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Biomedical subjects

E Klaschik

Publications and source records attributed to E Klaschik.

At least 19 recordsLinked to original sources
PubMed2005

[Pain treatment of patients with incurable malignant tumors].

BACKGROUND AND OBJECTIVE: Efficacious pain therapy is one of the main challenges in the management of patients with advanced cancer. It was the aim of this study to ascertain whether adequate pain treatment was achieved in a palliative care unit and what changes in medical treatment were undertaken during the patients stay in this unit. SUBJECTS AND METHODS: Medication against pain and pain intensity were documented during hospital care of 94 patients with cancer (mean age: 66.8 years; female/male 52.2/47.8%; discharged/deceased 58.5/41.5%) at admission and discharge. 32 patients were interviewed by phone after discharge about their current perception and intensity of pain, as well as their health. RESULTS: Highly significant reduction of pain intensity was achieved in all patients while receiving palliative care. Only those patients who were on oral morphine at admission to hospital required significantly raised morphine dosages while receiving palliative treatment. The other patients did not need significant changes of opioid medication. Pain reduction persisted even after discharge. CONCLUSION: In patients with advanced cancer the effects of psychological, social and spiritual factors on their perception of pain is probably of greater importance in achieving efficacious pain reduction than a change of medication. Further studies will be needed to confirm these findings.

Aged↗
PubMed2005

[Strong opioids and constipation].

In cancer pain therapy treatment with strong opioids is essential. However, it may be accompanied by the occurrence of various adverse effects. The most frequent and persistent side effect in the course of opioid treatment is constipation. It is mainly caused by linkage of the opioid to the peripheral mu-receptors in the bowel and may increase as a result of certain concomitant circumstances, such as poor intake of fluids or electrolyte disorder. Present research indicates that there is a relation between type of opioid and degree of constipation, i.e. treatment with transdermal fentanyl or methadone tends to cause less constipation compared to morphine or hydromorphone. The route of administration of morphine--oral vs. subcutaneous--does not seem to affect the incidence of opioid-induced constipation. Furthermore, prophylaxis and efficient control of opioid-induced constipation still fail to be part of the routine in pain treatment.

Analgesics, Opioid↗
PubMed2005

[Opioids for cancer pain treatment. Efficacy and side effects].

In Germany, about 400,000 people per year are diagnosed with cancer. In the terminal stage of their disease, up to 95% of cancer patients suffer from pain. In earlier stages, this is true for about 50% of patients. It is estimated that 220,000 people in Germany are in need of cancer pain therapy. If the pain therapy is going to be changed, this must be comprehensively discussed with the patient in advance, particularly when strong opioids are used which are mostly indicated in these patients. Opioids are effective and reliable drugs when pain therapy is performed according to the basic principles. It is widely agreed that the WHO analgesic ladder serves as orientation and that the choice of substances must be suited to the cause and pathophysiological type of pain. Even though a variety of other strong opioids is in clinical use, morphine remains the reference substance for efficacy and occurrence of side effects in opioids.

Analgesics↗
PubMed2004

[Cannabinoids in the treatment of the cachexia-anorexia syndrome in palliative care patients].

Loss of appetite and cachexia are frequent symptoms in palliative care patients. However, therapeutic regimens often prove ineffective, and the quality of life of many patients is significantly impaired by these symptoms. Causes and pathophysiology of anorexia and cachexia are complex and must be identified and treated. Symptomatic pharmacological therapy aims at metabolic, neuroendocrinological and catabolic changes. Prokinetic drugs, corticosteroids and gestagenes are used for symptomatic therapy. Recently, the use of cannabinoids for treatment of loss of appetite and cachexia has become the focus of interest. In cancer patients, cannabinoids proved more effective than placebo but less than gestagenes. Compared to placebo, higher efficacy of cannabinoids could be demonstrated in patients with AIDS as well as in patients with Morbus Alzheimer. However, side effects, such as dizziness, tiredness and daze led to discontinuation of the cannabinoid therapy in some patients.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Attitudes on euthanasia, physician-assisted suicide and terminal sedation--a survey of the members of the German Association for Palliative Medicine.

BACKGROUND: Due to recent legislations on euthanasia and its current practice in the Netherlands and Belgium, issues of end-of-life medicine have become very vital in many European countries. In 2002, the Ethics Working Group of the German Association for Palliative Medicine (DGP) has conducted a survey among its physician members in order to evaluate their attitudes towards different end-of-life medical practices, such as euthanasia (EUT), physician-assisted suicide (PAS), and terminal sedation (TS). METHODS: An anonymous questionnaire was sent to the 411 DGP physicians, consisting of 14 multiple choice questions on positions that might be adopted in different hypothetical scenarios on situations of "intolerable suffering" in end-of-life care. For the sake of clarification, several definitions and legal judgements of different terms used in the German debate on premature termination of life were included. For statistical analysis t-tests and Pearson-correlations were used. RESULTS: The response rate was 61% (n = 251). The proportions of the respondents who were opposed to legalizing different forms of premature termination of life were: 90% opposed to EUT, 75% to PAS, 94% to PAS for psychiatric patients. Terminal sedation was accepted by 94% of the members. The main decisional bases drawn on for the answers were personal ethical values, professional experience with palliative care, knowledge of alternative approaches, knowledge of ethical guidelines and of the national legal frame. CONCLUSIONS: In sharp contrast to similar surveys conducted in other countries, only a minority of 9.6% of the DGP physicians supported the legalization of EUT. The misuse of medical knowledge for inhumane killing in the Nazi period did not play a relevant role for the respondents' negative attitude towards EUT. Palliative care needs to be stronger established and promoted within the German health care system in order to improve the quality of end-of-life situations which subsequently is expected to lead to decreasing requests for EUT by terminally ill patients.

Attitude of Health Personnel↗
PubMed2003

Constipation--modern laxative therapy.

It is estimated that one third of the population in Western industrial countries suffers from constipation at least from time to time. Constipation may have somatopathic or functional causes. Furthermore, a great number of substances are known to cause medication-induced constipation, i.e. opioid-induced constipation is caused by linkage of the opioid to opioid receptors in the bowel and the central nerve system. Whenever possible, causal therapy should be undertaken. Patients in palliative care mostly suffer from chronic functional constipation. The treatment consists of basic measures and the application of laxatives. According to their mode of action, they are divided into bulk-forming laxatives, osmotic laxatives, stimulant laxatives, lubricating agents and others. Bulk-forming laxatives are not recommended for use in palliative care patients, for such patients are normally not able to take in the required amount of fluids. Osmotic laxatives are divided into (magnesium) salts, saccharine, alcohols and macrogols. Lactulose is the most popular saccharine laxative. Because of its side effects (flatulence, bloating and abdominal cramping), lactulose is not a laxative of our choice; instead, we prefer to give macrogol. Orally administered, macrogol is not metabolised and pH value and bowel flora remain unchanged. Macrogol hydrates hardened stools, increases stool volume, decreases the duration of colon passage and dilates the bowel wall that then triggers the defecation reflex. Even when given for some time, the effectiveness of macrogol will not decrease. Because of its high effectiveness and commonly good tolerance, macrogol has become the laxative of first choice in palliative care patients with all kinds of chronic constipation, if these patients are able to take in the necessary amount of fluids. From the general medical point of view, lubricating agents have become obsolete. In palliative care patients, however, they are still important laxatives for prophylactic treatment or therapy of constipation. Due to clinical experience, in palliative care a laxative ladder has proven successful.

Aged↗
PubMed2003

[Laxative use and efficacy in palliative care of patients with cancer pain and morphine therapy. A retrospective study with special regard to polyethylene glycol].

GOAL: Goal of this study was the assessment of the frequency of constipation in patients of palliative care medicine and the efficacy of the use of laxatives. METHODS: In a retrospective study the computerized data of 206 patients were analysed by descriptive statistics. RESULTS: Constipation occurred in 42.7% of patients. Constipation appeared in 34% of 159 patients, who were treated with morphine. There was no correlation to gastrointestinal tumors. Laxatives were given to 74.3% of patients. Laxative use was uncomplicated in 78.4%. For therapy of constipation combined administration of polyethylene glycol, sodium picosulphate and paraffin was most effective. CONCLUSION: In palliative care patients the use of polyethylene glycol is recommended for treating morphine-related-constipation.

Aged↗
PubMed2003

[Pain treatment today--current standing of pain treatment in Germany].

Beyond doubt the provision of pain therapy for patients with acute and chronic pain in Germany has improved over the last 30 years. This positive development comprises i. e. the growing impact of acute pain services on the treatment of patients with postoperative pain and the implementation of new developments in research into the clinical setting of obstetric pain therapy. Nevertheless, the provision of pain therapy for patients with chronic pain syndromes, for children, and in the fields of cancer pain and palliative medicine is neither qualitatively nor quantitatively sufficient.

Acute Disease↗
PubMed2002

[Palliative medicine--physician's responsibility].

When caring for patients with an incurable progressive disease, the physician experiences a feeling of powerlessness because there is no curative treatment that he can offer. The reaction to this must not be resignation, but active palliative medicine to achieve the best possible quality of life for the remaining time. Palliative medicine is a holistic concept of treatment in an outpatient or inpatient setting, integrating physical, psychological, social and spiritual aspects. Palliative medicine started in Germany in the 1980s with a manifest delay compared to Great Britain and the Scandinavian countries and developed in the 90s with a growing dynamic. Even so, we are still a long way from a satisfactory situation in the field of palliative medicine in Germany. This is true for the practical implementation of palliative medicine in the outpatient or inpatient setting, for the training of physicians and nurses and for teaching and research at universities. The decision-makers in our health care system are called upon to support palliative medicine and ensure access to palliative care all over the country. Palliative medicine was started to ease suffering, preserve or restore autonomy and maintain dignity. As an active life aid it is, in our opinion, an alternative to any demand for euthanasia.

Cross-Cultural Comparison↗
PubMed2001

[The role of pychosocial care and bereavement counselling].

Within their psychosocial problems, badly ill patients and their families often feel left alone by caregivers, as there are physicians and nurses. It is the caregiver's task to allow patients to communicate all their feelings, not seeking to mollify, or banish them by attempting to cheer up or distract the patient. Sharing means to communicate the patient's and his family's anger, sorrows, social pains, spiritual questions, anxiety, as well as their hope and special aims to reach. The first step for the caregiver is, to set up a profound psychosocial diagnosis and to establish some kind of a hierarchy among all the needs. Both of them, caregiver and patient have to find out their primary goals and challenges in the process of dying and come to an agreement. Communicating with a dying patient and being with him in the last period of his life presupposes a deepened communication with oneself and the own hopes and fears.

Attitude to Death↗
PubMed2000

[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.

Germany↗