What is a medical expert? A reply to Kapur (2024).

The promotion and protection of human rights is one of the fundamental priorities of the United Nations, the European Union and every rule of law and democracy governed country. One of the most serious violations of human rights and human dignity is torture and other forms of cruel, inhuman or degrading treatment or punishment. For decades, the international community and the European Union take a number of actions aimed at preventing and limiting this type of negative manifestations. The main ones are the adoption of international universal and regional human rights instruments and the creation of specialized jurisdictions to monitor compliance with the established legal framework. Judicial experts and their expertise play an extremely important role in the proper and effective investigation of torture and other forms of cruel, inhuman or degrading treatment or punishment. The serious importance that the international community attaches to these medical professionals and their expertise is reaffirmed in the 2004 Istanbul Protocol drawn up by the Office of the United Nations High Commissioner for Human Rights. This act establishes internationally recognized standards and principles for the effective investigation and documentation of torture and other forms of cruel, inhuman or degrading treatment or punishment, some of which relate specifically to the role of judicial experts and their medical expertise. These include: the principles of impartiality and independence of medical experts in identifying such types of offenses, the compliance of their activities with the highest ethical standards, the principle of obtaining informed consent from the person alleged to be a victim of torture before doing any research. The Istanbul Protocol also introduced standards for order in which any medical examination of victims of torture or other ill-treatment should take place, as well as on the form and structure of medical expertise.The particular emphasis placed on the role of judicial experts by the international community is completely understandable, as it is these medical professionals who make the physical and / or psychological evaluation of the victim, which is objectified in the medical expertise, medical psychiatric expertise, or medical psychological expertise. On the basis of these expertises, the investigating authorities have the opportunity to prove the causal link between the victim's bodily harm and the psycho-traumas with the alleged torture or other cruel, inhuman or degrading treatment or punishment. Medical expertise is a method of proof not only in the course of the investigation, but also in the judicial process, as the specialized knowledge of forensic experts assist the court in establishing the objective truth, as well as the victims and their lawyers in the exercise of their rights of defense.

This contribution examines the important role that medical experts and expertise played at convivial networking events in the High Roman Empire, as imagined by a non-specialist in the field, viz. the famous Platonist intellectual Plutarch of Chaeronea (ca. 45–120 CE). An analysis of a number of medical problems discussed in his Table Talk will yield fresh insights into the social and intellectual role which doctors, as members of the educated elite, were expected to play in convivial community contexts and also how popular or common had become certain theories, concepts and beliefs relating to health and healing in the High Imperial era. At the same time, it will give a clearer idea of what was the place of medical experts and expertise in Plutarch’s intellectual programme, and how this interest ties in with his (natural) philosophical endeavours more generally.

The reliable literature describes the state of examination of temporary disability (EVN) in a number of leading countries of the world, the development of EVN in Russia. In foreign capitalist countries, insurance companies deal with the assessment of temporary or permanent disability, which attract medical experts for examination. Social health insurance institutions have been established in a number of countries on the basis of laws on people’s insurance in case of disability. In Russia, the development of EHS as a branch of medical science and practice took place in stages, reflecting the periods of formation, formation and development of the social protection system. In the first years after the October revolution, the examination of working capacity was entrusted to medical control commissions, much attention was paid to medical and labor expertise. Currently, in accordance with the new legislative acts in medical practice introduced a new concept — «medical expertise», which, taking into account the diverse expert activities, the following types of expertise: EVN, medical and social expertise, military medical expertise, forensic and forensic psychiatric expertise and independent expertise. The regulatory legal framework of EVS has undergone major changes in recent years: a significant number of documents affecting the organizational issues of EVS have been developed. At the same time, the scientific literature poorly covers the issues of EVN in dental practice.

We describe our misgivings concerning the use of transcripts of covert recordings of medico-legal assessments made by claimants as evidence in actions for compensation for personal injury. These recordings raise issues of lack of trust between the claimant and the medical expert, leading to bias in the consultation that is hidden from the medical expert. In addition, there is a risk of widespread dissemination of the recording through social media to the detriment of the reputation of the medical expert, and likely interference with the probity of the court hearing. We argue that the claimant and the medical expert have equal rights to privacy within a medical or medico-legal consultation, and recordings should not be made without mutual agreement. Furthermore, the courts should rely only on the report of the medical expert since a recording of the consultation represents only part of the process of medical assessment. We argue that the current advice given by the General Medical Council on covert recording of medical or medico-legal consultations should be reconsidered by a panel of experienced medical and legal experts.

The viewpoints of Shahid Beheshti University of Medical Sciences medical experts'' were compared with those of auxiliary health workers regarding health culture related to human papillomavirus vaccination in 2020. In this cross-sectional study, 220 medical experts' (gynecologists, cultural, psychological, infectious, dermatological, and educational) and auxiliary health workers were randomly selected and investigated. The required data were collected using a researcher-made questionnaire modeled on international questionnaires. These questionnaire contained demographic information on the subjects' age and sex as well as health culture was also assessed by measuring the knowledge, attitude, and practice of the subjects. The mean age of the included medical experts' and auxiliary health workers was 38.0 3±8.3 and 35.2±7.5 years old, respectively. There was a significant difference in the knowledge of auxiliary health workers as 55.3 ± 3.8 in comparison with the medical experts' as 51.6 3± 6.3 (p <0.002). There was a significant difference on whether changing cultural attitudes about the need for vaccination could be effective on reducing sexually transmitted diseases between the auxiliary health workers and medical experts' (p <0.001). There was a significant difference in the knowledge of auxiliary health workers 55.3 ± 3.8 in comparison with the psychology and cultural experts' as 48.5± 6.3, 48.3± 6.8 (p<0.001) respectively. Knowledge among the auxiliary health workers was significantly different from that of psychology and cultural experts' in relation to health culture for human papillomavirus vaccination. It was indicated that these experts need to upgrade their health culture knowledge to increase the rate of community participation in human papillomavirus vaccination.

Advice for Identifying, Recruiting and Training Medical Expert Witnesses in Quality of Care Cases

Background: Artificial intelligence (AI) has recently made unprecedented contributions in every walk of life, but it has not been able to work its way into diagnostic medicine and standard clinical practice yet. Although data scientists, researchers, and medical experts have been working in the direction of designing and developing computer aided diagnosis (CAD) tools to serve as assistants to doctors, their large-scale adoption and integration into the healthcare system still seems far-fetched. Diagnostic radiology is no exception. Imagining techniques like magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET) scans have been widely and very effectively employed by radiologists and neurologists for the differential diagnoses of neurological disorders for decades, yet no AI-powered systems to analyze such scans have been incorporated into the standard operating procedures of healthcare systems. Why? It is absolutely understandable that in diagnostic medicine, precious human lives are on the line, and hence there is no room even for the tiniest of mistakes. Nevertheless, with the advent of explainable artificial intelligence (XAI), the old-school black boxes of deep learning (DL) systems have been unraveled. Would XAI be the turning point for medical experts to finally embrace AI in diagnostic radiology? This review is a humble endeavor to find the answers to these questions. Methods: In this review, we present the journey and contributions of AI in developing systems to recognize, preprocess, and analyze brain MRI scans for differential diagnoses of various neurological disorders, with special emphasis on CAD systems embedded with explainability. A comprehensive review of the literature from 2017 to 2024 was conducted using host databases. We also present medical domain experts' opinions and summarize the challenges up ahead that need to be addressed in order to fully exploit the tremendous potential of XAI in its application to medical diagnostics and serve humanity. Results: Forty-seven studies were summarized and tabulated with information about the XAI technology and datasets employed, along with performance accuracies. The strengths and weaknesses of the studies have also been discussed. In addition, the opinions of seven medical experts from around the world have been presented to guide engineers and data scientists in developing such CAD tools. Conclusions: Current CAD research was observed to be focused on the enhancement of the performance accuracies of the DL regimens, with less attention being paid to the authenticity and usefulness of explanations. A shortage of ground truth data for explainability was also observed. Visual explanation methods were found to dominate; however, they might not be enough, and more thorough and human professor-like explanations would be required to build the trust of healthcare professionals. Special attention to these factors along with the legal, ethical, safety, and security issues can bridge the current gap between XAI and routine clinical practice.

Assessing Competence in Emergency Radiology Using an Online Simulator

Congenital Central Hypoventilation Syndrome (CCHS) is a rare condition combining respiratory hypoventilation with symptoms of autonomic dysregulation. Management of patients requires both medical and dental expertise to achieve a successful outcome. The aim of this paper is to present the dental management of a child diagnosed with CCHS, without pharmacological measures and in cooperation with medical expertise. A 7-year-old girl was referred to a private dental practice with the chief complaints being pain and poor aesthetics. The child had been diagnosed with CCHS since infancy and had undergone several courses of medication. Although the patient was uncooperative, the paediatric pulmonologist advised against general anaesthesia. As a result, she was treated in the operating theater (OT) without sedatives, being monitored throughout the entire procedure. A total of eight primary teeth needed dental treatment (3 were restored, 4 were extracted and 1 was restored with a preformed metal crown). A mandibular lingual holding arch was placed, twoweeks later. The patient was seen after 6 months and 1 year. Her oral hygiene had improved significantly and her mother reported that the child ate better, brushed her teeth on a daily basis and was careful with dietary habits. The collaboration between medical experts and a paediatric dentist was of crucial importance. The use of basic behaviour management techniques in conjunction with monitoring the patient's vital signs led to a successful outcome and an improvement in the behaviour of the patient.

Diabetes management by insulin administration is based on medical experts' experience, intuition, and expertise. As there is very little information in medical literature concerning practical aspects of this issue, medical experts adopt their own rules for insulin regimen specification and dose adjustment. This paper investigates the application of a neural network approach for the development of a prototype system for knowledge classification in this domain. The system will further facilitate decision making for diabetic patient management by insulin administration. In particular, a generating algorithm for learning arbitrary classification is employed. The factors participating in the decision making were among other diabetes type, patient age, current treatment, glucose profile, physical activity, food intake, and desirable blood glucose control. The resulting system was trained with 100 cases and tested on 100 patient cases. The system proved to be applicable to this particular problem, classifying correctly 92% of the testing cases.

Background: The COVID-19 pandemic has spurred large-scale, interinstitutional research efforts. To enable these efforts, researchers must agree on data set definitions that not only cover all elements relevant to the respective medical specialty but also are syntactically and semantically interoperable. Therefore, the German Corona Consensus (GECCO) data set was developed as a harmonized, interoperable collection of the most relevant data elements for COVID-19-related patient research. As the GECCO data set is a compact core data set comprising data across all medical fields, the focused research within particular medical domains demands the definition of extension modules that include data elements that are the most relevant to the research performed in those individual medical specialties. Objective: We aimed to (1) specify a workflow for the development of interoperable data set definitions that involves close collaboration between medical experts and information scientists and (2) apply the workflow to develop data set definitions that include data elements that are the most relevant to COVID-19-related patient research regarding immunization, pediatrics, and cardiology. Methods: We developed a workflow to create data set definitions that were (1) content-wise as relevant as possible to a specific field of study and (2) universally usable across computer systems, institutions, and countries (ie, interoperable). We then gathered medical experts from 3 specialties-infectious diseases (with a focus on immunization), pediatrics, and cardiology-to select data elements that were the most relevant to COVID-19-related patient research in the respective specialty. We mapped the data elements to international standardized vocabularies and created data exchange specifications, using Health Level Seven International (HL7) Fast Healthcare Interoperability Resources (FHIR). All steps were performed in close interdisciplinary collaboration with medical domain experts and medical information specialists. Profiles and vocabulary mappings were syntactically and semantically validated in a 2-stage process. Results: We created GECCO extension modules for the immunization, pediatrics, and cardiology domains according to pandemic-related requests. The data elements included in each module were selected, according to the developed consensus-based workflow, by medical experts from these specialties to ensure that the contents aligned with their research needs. We defined data set specifications for 48 immunization, 150 pediatrics, and 52 cardiology data elements that complement the GECCO core data set. We created and published implementation guides, example implementations, and data set annotations for each extension module. Conclusions: The GECCO extension modules, which contain data elements that are the most relevant to COVID-19-related patient research on infectious diseases (with a focus on immunization), pediatrics, and cardiology, were defined in an interdisciplinary, iterative, consensus-based workflow that may serve as a blueprint for developing further data set definitions. The GECCO extension modules provide standardized and harmonized definitions of specialty-related data sets that can help enable interinstitutional and cross-country COVID-19 research in these specialties.

For the past 50 years, the “shaken baby” syndrome (SBS) has been one of the many terms used to describe a form of abusive head trauma in children. The term now preferred is pediatric abusive head trauma (AHT), which is defined as “an injury to the skull or intracranial contents of an infant or young child (less than five years of age) due to inflicted blunt impact and/or violent shaking.”1, 2 This new term reflects the fundamental construct that certain forms of head trauma are intentionally inflicted. The incidence is estimated to be 20 to 30 cases per 100,000 children under one year of age with a case fatality rate exceeding 20% and significant disability for about two-thirds of the survivors. 1 In addition, AHT results in major healthcare costs for the survivors. (see Libby AM, Sills MR, Thurston NK, Orton HD. Costs of childhood physical abuse: comparing inflicted and unintentional traumatic brain injuries.

Nowadays, the mobile medical community, providing a communication platform for medical, medical treatment, pharmacy, life science as well as other related domains, acts as a professional social network for doctors, medical institutions, healthcare practitioners and life science. In the medical community, users can ask questions and receive the response from a professional doctor. It is possible to push the user's question to the specific doctor via classifying medical experts in the community, Therefore, the user's question can be answered in time. In the training of classification model of medical experts, the general approach is supervised learning. However, several different domains, including respiratory and chest diseases, first aid and critical illness and neuroscience, could be found in the medical community. Classical supervised learning algorithms find good classifiers for a given learning task using labeled input-output pair and require a large number of labeled training samples, when labeled data is limited and expensive to obtain. However, the original classification model can not obtain the optimal effects n the new domain. Moreover, trace number of categories or unclassified need to be re-labelled, leading to a higher price. In order to address the problem of cross-domain expert classification model in medical community, we combine user's inherent information as the keyword together with user's potential information, thereby improving the cross-domain model of medical community expert classification. Through the data collected in the medical community, our experimental results suggest that the method can be used to achieve better classification effect in small or unlabeled new domains.

This paper explores the methods and applications of intuitive visualization and interactive analysis of medical domain knowledge to help medical experts editing it autonomously. SissiExpression system is developed using C# and WPF technology, in which, medical knowledge is modeled as expression. The application of knowledge and execution process is clear and visible, the work of debugging and maintenance is convenient, so the result can be understood and gain recognition by experts. Expressions and knowledge are saved in XML file format, decoupled from program framework, subsequent maintenance, adding new knowledge and functions, can be achieved agilely, conveniently, with better cost control. Appropriate knowledge edition can be chosen flexibly according to demand, medical experts can possess their personal executable knowledge base. This program can help medical experts to mitigate human-computer interaction obstacles to some extent, both medical and information experts can focus on their own profession and tasks.

The Chornobyl catastrophe (ChCt) resulted in radiation exposure of great quantity of people. Amongthem there were personnel of Chernobyl NPP (ChNPP) and workers of supporting enterprises, radiation protectionprofessionals, clean-up workers of different specialties including military personnel that were send for liquidationof its consequences, inhabitants of the Prypyat city and Chernobyl 30km exclusive zone (including children) thatwere evacuated during first days after accident and population of radioactive contaminated territories. Loss ofhealth, disability and death as a result of radiation exposure influence in conditions of the ChCt under discharge ofprofessional, military or official duties and/or living on radiation contaminated territories not by his own fault callfor developing of special form of medical expertise as part of medical social protective system for this contingents.The objective of the study was to analyze the state of medical and social expertise for the interdependence of thediseases that bring to the disability and death with the impact of the Chornobyl accident consequences for the adultpopulation and to determine the main directions for improvement of this system. The analysis of the medical expertise state for the interdependence of the diseases thatbring to the disability and death by the effect of the Chornobyl accident consequences for the adult population ina remote post-accidental period during 2013-2017 years (26142 personal medical expert investigations) was per-formed. It was determined that the total number of population suffered from ChCt during 2007-2018 years reduced for 26.05 % or by 657,988 persons. At the same time, there has been rapid increase in the num-ber of victims with disability who received positive medical expertize certificate about interdependence of diseasewith effect of ChCt (the 1st category according Ukrainian legislation) - from 40,106 in 1995 to 107,115 in 2018. Theincrease in the frequency of medical expertise cases of oncological diseases - 51,49 %, as well as cases concerningthe interdependence of diseases that caused the deaths of the victims - 34,99 % were shown. The outstandingissues of the medical expertise of diseases interdependence with ChCt effects for certain categories of victims (thy-roid cancer in persons who have lost their status after reaching adulthood, the definition of the legitimacy of thestatus of victims for inhabitants of territories that undergone radiation ecological control (the 4th-V category) thatrequire changes and additions to the legislative framework are discussed.