Wiener Klinische Wochenschrift最新文献

Clinical Ethics Consultation (CEC) provides support to treatment teams in complex decision-making situations, focusing on patient autonomy, interprofessional collaboration and the legal framework. Following the introduction of CEC at the Vienna General Hospital and the Medical University of Vienna, a structured service has been established that systematically integrates ethical issues into everyday clinical practice. As well as conducting ethics case consultations, the initiative includes training programs, development of documentation tools for therapy goal planning and expansion of curricula and basic medical education. The aim is to strengthen teams' decision-making competence, to make ethical principles visible, and to sustainably increase the quality of patient-centered care. This supplement presents the background, implementation steps and experiences of the initiative, and illustrates practical approaches to embedding clinical ethics within an increasingly complex healthcare system in a sustainable way.

Perioperative anemia and blood transfusions are frequent and both are associated with a worse outcome in patients undergoing colorectal cancer surgery. To assess if treatment of anemia by transfusions can improve outcome, we conducted the present retrospective analysis.Of all patients who underwent elective colorectal cancer surgery at the University Hospital of Innsbruck between 2010 and 2019, 654 patients could be included in the study. The impact of preoperative anemia and transfusion on 1‑year survival was assessed using Kaplan-Meier analysis, univariate and multivariate Cox regression and inverse probability treatment weighting models to estimate the effects of preoperative transfusion on outcome.Preoperative anemia was present in 62.4% of patients and was the strongest predictor of perioperative transfusions. Intraoperative or postoperative transfusion occurred in 30.3% of the cohort, with higher rates in anemic patients. The transfusion rate was 36% between 2010 and 2015 and 25% in patients who underwent surgery from 2015 onwards.The 1‑year survival was significantly lower in transfused compared to nontransfused patients. After adjusting for age, sex and hemoglobin, transfusions and anemia were no longer independent predictors of survival. Elevated C‑reactive protein (CRP), higher tumor stage, age and minimally invasive surgery were identified as the main independent predictors of 1‑year mortality.Preoperative anemia predicts a higher rate of perioperative transfusions and is associated with worse 1‑year survival after colorectal cancer surgery. Transfusions do not correct impaired survival in patients with anemia. These findings underline the importance of proactive anemia management before surgery to improve postoperative outcome.

Inappropriate prescribing remains a global challenge with implications for patient outcomes and healthcare costs. A recent Danish nationwide study investigated potentially inappropriate medications (PIMs), defined using a modified screening tool of older persons' prescriptions (STOPP)/screening tool to alert to right treatment (START) framework and their associations with socioeconomic and sociocultural factors. The STOPP-defined PIMs, indicating potential overtreatment, were present in 3.1% and strongly associated with lower income, education, limited social support and living alone, while START-defined PIMs (12.5%), reflecting potential undertreatment, showed no such associations. These findings highlight the role of socioeconomic and cultural determinants for obtaining optimal care, even within a universal healthcare system, which minimizes cost-related barriers.This article provides an Austrian perspective on this important topic. Available Austrian (and international) data confirm socioeconomic status as a key driver of polypharmacy and PIM exposure, although patterns vary across regions and populations. Broader evidence links PIMs to higher costs, reduced quality of life and increased hospitalizations. Addressing this complex issue requires multifaceted strategies: strengthening health literacy, educating healthcare professionals and fostering multidisciplinary collaboration, integrating deprescribing into clinical care and targeting vulnerable groups such as those with low socioeconomic status or migration backgrounds. Effective implementation of these measures may improve equity, safety and sustainability in pharmacotherapy.

Introduction: Diverticulosis is a multifactorial condition influenced by genetic, age-related and cardiometabolic factors. Given overlapping risk profiles, its association with diabetes mellitus remains of interest, although evidence is inconsistent.

Methods: In a retrospective cohort study of 5924 asymptomatic individuals undergoing colorectal cancer screening in Austria, participants were stratified by glycemic status and assessed for diverticulosis via endoscopy. Incidence rate ratios (IRRs) were estimated using Poisson regression with robust standard errors, sequentially adjusting for demographic and cardiometabolic variables. Interaction and sensitivity analyses evaluated effect modification by age, sex, and metabolic parameters.

Results: The prevalence of diverticulosis increased with diabetes status: lowest in participants without diabetes (29%), intermediate in prediabetes (41%), and highest in diabetes (46%; p < 0.001). In fully adjusted models, prediabetes remained moderately associated with diverticulosis (IRR: 1.10; 95% confidence interval, CI: 1.01-1.21; p = 0.034), while the association with diabetes was attenuated (IRR: 0.98; 95% CI: 0.86-1.11; p = 0.743). Right-sided diverticulosis showed a weak residual association with prediabetes (RRR: 1.62; p = 0.012) but not with diabetes. Associations were modified by age, sex, body mass index (BMI) and hypertension, with stronger effects observed in younger, female, non-obese, normotensive individuals.

Conclusion: The association between (pre)diabetes and diverticulosis is largely attributable to shared metabolic risk factors. Observed signals for right-sided diverticulosis should be considered exploratory and hypothesis-generating, warranting further studies. Given the cross-sectional design, causality cannot be inferred and our findings should be interpreted as associations only.

Background: Infertility affects 10-15% of couples worldwide. In Austria, the In Vitro Fertilization Fund supports assisted reproductive technology under specific conditions. While assisted reproductive technology is generally effective, its impact on pregnancy and neonatal outcomes remains under discussion.

Methods: The Register and Biobank on the Influence of Assisted Reproduction on Pregnancy, Maternal and Neonatal Outcomes is a prospective multicenter register and biobank. It includes five in vitro fertilization centers and two obstetric departments in Vienna and Lower Austria. Standardized clinical and laboratory data are collected via electronic case report forms and pseudonymized using a unique code linking fertility and obstetric data. Recruitment started in 2022, and biobanking (blood, urine, placenta, and umbilical cord samples) was added in 2025.

Results: By early 2025, complete data were available for 366 patients. Male infertility was the most frequent indication (231 cases), followed by tubal factor infertility, polycystic ovary syndrome, and endometriosis. The register enables linking of assisted reproductive technology procedures with detailed pregnancy and neonatal outcomes such as Apgar scores, delivery mode, and Neonatal Intensive Care Unit transfers.

Conclusion: This register offers a unique real-world dataset connecting assisted reproductive technology treatment with maternal and neonatal outcomes. Continued recruitment will support hypothesis-driven research and improve assisted reproductive technology practices. It underlines the importance of high-quality, longitudinal data to understand potential assisted reproductive technology-related risks and guide future care.