Minimally Invasive Approach versus Sternotomy for Cardiac Surgery in Jehovah's Witness Patients.

OBJECTIVE: To evaluate the outcomes of minimally invasive cardiac surgery (MICS) compared with the sternotomy approach for Jehovah's Witness (JW) patients who cannot receive blood transfusions DESIGN: This was a retrospective observational study. SETTING: The study was conducted at a specialized cardiovascular intervention and surgery institute. PARTICIPANTS: The study cohort comprised JW patients undergoing cardiac surgery between September 2016 and July 2022. INTERVENTIONS: None MEASUREMENTS AND MAIN RESULTS: Patients (n = 63) were divided into MICS (n = 19) and sternotomy (n = 44) groups, and clinical outcomes were analyzed. There was no difference in types of operation except coronary bypass grafting (n = 1 [5.3%] in the MICS group v n = 20 [45.5%] in the sternotomy group; p = 0.005). There were no between-group differences in early mortality and morbidities. Overall survival did not differ significantly during the follow-up period (mean, 43.9 ± 24.4 months). The amount of chest tube drainage was significantly lower in the MICS group on the first postoperative day (mean, 224.0 ± 122.7 mL v 334.0 ± 187.0 mL in the sternotomy group; p = 0.022). The mean hemoglobin level was significantly higher in the MICS group on the day of operation (11.7 ± 1.3 mg/dL v 10.6 ± 2.0 mg/dL in the sternotomy group; p = 0.042) and the first postoperative day (12.3 ± 1.8 mg/dL v 11.2 ± 1.9 mg/dL; p = 0.032). CONCLUSIONS: MICS for JW patients showed favorable early outcomes and mid-term survival compared to conventional sternotomy. MICS may be a viable option for JW patients who decline blood transfusions.

To what extent does post-identification feedback translate into witness behaviour?

When eyewitness receive feedback implying they have accurately identified the perpetrator from a lineup, it boosts their confidence and possibly distorts their memory. Most research investigating this "post-identification feedback effect" (PIF effect) suggests the feedback changes eyewitness' retrospective memory of their actual experiences. But it remains unclear to what extent this feedback might change the eyewitness's subsequent behaviour. Across four experiments, we addressed this issue. We investigated whether people who received confirming feedback were more likely to provide recorded or written statements as evidence for an ongoing trial. Across the four experiments, we replicated the basic PIF effect. But we found no consistent evidence that these same people were more willing to offer their experimental data nor to submit a statement about what they saw. We did find preliminary evidence that people who received confirming feedback submitted longer statements. Taken together, these findings have theoretical implications establishing boundary conditions on the influence of feedback. On the practical side, these findings suggest caution in extrapolating the influence of PIF beyond a relatively small set of retrospective reports, beliefs, and inclinations.

Public involvement in UK health and care research 1995-2020: reflections from a witness seminar.

BACKGROUND: Public involvement is important to the relevance and impact of health and care research, as well as supporting the democratisation of research. In 2020, the National Institute for Health Research (NIHR) reorganized and eliminated INVOLVE, an internationally recognised group that had played a central role in public involvement in the UK since 1996. Its remit was subsumed within a new center tasked with public involvement, participant recruitment, and evidence dissemination. A year later, in 2021, interested parties came together to discuss the evolution of INVOLVE and consider how to retain some of the important historical details and learn lessons from its long and important tenure. METHODS: We hosted a witness seminar in 2022 that was one of four work groups and brought together public involvement leaders that had been part of the conception, development, and evolution of INVOLVE between 1995 and 2020. Witness seminars are a method used to capture the complexity and nuance of historical events or initiatives. They support critical thinking and reflection rather than simple commemoration. We identified those who had played a role in INVOLVE history, ensuring diversity of perspective, and invited them to attend and speak at the seminar. This took place during two sessions where witnesses provided their recollections and participated in a facilitated discussion. RESULTS: Across the two online sessions, 29 witnesses attended and contributed thoughts and recollections. Two authors (SS, MP) identified six themes that were described in the witness seminar report and have been discussed, elaborated, and illustrated with witness quotations. These are: the importance of historical perspective; INVOLVE as a social movement; how INVOLVE worked (e.g. its hospitality, kindness, and inclusivity); INVOLVE as a quiet disruptor; public involvement evidence, knowledge, and learning; the infrastructure, processes, and systems developed by INVOLVE; and the demise and loss of INVOLVE as an internationally recognized center of excellence. DISCUSSION: The authors of this commentary reflected on the discussions that took place during the witness seminar and the themes that emerged, and share six broad learnings for future practice; (1) it is important to create and nurture public involvement communities of practice; (2) collaborative ways of working support open discussion amongst diverse groups; (3) be aware of the tensions between activism and being part of the establishment; (4) continued efforts should be made to build an evidence base for public involvement practice; (5) there are both benefits and drawbacks to having a centralized organization leading public involvement; and (6) support for public involvement in research requires a fit-for-purpose tendering process that embeds robust public involvement.

BACKGROUND: Involving members of the public in research can improve the way that research is planned, managed, and shared. Between 1996 and 2020 an organization in the UK called INVOLVE had an important role in public involvement in research. When INVOLVE lost this role, some people who had been part of the group got together to think about how to save some of the important information and learn lessons from the time it had existed. METHODS: A meeting was arranged where people who have been part of an event or topic get together to share what it was like for them. This was called a witness seminar and it took place online over two days in 2022. Twenty-nine people attended and spoke about their experiences. RESULTS: The people who attended the witness seminar had different ideas about why INVOLVE was important and agree that it is now missed. People talked about INVOLVE as part of a certain time in history and said it was a social movement. They felt that it was kind and caring, brought together lots of people with different ideas, and supported changes in thinking. INVOLVE had a focus on evidence and learning and created structure and systems to support public involvement in research. Losing INVOLVE was difficult because a lot of people within the UK and beyond looked to them as a leader in public involvement. We share quotes on all of these topics. DISCUSSION: In this article we looked at how people remembered INVOLVE and thought about what information could be saved. We share lessons that will support thinking about the future of public involvement. These include things like how important it is for there to be spaces for people to come together to learn, discuss, and share, and that we have more work to do to understand public involvement and fully include it in research.

Medical-Legal Issues in Traumatic Brain Injury.

Traumatic Brain Injury (TBI) cases often involve both medical and legal issues, litigation and prolonged recovery timelines. As TBI cases are often complex, and can have a significant impact on the lives of the patients and their families/caregivers, having a comprehensive understanding of the causes, diagnoses, treatments and long term outcomes will be valuable in understanding the medical and legal aspects of this type of injury. Patients, families, and health care professionals will all benefit from a deeper understanding of the medical and legal aspects of TBI, which should help improve rehabilitation and recovery outcomes.

Fatal Hemoptysis With Pleural Effusions Secondary to Superior Vena Cava Obstruction as a Complication of Central Venous Catheterization.

This report outlines a rare case of superior vena cava (SVC) syndrome presenting with hemoptysis in a 33-year-old female Jehovah's Witness patient with a complex medical history, including systemic lupus erythematosus (SLE) and chronic hemodialysis dependency due to end-stage renal disease and a failed renal transplant. The SVC syndrome was attributed to occlusion from a right subclavian dialysis catheter. The management of this case was particularly challenging due to the patient's severe anemia and the development of a tension hemothorax following thoracentesis, compounded by her refusal of blood transfusions in adherence to her religious beliefs. A multidisciplinary approach, incorporating bloodless medical techniques such as erythropoietin and iron infusions alongside surgical interventions without blood transfusion, was successfully employed. This case sheds light on the evolving etiology of SVC syndrome and highlights the uncommon but potentially fatal occurrence of hemoptysis as a complication. It also emphasizes the importance of respecting patient values in complex medical decisions.

Outcomes associated with absent blood product utilization in Jehovah's witness patients compared to the standard of care in cardiac surgery: A ten-year experience.

INTRODUCTION: For Jehovah's Witness (JW) patients requiring cardiac surgery, various strategies such as preoperative use of erythropoietin stimulating agents (ESAs), intravenous iron (IVI), and non-pharmacologic interventions have emerged to prevent complications from blood loss given transfusion is not acceptable in this population. METHODS: Retrospective case-control of cardiac surgeries performed by the same surgeon between 1/1/2011 and 8/30/2021. JW patients were matched to non-JW who received blood products and non-JW who did not receive blood products on a 1:2:2 basis. Patients were matched on procedure, age, gender, and Society of Thoracic Surgeons morbidity score. Eligible patients were aged >18 years and had a sternotomy procedure. The primary efficacy and safety outcomes included mean hematocrit values perioperatively and thrombotic events. RESULTS: A total of 27 JW, 52 non-JW transfused, and 53 non-JW not transfused patients were included in the analysis. JW patients had significantly higher mean hematocrits at every time point when compared to non-JW transfused patients and at all time points except clinic and the last recorded operating room value when compared to non-JW not transfused patients. No significant differences in thrombotic rates were found between groups, however there was a numerically higher incidence in the JW population (JW: 7.4%; non-JW transfused: 0%; non-JW not transfused: 1.9%; p = .106). CONCLUSION: A blood conservation protocol in a JW population was associated with higher perioperative hematocrit values when compared to matched controls. Further prospective study is warranted before applying similar protocols to other populations given the possibility for an increased rate of venous thromboembolism.

Lost diagnoses? A multi-year trajectory of patients with childhood ADHD in the criminal justice system in Switzerland.

Background: Attention-deficit/hyperactivity disorder (ADHD) is prevalent amongst offenders, increasing risks for aggressive and delinquent behaviors. Since ADHD and its symptoms can persist into adulthood, accurately diagnosing and maintaining diagnoses in offenders is crucial to ensure appropriate treatment and reduce recidivism. Methods: This study employed a retrospective longitudinal design to investigate ADHD amongst adult offenders with a confirmed diagnosis of ADHD during childhood or adolescence at a Swiss forensic outpatient clinic between 2008 and 2021. N = 181 patient files were reviewed, including forensic expert witness assessments and treatment reports. We charted the adulthood trajectory of patients with a confirmed childhood/adolescence ADHD diagnosis, examining the course of their diagnoses. Results: Of 181 patients, evidence indicated that 12 (7%) had an ADHD diagnosis in childhood/adolescence. In 1 (8%) of these 12 cases, the diagnosis was maintained throughout the observation period. For 4 patients (33%), a diagnosis was given in the first forensic psychiatric expert witness assessment in adulthood but subsequently dropped. In another 4 cases (33%), the diagnosis was dropped in adulthood but later re-assigned, whereas in 3 cases (25%), the diagnosis was discontinued throughout the observation period. In 50% of cases with a diagnostic change, the discontinuation of an adult ADHD diagnosis coincided with a newly diagnosed personality disorder (or vice versa). Conclusions: Our findings highlighted considerable inconsistencies in the assignment of adult ADHD diagnoses amongst offenders. Whilst ADHD remission in adulthood occurs, the diagnostic variability in our results warrants detailed scrutiny. One possibility is that ADHD has similar fluctuations to conditions like depression, as argued elsewhere. Equally, diagnoses may become "lost", meaning they are not given even when applicable and replaced by other diagnoses. Additionally, residual symptoms may remain but beyond the diagnostic threshold. This is significant because untreated ADHD can increase re-offending risks and adverse health outcomes.

Trust but verify: The biasing effects of witness opinions and background knowledge in workplace investigations.

INTRODUCTION: A unique feature of workplace investigations is the familiarity that investigators and witnesses have with the factors involved in the adverse incident. Familiarity creates expectations that can shape investigators' and witnesses' assumptions and opinions. The current research examined the biasing effect of non-factual witness claims on investigators' judgments. These claims, which we call 'uncheckable,' included opinions about factors involved in the event and the future. We also examined how participants' a priori knowledge of an employee's history influenced their judgments. METHOD: This experiment used a 2 (background information: control or unsafe) × 2 (uncheckable content: neutral or unsafe) between-subjects design. Participants were provided with background information about a worker (control or unsafe history) and a witness statement about a workplace event that contained uncheckable claims (neutral or worker as unsafe). We tested how our manipulations biased participants' judgments of: (i) the cause of the event, (ii) the witness's confidence and credibility, and (iii) the diagnosticity of the witness's account. We also tested if biasing background information affected how factual participants found the witness's statement. RESULTS: Biasing uncheckable information (i.e., opinions) affected participants' judgments of event cause (ηp2 = 0.033) and increased their ratings of witness confidence (ηp2 = 0.074). Biasing background information about a worker affected participants' judgments of the cause of the event (ηp2 = 0.088), the diagnostic value of the witness statement (ηp2 = 0.054), and the number of factual claims in the witness statement, resulting in more uncheckable claims being misclassified as potential facts (ηp2 = 0.18). CONCLUSION: This experiment demonstrated the significant effect that non-factual witness statements and irrelevant background information can have on the interpretation of evidence and judgments about the cause of events. PRACTICAL APPLICATION: Understanding how contextual information can bias investigative judgment helps workplace investigators manage its influence in their judgment practices.

Crime, punishment, and detention in secure psychiatric hospital.

Many legal jurisdictions offer some form of hospital diversion and disposal as an alternative to incarceration in prison for mentally disordered offenders. Such diversion is commonly understood as offering a non-punitive alternative in terms of sentencing decisions. However, complete loss of responsibility with respect to acts of violence is rare and indicative of extreme degrees of mental disorder. This raises challenges for sentencers when considering disposal options. From the perspective of the patient and healthcare providers while hospital may be framed as non-punitive, it still involves marked loss of freedom and rights. In this essay, it is argued that failure to acknowledge the punitive element, inherent in hospital detention, risks its repression, and a false dichotomy being established with prison being seen as solely punitive and hospital as solely therapeutic. It is suggested that this division is unhelpful, even potentially harmful, and that a synthesis as solution to this dialectic opposition may be generative in terms of therapeutic work in hospitals, clarification of the role of hospitals in terms of criminal justice disposal, and greater transparency in relation to multi-agency working and the social circumstances of patients detained in secure hospitals. Further work to understand this process is suggested with a particular emphasis being placed on the experience of specific groups of patients, such as women, who may find themselves in a notably precarious state within secure care.

Protecting against misinformation: Evaluating the effectiveness of three techniques to reduce memory conformity.

The memory conformity effect occurs when people witness a given incident (e.g. a crime) then talk to each other about it, and the statement of one person affects the memory account of the other person with respect to this incident. The aim of this article is to improve the quality of witness testimony by verifying the effectiveness of three methods that aim to reduce memory conformity effect: (1) an extended warning against misinformation; (2) a method based on information about memory functioning and its fallibility and (3) a method consisting in motivating participants to resist influence and demonstrating their individual vulnerability to it. In the presented experiment, the innovative MORI technique was used to study the memory conformity effect. This technique allows a pair of participants to sit beside each other, look at the same screen and see a different version of the same criminal event. In the next stages, the subjects are asked to answer a series of questions about different details, thereby introducing mutual misinformation; then, the participants perform an individual memory test. In the experimental conditions, this test was preceded by one of the three tested methods in each group, with the aim of determining their effectiveness in reducing memory conformity. It turns out that the implementation of an extended warning against misinformation eliminated the memory conformity effect, while the application of two other methods led to a reduction (but not complete elimination) of the studied phenomenon.

Clinical Characteristics of Children With Foreign Bodies in the Digestive Tract and Analysis of Risk Factors for Serious Complications.

Foreign bodies (FBs) in the digestive tract are common in children, we analyzed the clinical characteristics of children with FBs in the digestive tract and discuss the risk factors for serious complications. We retrospectively reviewed clinical data of 139 children with FBs in the digestive tract. Based on the severity of complications caused by FBs, the patients were divided into risk and general groups for analysis and comparison. Significant differences were observed in the retention sites of FBs, the diameter of FBs retained in the esophagus, FBs retention time exceeding 24 h, and the absence of witnesses between the 2 groups. Inadequate care, button batteries (BBs), ingested mmFBs, FBs retained in the esophagus, long-term retention, and giant gastric bezoars may cause serious complications. In addition to treating FBs and the complications, clinicians should emphasize the importance of childcare to prevent the ingestion of FBs.

3D scanning a crime scene to enhance juror understanding of Bloodstain Pattern Analysis evidence.

There are numerous crime scene investigation applications of 3D scanning that have been previously documented. This paper documents the application of a 3D point cloud in the presentation of Bloodstain Pattern Analysis evidence to mock jurors. 150 mock jurors viewed a presentation of Bloodstain Pattern Analysis evidence from a murder trial in the UK. After viewing the evidence, the participants were tested on their knowledge of the evidence and repeated the test again 2 weeks later; to simulate criminal trial conditions; whereby there is a time lapse between the initial viewing of evidential material and deliberation. This paper found that the mock jurors who additionally viewed a 3D flythrough of a point cloud of the crime scene, better retained knowledge of the evidence over time, reported a greater ability to visualise the crime scene and had higher levels of interest in the evidence. Crucially, the 3D flythrough group did not report different levels of confidence in the accuracy of their memories of the evidence, nor different levels of emotional arousal to the group that viewed the evidence without the 3D presentation. Together, these findings suggest that 3D scanning of crime scenes, and the resultant point cloud's presentation to jurors, could add further value to the justice system when spatial information, such as Bloodstain Pattern Analysis evidence, is presented.

Medical and forensic aspects of performing a remote interrogation of persons with disabilities / Aspectos médicos y forenses de la realización de un interrogatorio a distancia a personas con discapacidad / Aspectos médicos e forenses da realização de um interrogatório remoto de pessoas com deficiências

The purpose of the study is to develop new proposals for improving criminal procedural legislation in the field of conducting remote investigative actions with disabled persons, taking into account their physiological and functional characteristics. Research material and methods: This study is based on an analysis of the norms regarding the criminal procedural legislation of the Republic of Kazakhstan and a number of foreign states that regulate the procedure for conducting remote investigative actions - as well as scientific publications on the research topic in the field of psychology and medicine. An integrated approach involves considering the studied phenomena of communication during an investigative action as a set of interconnected and interdependent elements, i.e., consideration of the issue from the medical, psychological and legal points of view. Situational and systemic types of analysis, complex sociological analysis, diagnostics and forecasting investigative situation were also used. Methods of analysis and synthesis, induction, deduction, methods of qualitative and quantitative analysis were employed to clarify the legal essence of the studied phenomenon. Findings: practical recommendations aimed at improving and developing the performance of remote investigative actions involving persons with disabilities (further ­ FWDs) y creating optimal conditions for the transfer of verbal, medical, and psychological information, as well as technical and forensic support for conducting RIAs. The following conclusions were made: in order to improve the current legislation, it is advisable to consider the issue of developing and including a special norm in the legislation, taking into account the characteristics of the communicative competencies of persons with disabilities. This norm regulates the procedure for conducting investigative actions involving the mute, deaf, blind and other persons with disabilities.

El objetivo del estudio es elaborar nuevas propuestas de mejora de la legislación procesal penal en el ámbito de la realización de actuaciones de investigación a distancia con personas con discapacidad, teniendo en cuenta sus características fisiológicas y funcionales. Material y métodos de investigación: Este estudio se basa en un análisis de las normas relativas a la legislación procesal penal de la República de Kazajstán y de una serie de Estados extranjeros que regulan el procedimiento para llevar a cabo acciones de investigación a distancia -, así como publicaciones científicas sobre el tema de investigación en el campo de la psicología y la medicina. Un enfoque integrado implica considerar los fenómenos estudiados de comunicación durante una acción de investigación como un conjunto de elementos interconectados e interdependientes, es decir, considerar la cuestión desde los puntos de vista médico, psicológico y jurídico. También se utilizaron los tipos de análisis situacional y sistémico, el análisis sociológico complejo, el diagnóstico y la previsión de la situación de investigación. Se emplearon métodos de análisis y síntesis, inducción, deducción, métodos de análisis cualitativo y cuantitativo para aclarar la esencia jurídica del fenómeno estudiado. Conclusiones: recomendaciones prácticas destinadas a mejorar y desarrollar la realización de acciones de investigación a distancia en las que participen personas con discapacidad (en adelante - RIA) y crear condiciones óptimas para la transferencia de información verbal, médica y psicológica, así como apoyo técnico y forense para la realización de las RIA. Se llegó a las siguientes conclusiones:con el fin de mejorar la legislación actual, es aconsejable considerar la cuestión de desarrollar e incluir una norma especial en la legislación, teniendo en cuenta las características de las competencias comunicativas de las personas con discapacidad. Esta norma regula el procedimiento para llevar a cabo acciones de investigación en las que estén implicadas personas mudas, sordas, ciegas y otras personas con discapacidad.

O objetivo do estudo é desenvolver novas propostas para aprimorar a legislação processual penal no campo da realização de ações investigativas remotas com pessoas com deficiência, levando em conta suas características fisiológicas e funcionais. Material e métodos de pesquisa: Este estudo baseia-se em uma análise das normas relativas à legislação processual penal da República do Cazaquistão e de vários países estrangeiros que regulamentam o procedimento para a realização de ações investigativas remotas, bem como em publicações científicas sobre o tópico de pesquisa no campo da psicologia e da medicina. Uma abordagem integrada envolve a consideração dos fenômenos estudados de comunicação durante uma ação investigativa como um conjunto de elementos interconectados e interdependentes, ou seja, a consideração da questão dos pontos de vista médico, psicológico e jurídico. Também foram usados tipos de análise situacional e sistêmica, análise sociológica complexa, diagnóstico e previsão da situação investigativa. Métodos de análise e síntese, indução, dedução, métodos de análise qualitativa e quantitativa foram empregados para esclarecer a essência legal do fenômeno estudado. Resultados: recomendações práticas com o objetivo de aprimorar e desenvolver o desempenho de ações investigativas remotas envolvendo pessoas com deficiência (mais adiante - FWDs), criando condições ideais para a transferência de informações verbais, médicas e psicológicas, bem como suporte técnico e forense para a realização de RIAs. Foram feitas as seguintes conclusões: para aprimorar a legislação atual, é aconselhável considerar a questão do desenvolvimento e da inclusão de uma norma especial na legislação, levando em conta as características das competências comunicativas das pessoas com deficiência. Essa norma regulamenta o procedimento para conduzir ações investigativas envolvendo pessoas mudas, surdas, cegas e outras pessoas com deficiência.

Mock court: a valuable tool to teach legal procedures to undergraduate medical students.

BACKGROUND: Teaching through role-plays is a preferred modality when certain behaviours or skills need to be taught. They provide a risk-free environment that simulates a real-life scenario. For a clinician, appearance in a Court of Law as an expert witness is a part of his/her legal obligation. OBJECTIVE: To explore the utility of Mock Court as an additional teaching tool for undergraduate medical students, in understanding and familiarizing with legal procedures, specifically the courtroom procedures. METHODOLOGY: We conducted Mock Court sessions with the students playing various roles, following which feedback was collected from the students, teachers and guest assessors. The data was statistically analysed by comparison of frequencies and paired t-test (pre- and post-session comparison). RESULTS: The study revealed a positive effect of the Mock Court sessions on the students, based on their increased confidence, motivation and a better grasp of legal procedures. There was a statistically significant (p < 0.001) improvement in the understanding of specific aspects of courtroom procedures after the session. CONCLUSION: The authors recommend the active implementation of Mock Court as a teaching aid for undergraduate medical students, and the use of PDSA (Deming) cycle as a tool for quality-checks and self-improvement in subsequent sessions.

Bloodless Gynecological Surgery in Blood Products Refusing Patients: Experience of a Single Institution.

Propose: This pilot study aimed to apply the central tenets of bloodless surgery and to analyze the effectiveness of specific preoperative, intraoperative, and postoperative strategies to minimize the risk for blood transfusion after gynecological surgery in a specific group of patients who refused blood products. Methods: A total of 83 patients undergoing gynecological surgery were included in the study. Forty-two patients received preoperatively oral iron, acid folic, and vitamin B12 supplementation in the 30 days before surgery, and 41 patients did not receive therapy. Results: No significant differences were found when comparing the two study groups. The implementation of all procedures to maintain a bloodless surgery has been helpful, in association with the other available procedures, in achieving optimal management and maintenance of hemoglobin levels, even in the most critical situations. Conclusion: In conclusion, implementing the bloodless approach as much as possible could guarantee the patient better and safer clinical and care management. Furthermore, well-designed research is required to clarify further the effects of bloodless surgery in gynecological patients.

Successful Heart Transplantation Without Blood Transfusion in a Jehovah's Witness Patient With Congenitally Corrected Transposition of the Great Arteries: A Case Report.

We report a case of heart transplantation in a 68-year-old Jehovah's Witness patient with congenitally corrected transposition of the great arteries (ccTGA) who developed heart failure due to right ventricular dysfunction. The patient underwent successful heart transplantation without the use of blood products, employing meticulous hemostasis and careful surgical planning. This case highlights the anatomical considerations and challenges in transplanting a heart in a patient with ccTGA, including the reversed positions of the pulmonary artery and the ascending aorta. It also emphasizes the importance of tailored surgical strategies to achieve hemostasis and avoid blood transfusion in Jehovah's Witness patients. This case adds to the limited literature on heart transplantation in patients with ccTGA and demonstrates that heart transplantation can be successfully performed without blood transfusion in Jehovah's Witness patients.

Prescribing Justice: A Close Examination of Physicians Acting As Expert Witnesses in Saudi Arabia.

INTRODUCTION: An expert witness is a person who provides testimony on issues that the court finds to be outside the scope of their expertise and experience. Any physician who has performed an independent medical evaluation or written medical records can and should expect to be requested as an expert witness. Medical malpractice, workers' compensation, and personal injury are the most prominent areas where medical expert witnesses participate and provide opinions and testimony. To our knowledge, this is the first study to be conducted in Saudi Arabia on physicians acting as expert witnesses. METHODS: This observational descriptive cross-sectional study conducted in Saudi Arabia from November 2022 to July 2023 aimed to assess physicians' experiences, education, training, willingness, self-competency, attitude, and perception as expert witnesses. The study population consisted of physicians working in Saudi Arabia, with at least a specialist level of professional expertise. Participants completed a self-administered online survey, utilizing a researcher-designed questionnaire. RESULTS: In total, 417 participants, with males comprising 51.3% of the sample, responded to the survey. More than half of the physicians (58.3%) had never produced a medical report for the court. Among those who had, the majority had done so one to twice. Similarly, the majority had never testified in court (77.5%), with only a small percentage having done so once or twice. Approximately 80% of participants had no prior education or training as expert witnesses, but among those who did, courses and workshops were the most common forms of education or training. Most participants expressed interest in learning or training for this role (69.1%) and were willing to provide medical reports or court testimony (73.9%). However, half of the participants did not feel competent in writing a medical report for the court, and more than half lacked confidence in giving testimony. CONCLUSION: The findings highlight the need for increased engagement, education, and training among physicians, particularly early and mid-career professionals, to enhance their confidence and competence as expert witnesses and ensure ethical practices in the medicolegal domain in Saudi Arabia.

The Forensic Mental Health Implications of Social Media Challenges.

Children and adults are increasingly spending time on social networking sites where they may be exposed to social media challenges. These challenges, which are essentially dares or competitions, often involve participants recording themselves performing various activities to create a short video which they then share online. Many social media challenges may be considered relatively benign, but others may involve behaviors or tasks that lead to adverse outcomes, including injury and death. In this article, the authors describe different types of social media challenges, susceptibility to risk-taking among social media users, and the potential criminal and civil legal aspects of these challenges. This article focuses on the forensic mental health implications of social media challenges, including considerations for forensic psychiatrists and other mental health professionals who may become involved in court cases related to these challenges.

Consequences and coping strategies of nurses and registered nurses perceiving to work in an environment characterized by workplace bullying.

Aim: The aim of this study was to analyze the well-being and coping strategies of nurses working in an organizational setting perceived as characterized by workplace bullying. The innovative aspect of this study is that we considered only those who perceive to work in an organizational environment characterized by workplace bullying, and not those who see themselves as victims and those who perceive they work in an organizational environment not characterized by workplace bullying. Method: A questionnaire with the NAQ-R, PGWBI, Val.Mob. and Brief COPE scales was administered to nurses. To better understand this phenomenon, a comparison was made between 331 nurses and 166 workers in other professions who also work in an organizational environment perceived to be characterized by workplace bullying. Results: In both groups (nurses and workers), the results were approximately the same in terms of personal bullying and workplace bullying episodes and the number of physical and emotive symptoms. The PGWBI score was lower for nurses than for workers in other fields. Among the individual symptoms, nurses and registered nurses were more likely to report gastritis, insomnia and heartburn than workers in other contexts. Workers in other contexts were more likely than nurses to report symptoms of anxiety, fear, feelings of insecurity, inferiority and guilt. In terms of coping strategies, nurses were more likely than other workers to report distraction, substance use, emotional support, disengagement, venting, positive reframing, humor, and religion. Workers in other professional context were more likely than nurses to report active coping, denial, instrumental support, planning, acceptance, and self-blame. Conclusion: Results suggest that the consequences of working in a perceived organizational environment characterized by workplace bullying are similar for both groups of workers, with nonstatistical differences in perceived workplace bullying episodes and sum of physical and emotive symptoms. Implication: Overall, findings suggest that workplace bullying prevention is a fundamental element in training workers in all types of workplaces and should be an integral part of curriculum activities.