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Resurrecting the Autopsy: Benefits and Recommendations

      Maintenance of high autopsy rates is associated with specific benefits, especially for clinical practice and for clinical and epidemiologic research. We have compiled and evaluated (on the basis of related costs and benefits) a comprehensive list of recommendations to resurrect the autopsy and reestablish it as a central contributor to medical practice, teaching, and research.
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      REFERENCES

        • Nemetz PN
        • Ballard DJ
        • Beard CM
        • Ludwig J
        • Tangalos EG
        • Kokmen E
        • Weigel KM
        • Belau PG
        • Bourne WM
        • Kurland LT
        An anatomy of the autopsy, Olmsted County, 1935 through 1985.
        Mayo Clin Proc. 1989; 64: 1055-1064
        • Nemetz PN
        • Ludwig J
        • Kurland LT
        Assessing the autopsy.
        Am J Pathol. 1987; 128: 362-379
        • McFarlane MJ
        • Feinstein AR
        • Wells CK
        • Chan CK
        The ‘epidemioloic necropsy’: unexpected detections, demographic selections, and changing rates of lung cancer.
        JAMA. 1987; 258: 331-338
        • Schoenberg BS
        • Okazaki H
        • Kokmen E
        Reduced survival in patients with dementia: a population study.
        Trans Am Neurol Assoc. 1981; 106: 306-308
        • Terry RD
        • Katzman R
        Senile dementia of the Alzheimer type.
        Ann Neurol. 1983; 14: 497-506
      1. Specific protein found in brains of Alzheimer's disease patients.
        The New York Times. Apr 25, 1986; : 15
        • Kokmen E
        • Offord KP
        • Okazaki H
        A clinical and autopsy study of dementia in Olmsted County, Minnesota, 1980–1981.
        Neurology. 1987; 37: 426-430
        • Whitehouse PJ
        • Price DL
        • Clark AW
        • Coyle JT
        • DeLong MR
        Alzheimer disease: evidence for selective loss of cholinergic neurons in the nucleus basilis.
        Ann Neurol. 1981; 10: 122-126
        • Kurland LT
        • Molgaard CA
        The patient record in epidemiology.
        Sci Am. October 1981; 245: 54-63
        • Kurland LT
        The role of the Mayo Clinic in the epidemiology of neurologic and other diseases in Olmsted County, Minnesota, and results of initial long-term trend studies.
        Clin Neurol (Japan). 1970; 10: 8-17
        • Kurland LT
        • Elveback LR
        • Nobrega FT
        Population studies in Rochester and Olmsted County, Minnesota, 1900–1968.
        in: Kessler II Levin ML The Community as an Epidemiologic Laboratory: A Casebook of Community Studies. Johns Hopkins Press, Baltimore1970: 47-70
        • Kurland LT
        • Elveback LR
        • Nobrega FT
        Mayo Clinic records linkage system in the Rochester-Olmsted epidemiology program project.
        in: Davies AM Uses of Epidemiology in Planning Health Services. Savremena Administracija, Belgrade, Yugoslavia1973: 164-176
        • Kurland LT
        • Brian DD
        Contributions to neurology from records linkage in Olmsted County, Minnesota.
        Adv Neurol. 1978; 19: 93-105
        • Kurland LT
        • Annegers JF
        • O'Fallon W
        Utilization of Mayo Clinic records for population-based long-term evaluations of drug exposure.
        in: Ducrot H Goldberg M Hoigne R Middleton P Computer Aid to Drug Therapy and to Drug Monitoring. North Holland Publishing Company, Amsterdam1978: 69-76
      2. Kurland LT, Annegers JF, Lutz TD: The Mayo Clinic patient data base with emphasis on epidemiology and long-term effects of drugs in the population of Olmsted County, Minnesota. Proceedings of the Second Annual Conference, World Association for Medical Informatics, Symposium on Medical Informatics. Versailles, France, March 19 to 22, 1979

        • Kurland LT
        The contribution of the Mayo Clinic centralised diagnostic index to neuroepidemiology in the United States.
        in: Rose FC Clinical Neuroepidemiology. Pitman Medical, Tunbridge Wells, England1980: 37-46
        • O'Fallon WM
        • Beard CM
        • Weigel KM
        • Kurland LT
        The clinical record as an epidemiological data source: the Rochester Project experience.
        in: Shriver B Walker TM Grams RR Sprague Jr, RH Proceedings of the Fourteenth Hawaii International Conference on System Sciences. Vol 2. Western Periodicals Company, Hollywood, California1981: 123-143 (Section 1)
        • Kurland LT
        • Molgaard CA
        • Schoenberg BS
        Mayo Clinic records-linkage: contributions to neuroepidemiology.
        Neuroepidemiology. 1982; 1: 102-114
        • Kurland LT
        • Molgaard CA
        • Weigel KM
        The minimum basic data set and epidemiologic research: the Mayo Clinic experience.
        in: Lambert PM Roger FH Hospital Statistics in Europe. North Holland Publishing Company, Brussels1982: 24-41
        • Kurland LT
        The Rochester Epidemiology Program Project.
        in: Lawrence RC Shulman LE Current Topics in Rheumatology: Epidemiology of the Rheumatic Diseases. Gower Medical Publishing, New York1984: 359-363
      3. Nobrega FT, Ferguson RH, Kurland LT, Hargraves MM: Lupus erythematosus in Rochester, Minnesota, 1950–1965: a preliminary study. Excerpta Medica International Congress Series No. 148, 1968, pp 259–266

        • Kurland LT
        Geography of neural tumors.
        in: Minckler J Pathology of the Nervous System. Vol 3. McGraw-Hill Book Company, New York1972: 2803-2808
        • Linos A
        • Kyle RA
        • O'Fallon WM
        • Kurland LT
        Incidence and secular trend of multiple myeloma in Olmsted County, Minnesota: 1965–77.
        J Natl Cancer Inst. 1981; 66: 17-20
        • Nobrega FT
        • Sedlack JD
        • Sedlack RE
        • Dockerty MB
        • Ilstrup DM
        • Kurland LT
        A decline in carcinoma of the stomach: a diagnostic artifact?.
        Mayo Clin Proc. 1983; 58: 255-260
        • Beard CM
        • Annegers JF
        • Woolner LB
        • Kurland LT
        Bronchogenic carcinoma in Olmsted County, 1935–1979.
        Cancer. 1985; 55: 2026-2030
        • Shirts SB
        • Annegers JF
        • Hauser WA
        • Kurland LT
        Cancer incidence in a cohort of patients with seizure disorders.
        J Natl Cancer Inst. 1986; 77: 83-87
        • Linos A
        • Beard CM
        • Banks PM
        • Kurland LT
        Malignant lymphoma in Olmsted County, Minnesota, 1970 through 1977.
        Mayo Clin Proc. 1986; 61: 706-713
        • Nicolosi A
        • Hauser WA
        • Beghi E
        • Kurland LT
        Epidemiology of central nervous system infections in Olmsted County, Minnesota, 1950–1981.
        J Infect Dis. 1986; 154: 399-408
        • O'Sullivan JN
        • Nobrega FT
        • Morlock CG
        • Brown Jr, AL
        • Bartholomew LG
        Acute and chronic pancreatitis in Rochester, Minnesota, 1940 to 1969.
        Gastroenterology. 1972; 62: 373-379
        • Ochi JW
        • Melton III, LJ
        • Palumbo PJ
        • Chu C-P
        A population-based study of diabetes mortality.
        Diabetes Care. 1985; 8: 224-229
        • Driscoll DJ
        • Edwards WD
        Sudden unexpected death in children and adolescents.
        J Am Coll Cardiol. 1985; 5: 118B-121B
        • Schoenberg BS
        • Kokmen E
        • Okazaki H
        Alzheimer's disease and other dementing illnesses in a defined United States population: incidence rates and clinical features.
        Ann Neurol. 1987; 22: 724-729
        • Kokmen E
        • Chandra V
        • Schoenberg BS
        Trends in incidence of dementing illness in Rochester, Minnesota, in three quinquennial periods, 1960–1974.
        Neurology. 1988; 38: 975-980
        • Kurland LT
        • Choi NW
        • Sayre GP
        Implications of incidence and geographic patterns on the classification of amyotrophic lateral sclerosis.
        in: Norris Jr, FH Kurland LT Motor Neuron Diseases: Research on Amyotrophic Lateral Sclerosis and Related Disorders. Grune & Stratton, New York1969: 28-50
        • Yoshida S
        • Mulder DW
        • Kurland LT
        • Chu C-P
        • Okazaki H
        Follow-up study on amyotrophic lateral sclerosis in Rochester, Minn., 1925 through 1984.
        Neuroepidemiology. 1986; 5: 61-70
        • Elveback LR
        Coronary heart disease in Rochester, Minn., 1950–1975: incidence and survivorship.
        in: Havlik RJ Feinleib M Proceedings of the Conference on the Decline in Coronary Heart Disease Mortality (NIH Publication No. 79–1610). US Department of Health, Education, and Welfare, Public Health Service, Washington, DC1979: 116-123
        • Byrd RB
        • Nobrega FT
        • Divertie MB
        • Carr DT
        • Woolner LB
        • Kurland LT
        The 30-year trend of bronchogenic carcinoma in Olmsted County, Minnesota, 1935–1964.
        J Chronic Dis. 1971; 24: 9-18
        • Turney TM
        • Garraway WM
        • Whisnant JP
        The natural history of hemispheric and brainstem infarction in Rochester, Minnesota.
        Stroke. 1984; 15: 790-794
        • Griffin MR
        • Wilson WR
        • Edwards WD
        • O'Fallon WM
        • Kurland LT
        Infective endocarditis: Olmsted County, Minnesota, 1950 through 1981.
        JAMA. 1985; 254: 1199-1202
        • Kyle RA
        • Nobrega FT
        • Kurland LT
        • Elveback LR
        The 30-year trend of leukemia in Olmsted County, Minnesota, 1935 through 1964.
        Mayo Clin Proc. 1968; 43: 342-353
        • Nobrega FT
        • Kyle RA
        • Harrison Jr, EG
        Malignant lymphoma including Hodgkin's disease occurring in the vicinity of a large medical center (Olmsted County, Minn., 1945 through 1969).
        Cancer. 1973; 31: 295-302
        • Kyle RA
        • Nobrega FT
        • Kurland LT
        Multiple myeloma in Olmsted County, Minnesota, 1945–1964.
        Blood. 1969; 33: 739-745
      4. Nobrega FT, Glattre E, Kurland LT, Okazaki H: Comments on the epidemiology of parkinsonism including prevalence and incidence statistics for Rochester, Minnesota, 1935–1966. Excerpta Medica International Congress Series No. 175, 1969, pp 474–485

        • Whisnant JP
        • Fitzgibbons JP
        • Kurland LT
        • Sayre GP
        Natural history of stroke in Rochester, Minnesota, 1945 through 1954.
        Stroke. 1971; 2: 11-22
        • Fitzgibbons Jr, JP
        • Nobrega FT
        • Ludwig J
        • Kurland LT
        • Harris LE
        Sudden, unexpected, and unexplained death in infants.
        Pediatrics. 1969; 43: 980-988
        • Ludwig J
        • Fitzgibbons JP
        • Nobrega FT
        Sudden unexpected unexplained death in infants: a comparative clinicopathologic study.
        Virchow Arch [Path Anat]. 1969; 346: 287-301
        • Beard CM
        • Griffin MR
        • Offord KP
        • Edwards WD
        Risk factors for sudden unexpected cardiac death in young women in Rochester, Minnesota, 1960 through 1974.
        Mayo Clin Proc. 1986; 61: 186-191
        • Lanier AP
        • Wychulis AR
        • Dockerty MB
        • Elveback LR
        • Beahrs OH
        • Kurland LT
        Colorectal cancer in Rochester, Minnesota, 1940–1969.
        Cancer. 1973; 31: 606-615
        • Beghi E
        • Nicolosi A
        • Kurland LT
        • Mulder DW
        • Hauser WA
        • Shuster L
        Encephalitis and aseptic meningitis, Olmsted County, Minnesota, 1950–1981. I. Epidemiology.
        Ann Neurol. 1984; 16: 283-294
        • Annegers JF
        • Schoenberg BS
        • Okazaki H
        • Kurland LT
        Epidemiologic study of primary intracranial neoplasms.
        Arch Neurol. 1981; 38: 217-219
        • Sampson RJ
        • Woolner LB
        • Bahn RC
        • Kurland LT
        Occult thyroid carcinoma in Olmsted County, Minnesota: prevalence at autopsy compared with that in Hiroshima and Nagasaki, Japan.
        Cancer. 1974; 34: 2072-2076
        • Beard CM
        • Sheps SG
        • Kurland LT
        • Carney JA
        • Lie JT
        Occurrence of pheochromocytoma in Rochester, Minnesota, 1950 through 1979.
        Mayo Clin Proc. 1983; 58: 802-804
        • Iglesias CG
        • Torres VE
        • Offord KP
        • Holley KE
        • Beard CM
        • Kurland LT
        Epidemiology of adult polycystic kidney disease, Olmsted County, Minnesota: 1935–1980.
        Am J Kidney Dis. 1983; 2: 630-639
        • Schoenberg BS
        • Christine BW
        • Whisnant JP
        The resolution of discrepancies in the reported incidence of primary brain tumors.
        Neurology. 1978; 28: 817-823
        • Sasanelli F
        • Beghi E
        • Kurland LT
        Primary intraspinal neoplasms in Rochester, Minnesota, 1935–1981.
        Neuroepidemiology. 1983; 2: 156-163
        • Resseguie LJ
        • Nobrega FT
        • Farrow GM
        • Timmons Jr, JW
        • Worobec TG
        Epidemiology of renal and ureteral cancer in Rochester, Minnesota, 1950–1974, with special reference to clinical and pathologic features.
        Mayo Clin Proc. 1978; 53: 503-510
        • Ragozzino MW
        • Melton III, LJ
        • Kurland LT
        • Chu CP
        • Perry HO
        Risk of cancer after herpes zoster: a population-based study.
        N Engl J Med. 1982; 307: 393-397
        • Riegelman R
        Cancer and herpes zoster (letter to the editor).
        N Engl J Med. 1982; 307: 1706-1707
        • Linos DA
        • O'Fallon WM
        • Thistle JL
        • Kurland LT
        Cholelithiasis and carcinoma of the colon.
        Cancer. 1982; 50: 1015-1019
        • Lotfi AM
        • Spencer RJ
        • Ilstrup DM
        • Melton III, LJ
        Colorectal polyps and the risk of subsequent carcinoma.
        Mayo Clin Proc. 1986; 61: 337-343
        • Palumbo PJ
        • Elveback LR
        • Connolly DC
        Coronary heart disease and congestive heart failure in the diabetic: epidemiological aspects; the Rochester Diabetes Project.
        in: Scott RC Clinical Cardiology and Diabetes. Vol 1. Futura Publishing Company, Mount Kisco, New York1981: 13-28
        • Ragozzino MW
        • Melton III, LJ
        • Palumbo PJ
        • Chu C-P
        Risk of lymphoma in individuals with diabetes mellitus.
        J Chronic Dis. 1983; 36: 363-365
        • Severson RK
        Association between diabetes and subsequent lymphoma (letter to the editor).
        J Chronic Dis. 1984; 37: 313-314
        • Ragozzino M
        • Melton III, LJ
        • Chu C-P
        • Palumbo PJ
        Subsequent cancer risk in the incidence cohort of Rochester, Minnesota, residents with diabetes mellitus.
        J Chronic Dis. 1982; 35: 13-19
        • Schafer LW
        • Larson DE
        • Melton III, LJ
        • Higgins JA
        • Ilstrup DM
        The risk of gastric carcinoma after surgical treatment for benign ulcer disease: a population-based study in Olmsted County, Minnesota.
        N Engl J Med. 1983; 309: 1210-1213
        • Del Junco DJ
        • Del Junco Jr, GW
        • Logan RFA
        • Langman MJS
        Gastric cancer after gastric operations (letters to the editor).
        N Engl J Med. 1984; 310: 1192-1193
        • Maruchi N
        • Annegers JF
        • Kurland LT
        Hashimoto's thyroiditis and breast cancer.
        Mayo Clin Proc. 1976; 51: 263-265
        • Ragozzino MW
        • Melton LJ
        • Kurland LT
        Herpes zoster and diabetes mellitus: an epidemiological investigation.
        J Chronic Dis. 1983; 36: 501-505
        • Ragozzino MW
        • Kurland LT
        Epidemiologic investigation of the association between herpes zoster and multiple sclerosis.
        Neurology. 1983; 33: 648-649
        • Schafer LW
        • Larson DE
        • Melton III, LJ
        • Higgins JA
        • Zinsmeister AR
        Risk of development of gastric carcinoma in patients with pernicious anemia: a population-based study in Rochester, Minnesota.
        Mayo Clin Proc. 1985; 60: 444-448
        • Katusic S
        • Beard CM
        • Kurland LT
        • Weis JW
        • Bergstralh E
        Occurrence of malignant neoplasms in the Rochester, Minnesota, rheumatoid arthritis cohort.
        Am J Med. 1985; 78: 50-55
        • Spencer RJ
        • Melton III, LJ
        • Ready RL
        • Ilstrup DM
        Treatment of small colorectal polyps: a population-based study of the risk of subsequent carcinoma.
        Mayo Clin Proc. 1984; 59: 305-310
        • Geller SA
        Autopsy.
        Sci Am. March 1983; 248 (132; 135–136): 124-129
        • Brown HG
        Lay perceptions of autopsy.
        Arch Pathol Lab Med. 1984; 108: 446-448
        • McPhee SJ
        • Bottles K
        Autopsy: moribund art or vital science?.
        Am J Med. 1985; 78: 107-113
        • McPhee SJ
        • Bottles K
        • Lo B
        • Saika G
        • Crommie D
        To redeem them from death: reactions of family members to autopsy.
        Am J Med. 1986; 80: 665-671
        • Reichert CM
        • Kelly VL
        Prognosis for the autopsy.
        Health Aff (Millwood). Summer 1985; 4: 82-92
        • Svendsen E
        • Hill RB
        Autopsy legislation and practice in various countries.
        Arch Pathol Lab Med. 1987; 111: 846-850
        • Beneke JA
        • Suvalsky SD
        • McManus BM
        The autopsy in medical science and clinical practice: what are we doing in Nebraska?.
        Nebr Med J. 1986; 71: 222-229
        • Reynolds RC
        Autopsies—benefits to the family.
        Am J Clin Pathol. 1978; 69: 220-222
        • Valdes-Dapena M
        The postautopsy conference with families.
        Arch Pathol Lab Med. 1984; 108: 497-498
        • Hirsch CS
        Talking to the family after an autopsy.
        Arch Pathol Lab Med. 1984; 108: 513-514
        • Hill Jr, RB
        Conference recommendations.
        Arch Pathol Lab Med. 1984; 108: 512
        • Smith C
        The autopsy diagnosis (editorial).
        Hum Pathol. 1986; 17: 645-647
        • Council on Scientific Affairs
        Autopsy: a comprehensive review of current issues.
        JAMA. 1987; 258: 364-369
        • Anderson RE
        Autopsy-related initiatives in the United States: current status and suggestions for the future.
        Hum Pathol. 1987; 18: 977-979
        • Carter JR
        • Nash NP
        • Cechner RL
        • Platt RD
        Proposal for a national autopsy data bank: a potential major contribution of pathologists to the health care of the nation.
        Am J Clin Pathol. 1981; 76: 597-617
        • Lundberg GD
        Now is the time to emphasize the autopsy in quality assurance (editorial).
        JAMA. 1988; 260: 3488
        • Friederici HHR
        Reflections on the postmortem audit.
        JAMA. 1988; 260: 3461-3465
        • Travers H
        Mortui vivos docent: the dead teach the living.
        Kans Med. 1986; 87: 329-333
        • Geller SA
        To see or not to see: the status of the autopsy at the Mount Sinai Medical Center.
        Mt Sinai J Med (NY). 1979; 46: 33-38
        • King DW
        Potential of the autopsy.
        Arch Pathol Lab Med. 1984; 108: 439-443
        • Smith RD
        • Zumwalt RE
        One department's experience with increasing the autopsy rate.
        Arch Pathol Lab Med. 1984; 108: 455-457
        • Dorsey DB
        A perspective on the autopsy.
        Am J Clin Pathol. 1978; 69: 217-219
        • Pontius EE
        Financing mechanisms for autopsy.
        Am J Clin Pathol. 1978; 69: 245-247
        • Valaske MJ
        Loss control/risk management: a survey of the contribution of autopsy examination.
        Arch Pathol Lab Med. 1984; 108: 462-468
        • Clark MA
        The value of the hospital autopsy: is it worth the cost?.
        Am J Forensic Med Pathol. 1981; 2: 231-237
        • Friederici HHR
        Turning autopsy liabilities into assets (letter to the editor).
        JAMA. 1983; 250: 1165
        • Shapiro MJ
        Reimbursement for autopsies: a personal view.
        Arch Pathol Lab Med. 1984; 108: 473-474
        • Yesner R
        • Robinson MJ
        • Goldman L
        • Reichert CM
        • Engel L
        A symposium on the autopsy.
        Pathol Annu. 1985; 20: 441-477
        • Friederici HHR
        • Sebastian M
        An argument for the attendance of clinicians at autopsy.
        Arch Pathol Lab Med. 1984; 108: 522-523
        • Roberts WC
        The autopsy: its decline and a suggestion for its revival.
        N Engl J Med. 1978; 299: 332-338
        • Collins JA
        The importance of autopsies in geriatric medicine.
        Geriatrics. October 1981; 36 (36; 38–39): 33
        • Goldman L
        Autopsy: seventy-five years after Cabot (editorial).
        J Am Geriatr Soc. 1986; 34: 897-898
        • Orsini LA
        Health insurance and the autopsy.
        Am J Clin Pathol. 1978; 69: 248-249