BACKGROUND:The myofascial release technique is applied to improve symptoms by releasing fascial tissues. The aim of this study was to determine the effects of the myofascial release technique on proprioception, range of motion, pain, shoulder function, and flexibility in patients with rotator cuff tear. MATERIAL AND METHODS:In this study 29 patients with partial rotator cuff tear were randomly divided into 2 groups. The control group received conventional physiotherapy including hot pack, transcutaneous electrical nerve stimulation and exercise program, while the treatment group received the same conventional physiotherapy along with the myofascial release technique. All procedures were performed for 4 weeks. Proprioception, pain severity, range of motion, shoulder functional level, and flexibility were assessed before and after the treatment. RESULTS:Improvement in proprioception was significant in all directions in the treatment group and only in flexion in the control group (p < 0.05). Flexibility significantly increased only in the treatment group (p < 0.05); however, no significant between-group differences were found in proprioception and flexibility (p > 0.05). Both groups showed significant improvement in pain severity, range of motion, and functional level (p < 0.05); however, compared to control group, the treatment group demonstrated significantly greater improvements in pain severity during activity, internal rotation, and functional level (pain and total scores) (p < 0.05), whereas no significant between-group difference was found for the functional level (disability score) (p > 0.05). CONCLUSION:The addition of the myofascial release technique to conventional physiotherapy could contribute to improvements in pain severity during activity, internal rotation, and functional level (pain and total scores) in patients with partial rotator cuff tear, and its inclusion in physiotherapy programs could optimize treatment outcomes.
This consensus recommendation of the Working Group for Congenital and Acquired Heart Disease and the Working Group for Rhythmology of the Austrian Society of Cardiology (ÖKG) describes the pathophysiological foundations, clinical presentation, diagnosis and treatment of arrhythmias in adult patients with congenital heart defects. It also illuminates malformation-specific aspects with respect to the anatomy, typical corrective interventions, risk of arrhythmia and treatment.
Vascular liver diseases such as porto-sinusoidal vascular disorder (PSVD), Budd-Chiari syndrome (BCS), and non-cirrhotic portal vein thrombosis (NCPVT) are rare causes of portal hypertension (PH) but share the same phenotype with parenchymal chronic liver disease (CLD). We assessed whether blood-based and elastography-based noninvasive tests (NITs) can: (i) differentiate vascular from parenchymal liver disease, (ii) detect specific signs of portal hypertension within etiologies and (iii) identify portal vein thrombosis. Consecutive patients with PSVD, NCPVT, BCS, or CLD treated at a tertiary referral center between January 2022 and December 2024 were included. Assessed NITs included platelet count, liver stiffness measurement (LSM), spleen stiffness measurement (SSM), the SSM to LSM ratio, ANTICIPATE, and NICER. This study included 411 patients: PSVD n = 43, NCPVT n = 38, CLD n = 309, and BCS n = 21. Among patients without PVT, NIT patterns differed between etiologies. The PSVD showed low LSM despite elevated SSM, resulting in the highest SSM to LSM ratio. This ratio best discriminated PSVD from CLD and BCS (AUC ≥ 0.870); the proposed cut-off of > 2 showed good diagnostic performance. The ANTICIPATE also differentiated PSVD from CLD/BCS, whereas SSM alone did not. Detection of specific PH signs was etiology dependent. In PSVD, platelet count showed the highest accuracy (AUC 0.823). In CLD, several NITs were associated with specific PH signs but accuracy was limited. In BCS, differences of the tested NITs for specific PH signs were not statistically significant. Across etiologies, NITs showed limited accuracy for detecting PVT. Combined assessment of LSM and SSM, particularly the SSM to LSM ratio, supports differentiation of PSVD from parenchymal and posthepatic liver disease, whereas platelet counts was most informative to detect specific PH signs within PSVD.
PURPOSE:Graft choice in primary anterior cruciate ligament (ACL) reconstruction remains controversial. While hamstring autografts are common, allografts offer advantages such as no donor site morbidity and reduced operation time. This study aimed to compare the clinical, functional and health-related quality of life (HRQOL) outcomes of hamstring allografts vs. autografts in primary ACL reconstruction. METHODS:In this single-center randomized controlled trial, patients undergoing primary ACL reconstruction were randomized to receive either a hamstring allograft or autograft. Clinical evaluation and patient-reported outcome measures (PROMs), including the International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Short Form (SF)-36 Health survey, were collected preoperatively and at multiple follow-ups to 12 months. Operation time and postoperative magnetic resonance imaging (MRI) scans at 12 months were also analyzed. RESULTS:The final cohort included 25 patients (13 allograft, 12 autograft). At 12 months, no statistically significant differences between groups were detected for any PROM. Mean IKDC scores were 83.0 ± 7.2 in the allograft group and 87.2 ± 5.0 in the autograft group (p = 0.12). Both groups demonstrated improvement in patient-reported functional outcomes; however, objective instrumented laxity testing was not performed. Mean operation time was significantly shorter for the allograft group (61.6 ± 11.4 min) compared to the autograft group (83.0 ± 13.6 min; p < 0.001). CONCLUSION:In this small pilot randomized cohort of patients aged 27 years and older, no statistically significant short-term differences in PROMs were detected between hamstring allograft and autograft ACL reconstruction at 12 months. Allograft use was associated with significantly shorter operative time. These findings should be interpreted cautiously because the study was not powered to demonstrate equivalence or noninferiority and longer term follow-up with objective laxity testing is required to assess graft durability and stability.
Graft choice in primary anterior cruciate ligament (ACL) reconstruction remains controversial. While hamstring autografts are common, allografts offer advantages such as no donor site morbidity and reduced operation time. This study aimed to compare the clinical, functional and health-related quality of life (HRQOL) outcomes of hamstring allografts vs. autografts in primary ACL reconstruction. In this single-center randomized controlled trial, patients undergoing primary ACL reconstruction were randomized to receive either a hamstring allograft or autograft. Clinical evaluation and patient-reported outcome measures (PROMs), including the International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Short Form (SF)-36 Health survey, were collected preoperatively and at multiple follow-ups to 12 months. Operation time and postoperative magnetic resonance imaging (MRI) scans at 12 months were also analyzed. The final cohort included 25 patients (13 allograft, 12 autograft). At 12 months, no statistically significant differences between groups were detected for any PROM. Mean IKDC scores were 83.0 ± 7.2 in the allograft group and 87.2 ± 5.0 in the autograft group (p = 0.12). Both groups demonstrated improvement in patient-reported functional outcomes; however, objective instrumented laxity testing was not performed. Mean operation time was significantly shorter for the allograft group (61.6 ± 11.4 min) compared to the autograft group (83.0 ± 13.6 min; p < 0.001). In this small pilot randomized cohort of patients aged 27 years and older, no statistically significant short-term differences in PROMs were detected between hamstring allograft and autograft ACL reconstruction at 12 months. Allograft use was associated with significantly shorter operative time. These findings should be interpreted cautiously because the study was not powered to demonstrate equivalence or noninferiority and longer term follow-up with objective laxity testing is required to assess graft durability and stability.
To evaluate the effects of exercise-based early cardiac rehabilitation (EB-ECR) initiated within 24 h after acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI) on cardiac function and functional capacity at 12 weeks. Single-center, parallel-group randomized pilot trial. Setting: a tertiary hospital with dedicated cardiac rehabilitation services. Participants: clinically stable AMI patients within 24 h of successful PCI. Interventions: participants were randomized 1:1 to EB-ECR, consisting of an individualized, phased rehabilitation program initiated in-hospital and continued postdischarge, or usual care without structured cardiac rehabilitation (NO-CR). Primary endpoints included left ventricular ejection fraction (LVEF), peak oxygen uptake (VO2 peak), 6‑minute walk distance (6 MWT) and B‑type natriuretic peptide (BNP) at 12 weeks. In this study 24 participants were randomized (EB-ECR n = 12; NO-CR n = 12). Compared to NO-CR, baseline-adjusted analyses favored EB-ECR: LVEF was higher by 2.8
To investigate the relationship between patient load or time constraints and attitudes towards person-centered care vs. doctor or disease-centered care within the context of primary care and family medicine in Austria. A cross-sectional questionnaire-based study was conducted in Austria as part of the international Person-centered care Attitudes among European General Practitioners/Family Physicians (PACE GP/FP) study [1]. The primary analysis examined the association between continuous patient-practitioner orientation scale (PPOS) scores and self-reported patient load using multivariable linear regression adjusted for age, sex and perceived stress. For a secondary analysis, participants were assigned to one of three care-approach groups, based on PPOS scores (patient-centered, medium patient-centered and doctor/disease-centered) and compared regarding the self-reported number of patients seen per day using a Kruskal-Wallis test. In multivariable linear regression analyses, higher patient load remained independently associated with lower continuous PPOS scores (B = −0.003, 95
OBJECTIVE:To investigate the relationship between patient load or time constraints and attitudes towards person-centered care vs. doctor or disease-centered care within the context of primary care and family medicine in Austria. METHODS:A cross-sectional questionnaire-based study was conducted in Austria as part of the international Person-centered care Attitudes among European General Practitioners/Family Physicians (PACE GP/FP) study [1]. The primary analysis examined the association between continuous patient-practitioner orientation scale (PPOS) scores and self-reported patient load using multivariable linear regression adjusted for age, sex and perceived stress. For a secondary analysis, participants were assigned to one of three care-approach groups, based on PPOS scores (patient-centered, medium patient-centered and doctor/disease-centered) and compared regarding the self-reported number of patients seen per day using a Kruskal-Wallis test. RESULTS:In multivariable linear regression analyses, higher patient load remained independently associated with lower continuous PPOS scores (B = -0.003, 95% CI -0.005 to -0.001, p = 0.002). In our sample, patient load differed significantly across the different care approaches, H(2) = 6.112, p = 0.047, η2 = 0.058. General practitioners (GPs) in the doctor/disease-centered group saw significantly more patients per day (median = 90, interquartile range, IQR = 68) compared to the patient-centered group (median = 50, IQR = 65). Additionally, a high workload, characterized by high clinical demands and time pressure, was the most commonly reported barrier for person-centered care in daily practice. CONCLUSION:Higher patient load was associated with a lower patient-centered orientation among Austrian general practitioners. Our findings suggest the need to address systematic factors contributing to time constraints and emphasize the importance of equipping general practitioners with the resources needed to integrate person-centered care into their practice.
AIM:Fistula laser closure (FiLaC) is a minimally invasive treatment option for perianal fistulas with acceptable healing rates. We report implementation and include short-term results in line with the IDEAL (Idea, Development, Exploration, Assessment, Long-term study) 2A framework in patients with complex fistulas and previous surgical repair attempts. METHOD:Prospective audit data from 56 consecutive patients with perianal fistulas treated between June 2024 and January 2025. The FiLaC procedure included cleaning the fistula tract, application of approximately 100 J/cm fistula length and closing of the internal opening with a stitch. All patients refused more invasive operations and/or were not suitable for advanced repair. RESULTS:Patients were diagnosed with fistulas after a median of 34.5 months (interquartile range, IQR 13.8-54.2 months), with a median of 3 months (IQR 1.8-4.0 months) following previous fistula-related surgery. Most patients had cryptoglandular fistulas (80.4%) while 19.6% had inflammatory bowel disease-related fistulas. Most fistulas were transsphincteric (69.6%), and only 32.1% of patients were seton-free before the procedure. During the first postprocedural outpatient visit at 7.9 weeks (median; IQR 6.4-10.9 weeks), clinical healing was evident in 14 (24.1%) cases, and 23 (39.7%) patients reported relevant symptomatic improvement. A total of 21 patients (36.2%) did not report any improvement, 3 patients (5.2%) experienced a postoperative complication, with 1 (1.7%) requiring a return to theatre due to an abscess. After a median of 10.4 months, the "seton-free rate" was 67.9%, This represents a relevant improvement to 32.1% before FiLaC. CONCLUSION:The use of FiLaC is a safe, sphincter-preserving treatment for complex perianal fistulas and was associated with a marked increase in the seton-free rate. While complete fistula healing rates were lower than previously reported, FiLaC remains an option for patients with complex disease.
Fistula laser closure (FiLaC) is a minimally invasive treatment option for perianal fistulas with acceptable healing rates. We report implementation and include short-term results in line with the IDEAL (Idea, Development, Exploration, Assessment, Long-term study) 2A framework in patients with complex fistulas and previous surgical repair attempts. Prospective audit data from 56 consecutive patients with perianal fistulas treated between June 2024 and January 2025. The FiLaC procedure included cleaning the fistula tract, application of approximately 100 J/cm fistula length and closing of the internal opening with a stitch. All patients refused more invasive operations and/or were not suitable for advanced repair. Patients were diagnosed with fistulas after a median of 34.5 months (interquartile range, IQR 13.8–54.2 months), with a median of 3 months (IQR 1.8–4.0 months) following previous fistula-related surgery. Most patients had cryptoglandular fistulas (80.4
Living kidney donation among carefully selected individuals is generally considered safe but post-donation health risks vary by factors including family history. Data on long-term outcomes of related living kidney donors of recipients with familial Mediterranean fever (FMFLRD) are limited. This retrospective multicenter study reviewed the medical records of living donors who donated between 2010 and 2021 across six transplantation centers. Cardiovascular and kidney outcomes were compared between 37 FMFLRD and a propensity-matched control group of 74 donors to recipients without FMF (non-FMFLRD). Propensity score matching was based on donor age, sex, and follow-up time. Outcome measures included major cardiac events (MACE), new-onset hypertension, new-onset diabetes mellitus, proteinuria and estimated glomerular filtration rate (eGFR). The median follow-up duration of all donors was 4.0 years (interquartile range, IQR 2.0–11.0 years). The mean age of the FMFLRD group was 48.9 ± 9.3 years, The FMFLRD group showed a significantly lower proportion of MACE (2.7
Abstract Introduction Treatment initiation or intensification to prevent exacerbation of chronic obstructive pulmonary disease (COPD) is based on the identification of patients with high exacerbation risk. The commonly used high-risk category of at least 2 moderate or 1 severe exacerbation within the prior 12 months has limited supporting evidence. We aimed to test the discriminative accuracy and assess the clinical utility of various COPD exacerbation categories for predicting future exacerbations. Methods In the COPDGene and NOVELTY cohorts, for each 1-year and 2-year recall periods, we estimated 6 distinct categories of exacerbation frequencies: ≥1 moderate (M1), ≥2 moderate (M2), ≥1 severe (S1), ≥1 moderate and ≥1 severe (M1andS1), ≥1 moderate or ≥ 1 severe (M1orS1), and ≥2 moderate or ≥ 1 severe (M2orS1), each ascertained in 3 ways: within 1 year, in each of 2 consecutive years (suffix E), and over a rolling combined 2-year period (suffix R). We used the area under the receiver operating characteristic curve (AUC) and decision curve analysis to evaluate the discriminative accuracy and clinical utility of these 18 categories for predicting the occurrence of M2orS1 (current standard) in the subsequent year. Results In COPDGene (n = 3,035), for the prediction of future M2orS1, baseline M1orS1R had the highest AUC (0.69, 95%CI 0.67-0.71) vs. baseline M2orS1 (0.66, 95%CI 0.64-0.67; Δ = 0.03;p<0.001). In NOVELTY (n = 3,080), M1orS1R category had the highest AUC (0.87, 95%CI 0.85-0.88) vs. M2orS1 (0.75, 95%CI 0.72-0.77, Δ = 0.12;p<0.001). Decision curve analysis demonstrated that the two-year rolling patterns provided the highest clinical utility across a clinically relevant treatment threshold range of 5% to 30% (Figure). M1orS1R also had the highest AUC for predicting any exacerbation (M1orS1) in both COPDGene (AUC = 0.68, 95%CI 0.66-0.70) and in NOVELTY (AUC = 0.86, 95%CI 0.85-0.88). Conclusions At least 1 moderate or 1 severe exacerbation over the previous 2 years has the highest discrimination and confers the highest clinical utility for predicting high COPD exacerbation risk. Overall, the combination of higher performance of various exacerbation history patterns in terms of their statistical (AUC) and clinical utility (net benefit) indicates that using a two-year recall and a lower threshold for high-risk classification (any moderate/severe events) is superior to the current standard of care. This abstract is funded by: This work was supported by NHLBI R01 HL151421 (SPB and AN), U01 HL089897 and U01 HL089856, by NIH contract 75N92023D00011, and by a Team Grant from the Canadian Institutes of Health Research (PHT 178432). COPDGene is also supported by the COPD Foundation through contributions made to an Industry Advisory Board that has included AstraZeneca, Bayer Pharmaceuticals, Boehringer Ingelheim, Genentech, GlaxoSmithKline, Novartis, Pfizer, and Sunovion. The NOVELTY study was funded by AstraZeneca.
Venöse Thromboembolien (VTE), eine Krankheitsentität die tiefe Venenthrombosen (TVT) und/oder Lungenembolien (PE) umfasst, gehören in der Orthopädie und Traumatologie zu den häufigsten und potenziell lebensbedrohlichen Komplikationen [1]. Die bislang gültige österreichische Empfehlung zur VTE-Prophylaxe bei muskuloskeletalen Eingriffen aus dem Jahr 2014 [2] bildet die aktuellen evidenzbasierten pharmakologischen und nichtpharmakologischen Strategien nicht mehr adäquat ab. Aktuelle internationale interdisziplinäre Leitlinien zur VTE-Prophylaxe wie von der European Society of Anaesthesiology and Intensive Care (ESAIC) [3] und der Arbeitsgemeinschaft Wissenschaftlich-medizinischer Fachgesellschaften (AWMF) [4] wurden daher unter Berücksichtigung österreichischer Versorgungsstrukturen adaptiert. Insbesondere fehlen bislang klar definierte Kriterien für ein funktionelles Frühmobilisationskonzept im Sinne eines Fast-Track-Programms sowie strukturierte Empfehlungen zur VTE-Prophylaxe bei konservativen orthopädisch-traumatologischen Behandlungen. Zur Erarbeitung praxisorientierter, evidenzbasierter Empfehlungen wurde eine interdisziplinäre Konsensusgruppe aus Vertreter:innen der für dieses Thema relevanten österreichischen Fachgesellschaften einberufen. Das Ziel war, strukturiertere, risikoadaptierte Handlungsempfehlungen unter Berücksichtigung der österreichischen Versorgungsrealität zu formulieren.
Venous thromboembolism (VTE), a disease entity comprising deep vein thrombosis (DVT) and/or pulmonary embolism (PE), represents one of the most frequent and potentially life-threatening complications in orthopaedics and traumatology [1]. The previous Austrian recommendation on VTE prophylaxis in musculoskeletal procedures, dating from 2014 [2], no longer adequately reflects current evidence-based pharmacological and nonpharmacological strategies. Current international interdisciplinary guidelines on VTE prophylaxis, such as those issued by the European Society of Anaesthesiology and Intensive Care (ESAIC) [3] and the Association of the Scientific Medical Societies in Germany (AWMF) [4], were therefore adapted with consideration of Austrian healthcare structures. In particular, clearly defined criteria for a functional early mobilisation concept within the framework of a fast-track programme, as well as structured recommendations on VTE prophylaxis in conservative orthopaedic and traumatological treatments, have been lacking to date. To develop practice-oriented, evidence-based recommendations, an interdisciplinary consensus group comprising representatives of the Austrian medical societies relevant to this topic was convened. The aim was to formulate more structured, risk-adapted recommendations that take the Austrian healthcare context into account.
Video-assisted thoracoscopic surgery (VATS) is widely used for anatomical lung resections. Despite available enhanced recovery after surgery (ERAS) recommendations, perioperative management may vary between institutions. This survey assessed current perioperative practice for VATS procedures in Austria. A structured questionnaire comprising 19 items was distributed to all anesthesia departments performing thoracic surgery in Austria (n = 13) in February 2024. The survey addressed institutional characteristics, airway management, intraoperative anesthesia strategies, monitoring practices and perioperative analgesia. Data were analyzed descriptively. A total of 10 centers responded (response rate 76.7
Mental health among young people and suicidality are major ongoing public health issues. This study aims to provide updated epidemiological information on youth suicides in Austria. Suicide and population data for 10–19-year-olds were obtained from Statistics Austria. We examined the distribution of suicide methods, age, sex and regional differences, as well as monthly distribution of suicides for the period 2015–2024. In addition, we calculated trends in youth suicides using annual suicide rates for boys and girls between 2005 and 2024 and assessed if the pandemic year (2020) resulted in changes in suicide rates. A total of 302 youth suicides (29.5
Acromioclavicular (AC) joint dislocations are common injuries in young, active individuals. Surgical reconstruction aims to restore stability, yet loss of reduction is frequently reported. It remains unclear whether radiographic alignment correlates with patient satisfaction and functional outcomes. A multicenter retrospective study was conducted, including adult patients with Rockwood type III–VI AC joint injuries, treated surgically between 2019 and 2024. Patients were divided into two groups based on postoperative X‑rays (stable and dislocated), conducted 6 months following surgical treatment. Clinical outcome was assessed using patient-reported outcome measures, including the American Shoulder and Elbow Surgeons (ASES score), the simple shoulder test (SST), single assessment numeric evaluation (SANE) and visual analogue scale (VAS). Radiographic evaluation and clinical outcome at 6 months postoperative were used for analyses in this study. A total of 46 patients (95.7
