Wiener Klinische Wochenschrift最新文献

Background: With widespread smartphone use, there is growing concern about their potential impact on human health.

Objective: The effects of smartphone use on self-reported hearing ability, tinnitus, balance, falls, and anxiety level were investigated in this study.

Methods: This study included 682 participants who were divided into 2 groups: a high smartphone use (HSU) group and a low smartphone use (LSU) group. Both groups were evaluated for hearing ability using the Amsterdam inventory for auditory disability and handicap; balance status using the vertigo, dizziness, imbalance symptom scale; anxiety status using the Beck anxiety index; and fall and tinnitus status using the visual analog scale.

Results: The HSU group showed significantly worse hearing ability, tinnitus, balance, falling, and anxiety status results than the LSU group (p < 0.001). There was a positive correlation between smartphone addiction severity and auditory impairment, tinnitus, risk of falling, and anxiety, as well as a negative correlation with balance score (p < 0.001).

Conclusion: The findings suggest that individuals with excessive smartphone use are more likely to experience hearing, tinnitus, balance, falling, and anxiety problems than those who use smartphones less frequently. Excessive smartphone use may be considered a potential risk factor for these problems.

Background: A non-inferiority clinical study evaluated the efficacy and safety of abobotulinumtoxinA vs. incobotulinumtoxinA intradetrusor injections in women with overactive bladder and urge urinary incontinence. Also, the effect of local anesthesia on the pain level of the procedure was assessed.

Methods: Patients were randomized to receive 20 intradetrusor injections of either 300 U abobotulinumtoxinA or 100 U incobotulinumtoxinA. They were further randomized to receive either local anesthesia (40 ml 1% lidocaine solution) or placebo before botulinum toxin injection. Before the procedure and 4 months after the procedure each patient reported urinary incontinence episodes, frequency, nocturia, completed the Urogenital Distress Inventory (UDI-6) score, Incontinence Impact Questionnaire (IIQ-7), and Incontinence Quality of Life (I-QOL) questionnaire. Each patient completed a patient satisfaction survey 4 months after the procedure. During the procedure, the patients graded the pain intensity of every injection on a visual analog scale (VAS). The total score of each questionnaire was considered.

Results: A total of 54 patients with a mean age of 66 ± 13 (SD) years completed the study. Total scores of UDI‑6, IIQ‑7, I‑QOL, patient satisfaction, urinary incontinence episodes, frequency, nocturia and VAS questionnaires did not show differences between the abobotulinumtoxinA (n = 26) or incobotulinumtoxinA (n = 28) group. Urinary retention requiring catheterization was noted in five patients. The VAS and patient satisfaction questionnaire values did not show significant differences between the group receiving bladder instillation with lidocaine solution (n = 28) or the group receiving placebo (n = 26).

Conclusion: In women with overactive bladder and urge urinary incontinence where conservative treatment failed, abobotulinumtoxinA vs. incobotulinumtoxinA intradetrusor injections showed comparable results regarding improved clinical outcome and patient satisfaction. Local anesthesia before the procedure did not reduce the pain level in comparison with the placebo.

Isolated pulmonary valve endocarditis (IPE) is a rare form of infectious endocarditis. This article reports the case of a 49-year-old patient with IPE who was initially admitted with suspected cholecystitis. After vegetations were detected by transthoracic (TTE) and transesophageal echocardiography (TEE), antibiotic therapy in accordance with the antibiogram was primarily attempted; however, due to persistently elevated infection parameters and structural valve damage a pulmonary valve replacement was eventually performed.

Introduction: An increasing number of high voltage electric burn injuries in a typically younger patient collective of train surfers and climbers at our level I center for burns was recognized. The purpose of this study was a retrospective data evaluation and as a consequence the implementation of an awareness program against train surfing.

Material and methods: In a retrospective analysis of prospectively collected data, 17 patients with high voltage injuries, who had been treated at our unit between January 2022 and January 2023, were identified. Of these patients seven were treated for injuries due to train surfing or climbing and therefore included in this study. The patients were assessed clinically for total burn surface area (TBSA), degree of burn, associated Injuries, hospital length of stay, number and type of surgeries (fasciotomy, minor/major amputations, defect coverage split skin graft or flaps).

Results: A total of seven males formed the basis of this report with an average age of 17.7 years (range 14-21 years). The highest ABSI (Abbreviated Burn Severity Index) score was 12, leading to the death of the 21-year-old patient who had 80% TBSA as well as multiple comorbidities including severe brain damage. The mean duration of stay at the intensive care unit (ICU) was 24.8 days and the mortality rate was 14.29%.

Conclusion: This study highlighted the severity of injuries, with a mean TBSA of 41.42% and a mortality rate of 14.29% among the study population. Train climbing and surfing patients presented with severe injuries and fatal long-term consequences. A pilot project involving several stakeholders was initiated in order to raise awareness of the dangers of electric arcs and the risk involved.

Background: Proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors have emerged as important therapeutic options for patients unable to achieve the low-density lipoprotein cholesterol (LDL‑C) target or to tolerate alternative lipid-lowering agents. The aim of this study was to investigate the efficacy of PCSK9 inhibitor treatment in tertiary routine care, by determining the percentage of patients reaching individual LDL‑C target levels 1 year after treatment initiation.

Patients and methods: Patients routinely started on PCSK9 inhibitors at our lipid clinic between 2017 and 2020 were retrospectively analyzed. Attainment of the LDL‑C target, utilization of follow-ups, cardiovascular events and effects on laboratory parameters were investigated.

Results: In this study 347 patients were included, with the majority managed in secondary prevention (94.5%). The LDL‑C target was achieved by 44.9% after ca. 14 months, with differences between statin users and non-users (51.0% vs. 22.7%; p < 0.001). The median LDL‑C decreased from 126.00 mg/dL at baseline to 48 mg/dL (-61.6%; -77.00 mg/dL; p < 0.001) after ~2 months and to 60 mg/dL (-52.9%; -59.00 mg/dL; p < 0.001) after ~14 months. Median lipoprotein(a) levels decreased significantly from 184.0 nmol/L to 165.5 nmol/L (-25.9%; -25.5 nmol/L; p = 0.001) after ~2 months, whereas no effects on creatine kinase, amylase and lipase were detectable. Of the patients 15% utilized 4 follow-ups. The PCSK9 inhibitor intolerance occurred in 3.5% of patients.

Conclusion: With the effect of LDL-lowering remaining constant over 14 months, PCSK9 inhibitor treatment showed effective and sustainable LDL‑C lowering in a majority of patients in secondary prevention, bringing them closer to the recommended LDL‑C goal, particularly those under concomitant statin medication. Treatment with PCSK9 inhibitors appears to be well-tolerated, confirming data from clinical trials in real life.

Background: Current demographic changes bear challenges for national care systems due to higher life expectancy of older citizens. Largely cut off from society, nursing home residents are at risk for violence, neglect, and other potential human rights violations. This study aimed to investigate healthcare vulnerabilities in nursing homes and evaluate the Austrian National Preventive Mechanism (NPM).

Methods: Between 2017 and 2019, 55 monitoring visits were conducted in 32 nursing homes. Study outcomes from two Austrian provinces included data on infrastructure, occupancy, staffing, resident's demographics and medical conditions, as well as measures related to the functioning of the NPM.

Results: Accessibility with mobility aids was sufficient in 87%, but assistance for persons with visual or hearing impairments solely in 20-40% of the institutions. An understaffing with nursing assistants (-5.2 full-time equivalents in Carinthia) and home helpers (-1.6 in Carinthia and Styria) was present. Less than 20% of the personnel received advanced training related to dementia and neuropsychiatric care. While 50% of the residents were diagnosed with a psychiatric disorder, approximately 36% received support from an appointed legal guardian. Of the monitoring visits 58.1% were conducted due to anonymous complaints and urgent referrals. The median processing times of the NPM and the provincial governments exceeded 250 days.

Conclusion: Human rights monitoring reveals critical aspects in nursing home care, including insufficient accessibility, understaffing and inadequate training. Although the authorities' handling times hinder prompt responses, the NPM may foster systemic improvements and accountability within nursing homes.

While glucocorticoids remain the standard first-line treatment for chronic idiopathic eosinophilic pneumonia (CIEP), the long-term use is marred by significant side effects. This case study explores the effectiveness of mepolizumab, an anti-interleukin‑5 (IL-5) monoclonal antibody, as a novel corticosteroid-free alternative in treating CIEP. A 50-year-old woman presented with a 3-week history of progressive shortness of breath, dry cough and night sweats. The blood tests showed eosinophilia, and chest radiography identified lung consolidations. The CIEP was confirmed, ruling out other conditions through a detailed clinical and bronchoscopic work-up. The patient declined to be treated with systemic glucocorticoids. Treatment with mepolizumab was remarkable for effectively resolving symptoms and improving radiological findings without any prior or concurrent glucocorticoid therapy. Notably, the patient remained relapse-free over a 2-year follow-up, underscoring mepolizumab's efficacy as a corticosteroid-free treatment for CIEP. This case study calls for further research into anti-IL‑5 treatment of rare respiratory conditions.

Background: Concerns are growing when it comes to the shortage of primary care physicians, therefore it seems necessary to take a closer look at job satisfaction and self-care as one of many influences on career choice. A higher job satisfaction reduces the risk to experience burnout and job-related stress and in addition it will contribute to staying in the profession. The objective of this study is to investigate the impact of regular participation in Balint groups on job satisfaction and self-care among general practitioners.

Methods: Descriptive qualitative study with semi-structured expert interviews of 7 general practitioners. Thematical analysis of data and narrative summary.

Results: A total of 402 coded segments were categorized into 8 main themes and 39 subthemes. Interviewees emphasized changes in self-care and job satisfaction as a result of Balint work and mentioned Balint work as a burnout prophylaxis for themselves. Competences that were learnt or improved through Balint work were described as well as aspects such as feedback and connection with colleagues or professional challenges and difficulties.

Conclusion: The results of the study give rise to the assumption that regular participation in Balint groups might help to improve self-care, resilience, and contribute to job satisfaction. Further research is needed before a general recommendation can be made. Many positive aspects were described by the experts, while no harmful negative influences of Balint work were identified.

General practice/family medicine has recently been recognized as a medical discipline in Austria. This paper is a short report on the prevailing understanding of its goals and subjects, comparing the Austrian perception with international definitions. It comments on shortcomings and introduces an outline for the development of a revised professional theory.At present, there is no clear uniform image of the discipline, neither among the general public, nor among physicians, healthcare professionals or decision makers. The reason for this lies in the historical development which, with the triumph of specialization, has led to a loss of importance for generalist medicine. Now it is the fragmentation that extensive specialization entails that gives a new meaning to generalist, contextual and patient-centered medicine.This change needs to be analyzed and understood. A description of the responsibilities, tasks and very specific methods unique to the discipline will be developed, which should enable the sensible, contemporary use of general practice/family medicine for the benefit of patients and the healthcare system.