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PubMedDate not supplied

Clinical approaches to the withdrawal of nutrition and hydration.

The request for withdrawal of nutrition and hydration from the vegetative patient is rare, but when it occurs it causes considerable anxiety for the clinical team. This anxiety is exacerbated by the need to seek a declaration from court that withdrawal of treatment would be legal. This paper discusses the process from the time of the request to the withdrawal of the tube feeding, and the actions the clinical team needs to take.

Decision Making↗
PubMedDate not supplied

Effects of hypericum extract HYP 811 in patients with psychovegetative disorders.

The efficacy of tolerability of a 6-week course of Hypericum extract HYP 811 were investigated in a postmarketing surveillance study of 758 outpatients suffering from psychovegetative disorders. The investigations included a standardized list of typical somatic symptoms and global evaluations of the drug's efficacy and tolerability. By study end, 83.1% of patients had experienced a reduction in symptom severity, and the frequency of symptoms had improved by an average of 37.3%. After 3 weeks of treatment, the dosage could be reduced to one capsule per day in 35.8% of patients.

Adolescent↗
PubMed1998

Clinical studies on diffuse axonal injury in patients with severe closed head injury.

OBJECTIVE: To discuss the clinical criteria for diagnosing diffuse axonal injury (DAI). METHODS: Clinical and computed tomographic features of 117 patients with severe closed head injury were analyzed. The authors preliminarily put forward CT diagnostic criteria of DAI, that is, 1) single or multiple small intraparenchymal hemorrhages in the cerebral hemispheres (< 2 cm in diameter); 2) intraventricular hemorrhage; 3) hemorrhage in the corpus callosum; 4) small focal areas of hemorrhage adjacent to the third ventricle (< 2 cm in diameter); and 5) brain stem hemorrhage. All patients were divided into two groups, DAI and non-DAI group, according to the criteria. There were 42 patients in the DAI group and 75 patients in the non-DAI group. The injury causes, Glasgow coma scale (GCS) scores on admission, coexisting injuries and outcomes were compared between the two groups. The relationship between DAI and the outcomes in the patients with severe head injury was analyzed. RESULTS: Traffic accident was the main injury cause in the cases of DAI. GCS scores on admission in patients with DAI were significantly lower than those in patients without DAI. The incidence of diffuse brain swelling (DBS) in the DAI group was significantly higher than that in the non-DAI group, whereas the incidences of both skull fracture and epidural hematoma (EDH) in the DAI group were significantly lower than those in non-DAI group. There was no significant difference between the incidence of subarachnoid hemorrhage (SAH) and subdural hematoma (SDH) in the two groups. The incidence of poor outcome in the DAI group was significantly higher than that in the non-DAI group, although there was no significant difference between the mortalities in the two groups. CONCLUSIONS: Because DAI is a very important factor worsening the outcome of patients with head injury, it is essential to make a diagnosis as soon as possible. The clinical manifestations of DAI, however, are not specific and DAI does not show directly on CT scans, so it is difficult to make a definite diagnosis. The CT diagnostic criteria of DAI put forward in this article are practicable, though they are by no means perfect.

Adolescent↗
PubMed1999

[Foregoing artificial feeding and hydration for nursing home patients in the last phase of life].

For 3 nursing home patients in bad physical and psychiatric condition and with a poor prognosis, 2 women aged 86 and 84 years and 1 man aged 55 years, it was decided to forgo artificial feeding and hydration, after which they passed away quietly within about a week. It appears that dying in that way does not cause much suffering. Before the decision of forgoing is taken the following factors should be considered: the cause of a diminishing food and fluid intake, the severity and prognosis of underlying diseases and the (supposed) wishes of the patient. Therefore an open communication with relatives and nurses is necessary.

Aged↗