Dyspnoea associated with anxiety--symptomatic therapy with opioids in combination with lorazepam and its effect on ventilation in palliative care patients.

Purpose: Opioids are used for symptomatic therapy of dyspnoea, and benzodiazepines if dyspnoea is associated with anxiety. When given at the same time, the risk of respiratory depression will increase. The aim of this study was to assess the safety of this treatment regimen in palliative care patients.

Managing opioid-induced constipation in advanced illness: focus on methylnaltrexone bromide.

Constipation is a common symptom in palliative care patients which can generate considerable suffering. There is uncertainty about the choice of treatment options from varying recommendations for management of constipation and a varying clinical practice in palliative care settings. The purpose of the review was to evaluate the current recommendations of therapy guidelines for the management of opioid-induced constipation in palliative care patients with a focus on methylnaltrexone bromide.

[Integration of principles of palliative medicine into treatment of patients in intensive care units].

Intensive care medicine, as well as palliative medicine, is dealing with the limits of life-preserving care. Decision-making in matters of life and death is one of the greatest challenges for physicians, because it may be an area of conflict with regard to aspects of patient autonomy, medical prognosis and the ethics of medical care. At first sight palliative medicine and intensive care medicine seem to be at the opposite ends of care.

Use of oxygen and opioids in the palliation of dyspnoea in hypoxic and non-hypoxic palliative care patients: a prospective study.

Background: Dyspnoea is a complex experience of the body and the mind. Whereas the effects of opioids on dyspnoea in advanced disease have been the focus of studies for management of dyspnoea in palliative medicine, the role of oxygen is still unclear. The effects of symptomatic oxygen and opioid treatment on ventilation and palliation of dyspnoea in hypoxic (H) and non-hypoxic (NH) palliative care patients were assessed and compared.

Management of constipation in palliative care patients.

Purpose Of Review: Constipation is a common symptom in palliative care patients that can generate considerable suffering due to both unpleasant physical symptoms and psychological preoccupations that may arise. There is uncertainty about the choice from varying recommendations for management of constipation and a varying clinical practice in palliative care settings. The purpose of the review is to evaluate the current recommendations of therapy guidelines and to determine the effectiveness of laxative administration for the management of constipation in palliative care patients.

Attitudes toward active euthanasia among medical students at two German universities.

Aim: There has been an ongoing debate about a legalisation of active euthanasia (AE) in Germany. Palliative care education in German medical schools seeks to foster and cultivate a negative attitude toward AE, but little is known about its effectiveness in this respect. The aim of this study was to assess attitudes toward AE among students with and without palliative medicine tuition (PMT).

Is there a higher risk of respiratory depression in opioid-naïve palliative care patients during symptomatic therapy of dyspnea with strong opioids?

Objective: Dyspnea is a highly prevalent symptom in palliative care patients. Opioids are the first-line therapy for symptomatic relief of dyspnea. However, respiratory depression is still a feared side effect of therapy with WHO III opioids.

Effect of hydromorphone on ventilation in palliative care patients with dyspnea.

Goals: This study assessed the effect of hydromorphone treatment on ventilation and the intensity of dyspnea in palliative care patients. The assessments measured changes in peripheral oxygen saturation (SaO(2)), transcutaneous arterial pressure of carbon dioxide (tcpaCO(2)), respiratory rate (f), and pulse frequency (PF) during the titration phase with hydromorphone for symptomatic therapy of dyspnea. The aims of the study were to verify the efficacy of hydromorphone for the management of dyspnea and assess its effect on ventilation.

Clinical experience with transdermal and orally administered opioids in palliative care patients--a retrospective study.

Background: Transdermal fentanyl is a widely used opioid for the treatment of cancer pain. Simplicity of use and high patient compliance are the main advantages of this opioid. However, based on our clinical experience, transdermal fentanyl is often not efficacious in terminally ill palliative care patients.

[State of the art 2007].

The beginning of the modern hospice movement and palliative medicine relates to the recognition of the fact that a cure-oriented health care system often neglects the critically ill and the dying in terms of appropriate treatment and human care. Therefore, the idea was born to offer comprehensive medical, nursing, psychological, social and spiritual care for these patients and their families at a suitable location . This first location was St Christopher's Hospice in London; the starting point of a still ongoing humanly and ethically demanded development.

Symptomatic therapy of dyspnea with strong opioids and its effect on ventilation in palliative care patients.

This study assessed the effect of opioid treatment on ventilation in dyspneic palliative care patients who received symptomatic treatment with strong opioids. The assessments measured changes in peripheral arterial oxygen saturation (SaO(2)), transcutaneous arterial pressure of carbon dioxide (tcPCO(2)), respiratory rate (f), and pulse rate (PF) during the titration phase with morphine or hydromorphone. The aims of the study were to verify the efficacy of opioids for the management of dyspnea, assess the effect on ventilation, and show whether nasal O(2) insufflation before opioid application leads to a decrease in the intensity of dyspnea.

Undergraduate training in palliative medicine in Germany: what effect does a curriculum without compulsory palliative care have on medical students' knowledge, skills and attitudes?

Introduction: The effect of a curriculum without compulsory courses in palliative medicine on students' knowledge, kills and attitudes towards the care of dying patients and decisions at the end of life was investigated.

Methods: In a cross sectional, questionnaire based survey at the medical school of Bonn 1st, 3rd and 5th year students had to grade their knowledge and skills in items concerning palliative medicine. Attitudes towards end of life decisions were queried.

Management of constipation in palliative care patients undergoing opioid therapy: is polyethylene glycol an option?

This study assessed the efficacy of laxative use for treatment of constipation in patients receiving opioid therapy, with special attention to polyethylene glycol 3350/electrolyte solution (PEG-ES). Computerized data from 206 patients were analyzed using descriptive statistics. Subgroups were analyzed using confirmatory statistics.

Drugs in palliative care: results from a representative survey in Germany.

The development of palliative medicine in inpatient units in Germany has been impressive in the last years. As a first step of quality assurance, a core documentation form was developed in 1996. In 2001, 55 of the 83 palliative inpatient units in Germany and one unit each in Switzerland and Austria participated in the third phase of the evaluation of the core documentation.