another, the expert sided with the defendant. The plaintiff in the case was always an individual. The defendant was sometimes a corporation and sometimes an individual. The results showed that mock jurors sided with the court appointed expert in every condition except when the expert favored a corporate defendant. The results were discussed in terms of heuristic processing of persuasive information. Copyright © 2000 John Wiley & Sons, Ltd. [source] Training scenario prototyping for VR-based simulation of neonatal decision-makingCOMPUTER APPLICATIONS IN ENGINEERING EDUCATION, Issue 4 2007A. Holobar Abstract This paper presents the design and implementation of a real-time system for virtual reality (VR)-based training in neonatal medicine, with main emphasis on simple creation of various training scenarios. This system combines an articulated 3D model of a virtual newborn with text-based descriptions of its physiological and behavioral responses, enabling medical experts to easily construct, simulate and revise an arbitrary postnatal critical situation. Afterwards, the resulting descriptions of newborn's behavior can be used for technical specifications (and even for automatic generation) of more complex behavioral models, such as finite-state automata. © 2007 wiley Periodicals, Inc. Comput Appl Eng Educ 15: 317,328, 2007; Published online in Wiley InterScience (www.interscience.wiley.com); DOI 10.1002/cae.20121 [source] Are psychiatrists affecting the legal process by answering legal questions?CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 2 2008Timothy Hardie Background,Psychiatrists are often asked to answer legal questions. The extent to which they answer strictly legal rather than medical matters is not known. Aim,To investigate how strongly psychiatrists in England and Wales express opinions on one legal question , that of diminished responsibility in respect of a murder charge, and how this is related to outcome in court. Method,Our data were extracted from psychiatric reports and case files supplied by the then Department of Constitutional Affairs (now the Ministry of Justice) on cases heard in the Crown Courts between 1 January 1997 and 31 December 2001 in which the defence of diminished responsibility had been raised. The cases had been selected by the Law Commission in their earlier review of partial defences to murder. We devised a reliable system of rating the presence/absence and strength of expression of a legal opinion in the medical reports. We tested the data for relationship between nature and strength of opinion and progression to trial and verdict. Results,Psychiatric reports were available on 143 of 156 cases in which diminished responsibility was considered. They yielded 338 opinions on at least one aspect of diminished responsibility. In 110 (93%) of the 118 cases in which there was a diminished verdict, this was made without trial and, therefore, without reference to a jury. In only eight (27%) out of the 30 cases that went to trial, was a diminished responsibility verdict made. Half of the reports (169) gave a clear opinion on diminished responsibility, a third (121) invited the court to draw a particular conclusion and only 11% (36) provided relevant evidence without answering the legal questions. When there was an opinion or an invitation to make a finding on the legal question, a trial was less likely. A trial was also less likely if reports agreed on what the verdict should be. Conclusions,Psychiatrists frequently answer the legal question of diminished responsibility. The judiciary and medical experts should join in research to examine the consequences of different styles or approaches in presentation of essentially similar evidence in court. Copyright © 2008 John Wiley & Sons, Ltd. [source] A study of argumentation in a causal probabilistic humanistic domain: Genetic counselingINTERNATIONAL JOURNAL OF INTELLIGENT SYSTEMS, Issue 1 2007Nancy Green We present the results of an in-depth qualitative analysis of argumentation in two genetic counseling patient letters. In addition to argumentation techniques designed for medical experts, we found other types of causal argumentation designed for lay readers, reflecting the educational and supportive counseling functions of these letters. Analysis was facilitated by use of a coding scheme for representing causal probabilistic biomedical content of the letters as Bayesian networks. We define the argument techniques used in the letters in terms of Bayesian network, semantic network, argumentation theory, and user model concepts rather than in terms of genetics concepts. © 2007 Wiley Periodicals, Inc. Int J Int Syst 22: 71,93, 2007. [source] Effects of Communicator Credibility and Fear on Adaptive and Maladaptive Coping Reactions to the HIV ThreatJOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH, Issue 3 2005Kanayo Umeh Late diagnosis is currently the principal cause of continued mortality among HIV-infected people. Consequently, medical experts (i.e., GPs) are now required to play a more active role in promoting HIV prevention. Social psychological studies suggest that communicator credibility (CC) affects persuasion. However, there is a paucity of research focusing on HIV/AIDS. We tested propositions that a credible (i.e., "expert") communicator is more persuasive than a noncredible source, and that this effect is moderated by fear. Drive-reduction models (Hovland, Janis, & Kelley, 1953) provided the theoretic framework. One hundred undergraduates were exposed to a communication about HIV/AIDS. CC and fear arousal were manipulated with adaptive coping (intentions to use condoms) and maladaptive coping (rationalizations, denial) treated as outcome variables. Multivariate analysis of variance revealed neither a main effect of CC nor an interaction with fear. However, fear arousal seemed to negate persuasion by increasing maladaptive coping. The partial eta-squared (n,2) value indicated a weak-to-modest effect size. Overall, these findings echo drive-reduction models but raise new questions about relevance of source expertise in health persuasion. [source] The costs of heparin-induced thrombocytopenia: a patient-based cost of illness analysisJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 5 2009T. WILKE Summary.,Background and objectives:,Due to the complexity of heparin-induced thrombocytopenia (HIT), currently available cost analyses are rough estimates. The objectives of this study were quantification of costs involved in HIT and identification of main cost drivers based on a patient-oriented approach. Methods:,Patients diagnosed with HIT (1995,2004, University-hospital Greifswald, Germany) based on a positive functional assay (HIPA test) were retrieved from the laboratory records and scored (4T-score) by two medical experts using the patient file. For cost of illness analysis, predefined HIT-relevant cost parameters (medication costs, prolonged in-hospital stay, diagnostic and therapeutic interventions, laboratory tests, blood transfusions) were retrieved from the patient files. The data were analysed by linear regression estimates with the log of costs and a gamma regression model. Mean length of stay data of non-HIT patients were obtained from the German Federal Statistical Office, adjusted for patient characteristics, comorbidities and year of treatment. Hospital costs were provided by the controlling department. Results and conclusions:,One hundred and thirty HIT cases with a 4T-score ,4 and a positive HIPA test were analyzed. Mean additional costs of a HIT case were 9008 ,. The main cost drivers were prolonged in-hospital stay (70.3%) and costs of alternative anticoagulants (19.7%). HIT was more costly in surgical patients compared with medical patients and in patients with thrombosis. Early start of alternative anticoagulation did not increase HIT costs despite the high medication costs indicating prevention of costly complications. An HIT cost calculator is provided, allowing online calculation of HIT costs based on local cost structures and different currencies. [source] Living it on the skin: Italian states, working illnessAMERICAN ETHNOLOGIST, Issue 2 2008NOELLE J. MOLÉ ABSTRACT In this article, I examine the codification of an Italian work-related illness caused by mobbing, a type of psychological harassment that emerged at the moment neoliberal policies transformed Italy's historically protectionist labor market. I trace how the medicalization of mobbing has expanded workers' access to compensation, resources, and discursive tools for criticizing neoliberal labor conditions, even as it has produced new structures of surveillance. I unravel the neoliberal politics of a state that protects workers' health yet governs worker,citizens through an apparatus of medical experts. I find that workers' labor problems are experienced and managed as bodily problems in ways important to remaking Italian citizenship. [neoliberalism, state, labor, biopolitics, citizenship, bodies, Italy] [source] Estimation of health-care costs for work-related injuries in the Mexican Institute of social securityAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 3 2009Fernando Carlos-Rivera MScE Abstract Background Data on the economic consequences of occupational injuries is scarce in developing countries which prevents the recognition of their economic and social consequences. This study assess the direct heath care costs of work-related accidents in the Mexican Institute of Social Security, the largest health care institution in Latin America, which covered 12,735,856 workers and their families in 2005. Methods We estimated the cost of treatment for 295,594 officially reported occupational injuries nation wide. A group of medical experts devised treatment algorithms to quantify resource utilization for occupational injuries to which unit costs were applied. Total costs were estimated as the product of the cost per illness and the severity weighted incidence of occupational accidents. Results Occupational injury rate was 2.9 per 100 workers. Average medical care cost per case was $2,059 USD. The total cost of the health care of officially recognized injured workers was $753,420,222 USD. If injury rate is corrected for underreporting, the cost for formal injured workers is 791,216,460. If the same costs are applied for informal workers, approximately half of the working population in Mexico, the cost of healthcare for occupational injuries is about 1% of the gross domestic product. Conclusions Health care costs of occupational accidents are similar to the economic direct expenditures to compensate death and disability in the social security system in Mexico. However, indirect costs might be as important as direct costs. Am. J. Ind. Med. 52:195,201, 2009. © 2008 Wiley-Liss, Inc. [source] Psychometric evaluation of the acute coronary syndrome (ACS) response indexRESEARCH IN NURSING & HEALTH, Issue 6 2007Barbara Riegel Abstract Knowledge, attitudes, and beliefs of persons with ischemic heart disease are important predictors of delay in seeking treatment. We tested the psychometric profile of the Acute Coronary Syndrome (ACS) Response Index, a measure assessing patient knowledge, attitudes and beliefs about ACS symptoms and response, in 3,522 patients. On factor analysis, 21 dichotomous knowledge items loaded onto four factors (alpha .82). In a separate factor analysis, another five items loaded on two attitude factors, and seven items loaded on two belief factors (alpha .76). The scales discriminated between patients previously exposed to medical experts. Scale scores were significantly correlated but without evidence of multicolinearity. Initial tests of reliability and validity support further testing of this new instrument. © 2007 Wiley Periodicals, Inc. Res Nurs Health 30:584,594, 2007 [source] Towards automatic computer-aided knee surgery by innovative methods for processing the femur surface modelTHE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 3 2010Pietro Cerveri Abstract Background The femoral shaft (FDA) and transepicondylar (TA), anterior,posterior (WL) and posterior condylar (PCL) axes are fundamental quantities in planning knee arthroplasty surgery. As an alternative to the TA, we introduce the anatomical flexion axis (AFA). Obtaining such axes from image data without any manual supervision remains a practical objective. We propose a novel method that automatically computes the axes of the distal femur by processing the femur mesh surface. Methods Surface data were processed by exploiting specific geometric, anatomical and functional properties. Robust ellipse fitting of the two-dimensional (2D) condylar profiles was utilized to determine the AFA alternative to the TA. The repeatability of the method was tested upon 20 femur surfaces reconstructed from CT scans taken on cadavers. Results At the highest surface resolutions, the relative median error in the direction of the FDA, AFA, PCL, WL and TA was < 0.50°, 1.20°, 1.0°, 1.30° and 1.50°, respectively. As expected, at the lowest surface resolution, the repeatability decreased to 1.20°, 2.70°, 3.30°, 3.0° and 4.70°, respectively. The computed directions of the FDA, PCL, WL and TA were in agreement (0.60°, 1.55°, 1.90°, 2.40°) with the corresponding reference parameters manually identified in the original CT images by medical experts and with the literature. Conclusions The proposed method proved that: (a) the AFA can be robustly computed by a geometrical analysis of the posterior profiles of the two condyles and can be considered a useful alternative to the TA; (b) higher surface resolutions leads to higher repeatability of all computed quantities; (c) the TA is less repeatable than the other axes. Copyright © 2010 John Wiley & Sons, Ltd. [source] Persistent effects of a pedagogical device targeted at prevention of severe hypoglycaemia: A randomized, controlled studyACTA PAEDIATRICA, Issue 10 2005Sam Nordfeldt Abstract Aim: To study the long-term use of self-study material in type 1 diabetes patient education targeted at the prevention of severe hypoglycaemia. Methods: Randomized 1,1,1 control study in three local hospitals. We studied 332 type 1 diabetes patients from the geographic population, aged 2.6,18.9 y at entry. The intervention group received a videotape and brochure in which interviewed patients, parents and medical experts reviewed in detail practical skills for self-control and treatment, with the aim of preventing severe hypoglycaemia. There were two control groups: one received a videotape and brochure with general diabetes information and the other only traditional treatment. Primary endpoints were severe hypoglycaemia needing assistance by another person and HbA1c. Dissemination, reading/viewing level, patients' attitudes and extra contact with caregivers were also investigated. At 24 mo, 249 subjects provided data. Results: The yearly incidence of severe hypoglycaemia decreased at 24 mo from 42% to 25% (difference 17%, 95% CI 3,31, p=0.0241) in the intervention group, but not in controls. HbA1c remained unchanged. Video use during months 13,24 was higher in the intervention group than in controls (p=0.0477), ranging from 1,15 (median 2) times, among 37% of patients (months 1,12, 100%). Higher future use was anticipated for intervention material (p=0.0003). Extra caregiver contact was related to severe hypoglycaemia (p=0.0009). The cost of the material was
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