Sedation in palliative care – a critical analysis of 7 years experience

BACKGROUND: The administration of sedatives in terminally ill patients becomes an increasingly feasible medical option in end-of-life care. However, sedation for intractable distress has raised considerable medical and ethical concerns. In our study we provide a critical analysis of seven years experience with the application of sedation in the final phase of life in our palliative care unit. METHODS: Medical records of 548 patients, who died in the Palliative Care Unit of GK Havelhoehe between 1995–2002, were retrospectively analysed with regard to sedation in the last 48 hrs of life. The parameters of investigation included indication, choice and kind of sedation, prevalence of intolerable symptoms, patients' requests for sedation, state of consciousness and communication abilities during sedation. Critical evaluation included a comparison of the period between 1995–1999 and 2000–2002. RESULTS: 14.6% (n = 80) of the patients in palliative care had sedation given by the intravenous route in the last 48 hrs of their life according to internal guidelines. The annual frequency to apply sedation increased continuously from 7% in 1995 to 19% in 2002. Main indications shifted from refractory control of physical symptoms (dyspnoea, gastrointestinal, pain, bleeding and agitated delirium) to more psychological distress (panic-stricken fear, severe depression, refractory insomnia and other forms of affective decompensation). Patients' and relatives' requests for sedation in the final phase were significantly more frequent during the period 2000–2002. CONCLUSION: Sedation in the terminal or final phase of life plays an increasing role in the management of intractable physical and psychological distress. Ethical concerns are raised by patients' requests and needs on the one hand, and the physicians' self-understanding on the other hand. Hence, ethically acceptable criteria and guidelines for the decision making are needed with special regard to the nature of refractory and intolerable symptoms, patients' informed consent and personal needs, the goals and aims of medical sedation in end-of-life care

Orbital ordering phenomena in dd- and ff-electron systems

In recent decades, novel magnetism of $d$- and $f$-electron compounds has been discussed very intensively both in experimental and theoretical research fields of condensed matter physics. It has been recognized that those material groups are in the same category of strongly correlated electron systems, while the low-energy physics of $d$- and $f$-electron compounds has been separately investigated rather in different manners. One of common features of both $d$- and $f$-electron systems is certainly the existence of active orbital degree of freedom, but in $f$-electron materials, due to the strong spin-orbit interaction in rare-earth and actinide ions, the physics seems to be quite different from that of $d$-electron systems. In general, when the number of internal degrees of freedom and relevant interactions is increased, it is possible to obtain rich phase diagram including large varieties of magnetic phases by using several kinds of theoretical techniques. However, we should not be simply satisfied with the reproduction of rich phase diagram. It is believed that more essential point is to seek for a simple principle penetrating complicated phenomena in common with $d$- and $f$-electron materials, which opens the door to a new stage in orbital physics. In this sense, it is considered to be an important task of this article to explain common features of magnetism in $d$- and $f$-electron systems from a microscopic viewpoint, using a key concept of orbital ordering, in addition to the review of the complex phase diagram of each material group.Comment: 112 pages, 38 figure