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Sabatowski R, Förderreuther S, Radbruch L. [Complementary and alternative medicine-A CME article, the critics and a concluding comment of the editor]. Schmerz 2024; 38:55-56. [PMID: 38206420 DOI: 10.1007/s00482-023-00781-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 01/12/2024]
Affiliation(s)
- R Sabatowski
- UniversitätsSchmerzCentrum, Universitätsklinikum und Medizinische Fakultät "Carl Gustav Carus", Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - S Förderreuther
- Neurologische Klinik und Poliklinik, LMU Klinikum, LMU München, München, Deutschland
| | - L Radbruch
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
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Bausewein C, Hodiamont F, Berges N, Ullrich A, Gerlach C, Oechsle K, Pauli B, Weber J, Stiel S, Schneider N, Krumm N, Rolke R, Gebel C, Jansky M, Nauck F, Wedding U, van Oorschot B, Roch C, Werner L, Fischer M, Schallenburger M, Reuters MC, Schwartz J, Neukirchen M, Gülay A, Maus K, Jaspers B, Radbruch L, Heckel M, Klinger I, Ostgathe C, Kriesen U, Junghanß C, Lehmann E, Gesell D, Gauder S, Boehlke C, Becker G, Pralong A, Strupp J, Leisse C, Schloesser K, Voltz R, Jung N, Simon ST. National strategy for palliative care of severely ill and dying people and their relatives in pandemics (PallPan) in Germany - study protocol of a mixed-methods project. BMC Palliat Care 2022; 21:10. [PMID: 35027041 PMCID: PMC8756412 DOI: 10.1186/s12904-021-00898-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 12/17/2021] [Indexed: 12/15/2022] Open
Abstract
Background In the SARS-CoV-2 pandemic, general and specialist Palliative Care (PC) plays an essential role in health care, contributing to symptom control, psycho-social support, and providing support in complex decision making. Numbers of COVID-19 related deaths have recently increased demanding more palliative care input. Also, the pandemic impacts on palliative care for non-COVID-19 patients. Strategies on the care for seriously ill and dying people in pandemic times are lacking. Therefore, the program ‘Palliative care in Pandemics’ (PallPan) aims to develop and consent a national pandemic plan for the care of seriously ill and dying adults and their informal carers in pandemics including (a) guidance for generalist and specialist palliative care of patients with and without SARS-CoV-2 infections on the micro, meso and macro level, (b) collection and development of information material for an online platform, and (c) identification of variables and research questions on palliative care in pandemics for the national pandemic cohort network (NAPKON). Methods Mixed-methods project including ten work packages conducting (online) surveys and qualitative interviews to explore and describe i) experiences and burden of patients (with/without SARS-CoV-2 infection) and their relatives, ii) experiences, challenges and potential solutions of health care professionals, stakeholders and decision makers during the SARS-CoV-2 pandemic. The work package results inform the development of a consensus-based guidance. In addition, best practice examples and relevant literature will be collected and variables for data collection identified. Discussion For a future “pandemic preparedness” national and international recommendations and concepts for the care of severely ill and dying people are necessary considering both generalist and specialist palliative care in the home care and inpatient setting. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00898-w.
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Nehls W, Delis S, Haberland B, Maier BO, Sänger K, Tessmer G, Radbruch L, Bausewein C. [Management of Patients with COVID-19 - Recommendations from a Palliative Care Perspective]. Pneumologie 2020; 74:652-659. [PMID: 32316056 PMCID: PMC7645808 DOI: 10.1055/a-1156-2759] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- W Nehls
- Lungenklinik Heckeshorn, Klinik für Pneumologie, Helios Klinikum Emil von Behring, Berlin
| | - S Delis
- Lungenklinik Heckeshorn, Klinik für Pneumologie, Helios Klinikum Emil von Behring, Berlin
| | - B Haberland
- LMU Klinikum, Klinik und Poliklinik für Palliativmedizin, München
| | - B O Maier
- Palliativmedizin und interdisziplinäre Onkologie, Med. Klinik III, St. Josefs-Hospital, Wiesbaden
| | - K Sänger
- Klinik für Pneumologie, Evangelische Lungenklinik, Berlin
| | - G Tessmer
- Klinik für Pneumologie, Evangelische Lungenklinik, Berlin
| | - L Radbruch
- Klinik für Palliativmedizin, Universitätsklinikum Bonn
| | - C Bausewein
- LMU Klinikum, Klinik und Poliklinik für Palliativmedizin, München
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Hoffmann-Menzel H, Goldmann J, Kern M, Weckbecker K, Wüllenweber L, Radbruch L. [Palliative care of patients receiving opioid substitution therapy]. Schmerz 2019; 33:263-280. [PMID: 31098705 DOI: 10.1007/s00482-019-0376-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Patients with opioid use disorder survive longer and reach higher ages due to harm reduction and maintenance programs. Therefor and because of concomitant comorbidities there is an increased incidence of life-limiting diseases. Thus, increasing numbers of patients with opioid use disorder or in maintenance programs will require palliative care. However, both inpatient and outpatient service providers are uncertain about providing palliative care for these patients. Home-care teams and inpatient hospices have been known to refuse admission for patients with opioid use disorder. Providing medical care to patients receiving substitution therapy can be challenging because maintenance programs require strict compliance with their rules and regulations; however, an individualized approach with knowledge of basic legal requirements enables good palliative care. In this manner, it is possible to ensure healthcare for these aging patients.
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Affiliation(s)
- H Hoffmann-Menzel
- Zentrum für Palliativmedizin, Malteser Krankenhaus Seliger Gerhard Bonn/Rhein-Sieg, Von-Hompesch-Str. 1, 53123, Bonn, Deutschland. .,Klinik für Palliativmedizin, Universitätsklinik Bonn, Bonn, Deutschland.
| | - J Goldmann
- Lighthouse-Verein für Hospizarbeit e. V., Bonn, Deutschland
| | - M Kern
- Zentrum für Palliativmedizin, Malteser Krankenhaus Seliger Gerhard Bonn/Rhein-Sieg, Von-Hompesch-Str. 1, 53123, Bonn, Deutschland.,Alpha Rheinland, Bonn, Deutschland
| | | | - L Wüllenweber
- Diamorphin- und Substitutionsambulanz Heerstraße, Bonn, Deutschland
| | - L Radbruch
- Zentrum für Palliativmedizin, Malteser Krankenhaus Seliger Gerhard Bonn/Rhein-Sieg, Von-Hompesch-Str. 1, 53123, Bonn, Deutschland.,Klinik für Palliativmedizin, Universitätsklinik Bonn, Bonn, Deutschland
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Scholten W, Simon O, Maremmani I, Wells C, Kelly J, Hämmig R, Radbruch L. Re: Letter to the editor of public health in response to ‘Access to treatment with controlled medicines rationale and recommendations for neutral, respectful, and precise language’. Public Health 2018; 160:157-158. [DOI: 10.1016/j.puhe.2018.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 02/05/2018] [Indexed: 12/01/2022]
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Schaible HG, Radbruch L. Neue Rubrik „PAIN CLINICAL UPDATES“ in Der Schmerz. Schmerz 2018; 32:89. [DOI: 10.1007/s00482-018-0274-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schaible HG, Radbruch L. Nachruf für Herrn Prof. Dr. med. D. Sc. h.c. Robert F. Schmidt, Ph.D. Schmerz 2018; 32:15-16. [DOI: 10.1007/s00482-018-0265-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Marinova M, Strunk HM, Rauch M, Henseler J, Clarens T, Brüx L, Dolscheid-Pommerich R, Conrad R, Cuhls H, Radbruch L, Schild HH, Mücke M. [High-intensity focused ultrasound (HIFU) for tumor pain relief in inoperable pancreatic cancer : Evaluation with the pain sensation scale (SES)]. Schmerz 2018; 31:31-39. [PMID: 27402264 DOI: 10.1007/s00482-016-0140-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) in combination with palliative standard therapy is an innovative and effective treatment option for pain reduction in patients with inoperable pancreatic cancer. OBJECTIVE Evaluation of the effects of additive ultrasound (US)-guided HIFU treatment in inoperable pancreatic cancer on the sensory and affective pain perception using validated questionnaries. MATERIAL AND METHODS In this study 20 patients with locally advanced inoperable pancreatic cancer and tumor-related pain were treated by US-guided HIFU (6 stage III, 12 stage IV according to UICC and 2 with local recurrence after surgery). Ablation was performed using the JC HIFU system (HAIFU, Chongqing, China) with an ultrasonic device for real-time imaging. Clinical assessment included evaluation of pain severity using validated questionnaires with particular attention to the pain sensation scale (SES) with its affective and sensory component and the numeric rating scale (NRS). RESULTS The average pain reduction after HIFU was 2.87 points on the NRS scale and 57.3 % compared to the mean baseline score (n = 15, 75 %) in 19 of 20 treated patients. Four patients did not report pain relief, however, the previous opioid medication could be stopped (n = 2) or the analgesic dosage could be reduced (n = 2). No pain reduction was achieved in one patient. Furthermore, after HIFU emotional as well as sensory pain aspects were significantly reduced (before vs. 1 week after HIFU, p < 0.05 for all pain scales). CONCLUSION US-guided HIFU can be used for effective and early pain relief and reduction of emotional and sensory pain sensation in patients with locally advanced pancreatic cancer.
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Affiliation(s)
- M Marinova
- Radiologische Klinik, Universitätsklinikum, Siegmund-Freud-Str. 25, 53105, Bonn, Deutschland.
| | - H M Strunk
- Radiologische Klinik, Universitätsklinikum, Siegmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - M Rauch
- Radiologische Klinik, Universitätsklinikum, Siegmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - J Henseler
- Radiologische Klinik, Universitätsklinikum, Siegmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - T Clarens
- Radiologische Klinik, Universitätsklinikum, Siegmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - L Brüx
- Radiologische Klinik, Universitätsklinikum, Siegmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - R Dolscheid-Pommerich
- Institut für Klinische Chemie und Pharmakologie, Universitätsklinikum, Bonn, Deutschland
| | - R Conrad
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum, Bonn, Deutschland
| | - H Cuhls
- Klinik und Poliklinik für Palliativmedizin, Universitätsklinikum, Bonn, Deutschland
| | - L Radbruch
- Klinik und Poliklinik für Palliativmedizin, Universitätsklinikum, Bonn, Deutschland
| | - H H Schild
- Radiologische Klinik, Universitätsklinikum, Siegmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - M Mücke
- Klinik und Poliklinik für Palliativmedizin, Universitätsklinikum, Bonn, Deutschland
- Institut für Hausarztmedizin, Universitätsklinikum, Bonn, Deutschland
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Mücke M, Conrad R, Marinova M, Cuhls H, Elsner F, Rolke R, Radbruch L. [Dose-finding for treatment with a transdermal fentanyl patch : Titration with oral transmucosal fentanyl citrate and morphine sulfate]. Schmerz 2017; 30:560-567. [PMID: 27072143 DOI: 10.1007/s00482-016-0106-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
To date, no studies investigating titration with oral transmucosal fentanyl for the dose-finding of transdermal fentanyl treatment have been published. In an open randomized study 60 patients with chronic malignant (n = 39) or nonmalignant pain (n = 21), who required opioid therapy according to step three of the guidelines of the World Health Organization (WHO), were investigated. In two groups of 30 patients each titration with immediate release morphine (IRM) or oral transmucosal fentanyl citrate (OTFC) was undertaken. For measurement purposes the Brief Pain Inventory (BPI) and Minimal Documentation System (MIDOS) were used. After a 24-h titration phase, in which patients documented the intensity of pain, nausea, and tiredness, treatment with transdermal fentanyl was evaluated over a 10-day period by means of the necessary dose adaptation (responder ≤ 1 dose adaptation; conversion formula 1:1 [OTFC group] vs 100:1 [IRM group]).The pain reduction over the first 24 h (titration phase) did not differ significantly between the groups. The number of responders (17 OTFC vs. 21 IRM) over the 10-day period did not show any difference either. In both groups there was a significant reduction in pain intensity (p < 0.001). Over the course of the study, there were significantly more drop-outs because of adverse effects in the OTFC group than in the IRM group (8 vs 1, p = 0.028).Oral transmucosal fentanyl citrate can be applied for the titration of transdermal fentanyl, but it does not show any clinically relevant advantage. For example, the risk of side effects-induced drop-outs was greater in the present study. Whether the unnecessary opioid switching to treat chronic pain and breakthrough pain is advantageous with regard to minimizing conversion errors cannot be definitively answered within the scope of this study.
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Affiliation(s)
- M Mücke
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland. .,Institut für Hausarztmedizin, Universitätsklinikum Bonn, Bonn, Deutschland.
| | - R Conrad
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - M Marinova
- Radiologische Klinik, Universitätsklinikum Bonn, Bonn, Deutschland
| | - H Cuhls
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - F Elsner
- Klinik für Palliativmedizin, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - R Rolke
- Klinik für Palliativmedizin, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - L Radbruch
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland.,Zentrum für Palliativmedizin, Malteser Krankenhaus Seliger Gerhard Bonn/Rhein-Sieg, Bonn, Deutschland
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10
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Scholten W, Simon O, Maremmani I, Wells C, Kelly J, Hämmig R, Radbruch L. Access to treatment with controlled medicines rationale and recommendations for neutral, precise, and respectful language. Public Health 2017; 153:147-153. [DOI: 10.1016/j.puhe.2017.08.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 08/24/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
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Mücke M, Tils M, Conrad R, Kravchenko D, Cuhls H, Radbruch L, Marinova M, Peuckmann-Post V, Rolke R. Matrix stimulation in cancer pain: Methodology, safety and effectiveness. Eur J Pain 2017; 22:58-71. [PMID: 28805336 PMCID: PMC5763394 DOI: 10.1002/ejp.1089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2017] [Indexed: 12/18/2022]
Abstract
Background This feasibility study addresses the applicability of matrix electrodes for the reduction of ongoing pain in cancer patients via low‐frequency electrical stimulation (LFS). Methods Low‐frequency matrix stimulation (4 Hz) was applied to the skin within the ‘Head's zones’ referring to the tumour localization of cancer pain patients. Pain at baseline was compared to a 3‐day treatment interval consisting of 5 min of matrix stimulation in the morning and evening followed by a 3‐day follow‐up period without therapy. Main outcome parameters included numeric rating scale values (rating scale 0–100), painDETECT, HADS, and German pain questionnaire, as well as the opioid intake, calculated as the oral morphine equivalent (OME). Results Twenty patients with cancer pain (aged 64.4 ± 10.3; 9 women) were examined. In the majority of patients, the pain was classified as nociceptive. The mean pain reduction achieved by matrix therapy was 30%, under stable daily controlled‐release opioid doses between 177 and 184 mg/day (OME). Seventeen patients (85%) were responders, defined by a pain reduction of at least 30%, while four responders experienced a pain reduction of over 50%. The only side effect was short‐term erythema. Conclusion Findings are consistent with the concept of synaptic long‐term depression in cancer pain induced after conditioning LFS. Despite the short, but well‐tolerated, treatment duration of 2 × 5 min/day, effects persisted throughout the 3‐day follow‐up. Significance Cutaneous neuromodulation using LFS via a matrix electrode has been shown to be a safe intervention for effectively reducing cancer pain in palliative care patients.
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Affiliation(s)
- M Mücke
- Department of General Practice and Family Medicine, University Hospital Bonn, Germany.,Department of Palliative Medicine, University Hospital Bonn, Germany.,Center for Rare Diseases Bonn (ZSEB), University Hospital Bonn, Germany
| | - M Tils
- Department of Palliative Medicine, University Hospital Bonn, Germany
| | - R Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany
| | - D Kravchenko
- Department of Palliative Medicine, University Hospital Bonn, Germany
| | - H Cuhls
- Department of Palliative Medicine, University Hospital Bonn, Germany
| | - L Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Germany.,Centre for Palliative Care, Malteser Hospital Bonn/Rhein-Sieg, Germany
| | - M Marinova
- Department of Radiology, Medical School & Hospital, University Hospital Bonn, Germany
| | - V Peuckmann-Post
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Germany
| | - R Rolke
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Germany
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Mücke M, Schulze H, Radbruch L, Marinova M, Cuhls H, Kravchenko D, Conrad R, Rolke R. [Neuromodulation using matrix stimulation : A treatment for acute pain?]. Schmerz 2017; 31:594-600. [PMID: 28674829 DOI: 10.1007/s00482-017-0233-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is currently a lack of studies that evaluate the effects of matrix electrode neuromodulation on acute pain. In this prospective and randomized cross-over study, we investigated the efficacy of 4 Hz-matrix stimulation on venipuncture-induced pain in 30 healthy subjects. METHODS We compared two conditions of neurostimulation: in EC1 (experimental condition 1), we performed venipuncture during stimulation, with 2.5 min of prestimulation with 600 stimuli; in EC2 (experimental condition 2), the length of stimulation was 5 min, at 1200 stimuli, with subsequent venipuncture. A group with no stimulation was used as control condition. RESULTS The EC2 group did not only show a 77% reduction in puncture pain when compared to the control group (p < 0.001; effect size [ES] d = 1.45), but also had a significant effect compared with EC1 (p < 0.001; ES d = 1.33). EC1, on the other hand, did not demonstrate a significant difference to the control group. The status of the veins was evaluated based on visibility and did not differ significantly between the conditions. CONCLUSION The results of this study showed for the first time that pre-emptive matrix stimulation could be an effective way to reduce acute pain. The duration of stimulation seems to play a key role in the effectiveness of the neurophysiological mechanism of action. Matrix stimulation is a therapeutic intervention with very few side effects, which could, in the future, expand our pain-management options for the treatment of acute pain.
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Affiliation(s)
- M Mücke
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland.
- Institut für Hausarztmedizin, Universitätsklinikum Bonn, Bonn, Deutschland.
- Zentrum für Seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Bonn, Deutschland.
| | - H Schulze
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - L Radbruch
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
- Zentrum für Palliativmedizin, Malteser Krankenhaus Seliger Gerhard Bonn/Rhein-Sieg, Bonn, Deutschland
| | - M Marinova
- Radiologische Klinik, Universitätsklinikum Bonn, Bonn, Deutschland
| | - H Cuhls
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - D Kravchenko
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - R Conrad
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - R Rolke
- Klinik für Palliativmedizin, Uniklinik RWTH Aachen, Aachen, Deutschland
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Radbruch L, Schaible HG. [Too many pain journals and too few reviewers]. Schmerz 2017; 31:405-406. [PMID: 28536817 DOI: 10.1007/s00482-017-0224-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- L Radbruch
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland. .,Zentrum für Palliativmedizin, Malteser Krankenhaus Bonn/Rhein-Sieg, Von-Hompesch-Str. 1, 53123, Bonn, Deutschland.
| | - H-G Schaible
- Institut für Physiologie, Universität Jena, Jena, Deutschland
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Abstract
Chronic pain in the knee joint is most commonly caused by osteoarthritis, especially in elderly patients but can be due to other causes, such as rheumatoid arthritis. The diagnostics include an exact patient medical history and a clinical examination, which often already provide clear indications of the cause of the knee pain. Subsequently, further diagnostics can then be considered, such as radiological procedures and laboratory diagnostics. The treatment is determined by the cause and the individual patient and aims to reduce pain and to preserve the mobility of the joint. Generally, therapy consists of pain management and physiotherapy as well as alternative therapeutic procedures, mostly in combination. Proximal tibial opening wedge osteotomy can be useful; however, partial or total knee arthroplasty should only be considered when conservative treatment options have been exhausted.
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Affiliation(s)
- T T A Bender
- Zentrum für seltene Erkrankungen Bonn, Universitätsklinikum Bonn, Bonn, Deutschland
| | - M Marinova
- Radiologische Klinik, Universitätsklinikum Bonn, Bonn, Deutschland
| | - L Radbruch
- Zentrum für Palliativmedizin, Malteser Krankenhaus Seliger Gerhard Bonn/Rhein-Sieg, Bonn, Deutschland.,Institut für Hausarztmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - R Conrad
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - D Jobst
- Institut für Hausarztmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - M Mücke
- Zentrum für seltene Erkrankungen Bonn, Universitätsklinikum Bonn, Bonn, Deutschland. .,Institut für Hausarztmedizin, Universitätsklinikum Bonn, Bonn, Deutschland. .,Klinik für Palliativmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
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Simon S, Altfelder N, Alt-Epping B, Bausewein C, Weingärtner V, Voltz R, Ostgathe C, Radbruch L, Lindena G, Nauck F. Charakteristika von Palliativpatienten mit Atemnot. Pneumologie 2017; 71:40-47. [DOI: 10.1055/s-0042-112837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S. Simon
- Institut für Palliative Care, Oldenburg
| | | | - B. Alt-Epping
- Klinik für Palliativmedizin, Universitätsmedizin Göttingen
| | | | | | - R. Voltz
- Zentrum für Palliativmedizin, Uniklinikum Köln
| | - C. Ostgathe
- Palliativmedizinische Abteilung, Universitätsklinikum Erlangen, CCC EMN, Erlangen
| | - L. Radbruch
- Klinik für Palliativmedizin, Universitätsklinikum Bonn
| | | | - F. Nauck
- Klinik für Palliativmedizin, Universitätsmedizin Göttingen
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Häuser W, Bock F, Engeser P, Hege-Scheuing G, Hüppe M, Lindena G, Maier C, Norda H, Radbruch L, Sabatowski R, Schäfer M, Schiltenwolf M, Schuler M, Sorgatz H, Tölle T, Willweber-Strumpf A, Petzke F. [Recommendations of the updated LONTS guidelines. Long-term opioid therapy for chronic noncancer pain]. Schmerz 2016; 29:109-30. [PMID: 25616996 DOI: 10.1007/s00482-014-1463-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The regular update of the German S3 guidelines on long-term opioid therapy for chronic noncancer pain (CNCP), the"LONTS" (AWMF registration number 145/003), began in November 2013. METHODS The guidelines were developed by 26 scientific societies and two patient self-help organisations under the coordination of the Deutsche Schmerzgesellschaft (German Pain Society). A systematic literature search in the Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Scopus databases (up until October 2013) was performed. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. The strength of the recommendations was established by multistep formal procedures, in order to reach a consensus according to German Association of the Medical Scientific Societies ("Arbeitsgemeinschaft der Wissenschaftlich Medizinischen Fachgesellschaften", AWMF) regulations. The guidelines were reviewed by the Drug Commission of the German Medical Association, the Austrian Pain Society and the Swiss Association for the Study of Pain. RESULTS Opioids are one drug-based treatment option for short- (4-12 weeks), intermediate- (13-25 weeks) and long-term (≥ 26 weeks) therapy of chronic osteoarthritis, diabetic polyneuropathy, postherpetic neuralgia and low back pain. Contraindications are primary headaches, as well as functional somatic syndromes and mental disorders with the (cardinal) symptom pain. For all other clinical presentations, a short- and long-term therapy with opioid-containing analgesics should be evaluated on an individual basis. Long-term therapy with opioid-containing analgesics is associated with relevant risks (sexual disorders, increased mortality). CONCLUSION Responsible application of opioid-containing analgesics requires consideration of possible indications and contraindications, as well as regular assessment of efficacy and adverse effects. Neither an uncritical increase in opioid application, nor the global rejection of opioid-containing analgesics is justified in patients with CNCP.
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Affiliation(s)
- W Häuser
- Medizinisches Versorgungszentrum (Schmerztherapie, Palliativmedizin, Psychiatrie, Psychotherapie) Saarbrücken - St. Johann, Saarbrücken, Deutschland,
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17
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Affiliation(s)
- L Radbruch
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland. .,Deutsche Gesellschaft für Palliativmedizin, Berlin, Deutschland.
| | - M Schäfer
- Klinik für Anästhesiologie und operative Intensivmedizin, Charité - Universitätsmedizin, Campus Virchow, Berlin, Deutschland.,Deutsche Schmerzgesellschaft, Berlin, Deutschland
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18
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Abstract
Cancer pain and pain associated with non-neoplastic diseases can be associated with pain mechanisms, such as a peripheral or central sensitization or deafferentation. The clarification allows indirect conclusions about the underlying mechanisms based on clinical signs, such as allodynia or hyperalgesia. Non-opioid analgesics are the basis of cancer pain therapy according to the World Health Organization (WHO) pain ladder. In the case of severe cancer pain, treatment can be escalated directly from level 1 to level 3. Opioids are highly effective for the treatment of cancer pain even with a neuropathic component, which can occur in up to 40 % of cases as amixed pain syndrome. Coanalgesics represent a valuable therapeutic adjunct for better pain control and can address treatment of comorbidities, such as anxiety, depression and sleep disorders. When liver and/or renal function is reduced, the dosage of many drugs has to be adapted. Treatment of multimorbid or critically ill patients with opioids and antidepressants/anticonvulsants requires consideration of numerous possible pharmacodynamic and pharmacokinetic interactions.
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Affiliation(s)
- R Rolke
- Klinik für Palliativmedizin, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - S Rolke
- Klinik für Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum RWTH Aachen, Aachen, Deutschland
| | - S Hiddemann
- Klinik für Palliativmedizin, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - M Mücke
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland.,Institut für Hausarztmedizin, Medizinische Fakultät, Universität Bonn, Bonn, Deutschland.,Zentrum für Seltene Erkrankungen Bonn (ZSEB), Universitätsklinikum Bonn, Bonn, Deutschland
| | - H Cuhls
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - L Radbruch
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - F Elsner
- Klinik für Palliativmedizin, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - V Peuckmann-Post
- Klinik für Palliativmedizin, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
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Siouta N, Van Beek K, van der Eerden ME, Preston N, Hasselaar JG, Hughes S, Garralda E, Centeno C, Csikos A, Groot M, Radbruch L, Payne S, Menten J. Integrated palliative care in Europe: a qualitative systematic literature review of empirically-tested models in cancer and chronic disease. BMC Palliat Care 2016; 15:56. [PMID: 27391378 PMCID: PMC4939056 DOI: 10.1186/s12904-016-0130-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/30/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Integrated Palliative Care (PC) strategies are often implemented following models, namely standardized designs that provide frameworks for the organization of care for people with a progressive life-threatening illness and/or for their (in)formal caregivers. The aim of this qualitative systematic review is to identify empirically-evaluated models of PC in cancer and chronic disease in Europe. Further, develop a generic framework that will consist of the basis for the design of future models for integrated PC in Europe. METHODS Cochrane, PubMed, EMBASE, CINAHL, AMED, BNI, Web of Science, NHS Evidence. Five journals and references from included studies were hand-searched. Two reviewers screened the search results. Studies with adult patients with advanced cancer/chronic disease from 1995 to 2013 in Europe, in English, French, German, Dutch, Hungarian or Spanish were included. A narrative synthesis was used. RESULTS 14 studies were included, 7 models for chronic disease, 4 for integrated care in oncology, 2 for both cancer and chronic disease and 2 for end-of-life pathways. The results show a strong agreement on the benefits of the involvement of a PC multidisciplinary team: better symptom control, less caregiver burden, improvement in continuity and coordination of care, fewer admissions, cost effectiveness and patients dying in their preferred place. CONCLUSION Based on our findings, a generic framework for integrated PC in cancer and chronic disease is proposed. This framework fosters integration of PC in the disease trajectory concurrently with treatment and identifies the importance of employing a PC-trained multidisciplinary team with a threefold focus: treatment, consulting and training.
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Affiliation(s)
- Naouma Siouta
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.
| | - K Van Beek
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium
| | - M E van der Eerden
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - N Preston
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - J G Hasselaar
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - S Hughes
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - E Garralda
- Department of Palliative Medicine, University of Navarra Hospital, Pamplona, Navarra, Spain
| | - C Centeno
- Department of Palliative Medicine, University of Navarra Hospital, Pamplona, Navarra, Spain
| | - A Csikos
- Faculty of Medicine, Institute of Family Medicine, University of Pécs Medical School, Pécs, Hungary
| | - M Groot
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - L Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - S Payne
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - J Menten
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium
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Strunk HM, Henseler J, Rauch M, Mücke M, Kukuk G, Cuhls H, Radbruch L, Zhang L, Schild HH, Marinova M. Clinical Use of High-Intensity Focused Ultrasound (HIFU) for Tumor and Pain Reduction in Advanced Pancreatic Cancer. ROFO-FORTSCHR RONTG 2016; 188:662-70. [PMID: 27272685 DOI: 10.1055/s-0042-105517] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Evaluation of ultrasound-guided high-intensity focused ultrasound (HIFU) used for the first time in Germany in patients with inoperable pancreatic cancer for reduction of tumor volume and relief of tumor-associated pain. MATERIALS AND METHODS 15 patients with locally advanced inoperable pancreatic cancer and tumor-related pain symptoms were treated by HIFU (n = 6 UICC stage III, n = 9 UICC stage IV). 13 patients underwent simultaneous standard chemotherapy. Ablation was performed using the JC HIFU system (Chongqing, China HAIFU Company) with an ultrasonic device for real-time imaging. Imaging follow-up (US, CT, MRI) and clinical assessment using validated questionnaires (NRS, BPI) was performed before and up to 15 months after HIFU. RESULTS Despite biliary or duodenal stents (4/15) and encasement of visceral vessels (15/15), HIFU treatment was performed successfully in all patients. Treatment time and sonication time were 111 min and 1103 s, respectively. The applied total energy was 386 768 J. After HIFU ablation, contrast-enhanced imaging showed devascularization of treated tumor regions with a significant average volume reduction of 63.8 % after 3 months. Considerable pain relief was achieved in 12 patients after HIFU (complete or partial pain reduction in 6 patients). CONCLUSION US-guided HIFU with a suitable acoustic pathway can be used for local tumor control and relief of tumor-associated pain in patients with locally advanced pancreatic cancer. KEY POINTS • US-guided HIFU allows an additive treatment of unresectable pancreatic cancer.• HIFU can be used for tumor volume reduction.• Using HIFU, a significant reduction of cancer-related pain was achieved.• HIFU provides clinical benefit in patients with pancreatic cancer. Citation Format: • Strunk HM, Henseler J, Rauch M et al. Clinical Use of High-Intensity Focused Ultrasound (HIFU) for Tumor and Pain Reduction in Advanced Pancreatic Cancer. Fortschr Röntgenstr 2016; 188: 662 - 670.
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Affiliation(s)
| | | | - M Rauch
- Department of Radiology, Medical School & Hospital, University of Bonn
| | - M Mücke
- Department of Palliative Medicine, Medical School & Hospital, University of Bonn
| | - G Kukuk
- Department of Radiology, Medical School & Hospital, University of Bonn
| | - H Cuhls
- Department of Palliative Medicine, Medical School & Hospital, University of Bonn
| | - L Radbruch
- Department of Palliative Medicine, Medical School & Hospital, University of Bonn
| | - L Zhang
- Chongqing Key Laboratory of Ultrasound in Medicine and Engineeríng, Chongqing Medical University, China
| | - H H Schild
- Department of Radiology, Medical School & Hospital, University of Bonn
| | - M Marinova
- Department of Radiology, Medical School & Hospital, University of Bonn
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21
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22
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Simon ST, Altfelder N, Alt-Epping B, Bausewein C, Weingärtner V, Voltz R, Ostgathe C, Radbruch L, Lindena G, Nauck F. [Characteristics of patients with breathlessness - results of the german hospice and palliative care evaluation]. Dtsch Med Wochenschr 2016; 141:e87-95. [PMID: 27176070 DOI: 10.1055/s-0041-106678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Breathlessness is a common and distressing symptom in patients with advanced life-limiting disease. The aim of this study was to describe demographical and clinical characteristics of patients with breathlessness in Germany. METHODS We conducted a secondary analysis of hospice and palliative care inpatient data from 2006 to 2008. The Hospice and Palliative Care Evaluation (HOPE) is an annual prospective German survey, that includes a validated 16-item symptom-and-problem checklist (severity score 0-3). Characteristics of patients with or without breathlessness were compared in a pure descriptive manner. Interpretation of given p-values takes the error inflation due to multiple testing into account. RESULTS Breathlessness was recorded in 2860/5320 (53.8 %) patients (mean age 67.2 years (SD 12.4), 51.4 % female, 93.6 % malignant disease (female / male lung cancer 15.7/29.5 %, breast cancer 20.3/0.3 %, colon 10.3/8.7 %)). Breathless patients compared with those without breathless ness had a significantly worse functional status (ECOG 3-4: 78.4 % vs. 70.8 %, p < 0.001), suffered from a larger number (11.1 vs. 9.5, p < 0.001) of symptoms and the symptoms were of higher intensity (except confusion). Breathless patients had a higher risk to die during inpatient stay (43.5 % vs. 32.4 %, p < 0.001). CONCLUSION Based on this large sample of hospice and palliative care inpatients, breathlessness is associated with a high symptom burden and shortened survival. Breathless patients need more attention in health care.
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23
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Affiliation(s)
- L Radbruch
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland. .,Deutsche Gesellschaft für Palliativmedizin e. V., Berlin, Deutschland.
| | - M Schäfer
- Klinik für Anästhesiologie und operative Intensivmedizin, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Deutschland.,Deutsche Schmerzgesellschaft e. V., Berlin, Deutschland
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24
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Berendt J, Oechsle K, Thomas M, van Oorschot B, Schmitz A, Radbruch L, Simon ST, Gärtner J, Thuß-Patience P, Schuler US, Hense J, Gog C, Viehrig M, Mayer-Steinacker R, Stachura P, Stiel S, Ostgathe C. [State of integration of palliative care at Comprehensive Cancer Centers funded by German Cancer Aid]. Dtsch Med Wochenschr 2016; 141:e16-23. [PMID: 26800076 DOI: 10.1055/s-0041-106089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Similarities and differences of integration of palliative care in clinical care, research and education structures at German Comprehensive Cancer Centers (CCC) are not known in detail. OBJECTIVE Provide an overview of availability and the way of integration of specialized palliative care at CCCs funded by the German Cancer Aid (Deutsche Krebshilfe, DKH). METHOD We conducted structured interviews from May to August 2014 with heads of palliative care departments (personally or by telephone). The interviews included a quantitative and a qualitative part. Other stakeholders of CCCs were asked the questions of the qualitative part. We evaluated the qualitative data using the content analysis by Mayring and MAXQDA 11.0. SPSS 21.0 was used for quantitative analysis. RESULTS 26 interviews were realized in 13 CCCs with 14 sites, which received funding, by DKH till August 2014 (one CCC had two university hospitals). Of these, 12 sites had a palliative care unit (86%), 11 sites had palliative care consulting services available (79%). Participation of palliative care specialists in tumor boards is not provided in 3 institutions (21%) and is often not feasible on regular basis in the other institutions, due to staffing shortage. In 7 sites (50%) defined criteria to integrate palliative care into CCCs were available. In the last 5 years specialized palliative care of 4 sites received an invitation for a research project by another department within the CCC (29%). 10 sites (71%) had started own palliative care research projects. Chairs in palliative care were available in 4 CCCs (29%). CONCLUSION The extent and depth of palliative care integration in the 14 CCC sites is heterogeneous.
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25
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Marschall U, L'hoest H, Radbruch L, Häuser W. Long-term opioid therapy for chronic non-cancer pain in Germany. Eur J Pain 2015; 20:767-76. [DOI: 10.1002/ejp.802] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 11/05/2022]
Affiliation(s)
- U. Marschall
- Department of Business Strategy; BARMER GEK Head Office; Wuppertal Germany
| | - H. L'hoest
- Department of Business Strategy; BARMER GEK Head Office; Wuppertal Germany
| | - L. Radbruch
- Palliative care; Universitätsklinikum Bonn; Germany
| | - W. Häuser
- Internal Medicine I; Klinikum Saarbrücken GmbH; Germany
- Department of Psychosomatic Medicine and Psychotherapy; Technische Universität München; Germany
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26
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Powell RA, Ali Z, Luyirika E, Harding R, Radbruch L, Mwangi-Powell FN. Out of the shadows: non-communicable diseases and palliative care in Africa. BMJ Support Palliat Care 2015; 7:128-132. [PMID: 26391751 DOI: 10.1136/bmjspcare-2014-000751] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 06/25/2015] [Accepted: 09/06/2015] [Indexed: 01/29/2023]
Abstract
Non-communicable diseases (NCDs) in Africa have been comparatively neglected, partly due to donor-driven funding priorities. This is despite NCDs being the principal cause of mortality globally, with the majority incidence occurring in low-income and middle-income nations. Most of the patients with NCDs will suffer from pain, breathlessness and other physical symptoms, or need support with psychosocial or spiritual problems. Reflecting regional disease prevalence, late-stage clinical presentation, limited funding and restricted access to curative therapies, palliative care need in Africa is significantly high. Although palliative care provision has advanced significantly on the continent in the past decade, much of this development was driven by services for adult HIV patients. However, recent international and regional political declarations and commitments constitute a new global NCD agenda that calls for the integration of palliative care into the NCD response. This could be achieved under a chronic care model of service provision in partnership with other clinical providers in an integrated care continuum spanning prevention, early detection, diagnosis, treatment, survivorship and the end of life. Four important challenges have to be addressed if palliative care is to contribute meaningfully to this NCD agenda: (1) existing variation in the ability of countries to deal with NCDs per se; (2) ensuring clinical partners are integrated effectively with palliative care; (3) agreeing implementation is linked to relevant national-level and patient-level metrics; and (iv) underpinning palliative care and NCD care with a rigorous and locally relevant evidence base demonstrating appropriate, feasible and effective care.
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Affiliation(s)
- R A Powell
- Global Health Researcher, Nairobi, Kenya
| | - Z Ali
- Kenya Hospice and Palliative Care Association, Nairobi, Kenya
| | - E Luyirika
- African Palliative Care Association, Kampala, Uganda
| | - R Harding
- King's College London Cicely Saunders Institute, London, UK
| | - L Radbruch
- Department of Palliative Medicine, University of Bonn, University Hospital Bonn, Malteser Hospital Bonn/Rhein-Sieg, Bonn, Germany
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27
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Galushko M, Frerich G, Perrar KM, Golla H, Radbruch L, Nauck F, Ostgathe C, Voltz R. Desire for hastened death: how do professionals in specialized palliative care react? Psychooncology 2015; 25:536-43. [DOI: 10.1002/pon.3959] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 08/04/2015] [Accepted: 08/10/2015] [Indexed: 11/10/2022]
Affiliation(s)
- M. Galushko
- Center for Palliative Medicine; University Hospital of Cologne; Köln Germany
| | - G. Frerich
- Center for Palliative Medicine; University Hospital of Cologne; Köln Germany
| | - K. M. Perrar
- Center for Palliative Medicine; University Hospital of Cologne; Köln Germany
- Center for Integrated Oncology; (CIO); Köln/Bonn Germany
| | - H. Golla
- Center for Palliative Medicine; University Hospital of Cologne; Köln Germany
- Center for Integrated Oncology; (CIO); Köln/Bonn Germany
| | - L. Radbruch
- Department of Palliative Medicine; University Hospital Bonn; Bonn Germany
- Palliative Care Center; Malteser Hospital Seliger Gerhard Bonn/Rhein-Sieg; Bonn Germany
- Center for Integrated Oncology; (CIO); Köln/Bonn Germany
| | - F. Nauck
- Departmentof Palliative Medicine; University Hospital; Göttingen Germany
| | - C. Ostgathe
- Division of Palliative Medicine & Comprehensive Cancer Center, CCC Erlangen-EMN; University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Erlangen Germany
| | - R. Voltz
- Center for Palliative Medicine; University Hospital of Cologne; Köln Germany
- Center for Integrated Oncology; (CIO); Köln/Bonn Germany
- Clinical Trials Center Cologne; (ZKS); Köln Germany
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Azad SC, Pogatzki-Zahn EM, Radbruch L, Schaible HG. [Pain medicine yesterday, today, tomorrow: 40 years of the Deutsche Schmerzgesellschaft]. Schmerz 2015; 29:466-8. [PMID: 26351126 DOI: 10.1007/s00482-015-0056-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- S C Azad
- Interdisziplinäre Schmerzambulanz und Tagesklinik, Klinik für Anaesthesiologie, Klinikum der Universität München, München, Deutschland
| | - E M Pogatzki-Zahn
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Münster, Deutschland
| | - L Radbruch
- Klinik und Poliklinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - H-G Schaible
- Institut für Physiologie 1/Neurophysiologie, Universitätsklinikum Jena, Teichgraben 8, 07743, Jena, Deutschland.
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29
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Affiliation(s)
- L Radbruch
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Sigmund Freud Straße 25, 53127, Bonn, Deutschland,
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Radbruch L, Ostgathe C, Nauck F. [Not Available]. Schmerz 2014; 28:571-572. [PMID: 25610933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Cherny NI, Cleary J, Scholten W, Radbruch L, Torode J. The Global Opioid Policy Initiative (GOPI) project to evaluate the availability and accessibility of opioids for the management of cancer pain in Africa, Asia, Latin America and the Caribbean, and the Middle East: introduction and methodology. Ann Oncol 2014; 24 Suppl 11:xi7-13. [PMID: 24436961 DOI: 10.1093/annonc/mdt498] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Opioid analgesics are critical to the effective relief of cancer pain. Effective treatment is predicated on sound assessments, individually tailored analgesic therapy, and the availability and accessibility of the required medications. In some countries, pain relief is hampered by the lack of availability or barriers to the accessibility of opioid analgesics. As the follow-up to a successful project to evaluate the availability and accessibility of opioids and regulatory barriers in Europe, the European Society for Medical Oncology (ESMO) and the European Association for Palliative Care (EAPC) undertook to expand their research to those parts of the world where data were lacking regarding these aspects of care, in particular Africa, Asia, the Middle East, Latin America and the Caribbean, and the states of India. This project has been undertaken in collaboration with the Union for International Cancer Control (UICC), the Pain and Policy Studies Group (PPSG) of the University of Wisconsin, and the World Health Organization (WHO), together with a consortium of 17 international oncology and palliative care societies. This article describes the study methodology.
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Cleary J, Radbruch L, Torode J, Cherny NI. Next steps in access and availability of opioids for the treatment of cancer pain: reaching the tipping point? Ann Oncol 2014; 24 Suppl 11:xi60-4. [PMID: 24285231 DOI: 10.1093/annonc/mdt504] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The reports of the Global Opioid Policy Initiative (GOPI) project to evaluate the availability and accessibility of opioids for the management of cancer pain in Africa, Asia, Latin America and the Caribbean, and the Middle East, together with the previous 2010 European Society for Medical Oncology (ESMO)/European Association for Palliative Care (EAPC) report from Europe, have provided critical data in demonstrating the deficiencies in many countries throughout the world. Formulary deficiencies and over-regulation are pandemic and must be addressed. This process is challenging and will require concerted and sustained efforts by clinical leaders and advocacy groups partnering with international and regional organizations and, of course, with national governments and their competent authorities. There is a growing international expertise and infrastructure to coordinate advocacy and strategic planning based on the World Health Organization (WHO) Model of Education, Policy Reform and Medication Availability.
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Affiliation(s)
- J Cleary
- Department of Medical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Cleary J, Powell RA, Munene G, Mwangi-Powell FN, Luyirika E, Kiyange F, Merriman A, Scholten W, Radbruch L, Torode J, Cherny NI. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Africa: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol 2014; 24 Suppl 11:xi14-23. [PMID: 24285225 DOI: 10.1093/annonc/mdt499] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
With nearly 1.1 billion inhabitants living in more than 50 countries, Africa is the world's poorest and most socioeconomically underdeveloped continent. Despite some advances for individual states, many African countries have very low opioid consumption and, overall, the continent has the lowest consumption per capita of any in the world. This article presents the findings of the first systematic study of the availability and accessibility of opioids for the management of cancer pain across the continent. Data are reported on the availability and accessibility of opioids for the management of cancer pain in 25 of 52 countries, with 744 million of the region's 1127 million people (66%) covered by the survey. Many countries had severely restricted formularies of opioids and only 15 of 25 had morphine available in oral IR, CR and injectable formulations. Even when opioids are on formulary they are often unavailable, and access is significantly impaired by widespread over-regulation that is pervasive across the region.
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Affiliation(s)
- J Cleary
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Kopf A, Radbruch L. [Pain medicine in teaching: Relatively late and quite early]. Schmerz 2014; 28:352-3. [PMID: 25070722 DOI: 10.1007/s00482-014-1467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- A Kopf
- Klinik für Anästhesiologie mit Schwerpunkt Intensivmedizin, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12202, Berlin, Deutschland,
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Schmidt-Wolf G, Elsner F, Lindena G, Hilgers RD, Heussen N, Rolke R, Ostgathe C, Radbruch L. [Evaluation of 12 pilot projects to improve outpatient palliative care]. Dtsch Med Wochenschr 2013; 138:2585-91. [PMID: 24301491 DOI: 10.1055/s-0033-1359858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND With a priority programme the German Cancer Aid supported the development of quality-assured outpatient palliative care to cover the whole country. The 12 regional pilot projects funded with the aim to improve outpatient palliative care in different models and different frameworks were concurrently monitored and evaluated. METHODS The supported projects, starting and ending individually, documented all patients who were cared for using HOPE (Hospice and palliative care evaluation) and MIDOS (Minimal documentation system for palliative patients). Total data were analyzed for 3239 patients decriptively. In addition to the quantitative data the experiences of the projects were recorded in a number of workshops (2008, 2009, 2010, and 2012). In particular, the experiences reported in the final meeting in July 2012 were considered for this article as well as the final reports for the German Cancer Aid. RESULTS In the quantitative evaluation 85.6% of 3239 palliative care patients had a cancer diagnosis. In all model projects the goal of a network with close cooperation of primary providers, social support, and outpatient and inpatient specialist services has been achieved. For all projects, the initial financing of the German Cancer Aid was extremely important, because contracts with health insurance funds were negotiated slowly, and could then be built on the experiences with the projects. CONCLUSION The participants of the project-completion meeting emphasized the need to carry out a market analysis before starting palliative care organizations considering the different regional structures and target groups of patients. Education, training and continuing education programs contribute significantly to the network. A reliably funded coordination center/case management across all institutions is extremely important.
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Cleary J, Silbermann M, Scholten W, Radbruch L, Torode J, Cherny N. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in the Middle East: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol 2013; 24 Suppl 11:xi51-9. [DOI: 10.1093/annonc/mdt503] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Cleary J, Radbruch L, Torode J, Cherny N. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Asia: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol 2013; 24 Suppl 11:xi24-32. [DOI: 10.1093/annonc/mdt500] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Cleary J, Simha N, Panieri A, Scholten W, Radbruch L, Torode J, Cherny N. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in India: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol 2013; 24 Suppl 11:xi33-40. [DOI: 10.1093/annonc/mdt501] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cleary J, De Lima L, Eisenchlas J, Radbruch L, Torode J, Cherny N. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Latin America and the Caribbean: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol 2013; 24 Suppl 11:xi41-50. [DOI: 10.1093/annonc/mdt502] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Elsner F, Sonntag B, Radbruch L, Sabatowski R. Improvement of health care for headache patients with a regional pain management network. ACTA ACUST UNITED AC 2013. [DOI: 10.1163/1568569042664558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Radbruch L, Schaible HG. Vom Recht auf die eigene Meinung. Schmerz 2013; 27:5-6. [DOI: 10.1007/s00482-012-1281-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Klindtworth K, Schneider N, Radbruch L, Jünger S. Versorgung am Lebensende: Haltungen und Einstellungen in der Bevölkerung. Palliativmedizin 2013. [DOI: 10.1055/s-0032-1305163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- K. Klindtworth
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover
| | - N. Schneider
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover
| | - L. Radbruch
- Klinik für Palliativmedizin, Universitätsklinikum Bonn
| | - S. Jünger
- Klinik für Palliativmedizin, Universitätsklinikum Bonn
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Rolke R, Radbruch L, Laufenberg-Feldmann R, Cuhls H. Schmerzbehandlung in der Palliativmedizin. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1327673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- R. Rolke
- Klinik und Poliklinik für Palliativmedizin, Uniklinik, Rheinische Friedrich-Wilhelms Universität Bonn
| | - L. Radbruch
- Klinik und Poliklinik für Palliativmedizin, Uniklinik, Rheinische Friedrich-Wilhelms Universität Bonn
| | - R. Laufenberg-Feldmann
- Klinik für Anästhesiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
| | - H. Cuhls
- Klinik und Poliklinik für Palliativmedizin, Uniklinik, Rheinische Friedrich-Wilhelms Universität Bonn
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Abstract
BACKGROUND Palliative care in nursing homes has become an increasing focal point of healthcare in Germany and the evaluation of the specific quality of palliative care in this setting is under discussion. The assessment of quantitative data has the advantage of allowing pre-post comparisons of different interventions and implementation procedures and can therefore be used for evaluation of effectiveness. However, no assessment tool in German is available yet. Recent research on the assessment of healthcare professionals' knowledge indicated that knowing about technical and psychosocial aspects of palliative care is an easily measurable index for the quality of care. In consequence this index will be used as the core of the test instrument. The specific self-efficacy related to palliative care should be additionally included. METHOD An analysis of the two most common tests of palliative care knowledge by three experts revealed that these instruments were only partly useful in Germany because of differences in the healthcare systems. The experts also criticised that the tests included only a few items concerning psychosocial care and that these items often showed ceiling effects. In addition, the instruments were not suitable for use in nursing homes. For specific self-efficacy only one test is available in Dutch. The items of these three instruments were face validated by 5 experts and new items were generated where needed. The content validity was verified again by five experts with the think-aloud method. Items were validated in 23 calliative care trainers whose expert knowledge served as an external criterion. Items that scored low in this group were eliminated. A second sample of 36 assistant nurses working in nursing homes who took part in a workshop for palliative care was used to assess change sensitivity before and after training. RESULTS A total of 23 items for the knowledge test and 15 items for specific self-efficacy were selected. The level of difficulty was suitable because an expert group could answer the questions while for assistant nurses the items were sufficiently difficult to show a difference between groups. Items were very sensitive to change after a training course. CONCLUSION The BPW is the first standardized test instrument for palliative care in the German language. In comparison to the other tests it includes items from the psychosocial domain without demonstrating a ceiling effect for these items. Content and criterion validity were good. Additional tests with larger samples and with other groups of nurses working in other settings would be needed to improve the data on reliability and to extend the validation to other settings.
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Affiliation(s)
- D Pfister
- ALPHA Rheinland, Von-Hompesch-Str. 1, 53123, Bonn, Deutschland.
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Cremer-Schaeffer P, Radbruch L. [Palliative care in the light of legal and regulatory requirements in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:231-7. [PMID: 22290167 DOI: 10.1007/s00103-011-1408-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
In Germany, palliative care has developed rapidly since the establishment of the first palliative care unit in 1983. More improvements in patient-centered care are only possible if legal requirements as well as education of physicians, nurses, and other professionals involved in palliative care are adapted to current needs. This paper provides an overview of legal and regulatory requirements including a critical appreciation of their influence on palliative care in Germany. Only recently has medical education in palliative medicine been implemented as an integral part of medical studies at German universities. Starting in 2014, physicians applying for a license to practice medicine will have to provide a certificate of basic training in this field. The challenge in upcoming years will be the establishment and enhancement of comprehensive, standardized, and quality-controlled education at the universities. Only six universities have established chairs for palliative medicine, and it will be essential to not only establish more chairs but also to involve medical students in the development of the education. Only minimal requirements are specified for education of nurses in palliative care in the legislation. However, standardized and quality-controlled advanced training courses are available. This training is frequently requested as a prerequisite for nurses working in palliative care. Only limited education programs exist for other professional groups that are an important part of the palliative care team. In addition to the development of palliative care for inpatients with an increasing number of palliative care units, hospices, and first chairs of palliative medicine, different forms of ambulant palliative care services have been developed. Changes in the legislation have influenced the situation for home care enormously in the last 5 years, also making it more complex. With the Law for the Consolidation of the Competition in Compulsory Health Insurance ("Gesetz zur Stärkung des Wettbewerbs in der gesetzlichen Krankenversicherung"), a legal claim for palliative home care has been implemented in the fifth book of the social law in 2007. The ambitious goal of full coverage with comprehensive palliative home care has still not been achieved in most locations. However, after initial negotiation difficulties between palliative care providers and health insurance funds, an increasing number of contracts have been made. As a consequence-in addition to more than 240 palliative care units in Germany-more than one hundred palliative care teams have begun work in the field of specialized palliative home care. Legal regulations for the supply of opioids and other medications for the treatment of patients at home have been adapted recently, thus, facilitating fast and comprehensive medical treatment in emergency situations. Overall, the legislation has been adapted significantly, hence, contributing to improvements for patients requiring palliative care. It remains to be seen whether additional adjustments are required in the future.
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Affiliation(s)
- P Cremer-Schaeffer
- Bundesopiumstelle, Bundesinstitut für Arzneimittel und Medizinprodukte, Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Deutschland.
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Mercadante S, Radbruch L, Popper L, Korsholm L, Davies A. 686 EASE OF USE AND PREFERENCE FOR INTRANASAL FENTANYL SPRAY (INFS) VERSUS ORAL TRANSMUCOSAL FENTANYL CITRATE (OTFC) FOR BREAKTHROUGH CANCER PAIN. Eur J Pain 2012. [DOI: 10.1016/s1090-3801(09)60689-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - L. Radbruch
- Universitätsklinikum Aachen, Aachen, Germany
| | - L. Popper
- Research & Development Nycomed, Roskilde, Denmark
| | - L. Korsholm
- Research & Development Nycomed, Roskilde, Denmark
| | - A. Davies
- The Royal Marsden Hospital, Sutton, United Kingdom
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Ostgathe C, Lindena G, Heussen N, Knübben K, Elsner F, Radbruch L. [Accompanying evalution of funded projects in palliative medicine of the German Cancer Aid]. Schmerz 2011; 25:676-84. [PMID: 22120921 DOI: 10.1007/s00482-011-1113-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The German Cancer Aid funded 12 regional projects which developed different models of palliative home care. The realization of the projects were concurrently monitored and evaluated. MATERIAL AND METHODS The funded projects were asked to document all patients who were cared for beginning in January 2009 using HOPE (Hospice and palliative survey), MIDOS (Minimal documentation system for palliative patients) and the Barthel index. Documentation was mandatory at the beginning and the end of care as well as when patients changed settings, for example when patients were transferred from a palliative care unit to a palliative home care service. Additionally the projects were visited by an independent observer. RESULTS Overall the 12 projects documented 2,663 patients. Analysis revealed differences between the projects mainly concerning target groups and interventions. DISCUSSION The results of this evaluation can support the discussion about the development of palliative home care in Germany with particular focus on possible interrelations between structures, target groups and possible outcomes of care.
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Affiliation(s)
- C Ostgathe
- Abteilung für Palliativmedizin, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland.
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Powell RA, Mwangi-Powell FN, Kiyange F, Radbruch L, Harding R. Palliative care development in Africa: how can we provide enough quality care? BMJ Support Palliat Care 2011; 1:113-4. [DOI: 10.1136/bmjspcare-2011-000101] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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