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Mental health practitioners may be called to an inquest after the unexpected death of a patient. Our review aimed to synthesise publicly available guidance written for practitioners working in mental health who are called to give evidence at a coroner’s inquest. We conducted both a systematic database and web search. We conducted a quality appraisal and data synthesis using the Framework Method. We found limited guidance specifically for those working in mental health. Guidance gave advice on preparing effectively including how to give oral evidence and write witness statements. Support was often assumed to be given by the employing Trust. Only a minority of guidance suggested means of psychological support. We identified a set of practically applicable principles for healthcare practitioners attending inquests. Many recommendations were not backed by evidence and lacked stakeholder input. [ABSTRACT FROM AUTHOR]

• Many factors contribute to unexpected fatalities. Colloid cyst at many times can cause sudden death. • Timing of death in association with the three most prevalent intracranial lesions linked to unexpected death is meningiomas, astrocytomas and glioblastoma. • This study investigate the occurrence and etiology of unexpected mortality caused by primary brain tumors other than colloid cysts. The major objective is to comprehend the underlying factors contributing to this phenomenon and to deliberate viable strategies for timely identification and intervention. Primary brain tumors have the potential to present a substantial health hazard, ultimately resulting in unforeseen fatalities. Despite the enhanced comprehension of many diseases, the precise prediction of disease progression continues to pose a significant challenge. The objective of this study is to investigate cases of unexpected mortality resulting from primary brain tumors and analyze the variables that contribute to such occurrences. This systematic review explores research on individuals diagnosed with primary brain tumors who experienced unexpected deaths. It uses PRISMA standards and searches PubMed, Google Scholar, and Scopus. Variables considered include age, gender, symptoms, tumor type, WHO grade, postmortem findings, time of death - time taken from first medical presentation or hospital admission to death, comorbidity, and risk factors. This study examined 46 studies to analyze patient-level data from 76 individuals with unexpected deaths attributed to intracranial lesions, deliberately excluding colloid cysts. The cohort's age distribution showed an average age of 37 years, with no significant gender preference. Headache was the most common initial symptom. Astrocytomas, meningiomas, and glioblastoma were the most common lesions, while the frontal lobe, temporal lobe, and cerebellum were common locations. Meningiomas and astrocytomas showed faster deaths within the first hour of hospital admission. The etiology of unforeseen fatalities resulting from cerebral tumors elucidates an intricate and varied phenomenon. Although unexpected deaths account for a very tiny proportion of total fatalities, it is probable that their actual occurrence is underestimated as a result of underreporting and misdiagnosis. [ABSTRACT FROM AUTHOR]

Background and aims: Individuals bereaved after sudden and unexpected deaths can benefit from professional help to cope after the loss, and the bereaved call for proactive, early and flexible help from professional services. Most drug-related deaths (DRDs) happen suddenly and unexpectedly. DRDs are a significant public health issue, yet few studies have examined DRD-bereaved people's needs and experiences with professional help. This article investigates the needs for help and received help reported by DRD-bereaved family members and friends, and suggests improvements in services based on the findings. Data and method: A heterogeneous convenience sample of DRD-bereaved family members and close friends (n = 255) were recruited for a survey from February to December 2018. Descriptive analyses were conducted for experiences with professional help, chi-square analyses to find predictors for help needs and received help, and logistic regression analysis to find predictors for satisfaction with the help provided. Results: Most DRD-bereaved individuals reported a need for professional help after the death regardless of family relation to the deceased, and about half of the participants received help. Nearly half of them were satisfied with the help. Our results indicated higher satisfaction with help among older bereaved, and the participants who received help from a crisis team or psychotherapist. The latter was particularly stated for younger participants. Few participants with children in the family reported that the children had received help, and less than one-third were satisfied with this help. Conclusion: The study shows that younger age groups and children need particular recognition, and a family perspective from services is essential. When assessing the help needs of the DRD-bereaved, relations of both psychological and biological closeness should be recognised. Help efforts should be tailored according to established knowledge of the provided help that bereaved populations deem effective. [ABSTRACT FROM AUTHOR]

Abstract Background Colloid cysts arise from congenital abnormalities of the endodermis and are characteristically comprised of an external fibrous layer, with a lining of cuboidal and columnar epithelial cells and endodermal ciliated cells. They contain a gelatinous matrix, produced by mucus-producing epithelial cells. Case presentation An 8-year-old Saudi girl died in Dammam Central Hospital, to which she was admitted by her parents following her complaints of intense headaches. When the body was examined externally, it was noted that she had bilateral eye congestion, evidence of needle marks on all four limbs and in the region of the femoral triangle and bruising in the central chest and left shoulder areas. No other evidence of injury was noted. A cyst in the third ventricle of the brain was identified at post mortem. Investigations for alcohol, toxins and illicit substances were negative. Conclusion It was surmised that the child had died as a result of a cerebral colloid cyst and its clinical sequelae.

Amongst other molecules, the cholinergic system consists of choline-acetyltransferase (ChAT, − synthesis enzyme), acetylcholinesterase (AChE – primary hydrolysis enzyme), and butyrylcholinesterase (BuChE – secondary hydrolysis enzyme). In the brainstem, the Dorsal Motor Nucleus of The Vagus (DMNV) has high cholinergic expression and is a region of interest in the neuropathology of sudden infant death syndrome (SIDS). SIDS is the unexpected death of a seemingly healthy infant, but postmortem brainstem abnormalities suggesting altered cholinergic regulation have been found.This study aimed to determine the percentage of positive ChAT and AChE neurons within the infant DMNV through immunohistochemistry at the three levels of the brainstem medulla (caudal, intermediate, and rostral), to investigate whether the proportion of neurons positive for these enzymes differs amongst the diagnostic subgroups of SIDS compared to those with an explained cause of Sudden unexpected death in infancy (eSUDI), and whether there were any associations with SIDS risk factors (male gender, cigarette smoke exposure, co-sleeping/bed sharing, and prone sleeping). Results showed that ChAT-positive neurons were lower in the rostral DMNV in the SIDS II cohort, and within the caudal and intermediate DMNV of infants who were exposed to cigarette smoke. These findings suggest altered cholinergic regulation in the brainstem of SIDS infants, with potential contribution of cigarette smoke exposure, presumably via the nicotinic acetylcholinergic receptor system.

Sudden cardiac death (SCD) is an unexpected natural death due to cardiac causes, usually happening within one hour of symptom manifestation or in individuals in good health up to 24 h before the event. Genomic screening has been increasingly applied as a useful approach to detecting the genetic variants that potentially contribute to SCD and helping the evaluation of SCD cases in the post-mortem setting. Our aim was to identify the genetic markers associated with SCD, which might enable its target screening and prevention. In this scope, a case–control analysis through the post-mortem genome-wide screening of 30 autopsy cases was performed. We identified a high number of novel genetic variants associated with SCD, of which 25 polymorphisms were consistent with a previous link to cardiovascular diseases. We ascertained that many genes have been already linked to cardiovascular system functioning and diseases and that the metabolisms most implicated in SCD are the lipid, cholesterol, arachidonic acid, and drug metabolisms, suggesting their roles as potential risk factors. Overall, the genetic variants pinpointed herein might be useful markers of SCD, but the novelty of these results requires further investigations. [ABSTRACT FROM AUTHOR]

Background: Colloid cysts arise from congenital abnormalities of the endodermis and are characteristically comprised of an external fibrous layer, with a lining of cuboidal and columnar epithelial cells and endodermal ciliated cells. They contain a gelatinous matrix, produced by mucus-producing epithelial cells. Case presentation: An 8-year-old Saudi girl died in Dammam Central Hospital, to which she was admitted by her parents following her complaints of intense headaches. When the body was examined externally, it was noted that she had bilateral eye congestion, evidence of needle marks on all four limbs and in the region of the femoral triangle and bruising in the central chest and left shoulder areas. No other evidence of injury was noted. A cyst in the third ventricle of the brain was identified at post mortem. Investigations for alcohol, toxins and illicit substances were negative. Conclusion: It was surmised that the child had died as a result of a cerebral colloid cyst and its clinical sequelae. [ABSTRACT FROM AUTHOR]

Phenomenological interviews were conducted with nine collegiate student-athletes (M= 24.11 years; SD = 3.76), from a range of sports, to explore how they experienced the unexpected death of a teammate. Qualitative analysis of interview data revealed a total of 626 meaning units which were used to produce a final thematic structure consisting of six higher order themes: Emotional Response, Behavioral Response, Faith, Social Support, Team Cohesion, and Change of Life Perspective. The results suggest that student-athletes who experience the unexpected death of a teammate go through a wide range of emotional (e.g., shock, denial) and behavioral responses (e.g., deliberate isolation from others, tributes), which ultimately changed their perspective on life. The specific nuances of these experiences offer several practical applications for sport psychology consultants, coaches, and administrators wishing to provide support to this population during such a difficult time. [ABSTRACT FROM AUTHOR]

We report unexpected death of a 72-year-old man due to a hemoperitoneum (1.9 L of blood in the abdominal cavity). Postmortem examination revealed that the cause of the hemorrhage was an arterial aneurysmal lesion in the greater omentum. The lesion measured 4 × 4 × 6 cm with a generally smooth wall, but with a focal area of rupture within a hemorrhagic region measuring 1 × 2 cm. There was a substantial feeding artery. Histological examination revealed features in keeping with a pseudoaneurysm, but also with some features of a true aneurysm. There was no history of trauma and the rupture of the aneurysmal lesion that had caused the hematoperitoneum was considered to be spontaneous. Prior to his death the deceased had attended hospital for epigastric pain, which was attributed to dyspepsia, but otherwise he had not had symptoms prior to his death. [ABSTRACT FROM AUTHOR]

Aims: The aim was to explore the experiences of relatives seeing and saying goodbye to brought in dead persons in a Danish emergency department. Design: This was a qualitative study based on interpretive description methodology. Methods: Data were collected through semi‐structured individual interviews with relatives (n = 11) of brought in dead persons and 30 h of participatory observations of these relatives visiting the emergency department to see and say goodbye to the deceased. Data were collected between February 2019 and December 2020. Results: Our analyses revealed internal and external chaos as an overarching theme, covering 4 themes and 10 subthemes. The four themes were traumatic events, restricted access, briefly being together again, and final goodbyes and departures. Conclusion: Emergency departments were highly acute and busy settings that prioritized survival more than the care of deceased people and their relatives. The relatives were, in every way, affected by internal and external chaos; the external chaos in the emergency department reinforced the feeling of internal chaos. It is necessary for managers and nurses in emergency departments to organize and practice care for relatives, whilst bringing in deceased individuals in a less chaotic and more caring manner. Impact This study contributes to the knowledge of relatives' experiences regarding brought in dead persons, underpinning the need to care for this subpopulation in emergency departments. Care for relatives of brought in dead individuals has the potential to relieve suffering and prevent diseases, which are core elements of nursing. [ABSTRACT FROM AUTHOR]

A 9-year-old boy collapsed shortly after complaining of shortness of breath. Despite immediate resuscitation measures, the boy died. A few weeks earlier, he had received antibiotic treatment for respiratory infection. However, the post-mortem examination revealed an advanced tumor mass of the mediastinum with infiltration of vital structures, which was identified as a small blue round neoplasm with aspects of an extramedullary Ewing-like sarcoma by supplementary histological and immunohistochemical examinations. This dramatic clinical course of events shows that the possible presence of serious diseases should always be considered behind harmless symptoms, even in children. [ABSTRACT FROM AUTHOR]

In Japan, a new cause-of-death investigation system and related new laws were enacted in the mid-2010s. These laws provided for an autopsy system for non-criminal unnatural deaths and a medical accident investigation system outside the criminal justice process for health care-related deaths. We retrospectively explored changes in the number and characteristics of medico-legal autopsy cases of health care-related deaths in Chiba Prefecture, Japan, and examined trends over time during these reforms. We found that the percentage of forensic autopsies based on the Code of Criminal Procedure for health care-related deaths had decreased significantly. The number of autopsies of accidental and unintentional deaths in nursing homes, which are not covered by the newly established medical accident investigation system, has been increasing, reflecting the ageing of society. The trend toward decriminalisation of health care-related deaths was expected to contribute more to medical safety if the scope was expanded and a system for disclosure of autopsy information was established. [ABSTRACT FROM AUTHOR]

The unexpected death of a child is one of the most challenging losses as it fractures survivors’ sense of parenthood and other layers of identity. Given that not all the bereaved parents who have need for support respond well to available treatments and that many have little access to further intervention or follow-up over time, online interventions featuring therapeutic writing and peer support have strong potential. In this article we explore how a group of bereaved mothers experienced the process of participating in an online course in therapeutic writing for the integration of grief. Our research questions were: How do parents who have lost a child experience being part of an online course in therapeutic writing? What are the perceived benefits and challenges of writing in processing their grief? We followed an existential phenomenological approach and analyzed fieldwork notes (n = 13), qualitative data from the application and assessment surveys (n = 35; n = 21), excerpts from the journals of some participants (n = 3), and email correspondence with some participants (n = 5). We categorized the results in three meaning units: (1) where does my story begin? The “both and” of their silent chaos; (2) standing on the middle line: a pregnancy that does not end; (3) closures and openings: “careful optimism” and the need for community support. Participants experienced writing as an opportunity for self-exploration regarding their identities and their emotional world, as well as a means to develop and strengthen a bond with their children. They also experienced a sense of belonging, validation, and acceptance in the online group in a way that helped them make sense of their suffering. Online writing courses could be of benefit for bereaved parents who are grieving the unexpected death of a child, but do not replace other interventions such as psychotherapy. In addition to trauma and attachment informed models of grief, identity informed models with a developmental focus might enhance the impact of both low-threshold community interventions and more intensive clinical ones. Further studies and theoretical development in the area are needed, addressing dialogical notions such as the multivoicedness of the self.

The unexpected death of a child is one of the most challenging losses as it fractures survivors' sense of parenthood and other layers of identity. Given that not all the bereaved parents who have need for support respond well to available treatments and that many have little access to further intervention or follow-up over time, online interventions featuring therapeutic writing and peer support have strong potential. In this article we explore how a group of bereaved mothers experienced the process of participating in an online course in therapeutic writing for the integration of grief. Our research questions were: How do parents who have lost a child experience being part of an online course in therapeutic writing? What are the perceived benefits and challenges of writing in processing their grief? We followed an existential phenomenological approach and analyzed fieldwork notes (n = 13), qualitative data from the application and assessment surveys (n = 35; n = 21), excerpts from the journals of some participants (n = 3), and email correspondence with some participants (n = 5). We categorized the results in three meaning units: (1) where does my story begin? The "both and" of their silent chaos; (2) standing on the middle line: a pregnancy that does not end; (3) closures and openings: "careful optimism" and the need for community support. Participants experienced writing as an opportunity for self-exploration regarding their identities and their emotional world, as well as a means to develop and strengthen a bond with their children. They also experienced a sense of belonging, validation, and acceptance in the online group in a way that helped them make sense of their suffering. Online writing courses could be of benefit for bereaved parents who are grieving the unexpected death of a child, but do not replace other interventions such as psychotherapy. In addition to trauma and attachment informed models of grief, identity informed models with a developmental focus might enhance the impact of both low-threshold community interventions and more intensive clinical ones. Further studies and theoretical development in the area are needed, addressing dialogical notions such as the multivoicedness of the self. [ABSTRACT FROM AUTHOR]

The communication of bad news, particularly in situations of an unexpected death, is one of the most difficult tasks for health professionals. It is important to be aware of the words used and the way the loss is conveyed, as these can mark the family forever, influencing grief management. The communication of death should therefore not be an improvised act, but rather, the health professional should have knowledge about the most adequate communication approach for each situation. In the chaotic and often violent prehospital environment, no protocols with the aim of guiding professionals to carry out this communication were discovered.

A 35-year-old man with schizophrenia died from an overdose of propranolol (blood level = 60 mg/L). Post mortem CT scanning showed marked distension of the esophagus by granular material with a bolus of similar material within the stomach. At autopsy 62 g of lime green pharmacobezoar was present within the esophagus with an additional 130gm mass of similar material within the stomach, both of which contained propranolol. The rest of the gastrointestinal tract was unremarkable. The mouth, pharynx, glottis, larynx, trachea and bronchi were all structurally normal with no obstructive material. Thus, there was no evidence of airway compromise to suggest that the bezoar had mechanically contributed to death. Rather, elution of the drug had resulted in lethal blood levels. The color of the pharmacobezoar derived from the green color of certain propranolol tablets. Death was therefore attributed to propranolol toxicity with an associated finding of a massive gastro-esophageal pharmacobezoar. [ABSTRACT FROM AUTHOR]

Cryptococcosis is a fungal disease caused predominantly by Cryptococcus neoformans and Cryptococcus gatti. It is most often found in immunocompromised individuals and has quite protean and chronic manifestations affecting all body systems. The unexpected death of a 22-year-old man with cryptococcal meningoencephalitis demonstrates, however, that it may have a fulminant course in previously well individuals. Also present at autopsy was a toruloma of the upper lobe of the right lung. Delays in clinical diagnoses, confusion with tuberculosis and precipitate clinical deterioration may mean that cases will be encountered unexpectedly during medicolegal autopsies. [ABSTRACT FROM AUTHOR]

Child loss is the most traumatic loss a parent can experience, increasing their risk of negative outcomes such as complicated grief. Unexpected loss in the unfamiliar environment of the Emergency Department (ED) significantly increases this risk. Despite this knowledge, research on child loss in the context of the ED is scarce. An interpretive description qualitative research study was performed with eight parents (five mothers and three fathers) to examine their experience of unexpectedly losing a child in the pediatric ED. Data collection included interviews, demographic questionnaires, and field notes. Data were analyzed using a constant comparative method and revealed four main themes: "grief as waves," "being the good parent," "coping through the waves of grief," and "the new normal." Improving understanding around child loss and implementing stronger support for parents, through communication, advocacy, and physical presence while in the ED, could greatly reduce parents' risk of negative outcomes. [ABSTRACT FROM AUTHOR]

Background: Umbilical cord hematomas (UCHs) can cause life-threatening outcomes, although extremely uncommon. They can lead to fetal distress and stillbirth. They have been observed in about 1:5500 pregnancies; they are associated with poor outcome in about the 50% of all cases. UCHs commonly occur due to rupture/lesion of umbilical vein's walls, or less frequently of umbilical arteries' ones. Case Report: We present a case of a fetal demise which acutely and unexpectedly occurred in the last phases of labor. In this fetus, the identification of the cause of death was made only after post-mortem examination. The present report depicts the uncommon eventuality of umbilical cord hematomas which can cause unexpected fetal demise. Conclusion: This case points out that in these cases careful examination of umbilical cord's macroscopic/microscopic examination is fundamental to clarify the natural cause of fetal death for statistical purposes; to close parents' mourning process; to ascertain medical malpractice claims. [ABSTRACT FROM AUTHOR]

A 27-year-old man presented to hospital with neck swelling and difficulty breathing following a recent tooth extraction. He underwent uncomplicated surgical drainage of the submandibular region after which he became acutely short of breath and collapsed and was not able to be resuscitated. At autopsy the major findings were swelling of the neck due to diffuse cellulitis with edema and neutrophil infiltrates within connective tissue and marked submucosal edema of the epiglottis, glottic inlet and tonsils sufficient to cause airway obstruction. Cultures from the site of surgical intervention showed a mixed growth of Gram positive and negative bacilli and Gram positive cocci. Death was due to airway obstruction resulting from marked submucosal edema of the glottic inlet associated with submandibular cellulitis (Ludwig's angina) following extraction of a right lower first molar tooth. Lethal Lugwig angina, although rare in current forensic practice, may still present as a cause of acute upper airway occlusion and must be considered in the differential diagnosis of significant upper airway compromise. [ABSTRACT FROM AUTHOR]

Background: Considerable attention is rightly paid to preventable deaths in adults with intellectual disabilities. The pattern of these deaths and the implications for services have been less considered. Method: This paper forms part of a larger cross‐sectional study of deaths in a defined population of adults with intellectual disabilities. Data from VOICES‐SF were obtained from intellectual disability service providers for each death within their supported population over 18 months, 149 decedents in all. Results: Only 34.2% of deaths were anticipated, death was often sudden or followed a short illness. Four dying trajectories were identified, and categorized by length of illness, service use, care outcomes, symptom control and cause of death. Conclusions: Recognition that most deaths in this group were unanticipated implies a need for better preparation for less expected dying and better anticipation. A descriptive epidemiology of dying among people with intellectual disabilities is needed. [ABSTRACT FROM AUTHOR]

A previously healthy, one-year-old, intact female Vizsla dog collapsed and experienced cardiopulmonary arrest after a stressful event. Postmortem examination identified juxtaductal aortic coarctation (AoCo) with complex morphology. Located in the isthmus aorta adjacent to the ligamentum arteriosum, the AoCo comprised a shelf-like structure caused by invagination of the aortic wall into the lumen. Just distally, a second region of aortic occlusion resulted from an obstructing aortic membrane that restricted blood flow into the descending aorta through a small, eccentric ostium. Plausibly, the AoCo contributed to high afterload which led to reduction of coronary blood flow, myocardial hypoxia, and sudden death during physical stress. Although AoCo is a well-recognized congenital defect in humans, it has been reported only rarely in animals. The present case details the gross and histologic features of a complex, juxtaductal AoCo in a dog who died suddenly after stress. These morphologic findings may be informative when contemplating diagnosis of this anomaly. [ABSTRACT FROM AUTHOR]

Injection drug use-related infective endocarditis (IDU-IE) assumes peculiar epidemiological, pathogenetic, and prognostic characteristics that allow to consider it a distinct nosological entity, as well as a current problem of considerable social weight. Incidence is reasonably underestimated because diagnosis is often accidental in postmortem examination when drug-related death is suspected. In many cases, postmortem toxicological examinations are negative for acute drug abuse, and findings of infective endocarditis became relevant in the explanation of the mechanism of death. Extracardiac involvement of infective endocarditis is rarely reported as fatal. Fragmentation and embolization of bacterial vegetations can be associated with parenchymal infarcts, systemic spread of the infectious process by formation of an abscess. A case of septic shock as a consequence of the constant bacteremia determined by the continuous proliferation and release of bacteria into the circulation is presented in an injection drug user with left-sided endocarditis and widespread septic embolization. Authors reviewed forensic and medical literature and promote epidemiological value of medical and forensic autopsy. Extracardiac involvement of infective endocarditis may represent a remote and alternative cause of death in injection drug users, and an early diagnosis can be relevant for prognosis. Postmortem examination still represents a valuable opportunity of learning for clinicians and improving diagnostic accuracy with injection drug users. A call for changing of attitudes and practice toward autopsy is finally demanded. [ABSTRACT FROM AUTHOR]

Background: Hypertrophic cardiomyopathy is characterized by intrinsic myocardial hypertrophy that is not consequent to hemodynamic stimuli. Infantile hypertrophic cardiomyopathy (<1 year of age) has a frequency of about 3.6 per 1 million children, is usually diagnosed in utero, at birth, or in the first months of life. The most common outcome of this form is heart failure that may result in the death of the child. Case Report: We present an 11-month old infant with hypertrophic cardiomyopathy, complicated by terminal bronchopneumonia, without the typical clinical signs/symptoms in which the diagnosis was made only after postmortem examination. Conclusion: The present report depicts that IHCM may present with the unexpected death of an infant. [ABSTRACT FROM AUTHOR]