Establishing and evaluating minimally invasive autopsy to determine cause of death from infectious disease in Vietnam

建立和评估微创尸检以确定越南传染病死因

• 批准号: MR/R026300/1
• 负责人: Hindrik Rogier Van Doorn
• 金额: $ 61.87万
• 依托单位: University of Oxford
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2020
• 资助国家: 英国
• 起止时间: 2020 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FR026300%2F1
• 关键词: Establishing; evaluating; minimally; invasive; autopsy

Pathology is the science of the causes and effects of diseases, especially the branch of medicine that deals with the laboratory examination of samples of body tissue for diagnostic or forensic purposes that have been obtained from an affected part of the body while the patient is alive (biopsy) or dead (necropsy or autopsy). In medicine, pathologic examination of tissues from patients who have died can be helpful to establish the cause of death. Knowledge of cause of death is of importance for prioritizing and distribution of public health resources. In Vietnam pathology is not part of routine diagnostics of patients and is not routinely used to establish cause of death. Knowledge of cause of death in Vietnam is therefore limited, also due to limited diagnostic capacity and inadequate national recording and reporting systems. In infectious diseases, which are the cause of death of around 10-15% of all people who die, the cause of death is only known in a minority of cases.In the proposed project we aim to do three things.1. To explore the attitudes towards postmortem investigations2. To build pathology capacity in two large infectious diseases hospitals3. To evaluate the use of a novel way of doing autopsies by only taking small samples using hollow needles from different sites of the human body. This is called minimally invasive autopsy (MIA). Attitudes: A social scientist will explore the attitudes and perceptions towards postmortem investigations and sampling among a) the general public by inviting people to complete an online survey in a press release in national newspapers and b) healthcare professionals, religious leaders and patients relatives during focus group discussions. We will discuss postmortem investigations and sampling in general, and full autopsy and MIA in particular. We will show a video of both full and minimally invasive autopsies and ask participants to comment, to discuss their perceptions and beliefs regarding both procedures on a professional and personal level.Capacity: Simultaneously, we will build capacity for pathology in the National Hospital for Tropical Diseases and Bach Mai Hospital in Hanoi. This will include purchase of necessary equipment and consumables for taking and analysing biopsy and MIA samples, training of Vietnamese clinical and laboratory staff by UK based pathologists and enabling implementation of pathology in routine clinical diagnostics, e.g. liver biopsy in infectious diseases of the liverEvaluation: Evaluate the contribution of MIA to establish the cause of death in patients who have died from one of three infectious clinical syndromes: infection of the central nervous system (brain and spinal cord), of the lungs (pneumonia) and of the bloodstream (sepsis/septic shock). After obtaining permission from relatives, we will use the validated MIA protocols - adapted to be acceptable locally using information from the Attitude phase - to take samples from the deceased patient and we will use general and pathogen specific pathologic examination and highly sensitive molecular techniques that detect genetic information of almost all known infectious agents (next generation sequencing) to establish cause of death. We will do this on a total of 100 patients. All OUCRU's work is made available in open-access publications, and will be presented at (inter)national conferences and at policy groups. Public Engagement (PE) activities will be designed and coordinated by the very active OUCRU PE team, working with project researchers and health workers in each site to implement and communicate these activities.

病理学是一门研究疾病的原因和影响的科学，尤其是医学的分支，它处理用于诊断或法医目的的身体组织样本的实验室检查，这些样本是在患者活着（活组织检查）或死亡（尸检或尸检）时从身体的受影响部分获得的。在医学上，对死亡病人的组织进行病理学检查有助于确定死亡原因。了解死亡原因对于公共卫生资源的优先分配具有重要意义。在越南，病理学不是患者常规诊断的一部分，也不是确定死亡原因的常规方法。因此，越南对死亡原因的了解有限，这也是由于诊断能力有限以及国家记录和报告系统不足。在传染病中，约有10-15%的人死于传染病，但只有少数病例的死因是已知的。在拟议的项目中，我们的目标是做三件事。1.探讨调查对象对尸体检验的态度。在两家大型传染病医院建立病理学能力3。评价一种新的尸检方法的使用，该方法仅使用空心针从人体不同部位采集少量样本。这被称为微创尸检（MIA）。态度：一位社会科学家将在以下人群中探讨对尸检调查和抽样的态度和看法：a）普通公众，邀请人们在全国性报纸的新闻稿中完成在线调查; B）医疗保健专业人员、宗教领袖和患者亲属，在焦点小组讨论期间。我们将讨论一般的验尸调查和取样，特别是全面的尸检和MIA。我们将播放完整和微创解剖的视频，并请参与者发表评论，讨论他们对专业和个人层面上的两种程序的看法和信念。能力：同时，我们将在河内的国家热带病医院和Bach Mai医院建立病理学能力。这将包括购买必要的设备和消耗品，用于采集和分析活检和MIA样本，由英国病理学家培训越南临床和实验室工作人员，并在常规临床诊断中实施病理学，例如肝脏传染病的肝脏活检。评价MIA对确定死于以下三种感染性临床综合征之一的患者的死因的贡献：中枢神经系统（脑和脊髓）、肺部（肺炎）和血流（脓毒症/脓毒性休克）感染。在获得亲属的许可后，我们将使用经过验证的MIA方案-根据态度阶段的信息进行调整，使其在当地可接受-从死亡患者身上采集样本，我们将使用一般和病原体特异性病理检查以及高灵敏度分子技术，检测几乎所有已知传染因子的遗传信息（下一代测序），以确定死因。我们将在总共100名患者中进行这项研究。该组织的所有工作都以公开出版物的形式提供，并将在国家（国际）会议和政策小组上介绍。公众参与（PE）活动将由非常活跃的OUCRU PE团队设计和协调，与每个站点的项目研究人员和卫生工作者合作，实施和宣传这些活动。