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。     

Medicolegal practice in Samoa: an inside view

Samoa, considered the heart of Polynesia, has a medicolegal system with some limitations. There is a need to build a well-organized medicolegal service. The authors briefly outline the medicolegal system in Samoa from its beginning to the present and discuss future improvements.     

The forensic medical expertise of acute local radiation trauma]

Informative diagnostical criteria of medicolegal evaluation and prognosis of corporal lesion gravity in case of acute local radiation trauma as well as algorithm of medicolegal diagnostical process concerning these lesions with reference to external radiation exposure, kind of injuring factor, differential-diagnostical signs of acute local radiation trauma are suggested. They make it possible to formulate medicolegal diagnosis and can form the basis for developing diagnostical programmes.     

Transsexualism in medicolegal limine: an examination and a proposal for change

This article investigates transsexualism and our creation of a state of medicolegal limine for transsexuals. The article addresses transsexuality as it is currently defined and explores our dichotomization of sex and gender. The author discusses both the social construction and the praxis of transsexuality, highlighting the medicolegal implications resulting from our current approach to transsexuality. The author argues that the creation of a medicolegal limine essentially prevents transsexuals from ever integrating fully as a member of one sex or gender, while simultaneously preventing the larger society from reconsidering its definitions of sex and gender. The article concludes with a summary of current challenges to our model of transsexualism and with suggestions for the resolution of this liminal medicolegal phase.     

The interfaces of law and medicine.

The relationship between the legal and medical professions is improving, but many problems remain. There has been been and continues to be substantial growth in medicolegal organizations of various kinds. Better medicolegal investigative methods are being developed, and medicolegal teaching programs are on the increase. The two professions have worked together successfully on such problems as human heart transplantation and drug abuse. On the other hand, several problem areas continue to cause difficulty and friction, including medical experimentation on humans, the legal definition of death, abortion, euthanasia, and medical malpractice. The author calls on the existing medicolegal organizations to apply their expertise and influence to define and resolve these problems.     

Uncertainty of determining mode of death in medicolegal material without autopsy — A systematic autopsy study

Systematic autopsy was performed in 807 medicolegal deaths where the police had not requested autopsy. In all cases both the cause of death and the mode of death had been reported at the medicolegal external examination. The autopsy revealed differences in the mode of death in about 4% of all cases. This was due in particular to the problems associated with distinguishing presumed natural deaths from accidents and suicide. The cases of “concealed” suicide were found in particular among the higher age groups. However, no characteristic relationship was found between the proportion of differing modes of death and the age groups. All cases of homicide were recognized at the medicolegal external examination.Malignant disease that had not been diagnosed previously was found in about 4% of the cases, the reason being the large proportion of elderly subjects in the material. Syphilitic aortitis that had not been previously diagnosed was demonstrated in about 1% of all cases, and pulmonary tuberculosis that had not been previously diagnosed was demonstrated in 0.7% of the cases.The conclusion is that the results provide no support for replacing the medicolegal autopsy by medicolegal external examination alone, but rather suggest that the proportion of medicolegal autopsies should be increased.     

Various aspects of thanatogenesis and forensic medical diagnosis of combined poisoning with ethanol and psychotropic substances

Epidemiological and some medicolegal aspects of fatal poisonings with basic groups of psychotropic drugs in combination with ethanol are discussed and some recommendations concerning the improvement of medicolegal diagnosis of such poisonings are presented.     

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.     

客机失事的法医学鉴定——附一例报告

本文报告了1985年1月18日,中国民航 B-434(安-24)号客机在济南失事的法医学鉴定。机上乘员41人,死38人,伤3人。死难中以撞击伤(大部四肢骨折)和烧伤为主。死因主要是脏器的严重损坏、创伤性休克、大出血。部分死于烧伤。个人识别是空难法医学鉴定的主要内容,本例主要采用体貌鉴别和个人遗物鉴别(占90％),得到满意结果。本文讨论了客机失事的法医学处理问题,还就作者实践并结合国外经验提出我国飞机失事法医学鉴定程序的设想。     

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.     

Essential medicolegal death investigation services: standardization of a survey instrument based on the Essential Public Health Services

The National Academy of Sciences recommends that states assess the performance of medicolegal death investigation agencies. To aid in performance assessment, we adapted an instrument based on the CDC's 10 Essential Public Health Services by translating the terminology to that of essential medicolegal death investigation services. This produced a survey that could be used to standardize reporting practices and services of agencies. To validate the instrument, a stratified random sample of 12 death investigation chiefs in 12 states was interviewed. This sample represented both medical examiner and coroner jurisdictions within the varying medicolegal structures. A cognitive testing process elicited how well participants could respond to and interpret the survey questions. The response was favorable in that the respondents agreed that given specific revisions toward question clarification, the instrument would be a useful and relevant tool for assessing system performance.     

法院法医鉴定制度重构——兼议法医鉴定之证据属性及审查完善

本文通过对中外法医鉴定制度的比较和分析,剖析出我国法院法医鉴定制度的现状及存在的主要问题,并对现状之成因进一步探析.全文从法医鉴定结论之证据属性及现状成因二个方面来论述我国法院去医鉴定制度必需重构的理由,并对鉴定制度中鉴定机构、鉴定人制度、鉴定结论采信方面提出了重构的模式及完善建议.     

Trends in domestic animal medico-legal pathology cases submitted to a veterinary diagnostic laboratory 1998-2010*

Abstract: Pathologists at veterinary diagnostic laboratories receive medico‐legal cases from a variety of animal species for postmortem examination. A search of computerized records of the Animal Health Laboratory, University of Guelph, Guelph, Ontario, Canada from 1998 to 2010 identified 1706 medicolegal cases. These were categorized according to the history as criminal investigations, anesthetic‐related deaths, insurance, litigation, malpractice cases, and regulatory cases. Statistically significant linear trends in the proportion of medicolegal cases for all animals and criminal cases for companion animals were identified over the 12 year period. Companion animals had significantly greater odds of being a medicolegal case in all categories except for insurance and regulatory cases, compared to noncompanion animals. Based on pathology reports for the 271 criminal cases, 43.1% were consistent with neglect, 29.2% were compatible with non‐accidental injury, 4.80% were poisonings, 10.7% were deemed to be due to natural disease, and 11.43% were inconclusive.     

医疗纠纷法医学鉴定质量评价模型的建立

目的建立医疗纠纷法医学鉴定质量评价模型。方法收集同济医学院法医学系近10年410例涉及医疗纠纷的法医学鉴定的案例,对影响医疗纠纷法医学鉴定质量的10个关键指标,运用SAS软件进行了主成分分析。结果通过统计学分析,筛选出6个能反映所有原指标变量主要信息的主成分,并依此结果推算出评价法医学系医疗纠纷的鉴定质量评价模型。结论在建立“医疗纠纷鉴定质量管理体系”时,应按影响鉴定质量的主成分设计相应的对策。     

A suicide decision as a motive for murder--an airplane as the murder weapon

It is supposed that some fatal aviation accidents of "cause unknown" especially of light and private airplanes are possibly intended by a suicidal act. However it is difficult to prove this suggestion. A case of a light aircraft accident is reported in which the medicolegal autopsy and the police investigation revealed, unexpected, a simultaneous homicide and suicide caused by a stabbing attack on the pilot. This paper stresses the importance of autopsies of the victims in aircraft accident investigation and discuss the medicolegal and psychopathological aspects of the case.     

Acute nonfatal poisonings by drug preparations]

Acute non-lethal poisonings with drugs within the period of 10 years according to archives data of Toxicological center and medicolegal department of victims' examination in Leningrad medicolegal expert Bureau were analysed. Number of drug poisoning cases increased two-fold and formed 76% of all poisoning cases. Tranquilizers, then antihistaminic, neuroleptic and hypotensive (clofelin) agents were used most often. Drugs were taken with suicidal attempt or with the aim of getting "alcoholic" effect. Poisonings among women were registered three times more often than among men.     

Surveillance of human immunodeficiency virus (HIV) antibodies in medicolegal autopsies in Finland--monitoring early changes in HIV-seropositivity among risk groups and average population.

In order to cooperate with voluntary screening programs aimed at the surveillance of the HIV epidemic in Finland, we have studied medicolegal autopsies for HIV antibodies since 1986 using an enzyme immunoassay on postmortem sera. The investigation covered 47.4% and 39.2%, respectively, of all deaths under the age of 65 years in the metropolitan areas of Helsinki and Turku--two cities on the densely populated southern coast of Finland from which most HIV infections have thus far been detected. Nine HIV-positive cases (0.12%) were detected among the 7305 medicolegal autopsies tested in 1986 to 1990. This figure is higher than the prevalence of 0.01 to 0.03% in voluntary screening programs for the general population would suggest. Seven of our cases had previously tested positive, and two were previously unknown cases, indicating that people at high risk are clustered in the medicolegal autopsy series. Of the six cases in an early stage of infection, three committed suicide suggesting the importance of HIV-screening in suicide cases in tracing symptomless HIV carriers. Five of the cases were detected in 1990, a year when the number of new HIV infections had more than doubled compared to the previous two years. This suggests that testing of medicolegal autopsies as surrogate tests for the population gives useful information even in low-prevalence areas like Finland. Such testing has none of the ethical problems of many other back-up surveys, and may be particularly sensitive to early changes in epidemiology.     

Uncertainty of determining cause of death in a medicolegal material without autopsy. An autopsy study

In constrast to other studies, this investigation was made on cases of medicolegal deaths that would not normally be autopsied. 223 females and 322 males, whose deaths were found to be natural before as well as after autopsy, were studied. The cause of death was estimated by external medicolegal examination, and after autopsy.In 79 females and 109 males, i.e. 35% and 34% respectively, estimated cause of death was found to be different after the autopsy. This was mostly because ischaemic heart disease as a cause of death was overestimated at the external medicolegal examination. No constant relationship between differing causes of death and age group could be demonstrated. Underdiagnoses and overdiagnoses tended to outweigh each other. Pneumonia, pulmonary embolism, cor pulmonale and aortic stenosis were clearly underestimated before autopsy. In addition, a variety of diseases that were not even mentioned at the medicolegal examination was found (subarachnoid haemorrhage, uraemia, perforated and bleeding gastric ulcers, tuberculosis).The same unreliability in the estimated cause of death therefore exists among cases not normally autopsied as found in retrospective studies of cases where autopsy is performed under all circumstances at the request of the police.False information will thus be given to the mortality statistics among the approximately 5000 cases of medicolegal deaths not autopsied in Denmark per year, most of these being natural deaths. Besides, contagious and inherited diseases could be overlooked, relatives given false information and the value of scientific studies in causes of death diminished.The conclusion is that autopsy is still essential to ensure continuous control and correction of causes of death.     

The serological determination of myoglobin for forensic medical purposes

Possibility of using diagnosticum for myoglobin detection in passive hemagglutination reaction during evaluation of medicolegal objects is shown.     

Mortality statistics and autopsy: reliability of estimation of the mode of death in Copenhagen and a rural district of Sealand, Denmark

During a one-year-period 1243 medicolegal deaths in the City of Copenhagen were autopsied after the mode of death was provisionally determined by an external medicolegal examination. In 35% of the cases an atuopsy was requested by the police. Without autopsy the mode of death would have been defined erroneously in 10.4% of all cases. This was particularly because of the difficulties in distinguishing between natural and non-natural death. In a rural district of Sealand in the autopsy rate in the same period was 14%. The rate among presumed natural deaths and accidents was particularly low (7% and 26%, respectively) against 23% and 77% in Copenhagen. This means a greater risk for errors in the estimated mode of death compared to Copenhage. This can also mean unequal rights by law. It is stressed that the police, in some rural areas, should be more liberal in requesting autopsies and at least increase them to the Copenhagen level of about 30%. The external medicolegal examination alone offers too little reliability, and it is stressed that such differences from one part of the country to another should not exist in a small well-organised country such as Denmark.