We examined the use of graphs as an aid to communicating statistical risk among forensic clinicians. We first tested four graphs previously used or recommended for forensic risk assessment among 442 undergraduate students who made security recommendations about two offenders whose risk differed by one actuarial category of risk for violent recidivism (Study 1). Effective decision making was defined as actuarially higher risk offenders being assigned to greater security than lower risk offenders. The graph resulting in the largest distinction among less numerate students was a probability bar graph. We then tested this graph among 54 forensic clinicians (Study 2). The graph had no overall effect. Among more experienced staff, however, decisions were insensitive to actuarial risk in the absence of the graph and in the desirable direction with the addition of the graph. Further research into the benefit of graphs in violence risk communication appears viable.
In our population of term infants receiving therapeutic hypothermia, no type of placental pathology was related to extensive brain injury or adverse neurodevelopmental outcome.
OBJECTIVE: To perform a systematic review of the literature to estimate the prevalence and outcomes of occult tubal carcinoma in BRCA mutation carriers and high-risk patients undergoing risk-reducing salpingo-oophorectomy. DATA SOURCE: A search was done using OVID MEDLINE, EMBASE, and ClinicalTrials.gov between 1946 and March 2019 with keywords and MeSH terms selected by an expert medical librarian and coauthors. METHODS OF STUDY SELECTION: Two independent reviewers performed study selection with an initial screen on abstracts and a second on full articles. Articles were rejected if they were irrelevant to the study question, pertained to a different population or did not report occult tubal neoplasia. Quality was assessed using methodologic index for nonrandomized studies criteria. TABULATION, INTEGRATION, AND RESULTS: Data were extracted and recorded in an Excel database. Forest plots for the prevalence of occult carcinoma were done using STATA. Among 2,402 studies assessed, 27 met the inclusion criteria for qualitative and quantitative analysis. A total of 6,283 patients underwent risk-reducing salpingo-oophorectomy between 2002 and 2019: 2,894 cases were BRCA1, 1,579 BRCA2, and 1,810 high-risk based on family history. Among these, 75 patients were diagnosed with occult tubal carcinoma at the time of surgery. The pooled prevalence was 1.2% (I2=7.1%, P=.363) occurring at a median age of 53.2 years (range 42.4–67). In a subanalysis of 18 studies reporting follow-up data, 10 recurrences (18.7%, 95% CI 7.5–53%) and 24 cases of post–risk-reducing salpingo-oophorectomy peritoneal cancer (0.54%, 95% CI 0.4–1.9%) were reported after a median follow-up of 52.5 months. BRCA1, older age, and previous breast cancer were more often associated with occult malignancy. CONCLUSION: Occult tubal carcinomas found at risk-reducing salpingo-oophorectomy in high-risk patients and BRCA mutation carriers have significant potential for recurrence despite the frequent administration of postoperative chemotherapy.
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