Medical Examiner System Research Articles

Unequal burials: Medicolegal death investigation system variation as a determinant of FEMA's disaster funeral assistance allocation

AbstractFederal Emergency Management Agency (FEMA) disaster funeral assistance is available to cover funeral expenses for the relatives of disaster victims in the United States. However, funds are dependent on death certificate proof of a disaster‐related cause of death. Previous research has shown that the medicolegal death investigation (MDI) system may impact the quality of death certificate data. This research examines the relationship between MDI systems and FEMA disaster funeral assistance distribution. The results of the study indicate that centralized medical examiner systems have higher funeral assistance acceptance rates than other MDI system types. Democratic states and counties with fewer minority residents also have higher acceptance rates. Furthermore, acceptance rates varied significantly by FEMA regional office. These findings suggest that the distribution of funeral assistance may be influenced by administrative and political differences between states.

Synthetic cannabinoid identification in cases associated with blue lotus and valerian root vaping products.

Synthetic cannabinoids emerged in the early 21st century and have continued to evolve and flourish to present day. Like other novel psychoactive substances (NPS), synthetic cannabinoids have been sold under the guise of legitimate products. Some examples include "potpourri," "incense," and herbal material. Between May 2020 and December 2023, the United States Army Criminal Investigation Laboratory, Drug Chemistry Division (USACIL) received 29 seized drug cases mentioning "blue lotus" or "valerian root." In 90% of these cases, at least one exhibit contained one or more synthetic cannabinoids. During the same timeframe, the Armed Forces Medical Examiner System, Division of Forensic Toxicology received 65 toxicology cases that contained synthetic cannabinoids and/or their corresponding metabolites where case history mentioned "blue lotus." The most frequently observed synthetic cannabinoids between laboratories were 5F-MDMB-PICA, ADB-BUTINACA, and MDMB-4en-PINACA. Innocuous branding and marketing may deceive law enforcement, investigators, and healthcare providers into believing that the adverse effects of erratic behavior, sedation, slurred speech, and hallucinations are a result of toxicity from botanical extracts (e.g. apomorphine and nuciferine in blue lotus). Due to the dangerous nature of these NPS, synthetic cannabinoid screening is recommended for all cases where there is suspected use of vaping products suggested to contain "blue lotus" or "valerian root" as vendors continue to conceal the presence of these compounds.

Dynamics of Some Medical and Demographic Indicators in St. Petersburg During the Period from 2018 to 2023

Background. There have been negative trends in the birth rate and population growth decline in recent years. Forecasts from demographers are also not so encouraging as the next generation of childbearing age is one from the end of the last century which is characterized by low birth rate. Population mortality exceeded the birth rate during the years of challenging and questionable economic reforms. Moreover, there was a high level of chronic morbidity in child population, and physical development had the trend to retardation. Meanwhile under these circumstances, the President of Russian Federation and the Government adopted regulatory documents (decrees, dedicated programs) that determined the directions of state social policy on improving the situation with children in Russian Federation until 2000.Objective. The aim of the study is to evaluate the dynamics of several medical and social indicators of 2018–2023 characterizing demographic trends direction, with proposals on improving medical care in the maternal and child health care system.Methods. The study has covered reporting form No. 19 of Russian Federal State Statistics Service (Rosstat) for children’s outpatient clinics, form No. 14 for children’s hospitals, form No. 030/у “Check-list of dispensary observation”. The study has used the materials of the Presidential Coordination board meeting from November 15, 2016. Statistical data was obtained from the “Office of the Federal State Statistics Service for St. Petersburg and the Leningrad Region” (Petrostat) and the Center for Analysis and Forecast of Mother and Child Health at Health Committee of St. Petersburg, Medical Information and Analytical Center (“Major results in the field of health care in St. Petersburg”, 2019, 2020, 2021, 2022). Statistical processing was carried out via variational statistics methods (Pearson’s criterion, Fisher’s angular transformation criterion) and data from the automated system of prophylactic medical examination, registration certificate FSR No. 2009/05279, corresponding to the order of the Ministry of Health of Russian Federation No. 514н dated August 10, 2017.Results. The analysis of study results confirms the negative demographic patterns in St. Petersburg like the all-Russian. Increase assisted reproductive technologies was noted alongside with birth rate decrease. There are still high rates of stillbirth and perinatal mortality, as well as increased infant mortality rate. The correlation of depopulation processes with children’s health worsening and increasing disability is emphasized.Conclusion. The problems raised in this paper do not have an straightforward solution and require multimodal approach.

Direct Combat-related U.S. Army Aviation Injuries 2003-2014.

The U.S. Army Aeromedical Research Laboratory (USAARL), a partner in the Joint Trauma Analysis for the Prevention of Injury in Combat (JTAPIC) partnership, conducted a series of retrospective reviews to investigate injuries sustained by occupants of U.S. Army rotary-wing aircraft involved in combat damage incidents. The reviews were conducted to provide occupant survivability information to the Aviation Survivability Development and Tactics team, an agency within the U.S. Army Aviation Center of Excellence. For these reviews, combat damage incidents that produced casualties were separated into direct events (i.e., events in which an enemy weapon system directly injured occupants) and indirect events (i.e., incidents in which occupants were injured as a result of a crash caused by the enemy weapon system). The previous USAARL reviews provided an overview of injuries sustained during direct and indirect events. The objective of this review was to conduct a detailed analysis of injuries occurring during direct events. A descriptive retrospective review was conducted on injuries sustained by occupants of U.S. Army rotary-wing aircraft involved in combat damage incidents between 2003 and 2014. All Black Hawk, Apache, and Chinook combat aviation damage incidents for the study period were reviewed. Personnel casualty information from the Defense Casualty Information Processing System (DCIPS) was linked to combat damage incident information by matching the aircraft platform, incident date, and circumstantial information found in incident narratives. Injury information for personnel identified in DCIPS as being wounded in action was obtained from the JTAPIC partnership; injury data for personnel killed in action were retrieved from the Armed Forces Medical Examiner System. All injuries were coded using the Abbreviated Injury Scale (AIS). Descriptive statistics were used to describe the frequency and distribution of injuries to personnel involved in direct events. Overall, the extremities were the most commonly injured body regions, with lower extremities suffering more injuries than upper extremities. Penetrating injuries were identified as the primary injury mechanism for all body regions. Injuries to each AIS body region were predominantly of minor (AIS 1) and moderate (AIS 2) severity. Although injury severities were generally low (AIS 1 or AIS 2), the results of this effort indicate which body regions may benefit from additional protection during rotary-wing operations in hostile environments. The influence of occupant position within the aircraft and the use and effectiveness of personal protective equipment could not be effectively analyzed due to a lack of information.

The role of a Medical Examiner Service in an acute NHS hospital: Perspectives from doctors and next of kin.

A new Medical Examiner system was introduced in England and Wales in 2019 to scrutinise all non-coronial deaths. The three key roles of independent Medical Examiner scrutiny are to establish accurate causes of death, determine whether coronial referral is required and identify any care concerns. This is the first published service evaluation exploring the views of doctors and next of kin with whom Medical Examiner Services interact. The aims were to understand whether the Medical Examiner Service was achieving its three main roles. Surveys were sent electronically to the qualified attending practitioners, and by post to the next of kin, of a consecutive series of deceased patients reviewed by an acute NHS hospital Medical Examiner Service in the East of England. Recruitment took place over a five month period in 2023. Results are based on 100 returned surveys from doctors (response rate 35%) and 179 completed by next of kin (response rate 65%). Findings suggest the Medical Examiner Service was successfully achieving its three key roles and well received by both doctors and next of kin. Service user feedback is clearly important as Medical Examiner Services continue to develop into the statutory phase during 2024, when they are anticipated to review approximately 400,000 deaths per annum in England and Wales. This study demonstrates such feedback is not only useful for service development, but also eminently possible.

Changes in the nature and outcome of notifications to HM Coroner from the Norfolk and Norwich University Hospital, UK, before and after the introduction of a medical examiner service: 2018 versus 2022

A medical examiner (ME) system was introduced to England and Wales in 2019 intended to ensure appropriate notification of cases to HM Coroner (HMC). The aim of the study is to determine and compare: (a) the nature of notifications to HMC for Norfolk from the Norfolk and Norwich University Hospital (NNUH) in 2018 compared with 2022; (b) to determine the outcome of those notifications and (c) to establish patterns of change in the number and nature of such notifications. HMC and ME datasets were interrogated to determine differences between notifications to HMC and outcomes in 2018 compared with 2022. From deaths at NNUH (2018 – n = 2605; 2022 – n = 2969), there were significantly fewer HMC notifications in 2022 compared with 2018 (25.3% vs. 17.6%). A decrease in notifications was noted for persons undergoing any ‘treatment or procedure of a medical or similar nature’ (24.0% vs. 16.2%) p < 0.0014. An increase in notifications was noted for neglect, including self-neglect (3.3% vs. 12.2%) p < 0.001. Of the coronial outcomes, there were significant increases in the numbers of post-mortem (PM) examinations (29.3% vs. 35.5%) p = 0.0276 and inquests (26.0% vs. 31.4%) p = 0.0485). There was a significant decrease in no further action by HMC (5.7 vs. 2.3) p = 0.0485. The study shows that the introduction of the medical examiner service has resulted in significant change in the nature of HMC notification categories. The notifications appear to be more appropriate, with an increased proportion of inquests and PM examinations and with a reduction in 100 A or ‘no further action’ outcomes.

Attitudes of UK pathologists and judicial officers towards medicolegal view and grant examinations: a cross-sectional mixed-methods study

AimsDespite the 1988 ‘Dundee Initiative’, which maximised the use of view and grant examinations to reduce the invasive forensic autopsy rate in Tayside, the view and grant itself remains controversial....

Health Symptoms Affecting the Marriage Contract Between Pay and Lift

The research, titled (Health symptoms affecting the marriage contract between payment and withdrawal), aims to participate in developing appropriate solutions to reduce the rates of divorce and annulments that are growing day after day. The research relied on the inductive and analytical approach to the texts of jurists and examined their meanings and objectives. To achieve the objectives of this study. The research included an introduction, two sections, and a conclusion. The first section, Pictures of jurists’ attention to health symptoms affecting the marriage contract, contains two requirements. The second topic is the guardian’s right to organize a healthy marriage contract and its legal and theoretical supports, and it contains three demands. The researcher concluded that the health symptoms that require annulment between spouses are not limited to specific descriptions but rather everything that prevents enjoyment, causes alienation, reduces it, or affects the regularity of marital life, such as psychological illnesses, which are left to the discretion of the judge. He also concluded that a legal document was drawn up that gives the guardian the right to expand the conduct of medical examinations as needed and for the benefit of the public, provided that the contracting parties are not obligated to perform the results of the examinations and that they are left free to sign the marriage contract or withdraw from it. Thus, it is known that the medical examination before marriage is not a condition for the validity of the marriage contract but rather a condition for its legal documentation. Among the most important recommendations were health authorities continuing to raise awareness and educate the community about the necessity of adhering to the results of medical examinations that have health consequences for the individual, the family, and society, and the attention of the media and mosque preachers to spread awareness among people by disclosing the spouses’ faults before the marriage contract; To avoid or reduce division after the contract, and to urge universities to conduct studies to evaluate the results of the medical examination system, its positive or negative effects, and the means of treating them, through scientific dissertations, or scientific promotion research for faculty members.

Improving state medicolegal death investigation: Does system level reform improve public health data concerning drug-related mortality?

In the United States, the governance of unnatural death certification varies greatly by state. Although cross-sectional research has linked mortality data quality with variation in medicolegal death investigation systems across states-especially with regards to drug-related deaths-this relationship has not be sufficiently tested using longitudinal data. This research assesses the impact of system governance reform on the quality of drug mortality data by assessing the impact of transitioning from a coroner system to a medical examiner system on data quality. The research finds no evidence that system-level reform is associated with improved drug-related mortality data quality. These findings suggest that alternative methods should be examined for improving public health data concerning drug-related mortality. These likely include focusing on individual-level characteristics and practices of officials and offices, rather than system-level variables.

Twenty-five year occupational homicide mortality trends in North Carolina: 1992–2017

IntroductionDetermining industry of decedents and victim–perpetrator relationships is crucial to inform and evaluate occupational homicide prevention strategies. In this study, we examine occupational homicide rates in North Carolina (NC) by...

25-Year fatal workplace suicide trends in North Carolina: 1992-2017.

Suicide is a serious public health problem in the United States, but limited evidence is available investigating fatal suicides at work. There is a substantial need to characterize workplace suicides to inform suicide prevention interventions and target high-risk settings. This study aims to examine workplace suicide rates in North Carolina (NC) by worker characteristics, means of suicide used, and industry between 1992 and 2017. Fatal workplace suicides were identified from records of the NC Office of the Chief Medical Examiner system and the NC death certificate. Sex, age, race, ethnicity, class of worker, manner of death, and industry were abstracted. Crude and age-standardized homicide rates were calculated as the number of suicides that occurred at work divided by an estimate of worker-years (w-y). Rate ratios and 95% confidence intervals (CIs) were calculated, and trends over calendar time for fatal workplace suicides were examined overall and by industry. 81 suicides over 109,464,430 w-y were observed. Increased rates were observed in workers who were male, self-employed, and 65+ years old. Firearms were the most common means of death (63%) followed by hanging (16%). Gas service station workers experienced the highest fatal occupational suicide rate, 11.5 times (95% CI: 3.62-36.33) the overall fatal workplace suicide rate, followed by Justice, Public Order, and Safety workers at 3.23 times the overall rate (95% CI: 1.31-7.97). Our findings identify industries and worker demographics that were vulnerable to workplace suicides. Targeted and tailored mitigation strategies for vulnerable industries and workers are recommended.

Equity in the End:

This Promoting Social Justice essay brings attention to public sector death management, especially where equity concerns could arise. Based on interviews with deathcare professionals, some issues can include challenges of death certificates, land use at cemeteries, and coroner versus medical examiner systems. Research questions for future study are included in each section.

The Management of Death in Sri Lanka and Potential Solutions for the Future

Death is an inevitable human occurrence, and ancient humans experienced anxiety and apprehension when faced with unnatural deaths. Prehistoric humans valued funeral proceedings and ceremonial rites due to their belief in life after death and reincarnation. Dead bodies can be disposed of legally or illegally. Legal methods include soil burials, entombment, cremation, or donation to medical institutions. Legal disposal requires certification by a medical practitioner and a death certificate. Illegal disposal involves secret burials, such as being thrown into waterways or burnt. Ancient societies used customs like burying corpses in uninhabited jungles or constructing “Towers of Silence” to prevent scavenging by animals. Sea burials are also practiced in some cases. To register a death, authorized individuals confirm its occurrence, transfer the body to undertakers for final disposition, and relatives register it with the registrar of birth, marriage, and death. Various death investigation methods have been implemented in different parts of the world, generally varying based on the investigating authority’s jurisdiction.The death investigation system of Sri Lanka is based partly on the English coroner’s system. The death investigation procedure in Sri Lanka is described in Sections 369 to 373 of the Code of Criminal Procedure (CCP) of Sri Lanka 1980. However, the current inquest system has several deficiencies. It is high time to adopt a system. Sri Lanka should contemplate transitioning from the inquest system to the medical examiner system, as the medical examiner system is more efficient, and several countries followed this successfully.

Application of telemedicine in cardiovascular disease prevention and management

With the rapid advances of technology and wireless program, the clinical application of telemedicine is received increasingly great attention for its convivence and real-time monitoring. The present study focuses on telemedicine, which is a new tool employed the newly technology like 5G and artificial intelligence to achieve contactless but real-time monitoring patients or subjects for disease management or prevention of future medical events. Telemedicine is useful for help people that in the remote area and do not have access to good medical treatment, more professional experts, better medical examination system or sound surveillance system. It can improve equality and compensate for regional differences. Herein, we summarized trials that have been done recently, and each was compared telemedicine to traditional approaches. Lastly, depending on these reviewed trials, the present study has summarized the advantages and the disadvantages of the telemedicine. We also reviewed the future direction of development of the telemedicine and the facing challenges of telemedicine.

Design and evaluation of an intelligent physical examination system in improving the satisfaction of patients with chronic disease

Backgroundand Purpose: Enhancing patient satisfaction remains crucial for healthcare quality. The utilization of artificial intelligence (AI) in the Internet of Health Things (loHT) can streamline the medical examination process. Most Traditional Chinese Medicine (TCM) examinations are non-invasive and contribute significantly to patient satisfaction. Our aim was to establish an intelligent physical examination system that amalgamates TCM and Western medicine and to conduct a preliminary investigation into its effectiveness in enhancing the satisfaction of patients with chronic diseases. Materials and methodsExperts from clinical departments, the equipment department, and the software development department were invited to participate in group discussions to determine the design principles and organizational structure of the intelligent physical examination system. This system integrates TCM and Western medicine. We compared the satisfaction levels of patients examined using the intelligent physical examination system with those examined using the traditional medical examination system. ResultsAn intelligent physical examination system, combining TCM and Western medicine, was developed. A total of 106 patients were finally enrolled (intelligent group vs. control group) to evaluate satisfaction. There were no statistically significant differences between the intelligent group and the control group in age, gender, education, or income level. We identified significant differences in five aspects of satisfaction: 1) the physical examination environment; 2) the attitude and responsiveness of doctors; 3) the attitude and responsiveness of nurses; 4) the effectiveness of obtaining results; and 5) the information regarding physical examination and medical advice (p < 0.05). Furthermore, these differences remained statistically significant even after adjusting for age, gender, education, and income level. ConclusionsThe intelligent physical examination system effectively capitalized on the advantages of combining AI with the integration of TCM and Western medicine, substantially optimizing the medical examination process. In comparison to the traditional physical examination system, the intelligent system significantly enhanced patient satisfaction. Future improvements could involve integrating chronic disease follow-up technology into the system.

Fatal occupational injuries in North Carolina, 1992–2017

ObjectivesAfter declining for several decades, fatal occupational injury rates have stagnated in the USA since 2009. To revive advancements in workplace safety, interventions targeting at-risk worker groups must be implemented....

Will medical cause of death certifications data quality improve in the UK with the new medical examiner system?

ObjectivesThere are deficits in the completeness, accuracy and timeliness of death certification internationally. In April 2023, England implemented a statutory Medical Examiners system primarily aiming to improve the quality of certification of death data. We sought to assess the current quality of death certification among general practitioners and medical examiners. MethodsAn online survey was conducted with general practitioners and medical examiners in the Yorkshire region to determine how Medical Certifications of Cause of Death (MCCD) are completed and commonly experienced sources of errors (e.g., a lack of a reported time frame, absent or inadequate reporting of comorbidities, incorrect underlying cause-of-death, and an inaccurate sequence of events). ResultsThe survey was completed by general practitioners (n = 95) and medical examiners (n = 9). Participant responses, including to a hypothetical case, confirmed the quality of the certification was less variable among MEs compared to GPs, but still below international standards. ConclusionsEfforts to enhance the quality of death certification require further consideration. Mandating a medical examiner system may not lead to intended improvements in the quality and cause of death data that form a critical component of mortality statistics that underpin health planning and monitoring.

ChatGPT Knowledge Evaluation in Basic and Clinical Medical Sciences: Multiple Choice Question Examination-Based Performance.

The Chatbot Generative Pre-Trained Transformer (ChatGPT) has garnered great attention from the public, academicians and science communities. It responds with appropriate and articulate answers and explanations across various disciplines. For the use of ChatGPT in education, research and healthcare, different perspectives exist with some level of ambiguity around its acceptability and ideal uses. However, the literature is acutely lacking in establishing a link to assess the intellectual levels of ChatGPT in the medical sciences. Therefore, the present study aimed to investigate the knowledge level of ChatGPT in medical education both in basic and clinical medical sciences, multiple-choice question (MCQs) examination-based performance and its impact on the medical examination system. In this study, initially, a subject-wise question bank was established with a pool of multiple-choice questions (MCQs) from various medical textbooks and university examination pools. The research team members carefully reviewed the MCQ contents and ensured that the MCQs were relevant to the subject's contents. Each question was scenario-based with four sub-stems and had a single correct answer. In this study, 100 MCQs in various disciplines, including basic medical sciences (50 MCQs) and clinical medical sciences (50 MCQs), were randomly selected from the MCQ bank. The MCQs were manually entered one by one, and a fresh ChatGPT session was started for each entry to avoid memory retention bias. The task was given to ChatGPT to assess the response and knowledge level of ChatGPT. The first response obtained was taken as the final response. Based on a pre-determined answer key, scoring was made on a scale of 0 to 1, with zero representing incorrect and one representing the correct answer. The results revealed that out of 100 MCQs in various disciplines of basic and clinical medical sciences, ChatGPT attempted all the MCQs and obtained 37/50 (74%) marks in basic medical sciences and 35/50 (70%) marks in clinical medical sciences, with an overall score of 72/100 (72%) in both basic and clinical medical sciences. It is concluded that ChatGPT obtained a satisfactory score in both basic and clinical medical sciences subjects and demonstrated a degree of understanding and explanation. This study's findings suggest that ChatGPT may be able to assist medical students and faculty in medical education settings since it has potential as an innovation in the framework of medical sciences and education.

The personalized operational control of the functional state in railway transport workers

Introduction. One of the important directions of medical and psychological research is the scientific search for approaches and research methods in the field of adaptive resources of the individual necessity to maintain optimal performance and successful functioning of a specialist in occupational activity. At the present stage, the indicators of the functional state of the employee are taken into account and analyzed according to average values, without taking into account personalized data. This approach may lead to inaccuracies in the interpretation of the results obtained.&#x0D; The purpose of the study is to determine the most significant criteria for assessing the functional state of railway transport workers based on the analysis of the database of the automated system of pre‒trip medical examinations (KAPD-01-ST complex, ASF), taking into account the previously established individual threshold values of their current functional state indicators.&#x0D; Materials and methods. As part of the work, the database of the system of pre-trip medical examination of four hundred employees of locomotive crews was analyzed. Among them, 200 people (according to the assessment of their psychophysiological state) were classified as a “risk group”. The average age (not included in the “risk group”) is 51.4 ± 2.8 years; those included in the “risk group” ‒ 51.6 ± 3.5 years.&#x0D; Results. According to the results of factor analysis (CMO = 0.737, Barlett sphericity criterion p&lt;0.05), 5 factors were identified. The cumulative percentage &#x0D; on the last component is 94.723. Based on the study of the results of the automated system of pre-trip medical examination (ASP), the most significant indicators &#x0D; of assessing the functional state of employees of locomotive crews of railway transport in the formation of a “risk group” were identified.&#x0D; Limitations. The representativeness of the sample size was ensured by the participation of 400 employees of locomotive crews in the study. The limitations of the study are related to the distribution of respondents by gender: there are no female respondents in the sample.&#x0D; Conclusion. The previously applied approaches of the system, the assessment of the functional state of the employee according to group criteria, taking into account the average values, do not allow today to obtain a forecast of occupational reliability that meets modern requirements. There is an obvious need to create a new, more objective assessment system of the degree of overstrain of the functional systems of the human body, aimed at taking into account the individual characteristics of the operator professions.

Exertional-Related Sudden Cardiac Death in a Young, Presumed Healthy, and Medically Screened Population: A Military Case Series.

Sudden cardiac death (SCD) is defined as death from cardiac causes with loss of consciousness occurring within 1 hour of a change in cardiovascular status. As subset, SCD associated with physical exertion (SCD/E) can be defined as a cardiac event whose symptoms start during or within 1 hour of physical exertion. The US military represents a unique opportunity for studying SCD/E because of medical screening at recruitment, mandatory physical training, an active surveillance system, and centralized autopsy services. Because of medical screening, recruits are presumed healthy, but significant conditions can go undetected. We present 4 diverse cases of SCD/E in the military setting. Sudden cardiac death associated with physical exertion is often the first indication of a serious occult cardiac pathology. Postmortem genetic testing revealed a causative pathogenic mutation in 1 of 4 cases, enabling genetic testing of family members to prevent similar catastrophic loss of life, underscoring the importance of postmortem evaluation including genetic testing. Further investigations will help direct screening and prevention to capture those at risk for SCD. The cases presented in this series are a sample of the diverse etiologies and contexts surrounding SCD/E in the military setting that have been captured by Armed Forces Medical Examiner System.