Reforming the coroner and death certification service

The intention of the Home Office is to introduce a new system that combines an independent check on all deaths and a professional oversight of death patterns, with, for the majority of cases, the minimum of bureaucracy. No public consultation is intended, so that reforms are not delayed. However as the proposals are developed in the coming months, the details, practicalities and costs will be discussed “with relevant professionals (not defined) and those with experience of the existing arrangements”. The imperfections of the present system are outlined. It is hoped the medical profession will have an input, since statements such as “ ‘hospital post mortems’, which are for medical research and public health protection purposes” need amendment. There should be a change in perception of the audit value of this procedure to BOTH the family and the treating doctor. Unfortunately it is proposed the new system in total should cost no more than at present. “Professionals” (not defined) will be involved in the financial detail.All deaths, after verification and certification of the medical cause of death (if known) would then be referred to the ‘medical examiner’ based in the coroner's office. He/she would be a qualified doctor employed by the new coroner service and independent of the Health Service. The medical examiner could provide supplementary advice on medical matters required by the coroner. “Retention of tissue should only take place where absolutely necessary and the coroner and his or her other staff should take account of the needs of families and friends carefully throughout the process.” “Coroners could take advice from their medical examiner to ascertain and prescribe the minimum level of invasiveness to establish the cause of death.” This issue is far from resolved, as signified by a recent call from the DoH giving a grant to study the value of MRI versus a full post mortem. No thought is given to systemic diseases, which may present in one organ system or another disease process, other than that causing death. Medical examiners will have to keep abreast of current developments in medicine BUT will be outside the NHS, which could cause problems. Medical examiners will be appointed (with an input from Regional Directors of Public Health) and managed from within the coroner service. They would work closely with the registrar of births and deaths.Deaths from unnatural causes or when the medical cause of death is unknown will result in judicial inquests. The medical examiner will have an input into causes of death and relevant investigations.Details of the proposed structure of the system are given, as well as the investigative and other roles of Coroner's officers.The establishment of medico-legal centres, as “examples of good practice” is advocated. The drawbacks of this system are stressed in this paper. There is at present an on-going review of forensic pathology services and it is hoped thought will be given to the increasing trend for sub-specialisation in medicine.     

Agressions sexuelles commises par des adolescents : relations entre des dimensions de l’organisation de la personnalité et des caractéristiques du délit

ObjectivesAdolescent sexual offending is still an understudied research domain, with no consensual explicative model. Otto F. Kernberg's model of normal and disordered personality functioning constitutes a sound theoretical framework allowing study of the relationships between personality pathology and sexual pathology. The aim of the present research is to explore the relationships between personality organization dimensions and offence characteristics among adolescent sexual offenders. We hypothesize that the more severe offences (in terms of frequency, degree of intrusion, and use of violence) should be associated with a more pathological or immature intrapsychic personality functioning.MethodThe study was based on retrospective analysis of archival data from 40 adolescents aged between 15 and 17 years old who had committed a sexual aggression. Files from which information was retrieved included an assessment protocol, which fully explores psychological, interpersonal and psychosexual functioning of adolescents, as well as police reports depicting offences and their main characteristics. Personality variables of interest were assessed using the Personality Organization Diagnostic Form, and subscales from the Social Cognition and Object Relations Scale and the Millon Adolescent Clinical Inventory.ResultsSignificant correlations were found, on one hand, between identity diffusion, primitive defense mechanisms and type of object relations, and some offense characteristics (age of victims, type of offence, use of violence). Multiple regression analyses revealed that primitive defense mechanisms explain a significant proportion of variance for the type of offence and the use of violence during aggression.DiscussionResults are coherent with psychodynamic formulations on sexual aggression. Bivariate correlations support Kernberg's formulations regarding the correspondence between sexual and personality pathologies: a more severe sexual pathology in terms of intrusion and use of violence is observed in adolescents showing a more immature personality organization characterized by more identity diffusion, a more pervasive use of primitive defenses, poorer interpersonal functioning, and a failure to integrate aggressive and libidinal drives. Regression analyses showed that primitive defenses (such as denial, splitting, omnipotence and omnipotent control) were the strongest predictor of the type of offence and use of violence during aggressions; this result suggests that primitive defenses may represent a mechanism that entails deactivation of empathy and dehumanization of the other in violent interpersonal encounters. Despite some limitations to the current study, mostly regarding generalization of the results, it opens various research avenues on sexual aggression within a psychodynamic framework, an angle too seldom explored of late.ConclusionsOur observations, which highlight the relationships between intrapsychic personality dimensions and offence characteristics among adolescent sexual offenders, suggest a framework radically different from mainstream Anglo-Saxon literature, which tends to focus on manifest characteristics of the offence, its victim or its perpetrator.     

Coronary artery bypass graft surgery: discharge planning for successful recovery

BACKGROUND: Coronary artery bypass graft (CABG) surgery is a lifesaving intervention, but the early recovery period presents a number of challenges for patients, carers and nurses. Early and adequate discharge planning based on in-depth knowledge of the postdischarge experience can help to ensure optimal recovery. AIM: This paper reports a study to examine the range of postdischarge issues, concerns and needs of patients and their family carers after discharge after CABG surgery, and explore their perceptions of unmet needs 1 year later. METHODS: A two-phase naturalistic inquiry was undertaken. Interviews were conducted with 30 patients and their carers 4-5 weeks after coronary artery bypass grafting (phase 1) and 1 year after the initial interview (phase 2). Thematic analysis was used to identify the major concerns of participants. FINDINGS: Almost half the patients experienced heart surgery as a huge personal shock. Adjusting to life afterwards was difficult, and they experienced a variety of changes, including pain. An unexpected finding was a heightened sense of body awareness and the need for postoperative physical adjustments. The financial implications of surgery were a major burden. Lifestyle adjustments were important and led to suggestions for support services, using telephone support and/or community patient networks. All participants recommended strengthening discharge planning with more accurate information about what to expect during recovery, to help them anticipate fluctuations in health and wellbeing. Carers experienced a wide range of unanticipated feelings during early recovery and had to deal with a number of personal changes. CONCLUSIONS: The findings suggest a need to improve discharge preparation and provide enhanced home support services. Further research should evaluate models of periodic follow-up and mechanisms for mutual support, and compare the experiences of cardiac patients and their carers with those of other surgical cohorts.     

门诊血液标本采集患者检验咨询服务需求的质性研究

目的了解门诊血液标本采集患者采血检验的真实感受和体验,寻求门诊开展检验咨询服务的方向和方法。方法采用解释现象学质性研究方法对8名成人患者及5名患儿家长进行半结构式深度访谈,了解其对血液标本采集检验的态度、检验咨询服务需求等,运用类属分析法归纳主题。结果共提炼出5个主题,包括采血患者准备知识的需求、标本采集送检知识的需求、检验结果咨询服务的需求、检验结果领取服务的需求、检验项目价格。结论在患者血液标本采集过程中,应关注患者及家属的检验咨询服务需求,有针对性的开展多种形式的检验咨询服务,提高检验质量,满足患者健康教育需求。     

四大负责制保驾优质医疗服务

文章阐述了首诊负责制、首问负责制、首定负责制、首诉负责制四项制度建设,以及尊重患者知情权、展示医院人性化关怀等方面,探索了实现优质人文医疗服务的途径与方法。     

应用Access程序设计医院个性化药品查询系统

目的:提高药学服务的质量,方便医务人员查询药品信息。方法:收集和整理药品说明书信息,利用Access对数据库的管理功能设计医院药品查询系统。结果与结论:该系统使用简便、界面清晰、操作人性化,能方便地提供药品信息,通过日常的维护,能轻松实现医院药品信息查询个性化,可满足不同医院门诊药物咨询的要求。     

现代针刺得气文献数据库的设计和建立

通过四大中文生物医学数据库检索系统(CNKI、万方、VIP和CBM)搜索中文针刺得气文献,PubMed数据库检索系统检索英文针刺得气文献,然后分类,采用Microsoft SQL Server 2005数据引擎建立现代国内外针刺得气文献关系型数据库,介绍数据库系统表字段内容、数据类型、信息结构和逻辑约束信息,实现对针刺得气文献一般信息、试验信息、经验信息、古籍信息和综合文献信息的细节查询,为得气相关文献质量评价及数据挖掘研究奠定基础,以期探寻得气隐藏规律,指导针灸科研与临床。     

Self-reported risk factors related to the most frequent musculoskeletal complaints among Czech dentists

The purpose of the study was to describe the occurrence of the most common complaints related to MSDs in Czech dentists and to assess the risk factors affecting them. A questionnaire survey of 581 Czech dentists (the response rate 72.6%) was conducted in 2011. The questionnaire ascertained general information about the respondents, their work habits and environment along with the occurrence of musculoskeletal disorders. The respondents filled out the questionnaires during the educational events organized by the Czech Dental Chamber. At least mild difficulties associated with the motoric system were reported by 96.9% of the respondents, with 66.3% of respondents reporting moderate or major difficulties. Back and neck pain followed by shoulder pain and headache were the most common complaints in our sample. According to our data: age, gender, length of practice, a history of serious MSDs, the occurrence of MSDs in blood relatives, the perception of work as psychologically demanding, and especially a perceived moderate/bad general health were significantly associated with the four most common musculoskeletal complaints. Some of the factors were found as protective. This study suggests that MSDs represent a significant burden for Czech dentists and further research is needed to elucidate this issue.     

我院“军字一号”历史病历光盘查询系统的实现

本文介绍我院在＂军字一号＂信息平台上建立相应的病案转存系统的技术和实现方法。解决了＂军字一号＂文件服务器中的病历文件越积越多、不便查询的问题。