-
Dahlgaard Singleton posted an update 1 week, 4 days ago
BACKGROUND Terrorism belongs to the extreme forms of violence that have so far received little attention in psychiatric research and are rarely mentioned in textbooks of psychiatry. After terror attacks, however, the question regularly arises whether terrorists suffer from mental disorders. OBJECTIVE AND METHODS The aim of this review is to summarize the multidimensional causes of terrorism with special emphasis on psychopathological aspects of the perpetrators. In addition to a brief summary of the historical background and recent developments in terrorism, a literature search was performed using PubMed, SCOPUS, PsychInfo and PsychARTICLES. RESULTS From a psychiatric point of view, a differentiation between lone terrorists and group terrorists is essential. Lone terrorists have a much higher prevalence of psychiatric disorders, such as psychotic, paranoid and affective symptoms. The majority of terrorists acting in groups rarely suffer from such mental disorders. For these perpetrators biographic aspects and socialization, group dynamics and ideological personality profiles with narcissistic, histrionic, fanatic and antisocial components are more relevant. The phenomenon of terrorism predominantly being a male domain is discussed. CONCLUSION The manifold manifestations of terrorism are caused by complex patterns of interacting biographic, sociological, ideological and psychopathological components that differ between lone acting and group terrorists. The real causes for acts of terrorism are not various ideologies permitting violence but consist more of a pre-existing violence-oriented mentality of the perpetrators looking for such ideologies to justify their acts. The possibilities of psychiatry in prevention and early recognition are limited. Some recently developed scales for risk assessment of extreme violence are mentioned.OBJECTIVE The surgical management of tibial plateau fractures remains a challenge. The aim of surgery is the anatomical reconstruction of the joint surface with correct length, axis and rotation. The goal of osteosynthesis is to maintain a stable reduction to allow bone healing and functional aftercare. The continued advancements in 3D computed tomography has changed, the classification systems and, in parallel, the treatment strategies significantly changed. The 3‑column concept of Luo et al. find more has proven to be advantageous for planning of access, reduction and stabilisation. INDICATIONS Taking into consideration patient-specific factors. most displaced tibia plateau fractures are treated by surgery. However, no clear treatment recommendations exist in literature. In our clinical practice, joint displacement of more than 2 mm is generally not tolerated and surgical therapy is advised. OPERATION TECHNIQUE The surgical technique is preceded by the surgical strategy, which is based on the soft tissue situation and imaging results. The gold standard in imaging is computed tomography. Timing of surgery, patient positioning, surgical approaches as well as the implants are individually adapted to the fracture pattern. RESULTS The postoperative results are strongly influenced by fracture type, soft tissue condition, patient-specific factors, treatment method, and successful joint reconstruction. The functional postoperative results are often satisfactory even after complex tibia plateau fractures. In the literature, development of posttraumatic arthritis is reported to be 23-44%. In a study by Mehin et al. joint replacement of the knee was performed in 4.5% of cases following the surgical treatment of tibia plateau fractures.The original version of this paper included errors in Fig. 3. The corrected Fig. 3 is presented here.BACKGROUND Although vestibular symptoms are amongst the most frequent reasons for seeking emergency medical help, many patients remain undiagnosed. OBJECTIVE In this cross-sectional study, we investigated the spectrum of vertigo and dizziness in a tertiary ear, nose, and throat (ENT) emergency department (ED). Furthermore, we investigated the attendant symptoms, clinical signs, and the diagnostic tests performed. METHODS We screened all ED reports from 01/2013 to 12/2013 for adult patients with vestibular symptoms referred to the ENT department. RESULTS In total, we found 2596 cases with reported vestibular symptoms in the ED as a main or accompanying complaint. Of these, 286 were referred to the ENT specialist directly (n = 98) or via other major medical specialties (n = 188). Benign paroxysmal positional vertigo (BPPV) was the most frequent diagnosis in our study (n = 46, 16.1%), followed by vestibular neuritis (n = 44, 15.4%), otitis media (n = 20, 7%), and 9 patients (3.1%) had an ischemic stroke or a transient ischemic attack. In 70 (24.5%) cases, dizziness was not further specified. CONCLUSION BPPV is the most frequent diagnosis seen in the ED; however, physicians need to document nystagmus more precisely and perform diagnostic tests systematically, in order to make an accurate diagnosis. To avoid misdiagnoses, ED physicians and ENT specialists should be able to recognize central signs in patients with an acute vestibular syndrome. Every fourth patient does not receive a definitive diagnosis. Diagnostic ED workup for patients with dizziness needs further improvement.BACKGROUND Laboratory diagnostics are essential for diagnosis, initiation of therapy, and monitoring of patients. Laboratory results that are overlooked or incorrectly interpreted lead to adverse events and endanger patient safety. Clinical decision support systems (CDSSs) may facilitate appropriate interpretation of results and subsequent medical response. OBJECTIVES The research project on digital laboratory medicine (AMPEL) aims at developing a CDSS based on laboratory diagnostics, which supports practitioners in ensuring the necessary medical consequences. MATERIALS AND METHODS A literature review of CDSSs describes the current state of research. The research project AMPEL is presented with its objectives, challenges, and first results. Furthermore, the development of a framework and reporting system is illustrated through the clinical example of severe hypokalemia. RESULTS AND CONCLUSION Through interdisciplinary development and constant optimization, a specific CDSS with high acceptance among clinicians was developed.