Wiener medizinische Wochenschrift
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Wien Med Wochenschr · Jan 2003
Comparative Study[Transdermal buprenorphine for treatment of chronic tumor and non-tumor pain].
Patients with moderate to severe pain were treated with buprenorphine patches in one of 3 concentrations: 35 micrograms/h, 52.5 micrograms/h and 70 micrograms/h (= 0.8 mg/d, 1.2 mg/d and 1.6 mg/d respectively). The aim of this review was to assess the efficacy and tolerability of this transdermal system (TDS) in patients with chronic pain. A total of 445 patients were included in 3 double-blinded studies. ⋯ Half the cases of erythema and more than on third of the cases of pruritus were spontaneously reversible. More than half the patients (53.7%) in the double blind studies wished to continued treatment with buprenorphine transdermal system. These results demonstrate that buprenorphine patches achieved a very good analgesic effect in all 3 studies and that in particular with respect to the quality of life of the patient these patches offer an exceptional alternative to other conventional therapies.
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Wien Med Wochenschr · Jan 2003
[The geriatric psychiatry patient--a new indications field for psychotherapy?].
Despite the fact that 9% of the elderly would need psychotherapeutic treatment, only 1% of the applications for such treatment were initiated by the elderly. Older people often lack the ability to verbalize their emotional problems, which is an obvious prerogative for expressing the wish for psychotherapy. However elderly people tend to indulge in childhood memories, and therefore would be excellent candidates for psychoanalytic-orientated treatment. ⋯ Psychotherapy in a narrow sense is indicated when the psychic structure, the mental flexibility and the motivational state are quite good and if differentiated verbal interactions are possible. In a broader sense, psychotherapy stands for actional and training aspects, and integral environmental and socio-therapeutic treatment so that autonomy and quality of life can be properly improved. This definition of psychotherapy makes it obvious that demented and care-dependent patients are potential candidates for psychotherapy.
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Wien Med Wochenschr · Jan 2003
Review Comparative StudyPrevention and treatment of bleeding by pro-hemostatic treatment strategies.
Pro-hemostatic therapy may achieve an improvement of hemostasis, by amelioration of primary hemostasis, stimulation of fibrin formation or inhibition of fibrinolysis. Pro-hemostatic interventions appear to be effective in reducing peri-operative blood loss and reducing transfusion requirements in specific situations and may be helpful adjuncts in the management of severe spontaneous and post-operative bleeding. The risk of a higher incidence of thrombotic complications associated with the use of pro-hemostatic therapy is unknown but seems not to be very high in clinical practice. There is a need for more systematic and adequately controlled clinical observations to better establish the efficacy and safety of pro-hemostatic interventions.
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Nowadays, fibromyalgia syndrome (FMS) should be diagnosed according to established criteria in order to differentiate it from other specified or unspecified pain conditions. Various underlying reasons for pain exist and possible correlations with FMS should be thoroughly discussed with the patient. Recent pathophysiological examinations suggest that fibromyalgia syndrome may constitute a disorder of the central nervous system, especially of the hypothalamus-hypophysis-axis, and/or of the autonomous nervous system and of pain regulating nerves. ⋯ Extensive patient information, therapeutic devotion and means of physical therapy seem to be more efficient, providing a multitude of therapeutic options. Both fibromyalgia syndrome and chronic fatigue syndrome have to be accepted as medical entities, treated efficiently and studied scientifically. By these means, patients suffering from fibromyalgia syndrome, will not be lost to non-established forms of therapy.
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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.