Forensic-medical obstetric-gynecological examinations in cases on professional delinquency of medical personnel

We studied the trend in the number of forensic-medical examinations in trials against obstetricians and gynecologists conducted in Primorsky Region in 1997-2005. Most typical defects in obstetric-gynecological care are characterized. These cases are analysed in terms of forensic-medical practice. Detection and forensic-medical analysis of the above defects contribute to optimization of the diagnosis and treatment both in obstetric-gynecological practice and in wide medical practice.     

Forensic-medical evaluation of medical care errors in obstetric-gynecological practice

The authors show the necessity of elaboration and practical application of normative documents (standards) and forensic-medical criterions of assessment of defects in obstetric-gynecological medical aid. The examples of the above assessment are given in the article.     

Sexual assault examinations and forensic medical samples

Recent studies and a review in the United States have identified that tens of thousands of used but untested sexual assault examination kits containing medical examination specimens are to be found in police station evidence rooms, forensic science laboratories, hospitals and rape crisis centres. A 2007 survey undertaken by the National Institute of Justice in the United States explored some of the reasons why forensic specimens are not tested by forensic science laboratories. Many of these relate to lack of knowledge on the part of investigators as to how scientific information can assist the investigation process, even if not used subsequently at trial. Cost factors and laboratory casework overload were also identified as significant. For the medical practitioner, the lack of testing poses issues that include quality management of the forensic medical examination and informed consent in a setting requiring the balancing of public and private benefits for the examinee. Limiting scientific testing, even with intelligence-led triaging of sample testing, could have an adverse effect on both prosecution and defence decision-making and ultimately could adversely affect trial outcomes.     

论临床诊断与法医学鉴定结论的区别

医师运用医学知识 ,结合实践经验和病人的症状和体征以及相关的辅助检查资料判断疾病 ,称为临床诊断。临床诊断有门诊诊断、住院诊断、手术诊断等等。而法医学是应用医学、生物学及其他自然科学的理论和技术 ,研究并解决法律实践中有关医学问题的一门科学。法医学鉴定结论则是法医学鉴定人对案件经办者所提供的人和物等检材进行检查、判断 ,将分析意见、审查结果写成结论以解决案件的实质性问题。临床诊断与法医学鉴定结论两者既有联系 ,又存区别。过去曾有将临床诊断直接作为损伤的办案证据 ,从而产生不良影响的教训 ,应引以为鉴。现将两者…     

论临床诊断与法医学鉴定结论的区别

医师运用医学知识,结合实践经验和病人的症状和体征以及相关的辅助检查资料判断疾病, 称为临床诊断.临床诊断有门诊诊断、住院诊断、手术诊断等等.而法医学是应用医学、生物学及其他自然科学的理论和技术,研究并解决法律实践中有关医学问题的一门科学.法医学鉴定结论则是法医学鉴定人对案件经办者所提供的人和物等检材进行检查、判断,将分析意见、审查结果写成结论以解决案件的实质性问题.临床诊断与法医学鉴定结论两者既有联系,又存区别.过去曾有将临床诊断直接作为损伤的办案证据,从而产生不良影响的教训, 应引以为鉴.现将两者的区别叙述如下:     

Learning in practice for becoming a professional forensic expert

The study explores the professional development of future forensic experts. Specifically, it investigates how the forensic expert trainees learn through the internal training program at the Swedish National Laboratory of Forensic Science with a focus on the supervision at work. The findings are drawn from an ethnographical study where five trainees and their supervisors have been observed and interviewed. By drawing on a socio cultural perspective on learning, the results show that supervision is crucial for professional development. Two types of activities and relations define how supervision is implemented. There is a "transitional movement" in how supervision is staged depending on the trainees' gradual changes in participation in the work practice and increased experience. Forensic experts need skills and know-how to make wise and impartial judgments, i.e. a kind of tacit professional practical knowledge, as well as the skill to communicate with other professionals. However, the development of a professional language is somewhat unspoken or planned. Becoming a forensic expert is a learning process in practice where supervision plays a decisive role in maintaining the professional knowledge in the judicial system. Therefore, supervision for supervising might be a valuable support for supervisors.     

Posttraumatic neurosensory hypoacusis in forensic medical practice

Literature data and results of epidemiological examination show that traumas play a significant role in emergence of neurosensory hypoacusis (NSHA) in young healthy population. The diagnosis of NSHA is often missed in forensic-medical examination and this may cause a social problem. Audiometric signs of NSHA were studied in subjects with trauma of the labyrinth. Pure tone audiometry results can be used for differential diagnosis of mechanical and barotraumas and as additional criteria in determination of the harm to health.     

多层螺旋CT诊断颅底骨折及其法医学应用价值

目的 比较多层螺旋CT三种重建方法在显示颅底骨折方面的差异,探讨其在法医学鉴定中的应用价值。方法 对40例颅脑外伤后怀疑颅底骨折的伤者进行多层螺旋CT扫描,然后将容积数据输入工作站进行横断面重建、多平面重建(MPR)和三维重建,三维重建采用表面显示法(SSD)。结果 24例颅前窝骨折,其中横断面显示骨折9例,MPR显示骨折24例,SSD显示9例;3组比较有显著性差异(P<0.001)。24例颅中窝骨折,横断面显示骨折15例,MPR显示骨折24例,SSD显示骨折4例;3组比较有显著性差异(P<0.001)。横断面重建和MPR均显示颅后窝骨折3例,两者无明显差异,SSD有1例显示。结论 SSD成像直观立体地显示了骨折的形态、走行、空间位置等情况,但对细小骨折显示不佳;多层螺旋CT检查可用于颅底骨折的法医学鉴定。     

Decision making and examiner bias in forensic expert recommendations for not guilty by reason of insanity

Source of nomination (prosecution, defense, judge) was varied in a fictional not guilty by reason of insanity (NGRI) case distributed to 180 community forensic evaluators in a state employing theM'Naghten rule. Differences among examiners by appointment for the final NGRI judgment was not significant; interrater reliability for psychopathological symptomatology was .73. Discriminant analysis revealed significant differences in the decision-making process between evaluators recommending sanity and those endorsing insanity, as well as between psychiatrists and psychologists.     

Combined trauma and sepsis in forensic medical practice

The relationship between combined injury and sepsis is an important problem of forensic medicine. A total of 227 cases with combined injuries have been investigated postmortem at Bureau of Forensic Medical Expert Evaluations of Moscow in 1997. Sepsis developed in 9.7% cases. The studies revealed a direct cause-and-effect relationship between mechanical injuries and development of sepsis in the overwhelming majority of cases. Sepsis may develop at any period of the traumatic disease, except the first one, and the infection is prone to generalization in the remote postoperative period.     

Antigenic differentiation of blood stains by the Lewis system in practical forensic medical expert evaluation

A modification of quantitative absorption and absorption elution tests with blood stain washing before the absorption phase is presented. Due to washing, the effect of carrier object on anti-Le(a) and anti-Le(b) sera is decreased and the sensitivity of the method is increased. Additional adsorption of the sera and elution into test erythrocytes treated with protease C is suggested for increasing the number of standard sera fit for the absorption-elution test. A new technology for preparing anti-Le(a) and anti-Le(b) immunoreagents is described.     

Urgent problems of forensic medical expert evaluation of disability in civil suits

The author discusses urgent medicolegal problems related to evaluation of the degree of occupational disability, necessity of additional diet for victims, which arise in connection with civil actions of persons who underwent non-occupational trauma.     

New prospects in forensic medical expert evaluation of perforating wounds of the eye

The criterion "percentage of stable loss of total working capacity" is usually used in expert evaluation of perforated wounds of the eyes. However it does not always allow an objective evaluation of the ocular status. Visual acuity can vary greatly during the posttraumatic period for a rather long time, becoming worse or better during up to 1 year. Treatment and observations of 160 victims (165 eyes) helped determine the major clinical symptoms of perforated wounds and distinguish 8 symptoms characteristic of severe injuries. Use of these symptoms as criteria for evaluating the severity of injury inflicted to health helps make an objective conclusion without waiting for recovery.     

骨盆损伤鉴定的影像学检查方法选择探讨

目的通过研究骨盆结构和常用影像学检查方法,对骨盆损伤的影像学检查方法的选择提出建议。方法研究数例法医学鉴定中骨盆损伤的案例,结合骨盆环的生物力学和骨盆损伤分型,并对X线透视、X线摄片检查、CT等检查方法进行比较。结果四个骨盆损伤案例都是多发损伤,通过X线和CT检查均能满意地确认。结论结合骨盆致伤方式和生物力学,注意被鉴定人是否存在多发伤,来选择适合的影像学检查方法以正确评价骨盆损伤。     

Case studies in forensic soil examinations

The examination and comparison of forensic soil samples is discussed. The origin of a simple and easy to learn procedure used and modified by the authors is reviewed. The process begins with a preliminary observation, removal of artifacts, and sieving of each specimen. A specific size fraction is split into three fractions for color matching, polarized light microscopy (PLM) examination (particle counting) and optional gradient comparison. Next, several cases are reviewed in which the modified method was used to evaluate the likelihood of common origin for questioned and known specimens.     

Naturalistic decision making in forensic science: toward a better understanding of decision making by forensic team leaders

This study uses the naturalistic decision-making (NDM) perspective to examine how Dutch forensic team leaders (i.e., the officers in charge of criminal forensic research from the crime scene until the use of laboratory assistance) make decisions in real-life settings and identifies the contextual factors that might influence those decisions. First, a focus group interview was conducted to identify four NDM mechanisms in day-to-day forensic decision making. Second, a serious game was conducted to examine the influence of three of these contextual mechanisms. The results uncovered that forensic team leaders (i) were attracted to obtain further information when more information was initially made available, (ii) were likely to devote more attention to emotionally charged cases, and (iii) used not only forensic evidence in the decision making but also tactical, unverified information of the police inquiry. Interestingly, the measured contextual influences did not deviate significantly from a control group of laypeople.