Ludwig Boltzmann Gesellschaft

Including the patient perspective in health research is not merely beneficial but essential. The establishment of the Austrian Patient Council serves as a practical example of how this goal can be effectively realized. This comprehensive mixed methods study offers valuable insights into the preparatory, foundational, and evaluative steps involved in setting up such a council. By analyzing online surveys conducted at two different points in time and conducting qualitative interviews, the study highlights the critical factors contributing to the council's success. These include selecting research topics of genuine interest to council members; establishing a robust project and administrative structure; ensuring the council is of an appropriate size; and that its membership is diverse and heterogeneous. The study also underscores the importance of implementing measures to facilitate and support active participation, and the need for continuous feedback and flexibility. Overall, the findings demonstrate that patient involvement in health research is feasible and provides a roadmap for meaningful engagement.

Purpose Understanding the impact of gene expression in pathological processes, such as carcinogenesis, is crucial for understanding the biology of cancer and advancing personalised medicine. Yet, current methods lack biologically-informed-omics approaches to stratify cancer patients effectively, limiting our ability to dissect the underlying molecular mechanisms. Results To address this gap, we present a novel workflow for the stratification and further analysis of multi-omics samples with matched RNA-Seq data that relies on MSigDB curated gene sets, graph machine learning and ensemble clustering. We compared the performance of our workflow in the top 8 TCGA datasets and showed its clear superiority in separating samples for the study of biological differences. We also applied our workflow to analyse nearly a thousand prostate cancer samples, focusing on the varying expression of the FOLH1 gene, and identified specific pathways such as the PI3K-AKT-mTOR gene sets as well as signatures linked to prostate tumour aggressiveness. Conclusion Our comprehensive approach provides a novel tool to identify disease-relevant functions of genes of interest (GOI) in large datasets. This integrated approach offers a valuable framework for understanding the role of the expression variation of a GOI in complex diseases and for informing on targeted therapeutic strategies.

Introduction Cancer remains a major global health challenge, affecting millions annually and ranking as the second leading cause of death worldwide. The complexity of cancer treatment requires an interdisciplinary approach, connecting professionals from various fields to deliver personalised and integrated care. However, structural issues and insufficient interdisciplinary training can impede effective collaboration, which is why effective interprofessional education (IPE) is needed. This protocol depicts the planned procedures for a scoping review that aims to explore the role of IPE in enhancing interdisciplinary collaboration within oncology by mapping and synthesising the implementation, impact and evaluation strategies of patient-centred IPE programmes. Methods and analysis This scoping review will be conducted in line with the Joanna Briggs Institute guidelines for scoping reviews. The research team will develop a comprehensive search strategy and apply it to the following databases: CENTRAL, CINAHL, Embase, MEDLINE, PsycInfo, Scopus and Web of Science . Additionally, we will search for grey literature (eg, using OpenDOAR) and contact relevant organisations for pertinent reports. Each database will be searched without date restrictions on 11 September 2024. In the first stage, eligibility criteria will be assessed through a blinded title and abstract screening, followed by a full-text review. The research team will then extract and synthesise data related to the scoping review questions, focusing on implementation, impact and evaluation strategies employed in the included studies. Ethics and dissemination As this protocol does not involve collecting primary data, ethical approval is not required. The results of this review will be published in a peer-reviewed journal and disseminated through institutional websites and conferences.

Background: The use of telemedicine can contribute to patient satisfaction, support hygienic concepts by avoiding physical contact when not required, and reduce waiting and travel time. We aimed to evaluate our recently implemented telemedical approach of remote pre-anesthesia assessment. Methods: We designed a questionnaire to assess patient satisfaction with remote pre-anesthesia assessment procedures, completeness of understanding, and technical feasibility. In total, 250 patients were asked to voluntarily complete the questionnaire after their pre-anesthesia assessment via telephone. Digital anesthesia records were subsequently reviewed for unexpected events and complications to investigate the quality and safety of the approach. Results: Patients included in our study were 51 years old (median, range 18–85 years), mostly female (58%) and had an American Society of Anesthesiologists (ASA) physical status of 1–3 (22.8%, 56.4%, and 20.8%, respectively). Patient satisfaction was high with ratings of “very good” or “good” in over 90% of all questions related to the pre-anesthesia assessment via telephone. Patient’s evaluation for the use of telemedicine in general also showed a wide acceptance with 84.4% rating the idea as “very good” (55.6%) or “good” (28.8%). Duration of patient-physician interaction positively correlated with age (p = 0.005) and ASA status (p = 0.003). Upon review of the digital anesthesia records, there were no intraoperative complications or unexpected events related to the remote pre-anesthesia assessment. Conclusion: Remote pre-anesthesia assessment via telephone is safe, technically feasible, and satisfactorily accepted in selected patients. These results encourage the continuing implementation of telemedical approaches for pre-anesthesia assessment.

Introduction Language barriers within clinical settings pose a threat to patient safety. As a potential impediment to understanding, they hinder the process of obtaining informed consent and uptake of critical medical information. This study investigates the impact of the current use of interpreters, with a particular focus on of engaging laypersons as interpreters, rather than professional interpreters potentially affecting patient safety. A further objective is to explore the reliability of phone-based telemedicine in terms of the retention of important medical facts. Methods In three groups (N per group = 30), we compared how using lay or professional interpreters affected non-German speaking patients’ subjectively perceived understanding (understood vs. not understood) and recollection (recollected vs. not recollected) of information about general anaesthesia. Proficient German speaking patients served as the control group. Statistical analyses (χ2 tests and binomial) were calculated to show differences between and within the groups. Results All three groups indicated similar, high self-reported levels of having understood the medical information provided. This was in stark contrast to the assessed objective recollection data. In the lay interpreter group, recollection of anaesthesia facts was low; only around half of participants recalled specific facts. For patients supported by professional interpreters, their recollection of facts about anaesthesia was significantly enhanced and elevated to the same level of the control group (fluent in German). Moreover, for these patients, providing information by means of phone-based telemedicine before anaesthesia yielded high levels of understanding and recollection of anaesthesia facts. Conclusion Phone-based telemedicine is a safe and reliable method of communication in the professional interpreter group and German speaking control group, but not in the lay interpreter group. Compared to lay interpreters, professional interpreters significantly improve patients’ uptake of critical information about general anaesthesia, thus highlighting the importance of professional interpreters for patient safety and informed consent.

Background Cancer remains a critical global health issue requiring a comprehensive interdisciplinary approach for effective treatment. Interprofessional education (IPE) is essential for overcoming barriers to collaboration among healthcare professionals and fostering efficient teamwork in cancer care. Objective This systematic scoping review aims to explore the role of IPE in enhancing interprofessional collaboration within cancer care by mapping and synthesizing the implementation, impact, and evaluation strategies of patient-centered IPE programs in this field. Methods A comprehensive search was conducted across seven databases, including CENTRAL, CINAHL, Embase, MEDLINE, PsycInfo, Scopus, and Web of Science, from their inception to January 2024. Grey literature was also sought through online sources and by contacting relevant organizations. Data were extracted and synthesized narratively following a standardized protocol. Results Seven studies met the inclusion criteria, highlighting various educational methods such as web-based platforms, face-to-face interactions, experiential learning, and simulation-based training. Patient-centered IPE programs notably improved interprofessional collaboration, communication, knowledge, and self-confidence among healthcare professionals. Additionally, several programs led to concrete changes in clinical practice and institutional policies. Evaluation strategies primarily utilized established frameworks such as Kirkpatrick’s model and Moore’s outcome levels to assess multiple layers of outcomes, including participant satisfaction, knowledge acquisition, competence, and behavior change. Conclusions The findings indicate that patient-centered IPE programs effectively promote interprofessional collaboration and enhance clinical competencies in cancer care. Future research should focus on long-term evaluations, address systemic barriers, expand geographical scope, and utilize standardized evaluation frameworks to further improve the design and implementation of patient-centered IPE programs in cancer care.

Background Telehealth has been effective in managing cardiovascular diseases like stroke and heart failure and has shown promising results in managing patients with peripheral arterial disease. However, more work is needed to fully understand the effect of telehealth-based predictive modeling on the physical fitness of patients with peripheral arterial disease. Objective For this work, data from the Keep Pace study were analyzed in depth to gain insights on temporal developments of patients’ conditions and to develop models to predict the patients’ total walking distance at the study end. This could help to determine patients who are likely to benefit from the telehealth program and to continuously provide estimations to the patients as a motivating factor. Methods This work analyzes continuous patient-reported telehealth data, in combination with in-clinic data from 19 Fontaine stage II patients with peripheral arterial disease who underwent a 12-week telehealth-based walking program. This analysis granted insights into the increase of the total walking distance of the 6-minute walk tests (6MWT) as a measure for physical fitness, the steady decrease in the patients’ pain, and the positive correlation between well-being and the total walking distance measured by the 6MWT. Results This work analyzed trends of and correlations between continuous patient-generated data. Findings of this study include a significant decrease of the patients’ pain sensation over time ( P =.006), a low but highly significant correlation between pain sensation and steps taken on the same day ( r =−0.11; P <.001) and the walking distance of the independently performed 6MWTs ( r =−0.39; P <.001). Despite the reported pain, adherence to the 6MWT measurement protocol was high (85.53%). Additionally, patients significantly improved their timed-up-and-go test times during the study ( P =.002). Predicting the total walking distance at the study end measured by the 6MWT worked well at study baseline (root mean squared error of 30 meters; 7.04% of the mean total walking distance at the study end of 425 meters) and continuously improved by adding further telehealth data. Future work should validate these findings in a larger cohort and in a prospective setting based on a clinical outcome. Conclusions We conclude that the prototypical trend estimation has great potential for an integration in the telehealth system to be used in future work to provide tailored patient-specific advice based on these predictions. Continuous data from the telehealth system grant a deeper insight and a better understanding of the patients’ status concerning well-being and level of pain as well as their current physical fitness level and the progress toward reaching set goals.

Background Stakeholder engagement plays a vital role in driving advancements in product development. This imperative now extends to the healthcare domain, driven by the scarcity of healthcare professionals and the pressing demand for effective solutions. Through the application of design thinking and co-design methodologies, this study endeavours to promote comprehensive stakeholder involvement, creating streamlined processes and adaptable templates geared towards fostering innovative solutions for tele-emergency medicine. Methods In this study design thinking and co-design methods are developed, adapted, and tested, to create effective tools and demonstrate their application. This is part of a process involving stakeholders and lead users to develop a telemedicine solution for emergency medical services. This research is descriptive in kind, offering a transparent and holistic portrayal of the co-design process. The rural region of Burgenland in Austria was chosen for this study, with the challenges of its weak infrastructure offering valuable insights. The tools were tested in co-design workshops, with the participants continuously observed by the research team. Results Seventeen healthcare professionals, emergency medical technicians and academics participated in a co-design process to develop a telemedicine solution for emergency medical services. The results section presents practical co-creative healthcare innovation tools and templates that have been shown to facilitate the co-design process. Conclusions The study developed and applied co-design elements for the creation of a prototype concept for telemedicine in emergency medicine and offers valuable insights for similar projects involving diverse stakeholders. It shows that structured co-design activities help all stakeholders to jointly create solutions that meet the overall needs.

Traditional funding models allow for little external collaboration and exploration. To overcome ‘siloing’ of disciplines and enable more risky research, the Ideas Lab method was developed to enable new multidisciplinary ways of working. In this study, we explore the Ideas Lab as a cooperative funding instrument enabling transdisciplinary collaboration. We interviewed eight researchers participating in the Austrian Ideas Lab in 2017 after a 4-year project implementation and analysed their applications prior to the 5-day workshop. Researchers dealt with high pressure and stress and applied coping mechanisms to manage social dynamics. They changed their ways of working, dipping into new research areas, gaining new skills, and applying new engagement strategies with stakeholders as early as possible in the process. Openness and flexibility were essential to adjust to inputs from stakeholders. We conclude that the characteristics of the Ideas Lab as a funding instrument are well suited to the establishment and implementation of transdisciplinary research projects.

Although extracorporeal membrane ventilation offers the possibility for low-frequency ventilation, protocols commonly used in patients with acute respiratory distress syndrome (ARDS) and treated with extracorporeal membrane oxygenation (ECMO) vary largely. Whether strict adherence to low-frequency ventilation offers benefit on important outcome measures is poorly understood. Background/Objectives: This pilot clinical study investigated the efficacy of low-frequency ventilation on ventilator-free days (VFDs) in patients suffering from ARDS who were treated with ECMO therapy. Methods: In this single-center randomized controlled trial, 44 (70% male) successive ARDS patients treated with ECMO (aged 56 ± 12 years, SAPS III 64 (SD ± 14)) were randomly assigned 1:1 to the control group (conventional ventilation) or the treatment group (low-frequency ventilation during first 72 h on ECMO: respiratory rate 4–5/min; PEEP 14–16 cm H2O; plateau pressure 23–25 cm H2O, tidal volume: <4 mL/kg). The primary endpoint was VFDs at day 28 after starting ECMO treatment. The major secondary endpoint was ICU mortality, 28-day mortality and 90-day mortality. Results: Twenty-three (52%) patients were successfully weaned from ECMO and were discharged from the intensive care unit (ICU). Twelve patients in the treatment group and five patients in the control group showed more than one VFD at day 28 of ECMO treatment. VFDs were 3.0 (SD ± 5.5) days in the control group and 5.4 (SD ± 6) days in the treatment group (p = 0.117). Until day 28 of ECMO initiation, patients in the treatment group could be successfully weaned off of the ventilator more often (OR of 0.164 of 0 VFDs at day 28 after ECMO start; 95% CI 0.036–0.758; p = 0.021). ICU mortality did not differ significantly (36% in treatment group and 59% in control group; p = 0.227). Conclusions: Low-frequency ventilation is comparable to conventional protective ventilation in patients with ARDS who have been treated with ECMO. However, low-frequency ventilation may support weaning from invasive mechanical ventilation in patients suffering from ARDS and treated with ECMO therapy.

Background In the context of stigma and mental health research, limited empirical studies examine stigma through the positioning of individuals within interview contexts. This study addresses this gap by investigating the positioning processes in interviews with mothers with a mental illness, with a specific focus on the use of contrast devices as a strategy identified through analysis. By analysing how mothers position themselves through contrast devices and to which discourses they refer, this study provides insights into how stigmatising discourses are evident in the narratives of mothers with a mental illness. Methods This study is based on 20 semi-narrative interviews with mothers with a mental illness who participated in the Village Project (a pilot project co-created for children of parents with mental illness in Tyrol, Austria). Our analysis focuses on identifying stigmatising discourses related to motherhood and mental illness by examining the use of contrast devices in their accounts. Results The analysis shows insights into mothers’ efforts to distance themselves from labels such as ‘bad mother’, ‘not normal/crazy women’ and ‘weak person’. These positions often carry a gendered dimension, with motherhood emerging as a central position. Our study highlights the challenges mothers with a mental illness face in navigating societal norms and expectations related to motherhood during research interviews. Conclusion The research contributes to a deeper understanding of mental health stigma in the context of motherhood, emphasising the importance of considering gendered dynamics and societal expectations in mental health research.

Background Becoming a parent, while often perceived as a joyous event, can also be a vulnerable life transition, with approximately one in five mothers experiencing perinatal mental illness. Peer support is recommended for its preventive and therapeutic benefits. However, relevant program components of perinatal mental health peer support remain to be identified. Objectives This review aims to (1) identify peer support programs in perinatal mental health through existing reviews and to (2) synthesize the components of these programs. Methods A systematic literature review guided by PRISMA was conducted searching four databases, supplemented by hand searches. The Template for Intervention Description and Replication (TIDieR) checklist facilitated the systematic extraction and synthesis of program components. Results Eleven peer support programs were identified from three reviews, largely conducted in English-speaking countries. The identified reviews highlight the benefits of peer support in perinatal mental health. Key components of individual programs were contextual background, materials, provider training and support, delivery modes and locations, and evaluation. Sharing lived experience and providing flexible support were central to all programs. Conclusion Aspects of flexibility, authenticity and the challenges of program evaluation in peer support must be considered. Findings can now inform future planning and implementation efforts of peer support programs in periantal mental health.

Objectives The objective of this study is to develop classification criteria for overall hand osteoarthritis (OA), interphalangeal OA and thumb base OA based on self-reported data and radiographic features. Methods The classification criteria sets were developed in three phases. In phase 1, we identified criteria that discriminated hand OA from controls. In phase 2, we used a consensus-based decision analysis approach to derive a clinician-based evaluation of the relative importance of the criteria. In phase 3, we refined the scoring system, determined the cut-offs for disease classification and compared the sensitivity and specificity of the European Alliance of Associations for Rheumatology (EULAR) criteria with the 1990 American College of Rheumatology (ACR) criteria. Results In persons with hand symptoms and no other disease (including psoriasis) or acute injury that can explain the hand symptoms (mandatory criteria), hand OA can be classified based on age, duration of morning stiffness, number of joints with osteophytes and joint space narrowing, and concordance between symptoms and radiographic findings. Using a sum of scores based on each diagnostic element, overall hand OA can be classified if a person achieves 9 or more points on a 0–15 scale. The cut-off for interphalangeal OA and thumb base OA is 8 points. While the EULAR criteria demonstrated better sensitivity than the ACR criteria in the phase 1 data set, the performance of the two criteria sets was similar in two external cohorts. Conclusions International experts developed the EULAR criteria to classify overall hand OA, interphalangeal OA and thumb base OA in clinical studies using a rigorous methodology.

Background Substance use disorders (SUD) are prevalent disorders worldwide. Among other associated health problems, patients with SUD are at an increased risk of dying of suicide, with females displaying an even higher risk than males. Therefore, the aim of this study was to conduct a gender-sensitive evaluation of changes in suicidal ideation during multimodal inpatient treatment at a hospital facility specialized in treating addiction. Methods A total of 694 patients (68.2% male) completed routine assessment including suicidal ideation, abstinence confidence, impulsivity, emotion regulation, self-efficacy and autonomy and joy both before (T1) and at the end (T2) of treatment. Mean changes were evaluated with repeated measures MANOVAs. Results Before treatment, a total of n=127 (18.3%) of the respondents reported suicidal ideation, which was reduced to n=72 (10.4%) by the end of treatment. Among female patients, the change in reported suicidal ideation compared from T1 to T2 (21.7% vs 7.7%) was significantly higher than among male patients (T1: 16.7%%, T2: 11.6%; p=0.040). Generally, females reported worse symptoms scores and slightly higher numbers of suicidal thoughts at baseline (effect sizes ranging from η²=.008 – 0.044). While both genders significantly profited from the treatment, female patients generally showed larger improvements than male. Discussion Our study underscores the beneficial effect of addiction-specialized inpatient treatment on suicidal ideation. Additionally, we found a substantial gender effect: while female patients generally were more distressed before treatment, they also reported higher symptom reduction during the treatment. This result highlights the need to perform more gender-sensitive research and develop more gender-sensitive treatment programs.

Children whose parents have a mental illness are much more likely to experience mental health problems and other adverse long-term impacts. Child-centred psychosocial interventions can be effective, but not much is known about how to design and implement them in different settings. A pre-post, mixed methods, single-arm evaluation of a co-designed social support intervention with parents and children (4-18 years) measured parents' mental health (PHQ-9), perceived social support (ENRICHD), parental self-efficacy (PSAM) and children's mental health (SDQ), quality of life (Kidscreen-27), and child service use (CAMHSRI-EU) at baseline and 6 months. Qualitative data were gathered at 6 months to explore parents' and children's experience with the intervention. Twenty-nine parents and 21 children completed baseline and follow-up questionnaires; 22 parents and 17 children participated in interviews. Parents' depression (MD -1.36, SD 8.08), perceived social support (MD 1, SD 5.91), and children's mental health potentially improved, and children's service use and costs potentially reduced (€224.6 vs. €122.2, MD 112.4). Parental self-efficacy was potentially reduced (MD -0.11, SD 3.33). The sample was too small to perform statistical analysis. Favourable themes emerged describing the high satisfaction with the intervention, parents' improved understanding of the impact of their mental health problems on children, and improvements in parent-child relationships. This study contributes to an emerging evidence base for co-designed child-centred interventions to prevent the transgenerational transmission of poor mental health.

In times of educational reforms, financial cuts in graduation programs, and the downsizing of many humanities’ departments all over Europe and the United States, a book like Christopher Celenza’s The Italian Renaissance and the Origins of the Modern Humanities acquires a social value that goes far beyond its mere scholarly value. This book confronts the crisis of the humanities and the “crisis of reading” on a profound level (ix). It reacts to our modern question of how to deal with information and facts, what sources to trust, and how to impart knowledge. Celenza argues that our modern challenges surrounding these issues can be traced to the development of what could anachronistically be called “the humanities” in the Renaissance and the early modern period. Despite this confident supposition, Celenza makes an honest effort not to force an opinionated teleology. As he states in the introduction, the indefinite article “an” in the book’s subtitle refers to one (i.e., his) of many possible ways of looking at the period from 1400 to 1800 (ix). Thus, Celenza exemplarily demonstrates that the humanities constitute a method in themselves to explore the world and to exchange views.

Background Demographic change and the rise of diabetes mellitus are leading to a projected increase in the prevalence of chronic wounds. People suffering from chronic wounds experience significant losses in their health-related quality of life. Health systems struggle to meet the needs of these persons, even in high-income countries. This paper explores wound nurses’ perspectives on their professional practice in Austria. They play a key role as they do much of the treatment work, contribute to advancing the field, and enable interprofessional coordination. Their perspectives enable insights into how a health system provides care for elderly and chronically ill people. Methods We used the Constructivist Grounded Theory framework to analyse transcripts of 14 semi-structured qualitative interviews with nurses who work in different treatment settings. Results We identified three themes. Firstly, the interviewees characterise working with patients as a balancing act between offering enough support to build a trustful relationship while protecting themselves against the overwhelming situation of caring for a chronically ill person. Secondly, the interviewees compensate for nonexistent care pathways by building informal networks with doctors, which requires delicate relationship work. Thirdly, the study participants must prove their competence in every new professional encounter. Their need for professional autonomy clashes with the traditional doctor-nurse hierarchy. Based on these insights, we propose a grounded theory that conceives of nursing practice in terms of ‘acts of negotiations’. Conclusion Our results demonstrate that wound nurses in Austria operate in an institutional environment whose outdated imagination of the nursing role is at odds with the care demands that arise from a growing number of elderly and chronically ill people. We detailed the ‘acts of negotiation’ nurses deploy to compensate for this situation. We identify areas for policy intervention to strengthen the autonomy of wound nurses, including access to statutory health insurance billing.

Background: Physical inactivity is one of the most detrimental modifiable cardiovascular risk factors. Despite the well-established benefits of physical activity (PA) on the overall health of people with cardiovascular disease (CVD), challenges remain in maintaining heart-healthy PA behaviour after completing a cardiac rehabilitation programme. This study aimed to collect and analyse observational data on the relative importance of determinants for heart-healthy PA levels in people with CVD, to inform behaviour change research and intervention development in CVD secondary prevention. Methods: This systematic review included studies reporting bivariate association statistics of determinants and PA behaviour in adults fulfilling the medical indications for cardiac rehabilitation. Included were peer-reviewed journal articles published in English, Dutch, or German since 2005. Five electronic databases (CINAHL, Embase, MEDLINE via PubMed, PsycINFO, Web of Science Core Collection) were last searched in April 2023. Risk of bias of included studies was assessed using the National Heart, Lung, and Blood Institute's Study Quality Assessment Tool for Observational Studies. Data were analysed using descriptive analysis and narrative synthesis. Results:Included were 57 articles reporting on 54 primary studies from 23 countries, with the majority from North America (n=22), Europe (n=18) and Asia (n=10). Twenty-nine studies were rated good quality and 25 studies fair quality. The studies report on altogether 17,639 individual participants, providing collated empirical evidence for 51 determinants and their patterns of association with PA behaviour in the cardiac population. Those determinants showing distinct positive associations with PA behaviour are self-efficacy, life attitude, intention, exercise belief, education, weather, exercise behaviour, habit formation, social support, psychological wellbeing and employment; whereas those determinants showing distinct negative associations with PA behaviour are age, emotion (including anxiety and kinesiophobia), depression and comorbidity. Conclusions: This systematic review has identified determinants of PA behaviour that bear particular relevance for the cardiac population. Developers of behaviour change interventions may draw on these findings to inform intervention concepts, methods and designs. Further research in underrepresented geographic regions, and studies into underrepresented determinants of PA and dynamic changes of PA behaviours over time are warranted. Systematic review registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42020206637