[Joint contractures in nursing textbooks]. / Gelenkkontrakturen in Lehr- und Fachbüchern für die Pflege.

BACKGROUND: The transparency criteria of the German statutory health insurance on joint contracture prevention have led to controversies about the appropriate assessment, prevention and treatment as well as to various actions in nursing practice. However, appropriate nursing assessments and proven treatment options are lacking so far. It is unclear whether textbooks on nursing reflect these uncertainties. METHODS: Search for textbooks on nursing through internet-based search engines and publisher registers, data extraction by one investigator and control by a second. RESULTS: A total of 35 textbooks with contributions on joint contractures were identified of which 25 included a definition, causes/risk factors are presented in 32 textbooks and assessments are presented in 5 books. Most often positioning into a physiological or functional neutral position and passive moving of limbs are recommended as passive prophylaxis. Recommended therapeutic and preventive options do not differ. None of the textbooks reflect that there is a lack of scientific knowledge on the subject. CONCLUSION: Textbooks on nursing do not deal with complete and scientific sound information on joint contractures.

Caring for people with dementia in general hospitals: an education curriculum from the Alzheimer's Society of Lower Saxony, Germany.

Since 2006, the Alzheimer's Society of Lower Saxony, Germany, has been working to improve care and medical treatment for people with cognitive impairment or dementia in general hospitals. An interdisciplinary team systematically worked on the topic for several years and presented results at various symposia. In 2011, a two-stage curriculum was completed and sent in combination with additional training documents to all hospitals and nursing training colleges in Lower Saxony, Germany. The manual comprised a two-step approach with a 14-h training for hospital staff and a 160-h training for qualification of trainers and dementia appointees/chaperones. In addition, the manual included a list of 13 essential points for "dealing with demented people in a general hospital," the information sheet of the German Alzheimer's Society on aspects requiring special attention when a demented person is admitted to a hospital, short descriptions of best practice models, a list of established speakers in the field, and a 30-min film. In 2012, the project won the "Preis für Engagement und Selbsthilfe" of the Hertie Foundation and the "Niedersächsischen Gesundheitspreis" awarded by the Lower Saxon Ministry for Social, Women, Family, and Health Affairs.

[Chronic cardiac insufficiency in the elderly]. / Chronische Herzinsuffizienz im Alter.

The incidence of chronic heart failure rises with increasing age as does the proportion of diastolic dysfunction in comparison to heart failure with reduced systolic ejection fraction. Symptoms are less specific, such as fatigue, which makes a diagnosis more difficult but classification and diagnostic work-up are the same as in younger patients. Regarding therapy there is less data because the typical study population does not include geriatric patients with multimorbidity. Nevertheless ACE inhibitors, angiotensin receptor blockers, aldosterone antagonists, diuretics and digoxin should also be used in geriatric patients considering indications and contraindications and especially interactions with co-morbidities and other prescribed medication on an individual basis. The numbers of patients above the age of 75 years receiving heart surgery is increasing. Current scores often overestimate the risk of an operation even though after individual stratification surgical and interventional procedures can be performed with low risk.

[Joint contractures in older age. A systematic literature review]. / Erworbene Kontrakturen der Gelenke im höheren Lebensalter. Eine systematische Literaturanalyse.

BACKGROUND: Free movement of the limbs is a prerequisite of mobility and autonomy in old age. The prevalence of contractures in international studies has been reported to range between 15% and 70%. The wide variation might be explained by different definitions and diagnostic criteria, settings, and participants' characteristics. Contractures lead to additional nursing demands. In Germany, contracture risk assessment and prevention have been recently defined as a quality indicator of nursing home care that should be regularly monitored by expert raters of the statutory health insurance system. Therefore, it is necessary to have a clear definition of contracture. The goal of this literature review was to identify definitions of contractures used in controlled trials. METHODS: A systematic literature search of controlled trials investigating contracture as primary, secondary, or adverse outcome was conducted using the databases PubMed, CINAHL, Embase, and the Cochrane Library. The search was limited to articles published after 1985 and written in English or German language. Publications were excluded, if animals, children, or congenital contracture were investigated. Two reviewers independently screened the abstracts and extracted data from full publications. Disagreement was solved by consensus involving a third reviewer. RESULTS: Initially, 544 publications were identified; 37 controlled studies fulfilled the inclusion criteria and were included. A total of 33 studies investigated contracture as primary outcome, three as secondary outcome, and one as adverse outcome. Five studies clearly defined the term contracture. However, all these definitions are different. In 31 studies, only the diagnostic criteria were mentioned and one study mentioned neither a definition nor specific diagnostic criteria. CONCLUSION: The majority of clinical trials investigating contracture as outcome parameter do not provide a clear definition. However, the success of contracture prevention and treatment in clinical trials and practice can only be judged in the presence of a clear definition. Thus, it appears especially difficult to use contracture as a quality indicator for nursing homes.

[Nosocomial urinary tract infections in the geriatric hospital - pathogen spectrum and resistancies]. / Erregerspektrum und Resistenzanalyse von Harnwegsinfektionen im geriatrischen Akutkrankenhaus - eine Zweijahresanalyse.

We examined 834 isolates of urinary cultures (26 fungi and 808 isolates from 28 bacteria) in an academic geriatric teaching hospital for microbial spectrum and resistance analysis. Of the bacteria, 90% were associated to ten species. Detection rate of MRSA and ESBL was 1%, detection rate for pseudomonas aeruginosa, proteus species, coagulase negative staphylococci and klebsiella species were higher than in an university clinic (p < 0.001). Resistency rates were high for the 10 most frequent bacteria: 53.3% of cross-tabulations between bacterium and antibiotic agent (sulfamethoxazol-trimethoprim, amoxicillin-clavulanate, ciprofloxacin, moxifloxacin, cefuroxim, imipenem) showed resistency rate higher than 10%. We assume that specific factors of geriatric sample taking have an impact to our 2-year resistogram results. It is necessary to combine data analysis from comprehensive geriatric assessment and microbiological methods.

[Documentation procedures in geriatrics--on unreliability of routinely gathered clinic data]. / Dokumentationsverfahren in der Geriatrie--Zur Unschärfe alltagsnah erhobener Klinikdaten.

UNLABELLED: We analyzed quality assurance protocol records of 532 geriatric hospital patients in comparison to an administration database concerning data on "length of stay" information (LOS). Doctors handwritten quality assurance protocol records corresponded in 74.25% of cases to administration data. 14.47% of cases were registered with different LOS; 11.28% of LOS information was missing. The increasing amount of documentation tasks in German geriatric hospitals is discussed. CONCLUSION: We assume that not only discrete well known information (admission and discharge dates, LOS) are contaminated by documentation failure but also data on functional status of geriatric patients which may have important influence on external data processing.

[Quality assurance in geriatric medicine]. / Qualitätssicherung in der Geriatrie.

This article describes the peculiarities of geriatric quality assurance from the view of a clinical setting. Description of structural elements of quality are well known. Improvements in process quality of individual patient care have been sustained by controlled studies on comprehensive geriatric assessment. However, implementation of results from comprehensive assessment into external rating systems for hospital accreditation/certification still needs further research. The documentation of product quality depends on the measurement of patients' independency, activities of daily living and subjective well being.

Premorbid personality traits in Alzheimer's disease: do they predispose to noncognitive behavioral symptoms?

The purpose of this study was to examine whether premorbid personality traits predispose to noncognitive symptoms in Alzheimer's disease (AD). The Munich Personality Test was used to evaluate caregivers' perception of personality prior to symptom onset in 56 outpatients with probable AD. Caregivers also completed the "mood" and "disturbed behavior" scales of the Nurses' Observation Scale for Geriatric Patients. A neuropsychiatrist rated depressive symptoms on the Cornell Scale for Depression and the occurrence of personality change in four domains according to ICD-10. Under statistical control of confounding variables, results showed a moderate association between (high) premorbid neuroticism, subsequent troublesome behavior, and personality change, on the one hand, and (low) frustration tolerance and depression, on the other. Premorbid personality traits may indeed predispose to subsequent noncognitive symptoms in AD.

[Tinetti motor ability test: sensitivity to change in gait assessment during geriatric hospitalization--aspects of its clinical relevance and quality assurance]. / Der Motilitätstest nach Tinetti: Anderungssensitivität der Gangbeurteilung im Verlauf geriatrischer Krankenhausbehandlung--Aspekte der klinischen Relevanz und Qualitätssicherung.

Assessment instruments are recommended in addition to the clinical examination of gait disorders in elderly patients. We examined the sensitivity of gait assessment in a geriatric hospital by using a modified Tinetti's motility score in order to study aspects of clinical relevance and quality assurance. Forty patients were assessed on admission and discharge. The results were rated for information profit in comparison to clinical admission report. Three geriatricians rated the results for clinical relevance. Three quarters of the patients' mobility changed significantly on the course. There were no significant differences in patients with dementia. Assessment by using Tinetti's motility score gained 41% new information and 49% partly new information. This information was rated as considerably relevant to the clinical course in 56% to 80% of the patients. A structured motility score is useful for the purpose of internal quality assurance in a geriatric hospital.

[Use of clinical databanks with special reference to gerontologic-geriatric quality assurance]. / Anwendungen klinischer Datenbanken unter besonderer Berücksichtigung der gerontologisch-geriatrischen Qualitätssicherung.

Geriatric institutions enforce clinical documentation in order to assure quality of care. Different means include basic information of the clinical course, data gathering by administration and extractions from research projects. The use of electronic data bases and common data processing shall provide a base for the development of a cooperation network, academic progress, quality assurance programs and models of utilization review. In this article, clinical data bases are defined and described with reference to their organization. Data elements collected depend on the focus and function of a data base which must be considered in developing a quality assurance program. Usually there is a focus on 1) therapy, device or procedures or 2) diseases or populations. However, the measurement of variables concerning health aspects of older patients crosses more than one dimension. Geriatric teams may have an advantage in developing a successful data base because of the fact that this requires a multidisciplinary team. It is necessary to follow principles of quality assurance and well-defined data base design in order to succeed in enforcing the objectives mentioned above.