Forensic Clinical Examinations Research Articles

A decision support system to determine the amount of wergild and compensation based on forensic medicine clinical examinations

BackgroundForensic medicine is crucial in ensuring that the law and justice are carried out as swiftly, effectively, clearly, and accurately as possible. The significant number and interactions of forensic clinical examination variables, the complexity of their differentiation, and the existence of multiple decision-making paths can lead to erroneous decisions that cause irreparable harm to individuals and society. This study aimed to develop and evaluate a decision support system for determining the amount of wergild and compensation based on forensic medicine clinical examinations and the severity of the patient’s injury.MethodsA total of 264 data elements and decision-making rules were identified based on an analysis of information sources and focus group discussions. In addition, a decision tree was used to organize the decision-making rules. Then, a system was developed using algorithms for intelligent decision-making. We included 500 patients in our analysis. This system was ultimately evaluated based on the following criteria: precision and accuracy, sensitivity, specificity, usability, and documentation quality.ResultsThe results indicated that the precision and accuracy, sensitivity, and specificity of the system were 100%. Furthermore, the documentation quality (completeness) increased from 78.2 to 100%. The average score for system usability was 4.35 out of 5, indicating a highly acceptable range.ConclusionThe designed system was effective and beneficial for forensic clinical examinations and quantifying physical damage (wergild and compensation). Therefore, this system can be utilized in forensic medicine’s administrative and clinical processes, and its production and commercialization will result in an adequate market penetration rate. In addition, this will empower forensic medicine physicians and reduce decision-making errors.Graphical

Sexual Assault Against Women: A Retrospective Study of 292 Cases in Fujian Province, China.

In China, rape is defined as forced sexual intercourse against a woman's will by violence, coercion, or any other means or intentionally having sexual intercourse with a girl under the age of 14 years who is legally incompetent of giving consent. A retrospective study of 292 cases of rape in Fujian Province, China, between the years 2014 and 2017 was conducted. Sociodemographic characteristics of victims and perpetrators, perpetration patterns of rape, and associated factors were reviewed and analyzed. Over a quarter of rape victims were under the age of 18 years. In over half of cases, the perpetrators were known to the victims, which was more frequent in minors than in adult victims. Over half of perpetrators were within the age range of 18-30 years. Most perpetrators had received a low level of education and were from low-income populations. Nighttime has the highest occurrence of rapes: 39.9% of rapes occurred during late night; and 24.6%, during early night. Victim perpetrator relationship and the location were significantly related (χ2 = 23.667; df = 3, 266; p < 0.001). Risk evaluation showed that 30.8% and 28.1% of cases occurred under medium- and high-risk settings, respectively. Sexual motivation was present in over 95% of cases. Physical force was used in almost half of cases. Less than half of victims received forensic clinical examination after perpetration. The findings provide population-based data to contribute to the future development of prevention strategies and to raise awareness of the urgent need for victim assistance services.

One Case of Forensic Clinical Identification of Ulnar Radius Fracture not Involving Epiphysis

In order to investigate the relationship between injury and injury of the identified person, to determine the real disability of the identified person, to determine whether the fracture of ulna and radius of the identified person is involved in the epiphysis, and to be commissioned by the court, the identified person is specially re-identified. According to the contents and methods of the Technical Specification for Forensic Identification (SF/ZJD0103003-2011) of the Ministry of Justice, the forensic clinical examination was conducted. After consulting the case data and conducting the forensic clinical examination of the identified person, this appraisal concluded that the left ulna and radius broken line of the patient disappeared, the epiphyseal plate was clear, and there was no deformity, and the disability grade was not constructed according to the provisions of the Classification of the degree of disability caused by human injury.

Intimate partner violence in Greece: a study of 664 consecutive forensic clinical examinations.

Intimate partner violence (IPV) is a well-known phenomenon, which affects mostly women. While IPV victims may attend emergency departments (EDs) seeking medical care, not all of them will make an allegation against their abusers. The aim of this study was to examine the prevalence and the characteristics of the victims, who had made an allegation about the violent incident and had been examined by a forensic pathologist for judicial purposes, and had attended EDs seeking medical care, before the forensic examination. We reviewed the archives of clinical examinations that were conducted at the Department of Forensic Medicine and Toxicology of National and Kapodistrian University of Athens during a 5-year period (2012-16). Six hundred sixty-four clinical examinations were conducted at our Department for IPV allegations. According to our findings, women were more likely to seek medical care than men. Victims who have attended EDs were more likely to have sustained injuries located at least on the head or on the lower limbs. The majority of IPV victims in the broader region of Attica (Greece) were women, usually married, and aged between 30 and 49 years old. Despite the fact that the majority of IPV incidents are not reported to police, every person who is engaged in the process of dealing with IPV victims has to be educated and adequately informed about this phenomenon, its implications and the possible ways to deal with it. Furthermore, victims need to be educated and informed adequately in waiting rooms of EDs.

The significance of the forensic clinical examination on the judicial assessment of rape complaints – developments and trends

ObjectiveThe aim of this study was to investigate the role of the forensic clinical examination in the judicial assessment made by the Prosecution Service in cases of rape. MethodsAll cases of police-reported sexual assault in the county of Funen, Denmark in a six-year period were reviewed, and the retrospective data was collected. Cases in which a forensic clinical examination was performed were included. ResultsThe Prosecution Service in the county of Funen received 348 police-reported rape cases and of these 184 cases were included. The Prosecution Service stated that the forensic clinical examination (FCE) was important for the decision-making process in approximately half of the cases. The Prosecution Service finding an FCE important due to the presence of relevant findings was significantly associated with the case going to trial, whereas importance due to absence of relevant findings was significantly associated with the cases not going to trial. The only single factor associated with a case going to court and a guilty verdict was an FCE of the alleged perpetrator. There were no crude associations between any other factors i.e. the type of assault, victim injuries or alcohol consumption. In a logistic regression model, however, it was significantly more likely (p < 0.05) that a forensic clinical examination of the victim was used in the Prosecution Service’s decision if there were both anogenital and extra-genital injuries documented, that could originate from the alleged crime. The odds were 7.83 times higher compared to if no injuries were detected. The Prosecution Service’s use of the clinical examination in their argumentation of the decision of a rape complaint has been significantly increasing from 2003 to 2015. ConclusionThe results of the first in-depth analysis of the overall importance of a forensic clinical examination in cases of rape and sexual assault shows that we need to continuously focus on the documentation of sexual assault, as documentation is part of the decision-making process at all stages of the judicial process.

The use of HIV post-exposure prophylaxis in forensic medicine following incidents of sexual violence in Hamburg, Germany: a retrospective study.

In Hamburg, Germany, the initiation of HIV post-exposure prophylaxis (HIV PEP) in cases of sexual violence is often carried out by forensic medical specialists (FMS) using the city's unique Hamburg Model. FMS-provided three-day HIV PEP starter packs include a combination of raltegravir and emtricitabine/tenofovir. This study aimed to investigate the practice of offering HIV PEP, reasons for discontinuing treatment, patient compliance, and whether or not potential perpetrators were tested for HIV. We conducted a retrospective study of forensic clinical examinations carried out by the Hamburg Department of Legal Medicine following incidents of sexual violence from 2009 to 2016. One thousand two hundred eighteen incidents of sexual violence were reviewed. In 18% of these cases, HIV PEP was initially prescribed by the FMS. HIV PEP indication depended on the examination occurring within 24 h after the incident, no/unknown condom use, the occurrence of ejaculation, the presence of any injury, and the perpetrator being from population at high risk for HIV. Half of the HIV PEP recipients returned for a reevaluation of the HIV PEP indication by an infectious disease specialist, and just 16% completed the full month of treatment. Only 131 potential perpetrators were tested for HIV, with one found to be HIV positive. No HIV seroconversion was registered among the study sample. Provision of HIV PEP by an FMS after sexual assault ensures appropriate and prompt care for victims. However, patient compliance and completion rates are low. HIV testing of perpetrators must be carried out much more rigorously.

Pushing the Boundaries: The Impact of the Role of the Clinical Nurse /Midwife Specialist (CN/MS) Sexual Assault Forensic Examination (SAFE) in Ireland

Introduction: Landmark research of Magee et al. (2002) (n=3,120) found that in Ireland , 4 in 10 women (42%) and almost 3 in 10 men (28%) experienced sexual assault or abuse in their lifetime. Subsequently, a National Review of Sexual Assault Treatment Services found sexual assault remains one of the most underreported and under recorded violent crimes in Ireland (O’Shea 2006). Key recommendations included expansion of existing services and introduction of a pilot programme in forensic nursing in Ireland, where nurses would undergo a higher diploma and apply for accreditation as CN/MS (SAFE). Short description of practice change implemented: Expansion of Sexual Assault Treatment Units (SATU) from four to six units in Cork, Dublin, Letterkenny, Waterford, adding Galway, Mullingar (2009). Successful implementation of nurse training following pilot programme CN/MS (SAFE). Aim and theory of change: Patients attending SATU may be physically and /or psychologically traumatised making difficult, life changing decisions. SATUs need to be appropriately staffed and available around the clock to provide prompt medical /supportive care and collect forensic evidence. As a nationally agreed service with defined multiagency guidelines (National SATU Guidelines 2014) and choice of care pathways, the CN/MS (SAFE) can consolidate the initial healthcare response to the under-reported crime of rape/sexual assault by utilising specialistic clinical nursing/midwifery knowledge and critical thinking skills to provide optimum patient care. This change also addresses the issue of recruitment/retention of doctors to carry out forensic examinations (O’Shea 2006). Targeted population and stakeholders: All male /female patients age 14 or older who present to SATU following recent rape/sexual assault. The optimisation of the role of nurses /midwives as Forensic Clinical Examiners realises advantages to Patients, SATU services, Nursing/Midwifery, the wider Inter-disciplinary Team, Inter-disciplinary working ,Criminal Justice System. Timeline: 3 groups of CN/CM (SAFE) graduated 2010-16 developing, assimilating, integrating a broad in-depth knowledge base in this speciality through a structured academic and clinical framework. Highlights: Innovations, Impact, Outcomes CN/MS (SAFE) has transformed the care/services for patients significantly advancing and extending the breadth /depth of SATU services namely: availability of trained staff on a 24 hr basis streamlined response times, accessibility, efficiency of healthcare/forensic service delivery (see Table 1) implementation of patient focused care initiatives including increased patient care pathways influential in driving quality improvement in SATUs nationally participation in patient, staff, community education / risk reduction programmes contribute to development, evaluation and implementation of national strategies Table 1 table of case numbers from 2009 to present day will not load! Sustainability: Some CN/MS (SAFE) have advanced skills in both the academic and practice arena and the enhancement and expansion of this nursing/midwifery role to Registered Advance Nurse Practitioner (RANP (SAFE) would support national policy direction promoting quality patient care. Realisation of the RANP (SAFE) would also ‘assist sustainability, the long range thinking’ (Markowitz 2009) for this unique and extremely challenging area of healthcare practice. Transferability: Transferable skills to other health related services e.g. sexual health, paediatric sexual assault forensic examination etc. Scope for other jurisdictions internationally to adopt and develop the Irish model of CN/MS (SAFE) training and role into their own programmes of care. Discussions & Key findings: CN/CM (SAFE) are attached to a SATU strategically located nationally so that the patient has no more than a three hour drive to the nearest SATU. SATU availability helps to minimise patient distress and ensures timely collection of forensic evidence (O’Shea 2006). The CN/CM (SAFE) initiative is unique to Ireland. It demonstrates international leadership, supported at Government level and by the many different disciplines /agencies involved including An Garda Siochana, the Rape Crisis Centres. Since 2009, Forensic Clinical Examiners in Ireland are either Medical Doctors or CN/MSs (SAFE). Conclusions: To date, CN/MS (SAFE) in the realms of rape / sexual assault in Ireland have forged a path through a previously unknown clinical area. Working as Forensic Clinical Examiners, the CN/MS (SAFE) use a consistent, standardised, patient focused approach with the interdisciplinary team to improve outcomes and reduce the long term sequelae for each patient regardless of the circumstances of the incident or a person’s engagement, or not with the criminal justice system. Expansion of SATU services in Ireland and availability of CN/MS (SAFE) has greatly improved accessibility for patients following rape /sexual assault.

Contrast Visual Evoked Potentials under Pattern Stimulus in Ocular Trauma

To study the characteristic of contrast visual evoked potentials （CVEP） in patients with ocular trauma. Sixty patients defined as ocular trauma by forensic clinical examination in our center were selected, and split into 0.2-0.3 （Group A）, 0.3-0.5 （Group B） and ≥0.5 （Group C） according to the best corrected visual acuity. The variation characteristics of wave amplitude and latency of CVEP under 100%, 25% and 10% contrast were observed and analyzed statistically. （1） Under the same contrast, the wave amplitude of P₁₀₀ decreased with the decrease of stimulus perspective. （2） Under the same stimulus perspective, the wave amplitude of P₁₀₀ decreased with the decrease of contrast （P<0.05）. （3） Under the contrast of 100% and 25% with the same stimulus perspective （except 100% 7' perspective stimulus）, the difference between group A and group B had no statistical significance （P>0.05）. Between group A and group C, group B and group C, the wave amplitude of P₁₀₀ gradually increased with the increase of vision （P<0.05）. Under the contrast of 10% with 15' stimulus perspective, the wave amplitude of P₁₀₀ increased with the increase of vision （P<0.05）. （4） Under the same contrast with the same stimulation perspective, the latency of P₁₀₀ wave shortened with the increase of vision, while the difference had no statistical significance （P>0.05）. Under the same stimulus perspective, the latency of P₁₀₀ wave was prolonged with the decrease of contrast （P>0.05）. CVEP may become one of the possible methods for the evaluation of contrast visual acuity.

DNA and the minimum requirements for dna decontamination from a clinical forensic perspective

Forensic DNA testing has had a significant impact upon the investigation of crimes and the process has attained infallibility status in the minds of many involved in the medico-legal system. This has led to some significant miscarriages of justice both in Australia and abroad. DNA fingerprinting, despite becoming increasingly sensitive, is not infallible and is open to error at numerous points during the process of specimen collection, testing, interpretation and application. To minimise the risk of unintentional contamination of biological specimens collected, the clinical forensic practitioner must implement appropriate cleaning and DNA decontamination of clinical examination areas and of the equipment used during any clinical examination. Mindful that cleaning, sterilisation and DNA decontamination are each different processes, a generic DNA decontamination process is proposed that is applicable across jurisdictions and in both dedicated and non-dedicated forensic clinical examination suites. This process is based on the understanding that, in the clinical setting, DNA contamination may only be minimised, not eliminated. There are four basic elements to the process: cleaning, selection of disposables, protection of permanent clinical equipment, and limiting contamination from the examiner. These processes are discussed from an evidentiary basis.

HOMED-homicides eastern Denmark: an introduction to a forensic medical homicide database.

An introduction to a forensic medical homicide database established at the Department of Forensic Medicine in Copenhagen. The database contains substantial clinical and demographic data obtained in conjunction with medico-legal autopsies of victims and forensic clinical examinations of perpetrators in homicide cases in eastern Denmark. The database contains information on all homicide cases investigated at the Department of Forensic Medicine in Copenhagen since 1971. Coverage for the catchment area of the department is assumed to be very good because of a medico-legal homicide autopsy rate close to 100%. Regional differences might exist however, due to the fact that the catchment area of the department is dominated by the city of Copenhagen. The strength of the database includes a long running time, near complete regional coverage and an exhaustive list of registered variables it is useful for research purposes, although specific data limitations apply.

Multidisciplinary forensic approach – investigation of a neonaticide and alleged concomitant rape

In the case presented, a young woman claimed to have spontaneously aborted a 30-weeks old fetus conceived after being raped by her cousin. The police investigation was centred on a probable neonaticide, mitigated by a possible rape. In Israel, the crime of rape carries a heavy punishment similar to that of first degree murder. Thus the implementation of the most recent scientific forensic techniques is of paramount importance in charging or clearing a suspected rapist. The skeletonized fetal remains were found four months after the reputed abortion. The alleged neonaticide was supported by the results of the forensic clinical and anthropological examinations, while the rape accusation was dismissed by the results of the molecular biology identification of the skeletonized fetal remains. The aim of this report is to encourage the forensic community to apply a multi-disciplinary approach, thus maximizing the decision making competence of the courts of law.

Judicial applications of hair testing for addicts in Crete: sectional hair analysis of heavy heroin abusers

Laboratory examination of hair from drug users has been employed for the last 5 years in Crete, in addition to the psychiatric or other forensic clinical examinations necessary for the confirmation of a person's use of drugs. The present study reports results of total and sectional head, axillary and pubic hair analysis of imprisoned abusers under interrogation and awaiting presentation at the Crime Court. Morphine levels in total head hair samples 1, 2 and 4 months after preliminary imprisonment ranged from 1.2 to 38.2, 0.5 to 22.5 and 0.1 to 4.9 ng/mg of hair respectively, while the maximum morphine levels amongst all studied groups of those arrested were found in the sections of axillary and pubic hair. Notably high morphine levels in head, axillary and pubic hair sections (13.7, 8.4 and 18.1) ng/mg respectively) were measured, even in abusers who had been imprisoned between 2 and 4 months. Hair tests may considerably assist to evaluate the systematic present and past abuse of heroin and other drugs. Consequently, it may be used as valuable expertise evidence during questioning and in court.