[Features of methodology for the formation of standard operational procedure in the practice of bureau of forensic medical expertise]. / Osobennosti metodologii formirovaniya standartnykh operatsionnykh protsedur v prakticheskoi deyatel'nosti byuro sudebno-meditsinskoi ekspertizy.

OBJECTIVE: To analyze and summarize data on formation and implementation in practice of standard operational procedures for developing algorithm to improve the quality management system of bureau of forensic medical expertise. MATERIAL AND METHODS: Normative legal documents regulating principles of standardization in healthcare were studied. Literature was analyzed in PubMed, Google Scholar, eLIBRARY search engines in English and Russian languages on the issues of development and implementation of standard operational procedures in practice. RESULTS: Data on using standard operational procedures as a standardization element in medical practice have been analyzed and generalized. Specific proposals for developing system of standard operational procedures, based on general principles for the creation of such documents, in forensic medical expert institutions have been proposed. CONCLUSION: Suggested recommendations can be used in practice to develop new common standard operational procedures.

La gestión de las personas fallecidas a causa de la pandemia de COVID-19 y los retos organizativos desde la óptica de los servicios medicolegales / The management of the deceased from the COVID-19 pandemic and its organizational challenges from the medico-legal services perspective

La enfermedad por el nuevo coronavirus (COVID-19), surgida a fínales de 2019 en la ciudad china de Wuhan, fue declarada como pandemia por la Organización Mundial de la Salud el 11 de marzo de 2020. En los países y regiones más afectadas, paralelamente al elevado número de pacientes y a la saturación de los servicios de salud, la cantidad inhabitual de fallecidos supone un importante esfuerzo de gestión para las autoridades. El presente artículo tiene como objetivo identificar los retos particulares de una adecuada gestión y coordinación de las instituciones implicadas y proponer recomendaciones de actuación para el manejo correcto y digno de los fallecidos y la protección del derecho de sus familiares a un trato respetuoso, a conocer la suerte y el paradero de sus seres queridos y a honrarlos de acuerdo con sus creencias. Se destaca el importante papel que los servicios medicolegales deben jugar para ello. (AU)

The new coronavirus disease (COVID-19), which emerged at the end of 2019 in the Chinese city of Wuhan, was declared as a pandemic by the World Health Organization on 11 March 2020. In the most affected countries and regions, in parallel to the high number of patients and the consequent saturation of the health services, the unusually high number of deaths adds a very sensitive burden to authorities regarding the management of corpses. The purpose of this article is to identify the particular challenges of an appropriate management and coordination of the institutions involved and to propose recommendations for action for the proper and dignified management of the deceased and the protection of the rights of their families to a respectful treatment, to know the fate and whereabouts of their loved ones and to honor them according to their beliefs and customs. The important role that medical-legal services may play for this is highlighted. (AU)

Especialidades médico forenses de la Universidad de Costa Rica: fortalezas y desafíos / Medical forensic specialties of the University of Costa Rica: Strengths and Challenges

Resumen El Programa de Posgrado en Especialidades Médico Forenses de la Universidad de Costa Rica, presenta una serie de particularidades propias que le confieren fortalezas, tales como el convenio interinstitucional con el Poder Judicial, el cual permite la formación de posgrado de sus médicos especialistas; el fomento a la educación médica continua, a través del deber de recertificación médica y el sistema de la gestión de calidad en el Poder Judicial, el cual busca mejorar las competencias técnicas de sus funcionarios, el fomento a la investigación biomédica y la relación internacional de médicos residentes y docentes de este programa de posgrado, facilitada por su ubicación estratégica dentro del Poder Judicial. No obstante, en la actualidad presenta una serie de desafíos, los cuales es necesario que el cuerpo médico contextualice, por ser un servicio médico esencial para la sociedad.

Abstract The Postgraduate Program in Forensic Medical Specialties of the University of Costa Rica currently presents a series of peculiarities that give it strengths such as the inter-institutional agreement with the judiciary, which allows the postgraduate training of its medical doctors, the promotion of continuing medical education through the duty of medical recertification and the quality management system in the judiciary that seeks to improve the technical skills of its forensic doctors, the promotion of biomedical research and the international relationship of medical doctors of this postgraduate program facilitated by its strategic location within the judiciary. However, nowadays it presents a series of challenges, which the medical doctors need to contextualize, as it is an essential medical service for society.

Sexual assault examination and COVID-19: risk reduction strategies in conducting forensic medical examinations of a suspected or confirmed COVID-19 positive patient in Melbourne hospital hot zones.

The rapidly evolving context of the COVID-19 pandemic has necessitated profound modifications to the provision of health care services on a global scale. The concomitant requirements of lockdowns and social isolation has had marked ramifications for vulnerable individuals at risk of violence. This ripple effect of the pandemic has been observed globally. It is crucial that clinical forensic medical units continue to provide quality and timely essential services to those affected by interpersonal violence. As such, processes in this field must be modified as COVID-19 cases present and knowledge about the disease changes. The experiences of conducting sexual assault forensic examinations of suspected and confirmed COVID-19 positive (S/COVID-19) patients in a hospital hot zone are presented, and additional forensic issues specific to the emerging COVID-19 context are discussed.

Nurses and Medicolegal Death Investigation.

Forensic nurses currently serve in medicolegal death investigation settings nationwide, yet registered nurses seldom recognize death investigation as a career option. The purpose of this article is to describe medicolegal death investigation in the United States and the roles nurses can achieve, depending upon state and agency job requirements. Duties and qualifications for job positions, whether filled by election, appointment, or staff hiring, are described to provide examples of nurses' roles within the medicolegal death investigation setting and to present career options. Forensic nurses have the educational preparation, medical skills, and forensic knowledge to serve within death investigation systems as a chief officer (e.g., coroner), deputy officer, or staff investigator.

A roadmap to the safe practice of forensic medicine in the COVID-19 pandemic.

The COVID-19 pandemic has forced forensic practitioners to consider how we perform our normal duties, especially when those duties involve humans. The potential for contracting the virus from working in close contact with living sufferers is high, and we have yet to fully determine the risk of infection from the deceased. In an attempt to support the community, the Journal of Forensic & Legal Medicine has drawn together three articles which underline the importance of continued forensic medical practice during the pandemic and highlight some factors to consider in a Roadmap towards safe practice. Our Roadmap has intentionally taken an international perspective and supports other work we have published in the Journal on our collective response to the COVID-19 crisis.

Medico-legal encounters of 2015 Nepal earthquake - Path traversed and the road ahead.

The Gorkha Earthquake hit the region on 25th of April 2015, at 12:58, with the epicentre approximately 80 km N-NW of Kathmandu, recording 7.8 Mw on the Richter Scale. The disaster left almost 9000 individuals dead. The search and recovery as well as the subsequent Disaster Victim Identification (DVI) operations left much to be desired. The entire DVI operations consisted of examination of 365 bodies and collection of 15 blood/hair samples and 60 bone/tooth samples. This resulted in the scientific identification of eight individuals and visual recognition of 357. The scientific basis of identification of more than 8000 individuals, remains a question. The Disaster Response was hampered by miscommunication, incoordination and mismanagement on the part of all stakeholders and could have led to misidentification as well as missed identification. This demonstrates the importance of systematic management of dead bodies in mass casualty events to ensure dignity and respect of the deceased as well as family members. The helplessness felt by technical experts was compounded by the general lack of political will and the pressure on the law enforcement for quick disposal, irrespective of the available standards and protocols. Therefore, DVI operations can only be assumed to be a disaster in the making, when faced with lack of political will, lack of strict adherence to international standards as well as lack of determination from all stakeholders. Such a response from authorities is usually driven by panic following mass fatalities especially in disasters of great magnitude, like this one. The article discusses the challenges faced by the technical experts in the field and describes the advancements as well as recommendations for further improving the DVI operations in a resource-stricken country.

Actividad de un servicio de medicina legal hospitalaria del siglo XXI / Activity of a 21st century hospital medico-legal department

INTRODUCCIÓN: La implantación de un Servicio de medicina legal hospitalaria, como asesor y consultor en aspectos médico-legales, éticos y deontológicos de la práctica asistencial, se ha consolidado en el Hospital Clínico de San Carlos de Madrid. Una cartera de servicios sencilla basada en la prevención de riesgos legales, ha permitido que los profesionales, la administración sanitaria y los propios pacientes confíen en él. RESULTADOS: En el período 2007-2017 se gestionaron 1.213 expedientes, aumentando de forma progresiva y destacando los años 2009 y 2017 con un 13,8 y 12,3% de la actividad total, respectivamente. Las unidades que más consultaron fueron el equipo directivo 158 (13%), el Instituto de la Mujer 144 (11,9%) y el Servicio de Atención al Paciente 116 (9,6%). DISCUSIÓN Y CONCLUSIONES: El servicio participa en múltiples comisiones y grupos de trabajo elaborando guías, documentos y protocolos, abordando conflictos, dudas normativas, deficiencias formativas, recomendando cursos de acción, e intermediando con pacientes y familiares para disminuir la incertidumbre del profesional

INTRODUCTION: A hospital legal medicine department, to advice and consult on the legal, ethical and deontological aspects of healthcare practice, has been implemented in our centre, Hospital Clínico San Carlos (Madrid Spain). A simple service portfolio based on the prevention of legal risks, has allowed professionals, health service and patients to place their trust in it. RESULTS: The number of cases over the period 2007-2017 reflects major activity, and 2009 and 2017 are highlighted with 13.8% and 12.3% of the total activity respectively. The units that consulted the most were the management team 158 (13%), the Institute for Women's Affairs 144 (11.9%) and the Patient Care Service 116 (9.6%). DISCUSSION AND CONCLUSIONS: The department participates in multiple committees and working groups preparing guidelines, documents and protocols, addressing conflicts, regulatory doubts, training deficiencies, recommending courses of action, and mediating with patients and family members to reduce professional uncertainty

Reform of the death investigation system in Japan.

The autopsy rate in Japan is lower than that in other countries, and most death investigations have historically been conducted by police officers through external inspection. Although medicolegal autopsy was not performed during the samurai administration, the European death investigation system was adopted in the second half of the 19th century and judicial autopsy began in universities' forensic medicine departments. After World War II, the medical examiner system was introduced under US influence, but it was only adopted in certain areas. Further reforms were introduced in the 21st century-in 2012, two laws relating to death investigation were enacted: The Act on Promotion of Death Investigation (Promotion Act), which provided foundational principles and included measures for investigating the causes of death and identification of bodies, and the Act on the Investigation of Cause of Death and on Identification of Bodies Handled by the Police, which recommended a procedure for death investigation, including a new autopsy system.The Death Investigation Promotion Program was to meant to be decided by the government in 2014. However, the relevant Act expired after it ran out of time. Later, in 2019, the Basic Act for Promotion of Death Investigation, the successor to the Promotion Act, was passed. This Act is significant because it sets the basic foundational principle and imposes plans created by the government. However, it remains unclear how these measures can be implemented, so further discussion and financial investment are now required.

[Organization of forensic medical service work in case of fires with massive number of victims]. / Organizatsiia raboty sudebno-meditsinskoi sluzhby pri pozharakh s massovym chislom zhertv.

A complex algorithm is proposed for the forensic medical service response in emergency situations marked by a large number of deaths from fire. Its use will promote increased efficiency in the work of forensic medical units while limiting the consequences to human victims in emergency situations.

Building a Patient-Centered Medical-Legal Home in Hawaii's Kalihi Valley.

The Medical-Legal Partnership for Children in Hawai'i (MLPC) has worked to address the social determinants of health for low-income patient-families since 2009. Focused on identifying health-harming legal needs, doctors and lawyers work together to assist families with family law, housing, public benefits, education, employment, civil rights, and other concerns. Providing free, direct legal service in the medical setting allows the medical-legal partnership (MLP) team to identify community-wide concerns such as language access violations, racial discrimination, and unfair policies. These individual concerns then inform systemic advocacy and community engagement efforts. The MLPC Hawai'i team has grown through its experiences working with public housing residents, Micronesian migrant communities, and low-income families, ultimately evolving the national MLP framework to become a patient-centered "medical-legal home." This evolution is possible through the utilization of "rebellious lawyering" concepts of working with, not just on behalf of, community clients. This article will introduce the concept of a medical-legal partnership, provide examples of lessons learned from working alongside vulnerable and resilient communities, and explore the idea of the patient-centered medical-legal home as an innovative program to improve the social determinants of health and reduce health disparities.

Improving medicolegal death investigative gaps of fatal elder abuse.

The purpose of this brief is to present several case vignettes that illustrate omissions in the investigation of elder deaths. These vignettes demonstrate the need for a standardized approach in the conduct of medicolegal investigations of fatal elder abuse. For each of the described oversights, a recommendation is offered to address the gap in investigation processes, which in turn could improve the determination of cause and manner of elder death. Inherent limitations of resources and practical realities of death investigation are discussed and recommendations are made for future research. Viewed broadly, deficiencies in elder death investigations can lead to the underreporting of elder abuse and the reduction of legal options for victims, which may reflect a systemic pattern of social injustice.

Self-inflicted long bone fractures for insurance fraud.

Self-inflicted fractures simulating traffic accident represent a new social fraud opportunity for criminality. Recognising scams through an increase of awareness of existence of self-inflicted arm fractures for insurance fraud could help community health workers to report these injuries to the competent authorities. In this article, authors have recognised an unusual but consistent pattern of upper and lower limb fractures whose incidence does not coincide in numerical terms with what is reported in literature. The aim of the present study is to describe fracture patterns observed over the past 2 years. Further, authors describe clinical presentations of these fractures and attempt to define a possible mechanism of these types of injuries.

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.