Articles: patients.
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The objective of this survey was to investigate the current status of the epidural and intrathecal management in patients with chronic cancer and non-cancer pain in Germany and Austria. ⋯ Epidural and intrathecal pain therapy is frequently used in Germany and Austria, either as a complementary or alternative treatment to systemic pain therapy. Local anaesthetics followed by opioids are the most commonly used medicaments for this treatment. For some of the applied substances neurotoxicological data are lacking. The use of these substances has to be considered very carefully.
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We performed 52 peripheral nerve stimulation procedures since 1991. In addition to 48 patients with CRPS II, 4 patients with phantom-limb pain were treated. Incomplete or complete lesion of the stimulated peripheral nerves was determined in all patients. Surgically treatment failed in all cases. All patients had been given extensive conservative pain therapy. ⋯ Neurostimulation of peripheral nerves should be considered as an established concept to treat surgically failed peripheral nerve lesions.
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Outcome quality of medical treatment depends on structure quality of the treatment facility. In the present study we tried evaluate structural parameters of outpatient treatment facilities relating to management of headache, low back pain and cancer pain. ⋯ There are considerable structural deficits in outpatient treatment facilities involved in management of patients suffering from chronic headache, chronic back pain and cancer pain. Realisation of standards according to the "Schmerztherapievereinbarung" needs organisation of an interdisciplinary network between the different specialties necessary for pain management. Interdisciplinary cooperation should be supported by the official organization of the medical self-government in Germany--the Kassenärztliche Vereinigung--which has to assure optimal conditions for outpatient treatments.
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Two-thirds of deaths from coronary disease occur in the pre-hospital phase and are caused by ventricular fibrillation or pulseless ventricular tachycardia, for which electrical defibrillation is the only effective treatment. The time delay between the onset of ventricular fibrillation and the administration of the first defibrillatory shock is the most important determinant for survival. To achieve the earliest defibrillation possible, rescuers others than physicians need to be able to initiate this treatment. ⋯ The 'Utstein Style' nomenclature is a glossary of terms and a reporting guideline for uniform description of cardiac arrest, resuscitation, the emergency medical service (EMS) system and the outcome. Reports on experiences with AED programmes by traditional and non-traditional professional rescuers support the view that AEDs should not be implemented in EMS systems as an isolated intervention, but that efforts are equally needed to strengthen the other links of the chain of survival. The international scientific community (American Heart Association, International Liaison Committee on Resuscitation and European Resuscitation Council) have issued guidelines for the use of AEDs by EMS providers and first responders, and a universal treatment algorithm is proposed.
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Thunder Bay Regional Hospital (TBRH) developed a chest pain strategy (CPS) to support its emergency physicians in making the difficult clinical decisions required to properly evaluate and manage ED "chest pain" patients. This strategy was developed to ensure excellent patient care in a setting of diminished inpatient bed availability and increasing ED congestion. ⋯ Following the introduction of the CPS in 1997, TBRH realized significant ($500 000/yr) institutional resource savings through a 60% decrease in the admission rate of non-myocardial infarction, non-unstable angina chest pain patients, a 30% decrease in ED chest pain evaluation time, and improved ED availability of monitored stretchers. The CPS has allowed TBRH to simultaneously decrease costs and improve patient care.