[Problems of hygiene for undertakers].
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Germany, East↗
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[The oldest forensic medical morgue in Moscow (on the 150th anniversary of the Lefortovo Morgue)].
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Forensic Medicine↗
[Autopsy before cremation--formality without efficacy?].
A multicentre study involving 36 out of 38 German medico-legal Institutes discovered 784 non-natural fatalities among 78,000 external examinations before cremation (1%) in 1995. These included 169 accidents, 16 suicides, 3 homicides and 589 deaths in connection with medical treatment. In the remaining 7 cases, a belated differentiation between homicide and accident was not successful. A linear projection results in 1980 non-natural fatalities among all 197,000 external examinations before cremation. This number includes 8 homicides but due to considerable inhomogeneities, a number of 40 homicides appears to be realistic. Consequently, abolishing the mandatory external examination before cremation would be equivalent to an official renouncement of solving relevant non-natural deaths. In case of a thorough external examination, a total of 18,000 non-natural fatalities including approximately 180 homicides could be detected per year during the first external examinations (n = 885,000).
Autopsy↗
Implantable cardioverter-defibrillators and the pathologist: comment and cautionary notes.
This paper briefly reviews the components of, the clinical uses of, the techniques to place, and the complications related to implantable cardioverter-defibrillators (ICDs). Information useful in the specific identification of ICDs is presented. A series of recommendations for the autopsy examination or postmortem explantation of ICDs by the pathologist is given. Because of the serious risk of injury to the pathologist possible with postmortem discharges of ICDs which have not been deactivated, and because of the risk of device explosion if the ICD is incinerated, a number of cautionary notes are provided. A brief case with occurrence of accidental postmortem discharge of an active ICD is also presented.
Accidents, Occupational↗
Direct detection of Pneumocysytis carinii in outdoor air: preliminary results of a field study.
P. carinii causes pneumonia in immunocompromised patients. New studies are suggestive of the de novo infections. Although P. carinii is believed to be ubiquitous it has not been detected directly from outdoor air. Therefore, outdoor air samples (n = 20) of 5 m3 were collected onto gelatin filters (pore size: 3 microns) on a cemetery using a suction pump (Sartorius MD8). Five samples were silver-stained, five samples were stained with an indirect immunfluorescence test kit, the remaining ten samples were stained with the combinations of the two individual stains. In a total of 100 m3 outdoor air one cyst resembling P. carinii was detected by the methenamine silver stain. Other cells not resembling P. carinii were found with a silver stained cell wall and positive fluorescence. The natural reservoir of P. carinii remains unknown. The indirect immunfluoresence which is common in the clinical laboratory is probably not specific enough for environmental samples.
Air Microbiology↗
[Epidemic recrudescence of the Great Plague in Marseille (May-July 1722): excavation of a mass grave].
The return of some infectious disease has stimulated specialists to study historical aspects of human infections. A major model for this study is Yersinia pestis which has had a great impact on human demography due to the fact that it is highly contagious and has a high mortality rate similar to that of the most lethal viral pathogenic agents. We carried out excavation of a mass grave containing the bodies of victims of an outbreak of bubonic plague that occurred in Marseille from 1720 to 1722. More than 200 skeletons were uncovered from the grave known as the Observance (second district in Marseille). In conjunction with laboratory testing, archival records were studied to determine the conditions and dates surrounding the use of this mass grave and to explain certain findings made at the site. This multidisciplinary approach revealed previously unknown facts concerning the Great Plague and provided new insight into recrudescence of the epidemic in 1722.
Autopsy↗
Health and safety standards in New Zealand mortuaries.
AIM: To establish the degree of compliance with health and safety standards in New Zealand mortuaries. METHOD: A mortuary audit tool was developed based mainly on British mortuary health and safety standards. This was tested and then applied to all identified mortuaries. RESULTS: Less than 50% (seven out of 15 institutions) met the standards required to carry out "basic" autopsies. Only one institution had mortuary facilities that were deemed suitable for "high risk" procedures. Where necessary, recommendations for improvements were made. CONCLUSIONS: New Zealand (and preferably Australasian-wide) standards need to be established and adopted for mortuaries. Some rationalisation of mortuary services so as to isolate risk (and improve quality control?) is necessary. People working in mortuaries need to adhere to stricter work practices while working in purpose-designed environments that minimise their risk.
Benchmarking↗
Funeral directors, mortuaries and necropsies: implications for necropsy consent rates and the prevention of infection.
AIM: To evaluate the attitudes and experiences of funeral directors in relation to necropsies. METHODS: All 1631 members of the National Association of Funeral Directors were surveyed by postal questionnaire about the purposes of necropsies, the technical and administrative problems associated with necropsied cases and their relations with relatives, mortuaries and pathology departments. RESULTS: In total, 123 funeral directors completed the questionnaire (8% response rate). Workload, proportion of cases necropsied and type of mortuary did not influence answers. Necropsies were considered important for the assessment of treatment outcome, identification of inherited disease and junior pathologist training, but not for medical audit. There was strong support for more education about necropsies. The areas of necropsy practice most frequently discussed with relatives related to concerns about funeral delay and the involvement of the coroner or equivalent authority. Funeral directors occasionally counselled relatives for or against giving necropsy consent. The commonest technical problems associated with necropsies were difficulties in embalming, leakage of body fluids and scalpel penetration in visible areas. Few administrative problems were reported; the commonest was inflexibility in body collection times. There was strong support for a national code of practice to cover relations between funeral directors and mortuaries despite general satisfaction with relations with local pathology departments. CONCLUSIONS: Although the relation among the funeral profession, mortuaries and pathology departments is largely satisfactory, a national code of practice for funeral directors and mortuaries is desirable.
Attitude↗
Aerosols in the mortuary.
Air counts in seven mortuaries during necropsies revealed that providing care is taken with washing intestines and close dissection, bacterial numbers are often less than those found in an operating theatre, and relate more to the number of people and movement in the room than the work. The acknowledged hazard of work in the mortuary seems to depend more on contact with infected material, and particularly with splashes on surfaces, than to inhalation of infectious material. Mortuaries should be ventilated, if only to contain the smell, but the recommendations of the Howie code of practice seem more than adequate. Provision of exhaust hoods for close dissection should be considered. Mortuary surfaces should be crack-free and easy to clean, and the room free of needless equipment.
Air Microbiology↗
Human DNA contamination of mortuaries: does it matter?
With the continuing development of extremely sensitive, automated systems for the detection of human DNA from a number of cellular sources, the problem of sample contamination from scenes of crime, cadavers, and the mortuary environment has become a potentially serious issue, with implications for all involved in forensic investigations. A recent survey of 20 mortuaries identified quantifiable human DNA on mortuary work surfaces and instruments which, when amplified, produced in some cases three or more profiles from single site samples. Possible sources of DNA contamination in the mortuary are discussed, along with implications related to its presence and its avoidance during the sampling process. These observations may not be confined to forensic practice.
DNA↗
[Professional management of death--sociocultural aspects].
UNLABELLED: During recent decades, treatment of death has been removed from the family and placed in the hands of experts and specialized institutions. More and more people die outside their homes. Our statistical analysis shows that in Switzerland between 1969 and 1986 the old people's home has replaced the private home. However the proportion of people dying in the hospital (55%) has not changed. Proceeding from these facts, we conducted a sociological research project with participant observation that explored attitudes, strategies and practices of professionals who deal closely with death and dying. Our case studies involved people working on the wards of a hospital, in a hospital mortuary, in an old people's home, in an autopsy department, in a funeral home and in a cemetery. The analysis showed that in the context of preservation of life (hospital), the consciously maintained attitude is ambivalence and an openness to various outcomes. In the context of applied science (autopsy department), the attitude is search for unequivocal exactness. In the context of loss (funeral home, cemetery), we find two different orientations among two different groups of actors. Those who deal with the practical side of death, such as the crematorium attendant, show a technical orientation, while those who deal with death's non-practical side, such as the minister, show a social and a symbolic orientation. At the points of intersection between these contexts, the actors develop complex strategies: maintenance of the past, negation of the present and anticipation of the future. CONCLUSIONS: (1.) The fight against death in the university hospital is being more and more replaced by the development of a strategy of openness.(ABSTRACT TRUNCATED AT 250 WORDS)
Attitude of Health Personnel↗
Tales of the crypt for psychiatrists: mourning, melancholia, and mortuary malpractice.
Death awaits all, leaving in its wake relatives and friends affected by the loss of a loved one. Immediately following death, the funeral process begins, resulting in permanent burial in a cemetery. This report investigates the dysfunctional interactions between grief-stricken relatives and mortuaries that are associated with civil litigation for negligence. Psychiatric evaluations of 25 bereaved plaintiffs from nine separate lawsuits were performed. In addition, medical records and legal pleadings were reviewed as sources of additional information. General themes from the clinical material are identified and illustrated by two cases. Surviving relatives are in an acute state of emotional turmoil, rendering them exquisitely sensitive to lapses in expected routine and perceived disrespect toward the decreased. These issues are intensified when the circumstances of the death were traumatic, when the relationship with the deceased was ambivalent, when specific cultural and religious factors are present, and when the influence of litigation is felt. If the burial process is disrupted, civil suits for negligence may be filed that exacerbate grief and challenge the psychiatrist's efforts to resolve diagnostic ambiguity in the face of emotionally charged cultural and religious practices.
Adult↗
Clinical chemistry since 1800: growth and development.
The 19th and 20th centuries witnessed the growth and development of clinical chemistry. Many of the individuals and the significance of their contributions are not very well known, especially to new members of the profession. This survey should help familiarize them with the names and significance of the contributions of physicians and chemists such as Fourcroy, Berzelius, Liebig, Prout, Bright, and Rees. Folin and Van Slyke are better known, and it was their work near the end of the second decade of the 20th century that brought the clinical chemist out of the annex of the mortuary and into close relationship with the patient at the bedside. However, the impact on clinical chemistry and the practice of medicine by the 1910 exposé written by Abraham Flexner is not as well known as it deserves to be, nor is the impetus that World War I gave to the spread of laboratory medicine generally known. In the closing decades of the 20th century, automated devices produced an overabundance, and an overuse and misuse, of testing to the detriment of careful history taking and bedside examination of the patient. This is attributable in part to a fascination with machine-produced data. There was also an increased awareness of the value of chemical methods of diagnosis and the need to bring clinician and clinical chemist into a closer partnership. Clinical chemists were urged to develop services into dynamic descriptions of the diagnostic values of laboratory results and to identify medical relevance in interpreting significance for the clinician.
Animals↗
[Forensic medicine in Dar-es-Salaam, United Republic of Tanzania].
The authors had opportunities to visit and see the present state of forensic medicine in Dar-es-Salaam, a capital city of United Republic of Tanzania. In this city, Department of Histopathology and Morbid Anatomy in Muhimbili University College of Health Sciences is in charge of education and practice of forensic medicine. All bodies of unusual death, about 3,000 cases per year, are brought to the university mortuary and examined by pathologists. An order of forensic autopsy from the Tanzanian police is submitted to the department with details of the case, i.e. circumstances of death, witnesses, weapons, etc. In each case, a pathologist signs out a death certificate and issues an autopsy report which is standardized throughout the country. Embalming after autopsy is essential in a tropical country. Tanzania in particular, to prevent both putrefaction of the body and dispersion of pathogens during its transportation. Preventive measures against biohazards from human immunodeficiency virus-infected bodies are considered in the autopsy room and laboratory. Although Tanzania is one of the developing countries in the world, the forensic medicine in the capital city is rendering great services in the promotion of public health.
Acquired Immunodeficiency Syndrome↗
Artefact in forensic medicine: scrotal mummification.
Misinterpretation of postmortem artefacts in forensic medical practice may result in a misdiagnosis of criminal activity. Forensic physicians at the scene can liaise with forensic pathologists and visit the mortuary in the company of the crime scene investigators or scenes-of-crime officers to ensure all relevant facts are identified. In this case a postmortem change created by partial dessication of the scrotal skin was misinterpreted as a suspicious injury.
Journal Article↗
Nursing care of dead bodies: a discursive analysis of last offices.
BACKGROUND: Nurses care for patients before they are born, after they have died and during the lifetime in between. This paper explores nursing care of the patient after they have died including the actions by nurses in preparation of the body, the covering with a shroud, and the transfer to the mortuary. AIMS: The analysis of a procedure manual excerpt Last Offices, which directs care of the dead patient aims to explore nursing care practices in regard to dead patients, as well as the impact of the health care institution and society at large on these care practices. METHOD: An acute care teaching hospital located in a major Australian city was approached and permission was granted to access their procedure and policy manuals. The Last Offices excerpt of the procedure manual was discursively analysed. FINDINGS: It is the contention of this paper that, through their care, nurses enact the transition between life and death, and from person to corpse. Furthermore, nurses mediate the move from embodied person to becoming dead, and in so doing traverse the cultural, ontological and epistemological breaks that death entails.
Attitude of Health Personnel↗
State of research in high-consequence hospital surge capacity.
High-consequence surge research involves a systems approach that includes elements such as healthcare facilities, out-of-hospital systems, mortuary services, public health, and sheltering. This article focuses on one aspect of this research, hospital surge capacity, and discusses a definition for such capacity, its components, and future considerations. While conceptual definitions of surge capacity exist, evidence-based practical guidelines for hospitals require enhancement. The Health Resources and Services Administration's (HRSA) definition and benchmarks are extrapolated from those of other countries and rely mainly on trauma data. The most significant part of the HRSA target, the need to care for 500 victims stricken with an infectious disease per one million population in 24 hours, was not developed using a biological model. If HRSA's recommendation is applied to a sample metropolitan area such as Orange County, California, this translates to a goal of expanding hospital capacity by 20%-25% in the first 24 hours. Literature supporting this target is largely consensus based or anecdotal. There are no current objective measures defining hospital surge capacity. The literature identifying the components of surge capacity is fairly consistent and lists them as personnel, supplies and equipment, facilities, and a management system. Studies identifying strategies for hospitals to enhance these components and estimates of how long it will take are lacking. One system for augmenting hospital staff, the Emergency System for Advance Registration of Volunteer Health Professionals, is a consensus-derived plan that has never been tested. Future challenges include developing strategies to handle the two different types of high-consequence surge events: 1) a focal, time-limited event (such as an earthquake) where outside resources exist and can be mobilized to assist those in need and 2) a widespread, prolonged event (such as pandemic influenza) where all resources will be in use and rationing or triage is needed.
Benchmarking↗
Surveillance of severe acute respiratory syndrome (SARS) in the post-outbreak period.
INTRODUCTION: This retrospective one-month survey evaluated the practicality of post-severe acute respiratory syndrome (SARS) surveillance recommendations in previously SARS-affected countries, namely Singapore. These included staff medical sick leave for febrile illness, inpatient fevers, inpatient pneumonia, atypical pneumonia, febrile illnesses with significant travel history and sudden unexplained deaths from pneumonia/ adult respiratory distress syndrome (ARDS). METHODS: Surveillance data on medical sick leave of staff, all inpatient fevers, all febrile (temperature greater than or equal to 38 degrees Celsius) inpatient pneumonia, including atypical pneumonia, and deaths from pneumonia were collected from sick leave reports, ward reports, isolation room rounds and mortuary reports from 1 to 28 September 2003. RESULTS: Baseline results show 167 (1.4/1000 staff-days) observed in staff sick leave for febrile illnesses, and 1798 (71.3/1000 bed-days) observed for inpatient fever. There were 40, 31 and 12 instances, respectively, of staff having temperatures of high fever (greater than or equal to 38 degrees Celsius), prolonged sick leave (3 days or more), and repeated sick leave (within 7 days) for febrile illnesses. An average of 4.6 wards a day potentially fulfilled the World Health Organisation SARS alert criteria. Of 27 cases with fever, pneumonia and a total white count of less than 10,000 cells per cubic mm as per Ministry of Health, Singapore criteria for the diagnosis of atypical pneumonia, only five were identified by clinicians. CONCLUSION: Surveillance is time-consuming and current recommendations are not specific enough to be used practically. Surveillance indicators for inpatients must overcome a high degree of background noise.
Allied Health Personnel↗