No abstract

The most common cause of sudden unexpected deaths is cardiovascular system diseases. Ischemic heart injuries take the biggest part in this group. Cardiac diseases such as coronary artery disease and myocardial infarction play a significant role in forensic medicine practice due to being very common and fatal. Therefore, many methods are being tried in postmortem diagnosis and reliability and validity studies are performed for these methods. In this study, we aimed to investigate the postmortem diagnostic features of apoptosis in the myocytes in myocardial injury. For this reason, apoptosis conditions were evaluated using terminal deoxynucleotidyl transferase-mediated dUTP nick end labelling (TUNEL), Bcl-2, Fas, and p53 immunohistochemical staining methods in the myocardial tissues of 43 medicolegal autopsies. The cases that have 75% or more stenosis in at least one of the coronary arteries and that had been diagnosed with myocardial infarction apoptosis markers are stained in a higher rate. In the cases that have 50% or more stenosis in at least one coronary artery, Fas and bax staining were found as statistically significant. Apoptosis may be helpful in diagnosing the cases with myocardial injury such as acute myocardial infarction and Bcl-2, bax, Fas, p53 markers and TUNEL staining method may be used for his purpose. We think that these methods may be insufficient due to the low specificity and suggest supporting them with other methods.

ObjectivesTo assess the effects of a quality improvement (QI) team training intervention, by measuring the intervention fidelity and the compliance with a surgical site infection (SSI) bundle in the operating theatre (OT).DesignMulticentre before–after study.SettingThis study was performed in four Dutch hospitals.InterventionThe QI team training intervention consisted of four sessions per hospital and stimulated participants to set culture norms and targets, identify barriers, and formulate management activities to improve compliance with four standard operating procedures (SOPs) of a SSI bundle in the OT. Participants were executive board members, top-level managers, leading clinicians and support staff. The four SOPs were: (1) reducing door movements; (2) preoperative antibiotic prophylaxis prescribing; (3) preoperative shaving; and (4) postoperative normothermia.Poissonand logistic regression analyses were performed to analyse the effect of the intervention on compliance with the individual SOPs (primary outcome measure) and on the influence of medical specialty, time of day the procedure took place and time in the OT (secondary outcome measures).ResultsNot all management layers were successfully involved during all sessions in the hospitals. Top-level managers were best represented in all hospitals, leading clinicians the least. The number of implemented improvement activities was low, ranging between 2 and 14. The team training intervention we developed was not associated with improvements in the compliance with the four SOP of the SSI bundle. Medical specialty, time of day, and time in OT were associated with median number of door movements, and preoperative antibiotic prophylaxis administration.ConclusionThis study showed that after the QI team training intervention the overall compliance with the four SOPs did not improve. Minimal involvement of leading clinicians and a low number of self-initiated activities after the team training were important barriers for compliance.