Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
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Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz · Nov 2006
Review[Comprehensive nursing care of the terminally ill and the dying patient. Selected symptoms and interventions].
The special care and attention due to terminally ill and dying patients will be demonstrated in this contribution with the help of specifically chosen paradigm cases and examples. The paper focuses on the needs of dying patients and their (nurs ing) relatives during the last days/hours of life (48-72 hours). ⋯ Especially subcutaneous therapy has been shown to be a simple, non-invasive, and outstandingly effective option for easing symptoms and suffering of terminally ill people. Furthermore, this contribution wants to stimulate the critical reflection of carers within their own organizational structure in order to foster patient focused, competent, and comprehensive therapy, care, and attention of terminally ill and dying patients during their last days of life.
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Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz · Nov 2006
Review[Supporting severely ill and dying children. Suggestions for practical interventions].
In our culture, the death of a child is a rare, but shocking experience. Supporting severely ill or dying children requires knowledge of developmental psychology and consideration of their social environment. This article summarizes aspects of children's concepts of death and outlines the psychological reactions of seriously ill children and adolescents. Finally, the authors provide practical suggestions for meaningful interventions.
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Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz · Nov 2006
Review[Palliative care in Germany].
The delivery of palliative care in Germany is still characterized by a wide-spread undersupply both for inpatients and outpatients. Nevertheless over the last 15 years progress has also been made in Germany, which is pleasing and which has directed professional and public attention increasingly to the situation of the incurably ill and dying. In the course of this development the first structures for specialized palliative care have been established. ⋯ It is important to realize the needs of the incurably ill and dying and of their relatives and friends. Our society has to call attention to this subject and it should be placed on the healthpolitical agenda as a topic of the highest priority level. The current developments in the federation and in the federal states are encouraging and allowing hope that the delivery of palliative care for all who need it (and not only the ill) will improve further in the coming years.
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Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz · Nov 2006
Review[Pastoral care in palliative medicine].
The orientation of life before death towards a quality as high as possible leads to an understanding of palliative medicine not as a pure medical discipline but rather as an integral approach of different disciplines, professions and services, combining several sectors and not being restricted to professionals. Within this change of patterns the pastoral care contribution is developed from professional clinical pastoral care, at first the pastoral care attitude in palliative medicine, challenged by the irritating expectation which dying and death every time demands of all involved. ⋯ Different competence areas of pastoral care are linked to the dimensions of myth, ethos and rite. Finally a couple of tasks and challenges concerning interreligious cooperation, the cooperating with relatives and volunteers as well as structural questions of pastoral care are mentioned.
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Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz · Oct 2006
Review Comparative Study[State of the art of pharmacogenetic diagnostics in drug therapy].
Individual differences in the effect and side effect of drugs are partly due to genetic factors (genetic polymorphisms). The responsible polymorphisms lie in genes encoding for drug metabolism and transport but also in direct and indirect drug targets. While genetic variants in pharmacokinetic structures exert effects on drug efficacy via the differences in drug exposure, polymorphisms in drug targets can directly affect clinical efficacy and may lead to a broad variation spectrum between inefficacy and severe side effects. ⋯ The most important reason, however, may be that most results of pharmacogenetic research are so far not translated into therapeutically usable conclusions and therapy recommendations. Thus, testing for a genotype without concrete consequences for the drug therapy of an individual patient does not make sense. Pharmacogenetic research, thereby, stands in many cases at the threshold to clinical applicability and in many cases, for instance for the genotyping for thiopurine methyltransferase polymorphisms prior to azathioprine therapy or of dihydropyrimidine dehydrogenase polymorphisms prior to treatment with 5-fluorouracil, as well as for diagnostics of CYP2D6 before therapy with certain tricyclic antidepressants and neuroleptics, one would ask already today whether a such drug therapy is still responsible without pharmacogenetic diagnostics.