ABSTRACT
OBJECTIVE: Recently palliative care has become an integral and compulsory part of undergraduate medical training in Germany. From 2014 onwards every German medical faculty must have developed and implemented undergraduate teaching in this cross-disciplinary medical field and to conduct examinations. At Witten/Herdecke University (Germany) this new cross-sectional course in palliative care was taught for the first time in 2011. The film "Keep on the open road" was incorporated and the use of this film as part of compulsory palliative care education was evaluated from the student perspective. METHOD: In two teaching units (1.5 h each) the film was watched with the students and discussed in the context of the palliative care setting with a special focus on psychosocial aspects. A semi-quantitative evaluation was performed after the debriefing. RESULTS: A total of 23 students participated in the course, 87 % (n = 20) evaluated the use of the film as unrestricted useful and 14 indicated a benefit from the film in terms of their medical attitude. Most of the students (n = 19, 83%) did not consider bed-side teaching to be more useful than the film unit. The free text answers underlined that primarily the multidisciplinary aspects of a palliative treatment situation and the meaning of a social environment were highlighted by the film. CONCLUSIONS: According to the evaluation of the students and the judgement of the participating teachers the use of the film is a suitable method to clarify complex medical, social and psychological aspects in palliative care. Especially at faculties with much larger numbers of students the film unit is thought to be a helpful method to teach psychosocial aspects and to promote development of attitude in palliative care. In future semesters further experience with the unit and the use of films in palliative care teaching will be collected.
Subject(s)
Education, Medical/methods , Motion Pictures , Palliative Care , Attitude of Health Personnel , Curriculum , Education, Medical, Undergraduate , Humans , Physician-Patient Relations , Students, Medical , TeachingABSTRACT
Calciphylaxis, or calcific uremic arteriopathy, is a rare complication of end-stage renal impairment. It is characterized by calcification of arterioles and development of intensely painful subcutaneous ischemic ulcerations. While symptomatic management is the mainstay of treatment, particular emphasis is placed on adequate analgesia. Conventional analgesic concepts have mostly proved to be insufficient which increases the extreme suffering of patients. This case report describes the successful analgesic treatment of calciphylaxis with levomethadone.
Subject(s)
Analgesics, Opioid/therapeutic use , Calciphylaxis/drug therapy , Methadone/therapeutic use , Pain, Intractable/drug therapy , Palliative Care , Aged , Analgesics, Opioid/adverse effects , Calciphylaxis/psychology , Calciphylaxis/surgery , Combined Modality Therapy , Cooperative Behavior , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Humans , Interdisciplinary Communication , Kidney Failure, Chronic/complications , Leg Ulcer/drug therapy , Leg Ulcer/psychology , Leg Ulcer/surgery , Methadone/adverse effects , Pain Measurement/drug effects , Pain, Intractable/psychology , Renal Dialysis , StereoisomerismABSTRACT
BACKGROUND: Modern medical analgesia is based on a bio-psycho-social model of disease. From this bio-psycho-social perspective it seems essential to include religiosity in the multidimensional and interdisciplinary assessment of pain patients. MATERIAL AND METHODS: A total of 450 consecutively referred in- and outpatients to a neurological department completed an epidemiologic pain questionnaire. This patient self-administered questionnaire included diagnostic screening tests for anxiety and depression, a generic health-related quality of life measure and sociodemographic questions. Pain severity grades and pain chronicity stages were measured. The acceptance of chronic pain was assessed with the chronic pain acceptance questionnaire. The significance of religiosity was measured employing the structure of religiosity test. RESULTS: Of the neurological patients 82% complained of having had pain within the past 3 months and 79% within the last 12 months. Patients who accepted the pain and pursued their daily activities despite the pain were less depressive and anxious and showed an enhanced health-related quality of life. The importance of religion to the pain patients was associated with a higher level of pain tolerance. CONCLUSIONS: This study proved that the significance of religiosity to the patient is related to psychic distress and health-related quality of life and at the same time may play an important role in the bio-psycho-social pain concept.
Subject(s)
Adaptation, Psychological , Pain/psychology , Quality of Life/psychology , Religion and Medicine , Sick Role , Spirituality , Activities of Daily Living/psychology , Aged , Anxiety/psychology , Chronic Disease , Depression/psychology , Female , Humans , Male , Middle Aged , Pain Measurement , Personality Inventory/statistics & numerical data , PsychometricsABSTRACT
BACKGROUND: The state of organized care of neurologic pain patients in Germany was to be established with the the help of our survey. METHODS: A five-page questionnaire was sent to 391 neurologic department heads. RESULTS: Nearly 60% of the departments participated in the survey. Almost all neurologic departments admit pain patients, especially for further diagnostics and neurologic treatment. These are accepted as important neurologic tasks. The quality of care is excellent. For the diagnostics of chronic pain, multidimensional questionnaires are used in nearly 64% of the departments and psychometric tests in almost 70%. Sixty percent of all units document the acute course of pain treatment. Follow-up examinations are performed in 26% of all hospitals. CONCLUSION: Structures exist concerning diagnostics and therapy for neurological in- and outpatients with pain. Care procedures for inpatients with pain need improvement. Outcome is seldom documented.
Subject(s)
Analgesics/therapeutic use , Nervous System Diseases/drug therapy , Neuralgia/drug therapy , Ambulatory Care , Analgesics/adverse effects , Chronic Disease , Combined Modality Therapy , Data Collection , Germany , Hospital Departments , Humans , Neuralgia/classification , Neuralgia/diagnosis , Neurology , Pain Clinics , Pain Measurement , Practice Patterns, Physicians' , Quality Assurance, Health Care , Referral and Consultation , Surveys and QuestionnairesABSTRACT
HISTORY AND ADMISSION FINDINGS: 5 heroin addicts (aged 31-44 years; 1 female, 4 men) presented with a history of blurred vision and diplopia followed by dysarthria. 3 of the patients also developed respiratory failure requiring long-term ventilatory support. Physical examination revealed cranial nerve deficits and abscesses at injection sites in 3 of them. DIAGNOSIS: In 4 patients wound botulism was diagnosed on the basis of symptoms, course of the illness and response to specific treatment. Clostridium botulinum was grown from wound swab in one patient. TREATMENT AND COURSE: Two of the patients, having been injected with antitoxin immediately after admission, were discharged almost symptom-free after only a few days. Adjuvant antibiotics and, in 3 patients, surgical débridement of the abscesses were needed. CONCLUSIONS: Progressive cranial nerve pareses in addicts who inject drugs intravenously or intramuscularly should raise the suspicion of wound botulism and require hospitalization. While indirect demonstration of toxin supports the diagnosis, false-negative results are common.
