Austrian Red Cross

IndroductionMultiple sclerosis (MS) is mediated by innate and adaptive immune response deviation involving immune cells and cytokines. Here, we investigated whether combined cytokine profiling and T-cell receptor (TCR) repertoire analysis can better display the complex landscape of MS-driving immune responses.MethodsWe used advanced computational methods to systematically cluster highly variable individual levels of 48 cytokines in cerebrospinal fluid (CSF) and blood of 24 MS patients compared to that of nine controls. Relevant TCR sequences were compared to 88 healthy controls. We correlated cytokines with predominant shared TCR sequences to identify immune response networks.ResultsMS patients had significantly elevated MIP-1α and IP-10 levels in CSF, and additional 36 blood cytokines variably but significantly elevated. We identified 77 predominantly pro-inflammatory cytokine correlations in MS-CSF. TCR sequencing revealed more productive rearrangements in CSF of MS and a significantly higher shared clone recovery rate in blood. We found significant associations involving 492 unique sequences and 34 cytokines in blood. Particularly, the less significant individual cytokine deviations were found to contribute to a general Th1-biased type I immune response correlating with clonal expansion of T cells directed against EBV, CMV, and other infectious agents.DiscussionCorrelation of significantly altered T-cell repertoire with cytokine deviations in MS despite individual patient data variability indicates that future diagnostic strategies may need to address immune response patterns rather than individual protein targets.

BackgroundThe growing importance of online education in recent years has led to an increased focus on implementing and optimizing online learning formats. This study investigated how a lecture delivered in an asynchronous or synchronous online teaching format affects acceptance, intrinsic motivation and knowledge levels after training. The results can be used to optimize online education by identifying format-specific advantages and adapting them to learners’ needs.MethodsAll the Styrian paramedics (N = 5910) were invited to participate in the study and randomly assigned to one of two groups. A total of 1044 participants completed the trial, with one group receiving asynchronous training via a learning platform (N = 545) and the other group participating in synchronous training via webinars (N = 499) providing the same content. After completing a two-hour psychiatric emergency course, the participants were invited to complete a multiple-choice test and a survey assessing acceptance, preferences and intrinsic motivation. Linear regression, t tests and mediation analyses were conducted.ResultsThe asynchronous training format was significantly more accepted (p <.001) and preferred overall. The participants’ preferences depended significantly on the type of learning format (p <.001). The synchronous learning format fostered greater intrinsic motivation (p =.001) and greater perceived autonomy (p <.001) but also a higher level of perceived pressure/tension (p =.003). The analysis revealed no significant difference in test results (p =.449) or perceived competence between the groups (p =.420). Furthermore, the difference in intrinsic motivation was fully mediated by perceived autonomy.ConclusionsThere are different advantages and disadvantages to providing a lecture via webinar or online learning platform. Both formats are equally effective in terms of knowledge levels after training, highlighting the importance of adapting teaching strategies to learners’ preferences.

A growing amount of evidence shows the positive impact of arts-based interventions in dementia care. Existing studies focus on the impact of such interventions on individuals with dementia, yet there is little known about contextual factors influencing the impact of such practices. Contextual factors include personal and relational processes, such as the collaboration between staff, family members, and artists. It also includes making specific organizational choices about the way in which arts and care organizations structure and organize their collaboration. The study aimed to investigate contextual factors influencing the potential impact of health care clowning for persons with dementia. Through multi-country participatory action research (PAR) into health care clowning in dementia care, this study engaged artists (health care clowns), staff, family members, and representatives from four long-term dementia care facilities and three health care clowning organizations. The presented findings show that for arts-based interventions to have sustainable impact within the context of long-term dementia care, focusing on the intervention itself is not enough. Additional time and space are needed for implementation of the intervention and good collaboration on the work floor. The results of this study demonstrate that elements in the PAR process such as open dialogue and arts-based research methods can create communicative spaces which can serve as a catalyst for effective implementation of arts-based practices in long-term dementia care. Elements of the PAR process can therefore be regarded as a form of successful boundary work and in the future could be applied when implementing arts-based interventions in care settings.

ABSTRACT Pelvic running injuries often require extensive rehabilitation and pelvic girdle pain is a barrier to running engagement in population sub-groups, such as perinatal women. However, exploration into how external pelvic loading may be altered during running is limited. This study assessed which biomechanical variables influence changes in external peak pelvic acceleration during treadmill running, across various stride frequency conditions. Twelve participants (7 female, 5 male) ran (9 km∙h−1) at their preferred stride frequency, and at ± 5% and ± 10% of their preferred stride frequency. Coordinate and acceleration data were collected using a motion capture system and inertial measurement units. Linear mixed models assessed peak tibial acceleration, displacement from hip to knee and ankle, contact time, and stride frequency as predictors of peak pelvic acceleration. Stride frequency and contact time interacted to predict peak vertical (p = .006) and resultant (p = .009) pelvic acceleration. When modelled, short contact times and low stride frequencies produced higher peak vertical (p = .007) and resultant (p = .016) pelvic accelerations than short contact times and average, or high stride frequencies. Increasing contact time, or increasing stride frequency at shorter contact times, may therefore be useful in reducing pelvic acceleration during treadmill running.

IntroductionNowadays, managing out-of-hospital cardiac arrest (OHCA) prioritises measures that achieve a good neurological outcome. Monitoring neurological function early is an essential step in identifying patients who could benefit from invasive techniques, such as extracorporeal membrane oxygenation, compared with patients suffering from irreversible hypoxic–ischaemic brain injury. Electroencephalography (EEG) has been used in the hospital; thus, its prehospital data are lacking. This study aimed to evaluate the feasibility of non-invasive EEG in the prehospital environment as a potential tool for neurological assessment.Methods and analysisThis feasibility trial will recruit 45 OHCA patients aged 18 and over in the catchment area of the physician response unit at the University Hospital Graz, Austria. Two different measurement conditions will be assessed: (1) during the phase of cardiopulmonary resuscitation (CPR) and (2) after the return of spontaneous circulation for those who achieve this condition. EEG not only has the potential to provide an early neurological prognosis for immediate treatments or outcome-related decisions but can also aid in better managing CPR-induced consciousness.Ethics and disseminationThe ethics committee of the Medical University of Graz (IRB00002556), decision number 35-352 ex 22/23, reviewed and approved this study protocol, registered at ClinicalTrials.gov (Identifier NCT06072092). The data generated from this research will be published openly alongside the study results.Trial registration numberNCT06072092.

BackgroundThis study aimed to address the challenges faced by rural emergency medical services in Europe, due to an increasing number of missions and limited human resources. The primary objective was to determine the necessity of having an on-site emergency physician (EP), while the secondary objectives included analyzing the characteristics of rural EP missions.MethodsA retrospective study was conducted, examining rural EP missions carried out between January 1st, 2017, and December 2nd, 2021 in Burgenland, Austria. The need for physical presence of an EP was classified based on the National Advisory Committee for Aeronautics (NACA) score into three categories; category A: no need for an EP (NACA 1–3); category B: need for an EP (NACA 1–3 along with additional medical interventions beyond the capabilities of emergency medical technicians); and category C: definite need for an EP (NACA 4–7). Descriptive statistics were used for analysis.ResultsOut of 16,971 recorded missions, 15,591 were included in the study. Approximately 32.3% of missions fell into category A, indicating that an EP’s physical presence was unnecessary. The diagnoses made by telecommunicators matched those of the EPs in only 52.8% of cases.ConclusionThe study suggests that about a third of EP missions carried out in rural areas might not have a solid medical rationale. This underscores the importance of developing an alternative care approach for these missions. Failing to address this could put additional pressure on already stretched EMS systems, risking their collapse.

Zielsetzung Die Entwicklung einer maßgeschneiderten pädiatrischen Dosierungshilfe (PDH) für die abgestufte präklinische Notfallversorgung in Graz gemäß den Wünschen und Bedürfnissen der Mitglieder des Medizinercorps Graz, sowie unter Einhaltung der in der Fachliteratur verfügbaren Empfehlungen zur Verwendung von PDH. Methoden Die Ergebnisse einer Umfrage unter aktiven Mitgliedern des Medizinercorps Graz im Österreichischen Roten Kreuz, Landesverband Steiermark, Bezirksstelle Graz-Stadt, sowie die Resultate eines systematischen Reviews bezüglich Empfehlungen zur Umsetzung und Anwendung von PDH wurden als Grundlage für das Design einer maßgeschneiderten PDH zur prähospitalen Verwendung im Rahmen von pädiatrischen Notfällen herangezogen. Die Angaben zu Norm- und Referenzwerten für Vitalparameter und Equipment erfolgte in Zusammenschau verfügbarer Werte in Studien und Fachliteratur. Die Auswahl der Medikamente, welche auf den PDH zu finden sind, richtete sich besonders nach der Verfügbarkeit auf den Notfallwagen des Roten Kreuzes Graz-Stadt. Die Dosierungen wurden gemäß Empfehlungen in Guidelines und Fachliteratur gewählt und mit Expert*innen der Universitätsklinik für Kinder- und Jugendheilkunde Graz akkordiert. Ergebnisse Die konzipierte PDH umfasst 16 doppelseitige Taschenkarten, bestehend aus einer Neugeborenenversorgungs-, 13 Kindernotfall-Taschenkarten, und zwei Zusatzkarten (Deckblatt, Legende). Die Neugeborenversorgungs-Taschenkarte enthält einen zusammengefassten Algorithmus der Neugeborenenversorgung gemäß ERC 2021, wichtige Medikamentendosierungen und Informationen zur Beurteilung und Versorgung von Neugeborenen. Die 13 Kindernotfall-Taschenkarten wurden nach Altersstufen gestaffelt (3/6/9 Monate, 1/2/3/4/5/6/8/10/12/14 Jahre) entworfen und sind identisch aufgebaut. Sie beinhalten Informationen zu Normwerten, Equipment-Referenzwerten, sowie fertig berechnete Medikamentendosierungen zur Anwendung im Rahmen diverser Kindernotfälle, zur Analgosedierung (intravenös, intranasal, rektal) und zur Kindernarkose. Diskussion Im Rahmen einer Bestellmöglichkeit einer gedruckten Version der entworfenen PDH zeigte sich ein großes Interesse mit über 350 bestellten Exemplaren. Die Praktikabilität und Anwenderfreundlichkeit, sowie eventuelle Stärken und Schwächen der PDH müssen anhand von Praxis-Erfahrungsberichten und Rückmeldungen beurteilt und eventuelle Adaptationen für zukünftige Auflagen vorgenommen werden.

Critical illness is an exquisitely time-sensitive condition and follows a disease continuum, which always starts before admission to the intensive care unit (ICU), in the majority of cases even before hospital admission. Reflecting the common practice in many healthcare systems that critical care is mainly provided in the confined areas of an ICU, any delay in ICU admission of critically ill patients is associated with increased morbidity and mortality. However, if appropriate critical care interventions are provided before ICU admission, this association is not observed. Emergency critical care refers to critical care provided outside of the ICU. It encompasses the delivery of critical care interventions to and monitoring of patients at the place and time closest to the onset of critical illness as well as during transfer to the ICU. Thus, emergency critical care covers the most time-sensitive phase of critical illness and constitutes one missing link in the chain of survival of the critically ill patient. Emergency critical care is delivered whenever and wherever critical illness occurs such as in the pre-hospital setting, before and during inter-hospital transfers of critically ill patients, in the emergency department, in the operating theatres, and on hospital wards. By closing the management gap between onset of critical illness and ICU admission, emergency critical care improves patient safety and can avoid early deaths, reverse mild-to-moderate critical illness, avoid ICU admission, attenuate the severity of organ dysfunction, shorten ICU length of stay, and reduce short- and long-term mortality of critically ill patients. Future research is needed to identify effective models to implement emergency critical care systems in different healthcare systems.

Introduction: Babesia is a tick-borne intraerythrocytic parasite that is globally ubiquitous, yet understudied. Several species of Babesia have been shown to be transfusion-transmissible. Babesia has been reported in blood donors, animals, and ticks in the Tyrol (Western Austria), and regional cases of human babesiosis have been described. We sought to characterize the risk of Babesia to the local blood supply. Methods: Prospective molecular testing was performed on blood donors who presented to regional, mobile blood collection drives in the Tyrol, Austria (27 May to October 4, 2021). Testing was conducted using the cobas^® Babesia assay (Roche Molecular Systems, Inc.), a commercial PCR assay approved for blood donor screening that is capable of detecting the 4 primary species causing human babesiosis (i.e., B. microti, B. divergens, B. duncani, and B. venatorum). A confirmatory algorithm to manage initial PCR-reactive samples was developed, as were procedures for donor and product management. Results: A total of 7,972 donors were enrolled and screened; 4,311 (54.1%) were male, with a median age of 47 years (IQR = 34–55). No positive cases of Babesia were detected, corresponding with an overall prevalence of 0.00% (95% CI: 0.00%, 0.05%). Discussion: The findings suggest that the prevalence of Babesia is low in Austrian blood donors residing in the Tyrol, even during months of peak tick exposure. Although one cannot conclude the absence of Babesia in this population given the limited sample size, the findings suggest that the regional risk of transfusion-transmitted babesiosis is low.