Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Nov 2003
Comparative Study[Cardiac rehabilitation in Austria. A need to treat analysis].
The aim of this analysis is to survey the general demand and current supply of cardiac rehabilitation in Austria on the basis of best evidence practice and to produce recommendations for a cost-effective structure of the entire cardiac rehabilitation system. Following the standards of indication of the Austrian Society of Cardiology an analysis of demand of cardiac rehabilitation has been carried out and juxtaposed with the current supply of facilities for cardiac rehabilitation. According to hospitalizations in the year 2000, 11,630 patients per annum would require inpatient phase II rehabilitation, 6,270 patients institutional based outpatient phase II rehabilitation and 14,319 patients institutional based phase III rehabilitation. ⋯ At present, the supply of cardiac rehabilitation in Austria is sufficient for inpatient phase II, but insufficient for the institutional based outpatient phase II and mainly phase III. Thus, a striking asymmetry exists between supply and demand. In view of the enduring effects of institutional based phase III rehabilitation, the individual and social use and finally the expected efficiency in terms of costs, this program should at least be offered without limits to all eligible patients.
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Using an actual case, this paper examines a number of ways in which physicians deal with such a case and with the various "principles" and ethical theories to which they are apt to appeal. It goes on to suggest that using Dewey's method of solving problems is most applicable at the bed-side.
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Wien. Klin. Wochenschr. · Oct 2003
Comparative StudyWomen's position during labour: influence on maternal and neonatal outcome.
To assess the maternal, perineal and neonatal outcomes of an upright position compared with a supine position during vaginal delivery, in terms of defined outcome variables. ⋯ The data indicate that labouring and delivering in an upright position is associated with beneficial effects such as a lower rate of episiotomy, and a reduced use of medical analgesia and oxytocin. In our opinion, the best recommendation is to give low-risk maternity patients the option of bearing in the mode that is most comfortable for them.
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Wien. Klin. Wochenschr. · Oct 2003
Comparative StudyPain and stress management in the Neonatal Intensive Care Unit--a national survey in Austria.
Neonates are sensitive to pain and vulnerable to both its short-term and long-term effects. Management of analgesia is thought to be hampered by lack of awareness that newborns are capable of experiencing pain and by fears about adverse effects associated with analgesics. The purpose of this study was to assess current medical practice in preventive analgesia and sedation in the neonate throughout Austria. This report details the results of a survey in 28 neonatal intensive care units (NICUs) in Austria. Data collection took place from October to December 2001. All NICUs reported the capability of newborns to experience and express pain and nearly all stated the possibility of pain affecting morbidity. Validated scores for pain assessment were used by 11% of NICUs, standardized protocols for analgesia existed in 75%, and 100% practiced non-pharmacological treatment strategies. The use of preventive measures in routinely performed painful procedures ranged from 8% to 96%. For example, only 8% of NICUs prevent distress and pain prior to umbilical vessel catheterization, 29% prior to subcutaneous injections and 46% prior to heel lancing. Nearly all NICUs apply analgesia before lumbar puncture and thoracic-drain placement, and all use analgesic and/or sedative medication in elective intubation. ⋯ There is widespread awareness among neonatologists of the importance and effects of distress caused by pain in newborns. However, the necessity of providing sufficient analgesia is underestimated. Further information on the safety of analgesic drugs in neonatology is imperative.