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The Role of the Mortuary
Published in Jason Payne-James, Suzy Lishman, The Medical Examiner Service, 2023
Hospital inpatients whose death is thought to be natural will still be formally reviewed. Whether the bereaved's next of kin requests a burial or cremation, paperwork will still need to be created and the death will require scrutiny by the Medical Examiner Service, which may include conversations with the deceased's GP and/or the hospital clinical team who treated them at the end of their life. If a natural death can be confirmed following these conversations, then the MCCD is completed, and the death registered with the local register office. Once registered, the deceased can be collected by the family's chosen funeral director.
Allergy–Asthma Practice
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Mark Holbreich, Pudupakkam K Vedanthan, PA Mahesh, Sitesh Roy
In general, the practice of medicine in the USA is highly regulated at several levels. Every practitioner has to meet the requirements of the State Board of Medical Examiners, a powerful arm of the respective state governments. Once the practitioner is licensed, he will able to practice medicine in that particular state. There are 50 different states in the USA and each state has its own licensing authority with slightly different requirements. The license in any state of USA has time limitations and has to be renewed along with evidence of Continued Medical Examination (CME) credits. The board has strict codes of moral and ethical conduct and if a physician is in conflict with those rules, he is liable for severe punishment,
Difficult areas in forensic neuropathology
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
Christopher Milroy, Helen Whitwell
In examining neuropathological aspects of a case, the pathologist will often be asked to give an opinion on the findings in the brain in the context of other pathological findings and the circumstances of a case. Such scenarios include falls, falls versus kicks, deaths in young children, sporting deaths and patterns of pathology in motor vehicle collisions. Inevitably certain areas of practice present more problems to the pathologist than others. The role of the pathologist is to assist the judicial system in determining what the manner of the death is. In some jurisdictions, notably the North American medical examiners’ systems, the determination of manner of death as well as cause of death lies with the pathologist. In other jurisdictions, such as the English coronial system or the Scottish system with the procurator fiscal, the pathologist does not decide manner of death, although clearly pathological evidence plays a pivotal role. Therefore, the identification of patterns of death that indicate accident, suicide or homicide is central to any death investigation.
Identifying Occupation Groups for Suicide Prevention: A Statewide Data Linkage Study
Published in Archives of Suicide Research, 2023
Morissa Henn, Catherine Barber, Wilson Zhang, Michael Staley, Deborah Azrael, Matthew Miller
The study is subject to limitations. It covers one state only, and findings may not generalize to other states. It covers only cases, not living controls, and as such cannot identify risk factors. Denominator data for each occupation are estimates and were not available by age group; these estimates were also pooled over time, losing any temporal patterning. Numerators in calculating rates will include some people over 65; at the same time, some occupations (like protective services) may typically have younger retirement ages than 65. The main variable on which occupation was classified was “Usual Occupation” and often there was no way to know whether the person was retired. Therefore, especially for occupations that typically have earlier or later than usual retirement ages, there may be some mismatch between numerator or denominator. Finally, circumstances recorded by the NVDRS abstractor depend on the police or Medical Examiner personnel who investigated the death having asked about, and recorded, circumstance information and on the presence of next of kin who can provide the information. This limitation was in part mitigated by linking the NVDRS records to hospital data, as this is not subject to recall bias or informant availability problems.
Mortality in an Opioid Treatment Program
Published in Journal of Psychoactive Drugs, 2022
Elenore P. Bhatraju, Caitlin Fuller, Paul Grekin, Shay Rockman, K. Michelle Peavy
We described the sample in terms of age, gender, housing status, time in treatment, methadone dose, recent hospitalizations, recent drug screen results including alprazolam, and hepatitis C status. These variables were chosen based on our hypotheses that individuals who died by drug poisoning would feature different profiles compared to those who died by other causes. This notion is in line with previous literature which states that certain factors including time in treatment (Degenhardt et al. 2009; Sordo et al. 2017; Zanis and Woody 1998), methadone dose (Centers for Disease Control and Prevention 2020), medical comorbidities including hepatitis C (Darke and Hall 2003; Schiavon et al. 2018; Valdiserri et al. 2014), and active polysubstance use (Amlani et al. 2015; McKnight and Des Jarlais 2018; O’Driscoll et al.’s 2001; Visconti et al. 2015) may act as risk factors for drug poisoning. Further, benzodiazepine use has been cited in the literature as a contributing factor in fatal drug poisonings when used in tandem with methadone (Chan et al. 2006; Gudin et al. 2013; Jones and McAninch 2015; Lee et al. 2012). Alprazolam was included due to a rise in prevalence among the population in our OTP. We categorized patients into five categories based on medical examiner reported cause of death: drug poisoning deaths, acute infectious causes, chronic medical conditions, violent deaths including suicide, and other causes. The cause of death categorization was reviewed independently by two of the authors (EB and CF) with consensus decisions determined prior to analysis of the results.
Stimulant storm – state health department psychostimulant age-adjusted mortality rate correlates with psychostimulant-based Michigan Poison Center case exposures over time
Published in Clinical Toxicology, 2021
Varun Vohra, Andrew King, Sydney Daviskiba, Brian Reed, Sarah Rockhill, Perri Kern, Diana Dean
The MDHHS database (“Vital Statistics”) includes all death certificates of state residents and those who died in Michigan, whether they were state residents or not, from 1999 to 2018. A physician or medical examiner (ME) must provide a completed and signed certification of death within 48 h of death or taking charge of the case. For violent or unexpected deaths and deaths without medical attendance in the past 48 h, the ME must investigate the cause and manner of death. Failure of a physician to submit a signed death certificate within 48 h of a death that would not otherwise be investigated by an ME does not constitute an assigned ME case. Although the ME must submit a death certificate to the state registrar within 48 h of death or assuming charge of the case, the initial certificate does not have to include the final cause of death determination. In many cases, the initial death certificate lists the cause of death as “pending”, with an updated death certificate typically submitted within 120 days.