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

No lexical competition without priming: evidence from the picture–word interference paradigm

Over the past 40 years, researchers have assumed that semantic interference effects in picture naming reflect competition among lexical candidates during retrieval. In this study, we examined the role of the familiarisation phase in which participants are shown the target pictures and required to rehearse the appropriate names before the picture–word interference (PWI) paradigm is performed. A previous study reported that omitting the familiarisation phase reversed the polarity of the semantic effect to facilitation. In two experiments using between-and within-participants design, respectively, we compared PWI performance with and without familiarisation while using matched stimuli and task parameters. Overall, the results showed the typical semantic interference effect following familiarisation. However, in both experiments, naming latencies did not differ significantly between related and unrelated distractors when familiarisation was omitted. The current findings suggest that familiarisation plays an important role in determining semantic interference in PWI, most likely via raising lexical competitor activation by priming links between targets and related concepts. We also discuss broader implications of our findings with respect to the replicability of reported semantic facilitation effects in PWI

Posturale Regulation und Stabilität unter akustischem Input bei Normalhörenden

Background!#!Postural regulation is based on complex interactions among postural subsystems. The auditory system too appears to have an influence on postural control.!##!Objective!#!The aim of this study was to measure the influence of auditory input on postural control and to gain a deeper understanding of the interactions between auditory input and postural subsystems including subjective aspects.!##!Materials and methods!#!In 30 healthy normal-hearing subjects, postural regulation and stability was measured with the Interactive Balance System (IBS; Inc. neurodata GmbH, Wien, Österreich) in 8 test positions with noise (frontal presentation) and plugged without noise. The IBS is an electrophysiological measurement device that measures postural control at the product level (e.g., stability, weight distribution) and the mechanisms of postural subsystems at the process level based on frequency-oriented fast-Fourier analysis of force-time relation.!##!Results!#!At the process level, we found a relevant reduction (η!##!Conclusion!#!In this study, a shift in the activity of postural subsystems was observed with auditory input, while no difference was seen in ST. This leads to new insights into mechanisms of audiovestibular interaction

Postural regulation and stability with acoustic input in normal-hearing subjects

Background!#!Postural regulation is based on complex interactions among postural subsystems. The auditory system too appears to have an influence on postural control.!##!Objective!#!The aim of this study was to measure the influence of auditory input on postural control and to gain a deeper understanding of the interactions between auditory input and postural subsystems including subjective aspects.!##!Materials and methods!#!In 30 healthy normal-hearing subjects, postural regulation and stability was measured with the Interactive Balance System (IBS; Inc. neurodata GmbH, Wien, Österreich) in 8 test positions with noise (frontal presentation) and plugged without noise. The IBS is an electrophysiological measurement device that measures postural control at the product level (e.g., stability, weight distribution) and the mechanisms of postural subsystems at the process level based on frequency-oriented fast-Fourier analysis of force-time relation.!##!Results!#!At the process level, we found a relevant reduction (η!##!Conclusion!#!In this study, a shift in the activity of postural subsystems was observed with auditory input, while no difference was seen in ST. This leads to new insights into mechanisms of audiovestibular interaction