To meet the unmet medical needs and better reflect the new clinical evidence of chronic hepatitis B management, Chinese Society of Hepatology developed expert consensus on expanding diagnosis and treatment in China. The recommendations include to expand HBsAg screening in the population and HBV DNA detection by sensitive quantitative real-time PCR (qPCR), decrease the alanine aminotransferase (ALT) threshold for treatment of chronic hepatitis B, and promptly start antiviral therapy in the patients who are at risk of disease progression, and appropriately manage the patients with low level viremia.
Alanine Transaminase ; DNA, Viral ; Expert Testimony ; Hepatitis B Surface Antigens ; Hepatitis B, Chronic/drug therapy* ; Humans

PURPOSE: Successful application experiences on public-private partnership (PPP) in different countries, suggest that PPP could be an option in road traffic injury (RTI) prevention. The present study aims at investigating the applicability of PPP policy in RTI prevention in Iran based on the experts' perspectives. METHODS: This is a qualitative study with grounded theory approach which has been conducted in Tabriz University of Medical Sciences, Iran in 2018. The participants were 22 experts in the field of RTIs selected using purposive sampling method. Data were collected by semi-structured interviews and analyzed with content-analysis method. RESULTS: The results were classified under 5 main themes (applicability, scopes and services, challenges, advantages, and strategies) for applying PPP policy and 37 sub-themes. Due to the prevalence of RTIs, the present challenges in public sector, existence of qualified private sector, and successful experiences in other areas, there are opportunities for private sector partnership in prevention of RTIs. Private sector could participate in different scopes and services regarding RTI prevention, including road construction and maintenance, maintenance and provision of vehicles safety and public education. The main challenges including legislation issues, ambiguities in collaboration, political and organizational unsustainability, government's financial hardship and lack of experienced experts in the field of RTI. However, there are significant advantages including high efficiency in program implementation, covering the weaknesses of public sector, effective and efficient management on application of PPP in RTI prevention. The strategies include identifying and prioritizing the assignable activities, identifying the qualified private sector, developing PPP policies and legal frameworks, creating a common language between public and private parties, trying to meet the expectations of the private sector by public sector, developing a comprehensive and sound contract, and cultivating public culture to accept private sector in the field of RTI prevention. CONCLUSION This study sought to determine whether PPP could be used as strategy to reduce the burden of RTIs in Iran. But it requires a lot of preliminary studies to provide the context and conditions for applying this policy.
Accidental Injuries ; prevention & control ; Accidents, Traffic ; prevention & control ; Adult ; Expert Testimony ; Female ; Humans ; Iran ; Male ; Middle Aged ; Public-Private Sector Partnerships ; organization & administration ; Qualitative Research

Objective To discuss the types, number and diagnostic methods of traumatic tooth fracture in order to provide reference for forensic clinical identification. Methods The 41 cases accepted by Judicial Appraisal Center of Gansu University of Political Science and Law from January 2015 to December 2017, were analyzed by descriptive statistics according to information such as the basic situation, injury manner, type and number of tooth fracture, diagnostic method and expert opinion. Results The 41 cases included 31 males and 10 females. Tooth fracture occurred mainly on the maxillary anterior teeth. The main injury manner of traumatic tooth fracture was collision injury. CT scan improved the accuracy of diagnosis. Conclusion There are gender differences in tooth fracture cases. The part of fracture is related to tooth anatomical characteristics. CT scan can be a priority in tooth fracture diagnosis. Forensic analysis of traumatic tooth fracture should comprehensively consider the types and number of tooth fracture, and define the relationship between tooth fracture and the injury.
Expert Testimony ; Female ; Forensic Medicine ; Humans ; Male ; Sex Factors ; Tomography, X-Ray Computed ; Tooth Fractures

Objective To explore the consistency between identification diagnosis and pre-identification clinical diagnosis of patients with mental disorder undergoing forensic psychiatry identification. Methods The identification data of 1 369 appraised individuals who underwent criminal responsibility identification carried out by the Forensic Institute of Second Affiliated Hospital of Jining Medical University from 2014 to 2017 were collected retrospectively using self-designed investigation data sorting table. A comparative analysis of the mental disorder diagnosis results of expert opinion and past clinical diagnosis results was made. Results Among 1 369 appraised individuals, 964 cases （70.4%） were identified and diagnosed with mental disorder and 405 cases （29.6%） without mental disorder. Among the former, 63.3% （610 cases） were clinically diagnosed, which was higher than 43.2% （175 cases, P<0.05） in the latter. Among the various mental disorders that had been identified and diagnosed, patients with hysteria, stress, and neurosis had the highest proportion of clinical diagnoses （86.7%）, while patients with mental retardation had the lowest proportion of clinical diagnoses （9.6%）. Schizophrenia had the highest overall consistency rate of identification diagnosis and clinical diagnosis （98.4%）, while personality and behavior disorder had the lowest （33.3%）. The overall consistency rate between clinical diagnosis and identification diagnosis of the mental disorder group was 84.1%, and the Kappa value was 0.759. Compared with clinical diagnosis, the consistency rate between inpatient diagnosis and identification diagnosis was higher （85.9%, P<0.05）. Conclusion In forensic psychiatry identification that provides data of past clinical diagnosis and treatment, a high consistency between identification diagnosis and clinical diagnosis of the appraised individual who is identified and diagnosed with mental disorder exists. Clinical diagnosis （especially the inpatient diagnosis） has a relatively good reference value for forensic psychiatry identification.
Criminals ; Expert Testimony ; Forensic Psychiatry ; Humans ; Mental Disorders/diagnosis* ; Psychotic Disorders ; Reproducibility of Results ; Retrospective Studies

In cases on compensation for personal injury, the issue of medical expense compensation involves the vital interests of the compensation obligor, the injured party and the medical institution. The rationality of medical expenses is likely to be controversial, however, there is no unified standard and stipulation for the medical expense rationality identification in forensic clinical identification at present, therefore, in the practice of judicial expertise, expert opinions easily become confused, and the legitimate rights of the parties could be infringed, which affects the impartiality and authority of judicial expertise. This article starts with the concept of medical expense and the rationality of medical expense and the reasons for disputes over the rationality of medical expense, to put forward the basic principles that should be followed in the identification of rationality of medical expenses, for peer reference.
Dissent and Disputes ; Expert Testimony ; Forensic Medicine

Laser corneal refractive surgery has become an important treatment to correct ametropia in recent years. Rational medication in the perioperative period is essential to ensure the success of the surgery and to reduce complications. However, in this area there has been no consistent understanding and unified application guide across the world. Experts in Refractive Surgery Group, Ocular Microcirculation Branch of Chinese Society of Microcirculation who are specialized in keratology and optometry had initiated extensive and rigorous discussions and reached a consensus on appropriate medication before, during and after the refractive surgeries. The consensus covers a broad spectrum of commonly used ophthalmic solutions, provides recommendations of routine and enhanced medication on prevention and management of adverse reactions and complications related to the laser corneal refractive surgeries. We hope the consensus serves as a standard perioperative medication regimen for ophthalmologists, helps to ensure the safety and effectiveness of laser corneal refractive surgeries, and improves the quality and outcome of the refractive surgeries.
Anti-Bacterial Agents/therapeutic use* ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use* ; Asian People/statistics & numerical data* ; China ; Consensus ; Cornea/surgery* ; Drug Therapy/methods* ; Expert Testimony ; Glucocorticoids/therapeutic use* ; Humans ; Lasers ; Ophthalmic Solutions/therapeutic use* ; Perioperative Care ; Refractive Errors/therapy* ; Refractive Surgical Procedures/methods*

Minimally invasive treatment of symptomatic thyroid nodules is now commonplace. Ethanol ablation (EA) of thyroid cystic nodules has been performed since the 1990s, but there is no global consensus or guideline. Although various limitations of EA have been described, recommendations for practical application are necessary. Therefore, the Task Force Committee of the Korean Society of Thyroid Radiology initiated the present consensus statement and here we provide recommendations for the role of EA in the management of symptomatic thyroid nodules. These recommendations are based on evidence to date from the literature and expert opinion.
Advisory Committees ; Consensus ; Ethanol ; Expert Testimony ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient's treatment goals.
Advisory Committees ; Bias (Epidemiology) ; Carcinoma, Squamous Cell ; Counseling ; Expert Testimony ; Humans ; Mouth Neoplasms ; Neck ; Republic of Korea

OBJECTIVES: Ultrasound has an established role in the diagnostic pathway for children with suspected appendicitis. Relevant clinical information can influence the diagnostic probability and reporting of ultrasound findings. A Bayesian network (BN) is a directed acyclic graph (DAG) representing variables as nodes connected by directional arrows permitting visualisation of their relationships. This research developed a BN model with ultrasonographic and clinical variables to predict acute appendicitis in children. METHODS: A DAG was designed through a hybrid method based on expert opinion and a review of literature to define the model structure; and the discretisation and weighting of identified variables were calculated using principal components analysis, which also informed the conditional probability table of nodes. RESULTS: The acute appendicitis target node was designated as an outcome of interest influenced by four sub-models, including Ultrasound Index, Clinical History, Physical Assessment, and Diagnostic Tests. These sub-models included four sonographic, three blood-test, and six clinical variables. The BN was scenario tested and evaluated for face, predictive, and content validity. A lack of similar networks complicated concurrent and convergent validity evaluation. CONCLUSIONS: To our knowledge, this is the first BN model developed for the identification of acute appendicitis incorporating imaging variables. It has particular benefit for cases in which variables are missing because prior probabilities are built into corresponding nodes. It will be of use to clinicians involved in ultrasound examination of children with suspected appendicitis, as well as their treating clinicians. Prospective evaluation and development of an online tool will permit validation and refinement of the BN.
Appendicitis ; Bayes Theorem ; Child ; Diagnostic Tests, Routine ; Emergency Medicine ; Expert Testimony ; Humans ; Methods ; Pediatrics ; Prospective Studies ; Ultrasonography

Pancreatic cystic neoplasms are becoming increasingly frequent, presenting a number of challenges in clinical practice. While several guidelines have been published to address these, they are largely composed of expert opinions based on relatively low-level evidence. Their recommendations are similar in general, but there are many differences in detail. Pancreatic neoplasms have differing malignant potential, based on the histologic type and clinical and radiological features of the cysts. It is necessary to stratify the malignancy risk of each cyst, using proper evaluation methods, and to manage it appropriately, with surgical resection or surveillance. In addition, risks associated with surgical resection, costs associated with long-term follow-up, and patient discomfort and anxiety must be considered in the proper management of pancreatic cystic neoplasms. In this review, we introduce four recently published guidelines.
Anxiety ; Expert Testimony ; Follow-Up Studies ; Humans ; Pancreatic Cyst ; Pancreatic Neoplasms