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Evaluation of Workplace Disability
Forensic mental health assessment (FMHA) has grown into a specialization informed by research and professional guidelines. This series presents up-to-date information on the most important and frequently conducted forms of FMHA. The 19 volumes address best approaches to practice for particular types of evaluation in the criminal, civil, and juvenile/family areas. Each volume contains a discussion of the relevant legal and psychological concepts, followed by a step-by-step description of the assessment process from preparing for the evaluation to writing the report and testifying in court. In making recommendations for best practice, chapters consider empirical support, legal relevance, and consistency with ethical and professional standards. These volumes offer invaluable guidance for anyone involved in conducting or using forensic evaluations. This volume focuses on evaluating the determination of disability status in the workplace. The reader is walked through every aspect of the evaluation, beginning with an introduction to the nature and legal meaning of disability. The chapters offer evidence-based practice recommendations and an overview of issues specific to evaluations for social security, worker's compensation, and other disability benefit programs.
eBook
Clinical guidelines for the management of treatment-resistant depression: French recommendations from experts, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental
Background
Clear guidance for successive antidepressant pharmacological treatments for non-responders in major depression is not well established.
Method
Based on the RAND/UCLA Appropriateness Method, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental developed expert consensus guidelines for the management of treatment-resistant depression. The expert guidelines combine scientific evidence and expert clinicians’ opinions to produce recommendations for treatment-resistant depression. A written survey comprising 118 questions related to highly-detailed clinical presentations was completed on a risk-benefit scale ranging from 0 to 9 by 36 psychiatrist experts in the field of major depression and its treatments. Key-recommendations are provided by the scientific committee after data analysis and interpretation of the results of the survey.
Results
The scope of these guidelines encompasses the assessment of pharmacological resistance and situations at risk of resistance, as well as the pharmacological and psychological strategies in major depression.
Conclusion
The expert consensus guidelines will contribute to facilitate treatment decisions for clinicians involved in the daily assessment and management of treatment-resistant depression across a number of common and complex clinical situations.
Journal Article
New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS)
Objective:Inflammatory back pain (IBP) is an important clinical symptom in patients with axial spondyloarthritis (SpA), and relevant for classification and diagnosis. In the present report, a new approach for the development of IBP classification criteria is discussed.Methods:Rheumatologists (n = 13) who are experts in SpA took part in a 2-day international workshop to investigate 20 patients with back pain and possible SpA. Each expert documented the presence/absence of clinical parameters typical for IBP, and judged whether IBP was considered present or absent based on the received information. This expert judgement was used as the dependent variable in a logistic regression analysis in order to identify those individual IBP parameters that contributed best to a diagnosis of IBP. The new set of IBP criteria was validated in a separate cohort of patients (n = 648).Results:Five parameters best explained IBP according to the experts. These were: (1) improvement with exercise (odds ratio (OR) 23.1); (2) pain at night (OR 20.4); (3) insidious onset (OR 12.7); (4) age at onset <40 years (OR 9.9); and (5) no improvement with rest (OR 7.7). If at least four out of these five parameters were fulfilled, the criteria had a sensitivity of 77.0% and specificity of 91.7% in the patients participating in the workshop, and 79.6% and 72.4%, respectively, in the validation cohort.Conclusion:This new approach with real patients defines a set of IBP definition criteria using overall expert judgement on IBP as the gold standard. The IBP experts’ criteria are robust, easy to apply and have good face validity.
Journal Article
The role of rapid multiplex molecular syndromic panels in the clinical management of infections in critically ill patients: an experts-opinion document
Rapid multiplex molecular syndromic panels (RMMSP) (3 or more pathogens and time-to-results < 6 h) allow simultaneous detection of multiple pathogens and genotypic resistance markers. Their implementation has revolutionized the clinical landscape by significantly enhancing diagnostic accuracy and reducing time-to-results in different critical conditions. The current revision is a comprehensive but not systematic review of the literature. We conducted electronic searches of the PubMed, Medline, Embase, and Google Scholar databases to identify studies assessing the clinical performance of RMMSP in critically ill patients until July 30, 2024. A multidisciplinary group of 11 Spanish specialists developed clinical questions pertaining to the indications and limitations of these diagnostic tools in daily practice in different clinical scenarios. The topics covered included pneumonia, sepsis/septic shock, candidemia, meningitis/encephalitis, and off-label uses of these RMMSP. These tools reduced the time-to-diagnosis (and therefore the time-to-appropriate treatment), reduced inappropriate empiric treatment and the length of antibiotic therapy (which has a positive impact on antimicrobial stewardship and might be associated with lower in-hospital mortality), may reduce the length of hospital stay, which could potentially lead to cost savings. Despite their advantages, these RMMSP have limitations that should be known, including limited availability, missed diagnoses if the causative agent or resistance determinants are not included in the panel, false positives, and codetections. Overall, the implementation of RMMSP represents a significant advancement in infectious disease diagnostics, enabling more precise and timely interventions. This document addresses relevant issues related to the use of RMMSP on different critically ill patient profiles, to standardize procedures, assist in making management decisions and help specialists to obtain optimal outcomes
Journal Article
Expert assessments of the cost of light water small modular reactors
Analysts and decision makers frequently want estimates of the cost of technologies that have yet to be developed or deployed. Small modular reactors (SMRs), which could become part of a portfolio of carbon-free energy sources, are one such technology. Existing estimates of likely SMR costs rely on problematic top-down approaches or bottom-up assessments that are proprietary. When done properly, expert elicitations can complement these approaches. We developed detailed technical descriptions of two SMR designs and then conduced elicitation interviews in which we obtained probabilistic judgments from 16 experts who are involved in, or have access to, engineering-economic assessments of SMR projects. Here, we report estimates of the overnight cost and construction duration for five reactor-deployment scenarios that involve a large reactor and two light water SMRs. Consistent with the uncertainty introduced by past cost overruns and construction delays, median estimates of the cost of new large plants vary by more than a factor of 2.5. Expert judgments about likely SMR costs display an even wider range. Median estimates for a 45 megawatts-electric (MW ₑ) SMR range from $4,000 to $16,300/kW ₑ and from $3,200 to $7,100/kW ₑ for a 225-MW ₑ SMR. Sources of disagreement are highlighted, exposing the thought processes of experts involved with SMR design. There was consensus that SMRs could be built and brought online about 2 y faster than large reactors. Experts identify more affordable unit cost, factory fabrication, and shorter construction schedules as factors that may make light water SMRs economically viable.
Journal Article
The use of expert elicitation in environmental health impact assessment: a seven step procedure
Background
Environmental health impact assessments often have to deal with substantial uncertainties. Typically, the knowledge-base is limited with incomplete, or inconsistent evidence and missing or ambiguous data. Consulting experts can help to identify and address uncertainties.
Methods
Formal expert elicitation is a structured approach to systematically consult experts on uncertain issues. It is most often used to quantify ranges for poorly known parameters, but may also be useful to further develop qualitative issues such as definitions, assumptions or conceptual (causal) models. A thorough preparation and systematic design and execution of an expert elicitation process may increase the validity of its outcomes and transparency and trustworthiness of its conclusions. Various expert elicitation protocols and methods exist. However, these are often not universally applicable, and need customization to suite the needs of a specific study. In this paper, we set out to develop a widely applicable method for the use of expert elicitation in environmental health impact assessment.
Results
We present a practical yet flexible seven step procedure towards organising expert elicitation in the context of environmental health impact assessment, based on existing protocols. We describe how customization for specific applications is always necessary. In particular, three issues affect the choice of methods for a particular application: the types of uncertainties considered, the intended use of the elicited information, and the available resources. We outline how these three considerations guide choices regarding the design and execution of expert elicitation. We present signposts to sources where the issues are discussed in more depth to give the newcomer the insights needed to make the protocol work. The seven step procedure is illustrated using examples from earlier published elicitations in the field of environmental health research.
Conclusions
We conclude that, despite some known criticism on its validity, formal expert elicitation can support environmental health research in various ways. Its main purpose is to provide a temporary summary of the limited available knowledge, which can serve as a provisional basis for policy until further research has been carried out.
Journal Article
Identification and treatment of offenders with attention-deficit/hyperactivity disorder in the prison population: a practical approach based upon expert consensus
Background
Around 25% of prisoners meet diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD). Because ADHD is associated with increased recidivism and other functional and behavioural problems, appropriate diagnosis and treatment can be a critical intervention to improve outcomes. While ADHD is a treatable condition, best managed by a combination of medication and psychological treatments, among individuals in the criminal justice system ADHD remains both mis- and under-diagnosed and consequently inadequately treated. We aimed to identify barriers within the prison system that prevent appropriate intervention, and provide a practical approach to identify and treat incarcerated offenders with ADHD.
Methods
The United Kingdom ADHD Partnership hosted a consensus meeting to discuss practical interventions for youth (< 18 years) and adult (≥18 years) offenders with ADHD. Experts at the meeting addressed prisoners’ needs for effective identification, treatment, and multiagency liaison, and considered the requirement of different approaches based on age or gender.
Results
The authors developed a consensus statement that offers practical advice to anyone working with prison populations. We identified specific barriers within the prison and criminal justice system such as the lack of adequate: staff and offender awareness of ADHD symptoms and treatments; trained mental health staff; use of appropriate screening and diagnostic tools; appropriate multimodal interventions; care management; supportive services; multiagency liaison; and preparation for prison release. Through discussion, a consensus was reached regarding prisoners’ needs, effective identification, treatment and multiagency liaison and considered how this may differ for age and gender.
Conclusions
This practical approach based upon expert consensus will inform effective identification and treatment of offenders with ADHD. Appropriate intervention is expected to have a positive impact on the offender and society and lead to increased productivity, decreased resource utilization, and most importantly reduced rates of re-offending. Research is still needed, however, to identify optimal clinical operating models and to monitor their implementation and measure their success. Furthermore, government support will likely be required to effect change in criminal justice and mental health service policies.
Journal Article
Interchangeability of biosimilars: A study of expert views and visions regarding the science and substitution
Healthcare systems have reached a critical point regarding the question of whether biosimilar substitution should become common practice. To move the discussion forward, the study objective was to investigate the views of experts from medicines agencies and the pharmaceutical industry on the science underpinning interchangeability of biosimilars. We conducted an empirical qualitative study using semi-structured interviews informed by a cross-disciplinary approach encompassing regulatory science, law, and pharmaceutical policy. In total 25 individuals with experience within biologics participated during September 2018–August 2019. Eight participants were EU national medicines authority regulators, and 17 had pharmaceutical industry background: five from two originator-only companies, four from two companies with both biosimilar and originator products, and eight from seven biosimilar-only companies. Two analysts independently conducted inductive content analysis, resulting in data-driven themes capturing the meaning of the data. The participants reported that interchangeability was more than a scientific question of likeness between biosimilar and reference products: it also pertained to regulatory practices and trust. Participants were overall confident in the science behind exchanging biosimilar products for the reference products via switching, i.e., with physician involvement. However, their opinions differed regarding the scientific risk associated with biosimilar substitution, i.e., without physician involvement. Almost all participants saw no need for additional scientific data to support substitution. Moreover, the participants did not believe that switching studies, as required in the US, were appropriate for obtaining scientific certainty due to their small size. It is unclear why biosimilar switching is viewed as scientifically safer than substitution; therefore, we expect greater policy debate on biosimilar substitution in the near future. We urge European and UK policymakers and regulators to clarify their visions for biosimilar substitution; the positions of these two frontrunners are likely to influence other jurisdictions on the future of biosimilar use.
Journal Article
Experts’ opinion about the primary headache diagnostic criteria of the ICHD-3rd edition beta in children and adolescents
Background
The 2013 International Classification of Headache Disorders-3 (ICHD-3) was published in a beta version to allow the clinicians to confirm the validity of the criteria or to suggest improvements based on field studies. The aim of this work was to review the Primary Headache Disorders Section of ICHD-3 beta data on children and adolescents (age 0-18 years), and to suggest changes, additions, and amendments.
Methods
Several experts in childhood headache across the world applied different aspects of ICHD-3 beta in their normal clinical practice. Based on their personal experience and the literature available on pediatric headache, they made observations and proposed suggestions for the primary headache disorders section of ICHD-3 beta data on children and adolescents.
Results
Some headache disorders in children have specific features which are different from those seen in adults and which should be acknowledged and considered. Some features in children were found to be age-dependent: clinical characteristics, risks factors and etiologies have a strong bio psycho-social basis in children and adolescents making primary headache disorders in children distinct from those in adults.
Conclusions
Several recommendations are presented in order to make ICHD-3 more appropriate for use with children.
Journal Article