The Clinician and Forensic Medicine

Although it is an intrinsic part of all medical practice forensic medicine often is either unrecognized as such or is consciously or subconsciously evaded. The failure to apply some rather basic and simple forensic principles that only the physician is capable of doing may result in problems to the patient ranging from frustration to near catastrophe. For physicians who are reasonably well equipped to understand the legal system, the successful conclusion of a legal case, including, sometimes, an appearance in court, can be stimulating and interesting.     

Population aspects of forensic genetics

The paper presents the methodology of forensic genetics as a synthesis of population genetics and forensic medicine. Main population genetic problems, appearing in calculation of probability statistics and interpretation of the results of forensic genetic investigations, are discussed in detail.     

Population aspects of forensic genetics

The paper presents the methodology of forensic genetics as a synthesis of population genetics and forensic medicine. Main population genetic problems, appearing in calculation of probability statistics and interpretation of the results of forensic genetic investigations, are discussed in detail.     

单核苷酸多态性检测技术在法医学中的应用进展

单核苷酸多态性是新一代的法医学检测标记,本文结合市面上常见的商品化试剂盒,对单核苷酸多态性的检测原理、试剂选择及具体操作等进行了综述.并在此基础上提出了它们在法医学应用中需要注意的问题.     

The Medical Investigation of Alleged Rape

The web of human entanglement resulting from the cry “rape” may twist and disrupt the lives of the persons involved. The physician who is prepared and able to deal with the forensic medical aspects of the problem can play a vital role in the determination of innocence or guilt. And, if he is prepared to recognize and deal with the psychologic problems, the emotional distress and the anxiety, the physician can provide invaluable help.     

案例教学法在法医病理学国家精品课程教学中的应用

精品课程是国家教育部关于高等学校教学质量和教学改革工程的重要内容,是衡量高等学校教学质量和人才培养质量的标杆之一,精品课程建设在高等医学教学工作中具有重要的地位。法医病理学是一门应用学科,是法医学专业的主干课程,法医病理学教材中部分内容单调、枯燥,在教学中紧靠教材上知识,很难调动起学生的热情。传统教学方法虽然可以系统讲解基本理论知识,但属灌输式教学,不利于发挥学生的主观能动性和培养学生的思维。采用案例教学法,以学生为中心,理论联系实践,提高学生分析问题和解决问题的能力,有组于学生实践能力的培养,提高了法医病理学教学质量,值得推广及应用。     

Expert systems in treating substance abuse.

Computer programs can assist humans in solving complex problems that cannot be solved by traditional computational techniques using mathematic formulas. These programs, or "expert systems," are commonly used in finance, engineering, and computer design. Although not routinely used in medicine at present, medical expert systems have been developed to assist physicians in solving many kinds of medical problems that traditionally require consultation from a physician specialist. No expert systems are available specifically for drug abuse treatment, but at least one is under development. Where access to a physician specialist in substance abuse is not available for consultation, this expert system will extend specialized substance abuse treatment expertise to nonspecialists. Medical expert systems are a developing technologic tool that can assist physicians in practicing better medicine.     

The Identification of Human Remains

The identification of human remains, especially if they have been mutilated or burnt, or occur in skeletal form, may pose a major problem for the forensic physician. It may involve the co-operation of coroner, police officer, forensic pathologist and forensic laboratory. It is first necessary to demonstrate that the remains are human, and that the tissue in question represents one, or more than one, body. A meticulous postmortem examination by the forensic pathologist will reveal all anatomical peculiarities for study and record. Photographs, radiographs, dental charts, fingerprints and blood type all contribute materially to the solution of the problem.     

Genetic variability and discriminating power of four microsatellite loci in Russian population

Allele and genotype frequencies of 4 STR loci (LPL, vWA, FES/FPS H F 13B), used in forensic medicine, were analyzed in Russian Siberian population. Genetic and molecular diversity of these polymorphic systems were characterized in comparison with US Caucasoid population. High discriminating power (PD = 0.99975) of the system of four studied STR loci was shown. Comparative analysis of genetic diversity in Russian population and Caucasoid US population revealed the significant differences between two populations and demonstrated that STR frequency data for US population should not be used for forensic expertise in Russia. The data obtained in the current investigation may be used as reference data for forensic medicine laboratories in Siberia.     

Lethal injection,autonomy and the proper ends of medicine

Gerald Dworkin has argued that it is inconsistent with the proper ends of medicine for a physician to participate in an execution by lethal injection. He does this by proposing a principle by which we are to judge whether an action is consistent with the proper ends of medicine. I argue: (a) that this principle, if valid, does not show that it is inconsistent with the proper ends of medicine for a physician to participate in an execution by lethal injection; and (b) that this principle is not valid, and this is because it mistakenly views the promotion of patient autonomy as one of the proper ends of medicine. Rather, I propose, we should view respect for a patient's autonomy as a constraint on the pursuit of the proper ends of medicine, rather than as one of the proper ends itself. With this revised understanding of the proper ends of medicine, we can conclude that it is inconsistent with the proper ends of medicine for a physician to participate in an execution by lethal injection.     

Laboratory medicine needs higher profile with medical students,MDs, pathologists say.

Laboratory medicine is a troubled specialty these days, buffeted by the conflicting pressures of reduced funding for more work and a declining physician population. A consortium of laboratory physicians has produced a report on the future of pathology and laboratory medicine, which explores the problems facing the specialties and some potential solutions. Raising the profile of laboratory medicine among medical students and eventual unification of pathology and the various arms of laboratory medicine are among the suggested solutions.     

道路交通事故所致骨折特点、致伤机制及其与交通方式关系的研究

研究道路交通事故所致骨折的流行病学特点、骨折的特征及致伤机制;探讨交通方式与骨折的关系及其法医学意义,为预防、控制道路交通事故、交通伤骨折的急救及法医学的鉴定提供重要的依据.本文对2004年昆明市道路交通事故所致骨折518例临床法医鉴定及199例法医病理检验鉴定资料进行系统性分析研究.2005年及2006年.全国与云南省的交通事故数量下降趋势明显.交通事故所致骨折有以下特点:(1)多处、多发性骨折常见;(2)骨折部位呈"离心性分布";(3)暴力传导性骨折明显;(4)骨折刨伤严重,粉碎性及开放性骨折多见,多数需手术治疗;(5)下肢骨折常见,胫腓骨是下肢骨折最常见的部位;(6)四肢多发骨折常发生同侧肢体,摩托车、电动车、自行车驾驶员及乘员和行人发生四肢骨折时以同侧肢体多见,机动车驾驶员及机动车乘员以异侧肢体多见.骨折损伤方式以碰撞为主,其次是摔跌.     

General medicine in the 'eighties.

The general physician with or without an interest is directly responsible for the initial and continuing care in most acute medicine. Specialty interests cover the whole range of medicine but in most instances are subordinate to the claims of general medicine. Consultants in district general hospitals carry a bigger caseload in acute medicine than their colleagues in teaching hospitals, and this has implications for undergraduate and postgraduate training. The management of patients in intensive care units remains very much the task of the general physician. The general physician will continue to be an essential member of the hospital service in the foreseeable future.     

Quelques donnees historiques concernant la sexologie

With the exception of forensic medicine and psychiatry, medicine has not historically been substantially influenced by sexology. After Freud and psychoanalysis grappled with sexual facts, a sociological phase followed. However, it was not until Masters and Johnson that sexology was established as an independent science. Now, thanks to the East Coast of the United States, sexological treatments are numerous, including the corporeal approach and the use of audiovisual aids. The problem now is to establish therapeutic strategies.     

Ethical decision making by Canadian family physicians.

Canadian family physicians were sent questionnaires that asked how they would handle the ethical problems posed by six sample cases and what reasons were relevant to their decisions. The ethical problems concerned how much information to divulge to patients, how extensively a physician should become involved in the lifestyles of patients and how to deal with a possible family problem. The study identified characteristics of family physicians that affect their ethical decision making and tested a theoretical model that regards ethical problems as conflicts between respecting patient autonomy and promoting patient welfare. The varied responses suggested that ethical issues are resolved on a case-by-case, rather than a theoretical, basis. Certification in family medicine was the only characteristic associated with a consistent pattern of responses; certificants were more likely than other physicians to involve patients in decisions.     

L'utilisation des tests diagnostiques dans une unité de médecine familiale.

For a random sample of 1029 visits occurring over a 1-year period in a family medicine service 1067 diagnostic tests were done within 1 week (or within 3 weeks in the case of nuclear medicine) following the visit; this represents a mean of 1.04 tests, costing $ 8.30, per visit. There was no test ordered in most (62.5%) of the visits. The results of 909 tests were recorded; 36.6% were abnormal. The pattern of use of diagnostic tests varied considerably among the physicians; however, no association was observed between this pattern and the status of the physician, the site of the encounter, or the age or sex of the patient. There was a weak and not statistically significant correlation between the number of problems identified and the number of tests with abnormal results per visit. These results suggest that the problem of overuse of diagnostic tests may not be as acute in a family medicine service as it has been observed to be in other settings.     

PSYCHOTHERAPY—A Concept for the Nonpsychiatric Physician

Patients tend to repeat with their physician, as with other significant people in their lives, their earlier previous patterns of behavior. The physician as well as the patient is involved in the physician-patient relationship. He will tend to respond to his patients in accordance with his earlier life experiences and his characteristic repetitive behavioral pattern. For both physician and patient, the relationship between them extends beyond the immediate reality situation.Psychotherapy is the utilization of psychological measures in the treatment of sick persons and the deliberate utilization by the physician of the physician-patient relationship for the benefit of the patient. The kind of psychotherapy that is practical and utilizable by the nonpsychiatric physician is that which uses education, reassurance, support and the management of the patient''s problems either directly or indirectly or through the intermediary of other people or agencies.The symbolic aspect of the physician-patient relationship is based essentially on the fact that a sick person, because of his anxiety and because of the threat to his physical and psychic integrity, is more dependent and more anxious than he would be if he were well, and therefore he has a correspondingly greater need for the authoritative and protective figure he finds in the physician.Psychotherapy is not directed exclusively to the treatment of flagrantly or obviously neurotic or psychotic patients. It should be and is directed to all sick persons. Limitations in psychotherapy are set by various determinants, among which are the nature of the precipitating factor in the illness, the nature of the sick person, the skill, knowledge and abilities of the physician, and the nature of the physician-patient relationship. In psychotherapy, as in all medicine, the physician should not do anything which may disturb the patient if the disturbance is of no value or if it cannot be followed through with special skills.     

Do physicians have an ethical obligation to care for patients with AIDS?

This paper responds to the question: Do physicians have an ethical obligation to care for patients with acquired immunodeficiency syndrome (AIDS)? First, the social and political milieu in which this question arises is sampled. Here physicians as well as other members of the community are found declaring an unwillingness to be exposed to people with AIDS. Next, laws, regulations, ethical codes and principles, and the history of the practice of medicine are examined, and the literature as it pertains to these areas is reviewed. The obligation to care for patients with AIDS, however, cannot be located in an orientation to morality defined in rules and codes and an appeal to legalistic fairness. By turning to the orientation to morality that emerges naturally from connection and is defined in caring, the physicians'' ethical obligation to care for patients with AIDS is found. Through an exploration of the writings of modern medical ethicists, it is clear that the purpose of the practice of medicine is healing, which can only be accomplished in relationship to the patient. It is in relationship to patients that the physician has the opportunity for self-realization. In fact, the physician is physician in relationship to patients and only to the extent that he or she acts virtuously by being morally responsible for and to those patients. Not to do so diminishes the physician''s ethical ideal, a vision of the physician as good physician, which has consequences for the physician''s capacity to care and for the practice of medicine.