Mechanistic approach to the management of cancer-related nausea and vomiting in a palliative care resource-limited setting

Background: Nausea and vomiting are two interrelated distressing symptoms experienced by patients with malignancies. They are multifactorial in aetiology. Case presentation: A middle-aged woman diagnosed with bilateral ovarian malignancy had undergone chemotherapy and was suffering nausea and vomiting, and was responding to basic therapeutic measures. Case management: She was resistant to treatment with metoclopramide that was commenced by the oncology team, as for any patient with nausea and vomiting. This report examines a ‘mechanistic’ approach to nausea management and life-style modifications. Case outcome: Within 2 days of the evidence-based revision of her management plan, the patient expressed that she had experienced a significant symptomatic relief and an improvement in her general wellbeing. Conclusion: The early identification of the most probable causative factors of nausea and vomiting in patients with advanced malignancies will lead to significant improvements in their quality of life and save time and resources.

856 Mortality and Morbidity Meetings in Oral and Maxillofacial Surgery: Hindsight is 20/20

Aim Mortality and Morbidity (M&M) meetings form a critical part of clinical governance however they often suffer from hindsight bias and lack objectivity. To combat this, Kahoot surveys were disseminated to senior clinicians prior to M&M meetings. Each case to be discussed is presented as a survey item with the clinical and radiographic information that was available to the performing surgeon pre-operatively and participants are asked to detail their ideal treatment. The aims of this study were to determine if the introduction of Kahoot surveys prior to M&M meetings improves the objectivity of the discussions and reduces the effects of hindsight bias. Method A 12-item questionnaire relating to the introduction and utility of Kahoot surveys prior to M&M discussions was distributed to all registrars and consultants within our department. Result An 80% response rate was obtained (16/20 responses). Prior to the introduction of Kahoot surveys, 62.6% of surgeons felt case discussions were clouded by the benefit of hindsight. Comparatively, 68.8% indicated the use of pre-M&M surveys reduced the effects of hindsight bias. 56.3% of participants expressed the objectivity of case discussions improved and 50% felt the quality of feedback improved. Conclusions The use of Kahoot surveys prior to M&M meetings demonstrates that withholding the case outcome until each clinician has given their own opinion reduces the effect of hindsight bias. The surveys utilise the Bolam Test, thereby enabling us to determine the correct error classifications with greater objectivity. Furthermore, they facilitate a higher quality of discussion and feedback.

Epidemiological profile of american tegumentary leishmaniasis in the state of Maranhão in recent years

American Tegumentary Leishmaniasis (ATL) is a non-contagious disease, caused by a protozoan of the genus Leishmania, vector-borne by sandflies. Initially it is enzootic, but it can affect humans in a secondary way, characterizing itself as a zoonosis. It has great epidemiological importance due to the complexity of the treatment. The disease has been spreading on a large scale throughout Brazil, as well as in the state of Maranhão. This study is a descriptive approach with the use of confirmed cases of ATL by the Department of Informatics of the Unified Health System, for the years 2010 to 2019 for the state of Maranhão. The following variables were analyzed: annual notifications, gender, age group, clinical forms, case outcome and municipalities with the most notifications. During the study period, 19,043 cases were confirmed in the state. The year 2011 had the highest number of notifications, with 2,948 cases and an incidence of 44.83 cases per 100,000 inhabitants. The male gender was the most affected with 71.9%. The predominant age group was between 20 and 39 years old, with 42.7%. The cutaneous form was prevalent with 96.4%. The three municipalities with the highest number of records were Montes Altos (West Mesoregion), Buriticupu (West Mesoregion) and Arame (Centro Maranhense Mesoregion). The state of Maranhão is considered endemic for ATL, so it is considered essential to continuously adopt measures to combat the vector and to conduct educational campaigns that inform the population about minimizing the possibilities of disease transmission.

A Retrospective Study on Data from Animal-Related Complaints, Abuse, Cruelty, Trafficking and Trade Received by Animal Welfare Organizations in Singapore in 2016

Introduction: Singapore is a first-world country, protected by an advanced police force, competent in investigating crime against human citizens. Little is known about crime against animals and what Singapore does in these instances. Methods: This research considered data from reports of various animal crime that occurred in 2016 as recorded by the three animal welfare organizations appointed to investigate crimes against animals (AVS, SPCA and ACRES). Details of the cases collected were sorted using eight parameters: date, location, perpetrator, victim, type of crime or complaint, case outcome, organization, and punishment. The type of crime or complaint were divided into the categories: abandoned, allowed to roam, barking animal, caged, poor conditions, sick and untreated, physically abused, poisoned, deceased, taken from the wild, illegal possession, illegal sale, smuggling, and licencing. Results: In 2016, a total of 831 cases committed by 839 perpetrators were reported, for a total of 2357 minimum number of animals involved, comprehensive of animal parts and items made from animals. The largest proportion of the cases occurred against domestic animals and in housing districts. Despite these high numbers, only perpetrators in 11 cases were charged with fines and/or imprisonment time. Conclusions: This research paints, for the first time, a picture of what animal crime looks in the Singaporean society. Results are of pivotal importance to identify criminal hot spots, most common type of crimes, and animal categories that are most often victimised, aiming to facilitate the work of the organizations involved in investigating animal-related crime in Singapore.

Understanding the challenges to investigating and prosecuting organ trafficking: a comparative analysis of two cases

The human organ trade is proliferating globally. However, far fewer cases have been prosecuted than would be expected based on estimates of the crime. Research exploring the challenges to investigating and prosecuting organ trafficking cases is practically non-existent. Also no studies exist that explain these challenges utilizing a criminal justice framework. This article aims to explain the legal, institutional and environmental factors that affected the investigation and prosecution of two organ trafficking cases: the Netcare case, exposed in South Africa and the Medicus case, exposed in Kosovo. It analyzes these factors through a comparative, mixed-method design, utilizing a theoretical criminal justice framework. Both cases constituted globally operating criminal networks involving brokers and transplant professionals that colluded in organizing illegal transplants. Both cases contained human trafficking elements, however only the Medicus case was prosecuted as a human trafficking case. Legal uncertainty, a lack of institutional readiness and cross-border collaboration issues hampered investigation and prosecution of the Netcare case. The Medicus case also reported problems during cross-border collaboration, as well as a corrupt environment and institutional barriers, which impeded a successful case outcome. Recommendations to improve enforcement of organ trafficking include improving identification of suspicious transplant activity, strengthening cross-border collaboration and enhancing whistleblower protection laws.

Gynecological Surgery and Machine Learning: Complications and Length of Stay Prediction

In this study we are developing predictive models for a length of stay after a gynecological surgery, complications and the length of the surgery using machine learning methods. The study was performed with the data of patients with the diseases of the female reproductive system. The patients were admitted to the Almazov National Medical Research Centre (Saint-Petersburg, Russia) within the period 2010-2020. The study included 8170 electronic medical records of inpatient episodes including 3500 operation protocols. The data included anamnesis of life, anamnesis of disease, laboratory tests, severity, outcome of a surgery, main and comorbid diagnosis, complications, case outcome. The dataset was randomly split into 70% train and 30% test datasets. Validation with the test dataset provided the following prediction metrics for the length of stay after a surgery model. Training score: AUC of ROC: 0.9582230976834093; K-fold CV average score: -8.73; MSE: 5.65; RMSE: 2.83.

Prospects for Enforcing Prohibitions on Off-Label Drug Promotion after United States v. Caronia: An Analysis of Litigated Cases

Context: Food and Drug Administration (FDA) rules restrict pharmaceutical manufacturers from promoting drugs for non-FDA-approved (off-label) indications. When manufacturers violate this rule, it has in many cases led to unsafe prescribing. However, in 2012, a federal circuit court ruled in United States v. Caronia that truthful off-label promotion was protected under the First Amendment, threatening government enforcement in this area. Methods: The authors extracted cases from the WestLawNext database that mentioned Caronia from 2012 to 2019. They collected information about plaintiff, procedural history, product and manufacturer involved, and case outcome. Cases were categorized as either “follows,” “does not follow,” or “distinguishes” from Caronia. The authors qualitatively reviewed the full text of each case to verify whether Caronia was given substantive discussion for perceptions of off-label promotion, application of commercial speech rights, and how courts interpreted Caronia. Findings: Among 42 cases in the study cohort, 22 (52%) followed Caronia's core holding that truthful, non-misleading off-label promotion was not actionable under FDA rules. By contrast, 20 cases (48%) treated Caronia negatively, either declining to follow (9 cases) or distinguishing it (11 cases). Conclusions: Enforcement on off-label marketing became more challenging after Caronia. This gives manufacturers greater flexibility to promote drugs for unapproved uses despite the substantial public health risks.

Clinical and paraclinical characteristics of young patients with myocardial infarction from Northeast of Romania

The aim of this study was to evaluate the clinical and paraclinical features in young patients (18–40 years) with acute myocardial infarction (AMI) in the Northeast of Romania. We have considered all patients admitted between the 1st of January 2017 through the 31st of December 2019 at a tertiary care Cardiology Institute with the primary discharge diagnosis of AMI. These patients have been split into 2 groups depending on their age: the first group consisting of patients with an age equal to or lower than 40 years old and the second group consisting of patients with an age greater than 40 years old. After this, we have randomly selected a representative sample from each of the two groups. A total of 99 patients were ultimately enrolled in the study: 42 in the first group and 57 in the second group. Data collected included age, gender, medical history, laboratory tests, echocardiography parameters, coronarography study results, and case outcome. Most young patients with myocardial infarction were male, more likely to smoke (69% vs 35.1%, p = 0.001), and with a positive family history of cardiovascular diseases (35.7% vs 1.8%, p < 0.001) in comparison to their older counterparts. Also, they had fewer comorbidities, such as diabetes mellitus, hypertension, or a positive history of stroke or atrial fibrillation. Mean ejection fraction was significantly higher in young patients (43.4 ± 10.65 vs 37.16 ± 10.77, p = 0.005) and both tricuspid and mitral valve regurgitations were less severe. Coronary lesions were more severe in the older patients (p = 0.009), usually with more coronary arteries involved. No significant difference was recorded in the number of hospitalization days or in the case outcome. Acute myocardial infarction in young patients typically occurs more in men who smoke, those who are more than 30 years old, and those who have a positive family history of cardiovascular diseases. Echocardiographic parameters seem to be better than in the case of older patients and the coronary involvement is usually less severe.

Sustainability of Portuguese Courts: Citizen Satisfaction and Loyalty as Key Factors

This paper aims to describe the satisfaction and loyalty of citizens towards the sustainability of Portuguese courts. This research was carried out under the Portuguese justice agenda named “Justice + Closer” between the years of 2017, 2018, and 2019. The methodological approach adopted was quantitative. Based on the literature review, a structural model of the relationships between the dimensions that directly and indirectly influence citizen satisfaction and loyalty was adapted from the arbitration centers to the court’s reality. Data collection was carried out during the three years mentioned—in person at the Portuguese Campus of Justice and also through questionnaires applied online. In the course of the three years, 3276 observations were collected. Through structural equation modeling, it was possible to measure positive relations produced between seven established dimensions. The results of this study contribute generally to applied research in the field of justice administration and to the understanding of this topic by those in the academic sector where it has been superficially addressed. Related future investigations might include a comparative study between the satisfaction and loyalty of citizens with (i) the formal adjudication processes and case outcomes of the Portuguese courts and (ii) alternative dispute-resolution processes and case outcome means reached by recognized arbitration and mediation centers, judges of peace, and related ADR services.