Management of patients with amyotrophic lateral sclerosis.
Standard recommendations for the clinical management of patient with ALS have been edited in recent years. These documents emphasise the importance of patient's autonomy.


OBJECTIVE
To measure how these different recommendations can be applied in the context of a general hospital without a specific ALS clinic.


METHODS
Review of medical records of 21 patients with an ALS diagnosis treated by the University Hospitals Geneva who died from 1996-2002.


RESULTS
Patients suffered from distressing symptoms during their last hospitalisation. Artificial nutrition was given to 5 patients. Six patients had non invasive ventilation (NIV). Written advance directives were only available in 2 cases. Discussions about theses issues were also conducted late in the evolution of the disease.


CONCLUSIONS
Some discrepancies between our daily practice and the existing recommendations exist, particularly regarding the key issues of artificial nutrition and ventilatory support.
Pautex
Sophie
S
CESCO, Department of Rehabilitation and Geriatrics, University Hospital Geneva, Collone-Bellerive, Switzerland. sophie-pautex@hcuge.ch
Janssens
Jean-Paul
JP
Vuagnat
Hubert
H
Conne
Pierre
P
Zulian
Gilbert B
GB
D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010166:Palliative Care; D010818:Practice Patterns, Physicians' / Q000592:standards*; D013557:Switzerland