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Skin-to-skin: DNA transfer
ABSTRACTS
However, there is still some reluctance amongst mortuary staff to follow guidelines and wear personal protective equipment such as face masks. This often stems from a belief that many staff have worked in the mortuary for many years and the documented incidence of the transmission of known infectious diseases in mortuary workers across the world is very low. Of those diseases documented to have been acquired by mortuary workers, Mycobacterium tuberculosis (MTB) is the most prevalent. The autopsy procedure for suspected spongiform en-
S25
cephalopathies (prion disease) such as Creutzfeldt-Jakob disease, has also been well documented, however, there have been very few known cases of the transmission of CJD from deceased persons. In 2006 it was documented that there was an outbreak of chicken pox amongst mortuary staff. Despite small numbers of known transmissions of these diseases, managers of mortuaries still have a legal requirement to assess and put procedures in place to minimise the risk.
Clinical Forensic Medicine THE EXAMINATION OF THE UNCONSCIOUS PATIENT Kate Gillman, Morris Odell, Justine Rogers, Jason Schreiber This session will explore the issues that are involved when a forensic examination is requested of an unconscious or disabled patient who is unable provide informed consent. Dr Schreiber will present a recent case where an intimate examination was performed on an unconscious woman for both forensic and medical reasons and questions arose later about whether this should have been done. A/Prof Odell will discuss the formulation of guidelines to assist forensic examiners in such cases. Dr Rogers and Ms Gillman will explore the legal issues involved, procedures for obtaining guardianship as they apply to forensic work, and the approach taken by medical defence organisations when complaints are made against doctors who have performed certain procedures where adequate consent may not have been obtained.
SKIN-TO-SKIN: DNA TRANSFER Zoe Bowman1, Dadna Hartman1,2, Kate Mosse1,2, Angela Sungaila1,2, Roland van Oorschot3 1 The Victorian Institute of Forensic Medicine, Melbourne, 2 Department of Forensic Medicine, Monash University, Melbourne, and 3Office of the Chief Forensic Scientist, Victoria Police Forensic Services Department, Melbourne, Vic, Australia Background: Forensic investigators play a crucial role worldwide in assisting the identification of alleged offenders. This study aimed to evaluate the efficiency of retrieving ‘offender’ DNA, transferred via skin-to-skin contact, from a ‘victim’s’ skin and clothing. Method: This study involved grabbing scenarios using pairs of participants. Each participant acted as the ‘offender’, grabbing the ‘victim’ on both arms. Swabs of the grabbed area were taken immediately, 3 hours or 24 hours later. At 3 and 24 hours, clothing placed over the grabbed area was also swabbed. DNA profiles were generated and analysed using the GlobalFilerTM STR Kit and STRmixTM respectively. Results: ‘Offender’ DNA with a likelihood ratio providing extremely strong support for the prosecutor’s hypothesis (Hp), could be detected in swabs from the ‘victim’s’ skin immediately and 3 hours after grabbing. ‘Offender’ DNA with extremely
strong support for Hp could be obtained from swabs of the ‘victim’s’ clothing 24 hours after grabbing. Outcome: Sufficient DNA to identify an ‘offender’ can be transferred to, and detected on, the ‘victim’ and their clothing hours after being grabbed. Minimising the time before a victim is examined or examining alternative sources, such as clothing, may increase the likelihood of detecting useful offender DNA.
CLOUDY WITH A CHANCE OF MEATBALLS: THE VALUE OF CLINICAL GOVERNANCE, RISK AND QUALITY IN CFM Angela Williams Forensic Services, Victorian Institute of Forensic Medicine, and Department of Forensic Medicine, Monash University, Vic, Australia Clinical governance, leadership and risk are important elements to ensure patient safety, quality services and the efficient use of resources in healthcare. Relatively foreign terms within the context of clinical forensic medicine, it is time to strengthen our knowledge, and gain the necessary skills to prevent adverse events and improve the quality of forensic medical health services. Once in a lifetime dramas need thorough assessment. However, focusing solely on the performance of an individual will never bring about the necessary systemic improvements. This presentation will describe the role of clinical governance, clinical leadership and clinical risk in the prevention, analysis and treatment of such scenarios and draws on the current Australian clinical governance models.
ABUSIVE HEAD TRAUMA John A. M. Gall1,2,3 1 Department of Paediatrics, The University of Melbourne, 2 Victorian Forensic Paediatric Medical Service, Royal Children’s Hospital and Monash Medical Centre, Melbourne, and 3Era Health, Melbourne, Vic, Australia Abusive head trauma (AHT) / shaken baby syndrome is the subject of intense controversy and this includes the names given to it. The deregistration by the GMC of Dr Waney Squier, a prominent UK neuropathologist, in relation to testimony she
However, there is still some reluctance amongst mortuary staff to follow guidelines and wear personal protective equipment such as face masks. This often stems from a belief that many staff have worked in the mortuary for many years and the documented incidence of the transmission of known infectious diseases in mortuary workers across the world is very low. Of those diseases documented to have been acquired by mortuary workers, Mycobacterium tuberculosis (MTB) is the most prevalent. The autopsy procedure for suspected spongiform en-
S25
cephalopathies (prion disease) such as Creutzfeldt-Jakob disease, has also been well documented, however, there have been very few known cases of the transmission of CJD from deceased persons. In 2006 it was documented that there was an outbreak of chicken pox amongst mortuary staff. Despite small numbers of known transmissions of these diseases, managers of mortuaries still have a legal requirement to assess and put procedures in place to minimise the risk.
Clinical Forensic Medicine THE EXAMINATION OF THE UNCONSCIOUS PATIENT Kate Gillman, Morris Odell, Justine Rogers, Jason Schreiber This session will explore the issues that are involved when a forensic examination is requested of an unconscious or disabled patient who is unable provide informed consent. Dr Schreiber will present a recent case where an intimate examination was performed on an unconscious woman for both forensic and medical reasons and questions arose later about whether this should have been done. A/Prof Odell will discuss the formulation of guidelines to assist forensic examiners in such cases. Dr Rogers and Ms Gillman will explore the legal issues involved, procedures for obtaining guardianship as they apply to forensic work, and the approach taken by medical defence organisations when complaints are made against doctors who have performed certain procedures where adequate consent may not have been obtained.
SKIN-TO-SKIN: DNA TRANSFER Zoe Bowman1, Dadna Hartman1,2, Kate Mosse1,2, Angela Sungaila1,2, Roland van Oorschot3 1 The Victorian Institute of Forensic Medicine, Melbourne, 2 Department of Forensic Medicine, Monash University, Melbourne, and 3Office of the Chief Forensic Scientist, Victoria Police Forensic Services Department, Melbourne, Vic, Australia Background: Forensic investigators play a crucial role worldwide in assisting the identification of alleged offenders. This study aimed to evaluate the efficiency of retrieving ‘offender’ DNA, transferred via skin-to-skin contact, from a ‘victim’s’ skin and clothing. Method: This study involved grabbing scenarios using pairs of participants. Each participant acted as the ‘offender’, grabbing the ‘victim’ on both arms. Swabs of the grabbed area were taken immediately, 3 hours or 24 hours later. At 3 and 24 hours, clothing placed over the grabbed area was also swabbed. DNA profiles were generated and analysed using the GlobalFilerTM STR Kit and STRmixTM respectively. Results: ‘Offender’ DNA with a likelihood ratio providing extremely strong support for the prosecutor’s hypothesis (Hp), could be detected in swabs from the ‘victim’s’ skin immediately and 3 hours after grabbing. ‘Offender’ DNA with extremely
strong support for Hp could be obtained from swabs of the ‘victim’s’ clothing 24 hours after grabbing. Outcome: Sufficient DNA to identify an ‘offender’ can be transferred to, and detected on, the ‘victim’ and their clothing hours after being grabbed. Minimising the time before a victim is examined or examining alternative sources, such as clothing, may increase the likelihood of detecting useful offender DNA.
CLOUDY WITH A CHANCE OF MEATBALLS: THE VALUE OF CLINICAL GOVERNANCE, RISK AND QUALITY IN CFM Angela Williams Forensic Services, Victorian Institute of Forensic Medicine, and Department of Forensic Medicine, Monash University, Vic, Australia Clinical governance, leadership and risk are important elements to ensure patient safety, quality services and the efficient use of resources in healthcare. Relatively foreign terms within the context of clinical forensic medicine, it is time to strengthen our knowledge, and gain the necessary skills to prevent adverse events and improve the quality of forensic medical health services. Once in a lifetime dramas need thorough assessment. However, focusing solely on the performance of an individual will never bring about the necessary systemic improvements. This presentation will describe the role of clinical governance, clinical leadership and clinical risk in the prevention, analysis and treatment of such scenarios and draws on the current Australian clinical governance models.
ABUSIVE HEAD TRAUMA John A. M. Gall1,2,3 1 Department of Paediatrics, The University of Melbourne, 2 Victorian Forensic Paediatric Medical Service, Royal Children’s Hospital and Monash Medical Centre, Melbourne, and 3Era Health, Melbourne, Vic, Australia Abusive head trauma (AHT) / shaken baby syndrome is the subject of intense controversy and this includes the names given to it. The deregistration by the GMC of Dr Waney Squier, a prominent UK neuropathologist, in relation to testimony she