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Original Article
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Relative's perspective scale of embalmment | ||||||
Sunday Ogunsuyi Popoola | ||||||
Senior Lecturer, Department of Anatomy, Ekiti State University, Ado-Ekiti, Nigeria
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Popoola SO. Relative's perspective scale of embalmment. Edorium J Anat Embryo 2018;5:100022A04SP2018. |
ABSTRACT
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Aims:
Relative's Perspective Scale of Embalmment is an innovative scoring tool born out of curiosity to address the limitations in preservation of tissue and embalming of human remains in an attempt to better anatomic sciences. Objectives: Specifically, emphasis is on acceptability and satisfaction of embalmed body by the relatives, suitability of mortuary for cadaver acquisition in research and training, and validation of the scoring tool by different mortuary institutions across the globe.
Keywords: Acceptability, Embalmment, Relatives, Scoring | ||||||
INTRODUCTION
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The initiation of embalming (6000BC to 600AD) was credited to the ancient Egypt in preserving their kings and other nobles through the gesture that was improved from mummification to encompassing physical, chemical or both methods in this present computer age [1]. Brenner, in his extensive review article on embalming dwelled on: the historical perspective and various techniques; chemicals involved; numerous approaches; and analysis of various company products but however failed to incorporate assessment from the relations of the dead [2]. Nevertheless, of recent, Hagens came out gallantly from German's arena to establish plastination as a special preservative method in Kingdom Animalia with resultant BodyWorlds for exhibition [3]. In view of the continuing development in science and technology, every human has an interest in health and on the other hand, a visit to the mortuary and museum may reveal the fascinating range and diversity of body preservation. The dead bodies where and when appropriate are either preserved in mortuary before burial/cremation rites or for anatomic education (dissection, teaching and research). Death is conventionally defined as complete cessation of activities of the three vital and interdependent systems - circulatory, nervous and respiratory - of the body [4]. Death is an inevitable end to all biological systems with resultant post-mortem changes and sequence of autolysis, putrefaction and decay. The purpose of embalmment and tissue fixation is to slow down the rate of progression to decay which depends on many factors but environmental temperature is the key [4]. Basically, preservation of a dead body can either be by treating with physical means, chemical agents or both. In the account of bereavement due to a traumatic death, the relations of the dead pass through psychological scenario of denial/shock, anger, bargaining, depression/suicidal attempt and acceptance/hope. Who among the relations and what stage/time can assessment or scoring be accessed without any prejudice? Explorative work of Chapple and Ziebland is worthy of consideration on diverse opinions of the relations interested in having contact or viewing the dead ones [5]. This scoring tool was exclusively developed for assessment of human remains in mortuary by the relatives for auditing of mortuary activities from curiosity into the ways and manners the human remains are handled in different parts of the world. Specific objectives were: determination of acceptability and satisfaction of embalmed body by the relatives; assessing suitability of mortuary for cadaver acquisition in research and training; validation of the scoring tool for auditing purposes by different mortuary institutions across the globe. From anatomic point of view, results obtained from the use of the scoring tool: Relative's Perspective Scale of Embalmment (RPSE) was meant to be compared in different centres in due course after validation. Searching the web and literature, articles related to this type of innovative scoring tool or system in embalming are rare. | ||||||
MATERIALS AND METHODS
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Approval was granted from the appropriate ethical committee of the institution before commencing the main study after the pilot/trial at the Mortuary Complex, Department of Anatomy, Ekiti State University, Ado-Ekiti, Nigeria. The duration of the study was 5 months. The scoring tool was developed solely from a 7-item scale designed to measure general relationship satisfaction [6]. Modification and addition were carried out with resultant 10-item scale. There are three forms with same identification code for A and B: Form A is to be handled by any of the close relatives of the dead, next-of-kin or family physician while Form B will be justified by the mortuary director, embalmer, pathologist or anatomist as the case may be after crosschecking the relative's assessment Form A. Form C is to be kept as RPSE Registry/Audit by the institution. Table 1 in Form A contains 10 questions. Any assistance on item 8 (in case of smelling disorder), a staff shall be informed and be documented as: Yes or No. It should be noted that items 4, 5 and 8 are reverse-scored; and scoring is kept continuous with minimum of 10 and maximum of 50. Table 2 was designed for categorization of numbers in Table 1 along with useful suggestions. Percentage score added to simplify quantitative statistical comparison amongst different centres. Final assessment was recorded as RPSE-A; the worst to RPSE-F; the best. The assessment proper comprising the two forms was made to occupy two pages as the meat of the whole exercise. This could as well be compressed into a single page/sheet. Table 3 is contained in Form C for yearly or interval pooling of all forms for auditing of action by the institution. A serial number is appended on each Form B while entering data into Table 3. The overall percentage for each assessment is collated for interval judgment on the state of the mortuary. Sample size of pilot study was 10. Data from the pilot study was collated and entered into Statistical Package for Social Sciences (SPSS version 21) for analysis calculating: means, frequency, Kendall's Coefficient of Concordance (KCC) with 95% Confidence Interval (CI) and Cronbach's alpha for test of reliability [7]. P-value of less than 0.05 was taken as index of significance. | ||||||
RESULT
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Tables 4 to 9 are on matters related to pilot study earlier conducted to ascertain the feasibility of the study. Table 4 shows the evaluation of ten embalmed bodies from the scores by the relatives. The core items are represented in words rather than numerals for coherency and understanding. Percentages of individual score calculated with assumption for a period and judgment implemented. In Table 5 , using Kendall's Coefficient of Concordance, p-value was statistically-insignificant. Therefore, null hypothesis was accepted at 95% Confident Interval (CI) proving that there was no significant difference on matters related to recognition by the relatives. In Table 6 , p-value assessing relationship of the relatives with the dead ones when alive equally confirmed no significance in the statistics. Null hypothesis was then accepted to show the similarities among the items. In Table 7 , p-value was greater than 0.05, hence statistically-insignificant and null hypothesis accepted: there were no differences on the assertions on embalmed centres. In Table 8 , null hypothesis was rejected because p-value was statistically-significant. It then means that the questions on the degree of satisfaction from the relatives were independent. Table 9 qualitatively shows the Cronbach's alpha value 0.828 corresponding to internal consistency of 'Good' ( Table 10 ) . Reliably speaking, this study is readily assessable as a scoring tool. |
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DISCUSSION
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Essentially, next-of-kin and other close relations apart from the close family physician will have a better assessment of someone's anatomy or body while alive. At death, this category of people will still be at an advantage to descriptive and comparative body anatomy of the dead. Emphatically, the death of a loved one, most especially, by way of untimely event is a painful one that may call for actions and reactions which are equal and opposite in physical sciences [8]. Table 4 of this study categorically proved that this scoring tool could be utilized in passing judgment on the state of embalming centres as a periodical exercise of auditing. Emotion of the relations is considered an important factor that can prejudice the scoring at the early stage of bereavement and assistance of psychologists, sociologists and perhaps theologians may be needed [5]. Similarly, following bereavement from suicide, who among the relations qualifies to assess (akin to scoring) was alluded to in another study which still needed further clarification [9]. Justice will be better done to item-1 from Table 1 by the relations. Pre-morbid photographs/images may be utilized for the scoring by curious law-enforcement agency or family attorney but the score may not be a good representation of the dead. These same reasons will equally go for items 2, 3 and 4. Items 4, 5 and 8 are reverse-scored because the reduction in the acquisition of knowledge in these particulars will be to the advantage of the mortuary system. However, the non-affiliations of the dead may also perform the scoring; the close dealings will still do better. In the pilot study, Kendall's Coefficient of Concordance showed no significant differences on the recognition by the various relatives Table 5 . The relatives in these cases were next-of-kins and very close allies from different socio-demographic profiles. One of the relatives who could neither read nor write was engaged by an interpreter without any prejudice to show that this scoring tool could fit into categories of all walks of life. These same observations should go for opinions on the relationship of the relatives with their loved ones while alive and at death. The term of partnership will afford the assessor to make a better scoring of the body. Seeing the naked physique often before death will give rise to a good anatomic description of the body. Debilitating diseases and frequent illnesses might have gotten effect on the physical appearance while alive with resultant changes hindering recognition at death [10]. Postmortem changes in which environmental condition is the key may have effect on the body. The delay for one reason or the other between death and embalming may affect the success of the exercise [4]. Relations, most times would have visited the mortuary to assess the body before evacuation for the funeral rites and disposal. A body at good condition in the first visit may not warrant other earnest visits for identification which can be disgusting. On expectation (item 6 of Table 1) , the assessor in this case had better seen the body just before being deposited in the mortuary. Perhaps that may afford him/her the opportunity of getting privy to other bodies deposited in the mortuary in other to make a good judgment on the day of evacuation of the body that brought his/her presence to the mortuary. Comparison of activities in one mortuary with others as stipulated in item-7 may help the state-of-the-art of the mortuary's modus operandi at that particular point in time. Assessing similarities and differences of the body along with the ones seen previously in other mortuaries will result in actions and reactions capable of advancing the ways forwards on the manners of operation [11]. In Table 7 , the test of concordance amongst the issues on the centres was statistically-insignificant. However, the fact that the relatives randomly came for the assessment on the items with no differences and singing the same songs ascertained the true condition of the centres. Perceptibility of odours (item 8) other than that of embalming fluids in the mortuary may signify the decaying of bodies or other biological specimen in the mortuary. The embalmer may then look inward to this negativity that may warrant legal exercises in some ideal situations [12], [13]. Relation with dysomia/anosmia may be exempted from assessing item-8 in that respect; another relative may be co-opted in assessing item-8 and should be noted in the form as a special report/documentation in Form A. At this juncture, it is of note to remember that a relative physically challenged with vision should be excluded from scoring. Satisfaction with the embalmed body spans from 'very low' to 'very high' as contained in item 9. This will be based on overall cognitive reasoning of assessor on the body and mortuary's state-of-the-art with consideration to environment and available facility. Fitness for exhibition (item 10) is the final assessment for members of the public consumption during the funeral rites. The assessor just has to say the minds of the public in judging activities in the mortuary and preservation of the bodies in the centre. Nevertheless, all members of the public will be interested in the good result from the embalmment irrespective of any challenges in the mortuary as this may further enhance bequeathing for anatomic education. In Table 8 , the assessment on the satisfaction showed that the assertions were two different entities as the p-value was statistically-significant and null hypothesis rejected. The opinion of the relatives may not tally with the evaluation of the general public during exhibition, lying-in-state and other funeral rites. Notwithstanding, the relative's or next-of-kin's opinion will still be sine qua non as the legitimate owner of the corpse. In 'Compartmentalization and Suggestion on RPSE', the table is self-explanatory. RPSE-A calls for re-establishment of the mortuary in the present location or better in another site. Definitely on RPSE-A, there might have been a structural and or unpalatable issue right from inception. RPSE-B will go for total renovation of the mortuary, otherwise, suggestion on RPSE-A may be beneficial. In RPSE-C, there is need for partial alteration of one or more operational systems to effect good rapport amongst members of the public patronizing the mortuary. RPSE-D calls for improvement as usual so as to continuing gaining confidence from the social environment. In RPSE-E, there is really no problem and thereby the embalmer and or the mortuary director should maintain the set standard. Lastly, RPSE-F is theoretically feasible but practically never realistic due to continuous changes in life. 'Change is the only permanent innovation on earth', so say an adage. The only certain way RPSE-F can be achieved considering various theories establishing the existence of man on earth (even at the best perceived embalming centre) is through the scripturally divine creationism's heaven rather than the man-imagined adaptive organic evolutionism which seems not perfect! On the average, the statistical legacy of Cronbach's alpha as a measure of internal consistency established this study to be 'Good' [7]. Therefore, it was a worthwhile exercise contributing to knowledge and abridging communication gaps in scientific world and should be adopted as a scoring and or auditing tool. | ||||||
CONCLUSION
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Relative's Perspective Scale of Embalmment (RPSE) is an innovative scoring tool born out of curiosity by the sole author to actual or proportional challenges in preservation of tissue and embalming of Homo sapiens loquens remains for anatomic teaching, dissection and research in other to better anatomic sciences. The scoring tool is simplified to be handled by the relatives of the dead. Without any prejudice, RPSE system of scoring will further enhance cadaver acquisition for anatomic sciences across the globe. The scoring system is hereby recommended for auditing of embalming both in developing and developed nations, perhaps, after validation if need be. | ||||||
REFERENCES
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Acknowledgements
The author appreciates Mr A E Ogundele, the Mortuary Director in the Department of Anatomy, Ekiti State University, Ado-Ekiti, Nigeria for his assistance while experimenting the feasibility of the scoring tool in the anatomy complex. |
Author Contributions
Sunday Ogunsuyi Popoola – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published |
Guarantor of Submission
The corresponding author is the guarantor of submission. |
Source of Support
None |
Conflict of Interest
Authors declare no conflict of interest. |
Copyright
© 2018 Sunday Ogunsuyi Popoola. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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