Wiener Klinische Wochenschrift最新文献

Introduction: Blood pressure (BP) management is essential in secondary stroke prevention. Strategies to ensure continuous home BP monitoring are needed. Few studies investigated factors influencing adherence to home BP management. Therefore, we designed a pilot study to investigate the feasibility of keeping BP diaries (BPDs) with personal images.

Methods: In this prospective trial, we randomized persons with a diagnosis of stroke or transient ischemic attack into two groups: (i) 10 patients received a personalized BPD with pictures of their choosing and (ii) 10 patients received a BPD without photographs. We instructed participants in both groups to document their BP at home twice daily over 28 days. Adherence was defined as the number of BP measurements performed relative to the maximum number of recommended measurements. We assessed patient reported outcomes as exploratory endpoints.

Results: We found no statistically significant difference in mean adherence between the control group (64%) and the intervention group (69%). The BP was within the recommended range and precision of documentation was high in both groups, without statistically significant differences. Patient reported outcomes such as depression scores did not differ significantly between study groups.

Conclusion: Our findings underline the relevance to investigate aspects of adherence to home BP management suggesting the inclusion of patient-provided pictures to be feasible.

Objective: Following recovery from COVID-19, there is evidence for pulmonary sequelae and functional impairment. Data regarding the immunopathological mechanisms are limited. This study aimed to investigate the relationship between bronchoalveolar lavage fluid (BALF) cellularity, lung function impairment and high-resolution computed tomography (HRCT) changes in post-COVID syndrome patients.

Methods: Patients with post-COVID syndrome were enrolled in this Austrian single-center prospective observational cohort study. All patients underwent a pulmonary function test (PFT) and chest HRCT. Those with pathological HRCT findings underwent bronchoscopy with BALF sampling for differential cell count and fluorescence-activated cell sorting analysis.

Results: In this study 26 patients with post-COVID syndrome underwent bronchoscopy with BAL. The HRCT showed ground-glass opacifications (69.2%), organizing pneumonia (7.7%) or both (11.5%). The PFT revealed restrictive lung disease in 38.5% and reduced diffusion capacity in 68%, 19.2% showed a pathological BAL cell pattern predominantly consisting of CD4⁺ T‑cells. The BALF lymphocyte count was associated with reduced forced vital capacity (p = 0.016) and an elevated alveolar-arterial oxygen gradient (p = 0.04).

Conclusion: A notable percentage of patients with post-COVID syndrome with persistent HRCT changes showed T‑helper lymphocytic inflammation in the lungs. The degree of alveolar lymphocytosis was associated with lung function impairment. This could suggest that a prolonged inflammatory response in the alveolar compartment contributes to the pathogenesis of post-COVID syndrome.

Background: In 2020, the Austrian Association of Emergency Medicine proposed structural quality criteria for in-hospital emergency care in Austria. However, it has not yet been assessed how these criteria apply to existing emergency departments.

Methods: All in-hospital emergency departments across Vienna were surveyed using a structured assessment based on published proposed structural quality criteria. A total of 54 criteria were analysed, each rated on a scale of 3 (comprehensive care), 2 (standard care), 1 (basic care), or 0 (not met).

Results: Among 16 hospitals, we identified 10 emergency departments. The scores ranged from 87 points (54%) to 151 points (95%). None of the departments met all structural quality criteria. Overall, across all emergency departments, 69% of the criteria aligned with comprehensive care, 7% with standard care and 3% with basic care, while 21% of the criteria were not met at all.

Conclusions: A set of proposed structural quality criteria for emergency departments could be quantitatively assessed. While the published criteria and the observed infrastructure are largely consistent, there is significant potential for improvement in both the definition of the criteria and the criteria per se. The extent to which these structural quality criteria are useful for assessing the classification of tiered care models requires further studies in different regions.

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.