Der Schmerz
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Postoperative pain can intensify the sympathoadrenergic reaction, which is commonly seen after surgery, and thus possibly pave the way for certain complications, such as coronary ischemia, bronchopneumonia, intestinal stasis, thromboembolism, infection, sepsis, and metabolic disturbances. Investigations of cardiovascular, respiratory, gastrointestinal, metabolic, and immunologic function indicate that high-quality pain relief can diminish postoperative organ impairment and failure. Some aspects of the improvements attributed to the quality of analgesia, such as prevention of tachycardia and hypertension, attenuation of hyperglycemia and catabolism, improvement of gastrointestinal motility and cellular immunity cannot be definitely distinguished from the effects of sympathetic blockade due to epidural analgesia with local anesthetics, however. ⋯ Some studies indicate that better analgesia is advantageous for the patient, especially with respect to postoperative complications, hospital stay, long-term well being, and costs. In other clinical trials incorporating more patients, however, this hypothesis had to be rejected. At present, therefore, we cannot state that effective pain relief influences postoperative morbidity and mortality.
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Amalgam, which has long been used as a restorative material, has recently become the target of more and more criticism. An assessment of amalgam requires consideration of different aspects of toxicology, allergology, electrochemistry, psychology, and dentistry. ⋯ Almost all preventive or therapeutic dental treatment can have adverse effects, and an attempt to eliminate all risks could well eliminate established methods in dentistry as well. This paper presents the ramifications of an amalgam ban, which is being called for by various groups, in some detail.
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Sixteen experienced and 15 inexperienced observers watched videotapes showing participants of a back school program perform simple tasks to assess the functional adequacy of their posture. They had received basis or more extensive observer training. Intraclass correlation coefficients were computed as a measure of intra-and interobserver reliability. ⋯ By selecting the most reliable items two alternative measures of overall posture were constructured whose reliability coefficients ranged fromr=0.89 to 0.93 for the group of experienced observers. The reliability of the judgments by the more extensively trained inexperienced observers was also satisfactory. The observation method presented here can thus be regarded as a reliable and potentially valid instrument for assessing the outcome of back school programs.