Recent status of the medical examiner system in Japan: demographic variation of medicolegal deaths in Hyogo Prefecture and uncertainty in medicolegal investigations conducted by medical practitioners.

The medical examiner system has been steadily abolished in Japan. Instead, medicolegal investigations are entrusted by the police to medical practitioners, who are not permitted to perform autopsies. The necessity for the medical examiner system was assessed through inquest records in Hyogo, one of the three prefectures which still have medical examiner systems. Standardized mortality ratios (SMRs) for accidents and suicides were negatively associated with population density, being high in rural areas with a large proportion of elderly citizens, while the SMR for natural deaths was high in urbanized areas and associated with the proportion of inquests to total resident deaths. The high proportion of inquests, however, did not always mean that inquest records were of good quality. Significant differences in the quality of medicolegal investigations seemed to exist between medical examiners and medical practitioners. That is, in order to certify the cause-of-death, medical examiners performed autopsies in about half of their cases, while only 2% of medical practitioner cases were subjected to autopsies. Medical practitioners, who certified the cause-of-death as "heart failure" without advising an autopsy, were regularly entrusted with inquests. It is likely that the causes-of-death for medicolegal cases may be questionable since more than 85% of all medicolegal deaths were investigated by medical practitioners, which may cause inaccuracy in at least 3-7% of mortality statistics. It is necessary to educate medical practitioners concerning the importance of mortality statistics and ICD and on the validity of autopsies, in order to obtain accurate mortality statistics from medicolegal cases.     

Schizophrenia and sudden death: a medical examiner case study.

This study reviews the causes of sudden death of 66 schizophrenic patients who presented to the Office of the Chief Medical Examiner (OCME) for the State of Maryland over a 3-year period from 1994 through 1996. We identified an increased incidence of suicide compared with the general population of OCME cases. This observation is consistent with reports by other investigators. The majority of the deaths were the result of natural diseases, mostly atherosclerotic cardiovascular disease. Accidents, suicides, and 1 homicide were also present in this group.     

The "new" genetics: emerging medicolegal issues in the prenatal issues in the prenatal diagnosis of hereditary disorders.

Major advances in prenatal genetic diagnosis have occurred in the past few years which pose difficult challenges to the law. This paper raises questions relative to family history taking, genetic counseling, carrier detection, amniocentesis, and prenatal genetic studies, and also raises questions with respect to the rights and responsibilities of the patient, the fetus, the physician, and society in light of such modern advances. Law reform often occurs only after prior harm to an individual, family or group. Perception and delineation of the most important issues in this area should serve to stimulate the development of medicolegal guidelines and corrective legislation prior to the occurrence of a genetic tragedy.     

Nonhuman remains and relics encountered by the medical examiner: Fulton County, Georgia, 2003-2004

BACKGROUND: Medical examiner and coroner offices occasionally respond to "death scenes" which, after investigation, are found to involve nonhuman remains or other relics not requiring further investigation or certification of death. This report describes such cases encountered by the Fulton County medical examiner during 2003 and 2004. METHODS: The electronic database used by the office contains check boxes to indicate whether a reported case involved nonhuman remains or other relics, in which case the name of the "deceased" is listed as "nonhuman remains" by selecting those words from a pull-down menu. Subject cases were identified during the 2-year period by searching the database for any case in which one of the boxes was checked or in which the name of the deceased was listed as nonhuman. RESULTS: Four thousand five hundred fifty-four deaths were investigated during the 2-year period, and 23 cases (0.5%) involved nonhuman remains or relics. Thus, the observed rate was about 5 cases per 1000 death investigations. Nineteen cases involved nonhuman bones. One case involved 2 human fetuses that had been teaching specimens. The other 3 cases involved a nonhuman fetus, a large decomposing dog that had been wrapped and dumped in residential area, and a sheep heart found in a bag which was a medical teaching specimen. CONCLUSIONS: Nonhuman remains and other relics are uncommonly seen in death investigation work and usually involve nonhuman bones, although a small variety of other atypical cases present themselves occasionally. Knowledge of these types of encounters is helpful so that the "unexpected" may become more "expected" and office policy and procedures tailored accordingly to facilitate case management.     

The predictive value of history and scene investigation for toxicology results in a medical examiner population

Medical examiner offices vary in the extent to which they pursue postmortem toxicology. Our office routinely tests decedents for ethanol and drugs of abuse, and we decided to evaluate the usefulness of our practice. We reviewed 1180 medical examiner cases examined in 2002-2003. History and scene investigation indicated that alcohol or drugs of abuse were likely to be detected in 369 cases, yet toxicology testing revealed an intoxicating substance in 589 cases, a prevalence of 50%. Screening for toxicology testing based on investigative findings had a sensitivity of 0.47, a specificity of 0.84, and a positive predictive value of 0.74. Moreover, even in the 811 cases where initial investigation did not suggest substance abuse, toxicology testing revealed at least 1 substance that was pertinent to the subsequent investigation in one third of the cases (260), and the intoxicating substance was sufficiently important to merit inclusion as a cause of death or contributing factor in nearly half of those cases (113). We conclude that investigation alone is ineffective at predicting the presence of intoxicating substances within decedents.     

U.S. experiences with racial and ethnic profiling: history, current issues, and the future

The issue of racial and ethnic bias in policing has been the focus of legal and criminal justice scholarship, court action, and public debate in the U.S. for a number of years. The issue has also been prominent in criminal justice scholarship, public discussion, and policy making in other countries, particularly the U.K., for an even longer period. This article surveys the history of the issue in the U.S. and attempts to give scholars and policy makers the benefit of the insights gained through the U.S. experience in handling the issue. Among these are the importance of the empirical question of the “hit rate” and how police use of race or ethnicity as a criterion changes it, and the difficulties of dealing with the thorny benchmarking issue. The article also discusses how advocates in the U.S. have attempted to meet and overcome arguments that police and their supporters have made in an attempt to minimize the problem or justify doing little or nothing about it.     

管理医疗机构公共安全视频图像信息系统的法律依据及相关问题

按照实施先后排序,对《北京市公共安全图像信息系统管理办法》等12省市地方立法、《中华人民共和国反恐怖主义法》、上海市《重点单位重要部位安全技术防范系统要求》(DB31/329.11-2009)等法律、法规、部门规章和地方技术标准进行梳理,结合案例说明医疗机构在建设、管理和使用公共安全视频图像信息系统的主要法律责任和需注意的若干问题。     

Medical devices; medical device, user facility, distributor, and manufacturer reporting, certification, and registration--FDA. Tentative final rule

The Food and Drug Administration (FDA) is issuing a tentative final rule to require that device user facilities and distributors, including importers, submit reports to FDA and to the manufacturers, of deaths, serious illnesses and serious injuries related to medical devices. FDA is authorized to issue regulations implementing reporting requirements for user facilities and distributors by certain provisions of the Safe Medical Devices Act of 1990 (the SMDA). This tentative final rule also amends existing reporting requirements for manufacturers to conform them with the proposed reporting requirements for user facilities and distributors, and requires distributors and manufacturers to report certain malfunctions that may cause a death, serious illness or serious injury. The tentative final rule also requires foreign manufacturers to be subject to the same reporting requirements as domestic manufacturers. FDA is designating this document a tentative final rule, although under the Administrative Procedure Act it is a proposed rule. Because of the statutory deadlines discussed below, this "tentative final rule" alerts the public not only to the agency's interest in receiving comments, but also to the need for device user facilities, distributors, and other affected persons to begin preparing for compliance.     

Medicare program; Medicare and laboratory certification program; enforcement procedures for laboratories--HCFA. Final rule

These regulations set forth the rules for sanctions that HCFA may impose on laboratories that are found not to meet Federal requirements. These include the principal sanctions of suspending, limiting, or revoking the laboratory's certificate issued under the Clinical Laboratory Improvement Amendments of 1988 (CLIA), and cancelling the laboratory's approval to receive Medicare payment for its services, and the alternative sanctions that may be imposed instead of or before the principal sanctions. These amendments are necessary to conform HCFA regulations to changes made in the law by the Omnibus Budget Reconciliation Act of 1987 (OBRA '87) and the 1988 amendments to section 353 of the Public Health Service Act (PHS Act). The latter are commonly referred to as "CLIA 88". The purpose of the amendments is to ensure that functioning laboratories are capable of providing accurate and reliable test results and that the health of individuals served by the laboratory and that of the general public is not adversely affected by laboratory operations and by testing procedures that do not meet the standards set forth in other subparts of part 493 of the HCFA regulations.     

Modification of certain medical standards and procedures and duration of certain medical certificates. Final rule

This rule extends the duration of first- and third-class medical certificates for certain individuals. A first-class medical certificate is required when exercising airline transport pilot privileges and at least a third-class medical certificate when exercising private pilot privileges. Certain conforming amendments to medical certification procedures and some general editorial amendments are also adopted. The intent of this action is to improve the efficiency of the medical certification program and service provided to medical certificate applicants.     

医院设置医务社会工作部门相关问题研究

医务社会工作是一种助人性质的工作,在医院内的职能包括开展个案辅助工作、协调医患关系等。医务社会工作在医院内作为一个独立的部门也会遇到很多问题,因此应该提供相应策略,从而让医务社会工作更好地为医院服务,为构建和谐社会贡献自己的力量。     

Death certificates, natural death, and alcohol. The problem of underreporting

Previous studies have identified an apparent underreporting of alcohol-related natural deaths on death certificates. This survey consists of a review of death certificates in one urban county, and provides further evidence that alcohol-caused natural deaths are underreported by physicians who sign death certificates.     

Medical devices; medical device, user facility, distributor, and manufacturer reporting, certification, and registration; correction--FDA. Tentative final rule; correction

The Food and Drug Administration (FDA) is correcting a tentative final rule that appeared in the Federal Register of November 26, 1991 (56 FR 60024). The tentative final rule was published with some editorial errors. In the preamble under the "Paperwork Reduction Act" heading, the last two lines in the table "Estimated Annual Burden for Reporting" should have been in the table "Annual Burden for Recordkeeping". As a result, the total figures in both tables were incorrect. This document corrects the errors in these two tables.