Proficiency testing for psychoactive substances in Italy

This paper describes the general design and main results of the Italian proficiency testing program for the analysis of psychoactive substances in urine, a long-term initiative created in 1995 on an educational basis and characterized by an innovative internet-based service for data exchange between laboratories and the organizing body. Batches of six urine samples, validated by reference laboratories, are sent every 3 months to participating laboratories, which may choose which classes of substances to test from those planned by the program panel and, within those classes, which type of analytical commitment to work on: identification of just one class (Option 1), identification of single substances (Option 2), or identification and quantification of single substances (Option 3). Comprehensive periodical reports and annual reports are provided to participants with evaluation of their performance and an annual workshop is organized to discuss technical-scientific topics related to clinical, forensic and analytical toxicology. About 200 laboratories currently participate in the program and a total of 67,059 analyses have been carried out since 1995. The mean percentage of correct results was 96.8%, with a yearly improvement of about 0.4%. The best average false positive and false negative rates were obtained for methadone (0.2% and 2.1% respectively) and cocaine (0.3% and 2.2%). The worst average false positive rates were obtained for amphetamines and opiates (3.2% and 5.0%) and worst average false negative rates for amphetamines, barbiturates and cannabinoids (17.4%, 30.7% and 19.9%).

Child abuse and forensic pediatric medicine fellowship curriculum statement

Physicians have been involved in the diagnosis and treatment of victims of child abuse and neglect for more than 35 years. In the past decade, a cadre of physicians has developed extensive expertise in the field. Now, physicians are requested for expert consultation by medical, investigative, and legal colleagues. As the field advances, it has become necessary to train more physicians in the field of child abuse and forensic pediatrics as well as to standardize the curricula of the existing fellowships. A joint working group of the American Academy of Pediatrics Section on Child Abuse and Neglect and the Forensic Pediatrics Physician Leadership Group convened to develop a curriculum for medical fellowships in child abuse and neglect. The authors present the model curriculum developed by this group.

Legal medicine education: the M.D./J.D. Dual Degree Program at Southern Illinois University

Southern Illinois University Schools of Medicine and Law sponsor an M.D./J.D. Dual Degree Program that leads to the concurrent award of degrees in law and medicine at the conclusion of a six-year course of study. The program rationale and justification, as well as a program description merit consideration by individuals interested in legal medicine education.

Courting disaster? A survey of the autopsy service provided by district surgeons in Kwazulu-Natal

AIM

To provide information on the overall quality of the autopsy service provided by district surgeons in KwaZulu-Natal (KZN) and in particular to identify factors which may have a negative impact on the judicial process.

METHOD

Confidential questionnaires were sent to 73 district surgeons and 216 legal practitioners including prosecution advocates, regional court prosecutors, defence advocates and attorneys. One hundred and twenty (43%) replies (47 doctors and 73 lawyers) were suitable for analysis.

RESULTS

District surgeons have no shortage of experience or maturity but their performance is hampered by the following: lack of appropriate training in forensic pathology; high case load; inadequate facilities and support staff; and lack of access to ancillary services.

CONCLUSION

This study has shown that the standard of autopsy services by district surgeons varies considerably. Overall, there is evidence that inadequacies on the part of district surgeons have negative repercussions for the criminal justice system. Urgent attention should be given to implement training programmes for the district surgeons and to improve service conditions.

Prison nurses need more educational support

Nurses working in secure environments and prisons will welcome the findings of a recent UKCC report on these areas of practice (UKCC, 1999). Traditionally, nursing in secure environments and prisons has not been an attractive career option among nurses which has led to the nurses working in these sectors feeling increasingly isolated from the rest of the nursing profession.

[Isn't there a gap between ideal and real actions in legal toxicology?]

I showed a view for some problems, which need to be solved, in the process of post mortem examinations and chemical analyses of deaths from poisoning. Basic education program of analytical chemistry has some problems for medical students, post graduated persons and analysts. Analytical procedures have also problems in quality assurance system. I expressed the necessity of "an analytical center of poisoning", following I showed a plan as a starting point for "the analytical center".

Preparing nurses to work effectively in the prison environment

Nurses who go to work in prisons begin their new career without having had any specific preparation for this unique and diverse role. The demands placed upon nurses are unlike any they will have experienced in their previous clinical posts. The work of a nurse in prison contains elements of both mental health nursing and practice nursing. The context in which this nursing occurs means that the nurse is presented with complex clinical and professional dilemmas. Consequently, few nurses start to work within this specialty with all of the core competencies required to be clinically effective and confident in their role. This article describes how this unmet educational need was addressed by the development of a diploma level module.