Introduction of postmortem CT increases the postmortem examination rate without negatively impacting the rate of traditional autopsy in daily practice: an implementation study

AimThe aim of this implementation study was to assess the effect of postmortem CT (PMCT) and postmortem sampling (PMS) on (traditional) autopsy and postmortem examination rates. Additionally, the feasibility of PMCT and PMS in daily practice was assessed.MethodsFor a period of 23 months, PMCT and PMS were used as additional modalities to the autopsy at the Department of Internal Medicine. The next of kin provided consent for 123 postmortem examinations. Autopsy rates were derived from the Dutch Pathology Registry, and postmortem examination rates were calculated for the period before, during and after the study period, and the exclusion rate, table time, time interval to informing the referring clinicians with results and the time interval to the Multidisciplinary Mortality Review Board (MMRB) meeting were objectified to assess the feasibility.ResultsThe postmortem examination rate increased (from 18.8% to 32.5%, p<0.001) without a decline in the autopsy rate. The autopsy rate did not change substantially after implementation (0.2% decrease). The exclusion rate was 2%, the table time was 23 min, and a median time interval of 4.1 hours between PMCT and discussing its results with the referring clinicians was observed. Additionally, more than 80% of the MMRB meetings were held within 8 weeks after the death of the patient.ConclusionsOur study shows that the implementation of a multidisciplinary postmortem examination is feasible in daily practice and does not adversely affect the autopsy rate, while increasing the postmortem examination rate.

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Abstract 13248: The Impact of Instructions for Covering the Mouth and the Nose on Dispatch-Assisted Cardiopulmonary Resuscitation

Circulation ◽

10.1161/circ.144.suppl_2.13248 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Hidetada Fukushima ◽

Hideki Asai ◽

Koji Yamamoto ◽

Yasuyuki Kawai

Keyword(s):

Cardiopulmonary Resuscitation ◽

Median Time ◽

Chest Compression ◽

Fire Department ◽

Emergency Call ◽

Time Interval ◽

Time Intervals ◽

Median Time Interval ◽

Study Results ◽

The Impact

Introduction: Under the SARS-CoV-2 pandemic, rescuers are recommended to cover their mouth and nose with a facemask or a cloth as well as victim’s mouth and nose when performing cardiopulmonary resuscitation (CPR). However, its impact on dispatch-assisted CPR (DACPR) has not been investigated well. Hypothesis: DACPR including the instruction for covering the rescuer’s and the victim’s mouth and nose can significantly delay the start of the first chest compression. Methods: We retrospectively analyzed DACPR records of the Nara Wide Area Fire Department, covering population of 853,000/3361km 2 , in Japan. We investigated the key time intervals of 505 DACPR records between May 2020 and March 2021. We also compared the results to that of the same period in 2019 (535 records). Results: Dispatchers failed to provide mask instruction in 322 cases (63.8%). The median time interval from the emergency call and the start of CPR instruction was longer in 2020 (197 seconds vs 190 seconds, p=0.641). The time to the first chest compression was also delayed in 2020 (264 seconds vs 246 seconds, p=0.015). Among the cases that dispatchers successfully provided mask instruction (183 cases, 36.2%), median time intervals to the start of instruction and the first chest compression were relatively faster than cases without mask instruction (177 seconds vs 211 seconds and 254 seconds vs 269.5 seconds, respectively). Conclusions: Dispatchers failed to provide mask instruction in the majority of CA cases. However, our study results indicate that the impact of mask instruction on DACPR can be minor in terms of immediate CPR provision.

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Agreement between premortem and postmortem diagnoses in patients with acquired immunodeficiency syndrome observed at a brazilian teaching hospital

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46651997000400007 ◽

1997 ◽

Vol 39 (4) ◽

pp. 217-222 ◽

Cited By ~ 16

Author(s):

Aércio Sebastião BORGES ◽

Marcelo Simão FERREIRA ◽

Sérgio de Andrade NISHIOKA ◽

Marco Túlio Alvarenga SILVESTRE ◽

Arnaldo Moreira SILVA ◽

...

Keyword(s):

Acquired Immunodeficiency Syndrome ◽

Causes Of Death ◽

Single Case ◽

Postmortem Examination ◽

Multiple Infections ◽

Postmortem Diagnosis ◽

Clinical Diagnoses ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome ◽

Postmortem Examinations

Acquired immunodeficiency syndrome (AIDS) is one of the main causes of death in adults worldwide. More commonly than in the general population, in patients with AIDS there is substantial disagreement between causes of death which are clinically suspected and those established by postmortem examination. The findings of 52 postmortem examinations were compared to the premortem (clinical) diagnoses, and there was 46% agreement between them. Fifty two percent of the patients had more than one postmortem diagnosis, and 48% had at least one AIDS-related disease not suspected clinically. Cytomegalovirus infection was the commonest (30.7%) autopsy finding, but not a single case had been suspected premortem. Bacterial infection, tuberculosis, and histoplasmosis were also common, sometimes not previously suspected, postmortem findings. This study shows that multiple infections occur simultaneously in AIDS patients, and that many among them are never suspected before the postmortem examination. These findings suggest that an aggressive investigation of infections and cancers should be done in patients with AIDS, particularly in those who do not respond to therapy of an already recognized condition

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Carotid Endarterectomy: Are We Meeting the Two Week Target?

Scottish Medical Journal ◽

10.1258/rsmsmj.54.2.27 ◽

2009 ◽

Vol 54 (2) ◽

pp. 27-29 ◽

Cited By ~ 9

Author(s):

RV Guest ◽

JMJ Richards ◽

SCA Fraser ◽

RTA Chalmers

Keyword(s):

Health Services ◽

Vascular Surgery ◽

Carotid Endarterectomy ◽

Median Time ◽

Retrospective Review ◽

Stroke Prevention ◽

Time Interval ◽

Median Time Interval ◽

Timing Of Onset ◽

Prevention Benefit

Objective It has been recommended that carotid endarterectomy should be carried out within fourteen days of the index event if maximum stroke prevention benefit is to be achieved. The aim of this study was to see whether this target was being met in our region and where in the pathway delays occurred. Methods This was a retrospective review of all patients (n=75) undergoing carotid endarterectomy in 2006 in a regional vascular unit. Eleven patients were excluded as the timing of onset of symptoms was unclear, leaving 64 patients for further analysis. Results The median time-interval from onset of symptoms to surgery was 47 days (interquartile range 32-65 days). Five of 64 patients (4.5%) had a carotid endarterectomy within 14 days. Median time from onset of symptoms to presentation to health services was one day (IQR 0-7 days), from presentation to health services to neurovascular clinic was 16 days (IQR 10-23 days), from neurovascular clinic to vascular surgery clinic was 13 days (IQR 9-24 days), and from vascular surgery clinic to operation was 13 days (IQR 8-22 days). Fifteen of the 51 patients (29%) attending a neurovascular clinic and five of the 57 patients (9%) attending a vascular surgery clinic were seen within 14 days. Conclusion The fourteen-day target is difficult to achieve due to the number of steps in the referral pathway. This delay may be jeopardising outcome. Reduction in the delay to surgery would require a multi-disciplinary approach and should involve education of the general public.

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Evaluation of measles and rubella integrated surveillance system in Apulia region, Italy, 3 years after its introduction

Epidemiology and Infection ◽

10.1017/s0950268818000407 ◽

2018 ◽

Vol 146 (5) ◽

pp. 594-599 ◽

Cited By ~ 1

Author(s):

I. A. Turiac ◽

F. Fortunato ◽

M. G. Cappelli ◽

A. Morea ◽

M. Chironna ◽

...

Keyword(s):

Laboratory Investigation ◽

Median Time ◽

Surveillance System ◽

Case Reports ◽

Quality Data ◽

Time Interval ◽

System Sensitivity ◽

Apulia Region ◽

Median Time Interval ◽

Capture Recapture

AbstractThis study aimed at evaluating the integrated measles and rubella surveillance system (IMRSS) in Apulia region, Italy, from its introduction in 2013 to 30 June 2016. Measles and rubella case reports were extracted from IMRSS. We estimated system sensitivity at the level of case reporting, using the capture–recapture method for three data sources. Data quality was described as the completeness of variables and timeliness of notification as the median-time interval from symptoms onset to initial alert. The proportion of suspected cases with laboratory investigation, the rate of discarded cases and the origin of infection were also computed. A total of 127 measles and four rubella suspected cases were reported to IMRSS and 82 were laboratory confirmed. Focusing our analysis on measles, IMRSS sensitivity was 82% (95% CI: 75–87). Completeness was >98% for mandatory variables and 57% for ‘genotyping’. The median-time interval from symptoms onset to initial alert was 4.5 days, with a timeliness of notification of 33% (41 cases reported ⩽48 h). The proportion of laboratory investigation was 87%. The rate of discarded cases was 0.1 per 100 000 inhabitants per year. The origin of infection was identified for 85% of cases. It is concluded that IMRSS provides good quality data and has good sensitivity; still efforts should be made to improve the completeness of laboratory-related variables, timeliness and to increase the rate of discarded cases.

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Does Drug Allergy Workup in Children Satisfy Their Parents?

International Archives of Allergy and Immunology ◽

10.1159/000518583 ◽

2021 ◽

pp. 1-7

Author(s):

Pinar Gokmirza Ozdemir ◽

Velat Celik ◽

Burcin Beken ◽

İbrahim Arcanlı ◽

Mehtap Yazicioglu

Keyword(s):

Drug Allergy ◽

Pediatric Patients ◽

Time Interval ◽

Procedure Time ◽

Multiple Choice Questions ◽

Pediatric Allergy ◽

Provocation Tests ◽

Median Time Interval ◽

Drug Provocation Tests ◽

Telephone Questionnaire

Introduction: Although drug allergy workup for pediatric patients (skin and drug provocation tests [DPT]) is performed, the procedures are troublesome, painful, and time-consuming. The aim of this study was to assess parents’ perception of and satisfaction with their child’s drug allergy workup. Further, to evaluate parents’ tendency to use the tested drug following a negative DPT and the consequences of re-exposure. Methods: Parents of children that underwent drug allergy workup from January 2017 to August 2020 in the Pediatric Allergy Department of Trakya University Medical Faculty were included. Satisfaction levels were assessed via a telephone questionnaire (3 open-ended, 7 multiple-choice questions). Satisfaction was scored on a Likert scale (1: very unsatisfied and 5: very satisfied). Results: A total of 102 parents participated the study. Fifty-two (51%) of patients were male, and median age was 6.2 years and a median time interval between admission and test appointment of 1 month; 16.7% had a positive drug allergy workup, with 88.3% reporting being satisfied (56.9%) or very satisfied (31.4%) with the workup. Satisfaction levels were inversely related to the time between admission and test appointment (rho: −0.254, p = 0.01), with 8.2% reporting they did not use the tested drug when necessary despite a negative result. The tested drug was used by 35 individuals (41.1%), 33 (94.2%) tolerating without reaction. Conclusion: Most parents were satisfied with the workup, but levels were inversely related to the admission and procedure time interval. Drug allergy workup should be performed as soon as possible to relieve parents’ anxiety and achieve more patient satisfaction.

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Variation in Major Pulmonary Fissures: Incidence in Fetal Postmortem Examinations and a Review of Significant Extrapulmonary Structural Abnormalities in Sixty Cases

Pediatric and Developmental Pathology ◽

10.1007/s100249900041 ◽

1998 ◽

Vol 1 (4) ◽

pp. 289-294 ◽

Cited By ~ 2

Author(s):

A.W. Bates

Keyword(s):

Pulmonary Hypoplasia ◽

Chromosomal Abnormalities ◽

Renal Dysplasia ◽

Situs Inversus Totalis ◽

Postmortem Examination ◽

Structural Abnormalities ◽

Appropriate For Gestational Age ◽

Cystic Renal Dysplasia ◽

Left Right Asymmetry ◽

Postmortem Examinations

A retrospective study of 1513 fetal postmortem examination reports from 1967 to 1996 yielded 35 cases with anomalous major pulmonary fissures (2.3%), to which a further 25 cases were added from fetal postmortem examinations performed between 1929 and 1966. Of 60 cases with anomalous fissures, 43 had an absent right horizontal fissure and 8 had a supernumerary left horizontal fissure; the remaining 9 showed various patterns in which one lung lacked major fissures. Histological examination in 29 cases did not reveal any additional pulmonary abnormality and pulmonary maturity was appropriate for gestational age. Additional malformations were present in 40 cases and these were frequently multiple, the most common being central nervous system, cardiovascular, and genitourinary system defects; notable heart malformations (10 cases); hydrocephalus (5 cases); and cystic renal dysplasia (4 cases). Chromosomal abnormalities were demonstrated in six cases although this figure does not reflect their prevalence, as many cases predate the availability of karyotyping. In seven cases, including three with polysplenia syndrome and one with situs inversus totalis, there was evidence of an underlying abnormality of left–right asymmetry, and in 13 cases there was documented pulmonary hypoplasia.

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Sudden death in racehorses: postmortem examination protocol

Journal of Veterinary Diagnostic Investigation ◽

10.1177/1040638716687004 ◽

2017 ◽

Vol 29 (4) ◽

pp. 442-449 ◽

Cited By ~ 7

Author(s):

Santiago S. Diab ◽

Robert Poppenga ◽

Francisco A. Uzal

Keyword(s):

Sudden Death ◽

Cardiovascular System ◽

Cause Of Death ◽

Public Perception ◽

Postmortem Examination ◽

The Public ◽

Examination Protocol ◽

Gross Lesions ◽

Postmortem Examinations ◽

Over Time

In racehorses, sudden death (SD) associated with exercise poses a serious risk to jockeys and adversely affects racehorse welfare and the public perception of horse racing. In a majority of cases of exercise-associated sudden death (EASD), there are no gross lesions to explain the cause of death, and an examination of the cardiovascular system and a toxicologic screen are warranted. Cases of EASD without gross lesions are often presumed to be sudden cardiac deaths (SCD). We describe an equine SD autopsy protocol, with emphasis on histologic examination of the heart (“cardiac histology protocol”) and a description of the toxicologic screen performed in racehorses in California. By consistently utilizing this standardized autopsy and cardiac histology protocol, the results and conclusions from postmortem examinations will be easier to compare within and across institutions over time. The generation of consistent, reliable, and comparable multi-institutional data is essential to improving the understanding of the cause(s) and pathogenesis of equine SD, including EASD and SCD.

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The Detection of Blood on Nonporous Environmental Surfaces: An Approach for Assessing Factors Contributing to the Risk of Occupational Exposure to Blood in the Autopsy Suite

Infection Control ◽

10.1017/s0195941700066601 ◽

1987 ◽

Vol 8 (10) ◽

pp. 424-426 ◽

Cited By ~ 11

Author(s):

Lorraine R. Beaumont

Keyword(s):

Hazardous Materials ◽

Postmortem Examination ◽

Good Work ◽

Work Practices ◽

Inexpensive Method ◽

Environmental Surfaces ◽

Risk Of Exposure ◽

Reagent Strips ◽

Indirect Route ◽

Postmortem Examinations

AbstractA simple and inexpensive method to assess the contamination of environmental surfaces and the associated potential risk of exposure of autopsy room personnel to potentially hazardous materials is described. Blood was selected as a marker of contamination and HEMASTIX® reagent strips were used to determine its presence on selected surfaces. The surfaces selected for examination typically do not come into direct contact with cadavers or tissues during a routine postmortem examination and thus are not included in routine cleanup. We documented the presence of blood on a variety of environmental surfaces in the autopsy suite and suggest that the contamination resulted from a breakdown in good work practices, most probably the indiscriminate handling or touching of materials and equipment with contaminated gloves. The risk of exposure to blood by the indirect route was deemed significant. The results of this study underscore the importance of establishing and consistently following good work practices and cleanup procedures to minimize the risk of exposure to blood before, during, and after postmortem examinations.

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Development of clinically apparent synovitis: a longitudinal study at the joint level during progression to inflammatory arthritis

RMD Open ◽

10.1136/rmdopen-2018-000748 ◽

2018 ◽

Vol 4 (2) ◽

pp. e000748

Author(s):

Robin M ten Brinck ◽

Hanna W van Steenbergen ◽

Annette H M van der Helm-van Mil

Keyword(s):

Longitudinal Study ◽

Inflammatory Arthritis ◽

Time Interval ◽

Subclinical Inflammation ◽

Joint Level ◽

Median Time Interval ◽

Persistent Inflammation ◽

Joint Examination ◽

Mtp Joints ◽

Anticitrullinated Protein Antibodies

IntroductionSubclinical inflammation, detected by MRI, in patients with arthralgia is predictive for development of inflammatory arthritis (IA). However, within patients that develop IA, the course of inflammation at the joint level during this transition is unknown. This longitudinal study assessed progression of inflammation at the joint level.Methods350 joints (unilateral metacarpophalangeals (MCPs), wrist, metatarsophalangeal (MTP) joints) of 35 patients presenting with clinically suspect arthralgia (CSA) that progressed to IA were studied at presentation with CSA and subsequently when clinical synovitis was first identified at joint examination (median time interval 17 weeks). At both time points, subclinical inflammation (bone marrow oedema, synovitis, tenosynovitis) was evaluated with MRI and joint examination was performed.ResultsAt presentation with CSA, 71 joints showed subclinical inflammation. During progression to IA, 20% of these joints had resolution of inflammation, 60% had persistent inflammation and 20% progressed to clinical synovitis. Of all joints that had developed clinical synovitis (n = 45), no prior subclinical inflammation was detected in 69%. Similar results were observed for anticitrullinated protein antibodies (ACPA)-positive and ACPA-negative patients.ConclusionsThis longitudinal study demonstrated moderate correlations between joints with subclinical inflammation and joints that developed clinical synovitis. These data imply that IA development is a more systemic rather than a locally outgrowing process.

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Evaluation of Pegfilgrastim Efficacy in Peripheral Blood Stem Cell Mobilization of Patients with Lymphoma

Blood ◽

10.1182/blood.v112.11.4129.4129 ◽

2008 ◽

Vol 112 (11) ◽

pp. 4129-4129

Author(s):

Krimo Bouabdallah ◽

Fontanet Bijou ◽

Marie-Sarah Dilhuydy ◽

Anne Banos ◽

Noel-Jean Milpied

Keyword(s):

Stem Cell ◽

Median Time ◽

Target Cell ◽

Peripheral Blood ◽

Peripheral Blood Stem Cell ◽

Time Interval ◽

Median Time Interval ◽

Cd34 Cells ◽

Cell Mobilization ◽

Stem Cell Collection

Abstract Twenty four patients (pts) with planned autologous stem cell transplantation for lymphoma diseases (Hodgkin’s disease=4; non-Hodgkin’s lymphoma=20) received chemotherapy (CT) (Induction CT=3 and salvage regimen= 21) followed by a fixed single dose (6 mg) administration of Pegfilgrastim (PF) after the last day of CT for peripheral blood stem cell collection (PBSC) (target cell dose of 3 2×106 CD34+/kg). Median age was 53 yrs (24–68) and median weight was 72, 5 kg (45–98). Among the 24 pts, 7 received more than 2 lines of CT regimens. The injection of PF was well tolerated. Median time interval between day 1(D1) of the cycle of CT mobilization and first leukapheresis session was 14 days (10–18) while the median time interval between injection of PF and first leukapheresis session was 9 days (6–13). Stem cell collection was started when the absolute number of circulating CD34+ cells was >10×106/L and performed with standard volume leukapheresis. Median CD34+ cells level at D1 of leukapheresis was 35, 5/mm3 (11–320) and interestingly, more than 35 % of pts could reach this median level of CD34+ early after PF injection (around D6). Notably, 22 pts reached the target cell dose in 2 sessions of leukapheresis or less (10 pts after 1 session, 10 other pts after 2 sessions, 2 pts after 3 and 4 sessions respectively). The median number of leukapheresis sessions was 2(1–4) and the median CD34+ cells harvested was 4×106/kg (0,8–26,6). Two pts (DLBCL = 1 and FL = 1) could not reach the level of CD34+ required to start leukapheresis and both became secondary refractory to CT. In univariate analysis, PBSC collection of > 4×106/kg was highly correlated with pts who started their collection at D9 of PF administration (P=0,01) and with those presenting a CD34+ cells level > 35.5/mm3 at D1 of leukapheresis (P=0,033). White blood cells level higher than 9 G/l was also predictive of circulating CD34+ cells >35,5/mm3 (P=0,033). These data suggest that PF may represent an attractive option for PBSC mobilization particularly for pts with lymphoma when optimal compliance of frequent sequential regimens of CT is required. We also emphasize that stem cell mobilization is effective even in pts in second or subsequent salvage CT regimen. Importantly, the circulating CD34+ count should be performed from D6 of PF administration. The presentation will include the updated data.

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