1 Gateway to research training Gjorgji Stanoevski, MD, MSc Nikola Vitlarov, MD, MSc

2 MSc in Health Sciences * One year programme * 70 ECTS * Specialisations: – Epidemiology – Clinical Epidemiology – Genetic Epidemiology – Public Health

3 * Introductory courses Erasmus Summer Programme (4.3 ECTS) * Skills courses (1.4 ECTS) SC01 English Language (1.4 ECTS) * Core courses (10.0 ECTS) CC01 Study Design (4.3 ECTS) CC02 Biostatistical Methods I: Basic Principles (5.7 ECTS) CE02 Clinical Epidemiology (5.7 ECTS) EP02 Methodologic Topics in Epidemiologic Research (1.4 ECTS) EP03 Biostatistical Methods II: Classical Regression Models (4.3 ECTS) * Research proposal (2.5 ECTS)

4 * Elective courses (4.3 to 5.7 ECTS) * Advanced courses (4.2 ECTS) * Research period (31 ECTS) In January, you will start working on your research project after approval of your proposal by your personal tutor. You are required to present your project to the department/research group of your tutor. This presentation should take place at least five weeks before graduating. Your paper must be approved by your tutor at the beginning of June and should be suitable for submission to an international, scientific journal. * Skills course (1.1 ECTS) SC02 Introduction to Medical Writing (1.1 ECTS)

Nikola Vitlarov, MD, MSc Ivo Wagensveld, MD Britt Blokker, MD Myriam Hunink, MD, PhD Annick Weustink, MD, PhD Wolter Oosterhius, MD, PhD Comparative analysis between Minimally Invasive Autopsy & Conventional Autopsy 5

6 Definition * Ancient Greek word “ α ὐ τοψία ”- see for oneself ; * Detailed external examination as well as dissection of organs from the different body cavities – cranial, thoracic, abdominal and pelvic; The value of autopsies * Improving safety and quality in diagnosis and treatment; * Providing benefits to families; * Advancing the scientific understanding of disease; * Educating medical health professionals; 1. Ayoub T, Chow J. The conventional autopsy in modern medicine. J R Soc Med.2008 April 1; 101(4): ; 2.The royal College of pathologists of Australia Autopsy Working Party. The decline of the hospital autopsy: a safety and quality issue for healthcare in Australia. MJA 2004;180: ;

7 Autopsy crisis Multifactorial causes : * Physicians “paranoid fear” of malpractice suits; * Improvement in the quality of diagnostic imaging procedures; * Adverse public perception after organ retention scandal in 1999 in the UK; * Religion groups that strongly reject “mutilation of the body” with autopsy; * Cost-cutting policies in Hospitals, and non-medical decision makers; * Diffuse and unclear benefits to the individual patient; 3.Caplan AL. Mortality Dissected: A Plea for Reform of Current Policies With Respect to Autopsy. Hum Path 1984; 12: ; 4.Sanner MA. In perspective of the declining autopsy rate: attitudes of the public. Arch Pathol Lab Med 1994; 118: [PubMed];

8 ALTERNATIVES ??? * NON-INVASIVE AUTOPSY * MINIMALLY INVASIVE AUTOPSY (MIA) * LIMITTED AUTOPSY (NEEDLE BIOPSIES)

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10 Distribution of cases n = 30 cases Diagnostic performance Cause of Death Comment 93 % CT superior to MRI for detection of calcifications and pneumothorax; MRI superior to CT for detection of brain abnormalities and pulmonary embolus; MIA vs CA 77 % Partial agreement in 3 cases: 1.severe pneumonia in MIA/ endocarditis in CA; 2.pneumonia and shock in MIA/ gastrointestinal hemorrhage in CA; 3.acute hearth failure in MIA and CA, but only in CA detected underlying myocardial infarction Weustink A, Hunnink M, et al. Minimally Invasive Autopsy: An Alternative to Conventional Autopsy? Radiology 2009: Volume 250: Number 3;

11 SectionMIA CA n=85 cases 1. Logistic preparation and case preparation € 102 € Transportation of the body€ 10 € 6 3. External examination and body preparation€ Macrosopy Torso Heart Brain € 206 € 362 * € 60 € 17 € Tissue sampling Torso Brain € 484 € 47 € 74 € Laboratory processing€ 345 € Restoration Torso Brain € 7 € 9 € 24 € Cleaning€ 8€ Finalizing the autopsy report€ 202€ 134 Mean cost per case € 1518 € 710 Cost Analysis

12 THANK YOU FOR YOUR ATTENTION