Der Schmerz
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Comparative Study Controlled Clinical Trial
[Multidisciplinary outpatient care program vs. usual care : Cost-benefit analysis in patients with chronic low back pain.]
Chronic low back pain (CLBP) is a major health problem in industrialized nations and is associated with very high total costs. These costs are split between direct costs brought about by the utilization of health care services and indirect costs due to back pain-related loss of productivity. Despite the existence of some evidence about the effectiveness of a multidisciplinary outpatient care programmes in Germany, the economic benefit of these programmes has not yet been studied in detail. ⋯ This study provides important information which is of value for decision-making and making an adequate allocation of medical resources for patients with CLBP. A multidisciplinary outpatient care programme can facilitate rapid return to work.
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The prevalence of chronic pain has been estimated to be 19% in the European population and criteria for disabling chronic pain were found in approximately 7% of the German population. Clinical care for these patients is provided in ambulant and hospital-associated facilities. In this context, invasive interventions are part of the diagnosis and treatment of several specific diseases. Current data on the structure of clinical care based regional anesthesia for chronic pain patients in Germany are not available. ⋯ This survey describes the current structures of specialized pain facilities for regional anesthesia in Germany including responses from predominantly anesthesiologists in a hospital-associated setting. In light of the limited evidence in the literature there is no consensus on the interventional therapeutic management of chronic pain. Especially the application of a series of blocks and the frequency as well as criteria to support continuing or terminating a series of regional anesthesia interventions are not sufficiently evaluated. This survey also gives an incentive for a possible revision of the existing practice in regional anesthesia in the context of multimodal therapy and currently existing guidelines in future clinical studies.
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Adequate and sufficient data on pain in nursing home residents is still lacking in Austria. This study intends to gather and increase available data on pain and pain assessment as well as identify potential improvement possibilities. ⋯ Our data on pain indicate a definite need for action. Accurately detecting pain requires reliable and resident-adapted means of assessment. Varying prevalence, specificity, and sensitivity numbers indicate the need for further research.
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The current debate about end-of-life decisions in Germany focuses on physician-assisted suicide (PAS). However, there is only limited information available on physicians' attitudes towards euthanasia or PAS, and no data on nurses' attitudes. ⋯ The fact that nurses had a more positive attitude towards euthanasia and PAS and that all respondents accepted life-ending acts for themselves more than for their patients hints to still existing severe deficits in Germany.
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We report on two patients with schizoaffective psychosis, cancer, and pain. However, it is not possible to make somatic or psychic disturbances alone responsible for the pain. In patients with current schizoaffective disorders, only administration of a combination of psychopharmaceutical and opioid agents is successful.