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Biomedical subjects

E Klaschik

Publications and source records attributed to E Klaschik.

At least 19 recordsLinked to original sources
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↗
PubMed2000

[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.

Education, Medical, Continuing↗
PubMed1998

[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.

Analgesics↗
PubMed1998

[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.

Ethics, Medical↗
PubMed1998

[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.

Canada↗