Multi-source feedback following simulated resuscitation scenarios: a qualitative study

Background: The direct observation and assessment of learners’ resuscitation skills by an attending physician is challenging due to the unpredictable and time-sensitive nature of these events. Multisource feedback (MSF) may address this challenge and improve the quality of assessments provided to learners. We aimed to describe the similarities and differences in the assessment rationale of attending physicians, registered nurses, and resident peers in the context of a simulation-based resuscitation curriculum. Methods: We conducted a qualitative content analysis of narrative MSF of medical residents in their first postgraduate year of training who were participating in a simulation-based resuscitation course at two Canadian institutions. Assessments included an entrustment score and narrative comments from attending physicians, registered nurses, and resident peers in addition to self-assessment. Narrative comments were transcribed and analyzed thematically using a constant comparative method. Results: All 87 residents (100%) participating in the 2017-2018 course provided consent. A total of 223 assessments were included in our analysis. Four themes emerged from the narrative data: 1) Communication, 2) Leadership, 3) Demeanor, and 4) Medical Expert. Relative to other assessor groups, feedback from nurses focused on patient-centred care and communication while attending physicians focused on the medical expert theme. Peer feedback was the most positive. Self-assessments included comments within each of the four themes. Conclusions: In the context of a simulation-based resuscitation curriculum, MSF provided learners with different perspectives in their narrative assessment rationale and may offer a more holistic assessment of resuscitation skills within a competency-based medical education (CBME) program of assessment.

Virtual embolization for treatment support of intracranial AVMs using an interactive desktop and VR application

Purpose The treatment of intracranial arteriovenous malformations (AVM) is challenging due to their complex anatomy. For this vessel pathology, arteries are directly linked to veins without a capillary bed in between. For endovascular treatment, embolization is carried out, where the arteries that supply the AVM are consecutively blocked. A virtual embolization could support the medical expert in treatment planning. Method We designed and implemented an immersive VR application that allows the visualization of the simulated blood flow by displaying millions of particles. Furthermore, the user can interactively block or unblock arteries that supply the AVM and analyze the altered blood flow based on pre-computed simulations. Results In a pilot study, the application was successfully adapted to three patient-specific cases. We performed a qualitative evaluation with two experienced neuroradiologist who regularly conduct AVM embolizations. The feature of virtually blocking or unblocking feeders was rated highly beneficial, and a desire for the inclusion of quantitative information was formulated. Conclusion The presented application allows for virtual embolization and interactive blood flow visualization in an immersive virtual reality environment. It could serve as useful addition for treatment planning and education in clinical practice, supporting the understanding of AVM topology as well as understanding the influence of the AVM’s feeding arteries.

Chekhov as a writer and as a doctor

In his short autobiography, Anton Pavlovich wrote that after a great number of years, although he could not remember what exactly had prompted him at one time to choose the profession of a doctor and enter the medical faculty of the university, he knew for sure that subsequently he never regretted his choice. In his letters, he even wrote that he considered literature to be his wife, while medicine was his mistress, and when he got tired of one, he turned his gaze to the other. «Perhaps this is immoral to some extent,» he wrote, «but I never get bored. Why not chase two hares if there were hounds!» Chekhov began his medical practice in the Zvenigorod district of the Moscow province. He was lucky to have as his mentor an outstanding physician P. A. Arkhangelsky, whose fame as a practicing therapist was so great that young doctors from almost all over the country came to him to gain experience. The eminent doctor was very pleased with the success of the talented young man, and even left him solely for the entire hospital as a practicing doctor. Such activity helped Chekhov not only gain invaluable medical experience, but also formed the basis of many of his works, such as «The Runaway», «Village Doctors», «On Official Duty». Anton Chekhov devoted the first half of the day to receiving patients, and in the afternoon, he took part in autopsies, acted as a medical expert, and consulted especially difficult and controversial cases of diseases.

Religious identity cues increase vaccination intentions and trust in medical experts among American Christians

Containing the COVID-19 pandemic in the United States requires mobilizing a large majority of the mass public to vaccinate, but many Americans are hesitant or opposed to vaccination. A significant predictor of vaccine attitudes in the United States is religiosity, with more-religious individuals expressing more distrust in science and being less likely to get vaccinated. Here, we test whether explicit cues of common religious identity can help medical experts build trust and increase vaccination intentions. In a preregistered survey experiment conducted with a sample of unvaccinated American Christians (n = 1,765), we presented participants with a vaccine endorsement from a prominent medical expert (NIH Director Francis Collins) and a short essay about doctors’ and scientists’ endorsement of the vaccines. In the common religious identity condition, these materials also highlighted the religious identity of Collins and many medical experts. Unvaccinated Christians in the common identity condition expressed higher trust in medical experts, greater intentions to vaccinate, and greater intentions to promote vaccination to friends and family than those who did not see the common identity cue. These effects were moderated by religiosity, with the strongest effects observed among the most religious participants, and statistically mediated by heightened perceptions of shared values with the medical expert endorsing the vaccine. These findings demonstrate the efficacy of common identity cues for promoting vaccination in a vaccine-hesitant subpopulation. More generally, the results illustrate how trust in science can be built through the invocation of common group identities, even identities often assumed to be in tension with science.

PROBLEMS OF INVESTIGATING MURDERS COMMITTED IN INSTITUTIONS THAT PROVIDE ISOLATION FROM SOCIETY

В статье анализируются вопросы организации расследования убийств, совершаемых в условиях учреждений, обеспечивающих изоляцию от общества. Рассмотрены элементы криминалистической характеристики данных преступлений. Изучены и проанализированы наиболее распространенные способы совершения пенитенциарных убийств, типичные следы и обстановка преступного события. Особое внимание уделено вопросам исследования психологического портрета личности пенитенциарного преступника. Сделан вывод о том, что тактические особенности расследования убийств в местах лишения свободы в значительной степени обусловлены спецификой исправительного учреждения. Исследованы правовые и организационные аспекты привлечения специалистов к участию в следственных действиях, вопросы организации деятельности судебно-медицинского эксперта. Указано на особое значение неотложности проведения осмотра места происшествия в условиях учреждения уголовно-исполнительной системы. Предложено производство осмотра силами данного учреждения, что позволит предотвратить возможную утрату доказательственной информации. Дана оценка использованию свидетельских показаний осужденных в судебном разбирательстве в качестве доказательств по делам о пенитенциарных убийствах. На основе обобщения опыта работы органов и учреждений ФСИН России выделены основные направления деятельности, в наибольшей степени влияющие на расследование убийств, совершенных осужденными и лицами, содержащимися под стражей. The article analyzes the issues of organizing the investigation of murders committed in institutions that provide isolation from society. The elements of the criminalistic characteristics of these crimes are considered. The most common methods of committing penitentiary murders, typical traces and the situation of a criminal event are studied and analyzed. Special attention is paid to the study of the psychological portrait of the personality of the penitentiary criminal. It is concluded that the tactical features of the investigation of murders in places of deprivation of liberty are largely determined by the specifics of the correctional institution. The legal and organizational aspects of attracting specialists to participate in investigative actions, issues of organizing the activities of a forensic medical expert are investigated. The special importance of the urgency of conducting an inspection of the scene of the incident in the conditions of the institution of the penitentiary system is indicated. It is proposed to conduct an inspection by the forces of this institution, which will prevent the possible loss of evidentiary information. The article evaluates the use of the testimony of convicted persons in court proceedings as evidence in cases of penitentiary murders. Based on the generalization of the experience of the bodies and institutions of the Federal Penitentiary Service, the main areas of activity that most affect the investigation of murders committed by convicts and persons in custody are identified.

Electronic patient medical records: Agility in the management of medical-expert information in the aeronautical health boards

The Electronic Patient Record (EPR) is already a reality in the practice of many offices, diagnostic centers and hospitals. The Federal Council of Medicine (FCM) regulated its use, through FCM Resolution n° 1,821/2007 In the Health Boards (HB) of the COMAER, agencies responsible for doing the medical-expert examinations of the military force, the paper record is still the rule. There is no automatic sharing of information between HB. In this context, it is perceived the need for the implementation of the unified EPR for the COMAER HB, because it speeds up the sharing of medical-expert information of the military and allows the military to carry out their health inspections in different locations, not interfering in the planning of missions so peculiar to the force, saving time and costs, speeding up the release of the results and control of inspections. The research thus consists of the qualitative approach, with exploratory objective and bibliographic procedure, carried out in the Scielo and Google Scholar databases, based on the discussion in ten articles, in addition to the FCM Resolutions. It was noted that the perspective that EPR has direct advantages for the Institution, however, requires an abrupt cultural change to the model that is made today, to provide a greater speed among the HB, even if in the transition phase, it is chosen to use in parallel in paper and Information and Communication Technologies. Therefore, the implementation of EPR in HB can provide both multidisciplinary teams and users of COMAER HB, a more efficient medical-expert assistance by promoting information sharing and agility in the performance of Health Inspections.

DIFFERENTIATED APPROACH TO THE CONTENT AND VOLUME OF FORENSIC MEDICAL KNOWLEDGE IN COMPETENCES OF DIFFERENT SUBJECTS OF LEGAL PROCEEDING

Aim of the article: to conduct a legal analysis of a differentiated approach to the content and volume of special forensic medical knowledge in the competence of various subjects of legal proceedings for their effective implementation of the norms of criminal procedure and other legislation, as well as of the educational context, within which preparation for professional activities requiring a certain the scope of the relevant competencies is conducted. Conclusions. The article deals with the requirements for the competence in the field of forensic medicine of various subjects of legal proceedings. Expert consciousness (as an integral system of expert thinking, expert knowledge, expert intuition, etc.) is attributed to the special competence of medical persons professionally knowledgeable in the field of forensic medicine. The lawyers participating in the proceedings are assigned an integrating and coordinating role, which requires general competence in forensic medicine, in particular, awareness of the modern possibilities of forensic medical examination and other forms of procedural and non-procedural application of forensic medical knowledge. The specified differentiated approach to the scope of competences of various subjects of the legal process does not imply any consolidation, interchangeability, but directly stipulates the need for goal-setting cooperation within the framework of a strict separation of the procedural roles assigned to these subjects, the integrity of the system of expert consciousness with the separation from it of the minimum necessary elements of forensic medicine knowledge sufficient to implement the procedural role of the investigator and other procedural ones. The consequences of the gaps are predictably negative in the education of lawyers, in particular, investigators, prosecutors, advocates and judges, caused by the absence of the discipline “Forensic medicine” in the basic (compulsory) part of the federal state standard of higher professional education in the field of “Jurisprudence”. The formation of an effective model of cooperation seems to be of current interest between subjects of legal proceedings with considering the establishment of differentiated requirements for the volume and content of forensic medical competencies. The complex structure of forensic competences, qualification requirements for forensic medical experts, the peculiarities of the education of medical specialists - should be taken into account by the subjects of the investigation, the court when involving forensic experts and other doctors to participate in the proceedings. It is necessary to change the wording of Art. 178 of the Criminal Procedure Code of the Russian Federation: «with the participation of a forensic medical expert, and if one’s participation is impossible, - for a doctor» to the wording: «with the participation of a forensic medical expert, and if his participation is impossible, - for another doctor».

The Substance of Cold: Indonesians’ Use of Cold Weather Theory to Explain Everyday Illnesses

Many people across the world use cold conditions, such as cold air and wet clothes, to explain everyday illness, such as colds and flu. In Indonesia, the concept masuk angin, or “trapped wind,” appears to reflect this line of folknatural thinking. Interestingly, Indonesians distinguish masuk angin from the common cold, which is a frequent target for “cold weather” explanations in other cultures. We interviewed Indonesian 8- and 10-year-old children, lay adults, and medical expert adults, about the cause, contagiousness, and treatment of everyday illnesses: the common cold, the flu, and masuk angin. Most Indonesian children, and especially adults, believed that cold and flu are caused by germs and are contagious. In contrast, most children and lay adults (but not experts) attributed masuk angin to cold conditions and viewed it as non-contagious. These findings reveal how folknatural and scientific theories of illness coexist in the minds of Indonesian children and lay adults.