[Requirements of good medical care for victims of violence and quality-assured "confidential securing of evidence". A qualitative study among physicians in Northrhine-Westphalia]. / Voraussetzungen für eine gute medizinische Gewaltopferversorgung und eine qualitätsgesicherte "vertrauliche Spurensicherung". Eine qualitative Studie mit Ärztinnen und Ärzten aus NRW.

BACKGROUND: Sexual and domestic violence against women and young girls are widespread and can lead to significant psychological, psychosocial and health consequences for the victims. "Confidential Securing of Evidence" ("vertrauliche Spurensicherung", VSS) offers victims the opportunity to have the consequences of the violent acts they have suffered documented without primary police involvement, thus gaining time for decision-making. However, VSS and, in general, the care for victims of violence pose special challenges to physicians. In North Rhine-Westphalia, the documentation app iGOBSIS was developed in a project to support physicians in the care for victims of violence, especially in the VSS. OBJECTIVES: The aim of the work was to clarify how physicians in North Rhine-Westphalia evaluate the functionality of violence victim care and VSS. Specifically, main deficits were to be identified, and suggestions and recommendations for optimizing care and VSS be explored. MATERIALS AND METHODS: Interviews with 39 physicians were conducted in focus groups and analyzed using qualitative content analysis. RESULTS: Medical care for victims of violence and VSS are mainly complicated by stress and time constraints and lack of professional qualification. There is a need for more public relations and educational work, better professional qualification, consistent documentation and secure funding. CONCLUSIONS: Readily available forensic medical support for documentation that will hold up in court, secure funding, networking and public relations are important elements to ensure good medical care for victims of violence and a functional VSS.

Characterisation of Victims Of Violence in the A & E Department and Analysis of the Acceptance of a Medico-Legal Expertise Centre After its Implementation vs. Multi-Year Consolidation. / Charakterisierung unfallchirurgischer Gewaltopfer und Erfassung der Inanspruchnahme nach Implementierung und mehrjähriger Etablierung einer rechtsmedizinischen Gewaltopferambulanz.

BACKGROUND: People who have become victims of domestic or public violence often suffer long-term physical, psychological and social impairment. Due to physical injury, the first contact with the health care system is frequently an A & E Department. Thus, physicians and especially surgeons play a key role in detecting victims of domestic or public violence. The specific needs of victims are adequate medical treatment of injuries, forensic documentation, as well as interdisciplinary medical support to prevent further morbidity and violence. To take this into account, so-called expertise centres for victims of violence have been established at several locations in Germany in recent years. In this study: I. We tried to define the characteristics of victims of domestic and public violence to ensure better identification by physicians/surgeons. II. We elucidate the acceptance and effectiveness of such an expertise centre one year after its implementation and for a period of three years (2007 - 2009) and for a follow-up period of three years (2014 - 2016) after establishment. MATERIAL AND METHODS: Patients were prospectively classified as victims of violence by the attending physician at the A & E Department and further treatment was initiated by the expertise centre for victims of violence. Medical reports from the A & E Department were analysed anonymously and compared with the number of patients of the expertise centre for victims of violence who had been referred from A & E Department. RESULTS: Orthopaedic and trauma surgery is the main referring discipline for the expertise centre for victims of violence. 0.9% of patients (2007 - 2009) and in the follow-up period (2014 - 2016) even 1.6% of patients were identified as victims of violence. However, the acceptance of such a centre fell from 22.2% (2007 - 2009) to 17.2% (2014 - 2016). CONCLUSION: Physicians and especially trauma surgeons are responsible for identifying victims of domestic or public violence and ensuring further treatment. Accordingly, it is crucial that the expertise centre should characterise the victims of violence and be aware of their different needs, if the expertise centre is to be accepted. The results of this study indicate that interdisciplinary training and close cooperation between traumatology and legal medicine are the main prerequisites for continuous improvement in the treatment of victims of violence.

["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.

Pulmonary and coronary foreign particle embolism after central venous injection of liquid nutrition.

A man was found dead in his nursing bed. The responsible assistant nurse explained that she had administered liquid nutrition (Isosource Energy Fibre 500 ml) via perfusion pump into the Hickman catheter, insisting that the Hickman catheter was a percutaneous endoscopic gastric tube. Autopsy findings were unspecific and could not reveal the cause of death. Histopathological examinations showed severe pulmonary foreign particle emboli, partially even emboli of the small coronary arteries. We present the pathological findings of the case in regard to the underlying pathophysiology.

Persistence of biological traces at inside parts of a firearm from a case of multiple familial homicide.

Backspatter from wounds caused by contact shots against a biological target had before been shown to be propelled into firearms' barrels where they can persist and be retrieved from as relevant forensic evidence. Herein, that insight was applied to the investigation of a case of multiple familial homicide with a firearm. Samples of backspatter were collected from the firearm using DNA-free swabs. DNA was extracted from the swabs, and 16 STR systems were PCR-amplified to generate DNA profiles of all victims shot by the firearm. The quality of the resulting DNA profiles was sufficient to exclude the perpetrator as donor and to differentiate the three closely related victims thereby proving that all three victims had been shot by the same firearm from very close or contact distance. A key insight gained from this case was that not only a firearms' barrel inside but other inner surfaces may be charged with profilable DNA.

Quality improvement of fingerprints of decayed corpses by local thanatopractical processing (Thanatoprint).

Thanatopractical processing allows morphological reconstruction of even advanced decayed bodies. By extracting fluids from the body's tissue antemortem tenseness and volume can be restored. If bodies are partly subject to thanatopractical processing in the hand region ("Thanatoprint"), fingerprints of high quality can be gathered even in cases of advanced decay. Without this treatment fingerprinting can be extremely difficult, if not impossible. Thanatopractical processing could be applied successfully in cases of partial to subtotal detachment of the epidermis as well. In an interdisciplinary study 400 fingerprints of bodies in various states of decay were examined after application of Thanatoprint. In 76.75% fingerprints were applicable for data entry into AFIS (Automated Fingerprint Identification System); another 11.00% of the fingerprints could be used for the process of non-elimination. Further advantages of the method are low invasivity while maintaining the integrity of the corpse, less time- and material requirement as well as its long-lasting effect.

[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.