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.

病理学是研究疾病的原因和后果的科学，尤其是医学的一个分支，它处理在病人活着(活组织检查)或死亡(尸检或尸检)时从受影响的身体部位获取的用于诊断或法医目的的身体组织样本的实验室检查。在医学上，对死亡患者的组织进行病理检查有助于确定死因。了解死因对于确定公共卫生资源的优先顺序和分配具有重要意义。在越南，病理学不是患者常规诊断的一部分，也不是常规用来确定死因的。因此，越南对死因的了解有限，这也是由于诊断能力有限以及国家记录和报告系统不健全。传染病约占所有死亡人数的10%-15%，在传染病中，死亡原因只在少数情况下是已知的。在拟议的项目中，我们旨在做三件事。探讨对尸检的态度。建设两家大型传染病医院的病理能力。为了评估一种新的尸检方法的使用，只使用人体不同部位的中空针头采集少量样本。这称为微创尸检(MIA)。态度：社会科学家将探讨公众对尸检和抽样的态度和看法，a)在全国性报纸的新闻稿中邀请人们完成在线调查，b)在焦点小组讨论期间，医疗保健专业人员、宗教领袖和患者亲属。我们将讨论一般的尸检和采样，特别是全面尸检和MIA。我们将播放一段完整和微创尸检的视频，并请参与者发表评论，讨论他们对这两种程序的看法和信念，从专业和个人层面。能力：同时，我们将在河内的国家热带病医院和Bach Mai医院建设病理学能力。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，培训越南临床和实验室工作人员，由英国的病理学家进行培训，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估：评估MIA对确定死于三种感染性临床综合征之一的患者的死亡原因的贡献：中枢神经系统(脑和脊髓)感染、肺部感染(肺炎)和血流(败血症/败血症休克)。在获得亲属的许可后，我们将使用经过验证的MIA协议-使用态度阶段的信息进行修改，以在当地被接受-从已故患者身上提取样本，并将使用普通和病原体特定的病理检查以及检测几乎所有已知感染源的遗传信息的高灵敏分子技术(下一代测序)来确定死因。我们将对总共100名患者进行这项研究。OUCRU的所有工作都在开放获取的出版物中提供，并将在(国际)国家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，与每个地点的项目研究人员和卫生工作者合作，实施和沟通这些活动。