[Prevalence of malnutrition, interventions and quality indicators in German nursing homes - first results of a nationwide pilot study]. / Prävalenz von Mangelernährung, Maßnahmen und Qualitätsindikatoren in deutschen Altenpflegeheimen - erste Ergebnisse einer landesweiten Pilotstudie.

AIM OF THE STUDY: The aims of this study were to test the transfer and feasibility of a Dutch annual survey on malnutrition into German nursing homes and to gather first data about the prevalence of malnutrition, treatment and quality indicators in German resident homes. METHODS: A cross-sectional multicentre study, using a standardised multilevel instrument (observation, questionnaire) developed in the University of Maastricht was applied. Variables are indicators for malnutrition and its risks, quality indicators, care dependency and treatment initiatives. RESULTS: The sample consisted of 32 nursing homes with 2,444 participating residents. 26% of the residents show indicators of malnutrition, a risk of malnutrition can be found in another 28%. Only one quarter of the nursing homes use a standardised nutritional screening instrument. Significantly more people with dementia have indicators of malnutrition. Most facilities provide a protocol or a guideline for the prevention and treatment of malnutrition. Also most are training their staff regularly in questions of malnutrition, half the institutions employ dieticians or nutritionists. Special treatment was initiated in half of all residents having indicators of malnutrition or showing a risk. CONCLUSION: The Dutch instrument is applicable in German nursing homes. Its utilisation shows that malnutrition is still a problem in German nursing homes. The standardised assessment of nutritional status is the exception; the interventions carried out should be improved.

Effects of peer review on outpatient psychotherapy: therapist and patient follow-up survey.

Interviews with 80 therapists and 50 patients at a community mental health center revealed that peer review effectively monitored the appropriateness of treatment and allocated limited treatment funds without unduly interfering with established treatment patterns, relationships, or outcomes. Most therapists reported receiving helpful consultation from the peer review committee, and the process encouraged them to focus more clearly on treatment goals. On the other hand, patients were concerned about the committee's role in making decisions about their treatment. Therapists noted as a problem the lack of certainty in establishing a treatment contract prior to peer review since the contract with the patient must remain fluid during the evaluation period. The therapists and patients demonstrated remarkable agreement in their assessment of treatment progress and whether further therapy was needed.

Automated gravimetric titrations.

Gravimetric titrations are performed by an automated system consisting entirely of readily available components, such as a digital electronic top-loading balance, a pH-meter, a titration controller, a titration valve assembly, and related accessories. Substantial increases in accuracy and speed result, along with improved data-handling capability and increased system flexibility.

Therapists' acceptance of peer review in a community mental health center.

Eighty therapists, the entire attending staff of a community mental health center, were interviewed to assess their perceptions of the center's interdisciplinary peer review system after it had been in operation for three and a half years. While many expressed reservations about parts of the system, about two-thirds felt that the review committee generally maintained an appropriate balance between quality of care and allocation of funds. More than 90 per cent found peer review an educational experience, and more than half said they would now choose to present casses to the committee even if not required to do so. Fifteen per cent felt they had experienced bias because of the professional disciplines of the reviewers. After presenting additional findings, the authors tell why they believe this particular system has a high degree of acceptance.

Therapists', patients', and inpatient staff's views of treatment modes and outcomes.

Data were gathered on 199 consecutive admissions to a community mental health center in an exploratory study to compare patients, therapists, and inpatient staff's perceptions of inpatient treatment. The three groups showed little agreement on the identification of patients' symptoms or on assessments of change for those cases in which they agreed on the symptoms. There was also little concurrence between the inpatient staff and therapists in reporting which major therapeutic modalities they used, and in identifying cases in which there were communication problems between therapist and staff. However, neither the use of different treatment approaches nor the existence of communication problems was related to longer lengths of stay or poorer outcomes. The authors note that many of the findings are consistent with comparisons elsewhere of patients' and caregivers' perceptions of outpatient psychotherapy and general medical care.