[The controversy over early diagnosis of Alzheimer's disease: A literature review of the advantages and disadvantages]. / Kontroverse um die Alzheimer-Frühdiagnostik ­ eine literaturbasierte Übersicht über die Vor- und Nachteile.

BACKGROUND: The continuum of Alzheimer's disease (AD) comprises three stages: the pre-clinical stage (with few to no subjective symptoms), the prodromal stage (measurable mild cognitive impairment) and the final stage of clinically manifest (AD) dementia. Neuropathological correlates in accordance with these stages have been found with varying frequency. The aim of early AD diagnosis is to determine such correlates in these preclinical and prodromal stages and to determine the probability of the manifestation of a later AD dementia. In this regard, the prognostic validity is of vital importance. From the perspective of those affected, the issue of early diagnosis cannot be reduced to AD, although Alzheimer's dementia is by far the most common form of dementia. The aim of this review is to provide a literature-based overview of the advantages and disadvantages of early AD diagnosis in contrast to other types of dementia. Based on this, recommendations will be formulated for the prioritisation of early diagnostic advantages and disadvantages in the patient counselling situation in clinical practice. METHODS: Three databases were searched for current reviews addressing the advantages, disadvantages and ethical aspects of early AD diagnosis. The search was limited to current German or English reviews published between January 1, 2018 and November 30, 2022. The systematic search strategy was based on the PICO model and included both a Boolean and a focus-expanding keyword search using previously defined search terms. In addition, snowballing was used as a search strategy. Qualitative synoptic content analysis in accordance with Mayring was used to analyse both advantages and disadvantages. Similar arguments were combined into single statements. The resulting statements were categorized into three main groups: social, individual or clinical aspects. To emphasize the aforementioned aims, arguments were additionally distinguished into "only valid for early AD diagnosis" and "valid for early diagnosis of all types of dementia". RESULTS: Overall, seven reviews with suitable content were included. Social aspects of early AD diagnosis comprise the protection of the affected person and the society as well as potential stigmatisation of the affected and their family members. Individual arguments range from the right to a "rational suicide", including the avoidance of financial and caregiving burdens on family members, to the right not to know the diagnosis. Clinical arguments include, for example, the scientific research context (facilitating the identification of suitable clinical trial participants) and various negative effects of a false positive or false negative early diagnosis. CONCLUSION: Early diagnosis of AD as well as of other forms of dementia is characterised by numerous advantages and disadvantages of a social, individual and clinical nature. The decision for or against early diagnosis should always be made by weighing the current advantages against the disadvantages in a specific case. In particular, the desires of the person affected, the validity of the diagnostic procedures available and, above all, the availability of effective preventive or therapeutic measures must be taken into account.

[CME: Depression in Primary Care]. / CME: Depression in der Hausarztpraxis.

CME: Depression in Primary Care Abstract. Depressions belong to the most common illnesses at all and to the five most common illnesses in the primary care. The primary care is the first point of contact for depressive patients and therefore has a key role in the early detection and initial treatment of depressive patients. A depressive disorder presents frequently with diffuse, unspecific and mostly somatic complaints. In the primary care only about half of the depressive disorders are detected. An undetected and untreated depression can have fatal consequences for the patients. Once detected, a depressive disorder is treatable. A very important screening test for the early detection of a depression is the two-question-test (sensitivity 96 %, specificity 57 %).

Quality of Life and Patient Satisfaction Following Male-to-Female Sex Reassignment Surgery.

BACKGROUND: Surveys on quality of life (QOL) of male-to-female (MTF) transsexuals have found low QOL scores before and increased satisfaction scores after sex-reassignment surgery (SRS). To our knowledge, many of them lack standardized questionnaires and comparisons with normative data to evaluate different vaginoplasty techniques. AIM: To analyze patient satisfaction and QOL after SRS. METHODS: Forty-seven patients participated in this study. All patients had surgery with our self-developed combined technique on average 19 months before the survey. They completed a self-developed indication-specific questionnaire concerning demographic and socioeconomic issues and postoperative satisfaction. Furthermore, a standardized self-assessment questionnaire on satisfaction and QOL (Fragen zur LebenszufriedenheitModule [FLZM]; Questions on Life SatisfactionModules) was used. The FLZM consists of three modules (general life satisfaction, satisfaction with health, and satisfaction with body image) with scores of weighted satisfaction for each item. Results of the general and health modules were compared with normative data. OUTCOMES: Demographics, QOL, general life satisfaction, satisfaction with health, and satisfaction with body image. RESULTS: The self-developed indication-specific questionnaire showed that 91% experienced an improvement of QOL. All patients stated they would undergo SRS again and did not regret it at all. Patients stated their femininity significantly increased. For the FLZM, the sum score for general life satisfaction (P < .001) was significantly lower than the normative data, whereas the sum score of the satisfaction with health module (P = .038) did not reach statistical significance. The two modules also showed positive trends for different items. Values of the body image module showed a significant increase in satisfaction with breasts (P < .001) and genitals (P = .002). CLINICAL IMPLICATIONS: The findings of this survey emphasize the importance of SRS in the interdisciplinary gender-reassignment process. The detailed description of our combined technique could help to improve the surgical outcome and patient satisfaction of this complex and non-standardized surgery. STRENGTHS AND LIMITATIONS: This is the first description of a new surgical technique (combined technique) for MTF SRS. QOL was assessed by a large number of patients by standardized questionnaires and could be compared with normative data. Because this is a retrospective study, we can draw only careful conclusions for pre- and postoperative changes. CONCLUSION: Our self-developed combined surgical technique seemed to have a positive influence on QOL after SRS. Satisfaction with breasts, genitals, and femininity increased significantly and show the importance of surgical treatment as a key therapeutic option for MTF transsexuals. Papadopulos NA, Lellé J-D, Zavlin D, et al. Quality of Life and Patient Satisfaction Following Male-to-Female Sex Reassignment Surgery. J Sex Med 2017;14:721-730.

[Is the formal quality of multiple choice questions used for continuing medical education influenced by guidelines for authors provided by the publishing houses?] / Welchen Einfluss haben Autorenrichtlinien der Verlage auf die formale Qualität von CME-Fragen in der ärztlichen Fortbildung?

INTRODUCTION: The widespread use of flawed multiple choice questions (MCQs) in continuing medical education (CME) has been demonstrated in different studies. In recent years, quality control measures have been established by some German publishing houses to ensure the quality of MCQs. OBJECTIVES: The purpose of the present study is to evaluate whether the quality of author's guidelines and the quality of MCQs correlate and whether the quality of MCQs in CME has improved following the implementation of quality control measures. MATERIALS AND METHODS: A set of 720 items from 6 journals was selected for analysis. A list of 10 item-writing flaws provided by Kühne-Eversmann et al. was modified. The existing guidelines for authors of the six selected journals were categorized by their comprehensiveness. RESULTS: There were substantial differences in item quality with the percentage of flawed items ranging between 34 % and 92 % of all items published by a journal. One journal showed considerable improvement of item quality following the implementation of guidelines for authors (61 % flawed items in 2006 vs. 33% in 2012). The comprehensiveness of the author's guidelines correlated negatively with the number of item-writing flaws. CONCLUSIONS: The correlation between the existence of elaborate guidelines for authors and the absence of item-writing flaws in MCQs suggests that the publication of guidelines for authors could result in a higher quality of MCQs, even though the review process might have a major influence.

A dimensional approach to personality disorders in a sample of juvenile offenders / Uma abordagem dimensional a distúrbios de personalidade em uma amostra de menores infratores / Une approche dimensionnelle aux troubles de la personnalité dans un échantillon de mineurs délinquants / Un abordaje dimensional de los trastornos de personalidad en una muestra de delincuentes juveniles

In a sample of 60 male Italian subjects imprisoned at a juvenile detention institute (JDI), psychopathological aspects of the AXIS II were described and the validity of a psychopathological dimensional approach for describing criminological issues was examined. The data show that the sample has psychopathological characteristics which revolve around ego weakness and poor management of relations and aggression. Statistically these psychopathological characteristics explain 85% of criminal behavior.

Em uma amostra de 60 sujeitos italianos do sexo masculino presos em un instituto de detenção para menores (JDI), descreveram-se os aspectos psicopatológicos do Axis II e examinou-se a validade de uma abordagem de dimensão psicopatológica para a descrição das questões criminológicas. No conjunto, os dados apontam que a amostragem apresenta características psicopatolócas que dizem respeito à debilidade do Ego e a uma má gestão das relações e da agressão. Estatísticamente, essas características psicopatológicas explicam 85% do comportamento criminal.

Un échantillon de 60 sujets italiens de sexe masculin détenus dans un établissement pénitentiaire pour mineurs (JDI) nous a servi de base pour décrire les aspects psychopathologiques de l'Axe II et pour examiner la validité d'une approche à dimensions psychopathologique pour décrire les questions criminologiques. Dans l'ensemble, les données indiquent que l'échantillon présente des caractéristiques psychopathologiques qui relèvent de la faiblesse de l'ego et de la mauvaise gestion des relations et de l'agression. Statistiquement, ces caractéristiques psychopathologiques expliquent à 85% le comportement criminel.

En una muestra compuesta por 60 sujetos italianos de sexo masculino encarcelados en un instituto correccional para jóvenes (ICJ), se hizo la descripción de los aspectos psicopatológicos de los trastornos de personalidad (AXIS II) y se examinó la validez del abordaje dimensional psicopatológico para describir las cuestiones criminológicas. Los datos demuestran que la muestra tiene características psicopatológicas que giran alrededor de la debilidad del ego y de gestión deficiente de las relaciones y de la agresión. Estadísticamente, esas caracteristicas psicopatológicas explican el 85% del comportamiento criminal.