Articles: palliative-care.
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Z Arztl Fortbild Qualitatssich · Sep 2000
[Treatment of nausea nad vomiting in palliative medicine].
Nausea and vomiting are the most distressing gastrointestinal symptoms in patients with far advanced malignant diseases. A complex pathophysiology exists between gastrointestinal tract and brainstem. Neurotransmitters play an important role. ⋯ Dependent on the cause the antiemetic, which blocks receptors peripherally or centrally, will be chosen. Main antiemetic groups are prokinetics, 5HT3-antagonists, dopaminantagonists, antihistaminics and phenothiazines. Symptom relief can be reached in 90% of the patients with a differentiated approach.
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Z Arztl Fortbild Qualitatssich · Sep 2000
[Consideration, assessment and treatment of difficulty in breathing in palliative medicine].
Next to pain, the most frequent fear of dying patients, their relatives and doctors in attendance is to suffocate, even if there is no significant dyspnoea. During their progress of disease, around half (40-60%) of all tumour patients suffer from difficulty in breathing. This is due to many reasons, which include the entire differential diagnosis of dyspnoea as well as psychological and social aspects. ⋯ Besides application of demand drugs as morphine and lorazepam the most important therapy against asphyxia is the individual treatment of symptoms. All people involved should be educated in general treatment, nursing and psychological care to reduce the dying patient's fear of suffocation. This will result in the reduction of the patients states of panic and therefore allow them to die in a more peaceful way.
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This study reports on experience acquired during the care of patients who could not participate in surgery, chemotherapy or radiation therapy because of the extent of the primary, recurrent or metastatic tumour, or because of the deterioration of the general condition or (in the event of recurrence), intervention with a curative aim could not be performed for the mentioned reasons. In these cases, improvement or preservation of the quality of life is the fundamental goal to be achieved at all times, for these patients must receive the best possible supportive treatment for the remainder of their lives, Unfortunately, the quaranteeing of this often tends to become mainly a financial question rather than a professional one. The medical staff has very little chance to influence the financial aspects, and must therefore do everything possible to ensure the highest possible level of care during hospitalization. Attention is drawn to the significant roles to be played by the family, the family doctor, the various home-care services and the hospice.