[Polarity of the freely formulated MMST sentence and state of health of people with dementia : Results of a cross-sectional study]. / Polarität des frei formulierten MMST-Satzes und Befinden von Menschen mit Demenz : Ergebnisse einer Querschnittstudie.

BACKGROUND: The mini-mental status examination (MMSE) includes a task in which participants are asked to write a sentence of their own choice. The emotional tone of the sentence may be related to the emotions of the writer; therefore, it was investigated whether the emotional tone of the sentence in the MMSE written by people with dementia was associated with health-related quality of life and depressive symptoms. MATERIAL AND METHODS: A secondary analysis was carried out based on the cross-sectional data of 107 people with dementia included in the "7th framework EU project RightTimePlaceCare". Two raters assessed the emotional tone of the sentence based on a standardized procedure as positive, neutral or negative. The association between the emotional tone of the sentence, health-related quality of life and depressive symptoms was investigated. Health-related quality of life was assessed by the quality of life in Alzheimer's disease questionnaire and depressive symptoms by the Cornell scale for depression in dementia questionnaire. RESULTS: The sentences were rated as either positive or neutral in both cases with 42 % and 16 % were judged to have a negative emotional tone. The variance analysis by ANOVA indicated significant differences between the three groups of sentences regarding health-related quality of life of the writer (p = 0.04). The results of the Scheffé test confirmed a significant difference between sentences with a positive and negative tone and the health-related quality of life where people who wrote a sentence with a negative tone showed a lower health-related quality of life (p = 0.043). No significant association was revealed regarding depressive symptoms (p = 0.97). CONCLUSION: It remains to be investigated in future studies whether the emotional tone is a reliable indicator of health-related quality of life and depressive symptoms of people with dementia, so that the written MMSE sentence can be used for diagnostic purposes.

The association between attendance of midwives and workload of midwives with the mode of birth: secondary analyses in the German healthcare system.

BACKGROUND: The continuous rise in caesarean rates across most European countries raises multiple concerns. One factor in this development might be the type of care women receive during childbirth. 'Supportive care during labour' by midwives could be an important factor for reducing fear, tension and pain and decreasing caesarean rates. The presence and availability of midwives to support a woman in line with her needs are central aspects for 'supportive care during labour'.To date, there is no existing research on the influence of effective 'supportive care' by German midwives on the mode of birth. This study examines the association between the attendance and workload of midwives with the mode of birth outcomes in a population of low-risk women in a German multicentre sample. METHODS: The data are based on a prospective controlled multicentre trial (n = 1,238) in which the intervention 'midwife-led care' was introduced. Four German hospitals participated between 2007 and 2009.Secondary analyses included a convenience sample of 999 low-risk women from the primary analyses who met the selection criterion 'low-risk status'. Participation was voluntary. The association between the mode of birth and the key variables 'attendance of midwives' and 'workload of midwives' was assessed using backward logistic regression models. RESULTS: The overall rate of spontaneous delivery was 80.7% (n = 763). The 'attendance of midwives' and the 'workload of midwives' did not exhibit a significant association with the mode of birth. However, women who were not satisfied with the presence of midwives (OR: 2.45, 95% CI 1.54-3.95) or who did not receive supportive procedures by midwives (OR: 3.01, 95% CI 1.50-6.05) were significantly more likely to experience operative delivery or a caesarean. Further explanatory variables include the type of hospital, participation in childbirth preparation class, length of stay from admission to birth, oxytocin usage and parity. CONCLUSION: Satisfaction with the presence of and supportive procedures by midwives are associated with the mode of birth. The presence and behaviour of midwives should suit the woman's expectations and fulfil her needs. For reasons of causality, we would recommend experimental or quasi-experimental research that would exceed the explorative character of this study.

TNFα-induced down-regulation of Sox18 in endothelial cells is dependent on NF-κB.

The transcription factor Sox18 plays a role in angiogenesis, including lymphangiogenesis, where it is upregulated by growth factors and directs the expression of genes encoding, e.g., guidance molecules and a matrix metalloproteinase. Conversely, we found that in human umbilical vein endothelial cells (HUVEC) Sox18 is repressed by the pro-inflammatory mediator TNFα (as well as IL-1 and LPS). Since a common feature of these mediators is the activation of the NF-κB signaling pathway, we investigated whether Sox18 downregulation is dependent on this transcription factor. Transduction of HUVEC with an adenoviral vector directing the expression of the NF-κB inhibitor IκBα prevented the downregulation of Sox18. Transient transfections of Sox18 promoter reporter genes revealed that the downregulation takes place on the level of transcription, and that the p65/RelA subunit of NF-κB was operative. Furthermore, the responsible promoter region of Sox18 is located within -1.0kb from the transcriptional start site. The repression of Sox18 and its target genes may lead to altered formation of vessels in inflamed settings.

Validity, reliability, and feasibility of the German version of the Caregiver Reaction Assessment scale (G-CRA): a validation study.

BACKGROUND: Instruments measuring caregiver reactions usually disregard positive aspects, and focus predominately on home care. The Caregiver Reaction Assessment (CRA) scale is an exception. Until now, no German version has been available. We translated the instrument to German (G-CRA) and evaluated its psychometric properties and feasibility. METHODS: Face-to-face interviews with 234 informal caregivers of persons with dementia were performed. Half of the persons with dementia (n = 118) had been recently admitted to institutional long-term care (iLTC); the remainder (n = 116) lived at home. Exploratory factor analysis (EFA) was performed. Subscales were intercorrelated and further correlated with the Zarit Burden Interview (ZBI), the General Health Questionnaire (GHQ-12), and the EuroQuol (EQ-5D). Internal consistency was measured (Cronbach's α), and interviewers (n = 9) appraised feasibility. The time needed to apply the scale was measured in 20 interviews. RESULTS: The EFA yielded six factors (Kaiser criterion), but a scree plot supported the five dimensions of the original version that explained 56.2% of variance. Low-to-moderate subscales' inter-correlation was revealed. Highest correlation (r = 0.5) was found between impact on health and impact on daily schedule, indicating slight overlap. Criterion validity was supported by reasonable correlations between subscales and ZBI and GHQ-12 (r = -0.21-0.71). Subscale impact on health was negatively correlated with the EQ-5D. The internal consistency was sufficient (α = 0.67 − 0.78). Interviewers judged the G-CRA to be appropriate. Completion took 6.50 min (median value). CONCLUSIONS: Our results suggest that the G-CRA is sufficiently valid and internally reliable. The instrument is applicable in home care and iLTC as well as in the transitional phase.

Shoulder reduction on the scene: current practice and outcome of the Bavarian Mountain Rescue Service-a prospective observational study.

Out-of-hospital reduction of shoulder dislocations using the Campell method is recommended by the International Commission for Alpine Rescue and applied in the Bavarian Mountain Rescue Service (Bergwacht Bayern, BWB) protocols. This prospective observational study includes patients out-of-hospital with suspected shoulder dislocation and treated and evacuated by the BWB. Data were systematically collected using three questionnaires: one completed on-site by the rescuer, the second in hospital by the physician and the third within 28 (8-143) days after the accident by the patient. The suspected diagnosis of shoulder dislocation was confirmed in hospital in 37 (84%) of 44 cases. Concomitant injuries in other body regions were found in eight (16%) of 49 cases and were associated with incorrect diagnosis (p = 0.002). Younger age (p = 0.043) and first shoulder dislocation event (p = 0.038) were associated with a higher success rate for reduction attempts. Out-of-hospital reduction of shoulder dislocations leads to significant pain relief and no poorer long-term outcome. Signs that are associated with successful out-of-hospital reduction (younger age and first event), but also those that are associated with incorrect diagnosis (concomitant injuries) should be considered before trying to reduce shoulder dislocation on site. The considerable rate of incorrect first diagnosis on site should give rise to an intensive discussion around teaching and training for this intervention.Trial registration: This study is registered with the German Registry for Clinical Trials (DRKS00023377).

NF-E2-related factor 2 regulates the stress response to UVA-1-oxidized phospholipids in skin cells.

Long-wavelength ultraviolet (UVA-1) radiation causes oxidative stress that modifies cellular molecules. To defend themselves against noxious oxidation products, skin cells produce detoxifying enzymes and antioxidants. We have recently shown that UVA-1 oxidized the abundant membrane phospholipid 1-palmitoyl-2-arachidonoyl-sn-glycero-3-phosphorylcholine (PAPC), which then induced the stress-response protein heme oxygenase 1 (HO-1) in dermal fibroblasts. Here we examined the effects of UVA-1- and UV-oxidized phospholipids on global gene expression in human dermal fibroblasts and keratinocytes. We identified a cluster of genes that were coinduced by UVA-1-oxidized PAPC and UVA-1 radiation. The cluster included HO-1, glutamate-cysteine ligase modifier subunit, aldo-keto reductases-1-C1 and -C2, and IL-8. These genes are members of the cellular stress response system termed "antioxidant response." Accordingly, the regulatory regions of all of these genes contain binding sites for NF-E2-related factor 2 (NRF2), a major regulator of the antioxidant response. Both UVA-1 irradiation and treatment with oxidized lipids led to increased nuclear accumulation and DNA binding of NRF2. Silencing and deficiency of NRF2 suppressed the antioxidant response. Taken together, our data show that UVA-1-mediated lipid oxidation induces expression of antioxidant response genes, which is dependent on the redox-regulated transcription factor NRF2. Our findings suggest a different view on UV-generated lipid mediators that were commonly regarded as detrimental

[The influence of understanding diagnostics on perceived stress of nurses caring for nursing home residents with dementia]. / Die Auswirkungen der Verstehenden Diagnostik auf das Belastungserleben Pflegender im Umgang mit Menschen mit Demenz in der stationären Altenhilfe.

Health services for nursing home residents with dementia require the expertise of highly trained nursing staff. In addition, dealing with challenging behaviour of people with dementia is often stressful for nurses and causes major difficulties for them. Being a part of the general nursing guidelines, «understanding diagnostics¼ enables nursing staff to deal with challenging behaviour of persons with dementia. The primary focus of the concept is to understand the behaviour. The aim of the study was to implement and evaluate «understanding diagnostics¼ through structured case conferences and the application of the 'Innovative dementia-oriented Assessment system' (IdA) in nursing homes for the first time. Nursing staff of 15 nursing homes in North- Rhine Westphalia were trained about the content and implementation of «understanding diagnostics¼. Nurses' perceived level of stress was measured before (n = 106) and after (n = 71) the intervention (9 months). The study results show positive effects on the nurses' perceived level of stress. They support the use of structured case conferences and the IdA assessment in order to understand the behaviour of nursing residents with dementia. The implementation of «understanding diagnostics¼ allows nursing staff to deal with challenging behaviour of nursing home residents with dementia.

Attitudes of relatives of nursing home residents toward physical restraints.

PURPOSE: Attitudes of nursing home staff, residents, and their relatives determine the decision-making process about the use of physical restraints. Knowledge of staffs' attitudes toward physical restraints is sparse; even less is known about relatives' attitudes. Therefore, we surveyed relatives' attitudes and opinions toward physical restraints and compared the results to a survey of nursing home staff. DESIGN: Cross-sectional survey comparing 177 nursing home residents' relatives from 13 German facilities in 2008 to 258 nursing home nurses from 25 German facilities in 2007. METHODS: The German version of the Maastricht Attitude Questionnaire was administered. Part I contains 22 items with three subscales (reasons, consequences, and appropriateness of restraints); Part II contains 16 items evaluating restrictiveness and discomfort of restraint measures, respectively. Descriptive and explorative inferential statistics were used for data analyses. FINDINGS: Response rate in both samples was above 90%. Mean age was 62 years (SD 12.60; range 24-93) in relatives and 44 years (SD 11.40; range 19-65) in nurses; 72% and 82% were female, respectively. Relatives assess physical restraints a little more positively compared to nurses, with an average of 3.40 (SD 0.60) versus 3.07 (SD 0.48) on a 5-point scale (5=strongly positive attitude). Relatives assess physical restraints as slightly less restrictive, with 2.11 (SD 0.33), and as less discomforting, with 2.10 (SD 0.38) points, compared to nursing staff, who assess the restraints' restrictiveness with 2.19 (SD 0.29) points and its discomfort with 2.17 (SD 0.32) on a 3-point scale (3=very restrictive/discomforting). Both groups consider wrist and ankle belts as most restrictive and uncomfortable, while sensor mats, infrared systems, and unilateral bedrails were rated as the lowest for restrictiveness and discomfort. CONCLUSIONS: Attitudes of nursing home residents' relatives toward physical restraints are rather positive and generally comparable with nursing home staffs' attitudes. CLINICAL RELEVANCE: Interventions aimed to reduce physical restraints need to include education of both staff and relatives of nursing home residents.

[Volunteers as family supporters in the home care setting: profile and motives]. / Das Ehrenamt bei der Unterstützung von Pflegebedürftigen und ihren Familien: Profil und Motive.

Family caregivers are increasingly receiving support in home care at low threshold from so called "social support services", since they are often overburdened with caring. Over the necessity for voluntary workers in and beyond this area, literature identifies different aspects that describe the profile of voluntary workers. The central idea of a "new culture of aid" manifests itself in various pilot projects. Such a project was implemented in North Rhine-Westfalia, Germany, during the years 2005 to 2008. It offered social support services to family caregivers and was scientifically assessed by means of case study research. The aim of this study was to depict the profile of voluntary workers, to understand their motives, and to identify their reasons for leaving the project. A total of 52 voluntary workers were surveyed by means of a standardised questionnaire, before and six months after their enrollment in the study. The motives for their commitment to participate in the study differed significantly from the first to the second interview, particularly with regard to participation allowance and the need to strengthen their sense of self-worth. The participation allowance in itself played no primary role in the motivation to become a voluntary worker, it is, however, a not to be underestimated aspect of acknowledgement for provided help.

The VEGF-induced transcriptional response comprises gene clusters at the crossroad of angiogenesis and inflammation.

VEGF-A is the major trigger of vasculogenesis and physiologic angiogenesis. We have investigated to which extent the gene repertoire induced by VEGF-A in endothelial cells is distinct from that of other growth factors and inflammatory cytokines. Genes upregulated in human umbilical vein endothelial cells treated with VEGF, EGF or IL-1 were compared by microarray analysis and clusters characteristic for individual or combinations of inducers were defined. VEGF-A upregulated in comparison to EGF a five-fold larger gene repertoire, which surprisingly overlapped to 60% with the inflammatory repertoire of IL-1. As shown by real-time RT-PCR for selected genes, VEGF-induction was mostly mediated by VEGF receptor-2 and the capacity of VEGF-A to induce genes in common with IL-1 largely depended on activation of the calcineurin/NFAT pathway, since cyclosporin A inhibited this induction. Another angiogenic growth factor, bFGF, did not share a comparable induction of inflammatory genes, but partially induced a small group of genes in common with VEGF-A, which were not regulated by EGF. Thus, the data display that VEGF-A induces a distinct gene repertoire, which, contrasting with other growth factors such as EGF or bFGF, includes an inherent inflammatory component possibly contributing to the cross-regulation of angiogenesis and inflammation as further indicated by the VEGF-mediated induction of leukocyte adhesion. Furthermore, a small group of genes selectively induced by VEGF-A with potential importance for angiogenesis is defined.

Diabetes foot self-care practices in the German population.

AIM: The object of this study was to find out which self-care activities patients with diabetes perform to prevent diabetic foot syndrome (DFS) and to look for differences between patient groups (diabetes education and foot at risk). BACKGROUND: Besides the importance of screening patients at risk to develop a DFS and the clinical interventions, it is also necessary to involve the patient with diabetes in the self-care of their feet. There is no information in Germany concerning self-care activities carried out by patients for the prevention of DFS. DESIGN: A cross-sectional study. METHOD: A secondary analysis of the data used in the study for the development of the 'Frankfurter Catalogue of Foot Self-Care - Prevention of Diabetic Foot Syndrome'. Two hundred and sixty-nine patients with type 1 and type 2 diabetes were included. The study population was divided into different training experience groups and foot at risk groups based on self-reported data. RESULTS: Patients who had participated in more than three education programmes performed significantly better self-care than patients who had no or only one training programme. Patients with a foot at risk for the development of diabetic foot ulcer perform more adequate self-care regarding professional assistance in foot care, but are not more active in the self-control of the feet, shoes and socks. CONCLUSIONS: There are self-care deficits regarding self-control of feet, shoes and socks. Based on the data it seems to be that more than three education programmes are needed to lead to performance of adequate self-care. Especially patients with a foot at risk need more professional support for their daily self-care activities to prevent DFS or further foot complications. RELEVANCE TO CLINICAL PRACTICE: The first findings support that it might be helpful to identify patients with self-care deficits and therefore to improve patients daily foot self-care.

TOUCAN 2: the all-inclusive open source workbench for regulatory sequence analysis.

We present the second and improved release of the TOUCAN workbench for cis-regulatory sequence analysis. TOUCAN implements and integrates fast state-of-the-art methods and strategies in gene regulation bioinformatics, including algorithms for comparative genomics and for the detection of cis-regulatory modules. This second release of TOUCAN has become open source and thereby carries the potential to evolve rapidly. The main goal of TOUCAN is to allow a user to come to testable hypotheses regarding the regulation of a gene or of a set of co-regulated genes. TOUCAN can be launched from this location: http://www.esat.kuleuven.ac.be/~saerts/software/toucan.php.

Deciphering regulatory patterns of inflammatory gene expression from interleukin-1-stimulated human endothelial cells.

OBJECTIVE: Endothelial cells comprise a key component of the inflammatory response. We set out to obtain a comprehensive overview of the immediate-early to early gene expression program of interleukin-1 (IL-1)-stimulated endothelial cells and to identify novel transcription factors and regulatory elements. METHODS AND RESULTS: Human umbilical vein endothelial cells (HUVECs) were stimulated with IL-1 for 0, 0.5, 1, 2.5, and 6 hours and analyzed using Affymetrix U133 microarrays. A total of 137 genes were found to be regulated >4-fold, including 18 transcription factors. The expression of selected genes was confirmed by real-time polymerase chain reaction. Cluster analysis was performed in order to group genes according to their expression profiles. To identify novel transcription factor-binding sites, the corresponding promoters were extracted from databases and analyzed for regulatory elements that were over-represented in specific clusters. Several potentially novel DNA binding sites were identified, and one was shown to specifically bind an IL-1-inducible protein from HUVEC. CONCLUSIONS: These results demonstrate that in the early phase after stimulation, IL-1 evokes a complex gene expression program that includes positive but also negative (feedback) regulators of diverse endothelial cell functions. Furthermore, the identification of a new promoter regulatory element demonstrates the feasibility of the bioinformatics-driven approach to discover novel regulatory mechanisms.

Pain prevalence in hospitalized patients in a German university teaching hospital.

Forty-eight units were enrolled in a descriptive, cross-sectional study to identify strengths and weaknesses of pain management in a German university teaching hospital. Patients had to be > or =18 years old and able to speak German; intensive care, psychiatric, obstetric and pediatric units were excluded. Structured interviews were conducted by an independent researcher not involved in patient care. Patients were asked about prevalence of pain during the interview at rest, on movement, and during the 24 hours before the interview; patients rated pain intensity at rest and on movement as well as the worst pain 24 hours before the interview by using a 10 cm visual analogue scale (VAS). In addition, patients indicated localization, duration, and causes of pain. Chart analysis was carried out to check for pain medication, ICD-10 diagnoses, and demographic data. To evaluate the adequacy of pain management, the Pain Management Index (PMI) was assessed. A total of 561 of the 825 inpatients who were contacted participated in the study. Fifty percent experienced pain during the interview and 63% reported pain during the preceding 24 hours. Fifty-eight percent had moderate or severe pain (VAS > or = 45 mm) and 36% reported severe pain (VAS > or = 65 mm). Thirty-three percent had pain for more than six months. The most prevalent localization of the strongest pain was in the lower extremities (20%). Fifty percent of patients with pain received pain medication. Patients on the surgical wards (P = 0.002) and those having severe pain (P < 0.001) were more likely to get analgesics. However, 30% of those with VAS> or =65 mm received no analgesic and only 24% had adequate medication. A negative PMI, indicating inadequate pain therapy, was found in 44% (246/559) of the sample. Sex and age did not influence pain prevalence, pain intensity, or pain therapy. Pain prevalence and intensity in this German university hospital were high and pain therapy was inadequate in many cases. Pain management needs to be improved by continuous assessment and adequate pain medication.

The occurrence of acute postoperative confusion in patients after cardiac surgery.

This study quantified the occurrence of acute confusion in cardiac surgery patients at three German hospitals. A total of 867 patients, 22-91 years old, were examined each nursing shift postoperatively for 5 days for the presence of acute confusion using a modified version of the Glasgow Coma Scale and Confusion Rating Scale. The night shifts and the third postoperative day showed the most frequent periods of occurrence. Confusional state was noted in patients ranging from 10.5% for patients aged <70, to 40.7% for patients >80 years of age. Those found at increased risk were patients of increasing age and coexisting disease. Targeted nursing interventions for patients at increased risk of acute confusion may decrease this complication.

A novel Cd8-cis-regulatory element preferentially directs expression in CD44hiCD62L+ CD8+ T cells and in CD8αα+ dendritic cells.

CD8 coreceptor expression is dynamically regulated during thymocyte development and is tightly controlled by the activity of at least 5 different cis-regulatory elements. Despite the detailed characterization of the Cd8 loci, the regulation of the complex expression pattern of CD8 cannot be fully explained by the activity of the known Cd8 enhancers. In this study, we revisited the Cd8ab gene complex with bioinformatics and transgenic reporter gene expression approaches to search for additional Cd8 cis-regulatory elements. This led to the identification of an ECR (ECR-4), which in transgenic reporter gene expression assays, directed expression preferentially in CD44(hi)CD62L(+) CD8(+) T cells, including innate-like CD8(+) T cells. ECR-4, designated as Cd8 enhancer E8VI, was bound by Runx/CBFß complexes and Bcl11b, indicating that E8VI is part of the cis-regulatory network that recruits transcription factors to the Cd8ab gene complex in CD8(+) T cells. Transgenic reporter expression was maintained in LCMV-specific CD8(+) T cells upon infection, although short-term, in vitro activation led to a down-regulation of E8VI activity. Finally, E8VI directed transgene expression also in CD8αα(+) DCs but not in CD8αα-expressing IELs. Taken together, we have identified a novel Cd8 enhancer that directs expression in CD44(hi)CD62L(+) CD8(+) T cells, including innate-like and antigen-specific effector/memory CD8(+) T cells and in CD8αα(+) DCs, and thus, our data provide further insight into the cis-regulatory networks that control CD8 expression.

[Acute postoperative confusion in heart surgery patients]. / Akute postoperative Verwirrtheit kardiochirurgischer Patienten.

Unlike other countries, Germany does not have data about the incidence of acute confusion following heart surgery. However, the occurrence of acute confusion does extend the hospitalization length by up to 13 days. Thus, this phenomenon is of high relevance for the health profession. This incidence study was performed with the goal to obtain exact information on the incidence rate of acute postoperative confusion after heart surgery (bypass and valve operations) through a multi-center evaluation. The data evaluation took place in the form of a convenient sample survey in three different German clinics specialized in heart surgery. The observation period lasted from the day of surgery up to the fifth postoperative day. In the context of this prospective cohort study, suitable study participants were all patients aged 18 or older who underwent heart surgery between February 1st and April 30th, 2000. At the end, 860 patients were included in the study. A total of 152 patients showed symptoms of acute confusion, meaning a total incidence of 17.4% (confidence interval 14-20%). The occurrence of this phenomenon was not symmetrical. A wide-spread occurrence could be observed particularly at night. Patients aged 81-91 were mainly affected, with an incidence of confusion of 43.5% in this group. The results confirm the clinical importance of this issue and require interdisciplinary approaches for solution.

[Predictive validity of the original and expanded Norton Scale in geriatric nursing]. / Die prädiktive Validität der originalen und erweiterten Norton-Skala in der Altenpflege.

Prevention of pressure sores is a central task of nursing. For ethical and economic reasons correct assessment of the risk of pressure sores is a prerequisite of adequate prevention of pressure sores. In Germany the Norton scale is one of the most widespread tools for assessing the risk of pressure sores. For practical purposes the original translated version of the Norton scale is in use, as well as an extended modified version. Validity and reliability of these two versions are in the early stages of examination in Germany. The present descriptive longitudinal study aims at determining the predictive value of both versions of the Norton scale in nursing homes. In a convenience sample of 146 individuals from five nursing homes residents from the age of 60 were assessed by professional nursing staff with the aid of both versions of the Norton scale at weekly intervals. Simultaneously the skin status was recorded on both sampling days. The results exhibit high values of sensitivity (91%-95%) and low specificity (6.2%-20.6%) in both scales. Both scales tend to overrate the risk of pressure sores. The values indicate that the original Norton scale assesses the residents free of pressure sores better than its extended version. Because of the convenience-sample the results are not representative and apply only to the investigated setting and population. The predictive validity of the original and modified version of the Norton scale is insufficiently verified, so there is great need of further investigation of the validity of the two versions. Application of assessment scales in nursing should be supplemented by professional expertise of the nursing staff to counterbalance assessment errors of the tools.

[Prevalence of ulcus cruris in home care nursing. An epidemiological study in North Rhine-Westphalia]. / Die Prävalenz des Ulcus cruris in der häuslichen Pflege. Eine epidemiologische Untersuchung in Nordrhein-Westfalen.

The aim of this study was to provide reliable data on prevalence of leg ulcers in home-care setting. A descriptive explorative cross-sectional design was used. In March 2000, a randomised sample of 520 community home nursing services in North-Rhine Westphalia was sent a standardised questionnaire. Apart from questions about the type of service provider and its geographical population, demographic patient data and information about duration and cause of ulcer was collected. The findings based on the data gathered from 161 nursing home-care services caring for a total 12,156 patients. The overall prevalence was 2.68% (+/- 0.29%) for leg ulcers in home-care setting. The median age of the 326 affected patients was 77.5 years. Women are more than twice as often affected as men, which could be due to the longer life-expectancy for women. A major problem for home nursing services, however, is the large number of leg ulcers of unknown origin. This was the case in almost a quarter of the sample. Depending on the causal factors, compression therapy is of paramount importance and crucial to the successful outcome of the treatment of the leg ulcer. The markedly chronic nature of leg ulcers is again confirmed by this study. Currently, leg ulcers have an average duration of ten months. However, it is not unusual for affected patients to suffer for years or even decades. Almost 80% of patients had their ulcer dressed once a day by the nursing home-care service.

[Interobserver reliability of the "Functional Independence Measure" (FIM) in patients with craniocerebral injuries]. / Die Interrater Reliabilität des "Functional Independence Measure" (FIM) bei Patienten mit Schädel-Hirn-Verletzungen.

This study was conducted to examine the inter-rater reliability of the "Functional Independence Measure" (FIM). The FIM is an assessment to determine the functional independence of patients with disabilities. It consists of eighteen items to assess activities of daily living. The degree of independence is measured by a seven point ordinal scale. The inter-rater reliability was examined by a convenience sample of 128 assessments with the FIM. Fifteen nurses assessed thirty patients with brain injuries in a centre for rehabilitation. The design was correlational. The degree of agreement between the assessments was calculated by Cohen's Kappa coefficients. The Kappa coefficients of the assessments were between kappa = 0.56 and kappa = 0.78; the median of the Kappa coefficients is kappa = 0.65. This indicates a moderate to high inter-rater reliability of the FIM when used by nurses for the assessment of patients with head injuries.