Effects of Head Extension on Peak Airway Pressure During Mask-Ventilation: A Prospective, Randomized, Clinical Single-Centre Trial

Background: Rescuers with basic skills may have difficulties to perform efficient and safe mask ventilation. This study aimed at determining the best head position for ventilation, while avoiding stomach inflation. Methods: Forty healthy patients were mechanically ventilated with a face mask (7 mL.kg-1). The head was positioned either with n = 20 or without a cushion support (n = 20), and in three different head extension positions. Results: Head angles differed more with no cushion support at 12°; 95% CI 6 - 18°), 25° (95% CI 17 - 33°) and 32° (95% CI 27 - 37°); P < 0.05) when compared with cushion support at 5° (95% CI 3 - 7°), 16° (95% CI 13 - 20°), and 22° (95% CI 18 - 26°); P < 0.05. Without cushion support, peak airway pressure in neutral position was higher (20 cmH2O, 95% CI 17 to 23 cmH2O) than in the anesthesiologist’s favorite position (16 cmH2O, 95% CI 13 to 19 cmH2O; P = 0.000) or in extension (16 _ 7 cmH2O, 95% CI 13 to 19 cmH2O; P = 0.000). Stomach inflation correlated with body mass index in the neutral position, and in the anesthesiologist’s preferred position without cushion support. Conclusions: Our data suggested that maximal head extension with no cushion support yields the lowest and thus safest peak airway pressure during mask ventilation. Trial Registration: ClinicalTrials.govNCT01909310, registered on July 24th, 201

Comparison of posterior foraminotomy and anterior foraminotomy with fusion for treating spondylotic foraminal stenosis of the cervical spine: study protocol for a randomized controlled trial (ForaC)

Background: Cervical radiculopathy caused by spondylotic foraminal stenosis may require surgical treatment. Surgical options include anterior cervical foraminotomy and fusion or posterior cervical foraminotomy. Controversy remains regarding the preferable surgical approach. Pertinent clinical evidence is limited to low-quality observational reports. Therefore, treatment decisions are predominantly based on the individual surgeon’s preference and skill. The study objective is to evaluate the efficacy and safety of posterior foraminotomy in comparison to anterior foraminotomy with fusion for the treatment of spondylotic foraminal stenosis. Methods/design: This is a multicenter randomized, controlled, parallel group superiority trial. A total of 88 adult patients are allocated in a ratio of 1:1. Sample size and power calculations were performed to detect the minimal clinically important difference of 14 points, with an expected standard deviation of 20 in the primary outcome parameter, Neck Disability Index, with a power of 80%, based on an assumed maximal dropout rate of 20%. Secondary outcome parameters include the Core Outcome Measures Index, which investigates pain, back-specific function, work disability, social disability and patient satisfaction. Changes in physical and mental health are evaluated using the Short Form-12 (SF-12) questionnaire. Moreover, radiological and health economic outcomes are evaluated. Follow-up is performed 3, 6, 12, 24, 36, 48 and 60 months after surgery. Major inclusion criteria are cervical spondylotic foraminal stenosis causing radiculopathy of C5, C6 or C7 and requiring decompression of one or two neuroforaminae. Study data generation (study sites) and data storage, processing and statistical analysis (Department of Medical Statistics, Informatics and Health Economics) are clearly separated. Data will be analyzed according to the intention-to-treat principle. Discussion: The results of the ForaC study will provide surgical treatment recommendations for spondylotic foraminal stenosis and will contribute to the understanding of its short- and long-term clinical and radiological postoperative course. This will hopefully translate into improvements in surgical treatment and thus, clinical practice for spondylotic foraminal stenosis. Trial registration Current Controlled Trials: ISRCTN8257806

Prevalence of SARS-CoV-2 antibodies in healthy blood donors from the state of Tyrol, Austria, in summer 2020.

BACKGROUND: Seroepidemiological studies provide important insight into the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) in our society. We aimed to determine seropositivity of SARS-CoV‑2 antibodies and its cross-sectional correlates in a large cohort of blood donors. METHODS: In this observational cohort study, we tested healthy blood donors residing in Tyrol, Austria, for SARS-CoV‑2 antibodies using the Abbott SARS-CoV‑2 IgG chemiluminescent microparticle immunoassay. We estimated 95% confidence intervals (95% CI) of seroprevalences using bootstrapping and tested for differences by participant characteristics using logistic regression. FINDINGS: Between 8 June and 4 September 2020, we screened 5345 healthy individuals at local blood donor sessions (mean age 42.7 years, SD 13.5 years, 46.7% female). Overall seroprevalence was 3.1% (95% CI 2.7-3.6%, 165 cases), which is 5.1-fold higher (95% CI 4.5-6.0%) than the case number identified by the health authorities in the state-wide testing program (0.6%; 4536 out of 757,634). Seroprevalence was higher in the district Landeck (16.6%, P < 0.001) and in individuals aged < 25 years (4.7%, P = 0.043), but did not differ by gender, blood types, or medication intake. The odds ratio for seropositivity was 2.51 for participants who had travelled to Ischgl (1.49-4.21, P = 0.001), 1.39 who had travelled to other federal states (1.00-1.93, P = 0.052), and 2.41 who had travelled abroad (1.61-3.63, P < 0.001). Compared to participants who had a suspected/confirmed SARS-CoV‑2 infection but were seronegative, seropositive participants more frequently reported loss of smell (odds ratio = 2.49, 1.32-4.68, P = 0.005) and taste (odds ratio = 2.76, 1.54-4.92, P = 0.001). CONCLUSION: In summer 2020, SARS-CoV‑2 seroprevalence in Tyrolean blood donors was 3.1%. Our study revealed regional variation and associations with young age, travel history and specific symptoms

Towards a Technology Roadmap for Big Data Applications in the Healthcare Domain

Abstract-Big Data technologies can be used to improve the quality and efficiency of healthcare delivery. The highest impact of Big Data applications is expected when data from various healthcare areas, such as clinical, administrative, financial, or outcome data, can be integrated. However, as of today, the seamless access to the various healthcare data pools is only possible in a very constrained and limited manner. For enabling the seamless access several technical requirements, such as data digitalization, semantic annotation, data sharing, data privacy and security as well as data quality need to be addressed. In this paper, we introduce a detailed analysis of these technical requirements and show how the results of our analysis lead towards a technical roadmap for Big Data in the healthcare domain

Epidemiology of Antepartum Stillbirths in Austria—A Population-Based Study between 2008 and 2020

(1) Background: Across Europe, the incidence of antepartum stillbirth varies greatly, partly because of heterogeneous definitions regarding gestational weeks and differences in legislation. With this study, we sought to provide a comprehensive overview on the demographics of antepartum stillbirth in Austria, defined as non-iatrogenic fetal demise ≥22+0 gestational weeks (/40). (2) Methods: We conducted a population-based study on epidemiological characteristics of singleton antepartum stillbirth in Austria between January 2008 and December 2020. Data were derived from the validated Austrian Birth Registry. (3) Results: From January 2008 through December 2020, the antepartum stillbirth rate ≥20+0/40 was 3.10, ≥22+0/40 3.14, and ≥24+0/40 2.83 per 1000 births in Austria. The highest incidence was recorded in the federal states of Vienna, Styria, and Lower and Upper Austria, contributing to 71.9% of all stillbirths in the country. In the last decade, significant fluctuations in incidence were noted: from 2011 to 2012, the rate significantly declined from 3.40 to 3.07‰, whilst it significantly increased from 2.76 to 3.49‰ between 2019 and 2020. The median gestational age of antepartum stillbirth in Austria was 33+0 (27+2–37+4) weeks. Stillbirth rates ≤26/40 ranged from 164.98 to 334.18‰, whilst the lowest rates of 0.58–8.4‰ were observed ≥36/40. The main demographic risk factors were maternal obesity and low parity. (4) Conclusions: In Austria, the antepartum stillbirth rate has remained relatively stable at 2.83–3.10 per 1000 births for the last decade, despite a significant decline in 2012 and an increase in 2020

Hairy Cell Leukemia Patients Have a Normal Life Expectancy&mdash;A 35-Year Single-Center Experience and Comparison with the General Population

Classic hairy cell leukemia (HCL) is an uncommon hematologic malignancy characterized by an excellent prognosis since purine analogues (PA), such as cladribine (2-CdA), have been introduced in the 1990s. However, most data on long-term outcomes is gathered from patients treated with PA first-line or include limited information on previous treatment outcomes, i.e., Interferon-&alpha; (IFN-&alpha;). Survival curves from previous series did not reach a plateau, indicating that nearly all patients ultimately relapse. Yet, overall survival (OS) data were rarely corrected for life expectancy of the general population. We here report 83 consecutive HCL patients treated between 1983 and 2017 at the University Center in Innsbruck, Austria. Median follow-up was 170 months (1&ndash;498). IFN-&alpha;, the first-line treatment of choice before 1990, was administered to 24 patients, achieving an overall response rate (ORR) of 86% and an unconfirmed complete remission (CRu) in 23%. All these patients relapsed after a median progression-free survival (PFS) of 30 months (3&ndash;80), but either remained drug-sensitive upon re-exposure to IFN-&alpha; or were successfully salvaged with PA. All 42 patients exposed to first-line 2-CdA responded (ORR of 100%). Sixteen patients received two to four successive courses of PA with a continuous decrease in the response quality (CRu rate 85.7% 1st-line vs. 41.5% 3rd-line treatment). Median PFS was not reached in both treatment-na&iuml;ve patients and those retreated at first relapse. Although pretreatment with IFN-&alpha; was associated with a shortened median PFS of 81 months (43&ndash;118) after PA therapy, this tendency of inferior PFS did not result in inferior OS. OS of all 83 patients was excellent and equivalent to that of age-, sex-, and diagnostic period-matched controls from the Tyrolean general population (standardized mortality ratio 0.8), regardless of their age at diagnosis or whether they were diagnosed until or after the year 2000. These results confirm that HCL patients may look forward to a normal lifespan when treated with PA irrespective of their pretreatment history

Evaluation of the New SingularityTM Air versus Ambu&reg; Aura GainTM: A Randomized, Crossover Mannequin Study

Background: This randomised crossover mannequin study aimed to compare the insertion time for the newly developed SingularityTM Air and the Ambu&reg; AuraGainTM. The SingularityTM Air includes a bendable tube in order to allow optimal passform. Methods: Fifty anaesthetists with a minimum of 100 supraglottic airway device insertions were recruited and randomly assigned to start either with the SingularityTM Air or with the Ambu&reg; AuraGainTM. Participants watched a tutorial video the day before the assessment and received a standardized introduction immediately before the assessment. The primary outcome was the time for successful insertion. Secondary parameters were the overall insertion success rate, the numbers of insertion attempts (maximum three), the glottic view through a flexible bronchoscope, and the success rate for gastric tube insertion. Results: Fifty participants were eventually recruited and randomly assigned to insert both devices according to the randomization. The insertion time was 24 s for SingularityTM Air as compared to 20 s for Ambu&reg; AuraGainTM (p &lt; 0.001). Overall insertion rate was 92% for the SingularityTM Air as compared to 100% for the Ambu&reg; AuraGainTM (p could not be derived as one variable is a constant). The primary insertion success rate was better for the Ambu&reg; AuraGainTM than for the SingularityTM Air (94% versus 68%; p: 0.002, respectively). Conclusion: The time for successful insertion and the insertion success rate for the newly developed SingularityTM Air is inferior to that for the Ambu&reg; AuraGainTM