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R D Start

Publications and source records attributed to R D Start.

At least 37 records · Page 2Linked to original sources
PubMed1996

Clinician beliefs underlying autopsy requests.

The aim of the study was to use psychological theory to identify and evaluate factors influencing clinical autopsy requests. A series of pilot interviews were conducted with 20 clinicians to identify beliefs about the benefits and drawbacks, social groups and circumstances influential in the decision to make an autopsy request. The most common beliefs, together with measures of intention to request autopsies, were incorporated into a questionnaire which was distributed among all appropriate clinicians in four hospitals. Statistical analyses identified which beliefs had the most influence on clinicians' intentions to request autopsies. A total of 145 clinicians returned the questionnaire, a response rate of 42%. Clinicians were significantly more likely to request autopsy the more they thought that the outcome of requesting would be of educational value, would confirm clinical diagnoses, would not distress relatives, would not be time-consuming and that the request itself would receive support from their consultant. An autopsy request was unlikely in circumstances where clinicians felt uncomfortable when requesting relatives' permission and when the patients were elderly. The fear of causing distress to relatives and the degree of support from the clinician's consultant were found to be the strongest predictors of intention to request autopsies. These are two areas in which intervention could help to increase autopsy request rates.

Attitude of Health Personnel↗
PubMed1995

The autopsy.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1995

The photocopier: an overlooked tool in surgical pathology.

Pictorial representation of gross pathological specimens aids interpretation of many specimens in surgical pathology. The availability of such images is invaluable to subsequent review of material. Line diagrams are subjective and imprecise. Photographic recording of specimens is expensive, particularly if an instant image is required. A completely enclosed technique in which a plain paper photocopier is used to record images of gross pathological specimens is described together with appropriate applications in surgical pathology. The photocopier represents an inexpensive, rapid and reliable method of producing an acceptable permanent record of many gross specimens.

Humans↗
PubMed1995

How do clinicians learn to request permission for autopsies?

A postal survey of 434 clinicians at four local hospitals was undertaken in order to identify the methods by which clinicians learn how to request permission for hospital autopsies and to assess the preferred techniques and timing of relevant communication skills training. The majority of 128 responding clinicians had learnt through personal experience with some assistance from senior colleagues and peers. Few clinicians appeared to have learnt through formal training. The preferred methods for the provision of communication skills training were training in small groups (such as seminars or tutorials) and observation of clinicians at work. The most desirable time for the provision of this training was considered to be between the beginning of the final undergraduate year and the end of the pre-registration house officer year. The communication skills training provided within medical education is in need of improvement. More emphasis should be given to clinical-task- or situation-specific applications such as requesting permission for autopsies.

Autopsy↗
PubMed1995

Have declining clinical necropsy rates reduced the contribution of necropsy to medical research?

AIMS: To examine trends in necropsy based research output for a period of 27 years during which there has been a progressive decline in clinical necropsy rates. METHODS: The numbers of necropsy based research papers published between 1966 and 1993 were determined using the CD-Plus Medline computed literature database. RESULTS: The number of necropsy based research papers containing necropsy or a synonym in the title increased by 220% between 1966 and 1993. When papers including necropsy or a synonym in the abstract, but not in the title, were included, the proportion of all indexed papers increased from 0.35% in 1975, when abstracts were first included, to 0.53% in 1993. Analysis of the subject material indicated that necropsy based research has constantly reflected trends and advances in clinical medicine. Neuroscience related research represented the largest subject category which may reflect the difficulties in obtaining human tissue from sources other than necropsy. CONCLUSIONS: The modern necropsy continues to provide valuable information for all clinical and laboratory based disciplines. The decline in clinical necropsy rates would not yet appear to have undermined the contribution of the necropsy to research.

Autopsy↗
PubMed1995

Cytodiagnosis and the necropsy.

AIMS: To assess the efficacy of cytodiagnosis in necropsy practice. METHODS: Fifty three focal lesions from 46 necropsies were assessed by direct smears taken from the lesions. The smears were air-dried and stained by a modified Giemsa technique, with two cases having supplementary histochemistry. All of the slides were assessed independently before review of the necropsy histology. RESULTS: Of the 35 malignant neoplasms, 34 were correctly identified as malignant and 14 of these were characterised precisely. Three of the four benign neoplasms were recognised as neoplastic. One was characterised precisely. Three of the four infected cases revealed the relevant microorganisms. Seven of the other 10 focal non-neoplastic lesions were correctly diagnosed as non-neoplastic. Only two cases proved unsatisfactory for cytodiagnosis. CONCLUSIONS: Direct smear cytodiagnosis is quick, cheap and technically simple. Tissue autolysis may account for some difficulty in assessing particular tissues, but this should diminish with experience. Necropsy cytodiagnosis is applicable to all necropsies in all centres.

Autopsy↗
PubMed1995

General practitioner's knowledge of when to refer deaths to a coroner.

BACKGROUND: In 1992 about 179,000 deaths were reported to coroners in England and Wales and these represented 32% of the total number of registered deaths. Many of these cases were referred to coroners by general practitioners who certify the vast majority of deaths which occur outside hospitals. The safeguards to society which are provided by the coroner system in England and Wales are undermined if doctors fail to recognize those deaths which should be reported for further investigation. AIM: A study was undertaken to assess the ability of general practitioners to recognize deaths which require referral to a coroner. METHOD-A postal questionnaire consisting of 12 fictitious case histories was sent to all 323 general practitioners in Sheffield and the senior staff of the local coroner's office (two coroner's officers and two deputy coroners). Ten of the case histories contained a clear indication for referral to the coroner. RESULTS: A total fo 196 general practitioners (61%) and all the coroner's office staff returned the questionnaire. General practitioners correctly identified whether or not referral was indicated, with reasons, in a mean of 8.5 cases (range 4-12). Only six general practitioners (3%) were correct in all 12 cases. All of the coroner's staff were correct in all cases. CONCLUSION: General practitioners may be failing to bring certain categories of cases to the attention of coroners because of misconceptions of ignorance of their medico-legal responsibilities. General practitioner education in this area, and a closer working relationship between general practitioners and coroners may improve the situation.

Cause of Death↗
PubMed1994

Attitudes of senior pathologists towards the autopsy.

The attitudes of 205 consultant British pathologists in four regions were assessed by a postal questionnaire in which they were asked to indicate their level of agreement with 15 statements relating to autopsies. A total of 144 pathologists completed the questionnaire (response rate 70 per cent). Senior pathologists strongly agreed with statements relating to the importance of autopsies within pathology workloads, medical audit, and accreditation for training posts. There was strong support for the attendance of clinicians at autopsy demonstrations and for the suggestion that material from medico-legal autopsies should be made available for teaching and research. There was strong disagreement with the suggestions that advances in diagnostic techniques have diminished the role of autopsies, that performing autopsies does not further pathologists' education, that the cost of autopsies may not be justifiable within a limited budget, and that the autopsy should no longer be part of the MRCPath examination. These results are discussed in the context of the current status of the autopsy in general.

Attitude of Health Personnel↗
PubMed1993

Clinicians and the coronial system: ability of clinicians to recognise reportable deaths.

OBJECTIVE: To assess the ability of clinicians to recognise deaths which require referral to the coroner. DESIGN: Postal questionnaire consisting of 16 fictitious case histories, 14 of which contained a clear indication for referral to the coroner. SETTING: Large teaching hospital. Coroner's office. SUBJECTS: 200 clinicians from general medical and surgical firms and senior staff of the local coroner's office (two coroner's officers and the two deputy coroners). MAIN OUTCOME MEASURES: Number of correct assessments on questionnaire. RESULTS: The mean recognition score for the clinicians was 9.11 (range 3-14) with no difference between the clinical grades. All of the coroner's senior staff recorded maximum recognition scores of 16. CONCLUSIONS: The study highlights several features of the coronial system which are poorly understood by clinicians and provides the basis for an initiative to improve the medicolegal education of all clinicians.

Adult↗
PubMed1993

Quantitation of the renal arterial tree by fractal analysis.

To determine whether the renal arterial system has a fractal structure, the fractal dimension of renal angiograms from 52 necropsy cases was measured using an implementation of the box-counting method on an image analysis system. The method was validated using objects with known fractal dimensions. The method was accurate with errors of less than 1.5 per cent and reproducible with initial values within 1.2 per cent of the mean of ten sets of measurements (reliability coefficient 0.968, 95 per cent confidence limits 0.911-0.984). In the 36 satisfactory angiograms the mean fractal dimension was 1.61 (SD 0.06), which was significantly greater than the topological dimension of 1 (P < 0.0001), indicating that the renal arterial tree has a fractal structure. There was no significant relationship between age (P = 0.494), sex (P = 0.136), or systolic (P = 0.069) or diastolic (P = 0.990) blood pressure, but two congenitally abnormal kidneys (hypoplastic dysplasia and renal artery stenosis) had fractal dimensions at the lower end of the normal range (third percentile). Since the renal arterial tree has a fractal structure, Euclidean geometric measurements, such as area and boundary length, are invalid outside precisely defined conditions of magnification and resolution.

Adult↗
PubMed1993

Clinical necropsy rates during the 1980s: the continued decline.

The trends in necropsy rates during the 1980s in three groups of British teaching hospitals in Leicester, Manchester, and Sheffield were compared in a retrospective study. The clinical necropsy rates declined in all three cities: in Leicester, from 16 to 10 per cent; in Manchester, from 14 to 8 per cent; and in Sheffield from 18 to 11 per cent. The medico-legal and overall necropsy rates showed variable trends between the cities. Specific events and changes in organization during the review period were correlated with the changing trends. The observed trends emphasize the continued decline in clinical necropsy rates over the last decade and illustrate the importance of monitoring differential necropsy rates.

Autopsy↗