Autopsy Practice in Ghana - Reflections of a Pathologist.

Autopsy practice in Ghana can be said to be far from satisfactory. Most Ghanaians do not know that there are different categories of death, which categories of death require an autopsy and who is required to perform the autopsy. The problems have further been complicated by the fact that, unlike other countries where separate facilities are available for storage of the different categories of dead bodies, all dead bodies in Ghana are conveyed to the hospital mortuary, thus encouraging hospitals to expand body storage facilities in their mortuaries to meet the increasing demand. Public or community mortuaries used elsewhere for storage of bodies of deaths occurring in the community pending the Coroner's directions are non-existent in Ghana. Storage of all categories of dead bodies in hospital mortuaries has resulted in virtually all autopsies being done by the hospital pathologists, especially in the large centres, at the expense of other very important diagnostic functions of the pathologist. This paper explains relevant portions of the Coroner's Act of 1960 and emphasises the need to separate the few hospital autopsies that require the expertise of the pathologist from Coroner's autopsies that may be carried out by any registered medical officer, as specified in the Act, or better still, by specially trained Forensic Physicians/Medical Examiners, as pertains in other countries. The paper also clarifies the different categories of death, those that fall in the jurisdiction of the Coroner and the personnel required to assist the Coroner in his investigastions. Suggestions have also been made on how to approach manpower development to ensure that appropriate personnel are trained to assist the Coroner in the investgation of medico-legal cases.

Improving sudden unexplained infant death investigation practices: an evaluation of the Centers for Disease Control and Prevention's SUID Investigation Training Academies.

Lack of thorough sudden unexplained infant death investigations (SUIDIs) has hindered accurate cause-of-death determination, infant mortality surveillance, and prevention strategies. To standardize SUIDI practices, the Centers for Disease Control and Prevention created a reporting form, guidelines, training curriculum, and SUIDI Training Academies using a train-the-trainer format. The training goal was to train teams of five in each state, who would reach an additional 1250 participants.The aim of this study is to evaluate the SUIDI Training Academies by determining professional characteristics of participants, assessing the level of confidence in infant death investigation components, enumerating the number of secondary trainings, and discussing recommendations for future trainings.To evaluate the training and the success of the train-the-trainer strategy, we used training evaluations, participant lists, and Web-based training logs to assess participant knowledge, skills, perceptions, and characteristics and number of secondary trainings.We trained 270 trainers at 5 SUIDI Training Academies. Greater than 96% of respondents reported confidence in case investigation skills and reported that hands-on laboratory sessions facilitated the practice of new skills. Academy trainers have trained greater than 23,000 medicolegal professionals, exceeding the training goal. This evaluation allowed us to identify opportunities to improve future SUIDI trainings.

Occupational injury and fatality investigations: the application of forensic nursing science.

The forensic evaluation of trauma in occupational injuries and fatalities can provide the benefit of a more thorough analysis of incident causation. Forensic nursing science applied during workplace investigations can assist investigators to determine otherwise unknown crucial aspects of the incident circumstances that are important to event reconstruction, the enforcement of occupational health and safety requirements, and the direction of workplace prevention initiatives. Currently, a medical and forensic medical knowledge gap exists in the subject-matter expertise associated with occupational accident investigations. This gap can be bridged with the integration of forensic nursing in the investigation of workplace fatalities and serious injuries.

Perícia odontolegal / Dentistry expert

A Odontologia Legal tem como finalidade precípua a aplicaçãodos conhecimentos da ciência odontológica a serviço da Justiça. É o perito a pessoa judicialmente habilitada para uma avaliação,exame ou vistoria de determinada área. Segundo Afrânio Peixoto, as qualidades essenciais dos peritos são: honestidade, técnica e imparcialidade.O perito odontolegista em seu dia a dia desenvolve tanto atividades clínicas quanto necroscópicas.

"Killed by its mother": infanticide in Providence County, Rhode Island, 1870 to 1938.

This article analyzes infanticide based on the Coroners' Records for Providence County, Rhode Island, from the 1870s to 1938 to determine doctors' and coroners' attitudes toward mothers who killed. The nineteenth century witnessed a medical discourse on the possibility of postpartum insanity as a cause of infanticide. While some women claimed temporary insanity, and some doctors and coroners legitimated this defense, its application to mothers who killed was arbitrary. They determined who deserved this diagnosis based on the woman's character, her forthrightness, and extenuating circumstances. Infanticide divided the profession nationally and at the local level and prevented doctors or coroners from speaking in a united voice on the issue. This article does not attempt to follow cases of infanticide through to jury verdicts. Instead, it provides an opportunity to analyze the circumstances women faced that led them to kill their newborns, and to analyze the responses of doctors and coroners to these mothers who killed. Unlike the findings of other studies, neither physicians nor coroners in Rhode Island were united in a claim of ignorance to save these women from guilty verdicts.

[Resident training program of coroner's office and trauma quality assurance in Los Angeles County, California, USA].

The author attended a practical training program at the Los Angeles County Coroner's Office for 2 weeks in June 2008. The systems of investigating the cause of death in the USA are not unified because every state has its own laws and systems, with Los Angeles County having a mixed system of Coroner and Medical Examiner. This report is presented to introduce the training course for medical residents at the Institute of LA. To begin, a tour through the office was provided. All residents then underwent a mask-fit-test in order to prevent infections. A conference to present cases for the day was held each morning, as well as lectures once or twice per week. The whole staff instructed the trainees with care, not only in the Institute but also at the death scene and the court. Additionally, the author also attended the LAC + USC Medical Center Combined Trauma Death Review Committee as an observer. This committee is very important for trauma quality assurance. The report of the coroner's autopsy is handed to the committee and the chairperson, a coroner, assesses the results of the emergency medical treatment. This greatly improves the quality of emergency medicine and reduces the number of preventable deaths.

Evaluating the SIDS diagnosis process utilized by coroners in Mississippi.

To assess the consistency of Mississippi coroners' practices in identifying Sudden Infant Death Syndrome (SIDS) cases, coroners were surveyed about diagnostic protocols. Findings were compared with published Centers for Disease Control guidelines and Mississippi law. One-third of coroners report they sometimes or never perform investigations at the place of infant death. The agency responsible for transferring the infant and the turn-around time for autopsy reports also varies. This study demonstrates inconsistency in SIDS diagnostic protocols among Mississippi coroners.

[External and internal post mortem examination according to the german code of criminal procedure (StPO)--review of section 87 StPO with special emphasis on the forensic autopsy]. / Die äussere und innere Leichenschau nach der deutschen Strafprozessordnung--Analyse des 87 StPO unter besonderer Berücksichtigung der gerichtlichen Leichenöffnung.

Section 87 subs. 2 of the German Code of Criminal Procedure stipulates that a forensic or court-ordered autopsy shall be performed by two physicians. One of them must be a "forensic medical officer" (in German "Gerichtsarzt") or the head of a public forensic or pathology institute or a physician of such an institute entrusted with this task and having specialist knowledge of forensic medicine. Recently, it has been suggested to amend Section 87 subs. 2 StPO to the effect that self-employed specialists in forensic medicine can also be entrusted with court-ordered autopsies. The authors object to such privatization of forensic autopsies for legal and factual reasons and recommend to keep the present regulation according to which one of the physicians conducting the autopsy is not only required to have the necessary professional qualification, but must also hold a public position as defined in the law.

The conversion of coroner systems to medical examiner systems in the United States: a lull in the action.

Coroner and medical examiner systems in the United States conduct death investigations for most deaths that are sudden and unexplained, or which involve external causes such as injury and poisoning. They play a very important role in the criminal justice, public health, public safety, and medical communities, and they also contribute a substantial portion of autopsy-based mortality data to the state and federal mortality statistics systems. Death investigations often involve complex medical issues and necessarily require the involvement of appropriately trained physicians. Over the years, there has been a trend to replace the elected lay coroner systems with systems run by appointed, physician medical examiners. Presently, about 31% of counties in the United States are served by a medical examiners at the county, district, or state level. Between 1960 and 1989, there was considerable conversion to medical examiner systems, but this trend slowed in the 1990s. Since 2000, only 6 counties in the United States have converted to a medical examiner system, no states have converted since 1996, and 1 county has reverted to a sheriff-coroner system. Possible reasons for this decline are discussed, including legislative, political, geographical, financial, population-based, and physician manpower distribution factors. It is important to ensure that all death investigation systems have appropriate access to medically educated and trained physicians such as forensic pathologists.

Correlación anatomoclínica de los pacientes que fallecieron en el Hospital Central de San Cristóbal durante el año 2004 / Anatomo-clinical pathology correlation of patients who died in the Hospital Central of San Cristóbal during in the year 2004

La evaluación de la correlación clinicopatológica es una de las vías más utilizadas en diferentes países para medir la calidad de todo el proceso de atención médica que precede al fallecimiento del paciente; de manera preocupante se observa en los últimos años un descenso en la solicitud de las mismas, apareciendo en nuestro medio con porcentajes bajos si se hace la comparación con otros países como Estados Unidos. Se realizó un estudio retrospectivo para conocer en proporción la correlación anatomoclínica de los pacientes que fallecieron durante el año 2004 en los servicios del Hospital Central de San Cristóbal, con la limitante de que los diagnósticos clínicos fueron tomados de las solicitudes de autopsias y no de las historias clínicas y los diagnósticos post mortem si tuvieron la posibilidad de conocerse por medio de los protocolos de autopsias. Solo un 6,52 por ciento de los fallecimientos fueron sometidos a autopsias clínicas, con un predominio de solicitudes en el Departamento de gineco obstetricia (55,55 por ciento) seguido por el Departamento de Medicina Interna con un 15,2 por ciento. En pediatría un 10,66 por ciento de solicitudes, pero con un elevado porcentaje de correlación de 67,57 por ciento; en Medicina interna un 57,7 por ciento de los pacientes autopsiados no tienen concordancia anatomoclínica. En conclusión, la autopsia clínica sigue siendo a pesar de los avances tecnológicos un instrumento importante no solo de evaluación del sistema de salud, sino de retroalimentación para los médicos en formación.

Coroner and medical examiner documentation of sudden unexplained deaths in epilepsy.

BACKGROUND: Prevalence data for sudden unexplained death in epilepsy (SUDEP) are hampered by its underuse as a final diagnosis on death certificates in appropriate cases. Few data exist about how coroners (COs) and medical examiners (MEs) in the United States use the diagnosis of SUDEP. METHODS: A survey instrument that addressed demographics, professional background, annual cases of epilepsy, seizure history, percentage of post-mortem examinations, cause of death, and use of SUDEP as a diagnosis was sent to all COs and MEs in the United States. Unadjusted comparisons between categorical variables used chi2 tests. A multiple regression model examined the odds of respondents considering SUDEP to be a valid diagnosis. RESULTS: Of 2995 surveys, 80.7% went to COs and 19.3% to MEs. The response rate was 15.9% for COs and 21.8% for MEs. Acknowledgment of SUDEP as a valid entity was greatest among pathologists (83.5%) versus other physicians and non-physicians (P< .001) and correlated with higher autopsy rates and seeing more cases of epilepsy. In actual practice, SUDEP was not used routinely as a death certificate diagnosis in most cases with no cause of death found at autopsy by any group in the survey regardless of title, educational background, location, autopsy rate, or number of seizure cases seen annually. CONCLUSIONS: SUDEP appears to be an underused final diagnosis by COs and MEs throughout the United States. There is a need to educate officials at all levels about this diagnosis in persons who have epilepsy with no other cause of death.

[Education of medical examiners qualified for death certification].

INTRODUCTION: Death certification is very important from public health perspective, in particular, referring to gathering of data for mortality statistics on local and national level. When examining the deceased, medical examiner is capable of detecting indications of violent death and report the case for further inquest. The Public Health Care Act of the Republic of Serbia defines the responsibilities of medical examiner (ME) to certify death and estimate the time and cause of death. On the territory of Belgrade, this Service is organized by Department of Public Health of the City Council. Education of doctors-medical examiners certifying death in Belgrade area was organized during 2002 and 2003. OBJECTIVE: Demonstrate the structure of the Program of continual medical education (CME) of medical examiners in Belgrade area, to look into some aspects of their professional career, and to analyze the results of their testing. METHOD: Based on the Program of CME for medical examiners, test consisting of 13 questions was prepared. These questions were related to thanatology and current legislation. The evaluation of test results as well as particular characteristics (age, duration of professional engagement, etc.) of tested doctors was carried out. RESULTS: A total of 138 participants of CME Program were subjected to test. Mean age of tested MEs was 40.27 +/- 8.06 years, while an average duration of professional engagement was 13.43 +/- 8.00 years. Almost 2/3 of tested MEs were employed as general practitioners, while the rest were specialists, mainly in internal medicine and emergency medicine. Slightly more than 1/5 of tested MEs (21.7%) failed on the test (less than 60% of maximum score). CONCLUSION: Given the fact that slightly more than 1/5 of tested MEs (21.7%), regardless of duration of their professional engagement, did not pass the test, the level of their specific knowledge of death certification was not sufficient. Therefore, it is necessary to organize periodical CME on specific topics, including practice related to death certification. Accordingly, the Institute of Forensic Medicine in cooperation with Center for CME, Faculty of Medicine, University of Belgrade, has created a specific program of CME whose realization is in progress.