Audit study of next of kin's satisfaction with clinical necropsy service

Rapid Research Autopsy: Piecing the Puzzle of Tumor Heterogeneity

Tumor heterogeneity decreases the effectiveness of anticancer therapies and is an important topic in translational cancer research, given its relevance in clinical oncology. Here, we discuss how rapid research autopsy of cancer patients can elucidate heterogeneity-associated processes including cancer evolution and acquired therapeutic resistance. In practice, rapid research autopsy is performed shortly after a patient's passing to procure multiple metastatic tumor samples for genomic studies through next-generation sequencing and development of patient-derived xenografts or organoids. Mechanistic insights gained from research autopsy studies of cancer patients can help identify new targets for therapeutic intervention. Finally, the success of research autopsy programs is bolstered by collaboration across different medical and scientific disciplines in addition to support from patients and families.

Identifying Errors in Forensic Autopsy Reports Using a Novel Web-Based Program

Introduction

Autopsy reports are often complex, with ample opportunity for errors and inconsistencies. These reports are often scrutinized by both families and attorneys. Identification of errors by proofreading physicians or clerical staff can be improved by utilizing a computer program to examine reports for discrepancies.

Methods

A webpage to review demographic consistency, organ descriptions, and pertinent information regarding gunshot wounds was developed to proofread reports. Thirty completed reports were analyzed from the Jefferson County Coroner/Medical Examiner Office. Additionally, a separate individual was instructed to sabotage reports and then determine if the software could detect the alterations.

Results

Of the 30 completed reports analyzed, no errors/omissions were identified; however, these reports were accurate upon manual inspection. Rarely, the computer triggered a warning that an organ should be confirmed if the author used a description that differed from the software's vocabulary (e.g., the author discussed "uterine wall" instead of "uterus"). The webpage detected eight out of ten errors supplied to the five sabotaged cases. These errors ranged from inconsistent age, race, and gender, to incomplete gunshot wound descriptions.

Conclusion

Identification of errors by a computer proofreading program can improve autopsy report quality. The webpage has been designed so that additional modules, such as strangulation proofreading, could easily be added. Furthermore, the ability of the software to detect errors will continue to improve as more words are added to its vocabulary. The webpage is freely available and can be adapted to other medical examiner offices needs from the GitHub website.

[An opinion survey about medical autopsy, Saint-Étienne University Hospital: are the French laws of bioethics to be revised?]

PURPOSE

The aim of the medical autopsy is to define the causes of a patient's death. Although its rate has dramatically decreased, the post-mortem examination remains one of the basic tools for the assessment of medical care. The objective of this study was to identify the factors influencing the acceptance of medical autopsies.

METHODS

A prospective survey was performed using questionnaire that was administered to patients and health care professionals of the Saint-Étienne university hospital. The survey consisted in several questions relating to the autopsy practice (on one's own body) and the knowledge of the procedure.

RESULTS

The population surveyed consisted of 186 individuals and 112 health care professionals, including physicians, residents and nurses. The results of the study overall showed a good acceptance of autopsy. Actually, 86% of the individauls and 94.6% of health professionals would not be opposed to their own autopsy (in order to identify the cause of the death, to help relatives bereavement, to foster medical research). The main reasons of medical autopsy opposition include religion belief, body integrity, dignity and respect. Only 42.5% of patients had previously received some information about autopsies, while 33.9% of health care professionals had received a specific formation.

CONCLUSION

The rate of refusal of medical autopsy was low in this survey but information relative to this procedure remains insufficient. The current law imposes to look after a nonopposition to medical autopsy of the died individual, including asking his/her relatives that markedly limit the organ donation. Modification of the French bioethical law should be beneficial to increase both medical autopsy organ donation rates.

Perinatal pathology in the context of a clinical trial: a review of the literature

Perinatal postmortem rates are declining world wide. In the United Kingdom, perinatal pathology has recently been seriously undermined by controversy. There are important consequences for perinatal trials that include pathology studies. This review looks at the reasons for the decline in perinatal postmortem examinations and the effects on research.

Perinatal pathology in the context of a clinical trial: attitudes of bereaved parents

BACKGROUND

Interviews with neonatologists in a related study had revealed a degree of discomfort with approaching bereaved parents for postmortem examinations (PMs) and a widespread concern that parents should not be further distressed or feel under pressure to consent.

OBJECTIVE

To report the attitudes of bereaved parents to trial related perinatal PMs, in the light of declining perinatal PM rates and poor levels of participation in pathology studies.

METHODS

A qualitative study was carried out, using semistructured interviews. The study involved 11 interviews with 18 bereaved parents from five UK neonatal units. The parents had consented to the enrolment of their baby in one of two neonatal trials.

RESULTS

The data provide support for the careful approach described by neonatologists in a related study, but also suggest that it may be possible to approach more parents without undermining their wellbeing. The interviews show the variety of reactions to PMs that one would expect, from parents who were clear that they did not want a PM to others who felt that they needed the information from the examination. Between these extremes were parents who were initially discomforted by the idea but who then made the decision to go ahead. Parents who elected to have a PM did so for their own needs, or to contribute to a trial, or for both reasons. The fact that the subject was raised was generally not seen as inappropriate, and none stated that they felt that they were actually pressured into making their decision. The data also suggest that for some parents the degree of caution and selectivity exercised by the neonatologists may not be entirely appropriate. In two cases, consent for the PM was driven by a sense of making an altruistic contribution to research, and, in another two, altruism was expressed in the context of their own desire for information from a PM.

CONCLUSIONS

It is important to determine whether trial related pathology studies are considered by professionals and lay people to be worth while and feasible. If there is support for such studies, the challenge is to develop the means to approach more parents in the most sensitive way.

Autopsy 101 (CE)

Although autopsy remains the only definitive way to confirm and sometimes diagnose disease, the autopsy rate has continued to decline during the past 3 decades. Despite numerous publications citing its value, the nursing literature lacks information addressing the benefits and implications of the autopsy to nurses who provide direct care to older adults. This article provides geriatric nurses with information about the benefits, purpose, process, and barriers of autopsy to better inform nurses as they ease family concerns and assist physicians in obtaining consent for autopsy.

A head and neck cancer patient dies! Why perform an autopsy: for the relatives, for the clinicians or for the pathologists?

It is no secret that autopsy rates at most hospitals worldwide--both teaching and community hospitals--have declined precipitously in recent decades, but is this a desirable state of affairs? This article explores this issue from three viewpoints: that of the family members who grant permission for autopsies; that of the clinicians who seek permission for the autopsy to be carried out; and that of the pathologists who actually perform the post-mortem examination. Family concerns about (the sometimes tangential) matter of organ retention following autopsy have recently been highlighted in Europe, with an accompanying negative overall impression of the autopsy being conveyed by many outlets of the popular media. Clinicians will often concede that they feel somewhat distanced from the whole process of autopsy, and so do not hold it in such high esteem as their predecessors once did decades ago. Pathologists at present often perform autopsies as "additional duties" to be fitted in around their central functions, and so do not see them as a primary task to be accomplished. However, there are reasons why this may be detrimental to patient care, including in particular the fact that clinical/radiographic diagnoses are sometimes not confirmed by the results of a complete autopsy. Suggestions for improving the autopsy rate--in particular amongst head and neck cancer patients--are discussed, and include performance of a more rapid limited autopsy and the designation of specialist pathologists in head and neck cancer to carry out autopsies of these patients as an extension of their clinical duties. One conclusion seems inescapable: to increase autopsy rates, the status of the procedure will necessarily have to be upgraded from that of "afterthought/perfunctory task" to that of "consultation", with all of the shifts in attitude such a modification would entail.

Referral for autopsies: analysis of 651 consecutive deaths in one general practice

Autopsies represent a key instrument in educating doctors and may aid quality assurance for primary and secondary care. This study shows that only a few patients have an autopsy, of which the majority are carried out at the request of the coroner for medicolegal reasons. Better education and communication between general practitioners, hospital clinicians, pathologists, and coroners may increase the rate of autopsies.

The role of the autopsy in medical education

The autopsy can make an important contribution to medical education. The decline in the hospital autopsy rate threatens this role. This article examines the educational opportunities that the post-mortem still provides.

Does funeral preference influence clinical necropsy request outcome?

Attitudes towards necropsy have been shown to be more favourable amongst those relatives preferring cremation as a method of disposal compared to those with a preference for burial. In a two-year retrospective study, no significant relationship was found between funeral preferences (burial or cremation) and clinical necropsy request outcome when age, sex and religion were taken into account. Potential religious objections to necropsy were infrequent and cremation was found to have become the most popular method of disposing of the dead during a period when local clinical necropsy rates have continued to decline. Funeral preference is unlikely to have been a significant factor in the decline in clinical necropsy rates.