Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Sep 2007
Comparative Study[Symptomatic treatment of dyspnoea in patients receiving palliative care: nasal delivery of oxygen compared with opioid administration].
Dyspnoea frequently occurs in patients with advanced tumor disease receiving palliative care (prevalence > 50). Aim of the study was to assess, in dyspneic patients in palliative care, the efficacy of opioids in treating their dyspnoea and to determine whether or not nasal administration of oxygen previous to opioid administration would decrease the severity of dyspnoea. ⋯ During nasal oxygen administration the severity of dyspnoea, as measured by use of NRS had not decreased, whereas it had significantly decreased after the first opioid administration.
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A 69-year-old female patient was admitted to a hospital for severe dyspnoea. It was conspicuous that shortness of breath and cyanosis only occurred in upright and completely disappeared in the supine position. This finding was objectified by pulse oximetry which demonstrated a decrease of arterial oyxgen saturation from 96 % in the supine to 86 % in the upright position. ⋯ Platypnoe-othodeoxia syndrome is a very rare syndrome but it can be substantiated by pathognomonic case history, clinical examination and simple machine-aided examinations. With a causative PFO a causal and save therapy is available.
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Dtsch. Med. Wochenschr. · Aug 2007
Review[How do patients with COPD circumvent their disease? Psychological factors].
Chronic illness permanently changes a patient;s lifestyle and requires continuous adaptation. Chronic diseases like COPD and its treatment place extensive behavioral demands on patients. The need for precisely scheduled daily medication, regular physical exercise, visits to health care providers and monitoring are some of the demands. ⋯ COPD patients often have perceived barriers and factors, which will hinder or facilitate an optimal self-management. For instance their individual treatment goals can differ from those of the physician, or patients feel distressed about having a chronic disease. The comprehension of psychological factors in medical treatment is essential not only to be more effective in improving patients' confidence in their ability to follow a self-care regimen but also have beneficial effects in achieving treatment goals.