The European Pressure Ulcer Advisory Panel, the Pan Pacific Pressure Injury Alliance, and the National Pressure Ulcer Advisory Panel are updating the 'Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline' (CPG) in 2019. The aim of this contribution is to summarize and to discuss the guideline development protocol for the 2019 update. A guideline governance group determines and monitors all steps of the CPG development. An international survey of consumers will be undertaken to establish consumer needs and interests. Systematic evidence searches in relevant electronic databases cover the period from July 2013 through August 2018. Risk of bias of included studies will be assessed by two reviewers using established checklists and an overall strength of evidence assigned to the cumulative body of evidence. Small working groups review the evidence available for each topic, review and/or draft the guideline chapters and recommendations and/or good practice statements. Finally, strength of recommendation grades are assigned. The recommendations are rated based on their importance and their potential to improve individual patient outcomes using an international formal consensus process. Major methodological advantages of the current revision are a clear distinction between evidence-based recommendations and good practice statements and strong consumer involvement. The 2019 guideline update builds on the previous 2014 version to ensure consistency and comparability. Methodology changes will improve the guideline quality to increase clarity and to enhance implementation and compliance. The full guideline development protocol can be accessed from the guideline website (http://www.internationalguideline.com/).

Background: Person-centred care (PCC) has been suggested as the preferred model of dementia care in all settings. The EPCentCare study showed that an adapted PCC approach was difficult to implement and had no effect on prescription of antipsychotics in nursing home residents in Germany. This paper reports the qualitative process evaluation to identify facilitators and barriers of the implementation of PCC in German nursing homes from the perspective of participating practice development champions. Methods: Five individual and 14 group interviews were conducted with 66 participants (staff and managers) from 18 nursing homes. The analysis was based on inductive coding to identify factors influencing the PCC implementation process. Identified factors were systematised and structured by mapping them to the four constructs (coherence, cognitive participation, collective action, reflexive monitoring) of the Normalization Process Theory (NPT) as a framework that explains implementation processes. Results: Facilitating implementation factors included among others broadening of the care perspective (coherence), tolerance development within the care team regarding challenging behaviour (cognitive participation), testing new approaches to solutions as a multi-professional team (collective action), and perception of effects of PCC measures (reflexive monitoring). Among the facilitating factors reported in all the NPT constructs, thus affecting the entire implementation process, were the involvement of relatives, multi-professional teamwork and effective collaboration with physicians. Barriers implied uncertainties about the implementation and expectation of a higher workload (coherence), concerns about the feasibility of PCC implementation in terms of human resources (cognitive participation), lack of a person-centred attitude by colleagues or the institution (collective action), and doubts about the effects of PCC (reflexive monitoring). Barriers influencing the entire implementation process comprised insufficient time resources, lack of support, lack of involvement of the multi-professional team, and difficulties regarding communication with the attending physicians. Conclusions: The findings provide a comprehensive and detailed overview of facilitators and barriers structured along the implementation process. Thus, our findings may assist both researchers and clinicians to develop and reflect more efficiently on PCC implementation processes in nursing homes. Trial registration: ClinicalTrials.gov identifier: NCT02295462; November 20, 2014.

The majority of nursing home residents with dementia experience behavioural and psychological symptoms like apathy, agitation, and anxiety. According to analyses of prescription prevalence in Germany, antipsychotic drugs are regularly prescribed as first-line treatment of neuropsychiatric symptoms in persons with dementia, although guidelines clearly prioritise non-pharmacological interventions. Frequently, antipsychotic drugs are prescribed for inappropriate reasons and for too long without regular reviewing. The use of antipsychotics is associated with adverse events like increased risk of falling, stroke, and mortality. The aim of the study is to investigate whether a person-centred care approach, successfully evaluated in nursing homes in the United Kingdom, can be implemented in German nursing homes and, in comparison with a control group, can result in a clinically relevant reduction of the proportion of residents with antipsychotic prescriptions. The study is a cluster-randomised controlled trial comparing an intervention group (two-day initial training on person-centred care and ongoing training and support programme) with a control group. Both study groups will receive, as optimised usual care, a medication review by an experienced psychiatrist/geriatrician providing feedback to the prescribing physician. Overall, 36 nursing homes in East, North, and West Germany will be randomised. The primary outcome is the proportion of residents receiving at least one antipsychotic prescription (long-term medication) after 12 months of follow-up. Secondary outcomes are residents’ quality of life, agitated behaviour, as well as safety parameters like falls and fall-related medical attention. A health economic evaluation and a process evaluation will be performed alongside the study. To improve care, a reduction of the current high prescription rate of antipsychotics in nursing homes by the intervention programme is expected. ClinicalTrials.gov: NCT02295462

Hintergrund: Patienten mit einer chronisch entzündlichen Darmerkrankung (CED) erleben vielfältige körperliche und psychosoziale Beeinträchtigungen. Wir berichten aktuelle Daten eines Fragebogen-Surveys. Methodik: Die Querschnittsstudie wurde 2005 als postalischer Survey in 3 Regionen Deutschlands (Kiel/Lübeck, Halle [Saale], Regensburg) durchgeführt. Befragt wurden Morbus-Crohn- und Colitis-ulcerosa-Patienten (MC, CU) aus gastroenterologischen Praxen, Hochschulambulanzen und dem Mitgliederbestand der DCCV. Die Entwicklung des Fragebogens orientierte sich an der International Classification of Functioning, Disability, and Health. Der Fragebogen umfasst national und international etablierte Fragen und Skalen (u. a. HADS). Ergebnisse: Die Fragebögen wurden von 1083 CED-Patienten beantwortet (58 % MC; 65 % Frauen; Alter/MW: 42 Jahre; Erkrankungsdauer/MW: 13 Jahre). 25 % der CED-Patienten litten stark oder sehr stark an der Erkrankung, ein Drittel gab starke Müdigkeit und Erschöpfung an, 52 % fühlten sich stark von Stress beeinträchtigt. Eine klinisch relevante Angst oder Depressivität wiesen je 24 % auf. Auffällig ist eine höhere Prävalenz der Depressivität bei männlichen Respondenten. Schwere Einschränkungen in verschiedenen Bereichen sozialer Teilhabe berichteten ein Viertel der Befragten. Schlussfolgerungen: Die Ergebnisse der Studie zeigen die multiplen und psychosozialen Beeinträchtigungen der CED. Dies weist auf einen Bedarf einer multi- und interdisziplinären Versorgung hin. Background: Patients with inflammatory bowel diseases (IBD) experience various bodily and psychosocial impairments. We report data from a recent German questionnaire survey. Methods: The cross-sectional study was conducted in 2005 as a postal survey in three regions in West (Kiel and Luebeck, Regensburg) and East (Halle/Saale) Germany. Patients with Crohn’s disease and ulcerative colitis (CD, UC) were recruited from specialized gastroenterological practices, university outpatient clinics, and the registry of a prominent patient organization (DCCV). The questionnaire followed the concept and distinctions of WHO’s ICF and incorporated (inter-)nationally established items and scales (i. a. HADS). Results: Survey responders (n = 1083, CD: 58 %, 65 % female) had a mean age of 42 years with an average disease duration of 13 years. 25 % suffered severely or very severely from their disease in general, one third stated at least severe fatigue, and 52 % felt profoundly affected by stress. A clinically relevant anxiety was observed in 24 % with no relevant difference between males and females. Depression was more common in men (29 %) than in women (21 %). Restrictions in social participation (family life, work) were actually prominent in at least a quarter of the responders. Conclusions: Beside somatic ailments typical for the disease, patients also reported multiple psychosocial impairments and participation restrictions and should hence profit from a multi- and interdisciplinary team care.

Die Bedeutung der Einstellung Pflegender für die Etablierung einer evidenzbasierten Pflegepraxis (EBP) ist international gut belegt. Für den deutschsprachigen Raum liegen bislang nur wenige Daten vor. Diese Querschnittstudie zielt darauf, pflegerische Sichtweisen auf relevante Kontextfaktoren für die Implementierung einer EBP zu erfassen. Hierfür wurden mithilfe eines selbst entwickelten Fragebogens auf Basis etablierter Instrumente in 21 norddeutschen Krankenhäusern 1384 Pflegende befragt, von denen 1023 (74 %) antworteten. Die Ergebnisse zeigen eine prinzipiell positive Einstellung gegenüber EBP. Die Mehrheit der Befragten erachtet Forschung als relevant für die Praxis. Unterstützung durch Vorgesetzte sowie Kolleg(inn)en wird als wichtige Voraussetzung gesehen. Die Umsetzung gelingt jedoch nur unzureichend. So sind Pflegende nicht über aktuelle Forschungsergebnisse informiert. Primärliteratur wird kaum genutzt. Lediglich eine Minderheit ist bereit, eigene Mittel für Tagungen aufzuwenden oder in naher Zukunft ein pflegewissenschaftliches Studium zu beginnen. Die Erhebung liefert erstmals für den deutschsprachigen Raum aussagekräftige Daten zur Einstellung Pflegender zu EBP. Pflegende bestätigen hierbei den Wert von Forschung für die eigene Praxis, es fehlt jedoch an Grundvoraussetzungen, beispielsweise der Nutzung aktueller wissenschaftlicher Fachinformationen, um relevante Forschung zu identifizieren und in die Praxis zu implementieren. Eine Ausrichtung der Ausbildung auf EBP, etwa im Rahmen von pflegewissenschaftlichen Studiengängen, erscheint in Deutschland überfällig.