Quality issues in forensic pathology
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The incidence of diagnostic error in medicine -- Graber -- BMJ Quality and Safety

The incidence of diagnostic error in medicine -- Graber -- BMJ Quality and Safety | Quality issues in forensic pathology | Scoop.it
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This article takes the reader through a thorough overview of how the incidence of clinical diagnostic error is calculated by varying types of study - including autopsy-based estimates.

 

Despite modern imaging techniques and clinical confidence in diagnoses, autopsy-based studies consistently find fatal lesions unsuspected by clinicians in life, as well as lesions that could be considered 'clinically insignificant'.

 

Pulmonary thromboembolism is a classic 'unexpected autopsy finding' in patients dying in hospital unexpectedly, for example.

 

One effect of the decline of 'consent post mortem examinations' is the removal of an important quality assurance check in the clinical diagnostic process.

 

Whether post mortem imaging studies will eventually come to replace conventional consent post mortems remains to be seen, but as a pathologist, I would argue that some form of regular post mortem audit of hospital deaths is facilitated by clinicians so that confidence in clinical diagnoses is seen to be justifiable.

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Kirk Bloodsworth - DNA Evidence

Kirk Bloodsworth was the first person to be exonerated and released from death row by DNA evidence.

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This is a sobering video showing the effects of a wrongful conviction subsequently overturned on the basis of DNA evidence recovered from a victim.

 

Trace evidence collected from bodies at autopsies must be carefully documented, recovered, and stored so that it is available to interested parties at a later date even if it is not subjected to analysis in the immediate aftermath of the autopsy. Contamination must be prevented, so that the integrity of the sample can be vouched for prior to analysis.

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Quality issues in forensic pathology - mistakes @ www.forensicmed.co.uk

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Several excellent papers have described the range of 'classic mistakes' that forensic pathologists can make, unless they are 'on their guard'.

 

This section of my website 'Forensic Medicine for Medical Students' explores those mistakes, and illustrates why quality standards are necessary in all aspects of medicine, including forensic pathology.

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GMC | Good medical practice (2013)

Good medical practice is the core ethical guidance the GMC provides to doctors. It is also intended to let the public know what they can expect from doctors.
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Forensic pathologists are medical doctors, and must practice in accordance with the principles described in this document from the General Medical Council (GMC).

 

As part of the revalidation of doctors, evidence that 'Good Medical Practice' domains have been achieved will have to be provided in appraisals. The Royal College of Pathologists provides guidance to pathologists on how best to demonstrate that they meet these quality standards, and forensic pathologists will be revalidated by the UK Government Home Office.

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BBC News - The virtual autopsy

Autopsies have traditionally been a messy affair. From weighing the organs to opening up bodies, seeing how a person died can take a lot of time, precision a...
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Could the traditional forensic/ medicolegal autopsy be replaced by a 'virtual autopsy'?

 

This is a question that has been debated for several years, particularly following improvements in imaging techniques.

 

The utility of post mortem CT scanning has been investigated in several countries, but was pioneered by the 'Virtopsy' group in Switzerland. 3D reconstructions of CT data allow bone fracture patterns to be visualised more impressively than at traditional autopsies, and seems to represent the optimal way of demonstrating trauma pathology.

 

There are, however, continued difficulties in imaging common fatal pathologies, including coronary artery atherosclerosis. Until a reliable imaging protocol has been developed for such deaths, post mortem CT will probably not completely replace the conventional autopsy.

 

The ability to link 3D surface scanning technology with CT datasets looks like a fascinating advance, and when forensic pathologists have routine access to CT scanners in the mortuary, the 'virtopsy' will undoubtedly take a more prominent role in medicolegal autopsies.

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CORE INFO | Cardiff Child Protection Systematic Reviews

CORE INFO | Cardiff Child Protection Systematic Reviews | Quality issues in forensic pathology | Scoop.it
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The evidence base for forensic medicine is sometimes questioned, and the Cardiff Child Protection Systematic Review Group has spent several years investigating the evidence underpinning aspects of forensic medicine relevant to suspected child abuse.

 

This website explores all of the systematic reviews completed to-date, including bruising patterns, inflicted burns, fractures, head injury, and visceral injuries, to name a few.

 

This is an excellent resource for students undertaking rotations/ placements in paediatric medicine, as well as in emergency medicine and forensic pathology.

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Curated weblinks - miscarriages of justice & mistakes (via Delicious)

Keep, share, and discover the best of the Web using Delicious, the world's leading social bookmarking service.
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The importance of quality standards in forensic pathology, and forensic science, is illustrated when things go wrong. The consequences of juries accepting unreliable expert forensic evidence can be dire for individuals whose liberty (or life) is at stake, as well as the integrity of the criminal justice system.

 

This collection of weblinks curated by me explores cases of actual, or alleged, miscarriages of justice from around the Globe, including those in which forensic expert evidence is implicated, at least in part.

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Standards for forensic pathology in England, Wales and Northern Ireland - Publications - Inside Government - GOV.UK

Standards for forensic pathology in England, Wales and Northern Ireland - Publications - Inside Government - GOV.UK | Quality issues in forensic pathology | Scoop.it
Richard Jones's insight:

 

Forensic pathologists in England, Wales and Northern Ireland are expected to meet the standards of practice contained within this document.

 

It covers all aspects of the medicolegal investigation of suspicious deaths in which the pathologist is involved, from the initial 'briefing' from the police, attendance at a scene of a suspicious death, the autopsy, production of a report, and court proceedings.

 

This document is important in setting expected quality standards for forensic pathologists, and forms the benchmark for reliable practice in this field.

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