2017, Number 1
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MEDICC Review 2017; 19 (1)
In defense of clinical autopsy and its practice in Cuba
Espinosa-Brito AD, de Mendoza-Amat JH
Language: English
References: 35
Page: 37-41
PDF size: 149.82 Kb.
ABSTRACT
There has been a notable decrease in the global practice of clinical autopsy; the rate has fallen to below 10%, even in high-income countries. This is attributed to several causes, including increased costs, overreliance on modern diagnostic techniques, cultural and religious factors, the emergence of new infectious diseases and negative attitudes on the part of doctors, even pathologists. Alternative methods to autopsy in postmortem studies have been developed based on imaging, endoscopy and biopsy (all quite expensive). These methods have been used in developed countries but never as effectively as the classic autopsy for identifying cause of death and potential medical errors.
Although Cuba has also seen a decrease in its autopsy rates, they remain comparatively high. Between 1996 and 2015, there were 687,689 hospital deaths in Cuba and 381,193 autopsies, 55.4% of the total. These autopsies have positively affected medical care, training, research, innovation, management and society as a whole. Autopsies are an important tool in the National Health System’s quest for safe, quality patient care based on the lessons learned from studying the deceased.
REFERENCES
Bassat Q, Castillo P, Alonso PL, Ordi J, Menéndez C. Resuscitating the dying autopsy. PLoS Med [Internet]. 2016 Jan 12 [cited 2016 Aug 7];13(1):e1001927. Available from: http://jour nals.plos.org/plosmedicine/article?id=10.1371/ journal.pmed.1001927
Espinosa-Brito A, Viera-Yaniz J, Chávez-Troya O, Nieto-Cabrera R. Death of the teaching autopsy. Autopsy is a success story in Cuba. Brit Med J. 2004 Jan 17;328(7432):166.
Shojania KG, Burton EC. The vanishing nonforensic autopsy. N Engl J Med. 2008 Feb 28;358(9):873–5.
Hasson J. Medical fallibility and the autopsy in the USA. J Eval Clin Pract. 1997 Aug;3(3):229–34.
Royal College of Pathologists of Australasia Autopsy Working Party. The decline of the hospital autopsy: a safety and quality issue for healthcare in Australia. Med J Aust. 2004 Mar 15;180(6):281–5.
Burton JL, Underwood J. Clinical, educational, and epidemiological value of autopsy. Lancet. 2007 Apr 28;369(9571):1471–80.
Hurtado de Mendoza-Amat J, Montero-González TJ, Ygualada-Correa I. Situación actual y perspectiva de la autopsia en Cuba. Rev Cubana Salud Pública [Internet]. 2013 Jan–Mar [cited 2013 Jan 30];39(1):135–47. Available from: http://scielo.sld.cu/pdf/rcsp/v39n1/spu12113.pdf. Spanish.
Hurtado de Mendoza-Amat J. La autopsia como fortaleza del sistema de salud de Cuba. Rev Cubana Salud Pública [Internet]. 2016 [cited 2016 Apr 18] 42;2. Available from: http://www .revsaludpublica.sld.cu/index.php/spu/article/ view/714/590. Spanish.
Hoyert DL. The changing profi le of autopsied deaths in the United States, 1972–2007. National Center for Health Statistics. NCHS Data Brief. 2011 Aug;(67):1–8.
van den Tweel JG, Wittekind C. The medical autopsy as quality assurance tool in clinical medicine: dreams and realities. Virchows Arch. 2016 Jan;468(1):75–81.
Goldman L, Sayson R, Robbins S, Cohn LH, Bettmann M, Weishberg M. The value of the autopsy in three medical eras. N Engl J Med. 1983 Apr 28;308(17):1000–5.
Ayoub T, Chow J. The conventional autopsy in the modern medicine. J R Soc Med. 2008 Apr;101(4):177–81.
Hurtado de Mendoza Amat J. Autopsia. Garantía de calidad en la medicina [Internet]. 2nd ed. Havana: Editorial Ciencias Médicas; 2014 [cited 2016 Apr 18]. 226 p. Available from: http://www .bvs.sld.cu/libros/autopsia_garantia_2daedicion/ indice_p.htm. Spanish.
Gorowitz S, MacIntyre A. Toward a theory of medical fallibility. In: Engelhart HT, Callahan D, editors. Science, Ethics and Medicine. New York: Hastings Center; 1976. p. 248–74.
Makary MA, Daniel M. Medical error—the third leading cause of death in the US. Brit Med J. 2016 May 3;353:i2139.
Fariña J, Millana C, Fernández-Aceñero MJ, Furió V, Aragoncillo P, Martín VG, et al. Ultrasonographic autopsy (echopsy): a new autopsy technique. Virchows Arch. 2002 Jun;440(6):635–9.
Blokker BM, Wagensveld IM, Weustink AC, Oosterhuis JW, Hunink MG. Non-invasive or minimally invasive autopsy compared to conventional autopsy of suspected natural deaths in adults: a systematic review. Eur Radiol. 2016 Apr;26(4):1159–79.
Bolliger SA, Thali MJ, Ross S, Buck U, Naether S, Vock P. Virtual autopsy using imaging: bridging radiologic and forensic sciences. A review of the Virtopsy and similar projects. Eur Radiol. 2008 Feb;18(2):273–82.
Weustink AC, Hunink MG, van Dijke CF, Renken NS, Krestin GP, Oosterhuis JW. Minimally invasive autopsy: an alternative to conventional autopsy? Radiology. 2009 Mar;250(3):897–904.
Whitby E. Minimally invasive autopsy. Lancet. 2009 Aug 8;374(9688):432–3.
Soleman N, Chandramohan D, Shibuya K. Verbal autopsy: current practices and challenges. Bull World Health Org. 2006 Mar;84(3):239–45.
Lamrani S. Cuba’s health care system: a model for the world. HuffPost Live [Internet]. 2014 [cited 2014 Oct 8]; [about 5 screens]. Available from: http://www.huffingtonpost.com/salim-lamrani/ cubas-health-care-system-_b_5649968.html
Spiegel J, Yassi A. Lessons from the margins of globalization: appreciating the Cuban health paradox. J Public Health Policy. 2004;25(1):85–110.
Keck CW, Reed GA. The curious case of Cuba. Am J Public Health. 2012 Aug;102(8):e13–22.
Hurtado de Mendoza Amat J, Álvarez Santana R. Situación de la autopsia en Cuba y el mundo. La necesidad de su mejor empleo. Patología. 2008;46(1):3–8. Spanish.
National Health Statistics and Medical Records Division (CU). Anuario Estadístico de Salud 2015. Havana: Ministry of Public Health (CU); 2016. 208 p. Spanish.
De Vos P, Ordúñez-García P, Santos-Peña M, Van der Stuyft P. Public hospital management in times of crisis: lessons learned from Cienfuegos, Cuba (1996–2008). Health Policy. 2010 Jun;96(1):64–71.
Hospital Universitario Dr. Gustavo Aldereguía Lima. Anuario Estadístico [Internet]. Cienfuegos: Hospital Universitario Dr. Gustavo Aldereguía Lima; 2015 [cited 2016 Apr 20]. Available from: http://www.gal.sld.cu/. Spanish.
Espinosa-Brito AD. La contribución del Hospital Dr. Gustavo Aldereguía Lima a la educación médica superior en Cienfuegos, 1979–2016. Medisur [Internet]. 2016 Apr [cited 2016 Apr 28];14(2):118–32. Available from: http://medi sur.sld.cu/index.php/medisur/article/view/3296. Spanish.
Navarro-Machado VR, Falcón-Hernández A, Espinosa- Brito A, Romero-Cabrera AJ. A scientifi c and technological innovation system in a Cuban hospital (2000–2014). MEDICC Rev [Internet]. 2016 Jan–Apr [cited 2016 Apr 30];18(1–2):34– 40. Available from: http://medicc.org/medicc review/index.php?issue=38&id=518&a=va
Espinosa AD, Álvarez Li FC, Borges Rodríguez E, Quintana Pérez S, Fernández Turner M. Estudio clínico-patológico de 460 fallecidos con Infarto Miocárdico Agudo. Informe de dos series (1985–1987 y 1991–1993). Clín Cardiovasc (España). 2000;35:449–61.
Fernández Turner M, Sotelo Suárez I, Borroto Lecuna S, Figueiras Ramos B, Corona Martínez LA. Correlación clínico-patológica en pacientes fallecidos con diagnóstico clínico o anatomopatológico de enfermedad cerebrovascular durante los años 1997 al 2001. Rev Cubana Med [Internet]. 2003 Sep–Oct [cited 2016 May 5];42(5). Available from: http://scielo .sld.cu/scielo.php?script=sci_arttext&pid=S0034 -75232003000500005&lng=es&nrm=iso&tlng= es. Spanish.
Espinosa-Brito AD. Mortalidad por hipertensión arterial. Tras la huella del “asesino silente”. Rev Finlay [Internet]. 2012 Mar [cited 2016 Jul 4];2(1):50–65. Available from: http://www.rev finlay.sld.cu/index.php/finlay/article/view/100. Spanish.
Espinosa-Brito AD, Álvarez-Li FC, Ordúñez-García PO, Espinosa-Roca AA, Bermúdez-López JM, Viera-Yaniz J. La autopsia como “prueba de oro” en la evaluación de la calidad brindada a los fallecidos hospitalarios. El caso del Infarto Agudo de Miocardio. Infodir [Internet]. 2009 [cited 2010 Apr 10];(8). Available from: http://bvs.sld.cu/ revistas/infd/n809/infd1209.htm. Spanish.
Santos Peña MA, Rocha Hernández JF. La calidad y seguridad del paciente. Un derecho en la salud pública cubana. Boletín Informativo-CIESS [Internet]. 2016 [cited 2016 Apr 22];14. Available from: http://boletin.ciess.org/pdf/La-Calidad-y-Seguri.pdf. Spanish.