The article is from the public number: smark: ID > , author: warm water, drawing from the title: “non-natural death.”
As of 2020On March 10, 113,697 people worldwide had been infected with the new coronavirus pneumonia, and 4,006 people died. However, the complete transmission route of the virus and its distribution in infected people are still unclear, so targeted measures for prevention and diagnosis are still lacking.
Although experts have pointed out that the pathological anatomy of the corpses of the patients with new coronary pneumonia can provide strong support for clinical diagnosis and treatment, but it was not until February 16th that after multiple efforts, the pathological anatomy of the two patients with new coronary pneumonia was finally launched .
On February 16th, after many efforts, the pathological anatomy of two patients with new coronary pneumonia was finally carried out. 丨 Screenshot
Domestic forensic experts are working hard to carry out pathological anatomy of the dead of new coronary pneumonia as early as possible, which reflects the problem that pathological anatomy in China is not valued.
In fact, not only China, but in the past few decades, the rate of pathological anatomy has continued to decline in most countries around the world. So what is the reason behind this?
Pathological anatomy, targeted at dead patients in hospitals
The anatomy that the public understands is mostly forensic anatomy that involves criminal cases and is implemented by public prosecution law and medical schools. In contrast, pathological anatomy is generally targeted at patients who die in hospitals.
Pathological anatomy is of great significance. The anatomy of the dead patients in the hospital can reveal the pathological manifestations of some diseases, which has direct educational significance for clinicians and medical students. At the same time, pathological anatomy can comprehensively evaluate whether the diagnosis and treatment of the patient before the death are effective, such as confirming some difficult-to-find lesions, whether the surgery has effectively removed the lesions, etc., so as to more accurately determine the cause of death of the patient and monitor the adverse effects during treatment reaction. If the family of the deceased raises doubts that the death of the patient was caused by a medical accident, pathological anatomy can also determine or rule out such doubts.
Pathological anatomy is generally aimed at patients who have died in hospitals. 丨 Picture Creativity
In addition, Using pathological anatomy, we can identify and judge emerging or re-emerging diseases .
During the SARS epidemic from 2002 to 2003, Chlamydia was once thought to be the pathogen causing the disease, and the pathological anatomy chaired by Professor Ding Yanqing of Guangzhou Southern Hospital confirmed that atypical pneumonia was caused by a virus rather than by Chlamydia, which is a disease Prevention and control laid a vital foundation.
In this outbreak of new crown pneumonia, also through pathological anatomy, Professor Liu Liang of Wuhan Tongji Medical College discovered that the disease caused by the new crown virus is different from the pathological changes of SARS and MERS.
The rate of pathological anatomy in countries around the world has generally declined year by year.
Anatomy rate can directly reflect the degree of attention and development of anatomical work.
Kevh G. Shojania, director of the Center for Quality Improvement and Patient Safety at the University of Toronto, said that only a small percentage American hospitals maintain a high rate of pathological anatomy, and most non-public hospitals rarely or even do pathological anatomy. Soyania et al. Conducted statistics on data from eight states including Illinois, and found that before 1970, about 40% to 60% of hospital deaths in the investigated area were necropsied. Between 1994 and 2005, The rate of pathological anatomy in these places has dropped to 5%.
The trend of pathological anatomy rate in some US states and hospitals 丨 Reference 1
Europe’s pathological anatomy rate also shows a downward trend. Data from the World Health Organization’s European region show that the pathological anatomy rate in WHO’s European region and EU member states has been slowly decreasing for about 25 years. Take the Netherlands as an example. Between 1977 and 2011, the pathological anatomy rate in the Netherlands decreased from 31.4% to 7.7%, with an average annual decline of 0.7%.
Annual deaths and pathological anatomy rates in the Netherlands 丨 Reference 2
Japan is one of the very few countries in the developed world whose total anatomy rate has not fallen but rises. According to data from the Tokyo Metropolitan Welfare and Health Bureau, Japan’s total anatomy rate increased from 9.7% to 12.4% during the ten years from 2008 to 2017. Although the overall anatomy rate is steadily increasing, according to data from the Japanese Ministry of Health, Labour and Welfare and the Japanese Society of Pathology, the number of deaths each year is on the rise, and the number of pathological anatomy in Japan fell by more than 70% between 1984 and 2017. This reflects to a certain extent that the Japanese government attaches importance to and vigorously improve the anatomy of unnatural death, while ignoring the pathological anatomy of deaths in hospitals.
The trend of pathological anatomy in Japan from 1974 to 2017 丨 The Japanese Society of Pathology
The year-on-year decline in pathological anatomy rate shows that related work is being paid less and less attention in these countries. In contrast, at what level is the pathological anatomy rate in China?
China’s current pathological anatomy rate is far lower than the world’s advanced level
An article published in 2011 by Chinese pathologist expert Zhu Minghua pointed out that since the autopsy was carried out, the rate of pathological anatomy in China has been the highest between 1950 and 1960. Promote the importance of pathological anatomy to the general public. In 1957, the government also issued the “Anatomy Rules” to regulate related anatomy. However, after the 1970s, the rate of pathological anatomy in China began to decline rapidly, reaching the lowest point in 1990.
According to Professor Zhu Minghua’s survey, from 1998 to 2008, the pathological anatomy rates of five representative teaching hospitals in China were: Beijing Union Hospital 2.04%, Shanghai Changhai Hospital 0.35%, Guangzhou South Hospital 0.21%, Xi’an Xijing Hospital 0.50 % And Shanghai Changzheng Hospital 0.04%. After 2000, most hospitals in China no longer carry out pathological anatomy. Prof. Zhu Minghua believes that Chinese clinicians, especially the younger generation, have almost lost the concept of pathological anatomy.
In 1982, Beijing Medical College (now Peking University School of Medicine) Experts in the Department of Pathology and Anatomy also performed autopsy data in this department Analyzed. Data show that the number of anatomical cases in the teaching and research departments in the 1970s and 1980s was far below the level in the 1950s and 1960s. This is basically similar to the statistical results of Professor Zhu Minghua.
1946 ～ 1980 Beijing Medical College’s Department of Pathology and Anatomy Numbers Anatomical Trend 丨 Reference 5
The rate of pathological anatomy has declined for a number of reasons.
With the improvement of medical diagnosis and treatment, it seems necessary to reduce the pathological anatomy performed to determine the death. But as Kev Soyanya puts it, one of the reasons for the decline in the rate of pathological anatomy is that people have gradually formed a misconception that traditional, systematic autopsy has been faced with cutting-edge diagnostic techniques Obsolete . The hospital was overconfident in the level of diagnosis and treatment, which underestimated the importance of pathological anatomy.
Although relatives of the deceased are more likely to undergo advanced and alternative minimally invasive examinations such as puncture and endoscope, these examinations are less accurate than autopsy. Sometimes there are differences between autopsy results and clinical diagnosis.
There are also sometimes differences between autopsy results and clinical diagnosis. 丨 Pixabay
Data and examples support these points. Professor Zhu Minghua’s survey of 15 large hospitals in Beijing, Shanghai, Chengdu and other places showed that among the cases with suspected cause of death, the proportion of pathological diagnosis and clinical diagnosis results were not consistent with more than 20%. Of the 4194 cases in the Department of Pathology and Anatomy of Beijing Medical College, 870 cases did not match the pathological diagnosis and clinical diagnosis.
The experts from Beijing Medical College also cited 6 typical examples to illustrate the significance of pathological anatomy. For example, a 3 and a half year old boy was sent to the emergency department for cough and shortness of breath. After eating peanut rice, the clinical diagnosis was “asphyxia, respiratory tract obstruction” caused by peanut rice entering the trachea by mistake. However, the pathological anatomy results showed that the boy had tuberculosis, and the real cause of death was suffocation caused by the rupture of the tuberculosis beside the trachea and the entry of necrotic matter into the trachea. Pathological anatomy clarified the true cause of death of the child, and also revealed that the diagnosis of tuberculosis should be taken seriously in children’s physical examination.
There are also sometimes differences between autopsy results and clinical diagnosis. 丨 Picture Creativity
Of course, the neglected pathological anatomy has complex reasons and cannot be simply blamed on the clinician.
Relevant authorities have ignored pathological anatomy in recent years and do not consider it as an important indicator for evaluating the level and quality of medical treatment. When the rate of anatomy has gradually decreased, effective measures have not been adopted to interfere with it. strong>.
In some countries, such as the Soviet Union, legislation to improve the rate of pathological anatomy has proven effective. In fact, the “Administrative Measures for Hospital Classification” issued by the former Ministry of Health has long stipulated that the anatomical rate of tertiary hospitals must reach 15% and secondary hospitals reach 10%. However, for various reasons, no hospital currently meets the standards.
Another important reason is that China’s pathologists have not received enough attention. At present, the pathology department of Chinese hospitals is often reduced to auxiliary departments, and the anatomy room of most hospitals has also been closed down. The heavy workload, the lack of practical experience, and the decrease in the number of employees have made most pathologists more than capable of increasing the rate of pathological anatomy.
The cognition and customs of the deceased’s family members also restrict the implementation of pathological anatomy. This requires active communication between doctors and their families, and the need for the state to publicize and popularize pathological anatomy to the public so that people understand the significance and value of this work. In fact, China ’s high anatomical rate in the 1950s and 1960s also depended on a lot of work done by the state and hospitals in science popularization and communication.
