Medical Expert Opinion Research Articles

Gender, Culture and Ethics: Confronting the Complexities of Sex-Selective Abortion in Canada

This article examines the ethical and cultural implications of sex-selective abortion, with a focus on the Indo-Canadian community. Drawing from a 2016 Canadian Medical Association Journal study and expert opinions, including a CBC radio discussion and Dr. Jen Gunter's commentary, it highlights the conflict between reproductive rights and entrenched gender biases. The piece critiques the challenges in legislating against sex-selective abortion, emphasizing the infringement on reproductive rights and privacy, and the need to address deeper societal and cultural factors behind sex selection. The analysis includes cultural perspectives, revealing how societal norms and familial pressures in the Indo-Canadian community impact reproductive decisions, often leading to coercion and loss of choice. The feminist viewpoint links sex-selective abortion to broader issues of gender inequality and misogyny. Conclusively, the article argues for a holistic approach to addressing sex-selective abortion, combining legal, educational, and cultural changes. This approach aims to cultivate a society that values gender equality and respects women’s autonomy, ensuring their decisions are free from coercion and societal prejudice.

Navigating ChatGPT's Alignment with Expert Consensus on Pediatric OSA Management

ObjectiveThis study aimed to evaluate the potential integration of artificial intelligence (AI), specifically ChatGPT, into healthcare decision-making, focusing on its alignment with expert consensus statements regarding the management of persistent pediatric obstructive sleep apnea. MethodsWe analyzed ChatGPT's responses to 52 statements from the 2024 expert consensus statement (ECS) on the management of pediatric persistent OSA after adenotonsillectomy. Each statement was input into ChatGPT using a 9-point Likert scale format, with each statement entered three times to calculate mean scores and standard deviations. Statistical analysis was performed using Excel. ResultsChatGPT's responses were within 1.0 of the consensus statement mean score for 63% (33/52) of the statements. 13% (7/52) were statements in which the ChatGPT mean response was different from the ECS mean by 2.0 or greater, the majority of which were in the categories of surgical and medical management. Statements with ChatGPT mean scores differing by more than 2.0 from the consensus mean highlighted the risk of disseminating incorrect information on established medical topics, with a notable variation in responses suggesting inconsistencies in ChatGPT's reliability. ConclusionWhile ChatGPT demonstrated a promising ability to align with expert medical opinions in many cases, its inconsistencies and potential to propagate inaccuracies in contested areas raise important considerations for its application in clinical settings. The findings underscore the need for ongoing evaluation and refinement of AI tools in healthcare, emphasizing collaboration between AI developers, healthcare professionals, and regulatory bodies to ensure AI's safe and effective integration into medical decision-making processes.

Machine Learning-based Prediction of African Swine Fever (ASF) in Pigs

African Swine Fever (ASF) is a contiguous viral disease of the pig with serious economic threats to the pork industry. Early identification of ASF infection is important to support sustainable developments in the ASF industry. There is also a need for a solution to identify the ASF infection as early as possible based on apparent symptoms of ASF to screen the infected animals, that are not targeted in the existing literature. Many machine learning (ML) solutions have been proposed in recent years for the prediction and identification of human, animal, and plant diseases. To deal with ASF in pigs ML-assisted model is proposed for the early identification of ASF infection without medical diagnosis and expert opinion. The data regarding apparent symptoms are collected from Chinese small pig farms. The loss of appetite, weakness, diarrhea, vomiting, coughing, skin redness, and breathing difficulty levels are taken as major apparent symptoms of ASF infection. Moreover, different ML models are also evaluated for their performance in the prediction of ASF infection based on selected apparent symptoms of ASF infection. In this regard, Support Vector Machine (SVM), K-Nearest Neighbor (k-NN), Decision Tree (DT), Random Forests (RF), and Gaussian Naïve Bayes ML models are evaluated for ASF infection prediction. The implementation of the proposed solution reveals that the GNB model is more accurate as compared to the other evaluated models for the identification of ASF infection from the apparent ASF symptoms in infected pig animals, with 94.31\% accuracy. The proposed solution would be very effective in the early screening of ASF-infected pig animals without medical diagnosis and expert judgment.

Value of Next Generation Sequencing (NGS) testing in advanced cancer patients

Aims: The availability of targeted therapies for oncology patients is increasing. Available genomic tests to identify treatment-eligible patients include single gene tests and gene panel tests, including the whole-exome, whole-transcriptome OncoExTraTM test. We assessed the costs and clinical benefits of test choice. Methods: A Microsoft Excel-based model was developed to evaluate test choice in patients with advanced/metastatic non-small cell lung cancer (NSCLC), breast, prostate, and colorectal cancer. Treatment pathways were based on NCCN guidelines and medical expert opinion. Inputs were derived from published literature. Annual economic results and lifetime clinical results with OncoExTra testing were projected per-tested-patient and compared with single gene testing and no testing. Separately, results were estimated for a US health plan without the OncoExTra test and with its use in 5% of patients. Results: Compared with no genomic testing, OncoExTra test use increased costs by $4,915 per patient; however, 82%-92% of individuals across tumor types were identified as eligible for targeted therapy or a clinical trial. Compared with single gene testing, OncoExTra test use decreased costs by $9,966 per-patient-tested while increasing use of approved or investigational targeted therapies by 20%. When considering a hypothetical health plan with 1 million members, 858 patients were eligible for genomic testing. Using the OncoExTra test in 5% of those eligible, per-member per-month costs decreased by $0.003, ranging from cost-savings of $0.026 in NSCLC patients to a $0.009 increase in prostate cancer patients. Cost-savings were driven by reduced treatment costs with increased clinical trial enrollment and reduced direct and indirect medical costs associated with targeted treatments. Conclusions: Limitations include the required simplifications in modeling complex conditions that may not fully reflect evolving real-world testing and treatment patterns. Compared to single-gene testing, results indicate that using NGS test such as OncoExTra identified more actionable alterations, leading to improved outcomes and reduced costs.

Psychiatrists as forensic authorities: evaluation of dangerous habitual offenders in West Germany during the 1960s - the Helmut Hoinka case.

Preventive detention for highly dangerous habitual offenders has been in force in Germany for 90 years. The necessity of this measure is hotly debated from a legal perspective. However, the assignment of preventive detention is largely determined by the opinion of medical experts. This article discusses the role of medical experts and the issues they face in evaluating the dangerousness of habitual offenders using the case of the marriage swindler Helmut Hoinka, prosecuted several times in the Federal Republic of Germany in the 1960s. Helmut Hoinka's case was chosen for analysis because of the rare opportunity to access detailed materials that allowed us to follow in detail the reasoning of the medical experts who evaluated Hoinka: medical reports stored in the Gerd Huber Archive at the University of Ulm, and Hoinka's court case from the State Archive of North Rhine-Westphalia. To examine these sources, we implemented the historical-critical method. The medical experts who evaluated Hoinka were aware of the defendant's criminal record prior to the evaluation, which was a source of bias. In addition, the criteria for classifying the offender as a dangerous habitual offender were open to a wide range of interpretations. Hoinka's high level of intelligence was negatively emphasized. Some test results were considered unreliable because it was assumed that Hoinka had manipulated his answers. Personal value judgments were allowed in assessing Hoinka's personality. Hoinka's criminal behavior was considered a medical symptom of psychopathy because it violated general moral and social norms. The medical reports of both experts showed that the psychiatrists believed in the genetic nature of psychopathy and criminal behavior. Their criminological prognosis was fully supported by the court in imposing the sentence. Challenges to Hoinka's criminological prognosis were the experts' personal biases, their belief in the theory of genetic predisposition to crime, the lack of clear criteria for antisocial personality disorder, and the absence of forensic recommendations for "psychopathic" criminals. The experts' opinion on Hoinka's criminal predisposition was crucial to the imposition of the sentence.

Analysis of the Prognosis Outcomes and Treatment Delay Among ST-Segment Elevation Myocardial Infarction Patients in Emergency Department Based on the Presence of Symptoms Suggestive of COVID-19.

During COVID-19 pandemic, the emergency department (ED) was challenged to treat patients with COVID-19-related symptom. Therefore, the aim of this study was to investigate treatment delay and prognostic outcomes in ST-segment elevation myocardial infarction (STEMI) patients during COVID-19 pandemic due to isolation or precaution and compare it with pre-COVID-19 period. This was a retrospective observation study using multicenter data with different case mix. Anonymized data were collected through each center's electronic medical data of common case report form. Primary outcomes were number and rate of in-hospital mortality within 28 days. Secondary outcomes were door-to-balloon time and length of stay in the ED. Kaplan-Meier estimation and Cox proportional hazard regression analysis were performed to determine impact of predictors on 28-day in-hospital mortality. Door-to-balloon time was longer in STEMI patients with COVID-19-related symptom(s) than those without symptom during the COVID-19 period (97.0 [74.8, 139.8] vs. 69.0 [55.0, 102.0] minutes, P<.001). However, there was no significant statistical difference in door-to-balloon time between STEMI patients with and without COVID-19-related symptom(s) during the pre-COVID-19 period (73.0 [61.0, 92.0] vs. 67.0 [54.5, 80.0] minutes, P=.2869). The 28-day mortality rate did not show a statistically significant difference depending on symptoms suggestive of COVID-19 during the pre-COVID-19 period (15.4% vs. 6.8%, P=.1257). However, it was significantly higher during the COVID-19 period (21.1% vs. 6.7%, P=.0102) in patients with COVID-19 suggestive symptoms than in patients without the symptoms. In Korea, symptoms suggestive of COVID-19 during the pandemic had a significant effect on the increase of door-to-balloon time and 28-day mortality in STEMI patients. Thus, health authorities need to make careful decision in designating symptoms indicated for isolation in ED based on opinions of various medical field experts.

Preventive measures for injuries in physical education training for students at Tan Trao University

Participation in physical education activities is an indispensable component of the holistic educational curriculum for students at Tan Trao University. In addition to enhancing physical health, developing physical skills, these activities also play a crucial role in training soft skills such as teamwork spirit, discipline, patience, and resilience. However, injuries during training are a major concern for both students and the university. These injuries can have serious consequences on students' health, mentality, and academic performance, and may even lead to long-term effects if not detected and treated promptly. Therefore, this study aims to propose effective preventive measures to enhance the safety and health of students participating in sports activities. The research methodology encompasses surveying the opinions of lecturers, students, and medical experts, as well as assessing the current safety measures at Tan Trao University. The research findings indicate that the provision of adequate personal protective equipment, such as helmets, gloves, and padding, is the top priority. Additionally, ensuring the safety of the physical infrastructure, including training grounds, gymnasiums, and practice areas, is an essential prerequisite. Furthermore, intensifying the training of injury prevention skills for lecturers and students is a key solution. Through comprehensive training programs, they can enhance their awareness and ability to handle injury situations, thereby contributing to maximum safety during the training process. Based on these research findings, the study provides specific and feasible recommendations for Tan Trao University to implement. The comprehensive deployment of injury prevention measures will not only ensure the safety of students but also contribute to the sustainable development of sports activities in the future, thereby enhancing the overall quality of education at the university.

Research on the Identification of Medical Damage Cases

Medical disputes are acute social problems caused by many factors. With the further deepening of the reform of the medical system, doctor-patient conflicts have become more prominent, and their common manifestation is the dispute over the attribution of medical accidents. How to prevent disputes, alleviate medical conflicts, properly deal with medical tort cases, and improve and refine the legal mechanism of doctor-patient conflicts are particularly important. For a long time, due to the complex and professional characteristics of medical damage cases and the status difference between doctors and patients, and the application of medical damage compensation law involving a large number of professional and complex evidence issues, it has become the primary problem for the district court to accurately grasp the evidence of the case in medical tort litigation, and rationally use the evidence to make a fair judgment. The crux of medical disputes lies in the evidence problem. In view of the strong professionalism in medical disputes, expert opinions and expert assistants' opinions often become the core evidence, and their accurate examination and judgment become the top priority in the settlement of medical damage cases. At present, the appraisal of medical damage faces many specific difficulties and challenges. Therefore, this paper advocates the introduction of a reasonable dialogue mechanism between technology and rules, such as evidence-based evidence from the medical perspective of technology, auxiliary rules construction.

The Potential of ChatGPT as a Self-Diagnostic Tool in Common Orthopedic Diseases: Exploratory Study.

Artificial intelligence (AI) has gained tremendous popularity recently, especially the use of natural language processing (NLP). ChatGPT is a state-of-the-art chatbot capable of creating natural conversations using NLP. The use of AI in medicine can have a tremendous impact on health care delivery. Although some studies have evaluated ChatGPT's accuracy in self-diagnosis, there is no research regarding its precision and the degree to which it recommends medical consultations. The aim of this study was to evaluate ChatGPT's ability to accurately and precisely self-diagnose common orthopedic diseases, as well as the degree of recommendation it provides for medical consultations. Over a 5-day course, each of the study authors submitted the same questions to ChatGPT. The conditions evaluated were carpal tunnel syndrome (CTS), cervical myelopathy (CM), lumbar spinal stenosis (LSS), knee osteoarthritis (KOA), and hip osteoarthritis (HOA). Answers were categorized as either correct, partially correct, incorrect, or a differential diagnosis. The percentage of correct answers and reproducibility were calculated. The reproducibility between days and raters were calculated using the Fleiss κ coefficient. Answers that recommended that the patient seek medical attention were recategorized according to the strength of the recommendation as defined by the study. The ratios of correct answers were 25/25, 1/25, 24/25, 16/25, and 17/25 for CTS, CM, LSS, KOA, and HOA, respectively. The ratios of incorrect answers were 23/25 for CM and 0/25 for all other conditions. The reproducibility between days was 1.0, 0.15, 0.7, 0.6, and 0.6 for CTS, CM, LSS, KOA, and HOA, respectively. The reproducibility between raters was 1.0, 0.1, 0.64, -0.12, and 0.04 for CTS, CM, LSS, KOA, and HOA, respectively. Among the answers recommending medical attention, the phrases "essential," "recommended," "best," and "important" were used. Specifically, "essential" occurred in 4 out of 125, "recommended" in 12 out of 125, "best" in 6 out of 125, and "important" in 94 out of 125 answers. Additionally, 7 out of the 125 answers did not include a recommendation to seek medical attention. The accuracy and reproducibility of ChatGPT to self-diagnose five common orthopedic conditions were inconsistent. The accuracy could potentially be improved by adding symptoms that could easily identify a specific location. Only a few answers were accompanied by a strong recommendation to seek medical attention according to our study standards. Although ChatGPT could serve as a potential first step in accessing care, we found variability in accurate self-diagnosis. Given the risk of harm with self-diagnosis without medical follow-up, it would be prudent for an NLP to include clear language alerting patients to seek expert medical opinions. We hope to shed further light on the use of AI in a future clinical study.

Child Sexual Abuse (CSA) Using Hypnosis

Child sexual abuse (CSA) is a global problem and a serious public health issue. Perpetrators often resort to threats and force to incapacitate their victims, including using hypnosis. The use of hypnosis increases the level of difficulty of clinical forensic examination by presenting a diagnostic issue and complicating the formulation of forensic medical expert opinions. This evidence-based case report (EBCR) aims at assessing the available evidence concerning the forensic examination and diagnosis of hypnosis-facilitated CSA. A comprehensive computer-based literature search was performed using several keywords related to the clinical question. The search yielded seven relevant articles. The articles were appraised using general critical appraisal questions from the Centre for Evidence-Based Medicine, University of Oxford. All articles suggest that there might be a place for hypnosis in a criminal investigation (‘forensic hypnosis’). The evidence on the correct application of forensic hypnosis and its benefits are, however, still inconclusive and conflicting. In cases of suspected sexual assault using hypnosis, forensic hypnosis could potentially help memory recall of the victim and aid forward-thinking in drawing a clear and unambiguous conclusion for the forensic medical expert opinion.

Expert Medical Opinion is an Act of Daring: Complex, Unknown and Necessary Work in Our Profession

The expert medical opinion is a professional activity, which does not have the purpose of making medical treatments or clinical actions, but to be aware of the state of health or loss of the health to a specific person, to define the causes of such state, the sequelae or definitive damages and its limitations for the daily life and productive activities performed before. The result of this work are the expert opinions based on expertise, that are provided so that judicial operators, social security or insurance companies, define those responsible for economic compensation for the damages objectified. The medical expert often issues ratings or scores that attempt to quantify the severity of the harm suffered by the victim evaluated. This activity entails a high requirement of knowledge, ethical and human commitment to the people affected by different conditions or traumas.

SHARING THE CARE: A project to enable prostate cancer care to be delivered in the community

AbstractProstate cancer has become the 2nd most common cancer in men worldwide. An ageing population and treatment improvements are increasing the number of men living with and beyond cancer. In 2013, there was both scant evidence to guide as to when, where or how men with prostate cancer should be followed up and neither, it appears, pointing to agreed pathways. Generally, follow up regimes are based on tradition and expert medical opinion rather than research or patient need. For men to have their follow up with their GP, several factors need to be in place such as a single system, an improved exchange of experiences, as well as information and knowledge sharing. A recent presentation of a randomized control trial has shown that there are no differences between secondary and primary care follow up. Understanding that the current model of follow up was not working and was unsustainable, a review of urological services was undertaken in 2011 in a large National Health Service (NHS) district general hospital in the north of England. The review evaluated current services, noting that some follow up pathways did not necessarily need to be undertaken within a secondary are setting. The process of relocating patients for primary care review, involved creating a shared care process for prostate cancer. A workstream consisting of consultant urologists, nurse specialists, GPs, service managers and clinical commissioners was convened. Protocols containing specific responsibilities for secondary and primary care were devised. The review and workstream, included a shared vision for improving and sustaining services. Whilst safely moving follow up from secondary to primary care, benefits were realized such as care closer to the home. In conclusion a radical approach to follow up was needed and undertaken. Shared care has yielded success for the patient, primary and secondary care.

Continuous Eye Disease Severity Evaluation System using Siamese Neural Networks

Evaluating the severity of eye diseases using medical images is a very essential and routine task performed in medical diagnosis and treatment. Current grading systems which are largely based on discrete classification are unreliable and do reflect not the entire spectrum of eye disease severity. The unreliability of discrete classification systems for eye diseases is clear, as classification is subjective and done based on the personal opinion of various medical experts, which may vary. In a bid to solve these issues, this study proposes a system for determining the severity of eye diseases on a continuous range using a twin-convoluted neural network approach known as Siamese Neural Networks. This system is demonstrated in the domain of diabetic retinopathy. Samples of retinal fundus images from an eye clinic in India are taken as test cases to evaluate the performance of a Siamese Triplet network which attempts to find the distance between their image embedding. The outputs of the Siamese network when a reference image is juxtaposed with a collection of images with distant severity categories (negative images), as well as when two reference images are compared to each other, are found to have a positive correlation (95\%) with originally assigned severity classes. Hence, these outputs indicate a continuous range of the severity and change in eye diseases.

Practical experience of the Sechenov University Reference Centre for immunohistochemical, pathomorphological, molecular genetic diagnostic methods

Against the background of a steady increase in the number of oncological diseases, as well as the complexity of the primary morphological diagnosis of malignant neoplasms (MNT) and precancerous conditions, especially in the regions of the Russian Federation, in 2019, the creation of a number of Reference Centers (RCs) for immunohistochemical, pathomorphological, molecular genetic methods was initiated research within the framework of the federal project “Fight against oncological diseases”. In 2020, on the basis of the centralized pathoanatomical department of the Clinical Center of Sechenov University, the RC began its work. Aim. To analyze the work of the RC of Sechenov University and compare the results obtained with the tasks of the federal project.Materials and methods. The data of histological, immunohistochemical studies from the registers of receipt of biopsy (surgical) materials and the issuance of the results of intravital pathoanatomical studies (account forms 014-2 / y and 057-y / 04), as well as data from the Telemedicine system of remote consultations, were analyzed. Results. For 21 months of work, the RC consulted 1476 requests received from 70 constituent entities of the Russian Federation. More than 10 % of reference diagnoses were made in a remote format through the Telemedicine system of remote consultations at the federal and regional levels using digital pathology techniques.Conclusion. Despite the obvious need for the work of RCs, there are still a number of issues that have a signifcant impact on the quality of diagnostic processes: specialization of specifc RCs, expansion of the range of incoming clinical and morphological diagnoses. It also requires attention to regularly improve the skills of RC employees in Russian and international educational systems and to equip the RC, frst of all, with virtual resources. The experience of the RC has demonstrated the importance of a second medical expert opinion in the primary diagnosis and verifcation of the diagnosis of malignant neoplasms of various localizations for the regions of the Russian Federation, where the acute problem is the general shortage of general pathologists and expert doctors.

Impact of (forensic) expert opinions according to the Istanbul Protocol in Germany—results and insights of the in:Fo-project

As part of a third-party funded project, expert opinions according to the Istanbul Protocol (IP) standards were compiled in Germany on a larger scale for the first time. The assessment process was initiated for 130 project participants. Statistical analysis on numerous variables was performed to test the impact of the expert opinions, foremost of the forensic medical expert opinions, on the individuals’ asylum proceedings. The variables were drawn from forensic medical expert opinions and reports of findings, questionnaires for the study participants’ counsellors in the project and a query on the asylum status of the study participants. Regression analysis and bivariate analysis on two dependent variables—subjective impact on the asylum procedure from the counsellors’ point of view and objective change in the asylum status—were performed to test for an influence on asylum procedures. No statistically significant results were obtained for the objective change of the study participants’ asylum status. For the subjective dependent variable, a positive prediction was possible when simultaneously controlling for the independent variables introduction of a forensic medical expert opinion and highest IP grade; a negative prediction was possible when simultaneously controlling for the independent variables introduction of a forensic medical expert opinion and use of IP grading. Apart from the statistical analysis, a positive effect of the assessment on the psychosocial well-being of the study participants could be demonstrated. The results differed from other European studies which demonstrated a correlation between the objective outcome of an asylum procedure (asylum status) and, for example, specific types of violence or the number of documented injuries. Differences also occurred in the use of the plausibility grades proposed by the IP, which questions their use in cases in which the reported torture happened a relevant time ago. Therefore, compiling individually worded evaluations instead of using the IP grading system—if possible, by an experienced forensic physician—is recommended in this scenario. Still, the assessment of alleged torture experiences should follow the IP guidelines, since psychological assessments are of especially high importance in cases with healed physical injuries and since the results also demonstrated a positive effect on the psychosocial well-being of the study participants.

Improving Evidence-Based Practice in Forensic Medicine: Validation of INtegration of Forensic Epidemiology and the Rigorous EvaluatioN of Causation Elements and Principles of Evidence-Based Reporting in FORensic Medicine-Pathology version in Indonesia

Abstract Introduction Expert opinions presented in legal proceedings should be scientifically accountable, which is known as evidence-based practice (EBP). Although forensic medical expert opinions are essential in legal proceedings, the methods used to formulate them are not always evidence based or based on standard methods. In forensic medicine, EBP has not been explicitly applied, including in Indonesia. One potential approach to formulate evidence-based expert opinions is called INtegration of Forensic Epidemiology and the Rigorous EvaluatioN of Causation Elements (INFERENCE). In addition, there is also no universal guideline for making forensic pathological reports. One prospective guideline is named the Principles of Evidence-based Reporting in FORensic Medicine-Pathology version (PERFORM-P). Methods This article describes the validation process of INFERENCE and PERFORM-P in Indonesia. This study uses a mixed method through three interrelated phases, i.e., (1) a cross-sectional survey to determine the characteristics of Indonesian forensic doctors and their current practice, (2) the adaptation and validation process of the two tools through a review by the Indonesian College of Forensic Medicine, and (3) a one-group pre–postintervention study to assess the validity and reliability of forensic medical expert opinions formulated using Indonesian-INFERENCE (i-INFERENCE) and reported using Indonesian-PERFORM-P (i-PERFORM-P). Results and Discussion In general, both tools received a positive reception and can potentially be used in the Indonesian setting with some additions/clarifications in the user manuals. Participants envision that both tools will be most useful in complex cases. Conclusions By obtaining the i-INFERENCE and the i-PERFORM-P, it is hoped that Indonesian forensic medical doctors are better equipped in analyzing and reporting complex cases, and the implementation of EBP can be improved.

2022 Chinese guideline for the management of pregnancy and reproduction in patients with systemic lupus erythematous

Systemic lupus erythematosus (SLE) is an autoimmune disease that affects women of childbearing age. With the improvement of diagnosis and treatment, the survival rate of SLE patients has improved significantly, but pregnancy is still an important challenge for SLE patients. It is urgent to strengthen the reproductive and pregnancy management of SLE patients and standardize the peri-gestational monitoring and treatment of SLE patients. This guideline is jointly sponsored by the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Chinese Systemic Lupus Erythematosus Treatment and Research Group (CSTAR), and Chinese Research Committee of pregnancy and reproduction in autoimmune rheumatic diseases (CHOPARD). Guided by clinical problems, after several rounds of clinical and methodological expert demonstration and selection, 13 clinical problems that need to be solved are finally formed, based on evidence-based medical evidence and expert opinions, guideline recommendations are given. The aim is to improve the pregnancy success rate and reduce the maternal and infant mortality rate in SLE patients.

Causal Relationship in Cases Related to Compensation for Harm Caused by Improper Provision of Medical Services

The paper studies some peculiarities of establishing by the court of a causal relationship between the unlawful action (inaction) of the tortfeasor and the resulting harm in considering compensation cases for harm caused due to improper provision of medical services. Having analyzed the judicial practice, the author considers the way the court classifies a legally significant causal relationship. The author raises a question about the significance and assessment by the court of a forensic medical expert opinion in establishing a causal relationship between defects in the medical service provided and the resulting harm. The experience of establishing a causal relationship in the litigation of England and Germany has been studied. The use of the doctrines of res ipsa loquitur, сondicio sine qua non, «fully managed risks» in the process of establishing a causal relationship when considering this category of cases, taking into account the specifics of the organization of medical activity, including in complex clinical cases, is considered.

Health Care Resource Utilization and Total Costs of Care Among Patients with Diffuse Large B Cell Lymphoma Treated with Chimeric Antigen Receptor T Cell Therapy in the United States

The use of chimeric antigen receptor (CAR) T-cell therapy after a second relapse of diffuse large B-cell lymphoma (DLBCL) has shown favorable efficacy in clinical trials; however, little is known about health care resource utilization (HCRU) and costs of CAR T cell therapy for patients treated in real-world settings. We assessed treatment patterns, HCRU, costs, and safety in patients receiving CAR T cell therapy for relapsed or refractory DLBCL across 3 US commercial claims databases. Adults with DLBCL treated with CAR T cell therapy were identified in the following 3 claims databases: Optum® Clinformatics® Data Mart, IBM MarketScan® Commercial & Medicare Database, and IQVIA PharMetrics® Plus. Mean total costs were calculated and adjusted to 2019 US dollars. HCRU and costs within 3 months of infusion were stratified by safety events of interest, including neurological events (NEs) and cytokine release syndrome (CRS), identified via unvalidated algorithms designed based on expert medical opinion. A total of 191 patients receiving CAR T cell therapy were identified across the databases; their median age ranged from 56 to 67 years, and 63% to 75% were male. Most patients (88% to 98%) received CAR T cell infusions in the inpatient setting; 30% to 75% received bridging therapy. CRS was reported in 75% to 84% of patients (severe CRS, 15% to 32%), and NEs were reported in 58% to 69% (severe NEs, 25% to 43%). Mean total inpatient hospital days ranged from 17 to 22 days and increased with severe CRS (19 to 27 days) or severe NEs (22 to 29 days). Mean total health care expenditures ranged from $380,000 to $526,000 and were generally higher with severe CRS or NEs (∼$406,000 to $679,000). HCRU and costs associated with CAR T cell therapy may vary in the real world depending on several factors, including occurrence and severity of adverse events.

Mental capacity including testamentary capacity.

Mental capacity including testamentary capacity.