Profitieren Schmerztherapiepatienten von ihren Mitpatienten?

Hintergrund Interdisziplinäre multimodale Schmerztherapie (IMST) wird meist im Gruppensetting durchgeführt, um den Erfahrungsaustausch zwischen Patienten anzuregen und so die Veränderung schmerzbezogener Einstellungen und Verhaltensweisen zu erleichtern. Wie aus der Psychotherapieforschung bekannt ist, haben die Mitpatienten einer Therapiegruppe einen relevanten Einfluss auf den Therapieerfolg der einzelnen Patienten. Ziel der Arbeit Wir untersuchten, inwieweit der Therapieerfolg in einer IMST-Gruppe von einzelnen Mitpatientencharakteristika wie dem mittleren Stadium kognitiv-verhaltensorientierter Schmerzbewältigung der Mitpatienten, der Differenz zum eigenen Schmerzbewältigungsstadium und dem Anteil an therapiewiederholenden Mitpatienten beeinflusst wird. Methodik In einer retrospektiv geplanten Untersuchung der psychometrischen Testungen aller Patienten in einer stationären IMST zwischen Januar 2013 und Februar 2020 wurde mittels binärer logistischer Regressionsanalysen der Einfluss der Mitpatientencharakteristika auf klinisch relevante Veränderungen hinsichtlich verschiedener Parameter zur Ausprägung der chronischen Schmerzerkrankung analysiert. Ergebnisse Untersucht wurden 540 Erstaufenthalte von 636 Behandlungsfällen. Pro Behandlungstag waren durchschnittlich 5 Mitpatienten, davon 15 % Therapiewiederholer, anwesend. Es zeigte sich, dass die Wahrscheinlichkeit, einen Erfolg in mindestens einem der untersuchten Parameter zu erreichen, zum einen vom Schmerzbewältigungsstadium der Mitpatienten (p < 0,001; OR = 2,885) und zum anderen vom Anteil an therapiewiederholenden Mitpatienten (p < 0,001; OR = 1,032) signifikant erhöht wird. Ein Einfluss auf den Therapieerfolg in einem spezifischen Parameter konnte nicht nachgewiesen werden. Fazit Trotz methodischer Limitationen legen unsere Ergebnisse nahe, in Patientengruppen einer IMST therapieerfahrene Patienten und solche in einem fortgeschrittenen Schmerzbewältigungsstadium mit Neulingen und Patienten, die noch am Anfang der Bewältigung der Schmerzerkrankung stehen, zu kombinieren

Ambulante Palliativmedizin

The right to adequate outpatient palliative care has existed for several years in Germany. In recent years outpatient palliative care has developed very positively. Nevertheless, in emergency situations paramedics and emergency physicians were often included in the care of palliative care of patients. The aim of our study was to investigate the cooperation between outpatient palliative care teams and the emergency medical services. Another aim was to identify structural realities and based on these to discuss the possibilities in the optimization of outpatient palliative medical emergency situations. A standardized self-designed questionnaire was distributed to specialized outpatient palliative care teams (SPCS) in Germany. For this purpose, closed and open questions (mixed methods) were used. The evaluation was carried out according to the questionnaire categories in quantitative and qualitative forms. The questionnaire was subdivided into general information and specific questions. The survey response rate was 79% from a total of 81 SPCS in 2011. The following standards in palliative emergency care were recommended: (1) early integration of outpatient palliative care services and basic outpatient palliative care systems, (2) end-of-life discussions, (3) defined emergency medical documents, emergency drug boxes, do not attempt resuscitation orders and (4) emergency medical training (physicians and paramedics). Outpatient palliative care in Germany has developed very positively during the last years; however, there are still deficits in terms of optimal patient care, one of which refers to the treatment of palliative care emergencies. In this context, optimization in the cooperation between outpatient palliative care services and emergency medical services should be discussed

The expenditure of computer-related worktime using clinical decision support systems in chronic pain therapy

Background Estimate the expenditure of computer-related worktime resulting from the use of clinical decision support systems (CDSS) to prevent adverse drug reactions (ADR) among patients undergoing chronic pain therapy and compare the employed check systems with respect to performance and practicability. Methods Data were collected retrospectively from 113 medical records of patients under chronic pain therapy during 2012/2013. Patient-specific medications were checked for potential drug-drug interactions (DDI) using two publicly available CDSS, Apotheken Umschau (AU) and Medscape (MS), and a commercially available CDSS AiDKlinik® (AID). The time needed to analyze patient pharmacotherapy for DDIs was taken with a stopwatch. Measurements included the time needed for running the analysis and printing the results. CDSS were compared with respect to the expenditure of time and usability. Only patient pharmacotherapies with at least two prescribed drugs and fitting the criteria of the corresponding CDSS were analyzed. Additionally, a qualitative evaluation of the used check systems was performed, employing a questionnaire asking five pain physicians to compare and rate the performance and practicability of the three CDSSs. Results The AU tool took a total of 3:55:45 h with an average of 0:02:32 h for 93 analyzed patient regimens and led to the discovery of 261 DDIs. Using the Medscape interaction checker required a total of 1:28:35 h for 38 patients with an average of 0:01:58 h and a yield of 178 interactions. The CDSS AID required a total of 3:12:27 h for 97 patients with an average time of analysis of 0:01:59 h and the discovery of 170 DDIs. According to the pain physicians the CDSS AID was chosen as the preferred tool. Conclusions Applying a CDSS to examine a patients drug regimen for potential DDIs causes an average extra expenditure of work time of 2:09 min, which extends patient treatment time by 25 % on average. Nevertheless, the authors believe that the extra expenditure of time employing a CDSS is outweighed by their benefits, including reduced ADR risks and safer clinical drug management

Palliative patients under anaesthesiological care: a single-centre retrospective study on incidence, demographics and outcome

Background While anesthesiologist’s involvement in palliative care has been widely researched, extensive data on palliative patients under anesthesiological care in the operating room is missing. This study was performed to assess the incidence, demographics, and outcome of palliative patients under anesthesiological care. Methods We conducted a single-center retrospective chart review of all palliative patients under anesthesiological care at a university hospital in 1 year. Patients were classified as palliative if they fulfilled all predefined criteria (a) incurable, life-threatening disease, (b) progression of the disease despite therapy, (c) advanced stage of the disease with limited life-expectancy, (d) receiving or being in need of a specific palliative therapy. Demographics, periprocedural parameters, symptoms at evaluation, and outcome were determined using different medical records. Results Of 17,580 patients examined, 276 could be classified as palliative patients (1.57 %). Most contacts with palliative patients occurred in the operating room (68.5 %). In comparison to the non-palliative patients, procedures in palliative patients were significantly more often urgent or emergency procedures (39.1 % vs. 27.1 %., P < 0.001), and hospital mortality was higher (18.8 % vs. 5.0 %, P < 0.001). Preprocedural symptoms varied, with pain, gastrointestinal, and nutritional problems being the most prevalent. Conclusions Palliative patients are treated by anesthesiologists under varying circumstances. Anesthesiologists need to identify these patients and need to be aware of their characteristics to adequately attend to them during the periprocedural period

Outpatient palliative medicine

The right to adequate outpatient palliative care has existed for several years in Germany. In recent years outpatient palliative care has developed very positively. Nevertheless, in emergency situations paramedics and emergency physicians were often included in the care of palliative care of patients. The aim of our study was to investigate the cooperation between outpatient palliative care teams and the emergency medical services. Another aim was to identify structural realities and based on these to discuss the possibilities in the optimization of outpatient palliative medical emergency situations. A standardized self-designed questionnaire was distributed to specialized outpatient palliative care teams (SPCS) in Germany. For this purpose, closed and open questions (mixed methods) were used. The evaluation was carried out according to the questionnaire categories in quantitative and qualitative forms. The questionnaire was subdivided into general information and specific questions. The survey response rate was 79% from a total of 81 SPCS in 2011. The following standards in palliative emergency care were recommended: (1) early integration of outpatient palliative care services and basic outpatient palliative care systems, (2) end-of-life discussions, (3) defined emergency medical documents, emergency drug boxes, do not attempt resuscitation orders and (4) emergency medical training (physicians and paramedics). Outpatient palliative care in Germany has developed very positively during the last years; however, there are still deficits in terms of optimal patient care, one of which refers to the treatment of palliative care emergencies. In this context, optimization in the cooperation between outpatient palliative care services and emergency medical services should be discussed