[Guidelines for consultations regarding incontinence care products]. / Leitlinie Hilfsmittelberatung bei Harninkontinenz.

An investigation of the German consumer organisation "Stiftung Warentest" in 2017 confirmed significant deficiencies in the information, advice and supply of incontinence care products received by urinary incontinence patients. The German Society of Urology (DGU) thereupon drafted and later published guidelines concerning the consultation of patients in the context of incontinence care. Important aspects of the consultation process include the determination of the type of incontinence as well as its severity, clinical examination, and advice regarding possible curative treatments. However, the advice appointment takes centre stage and should ideally be conducted by a qualified person in a separate room granting sufficient privacy and time. Furthermore, repeated supply of a selection of samples for differing degrees and types of incontinence, accommodating the patient's individual preferences and anatomical features, is crucial in order to ensure optimal incontinence care. In the case of commercial health care service providers, transparency relating to the financial implications of e.g. expensive products is key, which is what has been intended by German health insurance providers. The new guidelines concerning urinary incontinence care consultation constitute a step towards the improvement and structuring of processes in the consultation regarding, and the supply of, incontinence care products.

[Rehabilitation Processes in Out- and Inpatient Rehabilitation after Radical Prostatectomy]. / Rehabilitationsprozesse in ambulanter und stationärer Rehabilitation nach radikaler Prostatovesikulektomie.

We evaluated processes in in- and outpatient rehabilitation after radical prostatectomy. Overall, we analyzed motivation and expectations of 119 in- and 719 outpatients (aged≤64) at the beginning of rehabilitation as well as satisfaction and the amount of interventions at the end. Compared to inpatients outpatients had a higher socio-economic status and better physical condition. Both groups reported similar outcomes regarding motivation, expectation and satisfaction. Furthermore in- and outpatients got a comparable amount of interventions, but both groups differed to some extent in regard to the kind of interventions. In- and outpatients are comparable in regard to their received amount of interventions. Discrepancies concerning the kind of interventions are due to differences between in- and outpatients. The results indicate specific patients' characteristics in both settings, but more research is needed to verify these findings.

[Rehabilitation of prostate cancer patients : A multidisciplinary consensus]. / Rehabilitation von Patienten mit Prostatakarzinom : Ein multidisziplinärer Konsens.

BACKGROUND: Even though several specialist groups, including the German Pension Insurance (Deutsche Rentenversicherung) and health insurance funds, participate in the rehabilitation of patients with prostate carcinoma, there is no standardized rehabilitation program available for these patients. Consequently, there is no transparency regarding the services provided within the scope of rehabilitation for the referring physicians to uro-oncological rehabilitation, in particular, neither for physicians at urological acute-care clinics, nor for the patients concerned. Rehabilitation clinics are rather left to their own devices as to which services they provide in the treatment of the respective disease and in social situations, but also with regard to the consulting services offered. PROBLEM: Development of a standard for the rehabilitation of patients with prostate carcinoma, taking into account both specialist circles and self-help groups relevant to this matter. METHODS: Specialist groups, including self-help groups participating in the rehabilitation of patients with prostate cancer, have formed an expert group and developed the present standard. To this end, a thematic unsystematic literature review was carried out in advance to provide an evidence-based foundation. RESULTS: Views were given with regard to rehabilitation diagnostics, the therapy of urinary incontinence and erectile dysfunction, sport and physical exercise therapy, psycho-oncology, and social- and disease-related consulting. In this context, the focus was set on classification as well as on the consensus strength of the respective recommendations. CONCLUSION: All parties involved in the rehabilitation of prostate cancer patients, as well as the patients and the responsible cost bearers, can now use the standard as an orientation guide.

[Quality of life, psychological distress, and social outcomes after radical prostatectomy. Results from a urology competence center for rehabilitation]. / Lebensqualität, psychische Belastung und sozialmedizinisches Outcome nach radikaler Prostatektomie : Ergebnisse aus dem Urologischen Kompetenzzentrum für die Rehabilitation.

BACKGROUND: Quality of life is an important parameter for quality assurance of the results. After radical prostatectomy, quality of life is often limited. The degree of urinary incontinence correlates significantly with quality of life. RESULTS: Oncological and functional results are significantly decreased with the age of the patients. On the other hand, the psychological distress of younger patients is significantly greater than in the elderly. In the relative short period of 3-4 weeks of an inpatient rehabilitation in our urology competence center for rehabilitation, the mean decrease of urinary loss (24-h pad test) was 44.4 %. Psychological distress also decreased significantly as measured by the questionnaire on psychological distress FBK-R10 (p < 0.001). CONCLUSIONS: With this, quality of life significantly increased in all function and symptom scales of the QLQ-C30. Thus, this makes reintegration into social life easier. The return to work rate of employed persons after our specific urological rehabilitation program following radical prostatectomy was 87 %.

[Specialist uro-oncological rehabilitation after treatment for prostate cancer--update 2015. Position statement of the working group on "rehabilitation of urological and nephrological diseases" of the German Society of Urology with respect to current S3 guidelines]. / Fachspezifische uroonkologische Rehabilitation nach Therapie des Prostatakarzinoms--Update 2015. Positionsbestimmung des Arbeitskreises "Rehabilitation urologischer und nephrologischer Erkrankungen" der DGU vor dem Hintergrund der aktuellen S3-Leitlinie.

After uro-oncological primary therapy of prostate cancer the quality of life of patients is often limited. The adequate and prompt treatment of specific urological functional, physical and mental deficits has a decisive influence on the quality of life. These deficits can be recorded using instruments for measuring the quality of life, in particular the QLQ-C30 of the European Organization for Research and Treatment of Cancer (EORTC) and the SF-36 questionnaires. The quality of life is the most important parameter for quality assurance of the results. The primary objectives are the therapy of postoperative functional disorders, in particular urinary incontinence and erectile dysfunction in addition to overcoming the disease. The "urological triad" plays a central role in recovering the quality of life and patient satisfaction.

[Cleaning and disinfection of surfaces in hospitals: Data on structure, process and result in the Frankfurt/Main Metropolitan Area]. / Flächenreinigung und -desinfektion im Krankenhaus - Struktur-, Prozess- und Ergebnisqualität : Ergebnisse der infektionshygienischen Überwachung in Frankfurt am Main, 2014.

INTRODUCTION: In addition to hand hygiene and reprocessing of medical products, cleaning and disinfection of surfaces is also an important issue in the prevention of germ transmission and by implication infections. Therefore, in 2014, the quality of the structure, process and result of surface preparation of all hospitals in Frankfurt am Main, Germany, was monitored. METHODS: All 17 hospitals transferred information on the quality of structure. Process quality was obtained through direct observation during cleaning and disinfection of rooms and their plumbing units. Result quality was gained using the fluorescent method, i.e. marking surfaces with a fluorescent liquid and testing if this mark has been sufficiently removed by cleaning. RESULTS: Structure quality: in all hospitals the employees were trained regularly. In 12 of them, the foremen had the required qualifications, in 6 hospitals unclarity as to the intersection of the cleaning and care services remained. In 14 hospitals only visible contamination was cleaned on the weekends, whereas complete cleaning was reported to take place in 12 hospitals on Saturdays and in 2 hospitals on Sundays. The contractually stipulated cleaning (observations specified in brackets) averaged 178 m(2)/h (148 m(2)/h) per patient room and 69 m(2)/h (33 m(2)/h) for bathrooms. Process quality: during process monitoring, various hand contact surfaces were prepared insufficiently. Result quality: 63 % of fluorescent markings were appropriately removed. CONCLUSION: The need for improvement is given especially in the area of the qualification of the foremen and a in a clear definition of the intersection between cleaning and care services, as well as in the regulations for weekends and public holidays.

[Hygiene in endoscopy in clinic and practice 2013 in comparison with 2003--structure and process quality]. / Struktur- und Prozessqualität bei der Aufbereitung flexibler Endoskope in Klinik und Praxis in Frankfurt am Main--2013 im Vergleich zu 2003.

BACKGROUND: Endoscopy is an important part of modern medical diagnostics and therapy. The invasive procedures are however associated with a risk to transmit infections. Against this background the KRINKO has published the "Hygienic requirements for the reprocessing of flexible endoscopes and endoscopic accessories" in 2002 and has updated these recommendations in 2012. In 2003 and 2013 all gastroenterological facilities in Frankfurt am Main using flexible endoscopes were monitored for compliance with the recommendations. METHODS: The inspections were performed after prior notice by a staff member of the health authority using a checklist which had been developed on the basis of the current KRINKO recommendations. RESULTS: In both years all institutions performing endoscopic procedures were visited: 2003 15 hospitals and 23 practices; 2013 14 clinics and 10 practices. In 2013 (data for 2003 in brackets) 100 % (93 %) of the hospitals and 60 % (22 %) of practices reprocessed their endoscopes by automated methods. The appropriate reprocessing and filling of water bottles for rinsing the scope channels with sterile water and the sterilisation of accessories were satisfactorily performed in 2003 and 2013 by all hospitals. However in 2013 only 90 % (2003: 74 %) of the practices correctly reprocessed water bottles and 80 % (52 %) used sterile water for filling the bottle. In 2013 100 % (2003: 57 %) of the practices correctly sterilised accessory instruments, while 2 practices used disposable, i. e., single-use materials. In 2013 all institutions performed microbiological tests according to KRINKO recommendations, while in 2003 all hospitals but only 43 % of the practices could present such tests. DISCUSSION: While the gastroenterological departments of Frankfurt hospitals already complied with the KRINKO recommendations in 2003, the inspection of several practices in 2003 had revealed considerable shortcomings in the implementation of these recommendations. Subsequently the practices have improved their hygiene management.

[Voluntary work in social and health care: a critical review of assessment instruments]. / Freiwilligenengagement im Gesundheits- und Pflegebereich: Ein Critical Review über Assessmentinstrumente.

BACKGROUND: Due to an increasing need for voluntary workers in the provision of care for care-dependent people, sustainable recruiting, retention, and quality management strategies are required. In this regard, assessment instruments (AI) are helpful as a basis for obtaining information and planning. The aims of this critical review are to identify AIs in voluntary work and to analyze and critically appraise their domains, target groups, and psychometric properties. METHODS: A systematic search with an interdisciplinary emphasis was conducted in Medline, CINAHL, PsycINFO and other socioscientific databases. After the selection of identified articles, 12 research papers remained for analysis and were summarized in a critical review. RESULTS: In total, 15 AIs, 13 domains (e.g., motivation, satisfaction), and 4 target groups could be identified. The domain "motivation" and the target group "voluntary workers in hospice/palliative care" were most frequently represented. Currently, there are no instruments available which cover a broad range of domains and target groups. CONCLUSION: To support sustainability and quality of care in volunteerism, the development of new AIs is necessary.

[Most desirable is to take care of oneself as long as possible. Transitions into old age with respect to habitation]. / Das Erstrebenswerteste ist, dass man sich so lange wie möglich selbst versorgt: Altersübergänge im Lebensbereich Wohnen.

In the past, retiring from work life was considered the central threshold for the transition into the life phase of old age. In the meantime, however, the de-standardization of the life course calls for a redefinition of this transition: it has to be assumed that the exit from work life cannot be considered the only indicator for the transition into old age anymore. The results presented here address transitions into old age with respect to habitation. Adopting a qualitative empirical approach, older peoples' attitudes towards housing arrangements in late adulthood and at the end of life were surveyed and analyzed. The article focuses on the interviewees' descriptions regarding their anticipated and preferred housing scenarios which then serve as a basis for the reconstruction of concepts of transition into old age with respect to habitation.

[MRSA bloodstream infections in hospitals in Frankfurt/Main, Germany, 2010 : Results of the mandatory notification and suggestions for improvement]. / MRSA in Blutkulturen in Frankfurter Krankenhäusern 2010 : Ergebnisse der Meldepflicht nach Infektionsschutzgesetz und Vorschläge zu ihrer Verbesserung.

Since 1 July 2009 in accordance with the statuary order based on the German law for infectious diseases (Infektionsschutzgesetz), MRSA in blood and liquor must be notified to the public health authorities. The aim of extension of the notification to report is to improve the surveillance of nosocomial infections and the prevention of nosocomial MRSA infections. In addition to MRSA detection, data on symptoms and risk factors, e.g., medical devices, must also be reported. In this report, data of bloodstream MRSA infections in hospitals in Frankfurt/Main, Germany, for the first complete year (2010)were evaluated. In 2010, 58 MRSA-positive bloodstream infections were reported by the 17 hospitals in Frankfurt to the health protection authorities, i.e., 0.0360 MRSA/1,000 patient-days (range: 0- 0.109/1,000 patient-days). However, 10 of these infections initially had not been reported to the public health department in charge for the hospitals, but to the health departments according to the patient's addresses. Although most of the infections were reported from large hospitals (>100,000 patient-days/year), the highest incidences (0.0416/1,000 patient-days) were reported from small hospitals (<50,000 patient-days/year). Of the blood specimen, 13 (22.4%) were drawn on the first day of hospital stay, thus, indicating an imported infection. While 90% of the patients with MRSA in the bloodstream suffered from fever, 80% had sepsis and 34.5% suffered from pneumonia. Medical devices, such as central venous catheters and PEG, were reported from 60% of the patients. In the MRE network Rhine-Main region, the public health authorities asked for some more detailed information, such as risk factors for MRSA colonization (history for MRSA, recent hospital stay or antibiotic therapy, skin disorders, dialysis, residence in a retirements home), and for screening results as well as for the MRSA management, i.e., isolation of the patient and, if necessary, the contact patient. In 55% of the cases, the patients were identified by the clinics themselves as being patients with MRSA risk factors, mainly because of a history of MRSA (29%), recent hospital stay (71%), and antibiotic therapy during the last 6 months (52%). Screening was performed in 31 (53%) of the patients, most of them (71%) with positive MRSA nose swab. If the patients were screened, significantly fewer contact patients had to be screened and isolated later. Thus, to improve surveillance data on MRSA bloodstream infections, the notification route to the public health authorities responsible for the clinic hosting the patient must be strictly obeyed in order to avoid underreporting und underassessment of nosocomial infection. Although asking for clinical symptoms may be useful to validate the result in some cases, focus should be placed on risk factors and risk management, including screening and isolation. Only then can the aim of improving surveillance and reduction of nosocomial MRSA infection be achieved.

[Urinary incontinence after radical prostatectomy: do older patients have an increased risk?]. / Harninkontinenz nach radikaler Prostatovesikulektomie? : Haben ältere Patienten ein erhöhtes Risiko?

The investigation was intended to research the correlation between age and urinary incontinence after radical prostatectomy (RP). We considered the effects of RP as well as bladder function impairment and urge symptomatology of the elderly. A total of 3,912 patients after RP were included subsequent to aftercare. They were divided into age groups, and data on micturition and urinary loss were documented. We found that urinary loss was proportional to age. We concluded that older patients need more intense diagnostic workup and treatment during rehabilitation with respect to urinary incontinence. Presurgical advice should consider these facts.

[Transrectal prostate biopsy: effective anesthesia, complications, and influence on clinical outcome after radical prostatectomy]. / Prostatastanzbiopsien : Optimale Analgesie, Komplikationen und Einfluss auf Outcomeparameter nach radikaler Prostatektomie.

The aim of the study was to evaluate the best anesthesia for transrectal prostate biopsy, the complications after biopsy, and the influence of the biopsy on the clinical outcome after radical prostatectomy. The analysis included 1,383 patients after radical prostatectomy. With respect to compliance the biopsy should be performed under anesthesia. The most efficient procedure for pain reduction is analgosedation. Periprostatic local anesthetic in combination with the application of a lidocaine-containing jelly is in alternative use. Antibiotic prophylaxis should be given in consideration of possible antibiotic resistance due to recently administered antibiotic therapy. The percentage of R1 resection is higher if only one prostate biopsy can detect the carcinoma and leads immediately to radical prostatectomy. When several biopsies are necessary to detect the carcinoma the percentage of R1 resection is lower. Repeated prostate biopsies have no effect on the patients' outcome after radical prostatectomy. The best time for radical prostatectomy in relation to urinary incontinence is 8 weeks after prostate biopsy.

[Hygienic procedures in operating theatres--data obtained by hygiene control measures of the public health service at Frankfurt am Main in 2007 compared with 2000]. / Hygiene beim Operieren--Ergebnisse der infektionshygienischen Uberwachung von Operationseinheiten in Frankfurter Krankenhäusern 2007 im Vergleich mit 2000.

BACKGROUND: Good hygiene practice in hospitals and in operating theatres is mandatory to minimise nosocomial postoperative infections. Special guidelines of the German commission for hospital hygiene and infection prevention are available. Public health departments are obliged to control the implementation of appropriate hygienic measures in clinics. Here, the data of the hygiene control visits to all operating units in clinics in Frankfurt/Main in 2007 are presented, and compared to the data obtained in 2000. METHODS: The constructive and functional as well as the personal hygiene were surveyed in all operating theatres in hospitals in Frankfurt/M, using a very detailed checklist with more than 100 items, based on the guidelines of the German commission for hospital hygiene and infection prevention. Checklist and control procedure in 2007 were identical to those used in 2000. RESULTS AND DISCUSSION: Since 2000, two clinics and several peripheral OP theatres have been closed, whereas in other clinics new operation theatres have been built, so that in 2007 in 16 hospitals 29 operating wards with 122 operating theatres were controlled (2000: 18 hospitals, 36 operating wards and 106 operating theatres). Layout of rooms, equipment with operating materials, cleaning and disinfection of surfaces, of anaesthetic devices as well as of surgical instruments were very much improved. In 2007, in all clinics, surgical instruments were processed according to standardised and validated methods (2000: 0!). In total, great improvements in hygiene procedures in operating units in Frankfurt/Main could be seen in 2007, compared to 2000.

[Reprocessing rigid and flexible cystoscopes in urology: recommendations for ambulant practices]. / Sachgerechte Aufbereitung starrer und flexibler Zystoskope : Hinweise für die Praxis.

Infection control visits of the public health department in the city of Frankfurt a.M., Germany, revealed the need for easily understandable and practicable information and recommendations for the reprocessing of rigid and flexible cystoscopes. Based on the German Guidelines for reprocessing medical devices and cystoscopes practical information and examples of specific reprocessing schedules are given in this article in order to enable the personnel in the practices to comply with the guidelines and to prevent nosocomial infections.

[Reprocessing cystoscopes in urology. Guideline compliance in hospitals and private practices in Frankfurt/M, Germany in 2005/2006]. / Aufbereitung von Cystoskopen in der Urologie. Was geschieht wirklich? Ergebnisse der Begehungen des Stadtgesundheitsamtes Frankfurt, 2005/2006.

After having been informed about current guidelines, all urologic units in hospitals and private practices in Frankfurt/Main were visited in 2005/6 by members of the public health department and assessed using a checklist based on the recommendations of the German Guidelines for reprocessing medical instruments including rigid and flexible cystoscopes. In 12 hospitals and 22 private practices cystoscopy was performed using rigid cystoscopes, whereas flexible cystoscopes were used in 7 hospitals and 8 private practices. Cystoscopy with flexible instruments was more common in ambulatory than in clinic settings (about 1150/year vs. 280/year). In hospitals, reprocessing of the rigid cystoscopes was performed in special units for reprocessing (disinfection, sterilisation) using validated automatic processes, whereas reprocessing of flexible cystoscopes often was performed in the urologic units themselves, and not always in a correct manner. In the private practices, mainly manual reprocessing procedures were in use for rigid cystoscopes, in 18 out of 22 practices correct. However, only in 50 % of the private practices, sterilisation equipment was available for reprocessing rigid cystoscopes and/or endoscopic accessories. Flexible cystoscopes were reprocessed using a washer-disinfector in one practice, in the other ones, manual reprocessing was performed. In two practices only, reprocessing according to the guidelines was seen. Infection control advice and repeated control of the public health department resulted in the correction of most processing faults within some months.

[Current hygiene status in endoscopic practice. Results from monitoring the reprocessing of flexible endoscopes in hospitals and private practices in Frankfurt on the Main, Germany, 2003/4]. / Wie steht es um die Hygiene beim Endoskopieren? Ergebnisse der infektionshygienischen Uberwachung der Endoskopie-Einrichtungen in Frankfurt am Main, 2003 und 2004.

Flexible endoscopy is essential for the practice of modern medicine. However, with inadequate reprocessing of endoscopes and additional instruments, infections can be transmitted. Therefore, guidelines for reprocessing flexible endoscopes have been published in many countries. The goal of the present survey was to examine the current compliance with German Guidelines in a German urban region, covering all hospitals (15 hospitals) and private practices (23 practices) of this area, without any exception. All endoscopic units in Frankfort on the Main were visited by members of the Public Health Service, using a checklist based on the recommendations of the German Guidelines. In 2004, a reevaluation of 14 hospitals and 20 private practices took place, either by analysing the written reports of the institutions or by revisiting the institutions. In 2003, compliance with the guidelines in hospitals was satisfactory. In practices, however, many problems were identified in 2003. Between 2003 and 2004, great improvements could be seen (data of 2003 in parentheses). At the end of 2004, in 90% of the practices adequate storage of the endoscope without risk of recontamination (2003:52%), correct reprocessing the bottle and the tube for air/water channel flushing including filling with sterilized water was observed (2003:74% and 52%). In 100% of the practices, ultrasonic cleaning (2003:26%) and sterilizing of endoscopic accessories was guaranteed (2003:57%) and routine tests of endoscopes after reprocessing (2003:56%) were performed. In conclusion the relevance and the effect of the advising and control of public health have been so efficient that between 2003 and 2004 most faults have been corrected. Therefore control visits of the Public Health Services should not only cover hygiene in reprocessing the endoscopes but also hygiene in reprocessing endoscopic accessories as well.