Palliative Care and the Self-Fulfilling Prophecy in Stroke Patients: is There Anything to Fear? A Retrospective Study of Patients Who Died During Hospitalization in a Quaternary Care Hospital.

BACKGROUND AND PURPOSE: Primary palliative care (PC) aims to improve the quality of life for patients with acute ischemic stroke but is often misinterpreted as withdrawal of care. The self-fulfilling prophecy withdrawal bias is feared in this context of PC's early implementation. This study evaluates stroke patients who died in the hospital to determine the impact of PC evaluation. METHODS: A retrospective descriptive analysis of patients who died from acute ischemic stroke was conducted. The study included patients aged ≥18 years admitted to the Stroke Unit of a quaternary hospital in Brazil from January 2017 to December 2018. The impact of PC assessment on outcomes was analyzed, with significance set at 5%. RESULTS: Among the patients who died during hospitalization as a result of an ischemic stroke (n = 77), 39 (%) were assessed by the palliative care team. There was no difference in the total length of stay or duration of antibiotic therapy. Logistic regression corrected for significant variables from the univariate analysis revealed that PC evaluation was associated with a 31-fold increase in opioid use (P < 0.001), a nearly 14-fold increase in discharges to the ward, and a threefold reduction in ICU length of stay (P = 0.011). CONCLUSION: PC team involvement was associated with higher rates of discharge to the floors, inferring more time spent with family and increased opioid use, suggesting better symptom control, without reducing the overall length of stay or duration of antibiotic therapy. This underscores that PC does not equate to withdrawal of care.

NIH stroke scale and unfavourable outcomes in acute ischaemic stroke: retrospective study.

OBJECTIVES: To evaluate the determining factors of severe functional impairment (SFI) outcome at discharge and in-hospital mortality in patients who had an acute ischaemic stroke and thus favouring early implementation of primary palliative care (PC). METHODS: A retrospective descriptive study by the analysis of 515 patients who had an acute ischaemic stroke admitted at stroke unit, aged≥18 years, from January 2017 to December 2018. Previous clinical and functional status data, National Institute of Health Stroke Scale (NIHSS) on admission, and data related to the evolution during hospitalisation were evaluated, relating them to the SFI outcome at discharge and death. The significance level was set at 5%. RESULTS: Of 515 patients included, 15% (77) died, 23.3%(120) had an SFI outcome and 9.1% (47) were evaluated by the PC team. It was observed that NIHSS Score≥16 is responsible for a 15.5-fold increase in the occurrence of death outcome. The presence of atrial fibrillation was responsible for a 3.5-fold increase in the risk of this outcome. CONCLUSION: NIHSS Score is an independent predictor of in-hospital death and SFI outcomes at discharge. Knowledge about the prognosis and risk of developing unfavourable outcomes is important for planning the care of patients affected by a potentially fatal and limiting acute vascular insult.

Colorectal carcinoma in the first decade of life: a systematic review.

PURPOSE: The aim of this study is to better understand the main aspects related to colorectal carcinoma diagnosed in the first 10 years of life, through a systematic review. METHODS: We carried out a bibliographic search in PubMed and LILACS, focusing on identifying publications or case reports about colorectal carcinoma in the first 10 years of life. The bibliographical analysis was made in two steps. During the first phase, we excluded those articles whose titles or abstracts did not correspond with the objective settled. Publications without abstract were also included in this phase. During the second phase, we look at the articles and evaluated their content, selecting the cases with colorectal cancer under 10 years old. RESULTS: From 3880 publications, 132 were selected in the first phase and 84 were evaluated in the second phase. Based on these conditions, 33 articles have cases presented which 4 articles were case reviews and 29 were case reports. Duplicated cases were excluded from the analysis. Fifty-nine cases were described in English and Latin literature. There is an apparent similar proportion between the sexes, and the mean age was 8.6 years old. The main localization was the rectum and sigmoid (45.8 %). Pathologic findings showed that 86.4 % were adenocarcinoma. These tumors are frequently advanced at diagnosis. The Kaplan-Meier 60-month overall survival was 15.3 %. Dukes classification represents a factor related to survival (p = 0.03). CONCLUSIONS: In children, colorectal carcinoma presents distinctive characteristics, which determines poor survival.