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Source: Neurology
Therapy: Palliative

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Total 23 results found since Jan 2013.

Arterial ischemic stroke in children with cardiac disease
Conclusions: Infants with cyanotic CHD were most frequently affected by AIS during the periprocedural period. Prospective cohort studies are required to determine effective primary and secondary prevention strategies.
Source: Neurology - December 7, 2015 Category: Neurology Authors: Asakai, H., Cardamone, M., Hutchinson, D., Stojanovski, B., Galati, J. C., Cheung, M. M. H., Mackay, M. T. Tags: Childhood stroke, All Cerebrovascular disease/Stroke, All Pediatric, Cardiac, Pediatric stroke; see Cerebrovascular Disease/ Childhood stroke ARTICLE Source Type: research

Palliative Care Consultation Did Not Reduce Length of Stay in a Comprehensive Stroke Center (P1.212)
Conclusion: Palliative care consultation for patients with ischemic or hemorrhagic strokes was not associated with decreased hospital costs or LoS. This is in contrast to previously reported studies. We will further analyze the effect of early palliative care on a larger sample size to validate the findings. We also propose that a standardized palliative care trigger tool be implemented for early PC consultation in patients with debilitating stroke, advanced age, and multiple comorbid conditions.Disclosure: Dr. Tversky has nothing to disclose. Dr. Cheng has nothing to disclose. Dr. Mahmud has nothing to disclose. Dr. Schlo...
Source: Neurology - April 3, 2016 Category: Neurology Authors: Tversky, S., Cheng, D., Mahmud, S., Schloss, E., Wright, P. Tags: Re-admission and Stroke Outcomes Source Type: research

Older Patients with Acute Ischemic Stroke Receive Fewer Neurosurgery and Cardiology Consultations (P2.321)
Conclusions: Nearly half of our patient population was age蠅65-years but very few had geriatrics consultation. These patients are not receiving as many cardiology and neurosurgery consultations as the younger population. They are, however, receiving palliative care consults. Our results raise concern that resources are being disproportionately allocated to younger patients. Further study into resource allocation is warranted.Disclosure: Dr. Khawaja has nothing to disclose. Dr. Albright has nothing to disclose. Dr. Boehme has nothing to disclose. Dr. Sands has received research support from Biogen. Dr. Bavarsad Shahri...
Source: Neurology - April 3, 2016 Category: Neurology Authors: Khawaja, A., Albright, K., Boehme, A., Sands, K., Bavarsad Shahripour, R., Shiue, H., Gropen, T. Tags: Stroke Systems of Care Source Type: research

HIAT2 Predicts Poor Functional Outcome, Palliative Care Involvement, and In-hospital Mortality in tPA Treated and Untreated Ischemic Stroke Patients (P1.188)
Conclusions: Our results suggest that the variables used to create the HIAT2 score (age, NIHSS, glucose, ASPECTS score) are useful in predicting poor outcomes in patients receiving endovascular therapy, IV tPA, and neither. Despite its ability to predict poor outcome in these samples, treatment should not be withheld from patients that otherwise qualify.Disclosure: Dr. Kaur has nothing to disclose. Dr. Boehme has nothing to disclose. Dr. Albright has nothing to disclose. Dr. Sisson has nothing to disclose. Dr. Lyerly has nothing to disclose. Dr. Gropen has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Kaur, M., Boehme, A., Albright, K., Sisson, A., Lyerly, M., Gropen, T. Tags: Ischemic Stroke Outcomes Source Type: research

Triage in Stroke Units: Physicians Perceptions and Ethical Issues (P02.008)
CONCLUSIONS: Despite a vocation to take care of all patients, triage practices are pointed out during stroke unit admission. They depend on the role of each physician in the acute stroke management. They are the integration of a distributive justice theory, of contextual data, but also of subjective clinician evaluation. The triage decisions are ineluctable because of the scarcity of resource but are complex and difficult to take for clinicians, because they face to the "rule of rescue". These medical choices involve also the values of the society.Disclosure: Dr. Yger has nothing to disclose. Dr. Crozier has nothing to dis...
Source: Neurology - February 14, 2013 Category: Neurology Authors: Yger, M., Crozier, S., Dubourdieu, S., Vivien, B., Dolveck, F., Samson, Y. Tags: P02 Ethics, Pain, and Palliative Care Source Type: research

Can we Improve on Neuro-prognostication for Patients with Severe Ischemic Stroke? (P6.272)
Conclusions:The outcomes of patients presenting with severe ischemic stroke (NIHSS 16–20, 21+) is poor overall; although there were significant differences in early mortality, these are no longer significant at 90 days. A good recovery was predicted by early rapid improvement in NIHSS. More data is needed to improve neuro-prognostication to inform patients and families on expected outcomes and when to incorporate palliative care.Disclosure: Dr. Bu has nothing to disclose. Dr. Beilman has nothing to disclose. Dr. Sila has received personal compensation for activities with Axio Research, Hoffman La Roche, Medtronic, Ja...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Bu, J., Beilman, C., Sila, C. Tags: Cerebrovascular Disease Health Services Research Source Type: research

Early Palliative Care Consultation Decreases Length of Stay in Severe Stroke Patients (P1.211)
Conclusions:Early PCC in severe stroke patients decreased hospital LOS by 3 days. This may be due to prompt clarification of goals of care and hastened discharge to hospice. Advanced age, poor pre-stroke functional status, and severe post-stroke deficits and disability warrant early PCC. In addition to decreasing LOS, further study is needed to determine whether early PCC also limits futile tests, procedures, and iatrogenic complications. Ultimately, timely identification of PCC candidates may produce higher satisfaction and decreased hospital costs.Disclosure: Dr. Schloss has nothing to disclose. Dr. Tversky has nothing t...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Schloss, E. R., Tversky, S., Katz, J. M., Wright, P. Tags: Pain and Palliative Care Source Type: research

Rate of Utilization and Determination of Withdrawal of Care among Acute Ischemic Stroke Patient Treated with Thrombolytics (P02.002)
CONCLUSIONS: Our results identify several individual and institution related factors that determine the use of "withdrawal of care" among thrombolytic treated ischemic stroke patients. The excessively high mortality and resource utilization mandates a more evidence based policy for "withdrawal of care" in these patients.Disclosure: Dr. Suri has nothing to disclose. Dr. Adil has nothing to disclose. Dr. Gilani has nothing to disclose. Dr. ATACH Investigators has nothing to disclose.
Source: Neurology - February 14, 2013 Category: Neurology Authors: Suri, M. F., Adil, M., Gilani, W., Qureshi, A. Tags: P02 Ethics, Pain, and Palliative Care Source Type: research

Palliative Care is Underutilized in Ischemic Stroke Patients with Poor Functional Outcome (P6.089)
Conclusions:Our observations suggest that PC may be underutilized in ischemic stroke patients, particularly in those who may benefit from it the most. PC has great potential to diminish suffering through physical and psychological symptom management. Providers should at least consider PC consults for hospitalized stroke patients.Disclosure: Dr. Gropen has nothing to disclose. Dr. Sisson has nothing to disclose. Dr. Albright has nothing to disclose. Dr. Lakkur has nothing to disclose. Dr. Bakitas has nothing to disclose. Dr. Sands has received research support from Biogen. Dr. Kaur has nothing to disclose. Dr. Lyerly has no...
Source: Neurology - April 3, 2016 Category: Neurology Authors: Gropen, T., Sisson, A., Albright, K., Lakkur, S., Bakitas, M., Sands, K., Kaur, M., Lyerly, M., Burgio, K. Tags: Pain and Palliative Care: Patient Safety and Quality Source Type: research

The lack of documentation of preferences in a cohort of adults who died after ischemic stroke
Conclusions: Documented discussions about limitations on life-sustaining interventions during hospitalization were low, even though this cohort died within 30 days poststroke. Improving the documentation of preferences may be difficult given the 2015 Centers for Medicare and Medicaid 30-day stroke mortality hospital performance measure that is unadjusted for patient preferences regarding life-sustaining interventions.
Source: Neurology - May 29, 2016 Category: Neurology Authors: Robinson, M. T., Vickrey, B. G., Holloway, R. G., Chong, K., Williams, L. S., Brook, R. H., Leng, M., Parikh, P., Zingmond, D. S. Tags: Outcome research, Quality of life, Infarction, Palliative care ARTICLE Source Type: research

Increase in Rate of Utilization of Withdrawal of Care in Acute Ischemic Stroke in USA (P1.209)
Conclusions:We found a considerable increase in rate of withdrawal of care with aggressive treatment, which may be due to disease severity and/or patient/family preference. Prognostic models and clinical experience for severe stroke patients may be biased by frequent withdrawal of care, leading to errors in prognostication with significant consequences including premature withdrawal of care, suboptimal outcomes and higher risk of short-term mortalityStudy Supported by: NADisclosure: Dr. Adil has nothing to disclose. Dr. Zweifler has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Adil, M., Zweifler, R. Tags: Pain and Palliative Care Source Type: research

Failures to discuss and document preferences: Preventable medical errors in stroke care
In many cases, patients with early mortality after ischemic stroke die following family and medical team decisions to limit life-sustaining treatment, rather than dying despite maximal intensive care.1 Such decisions can involve a complex balancing of patient values: consider, for instance, how 2 different patients might evaluate the prospect of (1) a high likelihood of survival but with a poor projected neurologic prognosis, as compared to (2) a low likelihood of survival but with a favorable projected neurologic prognosis.2,3 Because decisions to extend or limit life-sustaining therapy after ischemic stroke can be highly...
Source: Neurology - May 29, 2016 Category: Neurology Authors: Xian, Y., Chiong, W. Tags: Outcome research, Quality of life, Infarction, Palliative care EDITORIALS Source Type: research

Aggressiveness of care following intracerebral hemorrhage in women and men
Conclusions: After ICH, women do not receive less aggressive care than men after controlling for the substantial comorbidity differences. Future studies on sex bias should include the presence of comorbidities, prestroke disability, and other factors that may influence management.
Source: Neurology - July 24, 2017 Category: Neurology Authors: Guha, R., Boehme, A., Demel, S. L., Li, J. J., Cai, X., James, M. L., Koch, S., Langefeld, C. D., Moomaw, C. J., Osborne, J., Sekar, P., Sheth, K. N., Woodrich, E., Worrall, B. B., Woo, D., Chaturvedi, S. Tags: All Cerebrovascular disease/Stroke, Intracerebral hemorrhage ARTICLE Source Type: research

Utilization Of In-Hospital Palliative Care For Ischemic Stroke Deaths In United States (S45.005)
Conclusions:In-hospital palliative care is associated with more conservative resource utilization. Significant patient and hospital related differences exists in palliative care utilization for AIS deaths in United States. A growing concern over high cost associated with end of life care in United States is expected to affect the trend of offering and adopting in-hospital palliative services impacting health care finances and quality of care measures.Disclosure: Dr. Shreyansh has nothing to disclose. Dr. Moradiya has nothing to disclose. Dr. Murthy has nothing to disclose.
Source: Neurology - April 9, 2014 Category: Neurology Authors: Shreyansh, S., Moradiya, Y., Murthy, S. Tags: Cerebrovascular Disease and Interventional Neurology: Rehabilitation, Recovery, and Complications Source Type: research

Accessing Care for Intracerebral Hemorrhage: An Unexpected Paradox? (P3.095)
Conclusions: Our data suggest that patients arriving by private vehicle were at lower odds of having an unfavorable outcome at discharge. Although this appears to be a paradox to traditional public health teaching, in reality, we would argue that patients presenting by private car should not be directly compared to patients arriving by EMS. Future research should be cognizant of this potential pitfall in an effort to avoid reporting erroneous relationships.Disclosure: Dr. Lyerly has nothing to disclose. Dr. Albright has nothing to disclose. Dr. Bavarsad Shahripour has nothing to disclose. Dr. Sands has nothing to disclose....
Source: Neurology - April 8, 2015 Category: Neurology Authors: Lyerly, M., Albright, K., Bavarsad Shahripour, R., Sands, K., Shiue, H., Sisson, A., Harrigan, M. Tags: Cerebrovascular Disease and Interventional Neurology: Intracerebral Hemorrhage Source Type: research