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Yoon L, Richardson GRA, Gorman M. Reflections on a Century of Extreme Heat Event-Related Mortality Reporting in Canada. Geohealth 2024; 8:e2023GH000895. [PMID: 38371353 PMCID: PMC10870068 DOI: 10.1029/2023gh000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/20/2024]
Abstract
Climate change is causing more frequent and severe extreme heat events (EHEs) in Canada, resulting in significant loss of life. However, patterns across mortality reporting for historical EHEs have not been analyzed. To address this gap, we studied deaths in Canadian EHEs from 1936 to 2021, identifying trends and challenges. Our analysis revealed inconsistencies in mortality data, discrepancies between vulnerable populations identified, difficulties in determining the cause of death, and inconsistent reporting on social vulnerability indicators. We provide some observations that could help inform solutions to address the gaps and challenges, by moving toward more consistent and comprehensive reporting to ensure no population is overlooked. Accurately accounting for affected populations could help better target evidence-based interventions, and reduce vulnerability to extreme heat.
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Affiliation(s)
- Liv Yoon
- School of KinesiologyThe University of British Columbia (UBC)VancouverBCCanada
| | | | - Melissa Gorman
- Extreme Heat ProgramClimate Change and Innovation BureauHealth CanadaOttawaONCanada
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Leske S, Weir B, Adam G, Kõlves K. Why Do We Agree to Disagree? Agreement and Reasons for Disagreement in Judgements of Intentional Self-Harm from Coroners and a Suicide Register in Queensland, Australia, from 2001 to 2015. Int J Environ Res Public Health 2023; 21:52. [PMID: 38248518 PMCID: PMC10815497 DOI: 10.3390/ijerph21010052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024]
Abstract
Suicides are likely to be underreported. In Australia, the National Coronial Information System (NCIS) provides information about suicide deaths reported to coroners. The NCIS represents the findings on the intent of the deceased as determined by coroners. We used the Queensland Suicide Register (QSR) to assess the direction, magnitude, and predictors of any differences in the reporting of suicide in Queensland. Therefore, we conducted a consecutive case series study to assess agreement and variation between linked data from the NCIS and QSR determinations of suicide for all suicide deaths (N = 9520) in the QSR from 2001 to 2015 recorded from routinely collected coronial data. The rate of concordance between the QSR and NCIS for cases of intentional self-harm was 92.7%. There was disagreement between the findings in the data, since 6.3% (n = 597) were considered as intentional self-harm in the QSR but not in the NCIS, and, less commonly, 0.9% (n = 87) were considered intentional self-harm in the NCIS but not in the QSR. Overall, the QSR reported 510 more suicides than the NCIS in 15 years. These findings indicate that using suicide mortality data from suicide registers may not underreport suicide as often.
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Affiliation(s)
- Stuart Leske
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD 4122, Australia; (S.L.); (B.W.); (G.A.)
- UQ Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4066, Australia
| | - Bridget Weir
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD 4122, Australia; (S.L.); (B.W.); (G.A.)
| | - Ghazala Adam
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD 4122, Australia; (S.L.); (B.W.); (G.A.)
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD 4122, Australia; (S.L.); (B.W.); (G.A.)
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Song K, Portwood C, Jindal J, Launer D, France H, Hey M, Richards G, Dernie F. Preventable deaths involving falls in England and Wales, 2013-22: a systematic case series of coroners' reports. Age Ageing 2023; 52:afad191. [PMID: 37847796 DOI: 10.1093/ageing/afad191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Falls in older people are common, leading to significant harm including death. Coroners have a duty to report cases where action should be taken to prevent future deaths, but dissemination of their findings remains poor. OBJECTIVE To identify preventable fall-related deaths, classify coroner concerns and explore organisational responses. DESIGN A retrospective systematic case series of coroners' Prevention of Future Deaths (PFD) reports, from July 2013 (inception) to November 2022. SETTING England and Wales. METHODS Reproducible data collection methods were used to web-scrape and read PFD reports. Demographic information, coroner concerns and responses from organisations were extracted and descriptive statistics used to synthesise data. RESULTS Five hundred and twenty-seven PFDs (12.5% of PFDs) involved a fall that contributed to death. These deaths predominantly affected older people (median 82 years) in the community (72%), with subsequent death in hospital (70.8%). A high proportion of cases experienced fractures (51.6%), major bleeding (35.9%) or head injury (38.7%). Coroners frequently raised concerns regarding falls risks assessments (20.9%), failures in communication (20.3%) and documentation issues (17.5%). Only 56.7% of PFDs received a response from organisations to whom they were addressed. Organisations tended to produce new protocols (58.5%), improve training (44.6%) and commence audits (34.3%) in response to PFDs. CONCLUSIONS One in eight preventable deaths in England and Wales involved a fall. Addressing concerns raised by coroners should improve falls prevention and care following falls especially for older adults, but the poor response rate may indicate that lessons are not being learned. Wider dissemination of PFD findings may help reduce preventable fall-related deaths in the future.
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Affiliation(s)
- Kaiyang Song
- Medical Sciences Division, University of Oxford, Oxford OX3 9DU, UK
| | - Clara Portwood
- Medical Sciences Division, University of Oxford, Oxford OX3 9DU, UK
| | - Jessy Jindal
- Medical Sciences Division, University of Oxford, Oxford OX3 9DU, UK
| | - David Launer
- Medical Sciences Division, University of Oxford, Oxford OX3 9DU, UK
| | - Harrison France
- Medical Sciences Division, University of Oxford, Oxford OX3 9DU, UK
| | - Molly Hey
- Medical Sciences Division, University of Oxford, Oxford OX3 9DU, UK
| | - Georgia Richards
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
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Zhang Q, Richards GC. Lessons from web scraping coroners' Prevention of Future Deaths reports. Med Leg J 2023; 91:142-147. [PMID: 36688377 PMCID: PMC10515464 DOI: 10.1177/00258172221141284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In England and Wales, coroners are required to write Prevention of Future Deaths reports when a death is deemed preventable so that action is taken to avert similar deaths. Since July 2013, Prevention of Future Deaths reports have been openly available via the Courts and Tribunals Judiciary website (https://www.judiciary.uk/prevention-of-future-death-reports/). However, their presentation to date have been insufficient to identify trends and learn lessons. We designed a web scraper to create the Preventable Deaths Tracker (https://preventabledeathstracker.net/). On 22 June 2022, 4001 PFDs were scraped, analysed, and compared to the Office of National Statistics' preventable mortality statistics. This commentary summarises the key findings and offers recommendations to improve the Prevention of Future Deaths system so lessons can be learnt to avert preventable deaths.
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Affiliation(s)
| | - Georgia C Richards
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Abstract
In the 1980s the traditional Hippocratic term excited delirium was transplanted from the bedsides of febrile, agitated and disoriented patients to the streets of Miami. Deaths in custody of young men who were intoxicated with cocaine and who were restrained by the police because of their erratic or violent behaviour were attributed to excited delirium. The blood concentrations of cocaine in these subjects were approximately ten times lower than the lethal level and other factors which might have contributed to the fatal outcome, such as the police use of neck-holds, choke-holds or 'hog-tying', were relegated to a minor role compared with the reframed 'diagnosis' of excited delirium. Over the course of the next few decades 'excited delirium' might be applied to virtually any highly agitated person behaving violently in a public place and who subsequently died in custody while being restrained or shortly afterwards. Expert witnesses, mainly forensic pathologists, testified that the deceased's death was probably inevitable given the perilous nature of excited delirium, even though this diagnostic entity lacked any consistent neuropathological basis and depended entirely on observed behaviour. This history of the rise and fall of this disputed diagnosis is a partial response to the sociologist Phil Brown's 1995 paper asking who benefits, or at least avoids trouble, by the identification and use of a diagnosis.
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Affiliation(s)
| | - Maurice Lipsedge
- Emeritus Consultant South London and Maudsley NHS Foundation Trust, Honorary Clinical Senior Lecturer Guy's, King's and St Thomas's School of Medical Education, London, UK
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Schleihauf E, Bowes MJ. Suicide and drug toxicity mortality in the first year of the COVID-19 pandemic: use of medical examiner data for public health in Nova Scotia. Health Promot Chronic Dis Prev Can 2021; 42:60-67. [PMID: 34757897 DOI: 10.24095/hpcdp.42.2.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The COVID-19 pandemic and governmental responses have raised concerns about any corresponding rise in suicide and/or drug toxicity mortality due to exacerbations of mental illness, economic issues, changes to drug supply, ability to access harm reduction services, and other factors. METHODS Data were obtained from the Nova Scotia Medical Examiner Service. Case definitions were developed, and their performance characteristics assessed. Pre-pandemic trends in monthly suicide and drug toxicity deaths were modelled and the observed numbers of deaths in the pandemic year compared to expected numbers. RESULTS There was a significant reduction in suicide deaths in the first year of the COVID-19 pandemic in Nova Scotia, with about 21 fewer non-drug toxicity suicide deaths than expected in March 2020 to February 2021 (risk ratio = 0.82). No change in drug toxicity mortality was detected. Case definitions were successfully applied to free-text cause of death statements and cases where cause and manner of death remained under investigation. CONCLUSION Processes for case classification and monitoring can be implemented in collaboration with medical examiners/coroners for timely, ongoing public health surveillance of suicide and drug toxicity mortality. Medical examiners and coroners are the stewards of a wealth of data that could inform the prevention of further deaths; it is time to engage these systems in public health surveillance.
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Affiliation(s)
| | - Matthew J Bowes
- Nova Scotia Medical Examiner Service, Dartmouth, Nova Scotia, Canada
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Ranson D. The Role of Patient-reported Outcome Measures in Post-operative Death Investigations. J Law Med 2019; 26:737-741. [PMID: 31682353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Coronial investigations of post-operative deaths can play an important role in improving the quality and safety of patient care. Correctly identifying reportable deaths in the post-operative period and reporting them to the coroner is a key responsibility of medical practitioners but may be challenging, particularly when determination of unexpectedness is problematic. Patient-reported outcome measures (PROMs) have a potential role to play in assisting clinicians with better identification of these reportable deaths. Moreover, the inclusion of PROMs within coronial investigations can assist in identifying systemic failures and result in recommendations on public health and safety. In particular, PROMs could be effective in addressing the overuse of surgery which remains a major public health concern. While the role of PROMs in clinical practice has undergone extensive research, their potential use in death investigations has been overlooked. As medicine continues to transition towards a patient-centred model of care, the use of frameworks such as PROMs will become increasingly important and may also provide benefit to the process of medicolegal death investigations.
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Sharp CA, Schulz Moore JS, McLaws ML. The Coroner's Role in the Prevention of Elder Abuse: A Study of Australian Coroner's Court Cases Involving Pressure Ulcers in Elders. J Law Med 2018; 26:494-509. [PMID: 30574733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The prevention of elder abuse is a health priority around the globe. The Australian Law Reform Commission's 2017 report on Australian residential aged care facilities found that neglect may constitute elder abuse and that painful pressure ulcers (PUs) fall into this category. The purpose of this article is to examine deaths from PUs in elders 65 years and older. A database search of Australian cases identified four coroner's court cases. This article considers the role and potential of coroners' recommendations to prevent PUs. The origin and site of PUs, prevention, wound and pain management, quality of care and coronial recommendations were examined. Coronial recommendations were made in two of the cases. As judicial officers with a statutory public health function, coroners have the potential to play an important role in the prevention of deaths attributable to PUs. This article makes recommendations to harness the potential of the coronial jurisdiction to prevent PUs.
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Ranson D. The Investigations into What Happened at the Gosport War Memorial Hospital - Did the Coroner's Process Help? J Law Med 2018; 26:306-310. [PMID: 30574719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The Gosport Independent Panel was established to review the care of older patients at the Gosport War Memorial Hospital in England over some 20 years. There had been a number of internal and external investigations that included police investigations, clinical care audits, GMC investigations and inquests. The Panel provided a means of public disclosure of much of the contents of the prior investigations and resulted in the creation of a catalogue of all relevant information. The report indicated that many of the investigative processes had failed to address the concerns of family and staff. In part this appears to have been the result of some investigations being limited in their ability to deal with social and community concerns and focusing on whether criminal prosecutions should be brought. Legislative restrictions regarding the nature and outcomes of the inquest process in the United Kingdom compounded these concerns. It is interesting to speculate whether a more proactive inquest system brought into play earlier might have alleviated many of the community and professional concerns regarding patient care.
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Affiliation(s)
- David Ranson
- Deputy Director, Head of Forensic Services, Victorian Institute of Forensic Medicine
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Freckelton I. Procedural Fairness and the Coroner. J Law Med 2018; 26:7-22. [PMID: 30302969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The hearing rule of procedural fairness applies to coroners' investigations and the findings made by coroners. Decisions by Australian and New Zealand appellate courts starting from the 1980s and early 1990s suggest that this will require interested parties to be accorded the opportunity to respond to any adverse findings, and probably comments, which a coroner is minded to make by being alerted in advance to what is proposed by the coroner. This editorial scrutinises decisions by the Victorian Supreme Court and Court of Appeal on the issue between 2016 and 2018 against the backdrop of appellate decisions in South Australia and New Zealand, as well as in the context of the development of modern administrative law in both Australia and New Zealand. It identifies conceptual challenges that exist as a result of the recent case law for coroners' courts, pointing to the uncertainty of what are "adverse" findings and comments for these purposes, a lack of clarity as to who is entitled to procedural fairness in the inquisitorial context of a coronial investigation, the uncertain parameters of reputation for such purposes, vagueness as to what is required for coroners to discharge their obligations, and the logistical difficulties that compliance with such obligations will pose for timeliness of coronial findings.
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Murphy BJ, Bugeja LC, Pilgrim JL, Ibrahim JE. Suicide among nursing home residents in Australia: A national population-based retrospective analysis of medico-legal death investigation information. Int J Geriatr Psychiatry 2018; 33:786-796. [PMID: 29505665 DOI: 10.1002/gps.4862] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 12/21/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Suicide among nursing home residents is a growing public health concern, currently lacking in empirical research. This study aims to describe the frequency and nature of suicide among nursing home residents in Australia. METHODS This research comprised a national population-based retrospective analysis of suicide deaths among nursing home residents in Australia reported to the Coroner between July 2000 and December 2013. Cases were identified using the National Coronial Information System, and data collected from paper-based coroners' records on individual, incident, and organizational factors, as well as details of the medico-legal death investigation. Data analysis comprised univariate and bivariate descriptive statistical techniques; ecological analysis of incidence rates using population denominators; and comparison of age and sex of suicide cases to deaths from other causes using logistic regression. RESULTS The study identified 141 suicides among nursing home residents, occurring at a rate of 0.02 deaths per 100 000 resident bed days. The ratio of deaths from suicide to deaths from any other cause was higher in males than females (OR = 3.56, 95%CI = 2.48-5.12, P = <0.001). Over half of the residents who died from suicide had a diagnosis of depression (n = 93, 66.0%) and had resided in the nursing home for less than 12 months (n = 71, 50.3%). Common major life stressors identified in suicide cases included the following: health deterioration (n = 112, 79.4%); isolation and loneliness (n = 60, 42.6%); and maladjustment to nursing home life (n = 42, 29.8%). CONCLUSIONS This research provides a foundational understanding of suicide among nursing home residents in Australia and contributes important new information to the international knowledge base.
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Affiliation(s)
- Briony J Murphy
- Department of Forensic Medicine, Monash University, Southbank, VIC, Australia
| | - Lyndal C Bugeja
- Department of Forensic Medicine, Monash University, Southbank, VIC, Australia
| | - Jennifer L Pilgrim
- Department of Forensic Medicine, Monash University, Southbank, VIC, Australia
| | - Joseph E Ibrahim
- Department of Forensic Medicine, Monash University, Southbank, VIC, Australia
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Romero-Pimentel AL, Mendoza-Morales RC, Fresan A, Garcia-Dolores F, Gonzalez-Saenz EE, Morales-Marin ME, Nicolini H, Borges G. Demographic and Clinical Characteristics of Completed Suicides in Mexico City 2014-2015. Front Psychiatry 2018; 9:402. [PMID: 30245640 PMCID: PMC6137233 DOI: 10.3389/fpsyt.2018.00402] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/09/2018] [Indexed: 12/25/2022] Open
Abstract
Objective: To analyze sex differences in demographic and clinical characteristics of individuals who died by suicide in Mexico City. Method: Statistical analysis of residents of Mexico City whose cause of death was suicide, during two years period from January 2014 to December 2015, with a coroner's report. Suicide mortality rates were calculated by age, sex, and location within the city. The Chi-squared test was used to assess statistical differences. Results: From January 2014 to December 2015, 990 residents of Mexico City died by suicide (men: 78.28%, women: 21.72%). Among males, the highest mortality rates were among the groups of 20-24 and 75-79 years old, whereas in women, the group with the highest mortality rate was 15 to 19 years old. 74% of the sample used hanging as suicide method. However, men had higher rates of a positive result in the toxicology test (40%) (p < 0.05). There was no concordance between male and female suicide by city jurisdictions. Conclusion: Our results provide evidence that the characteristics of Mexico City's residents who committed suicide had significant sex-related differences, including where they used to live. Understanding the contributory factors associated with completed suicide is essential for the development of effective preventive strategies.
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Affiliation(s)
- Ana L Romero-Pimentel
- Facultad de Psicología, Universidad Nacional Autónoma de Mexico, Ciudad de Mexico, Mexico.,Instituto Nacional de Medicina Genómica, Ciudad de Mexico, Mexico
| | | | - Ana Fresan
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de Mexico, Mexico
| | - Fernando Garcia-Dolores
- Instituto de Ciencias Forenses, Tribunal Superior de Justicia de la CDMX, Ciudad de Mexico, Mexico
| | | | | | | | - Guilherme Borges
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de Mexico, Mexico
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Cunningham N, Pham T, Kennedy B, Gillard A, Ibrahim J. A cross-sectional survey using electronic distribution of a questionnaire to subscribers of educational material written by clinicians, for clinicians, to evaluate whether practice change resulted from reading the Clinical Communiqué. BMJ Open 2017; 7:e014064. [PMID: 28554912 PMCID: PMC5730012 DOI: 10.1136/bmjopen-2016-014064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore whether subscribers reported clinical practice changes as a result of reading the Clinical Communiqué (CC). Secondarily, to compare the characteristics of subscribers who self-reported changes to clinical practice with those who did not, and to explore subscribers' perceptions of the educational value of the CC. DESIGN, SETTING AND PARTICIPANTS Online cross-sectional survey between 21 July 2015 and 18 August 2015 by subscribers of the CC (response rate=29.9%, 1008/3373), conducted by a team from Monash University, Australia. MAIN OUTCOME MEASURES Change in clinical practice as a result of reading the CC. RESULTS 53.0% of respondents reported that their practice had changed after reading the CC. Respondents also found that the CC raised awareness (96.5%) and provided ideas about improving patient safety and care (94.1%) leading them to discuss cases with their colleagues (79.6%) and review their practice (75.7%). Multivariate analysis indicated that working in a residential aged care facility (p<0.05) and having taken part in an inquest (p<0.05) were significantly associated with practice change. CONCLUSION The design and content of the CC has generated a positive impact on the healthcare community. It is presented in a format that appears to be accessible and acceptable to readers and achieves its goals of promoting safer clinical care through greater awareness of the medico-legal context of practice.
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Affiliation(s)
- Nicola Cunningham
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Tony Pham
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Briohny Kennedy
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Alexander Gillard
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Joseph Ibrahim
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
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Erck Lambert AB, Parks SE, Camperlengo L, Cottengim C, Anderson RL, Covington TM, Shapiro-Mendoza CK. Death Scene Investigation and Autopsy Practices in Sudden Unexpected Infant Deaths. J Pediatr 2016; 174:84-90.e1. [PMID: 27113380 DOI: 10.1016/j.jpeds.2016.03.057] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/11/2016] [Accepted: 03/23/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe and compare sudden unexpected infant death (SUID) investigations among states participating in the SUID Case Registry from 2010 through 2012. STUDY DESIGN We analyzed observational data from 770 SUID cases identified and entered into the National Child Death Review Case Reporting System. We examined data on autopsy and death scene investigation (DSI) components, including key information about the infant sleep environment. We calculated the percentage of components that were complete, incomplete, and missing/unknown. RESULTS Most cases (98%) had a DSI. The DSI components most frequently reported as done were the narrative description of the circumstances (90%; range, 85%-99%), and witness interviews (88%, range, 85%-98%). Critical information about 10 infant sleep environment components was available for 85% of cases for all states combined. All 770 cases had an autopsy performed. The autopsy components most frequently reported as done were histology, microbiology, and other pathology (98%; range, 94%-100%) and toxicology (97%; range, 94%-100%). CONCLUSIONS This study serves as a baseline to understand the scope of infant death investigations in selected states. Standardized and comprehensive DSI and autopsy practices across jurisdictions and states may increase knowledge about SUID etiology and also lead to an improved understanding of the cause-specific SUID risk and protective factors. Additionally, these results demonstrate practices in the field showing what is feasible in these select states. We encourage pediatricians, forensic pathologists, and other medicolegal experts to use these findings to inform system changes and improvements in DSI and autopsy practices and SUID prevention efforts.
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Havard JD. A Historical and Comparative Review of the Reception of Forensic Medical and Scientific Evidence under Different Systems of Law. Forensic Sci Rev 1991; 3:29-40. [PMID: 26266991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this paper is to review the historical basis for the substantial differences which exist between the two main systems of law (common law and civil law) in the reception of forensic medical and scientific evidence by courts of law, and in the medico-legal investigation of sudden deaths in the community. The historical reasons for these differences are explained, and the relevant merits of procedures for presenting expert evidence in the courts of common law and civil law countries are discussed. The early appearance of forensic medical and scientific evidence in continental European (civil law) courts is contrasted with its long delayed introduction into common law countries. Special attention is given to the role of such evidence in the routine investigation of sudden death, which now serves an important public health function. The paper concludes by pointing to the paradox that the civil law countries have succeeded in ensuring that their courts of law receive the best forensic medical and scientific evidence, whilst at the same time failing to ensure that sudden deaths of unexplained cause are adequately investigated.
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Affiliation(s)
- J D Havard
- Commonwealth Medical Association, BMA House, Tavistock Square, London, UK
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