两地区医疗纠纷法医学尸检鉴定质量的比较研究

目的研究影响涉及医疗纠纷法医学尸检鉴定质量差异的原因。方法两个具有代表性的法医学尸检鉴定机构所涉及医疗纠纷的相关案例,进行字2检验、t检验等统计学研究。结果通过字2检验发现,在设定的10个指标中,有7个指标存在显著性差异,提示两鉴定单位在“涉及医疗纠纷的法医学尸检鉴定”中检验手段和标准、规范性等均存在极大的差异。结论通过研究,提示法医学鉴定人素质、尸检的标准化和规范化、尸检检材的提取标准化、死因或疾病的诊断标准、会诊制度及法医学鉴定书的书写规范化等是法医学尸检鉴定质量控制和管理的重要环节。     

法医学鉴定质量评价与控制研究

目的探讨法医学鉴定质量评价与控制的有效途径。方法根据法医学鉴定的要求,选择评价指标、评价等级以及确定权重指数,应用模糊数学综合评判的方法,对法医学鉴定质量进行评价与控制,并结合实例分析如何应用模糊数学综合评判的方法对法医学鉴定质量进行评价与控制。结果该方法对法医学鉴定质量具有有效的评价与控制。结论模糊数学综合评判可作为法医学鉴定质量评价与控制的有效手段。     

法医学鉴定质量评价与控制研究

目的探讨法医学鉴定质量评价与控制的有效途径。方法根据法医学鉴定的要求，选择评价指标、评价等级以及确定权重指数，应用模糊数学综合评判的方法，对法医学鉴定质量进行评价与控制，并结合实例分析如何应用模糊数学综合评判的方法对法医学鉴定质量进行评价与控制。结果该方法对法医学鉴定质量具有有效的评价与控制。结论模糊数学综合评判可作为法医学鉴定质量评价与控制的有效手段。     

精神科医疗过错法医学鉴定与防范

目的 探究精神病院医疗纠纷法医学鉴定要点,加强精神病院管理,防范医疗纠纷,提高医疗质量。方法 以裁判文书网判决书为资料,对精神病院诊疗致死纠纷常见的过错与承担责任程度进行有序多分类Logistic回归分析。结果 护理不当、管理不当、对疾病认识不足、告知不明确、抢救不到位、用药不当、诊断不明确等7个过错为医疗纠纷承担责任程度的风险因素,其他疾病为保护因素。结论 分析精神病院发生诊疗致死纠纷时的常见过错及鉴定要点,从两方面整治,可有效防范医疗纠纷的发生,提升医疗质量,实现医患共赢。     

新生儿医疗纠纷相关因素的初探

目的 从法医学和管理学的角度初步探讨新生儿科医疗纠纷的防范与处理。方法 收集华中科技大学同济医学院法医学系1994—2002年8年间27例新生儿尸体解剖案例，进行回顾性分析研究。结果 27例新生儿尸体解剖案例中，男性患儿12名，女性患儿15名，平均年龄18，22天。其中围产期10例。其家属要求均为查明死因。经过鉴定，其中医疗事故为0例(37．03％)，不是医疗事故17例(62．97％)。结论 新生儿医疗纠纷的防范应从医方、患方以及国家与社会3方面努力进行防范；在处理方面，及时的尸体解剖和病理检查是解决医疗纠纷一种行之有效的方法。     

新生儿医疗纠纷相关因素的初探

目的　从法医学和管理学的角度初步探讨新生儿科医疗纠纷的防范与处理。　方法　收集华中科技大学同济医学院法医学系 1994— 2 0 0 2年 8年间 2 7例新生儿尸体解剖案例 ,进行回顾性分析研究。　结果　 2 7例新生儿尸体解剖案例中 ,男性患儿 12名 ,女性患儿 15名 ,平均年龄 18.2 2天。其中围产期 10例。其家属要求均为查明死因。经过鉴定 ,其中医疗事故为 0例 (3 7.0 3 % ) ,不是医疗事故 17例 (62 .97% )。　结论　新生儿医疗纠纷的防范应从医方、患方以及国家与社会 3方面努力进行防范 ;在处理方面 ,及时的尸体解剖和病理检查是解决医疗纠纷一种行之有效的方法。     

过敏性休克猝死的法医学鉴定7例

过敏性休克猝死的法医学鉴定７例黄飞骏，刘世沧（华西医科大学法医学系，四川６１００４１）过敏性休克的法医学鉴定有相当的困难。现将近１０年来我系鉴定为过敏性休克猝死的７例尸解材料进行分析，并就过敏性休克猝死的诊断问题进行探讨。１资料分析１．１一般情况死者...     

25例医疗纠纷的法医临床学鉴定回顾性分析

目的探讨医疗纠纷的法医临床学鉴定及其相关问题。方法对25例医疗纠纷案例资料进行了回顾性整理分析。结果医疗失误16例,其中有不良后果的10例,均发生于手术科室;无医疗失误9例。结论医疗纠纷法医学鉴定过程中认定医疗失误是基础,认定医疗失误与不良后果的关系是关键。     

医疗纠纷的法医学鉴定

目的研究医疗纠纷法医学鉴定的特点,并讨论医疗纠纷法医学鉴定的重点及难点。方法将医疗缺陷分为责任性缺陷、技术性缺陷、管理性缺陷、学科性缺陷和其他缺陷,对36件案例分别进行分类并进行统计。其中把18例由医疗事故鉴定委员会鉴定的结论与我室的鉴定结果进行比较分析,其他18例另行统计。结果36例案件中存在医疗缺陷的占86.11%,其中技术性缺陷66.67%,责任性缺陷和管理性缺陷均占25%。18例由医疗事故鉴定委员会鉴定的结论与我室的鉴定结果进行比较,医疗缺陷的认定两者有明显差异(P<0.05),对于医疗缺陷已对患者造成不良影响的认定,两者具有显著性差异(P<0.01)。结论法医进行医疗纠纷的鉴定,对医疗纠纷诉讼案件的处理起着积极的作用。目前,医疗纠纷的法医学鉴定仍存在许多问题需要进一步讨论。     

胎儿畸形医疗纠纷法医学鉴定12例分析

目的 探讨因胎儿畸形产生医疗纠纷的主要原因,分析法医学鉴定的切入点以及鉴定思路.方法 参照相关法律、法规与临床诊疗规范,分析本组因胎儿畸形所致12例医疗纠纷法医学鉴定案例中的医疗过错及其参与度划分.结果 本组案例中,存在医疗过错的为5例,其中未履行告知义务的2例,对异常结果未进行综合分析的2例,医疗技术水平有限并报告表...     

The effects of the (fentanyl-fueled) drug overdose epidemic on medicolegal death investigation in the United States

The evolving opioid epidemic in the United States, fueled by illicit fentanyl, has greatly increased deaths from illicit drug use. These nonnatural deaths require formal death investigation. The National Association of Medical Examiners states in its Forensic Autopsy Performance Standards that autopsy remains a necessary component for proper investigation of suspected acute overdose deaths. If a death investigation office lacks adequate resources to investigate all deaths under its jurisdiction while meeting expected standards, then that office may be forced to consider altering its protocols for investigation by changing the types of deaths investigated or the extent of its investigations. Drug death investigations take longer to complete because novel illicit drugs and mixtures of drugs complicate toxicological analyses, prolonging a family's wait for completion of a death certificate and autopsy report. Public health agencies must also wait for results, but some agencies have developed mechanisms for rapid notification of preliminary results to allow timely deployment of public health resources. The increased deaths have strained the resources of medicolegal death investigation systems throughout the United States. Given the significant workforce shortage of forensic pathologists, newly trained forensic pathologists are too few to meet the demand. Nevertheless, forensic pathologists (and all pathologists) must make time to present their work and themselves to medical students and pathology trainees to encourage an understanding of the importance of quality medicolegal death investigation and autopsy pathology and to provide a model that can encourage interest in a career in forensic pathology.     

The response of relatives to medicolegal investigations and forensic autopsy

Relatives of deceased persons, on whose body a forensic autopsy had been performed at the Institute of Forensic Science, Bern, Switzerland, were interrogated by a questionnaire. The aim was to investigate the attitude of relatives toward medicolegal investigation procedures in general and toward forensic autopsy in particular. A great majority of the relatives showed a positive or indifferent attitude toward a forensic autopsy. They showed a great interest in autopsy results and wished to be informed. It was concluded that information given before the autopsy is important for better understanding and can, if properly given, improve the relatives' acceptance and collaboration regarding forensic investigations. By contrast, a lack of information before the autopsy and about the autopsy results can cause further suffering on behalf of the bereaved. A forensic autopsy can be of great benefit for relatives and can help them to cope with a tragic loss.     

Medicolegal death investigator workplace safety hazards: A scoping review of the literature

In the United States, medicolegal death investigation practices and policies pertaining to sudden unexpected deaths are mandated by state government. Practices vary across states, which contributes to inconsistency in job prerequisites and training. In preparation for a study focused on occupational safety and health of medicolegal death investigators in their on-scene and follow-up activities, a scoping review was conducted to document known occupational safety risks and health-related conditions associated with death investigation. Searches used Boolean and subject heading operators both broad and narrow in scope, and search terms included scene responder, hazard, investigator, forensic pathology, injury, and safety. Twenty-five articles met inclusion criteria, which included seventeen survey-mixed method designs, two systematic reviews, five quasi-experimental designs, and one case study. Twelve articles addressed mental health and eleven focused on risks associated with infectious disease. One article addressed the risk of chemical exposure from cyanide among autopsy personnel (including forensic pathologists) and nine included a wide range of employees within the setting of medical examiner or coroner offices. One article, addressing burnout, included employees in a forensic science laboratory setting as well as medicolegal death investigators and two articles included forensic pathologists and medicolegal death investigators. Only one article addressed medicolegal death investigators specifically. Articles addressing occupational and environmental hazards of medicolegal death investigators associated with musculoskeletal, respiratory, cardiovascular, radiological, nuclear, electrical, or explosive threats were not identified. There is little published about safety risks inherent in conducting death investigations. Research is needed to adequately inform health promotion and injury prevention strategies.     

Is routine histopathologic examination beneficial in all medicolegal autopsies?

Postmortem examinations are performed for a number of reasons. Medical autopsies are performed at the request of and with the consent of the next of kin of a decedent and are often requested to determine the extent of a disease process or to evaluate therapy. In contrast, medicolegal autopsies are performed by a forensic pathologist primarily to determine cause and manner of death but also to document trauma, diagnose potentially infectious diseases and report them to the appropriate agencies, provide information to families about potentially inheritable diseases, provide information to family members and investigative agencies, and testify in court. As medicolegal and hospital autopsies differ in their purpose, so do they differ in procedure. Medicolegal autopsies often include histologic analysis, but not always, as with medical autopsies. We designed a prospective study to address the question of whether or not routine histologic examination is useful in medicolegal cases, defining a routine case as one where histology would not normally be performed and where the cause and manner of death were readily apparent during the gross autopsy. We reviewed brain, heart, liver, kidney, and lung sections on 189 routine forensic cases and compared the results to the gross anatomic findings. Of the 189 cases, in only 1 case did microscopic examination affect the cause of death and in no case did microscopic examination affect the manner of death. Thus, we feel that routine microscopic examination (performing histologic examination in all cases regardless of cause and manner of death) in forensic autopsy is unnecessary. Microscopic examination should be used, as needed, in certain circumstances but is not necessary as a matter of routine.     

Origin and development of forensic medicine in India

CONTEXT:: The medical profession is one of great antiquity in India. However, the history of medicine and, in particular, the role of medicine in the administration of justice in India has not been discussed very much. The present paper attempts to fill in this lacuna and traces the medicolegal practice from ancient times to British India. SOURCE:: This paper is based on archival materials collected from the Tamilnadu State Archives, Chennai, and Madras Medical College Library, Chennai, and University of Madras Library, Chennai. MAIN OBSERVATIONS:: The medical men in ancient India were considered as men of wisdom, and one of the ancient Tamil hymns equates the doctor-patient relationship to that of the dedicated love of a devotee to God. Kautilya's Arthashastra gives a list forensic evidence for establishing the cause of death and describes the necessity of autopsy in establishing the cause of death.In British India, the early incidence of custodial death and its certification by medical practitioners, issuance of medical certificate and wound certificate, and medicolegal autopsy are documented. The most outstanding contribution of India to legal medicine during this period is modern dactylography. It is recorded that there was a high ratio of homicidal poisonings in India.     

The forensic radiographer: a new member in the medicolegal team

Multidetector computed tomography is becoming more widespread in forensic medicine. In most services, autopsy assistants perform the radiological examination. We introduced professional radiographers into the legal medicine service and hypothesized they would also be able to take over duties currently reserved for other specialists. The aims of this study were to evaluate if radiographers could be trained as "forensic radiographers" by (1) integrating graduated medical radiographers into the legal medicine service, (2) investigating the advantages of this collaboration, and (3) defining the duties of the forensic radiographers.The study was performed prospectively on a group of 8 recruited radiographers who underwent a testing period with special training. They learned the basics of medicolegal case treatment, the autonomous execution of postmortem computed tomography angiography, and postprocessing of data. Seven of 8 radiographers finished the training and were integrated into our service. Although all radiographers were able to fulfill the duties demanded after the training period, some radiographers could not enter or complete the program because they were unable to work with dead bodies.Our study presents the advantages of integrating radiographers into the medicolegal team and proposes how to train the forensic radiographers. In addition, the duties and responsibilities of these new specialists are defined.     

Postmortem Computed Tomography in Firearm Homicides: A Retrospective Case Series,

Postmortem computed tomography (PMCT) is integrated into the evaluation of decedents in several American medical examiner offices and medicolegal death investigative centers in many other countries. We retrospectively investigated the value of PMCT in a series of firearm homicide cases from a statewide centralized medical examiner’s office that occurred during 2016. Autopsies were performed or supervised by board-certified forensic pathologists who reviewed the PMCT scans prior to autopsy. PMCT scans were re-evaluated by a forensic radiologist blinded to the autopsy findings and scored by body region (head–neck, thoracoabdominal, and extremities). Injury discrepancies were scored using a modified Goldman classification and analyzed with McNemar’s test. We included 60 males and 20 females (median age 31 years, range 3–73). Based on PMCT, 56 (79.1%) cases had injuries relevant to the cause of death in a single body region (24 head–neck region, 32 thoracoabdominal region). Out of these 56 cases, 9 had a missed major diagnosis by PMCT outside that region, including 6 extremity injuries visible during standard external examination. Yet all had evident lethal firearm injury. We showed that PMCT identifies major firearm injuries in homicide victims and excludes injuries related to the cause of death in other regions when a single body region is injured. Although PMCT has a known limited sensitivity for soft tissue and vascular pathology, it can be combined with external examination to potentially reduce or focus dissections in some of these cases depending on the circumstances and medicolegal needs.     

Forensic Radiology Pitfalls: CT Imaging in Gunshot Wounds of the Head

Computed tomography (CT) imaging is increasingly used in emergency departments and trauma services and is being offered as a supplemental tool with autopsy in coroner's and medical examiner's offices throughout the United States. The availability of CT images in lieu of traditional X‐rays for medicolegal autopsies may lead to misinterpretation of images for forensic pathologists who are not familiar with these types of images. Forensic pathologists must become familiar with CT imaging, the basis of CT image formation and how to interpret CT images appropriately. We highlight potential pitfalls of CT image interpretation through two cases of fatal gunshot wounds of the head. Antemortem CT imaging available at the time of autopsy led to discrepancy between the initial image findings and the autopsy due to inexperienced manipulation of the images. With appropriate understanding of CT image interpretation and manipulation, forensic personnel should be able to avoid most sources of misinterpretation.