Risultati per: Guida clinica per le cure palliative

Il 2022 per l’epilessia potrebbe essere l’anno della svolta: a maggio l’Organizzazione Mondiale della Sanità dovrà ratificare il primo documento ufficiale sulla gestione dell’epilessia e di altri disturbi neurologici

Stroke, Volume 53, Issue Suppl_1, Page ATP112-ATP112, February 1, 2022. Background and Purpose:Palliative is increasingly used in critically ill patients which has lead to shorter length of stays, higher inpatient mortality and lower utilization of aggressive treatment. We performed analysis to evaluate trends in utilization of palliative care among patients with Ischemic Stroke and its effect on in-hospital outcomes over a 10-year period.Methods:We obtained data for patients admitted to hospitals in the United States from 2009 to 2018 with a primary diagnosis of Ischemic stroke (IS) using a large national database. We determined the overall and among different races, rate of utilization of palliative care in patients with IS and associated in-hospital outcomes consisting of mean hospital charges, mean length of stay and in-hospital mortality.Results:Out of 5525248 patients admitted with primary diagnosis of IS, palliative care was used in 150301 (2.72%). There was a 1.05-fold utilization of PC (1.69% in 2009 vs 1.78% in 2018; p

Stroke, Volume 53, Issue Suppl_1, Page ATP130-ATP130, February 1, 2022. Background and Purpose:Palliative is increasingly used in critically ill patients which has lead to shorter length of stays, higher inpatient mortality and lower utilization of aggressive treatment. We performed analysis to evaluate trends in utilization of palliative care among patients with subarachnoid hemorrhage and its effect on in-hospital outcomes over a 10-year period.Methods:We obtained data for patients admitted to hospitals in the United States from 2009 to 2018 with a primary diagnosis of intracerebral hemorrhage (ICH) using a large national database. We determined the overall and among different races, rate of utilization of palliative care in patients with ICH and associated in-hospital outcomes consisting of mean hospital charges, mean length of stay and in-hospital mortality.Results:Out of 711787 patients admitted with primary diagnosis of ICH, palliative care was used in 105354 (14.8%). There was a 2.5-fold increase in utilization of PC (8.9% in 2009 vs 22.9% in 2018; p

Stroke, Volume 53, Issue Suppl_1, Page ATMP7-ATMP7, February 1, 2022. Background and Purpose:Palliative is increasingly used in critically ill patients which has lead to shorter length of stays, higher inpatient mortality and lower utilization of aggressive treatment. We performed analysis to evaluate trends in utilization of palliative care among patients with subarachnoid hemorrhage and its effect on in-hospital outcomes over a 10-year period.Methods:We obtained data for patients admitted to hospitals in the United States from 2009 to 2018 with a primary diagnosis of subarachnoid hemorrhage (SAH) using a large national database. We determined the overall and sub racial rate of utilization of palliative care in patients with SAH and associated in-hospital outcomes consisting of mean hospital charges, mean length of stay and in-hospital mortality.Results:Out of 199928 patients admitted with primary diagnosis of SAH, palliative care was used in 20490 (10.2%). There was a 2.2-fold increase in utilization of PC (6.5%% in 2009 vs 14.4% in 2018; p

Stroke, Volume 53, Issue Suppl_1, Page ATP79-ATP79, February 1, 2022. Background:Stroke is a common cause of death in patients with left ventricular assist devices (LVADs) and there is wide variation around end-of-life care. Palliative care encounters (PCEs) are associated with 6% of all stroke-related hospitalizations in the US but little is known about the palliative care needs or practices of PCE after LVAD-related stroke. We sought to better understand current practices around PCE after LVAD-related stroke and its association with outcomes.Methods:Using the National Inpatient Sample (2012 – 2018) we identified all LVAD-related acute ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) hospitalizations. Demographics, clinical variables, utilization of life-prolonging interventions (LPIs; e.g., percutaneous endoscopic gastrostomy and tracheostomy) and outcomes were compared using multivariable regression.Results:952 LVAD-related strokes were identified (58% IS, 22% ICH, and 19% SAH); 30% occurred perioperatively. PCE was associated with 16.9% of strokes (in 11% of IS, 24% of ICH and 28% of SAH), a rate that remained stable over time (P=0.112 for trend). Women made up a smaller proportion of those receiving PCE (17% vs 25%, P = 0.05). PCE was associated with 6% of non-fatal strokes and 46% of strokes resulting in in-hospital death. Among patients who died, SAH had the highest rate of PCE (54%), followed by IS (44%), and ICH (40%). Among decedents, PCE was associated with less frequent use of LPIs in ICH and SAH but did not effect length of stay (Figure).Conclusion:Although PCE is utilized more frequently in LVAD-related stroke compared to rates in the general stroke population, many LVAD stroke patients die without PCE intervention. PCE is not consistently associated with less aggressive care or early death in LVAD patients dying of stroke. Further work is needed to increase patient and family awareness of PCE services aimed at directing goal-concordant care after devastating neurologic injuries.

Stroke, Ahead of Print.

Comunicato del 12/10/2021 n°67