The method for expert assessment as a tool for the improvement of the methodological basis of the activities of a bureau of forensic medical expertise

An important aspect of the problem of iatrogenic poisoning is the lack of comprehensive relevant information. Many experts employed at the bureaus of forensic medical expertise believe that this problem can be resolved only based on a multifaceted approach. The results of questionnaire studies and cause-and-effect analysis allowed the following recommendations to be proposed for addressing the problem under consideration: making a minimal list of equipments necessary to maintain activities of forensic medical departments, updating the list of toxic substances to be studied in the laboratories of bureaus of forensic medical expertise, modification of the reporting form No 42 to be filled by such bureaus. The optimal approach is thought to be the equipment of all bureaus in compliance with the universal requirements, introduction of standard methods and technologies for the analysis of the materials included in the list of toxic substances to be determined.     

Forensic medical evaluation of flaws in medical care rendered at public health institutions in the Russian Federation

The authors analyze the flaws in medical care rendered at various public health institutions by the results of 2436 expert committee conclusions, verified at bureaus of forensic medical expert evaluations. The essence and causes of these defects at the hospital and prehospital stages of medical care, rendered by physicians of different specializations and nurses, are analyzed.     

Discrimination between functions of an expert bureau and a burial firm (topic for discussion)

The authors suggest measures aimed at discrimination of the functions performed by forensic medical experts and the services rendered by burial firms. The responsibilities of pathology departments of hospitals and bureaus of forensic medical expert evaluations, which should be reflected in official documents, should be confined to manipulations needed to solve the professional problems and removal of sections. Cases when utilization of certain chemicals or manipulations aimed at restoration of the body are prohibited should be listed in detail. The order of transfer of the body from pathology department or forensic medical bureau to the burial firm and to relatives should be regulated with consideration for the results of autopsy. The moment of the end of autopsy studies is to be determined.     

The material-and-technical equipment of state forensic medical bureaus of Russia's defense ministry: realities and outlooks

Issues related with the material-and-technical outfit of state forensic medical bureaus of Russia's defense ministry are under discussion. The present-day condition of their instrumentation degree is described; methods are suggested of how to build up the material-and-technical base by using the limiting form system with the "conclusive medicine" principles.     

Origin and development of forensic medicine in the Kingdom of Saudi Arabia

The medicolegal death investigation system in the Kingdom of Saudi Arabia (KSA) is unique in the world. It is exclusively derived from Islamic judiciary based on Shari'ah law, which is the definitive Islamic law or doctrine. This law is applied on Saudi citizens as well as foreigners. This is different from other Islamic countries, which have a combination of Islamic and other judiciary systems.The forensic medicine centers in KSA are related administratively to the Ministry of Health (MOH) and its subdivisions in the different governorates. They are concerned with forensic medical examination and autopsy, as well as the clinical forensic medical examination of sexual assault cases, and those injured in civil and criminal cases. The assisting laboratories (forensic histopathology, microbiology, serology, forensic chemistry) are working independently under the funding of MOH, whereas the DNA laboratory and other departments of forensic sciences, for example, counterfeiting and forgery unit are related administratively to the Ministry of Interior represented by the Administration of Criminal Evidences. Efforts concerning crime scene investigations are shared with Administration of Criminal Evidences' crime scene investigators.Forensic medicine education in KSA developed in the past few years after the foundation of Saudi specialty certificate in forensic medicine. The certificate is a postgraduation qualification equivalent to a doctorate degree in forensic medicine and requires completion of a 4-year training program in both MOH- and Ministry of Interior-related departments, as well as passing annual evaluation and examination.This review is aimed at providing in the next decade the medicolegal centers with national forensic specialists throughout the kingdom and granting skillful headships for the next generations. Moreover, this review suggests more scientific associations with the academic universities in the various fields of forensic sciences through academic cooperation.     

Characteristic of mortality in the Russian Federation

The objective of the present work was to estimate the overall mortality in the Russian Federation and to elucidate the structure and characteristics of violent and non-violent mortality in this country. The study is largely based on the materials of reports on the activities of local bureaus of forensic medical expertise for the period from 2003 to 2008; in addition, the data from the official demographic and statistical yearbooks issued by the Russian State Statistical Committee (Goskomstat) in 2008-2009 were used. It is shown that cardiovascular pathology appears to be currently the leading cause of general mortality in the Russian Federation. A substantial fraction in the structure of general mortality is constituted by mechanical injuries most of which are inflicted in car accidents. More than half of the fatal cases caused by external factors and around one third of the deaths from cardiovascular diseases are associated with alcohol intoxication. Statistical treatment of the results of analysis conducted in the present study provided materials for the development of recommendations designed to improve the demographic situation in the Russian Federation.     

Forensic medical expertise of injuries in the anorectal region and rectum related to the sexual assault

Injuries to the anorectal region and rectum associated with sexual crimes require forensic medical assessment even though this issue remains to be poorly developed. The results of 84 forensic medical expertises are presented based on the materials obtained by examining both women and men who applied with complains of sexual abuse (anogenital penetration) to the Primorskoye territorial Bureau of forensic medical expertise during 5 years, from 2005 to 2009. The study has demonstrated correlation between dynamics of applications of the victims of either sex and the lack of a tendency toward a decrease in their frequency. The signs characteristic of acute injuries and chronic conditions are described. The causes of diagnostic errors during forensic medical expertise of sexual abuse are discussed.     

Determination of the severity of endogenous intoxication at the level of average molecular peptides

A possibility was demonstrated of using the method related with determination of the level of average-weight molecules or average molecules (AM) for the diagnosis of sudden death in forensic medical expertise of cadaver. Blood plasma was investigated according to the method of M.I. Gabriekyan modified by Yu. V. Pervushin, which involves deproteinization of samples with subsequent spectrophotometry at 254 and 280 nm. The AM levels were studied in different pathologies including cardiovascular diseases, alcoholic and narcotic intoxications and pneumonia, caused by a variety of agents, as well as the syndrome of sudden children's death. An analysis of the obtained results denotes a possibility of using the postmortem determination of the AM level concurrently with determination of an endogenous intoxication degree in the forensic medical practice for establishing the cause and mechanisms of nonviolent death.     

论鉴定留置的若干法律问题

鉴定留置指为鉴定被告心神或者身体状态，而将被告送入医院或者其他适当处所之处分。鉴定留置的存在是与法医学的发展休戚相关。从某种意义上讲，现代去医学发展的不成熟是鉴定留置制度存活的土壤。鉴定留置应定性为一种依附性行为。即依附于强制鉴定，其本身属于调查程序。而非强制处分。鉴定留置属于强制鉴定延伸的自然结果．而强制鉴定将在一定程度上限制被告人的行动自由。应当接受司法审查。强制鉴定作为一种独立的强制措施．对自由的侵犯程度不可与羁押同日而语，甚至其结果可能减轻或者免除被告人的刑事责任。因此在司去审查控制下的鉴定留置期间不应当计入羁押期间。     

Tasks of research in forensic medicine - different study types in clinical research and forensic medicine

In the last years the research output of forensic medicine has sometimes been regarded as insufficient and as of poor quality, especially when parameters as impact factors and external funding were taken into account. However, forensic medicine has different tasks compared to clinical medicine. The main difference between basic subjects, clinical and forensic medicine is not a lack of scientific efficiency in forensic medicine but is a result of the questions asked, the available methods and specific aims. In contrast to natural-scientific research, forensic science has furthermore important intersections with arts and socio-scientific disciplines. Etiologic and pathogenetic research is of only limited relevance in forensic medicine. Thus, forensic medicine is excluded from these research fields, which are mainly supported by external funding. In forensic medicine research mainly means applied research regarding findings, the probative value and reconstruction as well as examination at different points of intersection between medicine and law. Clinical types of research such as controlled randomised, prospective cross-sectional, cohort or case-control studies can only rarely be applied in forensic medicine due to the area specific research fields (e.g. thantatology, violent death, vitality, traffic medicine, analytical toxicology, hemogenetics and stain analysis). The types of studies which are successfully established in forensic medicine are comparison of methods, sensitivity studies, validation of methods, kinetic examinations etc. Tasks of research in forensic medicine and study types, which may be applied will be addressed.     

产前畸形筛查医疗损害责任之司法鉴定20例分析

目的：研究产前畸形筛查医疗损害责任司法鉴定案件的一般规律及其医疗损害责任司法鉴定的特点,为法医学鉴定提供理论支持。方法：对20例产前畸形筛查医疗损害责任司法鉴定案例进行回顾性分析。结果：产前畸形筛查医疗损害责任司法鉴定案例逐年增多;发生纠纷的医疗机构以市（区）级为多见,发生纠纷的案件中以手足畸形和先心病多见;医疗损害责任司法鉴定的主要原因为医疗技术缺陷与医疗管理缺陷。     

医源性相关的异物医疗纠纷研究

目的探讨医源性相关异物医疗纠纷特点。方法对华西医科大学法医学院1990～2003年间18例医源性相关异物残遗留案例进行分析。结果男性10例,女性8例,年龄为48天～47岁,平均27岁,医源性相关异物残遗留以县、市级医院为主,门诊、妇产科及外科多见,可以外伤后异物残留未诊断、治疗中医疗异物遗留体内、治疗机械断裂或诈病形式出现。结论与国外的情况进行比较,并提出相应预防措施。     

The forensic medical expertise of the victims of large-scale fires]

The difficulties of present-day forensic medical expert evaluation of poisonings in fires are explained by exposure of man to highly toxic compounds that form during burning of polymers. Analyzing forensic medical expert evaluations of a large number of victims dead in a large-scale fire, the authors emphasize the necessity of measuring not only dead people's blood levels of HbCO, but of some other toxic combustion products that may exert combined effects on human body. The authors think it desirable that criteria of forensic medical evaluation of combined poisoning in fire be defined.     

Current status and prospects for developing chemical-toxicological (forensic chemical) studies in the Russian Federation

The authors discuss modern state and prospects of planning and carrying out research in forensic (toxicological) chemistry within the framework of practical forensic medical expert evaluation, state of forensic medical expert evaluation of alcohol and narcotic intoxication, and other pressing problems of forensic medical expert practice.     

The Rigor of Research Design and “Forensic” Publications in Neuropsychological Research

Seven neuropsychology journals that publish on topics relevant to clinical neuropsychology were examined for their experimental rigor according to the standards of the American Academy of Neurology (AAN) in their Clinical Practice Guidelines. By using a keyword approach on topics relevant to forensic neuropsychology, all articles that reported empirical findings from 2003 through 2008 were identified. Each study was rated by AAN classification criteria that ranged from a level I classification (prospective, most rigorous, and independent) to level IV (least rigorous). The typical forensic neuropsychological study averaged a class III ranking. Few studies were based on large sample sizes or utilized a reported masking or blind technique with regards to subject selection and how diagnostic criteria were met and/or data analyzed. While the authors for the average study reported a university affiliation, few reported explicit Institutional Review Board statements. Considerable variability across these seven journals with regards to conflict of interest (COI) disclosure policies was observed and only a few studies reported explicit statements about funding or COI issues. These observations suggest that neuropsychological research on forensic topics currently has many limitations and that future research needs to address these issues.     

试论法医学鉴定和医学鉴定之差异

随着司法鉴定制度改革的不断深入,越来越多的临床医学从业人员加入到法医学鉴定的队伍中来。在这种大趋势下,一个极易形成的误区就是把医学鉴定与法医学鉴定混淆起来。事实上,两者虽然在许多方面有相似之处,但毕竞有本质的不同。医学鉴定重视的是损伤本身,而法医学鉴定则是在医学鉴定基础之上,从法律规定的角度为损伤定性。因此,要求我们的法医学鉴定人既要重视医学知识的培训和提高,也要学习法律知识和法医学知识,才能更好地完成司法鉴定工作。     

手术并发症发生因素与医疗过错鉴定

医疗损害案件中因手术并发症而导致的占了很大的比重。发生手术并发症的发生原因可归结为医疗与患者两个方面。医疗方面的因素主要包括手术人员的责任心不强、医学基础知识欠缺、医疗技术生疏、诊断失误、术后护理及管理缺陷等;患者方面的因素主要有自身解剖变异、个体体质差异等。手术并发症产生的原因大多是可以被认知的,在此基础上判断产生手术并发症的医疗行为是否有过错时不能一概而论,应遵循一定的标准。建议按照医学理论和实际操作能力划分为两个标准,预见义务采用＂医学水平＂标准;防范义务采用＂医疗水平＂标准。通过两个＂标准＂来综合考量手术并发症才是科学的。     

2012年法医临床学研究进展

本文以中国知网为网络搜索平台,综述了2012年法医临床学研究领域的最新进展,主要包括伤残鉴定、损伤程度鉴定和医疗纠纷鉴定等。上述内容代表了法医临床学研究领域的最高研究水平。     

创伤科病历书写相关缺陷及其对司法鉴定的影响

病历是创伤病人进行司法鉴定的重要客观资料，病历书写中相关缺陷直接或间接影响着司法鉴定活动的正常进行。分析创伤科病历书写中的一些常见缺陷对司法鉴定带来影响，强调提高创伤科医务人员的法律意识及病历书写质量是保证司法鉴定结论客观公正的重要因素之一。