RESUMEN
OBJECTIVE: Evaluation of the effectiveness of local application of morphine or ropivacaine for treatment of local and radicular pain after lumbar disc operations. Critical review of the literature about the possibilities of management of postoperative pain after spinal operations. METHODS: A total of 113 patients were randomly given 5 mg morphine sulfate (N=42), 10 ml 0,25% ropivacaine (N=42) or physiological NaCl solution (N=21) locally after lumbar disc operation before wound closure. Postoperative lumbar and radicular pain was scored by the patients from 0 to 10 and registered on the evening of the day of operation and on the 1., 2., 3., and 5. days. Mean pain numbers of the 3 groups have been compared, subdivided into local lumbar and in radicular pain. Our own results have been compared with the results of reports in the literature. RESULTS: In our own study the morphine group had less lumbar and less radicular pain on all 5 days than both of the two other groups. This difference was statistically significant on days 0, 1, 2, and 3. The ropivacaine group was on all days less effective than the morphine group, better than the placebo group on the operation and first day, but the difference against the placebo group was statistically not significant. CONCLUSION: Local application of 5 mg morphine sulfate is effective in prevention or reduction of postoperative lumbar and radicular pain after lumbar disc operations. Ropivacain is less effective. The routine application of epidural morphine at the end of spinal operations can be recommended. It also can be justified to try to prolong the morphine effect by mixing it into a paste as described by Needham and by Hurlbert, and to irrigate the operative field with ropivacaine at the end of the operation.
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Amidas/administración & dosificación , Amidas/uso terapéutico , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Morfina/administración & dosificación , Morfina/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiología , Relación Dosis-Respuesta a Droga , Humanos , Inyecciones Epidurales , Dimensión del Dolor , Estudios Prospectivos , Ropivacaína , Resultado del TratamientoAsunto(s)
Comités de Atención Animal , Bienestar del Animal/normas , Revisión Ética/normas , Modelos Animales , Revisión de la Investigación por Pares/normas , Proyectos de Investigación/normas , Experimentación Animal , Derechos del Animal , Animales , Toma de Decisiones , Revisión de la Investigación por Pares/métodos , Reproducibilidad de los Resultados , Factores de TiempoAsunto(s)
Accidentes por Caídas , Hipotensión Ortostática , Periodo Posprandial , Anciano , Femenino , HumanosAsunto(s)
Servicios de Salud Comunitaria/organización & administración , Educación Continua/organización & administración , Geriatría/educación , Personal de Salud/educación , Capacitación en Servicio/organización & administración , Grupo de Atención al Paciente/organización & administración , Desarrollo de Programa/métodos , Anciano , Humanos , Evaluación de Necesidades , Técnicas de Planificación , SuizaRESUMEN
Clinical ethics is generally related to the clinical bedside activity. Clinical ethics constitutes one aspect of bioethics. In particular, its aim consists in facilitating the solving of conflicts of values in practical care. By encouraging effective communication and discussion within the interdisciplinary team, geriatricians will be able to make adequate diagnostic and therapeutic interventions, in accordance with the fundamental desire of the patient and her or his family.
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Medicina Clínica , Medicina Comunitaria , Ética Médica , Geriatría , Humanismo , Defensa del Paciente , Anciano , Conflicto Psicológico , Promoción de la Salud , Humanos , Grupo de Atención al Paciente/organización & administración , Cuidado TerminalRESUMEN
Does communication with terminal cancer patients about their disease influence their psychological well-being? The degree of patient-carer consensus about the disease was compared to psychological well-being related to acceptance of the disease, emotional state, and hope. These were evaluated and scored from 6 (good) to 0 (poor) through a semi-structured interview of 10 open-ended questions. Nineteen palliative care patients were studied, 18 of whom were suffering from advanced cancer. Overall, 57 interviews were conducted with the patients, staff nurses, and medical doctors. The answers of the carers (staff nurses and doctors) were compared to the patients' answers to determine the degree of consensus in terms of communication about disease, aim of treatment, and ultimate objective of hospitalization. The consensus between patients and carers was scored from 6 (satisfactory) to 0 (unsatisfactory). A significant positive correlation between the scores of consensus and those of psychological well-being (r = 0.90, p < 0.001) was found. These results suggest that good and truthful communication may improve patients' psychological well-being.
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Adaptación Psicológica , Actitud del Personal de Salud , Neoplasias/psicología , Cuidados Paliativos , Calidad de Vida , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Proyectos Piloto , Relaciones Profesional-Paciente , SuizaRESUMEN
Nineteen-year-old Swiss Army conscripts were questioned in 1992 (n = 1361) and 1995 (n = 1050) about their opinions regarding pain and euthanasia. In 1995, 85% (1992: 71%) considered pain as a fundamental part of life, 73% (1992: 77%) thought that the patient himself should decide how to control pain, and 50% (1992: 51%) would accept the idea of euthanasia at the request of a family member with an incurable disease and in pain. Significant differences were found only in correlation to the degree of religious belief.
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Actitud , Eutanasia , Personal Militar/psicología , Dolor , Adulto , Analgesia , Humanos , Masculino , Defensa del Paciente , Religión y Medicina , SuizaRESUMEN
OBJECTIVE: To investigate the change in systolic blood pressure (SBP) induced by meals and to compare their impact on the orthostatic SBP response in elderly Parkinson's disease with that in control patients. DESIGN: Ten elderly patients suffering from Parkinson's disease were compared with 10 age-matched elderly control patients. METHODS: The postprandial SBP change was measured by means of ambulatory blood pressure monitoring with the patient in the supine position. Orthostatic SBP responses were measured the next day by means of active standing and passive head-up tilting tests performed before and after the patients had their lunch. RESULTS: In Parkinson's disease patients, a postprandial SBP drop of 27 mmHg in the supine position was found compared with a drop of 8 mmHg in controls. In Parkinson's disease patients, that drop was moderately correlated to the orthostatic SBP responses and significantly correlated to the preprandial supine baseline SBP level. The orthostatic fall in SBP was greater with passive than with active standing and with both it was greater in Parkinson's disease patients than in the control subjects. The fall in orthostatic blood pressure was reduced by a previous meal. In contrast, there was no difference in orthostatic heart rate responses between the patients and the controls. CONCLUSIONS: Parkinson's disease patients demonstrated a significant postprandial drop in SBP and a tendency towards orthostatic hypotension, which was not worsened by the meal, probably owing to a stronger sympathetic activation. Postprandial supine SBP change and orthostatic SBP responses were only moderately associated in Parkinson's disease patients. In addition to autonomic dysfunction, an increased baseline SBP level might contribute to both phenomena.
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Envejecimiento/fisiología , Presión Sanguínea , Ingestión de Alimentos/fisiología , Hipertensión/fisiopatología , Enfermedad de Parkinson/fisiopatología , Anciano , Anciano de 80 o más Años , Femenino , Hemodinámica , Humanos , Hipotensión Ortostática , Masculino , Postura , SístoleAsunto(s)
Reposo en Cama/efectos adversos , Hospitalización , Enfermedad Iatrogénica , Anciano , Anciano de 80 o más Años , Infección Hospitalaria/etiología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Femenino , Evaluación Geriátrica , Humanos , Tiempo de Internación , Masculino , Estudios ProspectivosRESUMEN
The high frequency of infections in the elderly, at home as well as in institutions, raises the question of the place antibiotic therapy should occupy. Too often, unfortunately, antibiotic therapy is prescribed indiscriminately in cases of infection. Between therapeutic abstention and overtreatment there is room for a more rational and adapted medical decision which is the outcome of a clinical process integrating a rigorous biomedical approach, taking due account of the environment, the functionality and the quality of life of the elderly patient. The importance of human, ecological, pharmacological and economic constraints should lead to deeper consideration of the appropriateness of antibiotic therapy in geriatric practice.
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Antibacterianos/uso terapéutico , Ética Médica , Infecciones/tratamiento farmacológico , Anciano , Antibacterianos/administración & dosificación , Antibacterianos/economía , Costos de los Medicamentos , Mal Uso de los Servicios de Salud , HumanosRESUMEN
Although evaluation scales for quality of life (QOL) represent considerable progress in medicine, clinical experience shows striking discrepancies between QOL as evaluated by caregivers and QOL from the patient's point of view. Such paradoxes of QOL are analyzed and discussed. Autonomy is universally advocated but may be denied, especially in the hospital setting, where caregivers, family members, and doctors act as a pressure group. Circumstances that deepen the contradictions in QOL assessment include (a) a high degree of patient dependence, (b) a professional judgement that a patient is incompetent (c) professional values being placed over a patient's values, (d) a multidisciplinary team acting as a pressure group, (e) a lack of effective communication with the patient, and (f) a determination to minimize the symptoms at evaluation. QOL is multidimensional, complex, difficult to measure in clinical practice, and sometimes paradoxical.
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Actividades Cotidianas , Calidad de Vida , Cuidado Terminal/psicología , Anciano , Anciano de 80 o más Años , Actitud Frente a la Salud , Cuidadores/psicología , Comunicación , Femenino , Humanos , Control Interno-Externo , Masculino , Competencia Mental , Investigación Metodológica en Enfermería , Grupo de Atención al Paciente , Participación del PacienteRESUMEN
A prospective study for the treatment of cerebellar haemorrhage was conducted in a non-selected group of 33 patients. All patients with cerebellar haemorrhage arriving at the Department of Neurosurgery at Homburg/Saar have been included in this study, also those in bad condition, with high risk factors, and the aged. All of them required intensive care respectively intensive supervision. The following management protocol has been established. I. Cases with small haemorrhage, in good clinical condition, without hydrocephalus and/or occlusion of the basal cisterns: intensive supervision, operative intervention only if they deteriorate into one of the following groups. II. Cases with hydrocephalus-even if not yet pronounced-but without occluded basal cisterns and without major tonsillar herniation: pressure monitored ventricular drainage, which opens at 15 mm Hg and thus prevents higher CSF pressure developing. III. a): Cases with large haematoma, occluded basal cisterns and/or tonsillar herniation, but without severe general risk factors, as a first step: pressure monitored ventricular drainage; as a second step, if they do not improve soon after the normalization of the ventricular pressure: open surgical evacuation of the haematoma, which also decompresses the posterior fossa. If present and possible, causative vascular malformations may be dealt with at the same session. III. b): Same intracranial situation, but patients with severe general risk factors: pressure monitored ventricular drainage only. IV. Cases with causative aneurysm or angioma, who initially had been treated conservatively or by ventricular drainage: secondary operation of the vascular malformation after stabilization of the general conditions.(ABSTRACT TRUNCATED AT 250 WORDS)