Universitätsklinikum Krems

This study examines the lived experiences of family caregivers navigating the legal and emotional complexities of Austria's newly enacted Dying Decree Law. A qualitative interview study was conducted with nine family caregivers (eight women) of people seeking assisted suicide (PSAS) in Austria. Participants were recruited through purposive sampling through multiple recruitment channels. Interviews were analysed using thematic analysis (supported by MAXQDA). Seven overarching themes emerged: (1) Dynamics of Dying and Saying Goodbye; (2) Inclusion versus Exclusion in the Decision-Making Process; (3) Role Negotiation and Responsibilities; (4) Bureaucratic and Legal Barriers; (5) Social Exclusion and Stigmatisation; (6) Support Needs and Structures; and (7) Ramifications in the Post-Mortem Phase. Family caregivers reported a lack of formal guidance, often leading to isolation and exhaustion. Open communication was repeatedly highlighted as essential in order to honour the PSAS's wishes and alleviate family caregivers' grief. Family caregivers function as advocates and bureaucratic managers while simultaneously serving as carers who provide the PSAS with physical and emotional support. Rather than relying on the legal framework alone, public policy should also formally acknowledge this dual role and deliver government‑led structural support for family caregivers to lessen their emotional and bureaucratic burden. Family caregivers of PSAS were central to this research. We interviewed family caregivers about their experiences with assisted dying under Austria's Dying Decree Law, and incorporated their suggestions for addressing the identified challenges and improving support structures. Their contributions were integral to the study's findings and its focus on enhancing support structures for family caregivers within assisted dying systems.

Hospital Sterilization and Decontamination Units (HSDUs) play a critical role in ensuring the safe and efficient decontamination of surgical instruments to prevent healthcare-associated infections. This paper presents a mathematical modeling approach using Discrete Event Simulation (DES) to optimize staffing schedules within HSDUs at a district general hospital using Metaheuristic Optimization. The objective is to identify the optimal number of staff required to meet service demands while maintaining operational efficiency. A Greedy Heuristic and Tabu Search are employed to determine staffing levels that meet specific performance targets, including decontaminating at least 99% of items within the target time. Results showed that the Tabu Search algorithm significantly outperforms the Greedy Heuristic while maintaining 99% of items decontaminated within the required time. Our findings suggest that Tabu Search provides a more reliable and efficient method for optimizing staffing in HSDUs. Further work is recommended to explore cost implications of staffing decisions.

ABSTRACTObjectivesTo develop and validate educational clinical vignettes (CVs) based on real-life patients with serious pathology from the disciplines of oncology, internal medicine and orthopaedics that are relevant for physiotherapists (PTs) working in a non-direct access system.DesignA mixed-methods study using an iterative design was employed to develop and validate CVs that focused on serious pathology.SettingAcademic and clinical settings within health faculties at three universities in Austria and the UK.ParticipantsMedical doctors (MD) (n=3) and PTs (n=4) developed CVs in the disciplines of internal medicine, oncology and orthopaedics. Validation of the CVs was undertaken in three stages: internal validation by the research team (n=7), external validation by MDs (n=3) and external validation by PTs (n=18).Results25 CVs focusing on internal medicine (9), oncology (8) and orthopaedics (8) were developed. Results of the consensus method of Haute Autorité de Santé ranged between 7 and 9 in the internal validation stage. In the external validation stage with MDs, one orthopaedic CV was excluded, resulting in a final total of 24 validated CVs.ConclusionsThis is the first time educational CVs have been developed and validated across such a broad range of pathologies for countries without direct access to physiotherapy, for use in the education of PTs. Furthermore, the approach described in the Methods section of this paper may serve as a template in similar future projects.

Group B Streptococcus (GBS) colonisation affects around 13% of pregnant women and increases the risk of peripartum infection in newborns, preterm delivery and premature rupture of membranes. GBS infections are a major cause of neonatal sepsis. Early onset GBS (EOGBS) infections in the first seven days of life are particularly dangerous for newborns. Prevention is achieved by intrapartum antibiotic prophylaxis following a positive GBS screening during pregnancy. Screening strategies in pregnant women include universal GBS screening using a rectovaginal swab, assessment of maternal risk factors for EOGBS infection as a risk-based strategy, or a combination of both.The aim of this World Health Organization (WHO) recommendation was to improve the quality of care and outcomes for pregnant women and neonates with regard to the prevention of EOGBS. Consequently, there is a need to develop appropriate screening strategies for GBS in order to initiate intrapartum antibiotic prophylaxis.This recommendation was developed by a group of independent international experts and complements the existing recommendation on intrapartum antibiotic prophylaxis for positive GBS. It was developed in accordance with the WHO guideline development manual. This includes identification of key questions and outcomes, appraisal of the evidence, grading of the evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach, and formulation of the recommendation by the guideline group, considering additional factors such as cost, pregnant women's and family values and preferences, as well as impact on health equity.WHO recommends that pregnant women be screened for the need for intrapartum antibiotic prophylaxis to reduce the risk of EOGBS infection. Either universal antenatal GBS screening or a risk-based strategy should be offered as a screening strategy. Pregnant women with a positive test result or at increased risk should receive intrapartum antibiotic prophylaxis.

Every year, more than one billion people around the world are infected with influenza, an acute infection of the respiratory tract. Influenza spreads from person to person through air, contaminated hands or objects. Antiviral and immunomodulatory drugs are available for treatment of patients and prophylaxis of exposed persons. Reverse transcription polymerase chain reaction (RT-PCR), nucleic acid amplification tests (NAATs) and rapid tests are available for the diagnosis of influenza. Objective The aim of this World Health Organization (WHO) guideline is to provide recommendations for the diagnosis, drug treatment and prophylaxis of influenza.This updated guideline has been developed in accordance with standards for trustworthy guidelines. The recommendations are based on systematic reviews on safety and effectiveness. They take into account the magnitude of benefits and harms of treatments, the reliability of the evidence, and the needs of patients and healthcare professionals.For non-severe influenza, there is a conditional recommendation to use baloxavir if the risk of severe illness is high. Antivirals are not recommended if the risk is low. There is also a strong recommendation against the use of antibiotics if bacterial co-infection is unlikely. Oseltamivir is conditionally recommended for severe influenza. Not recommended are peramivir and zanamivir, as well as macrolide antibiotics (in the absence of co-infection), mTOR inhibitors and plasma therapy, and corticosteroids. Baloxavir and oseltamivir are conditionally recommended for prophylaxis in asymptomatic persons who have been exposed to seasonal influenza viruses and would be at very high risk of becoming hospitalised. For zoonotic influenza, laninamivir and zanamivir are also conditionally recommended in addition to baloxavir and oseltamivir, regardless of individual risk. For diagnosis, the use of NAAT or digital immunoassay (DIA) for suspected non-severe influenza and nucleic acid amplification test (NAAT) for suspected severe influenza is recommended.

Cancer care guidelines have been developed in many subspecialities, usually in advanced health systems. However, there are notable global disparities in healthcare access, which can impact sarcoma care. Unfortunately, there is a lack of global data on this subject. Our aim was to describe access to sarcoma care based on a comprehensive global survey among orthopaedic oncologists, and assess for global as well as regional differences. A 25-question survey was emailed to the attendees of the 2024 Birmingham Orthopaedic Oncology Meeting and included questions about the respondents' training and practice, access to sarcoma centres, and specific items for sarcoma diagnosis and treatment. For data analysis and comparison, countries were grouped geographically and per the World Bank's income classification. A total of 192 specialists from 47 countries completed the survey (67%). Overall, 40% declared that most patients in their country were treated in a specialized sarcoma centre. Declared access to specific diagnostic technology ranged from 69% (translocation studies) to 86% (various immunohistochemistry). Only 31% stated having access to proton therapy and 82% to all possible reconstruction methods. Compromise of ideal surgical management because of prior treatments and financial constraints was declared to have happened regularly in 40% and 17% of practices, respectively. Regions with better-developed healthcare systems had improved access to all aspects surveyed. Similar results were observed when comparing high-income countries against low- to middle-income countries. Our study highlights substantial global and regional disparities in access to sarcoma services, which could potentially impact clinical outcomes. Further studies are needed to clarify this reality.