Forensic medicine. What the perioperative nurse needs to know

Assessing the Need for Clinical Forensic Medicine Training in the Medical Undergraduate Curriculum

OBJECTIVE

This study was conducted to assess the need for clinical forensic medicine (CFM) training (hands-on and bedside) in medical undergraduate students and to determine the utility of skill-based teaching methodology in CFM.

METHOD

A cross-sectional study was carried out in the Government Medical College, where we used the mixed model approach (qualitative and quantitative component) to access the approach of three groups containing 50 participants each from (1) resident doctors/interns, (2) faculty, (3) casualty medical officers, toward skill-based teaching of CFM. A structured pretested questionnaire was administered to all study participants. The questionnaire was based on their perception regarding the legal problems faced during clinical practice and their attitude toward the need for CFM. It was followed by a focus group discussion (FGD) arranged separately for each group of 10 participants. Each FGD session lasts for 40 minutes with a moderator and recorder.

RESULT

Present MBBS (Bachelor of Medicine & Bachelor of Surgery) curriculum teaches CFM very early is strongly agreed by 20 (40%) of the faculty, four (8%) of interns, and three (6%) of medical officers. 40 (80%) of interns, 43 (86%) of medical officers, and 40 (80%) of faculty necessitate hands-on training in CFM in the MBBS curriculum. Forensic medicine specialists should handle clinical medico-legal cases (MLCs), as agreed by 50 (100%) faculty, 46 (98%) interns, and 47 (94%) medical officers.

CONCLUSION

Hands-on training in CFM is needed for a better practical approach for doctors toward handling MLCs. Hands-on training should be introduced in the second-year MBBS curriculum, and their clinical aspects should be taught simultaneously with clinical subjects till the internship.

The finite element method-based pattern recognition approach for the classification of patient-specific gunshot injury

Violence related injuries and deaths mostly caused by firearms are a major problem throughout the world. Understanding the factors that control the extent of hard-soft tissue wound patterns using computer imaging techniques, numerical methods, and machine learning algorithms may help physicians to diagnose and treat those injuries more properly. Here, we investigate the use of computational results coupled with the pattern recognition algorithms to develop an approach for forensic applications. Initially, computer tomography (CT) images of the patient whose leg was shot by a 9 × 19 parabellum bullet are used to construct the FE models of that patient’s femoral bone and the surrounding soft tissues. Then, Hounsfield units-based material properties are assigned to elements of the bone. To simulate the full range of loading conditions encountered in ballistic events, a constitutive model that captures the strain-rate dependent response is implemented. The entrance pathway vector of the bullet is directed in accordance with the patient’s wound and the simulations are deployed for the cases having various inlet velocities such as 150, 200, 250, 300, and 350 m/s. Once the FE results for each case are obtained, they are processed with supervised machine learning algorithms to classify the wound and inlet velocity correspondence. The results demonstrate that they can be diagnosed with a percent accuracy of 97.3, 97.5, and 98.3 for the decision tree (DT), k-nearest neighbors (kNN) and support vector machine (SVM) classifier, respectively. This approach may provide a useful framework in classifying the wound type, predicting the bullet impact velocity and its firing distance.

Her Majesty's coroners and home office forensic pathologists perception of the nurses' role in the coroner's enquiry

A study was performed to elicit the perceived role of the registered nurse in the coroner's enquiry from Her Majesty's coroners and Home Office forensic pathologists viewpoint. A qualitative small sample study of unstructured interviews was performed followed by a quantitative and qualitative survey of all 134 coroners and 44 forensic pathologists practising in England and Wales. 72 (53.5%) coroners and 26 (59.1%) forensic pathologists finally participated in the study of which 51% perceived that there was a role for the nurse in the coroner's enquiry. Roles identified included: actual i. e. keeping records, being conversant with nursing policies and "knowing" ("Knowing" means having knowledge about coroners' enquiries); potential i.e. resource provider, communicator, supporter, presencing, evidence giver and stewardship; and future i. e. certifying the fact of death and being an expert witness. Possible action by the registered nurse to embrace the outcome of this study is put forward.