Zentralblatt für Chirurgie
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To describe the idea of palliative medicine and its forms of organization in the inpatient and outpatient sectors, and in particular to describe the projects for palliative medicine at the University of Cologne, specifying costs and the 1996 statistics of the palliative care unit. ⋯ Palliative medicine is expensive; only a few patients have the benefit of this; relatives may suppose to be relieved of the burden of their responsibilities; however: the severely ill and dying patients of the hospital experience the best possible care at home or in a "family atmosphere"; gain in experience of palliative medicine and multiplier function, research; awaking our society to thoughts of their own hour of death and what comes after it.
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Palliative care is the active total care of patients whose disease is not or no more responsive to curative treatment. Its action strategies should be applied at the time when the goals change from cure to care. Palliative care is total care of body, mind and spirit. ⋯ The general principles of treating dyspnoea and pain are the same as for any other aspect of treatment in palliative care: 1. to define and treat the underlying cause of dyspnoea wherever possible and reasonable for the patient. This includes oncological interventions such as chemotherapy and radiotherapy as far as the patient's status allows it. 2. to relieve dyspnoea without adding new problems by way of sideeffects, interactive effects, social or financial burdens. The rule of proportionality to treatment affirms that symptom control and life-prolonging treatment are contraindicated when they cause more suffering than benefit. 3. to consider whether a treatment will be worthwhile for the patient and his family bearing in mind his prognosis and adverse effects of invasive procedures. 4. to discuss all reasonable treatment options (including the decision of "no intervention") with the patient and his family, allowing them to make the final decision as far as possible by themselves.
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Randomized Controlled Trial
[Influence of laparoscopic or conventional colorectal resection on postoperative quality of life].
In a prospective randomised study the influence of the operative technique on postoperative quality of life was evaluated in 60 patients undergoing laparoscopic (n = 30) or conventional (n = 30) resection of colorectal tumors. Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Core 30 Questionnaire (EORTC-QLQ-C30) before surgery as well as 1 week, 4 weeks and 3 months after surgery. Age, sex, sociological parameters, tumor characteristics and type of resection were comparable in both groups. ⋯ Pain, dyspnea and loss of appetite were more severe 1 week after conventional than laparoscopic surgery (each p < 0.05). There were no differences in quality of life in the further postoperative course. Laparoscopic resection of colorectal tumor is related with a better short-term quality of life than conventional resection, but a longer lasting effect of the laparoscopic technique on quality of life could not be detected with the EORTC-QLQ-C30.
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Review Case Reports
[Ethical challenges in preclinical emergency medicine].
Out-of-hospital emergency medicine, just like any other medical field, must be guided by general ethical principles of medical action. These include respecting the patient's autonomous decision, acting for his benefit, avoiding harm, and justice in distributing the available means. The confrontation with ethical conflicts in the routine of emergency medicine is illustrated by a case report. ⋯ Physiologically defined futility justifies the decision to withhold resuscitative efforts. In a particular case the refusal by the patient as well as an expected bad prognosis which is inconsistent with the patient's interest could support the emergency physician's decision not to initiate resuscitation. Such an individual decision should not only be guided by medical, but also by ethical considerations and be based on general ethical principles.