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Background Deep learning (DL) algorithms could improve the classification of ovarian tumors assessed with multimodal US. Purpose To develop DL algorithms for the automated classification of benign versus malignant ovarian tumors assessed with US and to compare algorithm performance to Ovarian-Adnexal Reporting and Data System (O-RADS) and subjective expert assessment for malignancy. Materials and Methods This retrospective study included consecutive women with ovarian tumors undergoing gray scale and color Doppler US from January 2019 to November 2019. Histopathologic analysis was the reference standard. The data set was divided into training (70%), validation (10%), and test (20%) sets. Algorithms modified from residual network (ResNet) with two fusion strategies (feature fusion [hereafter, DL

Background In breast cancer patients, late-term upper limb sequelae, such as shoulder pain and impaired shoulder function, remain common after primary breast cancer surgery. The aim of this trial is to evaluate whether an expert assessment of shoulder impairments, followed by an individualised treatment plan, is superior to a minimal physiotherapeutic rehabilitation program in reducing shoulder symptoms, among women with late-term shoulder impairments after primary breast cancer. Methods/design The study is designed as a stratified, parallel-group, assessor-blinded, randomised, controlled trial conducted in Denmark; 130 participants with late-term shoulder impairments 3–7 years after primary surgery for breast cancer will be recruited. Participants will be randomised (allocation 1:1) to either an expert assessment of shoulder impairments followed by an individualised treatment plan or to follow a minimal physiotherapeutic rehabilitation program delivered in a pamphlet. The primary outcome will be a change in shoulder pain and function from baseline to 12 weeks after initiating the treatment, as measured by the patient-reported outcome Shoulder Pain and Disability Index (SPADI) questionnaire. Discussion There has been an insufficient focus in research and clinical practice on late-term shoulder impairment in women following surgery for breast cancer. This trial will focus on interventions towards late-term shoulder impairments and is expected to provide evidence-based knowledge to physiotherapists and women about the management of shoulder pain and impaired shoulder function. Trial registration ClinicalTrials.gov NCT05277909. Registered on 11 March 2022.

Objectives To compare the exposure data generated by using the Canadian job-exposure matrix (CANJEM) with data generated by expert assessment, for jobs held by women. Methods We selected 69 occupational agents that had been assessed by experts for each of 3403 jobs held by 998 women in a population-based case–control study of lung cancer. We then assessed the same agents among the same jobs by linking their occupation codes to CANJEM and thereby derived probability of exposure to each of the agents in each job. To create binary exposure variables, we dichotomized probability of exposure using two cutpoints: 25 and 50% (referred to as CANJEM-25% and CANJEM-50%). Using jobs as units of observation, we estimated the prevalence of exposure to each selected agent using CANJEM-25% and CANJEM-50%, and using expert assessment. Further, using expert assessment as the gold standard, for each agent, we estimated CANJEM’s sensitivity, specificity, and kappa. Results CANJEM-based prevalence estimates correlated well with the prevalences assessed by the experts. When comparing CANJEM-based exposure estimates with expert-based exposure estimates, sensitivity, specificity, and kappa varied greatly among agents, and between CANJEM-25% and CANJEM-50% probability of exposure. With CANJEM-25%, the median sensitivity, specificity, and kappa values were 0.49, 0.99, and 0.46, respectively. Analogously, with CANJEM-50%, the corresponding values were 0.26, 1.00, and 0.35, respectively. For the following agents, we observed high concordance between CANJEM- and expert-based assessments (sensitivity ≥0.70 and specificity ≥0.99): fabric dust, cotton dust, synthetic fibres, cooking fumes, soldering fumes, calcium carbonate, and tin compounds. We present concordance estimates for each of 69 agents. Conclusions Concordance between CANJEM and expert assessment varied greatly by agents. Our results indicate which agents provide data that mimic best those obtained with expert assessment.

Infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to a multiorgan disease and subsequently to very different clinical manifestations of coronavirus disease 2019 (COVID-19). In addition to acute symptoms, the long-term complaints in the context of the infection, known as long or post-COVID syndrome, are increasingly attracting attention. With respect to social insurance systems, expert opinions of such problems will become more and more important, whereby neurological and psychiatric symptoms are the most frequent complaints. In addition to the legal principles of the medico-legal assessment with a focus on statutory accident insurance, this overview article discusses the principles of expert assessment and presents landmarks for the expert opinion of the most frequent neurological and psychiatric symptoms occurring in the context of post-COVID syndrome.Infektionen mit dem „severe acute respiratory syndrome coronavirus 2“ (SARS-CoV-2) können zu einer Multiorganerkrankung und in der Folge zu sehr unterschiedlichen klinischen Manifestationen der „coronavirus disease 2019“ (COVID-19) führen. Neben akuten Symptomen kommt den Langzeitbeschwerden im Kontext der Infektion vermehrte Aufmerksamkeit zu, man spricht vom Long- oder Post-COVID-Syndrom. Mit Blick auf die Sozialversicherungssysteme werden gutachterliche Beurteilungen solcher Gesundheitsprobleme zunehmend an Bedeutung gewinnen, wobei neurologische und psychiatrische Symptome die häufigsten Beschwerden sind. Neben rechtlichen Grundlagen der medikolegalen Begutachtung mit Schwerpunkt auf der gesetzlichen Unfallversicherung werden in der vorliegenden Übersicht grundlegende Aspekte der Begutachtung diskutiert und Orientierungshilfen für die Begutachtung der häufigsten neurologischen und psychiatrischen Symptome des Post-COVID-Syndroms geboten.

Recently in the Russian Federation there has been a significant increase in the number of commissions of forensic medical examinations on «medical cases» associated with inappropriate provision of medical care to the population. The problem of investigating such crimes is one of the most difficult tasks facing law enforcement agencies. A special place among them is occupied by examinations related to maternal mortality. Bleeding is one of the main causes of maternal mortality, the share of which in Russia in 2019 was 14.5%. An illustrative example of conditionally preventable death is the case of an unfavorable outcome of a pathological pregnancy in patientЗа последнее время в Российской Федерации отмечается значительное увеличение количества комиссионных судебно-медицинских экспертиз по «врачебным делам», связанным с ненадлежащим оказанием медицинской помощи населению. Особое место среди них занимают экспертизы, связанные с материнской смертностью. Кровотечения, доля которых в России в 2019 г. составила 14,5%, являются одной из главных причин материнской смертности. Наглядным примером условно предотвратимой смерти может послужить случай неблагоприятного исхода течения патологической беременности у пациентки

Objective - to evaluate the practical solution of forensic medical problems in cases of fatal multiple gunshot wounds. The materials of 426 forensic medical expert studies of fatal gunshot wounds were studied. The reasons for the insufficient realization of practical expert problems' solution have been established. The relevance of further scientific and experimental research was confirmed to test traditional criteria and search for new ones for expert assessment of gunshot injuries. In modern conditions, an expert assessment of multiple gunshot injuries should be based on the following principles: widespread introduction of experimental and simulation methods, attraction of methods of applied mathematics, solving practical expert problems in the form of private scientific research, evaluating the results of expert research on the basis of strict adherence to the laws of formal logic.Работы — оценить практическое решение судебно-медицинских задач в случаях смертельных множественных огнестрельных ранений. Изучили материалы 426 судебно-медицинских экспертных исследований смертельных огнестрельных ранений. Установили причины недостаточной реализации практического решения экспертных задач. Подтверждена актуальность дальнейших научно-экспериментальных исследований для проверки традиционных и поиска новых критериев экспертной оценки огнестрельных повреждений. Экспертная оценка множественных огнестрельных повреждений должна базироваться на следующих принципах: широкое внедрение методов эксперимента и моделирования, привлечение методов прикладной математики, решение практических экспертных задач в форме частных научных исследований, оценка результатов экспертных исследований на базе точного следования законам формальной логики.

INTRODUCTION: Plasma kallikrein is a mediator of vascular leakage and inflammation. Activation of plasma kallikrein can induce features of diabetic macular edema (DME) in preclinical models. Human vitreous shows elevated plasma kallikrein levels in patients with DME. Because of the incomplete response of some patients to anti-VEGF agents, and the treatment burden associated with frequent dosing, there is still considerable need for VEGF-independent targeted pathways. AREAS COVERED: This review covers the role of plasma kallikrein in the pathogenesis of DME and the therapeutic potential of plasma kallikrein inhibitors. It discusses early clinical studies of plasma kallikrein pathway modulation for DME, which have been associated with some improvement in visual acuity but with limited improvement in macular edema. This review also highlights KVD001, which is furthest along the development pathway, THR-149, which has recently completed a phase 1 study, and oral agents under development. EXPERT OPINION: Plasma kallikrein inhibitors have a potential role in the treatment of DME, with mixed functional/anatomic results in early clinical trials. Given the large unmet need in DME treatment, further studies are warranted.

Increasingly, hospitals and research institutes are developing technical solutions for sharing patient data in a privacy preserving manner. Two of these technical solutions are homomorphic encryption and distributed ledger technology. Homomorphic encryption allows computations to be performed on data without this data ever being decrypted. Therefore, homomorphic encryption represents a potential solution for conducting feasibility studies on cohorts of sensitive patient data stored in distributed locations. Distributed ledger technology provides a permanent record on all transfers and processing of patient data, allowing data custodians to audit access. A significant portion of the current literature has examined how these technologies might comply with data protection and research ethics frameworks. In the Swiss context, these instruments include the Federal Act on Data Protection and the Human Research Act. There are also institutional frameworks that govern the processing of health related and genetic data at different universities and hospitals. Given Switzerland's geographical proximity to European Union (EU) member states, the General Data Protection Regulation (GDPR) may impose additional obligations.To conduct this assessment, we carried out a series of qualitative interviews with key stakeholders at Swiss hospitals and research institutions. These included legal and clinical data management staff, as well as clinical and research ethics experts. These interviews were carried out with two series of vignettes that focused on data discovery using homomorphic encryption and data erasure from a distributed ledger platform.For our first set of vignettes, interviewees were prepared to allow data discovery requests if patients had provided general consent or ethics committee approval, depending on the types of data made available. Our interviewees highlighted the importance of protecting against the risk of reidentification given different types of data. For our second set, there was disagreement amongst interviewees on whether they would delete patient data locally, or delete data linked to a ledger with cryptographic hashes. Our interviewees were also willing to delete data locally or on the ledger, subject to local legislation.Our findings can help guide the deployment of these technologies, as well as determine ethics and legal requirements for such technologies.

Fil: Dicks, Lynn V. University of Cambridge. Department of Zoology. Reino Unido. Fil: Breeze, Tom D. Reading University. School of Agriculture, Policy and Development. Centre for Agri-Environmental Research. Reino Unido. Fil: Ngo, Hien T. IPBES Secretariat. Alemania. Fil: Senapathi, Deepa. Reading University. School of Agriculture, Policy and Development. Centre for Agri-Environmental Research. Reino Unido. Fil: An, Jiandong. Chinese Academy of Agricultural Sciences. Institute of Apicultural Research. China. Fil: Aizen, Marcelo A. Universidad Nacional del Comahue. Instituto de Investigaciones en Biodiversidad y Medioambiente. Río Negro, Argentina. Fil: Basu, Parthiba. University of Calcutta. Department of Zoology. India. Fil: Buchori, Damayanti. IPB University. Center for Transdisciplinary and Sustainability Sciences. Indonesia. Fil: Galetto, Leonardo. Universidad de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales. Córdoba, Argentina. Fil: Garibaldi, Lucas A. Universidad Nacional de Río Negro. Instituto de Investigaciones en Recursos Naturales, Agroecología y Desarrollo Rural. Río Negro, Argentina. Fil: Garibaldi, Lucas A. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Recursos Naturales, Agroecología y Desarrollo Rural. Río Negro, Argentina. Fil: Gemmill-Herren, Barbara. World Agroforestry Centre. Kenia. Fil: Howlett, Brad G. The New Zealand Institute for Plant & Food Research Limited. Nueva Zelanda. Fil: Imperatriz-Fonseca, Vera L. University of Sao Paulo. Biosciences Institute. Brasil Fil: Johnson, Steven D. University of KwaZulu-Natal. School of Life Sciences. Centre for Functional Biodiversity. Sudáfrica. Fil: Kovács-Hostyánszki, Anikó. Centre for Ecological Research. Institute of Ecology and Botany. Hungría. Fil: Jung Kwon, Yong. Kyungpook National University. School of Applied Biosciences. Corea del Sur. Fil: Lattorff, H. Michael G. International Centre of Insect Physiology and Ecology. Kenia. Fil: Lungharwo, Thingreipi. Naga Women’s Union. India. Fil: Seymour, Colleen L. Kirstenbosch Research Centre. South African National Biodiversity Institute. Sudáfrica. Fil: Vanbergen, Adam J. University of Bourgogne Franche-Comté. Francia. Fil: Potts, Simon G. Reading University. School of Agriculture, Policy and Development.Centre for Agri-Environmental Research. Reino Unido. Pollinator decline has attracted global attention and substantial efforts are underway to respond through national pollinator strategies and action plans. These policy responses require clarity on what is driving pollinator decline and what risks it generates for society in different parts of the world. Using a formal expert elicitation process, we evaluated the relative regional and global importance of eight drivers of pollinator decline and ten consequent risks to human well-being. Our results indicate that global policy responses should focus on reducing pressure from changes in land cover and configuration, land management and pesticides, as these were considered very important drivers in most regions. We quantify how the importance of drivers and risks from pollinator decline, differ among regions. For example, losing access to managed pollinators was considered a serious risk only for people in North America, whereas yield instability in pollinator-dependent crops was classed as a serious or high risk in four regions but only a moderate risk in Europe and North America. Overall, perceived risks were substantially higher in the Global South. Despite extensive research on pollinator decline, our analysis reveals considerable scientific uncertainty about what this means for human society.

STUDY QUESTION: Is there an association between maternal occupational exposure to solvents, pesticides and metals as assessed by expert-based assessment and congenital anomalies in the offspring? SUMMARY ANSWER: There is an association between maternal occupational exposure to solvents and congenital anomalies in the offspring, including neural tube defects, congenital heart defects and orofacial clefts. WHAT IS KNOWN ALREADY: One important environmental risk factor for development of congenital anomalies is maternal occupational exposure to chemicals in the workplace prior to and during pregnancy. A number of studies have assessed the association with often conflicting results, possibly due to different occupational exposure assessing methods. STUDY DESIGN, SIZE, DURATION: For this systematic review with meta-analysis, the search terms included maternal occupation, exposure, congenital anomalies and offspring. Electronic databases MEDLINE and EMBASE were searched for English studies up to October 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS: Two reviewers independently screened all citations identified by the search. Case-control studies and cohort studies were included if (I) they reported on the association between maternal occupational exposure to solvents, pesticides or metals and congenital anomalies, and (II) assessment of occupational exposure was performed by experts. Data on study characteristics, confounders and odds ratios (ORs) were extracted from the included studies for four subgroups of congenital anomalies. Methodological quality was assessed using the Newcastle-Ottawa Scale. In the meta-analysis, random effects models were used to pool estimates. MAIN RESULTS AND THE ROLE OF CHANCE: In total, 2806 titles and abstracts and 176 full text papers were screened. Finally, 28 studies met the selection criteria, and 27 studies could be included in the meta-analysis. Our meta-analysis showed that maternal occupational exposure to solvents was associated with neural tube defects (OR: 1.51, 95%CI: 1.09-2.09) and congenital heart defects (OR: 1.31, 95%CI:1.06-1.63) in the offspring. Also maternal occupational exposure to glycol ethers, a subgroup of solvents, was associated with neural tube defects (OR: 1.93, 95%CI: 1.17-3.18) and orofacial clefts (OR: 1.95, 95%CI: 1.38-2.75) in the offspring. Only one study investigated the association between maternal occupational exposure to solvents and hypospadias and found an association (OR: 3.63, 95%CI: 1.94-7.17). Results of the included studies were consistent. In our meta-analysis, we found no associations between occupational exposure to pesticides or metals and congenital anomalies in the offspring. LIMITATIONS, REASONS FOR CAUTION: A limited number of studies was included, which made it impossible to calculate pooled estimates for all congenital anomalies, analyse individual chemicals or calculate exposure-response relations. Bias could have been introduced because not all included studies corrected for potentially confounding factors. WIDER IMPLICATIONS OF THE FINDINGS: Employers and female employees should be aware of the possible teratogenic effects of solvent exposure at the workplace. Therefore, is it important that clinicians and occupational health specialist provide women with preconception advice on occupational solvent exposure, to reduce the congenital anomaly risk. STUDY FUNDING/COMPETING INTEREST(S): NSp was paid by the Graduate School of Medical Sciences (MD/PhD program), UMCG, Groningen, the Netherlands. EUROCAT Northern Netherlands is funded by the Dutch Ministry of Health, Welfare and Sports. There are no competing interests. REGISTRATION NUMBER: CRD42017053943.

OBJECTIVE: Computer vision was used to predict expert performance ratings from surgeon hand motions for tying and suturing tasks. SUMMARY BACKGROUND DATA: Existing methods, including the objective structured assessment of technical skills (OSATS) have proven reliable, but do not readily discriminate at the task level. Computer vision may be used for evaluating distinct task performance throughout an operation. METHODS: Open surgeries were videoed and surgeon hands were tracked without using sensors or markers. An expert panel of three attending surgeons rated tying and suturing video clips on continuous scales from 0 to 10 along three task measures adapted from the broader OSATS: motion economy, fluidity of motion, and tissue handling. Empirical models were developed to predict the expert consensus ratings based on the hand kinematic data records. RESULTS: The predicted v. panel ratings for suturing had slopes from 0.73 to 1, and intercepts from 0.36 to 1.54 (Average R(2) = 0.81). Predicted v. panel ratings for tying had slopes from 0.39 to 0.88, and intercepts from 0.79 to 4.36 (Average R(2) = 0.57). The mean square error among predicted and expert ratings were consistently less than the mean squared difference among individual expert ratings and the eventual consensus ratings. CONCLUSIONS: The computer algorithm consistently predicted the panel ratings of individual tasks, and were more objective and reliable than individual assessment by surgical experts.

Inadequate definition of key terms and their relationships generates significant communication and analytical problems in environmental planning. In this work, we evaluate an ontological framework for environmental planning designed to combat these problems. After outlining the framework and issues addressed, we describe its evaluation by a group of experts representing a range of expertise and institutions. Experts rated their level of agreement with 12 propositions concerning the definitions and models underpinning the framework. These propositions, in turn, were used to assess three assumptions regarding the expected effectiveness of the framework and its contribution to addressing the abovementioned planning problems. In addition to point-based best estimates of their agreement with propositions, expert ratings were also captured on a continuous interval-valued scale. The use of intervals addresses the challenge of measuring and modelling uncertainty associated with complex assessments such as those provided by experts. Combined with written anonymous expert comments, these data provide multiple perspectives on the level of support for the approach. We conclude that the framework can complement existing planning approaches and strengthen key definitions and related models, thus helping avoid communication and analytical problems in environmental planning. Finally, experts highlighted areas that require further development, and we provide recommendations for improving the framework.

The article proposes a methodology for creating an assessment of the quality of dental care based on the use of the method of analysis of hierarchies and the theory of fuzzy logic. Approbation of the methodology was carried out on the assessment of the quality of dental services for the manufacture of metal-ceramic crowns. When conducting a new assessment, you can achieve a reduction in the time of its conduct by 6 times, increasing the number of evaluation criteria by 2 times and get results with a confidence factor (Предложена методология оценки качества стоматологической помощи на основании использования метода анализа иерархий и теории нечетких множеств. Апробация методологии на оценке качества стоматологической услуги по изготовлению металлокерамической коронки показала, что при оценке можно достигнуть сокращения времени ее выполнения в 6 раз, увеличив в 2 раза количество критериев оценки, и получить результаты при коэффициенте доверительной вероятности

Forensic examination of a gunshot injury is the most difficult problem of domestic and foreign forensic medicine. A large amount of knowledge and practical observations on damage from standard samples of handguns has been accumulated. The emergence of new unique samples of special-purpose weapons requires forensic physicians and forensic experts to conduct a complex of morphological, spectral, forensic chemical, medico-forensic, radiological and other special laboratory studies of damage caused by such weapons. The article presents a case of forensic medical examination commission with the issue solution of differential diagnosis of causing a mortal fire wound injuries by a specific sample of special-purpose handgun.Судебно-медицинская экспертиза огнестрельной травмы является наиболее сложной проблемой отечественной и зарубежной судебной медицины. Накоплен большой объем знаний и практических наблюдений о повреждениях из штатных образцов ручного огнестрельного оружия. Появление новых уникальных образцов оружия специального назначения требует от судебных медиков и криминалистов проведения комплекса морфологических, спектральных, судебно-химических, медико-криминалистических, радиологических и других специальных лабораторных исследований повреждений, причиненных таким оружием. Представлен случай выполнения комиссионной судебно-медицинской экспертизы с решением вопроса дифференциальной диагностики причинения смертельного огнестрельного ранения конкретным образцом ручного огнестрельного оружия специального назначения.

Travellers' perception of their risk for acquiring travel-related conditions is an important contributor to decisions and behaviors during travel. In this study, we aimed to assess the differences between traveller-perceived and expert-assessed risk of travel-related conditions in children and adults travelling internationally and describe factors that influence travellers' perception of risk.Children and adults were recruited at the Hospital for Sick Children's Family Travel Clinic between October 2014 and July 2015. A questionnaire was administered to participants to assess their perceived risk of acquiring 32 travel-related conditions using a 7-point Likert scale. Conditions were categorized as vector-borne diseases, vaccine-preventable diseases, food and water borne diseases, sexually transmitted infections and other conditions. Two certified travel medicine experts reviewed each patient's chart and assigned a risk score based on the same 7-point Likert scale. Traveller and expert risk scores were compared using paired t-tests.In total, 207 participants were enrolled to participate in this study, 97 children (self-reported, n = 8; parent-reported, n = 89), and 110 adults. Travel-related risk for adults and parents answering for their children were significantly underestimated when compared to expert-assessed risk for 26 of the 32 assessed conditions. The underestimated conditions were the same for both adults and parents answering for children. Travel-related risk was not over-estimated for any condition.Adults underestimated their children's and their own risk for most travel-related conditions. Strategies to improve the accuracy of risk perception of travel-related conditions by travellers are needed to optimize healthy travel for children and their families.

Objective To evaluate the usefulness of a Doppler technology highly sensitive for low-velocity flow in the antenatal imaging of the torcular herophili (TH) in the second trimester of pregnancy. Design Prospective study. Setting Referral Fetal Medicine Unit. Population Non-consecutive series of singleton pregnancies submitted to antenatal neurosonogram between 20 and 28 weeks of gestation. Methods A midsagittal section of the fetal brain was obtained by insonating through the anterior fontanelle, then the MV-Flow™ and LumiFlow™ presets were selected to visualise the TH as the posterior confluence of the superior sagittal sinus and the straight sinus. Main outcome measures Evaluation of the anatomic relationship of the TH with the 'transpalatal line' joining the upper bony palate to the fetal skull. Results A total of 99 pregnant women were recruited, including one fetus with open spina bifida, one with Dandy-Walker malformation (DWM) and two with Blake's pouch cysts. In normal fetuses, the TH appeared to lie on or just below the 'transpalatal line'. In the cases of Blake's pouch cyst, the position of the TH appeared normal if compared with controls, whereas in DWM a supra-elevated position of the TH in respect of the transpalatal line was demonstrated. Finally, in the fetus with Chiari II malformation the TH was identified below the 'transpalatal plane'. Conclusions Prenatal ultrasound visualisation of the TH by means of newly developed Doppler technologies characterised by high sensitivity for low-velocity flow is feasible and allows the indirect evaluation of the insertion of cerebellar tentorium in the second trimester. Tweetable abstract Prenatal imaging of the torcular herophili using a Doppler technology highly sensitive for low-velocity flow.

Risk assessment models (RAMs) for venous thromboembolism (VTE) and bleeding in hospitalized medical patients inform appropriate use of thromboprophylaxis. Our aim was to use a novel approach for selecting risk factors for VTE and bleeding to be included in RAMs. First, we used the results of a systematic review of all candidate factors. Second, we used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of the evidence for the identified factors. Third, we using a structured approach to select factors to develop the RAMs, by building on clinical and methodological expertise. The expert panel made judgments on whether to include, potentially include, or exclude risk factors, according to domains of the GRADE approach and the Delphi method. The VTE RAM included age >60 years, previous VTE, acute infections, immobility, acute paresis, active malignancy, critical illness, and known thrombophilia. The bleeding RAM included age ≥65 years, renal failure, thrombocytopenia, active gastroduodenal ulcers, hepatic disease, recent bleeding, and critical illness. We identified acute infection as a factor that was not considered in widely used RAMs. Also, we identified factors that require further research to confirm or refute their importance in a VTE RAM (eg, D-dimer). We excluded autoimmune disease which is included in the IMPROVE (International Medical Prevention Registry on Venous Thromboembolism) bleeding RAM. Our results also suggest that sex, malignancy, and use of central venous catheters (factors in the IMPROVE bleeding RAM) require further research. In conclusion, our study presents a novel approach to systematically identifying and assessing risk factors to be included or further explored during RAM development.

A case of commission forensic medical examination in the St. Petersburg Bureau of Forensic Science of a civil case due to an unfavorable treatment outcome is presented. PatientПредставлен случай проведения в СПб ГБУЗ» комиссионной судебно-медицинской экспертизы по гражданскому делу в связи неблагоприятным исходом лечения. Пациентка

Although the number of major amputations is declining throughout Germany, more than 57,000 surgical procedures for amputation still take place. As a consequence of high prosthetic care costs, these often lead to disputes before the social court in which expert medical opinions are required. With knowledge of the legal norms, the remit of the expert opinion can be fulfilled. The expert begins with evaluation of the patient's file and a search of the contested parts. The investigation includes a medical history, in addition to a physical examination, in order to be able to comment on the disputed beneficial use of the therapeutic appliance and respond to questions of proof. Questionnaires may be helpful.

To estimate the extent of agreement between health professionals' (ClinRO) and patients' (PRO) ratings on disabilities associated with breast cancer (impairments, activity limitations and participation restrictions).Cross-sectional.Health care professionals measured arm impairments, activity limitations and participation restrictions with the international classification of functioning (ICF) breast cancer core set. Participants filled five outcomes measures targeting health aspects of QOL that were previously mapped to the ICF. Agreement between ClinRO and PRO was estimated with quadratic Kappa.About 245 paired clinician and participant completed the outcomes measures. A total of 60 items mapped to 24 different ICF breast cancer core set codes, which provide 68 analyses for agreement. Impairment was better addressed with PROs (mostly poor and fair level of agreement); Activity limitations, both PROs and self-reported outcomes (SRO) (fair); participation restrictions, PROs (fair).Clinicians usually underestimate the symptoms and impairments of the patients, leading to a greater proportion of poor agreement. PRO's provide valuable information on impairments at the mental function level and pain. ClinRO's provide more valuable information on physically assessed impairments (oedema). Activity limitations and participation restrictions, excluding reporting the difficulty aspect of various life situations, can be either SRO or ObsRO. Implications for rehabilitation Impairments, activity limitation and participation restrictions are common sequelae of breast cancer treatment, which ultimately may affect the person's quality of life and should be investigated early on in the continuum of care. Clinicians should rely on the symptoms' reported by the patient regarding lymphedema and should identify the presence and severity of it. Patients inform best on the severity of pain, fatigue and mental distress experienced during and post-breast cancer treatment as clinicians tend to underestimate them. Clinicians and patients concur on presence and severity of activity limitations but not on difficulty, which can only be assessed from the patient's perspective.

The purpose of the work is the analysis of etiology and pathogenesis of pneumocephaly in various injuries, diseases and pathological conditions for the reasonable determination of the severity of health damage during forensic medical examinations. The analysis of literature data on the causes and mechanisms of pneumocephaly is given. Attention is paid to the assessment of pneumocephaly in determining the health damage in patients with traumatic brain injury or if it is suspected. It is proposed to consider pneumocephaly as an indirect sign of a skull fracture. In case of pneumocephaly, a radiologically confirmed fracture is necessary to justify serious health damage. The medical documents of the victim should be examined to exclude concomitant diseases and pathological conditions that can lead to pneumocephaly.Анализ этиологии и патогенеза пневмоцефалии при различных повреждениях, заболеваниях и патологических состояниях для обоснованного установления тяжести вреда здоровью при проведении судебно-медицинских экспертиз. Приведен анализ данных литературы о причинах и механизмах возникновения пневмоцефалии. Уделено внимание оценке пневмоцефалии при определении вреда здоровью у пострадавших с черепно-мозговой травмой либо при подозрении на нее. Предложено рассматривать пневмоцефалию как косвенный признак перелома черепа. При пневмоцефалии для обоснования тяжкого вреда здоровью необходимо наличие рентгенологически подтвержденного перелома. Следует изучить медицинские документы пострадавшего для исключения сопутствующих заболеваний и патологических состояний, которые могут привести к пневмоцефалии.

Background The Trauma NOn-TECHnical Skills (T-NOTECHS) tool has been used to assess teamwork in trauma resuscitation, but its reliability and validity for self-assessment is unknown. Our purpose was to determine the reliability and validity of self-administered T-NOTECHS in pediatric trauma resuscitation. Methods Simulated in situ resuscitations were evaluated using T-NOTECHS in real time by experts and immediately afterwards by team members. Reliability was analyzed with linear-weighted kappa and intra-class correlation. T-NOTECHS scores were compared between expert (gold-standard) and self-assessment. Results Fifteen simulations were examined. T-NOTECHS scores were similar between self- and expert assessment for leadership. Self-assessment scores were higher than expert for the other domains and total composite score. Inter-rater reliability for total score was similar between the two groups, but differences were observed in the domains. Conclusions Self-assessment is not interchangeable with expert rating when using T-NOTECHS. Future studies need to determine how self-assessment can be best utilized. Level of evidence Studies of diagnostic accuracy – Level 2.

In numerous legal areas, expert assessments are needed to clarify the causality of herniated discs: Was the damage caused by an accident? The literature mentions specific requirements regarding the trauma mechanism as well as temporal criteria, which prescribe the causality test. These are essentially high-energy traumas with immediate functional impairments. Accident-related MRI examinations are of paramount importance in the expert assessment process to confirm the primary body harm. In examining the causality constituting liability, competitive causes must be assessed. Since the legal requirements of the causality test differ in civil and social law, legal norms need to be taken into account. We present a test scheme that supports the assessment process through entry, implementation and decision-making levels.In einer Vielzahl von Rechtsgebieten soll der Sachverständige die Kausalität von Bandscheibenschäden klären: Ist der Schaden Folge eines Unfalls? Die Literatur nennt spezifische Anforderungen an den Traumamechanismus sowie zeitliche Kriterien, welche die Kausalitätsprüfung vorgeben. Es handelt sich im Wesentlichen um hochenergetische Traumen mit unmittelbar einsetzenden Funktionsstörungen. Unfallnahe MRT-Untersuchungen haben im gutachterlichen Beurteilungsprozess überragende Bedeutung zur Sicherung des Körpererstschadens. Bei der Prüfung des haftungsbegründenden Zusammenhangs müssen konkurrierende Ursachen gewürdigt werden. Da sich die juristischen Anforderungen der Kausalitätsprüfung in Zivil- und Sozialrecht unterscheiden, bedarf es der Kenntnis der Rechtsnormen. Ein Prüfschema wird vorgestellt, das den Begutachtungsprozess über Einstiegs-, Realisierungs- und Entscheidungsebene unterstützt.

Contains fulltext : 177407.pdf (Publisher’s version ) (Open Access) BACKGROUND: During their clerkships, medical students are meant to expand their clinical reasoning skills during their patient encounters. Observation of these encounters could reveal important information on the students' clinical reasoning abilities, especially during history taking. METHODS: A grounded theory approach was used to analyze what expert physicians apply as indicators in their assessment of medical students' diagnostic reasoning abilities during history taking. Twelve randomly selected clinical encounter recordings of students at the end of the internal medicine clerkships were observed by six expert assessors, who were prompted to formulate their assessment criteria in a think-aloud procedure. These formulations were then analyzed to identify the common denominators and leading principles. RESULTS: The main indicators of clinical reasoning ability were abstracted from students' observable acts during history taking in the encounter. These were: taking control, recognizing and responding to relevant information, specifying symptoms, asking specific questions that point to pathophysiological thinking, placing questions in a logical order, checking agreement with patients, summarizing and body language. In addition, patients' acts and the course, result and efficiency of the conversation were identified as indicators of clinical reasoning, whereas context, using self as a reference, and emotion/feelings were identified by the clinicians as variables in their assessment of clinical reasoning. CONCLUSIONS: In observing and assessing clinical reasoning during history taking by medical students, general and specific phenomena to be used as indicators for this process could be identified. These phenomena can be traced back to theories on the development and the process of clinical reasoning.

In the assessment process of hearing impairment the medical expert has to verify its causality and to quantify its severity as hearing loss in percentage. Based on the determined hearing loss in percentage, the degree of impairment/disability or, in the case of work-related noise-induced hearing loss, the reduction in earning capacity is estimated. In Germany the guideline for the expert assessment of work-related noise-induced hearing loss is the Königstein Guideline. Currently, the 5

Expert medical opinions are necessary in pretrial cases and other legal matters. They act as means of evidence for administrative bodies and courts. It may be necessary to adapt the method of evaluation depending upon the issue or subject matter to be evaluated. We report on a social court case, which needed to answer the question of the medical necessity of a functional electrical stimulation orthosis prescribed to improve the function of a drop foot accompanied by an atactic gait disorder. The claimant suffered from a stroke, which had occurred several years before. Her aids were an ankle-foot-orthosis for foot lift and a wheeled walker. The current treatment was to be augmented by the disputed device. The statutory health insurance declined to meet the costs. They failed to find relevant benefits after analysis of video tapes of the patient's gait while using an electrical stimulation orthosis. The social court requested an expert opinion to answer the question as to whether or not there was a relevant functional benefit to using functional electrical stimulation over the existing orthosis or to an alternative treatment. Video documentation was desired by the court. We used the clinic's gait analysis laboratory, which is equipped with a gait course and the claimed video documentation. Standardised video documentation offers substantial advantages for answering forensic questions such as these. It assures reproducibility and comparability of all tested scenarios, with objectification of the individual advantages or limitations. This gain in both validity and reliability fulfills the scientific requirements placed upon an expert assessment.

Objectives: To compare assignment of occupational pesticide and solvent exposure using self-reported data collected by a computer assisted personal interview (CAPI) with exposure based on expert assessment of job codes. To discuss the advantages and disadvantages of using a CAPI to collect individual occupational exposure data. Methods: Between 2001 and 2004, 1495 participants were interviewed using a CAPI for a case-control study of adult brain tumours and acoustic neuromas. Two types of occupational data were collected: (1) a full history, including job title from which a job code was assigned from the Standard Occupational Classification; and (2) specific details on pesticide and solvent exposure reported by participants. Study members’ experiences of using the CAPI were recorded and advantages and disadvantages summarised. Results: Of 7192 jobs recorded, the prevalence of self-reported exposure was 1.3% for pesticides and 11.5% for solvents. Comparing this with exposure expertly assessed from job titles showed 53.6% and 45.8% concordance for pesticides and solvents respectively. Advantages of the CAPI include no data entry stage, automatic input validation, and a reduction in interviewer bias. Disadvantages include an adverse effect on study implementation as a consequence of resources required for programming and difficulties encountered with data management prior to analysis. Conclusions: Different methods of exposure assessment derive different exposure levels for pesticide and solvent exposure at work. Agreement between self-reported and expert assessment of exposure was greater for pesticides compared to solvents. The advantages of using a CAPI for the collection of complex data outweigh the disadvantages for interviewers and data quality but using such a method requires extra resources at the study outset.

This study examined the frequency and distribution of mental health problems in children and adolescents who had previously been psychologically evaluated in family law proceedings.The data stem from psychological evaluations (N=298) conducted between 2008 and 2012 at an evaluation institute in Bremen, Germany. The reports included were analyzed for indications of mental health problems by means of a content analysis. The total sample consisted of 496 children and adolescents.At least one mental health problem (according to ICD-F) was found in 39.5% of the children and adolescents. The comorbidity rate was 38.7%. Developmental deficits appeared in 12.3%, emotional or conduct problems in 22.8% of the sample. Furthermore, 11.5% were reported as having been victims of violence. Frequency distributions of mental health problems with respect to the juridical issues in question are given.These results provide a first empirical overview of mental health problems in psychologically evaluated children and adolescents. Our findings highlight the need for future studies to further examine mental health problems of children and adolescents in family court proceedings with respect to the juridical issues in question.

This study presents and evaluates an expert group's assessment of exposure to carcinogens for defined job categories in Norway's offshore petroleum industry, 1970-2005, to provide exposure information for a planned cohort study on cancer. Three university and five industry experts in occupational hygiene individually assessed the likelihood of exposure to 1836 combinations of carcinogens (n=17), job categories (n=27) and time periods (n=4). In subsequent plenary discussions, the experts agreed on exposed combinations. Agreement between the individual and the panel assessments was calculated by Cohen's kappa index. Using the panel assessment as reference, sensitivity and specificity were estimated. The eight experts assessed 63% of the 1836 combinations in plenary, resulting in 265 (14%) convened exposed combinations. Chlorinated hydrocarbons, benzene and inhalation of mineral oils had the highest number of exposed job categories (n=14, 9 and 10, respectively). The job categories classified as exposed to the highest numbers of carcinogens were the mechanics (n=10), derrick workers (n=6) and process technicians (n=5). The agreement between the experts' individual assessments and the panel assessment was kappa=0.53-0.74. The sensitivity was 0.55-0.86 and specificity 0.91-0.97. For these parameters, there were no apparent differences between the university experts and the industry experts. The resulting 265 of 1836 possible exposure combinations convened as "exposed" by expert assessment is presented in this study. The experts' individual ratings highly agreed with the succeeding panel assessment. Correlation was found between years of experience of the raters and agreement with the panel. The university experts and the industry experts' assessments had no apparent differences. Further validation of the exposure assessment is suggested, such as by new sampling data or observational studies.

Objectives: To efficiently and reproducibly assess occupational diesel exhaust exposure in a Spanish case-control study, we examined the utility of applying decision rules that had been extracted from expert estimates and questionnaire response patterns using classification tree (CT) models from a similar US study. Methods: First, previously extracted CT decision rules were used to obtain initial ordinal (0-3) estimates of the probability, intensity, and frequency of occupational exposure to diesel exhaust for the 10 182 jobs reported in a Spanish case-control study of bladder cancer. Second, two experts reviewed the CT estimates for 350 jobs randomly selected from strata based on each CT rule's agreement with the expert ratings in the original study [agreement rate, from 0 (no agreement) to 1 (perfect agreement)]. Their agreement with each other and with the CT estimates was calculated using weighted kappa (κw) and guided our choice of jobs for subsequent expert review. Third, an expert review comprised all jobs with lower confidence (low-to-moderate agreement rates or discordant assignments, n = 931) and a subset of jobs with a moderate to high CT probability rating and with moderately high agreement rates (n = 511). Logistic regression was used to examine the likelihood that an expert provided a different estimate than the CT estimate based on the CT rule agreement rates, the CT ordinal rating, and the availability of a module with diesel-related questions. Results: Agreement between estimates made by two experts and between estimates made by each of the experts and the CT estimates was very high for jobs with estimates that were determined by rules with high CT agreement rates (κw: 0.81-0.90). For jobs with estimates based on rules with lower agreement rates, moderate agreement was observed between the two experts (κw: 0.42-0.67) and poor-to-moderate agreement was observed between the experts and the CT estimates (κw: 0.09-0.57). In total, the expert review of 1442 jobs changed 156 probability estimates, 128 intensity estimates, and 614 frequency estimates. The expert was more likely to provide a different estimate when the CT rule agreement rate was

Limited knowledge of the German language represents a serious barrier for migrants into Switzerland to communicate successfully in a variety of health care settings, which may result not just in delayed access to treatment and poorer outcome, but also in difficulties judging eligibility for health and other social benefits. Especially when conducting disability and other occupational capacity evaluations, clinicians of all medical fields, but particularly psychiatrists, are required to obtain abundant information to allow them to perform a thorough mental health examination and to form a differentiated view of an evaluee's work capacity. Within a clinical context different translation and interpreting strategies are in use, and each strategy has its advantages and disadvantages. This mini-review describes the legal and modal aspects as well as the clinical-practical implications of the use of such interpreting services during disability evaluations.Unzureichende Sprachkenntnisse und Kommunikationsschwierigkeiten stellen eine grosse Herausforderung für Migranten in verschiedenen Bereichen des Gesundheitswesens dar und können nicht nur zu Verzögerungen in der Behandlung und zu schlechteren Therapieergebnissen, sondern auch zu Schwierigkeiten im Rahmen der Klärung von Anspruchsvoraussetzungen für Versicherungs- und Sozialleistungen führen. Dabei sind besonders im Rahmen der Einschätzung der Arbeitsfähigkeit im IV-Verfahren Kliniker aller Fachgebiete, besonders aber Psychiater, darauf angewiesen, ein möglichst differenziertes Verständnis der anamnestischen Angaben zu entwickeln, um das Funktionsniveau eines Exploranden einschätzen zu können. Im klinischen Kontext kommen deshalb verschiedene Formen von Sprachmittlung zum Einsatz. Der vorliegende Mini-Review soll die rechtlichen, formellen und klinisch-praktischen Aspekte des Einsatzes von Dolmetschern im Rahmen der medizinischen Abklärungen von Arbeitsunfähigkeiten bei Exploranden mit unzureichenden Sprachkenntnissen beleuchten.Des connaissances linguistiques insuffisantes et des difficultés de communication constituent un défi majeur pour les migrants dans différents domaines de la santé. Elles peuvent notamment entraîner des difficultés à identifier les conditions d'octroi des prestations des assurances sociales. Pour déterminer une atteinte à la santé et évaluer la capacité de travail dans la procédure AI, les cliniciens, et en particulier les psychiatres, doivent développer une compréhension aussi différenciée que possible des données anamnestiques et du bilan psychopathologique. Différentes approches de traduction et d'interprétation sont donc utilisées dans le contexte clinique. Cette mini-review éclaire les aspects cliniques, formels et juridiques du recours à des interprètes dans les examens médicaux d'incapacité de travail (de longue durée) lorsque les compétences linguistiques des personnes expertisées sont insuffisantes.

The article investigates the experience of practical implementation of expert assessment method for the evaluation of life quality of preschool children with different disabilities. The trial is carried out in four stages and two anonymous surveys. Based on the evaluation the most important eight problems are selected by experts. Seven problems related to social assistance of children with chronic disabilities and one problem related to availability of occupational therapy. It is recommended to use the results of expert evaluation in integrated development and establishment of standards of medical and social rehabilitation of patients.

Commissions for an expert assessment place basically high demands on commissioned eye specialists because this activity differs from the normal routine field of work. In addition to assessing objective symptoms and subjective symptomatics in a special analytical manner, eye specialists are expected to have knowledge of basic legal terminology, such as proximate cause, evidence and evidential value. Only under these prerequisites can an ophthalmologist fulfill the function of an expert with a high level of quality and adequately adjust the special medical ophthalmological expertise to the requirements of the predominantly legally based clients commissioning the report and oriented to the appropriate valid legal norms. Particularly common difficulties associated with making an ophthalmological expert report for private accident insurance, e.g. determination of the reduction in functional quality, consideration of partial causality and assessment of diplopia are discussed.

Background Retrospective exposure assessment in community-based studies is largely reliant on questionnaire information. Expert assessment is often used to assess lifetime occupational exposures, but these assessments generally lack transparency and are very time-consuming. We explored the agreement between a rule-based assessment approach and case-by-case expert assessment of occupational exposures in a community-based study. Methods We used data from a case–control study of childhood acute lymphoblastic leukaemia in which parental occupational exposures were originally assigned by expert assessment. Key questions were identified from the completed parent questionnaires and, on the basis of these, rules were written to assign exposure levels to diesel exhaust, pesticides and solvents. We estimated exposure prevalence separately for fathers and mothers, and used κ statistics to assess the agreement between the two exposure assessment methods. Results Exposures were assigned to 5829 jobs among 1079 men and 6189 jobs among 1234 women. For both sexes, agreement was good for the two assessment methods of exposure to diesel exhaust at a job level (κ=0.70 for men and κ=0.71 for women) and at a person level (κ=0.74 and κ=0.75). The agreement was good to excellent for pesticide exposure among men (κ=0.74 for jobs and κ=0.84 at a person level) and women (κ=0.68 and κ=0.71 at a job and person level, respectively). Moderate to good agreement was observed for assessment of solvent exposure, which was better for women than men. Conclusions The rule-based assessment approach appeared to be an efficient alternative for assigning occupational exposures in a community-based study for a selection of occupational exposures.

The literature suggests that misoprostol can be offered to patients for off-label use as it has reasonable efficacy, risk/benefit ratio, tolerance and patient satisfaction, according to the criteria for evidence-based medicine. Both the vaginal and sublingual routes are more effective than the oral route for first-trimester cervical dilatation. Vaginal misoprostol 800 μg, repeated if necessary after 24 or 48 h, is a possible alternative for management after early pregnancy failure. However, misoprostol has not been demonstrated to be useful for the evacuation of an incomplete miscarriage, except for cervical dilatation before vacuum aspiration. Oral mifepristone 200 mg, followed 24–48 h later by vaginal, sublingual or buccal misoprostol 800 μg (followed 3–4 h later, if necessary, by misoprostol 400 μg) is a less efficacious but less aggressive alternative to vacuum aspiration for elective or medically-indicated first-trimester terminations; this alternative becomes increasingly less effective as gestational age increases. In the second trimester, vaginal misoprostol 800–2400 μg in 24 h, 24–48 h after at least 200 mg of mifepristone, is an alternative to surgery, sulprostone and gemeprost. Data for the third trimester are sparse. For women with an unripe cervix and an unscarred uterus, vaginal misoprostol 25 μg every 3–6 h is an alternative to prostaglandin E2 for cervical ripening at term for a live fetus. When oxytocin is unavailable, misoprostol can be used after delivery for prevention (sublingual misoprostol 600 μg) and treatment (sublingual misoprostol 800 μg) of postpartum haemorrhage. The use of misoprostol to promote cervical dilatation before diagnostic hysteroscopy or surgical procedures is beneficial for premenopausal women but not for postmenopausal women. Nonetheless, in view of the side effects of misoprostol, its use as a first-line treatment is not indicated, and it should be reserved for difficult cases. Misoprostol is not useful for placing or removing the types of intra-uterine devices used in Europe, regardless of parity.

The reliability and validity of six experts' exposure ratings were evaluated for 64 nickel-exposed and 72 chromium-exposed workers from six Shanghai electroplating plants based on airborne and urinary nickel and chromium measurements. Three industrial hygienists and three occupational physicians independently ranked the exposure intensity of each metal on an ordinal scale (1-4) for each worker's job in two rounds: the first round was based on responses to an occupational history questionnaire and the second round also included responses to an electroplating industry-specific questionnaire. The Spearman correlation (r(s)) was used to compare each rating's validity to its corresponding subject-specific arithmetic mean of four airborne or four urinary measurements. Reliability was moderately high (weighted kappa range=0.60-0.64). Validity was poor to moderate (r(s)=-0.37-0.46) for both airborne and urinary concentrations of both metals. For airborne nickel concentrations, validity differed by plant. For dichotomized metrics, sensitivity and specificity were higher based on urinary measurements (47-78%) than airborne measurements (16-50%). Few patterns were observed by metal, assessment round, or expert type. These results suggest that, for electroplating exposures, experts can achieve moderately high agreement and (reasonably) distinguish between low and high exposures when reviewing responses to in-depth questionnaires used in population-based case-control studies.

Expert assessment of possibilities of naval medical service for delivery of assistance in emergency situations in deployment areas is performed. It is noted that the main menaces are radiation, chemical accidents, and explosiveness of objects. Inconsistency between supposed losses and possibilities of naval medical service is probable in case of emergency. This inconsistency requires improvement of interaction with medical services of other ministries, drill of coordinative actions of naval medical commands with other commands of other ministries in organizational frames of united Service for Disaster Medicine.

The authors discuss peculiarities of the performance of forensic medical expertise in the cases of unfavourable outcomes of the stomatological treatment. The methodological basis of expert assessment has been created to be applied in situations related to the unfavourable outcomes of dental care.

Adenocarcinomas of the nasal cavity and the paranasal sinuses after occupational exposure to sawdust from oak and beech have been listed as occupational diseases in Germany since 1988. Given that modes of treatment have changed, we analyzed the guidelines based on the recommendations of Hartung et al. for developing an expert assessment on reduced earning capacity.A retrospective analysis of 43 cases which had been evaluated between March 1994 and February 2007 for an occupational disease #4203, in the Ear-Nose-Throat clinic of the Münster University Hospital, Germany.Following the guidelines of Hartung et al., it was impossible to formally classify 21 of 43 cases (48.8 %) in an unambiguous manner. This was primarily due to the assessment of the results of radiotherapy, either adjuvant or therapeutic, as well as the grading of postoperative dysfunction in the area of the sinuses operated on (Rhinitis, Ozaena). Suggestions for a revision of the classification system include a modified assessment of radiotherapy as well as evidence for grading post-therapeutic inflammations of the sinus operated on based on the need for further care. These changes enable all cases in question to be classified unambiguously.The use of the revised guidelines is recommended for expert assessment of adenocarcinomas of the nasal cavity and the paranasal sinuses caused by wood dust.

Procedures of forensic medical examination are considered with special reference to the cases of unfavourable outcomes of the treatment and methodological basis of their expert assessment. The step-by-step analysis of the doctor's actions is proposed for their objective evaluation. The objective opinion of the expert commission should be based on the medical criteria for the doctor's actions.

The aim of the work was to carry out expert assessment of complexity of operations and to study interrelationship of the average score of complexity of the interventions with lethal outcome and duration of treatment in the Intensive Care Unit (exemplified by comparison with the outcomes of operations on cardiac valves performed in 2009 in the setting of artificial circulation in adult patients). Complexity was assessed by a total of 13 cardiovascular surgeons specialized in operations aimed at correcting valve defects (4 of them were from the A. N. Bakulev Scientific Centre for Cardiovascular Surgery), with none of the participants being aware of the therapeutic outcomes of each type of the operation performed. An average expert-defined score was assigned for each of the 33 names of the operations. The Kendall coefficient of concordance for all operations amounted to 0.29 (p0.001); consensus in the complexity-score (from 69 to 85%) was achieved for 48.5% of the operations thus considered. The values of the mean scores of complexity of operations, defined by the specialists form the SCCS (2.02±0.54) were significantly lower (Wilcoxon's test; p0.001) as compared with the average score assigned by specialists from other facilities (2.28±0.43). The duration of the stay at the ICU of the patients subdivided into groups depending on the expert score was found to differ significantly (p=0.007). The area under the ROC curve using the EuroSCORE (0.59) is suggestive of its lower accuracy in assessing the lethal outcome as compared to the expert score (0.68). The obtained findings strongly suggest advisability of using expert score of operations' complexity for solving complicated non-formalized tasks on allied problems of cardiovascular surgery and organization of public health care (accrediting of medical facilities, formation of the government order, and planning of the budget of medical facilities).

An expert evaluation of preventive measures focused on population health maintenance in the zone of guaranteed voluntary resettlement taking into account the limitations of the provisions of certain articles of the Law of Ukraine on the clean-up of the Chornobyl disaster aftermath.The research survey was applied using a peer review method. The three-level (national, regional, district) expert workgroup was involved been employed within recovery of the Chornobyl disaster aftermath. Professional experience of minimum 10 years, corresponding profile and current position were the requirements for selection. A simple streamlining the values of paired or consistent comparison was applied on the primary empirical data.The arrangements made in recent years by the Cabinet of Ministers of Ukraine and ministries engaged in clean-up and recovery from the Chornobyl nuclear power plant accident are ineffective. Costs from the Fund for the implementation of measures to clean-up the consequences of the Chornobyl disaster and social protection are reduced. There is no consensus among experts regarding some constraint of an action of certain articles of the Law of Ukraine "On the status and social protection of citizens affected by the Chornobyl disaster" on the principles of social protection and healthcare of the population living in contaminated areas.In addressing the social and health consequences of the Chornobyl disaster the Verkhovna Rada of Ukraine just for a long time has passes no amendment to the legislation on the subject. At that there are several restrictions in force for a large number of articles of the existing laws that were adopted in 1991. The mentioned above exacerbates social strain and destroys the "citizen-state relationship". The extreme need has emerged in a comprehensive public review of existing laws with involvement of multidisciplinary group of experts to a "round table" to justify the draft laws.Metoju danogo doslidzhennja stala ekspertna ocinka realizacii' likuval'no-profilaktychnyh zahodiv, sprjamovanyh na zberezhennja zdorov’ja naselennja zony dobrovil'nogo garantovanogo vidselennja z urahuvannjam obmezhen' dii' polozhen' okremyh statej Zakoniv Ukrai'ny z likvidacii' naslidkiv Chornobyl's'koi' katastrofy. Metody. V procesi doslidzhennja bulo zastosovano opytuvannja z vykorystannjam metodu ekspertnyh ocinok. Sformovana grupa fahivciv tr'oh rivniv (derzhavnyj, oblasnyj, rajonnyj) zajnjatyh u sferi likvidacii' naslidkiv Chornobyl's'koi' katastrofy. Vymogamy vidboru buly dosvid roboty za fahom ne mensh nizh 10 rokiv, vidpovidnyj profil' ta posada. Dlja otrymannja pervynnyh empirychnyh danyh bulo zastosovano proste uporjadkuvannja znachen', i'h parne chy poslidovne porivnjannja. Rezul'taty. Za ocinkamy ekspertiv organizacijna robota Kabinetu Ministriv ta ministerstv, shho zajnjati pry vyrishenni problem likvidacii' naslidkiv avarii' na ChAES, v ostanni roky je maloefektyvnoju. Zmenshujet'sja vykorystannja koshtiv z Fondu dlja realizacii' zahodiv shhodo likvidacii' naslidkiv Chornobyl's'koi' katastrofy i social'nogo zahystu naselennja. Ne isnuje odnostajnosti sered ekspertiv shhodo obmezhen' dii' okremyh statej Zakonu Ukrai'ny „Pro status i social'nyj zahyst gromadjan, jaki postrazhdaly vnaslidok Chornobyl's'koi' katastrofy”, shho stosujut'sja pryncypiv social'nogo zahystu ta organizacii' medychnoi' dopomogy naselennju, jake meshkaje na radioaktyvno zabrudnenyh terytorijah. Vysnovky. Pry vyrishenni social'nyh ta medychnyh problem naslidkiv Chornobyl's'koi' katastrofy, Verhovna Rada Ukrai'ny tryvalyj chas ne pryjmaje konceptual'no novyh zmin v zakonodavchij bazi z c'ogo pytannja, a til'ky obmezhuje dii' velykoi' kil'kosti statej isnujuchyh zakoniv, shho buly pryjnjati u 1991 roci. Ostannje zagostrjuje social'nu naprugu v suspil'stvi ta rujnuje zv’jazok „gromadjanyn-derzhava”. Sformuvalas' krajnja neobhidnist' provedennja vsebichnoi' gromads'koi' ekspertyzy isnujuchyh zakoniv iz zaluchennjam do „kruglogo stolu” fahivciv riznogo sprjamuvannja dlja obg'runtuvannja proektiv zakoniv.

An attempt was undertaken to elucidate the concrete mechanism of wound infliction by a self-made projectile, such as a harpoon with the archery broadhead, based on the entire volume of evidence provided by the inquest. The results thus obtained allowed the potential for differential diagnostics of clothes and body damages caused by arrow-headed projectiles to be extended.

We appreciate the opportunity to respond to the letter of Behrens and Taeger1 regarding our article ‘Comparison of expert and job-exposure matrix-based retrospective exposure assessment of occupational carcinogens in the Netherlands Cohort Study’.2 Behrens and Taeger raise concerns about ‘validating’ existing job-exposure matrices (JEMs). Instead, they propose a recently developed web-based tool into which existing JEMs can be incorporated as job-specific modules (JSMs, a set of questions relevant to a specific job) and in which exposure estimates can be adapted according to available exposure measurements, expert opinion and study-specific circumstances.3 As cohort members in the large …

Intraoperative neuromonitoring (IONM) was introduced into thyroid surgery approximately 10 years ago for better identification of recurrent laryngeal nerve palsy. Since then several studies have been performed for evaluation of this new technology. IONM is superior to visual nerve identification alone for prediction of postoperative local cord function. Therefore, in bilateral procedures IONM enables intraoperative decision-making concerning resection of the second side. To avoid misinterpretation of the results of IONM a standardized approach including preoperative and postoperative laryngoscopy and preresection and postresection vagus stimulation is recommended. Trouble-shooting requires systematic checking of the device including control of electrode position (needle or tube electrodes). For expert assessment purposes documentation of the standardized application of IONM is of utmost importance.