Wiener klinische Wochenschrift

As a consequence of improved survival rates after burn injury occupational reintegration of burn survivors has gained increasing significance. We aimed to develop a precise patient questionnaire as a tool to evaluate factors contributing to occupational reintegration. A questionnaire comprising 20 questions specifically evaluating occupational reintegration was developed under psychological supervision. The single-center questionnaire study was implemented in patients with burn injuries who were admitted to the 6‑bed burn intensive care unit (BICU) of the General Hospital of Vienna, Austria (2004–2013). The questionnaire was sent to burn survivors of working age (18–60 years) with an abbreviated burn severity index (ABSI) of 6 or greater, a total burn surface area (TBSA) of 15% or greater, and a BICU stay of at least 24 h. A total of 112 burn survivors met the inclusion criteria and were contacted by mail. Of the 112 patients 11 (10%) decided to participate in the study and 218/220 questions (99%) in 11 patients were answered. Out of 11 patients 7 (64%) reported successful return to work and 4 of 11 (36%) did not resume their occupation. Advanced age, longer BICU and hospital stays, higher TBSA, burn at work, lower education, and problems with esthetic appearance seemed to impair patients’ return to their occupation. When implementing the questionnaire, severely burned patients with higher age, lower education, and longer hospital and BICU stay seemed at high risk for failed reintegration in their profession after burn injury.

Bei der Beurteilung der gesundheitlichen Eignung zum Lenken eines Kraftfahrzeuges ist die öffentliche Sicherheit (Unfallprävention) das vorrangige Ziel. Der generelle Zugang zu Mobilität sollte jedoch nicht eingeschränkt werden, wenn kein besonderes Risiko für die öffentliche Sicherheit besteht. Für Menschen mit Diabetes mellitus sind im Führerscheingesetz (FSG) und in der Führerscheingesetz-Gesundheitsversorgung (FSG-GV) wichtige Aspekte zur Fahrsicherheit in Zusammenhang mit akuten und chronischen Komplikationen der Erkrankung geregelt. Zu den kritischen Komplikationen, die für die Verkehrssicherheit relevant sind, gehören schwere Hypoglykämie, ausgeprägte Hyperglykämie und Hypoglykämiewahrnehmungsstörung, sowie schwere Retinopathie und Neuropathie, weiters fortgeschrittene Nierenerkrankung und bestimmte kardiovaskuläre Manifestationen. Bei Verdacht auf Präsenz einer dieser Akutkomplikationen oder Folgeschäden ist eine genaue Evaluierung erforderlich. Darüber hinaus ist die individuelle antihyperglykämische Medikation auf vorhandenes Potenzial für Hypoglykämien zu überprüfen. Sulfonylharnstoffe, Glinide und Insulin gehören in diese Gruppe und sind daher automatisch mit der Auflage einer 5‑jährigen Befristung des Führerscheines assoziiert. Metformin, DPP-4-Hemmer (Dipeptidyl-Peptidase-4-Hemmer, Gliptine), SGLT2-Hemmer (Sodium-dependent-glucose-transporter‑2 inhibitors, Gliflozine), Glitazone und die zu injizierenden GLP-1 Analoga (GLP‑1 Rezeptor Agonisten) weisen kein Hypoglykämiepotential auf und sind daher nicht mit einer Befristung verbunden. Die FSG-GV gibt Spielraum für Interpretation, sodass im Folgenden spezifische Themen zur Fahrsicherheit für Menschen mit Diabetes mellitus aus fachärztlicher und verkehrsrelevanter Sicht aufgearbeitet wurden. Dieses Positionspapier dient zur Unterstützung von Personen, die mit dieser herausfordernden Materie befasst sind.

Nicht-invasive Beatmung mit positiven Drücken (NIPPV) ist in den vergangenen Jahren zu einem vieldiskutierten Beatmungsverfahren geworden, ohne dass es eine dementsprechende Verbreitung auf Intensivstationen gefunden hat. Grund dafür sind Unsicherheiten in der Indikationsstellung und Schwierigkeiten bei der Anwendung der Methode. In den letzten Jahren wurde durch die Einführung der Ganzgesichtsmaske und des Beatmungshelms eine Beatmungsmöglichkeit auch bei Patienten mit ungewöhnlicher Gesichtsform und Problemen mit Drucknekrosen gefunden. Für klassische Intensivbeatmungsgeräte sind speziell auf NIPPV ausgerichtete Software-Komponenten erhältlich. Klassische Indikationen für NIPPV (neuromuskuläre Erkrankungen. Wirbelsäulenfehlbildungen, Thoraxwanderkrankungen, COPD, kardiogenes Lungenödem) konnten in großen Studien gesichert werden. Für den Einsatz in der Beatmungsentwöhnung und beim respiratorischen Versagen nach Extubation fehlen ausreichende Daten. Es zeichnet sich jedoch eine Indikation für NIPPV ab, wenn die Therapie frühzeitig eingesetzt wird und ausreichend hohe Beatmungsdrücke gewählt werden. Beim hypoxisch hypokapnischen Lungenversagen zeigte sich mit Ausnahme des Einsatzes von NIPPV bei Patienten mit malignen Grunderkrankungen kein sicherer Vorteil gegenüber einer Standardtherapie. Lediglich an einen prophylaktischen Einsatz bei Hochriskopatienten ohne ausgeprägte respiratorische Insuffizienz ist zu denken. Strenge Abbruchkriterien für NIPPV sind jedoch gerade bei diesen Patienten notwendig, um nicht den Zeitpunkt zur Intubation zu verpassen. Gasaustauschstörungen bei fortgeschrittener Fibrose, Pneumonie und ARDS lassen sich mit NIPPV nicht ausreichend korrigieren. Kontraindikationen für NIPPV sind der nicht mitarbeitsfähige Patient, fehlende Husten- und Schluckreflexe, ausgeprägter Sekretverhalt und maligne Herzrhythmusstörungen. Relative Kontraindikationen sind das katecholaminpflichtigen Kreislaufversagen und der akute Myokardinfarkt, weil hier keine ausreichenden Daten zur Sicherheit unter NIPPV vorliegen.

The aim of this study was to analyze the impact of gender on tumor stage, overall and cancer-specific mortality of upper urinary tract urothelial cancer (UTUC) in a population-based, nationwide analysis. All Austrian patients with UTUC diagnosed between 1983 and 2010 were included in this study. Overall mortality was estimated by the Kaplan-Meier method. Cancer-specific (UTUC) mortality was estimated by cumulative incidence with mortality due to other causes as a competing risk. The effect of age was adjusted in a descriptive as well as a statistical inferential way. This study included 2066 patients (men n = 1169, mean age 68.3 ±11.5 years, women n = 897, 72.6 ±10.4 years). Tumor stage distribution was as follows: pT1: men n = 411, women n = 268, pT2: men n = 263, women n = 187, pT3: men n = 382, women n = 328 and pT4: men n = 113, women n = 114. The male:female ratio continuously declined from 1.5 for pT1 tumors to 1.4 for pT2 tumors, 1.2 for pT3 tumors and 1.0 for pT4-tumors. In the entire cohort the 5‑year cumulative overall mortality was 57 % for women versus 50 % for men (p = 0.0002). For pT1 (women 33 %, men 31 %) and pT2 stage tumors (women 45 %, men 45 %) the 5‑year overall mortality was comparable between both sexes. In pT3 (women 68 %, men 62 %) and pT4 (women 95 %, men 87 %) tumors women had a higher overall mortality rate. The 5‑year cancer-specific mortality (CSM) of the entire cohort was 12 % for women and 10 % for men (p = 0.067): pT1 women 5 % men 3 %, pT2 women 9 % men 10 %, pT3 women 14 % men 11 % and pT4 women 29 % men 27 %. In this population-based nationwide analysis, sex differences were notable for UTUC. Women tended to have more advanced tumor stages at diagnosis and a higher overall and cancer-specific mortality in advanced tumor stages.

Due to a legislative amendment in Austria to determine breath alcohol (BrAC) instead of blood alcohol (BAC) in connection with traffic offences, many results of blood alcohol calculations were simply converted using distinct conversion factors. In Austria, the transformation of BAC to BrAC was carried out by using a factor of 1:2000, which, however, is commonly known to be too low. Noticing the great demand for a calculation method that is not exclusively based on blood alcohol, a formula for calculating breath alcohol based on blood alcohol was published in 1989, but in which the body surface area (BSA) was considered the most important influencing variable. In order to refine this new method, a liquor intake experiment was conducted combined with measurements of total body water (TBW) as an additional variable, using hand to foot bioelectrical impedance assessment (BIA). The test group comprised 37 men and 40 women to evaluate the accuracy of TBW and BSA as an individual parameter for alcohol concentration. The correlation coefficient of BrAC with TBW was constantly higher than with BSA (maximum = 0.921 at 1 h and 45 min after cessation of alcohol intake). These results are valid for both men and women as well as in a gender independent calculation. Hence, for an accurate back calculation of BrAC adjusted values of eliminations rates had to be found. This study describes mean elimination rates of BrAC for both men (0.065 ± 0.011 mg/L h−1) and women (0.074 ± 0.017 mg/L h−1). As previously shown women displayed a significantly higher elimination rate than men (p = 0.006).

Non-alcoholic fatty liver disease (NAFLD) is frequent in people living with HIV (PLWH) and may be aggravated by metabolic comorbidities and antiretroviral therapy (ART)-associated adverse effects. We retrospectively assessed epidemiological, clinical and laboratory parameters and ART regimens at HIV diagnosis (BL) and at last follow-up (FU) in 1458 PLWH without viral hepatitis coinfection attending our HIV clinic in 2014–2016. Fibrosis was non-invasively assessed by the NAFLD fibrosis score (NFS). The median age of subjects was 37.8 years, 77.4% were male and 67.2% on ART, median CD4+ count was 356.0 cells/µL. At BL, 503 (34.5%) and 20 (1.4%) PLWH had dyslipidemia and diabetes, respectively. According to the NFS 16 (1.3%) showed advanced fibrosis (NFS ≥ 0.676), among which 1 (6.3%) had diabetes, 7 (43.8%) had dyslipidemia, and 5 (31.3%) were on HIV-protease inhibitors (PI). In addition, 191(15.1%) had intermediate NFS results, while fibrosis was ruled out (NFS ≤ 1.455) in 1065 (83.7%) PLWH. After a median follow-up of 6.3 years, 590 (42.8%) had dyslipidemia and 61 (4.4%) had diabetes. Also, 21 (1.6%) showed advanced fibrosis, of which 10 (47.6%) had diabetes, 4 (19.0%) had dyslipidemia, and 9 (42.9%) were on PI-based ART, 223 (17.4%) had intermediate NFS results, while 1039 (81.0%) showed no fibrosis. During FU, advanced NAFLD fibrosis occurred in 1.3–1.6% of PLWH. Dyslipidemia, diabetes, and PI-based ART were associated with advanced NAFLD fibrosis. Prospective investigations of NAFLD severity and risk factors in PLWH are warranted.

To evaluate quality of life in women suffering with osteoporosis with or without vertebral fractures for the first time with the German version of the osteoporosis quality of life questionnaire (OQLQ) and to correlate the German OQLQ with the medical outcome survey short-form health survey 36 (MOS SF-36). In a cross-sectional study, the OQLQ and the MOS SF-36 were randomly administered to 100 postmenopausal osteoporotic women with a median age of 73.5 (quartiles 65.0; 80.0) years in order to evaluate their quality of life. Of the total number, 56 women had osteoporosis with at least one vertebral fracture and 44 women had osteoporosis without vertebral fracture. All items of the OQLQ as well as the MOS SF-36 showed significantly worse values for the women with vertebral fracture compared to those without vertebral fracture. Both questionnaires’ domains evaluating physical wellbeing correlated strongly with each other, supporting the concept of convergent construct validity. The OQLQ domain “emotional function” showed higher correlations with different MOS SF-36 subscores than the MOS SF-36 subscore “role emotional” with the different OQLQ domains. The German version of the OQLQ was demonstrated to be feasible. Significantly, worse results in the German OQLQ for postmenopausal osteoporotic women compared to those without vertebral fracture revealed discriminant validity. The disease-targeted OQLQ seems to better reflect problems associated with low emotional wellbeing because of osteoporotic vertebral fracture.