Forensic Medical Practitioners Research Articles

Review of the monograph "Improving the forensic medical examination of a corpse" O.B. Dolgova, V.I. Starodubov, P.O. Romodanovsky, N.V. Nozhkina

The author gives a review of the monograph "Improving the forensic medical examination of a corpse", prepared by a team of authors O.B. Dolgova, V.I. Starodubov, P.O. Romodanovsky, N.V. Nozhkina.
 The monograph is devoted to a scientific approach to improving the forensic medical examination of a corpse, contains data on the regulatory and legal regulation of expert activities and scientific and methodological quality assurance of examinations, the authors present the results of an analysis of the opinions of state bodies and the medical service on the process of forensic medical examinations, data on forensic diagnostics of violent and nonviolent death, criteria and approaches to assess the qualitative component of expert activity; the concept of effective stage-by-stage training of a forensic medical expert at a medical university is proposed, the importance of the quality of forensic medical examination for improving methods of diagnosis and treatment of patients in medical organizations is determined.
 The publication is intended for forensic medical experts and medical practitioners, health care organizers, residents, graduate students studying in the specialty "forensic medical examination", including it can be recommended to judicial investigative authorities and a wide range of readers.

Raisonnement médico-légal dans la détermination de l’incapacité totale de travail : une étude qualitative à l’unité médico-judiciaire de l’Hôtel-Dieu de Paris

ObjectivesIn French forensic medical units, medical doctors are requested to assess the functional impact of violence on its victims and to determine a total incapacity for work (ITT). Specific to French criminal law, with significant consequences in the judicial field, this practice is highly heterogeneous with considerable differences depending on the center and the assessor. The objective of this qualitative study was to describe the assessment methods of practitioners in the forensic medical unit at the Hôtel-Dieu Hospital in Paris, where both forensic practitioners and psychiatrists contribute to the evaluation of total incapacity for work. Materials and methodsSemi-structured individual interviews were conducted with four forensic medical practitioners and four psychiatrists. The questionnaire addressed the evaluation methods and tools, the impact of the kinds of violence and their possible chronicity, as well as the rationale for a dual-evaluation by both a forensic practitioner and a psychiatrist. ResultsIn the absence of consensual tools, practitioners tend to take into account the judicial consequences of their assessment of total incapacity for work, while striving to establish an internal coherence between a fact, an injury and its functional repercussions. The osteoarticular system is given as a model, with determined durations of bone healing, while the field of psychotraumatology lacks a similar data set and requires the practitioners to aim to relate the traumatic impact on the daily consequences reported by patients. Forensic practitioners and psychiatrists differ in the extent to which they take into account the plaintiffs’ grievances and the assessment of chronic violence cases. The former tend to determine an incapacity for work based on a clinical lesion, either assessed during their own clinical exam or reported in a former medical certificate, while the latter establish an incapacity for work grounded in the functional consequences reported by patients, especially in cases of psychotraumatic symptoms (sleep disorders, avoidance symptoms, and social interaction limitations, for example) following a physical or sexual assault. A dual-assessment is seen as an efficient way to ensure that the psychological impact of violence is taken into account. However the question arises of the systematic recourse to a psychiatrist or another professional trained in the field of psychotraumatology. The assessment and the clinical symptoms are specific and require appropriate training. Medical certificates are also considered to be judicial material with a broader implication than the sole determination of total incapacity for work. In reporting griefs and the circumstances of the events which have an impact on the clinical situation of the patient, the practitioners also provide qualitative data that a judge may take into account. ConclusionsThis exploratory study describes certain methodological principles used by forensic practitioners and psychiatrists and the inter-specialty variability in the determination of total incapacity for work. It reflects a common expectation for consensual practices based on non-binding indicators. In civil expertise, tools and methodological principals are delineated and discussed, with scales and psychometric instruments which could usefully be relayed to practitioners in forensic medical units dealing with the evaluation of total incapacity for work, a notion that remains specific to French criminal law and whose evaluation standards may also be discussed with practitioners in the judicial field.

Classification of rib fracture types from postmortem computed tomography images using deep learning.

Human or time resources can sometimes fall short in medical image diagnostics, and analyzing images in full detail can be a challenging task. With recent advances in artificial intelligence, an increasing number of systems have been developed to assist clinicians in their work. In this study, the objective was to train a model that can distinguish between various fracture types on different levels of hierarchical taxonomy and detect them on 2D-image representations of volumetric postmortem computed tomography (PMCT) data. We used a deep learning model based on the ResNet50 architecture that was pretrained on ImageNet data, and we used transfer learning to fine-tune it to our specific task. We trained our model to distinguish between "displaced," "nondisplaced," "ad latus," "ad longitudinem cum contractione," and "ad longitudinem cum distractione" fractures. Radiographs with no fractures were correctly predicted in 95-99% of cases. Nondisplaced fractures were correctly predicted in 80-86% of cases. Displaced fractures of the "ad latus" type were correctly predicted in 17-18% of cases. The other two displaced types of fractures, "ad longitudinem cum contractione" and "ad longitudinem cum distractione," were correctly predicted in 70-75% and 64-75% of cases, respectively. The model achieved the best performance when the level of hierarchical taxonomy was high, while it had more difficulties when the level of hierarchical taxonomy was lower. Overall, deep learning techniques constitute a reliable solution for forensic pathologists and medical practitioners seeking to reduce workload.

Traumatic Diaphragmatic Injuries at Medicolegal Autopsy: A 1-Year Prospective Study.

Traumatic diaphragmatic injuries (TDIs) are relatively rare. The forensic literature pertaining to TDIs consists mainly of case studies, suggesting little attention to these injuries during autopsies and research. This prospective study was conducted at the Ga-Rankuwa Forensic Pathology Services mortuary over a 1-year period. We included all cases who had a full medicolegal autopsy, as prescribed by the relevant South African legislation (Inquest Act 58 of 1959). All diaphragms were examined by a forensic medical practitioner performing the autopsy. Nine hundred ninety-nine cases were analyzed; of these, 71 cases with TDIs were identified. The incidence of TDI was, therefore, determined to be 7.11%. A total of 60.56% involved the right hemidiaphragm, 19.72% the left hemidiaphragm, and 19.72% were present bilaterally. A total of 85.92% were present in men and 14.08% in women. Blunt force trauma comprised 33.80%, and penetrative trauma 61.97%. Most were associated with severe injuries. A total of 12.68% had organ herniation through the defects present. Our study revealed that TDIs were more common than initially reported. The right side was more often involved in our study than in other studies. Diaphragmatic injuries were observed in 21.46% of all penetrative trauma cases received in a year.

Perspectives on the construction of forensic autopsy laboratories designed to handle infectious diseases

Coronavirus disease 2019 has already infected tens of thousands of people in China. The existing autopsy laboratories are not qualified to perform autopsies on individuals confirmed or suspected to have died from an infectious disease. When dealing with corpses with uncertain health conditions or unknown contact with a pathogen, the forensic medical practitioners face severe risks of being infected. To meet the requirements of performing autopsies on such bodies, ensure the health and safety of forensic medical practitioners, and study the pathophysiological changes of infected patients, it is necessary to improve the construction requirements and regulations for forensic autopsy laboratories.

A review of the diversity in taxonomy, definitions, scope, and roles in forensic medicine: implications for evidence-based practice

The scope, roles, and tasks of forensic medicine and forensic medical experts currently vary widely between countries and legal systems, which has resulted in barriers to organization, standard setting, and quality assurance for practice in forensic medicine, including for reporting. The legal fact finder is thus confronted with variability in the quality, structure, and content of forensic medical reports. We sought to define and categorize the scope, methods, and practices that fall under the description of forensic medicine, the various issues encountered in current forensic medical practice, and the potential role of evidence-based practice in forensic medicine. We searched electronic databases and reviewed relevant articles, as well as conducting personal correspondences with forensic medical practitioners around the world, to obtain a description of current forensic medical practice. The terms forensic medicine, legal medicine, medical jurisprudence, medico-legal services, forensic pathology, and clinical forensic medicine are used with mixed interpretations in different countries. The systems and services rendered are not uniform either. The methods used by forensic medical practitioners are not always evidence-based, or based on standardized methods, and vary greatly between experts and centers. There are also no universally accepted guidelines to prepare a standard and admissible report. The lack of a uniform system in forensic medicine creates difficulties in assessing the development and performance of forensic medicine as a distinct discipline. To prepare evidence-based forensic medical reports, generally accepted guidelines are necessary.

Possibilities for more accurate prediction of thermal injury severity and determination of its impact on the body using the Abbreviated Burn Severity Index

INTRODUCTION: During the last decades, the chances of survival in burn patients have been progressively increasing, but the issue of prognosis of death after such injuries is still of great ethical, social, medical, and forensic interest. AIM: The purpose of our study was to examine and confirm the accuracy of the ABSI (Abbreviated Burn Severity Index) system in predicting the risk of death in thermal trauma by comparing its values with the actual risk reported. MATERIALS AND METHODS: In order to achieve this purpose, the medical records of burn patients admitted to the Clinic of Thermal Trauma, Plastic, Reconstructive and Aesthetic Surgery at the Naval Hospital of Varna for a five-year period (2011-2015) were studied and the death cases were analyzed. The mortality rate predicted by ABSI was compared to the actual death rate reported in the medical records. RESULTS: There was a significant difference in the mean values of ABSI in survivors and deceased: 4.65 and 11, respectively. All with an ABSI value less than 3 survived. For ABSI values up to 10, a slightly lower mortality was reported than the predicted. For the values ≥11 they matched. Despite these discrepancies, we believe that ABSI is suitable for calculating the risk of death in thermal trauma, especially in more severe burns, where the threat to life is higher. CONCLUSION: Three groups were differentiated with a sharp increase in the percentage of actually reported mortality. Their respective ABSI values can be taken as a reference for forensic medical practitioners in the classification of bodily injuries due to burns.

The impact of witnessing other people's trauma: The resilience and coping strategies of members of the Faculty of Forensic and Legal Medicine

IntroductionThe coping strategies, resilience and psychological distress of members of the Faculty of Forensic and Legal Medicine (FFLM) were measured in an attempt to establish how they are affected by, and accommodate potentially traumatic encounters with patients. Belief in a just world was also measured as it was deemed to be a mediating factor in the psychological distress exhibited in the medical practitioners who participated in this study. Methods120 members of the FFLM (65 females, 54 males and 1 undisclosed) volunteered to complete an online survey. Data was collected using Survey Monkey. Participants filled out the Personal Belief in a Just World Scale and General Belief in a Just World Scale, as well as the Connor-Davidson Resilience Scale 25, the COPE and the Brief Symptom Inventory. ResultsA multiple regression with stepwise entry was carried out. Personal belief in a just world, coping strategies and resilience were all identified as having a significant relationship with psychological distress. ConclusionsAlthough this is only a preliminary study into this phenomenon, findings suggest the personal belief in a just world, coping strategies and resilience are useful predictors of psychological distress amongst forensic medical practitioners. However they did not predict the majority of the variance and as such, more detailed investigations are needed to identify which other factors are important in order to design interventions and support for members of the Faculty of Forensic and Legal Medicine and other forensic medical practitioners.

Detainees in Police Custody in Yorkshire, United Kingdom: A Survey of the Common Mental Health Problems

Purpose: The purpose of this paper is to identify and study the common mental health problems presented by detainees in police custody as well their demographic characteristics. This would help to create awareness and sensitise health care practitioners working in custody, as well as custody staff towards early recognition and detection of cases, which should facilitate the health promotion and psycho social education of detainees and reduce the overall clinical risk in custody. Design/Methodology: The 'anonymised custody records' of a random sample of two hundred and fifty eight detainees in police custody as well as the Forensic Medical practitioners contemporaneous notes including 'direct clinical interviews 'were examined. Data was collected from the Risk assessment record completed by the custody officers and record of medical assessment by forensic Medical Examiners using a 'Standard Questionnaire format ‘. Data then was analysed. Findings: Detainees admitted into custody experienced a wide range of mental health problems.The most common mental health problems seen in detainees during the period of study were, substance misuse, depression, self-harm, anxiety disorder, epilepsy and schizophrenia in that order. Other conditions were identified such as Learning disabilities. The sex distribution was Male (83%) and Female (17%). In terms of age distribution most of the detainees were in the age range 20-41 (67.5%) for both sexes. The female detainees tend to be older compared to males.Heroin use was the most prevalent drug of abuse in custody. Some of the most common medications prescribed for detainees are Methadone, Mirtazapine, Citalopram, Diazepam, Sorbutex, sodium valproate and Thiamine. Originality/Value: The findings from this study would help to further identify and bring awareness to the common mental health problems encountered in detainees in police custody. It would help to reduce clinical risks and facilitate a safer detention in custody. It would also help to address the issue of the limited availability of data regarding the mental health of detainees.

The role of the medico-legal expert in the interpretation of airbag and seatbelt injuries: two case reports

Introduction Road traffic trauma is a preventable cause of morbidity and mortality across the globe. A wide array of automotive safety measures have been implemented over several decades. They provide with active safety and passive safety. Seatbelts and supplementary restraint systems (SRS airbags) have undoubtedly been recognized as two important passive safety measures for vehicle occupants though they themselves may occasionally cause significant injuries in severe crashes. Injuries caused by inbuilt safety devices upon the occupants often come in atypical forms whose interpretation would be dubious unless carefully appreciated by forensic medical practitioner. This fact is elaborated with the following two case examples. Case reports The first case is regarding superficial burns on the face as a result of the deployment of airbags. The exact type, mechanism and the cause of the injuries were not recognized during the initial management. The second case is a diaphragmatic rupture which is extremely rare in healthy individuals with properly fastened seatbelts. Conclusions Injuries of both cases were properly interpreted at the clinical forensic examination. As correctly expected from a clinician he or she very justly pays more attention on the acute management, critical care and therapeutic aspects of such injuries rather than attempting to identify the exact type, mechanism of causation and other medico-legally significant issues. Yet, in the big picture outside the boundaries of providing critical care, including the implementation of preventive measures, precise identification and interpretation of such injuries become the vital obligation of the forensic medical expert.

Getting to the core of medicine: Developing undergraduate forensic medicine and pathology teaching

Teaching and learning of forensic medicine and pathology in the undergraduate medical curriculum has been in decline for decades in the UK, and yet graduates are expected to be able to recognise, and protect, those who are most vulnerable in society – i.e. at risk of abuse or neglect - a matter highly relevant to the role of the forensic medical practitioner.When Cardiff University School of Medicine created a new ‘learner-centred’ undergraduate curriculum, championing case-based discussion in small groups, and earlier clinical contact, residual teaching on ‘the pathology of trauma’ disappeared. An opportunity to create a new course for the year 3 core curriculum, however, led to re-emergence of forensic medicine and pathology, with a focus on identification, and protection, of the ‘vulnerable patient’.This paper describes the development process of the first two iterations of that course, and the influence of ‘listening to the student voice’.Forensic medicine and pathology remain relevant in undergraduate medical education; effective, and ethical, safeguarding of the vulnerable is an essential ‘core’ skill of the modern medical graduate, and forensic medical practitioners can play an integral role in the preparation of medical students for their future clinical practice.

Role of forensic medicine in evaluating non-fatal physical violence against women by their husbands in Jordan

ObjectiveIntimate partner violence against women is a major health problem in most nations, but to date, there has been little awareness of the extent or seriousness of this issue in Jordan. Forensic medical practitioners play a significant role in diagnosing, evaluating and reporting these cases. The Jordanian judicial system is dependent on forensic reports. This study aims to assess the role of forensic medicine in evaluating the physical injuries sustained by women who are abused by their husbands. MethodA retrospective review of 158 forensic reports of Jordanian women alleging assault by their husbands and who were seen at Jordan University Hospital over the period 2010–2015. ResultsOf the 158 women who presented, 87 had multiple injuries. The majority of injuries were soft tissue injuries, but others included fractures, tympanic membrane perforation, burns and neck contusions. Twelve women were pregnant at the time of the assessment. The period of incapacity caused by these injuries (an important factor for the Jordanian judicial system) was between 1 and 14 days. ConclusionIntimate partner violence can present with a range of injuries from relatively minor to potentially disabling or life threatening. Forensic medicine has a role in documenting and evaluating these injuries and advising the judicial system in these cases. These are all key elements in increasing the awareness of the nature and extent of this behavior and its impact on women (and men) and the wider society.

2<sup>nd</sup> Prof. HVJ Fernando Oration - Gender based violence and the forensic medical practitioner

2<sup>nd</sup> Prof. HVJ Fernando Oration - Gender based violence and the forensic medical practitioner

Comparison of patterns of sexual assault among male victims during and after civil strife in Sri Lanka

Introduction: After the defeat of terrorism in May 2009, a significant change in the pattern of crime has been observed in Sri Lanka. Further, no in-depth studies have been conducted on male victims of sexual assault. This study was conducted to describe the nature of injuries and characteristics of male victims of sexual assaults during civil strife and compare those with after civil strife. Methods: A cross-sectional study on male victims of sexual assault was conducted at selected tertiary care hospitals in Sri Lanka. All Medico-legal examination forms (MLEFs) of 6 consented forensic medical practitioners covering 10 year period from May-2004 to May-2014 were studied. Results: Of all the MLEFs (31,210), 102 (0.3%) were male victims of sexual assault. Ages ranged from 03 to 36 years and 68% were 10-19 years of age. Ninety four percent had no injuries. Thirty five percent occurred during civil strife and 65% after it. The circumstances such as time, place, perpetrator and number of incidents had significant difference with the period of occurrence (p Conclusions: During civil strife, sexual assaults occurred at daytime, outside home, by non-relatives and multiple times. After civil strife, sexual assaults occurred during night, at home, by relatives and one episode. There was no significant difference in the nature of sexual acts. Significant increase in male sexual assaults at home by relatives after civil strife needs further investigations in order to develop evidence based interventions.

Where is the legal concept of "Injuries likely to cause death' found in Sri Lankan "Medico-legal classification of injuries"

Forensic medical practitioners (FMP) recognize different types of injuries according to severity as non-grievous, grievous endangering life, fatal in ordinary cause of nature and necessarily fatal. Legal concepts about severity of injuries are found in following sections of Penal Code of Sri Lanka-Non grievous hurt in Section 310, Grievous hurt in Section 311. , Fatal in the ordinary cause of nature in Section 294-(third)., Necessarily fatal in Section 294 (fourth). “Injuries likely to cause death” is an important legal concept applied for the judgment of offences against human life. But FMP do not recognize, academically discuss or research this topic because it is not directly mentioned in medico legal examination form or medico legal report as a category of medico-legal classification of injuries. This concept seems to be included in the category of “endangering life” under limb ‘h’ of grievous hurt and need careful consideration for correct recognition by doctors, police and judiciary. “Endangering life” category includes existing clinical conditions which may cause death such as- 1. Already developed rare fatal complication 2. Injuries which has significant possibility of death 40- 50%. 3. Injuries which has a probability of death (more than 50% chance of death or injuries likely to cause death). Till legal amendments are done to in cooperate “injury likely to cause death” in to medico-legal examination form and medico-legal report, forensic medicine practitioners should be informed to explain the basis for categorizing the injury under “endangering life” as one of above three reasons. Sri Lanka Journal of Forensic Medicine, Science & Law-December 2015; 6(2): 8-13

Risk assessment and risk management of violent reoffending among prisoners

Forensic medical practitioners and scientists have for several years sought improved decision support for determining and managing care and release of prisoners with mental health problems. Some of these prisoners can pose a serious threat of violence to society after release. It is, therefore, critical that the risk of violent reoffending is accurately measured and, more importantly, well managed with causal interventions to reduce this risk after release. The well-established predictors in this area of research are typically based on regression models or even some rule-based methods with no statistical composition, and these have proven to be unsuitable for simulating causal interventions for risk management. In collaboration with the medical practitioners of the Violence Prevention Research Unit (VPRU), Queen Mary University of London, we have developed a Bayesian network (BN) model for this purpose, which we call DSVM-P (Decision Support for Violence Management – Prisoners). The BN model captures the causal relationships between risk factors, interventions and violence and demonstrates significantly higher accuracy (cross-validated AUC score of 0.78) compared to well-established predictors (AUC scores ranging from 0.665 to 0.717) within this area of research, with respect to whether a prisoner is determined suitable for release. Even more important, however, the BN model also allows for specific risk factors to be targeted for causal intervention for risk management of future re-offending. Hence, unlike the previous predictors, this makes the model useful in terms of answering complex clinical questions that are based on unobserved evidence. Clinicians and probation officers who work in these areas would benefit from a system that takes account of these complex risk management considerations, since these decision support features are not available in the previous generation of models used by forensic psychiatrists.

Blood Stain with Hammer Imprint Shown in Crime Scene

Like most other areas of Forensic Science, bloodstain pattern evidence interpretation is characterized by the overlap from various other fields of science such as physics, computer science, medical science etc. For example, fluid mechanics particularly explains the forces that lead to the formation of a particular bloodstain pattern. Forensic Medical practitioners particularly work towards drawing the correlation between the bloodstain patterns formed and the wound formed on the body or head of the victim concerned. The paper studied hammer transfer stains in particular because of the easy availability and usability of hammer round the world. Also we studied effect of stain pattern in the crime scene. The authors are of the view that of the different types of bloodstain patterns, the most common stain patterns visible at the crime scene, particularly in the case where the victim is found to suffer blunt force injuries, are saturation, impact, cast off and transfer stain patterns.

The forensic aspects of sexual violence

Complainants of sexual assault may disclose to different agencies, the police and health professionals being the most likely. It is possible for certain evidence types to be collected before a clinical forensic assessment takes place that do not require the need for a Forensic Medical Practitioner. If the time frames after the incident and the nature of assault warrant the need for a forensic medical examination of either a complainant or a suspect, this should only be conducted by doctors and nurses who have received relevant, up-to-date specialist theoretical and practical training. Clear evidence shows that few other criminal offences require as extensive an examination and collection of forensic evidence as that of a sexual assault. The forensic evidence in a case may identify an assailant, eliminate a nominated suspect(s), and assist in the prosecution of a case. The elements of forensic medical examination, reviewed in this chapter, are those that are the most varied across jurisdictions around the world currently. Key focus points of this chapter are considerations for early evidence collection, utilising dedicated medical examination facilities for sample collection, contamination issues associated with evidence collection and certain practical aspects of forensic sampling methods which have evolved given results identified by Forensic Scientists processing evidential samples in sexual assault cases, Some of the problems encountered by the forensic science provider will also be discussed.

Modélisation 3D du viscéro-crâne. Applications en orthodontie et chirurgie orthognatique

Three D Modeling of the human face. The method combines the use of DICOM CT scan or cone beam data, anatomical informations and a mathematical tool, the axes of inertia, in order to create a 3D model for cephalometric analysis of the human face. The balance and symmetry of the model are stable enough to define normality for each individual, even when there are differences in ethnic and cultural origins. Imbalance and asymmetry characterize pathologies. Follow up shape and size of models allow growth prediction and modeling. An original statistical study of the 3D model variability using the "geometry morphometrics method" (GMM) is introduced. This 3D model is in the process of becoming an indispensable reference for all of those who are interested in studying the human face such as Orthodontists, Surgeons, Anatomists, Anthropologists and Forensic Medical Practitioners.

Careers in forensic and legal medicine

Forensic medicine is often seen as a glamorous yet morbid field of work, a myth perpetuated by television stars like the notorious Quincy, ME. But it's not all solving crimes and post mortems. Richard Jones and Roy Palmer describe the different career opportunities that bring the law and medicine together If you are interested in the law, or the legal aspects of practising medicine, there are a number of highly satisfying medicolegal careers. You may have to do a lot of casework and use a variety of skills that you would not use in clinical medicine. Forensic medicine combines knowledge of the law with that of various branches of medicine. You may have seen Dr Sam Ryan or Dr Quincy, ME, on television, working in that “most fascinating sphere of police work,” single handedly solving murders. The reality is somewhat different. A forensic practitioner is someone who provides evidence for court proceedings (the word “forensic” is from the Latin “forensis,” a court or forum). Practising clinicians working mainly in clinical medicine may occasionally find themselves giving professional evidence of fact, or expert opinion reports, in personal injury (including medical negligence) claims, other civil cases (for example, family law cases), in criminal courts, or for the coroner. Some careers, however, allow a practitioner to spend more of their time dealing with medicolegal matters. The ever popular Quincy Perhaps the most instantly recognisable forensic medical practitioner is the forensic pathologist. Forensic pathology is a subspecialty of histopathology and morbid anatomy. The modern forensic pathologist spends much of his or her time carrying out “routine” autopsies for the coroner, to determine the cause in cases of sudden, violent, or unexpected death. Most of these deaths are due to natural causes--for example, severe coronary artery disease, intracranial haemorrhages, or ruptured abdominal aortic aneurysms. The …