Factors associated with spousal burden in Parkinson's disease.

Parkinson's disease is characterized by motor and non-motor symptoms, which can lead to progressive disability that, in turn, can lead to a burden on caregivers. Thus, the objective of this study was to determine correlations between intensity of disease burden and characteristics of patients and their spouses. The study included 38couples (patients and spouses) living at home with no severe comorbidities. The following patients' characteristics were measured: disease severity (MDS-UPDRS); cognitive status (MoCA); non-motor signs (NMSS); quality of life (PDQ-8); anxiety and depression (HADS); and levodopa equivalent dose. The Zarit Burden Interview, quality of life questionnaire (EQ-5D-VAS) and HADS were administered to spouses. The average caregiver burden score was 14.4±12.7, and correlated (in descending order) with severity of non-motor signs (R2=0.46, P<0.0001), anxiety and depression in caregivers and patients (R2=0.35, P<0.0001 and R2=0.26, P<0.0001, respectively), motor severity (R2=0.3, P<0.0001), patients' quality of life (R2=0.27, P=0.0125), levodopa equivalent dose (R2=0.13, P=0.0261) and duration of illness (R2=0.12, P=0.0307). The severity of non-motor signs, patients' and caregivers' mood, and motor disease severity are the main determinants of caregiver burden, making them important targets in the management of Parkinson's disease.

[Acute pain therapy in German hospitals as competitive factor. Do competition, ownership and case severity influence the practice of acute pain therapy?]. / Akutschmerztherapie in deutschen Krankenhäusern als Wettbewerbsfaktor. Wird die Praxis der Akutschmerztherapie von Wettbewerb, Trägerschaft und Fallschwere beeinflusst?

BACKGROUND: Due to the implementation of the diagnosis-related groups (DRG) system, the competitive pressure on German hospitals increased. In this context it has been shown that acute pain management offers economic benefits for hospitals. The aim of this study was to analyze the impact of the competitive situation, the ownership and the economic resources required on structures and processes for acute pain management. MATERIAL AND METHODS: A standardized questionnaire on structures and processes of acute pain management was mailed to the 885 directors of German departments of anesthesiology listed as members of the German Society of Anesthesiology and Intensive Care Medicine (DGAI, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin). RESULTS: For most hospitals a strong regional competition existed; however, this parameter affected neither the implementation of structures nor the recommended treatment processes for pain therapy. In contrast, a clear preference for hospitals in private ownership to use the benchmarking tool QUIPS (quality improvement in postoperative pain therapy) was found. These hospitals also presented information on coping with the management of pain in the corporate clinic mission statement more often and published information about the quality of acute pain management in the quality reports more frequently. No differences were found between hospitals with different forms of ownership in the implementation of acute pain services, quality circles, expert standard pain management and the implementation of recommended processes. Hospitals with a higher case mix index (CMI) had a certified acute pain management more often. The corporate mission statement of these hospitals also contained information on how to cope with pain, presentation of the quality of pain management in the quality report, implementation of quality circles and the implementation of the expert standard pain management more frequently. There were no differences in the frequency of using the benchmarking tool QUIPS or the implementation of recommended treatment processes with respect to the CMI. CONCLUSION: In this survey no effect of the competitive situation of hospitals on acute pain management could be demonstrated. Private ownership and a higher CMI were more often associated with structures of acute pain management which were publicly accessible in terms of hospital marketing.

[Postoperative pain assessment after middle ear surgery]. / Postoperativer Schmerz nach Mittelohrchirurgie.

BACKGROUND: The purpose of this work was to assess postoperative pain management after middle ear surgery. MATERIALS AND METHODS: In a prospective clinical study, 73 adults were evaluated on the first postoperative day after middle ear surgery using the questionnaire of the Germany-wide project QUIPS (quality improvement in postoperative pain management). The main outcome measures were patients' characteristics, pain parameters, outcome, and pain therapy process parameters. RESULTS: Overall, pain on the first postoperative day was mild. Pain management consisted predominately of premedication with midazolam, remifentanil intraoperatively, metamizole in the recovery room and on the ward. Otherwise healthy patients suffered significantly more from pain than patients with reduced general condition in univariate and multivariate analyses. About half of the patients demanded pain relief on the ward. Despite immediate pain management with nonopioids and/or opioids, these patients had significantly more maximal pain and were less satisfied with overall pain therapy than patients not demanding pain therapy. DISCUSSION: QUIPS is a simple tool to evaluate the quality of in-hospital postoperative pain management following ear surgery. Pain on the first postoperative day seems to be moderate but should be improved for patients demanding more analgetics despite baseline pain therapy on the ward.

Postoperative pain assessment after septorhinoplasty.

Postoperative pain after septorhinoplasty and its optimal management has not been described in detail. Fifty-two adult septorhinoplasty patients were included in a prospective cohort single center study. Patients' and surgical characteristics were evaluated. Outcome and process parameters were analyzed using the questionnaires of the German-wide project Quality Improvement in Postoperative Pain Management (QUIPS) on the first postoperative day. Pain during the first operative day after septorhinoplasty was moderate. Pain management predominately consisted of remifentanil intraoperatively, metamizole in the recovery room, in combination with piritramide in one-third of the patients, and metamizole on ward. Patients younger than 31 years were less satisfied with pain management (P = 0.018). Open rhinoplasty was associated with less satisfaction with pain management (P = 0.007). Use of rib grafts led to more mobility, breathing, sleeping and mood disturbances (P = 0.003, 0.047; 0.047; 0.022, respectively). Preoperative pain counseling was followed by higher satisfaction, less breathing and mood disturbances after surgery (P = 0.021; 0.004; 0.046, respectively). Opioids in the recovery room in addition to non-opioids and treatment with non-opioids on ward led to less maximal pain (P = 0.027 and 0.040, respectively). We conclude that QUIPS is an easy tool to evaluate the quality of postoperative pain management following rhinoplasty. Preoperative pain counseling, specific care for patients with rib grafts, consequent use of opioids in the recovery room in addition to non-opioids, and use of non-opioids on ward seem to be effective to improve pain management after septorhinoplasty.

[Postoperative pain assessment in special patient groups: part I: children without cognitive impairment]. / Postoperative Schmerzmessung bei speziellen Patientengruppen: Teil I: Das kognitiv unbeeinträchtigte Kind.

The intensity of pain cannot be measured directly but can only be described subjectively. This obviously complicates the assessment especially in the younger age group. Pain evaluation and documentation are essential for good results in pain therapy. Pain can be measured by pain scales which should fulfill the requirements of practicability, reliability and validity. In neonates and children up to 4 years of age, standardized scales have been developed for observation of their activities. Children in the age group 4-6 years old are able to communicate about pain. At this age self-report scales can be used to assess pain sensations."Quality Improvement in Postoperative Pain Management in Infants" (QUIPSInfant) represents a new tool for pediatric outcome evaluation, consisting of standardized data acquisition of outcome and process quality indicators.

[What is the value of pain therapy in the German refined diagnosis-related-groups system?]. / Was ist Schmerztherapie im "German refined--diagnosis related groups-System" wert?

The German refined diagnosis-related-groups (G-DRG) system was introduced on 1st January 2003, initially on a voluntary basis and on 1st January 2004 the use of a G-DRG costing for stationary hospital treatment became obligatory. The possibility of a description of acute and chronic pain therapy in the G-DRG system was initially rudimentary and not logically planned and also a fair allotment of proceeds according to resources was not possible. By further development of the G-DRG system, pain therapeutic treatment could be improved in some areas, but in others it still remains unsatisfactory. This article offers a summary of the underlying systematics of the G-DRG system and consideration of chronic and current pain therapy in the G-DRG system 2006. In addition to information on currently available possibilities of a pain therapeutical coding in conformation with the G-DRG system, the tasks which are still outstanding will be outlined.

[Apomorphine therapy versus deep rain stimulation. Clinical and economic aspects in patients with advanced Parkinson disease]. / Apomorphintherapie versus tiefe Hirnstimulation. Klinische und ökonomische Aspekte bei Patienten mit fortgeschrittenem Morbus Parkinson.

Long-term dopaminergic treatment of Parkinson's disease is complicated by the occurrence of dyskinesia and motor fluctuations and is responsible for increasing the costs of treatment. In these patients, continuous subcutaneous therapy with the dopamine agonist apomorphine or deep-brain stimulation represents a promising strategy. While the costs for the treatment with apomorphine are covered by health insurance, separate reimbursement for deep-brain stimulation does not exist in Germany. The case reports (n = 3) presented here emphasize that deep-brain stimulation is less cost-intensive than subcutaneous treatment with apomorphine in selected patients. Even in the first postoperative year costs for medication and hospital stays were reduced by approximately 60%. Moreover, in all three patients, motor complications improved after deep-brain stimulation in comparison to previous subcutaneous application of apomorphine. Thus, to further ensure deep-brain stimulation in parkinsonian patients it is mandatory to find a mode of reimbursement for the institutions concerned.

[Assessment of social hearing with a questionnaire in relation to average hearing loss]. / Zur Einschtzung des Sozialgehörs mit Fragebogen in Relation zum mittleren Hörverlust.

In 86 patients with sensorineural hearing loss we checked if the measuring results obtained by conventional audiometric procedures correlate with the subjective impression of hard hearing ascertained via a special questionnaire. For this purpose we compared the average hearing loss (500, 1000, 2000 Hz) of the puretone audiogram with the results obtained via the questionnaire developed by v. Wedel and Tegtmeier for assessing the social hearing handicap (SHH). We can see that there is good correlation between the SHH index values and the average hearing loss with frequencies of 0.5, 1.2 kHz in pancochlear perception hearing loss, whereas in patients with basocochlear perception hearing loss the SHHI cannot be calculated with the help of the puretone audiogram, nor will a widening of the frequency range up to 6 kHz lead to a better correlation between the average hearing loss and SHHI.