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Biomedical subjects

F Stiefel

Publications and source records attributed to F Stiefel.

At least 55 records · Page 3Linked to original sources
PubMed1996

Palliative and supportive care: at the frontier of medical omnipotence.

Cancer patients have physical, social, spiritual an emotional needs. They may suffer from severe physical symptoms, from social isolation and a sense of spiritual abandonment, and emotions such as sadness and anxiety, or feeling of deception, helplessness, anger and guilt. In some of them, the disease is rapidly progressive and they ultimately die. Their demanding care evokes intense feelings in health care providers, the more so since these incurable patients represent a challenge, which can be characterized as one of 'medical omnipotence'. It may be assumed that the way health care providers cope with these circumstances profoundly influences the way these patients are cared for. Attitudes regarding the emerging heterogeneous movement of palliative and supportive care and its different models of implementation can be viewed form this vantage point. Here we look at these interrelations and discuss the potential pitfalls if they are ignored and remain unexamined.

Health Knowledge, Attitudes, Practice↗
PubMed1994

Common psychiatric disorders in cancer patients. I. Adjustment disorders and depressive disorders.

A high prevalence of adjustment and depressive disorders has been reported in oncology. These conditions are highly treatable, therefore the assumption that emotional distress is just a foreseeable and ordinary reaction to cancer had to be reviewed. Clinical presentation, etiology, assessment, and therapy of adjustment and depressive disorders are summarized in order to optimize supportive care.

Adjustment Disorders↗
PubMed1994

Common psychiatric disorders in cancer patients. II. Anxiety and acute confusional states.

Anxiety is a very prominent symptom of cancer patients and appears most frequently in connection with adjustment disorders. However, it can also be part of a normal adaptation to the disease, related to an anxiety disorder, or can be caused by variety of other reasons, including underlying somatic processes. The clinical presentation, etiology, diagnostic proceedings and the treatment of anxiety in patients with cancer is surveyed. Delirium (acute confusional states) is a neglected psychiatric syndrome in regard to diagnosis, treatment and research efforts. Especially in cancer patients, delirium is frequent and its incidence increases with advanced disease. A brief overview on the current literature of acute confusional states in cancer patients is presented.

Acute Disease↗
PubMed1993

[Chronic tumor pain and opiates: a survey of prescription practice among physicians of German-speaking Switzerland].

Motivated by clinical experience that opioids are still not administered adequately in cancer pain, a survey about their use involving 1200 physicians of the German-speaking part of Switzerland was conducted. The results confirm that a part of the treating physicians uses opioids not rationally, but that the majority follows established guidelines in the treatment of cancer pain. The results are compared and discussed with the current literature on the management of cancer pain.

Analgesics, Opioid↗
PubMed1993

[Suffering and suicide in tumor patients].

Epidemiological studies demonstrate that cancer patients are at increased risk for suicide. Vulnerability to suicide in cancer patients is influenced by a number of factors, including psychosocial and psychosomatic effects of advanced illness, pain, organic mental syndromes and pre-existing psychopathology. Ways of influencing these risk factors are discussed, together with their use in preventive care and management of suicidal cancer patients.

Depressive Disorder↗
PubMed1993

[Anxiety and terminal tumor disease].

Clinically relevant anxiety disorders are rare in terminally ill cancer patients. A variety of factors can cause symptoms of anxiety in this patient population, the imminence of death is not the most frequent reason. According to the results of a psychiatric evaluation, the physical examination and further diagnostic procedures, treatments can be effective in alleviating anxiety in these patients.

Anxiety Disorders↗
PubMed1993

Vapreotide, a new somatostatin analogue in the palliative management of obstructive ileus in advanced cancer.

Obstructive ileus is not common, but is a very distressing syndrome in a palliative care unit. The case of a 86-year-old woman with obstructive ileus due to advanced pancreatic cancer is presented. Successful management was made possible by a new somatostatin analogue (Vapreotide), administered i.m. at weekly intervals. Vapreotide was found to reduce nausea and vomiting considerably, by inhibiting the release and action of gastrointestinal hormones and the secretory and motor functions of stomach and intestines. The role of somatostatin analogues in the management of obstructive ileus in advanced cancer is discussed.

Aged↗
PubMed1993

Attitudes of Swiss physicians in prescribing opiates for cancer pain.

Following clinical observations showing that opiates are sometimes not consistently administered for chronic cancer pain, a survey was conducted among 1200 physicians in the German-speaking part of Switzerland. Their opium-prescribing habits were assessed by means of a postal questionnaire. The results indicate that, among the majority of physicians completing the questionnaire, established guidelines and basic principles of pain control with opiates in cancer patients are largely understood. Oral morphine is chosen by 89% to initiate treatment of chronic cancer pain, and the correct use of slow-release morphine is known to 87% of the responding physicians. Unfortunately, an important minority of physicians does not follow established guidelines in the treatment of cancer pain, and up to 20% still feel that the danger of addiction, respiratory depression and other side-effects are important reasons for withholding opiates in this patient population. The results and their implications are discussed and compared with the current literature on cancer pain management.

Attitude of Health Personnel↗
PubMed1993

Psychosocial aspects of cancer pain.

Pain, and especially cancer pain, is not a pure nociceptive, physical experience, but involves different dimensions of man, such as personality, affect, cognition, behavior and social relations. Cancer pain is best conceptualized as the convergence of multiple activated systems with feedback mechanisms to a complex, multidimensional model. The psychosocial aspects of this multidimensional model will be analyzed with special emphasis on results from recent research. Although most research has been conducted on the role of affect and cognition in cancer pain, data on other factors such as personality, behavior or social aspects exist and will be presented. In the second part of this paper the implications of these results for therapeutic strategies in clinical work will be discussed. Although a considerable body of knowledge exists to support the hypothesis of a multidimensional model of cancer pain, where psychosocial variables play an important role, only a few studies address the issue of to what degree different factors exercise their influence. This may be different from patient to patient and may change over the course of the disease. Whatever importance these single variables in the multidimensional model of cancer pain may have, the patient is best treated when none of these aspects is neglected in the assessment and all are taken care of in the treatment. A multidisciplinary team, with a psychiatrist as one of the team members, is often best prepared to fulfill this task.

Humans↗