International Stroke Conference Digest - February 21, 2008 - (Page 8)

2008 isC digest | New Orleans | February 21 8 Symposium will explore legal issues of stroke care clinical Practitioners in stroke neurology face a number of legal issues, such as how to obtain informed consent when a stroke patient cannot provide it. Several such issues will be addressed today in a session titled “Stroke and the Law: Legal Issues in Cerebrovascular Disease,” which will meet at 4:00 p.m. in Hall B2. The symposium’s speakers will discuss specific cases related to stroke that illustrate legal principles clinical neurologists may encounter. “We will also look at how legal issues currently impact stroke neurology and how recent developments in stroke neurology have an impact on stroke-related litigation,” said session moderator Mark Fisher, MD, FAHA, Professor of Neurology at the University of California at Irvine. “When a physician is treating a patient with stroke, particularly a patient with acute stroke, there is often concern about potential legal issues that may range from how informed consent is obtained to the legal risks of treatment-related adverse events. Clinicians may also have concerns about the legal consequences of not treating patients with acute stroke,” Dr. Fisher said. “If a patient is not competent to provide informed consent, it is then necessary to approach next of kin. However, sometimes no next of kin is available, and the question is how to proceed. That’s the sort of scenario we will discuss,” he added. “With regard to recent developments that have legal implications, an example under those circumstances.” Dr. Fisher will lead off the symposium with a discussion of the legal principles, such as the duty to obtain informed consent and the duty to follow standards of care, that underlie the case studies to be presented. “I about legal issues and their own liability, and stroke is a complex field,” Dr. Fisher said. “Stroke treatments are in fairly constant flux, and there is uneasiness about how these changing treatments and the changing clinical milieu may create liability for the practicing clinician.” Session co-moderator Thomas G. Brott, MD, Professor of Neurology and Associate Dean for Research at the Mayo Clinic in Jacksonville, Fla., noted that the symposium is important because neurologists and other health professionals who deal with treatments for stroke can be very knowledgeable of the science while lacking knowledge about the non-medical side of stroke treatments. “When the patient comes into the emergency department, a whole host of issues arise, including the risks of treatment to the patient, the fears and risks perceived by the family, and the consequences that go beyond science of unforeseen problems that may occur during treatment,” Dr. Brott said. “This session is designed to explore the legal side of stroke treatment, which is not something we can look up in our stroke textbooks nor is it something we ordinarily deal with in our medical journals,” he continued. “Yet, the legal issues can affect how patients and their families view treatment, how hospitals view treatment, and how willing, for example, physicians may be to think about tPA as the first treatment.” Mark Fisher, MD, FAHA Thomas G. Brott, MD is that treatment for hyperacute stroke is evolving all the time,” Dr. Fisher continued. “As the development of newer treatments become available,some of these treatments may notnecessarily be fully and extensively tested. Consequently, legal issues include how to present newer therapies to patients and their families and how to proceed with these therapies when no family member is present, or whether we can proceed at all will also define what medical malpractice means. There are specific elements that legally constitute medical malpractice, such as negligence in following standard of care,” he noted. Other issues to be discussed in the symposium include the impact of medical legal issues on the evaluation and treatment of stroke patients. “Physicians in general have concerns stroke therapy continued from page 1 Vasospasm Endovascular treatments offer a promising therapeutic option for vasospasm, although, unlike drugs aimed at prevention of vasospasm, it would be difficult to subject these endovascular interventions to randomized, continued from page 1 ing interventions for treating vasospasm, once it has occurred, are the endovascular therapies. The most useful and durable endovascular treatment strategy has been balloon angioplasty to mechanically open the vasospastic vessel,” she noted. The other endovascular therapy available is intra-arterial administration of agents aimed at relieving the spasm— generally calcium channel blockers, such as nicardipine or verapamil, Dr. Hanjani noted. “The final speaker will address a more controversial approach, which is prophylactic angioplasty. This approach to preventing vasospasm is exploring a new paradigm in prophylactic therapy. The speaker will address the risks and benefits of such an approach” she said. “Attendees to this session will be able to hear about the state of the art for current endovascular treatments and possible future preventive strategies,” Dr. Hanjani continued. “People should come away with a better understanding of the potential for prophylactic treatment and the current status of trials of available and developing therapies.” microglia to undertake the functions necessary for survival, he explained. “We have ex isti ng ev idence t hat animals subjected to models of stroke and treated with PPAR-gamma agonists suf fer from lesser injur y that can be monitored by a reduced amount of tissue necrosis following stroke, and the same animals perform better when subjected to neurological testing. So, the neurological deficit is reduced,” Dr. Aronowski noted. Other speakers at the symposium will discuss PPAR and molecular targets in vascular biology, the impact of PPARgamma in the cerebral circulation, and PPAR-agonists and acute stroke therapy. “We will bring data from animal models showing that when animals subjected to pretreatment with PPAR-gamma agonists suffer a stroke, they may benefit from neuroprotection. In addition, we have evidence that animals that have had a stroke who are treated up to two hours after the stroke with PPAR-gamma agonists still benefit,” Dr. Aronowski said. Sepideh Amin-Hanjani, MD controlled trials, Dr. Hanjani noted. “Patients who have developed vasospasm are often in dire straits and in need of any intervention that may be effective,” she said. “What we do know is that endovascular therapies appear to be one of the most effective treatments available in terms of helping to reverse existing vasospasm and avert stroke.” The first talk in the session will explore basic science research into novel neuroprotection signaling in experimental stroke. The second presentation will explore the biology and physiology of vasospasm, and the last two talks will cover endovascular interventions that are currently available or under study. “The presentations will span the range of what is known at the basic science level up to what is currently available at the clinical level, and they will give some preview of what may be coming down the road based on ongoing research,” Dr. Hanjani said. “The cutting-edge, most aggressive, and most promis- ISC Digest is published by TriStar Publishing, Inc. as a service to the attendees of the International Stroke Conference. ®2008, TriStar Publishing, Inc. 7285 W. 132nd Street, Suite 300 Overland Park, KS 66213 Phone: (913) 491-4200 Fax: (913) 491-4202 www.tristarpub.com http://www.tristarpub.com

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International Stroke Conference Digest - February 21, 2008

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