Diagnostics

Background/Objectives: Although medico-legal autopsy remains an important source of postmortem evidence for clarifying causes and circumstances of death, identifying diagnostic discrepancies, and evaluating adverse clinical outcomes, its relevance may extend well beyond individual case resolution. Evidence generated after death can contribute to healthcare risk management, organizational learning, and institutional decision-making, yet the mechanisms through which these benefits acquire broader system value remain insufficiently understood. This study therefore examined relationships among medico-legal risk mitigation, financial risk mitigation, organizational learning capability, perceived system value, and institutional adoption intention. Methods: A cross-sectional survey of 1035 professionals working in healthcare, forensic medicine, pathology, legal, and administrative settings in Serbia was analyzed using exploratory and confirmatory factor analyses, structural equation modeling, and bootstrap mediation analysis. Results: Greater medico-legal risk mitigation was associated with both financial risk mitigation and perceived system value, whereas financial risk mitigation and organizational learning capability independently contributed to perceived system value. In turn, perceived system value showed the strongest direct relationship with institutional adoption intention. Mediation analyses further identified an indirect learning pathway and a sequential mechanism linking medico-legal risk mitigation with institutional adoption through financial risk mitigation and perceived system value. Conclusions: These findings position postmortem evidence as a potential source of diagnostic and organizational intelligence rather than solely as the endpoint of retrospective investigation. Its broader institutional relevance depends on the extent to which evidence generated through autopsy can be translated into risk mitigation, organizational learning, and recognized system value that supports systematic integration into healthcare practice.

Objective: To examine whether the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), AST-to-platelet ratio index (APRI) and fibrosis-4 (FIB-4) score, derived from routine first-trimester tests, are associated with subsequent intrahepatic cholestasis of pregnancy (ICP) and, within ICP, with adverse perinatal outcomes. Materials and Methods: This retrospective case–control study included 115 women with ICP and 64 controls with normal liver tests. Indices were derived from 11- to 14-week values. The two primary hypotheses concerned APRI and SII (Bonferroni α = 0.025); all other analyses were exploratory, with false discovery rate (FDR) adjustment. Within ICP, the co-primary outcomes were a composite of preterm birth, meconium-stained amniotic fluid, fetal distress, neonatal intensive care admission or 1-min Apgar score < 7, and the same composite excluding preterm birth, because delivery timing was protocol-driven by bile acids. Results: APRI (AUC 0.786; 95% CI 0.718–0.852; p < 0.001) and SII (AUC 0.615; 0.530–0.697; p = 0.011) were higher in women who later developed ICP; FIB-4 was not. ALT alone discriminated better (AUC 0.895; DeLong p = 0.003), APRI and SII added no discrimination beyond ALT (AUC 0.904; p = 0.465), and when cases were restricted to the transaminase range of controls (ALT ≤ 31 U/L), the AUC of APRI fell to 0.644. Within ICP, no index demonstrated an association with either composite outcome (all FDR-adjusted q > 0.15), although power was only ~45% for an AUC of 0.60. Bile acids were associated with the composite excluding preterm birth (AUC 0.681; adjusted OR 1.43 per 10 µmol/L; 1.16–1.76); the stronger association with the full composite (AUC 0.754) is partly definitional. Conclusions: First-trimester APRI and SII carry a group-level signal in women who later develop ICP, but this signal largely reflects transaminases and is inflated by control selection. The indices did not demonstrate an association with perinatal outcomes, although small effects cannot be excluded; surveillance and delivery timing should continue to rely on bile acids.

Background/Objectives: To evaluate ChatGPT-generated (GPT-5) simplifications of shoulder MRI reports from the perspectives of orthopedic surgeons and non-healthcare volunteers. Methods: In this single-center retrospective study, 100 de-identified shoulder MRI reports issued between June 2024 and June 2025 were simplified with ChatGPT in February 2026 using a standardized prompt. Between 10 March and 10 April 2026, three orthopedic surgeons independently rated each simplified text against the original report for accuracy, completeness, understandability, and misleading potential on a 5-point Likert scale (higher scores indicating better ratings). In a second arm, 100 adult non-healthcare volunteers each reviewed one simplified report and completed a six-item questionnaire on perceived clarity, comprehensibility, usefulness, and appropriateness. Results: Median expert scores were 5.0 in all domains, and all three raters assigned scores ≥ 4 in 86–98% of reports. Gwet’s AC2 ranged from 0.93 to 0.98, whereas Krippendorff’s α ranged from −0.02 to 0.05. Among volunteers, agreement ranged from 47% for understanding report terms to 80% for the appropriateness of the text. Health literacy correlated positively with most items (r = 0.329–0.429, p ≤ 0.001), and age correlated negatively with understanding report terms (r = −0.352, p < 0.001). Conclusions: The simplified reports were rated favorably by orthopedic surgeons and were perceived as useful by non-healthcare volunteers. However, the study was limited by its single-center design, the use of a single model and prompt, the absence of a comparison with the original reports in the volunteer arm, and the reliance on self-reported rather than objectively tested comprehension; therefore, it does not demonstrate improved patient comprehension or clinical safety. Such texts should supplement, not replace, the original report and physician consultation.