[Methods of health economic evaluation for health services research]. / Methoden der gesundheitsökonomischen Evaluation in der Versorgungsforschung.

On August 30, 2010, the German Network for Health Services Research [Deutsches Netzwerk Versorgungsforschung e. V. (DNVF e. V.)] approved the Memorandum III "Methods for Health Services Research", supported by the member societies mentioned as authors and published in this Journal [Gesundheitswesen 2010; 72: 739-748]. The present paper focuses on methodological issues of economic evaluation of health care technologies. It complements the Memorandum III "Methods for Health Services Research", part 2. First, general methodological principles of the economic evaluations of health care technologies are outlined. In order to adequately reflect costs and outcomes of health care interventions in the routine health care, data from different sources are required (e. g., comparative efficacy or effectiveness studies, registers, administrative data, etc.). Therefore, various data sources, which might be used for economic evaluations, are presented, and their strengths and limitations are stated. Finally, the need for methodological advancement with regard to data collection and analysis and issues pertaining to communication and dissemination of results of health economic evaluations are discussed.

[At first a clear case: homicide by injury to the neck]. / Zunächst ein klarer Fall: Tötung durch Angriff gegen den Hals.

Reported is of a 33 year old female found dead in the basement of her home, manifesting strangulation/throttling marks on the neck. The attack on the throat was, however, not cause of death but a CO intoxication. This woman was killed by direct inhalation of 99% carbon monoxid administered by her husband (via a mask or hose). The carbon monoxid was obtained from a gas cylinder normally used for medical purposes.

[Ultrafiltration, an efficient method for purification of DNA from stains]. / Ultrafiltration, eine effiziente Methode für die Reinigung von DNA aus Spuren.

Isolating DNA from stains all pollutions are extracted, too. Restriction of the DNA can be prevented. After phenol extraction the DNA had been ultrafiltered. Photometrically measurement and fingerprinting showed, that the disturbing substances are removed.

[Forensic medicine and criminalistics]. / Gerichtliche Medizin und Kriminalistik.

The supplementary designation "criminalistics" in the title of certain forensic medical institutes in the first half of this century is to be regarded as a reaction to faulty developments in our specialty, which almost led to the elimination of forensic medicine as an independent scientific discipline in the 1960s. The ability to think in terms of criminalistics and the corresponding working procedures has always been a crucial precondition for the forensic physician, since forensic medicine is the application of medical knowledge for juridical purposes. Forensic medicine originated with the appraisal of cases of violent death by doctors, i.e., reconstruction of the facts in the case. To use the term "criminalistics" in the form of a supplementary designation is thus not required. An attempt is nevertheless made to define "medical criminalistics" as a small but important component of criminalistics. They are subdivided into two phases: the first part begins at the scene of the crime or the place of discovery (local evidence). Here, the trained eye of the forensic physician is indispensable to the criminal investigation department and the prosecutor. Medical criminalistic thinking and working procedures continue at the autopsy. Here, forensic autopsy differs from that practiced by the pathologist. Without knowledge of the situation at the discovery location, the forensic physician runs the risk of not recognizing facts that are important for reconstruction and thus becoming a "destroyer of clues". The second part of medical criminalistics is the actual detection of medical clues, i.e., the investigation of medical clues with special methods, including histological and toxicological investigations.(ABSTRACT TRUNCATED AT 250 WORDS)

[Quantitative determinations of Hp, Pi, Tf and GC in stored blood stains]. / Quantitative Bestimmungen von Hp, Pi, Tf und Gc aus gelagerten Blutspuren.

Quantitative analysis of serum proteins in blood stains by rocket immunoelectrophoresis showed the following results: Long elution times in processing blood stains do not produce a significantly higher yield of serum proteins in stains, and they increase the risk of structural alteration of protein molecules. The amount of proteins detected decreases with increasing age of blood stains. Some proteins are already altered in stains after a short storage time and are no longer useful for phenotyping. Our results confirm that blood stain material should be processed as soon as possible.

[Hair disease or the effect of heat (fire)?]. / Haarkrankheit oder Hitze-(Brand)-Einwirkung?

We found alterations in the ends of a man's hair, changes that were suspected of being incendiary. The hair ends were dull, but there were no typical macroscopic signs of alteration by heat; yet the microscopic findings were clear. Spindle-shaped changes in the hair were interpreted at first as heat damage but could be explained as the results of hair-setting lotion.

[Determination of questionable suicide as a homicide by studies of criminal stains]. / Aufklärung einer fraglichen Selbsttötung als Tötungsdelikt durch spurenkundliche Untersuchungen.

In a woman found dead with cuts on both arms in a domestic sauna plastered with blood were assumed next to a bleed to death. The question self-infliction or by a third party of arm injuries could not be decided. By investigation of blood traces only could be clarified the cause of death. The husband had strangled his wife and inflicted several cuts on both arms with a razor blade to simulate suicide. Afterwards, he also inflicted several cuts on himself with a razor blade with the intention of suicide. He survived these injuries.

[Sources of error in the determination of transferrin in frozen blood samples and blood stains]. / Fehlerquellen bei der Bestimmung von Transferrin aus gefrorenen Blutproben und aus Blutspuren.

Frozen or stored blood samples often show bands in the D-area of transferrin. These alterations can be misinterpreted as D-variants. The alterations do not appear in separated serum. Isoelectric focusing of dried blood traces shows changes in the Tf-subtype system that may lead to misinterpretations.

[Composition of intervillous thrombi from maternal and fetal blood]. / Zusammensetzung intervillöser Thromben aus maternem und fetalen Blut.

In serological studies blood groups of intervillous thrombi of the placenta were identical with maternal blood groups in 88.9%. Identity with fetal blood groups occurred in 11.1%. Utilizing an elution technique in smears prepared from intervillous thrombi, 11.68% of the erythrocytes were of fetal, 88.32% of maternal origin. In conclusion, intervillous thrombi are mainly composed of maternal cells. The existence of small amounts of fetal cells simultaneously, points to the possible etiology: Local damage of the trophoblastic epithelium of the villi is followed by escape of fetal cells into the intervillous space and later aggregation of maternal blood. Finally, the clinical relevance of intervillous thrombosis in maternal Rh-isoimmunization, pregnancy induced hypertension and intrauterine fetal anaemia is discussed.

[Dependability of ABO findings in stored blood samples]. / Uber die Zuverlässigkeit von ABO-Befunden in gelagerten Blutproben.

Report on the occurrence of "acquired" A or B in stored blood samples. This bacterial alteration is of importance when an indirect experimental investigation with the absorption-elution technique is needed in advanced cases of hemolysis. One has to consider this disturbing factor in identification tests (alcoholic blood samples). In dried blood stains we did not notice this problem, but it has to be taken into account in genitals stains.

[Detection of gamma globulin and Inv markers in vaginal secretions]. / Nachweis von Gammaglobulin- und Inv-Merkmalen im Vaginalsekret.

The Gm 1, Gm 2, and Inv 1-factors in the vaginal secretion are in accordance with the corresponding serum features to be expected basically. Deviations are possible. They are either caused by interference factors in the vaginal secretion or other factors which are not, however, always detectable in each case. It is important to test in advance the appropriate dilutions for the particular antiserum charges and to examine extracts of the samples to find out whether they have the necessary concentration.

[Detection of hereditary enzyme characteristics in vaginal secretion]. / Nachweis von erblichen Enzymeigenschaften im Vaginalsekret.

Upon investigation of semen- and blood-free vaginal swabs using starch gel electrophoresis the Phosphoglucomutase type was clearly identified in about 40%. Using cellulose acetate membrane electrophoresis PGM could not be demonstrated. In all cases the results correspond with those obtained in blood. No relation was found between secretor type (determined in saliva) and PGM typing. In vaginal material the following could not be determined: Adenylatkinase (AK) using starch gel electrophoresis, Esterase D (EsD) using cellulose acetate membrane electrophoresis, and Glyoxalase I (GLO) using agarose gel thin-layer electrophoresis.