["Because we feel, we have to do something" - Barriers in the prevention of violence and key areas requiring action : A qualitative interview study with professional nurses and managers in the field of elderly care]. / "Weil wir spüren, da müssen wir was tun" ­ Barrieren in der Gewaltprävention sowie zentrale Handlungserfordernisse : Eine qualitative Interviewstudie mit professionellen Pflegefachkräften und Führungskräften aus dem Bereich Altenpflege.

BACKGROUND: In recent years, politics and society have shown an increasing interest in the prevention of violence. Despite the scientific studies and prevention programs that have been conducted over the past few years, there is no indication that the prevalence of violence in elderly care is falling. A high number of unreported cases may still be assumed. OBJECTIVE: The present study examined the barriers in transferring research knowledge into practice. Furthermore, it dealt with the requirements of an interventional approach which is practical and which effectively addresses the barriers. MATERIAL AND METHODS: The data were collected in qualitative interviews (n = 20) and analyzed by using qualitative content analysis. RESULTS: The study revealed uncertainties in dealing with violence. The institutions lacked a clear definition of violence and the respondents did not have a clear concept of when and where violence starts. A high proportion of the respondents stated that violence occurred in various forms in daily nursing care but that there were no specific strategies for action. Only very few cases were documented at all. Moreover, a lack of practical further training was reported. The visibility of these barriers opens up new approaches to developing preventive measures which work in practice. CONCLUSION: A common definition of violence, clear and binding standards, regular training and education measures are central to the prevention of violence in care.

[Dealing with victims of domestic violence. Suggestions for daily practice]. / Umgang mit Opfern von häuslicher Gewalt in der ärztlichen Praxis. Anregungen für den Praxisalltag.

The recognition of victims of violence and their treatment in medical facilities is a subject which has been covered for several years in a number of ways. In medicine and in other disciplines, the focus of research, publication, and practical work has been on the quality of care provided. Guidelines for the treatment of victims of violence have been developed and needs have been assessed. These examples show there is an abundance of knowledge on the subject. Nevertheless, the transfer of this knowledge into the everyday practice of medicine at hospitals and doctors' offices is clearly still not functioning in an optimal way and faces a wide range of hurdles and stumbling blocks. Based on the experience gained in a pilot project involving the medical intervention in doctors' offices against violence perpetuated against women (Project MIGG, funded by the German Federal Ministry of Family, Senior Citizens, Women and Youth (BMFSFJ)), approaches for the optimal treatment of victims of violence in outpatient medical facilities are presented. The key steps to achieving the goal of optimal treatment are: (i) the entire practice team commits to establishing a victim-centered approach to care and (ii) the necessary processes and structures are implemented (i.e., adequate documentation in patient records, patient information is made available in the doctor's office, information on post-treatment services and sources of support in the region are provided, contact is maintained with such institutions, and programs of further education are offered). This paper provides a catalogue of keywords with an overview illustrating how to optimize practice management to deal with cases of domestic violence. In addition, various areas of work are described, such the special requirements involving the collection of evidence.

Lethal carbon monoxide poisoning in wood pellet storerooms--two cases and a review of the literature.

The installation of wood pellet heating as a cost-effective and climatically neutral source of energy for private households has increased steadily in recent years. We report two deaths that occurred within the space of about a year in wood pellet storerooms of private households in German-speaking countries and were investigated by forensic medical teams. This is the first report of fatalities in this special context as is shown in the literature review. Both victims died of carbon monoxide (CO) poisoning; one of the victims was a woman who was 4 months pregnant. Measurements at the scene detected life-threatening CO concentrations (7500 ppm, >500 ppm), which were not significantly reduced after ventilation of the storerooms as required by regulations. We carried out a series of experiments in order to confirm CO production by wood pellets. Thirty kilograms of freshly produced pellets from two different manufacturers were stored for 16 days in airtight containers at 26°C with different relative humidities. CO concentrations between 3100 and 4700 ppm were measured in all containers. There were no notable differences between the wood pellet products or storage at different humidities. Emission of CO from wood pellets has already been described, but fatal accidents have previously been reported only in association with pellet transport on cargo ships or storage in silos. It is therefore a new finding that fatal accidents may also occur in the wood pellet storerooms of private households. We show that significant CO concentrations can build up even when these rooms are ventilated in accordance with the regulations and that such levels may cause the death of healthy persons, as described in the following. As the safety recommendations from the wood pellet industry are inadequate, we consider that further fatal accidents are likely to occur and recommend urgent revision of the safety regulations.

[Diagnostic imaging in cases of suspected child abuse--focus craniocerebral trauma divergent guidelines and resulting problems]. / Bildgebende Diagnostik bei Verdacht auf Kindesmisshandlung--Fokus Schädel-Hirn-Trauma. Divergente Vorgaben und daraus resultierende Probleme.

For the clinical diagnosis of non-accidental craniocerebral trauma in children there are different recommendations and guidelines, which are not completely consistent. Depending on the examiner, the focus may be on therapeutic relevance, minimization of the exposure to radiation or potential conclusions as to the course of events. Under certain circumstances it may be difficult for the responsible institution to deal with all three perspectives, as is shown by the presented case. From the authors' point of view it would be desirable to work out a common guideline taking into account paediatric radiological and medicolegal aspects.

[Perforating gunshot to the head with a power-actuated tool]. / Kopfdurchschuss mit Bolzensetzgerät.

The article describes a shortly survived suicide with a powder-actuated tool. A 51-year-old man shot all through his head from the right to the left temple. The pin produced an extensive area of destruction in the brain tissue, but neither in the hospital nor during the autopsy was any projectile found. Finally the pin was detected in a metal fitting of the bed in which the man had killed himself. The suicide instrument was a powder-actuated tool firing a metal pin after igniting a cartridge. Unlike a nail gun using compressed air, pins fired by means of a propellant reach a velocity of up to 150 m/s thus developing a higher destructive potential.

[Examination of live victims of violent crimes at the Institutes of Legal Medicine of Hanover, Cologne and Leipzig]. / Untersuchung von Gewaltopfern Lebendbegutachtungen in den rechtsmedizinischen Instituten von Hannover, Köln und Leipzig.

During the last few years the importance of clinical forensic medicine has increased within the field itself, but also in interdisciplinary cooperation. Although examinations of live victims play a substantial role in the every-day work of most German forensic scientists, the number of data published on their frequency and the type of offence for which they were performed is small. For this reason a comparison of the data from the Institutes of Legal Medicine in Hanover, Cologne and Leipzig was carried out. Most of the examinations performed by all the three institutes were ordered by courts, the prosecution or the police. Only in a few cases did private persons or hospitals ask for a forensic expert opinion on injuries. During the study period the total number of examined violence victims per annum increased noticeably from 252 in 1999 to 507 in 2003. The total number of examinations during the five-year study period amounted to 1181 in Hanover, 393 in Leipzig and 198 in Cologne, which all have a similar number of inhabitants in the respective catchment area of the institutes. Most of the examinations were carried out in victims of bodily harm, sexual assault and child abuse, but also in traffic offences, for age determination, in self-inflicted injuries and in suspects of homicide. On the one hand the remarkable rise of the number of physical examinations shows that the importance of forensic expert opinions is increasingly recognized. On the other hand the considerable regional differences demonstrate that the competence offered by the Institutes of Legal Medicine in the documentation and interpretation of violence is by far not yet sufficiently used.

Tumor embolism as a cause of an unexpected death: a case report.

The primary causes of deaths for individuals with rare cancers can be difficult to diagnose clinically. Often, the symptoms implicate a variety of factors, and an autopsy is thus required to obtain the correct diagnosis. This study analyzes the death of a 45-year-old woman who reportedly died from an acute pulmonary dysfunction. The patient had been treated with antibiotics for three months for intractable pneumonia. Suspicious coin lesions detected by chest X-ray prompted a clinical clarification; however, no final diagnosis was made. The autopsy revealed a bulky thyroid tumor with venous invasion, leading to a massive pulmonary tumor embolism. Furthermore, microscopy identified the tumor as a rare pleomorphic myxoid sarcoma. Thus, the patient died of a large pulmonary tumor embolism originating from this rare sarcoma, and not of acute pulmonary dysfunction of any other means.

[Cooperation between criminal investigators and forensic medicine. A complementary system and its peculiarities, illustrated by a case from general practice]. / Zur Kooperation zwischen Ermittlungsbehörde und Rechtsmedizin. Ein komplementäres System und seine Besonderheiten, erläutert an einem Fall aus der Praxis.

Usually criminal investigations involving issues of medical misconduct require comprehensive inquiries which normally include the confiscation of medical files and the determination of certain events in their chronological order. This information is then submitted to the relevant experts as a basis for preparing their opinions. Where the subject of the investigations is complex, however, or where no suitable patient documentations are available, cooperation with the medical experts should start at an earlier stage already and be more comprehensive. On the basis of the relevant legal principles an already concluded investigation ("dietary capsule case") is critically discussed.