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1.
Internist (Berl) ; 63(5): 533-544, 2022 May.
Artigo em Alemão | MEDLINE | ID: mdl-35441880

RESUMO

Despite the availability of the instruments of advance directives, power of attorney and healthcare proxy, the patient's preferences for life-sustaining medical treatment in a specific situation often remain unknown. The aim of the systemically designed German Advance Care Planning (ACP) program is the reflection, documentation and implementation of patients' preferences regarding future medical treatment in case they are incapable of legally binding decision-making. A specially trained ACP facilitator initially supports the verbalization of the attitudes towards life, severe illness and death on an individual level. Based on these principal views, concrete preferences on how to be treated under defined medical circumstances can be discussed and documented in an advance directive. This includes the three scenarios medical emergency, inpatient hospital treatment in situations with decisional incapability of unknown duration and the situation of permanent cognitive impairment. Through cautious, nondirective conversational techniques in the sense of shared decision-making, the person is enabled to reflect and decide well-informed according to the informed consent standard. All persons participating in decisions regarding future medical treatment, especially future surrogate decision makers, are involved in the process as early as possible. A systematic institutional and regional implementation of the concept is necessary to ensure that the carefully assessed and documented preferences of the patients will be known and honored. The new German § 132g of the Social Code Book V (SGB V) enables institutions for long-term care and for the care of disabled persons, to offer facilitated ACP to all residents at the expense of the statutory health insurance funds. An increased dissemination of this concept is to be expected.


Assuntos
Planejamento Antecipado de Cuidados , Diretivas Antecipadas , Tomada de Decisões , Humanos , Medicina Interna , Cuidados Paliativos
2.
Anaesthesist ; 69(2): 78-88, 2020 02.
Artigo em Alemão | MEDLINE | ID: mdl-31820016

RESUMO

Despite the availability of the instruments of advance directives, power of attorney and healthcare proxy, the patient's preferences for life-sustaining medical treatment in a specific situation often remain unknown. The aim of the systemically designed German Advance Care Planning (ACP) program is the reflection, documentation and implementation of patients' preferences regarding future medical treatment in case they are incapable of legally binding decision-making. A specially trained ACP facilitator initially supports the verbalization of the attitudes towards life, severe illness and death on an individual level. Based on these principal views, concrete preferences on how to be treated under defined medical circumstances can be discussed and documented in an advance directive. This includes the three scenarios medical emergency, inpatient hospital treatment in situations with decisional incapability of unknown duration and the situation of permanent cognitive impairment. Through cautious, nondirective conversational techniques in the sense of shared decision-making, the person is enabled to reflect and decide well-informed according to the informed consent standard. All persons participating in decisions regarding future medical treatment, especially future surrogate decision makers, are involved in the process as early as possible. A systematic institutional and regional implementation of the concept is necessary to ensure that the carefully assessed and documented preferences of the patients will be known and honored. The new German § 132g of the Social Code Book V (SGB V) enables institutions for long-term care and for the care of disabled persons, to offer facilitated ACP to all residents at the expense of the statutory health insurance funds. An increased dissemination of this concept is to be expected.


Assuntos
Planejamento Antecipado de Cuidados/organização & administração , Planejamento Antecipado de Cuidados/normas , Diretivas Antecipadas , Anestesistas/normas , Comunicação , Tomada de Decisões , Humanos , Assistência Terminal
3.
Nervenarzt ; 89(5): 524-529, 2018 May.
Artigo em Alemão | MEDLINE | ID: mdl-29327100

RESUMO

As a result of a literature-based expert process, this review provides an overview about the principles of palliative care for people with advanced dementia that are relevant for clinical practice. In particular, the indications, impact and aims of palliative care for advanced dementia are described. Life-prolonging measures and management of symptoms at the end of life are discussed. Furthermore, the overview focuses on the legal basis of decision making.


Assuntos
Demência , Cuidados Paliativos , Tomada de Decisões , Humanos , Cuidados Paliativos/legislação & jurisprudência
4.
Nervenarzt ; 83(2): 187-94, 2012 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-22249602

RESUMO

Status epilepticus (SE) is a medical emergency. For diagnostic purposes EEG is mandatory when motor phenomena are absent or when a single seizure evolves into SE with impaired consciousness. The EEG may show focal or generalized status patterns, which must be distinguished from encephalopathies. Initially benzodiazepines are recommended; lorazepam is the drug of choice. When the SE persists, phenytoin, valproate, levetiracetam, lacosamide, and phenobarbital are administered. The choice depends on the underlying comorbidities. In this phase, only phenytoin is licensed. A generalized tonic-clonic status which is refractory is then treated with anesthetics including midazolam, disoprivan, or thiopental. The goal is to achieve burst suppression in the EEG and coadministration of antiepileptic drugs.


Assuntos
Anticonvulsivantes/uso terapêutico , Eletroencefalografia/métodos , Serviços Médicos de Emergência/métodos , Fenitoína/uso terapêutico , Estado Epiléptico/diagnóstico , Estado Epiléptico/tratamento farmacológico , Humanos , Estado Epiléptico/prevenção & controle
6.
Biophys Chem ; 48(2): 135-47, 1993 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-8298052

RESUMO

Intramolecular dynamics in Na,K-ATPase molecules have been studied by ultraviolet fluorescence spectroscopic methods: determination of temperature-dependent shifts in steady-state spectra, site-selective red-edge effects and their temperature dependence, and time-resolved emission decay as a function of excitation and emission wavelengths. The combination of these methods allows the characterization of the dipolar-relaxational mobility in the environment of the tryptophan residues. Our results show that the mean dipolar-relaxational time is of the order of one nanosecond at room temperature. This is much faster than what is usually observed in globular proteins. The fast dynamics of the protein dipoles are rapid enough so that the dipoles are in dielectric equilibrium during the slower ion transfer processes; this may have important functional consequences.


Assuntos
ATPase Trocadora de Sódio-Potássio/química , Soluções Tampão , Fenômenos Químicos , Físico-Química , Glicerol/química , Cinética , Fotoquímica , Espectrometria de Fluorescência/métodos , Sacarose/química , Temperatura , Termodinâmica , Fatores de Tempo
7.
Neurology ; 77(15): 1453-6, 2011 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-21987641

RESUMO

OBJECTIVE: We investigated whether crossed legs are a prognostic marker in patients with severe stroke. METHODS: In this controlled prospective observational study, we observed patients with severe stroke who crossed their legs during their hospital stay and matched them with randomly selected severe stroke patients who did not cross their legs. The patients were evaluated upon admission, on the day of leg crossing, upon discharge, and at 1 year after discharge. The Glasgow Coma Scale, the NIH Stroke Scale (NIHSS), the modified Rankin Scale (mRS), and the Barthel Index (BI) were obtained. RESULTS: Patients who crossed their legs (n = 34) and matched controls (n = 34) did not differ in any scale upon admission. At the time of discharge, the GCS did not differ, but the NIHSS was better in crossed legs patients (6.5 vs 10.6; p = 0.0026), as was the mRS (3.4 vs 5.1, p < 0.001), and the BI (34.0 vs 21.1; p = 0.0073). At 1-year follow-up, mRS (2.9 vs 5.1, p < 0.001) and the BI (71.3 vs 49.2; p = 0.045) were also better in the crossed leg group. The mortality between the groups differed grossly; only 1 patient died in the crossing group compared to 18 in the noncrossing group (p < 0.001). CONCLUSION: Leg crossing is an easily obtained clinical sign and is independent of additional technical examinations. Leg crossing within the first 15 days after severe stroke indicates a favorable outcome which includes less neurologic deficits, better independence in daily life, and lower rates of death.


Assuntos
Perna (Membro)/fisiopatologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Feminino , Seguimentos , Escala de Coma de Glasgow , Hospitalização , Humanos , Masculino , Observação , Avaliação de Resultados em Cuidados de Saúde , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Índice de Gravidade de Doença
10.
Nervenarzt ; 77(10): 1218-22, 2006 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-16871376

RESUMO

We report a case of reversible posterior leukoencephalopathy syndrome in a 50-year-old patient with severe untreated hypertension. Recent advances in magnetic resonance imaging (especially diffusion-weighted imaging) allow new pathopysiological insight: it was found that the resulting vasogenic edema was restricted neither to the posterior vascular territories nor to white matter. The apparent diffusion coefficient helps to differentiate between reversible vasogenic edema and cytotoxic edema, the latter indicating irreversible neuronal death.


Assuntos
Edema Encefálico/diagnóstico , Encefalopatia Hipertensiva/diagnóstico , Anti-Hipertensivos/uso terapêutico , Encéfalo/patologia , Edema Encefálico/tratamento farmacológico , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética , Quimioterapia Combinada , Cefaleia/etiologia , Humanos , Encefalopatia Hipertensiva/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Fibras Nervosas Mielinizadas/patologia , Testes Neuropsicológicos
11.
Epilepsy Behav ; 6(1): 43-9, 2005 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15652733

RESUMO

Personality adjustment of patients with unilateral temporal lobe epilepsy (TLE) was investigated in the light of special characteristics of the epilepsy process, psychosocial stressors, and the cognitive status of the patients. Thirty-seven patients with medically intractable unilateral temporal lobe epilepsy (16-55 years of age; 20 right temporal and 17 left temporal foci) were examined with standardized personality inventories (FPI, STAI, IPC, TSK) supplemented by a rating scale evaluated by the neuropsychologist (GEWLE). Patients with left temporal lobe epilepsy were characterized by increased emotional dependency, less externally judged composedness, increased depressive drive and mood, increased nervousness, increased search for information and exchange of disease experience, and greater tendency to persevere (P < 0.05). Cognitive status and psychosocial status did not significantly differ. The evaluation of personality adjustment contributes to the lateralization of the epileptogenic focus and reveals interesting patterns in the preoperative diagnostic puzzle, and in addition provides a strategy to individualize psychotherapeutic strategies.


Assuntos
Epilepsia do Lobo Temporal/fisiopatologia , Epilepsia do Lobo Temporal/psicologia , Lateralidade Funcional/fisiologia , Psicopatologia/métodos , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Testes Neuropsicológicos/estatística & dados numéricos , Transtornos da Personalidade/fisiopatologia , Transtornos da Personalidade/psicologia , Inventário de Personalidade/estatística & dados numéricos , Testes Psicológicos
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