Necropsies in the Elderly

Puxty, JohnA.H.; Horan, MichaelA.; Fox, R. A.

doi:10.1016/s0140-6736(83)92708-3

Cited by 63 publications

(25 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The incidence of pneumonias among the infectious causes is around 75%. Puxty et al (18), in their study published in 1983, also reported infections, especially respiratory infections, to be a common and often unrecognized finding in the elderly. Approximately one-half of the pulmonary infections in the Houston series were autopsyproven aspiration pneumonias.…”

Section: Discussionmentioning

confidence: 97%

Causes of Death in Geriatric Patients A Cross-Cultural Study

Klima

Povýšil

Teasdale

1997

The Journals of Gerontology Series A: Biological Sciences and M

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 97%

Causes of Death in Geriatric Patients A Cross-Cultural Study

Klima

Povýšil

Teasdale

1997

The Journals of Gerontology Series A: Biological Sciences and M

View full text Add to dashboard Cite

show abstract

“…This confirms the findings of previous reports which suggest that confidence in the premortem diagnosis is a key factor in a clinician's decision to request a necropsy.6717 The increased confidence in the perceived accuracy of clinical diagnoses is a consequence of the new diagnostic techniques available in modern medicine, and many clinicians mistakenly believe that these advances have reduced the value of the necropsy,1819 although this contradicts pronounced discrepancies between clinical and necropsy diagnoses in recent studies. '3 18 [20][21][22][23][24][25][26] The failure of the medical community to appreciate the role of the necropsy has influenced lay opinion.5 2729 Relatives are often reluctant to give permission for necropsies, and the widespread lack of proper procedures for obtaining consent must contribute to this antagonism.30-32 Although influential in this study, the wishes of relatives seemed to have comparatively little effect on the number of necropsy requests, and in most circumstances diagnostic confidence and patient age were the dominant factors. The considerable variation in the level of clinicians' interest in necropsies has been widely reported.…”

Section: Discussionmentioning

confidence: 90%

Factors which influence necropsy requests: a psychological approach.

Start

Hector-Taylor

Cotton

et al. 1992

Journal of Clinical Pathology

View full text Add to dashboard Cite

Aims: To determine which factors influence a clinician's decision to request a necropsy.Methods: Patient age, confidence in premortem diagnosis, relatives' attitudes, and conditions of necropsy practice were combined factorially (two levels each) in separate medical and surgical questionnaires based on clinical case histories. The interactions between the factors were measured by a repeated measures factorial analysis of variance for each of the two clinical groups. The influence of the clinician's interest in necropsies on these interactions was also examined by a similar method. Results: Necropsies were more likely to be requested on young patients, when diagnostic confidence was low, and when relatives' attitudes were favourable. Conditions of necropsy practice did not affect the likelihood of a request and there was no apparent overall difference in necropsy requests between the two groups of clinicians. The "patient age" and "relatives" factors had less influence on the decision of the surgical group to request necropsy. This was attributed to the opportunity to "see for themselves" at operation and was supported by the finding that surgeons were very likely to request necropsies in the absence of surgical intervention. Clinicians from both groups with a high pre-existing interest in the necropsy were consistently more likely to request necropsies. Conclusions: The "case history" based questionnaires successfully measured the relative influence of multiple factors in relation to the decision of clinicians to request a necropsy. These findings suggest that any attempt to reverse the decline in necropsy rates should focus on changing the clinician's perception of the value of the modern necropsy.Over the past 40 years hospital necropsy rates have progressively declined'3 despite a wealth of evidence which indicates the continuing value of necropsies in medical education and research, and in the confirmation of diagnostic accuracy as part of a wider conribution to clinical audit.'Although a wide range of factors has been reported to influence a clinician's decision to request a necropsy,5 some measurement of the relative influence of individual factors is required to develop a strategy to reverse the decline in necropsy rates.Previous enquiries into necropsy request behaviour have relied on questionnaires which required clinicians to answer numerous general questions relating to necropsy practice."These traditional methods of attitude measurement fail to consider the context in which an attitude is developed, held, and then enacted,9'0 but this can be achieved in part using fictitious case histories which allow the clinician to demonstrate his or her attitude in the form of role enactment. " This psychological approach was used for the first time to investigate the interactions between those factors considered to influence a clinician's decision to request a necropsy. MethodsTwo equivalent questionnaires were constructed for general medical and surgical clinicians to assess the interactions of five fac...

show abstract

“…Magnusson, 1989;Black & Jolley, 1990;Burns et al, 1990;Ryan, 1993). Puxty et al (1983) had found bronchopneumonia to be the most common immediate cause of death among older people dying after admission to acute medical wards. Nevertheless, the excess of deaths attributed to this 'non-specific' cause within organic brain disease is probably real: Sangstad & Odegard (1979) estimated this mode of death to be 10 times as common in organic brain disease than in other people; Magnusson (1989) found it to be five times as common in organic brain disease, even among very old people, and Peck et al (1978) found it to be twice as common in organic brain disease within a very elderly group of people in residential care.…”

Section: Dementia Spectrum Diagnosismentioning

confidence: 99%