Prehospital emergency physicians are confronted with emergencies in palliative care patients every day. In the treatment of these emergencies there are potentially serious conflicts due to the different therapeutic concepts of palliative medical care and emergency medical services. This study demonstrates that there is a need for regulated criteria for the therapy of palliative patients and patients at the end of life in emergency situations. Overall, more clinical investigations concerning end-of-life care and unresponsive palliative care patients in emergency medical situations are necessary.
A 62-year-old female suffered from therapy-resistant pain in the axilla after lymphadenectomy. The pain ranged from 8-10 on the numeric rating scale (NRS) despite multimodal pain therapy (non-steroid anti-rheumatics, opioids, physiotherapy, acupuncture). A paravertebral trial injection was performed preoperatively on the laminae of the thoracic vertebrae Th 2-Th 4. As the patient responded well, a paravertebral catheter was inserted close to Th 4 directly before the revision operation took place the following day. The case study describes the possibilities of eliminating pain segmentally in the axilla and an alternative technique to a paravertebral block (lamina technique).
In the context of developing and testing a procedure for "Outcome-oriented payment for rehabilitation after stroke", we found that the instruments commonly used to measure the outcomes of rehabilitation after stroke (e. g., Barthel-Index or FIM) were not meeting the special requirements of the new payment system. Therefore the "Scores of Independence for Neurologic and Geriatric Rehabilitation" (SINGER) was developed as a new assessment instrument. This instrument is based on the ICF and measures 20 aspects of "independence in activities of daily living". The characteristic feature of the SINGER is, above all, the way all items are graded in 6 steps: the gradation does not refer to the degree of disability but to the kind and amount of help required for the respective activity, i. e.: 0 = totally dependent on professional help; 1 = professional contact help needed; 2 = contact help by (instructed) lay persons sufficient; 3 = preparation or supervision by lay persons still needed; 4 = independent with assistive device or still slow; 5 = independent without assistive device. For experienced personnel in neurologic rehabilitation, these gradations are "intuitively plausible". A manual moreover describes each grade in detail for each item so that the instrument can be used in rehabilitation facilities without extensive training. The SINGER has been tested and validated in a pilot study (n = 100) and in 2 subsequent studies with large case numbers in neurologic rehabilitation (n = 1058 and n = 700 patients after stroke in all categories of severity). Factor analyses showed that the instrument contains 2 dimensions which can be interpreted as "physical activities" and "activities of communication and cognition". Each of these 2 dimensions can be split into 2 sub-dimensions that can be assigned to the tasks of therapeutical professions in care/Occupational Therapy, physiotherapy, logopedics, and neuro- psychology. The test criteria of reliability, sensitivity, convergent validity, floor and ceiling effects as well as sensitivity to change show good to very good results. Particular emphasis can be given to the high degree of interrater reliability and the wide range of possible applications in clinical practice as well as in research. A limitation of the instrument to be taken into account is the fact that the SINGER has not yet been tested and validated in geriatric rehabilitation facilities.
Syntheses and Properties of Pyrrolindigo Compounds*')4,4',5,5',6,6',7,7'-Octahydroindigo (Sc), 4,4'-dibutyl-5,5'-dimethylpyrrolindigo (9a) and di(cyc1o-penta)pyrrolindigo (9d) as well as the condensation products from 2-pyrrolin-4-ones with benzaldehyde, isatin, glyoxale, and 2-methoxy-3-indolone, plus N-methyl-and N,N'-dimethylderivatives of 9c and tetrahydroindigo 31 were all synthesized and compared with other indigoids especially the corresponding benzoannelated compounds. The unusual behavior of N-methylindigoids is discussed. In the boron chelate 39 of l-methy1-4,5,6,7-tetrahydroindigo the structure of a fixed tautomeric indigo is approached. ~~ ~Die von Liittke und Mitarbeitern' -3a,b) durchgefiihrten Untersuchungen an Indigoverbindungen lieferten die Erkenntnis, da13 das planare 1 ,ZDiamino-I ,ZdiketoethylenSystem 1 den Grundchromophor indigoider Verbindungen darstellt. Die beim Ubergang des Grundzustands von 1 zum angeregten Zustand iiber die zentrale Doppelbindung erfolgende Elektronenverschiebung von den Aminogruppen zu den Carbonylgruppen ist fur die relativ tiefe Farbe indigoider Verbindungen verantwortlich. Zwischen 1 und Xndigo (4) steht formal das Pyrrolindigo-System 2a.
Sur la permutation des intégrales d'une équation linéaire et homogène aux dérivées partielles du ordre Annales de la faculté des sciences de Toulouse 3 e série, tome 23 (1931), p. 139-181
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