Family violence in Victoria, Australia: a retrospective case-control study of forensic medical casework.

Objective: To identify the risk factors and assault characteristics of family violence among victims referred for forensic medical examination in Victoria, Australia.

Methods: A retrospective 1:1 case-control study was conducted, comparing adult family violence victims and non-family violence victims examined by clinical forensic practitioners from the Victorian Institute of Forensic Medicine, between July 2015 and June 2016. Data were extracted from victims' forensic medical casework.

Challenges with take-home naloxone in reducing heroin mortality: a review of fatal heroin overdose cases in Victoria, Australia.

Aim: Take-home naloxone (THN) programs have been implemented in order to reduce the number of heroin-overdose deaths. Because of recent legislative changes in Australia, there is a provision for a greater distribution of naloxone in the community, however, the potential impact of these changes for reduced heroin mortality remains unclear. The aim of this study was to examine the characteristics of the entire cohort of fatal heroin overdose cases and assess whether there was an opportunity for bystander intervention had naloxone been available at the location and time of each of the fatal overdose events to potentially avert the fatal outcome in these cases.

An analysis of issues in the classification and reporting of heroin-related deaths.

Aims: To investigate the extent of variability in the reporting of heroin-related deaths in Victoria, Australia. Additionally, to identify opportunities to improve the accuracy and consistency of heroin-related death reporting by examining variability in the attribution, death certification, classification and coding of heroin-related death cases.

Methods: Heroin-related deaths in Victoria, Australia during a 2-year period (2012-13) were identified using the National Coronial Information System (NCIS) and used as the 'gold standard' measure in this study.

Determining the effective dose of street-level heroin: A new way to consider fluctuations in heroin purity, mass and potential contribution to overdose.

Background & Aims: Heroin use is associated with a disproportionately high level of morbidity and mortality with most deaths attributable to drug overdose. Aggregate heroin purity data has been used to examine the relationship between overdose and variability in street-level heroin, however heroin purity data alone may not be the most appropriate nor a sensitive enough measurement tool for this assessment. The aim of this study was to measure the variability in effective dose of street-level heroin seizures, accounting for variation in both purity and mass, and determine the proportion of samples with higher than expected effective dose that would not be detected using a purity-only measure.

Catch and release: evaluating the safety of non-fatal heroin overdose management in the out-of-hospital environment.

The aim of this study was to investigate the safety of the management of non-fatal heroin overdose in the out-of-hospital environment; irrespective of whether or not naloxone had been administered. Heroin toxicity-related deaths as well as heroin intoxication-related traumatic deaths following patient-initiated refusal of transport were investigated. Heroin-related deaths in the state of Victoria, Australia between 1 January 2012 and 31 December 2013 were investigated and data linkage to pre-hospital Emergency Medical Services performed, in order to identify whether the death was related to the last episode of care by paramedics.

Increasing rates of quetiapine overdose, misuse, and mortality in Victoria, Australia.

Background: Quetiapine is misused due to its anxiolytic and hedonic effects and has been associated with deliberate self-harm. This study analyzed quetiapine-related calls to the Victorian Poisons Information Centre (VPIC), coronial data from Victorian Institute of Forensic Medicine (VIFM) and prescribed data from the Pharmaceutical Benefits Scheme (PBS) to determine current trends in overdose, misuse and mortality.

Methods: This was a retrospective review of multiple databases.

Accurate identification of opioid overdose deaths using coronial data.

Introduction: Defining drug-related mortality is complex as these deaths can include a wide range of diseases and circumstances. This paper outlines a method to identify deaths that are directly due to fatal opioid toxicity (i.e.

Chronic pain medication management of older populations: Key points from a national conference and innovative opportunities for pharmacy practice.

Objective: Inappropriate use of pain medication has serious consequences for older populations. Experts in the field have noted an increase in opioid prescriptions, and opioid-related hospitalisations and deaths among this vulnerable population. In the pursuit of educating pharmacists, physicians, allied healthcare professionals, researchers, academics and the public facing the challenges of chronic pain medication management, 'The Inaugural Monash University School of Public Health and Preventive Medicine (SPHPM) Best Practice in Chronic Pain Medication Management Day Conference' was held in December 2016 at the Alfred Medical Research and Education Precinct (Melbourne, Australia).

Unintentional mortality associated with paracetamol and codeine preparations, with and without doxylamine, in Australia.

Introduction: Misuse of paracetamol, codeine and doxylamine combination analgesics may lead to addiction and mortality. This study aimed to (1) identify unintentional deaths in Australia associated with use of combination analgesic products containing paracetamol, codeine and doxylamine; (2) describe cases characteristics, including demographics and additional medication use; and (3) identify common factors associated with misuse and mortality of these medicines in Australia.

Design: This retrospective case series analysed National Coronial Information System data to identify cases of unintentional death attributable to paracetamol, codeine and doxylamine products between 2002 and 2012.

Deaths from Resident-to-Resident Aggression in Australian Nursing Homes.

Objectives: To describe the frequency and nature of deaths from resident-to-resident aggression (RRA) in nursing homes in Australia.

Design: National population-based retrospective cohort study.

Setting: Accredited nursing homes in Australia.

The attribution of a death to heroin: A model to help improve the consistent and transparent classification and reporting of heroin-related deaths.

Introduction: Accurate attribution of heroin-related deaths, as well as the differentiation from other opioid analgesic-related deaths, is essential from a public health perspective. Heroin-related deaths involve a number of complexities where heroin-specific or non-specific metabolites and indicators (6-acetylmorphine [6-AM], morphine, and codeine) may or may not be detected. The aims of this study were therefore to develop a model for improved consistency in the attribution of heroin-related deaths and to determine areas of variation in the current decision-making processes.

The Use of Deceased Controls in Epidemiologic Research: A Systematic Review.

Scholarly debate on the use of deceased controls in epidemiologic research continues. This systematic review examined published epidemiologic research using deceased persons as a control group. A systematic search of 5 major biomedical literature databases (MEDLINE, CINAHL, PsycINFO, Scopus, and EMBASE) was conducted, using variations of the search terms "deceased" and "controls" to identify relevant peer-reviewed journal articles.

A global epidemiological perspective on the toxicology of drug-facilitated sexual assault: A systematic review.

Purpose: A systematic review was undertaken to determine the current global prevalence of drug-facilitated sexual assault (DFSA) reported in adults in order to identify trends in the toxicology findings in DFSA around the world over the past 20 years.

Methods: Databases PubMed, PsycINFO and Scopus were systematically searched using the terms: "drug-facilitated sexual assault", "chemical submission", "date rape", "rape drugs" and "drink-spiking" to identify relevant studies for inclusion in the review. This study focused on adult victims of suspected DFSA aged 16 years and above in which toxicology results were reported.

A Cluster of Fentanyl-Laced Heroin Deaths in 2015 in Melbourne, Australia.

The prevalence of opioid use in therapeutic and recreational settings has steadily increased throughout the western world. The addition of fentanyl into heroin products can produce potentially dangerous consequences, even to opioid tolerant individuals who may be unaware of such additions. Following an observed spike of heroin-fentanyl related deaths in Melbourne, Australia, a study was undertaken to determine the prevalence of these cases.

Frequency of forensic toxicological analysis in external cause deaths among nursing home residents: an analysis of trends.

There is a paucity of research examining the utility of forensic toxicology in the investigation of premature external cause deaths of residents in nursing homes. The aim of this study is to describe the frequency and characteristics of toxicological analysis conducted in external cause (injury-related) deaths amongst nursing home residents in Victoria, Australia. This study was a retrospective cohort study examining external cause deaths among nursing home residents during the period July 1, 2000 to December 31, 2012 in Victoria, Australia, using the National Coronial Information System (NCIS).

Drug-caused deaths in Australian medical practitioners and health-care professionals.

Background And Aims: There are numerous factors putting health-care professionals (HCP) at a higher risk of substance abuse and premature death, including high-stress jobs, access to controlled substances, long hours of practice and constant contact with the critically ill. This study aimed to examine fatal drug toxicity in this high-risk cohort, in order to: (1) estimate the rate of drug-caused deaths of Australian HCPs; (2) describe the key characteristics of the cohort; and (3) examine the relationship between HCP occupation and drug type, or intent.

Design: Retrospective cohort study.

Fatal acute poisonings in Australian children (2003-13).

Background And Aims: Fatal poisonings in children comprise a small proportion of cases investigated by an Australian coroner; however, they present a major opportunity for death prevention. This study aimed to examine fatal child poisonings in Australia to (1) estimate the rate of acute poisoning deaths in children; (2) describe the key characteristics of the cohort; and (3) describe the outcomes of coronial recommendations made as a death prevention measure.

Design: Retrospective case series.

Trends and characteristics of accidental and intentional codeine overdose deaths in Australia.

Objectives: To examine trends in codeine-related mortality rates in Australia, and the clinical and toxicological characteristics of codeine-related deaths.

Design And Setting: Analysis of prospectively collected data from the National Coronial Information System on deaths where codeine toxicity was determined to be an underlying or contributory cause of death. The study period was 2000-2013.

An update on oxycodone: lessons for death investigators in Australia.

Oxycodone is one of the most abused prescription drugs. Iatrogenic factors that lead to oxycodone-related death, such as mis-prescribing, present an opportunity for death prevention if identified early. This study investigated deaths involving oxycodone in Australia to explore potentially inappropriate prescribing and the coroner's investigation.