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A mixed-method, exploratory design was used to examine 101 cases of sexual violations in medicine. The study involved content analysis of cases to characterize the physicians, patient-victims, the practice setting, kinds of sexual violations, and consequences to the perpetrator. In each case, a criminal law framework was used to examine how motives, means, and opportunity combined to generate sexual misconduct. Finally, cross-case analysis was performed to identify clusters of causal factors that explain specific kinds of sexual misconduct. Most cases involved a combination of five factors: male physicians (100%), older than the age of 39 (92%), who were not board certified (70%), practicing in nonacademic settings (94%) where they always examined patients alone (85%). Only three factors (suspected antisocial personality, physician board certification, and vulnerable patients) differed significantly across the different kinds of sexual abuse: personality disorders were suspected most frequently in cases of rape, physicians were more frequently board certified in cases of consensual sex with patients, and patients were more commonly vulnerable in cases of child molestation. Drawing on study findings and past research, we offer a series of recommendations to medical schools, medical boards, chaperones, patients, and the national practitioners database. [ABSTRACT FROM AUTHOR]

Objectives. Identify pediatrician (faculty and resident) beliefs about spirituality and religion (SR) in medicine and the relationship of those beliefs to SR behavior and experiences in clinical practice. Methods. A self-report questionnaire was administered to full-time pediatric faculty (N = 65) and residents (N = 56) of an urban children's hospital affiliated with a school of medicine. The response rate was 70.8% among faculty (n = 46) and 78.6% among residents (n = 44). Respondents indicated the extent of their SR inquiry and the frequency of their SR experiences (requests by patients or families to discuss SR or pray), routinely and during health crisis, and rated 19 belief statements about SR in pediatrics. Results. Few pediatricians routinely ask about SR issues. Faculty were more likely than residents to ask about religious affiliation, whereas residents were more likely to be asked to pray during health crises, to believe that SR has health relevance, and to perceive pediatrician-initiated prayer as appropriate. Composite scores indicated that physicians who did not expect negative patient reactions to SR inquiry and prayer, who believed more strongly that SR is relevant to pediatric outcomes, and who felt more capable with SR inquiry were more likely to engage in SR inquiry and to experience SR requests. Conclusions. Pediatrician beliefs with respect to health relevance of SR, patient reactions to SR inquiry, and physician capabilities regarding SR in the clinic are strongly related to their clinical practice concerning SR inquiry and experiences. Correction of physician misperceptions about SR issues and incorporation of religious sensitivity into physician training may remove barriers to both patient and physician SR inquiry. Pediatrics 2003;111:e227-e235. URL: http://www.pediatrics.org/cgi/ content/full/111/3/e227; pediatrics, religion in medicine, physician's role, attitude of health personnel, internship and residency, medical education.

BACKGROUND: Several studies have reported that schizophrenia is associated with mitochondrial abnormalities, glutathione deficit, and increased brain oxidative stress (free radicals). N-acetylcysteine (NAC) is a strong antioxidant with potential therapeutic benefit in schizophrenia, according to some reports. We conducted a review of the published controlled studies, with the goal of determining the efficacy profile of NAC as an adjunctive treatment for schizophrenia. METHODS: An online search was conducted for all placebo-controlled, double-blind, randomized clinical trials of NAC in schizophrenia, and a review was conducted. RESULTS: Two studies met the criteria for inclusion. Berk et al (2008) used NAC as an adjunctive treatment to atypical antipsychotics in subjects with chronic schizophrenia who were stable on antipsychotic medications. Treatment at 8 weeks was less efficacious than placebo, but at 24 weeks produced significant reductions vs placebo in Positive and Negative Syndrome Scale (PANSS) negative (d - 0.52), general {d = 0.46), and total {d = 0.57) scores. Farokhnia et al (2013) used NAC as an adjunctive treatment to risperidone in subjects with chronic schizophrenia who were experiencing an acute exacerbation episode. Eight weeks of treatment led to clinically significant reductions vs placebo in PANSS negative (d = 0.96), general (d = 0.59), and total (d = 0.88) scores. CONCLUSIONS: The data suggest that adjunctive NAC may be efficacious in reducing negative and general symptoms in schizophrenia. [ABSTRACT FROM AUTHOR]

Background. While increasing evidence suggests that observers discount high-severity chronic pain, factors that occasion such discounting are poorly understood, particularly regarding health provider vs lay perspectives. Objective. This study examined the effects of supporting medical evidence and comorbid psychological distress (pain behavior) on medical student and lay clinical judgments of increasingly severe patient pain reports. Design. In a 2 x 2 x 2 x (7) mixed between- and within-subject design, participants (medical students vs lay) made clinical judgments after reading vignettes describing a hypothetical patient that varied in levels of medical evidence and pain behavior (low vs high) and pain severity (4/10-10/10). Subjects. Fourth-year medical students (N = 115) and lay persons in the community (N = 300) participated in this research. Results. While both medical student and lay judgments plateaued at high levels of pain severity, judgments regarding cause (medical vs psychological), treatment (opioid prescription), and disability showed growing divergence as levels of reported pain severity increased. Divergence relative to medical and psychological causes of pain was found irrespective of the level of supporting medical evidence; divergence relative to opioid treatment and support for a disability claim was found when supporting medical evidence was low. Conclusions. The results indicate differing expectations of chronic pain treatment for health care providers relative to the lay public that could impact clinical care, especially at high pain severity levels, where lay expectations diverge significantly from those of health professionals. [ABSTRACT FROM AUTHOR]