A medicolegal curriculum for internal medicine residents

Many residents lack knowledge about medicolegal issues. To assess the ability of 64 primary care residents to learn legal medicine, we studied the impact of a medicolegal curriculum in a randomized, controlled study. We measured residents' medicolegal knowledge using a novel test, the Legal Medicine Evaluation (LME). We found that the mean LME score of residents exposed to the curriculum increased 15.5 points (on a 100-point scale) to 65.9 ( p <.01), while the mean LME score of control residents increased only 3.5 points, to 53.5 ( p =. 05). Clearly, residents can learn basic medicolegal principles. Thus, observed deficiencies in medicolegal knowledge most likely arise from inadequate medicolegal instruction.

[A study of multimedia computer assistant instruction of forensic autopsy]

A study of software system for forensic autopsy teaching was carried on with multimedia computer and authour tool. This software system can meet the need of morphological instruction by combining the theory of forensic medicine with its practice. It also indicates that the multimedia computer is playing an impotant role in forensic medicine.

The role of the clinical forensic nurse in critical care

Forensic nursing deals with the population of people whose lives have been affected by societal violence. The clinical forensic nurse (CFN) is seen as a means of coping with the resultant increased complexity of nursing practice, society, and the law. Critical care areas are clinical forensic domains where the CFN addresses the needs of living forensic patients through activities involving physical and non-physical evidence collection, crisis intervention, and documentation. Within a health care team, the CFN enhances patient care management, resulting in clinical service, legal order, and forensic protocol.

The suspiciousness factor: critical care nursing and forensics

This conceptual article provides a guide for understanding the place of forensic nursing within the discipline of nursing. Ways of knowing in nursing and expert nursing practice are described to identify the role of intuition in nursing practice. The relationship between suspicion and intuition is explored. Strategies for developing forensic nursing expertise and increasing suspicion are described. Suspicion (intuition) is presented as a rapid, acquired, patient oriented perception that leads to decisive action.

Barriers to effective screening for domestic violence by registered nurses in the emergency department

Triage nurses in the emergency department are in a unique position to screen for domestic violence. This study, using Orlando's theory with a focus on two of her five major concepts, identifies barriers that prevent effective screening for domestic violence. A quantitative survey was distributed to 101 registered nurses employed in a large emergency department. Results identified three major barriers and a relationship between age and inservice attendance on domestic violence. Education on abuse and resources should be essential in nursing school curricula. Policy development and review should be part of an annual, mandatory inservice for all emergency nurses.

Forensic medicine in China

Although China has a long history of forensic medicine, with the first standard text published in 1247, modern practices appeared only in the 1930s under Professor Lin Ji. After the founding of the People's Republic of China in 1949, there was a period of rapid development, which was later interrupted by the Cultural Revolution of 1966-1976. Today, China has about 10,000 experts in forensic medicine organized within the separate agencies of police, prosecutor's offices, courts, universities, and the Justice Ministry. Eight medical colleges, the Institute of Forensic Sciences of the Ministry of Justice in Shanghai which publishes the Journal of Forensic Medicine, and the Forensic Medicine Association of China which publishes the Chinese Journal of Forensic Medicine are key organizations.

Forensic science program: a community effort

A forensic science program has been developed to assist the professional community population in using a scientific approach in the investigation of criminal offenses. The science of medicine and the principles of the law come together to form a multidisciplinary group of professionals to instruct in the collection of evidence after a crime has been committed. Specialists in these areas include forensic pathologists, forensic anthropologists, forensic odontologists, entomologists, and a radiologist with a specialty in forensics. No longer can educators ignore the necessity of community involvement in the apprehension and prosecution of the perpetrators of crime. This program is the first to offer basic forensic science courses to professionals in a variety of related fields.

Forensic autopsy in a pathology training program

OBJECTIVE

To review a satellite facility's autopsy experience with coroner's cases, to determine the volume and type of cases performed; and to evaluate the teaching value of forensic autopsies in a pathology residency training program.

DESIGN

A retrospective review of 65 Los Angeles County Coroner cases performed at Cedars-Sinai Medical Center, Los Angeles, Calif, from 1992 to 1996 was undertaken. Data were retrieved from cause of death statements, medical report forms, and autopsy reports.

RESULTS

In the 65 coroner's cases performed from 1992 to 1996, ages ranged from 6 months to 97 years. During this time period, the cases comprised 6.1% (65/1059) of all autopsies at Cedars-Sinai Medical Center and 11.3% (65/575) of autopsies excluding fetal and neonatal examinations. Manners of death in the cases were accidental (53.8%), natural (40.0%), suicide (4.6%), and undetermined (1.5%). The most common cause of death in natural deaths was related to heart disease (12/26 [46.2%]). Motor vehicle collisions were the most common cause of death (15/35 [42.9%]) in the accidental group. The remainder of the causes of death in both the natural and accidental groups encompassed a wide variety of pathologic processes and injuries.

CONCLUSIONS

Forensic autopsies in a pathology residency training program have the potential to supplement a diminishing number of hospital autopsies. A wide variety of diseases are encountered through coroner's cases. Forensic autopsies contribute to residency training by providing experience in trauma cases and a variety of medical disorders.

[Difficulty to diagnose the cause of death in emergency room]

We evaluated the diagnoses noted on the medical records of 275 patients admitted to Saga Medical College Hospital during the six-year period 1990-1995: 245 patients with cardiopulmonary arrest on arrival (CPAOA) and 30 patients with cardiopulmonary arrest occurring in the emergency room (CPAER). The most frequent cause of CPAOA was heart disease, and the next frequent cause was respiratory disease. In the CPAER patients, the most frequent cause was heart disease, while the next frequent was acute aortic dissection. There were discrepancies in the respective causes of cardiac arrest between the CPAOA and CPAER patients, which was probably due to difficulty in diagnosis in the emergency room. In the emergency room, the cardiopulmonary resuscitation is the first treatment to be performed for CPAOA, the examination for the cause of cardiac arrest is the next followed after the heart beating. However, the cause of cardiac arrest can not be diagnosed in the emergency room for the CPAOA patients without the successful resuscitation, because the examinations for the cause of cardiac arrest can not be performed for the patients without beating heart in the emergency room. Therefore, it is concluded that there exists a need to improve the training for finding out the abnormal death with the inspection and the medico-legal autopsy. It may be suggested that the training system of forensic medicine is ideal for clinical physician who can study the decision of the diseases ranging from toxicosis to acute cardiopulmonary arrest in both the emergency and the forensic medicine.

Sexual Assault Response Team: overcoming obstacles to program development

After several years of planning, The SART at Immanuel St. Joseph's--Mayo Health Systems became a reality in August 1997. The nurses who were trained for this program were already providing 24-hour coverage in the emergency department for psychiatric emergencies and patients with chemical dependency. The SANE responsibilities were added to their on-call duties. Five nurses participated in a 40-hour training program by SANE specialists and experts in the local community. As expected, nurses were apprehensive as they conducted their first examinations; however, all has gone well. Over time, the providers' and clients' satisfaction with the program has improved. The examination is completed in less time, and the person assaulted does not have to wait as long for the SANE to arrive. Members of law enforcement and the prosecutor's office are especially pleased with the quality of evidence collected and the procedures followed to maintain chain of evidence so the evidence obtained can be used in prosecution. The program has resulted in kind and compassionate care for persons who have been sexually assaulted. The providers are continuing to meet monthly as an interdisciplinary, interagency team and are addressing concerns as they arise. Members of the SART are developing a good working relationship. Everyone involved agrees that developing this program has been a worthwhile effort and that the hospital is providing a valued service for the community.

Developing medicolegal death investigator systems in forensic pathology

As a result of recent national events involving high-profile murder cases, medicolegal death investigation has begun to slowly receive the attention it deserves. Despite continued local problems of financial support and political control, the development of regionalized centers of forensic excellence is gradually improving the access of rural and suburban areas to high-quality forensic science services. Recent efforts to improve the quality of lay death investigators through hiring practices, training, and certification promises to eventually provide more professionally qualified and experienced death investigators.

Suggested guidelines for platform presentations

A platform presentation at an academic meeting requires preparation, practice, and self-discipline. Our observations and discussions of presentations made at national meetings of forensic scientists over the past several years compelled us to review the essentials of public speaking in the academic arena. We translated this review into a compilation of recommendations for the prospective presenter. Application of these recommendations will result in more informative, efficient, and enjoyable platform presentations.