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Psychiatry, Psychology, and Law : An... 2024A recent decision reveals how a New Zealand's disciplinary tribunal promoted justice for an unwell lawyer in a case of professional misconduct. In 2023, the Lawyers and...
A recent decision reveals how a New Zealand's disciplinary tribunal promoted justice for an unwell lawyer in a case of professional misconduct. In 2023, the Lawyers and Conveyancers Disciplinary Tribunal (LCDT) applied a 'merciful approach' when assessing the lawyer's misconduct and health issues. In [2023], the LCDT discussed the impacts of reproductive treatment in relation to the practitioner's conduct. This decision is the foundation to compare the disciplinary regime for legal and health practitioners in New Zealand. The article outlines New Zealand's framework for discipline of lawyers, noting the absence of a health pathway. The article discusses opportunities to resolve cases involving impaired lawyers outside the disciplinary system, including benefits and disadvantages of mandatory reporting. While focusing on the legal profession, the discussion is relevant to other professions and examines health-promoting regulatory strategies from other jurisdictions.
PubMed: 38895726
DOI: 10.1080/13218719.2024.2340098 -
Biology of Sex Differences Jun 2024Active and passive surveillance studies have found that a greater proportion of females report adverse events (AE) following receipt of either the COVID-19 or seasonal...
INTRODUCTION
Active and passive surveillance studies have found that a greater proportion of females report adverse events (AE) following receipt of either the COVID-19 or seasonal influenza vaccine compared to males. In a predominately young adult female population of healthcare workers, we sought to determine the intersection of biological sex and sociocultural gender differences in prospective active reporting of vaccine outcomes, which remains poorly characterized.
METHODS
This cohort study enrolled Johns Hopkins Health System healthcare workers (HCWs) who were recruited from the mandatory annual fall 2019-2022 influenza vaccine and the fall 2022 COVID-19 bivalent vaccine campaigns. Vaccine recipients were enrolled the day of vaccination and AE surveys were administered two days post-vaccination for bivalent COVID-19 and influenza vaccine recipients. Data were collected regarding the presence of a series of solicited local and systemic AEs. Open-ended answers about participants' experiences with AEs also were collected for the COVID-19 vaccine recipients.
RESULTS
Females were more likely to report local AEs after either influenza (OR = 2.28, p = 0.001) or COVID-19 (OR = 2.57, p = 0.008) vaccination compared to males, regardless of age or race. Males and females had comparable probabilities of reporting systemic AEs after either influenza (OR = 1.18, p = 0.552) or COVID-19 (OR = 0.96, p = 0.907) vaccination. Hormonal birth control use did not impact the rates of reported AEs following influenza vaccination among reproductive-aged female HCWs. Women reported more interruptions in their daily routine following COVID-19 vaccination than men and were more likely to seek out self-treatment. More women than men scheduled their COVID-19 vaccination before their days off in anticipation of AEs.
CONCLUSIONS
Our findings highlight the need for sex- and gender-inclusive policies to inform more effective mandatory occupational health vaccination strategies. Further research is needed to evaluate the potential disruption of AEs on occupational responsibilities following mandated vaccination for healthcare workers, a predominately female population, and to more fully characterize the post-vaccination behavioral differences between men and women.
Topics: Humans; Female; Male; Influenza Vaccines; Adult; COVID-19 Vaccines; Middle Aged; Sex Characteristics; Cohort Studies; Health Personnel; Vaccination; COVID-19; Influenza, Human; Young Adult
PubMed: 38890702
DOI: 10.1186/s13293-024-00625-z -
Clinical Chemistry and Laboratory... Jun 2024Drepanocytosis is a genetic disease relevant for its epidemiological, clinical and socio-economic aspects. In our country the prevalence is highly uneven with peaks in...
Drepanocytosis is a genetic disease relevant for its epidemiological, clinical and socio-economic aspects. In our country the prevalence is highly uneven with peaks in former malaria areas, but migration flows in recent years have led to significant changes. In this document we review the screening programs currently existing in Italy with particular emphasis on newborn screening, which in other countries around the world, including within Europe, is at most universal and mandatory. The essential laboratory issues are reviewed, from sampling aspects (cord blood or peripheral), to the analytical (analytical methods dedicated to neonatal screening and adult carrier detection) and post analytical (reporting, informative) ones. An economic analysis based on data collected in the province of Modena is also proposed, clearly showing that neonatal screening is also beneficial from an economic point of view.
PubMed: 38888156
DOI: 10.1515/cclm-2024-0478 -
Surgical Endoscopy Jun 2024Although minimally invasive hepato-pancreato-biliary (MIS HPB) surgery can be performed with good outcomes, there are currently no standardized requirements for centers...
BACKGROUND
Although minimally invasive hepato-pancreato-biliary (MIS HPB) surgery can be performed with good outcomes, there are currently no standardized requirements for centers or surgeons who wish to implement MIS HPB surgery. The aim of this study was to create a consensus statement regarding safe dissemination and implementation of MIS HPB surgical programs.
METHODS
Sixteen key questions regarding safety in MIS HPB surgery were generated after a focused literature search and iterative review by three field experts. Participants for the working group were then selected using sequential purposive sampling and snowball techniques. Review of the 16 questions took place over a single 2-h meeting. The senior author facilitated the session, and a modified nominal group technique was used.
RESULTS
Twenty three surgeons were in attendance. All participants agreed or strongly agreed that formal guidelines should exist for both institutions and individual surgeons interested in implementing MIS HPB surgery and that routine monitoring and reporting of institutional and surgeon technical outcomes should be performed. Regarding volume cutoffs, most participants (91%) agreed or strongly agreed that a minimum annual institutional volume cutoff for complex MIS HPB surgery, such as major hepatectomy or pancreaticoduodenectomy, should exist. A smaller proportion (74%) agreed or strongly agreed that a minimum annual surgeon volume requirement should exist. The majority of participants agreed or strongly agreed that surgeons were responsible for defining (100%) and enforcing (78%) guidelines to ensure the overall safety of MIS HPB programs. Finally, formal MIS HPB training, minimum case volume requirements, institutional support and infrastructure, and mandatory collection of outcomes data were all recognized as important aspects of safe implementation of MIS HPB surgery.
CONCLUSIONS
Safe implementation of MIS HPB surgery requires a thoughtful process that incorporates structured training, sufficient volume and expertise, a proper institutional ecosystem, and monitoring of outcomes.
PubMed: 38886227
DOI: 10.1007/s00464-024-10957-x -
Journal of Clinical Epidemiology Jun 2024Conducting longitudinal health research about people experiencing homelessness poses unique challenges. Identification through administrative data permits large,...
OBJECTIVE
Conducting longitudinal health research about people experiencing homelessness poses unique challenges. Identification through administrative data permits large, cost-effective studies; however, case validity in Ontario is unknown after a 2018 Canada-wide policy change mandating homelessness coding in hospital databases. We validated case definitions for identifying homelessness using Ontario health administrative databases after introduction of this coding mandate.
STUDY DESIGN AND SETTING
We assessed 42 case definitions in a representative sample of people experiencing homelessness in Toronto (n=640) from whom longitudinal housing history (ranging from 2018 to 2022) was obtained; and a randomly selected sample of presumably housed people (n=128,000) in Toronto. We evaluated sensitivity, specificity, positive and negative predictive values, and positive likelihood ratios to select an optimal definition, and compared the resulting true positives against false positives and false negatives to identify potential causes of misclassification.
RESULTS
The optimal case definition included any homelessness indicator during a hospital-based encounter within 180 days of a period of homelessness (sensitivity=52.9%; specificity=99.5%). For periods of homelessness with ≥ 1 hospital-based healthcare encounter, the optimal case definition had greatly improved sensitivity (75.1%) while retaining excellent specificity (98.5%). Review of false positives suggested that homeless status is sometimes erroneously carried forward in healthcare databases after an individual transitioned out of homelessness.
CONCLUSIONS
Case definitions to identify homelessness using Ontario health administrative data exhibit moderate to good sensitivity and excellent specificity. Sensitivity has more than doubled since the implementation of a national coding mandate. Mandatory collection and reporting of homelessness information within administrative data present invaluable opportunities for advancing research on the health and healthcare needs of people experiencing homelessness.
PubMed: 38880439
DOI: 10.1016/j.jclinepi.2024.111430 -
Journal of Robotic Surgery Jun 2024Robotic surgery (RS) is a milestone in minimally invasive surgery. More than 500 surgeons are trained in RS in India, and more than 100 robotic systems have been...
Robotic surgery (RS) is a milestone in minimally invasive surgery. More than 500 surgeons are trained in RS in India, and more than 100 robotic systems have been installed across various centers. RS offers various benefits to patients and surgeons. Although it is rapidly advancing and has several advantages, a robotic system is a complex system that is equipped with complex instruments. Qualitative research aims to take a broad view of the perceptions of stakeholders of RS and to synthesize their views to gain insight into scaling RS. This qualitative study aimed to explore the perspectives of relevant stakeholders on RS to learn how to develop the field and make it more affordable. This study is based on grounded theory methodology and uses the standards for reporting qualitative research (SRQR) guidelines for reporting. Three premier hospitals that are pioneers in RS in India served as the study locations. Purposive sampling was used to collect data from surgeons, nurses, and insurance staff. The surgeons interviewed have national and international exposure and are consulting and performing robotic surgeries across India and internationally. We conducted one-on-one interviews and wrote memos to gather further information before approaching each stakeholder. Samples were determined based on theoretical saturation. Fellowship training, which includes simulation, bedside assistance, and individual cases under supervision, was found to be the standard training method. The stakeholders mentioned a few prerequisites for performing RS, such as prior laparoscopic experience, passion for surgical knowledge and skill, and proper case selection. The surgeons discussed some technical considerations of RS, such as medico-legal issues and mechanical faults associated with it. Although there is increased scope for establishing robotic surgery, surgeons feel that the cost of RS is high. From the interactions with the stakeholders, it is understood that robotic surgeons are the most significant players in RS. Robotic surgery demands more skills and more trained professionals to scale up. Key findings highlight the importance of fellowship training, prior laparoscopic experience, and proper case selection. While RS has potential for growth, high costs, and technical issues remain concerns. Insurance companies include robotic surgery in their policies under the category of "modernized medicine." Depending on the insurance plan that the patient selects, the necessity of the robotic surgery, and the surgeon's justification, the insurance company will pay for the patient's robotic surgery. To make it affordable for patients, complete insurance coverage is mandatory along with creating more awareness among patients. The growth of RS is inevitable in the future with other robotic companies emerging which will ultimately reduce the capital cost and robotic surgeons are pivotal in advancing RS.
Topics: Robotic Surgical Procedures; India; Humans; Qualitative Research; Surgeons; Stakeholder Participation; Grounded Theory
PubMed: 38869619
DOI: 10.1007/s11701-024-02008-3 -
Acta Tropica Aug 2024The hard tick clade (Ixodidae) currently comprises 762 species worldwide (266 Prostriata and 496 Metastriata). A quarter of hard ticks are found in the Neotropical...
The hard tick clade (Ixodidae) currently comprises 762 species worldwide (266 Prostriata and 496 Metastriata). A quarter of hard ticks are found in the Neotropical region, and 42 species have been documented in Colombia. Ixodidae species are important vectors of pathogens such as bacteria, helminths, protozoa, and viruses. In tick-borne diseases, vertebrate hosts perform an important role in the transmission, maintenance, and spread of pathogens. Colombia ranks sixth among countries with the highest mammal biodiversity, with a total of 548 species, where some of these species may be involved in pathogen transmission cycles with ticks as vectors. This research evaluated the presence of two genera of bacteria (Borrelia and Rickettsia) and the protozoan (Babesia) in ticks and mammals in the Orinoquia region of Colombia, establishing interaction networks. The information comes from 734 mammals (655 wild and 79 domestic), belonging to 59 species. Tick infestation (n = 1,805) was found with 14.85 % (n = 109) of the examined mammals and corresponds to nine tick species confirmed morphologically and molecularly. To detect pathogens 272 ticks were collected while feeding on 96 mammals; samples from 93 mammals were analyzed. The presence of borreliae from the relapsing fever group (RFG) and the Lyme disease group (LDG) were detected. Rickettsia spp. was detected in ticks and mammals, while Babesia bigemina was only detected in ticks. This research is the first to address the prevalence of zoonotic pathogens in domestic and wild mammals infested with hard ticks in the Department of Arauca, Colombia. Considering that reporting cases of infections with Babesia, Borrelia, and Rickettsia in Colombia is not mandatory, their impact on public health cannot be estimated. This highlights the importance of continuously detecting, confirming, and identifying these and other important pathogens within the "One Health" framework, as they have a significant economic and medical-veterinary impact globally.
Topics: Animals; Colombia; Mammals; Rickettsia; Ixodidae; Babesia; Borrelia; Host-Pathogen Interactions; Tick Infestations; Tick-Borne Diseases
PubMed: 38861832
DOI: 10.1016/j.actatropica.2024.107282 -
Brain & Spine 2024The appropriate surgical management of insular gliomas is controversial. Management strategies vary considerably between centers. (Review)
Review
INTRODUCTION
The appropriate surgical management of insular gliomas is controversial. Management strategies vary considerably between centers.
RESEARCH QUESTION
To provide robust resection, functional and epilepsy outcome figures, study growth patterns and tumor classification paradigms, analyze surgical approaches, mapping/monitoring strategies, surgery for insular glioblastoma, as well as molecular findings, and to identify open questions for future research.
MATERIAL AND METHODS
On behalf of the EANS Neuro-oncology Section we performed a systematic review and meta-analysis (using a random-effects model) of the more current (2000-2023) literature in accordance with the PRISMA guidelines.
RESULTS
The pooled postoperative motor and speech deficit rates were 6.8% and 3.6%. There was a 79.6% chance for postoperative epilepsy control. The postoperative KPI was 80-100 in 83.5% of cases. Functional monitoring/mapping paradigms (which may include awake craniotomies) seem mandatory. (Additional) awake surgery may result in slightly better functional but also worse resection outcomes. Transcortical approaches may carry a lesser rate of (motor) deficits than transsylvian surgeries.
DISCUSSION AND CONCLUSIONS
This paper provides an inclusive overview and analysis of current surgical management of insular gliomas. Risks and complication rates in experienced centers do not necessarily compare unfavorably with the results of routine neuro-oncological procedures. Limitations of the current literature prominently include a lack of standardized outcome reporting. Questions and issues that warrant more attention include surgery for insular glioblastomas and how to classify the various growth patterns of insular gliomas.
PubMed: 38859917
DOI: 10.1016/j.bas.2024.102828 -
Indian Journal of Pathology &... Jun 2024Neoadjuvant chemoradiotherapy (NACRT) using CROSS protocol is currently the treatment of choice for esophageal cancer (EC). Tumor response grade (TRG) is a mandatory...
BACKGROUND
Neoadjuvant chemoradiotherapy (NACRT) using CROSS protocol is currently the treatment of choice for esophageal cancer (EC). Tumor response grade (TRG) is a mandatory reporting criterion in most guidelines. One of the most commonly used TRG systems is the modified Ryan system. We aim to assess the TRG using modified Ryan and seven other systems (Mandard, Chireac, Swisher, Japanese esophageal society guidelines, modified rectal cancer regression grading (mRCRG), CROSS, and Becker) to evaluate their reproducibility and role as a prognostic marker.
MATERIALS AND METHODS
Two pathologists independently reviewed all cases of post-NACRT (CROSS) EC, to score TRGs and other histological parameters. Inter-rater agreement assessment for different TRG systems and correlation with disease-free survival (DFS) was performed.
RESULTS
Our series includes 93 patients with predominantly mid-esophageal squamous cell carcinoma. Complete pathological response (pCR) was noted in 47% (44/93) patients. The kappa inter-rater agreement score for the Ryan system was substantial (0.774), while it was almost perfect agreement for tumor percentage assessment-based systems (Swisher, CROSS, and Becker). Only the mRCRG TRGs correlated significantly with prognosis, while the Ryan system did not. Tumor stage and pCR status did not correlate with DFS, though the nodal stage was clinically significant.
CONCLUSION
Though the inter-rater concordance was optimal for all the TRG systems studied, only the mRCRG system showed prognostic significance, while the commonly used modified Ryan system did not. It may be worthwhile to look at further evaluating other systems like mRCRG for inclusion in minimum dataset reporting.
PubMed: 38847226
DOI: 10.4103/ijpm.ijpm_109_23 -
Journal of the Academy of... Jun 2024We present the case of a physician who engages with a peer response team and discloses suicidal ideation while himself seeing patients in the hospital. Top experts in... (Review)
Review
We present the case of a physician who engages with a peer response team and discloses suicidal ideation while himself seeing patients in the hospital. Top experts in consultation-liaison psychiatry provide guidance for this clinical case based on their experience and a review of the available literature. Key teaching topics include a general approach to suicide risk assessment, peer response programs for healthcare workers, and ethical and clinical considerations in treating colleagues. Consultation-liaison psychiatrists should be familiar with suicide risk management, take a pro-active approach to addressing modifiable risk factors, and keep in mind unique challenges of treating colleagues referred for care.
PubMed: 38844207
DOI: 10.1016/j.jaclp.2024.05.006