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Aufgrund struktureller, organisatorischer und materieller Gegebenheiten wird die Zählkontrolle in der Praxis häufig unterschiedlich durchgeführt. Diese Situation spiegelte sich auch an den unterschiedlichen Standorten der Oberösterreichischen Gesundheitsholding (OÖG) wider. Um die Qualität zu steigern, wurde daher eine einheitliche Vorgehensweise und Zählkultur für alle OP-Bereiche festgelegt.

Introduction: While acute Coronavirus disease 2019 (COVID-19) affects the cardiovascular (CV) system according to recent data, an increased CV risk has been reported also during long-term follow-up (FU). In addition to other CV pathologies in COVID-19 survivors, an enhanced risk for arrhythmic events and sudden cardiac death (SCD) has been observed. While recommendations on post-discharge thromboprophylaxis are conflicting in this population, prophylactic short-term rivaroxaban therapy after hospital discharge showed promising results. However, the impact of this regimen on the incidence of cardiac arrhythmias has not been evaluated to date.Methods: To investigate the efficacy of this therapy, we conducted a single center, retrospective analysis of 1804 consecutive, hospitalized COVID-19 survivors between April and December 2020. Patients received either a 30-day post-discharge thromboprophylaxis treatment regimen using rivaroxaban 10 mg every day (QD) (Rivaroxaban group (Riva); n = 996) or no thromboprophylaxis (Control group (Ctrl); n = 808). Hospitalization for new atrial fibrillation (AF), new higher-degree Atrioventricular-block (AVB) as well as incidence of SCD were investigated in 12-month FU [FU: 347 (310/449) days].Results: No differences in baseline characteristics (Ctrl vs Riva: age: 59.0 (48.9/66.8) vs 57 (46.5/64.9) years, p = n.s.; male: 41.5% vs 43.7%, p = n.s.) and in the history of relevant CV-disease were observed between the two groups. While hospitalizations for AVB were not reported in either group, relevant rates of hospitalizations for new AF (0.99%, n = 8/808) as well as a high rate of SCD events (2.35%, n = 19/808) were seen in the Ctrl. These cardiac events were attenuated by early post-discharge prophylactic rivaroxaban therapy (AF: n = 2/996, 0.20%, p = 0.026 and SCD: n = 3/996, 0.30%, p < 0.001) which was also observed after applying a logistic regression model for propensity score matching (AF: χ2-statistics = 6.45, p = 0.013 and SCD: χ2-statistics = 9.33, p = 0.002). Of note, no major bleeding complications were observed in either group.Conclusion: Atrial arrhythmic and SCD events are present during the first 12 months after hospitalization for COVID-19. Extended prophylactic Rivaroxaban therapy after hospital discharge could reduce new onset of AF and SCD in hospitalized COVID-19 survivors.

(1) Background: Heart failure with reduced ejection fraction (HFrEF) remains a major health burden. Angiotensin-Receptor-Neprilysin-Inhibitors (ARNIs) are an established HFrEF therapy which increases natriuretic peptide levels by inhibiting neprilysin. Leptin is a lipid metabolism parameter, which is also involved in glucose metabolism and is suggested to correlate with HF burden. While the hormone also seems to interact with neprilysin, potential associations with ARNI therapy have not been investigated yet. (2) Methods: To study this issue, we measured levels of leptin and fructosamine in consecutive 72 HFrEF patients before initiation of ARNI therapy and 3–6 months after initiation of therapy in two European centers. Biomarker levels were correlated with clinical parameters including ejection fraction, LVEF, and NYHA class. (3) Results: During a follow-up of up to 6 months, clinical parameters improved significantly (LVEF: 30.2 ± 7.8% to 37.6 ± 10.0%, (p < 0.001) and a significant improvement of the mean NYHA class with initial 32 patients in NYHA III or IV and 8 patients in NYHA class III/IV during the follow up (p < 0.001). The initial NT-proBNP levels of 2251.5 ± 2566.8 pg/mL significantly improved to 1416.7 ± 2145 pg/mL, p = 0.008) during follow up. ARNI therapy was also associated with an increase in leptin levels (17.5 ± 23.4 µg/L to 22.9 ± 29.3, p < 0.001) and furthermore, affected glucose metabolism indicated by elevation of fructosamine values (333.9 ± 156.8 µmol/L to 454.8 ± 197.8 µmol/L, p = 0.013). (4) Conclusion: while in the early phase of therapy, ARNI promotes clinical improvement of HFrEF, and it also seems to affect fat and glucose parameters, indicating significant metabolic implications of this therapy regime.

IntroductionWhile in the CASTLE-AF trial, in patients with atrial fibrillation and heart failure with reduced ejection fraction, interventional therapy using pulmonary vein isolation was associated with outcome improvement, data on cavotricuspid isthmus ablation (CTIA) in atrial flutter (AFL) in the elderly is rare.MethodsWe included 96 patients between 60 and 85 years with typical AFL and heart failure with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF) treated in two medical centers. 48 patients underwent an electrophysiological study with CTIA, whereas 48 patients received rate or rhythm control and guideline-compliant heart failure therapy. Patients were followed up for 2 years, with emphasis on left ventricular ejection fraction (LVEF) over time. Primary endpoints were cardiovascular mortality and hospitalization for cardiac causes.ResultsPatients with CTIA showed a significant increase in LVEF after 1 (p p p = 0.003). In the multivariate regression analysis, CTIA remained the relevant factor associated with LVEF improvement (HR: 2.845 CI:95% 1.044–7.755; p = 0.041). Elderly patients (≥ 70 years) further benefited from CTIA, since they showed a significantly reduced rehospitalization (p = 0.042) and mortality rate after 2 years (p = 0.013).ConclusionsCTIA in patients with typical AFL and HFrEF/HFmrEF was associated with significant improvement of LVEF and reduced mortality rates after 2 years. Patient age should not be a primary exclusion criterion for CTIA, since patients ≥70 years also seem to benefit from intervention in terms of mortality and hospitalization.

Purpose The aim of the qualitative study was to explore the meaning of diaries for parents at the Neonatal Intensive Care Unit (NICU). Findings Based on Reflexive Grounded Theory, eight parents could be interviewed. By using a NICU diary, parents develop trust that everything will be fine in the end. It appears to be relevant by providing a kind of communication with the child beyond the physical level, reducing hospital atmosphere, strengthening the relationship between parents and nurses, and filling gaps when parents cannot be at the unit. In dealing with the NICU diary, parents are able to adopt strategies for action which result in writing and reading of the diary. Gender-specific differences between mothers and fathers could be outlined. Conclusion The NICU diary is a tool to support parents dealing with the situation at the NICU, establishing communication and humanizing critical care.

Background: Type 2 diabetes mellitus is one of the most common diseases worldwide. The demands on health services are rising as more people are diagnosed with the condition. In order to meet this demand, eHealth systems are increasingly being integrated into nursing care. Methods: Between November 2018 and February 2019, a literature search was carried out in the databases PubMed and CINAHL. Results: Twenty articles were found on nurses' use of eHealth systems, the majority with patients with diabetes. From this research, it would seem that eHealth systems have had a proven positive influence on patients' state of health and understanding of therapy. Subjectively perceived communication with the nursing staff also improved. Problems can arise in the implementation phase. Conclusion: In the future, increasingly, nurses will have to integrate eHealth systems into the treatment of patients with type 2 diabetes. It is important that nurses understand such systems in order to guarantee a sustainable and successful implementation.

Der intraoperative Augenschutz ist bei Operationen in Vollnarkose generell von Bedeutung. Im Speziellen zeigen sich aber Herausforderungen, wenn intraoperativ ein Laser verwendet wird. In der Gynakologie und Urologie werden Erkrankungen zunehmend mittels Laser therapiert, aber eine Lege-artis-Augenabdeckung/ein Lege-artis-Augenschutz ist in der internationalen Literatur noch nicht untersucht. Wie gestaltet sich laut PflegeexpertInnen eine lege artis durchgefuhrte Augenabdeckung wahrend einer gynakologischen/urologischen Laseroperation? Fur die Beantwortung der Forschungsfrage wurden standardisierte ExpertInneninterviews via Telefon, direkter „Face-to-face“-Befragung und E‑Mail in Schwerpunktkliniken in Osterreich durchgefuhrt. Die Erkenntnisse einer unsystematischen Literaturrecherche bildeten die Grundlage fur den dafur herangezogenen Interviewleitfaden. Elf ExpertInnen stimmten einer qualitativen Befragung zu. Als geeignete Masnahmen wurden hautfreundliche Pflaster in Kombination mit einer Vitamin-D-Augensalbe, Spezialpflaster/Abdeckungen und/oder Laserschutzbrillen mit einer Vitamin-D-Augensalbe und NaCl-Kompressen empfohlen. Neben dem direkten Schutz des Auges muss eine regelmasige intraoperative Lidschlusskontrolle erfolgen. Die Erkenntnisse aus den standardisierten ExpertInneninterviews verstehen sich als Praxisempfehlung. Zukunftig bedarf es weiteren Forschungen.

Zusammenfassung Hintergrund Bei Patientinnen und Patienten mit amyotropher Lateralsklerose (ALS) kann es im Krankheitsverlauf zum Auftreten von Veränderungen im Verhalten und in der Kognition kommen. Ein Teil der Betroffenen entwickelt eine Frontotemporale Demenz. Für die pflegenden Angehörigen stellen diese Veränderungen eine zusätzliche Herausforderung dar. Ziel der Arbeit Beschreibung der Auswirkungen von krankheitsbedingten Veränderungen in Kognition und Verhalten auf das emotionale Befinden der pflegenden Angehörigen und die genaue Erörterung der resultierenden Belastungen. Methodik In der vorliegenden Arbeit wurde mittels verschiedener Suchbegriffe in diversen Datenbanken recherchiert. Im Ergebnisteil erfolgt die Synthese der eingeschlossenen zehn Studien zur Beantwortung des Forschungsinteresses. Die Diskussion umfasst die weitere Auseinandersetzung mit der Thematik unter Einbeziehung ergänzender Literatur. Ergebnisse Veränderungen im Verhalten und in der Kognition können die Entstehung einer Angst- und Depressionssymptomatik bei pflegenden Angehörigen begünstigen. Des Weiteren verweisen die Ergebnisse der Studien auf einen Zusammenhang von Apathie, Enthemmung und exekutiven Dysfunktionen mit einem gesteigerten Belastungsempfinden bei pflegenden Angehörigen. Schlussfolgerung Veränderungen im Verhalten und in der Kognition bei Patienten mit amyotropher Lateralsklerose wirken sich negativ auf das emotionale Befinden der pflegenden Angehörigen aus und tragen zu einem erhöhten Belastungsempfinden bei. Hinsichtlich dieser krankheitsbedingten Veränderungen bedarf es einer frühzeitigen und ausführlichen Aufklärung der Betroffenen.

Background: Gender-specific differences in the outcome of COVID-19 patients requiring intensive care treatment have been reported. However, a potential association with ICU therapy remains elusive. Methods: A total of 224 consecutive patients (63 women) treated for severe COVID-19 disease requiring mechanical ventilation were screened for the study. After propensity score matching for gender, 40 men and 40 women were included in the study. Comparative analysis was conducted for laboratory parameters, ICU therapy and complications (pulmonary embolism, thrombosis, stroke, and ventricular arrhythmias), and outcome (mortality). Results: Male patients had significantly higher levels of CRP (p = 0.012), interleukin-6 (p = 0.020) and creatinine (p = 0.027), while pH levels (p = 0.014) were significantly lower compared to females. Male patients had longer intubation times (p = 0.017), longer ICU stays (p = 0.022) and higher rates of catecholamine dependence (p = 0.037). Outcome, complications and ICU therapy did not differ significantly between both groups. Conclusion: The present study represents the first matched comparison of male and female COVID-19 patients requiring intensive care treatment. After propensity matching, male patients still displayed a higher disease severity. This was reflected in higher rates of vasopressors, duration of ICU stay and duration of intubation. In contrast, no significant differences were observed in mortality rates, organ replacement therapy and complications during ICU stay.

Purpose The aim of this qualitative study was to determine which perception of personal comfort patients name in the context of their hospitalization in an Austrian Epilepsy Monitoring Unit (EMU). Methods Problem-centred interviews with twelve inpatients were conducted. Data analyses were done according to Mayring's qualitative content analyses following the technique of structuring-deductive category assignment. Results Patients experienced different kinds of comfort along with their hospitalization in the EMU. Comfort-decreasing factors were bed rest , boredom , and waiting for possible seizures . As comfort-increasing factors, hope for enhanced seizure control, support by family and staff, and intelligible information about the necessity of restrictive conditions were identified. Conclusions The study results should assist health care professionals, enabling them to design comfort enhancing interventions for patients undergoing video-electroencephalography (EEG) investigations in an EMU. Some of these seem to be simple and obtainable without high financial or technical effort. Others are more complex and have to be further assessed for their feasibility.

Im Anhang finden Sie Prasentationsbogen, welche als Vorlage fur die systematische Zusammenfassung von Studien im Journal Club herangezogen werden konnen. Der Aufbau orientiert sich an der international ublichen Gliederung von Studien, dem EMED-Format, welches eine ubersichtliche und intensive Auseinandersetzung gewahrleisten soll. Der Prasentationsbogen wurde des Weiteren durch das Feld „Kritisch-reflektierende Anmerkungen“ erganzt, wobei hierfur kapitelspezifische Leitfragen als zusatzliche Unterstutzung dienen.

In diesem Abschnitt wird naher auf die Zielsetzungen von Journal Clubs sowie den Aufbau und Ablauf der wissenschaftlichen Diskussionsrunden eingegangen.

In diesem Abschnitt werden exemplarisch Studien (Systematic Review, qualitative Studie, quantitative Studie, Mixed-Methods-Studie & Fallstudie) inhaltlich zusammengefasst und einer kritischen Bewertung unterzogen. Die Bewertung orientiert sich an den angefuhrten kapitelspezifischen Leitfragen in Tab. 4.1. Auch werden Beispielfragen fur DozentInnen angefuhrt, welche die Grundlage fur Diskussionen oder Exkurse darstellen konnen. Es empfiehlt sich, die Studienprasentation anhand von Bulletpoints in einer PowerPoint-Prasentation abzuhalten und ebenso Tabellen oder Grafiken der jeweiligen AutorInnen mit einfliesen zu lassen.

Die Qualitatskriterien eines Journal Clubs sollten bereits vor der Umsetzung festgelegen werden.

Sudden cardiac death (SCD), most often induced by ventricular arrhythmias, is one of the main reasons for cardiovascular-related mortality. While coronary artery disease remains the leading cause of SCD, other pathologies like cardiomyopathies and, especially in the younger population, genetic disorders, are linked to arrhythmia-related mortality. Despite many efforts to enhance the efficiency of risk-stratification strategies, effective tools for risk assessment are still missing. Biomarkers have a major impact on clinical practice in various cardiac pathologies. While classic biomarkers like brain natriuretic peptide (BNP) and troponins are integrated into daily clinical practice, inflammatory biomarkers may also be helpful for risk assessment. Indeed, several trials investigated their application for the prediction of arrhythmic events indicating promising results. Furthermore, in recent years, active research efforts have brought forward an increasingly large number of “novel and alternative” candidate markers of various pathophysiological origins. Investigations of these promising biological compounds have revealed encouraging results when evaluating the prediction of arrhythmic events. To elucidate this issue, we review current literature dealing with this topic. We highlight the potential of “classic” but also “novel” biomarkers as promising tools for arrhythmia prediction, which in the future might be integrated into clinical practice.

Manner und Frauen gehen unterschiedlich oft zum Arzt, Privatversicherte warten kurzer auf einen Arzttermin, Geringverdiener haben ein hoheres Korpergewicht, bewegen sich weniger und sind eher von Suchtmitteln abhangig. Unser Autorenteam hat sich mit der Frage beschaftigt, ob diese sozialen Ungleichheiten auch bei der Behandlung auf der Intensivstation eine Rolle spielen. Die Erkenntnis: Eine gesundheitliche Benachteiligung kann nicht vollig ausgeschlossen werden.

Summary Background Chronic obstructive pulmonary disease (COPD) is a frequent disease of the lungs. Its prevalence was estimated to be 26% in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) I and 11% for GOLD II–IV in Austria. Globally, it ranks third in mortality rate. The particular challenge is that care for these patients falls short due to the lack of structured integrated care. The aim was to assess the current status of multiprofessional COPD care in Austria and identify gaps and potentials. Methods We conducted guided focus group interviews between March and July 2016 addressing current COPD care and treatment gaps with the following professional and interest groups: general practitioners, nurses, patients, pharmacists, physiotherapists and pulmonologists. We interviewed 23 patients and 27 healthcare professionals. The interviews were transcribed verbatim and coded into 12 relevant categories. Results There needs to be a shift in thinking from treatment-based care to prevention. Patients, just like healthcare professionals, need periodic updates and comprehensive information on this disease. Creating internet platforms with useful information for COPD patients and solving the data privacy issues of the Austrian electronic medical record (ELGA) are also perceived as viable steps. There is a need and request for healthcare professionals to work as a team with clear COPD management guidelines in the outpatient sector, the establishment of outpatient rehabilitation centers as well as creating a new professional profile, the COPD nurse. Conclusion Current COPD care needs to be reorganized, particularly in the outpatient sector, to address the needs of patients and healthcare professionals.

Neurodegenerative diseases progress slowly, creating increasing physical disability with unpredictable disease trajectories. The disease's life-threatening nature often places these patients in palliative care. There are several factors that complicate the care of patients with neurodegenerative diseases in palliative care units. Owing to physical impairments, there are many communication barriers between patients and staff. Nurses are not able to duplicate the patient's meticulous daily routine leading to caregiver mistrust in the nurse's competencies. Even if the patient is hospitalised, caregivers may not take the much-needed time off to recuperate. The placement of patients with neurodegenerative diseases in palliative care is confusing, since they rarely die during in-hospital treatment but might even get better due to multidisciplinary treatment. Finally, patients and caregivers lack adequate knowledge about disease progression and available help and support programmes. Patients with neurodegenerative diseases urgently need palliative care and nurses and caregivers need better preparation to appropriately deal with these diseases.

The aim of this qualitative study was to determine which perception of personal comfort patients name in the context of their hospitalization in an Austrian Epilepsy Monitoring Unit (EMU).Problem-centred interviews with twelve inpatients were conducted. Data analyses were done according to Mayring's qualitative content analyses following the technique of structuring-deductive category assignment.Patients experienced different kinds of comfort along with their hospitalization in the EMU. Comfort-decreasing factors were bed rest, boredom, and waiting for possible seizures. As comfort-increasing factors, hope for enhanced seizure control, support by family and staff, and intelligible information about the necessity of restrictive conditions were identified.The study results should assist health care professionals, enabling them to design comfort enhancing interventions for patients undergoing video-electroencephalography (EEG) investigations in an EMU. Some of these seem to be simple and obtainable without high financial or technical effort. Others are more complex and have to be further assessed for their feasibility.