Iranian Journal of Forensic Medicine
Year:2014 | Volume:19 | Issue:1-4 (69)|Papers Count:11

Background: Suicide is one of the major health problems in our country particularly in Ilam province. The aim of this study was a comparative study of the causes and methods of suicide lead to deaths referred to Ilam Coroner in 2004-2009.Method: This study was a retrospective cross-sectional study, the data were collected by the check list. After coordination to the medico legal 581 cases of suicide lead to death over a six-year period from 2004 to 2010 were extracted and the data were analyses by SPSS software.Findings: Results showed that about half (47.9%) of all suicide cases related to the age group 16-25 years, (51.5%) were men and the rest (48.5%) were women. The highest frequency was housewives 38.2% and jobless 16.4%.The Highest rate of suicide lead to death among cities was for Ilam city with almost half of the (48.9%), then Shirvanchardavol with 38.2% and the lowest rate was Abdanan with 5.3%. Most methods of committed suicide in Ilam were self-Immolation with oil 46.26%, hanging out 28.4% and firearms 13.2%. The same pattern is seen in most cities except Darehshahr that poisoning with toxic was the dominant method of attempting suicide. During the six-year period of studied, throughout the all years burning has been more than hanging out except 2007 that frequency of hanging out has been higher. The overall trend of Suicide has been increase during the study Conclusion: Our findings show that the suicide death is increasing and has not changed much in the pattern of suicide attempts, so It is necessary to prevent this social problem by implemented mental health education initiative for young people, especially vulnerable groups.

Background: Poisoning is one of the most common medical emergencies. Essential measures in the management of a poisoned patient can be practiced in all medical centers in accordance with their facilities and the competency of the doctors while other precautions necessitate transferring of the patient to specialist centers, hence transfer of the poisoned patients to a specialist center with adequate medical equipments and proficient specialist doctors who are experienced in the groundwork of poisonings is concerned. The present study is conducted to determine the condition of transferring poisoned patients from medical centers to Noor Poisoning Center in Isfahan province of Iran.Methods: The present study is a descriptive-retrospective study. The studied population has been the patients who were transferred from medical centers to the poisoning center during a year. The sampling has been conducted in census method, and the researcher designed the questionnaire with regards to the available data in transfer forms which held questions about the preliminary measures taken in the management of the poisoned patient.Findings: the population involved 363 patients who were transferred to our referral center during one year. About 53% (15 of 32 cases) of the patients, who had required intubation, were not intubated prior to transfer to the poisoning emergency room. About 27% (98 cases) of the dispatched patients had unstable hemodynamics, and stabilization measures had been performed for 68% (25 cases) of the clinically unstable patients. Such measures were beneficial in 59% (14 cases) of these patients. About 13% (47 cases) of the patients were comatose and an appropriate prescription of coma cocktail had been done in 24% (11 cases) of them. Around 87% (267 of 306 cases) of the patients requiring gastric lavage had been lavaged which had been efficient in 62% (165 cases) of them. Charcoal had been only prescribed for 8% (15 of 196 cases) of the patients who required it. Special poison treatments had been administered in 63% (229 cases) of patients. In addition, 95% of the referring doctors were general practitioners who had not passed the poisoning course. The most common reason for transferring, according to the forms data, had been the lack of appropriate medical facilities (36% cases).Conclusion: Apparently, in order to reduce the problems of transferring poisoned patients, the most attention should be paid to increasing awareness of the physicians in general medicine course by including a poisoning course and also by emphasizing the presence of graduates in training poisoning programs. Moreover, there need to be more supervision on existence of the necessary equipments and medicines like coma cocktails and charcoal in medical centers.

Background: One of the major issues in forensic psychiatry would assess immediate risk of developing psychosis while committing the crime charged is real madnrss. Because according to islamic criminal legislation and the laws of other countries madness during ablative crime is free of criminal responsibility. The aim of this study was to determine the rate of spontaneous madness of cases referred to the alleged crimes committed during the commission of forensic psychiatry provinces of Lorestan and Ilam in 2006-2010 years.Methods: A retrospective cross-sectional study is the limited sample size sample of all cases referred to the Commission on Forensic Psychiatry provinces of Lorestan and Ilam in 2006-2010 is conducted during non-census.Legal offices, medical centers, visit the registration Lorestan and Ilam provinces and collected the archives of the files contents on completing objectives.Findings: A total of psychiatric cases referred to committees killing is the. only allege crime the madness is asserted in it. Also, only 9 cases (7 cases in Lorestan and Ilam file 2) claim insanity when they commit a crime.1 file of 9 claimants madness in Ilam, Lorestan and 2 cases were proved Madness. Madness with a history of mental illness were confirmed in all three cases. Crime proven tool block and brick involved. Only one of the cases had a history of drug use.Conclusion: Considering all the proved madness, The cases had history of mental illness and a history of drug use, proper diagnosis and control of mental disorders that are likely to reduce the risk of dementia problem of drug use and crime is important, and due to statistical limitations, this study should be carried out widely in the country.

Backgroung: The elderly are among the vulnerable groups in society, and elder abuse by caregivers is one of the forms of violence known as a public health problem throughout the world. The present study aimed to investigate different forms of elder abuse during hospital stay.Methods: Using non-random convenience sampling, this cross-sectional study was conducted on 200 elderly people over the age of 65 admitted to Meybod Hospital in 2012. A structured interview and a researcher-made questionnaire entitled “Studying the Abuse of the Hospitalized Elderly” were used to collect information.Findings: Most study samples were women (52%) and the 65 to 70 age group (65%). The prevalence of physical, psychological and financial abuses, as well as neglect and self-neglect were 11.8%, 9.68%, 5.08%, 21.17% and 21.14%, respectively. There was a significant difference between men and women in terms of physical (P=0.02), psychological and self-neglect (P=0.01) abuses. There was also a significant difference between the age groups in terms of physical (P=0.005) and neglect (P=0.02) abuses.Conclusions: Despite the great emphasis our culture puts on respecting patients and the elderly, the hospitalized elderly experience different types of abuse. Therefore, an accurate understanding of elder abuse in hospitals could increase the awareness and sensitivity of people, managers, personnel and organizations associated with this phenomenon so that they can take effective measures for prevention and design of a system identifying the elderly at risk.

Background: Attitude of physicians and patients about euthanasia has an important role in legal or illegal development of this action in the hospitals. This study was performed to determine the attitude of patients and physicians about euthanasia in hospitals affiliated to Tehran University of Medical Sciences during 2012-2013.Methods: This study was a cross-sectional study. Sample size was 100 cases in each group which included into the study by randomized classified method. Data gathered by a questionnaire. In data analysis by Pass, the frequency and standard deviations were calculated and t-test, and Chi-square tests were used for data analysis.Findings: 78% of patients and 63% of physicians agreed with at least one type of euthanasia. Agree with all types of voluntary and involuntary euthanasia significantly higher in patients than physicians (p<0.05). There was no statistically significant differences between gender, marital status, education level and age of the patients with attitude about euthanasia (p>0.05). Also there was no significant differences between gender, profession, place of work, hospitals ward, age and work history with physicians› attitudes about euthanasia (p>0.05).Cunclusion: Our findings showed that, the majority of patients and physicians participating in this study agreed with at least one type of euthanasia and patients more than physicians agreed with euthanasia. Future studies to clarify the training needs in this area and related legislation and regulations in this regard are recommended.

Background: Having reliable information about causes of mortality is a necessity for health planning and controling diseases in society. This study is performed to determine the causes of mortality in patients referred to Shohaday-e-Ashayer khorramabad hospital in 2011.Methods: The subject of this cross_sectional study were 863 patients that died in Shohaday-e-Ashayer khorramabad hospital in 2011. The causes of death were coded and classified based on the International Classification of Diseases (ICD) and needed informations were analyzed with methods of descriptive statistics such as tables of the frequency distribution tables, mean, standard deviation and ratio.Findings: According to this study higher level’s of mortality were for the age above 60 years.This study showed that mortality rate in men (62.8%) is higher than women (37.3%). The Cross Death Rate (CDR) in this study is 2.93%. Truma (28.51%), Internal disease (22.79%) and stroke (17.1%) are the most common cause of death. other causes of death are surgery (8.8%), cancer (7.5 %), cardiovascular disease (7%) and infective disease (4.2%). The most of mortality rates (45.7%) are whom hospitalized in emergency room.Conclusion: Relation between age and cause of death is most probable, so for increase of life expectancy decreasing truma, internal disease and stoke and risk factor for any disease is necessary.

Background: Medication errors are one of the most common errors related to patients’ safety. The study was carried on to investigate medication errors by nurses in Qazvin university hospitals.Methods: In this descriptive study, 150 nurses who were working in 4 Qazvin medical university teaching hospitals were selected by proportional random sampling, and data were collected by a researcher-made questionnaire including demographic characteristics, employment information and nurses’ medication errors.Findings: The mean of the participating nurses’ age was 30.7±6.5 years and their overwork time mean was 64.2±38 hours per month. Medication errors had been made by 40.8% of the nurses. The most common types of reported errors were prescribing Medicine to wrong patient. The most common causes were inaccuracy (41%), ward crowdedness (13.1%), physician and nurses’ illegible handwriting (11.5%). A medication error was occurred the most for Antibiotics (67%).81.97% of the nurses had orally reported their error only to their head nurses or their colleagues (42%). Data analysis showed no significant relation between nurses’ demographic and employment characteristics with medication errors.Conclusion: This study showed that medication administration error was common, so for prevents it and protect patient safety, we suggest improve working conditions for nurses, improve nurses’ pharmacological knowledge, encourage nurses to report their errors, promoting culture patient safety and set up a system to record medical errors.

In Iran, the problem of psychiatric evaluation of mentally ill patients and the safe care of persons with serious mental disorders who have committed a crime is facing challenges. During recent efforts to review the Islamic Penal Code, the necessity of establishing a secure mental hospital for criminal patients has been considered. Finally, the legislator has noticed on the subject in footnote2, article 150 at new Penal Code. However, it is a positive progress but it seems there are some shortcomings and ambiguities in the text of the footnote there. With regard to the draft of mental health act and forecast stressed by the legislator in the new Penal Code, it seems that establishing a secure mental hospital which includes special protected wards for psychiatric care, treatment and reside for criminal patients is feasible by cooperation with the judiciary system and the Ministry of Health. For doing that, we need to do a survey on some samples in other countries around the world carefully at first.

Although today, in most legal systems there is the agreement on the necessity to take responsibility for the physician’s actions according to duty of him,her to the patients, but the difference on the basis of responsibility is still remaining. Medical Malpractice theory has lost previous attraction for its failures, and physician’s responsibility has also its drawbacks despite the advantages that it has in compensation of the injured person.In French law, despite the physician’s responsibility in fact is based on the theory of malpractice, but gradually judicial procedure and Legislator has developed imposed obligations as an exception to medical law, that it can be mentioned as a change in the principles of responsibility.However, the essential basis of the mentioned developments can be considered in philosophical schools and social movements shaped at the beginning of the last century, which their common point is the protection of consumer rights.Theory of consumer protection as the weak contractual party, introduced, accepted and institutionalized in the last century. This theory generalized at the beginning of the present century, and today it is a general legal principle.Accordingly, in most legal systems in order to maintain a balance between consumers and professionals relationship, it is tried to take steps to follow this thinking.This is also no exception, between doctor and patient relationship. For this reason, inspired by this idea the responsibility of medical jurisprudence makes the changes in the French legal system that have been considered by legislators. Looking at the rules and regulations of the past two decades, it is realized the fact that the main basis for reform in this field is institutionalization of rules and principles of consumer rights in the medical law. Rule Number 4 March 2002 entitled «Code relating to the patient’s rights and the quality of the health system” is apparently evidence to this claiming. The author by studying the mentioned changes which is formed based on consumer protective attitudes of medical care is trying to provide the causes of the use of its achievements in Iranian law.The mentioned transformation of medical law in France may be summarized in three main axes which includes change in the division of medical malpractice, in the responsibility Basics, and in the means of proving negligence and compensation methods.In this paper, regarding to the importance of the medical responsibility principles it is attempted to make clear how France law has been able to support the expand of the patient’s rights as a consumer of a medical liability, despite the failure of liability based on negligence theory.

Background: The purpose of this study is description, diagnosis and necessity of psychotherapy and assessment of comorbidity disorders for patients with transsexual.Methods: Two cases had referred to clinic of psychology for the demandant of sexuality change. This two case were evaluated through clinical interview, a personality questionnaire of NEO (NEO-FFI) and the Minnesota Multifaceted personality inventory-short form (MMPI).Results: Overall results showed the applicants who refer to psychological clinics in order to change the gender, should be examined by diagnostic tools and clinical interviews by regard to clinical judgment permission of transsexuals grant to them. As in case1, are observed borderline and hystrionic personality characteristics (not pure), lack of assertiveness and depression.Conclusion: According to our results, two clients have demands for changing of their gender, However, They experience various psychological conditions, Thus it, must be done psychotherapy before therapy through surgery.