Introduction: Palliative care, firstly used for chronic diseases, is currently indicated for some acute pathology such as Stroke. Its implementation improves the quality of care for end-of-life patients. The aim of ou...Introduction: Palliative care, firstly used for chronic diseases, is currently indicated for some acute pathology such as Stroke. Its implementation improves the quality of care for end-of-life patients. The aim of our study is to report a series of patients who died in the intensive care stroke unit of Brazzaville. Method: It was a descriptive study of a series of 13 cases of severe stroke, admitted to the intensive care unit of the university hospital of Brazzaville, between January 2015 and December 2017. Sociodemographic, clinical, paraclinical and prognostic variables were studied. Result: The mean age of the patients was 46 ± 11.5 years with a male predominance in 69.2% (n = 9). They were all hypertensive. The motor deficit and consciousness disorder association was the reason for admission in 84.6% (n = 11) and an epileptic seizure of 15.4% (n = 2). The mean NIHSS at admission was 21 ± 5, that of Glasgow 6 ± 3. Stroke was hemorrhagic in 84.6% (n = 11) and malignant infarction in 15.4% (n = 2). All of these patients received invasive resuscitation with assisted ventilation and all died within 8 days of admission. Conclusion: The issue of limitation of care deserves to be debated, and is proposed on a case-by-case basis, in the face of a serious stroke. Therapeutic relentlessness is not only expensive, but also raises the problem of suffering of the individual at the end of life.展开更多
Stroke is a leading cause of disability and death in Australia. There is a clear benefit in caring for stroke patients in stroke care units. Access to these centres is limited particularly in the rural setting. Certif...Stroke is a leading cause of disability and death in Australia. There is a clear benefit in caring for stroke patients in stroke care units. Access to these centres is limited particularly in the rural setting. Certified stroke care units in the private health care setting are also unheard of. The superiority of these units is thought to be due to better adherence to processes of care (early utility of CT scan, allied health input within 24 hours, neurological observations, DVT prophylaxis and appropriate use of antiplatelet and anticoagulant use). We audited care of 100 patients who presented to the St. John of God Hospital (rural private hospital) over a period of 3 years. This included baseline demographics, adherence of processes of care, utility of appropriate investigations, and outcome measures such as discharge destination, level of function at discharge and complication rates. These data were compared with the national stroke report (AuSCR) and adherence to processes of care was compared with the SCOPE study (the first study to establish the benefit of POC). When compared with data from the AuSCR national report 2012, we found a higher mortality rate, an increased rate of disability on discharge, and a mixed adherence to processes of care. We also found a significant proportion of patients (40%) who were eligible to receive thrombolysis but did not. Overall we found that there were significant strengths to be drawn upon in the rural private healthcare setting and a more organised approach could improve outcomes.展开更多
文摘Introduction: Palliative care, firstly used for chronic diseases, is currently indicated for some acute pathology such as Stroke. Its implementation improves the quality of care for end-of-life patients. The aim of our study is to report a series of patients who died in the intensive care stroke unit of Brazzaville. Method: It was a descriptive study of a series of 13 cases of severe stroke, admitted to the intensive care unit of the university hospital of Brazzaville, between January 2015 and December 2017. Sociodemographic, clinical, paraclinical and prognostic variables were studied. Result: The mean age of the patients was 46 ± 11.5 years with a male predominance in 69.2% (n = 9). They were all hypertensive. The motor deficit and consciousness disorder association was the reason for admission in 84.6% (n = 11) and an epileptic seizure of 15.4% (n = 2). The mean NIHSS at admission was 21 ± 5, that of Glasgow 6 ± 3. Stroke was hemorrhagic in 84.6% (n = 11) and malignant infarction in 15.4% (n = 2). All of these patients received invasive resuscitation with assisted ventilation and all died within 8 days of admission. Conclusion: The issue of limitation of care deserves to be debated, and is proposed on a case-by-case basis, in the face of a serious stroke. Therapeutic relentlessness is not only expensive, but also raises the problem of suffering of the individual at the end of life.
文摘Stroke is a leading cause of disability and death in Australia. There is a clear benefit in caring for stroke patients in stroke care units. Access to these centres is limited particularly in the rural setting. Certified stroke care units in the private health care setting are also unheard of. The superiority of these units is thought to be due to better adherence to processes of care (early utility of CT scan, allied health input within 24 hours, neurological observations, DVT prophylaxis and appropriate use of antiplatelet and anticoagulant use). We audited care of 100 patients who presented to the St. John of God Hospital (rural private hospital) over a period of 3 years. This included baseline demographics, adherence of processes of care, utility of appropriate investigations, and outcome measures such as discharge destination, level of function at discharge and complication rates. These data were compared with the national stroke report (AuSCR) and adherence to processes of care was compared with the SCOPE study (the first study to establish the benefit of POC). When compared with data from the AuSCR national report 2012, we found a higher mortality rate, an increased rate of disability on discharge, and a mixed adherence to processes of care. We also found a significant proportion of patients (40%) who were eligible to receive thrombolysis but did not. Overall we found that there were significant strengths to be drawn upon in the rural private healthcare setting and a more organised approach could improve outcomes.
