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Biomedical subjects

F Nauck

Publications and source records attributed to F Nauck.

At least 19 recordsLinked to original sources
PubMed2006

[Practical pain control in pediatric oncology. Recommendations of the German Society of Pediatric Oncology and Hematology, the German Association for the Study of Pain, the German Society of Palliative Care, and the Vodafone Institute of Children's Pain Therapy and Palliative Care].

In pediatric oncology, optimal pain control is still a challenge. A structured pain history and the regular scoring of pain intensity using age-adapted measuring tools are hallmarks of optimal pain control. Psychological measures are as important as drug therapy in the prophylaxis or control of pain, especially when performing invasive procedures. Pain control is oriented toward the WHO multistep therapeutic schedule. On no account should the pediatric patient have to climb up the "analgesic ladder" - strong pain requires the primary use of strong opioids. Give opioids preferably by the oral route and by the clock - short-acting opioids should be used to treat breakthrough pain. Alternatives are i.v. infusion, patient-controlled analgesia, and transdermal applications. Constipation is the adverse effect most often seen with (oral) opioid therapy. Adverse effects should be anticipated, and prophylactic treatment should be given consistently. The assistance of pediatric nurses is of the utmost importance in pediatric pain control. Nurses deliver the basis for rational and effective pain control by scoring pain intensity and documenting drug administration as well as adverse effects. The nurses' task is also to prepare the patient for and monitor the patient during painful procedures. It is the responsibility of both nurse and doctor to guarantee emergency intervention during sedation whenever needed. In our guideline we comment on drug selection and dosage, pain measurement tools, and documentation tools for the purpose of pain control. Those tools may be easily integrated into daily routine.

Analgesics↗
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↗
PubMed2004

[What is the profile of palliative care in Germany. Results of a representative survey].

Since 1996 a working group of palliative care physicians has been developing a core documentation for palliative facilities. The data on a total of 1304 patients were collected in 2001. Treatment in palliative care units was provided for 531 patients until their death (Pat-V), 604 patients could be discharged home, and 169 patients were transferred to other facilities (Pat-E). Infusion therapy, physical therapy, positioning and mobilization, together with counseling and social services were initiated in more than 30% of the patients, while specific measures such as ascites or pleura puncture were instituted in less than 10%. Chemotherapy, radiotherapy, immunotherapy, urinary catheter, physical therapy, mobilization, positioning, psychotherapy, and social services were documented more frequently in the Pat-E group than in the Pat-V group. Chemotherapy was started in only 35 patients and radiotherapy in only 31 patients while they were in the palliative care unit. Parenteral nutrition, infusion therapy, wound management, and counseling were documented more frequently in the Pat-V group. Advanced directives were available for 9,9% of the patients omission or discontinuation of therapies was documented for 28,1%. Specific indications for the quality of palliative care provided could not be identified with the documentation instruments applied. The core documentation does however furnish data from a representative sample of in-patient palliative care in Germany, which can be used as a comparative data pool for other studies and quality assurance measures.

Death↗
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

[Review of cannabinoids in the treatment of nausea and vomiting].

Cannabinoids are used to treat nausea and vomiting. The effect appears to be mediated by cannabinoid receptors in the nucleus tractus solitarius. Results are available from studies on the use of cannabinoids to manage nausea and vomiting after chemotherapy. None of these studies, however, compared cannabinoids with the newer serotonin antagonists. The antiemetic efficacy of cannabinoids for other indications has not yet been studied sufficiently. Most of the studies report significantly more or stronger side effects with cannabinoid medication in comparison to similar medication. In some of the studies on treatment after chemotherapy or radiotherapy, the patients terminated the cannabinoid therapy more frequently due to side effects. Although clinical studies have provided clear evidence for the antiemetic efficacy of cannabinoids, the frequency and severity of side effects argue against their use as the method of first choice. For patients who cannot be adequately treated with conventional antiemetic agents, cannabinoids can represent a valuable adjunct to the antiemetic regimen.

Antiemetics↗
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

[A review of side effects and complications with cannabinoid treatment].

In the last few years, the use of cannabinoids has been advocated for several indications, and evaluation of the side effect profile is necessary. Euphoric mood changes are among the most frequent side effects, while dysphoric reactions are less frequent. Triggering of acute psychotic episodes has been reported. Cannabinoids can initiate or exacerbate schizophrenic psychosis in predisposed persons. Cannabinoids impede cognitive and psychomotor performance, resulting in impaired driving ability. Chronic use can lead to the development of tolerance. Tachycardia and hypotension frequently are documented as adverse events in the cardiovascular system. A few cases of myocardial ischemia have been reported in young and previously healthy patients. Side effects on the respiratory system are induced by inhaling the smoke of cannabis cigarettes. Some reports have indicated a carcinogenic risk for the children when cannabis was used during pregnancy. In summary, a low risk profile is evident from the literature available. Life-threatening complications are very rare and were not reported after use of cannabinoids for medical indications. Cannabinoids are contraindicated during pregnancy or for patients with a history of cardiac ischemias.

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

[Morphine and alternative opioids in cancer pain: the EAPC recommendations].

An expert working group of the European Association for Palliative Care (EAPC) has revised and updated its guidelines on the use of morphine in the management of cancer pain. The revised recommendations presented here give guidance on the use of morphine and the alternative strong opioid analgesics which have been introduced in many parts of the world in recent years. Practical strategies for dealing with difficult situations are described presenting a consensus view where supporting evidence is lacking. The strength of the evidence on which each recommendation is based is indicated.

Analgesics, Opioid↗
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

[Development and state of the in-patient palliative care institutions in Germany].

In April 1999 altogether 114 inpatient units providing palliative care (50 palliative care units, 64 inpatient-hospices) offered a total of 989 beds. Compared to 1993 this has been an increase of 256%, compared to 1997 of 60%. The number of available beds, compared to 1997, increased markedly (58%), with a availability of 12 beds per one million residents. However, there are still major deficits: the distribution of the units is very irregular and the number of available beds is still to low, compared to the estimated need of 50 inpatient beds per one million residents. The quality of palliative care shows significant deficits (e. g. the availability of nursing staff, cooperation with pain clinics, standardised documentation, education). Differences between palliative care wards and hospices were huge. According to the definition of the German Society for Palliative Care, a palliative care ward should provide a ratio of at least 1.4 nursing staff per bed, however, only 18% of the palliative care units fulfil this definition. Only few hospices and half of the palliative care units worked in close cooperation with pain clinics. Despite a significant increase in units and inpatient beds providing palliative care, there still is a major deficit in the overall number of beds and the quality of palliative care.

Cross-Cultural Comparison↗
PubMed2001

[Symptom control in the terminal phase].

An appropriate medical treatment and care during the final phase can make a calm and peaceful dying possible. Aim of this review is to show the symptoms and treatment of patients with a far advanced disease in the last three days of life and to standardise terms used to describe the last period of life. There are definitions worked out for rehabilitation in palliative medicine, for the terminal phase and the final phase. We know that the final phase is a very dynamic process with sometimes a lot of symptoms and problems. Reasons for an "active" medical treatment in the last three days of life are, that new symptoms may occur or previous good controlled symptoms like pain, dyspnoea, vomiting, fear etc. can reappear, which could make a change or finishing of treatment necessary. The aim of palliative medicine is to improve the quality of life especially in the terminal phase. If we focus on the terminal phase most patients - even with cancer pain - can die peacefully and under good symptom control. The dynamic situation in the final phase and the ethical decisions force us to draw our attention to these patients and stay with them until they die. Humanity is besides a funded medical care essential in accompanying the patient in his last days of life. Until now there are not many clinical studies which can help us to find guidelines for the treatment in the last three days of live.

Analgesics↗
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↗