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British Medical Journal May 1979
Topics: Autopsy; Cadaver; Forensic Medicine
PubMed: 445042
DOI: No ID Found -
The British Journal of Radiology Apr 2014Although post-mortem MRI (PMMR) was proposed as an alternative to conventional autopsy more than a decade ago, the lack of systematic validation has limited its clinical... (Review)
Review
Although post-mortem MRI (PMMR) was proposed as an alternative to conventional autopsy more than a decade ago, the lack of systematic validation has limited its clinical uptake. Minimally invasive autopsy (MIA) using PMMR together with ancillary investigations has now been shown to be as accurate as conventional autopsy in foetuses, newborns and infants and is particularly useful for cerebral, cardiac and genitourinary imaging. Unlike conventional autopsy, PMMR provides a permanent three-dimensional auditable record, with accurate estimation of internal organ volumes. MIA is becoming highly acceptable to parents and professionals, and there is widespread political support and public interest in its clinical implementation in the UK. In the short to medium term, it is desirable that a supraregional network of specialist centres should be established to provide this service within the current National Health Service framework.
Topics: Autopsy; Child; Fetal Death; Fetus; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Organ Size; Whole Body Imaging
PubMed: 24288400
DOI: 10.1259/bjr.20130621 -
Swiss Medical Weekly Nov 2018Autopsies are a crucial source of medical knowledge. Unfortunately, autopsy rates have decreased markedly in Switzerland and many other countries. Communication between...
BACKGROUND
Autopsies are a crucial source of medical knowledge. Unfortunately, autopsy rates have decreased markedly in Switzerland and many other countries. Communication between clinicians and the deceased’s sceptical relatives is crucial to obtain autopsy permission. This survey investigates the personal views of multimorbid patients and their relatives on autopsies. In addition, the study examines whether motivational interviewing of the decedent’s relatives according to Miller and Rollnick can be used to increase autopsy rates.
METHODS
At the Department of Medicine of the Kantonsspital Winterthur, Switzerland, the views of multimorbid patients and their relatives on autopsies were surveyed between 1 September 2014 and 31 December 2015 (14 months) using a standardised questionnaire. All physicians participated in a 1-hour tutorial on motivational interviewing. From November 2014 to October 2015, motivational interviewing was used to improve the communication between physicians and the decedent’s relatives and to obtain autopsy permission. Autopsy rates before, during and after this intervention were compared.
RESULTS
Questionnaires were completed by 135 multimorbid patients and 82 corresponding relatives. Views on autopsies were mostly positive. Before the intervention, there had been a steady decline in the number of autopsies ranging from 18.9% (412 deaths and 78 autopsies) in 2010, to 12.8% (489 deaths and 53 autopsies) in the 12-month period prior to the intervention. During the intervention (motivational interviewing of the decedents’ relatives in asking for autopsy permission), 489 deaths occurred and 132 autopsies were performed (26.9%). This increase was highly statistically significant (p <0.0001). During the 12-month period after motivational interviewing was terminated, the autopsy rate dropped to 23.3% (statistically not significant; p = 0.174).
INTERPRETATION
The positive views on autopsies expressed by multimorbid patients and their relatives contrasts with the low and steadily declining autopsy rates at our institution and in general. Motivational interviewing is an easy-to-learn and effective technique to increase autopsy rates. Physicians should be taught how to communicate better with grieving relatives when asking for autopsy consent.
Topics: Aged; Autopsy; Communication; Female; Humans; Male; Middle Aged; Motivational Interviewing; Professional-Family Relations; Surveys and Questionnaires; Switzerland
PubMed: 30552859
DOI: 10.4414/smw.2018.14679 -
Scientific Reports Oct 2018Postmortem studies, including the complete diagnostic autopsy (CDA) and the minimally invasive autopsy (MIA), an innovative approach to post-mortem sampling and cause of...
Postmortem studies, including the complete diagnostic autopsy (CDA) and the minimally invasive autopsy (MIA), an innovative approach to post-mortem sampling and cause of death investigation, are commonly performed within 24 hours after death because the quality of the tissues deteriorates over time. This short timeframe may hamper the feasibility of the procedure. In this study, we compared the diagnostic performance of the two postmortem procedures when carried out earlier and later than 24 hours after death, as well as the impact of increasing postmortem intervals (PMIs) on the results of the microbiological tests in a series of 282 coupled MIA/CDA procedures performed at the Maputo Central Hospital in Mozambique between 2013 and 2015. 214 procedures were conducted within 24 hours of death (early autopsies), and 68 after 24 hours of death (late autopsies). No significant differences were observed in the number of non-conclusive diagnoses (2/214 [1%] vs. 1/68 [1%] p = 0.5645 for the CDA; 27/214 [13%] vs. 5/68 [7%] p = 0.2332 for the MIA). However, increasing PMIs were associated with a raise in the number of bacteria identified (rate: 1.014 per hour [95%CI: 1.002-1.026]; p = 0.0228). This increase was mainly due to rising numbers of bacteria of the Enterobacteriaceae family and Pseudomonas genus strains. Thus, performing MIA or CDA more than 24 hours after death can still render reliable diagnostic results, not only for non-infectious conditions but also for many infectious diseases, although, the contribution of Enterobacteriaceae and Pseudomonas spp. as etiological agents of infections leading to death may be overestimated.
Topics: Adult; Autopsy; Bacteria; Child; Female; Humans; Infant, Newborn; Postmortem Changes
PubMed: 30382145
DOI: 10.1038/s41598-018-34436-1 -
The American Journal of Pathology Aug 1987This study outlines the role of autopsies in medical practice and health policy, details the nature and reason for declining rates, including those in Rochester,... (Review)
Review
This study outlines the role of autopsies in medical practice and health policy, details the nature and reason for declining rates, including those in Rochester, Minnesota, and suggests possible remedial measures to halt or reverse this trend. It is concluded that one of the principal impediments to reversing the declining rate of autopsies is what is referred to in Economics as "market failure." In particular, the nature of the spatial and temporal distribution of costs and benefits has precluded the existence of an incentive structure which can lead to a realization of the major net social benefits from the autopsy. Ultimately, it is only the explicit recognition by the medical profession, government agencies, corporate insurers, and the general public of the nature and significance of this market failure and foregone benefits which can lead to remediation.
Topics: Age Factors; Autopsy; Costs and Cost Analysis; Diagnosis-Related Groups; Health Policy; Humans; Malpractice; Quality Control; Time Factors; United States
PubMed: 3113257
DOI: No ID Found -
Journal of the Royal Society of Medicine Apr 2008In many countries, including the UK, where relatives' consent is required, clinical autopsy rates (i.e. autopsies other than those required by law) have been declining... (Review)
Review
In many countries, including the UK, where relatives' consent is required, clinical autopsy rates (i.e. autopsies other than those required by law) have been declining since the 1950s. In the UK, even in teaching hospitals, the clinical autopsy rate has fallen to only 10% of deaths or less. At this rate of decline, clinical autopsies - and the pathologists who perform them - face extinction. The future practice of medicine will be blind to the many adverse consequences of clinical actions or omissions. The reasons for this decline are manifold and these have to be addressed if autopsy is to stand a chance of survival. The future of autopsy lies in promoting public support for autopsies, in some cases adapting the autopsy to address specific questions, thus making more effective use of information from autopsies. Only by ensuring that the next generation of doctors have experienced the powerful educational benefit of examining the body after death will the importance of autopsy to modern medicine be understood.
Topics: Attitude of Health Personnel; Autopsy; Education, Medical; Forecasting; Humans; Pathology Department, Hospital; Professional Practice
PubMed: 18387908
DOI: 10.1258/jrsm.2008.070479 -
PloS One 2017Although the autopsy still is a valuable tool in health statistics, health care quality control, medical education, and biomedical research, autopsy rates have been...
OBJECTIVE
Although the autopsy still is a valuable tool in health statistics, health care quality control, medical education, and biomedical research, autopsy rates have been declining worldwide. The aim of this study was to examine trends of overall, clinical and forensic autopsy rates among adults in the Netherlands over the last four decades, and trends per sex, age (groups), and hospital type.
METHODS
We performed a retrospective study covering 35 years of Dutch national death counts (1977-2011), the number of in-hospital deceased patients, the number of deaths due to external causes, and the proportion of autopsies performed in these populations. The effects of sex, age and hospital category were analysed by linear and logistic regression and differences were evaluated by chi-square tests.
RESULTS
Overall autopsy rates declined by 0.3% per calendar year, clinical autopsy rates by 0.7% per calendar year (from 31.4% to 7.7%), and forensic autopsy rates did not decline. Per calendar year the fraction of in-hospital deceased patients decreased by 0.2%. Autopsy rates were highest among men and younger patients; clinical autopsy rates were highest for patients dying in academic hospitals.
CONCLUSIONS
In the Netherlands clinical autopsy rates have rapidly declined while at the same time the fraction of in-hospital deaths decreased, both contributing to the overall reduced absolute number of autopsies performed. It is important to improve awareness among both clinicians and general practitioners of the significance of the clinical autopsy.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Autopsy; Cause of Death; Child; Child, Preschool; Female; Forensic Medicine; Hospital Mortality; Humans; Infant; Logistic Models; Male; Middle Aged; Netherlands; Retrospective Studies; Young Adult
PubMed: 28617835
DOI: 10.1371/journal.pone.0178200 -
Current Pharmaceutical Biotechnology 2021Autopsy is a valuable tool for understanding the physiopathology of any disease, and it is the gold standard to assess the cause of death. The clinical autopsy is the...
Is Hospital Autopsy Auditing Suitable for Clinical Risk Manage ment? Actualities and Perspectives of Auditing in the Autopsy Room Following Italian Law 24/2017 on Patient Safety.
BACKGROUND
Autopsy is a valuable tool for understanding the physiopathology of any disease, and it is the gold standard to assess the cause of death. The clinical autopsy is the ultimate medical service for a patient and plays a crucial role in the context of quality control, education of physicians and other medical personnel, as well as mitigation of risk of malpractice claims.
OBJECTIVE
This study aims to demonstrate the importance of improving an autopsy service and the relevance of this investigation procedure in daily clinical practice by evaluating the rate of major discrepancies between the assumed cause of death and the ascertained cause of death after a complete post mortem investigation. A further aim is to classify these discrepancies as class I or class II discrepancies according to the Goldman's criteria in order to assess performance quality.
METHODS
A retrospective study of the hospital autopsies performed from June 2018 to March 2020 was conducted by considering a diversified dataset, including age and sex of the deceased as well as the clinical and pathological causes of death.
RESULTS
362 cases were taken into consideration. Major discrepancies were found in 71.3% of cases, with a class I error of 22.7% and a class II error of 48.6%. The most frequent misdiagnosis were cardiovascular disorders, embolism, and aneurism rupture.
DISCUSSION
The rate of major discrepancies and the rate of class I and class II errors are way above the rate found in the literature. Despite the high rate of a major discrepancy, evidence collected from hospital autopsies (i.e., certainty of the cause of death, unknown comorbidities) has strengthened the legal defense in cases of medical malpractice litigation. In our experience, by accurately determining the cause of death, revealing new or unexpected findings, and any possible diagnostic or technical errors, post-mortem examinations can significantly contribute to the improvement of team performance and quality of care.
CONCLUSION
The presence of clinicians during an autopsy and the early sharing of results can be considered a new auditing strategy for hard clinical cases. Finally, by providing a clearer understanding of the nature and cause of the illness, the autopsy results assist in the grieving process by reassuring family members that action or inaction on their part had not contributed to the death.
Topics: Autopsy; Cause of Death; Diagnostic Errors; Hospitals; Humans; Italy; Patient Safety; Retrospective Studies
PubMed: 33292119
DOI: 10.2174/1389201021666201208115525 -
Archives of Medical Research 2005Deaths due to infectious diseases are common worldwide. The autopsy, although less frequently performed than previously, is important to our understanding of disease... (Review)
Review
Deaths due to infectious diseases are common worldwide. The autopsy, although less frequently performed than previously, is important to our understanding of disease pathogenesis. The autopsy also provides critical information regarding potential disease outbreaks. To optimize the benefits of an autopsy, the pathologist should approach the autopsy with a well-constructed differential diagnosis that provides the framework for appropriate selection of diagnostic specimens and tests. Standard microbiologic cultures, although necessary and important, are often insufficient and must be supplemented by newer molecular methodologies.
Topics: Animals; Autopsy; Communicable Diseases; Humans; Laboratory Infection; Molecular Diagnostic Techniques
PubMed: 16216653
DOI: 10.1016/j.arcmed.2005.04.006 -
Romanian Journal of Morphology and... 2017Perinatal autopsy remains the gold-standard procedure used to establish the fetal, neonatal or infant abnormalities. Progressively, perinatal pathology has become a... (Review)
Review
Perinatal autopsy remains the gold-standard procedure used to establish the fetal, neonatal or infant abnormalities. Progressively, perinatal pathology has become a specialized field with important roles of audit for fetal prenatal diagnostic tools, in parents counseling regarding future pregnancies, in scientific research, for epidemiology of congenital abnormalities and teaching. The differences between prenatal ultrasound and autopsy reports represent a strong argument for the autopsy examination following termination of pregnancy. The reasons for such discrepancies are related to the ultrasonographic or pathological examination conditions, the type of the anomalies, the expertise and availability of the operators. Several facts led to an undesirable increase of refusals from parents to consent to a conventional invasive autopsy: the centralization of pathology services, the poor counseling provided by non-experts in fetal medicine and the clinicians' over-appreciation of the importance of the ultrasound diagnostic investigation. Although non-invasive alternatives have been tested with promising results, conventional autopsy remains the gold standard technique for the prenatal diagnosis audit. We report and analyze several cases of prenatally diagnosed malformed fetuses with different particularities that underline the necessity of perinatal autopsy. We discuss the antenatal findings and management and post-mortem autopsies in the respective pregnancies.
Topics: Autopsy; Congenital Abnormalities; Female; Fetus; Humans; Pregnancy; Prenatal Diagnosis; Ultrasonography, Prenatal
PubMed: 28730216
DOI: No ID Found