Paracelsus Medical University

Objective People with epilepsy (PWEs) often face difficulties in obtaining or keeping employment. To determine the views on this topic of the heads of human resources (HHRs) and occupational physicians (OCPs). Method Twelve HHRs and five OCPs underwent a telephone interview concerning the opportunities and limitations of job applications for PWEs. The interviews were performed in May 2020, in the federal state of Salzburg, Austria, and they were analyzed using the qualitative method of content analysis (Kuckartz). The legal situation was investigated according to Global target 5.2 of the Intersectoral Global Action Plan (IGAP) on epilepsy and other neurological disorders 2022–2031 by WHO. Results Employers were confident that employees with epilepsy could be managed well in a positive company culture and with first responders in place. The Austrian law predisposes to uncertainty among both employers and employees. In particular, it allows only retrospective juridical clarification of health‐related questions in the job interview. The authors developed a classification system of workplaces, with “D0” (D‐zero) meaning no health or financial danger, for example, office workers and “D1” posing still no health hazard but includes regular work with cash, for example, salespersons. “D2” means potential medical implications for the person with epilepsy or any other person at the workplace, for example, industrial worker. Measures taken to abandon the risk in D2 workplaces, for example, a total sheath for a machine, leads to reclassification as “D2‐0.” With D2, OCPs evaluate the applicant's medical fitness for the job without disclosing medical details to the employer. The “compartment model of medical information in the job application process” guarantees that OCPs are the only persons who learn about the applicant's medical details. Significance The practical and simple classification of workplaces according to the D‐system, and the concept of making medical information accessible only to OCPs may diminish stigma and discrimination in the working world for PWEs.

The role of anthracyclines in the treatment of early breast cancer (EBC) is increasingly being challenged, especially in de-escalation strategies. However, owing to their immunogenic effects, anthracyclines are promising combination partners with immunotherapies. In the randomized phase 2 trial ABCSG-52 (EudraCT no. 2019-002364-27), we investigated epirubicin plus immunotherapy in women with human epidermal growth factor receptor 2 (HER2)-positive EBC. A total of 58 patients were randomized 1:1 to two cycles of a chemotherapy-free induction phase (part 1) of dual HER2 blockade with trastuzumab and pertuzumab (TP) plus the anti-programmed death ligand 1 antibody atezolizumab (TP-A) or TP alone. Thereafter, all patients received four cycles of TP-A in combination with epirubicin (part 2). The primary endpoint, pathological complete response (pCR), was met in 35 patients (60.3%; 95% confidence interval (CI) 47.5% to 71.9%), 19 patients (65.5%) in the TP-A group and 16 patients (55.2%) in the TP group. The residual cancer burden 0/I rate and objective response rate (secondary endpoints) in all patients with evaluable data were 80.0% (n = 44/55; 95% CI 67.6% to 88.4%) and 89.3% (n = 50/56; 95% CI 78.5% to 95.0%), respectively. Grade ≥3 adverse events were reported in 17 patients (29.3%). Based on our findings, we conclude that a neoadjuvant chemotherapy de-escalation immunotherapy regimen with trastuzumab, pertuzumab, atezolizumab and epirubicin is effective and safe in patients with HER2-positive EBC.

Aims Less pronounced calcification of the aortic valve (AVC) was observed in women with aortic stenosis (AS) as compared to men. Since women have smaller aortic valves (AV), this could explain a lower calcium load. We aimed to analyze the association of AV size with AVC independent from sex. Methods & Results Consecutive patients with high-gradient AS, who underwent cardiac computed tomography (CT), were assessed. AV annulus area and AVC with the Agatston score were measured on CT. In total, 601 patients (mean age 80±7 years, 45% female) were included. Women had smaller AV annulus areas (4.12±0.67cm2 vs 5.15 ±0.78cm2, p<0.001) and lower Agatston scores (2018 [1456-3017] vs. 3394 [2562-4530]; p<0.001) than men. We found a significant correlation (r=0.594, p<0.001) and independent association (β=926.20, p<0.001) of AV annulus area with AVC. On separate regression analyses for men and women, AVC was independently associated with AV annulus area in both sexes (βmen=887.77; βwomen=863.48, both p<0.001). When patients were stratified into AV size quartiles, patients in the lower quartiles were more likely to have AVC values below recommended sex-specific AVC thresholds. In the lowest quartile 28% of female and 27% of male patients had Agatston scores below 1200AU (women) and 2000AU (men) while this proportion decreased to 6% and 2%, respectively, in the quartiles with the largest annulus areas. Conclusion In high-gradient AS, AVC strongly depends on AV annulus area. This association is not dependent on sex. Thus, AVC should be indexed to AV size in addition to sex.

Atrial fibrillation is the most frequent cardiac arrhythmia in old age. As a result of the positive data on ablation, the focus has shifted to rhythm control. Older adults can also benefit from catheter ablation. Oral anticoagulation remains an essential part of the pharmacological treatment of atrial fibrillation. Recent study results show that geriatric patients require an individual treatment approach, which should be based on the recommendations of the current guidelines and the use of supplementary aids. The assessment of functionality should be taken into account in the treatment and the treatment goal planning as well as symptoms associated with atrial fibrillation. In acute situations cardioversion and long-term drug or interventional (catheter ablation) rhythm-stabilizing treatment are available for rhythm control.

Early mobilization of critical ill patients in the intensive care unit (ICU) has a positive effect on outcome. Currently, due to concerns of cerebral vasospasm and rebleeding patients with subarachnoid hemorrhage (SAH) have a prolong bedrest for 12–14 days. What effect does early mobilization have on vasospasm, clinical outcome, length of stay and ICU complication rate in patients with SAH compared to standard treatment? A systematic literature search was conducted in MEDLINE via the PubMed® (U.S. National Library of Medicine®, Bethesda, MD, USA) and CINAHL® (EBSCO, Ipswich, MA, USA) databases. A total of 14 studies were identified. Overall, the studies showed an improved functional outcome and a reduction in the length of hospitalization and ventilation time. Only in one study did vasospasms occur more frequently and the outcome of patients with early mobilization was worse. Further research is needed to identify possible positive effects of early mobilization in patients with SAH and to be able to describe the risk–benefit ratio more precisely.

Background To compare the clinical outcomes of inferior extensor retinaculum (IER) augmentation following repair of the anterior talofibular ligament (ATFL) with isolated ATFL repair in patients with an arthroscopically confirmed grade 3 lesion of the ATFL. Methods We conducted a retrospective study of consecutive chronic lateral ankle instability (CLAI) patients who underwent arthroscopic ATFL repair between March 2018 and August 2022. The average age of the patients was 31.5 ± 7.4 years (range, 16–50 years). All patients underwent all-inside arthroscopic repair, and were divided into two groups based on the ligament repair method: the Broström-Gould group (n = 64) and the Broström group (n = 67). At 3, 6, 12 and 24 months after surgery, ankle inversion stress tests and anterior drawer tests were employed to assess the stability of the ankle joint. The American Orthopedic Foot and Ankle Society ankle hindfoot scale(AOFAS-AH) and Karlsson ankle function score (KAFS) were employed to assess ankle function; the Tegner score was employed to assess the patient’s level of exercise; the Foot and Ankle Outcome Score [FAOS, including score of symptoms-diseases, pain, function-daily living score, function in sports and recreational activities, and quality of life] was used to assess the patient’s daily activity ability. Results The Tegner score, FAOS-function-daily living score, and FAOS-function in sports and recreational activities in the Broström-Gould group consistently outperformed the Broström group at 3 months and 6 months post-surgery, with the differences being statistically significant (all P < 0.05). However, although the differences are statistically significant, the clinical relevance of this statistical significance remains uncertain. At 12 and 24 months, there were no statistically significant differences between the two groups. Conclusions For CLAI patients with arthroscopic grade 3 lesion of the ATFL, both the all-inside arthroscopic Broström-Gould procedure and the Broström procedure provide stability and enhance ankle joint function, resulting in similar functional outcomes at a 2-year follow-up. IER augmentation following ATFL repair may facilitate earlier recovery exercises compared to isolated all-inside ATFL repair.

Background Alzheimer disease (AD) worsens naming abilities as the disease progresses. It is argued that traditional naming tests, commonly used to aid in staging AD severity, may overestimate semantic abilities. This study explored whether a more challenging naming task can distinguish between healthy adults and those with amnestic mild cognitive impairment (aMCI) or mild AD. Method In a cross‐sectional study, 16 individuals with aMCI, 15 with mild AD, and 20 healthy controls (see Table 1 for demographic details) performed a rapid automatized naming (RAN) task with emotionally balanced object and action pictures. Naming performance was assessed by response times (RTs) and accuracy (error rates). Regression analyses examined the relationship between RTs/error rates and group, sex, age, education, anxiety, and depression. Receiver operating characteristic (ROC) curves evaluated the discriminative ability of the RAN task. Result Patients with aMCI and mild AD showed significantly slower RTs and higher error rates compared to healthy controls (all p‐values < .001). Naming performance was especially impaired for negative stimuli compared to positive and neutral ones in healthy controls (p < 0.001) and aMCI patients (p < 0.01). However, this effect was absent in the AD group. Regression analyses revealed significant associations between RTs/error rates and group (both p‐values < 0.001), but not for age, sex, education, anxiety, and depression (see Table 2). ROC analysis demonstrated moderate diagnostic accuracy in classifying mild AD versus healthy controls (AUC of 0.887 for RTs; AUC of 0.854 for error rates; see Figure 1), but not in classifying aMCI versus healthy controls. Conclusion The RAN task reliably detects variations in naming ability across different stages of cognitive decline associated with AD. We observed an inhibitory effect of negative valence on lexical retrieval processes, which appeared to be dependent on the degree of cognitive impairment, as it was no longer evident in our AD group. Further research with larger sample sizes is warranted. A significant limitation of our study is the lack of standardization of our visual stimuli. It is possible that the ratings for emotional valence derived from written words may not precisely reflect the emotional responses of our participants.

Purpose The aim of this review is to give an overview of the results of prospective and retrospective studies using allogenic reconstruction and postmastectomy radiotherapy (PMRT) in breast cancer and to make recommendations regarding this interdisciplinary approach. Materials and methods A PubMed search was conducted to extract relevant articles from 2000 to 2024. The search was performed using the following terms: (breast cancer) AND (reconstruction OR implant OR expander) AND (radiotherapy OR radiation). Data from the literature on allogenic breast reconstruction and radiation are presented and discussed in relation to toxicity and cosmesis. Conclusion and recommendations Breast reconstruction is also feasible if PMRT is necessary. Patients need to be informed about the relevant risk of capsular fibrosis and implant failure. A planned reconstruction is no reason to forgo PMRT nor is an indication for PMRT a reason to forego implant-based breast reconstruction if desired by the patient. It is important to provide detailed information here to enable shared decision-making. There is still no clear consensus regarding implant-based reconstruction (IBR) and PMRT. However, in clinical practice, both a one-stage (immediate “implant-direct” IBR) procedure with PMRT up to the final implant and a two-stage (immediate-delayed IBR) procedure with PMRT up to the tissue expander (TE) and later exchange of the TE are used; both approaches have their specific advantages and disadvantages. Depending on patient-specific factors and the surgeon’s experience and estimates, both IBR procedures are also possible in combination with PMRT. When using a TE/implant approach, completing skin stretching by adequately filling the expander before PMRT may be favorable. This approach is particularly practical when adjuvant chemotherapy is planned but may lead to postponement of radiotherapy when primary systemic therapy is given. According to the latest data, moderate hypofractionation also appears to be safe in the context of the IBR approach. It is important to have a closely coordinated interdisciplinary approach and to fully inform patients about the increased rate of potential side effects.

This is the first in a series of five papers that detail the role and substantial impact that external quality assessment (EQA) and their providers‘ services play in ensuring in-vitro diagnostic (IVD) performance quality. The aim is to give readers and users of EQA services an insight into the processes in EQA, explain to them what happens before EQA samples are delivered and after examination results are submitted to the provider, how they are assessed, what benefits participants can expect, but also who are stakeholders other than participants and what significance do EQA data and assessment results have for them. This first paper presents the history of EQA, insights into legal, financing and ethical matters, information technology used in EQA, structure and lifecycle of EQA programs, frequency and intensity of challenges, and unique requirements of extra-examination and educational EQA programs.

Positron emission tomography/computed tomography (PET/CT) using prostate-specific membrane antigen (PSMA)-radioligands is currently suggested by several clinical guidelines for the assessment of prostate cancer (PCa) in various clinical settings. However, PSMA will also be overexpressed in different cancers, which should be considered on the PSMA PET/CT reading in patients with concomitant neoplastic diseases. We report a case of 82-year-old male presented with prostate and history of oesophageal cancer and B-cell chronic lymphocytic leukemia (B-CLL). Both ⁶⁸Ga-PSMA-11 and 2-(3-(1-carboxy-5-((6-(18f)fluoro-pyridine-3-carbonyl)-amino)-pentyl)-ureido)-pentanedioic acid (¹⁸F-DCFPyL) PET/CT, which were performed for prostate cancer staging and re-staging in about 1 year interval, showed focal uptake in the primary prostate tumor as well as an intense focal lesion in L2, suggestive of bone metastasis. ¹⁸F-FDG PET/CT scans performed before and after PSMA PET/CT examinations showed no abnormal uptake related to oesophageal and/or B-CLL. This pattern could present an oligometastatic PCa disease, which might change the treatment plan of the patient to radiation of the bone metastasis. However, bone biopsy of the detected lesion on L2 revealed infiltrates of B-CLL. The role of ⁶⁸Ga- and ¹⁸F-labeled PSMA PET/CT in prostate cancer is evolving and has been demonstrated to have high sensitivity, but may present limited specificity in patients with coexisting cancer(s), which should be considered in PSMA PET/CT reading.

Background Epidermolysis bullosa (EB) is a serious, painful, hereditary and still incurable genetic condition. Due to blistering or wounds on the skin caused by the slightest touch, a person suffering from epidermolysis bullosa is prevented from achieving the same quality of life as a healthy person. Until now, psychosocial research has focused on the description of the problems of people living with the disease. Objectives The aim of this paper is to provide a structured overview of potential psychosocial effects of epidermolysis bullosa on the everyday lives of people with the condition and to explore helpful aspects for coping with EB. Methods Semi-structured interviews with persons living with EB were conducted. Analyses were based on a combination of a reflexive grounded theory approach and a structured coding guide. By means of purposive sampling across three countries, a high diversity within the sample was achieved in order to obtain a wide range of possible effects. Results A total of 17 individuals living with EB across all EB types were interviewed, resulting in 36,315 words being analysed. Psychosocial aspects of EB comprise physical, emotional, social, and functional dimensions. Identified burdens and helpful aspects in dealing with EB are described along this structure. Conclusions Our results highlight the broad range of possible psychosocial effects caused by epidermolysis bullosa. It is particularly important to recognise those affected as individuals with their personal needs and to avoid unnecessary strains. Furthermore, emotional support is crucial in every respect.

Background Digital therapeutics (DTx) are software-based interventions that aim to prevent or treat especially non-communicable diseases. Currently, no framework for reimbursement of DTx exists in Austria. The aim of this study was to gather a comprehensive perspective on regulatory considerations of Austrian stakeholders with regard to reimbursement of DTx and to outline strategies for establishing a national reimbursement framework. Methods Based on a stakeholder analysis, seven semi-structured interviews with Austrian experts from the digital health-related fields medicine, public health, health technology assessment, health industry and social security providers were conducted. Interviews were analyzed according to seven predefined themes. Results Overall, participants agreed that reimbursement of DTx by the public insurance in Austria is desirable. Prerequisites are (i) a high user and prescriber acceptance of DTx, which must be integrated into a transparent and interoperable Austrian e-Health infrastructure, (ii) a sufficient, risk-based level of evidence for clinical effectiveness, (iii) national authorities that transparently provide evidence-base, indications, contra-indications and potential risks, (iv) adopting European regulations about data security, secondary use of data and use of artificial intelligence and (v) a health-economical evaluation of DTx. Conclusion A comprehensive national strategy for reimbursing DTx will need to consider technical, scientific and socio-economical requirements, patient safety and liability, secure health data handling and use of artificial intelligence in order to establish a sound framework with equitable access also for socioeconomically disadvantaged persons in order to address the growing burden of non-communicable diseases.

Background Early-term complications may not predict long-term success after adult cervical deformity (ACD) correction. Objective Evaluate whether optimal realignment results in similar rates of perioperative complications but achieves longer-term cost-utility. Study Design Retrospective cohort study. Methods ACD patients with 2-year data included. Outcomes: distal junctional failure (DJF), good clinical outcome (GCO):[Meeting 2 of 3: (1) NDI>20 or meeting MCID, (2) mJOA≥14, (3)NRS-Neck improved≥2]. Ideal Outcome defined as GCO without DJF or reoperation. Patient groups were stratified by correction to ‘Optimal radiographic outcome’, defined by cSVA 9 (<40 mm) AND TS-CL (<15 deg) upon correction. Cost calculated by CMS.com definitions, and cost-per-QALY was calculated by converting NDI to SF-6D. Multivariable analysis controlling for age, baseline T1-slope, cSVA, disability, and frailty, was used to assess complication rates, clinical outcomes, and cost-utility based on meeting optimal radiographic outcome. Results One hundred forty-six patients included: 52 optimal radiographic realignment (O) and 94 not optimal (NO). NO group presented with higher cSVA and T1-slope. Adjusted analysis showed O group suffered similar 90-day complications ( P >0.8), but less DJK, DJF (0% vs. 18%; P <0.001) and reoperations (18% vs. 35%; P =0.02). Patients meeting optimal radiographic criteria more often met Ideal outcome [odds ratio: 2.2, (1.1–4.8); P =0.03]. Despite no differences in overall cost, O group saw greater clinical improvement, translating to a better cost-utility [mean difference: $91,000, ($49,000–$132,000); P <0.001]. Conclusion Despite similar perioperative courses, patients optimally realigned experienced less junctional failure, leading to better cost-utility compared with those sub-optimally realigned. Perioperative complication risk should not necessarily preclude optimal surgical intervention, and policy efforts might better focus on long-term outcome measures in adult cervical deformity surgery. Level of Evidence Level III.

Background Demand for total hip and knee arthroplasty procedures continues to rise. Ongoing changes in surgical care and patient populations require continued monitoring of outcome trends. Using nationwide data from the USA, we aimed to describe updated trends in patient and peri‐operative care characteristics as well as complications among total hip and knee arthroplasty recipients. Methods We included patients who underwent elective primary total hip or knee arthroplasty between 2016 and 2021. Trends were reported for a variety of patient and peri‐operative care characteristics as well as complications. Results We identified significant trends in patient and peri‐operative care characteristics as well as the incidence of complications. While patient median age increased, demographic composition remained consistent over the time period studied. There was a shift towards outpatient total hip and knee arthroplasty procedures, with one in five performed in the outpatient setting in 2021; the median duration of hospital stay decreased by 1 day over the time period for both procedures. Parallel increasing trends of total procedure numbers were found for patients without comorbidities and those with ≥ 3 comorbidities. Postoperative mortality increased significantly over the time period analysed for patients having total hip arthroplasty but not those having total knee arthroplasty (0.08 to 0.15 events per 1000 inpatient days, p = 0.037 and 0.09 to 0.33 events per 1000 inpatient days, p = 0.149, respectively). Discussion Compared with previous trend analyses of patients having total hip or knee arthroplasty, the present study shows: an increasing rate of outpatient surgeries; increasing numbers of arthroplasty procedures in high comorbidity burden groups; and an increase incidence of certain serious postoperative complications.