Medicine, Science and the Law最新文献

High levels of service user satisfaction are viewed as a reliable indicator of a service providing good care and treatment. There has been limited research looking into levels of satisfaction in forensic mental health settings with most work focused on staff satisfaction in these settings. This study examined service users' levels of satisfaction with a forensic mental health service in the United Kingdom. The service covered two sites; one a purpose-built secure unit and the other based in an old cottage hospital. Thirty-nine in-patients completed a 60-item validated forensic satisfaction scale. The scale measured seven domains of satisfaction as well as reporting an overall satisfaction score. The results indicated the service users were reasonably satisfied with the care and treatment they received. The domains of rehabilitation, safety, staff interaction and overall care showed the highest level of satisfaction. The high rehabilitation satisfaction score demonstrated the importance of meaningful activities for users accessing forensic services and may have been influenced by the security measures on the wards. The high safety domain score indicated respondents felt safe and secure within the wards and were likely to be influenced by positive interpersonal interactions. Good staff interaction was also an important factor in helping service users feel safe on the wards. These interactions are likely to be associated with longer periods of admission in secure services allowing therapeutic relationships to develop. Financial advice/support was the one domain that recorded negative satisfaction levels. Financial literacy training may help develop money management skills.

Autolytic and putrefactive processes can cause considerable alterations to soft tissues and internal organs that may complicate forensic assessments. An overview was undertaken of the range of taphonomonic changes and processes that may result from postmortem putrefactive gas accumulation. The most commonly encountered phenomenon was purging of putrefactive fluids from the nose and mouth that was on occasion confused with bleeding from antemortem trauma. Much less common was putrefactive 'rigor mortis' where the limbs extend due to the accumulation of soft tissue and subcutaneous gas. This may sometimes be associated with alteration of the position of a body suggesting that it had been deliberately moved. Distension and stretching of the skin and subcutaneous tissues may cause recently sutured surgical incisions to dehisce, raising the possibility of inflicted incised wounds. Raised intra-abdominal pressures may cause diaphragmatic herniation of small intestine and has been associated with so-called 'coffin birth' where a fetus is expelled from the uterus after death due to pressure on the fundus. Gas accumulation on postmortem computed tomography examination may be confused with air embolism or the effects of trauma. All of these changes are the result of anaerobic bacterial action generating gases such as methane, carbon dioxide and hydrogen sulphide resulting in pressure gradients.

This study investigates the legal challenges posed by telesurgery, an emergent healthcare modality facilitated by advancements in 5G and Artificial Intelligence. It highlights the urgent need for a comprehensive legal framework reconciling the complexities of healthcare delivery and technology integration. The paper examines the Chinese adjudication of negligence and the evidentiary hurdles in telesurgery, interrogating the application of the 'reasonable doctor' standard, the intricate causation-negligence nexus and the distribution of evidentiary burdens. The analysis contends that current statutes require revision to apportion telesurgery-induced damages fairly. Further, it proposes the formation of multidisciplinary committees to oversee medical technology, calls for systemic reforms, more reasonable liability differentiation and fortifying medical insurance frameworks.

Cable or zip ties are mass produced inexpensive nylon fasteners, which have a locking mechanism to prevent them from being loosened. Their use in medicolegal cases is infrequent, being involved in situations of neck compression or restraint. The Forensic Science SA Pathology Database (in Adelaide, Australia) and search engines PubMed, Google Scholar and Google were examined for cases where cable ties were documented as either causing death or being potentially lethal, being a contributor to death, or having been used for restraint purposes. Neck compression resulting in ligature strangulation was found in cases of homicide and suicide in adults. Accidental neck compression was rarely reported in children. Cases of restraint again occurred in both homicides and suicides, with nonlethal wrist restraint being used by law enforcement officers in lieu of traditional handcuffs. Cable ties may also be used to fasten ligatures to suspension points in case of hanging. Despite their ready availability, cable ties are only relatively rarely involved in medicolegal cases. More traditional forms of manual or ligature neck compression are still favoured possibly because they require less dexterity.

A whole branch of theoretical statistics devotes itself to the analysis of clusters, the aim being to distinguish an apparent cluster arising randomly from one that is more likely to have been produced as a result of some systematic influence. There are many examples in medicine and some that involve both medicine and the legal field; criminal law in particular. Observed clusters or a series of cases in a given setting can set off alarm bells, the recent conviction of Lucy Letby in England being an example. It was an observed cluster, a series of deaths among neonates, that prompted the investigation of Letby. There have been other similar cases in the past and there will be similar cases in the future. Our purpose is not to reconsider any particular trial but, rather, to work with similar, indeed more extreme numbers of cases as a way to underline the statistical mistakes that can be made when attempting to make sense of the data. These notions are illustrated via a made-up case of 10 incidents where the anticipated count was only 2. The most common statistical analysis would associate a probability of less than 0.00005 with this outcome: A very rare event. However, a more careful analysis that avoids common pitfalls results in a probability close to 0.5, indicating that, given the circumstances, we were as likely to see 10 or more as we were to see less than 10.

A case of septic pulmonary thromboembolism arising from thrombophlebitis of the prostatic venous plexus associated with long-term urinary catheterisation in a 51-year-old man is reported. Despite a previous autopsy having been conducted in the country where he had been resident overseas, a re-examination showed histological evidence of mild patchy chronic prostatitis with a florid, focally purulent, thrombophlebitis of the periprostatic venous plexus with abscess formation and evidence of bacterial overgrowth. Corresponding microscopy of the lungs showed septic microthromboemboli within small pulmonary arteries with variable degrees of necrotising acute inflammation and thrombosis. Death was not due to 'acute pulmonary oedema' as had been originally certified but to septic thromboembolism. This case demonstrates the need to carefully evaluate the prostatic venous plexus at autopsy, and also the type of problems that may arise at the time of the re-examination of repatriated remains.

The majority of homicides do not occur in mass disasters but are often solitary events. This enables medicolegal investigations to be targeted around the features of a specific case. Mass disasters may, however, result in a large numbers of bodies being brought in over relatively short periods of time. Such disasters may also occur in isolated locations with limited resources and facilities resulting in full autopsies not being undertaken, with faster processing of cases than is usual. For this reason it is possible that injuries due to inflicted trauma may not always be identified. Given the varied circumstances of mass disasters, ranging from the London Blitz of WWII to the 2004 South East Asian tsunami, the possibility of concealed homicides should always be considered.