Wiener medizinische Wochenschrift
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Wien Med Wochenschr · Jan 2003
Advance directives for psychiatric patients? Balancing paternalism and autonomy.
Advance directives contain wishes and values, fears and refusals of competent lay people regarding medical interventions in future situations when they might lack communicative and decision-making capacities. However, these advance directives for medical, psychiatric and care interventions can very well be used to improve the care for patients in psychiatry and gerontopsychiatry and to provide individualized care and treatment. The development and use of advance-care documents in psychiatry, and the clinical and ethical appreciation and recognition of the wishes and values of those patients, represent a particularly difficult challenge to medical paternalism.
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Wien Med Wochenschr · Jan 2003
Clinical Trial[Effectiveness and safety of rectal analgesic sedation in ambulatory pediatric surgery].
Purpose of the study was to evaluate efficacy and safety of conscious sedation in ambulatory pediatric surgery. During 50 settings 38 patients were administered 0.75 mg/kg Ketamine and 0.4 mg/kg Midazolam rectally prior to the diagnostic or therapeutic procedure. Effects on vital signs, anxiolysis and pain reduction were documented. ⋯ Conscious Sedation can been administered safely by the physician, even in the absence of anesthesiological colleagues, as long as the correct indication is taken account of and only well established analgetics in standardised doses are given. Furthermore the intervention needs to take place in a well-organised setting. Advantages of the procedure are a cooperative patient with stable vital signs with the patients themselves and their parents profiting from stress-reduction through amnesia and effective pain management.
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On 10 April 2001, the Netherlands was the first country to pass a law on the killing of patients at their request (euthanasia), which took effect on 1 April 2002. Belgium followed and passed a euthanasia law on 16 May 2002, which took effect on 23 September 2002 and is even more liberal than the Dutch one. Physicians will be exempted from criminal liability provided they satisfy the so-called 'due care criteria'. ⋯ The current article provides insights into the Dutch, Belgian and Oregon euthanasia and physician-assisted suicide practices and reflects upon some central medical and legal documents on the regulation of euthanasia and the provision of palliative care. Modern palliative care includes both the delivery of competent palliative skills and a virtuous attitude of compassionate caring about the terminally ill patient as an autonomous person. Here, the author rejects killing as due care and proposes a novel concept of 'RAHME' (Aramaic: compassion, love, mercy), which calls for a holistically oriented concept where physicians act as companions to the terminally ill and dying patients.
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As doctors we are required to pursue symptom complaints and treat them, no matter whether they bear objectively verifiable evidence of specific disorders or not. In treatment we also take Hypnosis background feelings, conflicts or fatigue into account as contributing components. This fact pertaining to the practice of medical psychotherapy is central to the treatment of all patients suffering from psychosomatic disorders--i.e. approximately one half of all patients being treated by general practitioners. ⋯ Hypnosis is above all else useful in encouraging patients to contribute their very own individual resources to a multi-modal and interdisciplinary comprehensive therapy concept. This proves itself in the long run to be a factor that promotes a significant emancipation of the patient from those dependencies that are an outgrowth of illness (see hypnosis and self-hypnosis for symptom control) as well as the treatment system (optimal coping, self management) through the application of personal skills. A bio-psycho-social understanding of disorder is--both for ourselves as medical doctors (as "specialists of the objective dimension of the body") and for our patients (as "specialists of the subjective dimension of person")--a "conditio sine qua non".
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Wien Med Wochenschr · Jan 2003
[Surgical therapy of acute endocarditis of the aortic valve with paravalvular abscess. 7 years experiences].
Operative treatment of acute valve endocarditis with paravalvular abscess remains a surgical challenge. The aim of the study was gaining insights into the influence of our surgical strategy on the short- and midterm results. Over a period of 7 years 18 patients underwent surgical treatment of a paravalvular abscess accompanying their acute aortic valve endocarditis. ⋯ The operative risk of acute aortic valve endocarditis with paravalvular abscess is high but acceptable. Should a paravalvular abscess be diagnosed during a case of endocarditis urgent surgical therapy is highly advisable even there is only a minor deterioration of the patient' clinical state. Radical abscess debridement in combination with exclusion of the place of resection from circulation using an autologus pericard patch is a necessary condition for achieving good results.