Biomedical subjects
E Klaschik
Publications and source records attributed to E Klaschik.
[Palliative medicine--definitions and principles].
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[Euthanasia in Europe--give us alternatives].
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[Euthanasia--assisted suicide].
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[Palliative care--a challenge].
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[Development and state of palliative treatment in Germany].
Since the early nineties of the 20th century palliative medicine developed in a dynamic way. 65 palliative care units (p.c.u.), 81 hospices and some 600 outpatient services were in existence in spring 2000. Germany provides 7 beds in p.c.u. and 8 beds in hospices per 1 Mill. inhabitants. Stillitt is a long way to diminish the existing deficits in pain therapy, the control of other physical symptoms as well as the psychological, social and spiritual support.
[Quality assurance in palliative medicine. Survey of the structure and processing quality in palliative care units in North Rhine-Westphalia in Germany].
BACKGROUND AND METHODS: The aim of this study was to get detailed information about the current situation and the quality of the palliative care units in North Rhine-Westphalia (NRW). The aim of palliative medicine is the achievement of the best possible quality of life for patients and their families. Unrelieved pain and other symptoms or major social problems are the reason for the admission of a patient to a palliative care unit. Questionnaires were distributed to the 13 palliative care units in NRW. RESULTS: Most palliative care units in NRW focus on the achievement of pain relief and symptom control, trying to achieve the best possible quality of life. However, the quality of palliative care shows some significant deficits (in the availability of nursing staff, cooperation with general practitioners, standardised documentation and education). A multi-professional team is available in only four units. A total of 90 beds were available in NRW. In 1998 and 1999 palliative care units cared for 2308 patients, most of them (97.5%) suffering from cancer. CONCLUSION: There is a need for further education, not only for physicians but also for nursing staff and physicians already working in palliative care units. Furthermore, we need specialists in palliative medicine for the care for patients with particularly severe problems, and to initiate educational programmes and research in palliative medicine. In order to achieve an improvement of palliative care in Germany, we need to convince not only physicians and nursing staff of the advantages of palliative care, but also health care officials, the government and the public. Palliative care is not for free. However, palliative care does not necessarily lead to increasing costs in health care. Better pain management and symptom control may help to save the overall costs of medical treatment.
[Euthanasia--assisted suicide].
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[Pain therapy in palliative medicine].
The large majority of patients being managed in palliative medicine are suffering from incurable, far advanced and progressive cancer. An overall treatment strategy not only includes the treatment of physical symptoms but also integrates the psychological, social and spiritual problems of the patients and his/her relatives. The most stressful physical symptom is pain, which may be so severe as to be intolerable. With the judicious use of opioids and adjuvant substances, this can be managed satisfactorily. The opioid of choice is oral morphine. The value of oral oxycodone and hydromorphone has not yet been fully established, and it remains to be seen what role they will play in the future. These two substances are expected to become available in Germany in 1998.
[Palliative medicine].
Palliative medicine is the care and the study of that care for patients, with an active, progressive, and advanced disease, where life expectancy is relatively short. The goal is achievement of the best possible quality of life for patients and their families. Pain therapy, control of other physical symptoms and of psychological, social and spiritual problems are cornerstones of palliative medicine. Skilled empathetic communication and ethical issues are essential to many of the aspects of palliative care. Education and training of professional health workers involved in the care of dying patients is important.
[Historical development of palliative medicine].
The modern hospice movement started in St. Christopher's Hospice, London. From there it spread out rather quickly to the United Kingdom and many other countries. The first palliative care unit worldwide was founded in Montreal (Canada) 1975 and the first one in Germany was established in Cologne 1983. Until 1990 there was not much of a hospice or palliative movement in Germany. In the early nineties an increasing interest could be recognized and since May 1997 there are 34 palliative care units in existence.
[The quality of postoperative pain therapy].
Many patients still suffer from unnecessary pain in the postoperative period. Waiting for new technologies or drugs will not improve the status of acute pain management. The establishment of an acute service is needed to reduce the incidence of postoperative pain. Acute pain therapy is one of the great challenges we have to take up.
[Palliative medicine].
Palliative medicine has its origin in the modern hospice movement. It is based upon an integrated-care concept for seriously ill and dying patients. The first consideration of this particular form of treatment is not to prolong life, but to reach the best possible quality of a patient's remaining lifetime. Therefore, palliative medicine consists of: (1) excellent pain treatment and symptom control; (2) an integrated approach towards the psychic, social, and spiritual needs of the patient, relatives, and attending staff during the periods of illness, dying, and, after the patient's death; (3) competence in dealing with vital matters of communication and ethics; and (4) acceptance of death as a normal process. Palliative medicine clearly rejects euthanasia. Practical implementation of the idea of hospice services can be realised anywhere when taking care of seriously ill and dying patients, whether at home, in a nursing home, or in hospital. Experience shows that quite a few patients cannot be treated successfully without additional services, such as home-care services, day-care centres, in patient hospices, and palliative-care units. Up to now, severely ill tumour patients have benefited most from these services. In palliative care units an interdisciplinary team of doctors and nursing staff assisted by physiotherapists and members of psycho-social professions is taking care of and treating patients. Additional support is given by voluntary services and the integration of the patient's relatives in the caring process. Palliative medicine is the overall term for this special kind of treatment and care. In Great Britain, Canada, and Scandinavia considerable progress has been achieved in this field, including recognition as an independent clinical discipline and the establishment of lectureships in palliative medicine.
Tramadol in the management of post-operative pain: a double-blind, placebo- and active drug-controlled study.
A double-blind, randomized, placebo- and drug-controlled study in which the analgesic efficacy and safety of intravenous (i.v.) tramadol in patients with post-operative pain is reported. One hundred and eighty patients recovering from gynaecological or abdominal surgery were assigned to one of three treatment groups. After titration of an individual loading dose, patients could self-administer tramadol 20 mg, morphine 2 mg or placebo using a patient-controlled analgesia (PCA) device throughout a 48-h period. Criteria of efficacy were a decrease in pain intensity within the first 30 min of at least 20 on a visual analogue scale (VAS) (0 denotes no pain, 100 worst pain imaginable) and satisfactory analgesia in the patient's opinion during the study period. Patients treated with tramadol, morphine and placebo were assessed as responders at 66.7%, 75.0% and 18.3% (P < 0.0001). VAS after the initial bolus were 39.2 +/- 22.1, 35.9 +/- 21.6 and 50.0 +/- 24.2 (P = 0.002), the initial loading dose amounted to tramadol 144.9 +/- 51.2 mg, morphine 12.3 +/- 5.1 mg and placebo 17.2 +/- 4.9 mL. No serious opioid-related adverse events occurred in the patients given tramadol while two patients given morphine developed an impaired respiratory rate and a decreased oxygen saturation to 80% or less. Tramadol proved to be efficacious for PCA treatment of post-operative pain following gynaecological and abdominal surgery.
[Problem in indication and artificial ventilation during segmental resection of the trachea (author's transl)].
Based on clinical experience and lung function data (bronchial resistance and inspiratory and expiratory FEV1) obtained in experiments with stenosis in the front of the mouth, bronchial resistance and inspiratory and expiratory FEV1 should first be determined. Resection of tracheal stenosis is indicated at a bronchial resistance of more than 5 cm H2O/1/s. This corresponds to a stenosis diameter of less than 8 mm. In the case of carinal resection, one lung can be ventilated by artifical respiration for a short time only. The data obtained during resection confirm the well-known requirement of clamping the opposite pulmonary artery.
[The effect of positive pressure breathing on the correlation between pulmonary wedge and left atrial pressure in hyper-, normo- and hypovolaemic dogs (author's transl)].
The effect of altering end-expiratory inflation pressure from 0 to 20 cm H2O in relation to the pulmonary capillary wedge-pressure (PCWP) and the left atrial pressure (LAP) were studied in dogs, whose blood volume was varied by infusion of dextran or by haemorrhage. In the hyper- and normovolaemic state there was a good correlation between PCWP and LAP up to an end-expiratory pressure of 15 cm H2O. In the hypovolaemic dogs this close agreement existed only up to levels of PEEP 10 cm H2O. Above this end-expiratory pressure pulmonary capillary wedge-pressure increased more than left atrial pressure.
[A simple helium-dilution method for the determination of functional residual capacity in artificially ventilated patients (author's transl)].
A convenient modification of the classical closed circuit helium dilution technique was developped to determine functional residual capacity, especially in intubated and artificial ventilated patients. The determination of the still inflatable lung volume and its variability in the course of pulmonary insufficiency or after a change in the adjustment of the respirator (PEEP a.o.), was reproducible better than +/- 10%. This method can be performed in a short time, without risk for the patient and with instruments locally independent of the ICU, surgery or recovery room.
[Experimental studies about the origin of the "wedge-blood" in partially atelectatic lungs of mongrel dogs (author's transl)].
We measured in 8 experimental studies the oxygen and carbon dioxide partial pressure in systemic arterial, mixed venous and wedge-blood. The results were: 1. In healthy mongrel dogs with controlled intermittent and continuous positive pressure ventilation (FIO2 0,21 and 1,0) paO2 greater than pwO2 greater than pvO2 and pwCO2 less than paCO2 less than pvCO2. 2. During experimentally produced left-sided atelectasis of the lung and positioning of the catheter in the pulmonary artery a) in the ventilated lung we found pwO2 greater than paO2 greater than pvO2 and pwCO2 less than paCO2 less than pvCO2 b) in the atelectatic lung we found paO2 greater than pwO2 greater than pvO2 and paCO2 less than pwCO2 less than pvCO2. According to these findings the sample of highly saturated mixed venous blood from a catheter in the pulmonary artery should be a hint that pulmonary capillary blood is mixed with central venous blood.