Medicolegal death investigation
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Unexplained Drownings and Cardiac Channelopathies

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Dr Ackerman of the Mayo Clinic (USA) discusses the importance of considering inherited cardiac disease in the investigation of deaths thought to be caused by drowning, and the questions such an investigation should prompt pathologists to consider (did the deceased have a history of unexplained fits/ faints, or palpitations etc, or is there a family history of these symptoms, or a cardiac death at an early age etc).

 

Tissue sampling - for genetic mutation analysis (a 'molecular autopsy') can then assist the investigation into the death, as well as be of benefit to surviving family members, who can be screened by a cardiologist with an interest in sudden cardiac death if they wish.

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How clinical decisions are made. - PubMed - NCBI

Br J Clin Pharmacol. 2012 Oct;74(4):614-20. doi: 10.1111/j.1365-2125.2012.04366.x. Review
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An excellent introductory overview article to help you get to grips with the cognitive processes underpinning clinical reasoning and decision-making.

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The Royal College of Pathologists | Information about post-mortems | Examination of the body after death

The Royal College of Pathologists | Information about post-mortems | Examination of the body after death | Medicolegal death investigation | Scoop.it
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The Royal College of Pathologists has updated its information about the autopsy (June 2014), aimed at the general public.

 

It includes summaries of the two main types of post mortem examination that you will come across in your medical studies: the hospital ('consent') examination, and the medico-legal examination performed on behalf of the Coroner in England, Wales and Northern Ireland (or Procurator Fiscal in Scotland).

 

Could you explain what is involved in a post mortem examination to relatives of a deceased patient of yours? If not, this is a good place to start...

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A tight squeeze - INTENSIVE

A tight squeeze - INTENSIVE | Medicolegal death investigation | Scoop.it
A trauma patient shows signs of neurological deterioration and a CT head is performed.... Things don't look good.
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Based on an example case study of a man who has suffered significant head injuries, this blog post examines the apnoea test for 'brain-stem death', illustrated with neuroradiological images of diffuse brain swelling.

 

This post supplements other Scoops on this page relating to the clinical examination for 'brain death'.

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The pathophysiology of heat-related illness and death

The pathological investigation of deaths thought to be due to heat-stroke, or hyperthermia can be challenging. This article, guest authored by Dr Andrew Davison (Senior Lecturer in Forensic Pathology at the Wales Institute of Forensic Medicine), explores the pathophysiology of heat-related deaths.
Richard Jones's insight:

 

A tricky area of forensic medicine, but an excellent topic to explore with medical students, as it requires the application of physiological principles, the integration of wide ranging sources of information (an investigation of a death scene, for example), and a recognition of uncertainty in medicine/ pathology.

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Retinal haemorrhages and non-accidental injury

A causative link between retinal haemorrhages and abusive head trauma is not universally accepted, but the identification, and documentation, of ocular abnormalities is a standard component of the examination of the injured child in life and in death.
Richard Jones's insight:

 

Paediatric forensic pathology is quite a niche specialty, but there are aspects of the investigation of infant and child deaths that are pertinent to undergraduate medical students, not least the recognition of injuries, and patterns of injuries that should lead a clinician to seek advice from colleagues about the possibility of non-accidental injury.

 

The examination of the eyes by fundoscopy is a skill that students will (hopefully) master during their training, and retinal haemorrhages in the infant and child is a topic that could be used as a good 'anchor' for teaching and learning in opthalmology.

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Deaths in custody or following police contact

The medicolegal investigation of deaths following police contact, and deaths in custody is complex, and not without controversy.

This resource supports undergraduate medical student teaching in forensic medicine and pathology.
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This is a resource to support teaching and learning in forensic medicine and pathology, particularly for students taking the Student Selected Component (SSC)in forensic pathology in Cardiff University's School of Medicine.

 

The forensic pathological investigation of deaths occurring in custody, or following police contact, involves consideration of a multitude of factors from the pathophysiology of 'struggle against restraint', the toxicology of stimulant drugs of abuse, mental illness, and pressure to the neck, amongst many other fascinating topics.

 

Discussions take place during the SSC about such investigations, and illustrate the complex factors that are potentially involved in sudden death investigations, and how forensic pathology draws on a diverse literature base in order to attempt to answer questions raised by a death.

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The mind of a heroin addict: the struggle to get clean and stay sober

The mind of a heroin addict: the struggle to get clean and stay sober | Medicolegal death investigation | Scoop.it
After the death of actor Philip Seymour Hoffman, we asked recovering heroin users to share their experiences with us. The response was enormous
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Drug-related deaths form a relatively large proportion of our patients in forensic medicine and pathology, and it is important not to de-humanise them. This article draws on the - sometimes harrowing - words of addicts, and highlights their insight into the potential for their addiction to kill them.

 

 

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Forensic pathological investigation of fire deaths

An overview presentation of the forensic pathological investigation of fire deaths
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This overview presentation identifies the key components of the forensic pathological investigation process for fire-related deaths.

 

The forensic pathologist works as part of a multi-disciplinary team, including fire service personnel, crime scene investigators, forensic scientists, forensic dentists (odontologists), forensic anthropologists, and toxicologists.

 

Together they try to answer medicolegal questions raised by the death.

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File on 4: Coroners Under Scrutiny

File on 4: Coroners Under Scrutiny | Medicolegal death investigation | Scoop.it
Ann Alexander investigates whether families are getting justice in the coroner's court.
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A thought-provoking radio programme from the BBC about the role of the coroner, and the Inquest system, in the medicolegal investigation of deaths in hospital.

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The history of child abuse. [Forensic Sci Int. 1986 Feb-Mar] - PubMed - NCBI

PubMed comprises more than 22 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.
Richard Jones's insight:

 

Professor Bernard Knight - who set up the Wales Institute of Forensic Medicine, Cardiff, Wales - wrote this excellent review article several decades ago but it is still an excellent resource for readers interested in how society started to recognise that children were being abused - and killed - by those supposed to be caring for them.

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Deciding the cause of death after necropsy. [Lancet. 1993] - PubMed - NCBI

PubMed comprises more than 22 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.
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This article is not open access, but should be available through your institutional subscription - it is an excellent attempt at describing the decision making process required when determining the cause of death, and puts that process against a philosophical background.

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Confession of ignorance of causation in coroners' necropsies--a common problem?

Confession of ignorance of causation in coroners' necropsies--a common problem? | Medicolegal death investigation | Scoop.it
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A thought-provoking paper written by forensic pathologists at the Wales Institute of Forensic Medicine exploring the problem of insufficient pathological evidence to determine cause of death in medicolegal autopsies.

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The Crown Court - YouTube

An introduction to the Crown Court, the different roles within it and how a trial at the court works.

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This is a succinct introductory video about the roles played by judge, barristers, and jury, in a Crown Court criminal trial in England and Wales, produced by the University of Derby. It takes you through the stages of a trial - the course of evidence - and explains clearly how a trial progresses from start to finish.

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Thinking, Fast and Slow - Wikipedia, the free encyclopedia

Thinking, Fast and Slow

Thinking, Fast and Slow is a best-selling 2011 book by Nobel Memorial Prize in Economics winner Daniel Kahneman which summarizes research that he conducted over decades, often in collaboration with Amos Tversky. It covers all three phases of his career: his early days working on cognitive biases, his work on prospect theory, and his later work on happiness.

Richard Jones's insight:

This is an excellent book describing the work of Daniel Kahneman on how we think, how cognitive bias affects our ability to think rationally, and how we perceive risk. It is of direct relevance to the way in which we make decisions in medicine - how we go about the art of clinical reasoning.

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ARTNATOMY

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When an unidentified body is discovered, and visual recognition is not possible due to decomposition, fire-related damage, or trauma, forensic artists can create a facial reconstruction based on their knowledge of facial anatomy.

 

This interactive Flash-based online application will help you revise your facial muscle anatomy in a fun way! See where the main muscles are, revise their actions, and explore how the movements are co-ordinated during a range of facial expressions, such as fear, or surprise.

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Richard Jones's curator insight, June 12, 2014 1:18 PM

When an unidentified body is discovered, and visual recognition is not possible due to decomposition, fire-related damage, or trauma, forensic artists can create a facial reconstruction based on their knowledge of facial anatomy.

 

This interactive Flash-based online application will help you revise your facial muscle anatomy in a fun way! See where the main muscles are, revise their actions, and explore how the movements are co-ordinated during a range of facial expressions, such as fear, or surprise.

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UNODC: Global Study on Homicide

UNODC: Global Study on Homicide | Medicolegal death investigation | Scoop.it
Global Study on Homicide 2013 seeks to shed light on the worst of crimes - the 'unlawful death purposefully inflicted on a person by another person.' In 2012, intentional homicide took the lives of almost half a million people. The study of intentional homicide is relevant not only because it is the study of the ultimate crime, whose ripple effect goes far beyond the initial loss of human life, but because lethal violence can create a climate of fear and uncertainty. Intentional homicide also victimizes the family and community of the victim, who can be considered secondary victims, and when justice is not served, impunity can lead to further victimization in the form of the denial of the basic human right to justice.
Richard Jones's insight:

This report from the UN makes for grim reading.

 

There were 437,000 homicides globally in 2012, with big regional differences (5% in Europe vs 36% in the Americas). The global average homicide rate was 6.2 per 100,000 people, but the rate was over 24 per 100,000 in Central America and Southern Africa.

 

There is a widening gap between those countries with high and low homicide rates.

 

The vast majority of homicides occurred in the age ranges 15-29 years, and 30-44 years, and 79% were male (95% of perpetrators were also men). This masks a statistic of concern - 47% of women were killed by intimate partners or family members.

 

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Crime scene forensics: 360 image

Crime scene forensics: 360 image | Medicolegal death investigation | Scoop.it
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This interactive feature from the BBC immerses you in a crime scene, with a 360 degree photograph, and 'hotspots' which explore specific aspects of the evidence at the scene.

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Physiology of CPR

Physiology of CPR | Medicolegal death investigation | Scoop.it
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A nice article examining the physiology of cardiopulmonary resuscitation by the Greater Sydney Area HEMS service.

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Brain Stem Testing - A Demonstration - YouTube

Brain Stem Test
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This is an excellent video demonstration by Dr James Watts (Consultant Anaesthetist, East Lancs Hospital Trust) of how brain stem testing is carried out in intensive care settings.

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Forensic Science Simplified

Forensic Science Simplified | Medicolegal death investigation | Scoop.it
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Published by the US National Forensic Science Technology Center, this website provides a brief overview of forensic science. It is a great place to start if you are looking for an introduction to issues relating to toxicology, firearms, and trace evidence collection, amongst several other topics.

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What is forensic pathology?

"This short narrated animation explains what forensic pathology is."

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This is a short narrated animation that I created using an iPad app (Tellagami) and edited using Microsoft Movie Maker. The process is fairly painless, although there is a 30 second limit on the app at the moment that could do with being a lot longer for most teaching purposes.

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What the CPS does, and what happens at court

Video produced by CPS Gwent, that is relevent to people throughout England and Wales about how the Crown Prosecution Service works, and what it is like going...
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This is a useful introductory video for anyone wanting to know a little about what happens in court, and what the Crown Prosecution Service does.

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Deciding the cause of death after autopsy - revisited... [J Clin Forensic Med. 2005] - PubMed - NCBI

PubMed comprises more than 22 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.
Richard Jones's insight:

 

Following on from Cordner's philosophical exploration of the decision-making process involved in determining the cause of death, Pollanen - a forensic pathologist practising in Canada - expands the thesis, and considers problematic areas of forensic pathology practice in which that determination of causation is difficult - if not impossible.

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Next of kin clinics: a new role for the pathologist.

Next of kin clinics: a new role for the pathologist. | Medicolegal death investigation | Scoop.it
Richard Jones's insight:

 

Pathologists need to be able to effectively communicate complex medical findings to those with no medical knowledge, as do all medical practitioners.

 

Interactions with families of the deceased frequently takes place at Inquest, but the authors of this article argue for an extension of this dialogue to 'next of kin clinics'.

 

What do you think of this idea?

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