Forensic Neurology: Practice Considerations and Training Opportunities.

Neurologic evidence, including MRI, PET, and EEG, has been introduced in more than 2,800 criminal cases in the past decade, including 12% of all murder trials and 25% of death penalty trials, to argue whether neurologic diseases are present, contribute to criminal behavior, and ultimately whether the defendant is less criminally responsible, competent to stand trial, or should receive a reduced punishment for his or her crime. Unfortunately, neurologists are often not involved in these criminal cases despite being the medical specialty with the most relevant training and expertise to address these issues for the court. Reasons for the absence of neurologists in criminal cases include a lack of awareness from lawyers, judges, and other expert witnesses on the value of including neurologists in forensic evaluations, and the lack of experience, training, and willingness of neurologists to work as expert witnesses in criminal cases.

Cataract surgery using two 3D visualization systems: Complication rates, surgical duration & comparison with traditional microscopes.

Purpose: To compare the complication rates and surgical duration of cataract surgery using two 3D visualization systems and a traditional binocular microscope among experienced and inexperienced surgeons.

Methods: This retrospective case series included 571 eyes that received cataract surgery using either heads up cataract surgery, via a 3D head mounted system ( = 148-Group 1) or a 3D display screen ( = 338 eyes-Group 2), or traditional binocular microscope ( = 85 eyes-Group 3). The surgical records of consecutive patients who underwent cataract surgery by two groups of surgeons (experienced and inexperienced) were reviewed.

From posts to protection: Ethical considerations regarding forensic psychiatrists and a duty to warn based on social media.

Increasing use of social media in forensic mental health evaluations will lead to new challenges that must be resolved by forensic practitioners and the legal system. One such dilemma is the discovery of information that would typically trigger a legal duty and professional ethics obligation for mental health professionals to breach doctor-patient confidentiality to promote public safety and prevent harm to vulnerable third parties. Although the law and professional organizations offer clear guidance for practitioners in the treatment role, there is currently no clarity from the law or instruction from professional organizations on what mental health professionals should do if they discover such information during a confidential forensic evaluation.

Forensic neurology: a distinct subspecialty at the intersection of neurology, neuroscience and law.

Neurological evidence is increasingly used in criminal cases to argue that a defendant is less responsible for their behaviour, is not competent to stand trial or should receive a reduced punishment for the crime. Unfortunately, neurologists are rarely involved in such cases despite having the expertise to help to inform these decisions in court. In this Perspective, we advocate for the development of 'forensic neurology', a subspecialty of neurology focused on using neurological clinical and scientific expertise to address legal questions for the criminal justice system.

Work Intensity of Postoperative Care Following Implantation of Presbyopia-Correcting versus Monofocal Intraocular Lenses.

Purpose: To compare the work intensity of postoperative care following implantation of presbyopia-correcting intraocular lenses (IOLs) to that of standard monofocal IOLs.

Patients And Methods: This open-label, multicenter, comparative study retrospectively reviewed the case records of cataract surgery patients who underwent bilateral implantation of either presbyopia-correcting IOLs (presby-IOL group; N=177) or standard monofocal IOLs (monofocal group; N=177). Outcome measures included the total time the patient spent in the office, number of visits, mean duration of visits, and the number of procedures and diagnostic tests during the first postoperative year.

Pragmatic Approaches to COVID-19 Related Ethics Dilemmas for Psychiatrists.

Psychiatrists face complex ethics dilemmas in the COVID-19 pandemic era when assessing dangerousness in patients or forensic evaluees who threaten to purposely infect others or spread the virus. Understanding local public health and medical quarantine laws for their jurisdictions can help guide treating psychiatrists in how to handle some of these situations; however, challenges occur when what is ethically best conflicts with the action that will confer the greatest protection against legal liability. Additionally, the calculus of weighing competing ethics considerations changes based on how relevant it is to the duties of a particular role (e.

Real-World Experience with Intracapsular Administration of Dexamethasone Intraocular Suspension 9% for Control of Postoperative Inflammation.

Corticosteroids and non-steroidal anti-inflammatory drugs are commonly used prophylactically to control inflammation after ocular surgery. When prescribed as eye drops, as has been longstanding tradition, anti-inflammatory success is out of surgeons' hands, dependent on patient compliance and proper instillation technique. Sustained-release, intraoperatively administered anti-inflammatory drugs are emerging as another option.

First Real-World, Multicenter, Post-Marketing, Retrospective Study of Dexamethasone Intraocular Suspension for Inflammation After Cataract Surgery.

Purpose: To evaluate dexamethasone intraocular suspension 9% (intraocular DXM) in real-world clinical use to manage inflammation associated with cataract surgery.

Setting: Patients who underwent cataract surgery and received intraocular DXM at 22 outpatient eye surgery centers in the US.

Design: Retrospective, observational chart review.

Outcomes of toric IOL implantation guided by iris-registered femtosecond laser capsulotomy markings.

Purpose: To assess the accuracy and stability of iris-registered femtosecond laser-assisted anterior capsule axis markings (compensating cyclotorsion) along with refractive and visual outcomes after toric IOL implantation.

Methods: This prospective case series included eyes with visually significant cataracts and regular corneal astigmatism ranging from 1.25D to 4.

Argentinian Flag Sign and Its Management during Femtosecond Laser-Assisted Cataract Surgery in a Case with Intumescent Cataracts.

We describe a case of radial extension and its management during femtosecond laser-assisted cataract surgery (FLACS) in a patient with intumescent cataracts. Radial extension was observed after injection of trypan blue into the anterior chamber. Management of the extension was achieved by separation of adhesions between the incomplete capsulotomy, along with manual completion at the areas of extensions.

Voluntary intoxication, homicide, and mens rea: Past, present, and future.

Voluntary, or intentional, acute intoxication does not qualify for an insanity defense. However, in many jurisdictions, voluntary intoxication can create a diminished capacity to form a specific intent necessary for a criminal offense. This is a type of mens rea defense.

Comparative Assessment of Ergonomic Experience with Heads-Up Display and Conventional Surgical Microscope in the Operating Room.

Purpose: Musculoskeletal pain issues are prevalent in ophthalmic surgeons and can impact surgeon well-being and productivity. Heads-up displays (HUD) can improve upon conventional microscopes by reducing ergonomic stress. This study compared ergonomic outcomes between HUD and a conventional optical microscope in the operating room, as reported by ophthalmic surgeons in the US.

Heads-up Cataract Surgery: Complication Rates, Surgical Duration, and Comparison With Traditional Microscopes.

Purpose: To compare the complication rates and surgical duration between a three-dimensional visualization system (heads-up surgery) and traditional binocular microscope in cataract surgery.

Methods: This retrospective case series included 2,320 eyes that received cataract surgery using either a three-dimensional display system (n = 1,673 eyes) (3D group) or a traditional binocular microscope (n = 647 eyes) (traditional group). The medical records of consecutive patients who underwent cataract surgery by a single surgeon in The Eye Institute of West Florida from August 2016 to July 2017 using either a three-dimensional display system or the traditional binocular microscope for visualization were reviewed.

The Effect of NSAID Pretreatment on Aqueous Humor Prostaglandin E Concentration in Eyes Undergoing Femtosecond Laser-Assisted Capsulotomy.

Purpose: To assess aqueous humor concentration of prostaglandin E (PGE) after capsulotomy creation using a femtosecond laser (FLAC) in patients pretreated with short-term topical ketorolac versus patients without pretreatment.

Methods: This prospective study comprised consecutive patients scheduled to undergo cataract surgery using a femtosecond laser platform to perform only capsulotomies. An identical protocol for preoperative mydriasis was used for all the eyes included in the study, while aqueous humor was extracted from the anterior chamber of all patients immediately after the initial side port incision.

Crystalline lens endocapsular fragmentation using an elastic loop filament.

Purpose: To describe a novel mechanical endocapsular fragmentation technique of the crystalline lens during cataract surgery using a loop elastic-thin filament.

Methods: An alternative method to mechanically fragment the crystalline lens utilizing a nitinol loop is described. This device achieves lens sectioning in multiple pieces, decreasing ultrasonic energy expenditure during cataract surgery.

Cyclorotation during femtosecond laser-assisted cataract surgery measured using iris registration.

Purpose: To assess ocular cyclorotation of eyes having femtosecond laser-assisted cataract surgery using iris registration.

Setting: Eye Institute of West Florida, Largo, Florida, USA.

Design: Retrospective cases series.

Dysfunctional tear syndrome: dry eye disease and associated tear film disorders - new strategies for diagnosis and treatment.

Dysfunctional tear syndrome (DTS) is a common and complex condition affecting the ocular surface. The health and normal functioning of the ocular surface is dependent on a stable and sufficient tear film. Clinician awareness of conditions affecting the ocular surface has increased in recent years because of expanded research and the publication of diagnosis and treatment guidelines pertaining to disorders resulting in DTS, including the Delphi panel treatment recommendations for DTS (2006), the International Dry Eye Workshop (DEWS) (2007), the Meibomian Gland Dysfunction (MGD) Workshop (2011), and the updated Preferred Practice Pattern guidelines from the American Academy of Ophthalmology pertaining to dry eye and blepharitis (2013).

Review of Top 10 Prescribed Drugs and Their Interaction with Dental Treatment.

The proportion of people over age 60 is growing faster than any other group. Many patients take several medications to manage multiple chronic medical conditions. Poor oral health is common and dental visits by patients over the age of 65 are increasing.

Use of recombinant factor VII for tooth extractions in a patient with severe congenital factor VII deficiency: a case report.

Background And Overview: Patients with factor VII deficiency have an increased risk of prolonged perioperative hemorrhage. In this article, the authors present a case of severe factor VII deficiency in a patient who required tooth extraction.

Case Description: A 44-year-old woman with severe congenital factor VII deficiency sought care for a symptomatic, carious, and nonrestorable maxillary right second molar that required extraction.

Dialectical principlism: an approach to finding the most ethical action.

Most forensic psychiatrists occasionally face complex situations in forensic work in which ethics dilemmas cause discomfort. They want to determine the most ethical action, but the best choice is unclear. Fostering justice is primary in forensic roles, but secondary duties such as traditional biomedical ethics and personal values like helping society, combating racism, and being sensitive to cultural issues can impinge on or even outweigh the presumptive primary duty in extreme cases.

Informed Consent at Gunpoint: When Psychiatry Affects Gun Ownership.

As states take more steps to connect patients' gun ownership to their mental health, psychiatrists are being asked to provide mental health information after clinical interviews as well as after confiscation. This move into the patient-physician relationship raises new questions about how psychiatrists should obtain informed consent when interviews may result in reports to legal authorities. Consent warnings are already practiced more in the breach than in the observance and informed consent is imperfect at its best.