Interrater reliability of the Braden scale

Pressure ulcer risk assessment scales can assist nurses in determining the individual pressure ulcer risk. Although the Braden scale is widely used throughout Germany, its psychometric properties are yet unknown. The aim of the study was to determine the interrater reliability of the Braden scale and to compare the results with those of published data. A literature review was conducted. 20 studies measuring the interrater reliability of the Braden scale were evaluated. Only three of those studies investigated the interrater reliability of single items. The Pearson product-moment correlation coefficient (0.80 to 1.00) was calculated in most studies for an evaluation of the Braden scale as a whole. However, the use of correlation coefficients is inappropriate for measuring the interrater reliability of the Braden scale. Measures of the intraclass correlation coefficient varied from 0.83 to 0.99. The investigation of the interrater reliability of the Braden scale's German version was conducted in a German nursing home in 2006. Nurses independently rated 18 and 32 residents twice. Nurses achieved the highest agreement when rating the items "friction and shear" and "activity" (overall proportion of agreement = 0.67 to 0.84, Cohen's Kappa = 0.57 to 0.73). The lowest agreement was achieved when the item "nutrition" (overall proportion of agreement = 0.47 to 0.51, Cohen's Kappa = 0.28 to 0.30) was rated. For 66% of the rated residents the difference in the obtained Braden scores was equal or less than one point. Intraclass correlation coefficients were 0.91 (95% confidence interval 0.82 to 0.96) and 0.88 (95% confidence interval 0.61 to 0.96). This indicates that the interrater reliability of the Braden scale was high in the examined setting.     

Differences in prevalence of pressure ulcers between the Netherlands and Germany--associations between risk, prevention and occurrence of pressure ulcers in hospitals and nursing homes

Aim. This study compares pressure ulcer prevalence and prevention activities in nursing homes and hospitals within two European countries. Background. Over three years stable differences have been found between the Netherlands (NL) and Germany (GER) with higher pressure ulcer rates in the NL. As previous analyses have shown, the differences cannot be entirely explained by differences in the population’s vulnerability to pressure ulcers because they still remain after risk adjustment. Therefore, the differences in prevalence must be caused by other factors. The purpose of this study is to analyse if any potential differences in preventive activities can account for the varying occurrence of pressure ulcers. Method. In both countries, nation-wide surveys were conducted annually using the same standardised questionnaires. Trained nurses examined all consenting patients of the voluntarily participating facilities. This examination included a skin assessment of the entire body. Data regarding risk factors, prevention and details about wounds were then collected. Results. In-patients of 29 German (n = 2531) and 71 Dutch (n = 10 098) nursing homes and 39 German (n = 8515) and 60 Dutch (n = 10 237) hospitals were investigated. The use of pressure-reducing devices was more common in the NL than in GER, but all other interventions were more frequently provided to German risk patients than to their Dutch counterparts. The pressure ulcer prevalence was significantly higher in the Dutch sample. After adjusting for gender, age, Braden Score and prevention, the probability of having a pressure ulcer was 8·1 times higher for Dutch nursing home residents than for German residents. Conclusion. Some of the variance in pressure ulcer prevalence between the two countries can be explained by varying pressure ulcer prevention. However, some remarkable differences still remain unexplained. Relevance to clinical practice. The extent of pressure ulcer prevention, especially repositioning and nutrition intervention provided to patients at risk, is not in accordance with international guidelines.     

Die progressive multifokale Leukoenzephalopathie

Zusammenfassung □ Pathogenese  Die progressive multifokale Leukoenzephalopathie ist eine Entmarkungserkrankung des Zentralnervensystems, die durch eine Reaktivierung des JC-Virus hervorgerufen wird und bei etwa 5% aller Patienten mit HIV-Infektion auftritt. Nach den gegenw?rtigen Vorstellungen zur Pathogenese der progressiven multifokalen Leukoenzephalopathie handelt es sich um eine persistierende Infektion, die im Rhamen einer Abschw?chung der zellul?ren Immunit?t bei der HIV-Infektion reaktiviert wird. Als m?gliche Persistenzorte kommen Niere, Knochenmark, Lymphozyten oder das Zentralnervensystem selbst in Betracht. □ Diagnose  Die Diagnose einer progressiven multifokalen Leukoenzephalopathie wird durch das klinische Bild, das durch variable neurologische Herdsymptome gekennzeichnet ist, die Kernspintomographie des Gehirns und den Virusnachweis im Liquor gestellt. □ Therapie  Eine gesicherte erregerspezifische Therapie ist derzeit nicht m?glich. Mit der hochaktiven antiretroviralen Kombinationstherapie oder Cidofovir ergeben sich m?glicherweise neue therapeutische Optionen.      

Ten years' experience in aortic valve replacement with homografts in 389 cases

BACKGROUND AND AIM OF THE STUDY: Aortic valve replacement using homografts is an accepted alternative to the use of other replacement devices, and has been established at the authors' institution for more than 10 years. METHODS: Since 1992, a total of 389 homografts was implanted, and 332 patients (mean age 54 years, 72% males) were followed up. The initial patients (n = 75) had subcoronary implantation, all subsequent patients had root replacement. Both aortic grafts (AG) and pulmonary grafts (PG) were used. Follow up was conducted with regard to the factors 'graft origin', 'implantation technique' and 'gender', and included clinical examination, ECG and transthoracic echocardiography on an annual basis. RESULTS: Overall 30-day mortality was 5.4% (AG patients 3.9%, PG patients 13.5%; p = 0.09). Among late deaths (n = 22), six were valve-related (all prosthetic infection). Four minor thrombembolic events were recorded due to amaurosis fugax and transient ischemic attacks (TIA). Freedom from reoperation was 86.5%. Indication for graft replacement was greater after subcoronary implantation than after root implantation (p = 0.04). Reoperation was necessary in 24 patients due to restenosis (n = 4), regurgitation grade >II (n = 5), paravalvular leak (n = 2) and prosthetic infection (n = 13). At the latest echocardiographic follow up, mean peak pressure gradient was 15.60 +/- 11.76 mmHg, homograft regurgitation grade was 0.82 +/- 0.66, left ventricular end-diastolic diameter (EDD) was 49.1 +/- 7.54 mm, and mean aortic root diameter was 30.54 +/- 5.48 mm. When comparing parameters at a mean of five years postoperatively, the pressure gradient increased from 10.26 to 15.02 mmHg, regurgitation grade increased from 0.53 to 0.81, and EDD decreased from 52.3 to 50.4 mm. Other variables showed no significant differences. CONCLUSION: The present results confirmed good midterm-results for aortic valve replacement with homografts. These prostheses are vulnerable to infection, and root replacement was superior to the subcoronary implantation technique.     

Molecular characterization of antibody specificities against myelin/oligodendrocyte glycoprotein in autoimmune demyelination

Myelin/oligodendrocyte glycoprotein (MOG) is a target antigen for myelin-destructive Abs in autoimmune central nervous system demyelinating disorders. Little is known about the molecular and structural basis of these pathogenic Ab responses. Here, we have characterized anti-MOG Ab specificities in the marmoset model of experimental allergic encephalomyelitis, by means of a combinatorial IgG-Fab library. We found that a diverse population of Ig genes encodes for auto-Abs that exclusively recognize conformation-dependent antigenic targets on MOG. These antigenic domains correspond to exposed epitopes in vivo, as the Fab fragments recognize native MOG in situ in marmoset brain tissue. The Ab fragments described here represent Ab specificities that are common constituents of the humoral immune repertoire against MOG in outbred populations, as demonstrated by their ability to displace native anti-MOG Abs present in sera from MOG-immune marmosets and patients with multiple sclerosis. Furthermore, neuropathological analysis and characterization of Ab epitope specificities in animals immunized with MOG or MOG-derived peptides revealed that only conformation-dependent Abs are associated with demyelinating activity, suggesting that epitope recognition is an important factor for Ab pathogenicity. Our findings provide novel and unexpected knowledge on the diversity of anti-MOG Ab responses in nonhuman primates and humans, and will permit the dissection of pathogenic auto-Ab properties in multiple sclerosis.