Wiener Klinische Wochenschrift最新文献

Heart failure significantly burdens healthcare systems. eHealth products could alleviate this burden by providing patients with recommendations for intensifying diuretic therapy. As evidence on guiding diuretic therapy is scarce, our goal was to identify clinical parameters that eHealth products can use to support heart failure patients in intensifying their diuretic therapy. A post-hoc analysis of the trial of intensified versus standard medical therapy in elderly patients with congestive heart failure (TIME-CHF), comparing an NT-proBNP-guided management strategy with a symptom-guided strategy in elderly heart failure patients, was conducted. Clinical data were collected during patient evaluations at 1, 3, 6, and 12 months of follow-up. At each visit, any increase or new prescription of diuretic therapy was recorded as the outcome event. Mixed-effects logistic regression analyses were used to estimate odds ratios (OR) with 95% confidence intervals (CI), investigating the relationship between the patient data and the odds of diuretic therapy intensification. In this retrospective analysis, 568 heart failure patients were included. Over a 12-month period, 2013 follow-up visits were conducted, during which diuretics were initiated or increased in 370 visits (18.4%). Higher New York Heart Association (NYHA) classification (OR 2.60, 95%CI 1.94-3.50), presence of edema (OR 2.84, 95%CI 2.15-3.77), paroxysmal nocturnal dyspnea (OR 1.52, 95%CI 1.04-2.21), and orthopnea (OR 1.39, 95%CI 1.04-1.85) were significantly associated with the initiation or increase of diuretics. Dyspnea, edema, paroxysmal nocturnal dyspnea, and orthopnea are associated with the intensification of diuretic treatment in HF patients. These symptoms, which patients can easily report, should be integrated into eHealth devices that offer guidance on managing diuretic therapy.

Jejunal variceal bleeding due to portal hypertension remains a rare but serious complication of decompensated liver cirrhosis. Potential treatment options include endoscopic, surgical or interventional management. We present a case report of a patient with intestinal blood loss due to jejunal variceal bleeding who was treated using interventional transhepatic embolization.

Purpose: This study aimed to describe the clinical characteristics and summarize the treatment outcomes in epididymitis patients with abscess formation.

Material and methods: From February 2016 to August 2022, epididymitis was diagnosed in 442 patients in the outpatient setting or emergency department. Patient information and laboratory data were extracted from electronic medical records. The treatment was analyzed.

Results: A total of 24 epididymitis patients developed abscess formation. Pain was the most common symptoms and abscess rupture was presented in 8 patients. A causative microorganism was more likely to be positively detected in caput epididymitis than corpus or caudal epididymitis in both urine culture and abscess culture (p = 0.023 and p = 0.038, respectively). All patients received a complete course of antimicrobial therapy.

Conclusion: Abscess formation is a severe disease condition of epididymitis, and requires systemic treatment including complete antimicrobial therapy, abscess incision and drainage and even epididymectomy or epididymo-orchiectomy. Caput epididymitis is more likely to be combined with orchitis, and easier to detect pathogenic microorganisms.

Objectives: Obesity is a chronic, multifactorial disease that is often described as an epidemic or pandemic of the 21st century. General practitioners (GPs) play a crucial role in managing it, yet multiple barriers hinder effective care. This study explores Austrian GPs' experiences in obesity management, their self-assessed knowledge and care competencies, and the perceived barriers to optimal treatment.

Methods: A quantitative online survey was conducted among GPs in October and November 2023. The questionnaire covered prevention, treatment, barriers, and experiences in managing overweight and obesity in primary care.

Results: In all, 59 GPs (56% female) completed the survey. Nearly all recognized obesity as a chronic disease and felt responsible for its management, but almost half considered their training insufficient. While 80% acknowledged the need for multimodal therapy programs, awareness of available healthcare services was low. The most significant barrier to effective obesity care from the GP's point of view was a lack of patient motivation. Female GPs were more likely to screen for dietary habits and physical activity, refer patients to specialized care, and request additional resources, whereas male GPs were more likely to prescribe pharmacotherapy. More experienced GPs felt better trained but were less likely to seek treatment guidelines. Regional and practice-setting differences influenced attitudes and referral patterns. GPs with private insurance contracts felt best trained and were least likely to request additional support.

Conclusion: The survey revealed considerable uncertainty among GPs regarding the management of overweight and obesity. These findings highlight the need for targeted interventions to improve patient care and enhance GPs' training in obesity management.

Background: Accurate diagnosis of many pediatric disorders relies on age-specific laboratory reference ranges. This is particularly important for rare disorders such as X‑linked hypophosphatemia (XLH) and hypophosphatasia (HPP), which present with decreases in serum phosphate and alkaline phosphatase (ALP), respectively.

Objective: This study evaluated the use of pediatric reference ranges among Austrian medical laboratories.

Methods: A comprehensive list of all extramural clinical laboratories was compiled. A standardized serum sample with pathological values for a 4-year-old child was dispatched to 26 extramural laboratories. The returned absolute and stated reference values were assessed and analyzed.

Results: Of 22 responding laboratories, 18.2% used appropriate pediatric reference ranges for serum phosphate and 40.9% for ALP. In total, 54.5 and 36.4% of laboratories identified the sample as normal for serum phosphate or ALP, respectively.

Conclusion: Despite accurate absolute value measurements, the majority of laboratories failed to identify the test sample as pathologic. In a real-world setting, the results obtained could lead to significant diagnostic delays and missed diagnoses in pediatric patients. The lack of regulatory requirements for pediatric-specific reference ranges in Austria and most European countries contributes to this problem. The study highlights the need for standardization and mandatory implementation of pediatric reference ranges to improve diagnostic accuracy for rare pediatric disorders across Europe.