[Acceptance and practicability of evidence-based therapy standards in child and adolescent rehabilitation: results of a user survey]

The introduction of evidence-based therapy standards in child and adolescent rehabilitation of the German statutory pension insurance scheme (Deutsche Rentenversicherung Bund, 2011) was accompanied by a user survey that gave the participating rehabilitation centres the opportunity to comment on the new therapy standards and to suggest modifications.The survey questionnaire encompassed various topics related to the therapy standards, amongst them quality, comprehensibility, and acceptance, evaluation of feedback, and reasons for noncompliance with therapy standard requirements. For each of the 3 indications, a separate questionnaire was applied to assess modification suggestions regarding KTL therapy elements, the minimum percentage of patients to be treated accordingly, and the minimum duration of therapeutic procedures for each evidence-based treatment module. Responses from 14 rehab centres (return rate 54%) were obtained and analyzed.According to the majority of the responding rehabilitation centres, the therapy standards for child and adolescent rehabilitation fulfilled the quality features of topicality, multidisciplinarity, and relevance for routine rehabilitative practice. The degree of empirical grounding was evaluated more inconsistently. Difficulties with coding of KTL therapy elements were cited as the primary reasons for failing to comply with requirements in 2008.Exemplarily, the results of the user survey regarding the rehabilitative treatment of children and adolescents with obesity (age group: 8 years and older) are presented in detail.Concluding, the modifications to the therapy standards in child and adolescent rehabilitation introduced on the basis of the user survey are set out.

[Practice guideline for breast cancer rehabilitation from the perspective of the rehabilitation centres: findings of a user survey on acceptance and practicability of the pilot version]

BACKGROUND

The pilot phase of the rehabilitation guideline for patients with breast cancer of the German Pension Fund was accompanied by a user survey. This survey allowed oncological rehabilitation centres to comment on the guideline and to suggest changes.

METHODS

In the autumn of 2007 a total of 57 oncological rehabilitation centres treating a minimum of 50 patients with breast cancer (ICD-10: C50) annually were contacted with a written survey. The questionnaire was accompanied by an overview of performance data according to the KTL (Classification of Therapeutic Procedures) from 2006 allowing to determine the degree of adherence to the guideline's requirements.

RESULTS

Between 75% and 95% of the respondents agree that the rehabilitation guideline for breast cancer fulfils the quality attributes "scientific foundation (evidence)", "relevance for day-to-day work", "up-to-dateness", and "inter- and multidisciplinary development". 65% consider the guideline's comprehensiveness as "adequate" and structure and clarity as "rather to very structured". The individual chapters and treatment modules are "rather to very comprehensible" for 68% to 100%. Further information is needed especially with regard to "methodological overview", "information on the guideline's integration into the Pension Insurance's quality assurance programme", "scope" and "minimum percentage of patients requiring such treatment". Between 70% and 85% consider the KTL codes suggested to sufficiently represent the therapeutic contents of the treatment modules. 20% to 68% agree with the guideline's requirements regarding the "minimum percentage of patients requiring such treatment". In 7 of a total of 15 treatment modules the requirements are considered "adequate". The main reasons for insufficient adherence to the guideline's requirements are coding problems, as well as a high treatment volume and shortage of staff. The implementation of the guideline for the rehabilitation of patients with breast cancer raises positive and negative expectations.

DISCUSSION

The discussion centers around the normative standards regarding the minimum percentage of patients requiring such treatment that is considered too high in many modules. However, suggestions to alter the treatment requirements are at times quite heterogeneous. Coding problems should not be overrated as the performance data so far available date back to a period prior to introduction of the new KTL 2007.

CONCLUSION

At the end of the pilot phase the guideline will be revised where necessary, taking the rehabilitation centres' feedback into account. The Pension Insurance considers the guideline for the rehabilitation of patients with breast cancer an important addition to the quality assurance programme. According to the survey's results the guideline is generally accepted and realisable.

Skin tolerance and effectiveness of two hand decontamination procedures in everyday hospital use

BACKGROUND

Hand decontamination is crucial to control nosocomial infections. The utility of hand decontamination is related not only to its antimicrobial effectiveness, but also to its acceptability by hospital staff.

OBJECTIVES

We aimed to assess skin tolerance and antimicrobial effects of two widely accepted hand hygiene measures under in-use conditions.

METHODS

Fifty-two nurses were randomly assigned for an 8-day period to either an alcohol-based disinfectant or a hand wash with a non-antiseptic soap. At baseline and at the end of the test period, microbiological hand samples were obtained both before and after a hand hygiene procedure, and skin tolerance was assessed using clinical scores and measurement of transepidermal water loss.

RESULTS

Self-assessment of skin condition and grade of skin damage worsened significantly more in the group using soap than in the group using alcoholic disinfectant (P = 0.004 and P = 0.01, respectively). The alcohol-based rinse was significantly more effective than liquid soap in removing transient contaminant micro-organisms (P = 0.016). Twenty of 50 hand washes with non-antiseptic soap apparently resulted in bacterial contamination of the hands. At the end of the study, the total bacterial count increased with the increasing number of hand washes in the soap group (P = 0.003), and with the degree of skin damage (P = 0.005) in the antiseptic group.

CONCLUSIONS

In everyday hospital practice, alcohol-based disinfectant is more effective and better tolerated than non-antiseptic soap; soap is at risk of spreading contamination; and skin comfort strongly influences the number and the quality of hand hygiene procedures.