[Compression devices for decongestion therapy : A cross-sectional observational survey of handling, pressure, and comfort]. / Kompressionsmittel für die Entstauungstherapie : Vergleichende Erhebung im Querschnitt zu Handhabung, Anpressdruck und Tragegefühl.

BACKGROUND: If compression bandaging is not performed in a professional manner, the objectives of the therapy may not be achieved and side effects or complications may result. OBJECTIVES: This cross-sectional observational survey examines the handling of the treatment options: short-stretch bandages with padding, multicomponent compression systems, and adaptive compression bandages. PARTICIPANTS AND METHODS: During several training sessions on the topic of compression therapy, 137 participants performed compression bandagings on each other. In this regard, they were asked to achieve a predetermined pressure range (short-stretch bandages: 50-60 mm Hg, multicomponent compression systems: 40-50 mm Hg, adaptive compression bandage: 35-45 mm Hg). To evaluate the efficiency, the time used for application, the achieved pressure value, and the comfort were determined. RESULTS: Of the 302 bandagings (n = 137 participants), 28.4% lay within the given target pressure value range. This included 11.2% of performed short-stretch bandages, 35.2% of multicomponent compression systems, and 85.0% of adaptive compression bandages. Significant differences in the mean deviations are found between the treatment options. The bandage was described as being comfortable by 37.7% of users of short-stretch bandages with padding, by 65.0% of those wearing a multicomponent compression system, and by 94.6% of participants with an adaptive compression bandage. CONCLUSIONS: In practice, short-stretch bandages are still the most frequently used care option for the creation of a phlebological compression bandage. In this survey, they proved to be unsafe, time-consuming, and uncomfortable in relation to other treatment options. Multicomponent compression systems and adaptive compression bandages are treatment options that may be a contemporary alternative which also bares more comfort for the patient.

[German national consensus on wound documentation of leg ulcer : Part 2: Routine care - classification of variable characteristics]. / Nationaler Konsensus zur Wunddokumentation beim Ulcus cruris : Teil 2: Routineversorgung ­ Klassifikation der Variablenausprägungen.

BACKGROUND: Standards in the assessment and documentation of disease processes are the basis of guideline-based care. For the treatment of chronic wounds, especially leg ulcers, no approved parameters are available. OBJECTIVES: Against this background, our aim was to develop standards for the documentation of leg ulcer in routine care. This article presents the recommendations for the classification and characteristics of the variables. MATERIALS AND METHODS: The development of the documentation standard was based on a systematic literature research and was performed in a Delphi-based consensus process. The national consensus process included meetings as well as web-based questionnaires. The Consensus Group is coordinated by the German Center for Health Services Research in Dermatology (CVderm). RESULTS: The documentation standards and their variables for leg ulcer routine care were developed in seven meetings of the consensus group. The consensus group consists of 38 delegates of wound care societies, health insurances, wound networks and associations. DISCUSSION: For each variable, recommended in routine care, a distinct response scheme (defined set of variable characteristics) was defined. As a next step, a structured implementation process is required, which was part of the resolutions of the consensus group.

[German national consensus on wound documentation of leg ulcer : Part 1: Routine care - standard dataset and minimum dataset]. / Nationaler Konsensus zu Wunddokumentation beim Ulcus cruris : Teil 1: Routineversorgung ­ "Standard-Dataset" und "Minimum-Dataset".

BACKGROUND: Standards for basic documentation and the course of treatment increase quality assurance and efficiency in health care. To date, no standards for the treatment of patients with leg ulcers are available in Germany. OBJECTIVES: The aim of the study was to develop standards under routine conditions in the documentation of patients with leg ulcers. This article shows the recommended variables of a "standard dataset" and a "minimum dataset". MATERIALS AND METHODS: Consensus building among experts from 38 scientific societies, professional associations, insurance and supply networks (n = 68 experts) took place. After conducting a systematic international literature research, available standards were reviewed and supplemented with our own considerations of the expert group. From 2012-2015 standards for documentation were defined in multistage online visits and personal meetings. RESULTS: A consensus was achieved for 18 variables for the minimum dataset and 48 variables for the standard dataset in a total of seven meetings and nine online Delphi visits. The datasets involve patient baseline data, data on the general health status, wound characteristics, diagnostic and therapeutic interventions, patient reported outcomes, nutrition, and education status. DISCUSSION: Based on a multistage continuous decision-making process, a standard in the measurement of events in routine care in patients with a leg ulcer was developed.

[A standard data set for the evaluation of venous leg ulcers in selective contracts : National consensus]. / Standarddatensatz für die Evaluation bei Selektivverträgen bei Ulcus cruris : Nationaler Konsensus.

BACKGROUND: Selective agreements are becoming increasingly important in health care management. To date, no standard recommendations for the evaluation of selective contracts are available. OBJECTIVES: Against this background, a recommendation on the evaluation of selective contracts in patients with leg ulcers (LU) was developed and approved by the nationwide consensus conference. MATERIALS AND METHODS: Based on a systematic literature review and followed by a manual search through other possible evaluation indicators in the care of patients with LU, a Delphi-based consensus process was performed by various scientific societies, professional associations, insurances and supply networks. RESULTS: For the evaluation of efficiency and quality of care, a recommendation on the evaluation of selective agreements with patients with LU was consented in six meetings and in five multistage online surveys. In total, 44 evaluation indicators were identified in the quality subareas structure, process, and outcome. The outcome indicators are divided into clinical, patient-related, and cost-related indicators. CONCLUSIONS: The developed evaluation indicators represent the quality of care in patients with LU. The indicators can be applied individually, depending on the agreed contract-specific supply target. After implementation of this national standard, the comparability of selective agreements in the management of patients with LU can be ensured and consolidated.

Prevalence and Regional Distribution of Lower Limb Amputations from 2006 to 2012 in Germany: A Population based Study.

OBJECTIVE/BACKGROUND: International studies show conflicting results regarding the frequency of lower limb amputations over time. However, published data are often based on event related amputation frequencies per year, on hospital statistics or on regional surveys. Thus, they do not allow population based statements. The present study assesses the population based epidemiology of amputations in Germany. METHODS: Secondary analyses of 80 German statutory health insurance companies with 4 million insurants nationwide in 2012 were performed. From 2006 to 2012, lower limb amputations were identified in the entire population and in persons with diabetes mellitus (DM) and arterial occlusive disease (AOD). Lower limb amputations and persons with DM and arterial occlusive diseases were extracted by specific operation procedure codes and International Classification of Diseases-10 codes. Descriptive standardized analyses by age, sex, and regional distribution were conducted. RESULTS: The proportion of patients with at least one lower limb amputation in the entire population stayed constant over time at 0.04% (95% confidence interval [CI] 0.04-0.04). Extrapolated to the German population in 2012 there were 49,150 cases and 32,767 persons with amputations. In 2012, about 70% of amputations were minor (0.03% [95% CI 0.03-0.03]) versus major amputations (0.01% [95% CI 0.01-0.01]). Related to DM and AOD, there was a small decrease in the amputation rate per patient, even though the DM prevalence increased by 10.4%. CONCLUSION: The amputation rates per patient in Germany have remained stable in the overall population and show slight decline in patients with diabetes mellitus and with arterial occlusive disease between 2006 and 2012. In the future, intensified preventive measures are crucial to reduce the number of amputations of the lower extremities permanently.

Evaluation of patient-relevant outcomes of lymphedema and lipedema treatment: development and validation of a new benefit tool.

OBJECTIVES: Patient-relevant treatment benefit is traditionally measured with health-related quality of life (HRQoL) instruments. The Patient Benefit Index (PBI) methodology allows for a more direct measurement, with the patients rating both importance and achievement of treatment goals. Here, we developed and validated a PBI version specific for the assessment of benefit in lymphedema and lipedema treatment (PBI-L). METHODS: The development included five steps: (1) open item collection; (2) consensus of items in a multidisciplinary expert panel; (3) application of the German PBI-L in a cross-sectional study (n = 301); (4) translation into English; (5) application of the English PBI-L in a randomized clinical trial (n = 82). Subscales were developed using factor analysis. Construct validity was analyzed by correlating PBI-L and convergent criteria such as HRQoL and quality of care. To test for responsiveness, the association to change in HRQoL measures was computed. RESULTS: Floor and ceiling effects were low. There were few missing values. Two well-interpretable subscales were found with Cronbach's alpha >0.8 each. Global and subscale scores correlated with convergent criteria and with change in disease-specific HRQoL, but not with change in generic HRQoL. CONCLUSIONS: The PBI-L is an internally consistent, valid, and responsive instrument for the assessment of patient-relevant benefit of edema treatment.

Quality of care of patients with chronic lymphoedema in Germany.

BACKGROUND: The management of lymphoedema is complex and should be based on guidelines. To date, no data assessing quality of care in lymphoedema in Germany are available. OBJECTIVE: We aimed at evaluating the quality of care of lymphoedema in the metropolitan area of Hamburg using guideline-based indicators. METHODS: Cross-sectional, community-based study including patients with lymphoedema. Assessment included a structured interview, clinical examination and patient-reported outcomes. Quality indicators derived from guidelines by a Delphi consensus were applied. RESULTS: 348 patients (median age 60.5 years) with lymphoedema (66.4%), lipoedema (9.5%) or combined oedema (24.1%) were included. 86.4% performed compression therapy, 85.6% received lymphatic drainage. On average 55.0% of the quality of care criteria were met; 64.8% were satisfied with care. The distribution curve of the health care index was almost normal. Treatment by specialists led to a higher quality of care index. CONCLUSION: Although overall quality of care in lymphoedema is fair, many patients are not treated properly according to guidelines.

Methane emissions from MBT landfills.

Within the scope of an investigation for the German Federal Environment Agency ("Umweltbundesamt"), the basics for the estimation of the methane emissions from the landfilling of mechanically and biologically treated waste (MBT) were developed. For this purpose, topical research including monitoring results regarding the gas balance at MBT landfills was evaluated. For waste treated to the required German standards, a methane formation potential of approximately 18-24 m(3)CH(4)/t of total dry solids may be expected. Monitoring results from MBT landfills show that a three-phase model with differentiated half-lives describes the degradation kinetics in the best way. This is due to the fact that during the first years of disposal, the anaerobic degradation processes still proceed relatively intensively. In addition in the long term (decades), a residual gas production at a low level is still to be expected. Most of the soils used in recultivation layer systems at German landfills show a relatively high methane oxidation capacity up to 5 l CH(4)/(m(2)h). However, measurements at MBT disposal sites indicate that the majority of the landfill gas (in particular at non-covered areas), leaves the landfill body via preferred gas emission zones (hot spots) without significant methane oxidation. Therefore, rather low methane oxidation factors are recommended for open and temporarily covered MBT landfills. Higher methane oxidation rates can be achieved when the soil/recultivation layer is adequately designed and operated. Based on the elaborated default values, the First Order Decay (FOD) model of the IPCC Guidelines for National Greenhouse Gas Inventories, 2006, was used to estimate the methane emissions from MBT landfills. Due to the calculation made by the authors emissions in the range of 60,000-135,000 t CO(2-eq.)/a for all German MBT landfills can be expected. This wide range shows the uncertainties when the here used procedure and the limited available data are applied. It is therefore necessary to generate more data in the future in order to calculate more precise methane emission rates from MBT landfills. This is important for the overall calculation of the climate gas production in Germany which is required once a year by the German Government.

Effectiveness of advanced versus conventional wound dressings on healing of chronic wounds: systematic review and meta-analysis.

BACKGROUND: Wound dressings are essential in the treatment of chronic wounds and should be selected on valid and recent evidence. OBJECTIVE: Effectiveness of advanced compared to conventional dressings for chronic wound healing. METHODS: Comprehensive literature search, systematic review and meta-analyses of the results of advanced dressing studies on chronic wound treatment. Comprehensiveness and coverage of all relevant studies is the most striking difference in relation to other meta-analyses and systematic reviews. RESULTS: The mean odds ratio of complete healing was 1.52 favouring advanced over conventional dressings in 65 controlled trials. In 287 study conditions including uncontrolled studies, mean odds were 0.97 (advanced dressings/controlled studies), 0.77 (conventional/controlled) and 0.47 (advanced/uncontrolled). The overall healing rate was 33%. When causal treatment was applied, a reduced effect was observed. The consideration of all types of chronic wounds, advanced wound dressings and studies resulted in more study effects, more reliable estimates of mean effects and more statistical power. These differences in the design are likely to explain the differences in the meta-analytic results. CONCLUSION: A general superiority of advanced dressings on complete healing was shown. The generalizability of the results is limited by the methodological and report quality within studies identified, unexplained heterogeneity in study effects and possibly by publication bias.

[Registry research in dermatology]. / Registerforschung in der Dermatologie.

Patient registries are prospective, systematic data collections, which are non-interventional (observational) in nature and reflect care practices under routine conditions. As a result, they include the most common disease characteristics (e.g. in cancer registries) and/or medical interventions (e.g. in therapy registries). The importance of registries in health services research and in clinical medicine is rapidly increasing. This is due to increasingly scarce resources in the health system and the growing need for data on benefits and efficiency. Registries permit evaluation long-term outcomes on e.g. quality of life, effectiveness as well as treatment quality. An overview of registry methodology from definitions to data analysis is given, existing registries in dermatology in Germany are summarized.

Fundamental processes and implications during in situ aeration of old landfills.

Results of investigations from many old landfills in Germany and Europe indicate that significant emissions occur under conventional landfill operating conditions (i.e., anaerobic conditions). Significant emissions via the gas phase are predicted to last at least three decades after landfill closure, while leachate emissions are predicted to continue for many decades, potentially even lasting for centuries. When considering the specific type and quality, and quite often lack of, protection barriers associated with old landfills, these leachate and gas emissions may result in a significant negative impact on the environment. However, complete sealing of the landfill only temporarily reduces emissions because dry-conservation of the biodegradable waste fraction results, thus not allowing any severe reduction in the emission and hazardous potential of the landfill to occur. If noticeable damage of the surface capping system occurred in these landfills, infiltrating water would restart the interrupted emission formation. In contrast, aerobic in situ stabilization by means of low pressure aeration attempts to stabilize and modify the inventory of organic matter inside the landfill, acting to reduce the emission potential in a more sustainable manner. By enabling faster and more extensive aerobic degradation processes in the landfill (compared with anaerobic processes), the organics (e.g., hydrocarbons) are degraded significantly faster, resulting in an increased carbon discharge via the gas phase, as well as reduced leachate concentrations. Because carbon dioxide (CO(2)) is the main compound in the extracted off-gas (instead of methane (CH(4)), which dominated under anaerobic landfill conditions), the negative impact of diffuse LFG emissions towards an increased global warming effect may be significantly lowered. With respect to leachate quality, a reduction of organic compounds as well as ammonia-nitrogen can be expected. In addition to these positive ecological effects, aerobic in situ stabilization is associated with significant cost savings potential due to both quantitative and qualitative reductions in the aftercare period. This paper describes the fundamental processes and implications of in situ landfill aeration. Additionally, possible criteria for defining an endpoint of the active aeration process are presented and discussed.

Pollutant release and pollutant reduction--impact of the aeration of landfills.

The in situ stabilization of old deposits aims for a lasting and controlled reduction of pollutant emissions from the deposited waste in order to diminish expenditure and the duration of landfill aftercare measures. The stabilization operation so far, observed over a period of 1-2 years at three landfills in Germany, shows that leachate contamination is permanently reduced, biodegradation processes are significantly accelerated and main settlements take place within a short period of time.

Pathogenicity of Bacillus thuringiensis variety kurstaki to Ixodes scapularis (Acari: Ixodidae).

Pathogenicity of the entomopathogenic bacterium Bacillus thuringiensis variety kurstaki de Barjac & Lemille was tested against the black-legged tick, Ixodes scapularis Say. Engorged larvae dipped in a solution of 10(8) spores per milliliter showed 96% mortality 3 wk after infection. The LC50 value for engorged larve (concentration required to kill 50% of ticks) was 10(7) spores per milliliter. B. thuringiensis shows considerable potential as a microbial control agent for the management of I. scapularis.