Wiener Klinische Wochenschrift最新文献

Objective: The main objective of this study was to examine the relationship between mobility patterns during the coronavirus disease 2019 (COVID-19) pandemic and orthopedic trauma patients in Austria. Utilizing global positioning system (GPS)-based mobility data, the attempt was to assess both the impact of COVID-19 lockdowns on reducing orthopedic trauma patients and the degree of compliance to the imposed movement restrictions.

Methods: This retrospective analysis included all patients (283,501) treated at 3 major level I trauma centers in Austria. Analyzed time periods were 1 January 2019 to 8 February 2021. Freely available GPS-based mobility data from Google and Apple Inc. was gathered.

Results: A moderate to strong correlation between the cumulative average outpatients and the assessed mobility index was observed for all cities (Google: r = 0.70 p < 0.001, 95% confidence interval, CI: 0.67-0.73; Apple: r = 0.64 p < 0.001, 95% CI: 0.61-0.67). A significant linear regression equation was found for Vienna (adjusted r² = 0.48; F(1, 350) = 328,05; p < 0.01). During the first lockdown there was a drastic decline in mobility (up to -75.36%) and in numbers of orthopedic trauma outpatients (up to -64%, from 153 patients/day 2019 to 55 patients/day 2020) in comparison to the prepandemic era. The decline diminished as time passed.

Conclusion: Analyses of GPS-based mobility patterns show a correlation with trauma patient numbers. These findings can be used to develop prediction models, leading to better resource planning and public health policy, enhancing patient care and cost-effectiveness, especially in the event of future pandemics. Furthermore, the results suggest that compliance to mobility restrictions decreased over time during the COVID-19 pandemic, resulting in increased mobility and trauma patients.

Background: Early exercise intervention studies showed promising positive effects of physical exercising on post-COVID-19 symptoms; however, little is known about long-term training adherence and what influences it.

Material and methods: Semi-structured interviews were conducted with 17 participants of the 8‑week original exercise intervention study. Facilitators and barriers were identified via thematic analysis and compared between those participants who continued their regular exercise behavior (continuous exercise group, CEG, n = 7) and those who stopped exercising (discontinuous exercise group, DEG, n = 10). Physical performance parameters and questionnaires regarding psychological health dimensions and work ability were assessed analogously to the original study.

Results: Qualitative analysis showed that two of the top three facilitators, (improving physical and mental health, sport has high priority) were the same in both groups. The respective third of the top three facilitators was (re)build physical and cognitive performance in the CEG and training in the group in the DEG. The top three barriers (exhaustion, sport has little priority, procrastination) were not only the same in both groups but also in the same order.

Conclusion: The strongest post-COVID-19 associated facilitator for long-term exercise adherence is when the need for further reconditioning is felt. The strongest post-COVID-19 associated barrier is exhaustion. Availability of exercising in a group is a key factor in increasing long-term exercise adherence.

Background: The diagnosis of large vessel vasculitis (LVV) is often challenging due to the various clinical appearances and the low prevalence. Hybrid imaging by positron emission tomography and computed tomography (PET/CT) is a highly relevant imaging modality for diagnostics and disease surveillance but may be associated with a significant amount of radiation dose especially in patients with complications.

Objective: The aim of this retrospective analysis was to compare the image quality and impact of hybrid imaging methods PET/CT and PET/MRI on the potential for dose reduction.

Methods: This retrospective single-center study included a cohort of 32 patients who were referred to PET/MRI for the evaluation of LVV, including graft infections and fever of unknown origin. This cohort was compared to a similar cohort of 37 patients who were examined with PET/CT in the same period. Mean radiation dose as well as image quality to establish a diagnosis were compared between the groups.

Results: The mean radiation dose applied in PET/MRI was significantly lower when compared to PET/CT (mean 6.6 mSV vs. 31.7 mSV; p < 0.001). This effect was based on the partially multiphasic CT protocols. At the same time, diagnostic image quality using a 4-point scale showed similar results for both imaging modalities in the work-up of LVV.

Conclusion: With PET/MRI, the radiation exposure can be significantly reduced with similar image quality and diagnostic impact. Patients with LVV have a higher risk of receiving a clinically relevant cumulative effective dose (CED) and PET/MRI should be made available to them.

Introduction: Socioeconomic disparities have been linked to delayed prostate cancer diagnosis and poorer outcomes in various countries. This study aims to evaluate the socioeconomic disparities in prostate cancer diagnostics in Vienna, Austria, by examining initial prostate-specific antigen values and age at diagnosis across different districts and nationalities.

Methods: This retrospective study included 1356 prostate cancer patients treated at the Medical University of Vienna between 2012 and 2022. Influence of residential districts and nationalities of the patients on the initial prostate-specific antigen (iPSA) value and on the age at diagnosis were analyzed. Patient data, including iPSA values, residential districts, and nationalities, were retrieved from the hospital's internal documentation system. The information on average income of residential districts was obtained from the City of Vienna's municipality data. Nationalities were grouped into EU and non-EU categories. Statistical analyses, including linear regression and t‑tests, were performed to examine the relationship between iPSA values, age at diagnosis, and socioeconomic variables. Linear regression was used to analyze the relationship between district income and both iPSA values and age at diagnosis.

Results: The study found no significant differences in iPSA values and age at diagnosis between patients from higher income and lower income districts. Additionally, there were no significant differences among individual districts or between EU and non-EU nationals.

Conclusion: The findings suggest that the Austrian healthcare system provides equitable access to prostate cancer diagnostics across different socioeconomic groups.

Background: Peritoneal mesothelioma (PM) is a rare disease with various histopathological subtypes. For malignant peritoneal mesothelioma and borderline subgroups locoregional therapy with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been implemented. The aim of our study was to retrospectively present the outcome after CRS and HIPEC for patients with different subtypes of peritoneal mesothelioma.

Methods: In total 15 patients received CRS and HIPEC due to peritoneal mesothelioma at our tertiary referral hospital between 2013 and 2022. Surgical and oncologic outcomes of 14 of those patients were retrospectively evaluated as one patient was lost to follow-up.

Results: The cohort consisted of 9 patients with diffuse malignant peritoneal mesothelioma (64.3%), 3 patients with multicystic peritoneal mesothelioma (21.4%) and 2 patients with well-differentiated peritoneal mesothelioma (14.3%). Complete cytoreduction was possible in 85.7% (n = 12). The major complication rate was 28.6% (n = 4) and the reoperation rate was 14.3% (n = 2). Median follow-up was 55 months (standard error, SE 15.0%, 95% confidence interval, CI 25.6-84.4 months). Over this time period 64.3% (n = 9) had no evidence of disease, 21.4% (n = 3) were alive with disease and 14.3% (n = 2) died of peritoneal mesothelioma. The median recurrence-free survival of patients was 13 months (SE 13.0%, 95% CI 0.0-32.2 months). None of the patients with multicystic peritoneal mesothelioma had evidence of disease at the time of last follow-up.

Conclusion: Patients with peritoneal mesothelioma should receive locoregional treatment as good oncological results can be achieved with reasonable postoperative morbidity. Thus, awareness is necessary for this rare but potentially aggressive disease to offer the best medical care.