Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel

Introduction The trinational survey project conducted by the Young Forums of the German, Austrian, and Swiss Societies for Gynecology and Obstetrics aims to assess the preferences of prospective and practicing gynecologists regarding various work-time models, educations systems, career and work-family-live balance. Materials and Methods Between October 2023 and May 2024, a total of 1,364 participants took part in the FARBEN survey. The questionnaire consisted of 62 questions covering topics such as the workplace in general, work-time models, training priorities, team compositions, and professional goals. Participation was voluntary and anonymous. This is a national subanalysis evaluating individual preferences according to current workplace (university vs. non-university departments vs. outpatient care) of German participants. Results Of 1,008 participants from Germany, 26.3% were employed in university departments, 55.4% in non-university departments and 10.8% in outpatient care. Respondents employed in university departments were more likely to pursue a scientific-academic career (68.0% held a doctorate, 7.5% a habilitation [highest academic achievement in German-speaking countries] or a professorship; 38.5% aspiring to a habilitation vs. 6.6% in non-university departments). Women at university departments became mothers later than at non-university departments and returned earlier from parental leave. Childcare provided by the workplace was reported as better and more flexible at university departments (20.4% vs. 9.6% at non-university departments and 8.4% in outpatient care). 34.1% of participants from university departments reported their head of department was female, compared to 19.2% at non-university departments (p < 0.001). Conclusions The compatibility of family and career and a good work-life balance are important for the majority of gynecologists in specialty training, regardless of their place of work. Participants working in university settings were more likely to pursue academic career and reported higher flexibility and better childcare support. In times of a deficite of upcoming medical physicians, employment policy should focus on these points. Guidelines such as “Safe surgery during pregnancy” can help to ensure that family planning does not hinder clinical training.

Objective To develop and validate a wrist‐worn accelerometer‐based, deep‐learning tunable algorithm for the automated detection of generalized or bilateral convulsive seizures (CSs) to be integrated with off‐the‐shelf smartwatches. Methods We conducted a prospective multi‐center study across eight European epilepsy monitoring units, collecting data from 384 patients undergoing video electroencephalography (vEEG) monitoring with a wrist‐worn three dimensional (3D)–accelerometer sensor. We developed an ensemble‐based convolutional neural network architecture with tunable sensitivity through quantile‐based aggregation. The model, referred to as Episave, used accelerometer amplitude as input. It was trained on data from 37 patients who had 54 CSs and evaluated on an independent dataset comprising 347 patients, including 33 who had 49 CSs. Results Cross‐validation on the training set showed that optimal performance was obtained with an aggregation quantile of 60, with a 98% sensitivity, and a false alarm rate (FAR) of 1/6 days. Using this quantile on the independent test set, the model achieved a 96% sensitivity (95% confidence interval [CI]: 90%–100%), a FAR of <1/8 days (95% CI: 1/9–1/7 days) with 1 FA/61 nights, and a median detection latency of 26 s. One of the two missed CSs could be explained by the patient's arm, which was wearing the sensor, being trapped in the bed rail. Other quantiles provided up to 100% sensitivity at the cost of a greater FAR (1/2 days) or very low FAR (1/100 days) at the cost of lower sensitivity (86%). Significance This Phase 2 clinical validation study suggests that deep learning techniques applied to single‐sensor accelerometer data can achieve high CS detection performance while enabling tunable sensitivity.

MRI plays an increasingly important role in the diagnosis of status epilepticus (SE). Approximately half of patients with SE do not have pre-existing epilepsy, and the cause of de novo SE is frequently unknown. The role of MRI in the identification of causes of SE is invaluable. MRI is often helpful as a diagnostic tool in cases of non-convulsive status epilepticus (NCSE) with ambiguous EEG findings. Thus, MRI is recommended for all patients presenting with de novo SE, patients with known epilepsy with the first episode of SE and NCSE with equivocal EEG. Different peri-ictal MRI (PMA) alterations may be seen during ongoing SE or briefly after its cessation. They commonly present as peri-ictal hyper-perfusion, diffusion restriction and/or FLAIR-hyperintensity affecting specific brain areas such as the cortex, hippocampus, pulvinar of the thalamus, splenium of the corpus callosum, claustrum or cerebellum, frequently in combination, suggesting the existence of a “status epilepticus network”. MRI sequences, which are necessary for detecting PMA, include diffusion-weighted imaging, fluid attenuated inversion recovery, T1-weighted imaging with and without contrast application, as well as perfusion sequences such as arterial spin labeling. Recent research suggests that they may serve as biomarkers for predicting an outcome in SE. Patients with PMA seem to have a higher mortality rate compared to those without PMA. However, there is still a substantial knowledge gap and there are many open questions related to imaging in SE. Further prospective quantitative MRI studies with uniform protocols, timing and follow-up periods are needed to answer these important and clinically relevant questions.

Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a major driver of premature mortality in patients with rheumatoid arthritis (RA). Detection of RA-ILD is crucial but requires awareness among the treating physicians. To date, however, there is no international recommendation concerning screening for ILD in RA patients. After a systematic literature review, the modified Delphi technique in combination with the nominal group technique was used to provide a Delphi consensus statement elaborated by an expert panel of pneumonologists, rheumatologists, and a radiologist. Based on the available evidence, several clusters of questions were defined and discussed until consent was reached. A screening algorithm for ILD in patients with RA based on clinical signs, respiratory symptoms, and risk factors has been developed. Further, the recommendations address diagnostic tools for RA-ILD and the follow-up of RA patients qualifying for ILD screening.

Background/Objectives: Current evidence suggests that patients with unresectable non-small cell lung cancer (NSCLC) whose tumours harbour driver mutations do not benefit from immune checkpoint inhibition. Kirsten rat sarcoma virus mutations (KRASmts), however, seem to be the exceptions to the rule. To this end, we compared KRASmt patients who were treated with immunotherapy to those without. Methods: ALLSTAR is a nationwide registry for patients with histologically verified non-operable NSCLC aged 18 or older having a curative treatment option. This report presents a subcohort of KRASmt patients who were recruited between 2020/03 and 2023/04. The diagnostic work-up included ¹⁸F-FDG-PET-CT scan and contrast-enhanced cranial CT or—preferably—MRI. Patients were treated with chemoradiotherapy (CRT) either followed by immune checkpoint inhibition (ICI) or not. Results: Thirty-two KRASmt patients with a median follow-up of 25.9 months were included in this analysis. After CRT, 27/32 (84%) patients received ICI. The 2-year overall survival rate in KRASmt patients who received immunotherapy was significantly better compared to those without ICI (N = 32; 84% versus 20%; p < 0.001). Likewise, the 2-year progression-free-survival with immunotherapy was also significantly better than in those without ICI (N = 32; 75% versus 20%; p < 0.001). Of the 12/32 patients (38%) who had received radiation doses > 66 Gy, none had a locoregional relapse, whereas in the other 20 patients, 5 (25%) events occurred (p-value = 0.116). Conclusions: Since KRASmt patients could benefit from ICI treatment, immunotherapy should be offered to these patients, similar to those without actionable genetic drivers. Additionally, radiation dose escalation > 66 Gy may also improve locoregional control in this subset of patients.

Background Temporal lobe epilepsy (TLE) can lead to structural brain abnormalities, with thalamus atrophy being the most common extratemporal alteration. This study used probabilistic tractography to investigate the structural connectivity between individual thalamic nuclei and the hippocampus in TLE. Methods Thirty‐six TLE patients who underwent pre‐surgical 3 Tesla magnetic resonance imaging (MRI) and 18 healthy controls were enrolled in this study. Patients were subdivided into TLE with HS (TLE‐HS) and MRI‐negative TLE (TLE‐MRneg). Tractography and whole brain segmentation, including thalamus parcellation, were performed to determine the number of streamlines per mm³ between the thalamic nuclei and hippocampus. Connectivity strength and volume of regions were correlated with clinical data. Results The volume of the entire thalamus ipsilateral to seizure onset was significantly decreased in TLE‐HS compared to controls (Mann–Whitney‐U test: pFDR < 0.01) with the anterior thalamic nuclei (ANT) as important contributor. Furthermore, decreased ipsilateral connectivity strength between the hippocampus and ANT was detected in TLE‐HS (pFDR < 0.01) compared to TLE‐MRneg and controls which correlated negatively with the duration of epilepsy (ρ = −0.512, p = 0.025) and positively with seizure frequency (ρ = 0.603, p = 0.006). Moreover, ANT volume correlated negatively with epilepsy duration in TLE‐HS (ρ = −0.471, p = 0.042). Conclusions ANT showed atrophy and decreased connectivity in TLE‐HS, which correlated with epilepsy duration and seizure frequency. Understanding the dynamics of epileptogenic networks has the potential to shed light on surgery‐resistant epilepsy and refine the selection process for ideal neurosurgical candidates, consequently enhancing post‐surgical outcomes.

Introduction: Creutzfeldt-Jakob disease is a rare, neurodegenerative disorder that is incurable, always fatal, and transmissible. EEG is an integral part of the diagnostic workup with typical periodic sharp-wave complexes indicative of CJD, but early in the disease EEG is often unaltered. Accordingly, we aimed at evaluating disruption of brain network functional connectivity (FC) in regions belonging to the default mode network (DMN) as a potential early marker in CJD when EEG is considered visually normal. Methods: EEGs considered visually normal obtained from 7 CJD patients were compared to EEGs of 7 patients with subjective cognitive impairment (SCI) using Brainstorm application for Matlab. FC was calculated using the phase locking value separately for the delta-, theta-, alpha-, and beta-frequency-band. The global efficacy of the DMN was calculated as the inverse characteristic path length with brain-regions belonging to the DMN as nodes. Results: CJD vs. SCI had significantly lower global efficacy of the DMN in the gamma band. FC was decreased between bilateral orbitofrontal regions and the right parahippocampal gyrus and between bilateral orbitofrontal gyrus and the right anterior cingulate gyrus in CJD. Conclusion: Our findings provide evidence of disruption of the DMN in the gamma band and alterations of FC between specific brain regions in early CJD patients with visually normal EEGs. EEG brain network properties bear potential as a diagnostic tool for CJD early in the disease course in addition to established criteria. These findings call for further studies evaluating the diagnostic value of FC in early CJD.

Objective: Baricitinib is an oral, reversible and selective inhibitor of Janus kinase (JAK)1 and JAK2 that is approved as monotherapy or in combination with methotrexate for the treatment of adults with moderate-to-severe active rheumatoid arthritis (RA) who have responded inadequately to disease-modifying antirheumatic drugs. Evidence supporting the approved monotherapy indication is growing in real-world settings that reflect routine clinical practice. Methods: Results of separate analyses of real-world data from the observational prospective RA-BE-REAL, Erlangen Baricitinib cohort, the BSRBR-RA, and Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) registries, and the retrospective ORBIT-RA and SUSTAIN long-term chart reviews were reported, documenting baseline data and outcomes for a total of 932 patients with active RA receiving baricitinib as monotherapy. Findings were contrasted with those from a total of 850 patients receiving the drug as combination therapy. All analyses were descriptive and completed in September 2022. Results: Across the patient registries and observational studies, 39.4%-69.6% of patients received baricitinib monotherapy for the treatment of active RA. In these patients, after about 6-12 months of treatment, 40.7%-93.8% and 55.6%-88.0% achieved remission or low disease activity according to the composite measures of disease activity 28-joint count and Clinical Disease Activity Index, respectively. Treatment continuation/discontinuation rates differed across the studies. Conclusion: These findings suggest that baricitinib monotherapy can be a suitable treatment option in routine clinical practice for patients with RA, when used in accordance with current guidelines.

Zusammenfassung Einleitung Der Begriff „Second Victim“ erfuhr seit seiner Prägung im Jahr 2000 bedeutende inhaltliche Erweiterungen und wurde kürzlich international neu konsentiert. Bislang existiert keine einheitliche deutsche Definition des Begriffs „Second Victim“. Um eine Basis für ein flächendeckendes Verständnis des Phänomens zu schaffen und die Vergleichbarkeit durchgeführter Forschung zum Thema zu erleichtern, zielt diese Studie darauf ab, eine konsensbasierte Übersetzung der aktuellen englischen Definition des Begriffs Second Victim zu erarbeiten. Methode Die konsensbasierte Übersetzung wurde mittels der Delphi-Methode durchgeführt. Es wurden 11 deutschsprachige Expertinnen und Experten aus Deutschland, Österreich und der Schweiz mit einschlägigen Publikationen eingeladen und 3 Delphi-Runden geplant. Ergebnisse An der Studie beteiligten sich 9 von 11 eingeladenen Expertinnen und Experten. Die Übersetzung der internationalen Definition eines Second Victim wurde nach drei Delphi-Runden mit einer Zustimmungsrate von 90 % konsentiert. Ein Second Victim wird damit definiert als: „Jede Fachkraft im Gesundheitswesen, die direkt oder indirekt an einem unerwarteten unerwünschten Patientenereignis, einem unbeabsichtigten Fehler in der Gesundheitsversorgung oder einer Patientenschädigung beteiligt ist und die zur betroffenen Person wird, indem sie ebenfalls beeinträchtigt ist.“ Diskussion Mit der vorliegenden Delphi-Studie wurde erstmals eine deutschsprachige, evidenzbasierte Definition des Begriffs „Second Victim“ formal durch anerkannte Fachexpertinnen und Fachexperten konsentiert. Damit ist auch in Deutschland eine Grundlage für ein klares Verständnis des Begriffs geschaffen und ein Beitrag zu einer gemeinsamen Basis für die Diskussion und Erforschung des Second-Victim-Phänomens im deutschsprachigen Raum geleistet worden.

Objective: The aim of this analysis was to assess glycemic control before and during the coronavirus disease (COVID-19) pandemic. Methods: Data from 64 (main analysis) and 80 (sensitivity analysis) people with type 1 diabetes (T1D) using intermittently scanned continuous glucose monitoring (isCGM) were investigated retrospectively. The baseline characteristics were collected from electronic medical records. The data were examined over three periods of three months each: from 16th of March 2019 until 16th of June 2019 (pre-pandemic), from 1st of December 2019 until 29th of February 2020 (pre-lockdown) and from 16th of March 2020 until 16th of June 2020 (lockdown 2020), representing the very beginning of the COVID-19 pandemic and the first Austrian-wide lockdown. Results: For the main analysis, 64 individuals with T1D (22 female, 42 male), who had a mean glycated hemoglobin (HbA1c) of 58.5 mmol/mol (51.0 to 69.3 mmol/mol) and a mean diabetes duration 13.5 years (5.5 to 22.0 years) were included in the analysis. The time in range (TIR[70–180mg/dL]) was the highest percentage of measures within all three studied phases, but the lockdown 2020 phase delivered the best data in all these cases. Concerning the time below range (TBR[<70mg/dL]) and the time above range (TAR[>180mg/dL]), the lockdown 2020 phase also had the best values. Regarding the sensitivity analysis, 80 individuals with T1D (26 female, 54 male), who had a mean HbA1c of 57.5 mmol/mol (51.0 to 69.3 mmol/mol) and a mean diabetes duration of 12.5 years (5.5 to 20.7 years), were included. The TIR[70–180mg/dL] was also the highest percentage of measures within all three studied phases, with the lockdown 2020 phase also delivering the best data in all these cases. The TBR[<70mg/dL] and the TAR[>180mg/dL] underscored the data in the main analysis. Conclusion: Superior glycemic control, based on all parameters analyzed, was achieved during the first Austrian-wide lockdown compared to prior periods, which might be a result of reduced daily exertion or more time spent focusing on glycemic management.

Purpose The present study tested the hypothesis that repeated anti-VEGF injections are associated with reduced retinal nerve fiber layer (RNFL) and minimum rim width (MRW) of the optic nerve head. Patients and methods Sixty-six patients with a history of intravitreal injections due to neovascular age-related macular degeneration were included. RNFL and MRW were measured using optical coherence tomography (Spectralis OCT, Heidelberg Engineering, Heidelberg, Germany). Results Mean global RNFL was 90.62 μm and both RNFL as well as MRW significantly decreased with advanced age (p = 0.005 and p = 0.019, respectively). Correlating for the number of injections, no significant impact on RNFL was found globally (p = 0.642) or in any of the sectors. In contrast, however, global MRW was significantly reduced with increasing numbers of intravitreal injections (p = 0.012). The same holds true when adjusted for the confounding factor age (RNFL p = 0.566 and MRW p = 0.023). Conclusion Our study shows that repeated intravitreal injections due to choroidal neovascularization seem to have a deleterious effect on MRW but not on RNFL. This suggests that MRW is a more sensitive marker than RNFL for evaluating the effect of frequent intravitreal injections on the optic nerve head since it seems to be the first structure affected.

Background We aimed to analyze potentially prognostic factors which could have influence on postoperative seizure, neuropsychological and psychiatric outcome in a cohort of patients with mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS) after selective amygdalohippocampectomy (SAHE) via transsylvian approach. Methods Clinical variables of 171 patients with drug-resistant MTLE with HS (88 females) who underwent SAHE between 1994 and 2019 were evaluated using univariable and multivariable logistic regression models, to investigate which of the explanatory parameters can best predict the outcome. Results At the last available follow-up visit 12.3 ± 6.3 years after surgery 114 patients (67.9%) were seizure-free. Left hemispheric MTLE was associated with worse postoperative seizure outcome at first year after surgery (OR = 0.54, p = 0.01), female sex—with seizure recurrence at years 2 (OR = 0.52, p = 0.01) and 5 (OR = 0.53, p = 0.025) and higher number of preoperative antiseizure medication trials—with seizure recurrence at year 2 (OR = 0.77, p = 0.0064), whereas patients without history of traumatic brain injury had better postoperative seizure outcome at first year (OR = 2.08, p = 0.0091). All predictors lost their predictive value in long-term course. HS types had no prognostic influence on outcome. Patients operated on right side performed better in verbal memory compared to left (VLMT 1-5 p < 0.001, VLMT 7 p = 0.001). Depression occurred less frequently in seizure-free patients compared to non-seizure-free patients (BDI-II Z = − 2.341, p = 0.019). Conclusions SAHE gives an improved chance of achieving good postoperative seizure, psychiatric and neuropsychological outcome in patients with in MTLE due to HS. Predictors of short-term outcome don’t predict long-term outcome.

Many patients with allergic rhinitis (AR) have moderate-to-severe persistent AR. Meda Pharma’s AzeFlu (MP-AzeFlu®) is an intranasal AR treatment comprising a novel formulation of azelastine hydrochloride and fluticasone propionate in a single device. This prospective observational study of 214 adults and adolescents in Austria with moderate-to-severe persistent AR assessed the effectiveness of MP-AzeFlu (one spray/nostril twice daily; daily doses: azelastine hydrochloride 548 μg; and fluticasone propionate 200 μg) for AR control in clinical practice using the visual analog scale. Symptom severity was reported on days 0, 1, 3, 7, 14, 21, 28, 35, and 42. Patient demographics, AR phenotype, allergen sensitization, symptomatology, AR treatments in the previous year, and the reason for the MP-AzeFlu prescription were recorded. MP-AzeFlu treatment was associated with a rapid and statistically significant reduction in the visual analog scale score from baseline to each timepoint measured, including day 1 (all p < 0.0001). Mean (standard deviation) visual analog scale score was 53.5 mm (26.3) at baseline, 25.3 mm (21.0) on day 28, and 19.6 mm (17.4) on day 42, a mean overall reduction from baseline of 41.4 (23.9) mm for completers. Results were consistent irrespective of patient age, gender, severity, or traditional AR phenotype. Prior to MP-AzeFlu prescription, congestion was considered the most bothersome symptom. The majority of patients reported using at least two AR therapies in the past year, including oral antihistamines, intranasal corticosteroids, and intranasal antihistamines. Many patients in Austria live with uncontrolled persistent AR despite treatment. MP-AzeFlu provides effective and rapid control of persistent AR in a real-world Austrian setting.

Objective Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a major driver of premature mortality in patients with rheumatoid arthritis (RA). Detection of RA-ILD is crucial but requires awareness among the treating physicians. To date, however, there is no international recommendation concerning screening for ILD in RA patients. Methods After a systematic literature review, the modified Delphi technique in combination with the nominal group technique was used to provide a Delphi consensus statement elaborated by an expert panel of pneumonologists, rheumatologists, and a radiologist. Based on the available evidence, several clusters of questions were defined and discussed until consent was reached. Results A screening algorithm for ILD in patients with RA based on clinical signs, respiratory symptoms, and risk factors has been developed. Further, the recommendations address diagnostic tools for RA-ILD and the follow-up of RA patients qualifying for ILD screening.