91 results on '"Wiese, C H R"'
Search Results
2. Palliativmedizinische Aspekte in der klinischen Akut- und Notfallmedizin sowie Intensivmedizin.
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Michels, G., John, S., Janssens, U., Raake, P., Schütt, K. A., Bauersachs, J., Barchfeld, T., Schucher, B., Delis, S., Karpf-Wissel, R., Kochanek, M., von Bonin, S., Erley, C. M., Kuhlmann, S. D., Müllges, W., Gahn, G., Heppner, H. J., Wiese, C. H. R., Kluge, S., and Busch, H.-J.
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INTENSIVE care units ,CONSENSUS (Social sciences) ,LENGTH of stay in hospitals ,MEDICAL care costs ,CRITICAL care medicine ,QUALITY of life ,QUALITY assurance ,PALLIATIVE treatment ,EMERGENCY medicine - Abstract
Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2023
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3. Kurs „Lebensrettende Sofortmaßnahmen“: Überprüfung der theoretischen Kenntnisse von Teilnehmern
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Wiese, C. H. R., Bartels, U., Bahr, J., and Graf, B. M.
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- 2006
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4. Unterscheidung von „nichtpalliativer“ und „palliativer“ Tumorschmerztherapie wünschenswert
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Wirz, S., Schenk, M., Wartenberg, H. C., Gastmeier, K., Hofbauer, H., Hoffmann, E., and Wiese, C. H. R.
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- 2016
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5. Der finale Tumorpatient in der notfallmedizinischen Versorgung
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Wiese, C. H. R., Bartels, U., Seidel, N., Voßen-Wellmann, A., Graf, B. M., and Hanekop, G. G.
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- 2006
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6. Einstellungen zum perioperativen Umgang mit Therapielimitierungen: Eine Umfrage unter deutschen Anästhesisten.
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Lassen, C. L., Everding, J., Lindenberg, N., Graf, B. M., and Wiese, C. H. R.
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Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2021
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7. Ambulante Palliativmedizin
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Wiese, C. H. R., primary, Silbereisen, V. M. C., additional, Graf, B. M., additional, Bundscherer, A. C., additional, and Lassen, C. L., additional
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- 2018
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8. Glossopharyngeal neuralgia after resection of a glossopharyngeal schwannoma
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Lassen, C L, Kleinjung, T, Strutz, J, Graf, B M, Wiese, C H R, and University of Zurich
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2728 Neurology (clinical) ,610 Medicine & health ,10045 Clinic for Otorhinolaryngology ,2703 Anesthesiology and Pain Medicine - Published
- 2011
9. Kurs „Lebensrettende Sofortmaßnahmen“
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Wiese, C. H. R., primary, Bartels, U., additional, Bahr, J., additional, and Graf, B. M., additional
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- 2006
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10. Perioperative Betreuung von Palliativpatienten durch den Anästhesisten : Medizinische, psychosoziale und ethische Herausforderungen.
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Lassen, C L, Abel, R, Eichler, L, Zausig, Y A, Graf, B M, and Wiese, C H R
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Anesthetists will encounter palliative patients in the daily routine as palliative patients undergo operations and interventions as well, depending on the state of the disease. The first challenge for anesthetists will be to recognize the patient as being palliative. In the course of further treatment it will be necessary to address the specific problems of this patient group. Medical problems are optimized symptom control and the patient's pre-existing medication. In the psychosocial domain, good communication skills are expected of anesthetists, especially during the preoperative interview. Ethical conflicts exist with the decision-making process for surgery and the handling of perioperative do-not-resuscitate orders. This article addresses these areas of conflict and the aim is to enable anesthetists to provide the best possible perioperative care to this vulnerable patient group with the goal to maintain quality of life and keep postoperative recovery as short as possible. [ABSTRACT FROM AUTHOR]
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- 2013
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11. Anästhesiologische Akutschmerztherapie in Deutschland: Telefonbasierte Umfrage.
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Lassen, C L, Link, F, Lindenberg, N, Klier, T W, Graf, B M, Maier, C, and Wiese, C H R
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Introduction: The last survey of anesthesiological acute pain therapy in Germany was conducted in 1999. Since then new organisational as well as therapeutic aspects have developed. Amongst others the operation and procedures key (OPS) figure 8-919 complex acute pain therapy has been introduced in the German medical billing system, with the restriction that it cannot currently be redeemed. There is an ongoing debate on the role of epidural analgesia in acute pain therapy and new oral medication concepts have been established. Therefore a survey of the present state of acute pain therapy in Germany was conducted.Methods: Based on a list of all 1,356 hospitals in Germany a randomized list of 412 hospitals was generated. Out of these 412 hospitals those with anesthesiology departments (378 hospitals) were contacted via telephone and asked to participate in the survey. Out of the 378 hospitals 285 (75.4 %) agreed to take part. The survey consisted of a questionnaire containing closed and open questions regarding organisational and therapeutic aspects of acute pain therapy. The ethics committee of the University of Regensburg rated the survey as not being subject to approval due to the lack of personal patient data.Results: Of the participating hospitals 183 (64.2 %) had an acute pain service (APS) and of these 107 (58.5 %) met the quality criteria of the OPS 8-919. This figure however, was only consistently documented by 40 (37 %) APSs. Epidural analgesia (EA) was offered by 275 (96.5 %) hospitals and patient-controlled intravenous analgesia (PCA) by 255 (89.5 %). Likewise, 255 (89.5 %) hospitals used controlled-released opioids in acute pain therapy. Concerning EA, the medications most used were sufentanil as an opioid and ropivacaine as a local anesthetic in255 (92.7 %) of the hospitals with EA for sufentanil and 253 (92 %] for ropivacaine. An EA was offered on regular wards in 240 (87.3 %) hospitals. Uncertainty existed about concrete limits for coagulation values before removal of an epidural catheter. The opioid most utilized in PCA was piritramide with some hospitals using morphine or oxycodone (92.2 %, 9.4 % and 9.4 %, respectively). Other opioids, such as hydromorphone and tramadol were rarely used and remifentanil was not used at all. Oral medication was widely used with metamizole being the non-opioid analgesic and oxycodone/naloxone the controlled-release opioid being prescribed the most. New antiepileptic drugs, such as gabapentin or pregabalin were rarely employed in acute pain therapy.Conclusions: Since 1999 the number of hospitals that have implemented an APS has risen from 36.1 % to 64.2 %. The lack of consistent documentation of the OPS 8-919 will probably not increase the likelihood that it will become redeemable in the near future. Certain therapy methods, such as EA and PCA were still well established with oral therapy gaining in significance. The uncertainty regarding limits for coagulation values before removal of an epidural catheter could perhaps be reduced by a statement from the German Society of Anesthesia and Intensive Care. [ABSTRACT FROM AUTHOR]- Published
- 2013
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12. Palliativmedizinisch orientierte Therapieansätze für alle Patienten : Empfehlungen eines Expertenkreises.
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Wiese CH, Vagts DA, Kampa U, Pfeiffer G, Grom IU, Gerth MA, Schreiber-Winzig L, von Berswordt-Wallrabe M, Expertenkreis Palliativ-, Notfall- und Intensivmedizin der Akademie für Palliativmedizin und Hospizarbeit Dresden, Wiese, C H R, Vagts, D A, Kampa, U, Pfeiffer, G, Grom, I U, Gerth, M A, Schreiber-Winzig, L, and von Berswordt-Wallrabe, M
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Background: Since 2011 palliative care has been a compulsory part of the German medical study course (so-called Q13 palliative and pain medicine). Palliative care content does not, however, as often taught, have to focus only on patients in the so-called palliative stages of disease. The aim of this investigation was to encourage a discussion concerning the integration of palliative care aspects into general medical treatment.Methods: For data collection an open discussion of the main topics by experts in palliative medical care was used. The main outcome measures and recommendations included responses regarding current practices related to expert opinions, national and international literature and one case report. The literature search was performed using the databases "PubMed", "Medline" and "Google" (1990-2011).Results: As an important consensus, the following recommendations for optimization of inpatient and outpatient care were: (1) integration of aspects of palliative care into medical curricula of all disciplines, (2) palliative care content should be extended to the general optimization of therapy for all patients, (3) palliative medicine should be part of the everyday medical practice in all disciplines and (4) palliative medicine should not be isolated as "death medicine" or medicine of the dying patient.Conclusions: Palliative care treatment is increasingly becoming integrated into medical education and into medical curricula of all disciplines. Palliative ideas and goals are focussed on patients in the so-called palliative stages of disease. Furthermore, palliative medicine is often described as the medicine of dying patients. As a result of this study it seems to make sense to extend palliative care aspects to all patients and to all patient care. The extent to which such opportunities exist and such health care is economically feasible remains to be the subject of further clinical studies. [ABSTRACT FROM AUTHOR]- Published
- 2012
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13. Altersrationierung : Mittel zur Ressourcenverteilung im Gesundheitswesen.
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Wiese CH, Schepp CP, Bergmann I, Hinz JM, Graf BM, Lassen CL, Wiese, C H R, Schepp, C P, Bergmann, I, Hinz, J M, Graf, B M, and Lassen, C L
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The necessity of limiting resource in healthcare systems is becoming increasingly more evident. The population has requirements especially in the field of healthcare which are principally unlimited. However, there are only limited financial resources which can be used to satisfy the wishes of the population. For this reason rationing models are being discussed increasingly more often. One example of these models is called age rationing which means that defined services are only offered to patients up to a particular age. The aim of this article is to discuss the model of age rationing in the context of an optimized use of resources in the healthcare system. [ABSTRACT FROM AUTHOR]
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- 2012
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14. Naloxoninduziertes Lungenödem. Fallbericht mit Literaturübersicht und kritischer Bewertung.
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Lassen CL, Zink W, Wiese CH, Graf BM, Wiesenack C, Lassen, C L, Zink, W, Wiese, C H R, Graf, B M, and Wiesenack, C
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A case of pulmonary edema after the administration of naloxone for laparoscopic splenectomy is reported. Previous reports of naloxone-induced pulmonary edema are listed and reviewed. The clinical course is compared to other forms of non-cardiogenic pulmonary edema. Uncertainty remains about the underlying pathophysiological process and the true impact of naloxone on the development of pulmonary edema. [ABSTRACT FROM AUTHOR]
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- 2012
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15. Ernährungssonden bei kritisch kranken Patienten.
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Braun J, Bein T, Wiese CH, Graf BM, Zausig YA, Braun, J, Bein, T, Wiese, C H R, Graf, B M, and Zausig, Y A
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The use of enteral feeding tubes is an important part of early enteral feeding in intensive care medicine. In other faculties with non-critically ill patients, such as (oncologic) surgery, neurology, paediatrics or even in palliative care medicine feeding tubes are used under various circumstances as a temporary or definite solution. The advantage of enteral feeding tubes is the almost physiologic administration of nutrition, liquids and medication. Enteral nutrition is thought to be associated with a reduced infection rate, increased mucosal function, improved immunologic function, reduced length of hospital stay and reduced costs. However, the insertion and use of feeding tubes is potentially dangerous and may be associated with life-threatening complications (bleeding, perforation, peritonitis, etc.). Therefore, the following article will give a summary of the different types of enteral feeding tubes and their range of application. Additionally, a critical look on indication and contraindication is given as well as how to insert an enteral feeding tube. [ABSTRACT FROM AUTHOR]
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- 2011
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16. �bersicht – Kontrolle von gastrointestinalen Symptomen.
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Hanekop, G. G. and Wiese, C. H. R.
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- 2011
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17. Palliativpatienten und Patienten am Lebensende in Notfallsituationen. Empfehlungen zur ambulanten Versorgungsoptimierung.
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Wiese CH, Vagts DA, Kampa U, Pfeiffer G, Grom IU, Gerth MA, Graf BM, Zausig YA, Expertengruppe Palliativ- und Notfallmedizin Akademie für Palliativmedizin und Hospizarbeit Dresden, Wiese, C H R, Vagts, D A, Kampa, U, Pfeiffer, G, Grom, I-U, Gerth, M A, Graf, B M, and Zausig, Y A
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Background: At the end of life acute exacerbations of medical symptoms (e.g. dyspnea) in palliative care patients often result in emergency medical services being alerted. The goals of this study were to discuss cooperation between emergency medical and palliative care structures to optimize the quality of care in emergencies involving palliative care patients.Methods: For data collection an open discussion of the main topics by experts in palliative and emergency medical care was employed. Main outcome measures and recommendations included responses regarding current practices related to expert opinions and international literature sources.Results: As the essential points of consensus the following recommendations for optimization of care were named: (1) integration of palliative care in the emergency medicine curricula for pre-hospital emergency physicians and paramedics, (2) development of outpatient palliative care, (3) integration of palliative care teams into emergency medical structures, (4) cooperation between palliative and emergency medical care, (5) integration of crisis intervention into outpatient palliative emergency medical care, (6) provision of emergency plans and emergency medical boxes, (7) provision of palliative crisis cards and do not attempt resuscitation (DNAR) orders, (8) psychosocial aspects concerning palliative emergencies and (9) definition of palliative patients and their special situation by the physician responsible for prior treatment.Conclusions: Prehospital emergency physicians are confronted with emergencies in palliative care patients every day. In the treatment of these emergencies there are potentially serious conflicts due to the different therapeutic concepts of palliative medical care and emergency medical services. This study demonstrates that there is a need for regulated criteria for the therapy of palliative patients and patients at the end of life in emergency situations. Overall, more clinical investigations concerning end-of-life care and unresponsive palliative care patients in emergency medical situations are necessary. [ABSTRACT FROM AUTHOR]- Published
- 2011
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18. Tod durch (k)einen Atemweg.
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Russo, S. G., Zink, W., Herff, H., and Wiese, C. H. R.
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HOSPITAL care ,AIRWAY (Anatomy) ,INTUBATION ,MEDICAL care ,HEALTH - Abstract
Copyright of Anaesthesist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2010
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19. Lazarus-Phänomen.
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Wiese, C. H. R., Bartels, U. E., Orso, S., and Graf, B. M.
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CARDIAC resuscitation , *BLOOD circulation , *RESUSCITATION , *VITAL signs , *FIRST aid in illness & injury - Abstract
In the medical literature the Lazarus phenomenon is defined as the spontaneous return of circulation (SROC) after cessation of cardio-pulmonary resuscitation. Based on published literature recommendations concerning the treatment of patients after cessation of resuscitation and reasons for the Lazarus phenomenon are discussed. A literature search in Medline, PubMed, Embase, Google Scholar and Google from 1982 to 2009 was carried out for the terms “Lazarus phenomenon”, “cessation of cardiopulmonary resuscitation and return of spontaneous circulation (ROSC)”, “spontaneous return of circulation (SROC)”, “resuscitation and spontaneous defibrillation”, “spontaneous recovery and cardiopulmonary resuscitation”. Related secondary literature which was cited in the relevant articles was included as well as publications found in our personal literature base. More than 10,000 articles and comments could be recovered and of these 45 were considered to be medically relevant articles (letters to the Editor, abstracts, case reports and literature reviews). In the relevant medical literature, the Lazarus phenomenon is a rare occurrence. It seems to be a phenomenon which has often been described in non-medical literature but not published in medical literature. The pathophysiological mechanisms are poorly understood. In the literature several mechanisms are discussed which could be important for this phenomenon, e.g. autopositive end-expiratory pressure, hyperventilation and alkalosis, hyperkalemia, delayed action of drugs and unobserved minimal vital signs. In the literature it is recommended that patients should be passively monitored for at least 10 min after cessation of resuscitation. However, more scientific experimental investigations seem to be necessary to gain a better understanding of this phenomenon. [ABSTRACT FROM AUTHOR]
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- 2010
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20. Lazarus-Phänomen. Spontane Kreislauffunktion nach beendeten Reanimationsmassnahmen.
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Wiese CH, Bartels UE, Orso S, Graf BM, Wiese, C H R, Bartels, U E, Orso, S, and Graf, B M
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Background: In the medical literature the Lazarus phenomenon is defined as the spontaneous return of circulation (SROC) after cessation of cardio-pulmonary resuscitation. Based on published literature recommendations concerning the treatment of patients after cessation of resuscitation and reasons for the Lazarus phenomenon are discussed.Methods: A literature search in Medline, PubMed, Embase, Google Scholar and Google from 1982 to 2009 was carried out for the terms "Lazarus phenomenon", "cessation of cardiopulmonary resuscitation and return of spontaneous circulation (ROSC)", "spontaneous return of circulation (SROC)", "resuscitation and spontaneous defibrillation", "spontaneous recovery and cardiopulmonary resuscitation". Related secondary literature which was cited in the relevant articles was included as well as publications found in our personal literature base.Results: More than 10,000 articles and comments could be recovered and of these 45 were considered to be medically relevant articles (letters to the Editor, abstracts, case reports and literature reviews).Conclusions: In the relevant medical literature, the Lazarus phenomenon is a rare occurrence. It seems to be a phenomenon which has often been described in non-medical literature but not published in medical literature. The pathophysiological mechanisms are poorly understood. In the literature several mechanisms are discussed which could be important for this phenomenon, e.g. autopositive end-expiratory pressure, hyperventilation and alkalosis, hyperkalemia, delayed action of drugs and unobserved minimal vital signs. In the literature it is recommended that patients should be passively monitored for at least 10 min after cessation of resuscitation. However, more scientific experimental investigations seem to be necessary to gain a better understanding of this phenomenon. [ABSTRACT FROM AUTHOR]- Published
- 2010
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21. Ambulante und stationäre palliativmedizinische Patientenversorgung in Deutschland.
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Wiese, C. H. R., Zausig, Y. A., Vormelker, J., Orso, S., Graf, B. M., and Hanekop, G. G.
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PALLIATIVE treatment , *OUTPATIENT medical care , *EMERGENCY medical services , *MEDICAL care - Abstract
In Germany, specialized out-patient palliative care systems (SPCS) are still structurally and organizationally under construction. Palliative care patients need an easy access to a qualified SPCS. The purpose of the present investigation was to show the nationwide distribution of all SPCS teams in comparison to the distribution of emergency medical systems. Possibilities for an effective structure of palliative medical care systems will be discussed in order to optimize patient care.. All SPCS teams in Germany (according to the Guide to hospices and palliative medicine of the German Association for Palliative Care 2008/2009) were documented. A cartographic representation of the structural distribution of palliative care systems was made taking a catchment area diameter of 50 km for each SPCS team and an accessibility diameter of 20 km for every palliative ward into account. These data were compared with the nationwide distribution of emergency institutions. In Germany 25 SPCS teams and 198 palliative wards could be identified. In contrast there are 1,109 emergency physician locations (1,051 ground based, 58 air based). The nationwide distribution of the existing SPCS teams does not at present give exhaustive coverage in comparison to emergency medical structures. No structure which might potentially result in an exhaustive implementation of SPCS teams and palliative stations is recognizable in the analysis or distribution. The coverage of SPCS and in-hospital palliative care is still a theoretical construct in many regions of Germany. The number of existing SPCS teams and in-patient palliative institutions is insufficient to guarantee an exhaustive coverage of patient care as in emergency medical services. In order to achieve a higher quality of results the quality of the structure and processes must first be ensured. The distribution of palliative care should be centrally coordinated along the same lines as the emergency institutions in order to achieve a need-oriented exhaustive coverage. A surplus of care in some regions at the expense of an undersupply in other regions must be avoided. In the next step a further development and adaption of existing structures to the requirements would be a logical approach. [ABSTRACT FROM AUTHOR]
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- 2010
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22. Notfallmedizinische Betreuung von Palliativpatienten am Lebensende : Juristische Beurteilung notfallmedizinischer Handlungsweisen - retrospektive Fallbetrachtung zur medizinischen Indikation und zum Patientenwillen.
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Wiese CH, Duttge G, Weber AK, Zausig YA, Ruppert D, Hanekop GG, Graf BM, Wiese, C H R, Duttge, G, Weber, A K, Zausig, Y A, Ruppert, D, Hanekop, G G, and Graf, B M
- Abstract
Background: The treatment of out-of-hospital palliative emergency care situations during cardiac arrest is a special situation. The prehospital emergency physician (EP) and the paramedic must be informed about the medical, legal, and ethical specifics of these situations, but this knowledge is not integrated within emergency medical curricula at all. We present a case study to discuss such legal and ethical specifics.Methods: We retrospectively analysed six emergency cases with palliative care patients in the final stages of their illnesses. On the basis of these case studies, we present six different emergency cases with different regulatory frameworks for each EP and paramedic. In accordance with the Declaration of Helsinki, data were collected pseudonymously.Results: The six case studies show therapeutic concepts concerning the emergency medical care of palliative care patients during cardiac arrest. The differences are apparent in the treatment given by EPs and by paramedics (such as whether to start or stop resuscitation). EPs and paramedics differ in their therapeutic approach to these specific situations (e.g. paramedics more often start resuscitation during cardiac arrest even though patients would refuse this according to their advance directives). These differences may be important for the patient and his or her caregivers.Conclusions: Every EP and paramedic may be involved in the care of palliative care patients who are at the end of their lives. EPs and paramedics do not always adapt their treatment to the will or supposed will of the patient (especially in accordance with the new German law concerning advance directives). The reasons for this usually concern legal uncertainties. Therefore, EPs and paramedics should know that different legal meanings could be important in emergency medical care therapy of palliative care patients. A written "do not resuscitate" order as an advance directive must be evaluated as a desired therapeutic limitation. [ABSTRACT FROM AUTHOR]- Published
- 2009
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23. Treatment of palliative care emergencies by prehospital emergency physicians in Germany: an interview based investigation.
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Wiese, C. H. R., Bartels, U. E., Ruppert, D., Marung, H., Luiz, T., Graf, B. M., and Hanekop, G. G.
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PALLIATIVE treatment , *MEDICAL care for older people , *CRITICAL care medicine , *EMERGENCY physicians - Abstract
Palliative care medical emergencies as a consequence of advanced cancer account for approximately 3% of all prehospital emergency cases. Therefore, prehospital emergency physicians (EP) are confronted with 'end of life decisions'. No educational content exists concerning palliative medicine in emergency medicine curricula. Over the course of 6 months, we interviewed 150 EPs about their experiences in 'end of life decisions' using a specific questionnaire. The total response rate was 69% (n = 104). Most of the interviewed EPs (89%, n = 93) had been confronted with palliative care medical emergencies and expressed uncertainties in dealing with these difficult situations, especially in the area of psychosocial care of the patients (50%). The emergency treatment of palliative care patients can become a particular challenge for any EP. A large percentage of interviewed EPs felt uncertain about aspects of social care and in the assessment of decisions at the end of life. Further information and training are necessary to amenable EPs to provide adequate patient-oriented care to palliative care patients and their relatives in emergency situations. [ABSTRACT FROM AUTHOR]
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- 2009
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24. Not�rztliche Versorgung von Palliativpatienten.
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Wiese, C. H. R., Graf, B. M., and Hanekop, G. G.
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- 2009
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25. Palliativmedizin.
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Wiese, C. H. R., Bartels, U. E., Zausig, Y. A., Graf, B. M., and Hanekop, G. G.
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PALLIATIVE treatment , *THERAPEUTICS , *LIFE science education ,STUDY & teaching of medicine - Abstract
Palliative medicine has progressed during recent years to an independent medical faculty within the German health system. Despite this development palliative care systems for out-of-hospital and in-hospital palliative care are still insufficient in Germany so that the development of necessary resources must be considered as not yet completed. To support the further national development palliative medicine can be temporarily or permanently coupled to existing departments, which can be advantageous for all concerned and last but not least be profitable to patients and their relatives. Possibilities for participation of anaesthesiologists in this area of medical care are discussed in the study reported here. Anaesthesiologists have always historically been represented in palliative medical departments, e.g. as pain specialists. In the following investigation the special possibilities of anaesthesia departments for supporting the education and development of in-hospital and out-of hospital palliative medical care departments are reported. Previous experience of co-operation between these two departments is well established. Departments of palliative medicine depend on a well working interdisciplinary co-operation between different medical disciplines (e.g. anaesthesiology, radiotherapy, surgery and oncology) and several medical professions (e.g. physicians, nurses, psychologists). The aim of palliative care therapy is to be responsible for the best possible therapy for cancer patients and to give support to their care-giving relatives. Due to the increasing establishment of palliative care procedures in Germany, departments of anaesthesiology should actively take part in the further development. Part of the responsibility of most anaesthesia departments is to practice pain management and critical care medicine, which are reasons why anaesthesiologists are predestined to be part of the system for palliative care patients and their relatives. Anaesthesia departments can be responsible for the organization of in-hospital and out-of-hospital palliative medicine and palliative care. The integration of anaesthesiological expertise into palliative medicine departments and vice versa can be a great opportunity for both medical departments and therefore represents a worthwhile engagement. [ABSTRACT FROM AUTHOR]
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- 2009
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26. Palliativmedizin: Fünfte Säule anästhesiologischer Abteilungen?
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Wiese CH, Bartels UE, Zausig YA, Graf BM, Hanekop GG, Wiese, C H R, Bartels, U E, Zausig, Y A, Graf, B M, and Hanekop, G G
- Abstract
Palliative medicine has progressed during recent years to an independent medical faculty within the German health system. Despite this development palliative care systems for out-of-hospital and in-hospital palliative care are still insufficient in Germany so that the development of necessary resources must be considered as not yet completed. To support the further national development palliative medicine can be temporarily or permanently coupled to existing departments, which can be advantageous for all concerned and last but not least be profitable to patients and their relatives. Possibilities for participation of anaesthesiologists in this area of medical care are discussed in the study reported here. Anaesthesiologists have always historically been represented in palliative medical departments, e.g. as pain specialists. In the following investigation the special possibilities of anaesthesia departments for supporting the education and development of in-hospital and out-of hospital palliative medical care departments are reported. Previous experience of co-operation between these two departments is well established. Departments of palliative medicine depend on a well working interdisciplinary co-operation between different medical disciplines (e.g. anaesthesiology, radiotherapy, surgery and oncology) and several medical professions (e.g. physicians, nurses, psychologists). The aim of palliative care therapy is to be responsible for the best possible therapy for cancer patients and to give support to their care-giving relatives. Due to the increasing establishment of palliative care procedures in Germany, departments of anaesthesiology should actively take part in the further development. Part of the responsibility of most anaesthesia departments is to practice pain management and critical care medicine, which are reasons why anaesthesiologists are predestined to be part of the system for palliative care patients and their relatives. Anaesthesia departments can be responsible for the organization of in-hospital and out-of-hospital palliative medicine and palliative care. The integration of anaesthesiological expertise into palliative medicine departments and vice versa can be a great opportunity for both medical departments and therefore represents a worthwhile engagement. [ABSTRACT FROM AUTHOR]
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- 2009
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27. G�ttinger Palliativkrisenbogen: Verbesserung der notfallmedizinischen Versorgung von ambulanten Palliativpatienten.
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Wiese, C. H. R., Bartels, U., Geyer, A., Duttge, G., Graf, B. M., and Hanekop, G. G.
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- 2008
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28. "No-flow-time"-Reduzierung durch Einsatz des Larynxtubus: Vergleich zur Beutel-Masken-Beatmung.
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Wiese CH, Bahr J, Bergmann A, Bergmann I, Bartels U, Graf BM, Wiese, C H R, Bahr, J, Bergmann, A, Bergmann, I, Bartels, U, and Graf, B M
- Abstract
Objective: In 2005 the European Resuscitation Council (ERC) published the new guidelines for Advanced Life Support (ALS). One of the aims was to reduce the no flow time (NFT), without chest compression in the first period of cardiac arrest. Furthermore the guidelines recommend that endotracheal intubation should only be carried out by personnel experienced in this procedure.Methods: An attempt was made to evaluate whether the use of the laryngeal tube suction (LTS-D) for emergency airway management could contribute to reduce NFT compared to bag-mask ventilation (BMV). In a randomised prospective study 50 participants were asked to perform standardised simulated cardiac arrest management on a full-scale simulator following a one-day cardiac arrest training. Each participant was randomised into the LTS-D and the BMV group for airway management. At the end of each scenario an evaluation of the use of each ventilation procedure by the participants was made by means of a questionnaire.Results: During the manikin scenario (430 s for LTS-D and 420 s for BMV) there was a significant difference in the overall NFT comparing the use of the LTS-D vs. BMV (105.8 s, range 94-124 s vs. 150.7 s, range 124-179 s; p<0.01). This corresponded during the whole scenario to a proportion of 24.6% (LTS-D) or 35.9% (BMV). Using the LTS-D all participants were able to ventilate the manikin successfully (tidal volume 500-600 ml). In a subjective evaluation of the different airway management procedures by the participants more than 90% expressed a positive opinion about the LTS-D with respect to ease of insertion and safety of ventilation.Conclusion: The use of the LTS-D on a manikin by emergency physicians after standardised cardiac arrest training significantly reduces the NFT in comparison to BMV. Therefore the LTS-D seems to be a good alternative to BMV during a simulated cardiac arrest scenario. [ABSTRACT FROM AUTHOR]- Published
- 2008
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29. Foudroyante Meningokokkensepsis im Notarztdienst. Handlungsempfehlungen und Expositionsprophylaxe.
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Wiese CH, Roessler M, Bartels U, Quintel M, Graf BM, Wiese, C H R, Roessler, M, Bartels, U, Quintel, M, and Graf, B M
- Abstract
A paediatric emergency case with a rescue helicopter, which was reported as unexpected cardiac arrest of a 4-year-old child will be described. Based on this case, the symptoms and therapy of meningococcal sepsis and Waterhouse-Friderichsen-Syndrome under emergency conditions will be discussed as well as aspects of post-exposure prophylaxis. [ABSTRACT FROM AUTHOR]
- Published
- 2008
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30. Betreuung von Tumorpatienten in der finalen Krankheitsphase durch den Notarzt - Sieben Fallbeispiele.
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Wiese, C. H. R., Duttge, G., Bartels, U., Zausig, Y. A., Klie, S., Graf, B. M., and Hanekop, G. G.
- Published
- 2008
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31. Palliativ- und Notfallmedizin: Teamarbeit durch Kommunikation.
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Wiese, C. H. R., Bartels, U., Geyer, A., Graf, B. M., and Hanekop, G. G.
- Published
- 2007
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32. [Outpatient palliative medicine : Attitudes in the care of palliative emergencies. Prospective questionnaire-based investigation].
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Wiese CHR, Silbereisen VMC, Graf BM, Bundscherer AC, and Lassen CL
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- Delivery of Health Care, Integrated, Germany, Humans, Outpatients, Patient Care Team, Prospective Studies, Resuscitation Orders, Surveys and Questionnaires, Ambulatory Care methods, Attitude of Health Personnel, Emergency Medical Services methods, Palliative Care methods
- Abstract
Background: 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., Methods: 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., Results: 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)., Conclusion: 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.
- Published
- 2018
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33. [Differentiation between "nonpalliative" and "palliative" treatment of tumor pain is desirable].
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Wirz S, Schenk M, Wartenberg HC, Gastmeier K, Hofbauer H, Hoffmann E, and Wiese CH
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- Humans, Neoplasms, Pain, Palliative Care
- Published
- 2016
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34. [Simulation as possible training for palliative emergencies: prospective initial data analysis of participants from two simulation training sessions].
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Wiese CH, Bosse G, Schröder T, Lassen CL, Bundscherer AC, Graf BM, and Zausig YA
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- Adult, Curriculum, Female, Humans, Male, Patient Care Team, Prospective Studies, Surveys and Questionnaires, Emergency Medicine education, Palliative Care, Patient Simulation
- Abstract
Background: Palliative emergencies describe an acute situation in patients with a life-limiting illness. At present defined curricula for prehospital emergency physician training for palliative emergencies are limited. Simulation-based training (SBT) for such palliative emergency situations is an exception both nationally and internationally., Aim: This article presents the preparation of recommendations in the training and development of palliative care emergency situations., Material and Methods: A selected literature search was performed using PubMed, EMBASE, Medline and the Cochrane database (1990-2013). Reference lists of included articles were checked by two reviewers. Data of the included articles were extracted, evaluated und summarized. In the second phase the participants of two simulated scenarios of palliative emergencies were asked to complete an anonymous 15-item questionnaire. The results of the literature search and the questionnaire-based investigation were compared and recommendations were formulated based on the results., Results: Altogether 30 eligible national and international articles were included. Overall, training curricula in palliative emergencies are currently being developed nationally and internationally but are not yet widely integrated into emergency medical training and education. In the second part of the investigation, 25 participants (9 male, 16 female, 20 physicians and 5 nurses) were included in 4 multiprofessional emergency medical simulation training sessions. The most important interests of the participants were the problems for training and further education concerning palliative emergencies described in the national and international literature., Conclusion: The literature review and the expectations of the participants underlined that the development and characteristics of palliative emergencies will become increasingly more important in outpatient emergency medicine. All participants considered palliative care to be very important concerning the competency for end-of-life decisions in palliative patients. For this reason, special curricula and simulation for dealing with palliative care patients and special treatment decisions in emergency situations seem to be necessary.
- Published
- 2015
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35. [Perioperative care of palliative patients by the anesthetist : medical, psychosocial and ethical challenges].
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Lassen CL, Abel R, Eichler L, Zausig YA, Graf BM, and Wiese CH
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- Anesthesia psychology, Anesthesia Recovery Period, Anesthesiology ethics, Communication, Delirium etiology, Delirium therapy, Dyspnea therapy, Fatigue therapy, Humans, Neoplasms therapy, Pain Management, Palliative Care ethics, Palliative Care psychology, Perioperative Care ethics, Perioperative Care psychology, Physicians, Postoperative Care ethics, Postoperative Care psychology, Postoperative Care standards, Preoperative Care ethics, Preoperative Care psychology, Preoperative Care standards, Resuscitation Orders, Anesthesiology standards, Palliative Care standards, Perioperative Care standards
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Anesthetists will encounter palliative patients in the daily routine as palliative patients undergo operations and interventions as well, depending on the state of the disease. The first challenge for anesthetists will be to recognize the patient as being palliative. In the course of further treatment it will be necessary to address the specific problems of this patient group. Medical problems are optimized symptom control and the patient's pre-existing medication. In the psychosocial domain, good communication skills are expected of anesthetists, especially during the preoperative interview. Ethical conflicts exist with the decision-making process for surgery and the handling of perioperative do-not-resuscitate orders. This article addresses these areas of conflict and the aim is to enable anesthetists to provide the best possible perioperative care to this vulnerable patient group with the goal to maintain quality of life and keep postoperative recovery as short as possible.
- Published
- 2013
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36. [Patients at the end of life in the intensive care unit: cultural aspects of accompaniment].
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Grom IU, Vagts DA, Kampa U, Pfeiffer G, Schreiber-Winzig L, and Wiese CH
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- Communication, Family, Germany, Humans, Religion, Resuscitation Orders, Withholding Treatment, Culture, Intensive Care Units, Terminal Care methods
- Abstract
The accompaniment of people in the face of death offers insights into dimensions which are mostly not seen in ordinary life. These insights also exist in intensive care in German hospitals and are highly relevant in medical decision making. End-of-life decisions in particular often determine medical, cultural and spiritual aspects concerning medical treatment and therapeutic targets and if necessary new therapy targets. The following article especially illuminates cultural aspects and their characteristics in patients at the end of life in the intensive care unit.
- Published
- 2013
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37. [Anesthesiological acute pain therapy in Germany: telephone-based survey].
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Lassen CL, Link F, Lindenberg N, Klier TW, Graf BM, Maier C, and Wiese CH
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- Analgesia, Epidural, Analgesia, Patient-Controlled, Analgesics, Opioid therapeutic use, Anesthesiology organization & administration, Anesthesiology statistics & numerical data, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Delayed-Action Preparations, Dipyrone therapeutic use, Germany, Health Care Surveys, Hospitals, Humans, Pain Clinics statistics & numerical data, Pirinitramide therapeutic use, Acute Pain therapy, Anesthesiology trends
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Introduction: The last survey of anesthesiological acute pain therapy in Germany was conducted in 1999. Since then new organisational as well as therapeutic aspects have developed. Amongst others the operation and procedures key (OPS) figure 8-919 complex acute pain therapy has been introduced in the German medical billing system, with the restriction that it cannot currently be redeemed. There is an ongoing debate on the role of epidural analgesia in acute pain therapy and new oral medication concepts have been established. Therefore a survey of the present state of acute pain therapy in Germany was conducted., Methods: Based on a list of all 1,356 hospitals in Germany a randomized list of 412 hospitals was generated. Out of these 412 hospitals those with anesthesiology departments (378 hospitals) were contacted via telephone and asked to participate in the survey. Out of the 378 hospitals 285 (75.4 %) agreed to take part. The survey consisted of a questionnaire containing closed and open questions regarding organisational and therapeutic aspects of acute pain therapy. The ethics committee of the University of Regensburg rated the survey as not being subject to approval due to the lack of personal patient data., Results: Of the participating hospitals 183 (64.2 %) had an acute pain service (APS) and of these 107 (58.5 %) met the quality criteria of the OPS 8-919. This figure however, was only consistently documented by 40 (37 %) APSs. Epidural analgesia (EA) was offered by 275 (96.5 %) hospitals and patient-controlled intravenous analgesia (PCA) by 255 (89.5 %). Likewise, 255 (89.5 %) hospitals used controlled-released opioids in acute pain therapy. Concerning EA, the medications most used were sufentanil as an opioid and ropivacaine as a local anesthetic in255 (92.7 %) of the hospitals with EA for sufentanil and 253 (92 %] for ropivacaine. An EA was offered on regular wards in 240 (87.3 %) hospitals. Uncertainty existed about concrete limits for coagulation values before removal of an epidural catheter. The opioid most utilized in PCA was piritramide with some hospitals using morphine or oxycodone (92.2 %, 9.4 % and 9.4 %, respectively). Other opioids, such as hydromorphone and tramadol were rarely used and remifentanil was not used at all. Oral medication was widely used with metamizole being the non-opioid analgesic and oxycodone/naloxone the controlled-release opioid being prescribed the most. New antiepileptic drugs, such as gabapentin or pregabalin were rarely employed in acute pain therapy., Conclusions: Since 1999 the number of hospitals that have implemented an APS has risen from 36.1 % to 64.2 %. The lack of consistent documentation of the OPS 8-919 will probably not increase the likelihood that it will become redeemable in the near future. Certain therapy methods, such as EA and PCA were still well established with oral therapy gaining in significance. The uncertainty regarding limits for coagulation values before removal of an epidural catheter could perhaps be reduced by a statement from the German Society of Anesthesia and Intensive Care.
- Published
- 2013
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38. [Rapid release fentanyl administration forms. Comments of the Working Group on Tumor Pain of the German Pain Society].
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Wirz S, Wiese CH, Zimmermann M, Junker U, Heuser-Grannemann E, and Schenk M
- Subjects
- Advertising, Analgesics, Opioid pharmacokinetics, Breakthrough Pain blood, Drug Industry, Drug Tolerance, Education, Fentanyl pharmacokinetics, Germany, Humans, Off-Label Use, Opioid-Related Disorders prevention & control, Risk Factors, Analgesics, Opioid administration & dosage, Analgesics, Opioid adverse effects, Breakthrough Pain drug therapy, Fentanyl administration & dosage, Fentanyl adverse effects, Neoplasms physiopathology, Opioid-Related Disorders etiology, Societies, Medical
- Abstract
The spectrum of indications for rapid release fentanyl preparations is controversial. For this reason the Working Group on Tumor Pain will formulate comments on how to deal with these substances. Breakthrough pain should receive individualized therapy; therefore, the use of opioids of various galenic formulations seems to be advisable. New rapid release fentanyl preparations are suitable for alleviating spontaneous breakthrough pain in tumor patients due to a rapid but short-acting effect. However, a prior optimization of the analgesic basis medication is absolutely necessary. Uncontrolled prescription for non-cancer pain must be criticized due to the problem of addiction. The medical profession should be informed about the benefits of rapid release fentanyl preparations but must also be made aware of the risk of a rapid development of addiction and tolerance. A self-commitment of the pharmaceutical industry to waive advertising for the dangerous off-label use would be desirable. In the opinion of the Working Group on Tumor Pain the use of fentanyl should be openly discussed and further scientific investigations are imperative with the aim of formulating clear recommendations.
- Published
- 2013
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39. [Inpatient pain consultation service at a university hospital: a retrospective analysis of patient characteristics and the rate of the implementation of recommendations].
- Author
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Lassen CL, Sommer M, Meyer N, Klier TW, Graf BM, Pawlik MT, and Wiese CH
- Subjects
- Acute Pain psychology, Acute Pain therapy, Aged, Analgesics therapeutic use, Chronic Pain psychology, Chronic Pain therapy, Combined Modality Therapy, Female, Germany, Guideline Adherence, Hospitals, University, Humans, Male, Middle Aged, Pain Clinics, Pain Measurement, Pain, Intractable psychology, Pain, Intractable therapy, Physical Therapy Modalities psychology, Psychotherapy, Quality Assurance, Health Care, Retrospective Studies, Cooperative Behavior, Hospitalization, Interdisciplinary Communication, Pain Management methods, Referral and Consultation organization & administration
- Abstract
Background: The aim of this study was to conduct an audit of a university inpatient pain consultation service and to examine the quality and the implementation of the recommended therapeutic measures. Factors that influenced the implementation should be identified., Patients and Methods: All inpatients treated by the consultation service in the years 2009 and 2010 were analyzed retrospectively. Demographic patient characteristics as well as quality parameters of the consultation service and pharmacological and non-pharmacological recommendations and their implementation were analyzed., Results: In total 1,048 requests for the consultation service were processed of which 39.7% of the requests were for patients with acute pain, 33.8% with chronic and 19.9% with tumor-associated pain. Measures recommended most were medication, physiotherapy and psychological treatment. Recommended medications were actually prescribed in more than 80%, physiotherapy recommended in about 75% and psychological treatment recommended in 47% of the cases. Only a few influencing factors for the implementation of the recommended measures could be identified., Conclusion: Many different pain states are seen in an inpatient pain consultation service. The recommendations given are implemented in most cases especially concerning the medication.
- Published
- 2012
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40. [Interprofessional education in pain management: development strategies for an interprofessional core curriculum for health professionals in German-speaking countries].
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Fragemann K, Meyer N, Graf BM, and Wiese CH
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- Clinical Competence, Combined Modality Therapy, Curriculum, Germany, Humans, Pain Measurement, Patient Care Team, Quality Improvement organization & administration, Cooperative Behavior, Education, Professional organization & administration, Health Personnel education, Interdisciplinary Communication, Pain Management
- Abstract
The care of patients, suffering from acute, chronic, or malignant pain, requires systematic and interprofessional collaboration between all team members to ensure a holistic approach to pain management. In doing so, the different professions are often in a competitive, tense, or dependent relationship resulting from a lack of precise definitions and concepts regarding their responsibilities in the wide field of pain management. Considering pain management as a whole, we can define numerous interfaces concerning competencies and tasks which may open up some new perspectives on concepts of interprofessional education (IPE). Internationally, there have been many attempts to establish concepts of interprofessional education, and it is considered a great challenge to improve continuing medical education. However, interdisciplinary subjects like pain management may benefit from it. Apart from enhancing specialized knowledge, interprofessional education aims to consider the different roles, skills, and responsibilities as well as interprofessional strategies of decision-making. In Germany, only a few efforts have been made with regard to interprofessional pain education. In the following paper, different challenges, tasks, and roles within the field of pain management are discussed in the sense of potential areas of collaboration in the context of interprofessional education. Against this background, the Regensburg model for interprofessional pain management education is described as one national program to enhance the effectiveness of pain management.
- Published
- 2012
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41. [Palliative care oriented therapy for all patients : recommendations of an expert circle].
- Author
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Wiese CH, Vagts DA, Kampa U, Pfeiffer G, Grom IU, Gerth MA, Schreiber-Winzig L, and von Berswordt-Wallrabe M
- Subjects
- Attitude of Health Personnel, Caregivers psychology, Combined Modality Therapy, Consensus, Continuity of Patient Care, Data Collection, Diabetes Complications therapy, Diabetes Mellitus, Type 1 therapy, Education, Medical, Family Therapy, Goals, Health Services Accessibility, Hospital Units, Humans, Male, Middle Aged, Pain Management, Psychotherapy, Terminology as Topic, Palliative Care standards, Patient Care Management standards
- Abstract
Background: Since 2011 palliative care has been a compulsory part of the German medical study course (so-called Q13 palliative and pain medicine). Palliative care content does not, however, as often taught, have to focus only on patients in the so-called palliative stages of disease. The aim of this investigation was to encourage a discussion concerning the integration of palliative care aspects into general medical treatment., Methods: For data collection an open discussion of the main topics by experts in palliative medical care was used. The main outcome measures and recommendations included responses regarding current practices related to expert opinions, national and international literature and one case report. The literature search was performed using the databases "PubMed", "Medline" and "Google" (1990-2011)., Results: As an important consensus, the following recommendations for optimization of inpatient and outpatient care were: (1) integration of aspects of palliative care into medical curricula of all disciplines, (2) palliative care content should be extended to the general optimization of therapy for all patients, (3) palliative medicine should be part of the everyday medical practice in all disciplines and (4) palliative medicine should not be isolated as "death medicine" or medicine of the dying patient., Conclusions: Palliative care treatment is increasingly becoming integrated into medical education and into medical curricula of all disciplines. Palliative ideas and goals are focussed on patients in the so-called palliative stages of disease. Furthermore, palliative medicine is often described as the medicine of dying patients. As a result of this study it seems to make sense to extend palliative care aspects to all patients and to all patient care. The extent to which such opportunities exist and such health care is economically feasible remains to be the subject of further clinical studies.
- Published
- 2012
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42. [Age rationing : means of resource allocation in healthcare systems].
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Wiese CH, Schepp CP, Bergmann I, Hinz JM, Graf BM, and Lassen CL
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- Aged, Female, Germany, Humans, Male, Models, Organizational, Population, Age Factors, Delivery of Health Care organization & administration, Health Care Rationing organization & administration, Health Resources, Resource Allocation
- Abstract
The necessity of limiting resource in healthcare systems is becoming increasingly more evident. The population has requirements especially in the field of healthcare which are principally unlimited. However, there are only limited financial resources which can be used to satisfy the wishes of the population. For this reason rationing models are being discussed increasingly more often. One example of these models is called age rationing which means that defined services are only offered to patients up to a particular age. The aim of this article is to discuss the model of age rationing in the context of an optimized use of resources in the healthcare system.
- Published
- 2012
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43. [Naloxone-induced pulmonary edema. Case report with review of the literature and critical evaluation].
- Author
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Lassen CL, Zink W, Wiese CH, Graf BM, and Wiesenack C
- Subjects
- Adolescent, Airway Obstruction etiology, Airway Obstruction therapy, Analgesics, Opioid adverse effects, Analgesics, Opioid antagonists & inhibitors, Drug Overdose, Echocardiography, Fluid Therapy, Humans, Laparoscopy, Male, Oxygen blood, Platelet Count, Positive-Pressure Respiration, Pulmonary Edema diagnostic imaging, Pulmonary Edema therapy, Purpura, Thrombocytopenic, Idiopathic surgery, Radiography, Respiration, Artificial, Respiratory Function Tests, Splenectomy, Naloxone adverse effects, Narcotic Antagonists adverse effects, Pulmonary Edema chemically induced
- Abstract
A case of pulmonary edema after the administration of naloxone for laparoscopic splenectomy is reported. Previous reports of naloxone-induced pulmonary edema are listed and reviewed. The clinical course is compared to other forms of non-cardiogenic pulmonary edema. Uncertainty remains about the underlying pathophysiological process and the true impact of naloxone on the development of pulmonary edema.
- Published
- 2012
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44. [Physicians' knowledge on cancer pain therapy : Comparison of palliative care and prehospital emergency physicians in training].
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Wiese CH, Lassen CL, Vormelker J, Meyer N, Popov AF, Graf BM, Hanekop GG, and Wirz S
- Subjects
- Curriculum, Education, Medical, Education, Medical, Continuing, Humans, Pain classification, Psychometrics statistics & numerical data, Reproducibility of Results, World Health Organization, Clinical Competence, Emergency Medical Services, Emergency Medicine education, Medicine, Neoplasms physiopathology, Pain drug therapy, Palliative Care, Surveys and Questionnaires
- Abstract
Background: Palliative care needs a high level of expertise. In particular, there are some potential difficulties in the treatment of patients with the symptom cancer pain (for example lack of education). In Germany, various physicians are involved in cancer pain treatment but in general palliative care patients are treated by a physician who is educated in palliative medicine. In special circumstances prehospital emergency physicians and other physicians are involved in therapy decisions in palliative care patients as well. The authors surveyed different groups of physicians in Germany about their specific knowledge of cancer pain management., Material and Methods: A self-designed, standardized questionnaire (50 items) was given to palliative physicians in training (PP). The survey asked prospectively for knowledge on the World Health Organization (WHO) step ladder of cancer pain therapy. The results were retrolectively compared with an earlier investigation with the same background (emergency physicians in training EP)., Results: There was a 99.5% response rate with a total of 654 respondents (PP 185, EP 469) and 461 (70.5%) of the respondents had knowledge of the WHO step ladder for the treatment of cancer pain [PP 164/185 (88.6%), EP 297/469 (63.3%), PP versus EP p < 0.001)]. The correct numbers of therapeutic levels were known by 361/461 participants [PP 151/164 (92.1%), EP 210/297 (70.7%), p < 0.001].The EPs with a professional experience less than 5 years answered statistically significantly more questions correctly (p = 0.004). Concerning the defined parameters knowledge and professional experience, there was no statistically significant difference in the group of PP., Conclusions: The results of this study verified that the highest knowledge scores were achieved by PPs and overall, the knowledge scores showed an improvement in comparison to previous investigations. In recent years there seems to have been an improvement in education on pain treatment,for example during medical school. Whether this also leads to an improvement of patient care and the relevance of these data for the clinical practice needs to be investigated in further studies.
- Published
- 2011
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45. [Older emergency patients benefit from geriatric assessment].
- Author
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Wiese CH
- Subjects
- Aged, Cooperative Behavior, Follow-Up Studies, Germany, Humans, Independent Living, Interdisciplinary Communication, Patient Admission, Randomized Controlled Trials as Topic, Survival Analysis, Emergency Service, Hospital, Geriatric Assessment
- Published
- 2011
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46. [Preventive crisis management in general outpatient palliative care - prospectively cross-sectional study of General Practitioners in Eastern Bavaria].
- Author
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Wiese CH, Duttge G, Taghavi M, Lassen CL, Meyer N, Andreesen R, Graf BM, and Pfirstinger J
- Subjects
- Adult, Attitude of Health Personnel, Cross-Sectional Studies, Female, General Practice, Germany, Health Services Research, Homes for the Aged, Humans, Living Wills, Male, Middle Aged, Nursing Homes, Personal Autonomy, Surveys and Questionnaires, Advance Directives, Ambulatory Care methods, Delivery of Health Care, Integrated methods, Emergency Medical Services methods, Palliative Care methods
- Abstract
Background: General out-patient palliative care (GOPC) must be integrated into the care of patients with life-limiting diseases. Aim of the study was to evaluate experiences of general practitioners concerning advance directives and palliative emergency sheets., Methods: A self-provided survey was mailed to all general practitioners in Regensburg (cross-sectional study). Main outcome measures included responses regarding a palliative emergency sheet (PES) and a palliative emergency plan (PEP). The investigation period was four months. The analysis was performed using defined criteria (e. g. professional experience concerning palliative care patients, patients treated in nursing homes, patients with dementia)., Results: Sixty-nine questionnaires from 259 were analysed (response rate 27 %). 86 % of respondents named practical experience in the care of palliative patients, 46 % named theoretical knowledge in this field. 41 % and 40 % consider creating an advance directive for their practical work as important/very important (p = 0.004 concerning the treatment of more than five palliative care patients per three months). 52 % and 49 % regard a PES or a PEP to be relevant (PES median: 6.5, SD ± 2.7; PEP median: 6.5 SD ± 2.9; inter-group analysis p < 0.05). 94 % of respondents name the general practitioner to be suitable for creating an advance directive., Conclusion: In Germany, GOPC in end-of-life care is very important. This study shows that advance directives were declared as an important instrument for patients? autonomy. The sense of PES and PEP to ensure patients? autonomy, especially for acute emergency medical palliative care, must be better recognized. However, the increase in acceptance in the GOPC for such instruments must be disclosed. Further studies to investigate this problem are necessary., (© Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2011
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47. [Anesthesiology and palliative medicine. Structured results of a prospective questionnaire-based survey in German hospitals].
- Author
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Wiese CH, Felber S, Lassen CL, Klier TW, Meyer N, Graf BM, Zausig YA, and Hanekop GG
- Subjects
- Cooperative Behavior, Curriculum, Data Collection, Education, Medical, Continuing, Germany, Health Services Research, Hospitals, General, Hospitals, Special, Hospitals, University, Humans, Interdisciplinary Communication, Neoplasms physiopathology, Pain Measurement, Patient Care Team, Surveys and Questionnaires, Anesthesiology education, Palliative Care methods
- Abstract
Background: Anesthesiology departments were often integrated into the primary formation of palliative activities in Germany. The aim of this study was to present the current integration of anesthesiology departments into palliative care activities in Germany., Methods: The objective was to determine current activities of anesthesiology departments in in-hospital palliative care. A quantitative study was carried out based on a self-administered structured questionnaire used during telephone interviews., Results: A total of 168 out of 244 hospitals consented to participate in the study and the response rate was 69%. In-hospital palliative care activities were reported for most of the surveyed hospitals. Only two hospitals in the maximum level of care reported no activities. Participation in these activities by anesthesiology departments was described in up to 92%. Historically, most activities are due to the commitment of individuals, whereas the development of palliative care of cancer pain services and hospital support teams took place in the university hospitals by 2005., Conclusions: Until 2005 many university palliative care activities had their origins in cancer pain services. These were often integrated into anesthesiology departments. Currently, anesthesiology departments work as an integrative part of palliative medicine. However, it appears from the present results that there is a domination of internal medicine (especially hematology and oncology) in palliative activities in German hospitals. This allows the focus of palliative activities to be formed by subjective specialist interests. Such a state seems to be reduced by the integration of anesthesiology departments because of their neutrality with respect to faculty-specific medical interests. Advantages or disadvantages of these circumstances are not considered by the present investigation.
- Published
- 2011
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48. [Enteral feeding tubes for critically ill patients].
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Braun J, Bein T, Wiese CH, Graf BM, and Zausig YA
- Subjects
- Child, Digestive System Surgical Procedures, Endoscopy, Gastrointestinal, Enteral Nutrition adverse effects, Enteral Nutrition methods, Humans, Intubation adverse effects, Intubation instrumentation, Intubation methods, Magnetic Resonance Imaging, Nutritional Physiological Phenomena, Ultrasonography, Critical Care methods, Critical Illness, Enteral Nutrition instrumentation
- Abstract
The use of enteral feeding tubes is an important part of early enteral feeding in intensive care medicine. In other faculties with non-critically ill patients, such as (oncologic) surgery, neurology, paediatrics or even in palliative care medicine feeding tubes are used under various circumstances as a temporary or definite solution. The advantage of enteral feeding tubes is the almost physiologic administration of nutrition, liquids and medication. Enteral nutrition is thought to be associated with a reduced infection rate, increased mucosal function, improved immunologic function, reduced length of hospital stay and reduced costs. However, the insertion and use of feeding tubes is potentially dangerous and may be associated with life-threatening complications (bleeding, perforation, peritonitis, etc.). Therefore, the following article will give a summary of the different types of enteral feeding tubes and their range of application. Additionally, a critical look on indication and contraindication is given as well as how to insert an enteral feeding tube.
- Published
- 2011
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49. Prehospital emergency physicians' experiences with advance directives in Germany: a questionnaire-based multicenter study.
- Author
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Wiese CH, Bartels UE, Ruppert DB, Graf BM, and Hanekop GG
- Subjects
- Adult, Advance Directive Adherence, Female, Germany, Humans, Male, Middle Aged, Palliative Care standards, Surveys and Questionnaires, Terminal Care, Advance Directives, Emergency Medical Services standards, Physicians
- Abstract
Background: Palliative medical emergencies and end-of-life decisions resulting from the exacerbation of cancer account for approximately 3% of all out-of-hospital emergency applications in Germany. Therefore, prehospital emergency physicians (EP) may be confronted with advance directives and ethical and end-of-life decisions. The purpose of the study was to identify EPs' knowledge about ethical and end-of-life decisions and their legal education and experiences concerning advance directives., Methods: Over a six-month period, we questioned all 150 EPs from three emergency medical services (Braunschweig, Göttingen und Kaiserslautern). An anonymous, self-administered questionnaire with a mixed-methods design was used. The main outcome measures included responses regarding experiences related to advance directives and end-of-life decisions in palliative care patients. For statistical assessment, EPs were divided into three categories: competent, skilled, and unskilled., Results: A total of 104 EPs returned the questionnaire (response rate 69%). Eighty-nine percent of the respondents treated patients who had advance directives. The existence of an advance directive influenced the EP's therapy decision in about 77% of their encounters. Eighty-seven percent of the EPs reported the need for defined end-of-life care pathways and/or standard operating procedures. Eighty-two percent desired educational training concerning end-of-life decisions and the validity of advance directives., Conclusion: The prehospital emergency treatment of palliative care patients can be particularly challenging for any EP. A high percentage of the EPs in our study felt insecure in dealing with advance directives and ethical and end-of-life decisions in palliative care patients. Our results suggest that EPs may need more information and education about palliative medical care, legal issues and ethical and end-of-life decisions to provide adequate patient-oriented palliative care in prehospital emergency situations.
- Published
- 2011
50. [Glossopharyngeal neuralgia after resection of a glossopharyngeal schwannoma].
- Author
-
Lassen CL, Kleinjung T, Strutz J, Graf BM, and Wiese CH
- Subjects
- Administration, Oral, Adult, Analgesics administration & dosage, Analgesics, Opioid, Buprenorphine, Chronic Disease, Female, Humans, Injections, Magnetic Resonance Imaging, Pain Measurement drug effects, Pregabalin, Superior Cervical Ganglion drug effects, gamma-Aminobutyric Acid administration & dosage, gamma-Aminobutyric Acid analogs & derivatives, Autonomic Nerve Block, Glossopharyngeal Nerve surgery, Glossopharyngeal Nerve Diseases diagnosis, Glossopharyngeal Nerve Diseases drug therapy, Neurilemmoma surgery, Pain, Postoperative diagnosis, Pain, Postoperative drug therapy
- Abstract
Glossopharyngeal neuralgia is a rare condition and the origin is mostly idiopathic. Causes of symptomatic glossopharyngeal neuralgia can be tumors, infarction or trauma. We report the case of a 28-year-old patient who developed glossopharyngeal neuralgia after resection of a glossopharyngeal schwannoma, which is an extremely rare tumor. Treatment consisted of orally administered pregabalin and a series of injections of buprenorphine in the superior cervical ganglion (ganglionic local opioid application/analgesia, GLOA) which led to a substantial decrease in the frequency of pain attacks. This improvement was maintained at 1-year follow-up. This is the first report of development of glossopharyngeal neuralgia after resection of a glossopharyngeal schwannoma.
- Published
- 2011
- Full Text
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