[Support needs of care dependent individuals : Survey of general and specific needs for information, assistance and support of care dependent individuals and their relatives]. / Unterstützungsbedarfe pflegeempfangender Menschen : Erhebung allgemeiner und spezieller Informations­, Hilfe- und Unterstützungsbedarfe pflegeempfangender Menschen und ihrer Angehörigen.

BACKGROUND: In 2009, statutory regulations on information and counselling regarding nursing care needs, performed by so-called care advisors have been implemented for persons in need of long-term care and their relatives. In order to adequately prepare these care advisors, contemporary needs and requirements must be determined. The aim of the study was to determine the different needs of persons in need of long-term care and their relatives. METHOD: Care advisors were interviewed via an online survey tool using a standardized questionnaire. A 5-point Likert scale was used to determine the needs regarding information and advice on 16 specific topics. In general, overall needs regarding information and advice of care recipients and relatives were recorded using a 10-point scale (1 low and 10 high). Using classification and regression trees (CRT) and random forest, the correlation between the individual main topics and the general need for advice was analyzed. RESULTS: The participating care advisors (n = 276) rated the general demand for information of people in need of care and their relatives with a mean of 7.8 and 9.2, respectively. For those in need of care, the strongest association of general information needs was the topic of housing advice For the relatives, the topic social law aspects and benefits was the most relevant association. CONCLUSION: The general demand for information was rated very high. Since differences became obvious between those in need of care and their relatives, it is necessary to adjust care advice for these two groups.

Pressure ulcer prevention-Results of a multicentre cross-sectional survey on hospital infrastructures and processes in acute hospitals and accident and emergency departments.

AIMS AND OBJECTIVES: Pressure ulcers (PUs) are a serious health problem. They can be considered as an indicator of the quality of health care and are associated with considerable cost increases for the health care system. The prevention of PUs is a major concern in hospital care. The aim of the study was to reveal the current PU prevention-related processes and structures with a specific focus on the Accident and Emergency (A&E) Department. METHOD: In late 2018/early 2019, all German hospitals were invited to participate in a nationwide cross-sectional survey. One standardized questionnaire was assigned to a representative of each hospital. The representative was asked to state what PU-related structures and processes are implemented in their hospital, in general and specific to the A&E department. Besides mostly descriptive analysis, PU-related processes were analysed on PU incidence in a multivariate linear regression model. RESULTS: Two hundred seventy-six hospitals participated in the survey. 63.4% (n = 175) of the participating hospitals had at least one PU manager. Skin inspection was the most frequently performed procedure. Although not recommended, 1.3% (2.1%) of the facilities still use sheepskins quite often (very often). In the regression model on PU incidence, only the process 'mobilization in bed' was statistically significantly associated. Although the risk of developing a PU in the emergency department is high, more than half of the facilities had no PU guidelines. CONCLUSION: Even if recommended procedures (skin inspection, 30° positioning) have been used frequently, regular training could help to bring new scientific findings such as the use of local skin protection dressings into clinical practice. Prevention guidelines should be established in all areas of care even for A&E as well as when patients are transferred inside or out of the hospital, where the risk of PU development was considered low.

An international consensus on device-related pressure ulcers: SECURE prevention.

Catherine Milne and colleagues present the findings of their review, ccna2@juno.com.

TIME CDST: an updated tool to address the current challenges in wound care.

Despite the understanding that wounds are a common problem affecting the individual, the health service and society as a whole, there continues to be a lack of a systematic, structured, evidence-based approach to wound management. The TIME principle was first published in 2003, 1 and has since been integrated by many into clinical practice and research. However, this tool has been criticised for its tendency to focus mainly on the wound rather than on the wider issues that the patient is presenting with. At an expert meeting held in London in 2018, this conundrum was addressed and the TIME clinical decision support tool (CDST) was elaborated upon. This article introduces the TIME CDST, explains why it is required and describes how its use is likely to benefit patients, clinicians and health-service organisations. It also explores the framework in detail, and shows why this simple and accessible framework is robust enough to facilitate consistency in the delivery of wound care and better patient outcomes. Finally, it outlines the next steps for the rollout, use and evaluation of the impact of the TIME CDST.

[Prevalence and influencing factors of chronic wounds among clients of home care services in Germany]. / Prävalenz und Einflussfaktoren von chronischen Wunden bei Klienten von ambulanten Pflegediensten in Deutschland.

INTRODUCTION: Chronic or non-healing wounds are a serious problem for both the parties involved and the healthcare system. Currently, there are hardly any reliable data on the prevalence of chronic wounds in outpatient care, although this setting is becoming increasingly important. Therefore, the aim of this study was to determine the prevalence of and the factors associated with chronic wounds in clients cared for by home care services. METHOD: As part of a cross-sectional study throughout Germany in 2012, a survey was conducted among care recipients provided by home care services. The sample was drawn in a two-step procedure. First, a random sample of home care services was drawn for each federal state, followed by random selection of clients to be interviewed for each service. The aim of the study was to describe the prevalence of chronic wounds and influencing factors such as BMI, age, housing situation, activity and diabetes mellitus. Data collection through questionnaire was carried out by trained nurses. RESULTS: A total of 144 home care services with 1,296 clients had agreed to participate. With 880 care recipients from 100 home care services finally taking part in the survey, the response rate was 68 %. Of all care recipients examined, 101 had at least one chronic wound; the highest prevalence rates were observed for pressure ulcers (4.6 %) and leg ulcers (4.0 %). Care recipients with diabetes mellitus were more frequently affected by chronic wounds (16.4 %) than non-diabetic recipients (9.5 %). Community-living care recipients (14.1 % chronic wounds; 6.0 % pressure ulcers) and care recipients under the age of 65 (20 % chronic wounds; 9.5 % pressure ulcers) were affected more frequently than care recipients living alone (9.1 % chronic wounds; 3.0 % pressure ulcers) or care recipients older than 65 years (10.5 % chronic wounds; 4.0 % pressure ulcers). In the multivariate calculation, the BMI proved to be the strongest predictor. The prevalence of chronic wounds in the group of obese (BMI>35.3kg/m2) care recipients and those with activity restriction is 44.8 %. CONCLUSION: In view of the fact that one out of nine care recipients receiving assistance from home care services is affected by at least one non-healing wound, special attention should be paid to the prevention, detection and treatment of chronic wounds. Furthermore, it seems particularly necessary to identify the relevant risk groups in order to be able to initiate adequate and preventive measures at an early stage.

Specific item patterns in comparison to generalized sum score-the Care Dependency Scale (CDS) as a screening tool for specific care problems.

AIMS: The aim of this study is to identify items of the Care Dependency Scale (CDS) with overriding importance for the specific nursing care problems of pressure ulcers, falls, and malnutrition. METHOD: Secondary data analysis of 5 multicentre consecutive annual cross-sectional surveys from 2008 to 2012. For the study, data were analysed from 19 787 individuals in 262 long-term care facilities throughout Germany. Based on a standardized study protocol and international definitions, data regarding care dependency and care problems were gathered by direct examination. To identify the most relevant items of the CDS regarding pressure ulcers, falls, and malnutrition, classification trees (Classification and Regression Trees) were calculated. The validity of the identified items was then confirmed by applying "area under the receiver operating characteristic curve (AUC)" statistics. RESULTS: The Classification and Regression Tree analysis showed a total of 6 nodes for pressure ulcer prevalence on 2 levels. Both levels provided the CDS item mobility as the most important predictor for the prevalence of pressure ulcers with a prevalence of 9.0% for these being completely dependent. The most important CDS item to determine malnutrition is completely dependent on eat and drink with a malnutrition prevalence of 25.2%. Of all CDS items that have been entered into the model, the item mobility showed the strongest association with falls. For pressure ulcers, the CDS items mobility (0.72) and body posture (0.71) provided a higher AUC than the total CDS sum score. Furthermore, for malnutrition, we measured an AUC of 0.63 for item eat and drink while the total CDS provided an AUC of 0.62. CONCLUSIONS: The results of our study suggest that the CDS may be a useful tool for screening patients regarding the risk of pressure ulcers and/or malnutrition. According to our study, the CDS can be used as an assessment for many different care problems.

The effectiveness of lying surfaces in nursing care beds, a comparison of spring element systems versus conventional systems: A post marketing clinical follow-up pilot study.

BACKGROUND: Reduced mobility is a strong risk factor for pressure ulcer development in a nursing home setting. Despite this, there is a surprising lack of data regarding suitable nursing care beds in general and the prevention of pressure ulcers provided by lying surface systems in particular. In this context we aimed to assess the mobility of patients using lying surface systems either with spring elements (SES) and to compare these to conventional systems (CS; wooden slats or steel bars). METHODS: This was a prospective, randomized, controlled study in 29 patients with an age range of 54-95 years. Patients were randomly assigned to SES (n = 15) or CS (n = 14). The primary objective was to show a statistically significant difference in the proportion of patients with normal (up to 4 movements per hour) movements as evaluated by the Mobility Monitor®. Pressure distribution of the lying body weight was measured by a full body pressure mapping system XSensor®. Comfort, possibility of movement and recovery of sleep as well as pain at rest were self-rated. RESULTS: We screened a total of 39 patients of which 29 were eligible to be randomized into the two groups and 27 were finally analysed (SES = 14; CS = 13). The mean age was 81.7 ±â€¯9.5 years, 81.5% were female and the mean Braden Scale Score 22.4 ±â€¯1.3. We observed no statistically significant difference in the primary evaluation criterion (proportion of patients with a normal number of movements across 14 nights) between the SES group (81.4 ±â€¯10.8%) and the CS group (72.9 ±â€¯16.3%; p = 0.0757). There was a consistent trend for more movements in the normal range in the SES group however, which was observed when the number of hours with normal movement was plotted per night (p = 0.0004). Measured pressure values showed overall higher values for the lateral compared to the dorsal position with the SES but not the CS forming a "shoulder" between 35-55 mmHg in the dorsal position and between 35-45 mmHg in the lateral position. Self-rated comfort was significantly higher with the SES after night 14 (p = 0.0192) than with CS. CONCLUSIONS: The study is not aimed at the hard endpoint pressure ulcer, but at the physiological movement profile of patients in bed, which justifies a much smaller number of cases. For elderly nursing home patients it appears that beds with spring elements may be associated with higher normality of body movements and higher self-rated comfort. The presented study could be a contribution to reduce the care dependency of patients regarding mobility.

Underweight and malnutrition in home care: A multicenter study.

BACKGROUND & OBJECTIVES: This study aimed to provide representative figures about the prevalence of underweight and malnutrition among home care clients, and to determine the associated risk factors and the provided nutritional nursing interventions. METHODS: In 2012, a multicenter point prevalence study was conducted among 878 randomly selected clients from 100 randomly selected home care services across Germany. Following a standardized study protocol, demographics, nutritional assessments (Body Mass Index, Malnutrition Universal Screening Tool (MUST), Mini nutritional Assessment - short form (MNA-sf), nurses' clinical judgment on nutritional status) and interventions were assessed. Common nutritional risk factors for underweight and malnutrition were analyzed in a logistic regression model. RESULTS: Malnutrition figures varied between 4.8% (MNA-sf) and 6.8% (MUST), underweight between 8.7% (BMI < 20 kg/m(2)) and 10.2% (clinical judgment). Missing values were high in both malnutrition assessments (MNA-sf 48.8%, MUST 39.1%) due to a lack of information on many clients' loss of weight within the past 3-6 months. Regular weighing was performed in 33.6-57.3% of all clients, depending on weight and nutritional status. Mental overload (OR 8.1/4.4), needs help with feeding (OR 5.0/2.8) and loss of appetite (OR 3.6/3.9) were highly associated with malnutrition/underweight. CONCLUSION: Malnutrition and underweight are important issues in home care clients. Regular weighing should be performed in all home care clients so that a potential weight loss can be detected in time.

Mobility is the key! Trends and associations of common care problems in German long-term care facilities from 2008 to 2012.

BACKGROUND: Although enormous efforts have been made in auditing the quality of care, there are only few epidemiological studies available about the actual occurrence of immobility, malnutrition, urinary incontinence, cognitive impairment, falls and pressure ulcers in long-term care facilities. OBJECTIVE: The objective of this study was to provide prevalence estimates of common nursing care problems in long-term care facilities and to investigate any associations between them. DESIGN: Secondary data analysis of five consecutive annual cross-sectional multicenter studies from 2008 to 2012. SETTING: 262 different long-term care facilities throughout Germany. PARTICIPANTS: 14,798 residents older than 18 years who gave informed consent. METHODS: Health conditions were rated based on direct resident examinations according to the current international definitions. Demographic characteristics were compared with available national population statistics. Apart from descriptive statistics, Chi(2) tests were carried out for bivariate and log-regression models were performed for multivariate associations. RESULTS: Prevalence rates were stable over the years with the highest prevalence of 73.5% (95% CI 72.8-74.2) being found for urinary incontinence, for cognitive impairment it was 54.1% (95% CI 53.3-54.9) and for immobility it was 36.5% (95% CI 35.7-37.3). The lowest prevalence rates were established for the risk of malnutrition with 13.0 (95% CI 12.4-13.5), for pressure ulcers with 4.8% (95% CI 4.5-5.1) and for falls (4.4% 95% CI 4.1-4.8). In the multivariate model, immobility was most strongly associated with all of the other conditions. No statistically significant associations were found between pressure ulcers and falls, pressure ulcers and urinary incontinence, pressure ulcers and cognitive impairment and between malnutrition and urinary incontinence. CONCLUSION: Decision-makers and clinical practitioners may primarily focus on the maintenance and enhancement of mobility, because this seems to be the key predictor for many other health conditions in the context of care dependency in the nursing home setting.

Over- and undersupply in home care: a representative multicenter correlational study.

BACKGROUND/AIMS: Quality assurance and funding of care become a major challenge against the background of demographic changes in western societies. The primary aim of the study was to identify possible misclassification, respectively over and undersupply of care by comparing the Barthel Index of clients of home care service with the level of care (Stage 0, I, II, III) according to the statutory German long-term care insurance. METHODS: In 2012, a multi-center point prevalence study of 878 randomly selected clients of 100 randomly selected home care services across Germany was conducted. According to a standardized study protocol, demographics, the Barthel Index and the nurses' professional judgment-whether a client requires more nursing care-were assessed. Associations of the Barthel items and professional judgment were analyzed using univariate (Chi-square) and multivariate (logistic regression and classification-regression-tree-models) statistics. RESULTS: In each level of care, the Barthel Index showed large variability e.g. in level II ranging from 0 to 100 points. Multivariate logistic regression regarding possible under- and oversupply revealed occasionally fecal incontinence (2.1; 95 % CI 1.2-3.7), urinary incontinence (2.0; 95 % CI 1.1-3.6), feeding (1.7; 95 % CI 1.0-2.9), immobility (0.2; 95 % CI 0.1-0.6) and to be female (1.8; 95 % CI 1.2-2.6) to be statistically significantly associated. CONCLUSION: The variability in Barthel Index in each level of care found in this study indicated a large general misclassification of home care clients according to their actual need of care. Professional caregivers identified occasional incontinence, help with eating and drinking and mobility (especially in female clients) as areas of possible under- and oversupply of care. The statutory German long-term care insurance classification should be modified according to the above finding to increase the quality of care in home care clients.

Higher pressure ulcer risk on intensive care? - comparison between general wards and intensive care units.

OBJECTIVE: The objective of the study was to evaluate the effect of being treated in intensive care units in comparison with general hospital wards regarding pressure ulcer occurrence when controlled for various risk factors. BACKGROUND: Pressure ulcer occurrence is commonly used as an indicator for the quality of care. Large-scale incidence studies are costly and difficult to perform. DESIGN: Secondary analysis of patient data (n = 32,400) collected during 2002-2009 as part of eight multicentre pressure ulcer surveys in 256 German hospitals. METHODS: Ward-acquired pressure ulcer rate was used for the calculation of effect sizes as a surrogate parameter for pressure ulcer incidence. The SRISAG (surface, repositioning, immobility, shear forces, age, gender) logistic regression model was used to control for differences in case mix. RESULTS: Pressure ulcer prevention and intrinsic and extrinsic risk factors differ for patients from hospital wards compared with those from intensive care wards. The ward-acquired pressure ulcer rate in general hospital wards was 3·9% (1·5% excluding grade 1). In intensive care, the rate was 14·9% (8·5% excluding grade 1), which corresponds with an unadjusted odds ratio of 4·3 (95%CI 3·8-4·9). After the SRISAG model was applied, the odds ratio was reduced to 1·5 (CI 1·2-1·7). CONCLUSION: When surface, repositioning, immobility, shear forces, age and gender are controlled for the institutional factor intensive care unit vs. general hospital wards is no longer a high-risk factor for the development of pressure ulcer. The SRISAG model is simple and can be used to compare the occurrence of pressure ulcer between different medical specialties. RELEVANCE TO CLINICAL PRACTICE: Application of this model allows more valuable comparison of the occurrence of pressure ulcer in different specialities and enables clinical practitioners and health care planners to use this outcome as an indicator for the quality of care to avoid confounding.

Relation between pressure, friction and pressure ulcer categories: a secondary data analysis of hospital patients using CHAID methods.

BACKGROUND: According to the latest pressure ulcer definition provided by the EPUAP and NPUAP pressure and shear are named as factors causing pressure ulcers. Empirical evidence suggests that pressure forces in combination with shear seem to be primarily responsible for deeper tissue injuries leading to category III or IV pressure ulcers. Superficial frictional forces seem to cause skin lesion resembling category II pressure ulcers. OBJECTIVES: The objective of this study was to explore the empirical relationships between friction forces and category II pressure ulcers and between pressure forces and categories III and IV pressure ulcers. DESIGN: A secondary analysis of data from six German annual hospital pressure point prevalence studies. SETTINGS: 161 Hospitals of all specialties and categories throughout Germany. PARTICIPANTS: 28,299 Adult hospital patients. The average age was 65.4 (SD 17.0) years. Female participation was 55.0%. METHODS: For the classification of the sample regarding pressure ulcers as a dependent variable and the Braden scale items as predictor variables, Chi-square Automatic Interaction Detection (CHAID) for modelling classification trees, controlled for age, has been used. CHAID analysis was performed for category II pressure ulcers and categories III/IV pressure ulcers separately. RESULTS: 7.5% (95% CI 7.2-7.8) of the hospital patients had "Friction & Shear" problems according to the respective Braden sale item. 5.4% (95% CI 5.1-5.6) were "Completely immobile" according to the Braden scale item "Mobility". The category "Problem" of the item "Friction & Shear" was the strongest predictor for category II pressure ulcers. Categories III/IV prevalence was 1.9%. Compared to all other Braden scale items there was the strongest association between being completely immobile and deeper categories III/IV pressure ulcers. CONCLUSIONS: Based on a large sample of patients from multiple centres throughout Germany results indicate, that there is a strong relationship between friction forces and superficial skin lesions and between pressure forces and deeper categories III and IV PUs. This indicates that there might be different aetiologies causing different wounds. Given, that both superficial and deep ulcers have different aetiologies the validity of the current PU definition and classification is questionable, because ulcers due to maceration and excoriation are excluded from this classification system.

Falls in older hospital inpatients and the effect of cognitive impairment: a secondary analysis of prevalence studies.

AIMS AND OBJECTIVES: The objective of this study was to compare fall rates in older hospital inpatients with and without cognitive impairment. Relationships between age, gender, mobility, cognitive impairment, care dependency, urinary incontinence and medical disciplines were investigated. BACKGROUND: Falls are common in older people with cognitive impairment, but studies in the hospital setting are rare. DESIGN: A secondary analysis of three nationwide prevalence studies in German hospitals from the years 2005, 2006 and 2007 was conducted. METHOD: Trained staff nurses used a standardised instrument to collect data about accidental falls within the last two weeks in their institutions and about other patient characteristics. Data from 9246 patients aged 65 years or older from 37 hospitals were analysed. RESULTS: The fall rate for cognitively impaired patients was 12·9%, while only 4·2% of older persons without cognitive impairment experienced a fall. Comparison between medical disciplines showed great differences concerning fall risk for confused and non-confused inpatients. In multivariate logistic regression analysis, the odds-ratio association of cognitive impairment and falls was 2·1 (CI 1·7-2·7). Higher age (OR 1·5, CI 1·2-1·9), greater care dependency (OR 1·6, CI 1·1-2·1), reduced mobility (OR 2·6, CI 1·9-3·7) and being a patient on a geriatric ward (OR 1·8, CI 1·1-2·9) were also statistically significant predictors in this model. CONCLUSIONS: Cognitively impaired older people constitute a high-risk group for accidental falls in hospitals. RELEVANCE TO CLINICAL PRACTICE: Fall prevention strategies in the hospital setting should address cognitively impaired inpatients as an important high-risk group.

Friction and shear highly associated with pressure ulcers of residents in long-term care - Classification Tree Analysis (CHAID) of Braden items.

AIMS: Among various risk assessment scales for the development of pressure ulcers in long-term care residents that have been published in the last three decades, the Braden scale is among the most tested and applied tools. The sum score of the scale implies that all items are equally important. The aim of this study is to show whether specific items are of greater significance than others and therefore have a higher clinical relevance. DESIGN: Data analysis of six pressure ulcer prevalence studies (2004-2009). METHODS: A total of 17,666 residents (response rate 79.6%) in 234 long-term care facilities participated in 6 annual point prevalence studies that were conducted from 2004 to 2009 throughout Germany. For the classification of the sample regarding pressure ulcers as a dependent variable and the Braden items as predictor variables, Chi-square Automatic Interaction Detector (CHAID) for modelling classification trees has been used. RESULTS: Pressure ulcer prevalence was 5.4% including pressure ulcer grade 1 and 3.4% for pressure ulcer grades 2-4. CHAID analysis for the classification tree provided the item 'friction and shear' as the most important predictor for pressure ulcer prevalence. On the second level, the strongest predictors were 'nutrition' and 'activity' and on the third level they were 'moisture' and 'mobility'. Residents with problems regarding 'friction and shear' and poor nutritional status present with an 18.0 (14.8) pressure ulcer prevalence which is 3-4 times higher than average. CONCLUSION: CHAID analyses have shown that all items of the Braden scale are not equally important. For residents in long-term care facilities in Germany, the existence of 'friction and shear' as a potential and especially as a manifest problem has had the strongest association with pressure ulcer prevalence.

Pressure ulcer prevalence rates from 2002 to 2008 in German long-term care facilities.

BACKGROUND AND AIMS: Pressure ulcers continue to be an important issue in long-term care facilities. Besides quality initiatives (implementation of guidelines) and increased public awareness of the problem, little is known about the actual extent of the problem in Germany. The aim of this study is to provide information on the magnitude of this problem and to show whether there have been any changes through the years 2002 to 2008. In addition we wanted to know if the results were representative. METHODS: 18,706 residents in 218 long-term care facilities (response rate 77.5%). Skin examination of each resident by qualified trained nurses after informed consent was given by resident or proxy. Application of Chi-square tests, chi-square trend tests and one-way ANOVA to assess differences and trends across the years. Comparisons of study samples with data characterizing the potential population. RESULTS: Regarding gender, age, and pressure ulcer risk, the yearly samples were comparable. Pressure ulcer prevalence rates decreased from 12.5% (year 2002) to 5.0% (year 2008) (p<0.001). Prevalence rates, excluding non-blanchable erythema, decreased from 6.6% (year 2002) to 3.5% (year 2008) (p<0.001). CONCLUSIONS: Pressure ulcer prevalence in German long-term care facilities decreased from 2002 to 2008. It is highly probable that this decrease was due to more effective strategies and better prevention.

Impact of prevention structures and processes on pressure ulcer prevalence in nursing homes and acute-care hospitals.

AIM: The study aimed to give a description analysis of pressure ulcer-related structures, processes and outcomes in nursing homes and acute-care hospitals that participated once, twice and thrice in prevalence surveys. DESIGN: Repeated nationwide, multicentre, cross sectional surveys have been conducted. METHODS: A total of 7377 residents in 60 nursing homes and 28,102 patients in 82 acute-care hospitals in Germany participated in annual point prevalence surveys. Because of their strong differences in sampling and in order to be able to display the differences occurring during the repeated (first, second and third) participation of the institutions, they were arranged according to their frequency and order of participation. The percentage of used guidelines and risk assessment scales (structures), prevention devices and measures (processes), and prevalence and nosocomial prevalence (outcomes) among all persons at risk was calculated. RESULTS: The samples within the arranged groups showed no clinically relevant demographical differences. Nosocomial prevalence rates in hospitals dropped from 26.3% in the first year to 11.3% in the last year (nursing homes from 13.7% to 6.4%). The use of pressure ulcer-related structures remarkably increased during each repetition to more than 90%. Regarding the use of preventive measures and devices as an indicator for pressure ulcer-related processes results were more incoherent. CONCLUSION: Repeated participation in pressure ulcer surveys led to a decrease in outcomes (lower pressure ulcer prevalence rates), to high opposite effects regarding pressure ulcer-related structures (increased use of all guidelines/risk assessment scales) and to moderate adverse effects regarding pressure ulcer-related processes (increased use of most preventive measures and devices).

Dilemmas in measuring and using pressure ulcer prevalence and incidence: an international consensus.

Pressure ulcer prevalence and incidence data are increasingly being used as indicators of quality of care and the efficacy of pressure ulcer prevention protocols. In some health care systems, the occurrence of pressure ulcers is also being linked to reimbursement. The wider use of these epidemiological analyses necessitates that all those involved in pressure ulcer care and prevention have a clear understanding of the definitions and implications of prevalence and incidence rates. In addition, an appreciation of the potential difficulties in conducting prevalence and incidence studies and the possible explanations for differences between studies are important. An international group of experts has worked to produce a consensus document that aims to delineate and discuss the important issues involved, and to provide guidance on approaches to conducting and interpreting pressure ulcer prevalence and incidence studies. The group's main findings are summarised in this paper.

Pressure ulcers in German nursing homes and acute care hospitals: prevalence, frequency, and ulcer characteristics.

In German healthcare facilities, research-based knowledge of pressure ulcers and their relation to patient characteristics is limited. To provide information for national and international comparison on pressure ulcers and related issues, two cross-sectional surveys were conducted among 21,574 German hospital patients and nursing home residents (147 institutions total) in 2002 and 2003. Prevalence and frequency rates of pressure ulcers in people at risk (Braden score of