Wiener medizinische Wochenschrift
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Patient autonomy became increasingly important during the last decades. It is often described to be an antagonist to medical paternalism. Like for patients with full decisional capacity, autonomy should also be protected for incapacitated patients. ⋯ These tools should be combined with a process of communication with the patient's loved ones and consultation by a caring physician according to the integrative model. This can enhance and supplement the patient's autonomy. This article demonstrates surrogate decision making in theory and by the example of a case report.
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Wien Med Wochenschr · Jan 2008
Case Reports[Dyspnoea--a multifactorial and multidimensional symptom].
The treatment of dyspnoea is a considerable challenge in palliative care. Respiratory problems, besides pain, belong to the most common symptoms of terminally ill patients. ⋯ On the basis of a case study of a lung cancer patient, the complexity of different causes of dyspnoea will be discussed. Special consideration will be taken to the psychosocial dimension of dyspnoea.
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Heart failure is an increasingly prevalent, often progressive condition associated with high morbidity and mortality. In end-stage heart failure a strategy is urgently needed to ensure a truly progressive move away from invasive treatment toward supportive terminal care. The basic principles of palliative care--good communication and close attention to symptom control--should be adopted to improve the quality of life of heart failure patients. On the basis of a case study, the need of palliative care in the management of heart failure will be demonstrated.
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Severe pain caused by multiple metastases in bones in a pediatric patient suffering from rhabdomyosarcoma, a solid tumor of childhood, made palliative sedation therapy after developing metastases in lung necessary. The premises for this therapy, the difference in the choice of drugs compared to adults and psychology of the dying child are discussed.
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Cannabinoids have been known for many centuries because of their various effects in healthcare. They are primarily effective in reducing nausea, vomiting, pain, anorexia, spasticity and depression. ⋯ Today, the therapeutical use of cannabinoids in medicine is increasing, and access was made easier. Especially in pain-management and palliative care, they seem to be a valuable therapeutic option.