The value of autopsy from a clinical point of view. A survey of 250 general practitioners and hospital clinicians in the county of Sør-Trøndelag, Norway.

An enquiry into clinicians' attitudes to autopsies was conducted by questionnaire sent to 166 general practitioners in the county of Sør-Trøndelag in Norway and to 186 clinicians working at the University Hospital of Trondheim. It was considered especially important for us to include general practitioners. As the result of a government decision taken at the end of 1994, autopsies requested by general practitioners on patients dying outside hospitals have from January 1995 been covered by national health insurance. Answers were obtained from 250 doctors: 110 general practitioners and 140 hospital physicians. One hundred and seventy-nine (73.1%, n=245) felt that the possibility of having autopsies performed was of great importance in their daily work. Autopsy was considered to be a very important means of quality assurance in the health care system by 158 (66.4%, n=238). One hundred and two (41.2%, n=247) answered that improvements in medicine and technology during the last decades had not reduced the importance of autopsy. One hundred and twenty-two (81.3%, n=150) felt that especially computer tomography (CT) had reduced the value of autopsy. Among the general practitioners, 73 (68.9%, n=106) welcomed the opportunity to have non-forensic autopsies performed on patients who died outside hospitals. Our study showed differences in the attitudes of clinicians towards autopsies, but our results still indicate that the value of autopsy for furthering clinical knowledge is acknowledged by most clinicians.

[The value of autopsy in current health care. An analysis of autopsies performed during one year at the Regionsykehuset in Trondheim]. / Obduksjonens verdi i dagens helsevesen. En analyse av ett års obduksjonsmateriale fra Regionsykehuset i Trondheim.

We have reviewed the reports from 222 autopsies performed during one year (1994) at our Department of Pathology. The majority (74%) of all autopsies were performed on patients from the Department of Internal medicine at our hospital. Autopsy findings were correlated with the clinically suspected causes of death, as revealed by the death certificates and the clinical information in the written requests for autopsies. The direct cause of death, as found at autopsy, had been suspected by the clinicians in 70% of cases. The underlying cause of death, as found by the pathologists at autopsy, had been diagnosed by the clinicians in 75% of the cases. In 26 cases (12%) the underlying cause of death had neither been diagnosed nor suspected by the clinicians. In the last mentioned group, 77% of the patients were more than 70 years of age. In six cases where the underlying cause of death had not been diagnosed or suspected by the clinicians, the findings at autopsy were classified as type-1 findings. These are findings, if they had been known when the patient was still alive would probably have led to therapy that night have improved the prognosis.

Microbial contamination of contact lens cases among medical students.

PURPOSE: We performed a systematic examination of the rate and level of contamination of contact lens cases in a population of asymptomatic contact lens wearers using commercially prepared chemical disinfection solutions. METHODS: Solutions from the lens cases and from the conjunctiva of 21 asymptomatic contact lens wearers were examined. RESULTS: Contamination was found in five (24%) of the lens cases; four of the isolated microorganisms were recognized as potential ocular pathogens, namely Xanthomonas maltophilia, Pseudomonas cepacia, Serratia liquefaciens, and Serratia plymuthica. Serratia organisms have not been previously isolated from lens care solutions preserved with guanide, and, in addition, this was the first time that Serratia plymuthica has been isolated from a lens care system. Acanthamoeba was not detected in any of the examined samples, and no potential pathogens were isolated from the conjunctiva. Among students having contaminated lens cases, all reported problems such as itching, redness, dryness, and coating of the lens. CONCLUSIONS: The percentage of contaminated lens cases in this study was lower than in other studies. However, since the microorganisms identified in 80% of the contaminated lens cases were considered potential ocular pathogens, we feel contact lens wearers should be encouraged to frequently replace their lens cases.