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The timely integration of palliative medicine is an important component in the treatment of various advanced diseases. While a German S‑3-guideline on palliative medicine exists for patients with incurable cancer, a recommendation for non-oncological patients and especially for palliative patients presenting in the emergency department or intensive care unit is missing to date. Based on the present consensus paper, the palliative care aspects of the respective medical disciplines are addressed. The timely integration of palliative care aims to improve quality of life and symptom control in clinical acute and emergency medicine as well as intensive care. [ABSTRACT FROM AUTHOR]

Efficient swallowing without functional and structural limitations is indispensable for adequate oral intake of food and fluids. Regardless of food consistencies, food forms, or tablet forms, the act of swallowing is an extremely complex movement pattern involving the participation of up to 100 muscles. Impaired swallowing can occur in many neurological disorders, with stroke and neurodegenerative diseases being the most common. With advancing age, various changes occur in the body that also affect swallowing function and physiology in healthy older individuals, a condition known as presbyphagia. This process becomes visible as early as the age of 65, with its intensity and prevalence increasing with age and potentially progressing into a clinically relevant swallowing disorder called dysphagia. Despite its clinical relevance, swallowing disorders in older adults are underestimated by primary care providers as well as by seniors themselves. This paper highlights the key elements of diagnosis and therapy of swallowing disorders in the elderly, which will gain importance in outpatient primary care and in the primary care of the aging population. Consistent and structured swallowing diagnostics and therapy are crucial to efficiently prevent aspiration pneumonia with significant health economic consequences, such as frequent rehospitalizations. In addition, intact swallowing is essential for efficient oral medication intake and their effectiveness, as medications that are not swallowed cannot exert their effects or their pharmacokinetics may be compromised. [ABSTRACT FROM AUTHOR]

It is an accepted idea that poverty is much more than low incomes. Consequently, the multidimensional approach has become an alternative way to understand that question. The aim of this paper is to propose an alternative estimation of multidimensional poverty in Colombia. The methodology uses unconventional dimensions, continuous and pseudo-continuous variables; it will estimate dimensional gaps and apply Bourguignon and Chakravarty's methodology. Although, there has been a noticeable reduction of headcount poverty, the multidimensional poverty gap and its severity have not shown the same trend. In addition, there are huge regional differences, and dimensions with high deprivation. [ABSTRACT FROM AUTHOR]

Microscopic colitis (MC) is still an underestimated cause of chronic, non-bloody watery diarrhea. It is typically manifested in elderly patients with a female predominance. The incidence of microscopic colitis has been increasing. The aetiology and pathophysiology remain unclear. Conditions associated with it include autoimmune diseases. There may be a genetic predisposition, as familial cases have been described. As implicated by the name microscopic colitis, the diagnosis is found by histological examination. There are mainly two subtypes, the lymphocytic colitis (LC) and the collagenous colitis (CC). Even if the condition's long-term course is benign, a chronic recurrent course of the symptoms is frequent. Due to the symptoms, there is an impairment of patient's health-related quality of life. A correct diagnosis and therapy is therefore mandatory. The aim of this paper is to create awareness for microscopic colitis. [ABSTRACT FROM AUTHOR]

Effectiveness of rehabilitation services according German Social Act XII for persons with substance use disorders Abstract. Background: Rehabilitation services according to German Social Act XII (SGB XII) for persons with substance use disorders provided by mainly inpatient facilities in the greater Hamburg area are an important pillar of social and health care policy. Objective: The study analyzed the effectiveness of these interventions for new clients entering rehabilitation services with regard to the achievement of objectives in the areas of addiction and social integration which are determined in an agreement between client and rehabilitation staff on a regular basis at treatment onset. Methods: In a prospective pre-post-analysis both clients and rehabilitation staff were interviewed by means of a paper-pencil-survey. The interviews were conducted at treatment onset and after 6 months or, in case treatment was ended prior to the end of month 6, at an earlier date. Results: In total 255 clients were included in the study. The majority of clients either largely or fully met the agreed objectives in the areas of addiction and social integration. An improvement of the clients’ situation regarding substance use could be found in more than two thirds of all cases. Impairments according to ICF have decreased; psychological distress (BSI-18) and health-related quality of life (SF-12) have improved. A longer duration of interventions and a greater intensity of care show positive effects as to these improvements. Conclusion: The study is the first external evaluation of rehabilitation services according to German Social Act XII to show that the defined objectives are being fully met in a large part of clients. However, due to its single-arm study design the validity of this analysis is limited, further studies are required. Rehabilitation services according to German Social Act XII are an important supplement to the treatment system for persons with substance use disorders who are beyond the reach of regular health care measures and rehabilitation services. [ABSTRACT FROM AUTHOR]

Summary: Background: Complex regional pain syndrome (CRPS) constitutes an enigmatic post-traumatic pain disorder. Aim of the study: The paper provides state of the art knowledge about CRPS. Results: The typical constellation of symptoms of CRPS includes pain, sensory disturbances, motor symptoms, disturbances of the autonomic control of the limbs and trophic changes. These symptoms generalize distally and go beyond single nerve innervation territories. Diagnosis is made based on clinical findings. Three-phase bone scintigraphy may be the best supporting technical investigation. Symptoms typically change during the course of CRPS. In the acute stage inflammatory symptoms prevail and during chronic stages the most expressed findings are related to central neuroplasticity. These findings include hyperalgesia, sensory loss, CRPS movement disorder, body perception disturbances and autonomic symptoms. Medical treatment with anti-inflammatory agents (steroids) or bisphosphonates is most effective in the early stages and DMSO cream might also be beneficial. Administration of i.v. ketamine has been proven effective against CRPS pain and physical therapy with behavioral components, such as pain exposure helps to overcome central reorganization and functional impairment. Psychotherapy should be offered if there are significant comorbidities. All other forms of treatment are more or less empirical. Invasive treatment should be restricted to selected cases and should only be offered in specialized centers. Discussion: If these recommendations are followed the prognosis for CRPS is not as poor as commonly assumed. Whether this means a return to the previous quality of life is unclear and often depends on very personal factors. [ABSTRACT FROM AUTHOR]

Psychiatric complications are common in people with epilepsy and contribute significantly to the impaired quality of life of patients and relatives. This paper discusses psychosis, depression and psychiatric adverse events of anticonvulsants with a focus on practical issues of diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background: The existing health-related quality of life questionnaires on multiple sclerosis (MS) only partially reflect the patient's point of view on the reduction of activities of daily living. Their development and validation was not performed in different languages. That is what prompted the development of the Multiple Sclerosis International Quality of Life (MusiQoL) Questionnaire as an international multidimensional measurement instrument. This paper presents this new development and the results of the German subgroup versus the total international sample. Patients and methods: A total of 1,992 MS patients from 15 countries, including 209 German patients, took part in the study between January 2004 and February 2005. The patients took the MusiQoL survey at baseline and at 21±7 days as well as completing a symptom-related checklist and the SF-36 short form survey. Demographics, history and MS classification data were also generated. Reproducibility, sensitivity, convergent and discriminant validity were analysed. Results: Convergent and discriminant validity and reproducibility were satisfactory for all dimensions of the MusiQoL. The dimensional scores correlated moderately but significantly with the SF-36 scores, but showed a discriminant validity in terms of gender, socioeconomic status and health status that was more pronounced in the overall population than in the German subpopulation. The highest correlations were observed between the MusiQoL dimension of activities of daily living and the Expanded Disability Status Scale (EDSS). Conclusion: The results of this study confirm the validity and reliability of MusiQoL as an instrument for measuring the quality of life of German and international MS patients. [ABSTRACT FROM AUTHOR]

Background: An increasing number of television series deal with neurological disorders, including fictional portrayals of multiple sclerosis (MS). The aim of this paper was to analyze every available TV episode with an MS character. Material and Methods: Productions were identified by film databases and by hand search. Each episode was evaluated along neurologic and cinematic lines. Results: Between 1985 and 2006, portrayals of MS appeared in 17 episodes produced in Germany, the US, and the UK. The frequency of symptoms shown onscreen strongly differed from epidemiological data. In particular sensory, cognitive, and bladder symptoms as well as difficulties with sexual function were under-represented. The authenticity of the disease depiction was strongly dependent upon the genre. Coping stories could be identified as the most prominent genre. Television patients were often portrayed as 'brave fighters', 'refined characters', and 'afflicted without symptoms'. Conclusions: Television series attract millions of viewers and thus shape the public image of a disease. Sound knowledge of how symptoms, diagnosis, and therapeutic options are presented in mass media is therefore indispensable for all who deal with MS patients, relatives, and caregivers. [ABSTRACT FROM AUTHOR]