Der Schmerz
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Review
[Dipyrone (metamizole) : Considerations on monitoring for early detection of agranulocytosis].
Dipyrone (metamizole) is a non-opioid analgesic commonly used in Germany, which can, in very rare cases, cause life-threatening agranulocytosis. The prescribing information calls for regular monitoring of the differential blood count in cases of long-term treatment. However, there is uncertainty about how this testing should be handled in practice. ⋯ Providing patients and medical staff with better information about early symptoms of agranulocytosis could be a sensible way to prevent complications. Any suspicion of agranulocytosis should immediately lead to a differential blood count and to the withdrawal of all drugs possibly associated with agranulocytosis. Patients should be monitored and treated according to the severity of their symptoms.
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After having completed medical treatment cancer patients often suffer from pain that can impair the quality of life. While young adolescents and adults (AYA) with cancer have become the focus of research during recent years, literature on the prevalence, quality and relief of pain in AYA patients is lacking. ⋯ This study provides evidence that pain plays a relevant role for AYA patients after the end of medical treatment. A substantial proportion of AYA patients reported the need for support so that the question arises whether medical pain management is sufficient, particularly as pain was associated with impairment and strongly negatively associated with health-related satisfaction.
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Comparative Study Historical Article
[Historical pain concepts : Cultural influences on pain perception and interpretation].
In the age of globalization and cultural diversification differing concepts of pain in patient care are of increasing importance. Historical models of the origin and interpretation of pain, which in this article are presented in a cursory and exemplary way, help to understand the panoply of modern concepts outside of medicine. Basically, pain was viewed not only in religion and philosophy but also by premodern physicians as a psychophysical phenomenon crucially depending on the determination by a "soul" therefore creating therapeutic options even before the discovery of an effective analgesia. Furthermore, the historical interpretations of pain in and outside of medicine can still be of profound importance to patients even today.
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In September 2009 a new legislation for advance care planning was introduced in Germany with the important characteristics of bindingness and unlimited validity for individual directives. Knowledge regarding this act and the attitude towards its characteristics among patients is unclear. ⋯ The proportion of patients with a directive regarding advance care planning is only slowly increasing. Many patients are not well-informed, do not want to deal with dying or would like to delegate decisions to relatives and physicians. The present characteristics of the German legislation are controversially assessed and often do not represent the wishes of the patients.
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Palliative care is an approach that improves the quality of life of patients with incurable and progressive illnesses; therefore, in these situations physiotherapy can play an important role. ⋯ Despite its significant potential to relieve symptoms, physiotherapy is not systematically integrated into palliative care practice in Germany.