Category Archives: Forensic pathology

Journal articles relating to forensic pathology including coronial autopsies and Disaster victim identification.

An update on oxycodone: lessons for death investigators in Australia

Forensic Science, Medicine, and Pathology March 2015 Volume 11 Issue 1, pp 3-12  [Olaf H. Drummer]

Oxycodone is one of the most abused prescription drugs. Iatrogenic factors that lead to oxycodone-related death, such as mis-prescribing, present an opportunity for death prevention if identified early. This study investigated deaths involving oxycodone in Australia to explore potentially inappropriate prescribing and the coroner’s investigation. The National Coronial Information System identified cases from 2001 to 2011 where oxycodone was detected by toxicological analysis. There were 806 oxycodone-related deaths, with a significant increase in the 11-year period, from 21 deaths in 2001, up almost sevenfold in 2011 (139 deaths). Most deaths were caused by combined drug toxicity (63.4 %) or oxycodone toxicity alone (11.8 %). Most individuals were male (59.1 %), aged 35–44 years (26.7 %), who died unintentionally (56.4 %), with mental illness (52.1 %) and/or a history of acute or chronic pain (46.2 %). 312 cases (39 %) described a legitimate prescription for oxycodone, of which most involved non-cancer related chronic pain. About three quarters of the indications were deemed appropriate. There were at least 43 different indications treated with oxycodone that were inappropriate. The majority of oxycodone-related cases involved minor to no description of the drugs involved (n = 600; 74.4 %). A moderate description of oxycodone involvement was given in 162 cases (20.1 %), while only 44 cases (5.5 %) involved a thorough examination and recommendations from the coroners on oxycodone and other drugs involved in death. This study emphasized the need for medical practitioners to exercise caution when prescribing oxycodone and for coroners to provide more consistent and detailed information regarding drug use, in order to identify and implement preventive strategies.

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Governing the postmortem procurement of human body material for research.

Kennedy Inst Ethics J. 2015 Mar;25(1):67-88. doi: 10.1353/ken.2015.0000.

Human body material removed post mortem is a particularly valuable resource for research. Considering the efforts that are currently being made to study the biochemical processes and possible genetic causes that underlie cancer and cardiovascular and neurodegenerative diseases, it is likely that this type of research will continue to gain in importance. However, post mortem procurement of human body material for research raises specific ethical concerns, more in particular with regard to the consent of the research participant. In this paper, we attempt to determine which consent regime should govern the post mortem procurement of body material for research. In order to do so, we assess the various arguments that could be put forward in support of a duty to make body material available for research purposes after death. We argue that this duty does in practice not support conscription but is sufficiently strong to defend a policy of presumed rather than explicit consent

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New book in the library collection: The murder of Allison Baden-Clay

The Murder of Allison Baden-Clay (2014) / David Murray
The Murder of Allison Baden-Clay is written by the investigative journalist who covered the case from the start. It weaves together exclusive interviews and police and court records to explain how a father with no criminal history came to be on trial for a brutal murder. It’s also a story about everyday choices and their consequences.

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New book in the library collection: Working stiff

Working Stiff:  two years, 262 bodies, and the making of a medical examiner (2014) / Judy Melinek MD and TJ Mitchell

The fearless memoir of a young forensic pathologist’s “rookie season” as a NYC medical examiner, and the cases—hair-raising and heartbreaking and impossibly complex—that shaped her as both a physician and a mother.

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Reference Manual on Scientific Evidence: Third Edition (2011)

National Academies Press  ISBN: 978-0-309-21421-6

The Reference Manual on Scientific Evidence, Third Edition, assists judges in managing cases involving complex scientific and technical evidence by describing the basic tenets of key scientific fields from which legal evidence is typically derived and by providing examples of cases in which that evidence has been used.

First published in 1994 by the Federal Judicial Center, the Reference Manual on Scientific Evidence has been relied upon in the legal and academic communities and is often cited by various courts and others. Judges faced with disputes over the admissibility of scientific and technical evidence refer to the manual to help them better understand and evaluate the relevance, reliability and usefulness of the evidence being proffered. The manual is not intended to tell judges what is good science and what is not. Instead, it serves to help judges identify issues on which experts are likely to differ and to guide the inquiry of the court in seeking an informed resolution of the conflict.

The core of the manual consists of a series of chapters (reference guides) on various scientific topics, each authored by an expert in that field. The topics have been chosen by an oversight committee because of their complexity and frequency in litigation. Each chapter is intended to provide a general overview of the topic in lay terms, identifying issues that will be useful to judges and others in the legal profession. They are written for a non-technical audience and are not intended as exhaustive presentations of the topic. Rather, the chapters seek to provide judges with the basic information in an area of science, to allow them to have an informed conversation with the experts and attorneys.

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Informatics and Autopsy Pathology

Surgical Pathology Clinics Available online 26 March 2015;  doi:10.1016/j.path.2015.02.010

Many health care providers believe that the autopsy is no longer relevant in high-technology medicine era. This has fueled a decline in the hospital autopsy rate. Although it seems that advanced diagnostic tests answer all clinical questions, studies repeatedly demonstrate that an autopsy uncovers as many undiagnosed conditions today as in the past. The forensic autopsy rate has also declined, although not as precipitously. Pathologists are still performing a nineteenth century autopsy procedure that remains essentially unchanged. Informatics offers several potential answers that will evolve the low-tech autopsy into the high-tech autopsy.

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Cause of death [Feature]

Science 27 March 2015:  Vol. 347 no. 6229 pp. 1410-1413
DOI: 10.1126/science.347.6229.1410

As startling as it sounds, health experts don’t really know what kills many people worldwide. They’re especially likely to be in the dark when the cause was some kind of infection and the victim was a child. And without this information, health officials don’t know where to focus limited dollars, or how well current disease-reduction programs work. Researchers are therefore hoping that minimally invasive autopsies (MIAs)—which take fluids and bits of tissue from a half-dozen organs and examine them in the lab—can substitute for full autopsies and provide critical mortality data. The general idea of MIAs actually dates back several decades, but they have become a hot idea as international health agencies seek crucial data on causes of death. That’s why teams in several countries, including Mozambique, have spent the past few years testing both the scientific validity and cultural acceptability of MIAs—with an eye toward expanding them across the globe.

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