A virus from Aspergillus cibarius with features of alpha- and betachrysoviruses.

From the ascomycete Aspergillus cibarius strain NW-FVA 2590, which was originally isolated from a root, associated with stem collar necrosis of Fraxinus excelsior L., a novel virus was isolated and characterized. Its genome is encoded on three monocistronic dsRNA segments ranging from 3683 bp (dsRNA 1) over 3093 (dsRNA 2) to 2902 bp (dsRNA 3), which are packed in isometric particles of around 35 nm. While the viral RdRp (P1) is encoded on segment 1, protein sequencing showed that two more structural proteins are present which are translated from dsRNA 2 (P2) and dsRNA 3 (P3) and possibly form the viral capsid. Additionally, P2 and P3 may undergo posttranslational modifications since the detected proteins bands deviated from the calculated sizes. Due to its phylogenetic position, the novel virus was grouped in the family of Chrysoviridae and was tentatively denominated as Aspergillus cibarius chrysovirus 1 (AcCV1). Due to its composition, biological properties and phylogenetic position, distant from the genera Alphachrysovirus and Betachrysovirus, we suggest to position AcCV1 in a proposed genus "Gammachrysovirus".

Complete genome sequence of a novel alternavirus infecting the fungus Ilyonectria crassa.

A novel dsRNA mycovirus named Ilyonectria crassa alternavirus 1 (IcAV1) was found in Ilyonectria crassa isolate NW-FVA 1829. The fungus was isolated from an ash (Fraxinus excelsior L.) necrotic trunk disc infected with Hymenoscyphus fraxineus [(T. Kowalski) Baral, Queloz, Hosoya] causing ash dieback. The complete genome of IcAV1 is composed of three segments, each containing a single ORF on the positive-sense RNA. The extreme 5' UTRs of dsRNA 1 (3604 bp), dsRNA 2 (2547 bp), and dsRNA 3 (2518 bp) share a conserved hexadecamer sequence (5'-GGCTGTGTGTTTAGTT-3') and are capped. The 3' UTRs are polyadenylated. In silico analysis showed that the viral RdRP is encoded on dsRNA 1 and the capsid-protein subunits are encoded on dsRNA 3. Maximum-likelihood analysis of the aa sequence of the viral RdRP showed that IcAV1 clusters with alternaviruses from Fusarium spp., while the type member of the proposed family "Alternaviridae", Alternaria alternata virus 1 (AaV1), formed a clade together with Stemphylium lycopersici mycovirus (SlV). The function of the protein encoded on segment 2 is unknown. Based on its genome organization and its phylogenetic position, IcAV1 is suggested to be a new member of the proposed family "Alternaviridae". This is the first report of a mycovirus infecting I. crassa.

Complete genome sequence of a new quadrivirus infecting a member of the genus Thelonectria.

A novel dsRNA virus named "Thelonectria quadrivirus 1" (TQV1) was found in a member of the genus Thelonectria (Ascomycota), isolated from a root associated with stem collar necrosis of Fraxinus excelsior L. The complete genome of TQV1 is composed of four segments, each containing a single ORF on the positive sense RNA. The sequence of the 5´ (5´-(C/T)ACGAAAAA-3´) and 3´termini (5´AT(T/G)AGCAATG(T/C)GC(G/A)CG-3') of dsRNA 1 (4876 bp), dsRNA 2 (4312 bp), dsRNA 3 (4158 bp), and dsRNA 4 (3933 bp) are conserved. Based on its genome organization and phylogenetic position, TQV1 is suggested to be a new member of the family Quadriviridae. This is the first report of a mycovirus infecting a member of the genus Thelonectria.

[Nursing interventions by school nurses in Germany: A cross-sectional study]. / Interventionen der Schulgesundheitspflege in Deutschland.

Nursing interventions by school nurses in Germany: A cross-sectional study Abstract. Background: The internationally established professional profile of school nursing has not yet been implemented across the board in Germany. In model projects and some international schools the feasibility of the concept and the daily work of school nurses in Germany can already be observed. Urgent and currently often unsolved issues in the school setting are the inclusion of chronically ill students and health promotion in the living environment. Aim: The aim of this paper is to describe the interventions of school nurses in everyday school life. Method: Using a standardized online questionnaire, school nurses in Germany were surveyed regarding the activities they performed and their frequency. The data on the activities were collected based on the Nursing Intervention Classification (NIC). Data were analyzed using descriptive statistics. Results: Respondents (n = 25) focused on acute care and health education/promotion. Nursing interventions that have a family or population-based approach are performed only "every 2-3 months" or less by the average respondent. Conclusions: The daily intensive implementation of diverse nursing interventions indicates an urgent need for nursing expertise in schools.

Expression of a Structural Protein of the Mycovirus FgV-ch9 Negatively Affects the Transcript Level of a Novel Symptom Alleviation Factor and Causes Virus Infection-Like Symptoms in Fusarium graminearum.

Infections of fungi by mycoviruses are often symptomless but sometimes also fatal, as they perturb sporulation, growth, and, if applicable, virulence of the fungal host. Hypovirulence-inducing mycoviruses, therefore, represent a powerful means to defeat fungal epidemics on crop plants. Infection with Fusarium graminearum virus China 9 (FgV-ch9), a double-stranded RNA (dsRNA) chrysovirus-like mycovirus, debilitates Fusarium graminearum, the causal agent of fusarium head blight. In search for potential symptom alleviation or aggravation factors in F. graminearum, we consecutively infected a custom-made F. graminearum mutant collection with FgV-ch9 and found a mutant with constantly elevated expression of a gene coding for a putative mRNA-binding protein that did not show any disease symptoms despite harboring large amounts of virus. Deletion of this gene, named virus response 1 (vr1), resulted in phenotypes identical to those observed in the virus-infected wild type with respect to growth, reproduction, and virulence. Similarly, the viral structural protein coded on segment 3 (P3) caused virus infection-like symptoms when expressed in the wild type but not in the vr1 overexpression mutant. Gene expression analysis revealed a drastic downregulation of vr1 in the presence of virus and in mutants expressing P3. We conclude that symptom development and severity correlate with gene expression levels of vr1 This was confirmed by comparative transcriptome analysis, showing a large transcriptional overlap between the virus-infected wild type, the vr1 deletion mutant, and the P3-expressing mutant. Hence, vr1 represents a fundamental host factor for the expression of virus-related symptoms and helps us understand the underlying mechanism of hypovirulence.IMPORTANCE Virus infections of phytopathogenic fungi occasionally impair growth, reproduction, and virulence, a phenomenon referred to as hypovirulence. Hypovirulence-inducing mycoviruses, therefore, represent a powerful means to defeat fungal epidemics on crop plants. However, the poor understanding of the molecular basis of hypovirulence induction limits their application. Using the devastating fungal pathogen on cereal crops, Fusarium graminearum, we identified an mRNA binding protein (named virus response 1, vr1) which is involved in symptom expression. Downregulation of vr1 in the virus-infected fungus and vr1 deletion evoke virus infection-like symptoms, while constitutive expression overrules the cytopathic effects of the virus infection. Intriguingly, the presence of a specific viral structural protein is sufficient to trigger the fungal response, i.e., vr1 downregulation, and symptom development similar to virus infection. The advancements in understanding fungal infection and response may aid biological pest control approaches using mycoviruses or viral proteins to prevent future Fusarium epidemics.

Duplications in the 3' termini of three segments of Fusarium graminearum virus China 9.

The hypovirulence-inducing Fusarium graminearum virus China 9 (FgV-ch9) was described recently and is closely related to the Fusarium graminearum mycovirus-2 (FgV2). Both viruses share common properties of viruses belonging to the family Chrysoviridae. Re-sequencing of FgV-ch9 revealed duplications of the 3' non-coding regions of segments 2 and 3. Both duplications are arranged in a head-to-tail array, are attached to the complete terminus, and do not affect the encoded gene. An internal duplication was found in segment 5. This duplication resulted in an increase in the size of the encoded protein. In silico analysis showed similar duplications in segments 2 and 3 of FgV2.

A GFP-expressing minigenome of a chrysovirus replicating in fungi.

The Fusarium graminearum virus China 9 (FgV-ch9) is a member of the genus Betachrysovirus in the Chrysoviridae family and causes hypovirulence in its host, Fusarium graminearum, the causal agent of Fusarium head blight. Although insights into viral biology of FgV-ch9 have expanded in recent years, questions regarding the function of virus-encoded proteins, cis-acting elements, and virus transmission are yet to be answered. Therefore, we developed a tool for the establishment of an artificial 6th segment of FgV-ch9, which encodes a GFP gene flanked by the non-translated regions of FgV-ch9 segment 1. Subsequently, we have proved successful encapsidation of this artificial segment into virus particles as well as its horizontal transmission. Expression of GFP was further verified via immunoassay and life cell imaging. Thus far, we were able to establish for the first time a mini-replicon system for segmented dsRNA viruses replicating in fungi.

Does the care dependency of nursing home residents influence their health-related quality of life?-A cross-sectional study.

BACKGROUND: Studies on health-related quality of life (HRQOL) are missing for nursing home residents independent from their health conditions or interventions after admission. Our aim was to analyse if the care dependency of nursing home residents influence their HRQOL and to describe HRQOL of nursing home residents at the time of admission. METHOD: Eleven German nursing homes were randomly selected for a cross-sectional multicentre study from April 2008 until December 2009. HRQOL was measured with the Nottingham Health Profile (NHP) in the six domains "Physical Mobility", "Energy", "Pain", "Social Isolation", "Emotional Reaction" and "Sleep". Domain scores range from zero (good subjective health status) to 100 (poor subjective health status). Care dependency was evaluated using the Care Dependency Scale, age, sex, cognitive status and diseases were documented by the research assistants. Multivariate regression analysis was performed to quantify the influence of care dependency on HRQOL. RESULTS: 120 residents were included in total. HRQOL was mostly reduced in the domains "Physical Mobility" and "Energy" (mean scores >43.0), while impairment differences in the domains "Pain", "Social Isolation", "Emotional Reaction" and "Sleep" were only moderate (≤25.0). HRQOL was not influenced by the age. Women (n = 85) had a significantly poorer HRQOL in the domain "Pain" than men (mean score women: 29.5 ± 31.5; males: 14.9 ± 17.2; p = 0.011). Care dependency had an influence on the domain "Sleep" (ß = -0.195, p = 0.031), while the other domains were not influenced by care dependency. Residents with a low care dependency scored significantly lower (better HRQOL) in the domain "Sleep" than residents with a high care dependency (mean score 15.3; SD ± 19.0 versus mean score 32.8 SD ± 33.2; p < 0.02). CONCLUSION: The level of care dependency has no influence on the HRQOL from the nursing home residents' perspective apart from the domain "Sleep". High care dependency residents have a lower HRQOL in the domain "Sleep" compared to moderate and low care dependency residents. We found a significantly lower HRQOL in women compared to men in the domain "Pain".

Fast preparation of high-quality viral dsRNA from fungal tissue by commercial nucleic acid extraction kits.

The genomes of most known mycoviruses consist of double stranded RNA (dsRNA) or single stranded RNA (ssRNA). Therefore, for all aspects of mycovirology, the research is highly dependent on the quality and quantity of RNA either by the extraction of genomic dsRNA or dsRNA as a replicating intermediate. A common procedure to extract dsRNA is its binding on a cellulose matrix after a phenol/chloroform purification step. A commercial kit for dsRNA extraction facilitated the researchers´ daily work, but is not available anymore. To extract nucleic acids in a standardized good quality and quantity from small amounts of starting material, we compared commercial kits for gDNA extraction to the kits for RNA extraction using fungal material with a high and a low virus titer. Here we show that viral dsRNA can be extracted using commercial gDNA kits from fungal tissue with a high and a low virus titer in the same quality and quantity as it was done with the discontinued dsRNA extraction kit.

Stable overexpression and targeted gene deletion of the causative agent of ash dieback Hymenoscyphus fraxineus.

BACKGROUND: Due to the infection with the invasive ascomycete Hymenoscyphus fraxineus, which has been replacing the closely related and non-pathogenic native Hymenoscyphus albidus, the European ashes, Fraxinus excelsior (also known as the common ash), Fraxinus angustifolia (also known as narrow-leaved ash) and Fraxinus ornus (also known as the manna ash) are at risk. Hymenoscyphus fraxineus is the causative agent of ash dieback of the European ashes, but is non-pathogenic to the native Asian ash Fraxinus mandshurica (also known as the Manchurian ash). Even though the invasion of H. fraxineus is a great threat for ashes in Europe, the fungal biology is still poorly understood. By the use of live cell imaging and targeted gene knock-out, the fungal life cycle and host-pathogen interaction can be studied in more detail. RESULTS: Here, we developed a protocol for the preparation of protoplasts from mycelium of H. fraxineus, for their regeneration and for stable transformation with reporter genes and targeted gene knock-out by homologous recombination. We obtained mutants with various levels of reporter gene expression which did not correlate with the number of integrations. In an in vitro infection assay, we demonstrated the suitability of reporter gene overexpression for fungal detection in plant tissue after inoculation. As a proof of principle for targeted gene knock-out, the hygromycin resistance cassette of a reporter gene-expressing mutant was replaced with a geneticin resistance cassette. CONCLUSIONS: The invasive fungal pathogen H. fraxineus is threatening the European ashes. To develop strategies for pest management, a better understanding of the fungal life cycle and its host interaction is crucial. Here, we provide a protocol for stable transformation of H. fraxineus to obtain fluorescence reporter strains and targeted gene knock-out mutants. This protocol will help future investigations on the biology of this pathogen.

A novel mycovirus from Clitocybe odora.

The Ninth Report of the International Committee on Taxonomy of Viruses (ICTV) reports only a few species whose members replicate in fungi. Most of these mycoviruses are described to replicate in phytopathogenic and commercially cultivated fungi. A few reports describe virus-like symptoms and virus-like particles in non-cultivated basidiocarps such as Boletus edulis, Laccaria spp. and Cantharellus spp. However, viral sequences from non-cultivated Agaricomycotina are not available yet. In this report, I present a partial sequence of a virus found in Clitocybe odora (Bull.:Fr.) P. Kumm var. odora coding for a putative RNA-dependent RNA polymerase (RdRp) and a small 20-kDa ORF that may encode a coat protein (CP). The sequence of the putative RdRp (ORF 1) of C. odora clusters with those of the Tanathephorus cucumeris virus RdRp and the Tuber aestivum mitovirus RdRp. In addition to sequence homology, Tanathephorus cucumeris virus shows a similar codon usage and TA content in the 5'- and 3' non-translated regions, but it does not encode a putative CP. A viral DNA form proposed for Tanathephorus cucumeris virus was not found in Clitocybe odora. This viral sequence does not fit into any of the existing virus taxa.

The complete sequence of tobacco mosaic virus isolate Ohio V reveals a high accumulation of silent mutations in all open reading frames.

TMVOhioV was first described 1969 by [1] because it did break resistance of tomato breeding lines containing Tm-1- and Tm-2 resistance genes. It was obtained 1987 from Wetter (Saarbrücken, Germany) and transferred into the DSMZ-Plant Virus Collection (Braunschweig, Germany). A partial sequence of TMVOhioV, the CP gene, has been reported [11] and its comparison with a TMV type isolates (TMVtype), e.g. EMBL: V01409, revealed 50 point mutations in a total of 477 nucleotides (nts) leading to the replacement of only 7 amino acids (aa). In order to investigate the mutations in the non-translated regions and the number of silent mutation in the three other open reading frames (ORF), we sequenced the complete genome of isolate TMVOhioV and compared it to those of other Tobamoviruses.

The Nottingham Health Profile: a feasible questionnaire for nursing home residents?

BACKGROUND: The Nottingham Health Profile (NHP) assesses perceived emotional, social, and physical health problems and the extent to which such problems affect daily activities. The objective of our study was to determine the feasibility of the NHP for nursing home residents. METHODS: A prospective multicenter observational study was conducted in 11 nursing homes from April 2008 to December 2009 in which 286 newly admitted residents were included. Cognitive status was evaluated using the Mini-Mental State Examination (MMSE). The feasibility of the NHP was determined by administration rate, time and type of administration, and missing items. A cut-off point stating the MMSE score up to which the NHP can be applied was determined with receiver operating characteristics curves (ROC). Internal consistency (Cronbach's α) and test-retest reliability (intraclass correlation; ICC) were evaluated. RESULTS: Administration rate was 44.4% (n = 127) ranging from 76.1% for normal residents to 5.9% for residents with a severe cognitive impairment. An average of 12.6 (SD + 6.0) minutes was required for data collection and 92.1% (n = 117) of the questionnaires were completed during an interview. Frequently missing items were in the domain "Pain" (47.2). MMSE scores were significantly higher in the group with a completed NHP (P < 0.001) and analyses of ROC curves indicated a cut-off point of >16 on the MMSE score. Cronbach's α was >0.7 in four domains and >0.6 in two domains, while the ICC in all domains was >0.7. CONCLUSION: The NHP is a feasible questionnaire for residents with normal cognitive function and moderate cognitive impairment, and can be administered in nursing homes.

Use of physical restraints in nursing homes and hospitals and related factors: a cross-sectional study.

AIMS AND OBJECTIVES: The aim of the study was to investigate factors related to the use of restraints and to explore whether the rate of nurses was an influencing factor regarding the use of restraints in German nursing homes and hospitals. BACKGROUND: Restraints are frequently used measures in hospitals and nursing homes. Risks for falls and small nurse workforces are discussed in relation to the use of restraints. DESIGN: A secondary analysis of a cross-sectional study was carried out. Methods. Data were collected by trained nurses using standardised questionnaires in 76 nursing homes (n = 5521) and 15 hospitals (n = 2827). For data analysis, a 3-level random intercept logistic model was used. RESULTS: The prevalence of restraints (bed rails and/or belts) was 9·3% for hospital patients and 26·3% for nursing home residents. Amongst hospital patients, restraint use was more prevalent in women, older patients, patients with a high care dependency, patients who fell during the last two weeks, patients with a perceived risk of falls, polypharmacy, urinary incontinence, disorientation and confinement to bed. In the nursing homes, the restrained residents were significantly younger, more care dependent, had less falls and were more often urinary incontinent, disoriented and bedfast. The rate of nurses was not significantly related to the use of restraints in hospitals, and nursing homes according to the three-level random intercept model. CONCLUSIONS: Hospital patients with previous falls were more often restrained, but in the nursing homes, the restrained residents experienced less falls. The number of qualified nursing staff had no significant influence on the use of physical restraints. RELEVANCE TO CLINICAL PRACTICE: Lower nurse staffing ratios were not related to higher frequencies of restraint use in this study.

Characterization of a novel alternavirus infecting the fungal pathogen Fusarium solani.

A novel dsRNA mycovirus was found in Fusarium solani (F. solani) strain NW-FVA 2572. The fungus was originally isolated from a root, associated with stem collar necrosis of Fraxinus excelsior L. The viral genome is composed of four segments, which range from around 3.5 kbp to 1.7 kbp (RNA 1: 3522 bp; RNA 2: 2633 bp; RNA 3: 2403 bp; RNA 4: 1721 bp). The segments share a conserved and capped 5'-terminus and their 3'-termini are polyadenylated. Protein sequencing showed that the viral RdRP is encoded on segment 1. The virus clusters together with Aspergillus mycovirus 341 (AsV341), Aspergillus heteromorphus alternavirus 1 (AheAV1), Aspergillus foetidus virus-fast (AfV-F) and Cordyceps chanhua alternavirus 1 (CcAV1). As highest value, the RdRP showed 61.50% identical amino acids with P1 of the AfV-F. The capsid protein is encoded on segment 3, the proteins encoded on RNA 2 and RNA 4 are of unknown function. Segment 4 harbors large UTRs (186 nts at the 5'-terminus and 311 nts at the 3'-terminus). Based on its genome organization and phylogenetic position, the virus is suggested to be a new member of the proposed family Alternaviridae and was therefore named Fusarium solani alternavirus 1 (FsAV1). This is the first report of an Alternavirus infecting a fungus of the F. solani species complex (FSSC).

Pressure ulcer incidence in Dutch and German nursing homes: design of a prospective multicenter cohort study.

BACKGROUND: Pressure ulcers are a common and serious health care problem in all health care settings. Results from annual national pressure ulcer prevalence surveys in the Netherlands and Germany reveal large differences in prevalence rates between both countries over the past ten years, especially in nursing homes. When examining differences in prevalence and incidence rates, it is important to take into account all factors associated with the development of pressure ulcers. Numerous studies have identified patient related factors, as well as nursing related interventions as risk factors for the development of pressure ulcers. Next to these more process oriented factors, also structural factors such as staffing levels and staff quality play a role in the development of pressure ulcers. This study has been designed to investigate the incidence of pressure ulcers in nursing homes in the Netherlands and Germany and to identify patient related factors, nursing related factors and structural factors associated with pressure ulcer development. The present article describes the protocol for this study. METHODS/DESIGN: A prospective multicenter study is designed in which a cohort of newly admitted nursing home residents in 10 Dutch and 11 German nursing homes will be followed for a period of 12 weeks. Data will be collected by research assistants using questionnaires on four different levels: resident, staff, ward, and nursing home. DISCUSSION: The results of the study will provide information on the incidence of pressure ulcers in Dutch and German nursing homes. Furthermore, information will be gathered on the influence of patient related factors, nursing related factors and structural factors on the incidence of pressure ulcers. The present article describes the study design and addresses the study's strengths and weaknesses.

Processing of the capsid proteins of the Betachrysovirus Fusarium graminearum virus-China 9 (FgV-ch9).

While the capsid of viruses in the Alphachrysovirus genus is built of subunits of a single coat protein, the capsid of viruses grouped in the Betachrysovirus genus may consist of subunits of two different proteins. For four of these betachrysoviruses, the detected molecular weights of the putative coat proteins differ from the sizes deduced from the nucleic acid sequence. The origin of these modifications remained unclear and it was hypothesized that the coat proteins undergo unspecific degradation. In our study, we show that these modifications are based on processing steps performed by unknown factors present in extracts of several eukaryotic organisms. Furthermore, we show that the C-terminal domain of P3 is fully degraded after capsid processing and particle assembly.

Fall risk factors in older people with dementia or cognitive impairment: a systematic review.

AIM: This paper is a report of a review conducted to identify and summarize specific risk factors for falls in older people with dementia or cognitive impairments as documented by prospective or case-control studies. BACKGROUND: People with dementia have a doubled to threefold risk for falls, but the reasons for this have not yet been fully explained. Several integrative literature reviews discuss possible specific fall risk factors. However, there is lack of a systematic evaluation of studies. DATA SOURCES: The CINAHL, PubMed, EMBASE and PsychInfo databases were searched for the period between 1980 and May 2007. REVIEW METHODS: A systematic review was conducted. Cohort or case-control studies published in English or German were included if they investigated risk factors for falls or fall-related injuries in a sample consisting of participants with dementia or cognitive impairment. Two reviewers independently assessed study quality. RESULTS: Six prospective studies were included in the review. These differed concerning samples, settings, follow-up periods and examined variables. Therefore, meta-analysis was not possible. Eight categories of risk factors emerged: disease-specific motor impairments, impaired vision, type and severity of dementia, behavioural disturbances, functional impairments, fall history, neuroleptics and low bone mineral density. CONCLUSION: There is lack of sound studies examining fall risk factors in cognitively impaired elders. Well-known risk factors such as motor impairment show particular characteristics in people with dementia. In addition, behavioural disturbances contribute to their high risk for falls. Further prospective studies are needed.

Screening the risk of falls: a general or a specific instrument?

AIMS AND OBJECTIVES: The aim of this study is to investigate if a general instrument (Care Dependency Scale; CDS) has the same sensitivity and specificity as a specific instrument (Hendrich Fall Risk Model; HFRM) in a screening for fall risks. BACKGROUND: Falls of older patients are a common problem in hospitals. Apart from falls risk, nurses have to use many assessment tools to detect the patients' different care problems. To decrease the workload it would be helpful to have a general instrument used as a first screening for possible risks for different healthcare problems, such as falls, instead of specific risk instruments for each individual healthcare problem. DESIGN: A prospective design was used by measuring each patient upon admission and by registering all falls during their hospital stay. METHODS: The sample consisted of 560 patients of a geriatric hospital in Germany. All of whom gave their informed consent to participate in the study. Nurses filled in the CDS and the HFRM at the time of hospital admission. RESULTS: The CDS (cut off point or=11) had a sensitivity of 75% (47/63 fallers) and a specificity of 47% (237/497 non-fallers). CONCLUSION: The results of the CDS are similar to those of the HFRM in predicting falls. Relevance to clinical practice. The use of the CDS is preferred as it is more general and more reliable than the HFRM. The workload for nursing staff can be decreased when only one instrument is used.

[Diagnosis and classification of pressure ulcers and other skin lesions: interrater reliability and agreement]. / Diagnose und Klassifikation von Dekubitus und anderen Hautschäden: Interrater-reliabilität und Ubereinstimmung.

Accurate and precise diagnosis and classification of pressure ulcers is important in clinical practice and research. In the planning phase of a cohort study 14 data collectors were trained according to the classification of the European Pressure Ulcer Advisory Panel (EPUAP). Interrater reliability and agreement was measured using 20 images of the pressure ulcer classification CD (PUCLAS). Across all categories values varied between 0.36 (95 percent CI 0.32 to 0.40) and 0.54 (95 percent CI 0.49 to 0.58). Highest values of interrater reliability and agreement were measured for the categories "Pressure ulcer grade 4", "Pressure ulcer grade 2", and "Blanchable erythema". Low values were measured for the categories "Other lesion" and "Incontinence lesion". Interpretation and transferability of these results into practice is limited due to low prevalence of some categories, artificial assessment conditions and due to small sample sizes. More efforts must be made to further improve interrater reliability and agreement.