79 research outputs found
A CHRONIC PAIN PATIENT: MODERN DIAGNOSIS AND CONCEPT OF THERAPY
Ca. 80% der Patienten einer allgemeinmedizinischen
Praxis suchen diese wegen ihrer Schmerzen auf. Der Anteil an
Patienten mit chronischen Schmerzen liegt im deutschsprachigen
Raum bei ca. 20%. Und der Anteil an akuten
Schmerzen variiert, abhÀngig von der fachspezifischen
TÀtigkeit. So gehören akute Schmerzen zum Alltag eines jeden
chirurgisch oder anÀsthesiologisch tÀtigen Arztes: Operation
= Schmerz. Das gleiche gilt fĂŒr jede andere invasive
Intervention, egal ob beim Zahnarzt, Radiologen, Strahlentherapeuten,
Internisten und vielen anderen mehr.
Daher gehört die Therapie dieser âBefindlichkeitsstörungâ
zu den grundlegendsten Fertigkeiten eines jeden
Arztes, egal ob angestellt oder niedergelassen, egal ob
Jungarzt oder Routinier, unabhÀngig von seiner Ausbildung.
Und dies gelingt bei ca. 70% der Patienten. Bei den
verbleibenden 30% ist die Unzufriedenheit der Patienten mit
der angebotenen Schmerztherapie hoch, sowohlApproximately 80 per cent of primary care patients seek
their physicianâs attention due to pain. A fifth of the
population suffers from chronic pain with medium to high
intensity, and longer than 3 months. Especially those patients
are treated insufficiently when only non-opioids and opioids
are applied. Therefore it is necessary to tailor pain therapy by
using an interdisciplinary, multimodal treatment regimen.
This article presents a holistic concept to chronic pain
treatment by using the five columns of pain therapy. Based on
the bio-psycho-social approach, pharmaceutical, complimentary
(first column), physio- and psychotherapeutic (2nd and 3rd
column), social and invasive interventions (4th and 5th column)
have to be considered. The 1st column includes the WHO
ladder, in chronic pain patients with a large focus on coanalgesics
like antidepressants or antiepileptics. Based on the
individual history and factors achieved from the bio-psychosocial
diagnosis, components of these 5 therapeutic are
selected, always in agreement with the patient, and put
together to one interdisciplinary therapeutic concep
Manual Khalifa Therapy Improves Functional and Morphological Outcome of Patients with Anterior Cruciate Ligament Rupture in the Knee: A Randomized Controlled Trial
Rupture of the anterior cruciate ligament (ACL) is a high incidence injury usually treated surgically. According to common knowledge, it does not heal spontaneously, although some claim the opposite. Regeneration therapy by Khalifa was developed for injuries of the musculoskeletal system by using specific pressure to the skin. This randomized, controlled, observer-blinded, multicentre study was performed to validate this assumption. Thirty patients with complete ACL rupture, magnetic resonance imaging (MRI) verified, were included. Study examinations (e.g., international knee documentation committee (IKDC) score) were performed at inclusion (t0). Patients were randomized to receive either standardised physiotherapy (ST) or additionally 1 hour of Khalifa therapy at the first session (STK). Twenty-four hours later, study examinations were performed again (t1). Three months later control MRI and follow-up examinations were performed (t2). Initial status was comparable between both groups. There was a highly significant difference of mean IKDC score results at t1 and t2. After 3 months, 47% of the STK patients, but no ST patient, demonstrated an end-to-end homogeneous ACL in MRI. Clinical and physical examinations were significantly different in t1 and t2. ACL healing can be improved with manual therapy. Physical activity can be performed without pain and nearly normal range of motion after one treatment of specific pressure
The main concerns of European anaesthesiology postgraduate trainees: A European survey
This is the first study intended to identify the European anaesthesiology trainees' main concerns, to initiate a process of improvement of the training in anaesthesiology by the European Society of Anaesthesiology (ESA). The authors developed an electronic survey which addressed seven different concerns: autonomy transition, technical skills, exchange programs, residency costs, residency workload, employment prospects and educational contents/preparation for the European Diploma in Anaesthesiology and Intensive Care (EDAIC). The survey was disseminated by email to all anaesthesiology trainees registered in ESA and all European National Societies were asked to distribute the survey to their graduating trainees. 665 trainees initiated the survey with a completion rate of 54.6%. The trainees' main concerns were in descending order: educational contents, residency costs, employment prospects, residency workload, exchange programs, technical skills and autonomy transition. This report analyzes the three main concerns in more detail. 68% of respondents were unaware of the existence of the ESA e-learning platform. Other means to improve the preparation for the EDAIC such as a multiple-choice questions book should be developed. The main reason for not becoming an ESA Trainee member was the associated cost and 68% of respondents gave up activities or opportunities during their residency due to economic constraints; 56% of respondents considered emigrating for economic reasons and 28% elected Northern/Central Europe. The results of the present survey may provide additional background information for the development of specific improvements in strategies for training in anaesthesiology. (c) 2018 Elsevier Ltd. All rights reserved
Is PONV still a problem in pediatric surgery: a prospective study of what children tell us
BackgroundPostoperative nausea and vomiting (PONV) is an unpleasant complication after surgery that commonly co-occurs with pain. Considering the high prevalence among pediatric patients, it is important to explore the main risk factors leading to PONV in order to optimize treatment strategies. The objectives of this study are as follows: (1) to determine the prevalence of PONV on the day of surgery by conducting interviews with pediatric patients, (2) to assess PONV prevalence in the recovery room and on the ward by analyzing nursing records, and (3) to collect information on PONV risk factors on the day of surgery and the following postoperative days. We wanted to investigate real-life scenarios rather than relying on artificially designed studies.MethodsA prospective analysis [according to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines] of PONV on the day of surgery and the following postoperative days was conducted by evaluating demographic and procedural parameters, as well as conducting interviews with the children under study. A total of 626 children and adolescents, ranging in age from 4 to 18 years, were interviewed on the ward following their surgery. The interviews were conducted using a questionnaire, as children aged 4 and above can participate in an outcome-based survey.ResultsOn the day of surgery, several multivariable independent predictors were identified for PONV. The type of surgery was found to be a significant factor (pâ=â0.040) with the highest odds ratio (OR) in patients with procedural investigations [OR 5.9, 95% confidence interval (CI): 1.8â19.2], followed by abdominal surgery (OR 3.1, 95% CI: 0.9â11.1) when inguinal surgery was used as the reference category. In addition, the study identified several predictors, including the amount of fentanyl administered during anesthesia (”g/kg body weight) (OR 1.4, 95% CI: 1.1â1.8), intraoperative use of piritramide (OR 2.6, 95% CI: 1.5â4.4) and diclofenac (OR 2.0, 95% CI: 1. 3â3.1), opioid administration in the recovery room (OR 3.0, 95% CI: 1.9â4.7), and piritramide use on the ward (OR 4.5, 95% CI: 1.7â11.6).ConclusionsThe main risk factors for PONV include the intraoperative administration of opioids during the recovery room stay and at the ward, the intraoperative use of non-opioids (diclofenac), and the specific type of surgical procedure. Real-life data demonstrated that in clinical praxis, there is a gap between the adherence to established guidelines and the use of antiemetic prophylaxis in surgeries that are generally not associated with a high PONV prevalence. Further efforts are needed to improve the existing procedures and thus improve the overall outcome
Oxycodone and Naloxone Combination: A 12-Week Follow-up in 20 Patients Shows Effective Analgesia Without Opioid-Induced Bowel Dysfunction
The effect of ketamine on the incidence of emergence agitation in children undergoing tonsillectomy and adenoidectomy under sevoflurane general anesthesia
Long-term safety and efficacy of oxycodone/naloxone prolonged-release tablets in patients with moderate-to-severe chronic cancer pain
Systemic, but not intrathecal ketorolac is antinociceptive to uterine cervical distension in rats
- âŠ