Clinical Audit in a General Surgery Rotation: Responses and Professional Opinion of Participating House Officers

House officers (HOs) face numerous challenges to adapt to new working environment following months of unemployment. Several studies have addressed their psychological distress, and identified that general surgery is one of the most stressful rotation. In this current study, we intend to study their emotional responses when they are participating in clinical audit. The responses were assessed with Positive Affect and Negative Affect Scale (PANAS). Those who participated in the survey had more positive affect than negative affect. A small proportion of them had a sense of guilt and fear. HOs work far from original hometown and away from family members are having less positive affect. Appropriate measures to allow HOs to work close to family may improve work efficacy and emotional health.

Punishment of Persons Convicted of Economic (Business) Crimes and Malfeasance in Office, in the Assessment of the Public and Professionals

Introduction: the article considers ultra-liberal, ultra-radical and realistic views on the punishment of persons convicted of economic (business) crimes and malfeasance in office. The article analyzes public and professional opinion on this problem using the results of specific sociological studies conducted in 2018–2019 by Tkachevsky Research and Education Center “Problems of Penal Law” under Lomonosov Moscow State University. Research materials and methods: the research is based on the application of the specific sociological research method. The materials for our research include the results of the study of public and professional opinion on the punishment of those convicted of economic crimes and malfeasance in office, and on the places and conditions of their imprisonment. Empirical research includes surveys of three types of respondents: citizens of the Russian Federation; persons convicted of economic crimes and malfeasance in office who are serving sentences in correctional institutions; correctional officers. We also investigate proposals on sending the convicts under consideration to correctional institutions located in remote regions of Russia, and the prospects for the construction and opening of so-called private prisons for them. We analyze the practice of keeping persons convicted of economic crimes and malfeasance in office together with other categories of convicts. Results: we conclude that the public and professionals do not tend to hold extreme positions (ultra-liberal or ultra-radical) in the punishment of persons convicted of economic crimes and malfeasance in office. The public and professionals assess quite realistically the criminal policy of the state and judicial practice at the present stage of the state's development and allow, within certain limits, the application of punishment in the form of imprisonment to economic and official criminals. We emphasize that both categories of respondents (citizens and convicts) are more inclined to use imprisonment in relation to persons who have committed malfeasance in office than to those who committed economic crimes. We argue that public opinion is dissatisfied with the fact that persons convicted of malfeasance in office and economic crimes are kept together with other categories of convicts. There is no such dissatisfaction in the professional opinion: the majority of interviewed correctional officers do not support the idea of sending those convicted of economic crimes and malfeasance in office to separate correctional institutions. We put forward a proposal concerning the implementation of the idea that persons convicted of economic crimes and malfeasance in office should be held in separate correctional institutions in the course of modernization provided for by the Concept for development of the penal system of the Russian Federation until 2030, which consists in opening joint correctional institutions.

EXOSEKETONS: A REHAB TECH CONSUMER’S UNEXPECTED MARCH TO ACTION

This paper is both a stakeholder perspectives as well as a ‘case study’ describing a journey from sudden disability to participant and investor in exoskeleton design. It tells of my experiences and opinions, as a successful fashion designer, when my life took a drastic turn on becoming paralysed from the waist down over the course of 24 hours, by a spinal tumour. Getting this diagnosis was ‘the worst day in my life’, and it was quickly followed by the ‘second worst’ when, in my determination to walk again, I received Knee Ankle Foot Orthotics (KAFOs) and was shocked to learn that this appeared to be the best technology solution available on the market ‘suitable’ for use in the community. Initial anger at the system for not being better, at the rehab team for their complacency, and at myself for allowing a feeling of helplessness to take over led to questions such as: what does this say about our society? and what are we all willing to accept, for ourselves and others? This is professional opinion and an essay about how we see ourselves and how others see us. The journey from pre-injury ‘consumer’ to post-injury ‘disabled’ person and learning that being labeled ‘disabled’ leads to the additional handicap of the narrow vision of “cost” taken by the mobility industry where innovative ideas are stripped down to the bare minimum with the excuse that patients are “lucky” to have what they have been “given”. Grappling with these labels and inequities and seeking a better outcome, I became an integral team member of an exoskeleton development team, leading to the design of The Next Generation Exoskeleton! This is MY story, the story of Chloe Angus. It is the story of inclusive, user focused design and is a call to include and respect the end users of all assistive device technology design early in the design process and it is being told from the perspective of a person having experience and success in the world of business. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/37250/28296 How To Cite: Angus C. Exoseketons: a rehab tech consumer’s unexpected march to action. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.2. https://doi.org/10.33137/cpoj.v4i2.37250 Corresponding Author: Chloe AngusChloe Angus Design, Vancouver, BC, Canada.E-Mail: [email protected] ID: https://orcid.org/0000-0002-5468-3121

Clinical Reasoning in Forensic Psychiatry: Concepts, Processes, and Pitfalls

Forensic psychiatrists are often sought by the court of law to provide professional opinion on specific legal matters that have a major impact on the evaluee and possibly society at large. The quality of that opinion and recommendations rely on the quality of the analysis from the assessment results conducted by the psychiatrist. However, the definition and scope of a forensic psychiatric analysis is not clear. While existing literature on forensic psychiatric analysis generally includes organizing information, identifying relevant details, and formulating a set of forensic psychiatric opinions as components, there is no explicit and unified definition of these terms and process. This lack of clarity and guidelines may hinder forensic psychiatry from achieving its goal of providing objective information to the court or other relevant parties. Forensic psychiatric analysis exhibits numerous parallels to clinical reasoning in other fields of medicine. Therefore, this review aims to elaborate forensic psychiatric analysis through the lens of clinical reasoning, which has been developed by incorporating advances in cognitive sciences. We describe forensic psychiatric analysis through three prominent clinical reasoning theories: hypothetico-deductive model, illness script theory, and dual process theory. We expand those theories to elucidate how forensic psychiatrists use clinical reasoning not only to diagnose mental disorders, but also to determine mental capacities as requested by law. Cognitive biases are also described as potential threat to the accuracy of the assessment and analysis. Additionally, situated cognition theory helps elucidate how contextual factors influence risk of errors. Understanding the processes involved in forensic psychiatric analysis and their pitfalls can assist forensic psychiatrists to be aware of and try to mitigate their bias. Debiasing strategies that have been implemented in other fields of medicine to mitigate errors in clinical reasoning can be adapted for forensic psychiatry. This may also shape the training program of general psychiatrists and forensic psychiatrists alike.

Distilling Professional Opinion to Gauge Vulnerability of Guam Avifauna to Brown Treesnake Predation

The avifauna of Guam was devastated by the introduction of the Brown Treesnake, and the restoration of native birds would need to address the problem with eradication or suppression of BTS. With eradication of the snake unlikely in the near term, and suppression capabilities limited to specific finite areas, key information for reintroductions is how low BTS abundance will likely need to be for each bird species to be re-established based on their vulnerability to BTS predation. Here, we estimate vulnerability, which can no longer be measured directly, so biologists who are familiar with one or more of seven Guam birds were surveyed to obtain their knowledge and produce quantitative vulnerability estimates. As is typical of birds adapted to islands devoid of predators, respondents judged that our focal species exhibit few predator avoidance and tolerance traits, leaving body size as the prime determinant of vulnerability. Respondent opinion also holds that any behavior that reduces the likelihood of an encounter by BTS, e.g., roosting/nesting in palm crowns, cavity nesting, and in particular urban dwelling, substantially reduces vulnerability. Our results can help inform species-specific decisions about when it may be safe to consider the release of birds on Guam depending on the relative vulnerability of each species to predation by BTS.

Variation in treatment preferences of pulmonary exacerbations among Australian and New Zealand cystic fibrosis physicians

BackgroundDespite advances in cystic fibrosis (CF) management and survival, the optimal treatment of pulmonary exacerbations remains unclear. Understanding the variability in treatment approaches among physicians might help prioritise clinical uncertainties to address through clinical trials.MethodsPhysicians from Australia and New Zealand who care for people with CF were invited to participate in a web survey of treatment preferences for CF pulmonary exacerbations. Six typical clinical scenarios were presented; three to paediatric and another three to adult physicians. For each scenario, physicians were asked to choose treatment options and provide reasons for their choices.ResultsForty-nine CF physicians (31 paediatric and 18 adult medicine) participated; more than half reported 10+ years of experience. There was considerable variation in primary antibiotic selection; none was preferred by more than half of respondents in any scenario. For secondary antibiotic therapy, respondents consistently preferred intravenous tobramycin and a third antibiotic was rarely prescribed, except in one scenario describing an adult patient. Hypertonic saline nebulisation and twice daily chest physiotherapy was preferred in most scenarios while dornase alfa use was more variable. Most CF physicians (>80%) preferred to change therapy if there was no early response. Professional opinion was the most common reason for antibiotic choice.ConclusionsVariation exists among CF physicians in their preferred choice of primary antibiotic and use of dornase alfa. These preferences are driven by professional opinion, possibly reflecting a lack of evidence to base policy recommendations. Evidence from high-quality clinical trials is needed to inform physician decision making.

An Unusual Case of Gas Gangrene in Intravenous Heroin Addict

BACKGROUND: Gas gangrene is a clostridium infection primarily of muscle tissue, most commonly caused by C. perfringens. Clinical diagnosis is usually made by local inspection of the wound: the infected tissue shows characteristic signs of tissue inflammation with blistered changes. The disease can starts suddenly, 4-6 hours after the injury, but most commonly the incubation period lasts 2-4 days. Without proper medical intervention, death occurs in 4-24 hours after the development of the first symptoms, but even with timely and adequate therapy, the lethality is very high (around 12%). Due to its fulminant course, in all cases with fatal outcomes, a forensic autopsy is an obligatory procedure. However, discovering the entrance gate and source of infection is not an easy task, especially in the absence of a traumatic injury. CASE PRESENTATION: Male, 27 years old, an intravenous heroin addict for about 10 years, injured his left leg in a traffic accident. He only visited the doctor after 5 days. Upon examination, it was determined that there were no externally visible injuries and no fracture, and he was given a splint immobilization for an ankle luxation. Twelve days after the accident (or 7 days after the immobilization) his mother found him unconscious. CONCLUSION: From medicolegal aspects, it’s important to have in mind even the less frequent paths of infection, in order to give an expert professional opinion on origin and cause of death.

The perspectives of children and young people affected by parental life-limiting illness: An integrative review and thematic synthesis

Background: Although the death of a parent during childhood is relatively commonplace, the voices of children affected by parental life-limiting illness are under-represented in research evidence. Guidance for healthcare professionals is largely based upon professional opinion rather than the experience of children themselves. Aim: To synthesise and appraise the literature from primary research with children about their experience of having a parent with a life-limiting illness. Design: Integrative review and thematic synthesis. Registered on PROSPERO (CRD42019094581). Data sources: PsychINFO, Medline, Embase, Scopus and Web of Science were searched, supplemented by searches of grey literature and systematic reviews. There were no restrictions on publication date, and study quality was appraised using the Hawker checklist. Studies reporting the findings of primary research with participants under 18, whose parent has a life-limiting illness, were eligible for inclusion. Results: Twenty-one papers met the inclusion criteria ( n = 13 qualitative; n = 8 quantitative), reporting on n = 18 studies from high-income countries. Findings reveal that throughout parental life-limiting illness, children strive for agency, but are often shielded and excluded by adults. The experience of living with a dying parent is emotionally demanding for children and involves significant caregiving responsibilities. However these children are not passive, developing strategies to cope with the situation and wanting to be involved. Conclusions: The review has enabled the voices of children affected by parental life-limiting illness to be heard and will inform the development of guidance for parents and professionals.

Canal Builders

This chapter details how Giovanni Virginio Schiaparelli redrew and re-imagined the surface of Mars, and discovered what he believed to be a planet-girdling system of 75-mile-wide canals. It mentions the premier international prize in astronomy, the Lalande Prize, that was bestowed to Schiaparelli, who connected the physics of the dusty debris swept up by Earth as it orbits the Sun to the detritus shed by comets as they orbit the Sun. It also details Schiaparelli's first observations of Mars in the summer of 1877 using the 8.6-inch Merz refractor. The chapter considers the result of Schiaparelli's efforts as the most accurate map yet made of the surface of Mars during the time. It notes Schiaparelli's professional opinion that the Martian canal system was steadily growing more extensive across the planet.