title: Management of patients with amyotrophic lateral sclerosis.
abstract: 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.
authors.affiliation: CESCO, Department of Rehabilitation and Geriatrics, University Hospital Geneva, Collone-Bellerive, Switzerland. sophie-pautex@hcuge.ch
authors.forename: Sophie
authors.initials: S
authors.lastname: Pautex
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Janssens
authors.forename: Hubert
authors.initials: H
authors.lastname: Vuagnat
authors.forename: Pierre
authors.initials: P
authors.lastname: Conne
authors.forename: Gilbert B
authors.initials: GB
authors.lastname: Zulian
mesh_terms: 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