Engaging torture survivors in the global fight against torture

Lived experience can be emancipating and also paralysing, but foremost, it is immensely valuable to combat what has been suffered in first person (Henry, 2021). How to recognise that contribution and engage torture survivors in the global fight against torture? What role do survivors play in society? How to involve survivors in advocacy and policy-making processes? What are the existing power (in)balances at play? Who gets to decide whether a survivor should speak up or not? Acknowledging that it can prompt some organisational, therapeutic, and professional considerations, what are the limits? How do we ensure that the survivor’s well-being is protected along the process? To what extend should survivors be engaged in our organisation’s decision-making? In front of the current on-going debate on the need of actively engaging torture survivors in the global fight against torture, IRCT held a webinar to explore this topic. The webinar examined torture survivor engagement in the rehabilitation process of rebuilding lives, seeking justice and torture prevention. This article summarises the discussion held during the webinar with the presentations from Léonce Byimana[1], Feride Rushiti[2], Kolbassia Haoussou[3] and Vasfije Karsniqi-Goodman[4] and further inputs from other IRCT-members. [1] Executive Director of Torture Abolition and Survivors Support Coalition (TASSC) [2] Executive Director of the Kosova Rehabilitation Center for Torture Victims (KRCTV) [3] Director of Survivor Empowerment at Freedom From Torture [4] Survivor and member of the Kosovan parliamen

Thematic briefing: strengthening the recognition and protection of relatives of disappeared persons

News in the 2023(1) issue published in 17.03.202

New appointed Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment

News in the 2023(1) issue published in 17.03.202

Continuous Education: Case 1 and 2

Welcome to the Torture Journal Forensic Case Series, a new section of the Torture Journal. Through this Series, we aim to provide a source of information and continuing education for health and legal practitioners involved in the forensic evaluation of survivors of torture.   Cases in this section may describe unique or uncommon physical and psychological findings, illustrate barriers to a thorough evaluation, or present features that make effective articulation of a survivor’s claim challenging. Case discussions aim to provide further information about findings or reflections on how challenges were approached. We also aim to address common misconceptions about the clinical evaluation and the experience of torture. As one of the benchmarks for our discussions, we apply the principles and standards of the United Nation’s Istanbul Protocol.              We hope that you will find these case studies to be a useful resource for your work with survivors of torture.    Yours Truly,   Guest Editors: Prof. Dr. Ben McVane, Senior Medical Educator, Libertas Center for Human Rights Prof. James Lin, Istanbul Protocol Programme Coordinator, IRC

Obituary to Prof. Henrik Marcussen: Prof. Henrik Marcussen

Obituary to Prof. Henrik Marcussen(17 January 1938 - 22 February 2023

The use of electronic health records in Spanish hospitals

The aims of this study were to describe the level of adoption of electronic health records in Spanish hospitals and to identify potential barriers and facilitators to this process. We used an observational cross-sectional design. The survey was conducted between September and December 2011, using an electronic questionnaire distributed through email. We obtained a 30% response rate from the 214 hospitals contacted, all belonging to the Spanish National Health Service. The level of adoption of electronic health records in Spanish hospitals was found to be high: 39.1% of hospitals surveyed had a comprehensive EHR system while a basic system was functioning in 32.8% of the cases. However, in 2011 one third of the hospitals did not have a basic electronic health record system, although some have since implemented electronic functionalities, particularly those related to clinical documentation and patient administration. Respondents cited the acquisition and implementation costs as the main barriers to implementation. Facilitators for EHR implementation were: the possibility to hire technical support, both during and post implementation; security certification warranty; and objective third-party evaluations of EHR products. In conclusion, the number of hospitals that have electronic health records is in general high, being relatively higher in medium-sized hospitals

Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study

Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their association with six months mortality and neurological outcome. Methods: A preplanned subanalysis of the SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort study, describing the ICP treatment, graded according to Therapy Intensity Level (TIL) scale, in patients with ABI during the first week of intensive care unit (ICU) admission. Results: 2320 patients were included in the analysis. The median age was 55 (I-III quartiles = 39-69) years, and 800 (34.5%) were female. During the first week from ICU admission, no-basic TIL was used in 382 (16.5%) patients, mild-moderate in 1643 (70.8%), and extreme in 295 cases (eTIL, 12.7%). Patients who received eTIL were younger (median age 49 (I-III quartiles = 35-62) vs 56 (40-69) years, p < 0.001), with less cardiovascular pre-injury comorbidities (859 (44%) vs 90 (31.4%), p < 0.001), with more episodes of neuroworsening (160 (56.1%) vs 653 (33.3%), p < 0.001), and were more frequently monitored with an ICP device (221 (74.9%) vs 1037 (51.2%), p < 0.001). Considerable variability in the frequency of use and type of eTIL adopted was observed between centres and countries. At six months, patients who received no-basic TIL had an increased risk of mortality (Hazard ratio, HR = 1.612, 95% Confidence Interval, CI = 1.243-2.091, p < 0.001) compared to patients who received eTIL. No difference was observed when comparing mild-moderate TIL with eTIL (HR = 1.017, 95% CI = 0.823-1.257, p = 0.873). No significant association between the use of TIL and neurological outcome was observed. Conclusions: During the first week of ICU admission, therapies to control high ICP are frequently used, especially mild-moderate TIL. In selected patients, the use of aggressive strategies can have a beneficial effect on six months mortality but not on neurological outcome