Der Schmerz
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Older patients, particularly those with multimorbidity, complain about many symptoms which also occur under analgesics (especially with opioids). The goals of the study were to quantify symptoms and discuss the relationships to analgesics, pain, multimorbidity, function, age and gender. ⋯ Our results underline the difficult interpretation of symptoms as a side-effect of analgesic treatment in older patients. Pain and gender differences have to be considered. The recommendation to carefully record symptoms before analgesic treatment is supported by our results.
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Criterion-related validity of the Mainz Pain Staging System (MPSS) was examined. ⋯ The results support criterion validity of the MPSS, however, they also corroborate the concept that identification of medium and high grade pain by the MPSS has to be followed by a psychological diagnostic assessment. By this stepwise diagnostic process, therapy aims and treatment regimens can be designed more adequately.
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This paper examines a new approach to managed healthcare where a network of care providers exchanges patient information through the internet. Integrating networks of clinical specialists and general care providers promises to achieve qualitative and economic improvements in the German healthcare system. ⋯ The implementation and use of a cross-spectrum computerized solution for the management of patients and their care is the key for a successful managed healthcare system. This paper documents the managed healthcare of chronic headache patients and the development of an IT-solution capable of providing distributed patient care and case management.
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In order to match the interindividual and intraindividual differences in opioid requirements of pediatric oncology patients with mucositis, patient-controlled analgesia (PCA) seems to be the optimal pain therapy option, but scientific data are lacking. ⋯ PCA seems to be an ideal, dependable and feasible mode of analgesic administration for the individual titration of dose in children with chemotherapy-induced mucositis. This is expressed through the increase in daily self-administered opioid doses after starting PCA, the huge interindividual variability in opioid consumption and the rare event of an un-delivered bolus request during lock-out time. With the use of a background infusion, additional bolus requests are rare during the night.