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Sample records for decreasing in-hospital mortality

  1. Donepezil is associated with decreased in-hospital mortality as a result of pneumonia among older patients with dementia: A retrospective cohort study.

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    Abe, Yasuko; Shimokado, Kentaro; Fushimi, Kiyohide

    2018-02-01

    Pneumonia is one of the major causes of mortality in older adults. As the average lifespan has extended and new modalities to prevent or treat pneumonia are developed, the factors that affect the length of hospital stay (LHS) and in-hospital mortality of older patients with pneumonia have changed. The object of the present study was to determine the factors associated with LHS and mortality as a result of pneumonia among older patients with dementia. With a retrospective cohort study design, we used the data derived from the Japanese Administrative Database and diagnosis procedure combination/per diem payment system (DPC/PDPS) database. There were 39 336 admissions of older patients for pneumonia between August 2010 and March 2012. Patients with incomplete data were excluded, leaving 25 602 patients for analysis. Having dementia decreased mortality (OR 0.71, P LHS. Multiple logistic regression analysis identified donepezil as an independent factor that decreased mortality in patients with dementia (OR 0.36, P LHS and mortality were similar to those reported by others. Donepezil seems to decrease in-hospital mortality as a result of pneumonia among older patients with dementia. Geriatr Gerontol Int 2018; 18: 269-275. © 2017 Japan Geriatrics Society.

  2. [In-hospital mortality due to stroke].

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    Rodríguez Lucci, Federico; Pujol Lereis, Virginia; Ameriso, Sebastián; Povedano, Guillermo; Díaz, María F; Hlavnicka, Alejandro; Wainsztein, Néstor A; Ameriso, Sebastián F

    2013-01-01

    Overall mortality due to stroke has decreased in the last three decades probable due to a better control of vascular risk factors. In-hospital mortality of stroke patients has been estimated to be between 6 and 14% in most of the series reported. However, data from recent clinical trials suggest that these figures may be substantially lower. Data from FLENI Stroke Data Bank and institutional mortality records between 2000 and 2010 were reviewed. Ischemic stroke subtypes were classified according to TOAST criteria and hemorrhagic stroke subtypes were classified as intraparenchymal hematoma, aneurismatic subarachnoid hemorrhage, arterio-venous malformation, and other intraparenchymal hematomas. A total of 1514 patients were studied. Of these, 1079 (71%) were ischemic strokes,39% large vessels, 27% cardioembolic, 9% lacunar, 14% unknown etiology, and 11% others etiologies. There were 435 (29%) hemorrhagic strokes, 27% intraparenchymal hematomas, 30% aneurismatic subarachnoid hemorrhage, 25% arterio-venous malformation, and 18% other intraparenchymal hematomas. Moreover, 38 in-hospital deaths were recorded (17 ischemic strokes and 21 hemorrhagic strokes), accounting for 2.5% overall mortality (1.7% in ischemic strokes and 4.8% in hemorrhagic strokes). No deaths occurred associated with the use of intravenous fibrinolytics occurred. In our Centre in-hospital mortality in patients with stroke was low. Management of these patients in a Centre dedicated to neurological diseases along with a multidisciplinary approach from medical and non-medical staff trained in the care of cerebrovascular diseases could, at least in part, account for these results.

  3. ST-segment elevation myocardial infarction, systems of care. An urgent need for policies to co-ordinate care in order to decrease in-hospital mortality.

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    Malik, Ali Osama; Abela, Oliver; Allenback, Gayle; Devabhaktuni, Subodh; Lui, Calvin; Singh, Aditi; Diep, Jimmy; Yamashita, Takashi; Yoo, Ji Won; Malhotra, Sanjay; Ahsan, Chowdhury

    2017-08-01

    Regional trends for ST-segment elevation myocardial infarction (STEMI) treatment is not known in the state of Nevada. Great disparity exists for treatment for STEMI in different geographical areas of Nevada. There is a great potential to improve treatment and outcomes of STEMI patients in the State of Nevada. Admissions to non-federal hospitals in the state of Nevada, using 2011 to 2013 discharge data from the Nevada State Inpatient Data Base (acquired from Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality), were analyzed. Outpatient-onset STEMI patients were identified. The state of Nevada was divided into three divisions based on population densities, defined as population per square mile. Division A included counties with population density of 200 per square mile. Trends in use of STEMI-related therapies and the impact on in-hospital mortality rates were compared. Almost 20% of the patients with outpatient-onset STEMI do not get any STEMI-related therapy and have significantly higher mortality rate. Patients from Division A do not have direct access to percutaneous coronary intervention (PCI) centers. These patients receive less STEMI-related therapies. Low-volume PCI centers had equivalent mortality rates for STEMI patients who got PCI, compared to high-volume PCI centers. Policies must be created and processes streamlined so all STEMI patients in Nevada receive appropriate treatment. Copyright © 2017. Published by Elsevier B.V.

  4. Editor's Choice - High Annual Hospital Volume is Associated with Decreased in Hospital Mortality and Complication Rates Following Treatment of Abdominal Aortic Aneurysms: Secondary Data Analysis of the Nationwide German DRG Statistics from 2005 to 2013.

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    Trenner, Matthias; Kuehnl, Andreas; Salvermoser, Michael; Reutersberg, Benedikt; Geisbuesch, Sarah; Schmid, Volker; Eckstein, Hans-Henning

    2018-02-01

    The aim of this study was to analyse the association between annual hospital procedural volume and post-operative outcomes following repair of abdominal aortic aneurysms (AAA) in Germany. Data were extracted from nationwide Diagnosis Related Group (DRG) statistics provided by the German Federal Statistical Office. Cases with a diagnosis of AAA (ICD-10 GM I71.3, I71.4) and procedure codes for endovascular aortic repair (EVAR; OPS 5-38a.1*) or open aortic repair (OAR; OPS 5-38.45, 5-38.47) treated between 2005 and 2013 were included. Hospitals were empirically grouped to quartiles depending on the overall annual volume of AAA procedures. A multilevel multivariable regression model was applied to adjust for sex, medical risk, type of procedure, and type of admission. Primary outcome was in hospital mortality. Secondary outcomes were complications, use of blood products, and length of stay (LOS). The association between AAA volume and in hospital mortality was also estimated as a function of continuous volume. A total of 96,426 cases, of which 11,795 (12.6%) presented as ruptured (r)AAA, were treated in >700 hospitals (annual median: 501). The crude in hospital mortality was 3.3% after intact (i)AAA repair (OAR 5.3%; EVAR 1.7%). Volume was inversely associated with mortality after OAR and EVAR. Complication rates, LOS, and use of blood products were lower in high volume hospitals. After rAAA repair, crude mortality was 40.4% (OAR 43.2%; EVAR 27.4%). An inverse association between mortality and volume was shown for rAAA repair; the same accounts for the use of blood products. When considering volume as a continuous variate, an annual caseload of 75-100 elective cases was associated with the lowest mortality risk. In hospital mortality and complication rates following AAA repair are inversely associated with annual hospital volume. The use of blood products and the LOS are lower in high volume hospitals. A minimum annual case threshold for AAA procedures might improve

  5. Trends in hospital discharges, management and in-hospital mortality from acute myocardial infarction in Switzerland between 1998 and 2008

    Science.gov (United States)

    2013-01-01

    Background Since the late nineties, no study has assessed the trends in management and in-hospital outcome of acute myocardial infarction (AMI) in Switzerland. Our objective was to fill this gap. Methods Swiss hospital discharge database for years 1998 to 2008. AMI was defined as a primary discharge diagnosis code I21 according to the ICD10 classification. Invasive treatments and overall in-hospital mortality were assessed. Results Overall, 102,729 hospital discharges with a diagnosis of AMI were analyzed. The percentage of hospitalizations with a stay in an Intensive Care Unit decreased from 38.0% in 1998 to 36.2% in 2008 (p for trend Switzerland, a steep rise in hospital discharges and in revascularization procedures for AMI occurred between 1998 and 2008. The increase in revascularization procedures could explain the decrease in in-hospital mortality rates. PMID:23530470

  6. Trends in in-hospital mortality among patients with stroke in China.

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    Qian He

    Full Text Available BACKGROUND: The incidence and burden of stroke in China is increasing rapidly. However, little is known about trends in mortality during stroke hospitalization. The objectives of this study were to assess trends of in-hospital mortality among patients with stroke and explore influence factors of in-hospital death after stroke in China. METHODS: 109 grade III class A hospitals were sampled by multistage stratified cluster sampling. All patients admitted to hospitals between 2007 and 2010 with a discharge diagnosis of stroke were included. Trends in in-hospital mortality among patients with stroke were assessed. Influence factors of in-hospital death after stroke were explored using multivariable logistic regression. RESULTS: Overall stroke hospitalizations increased from 79,894 in 2007 to 85,475 in 2010, and in-hospital mortality of stroke decreased from 3.16% to 2.30% (P<0.0001. The percentage of severe patients increased while odds of mortality (2010 versus 2007 decreased regardless of stroke type: subarachnoid hemorrhage (OR 0.792, 95% CI = 0.636 to 0.987, intracerebral hemorrhage (OR 0.647, 95% CI = 0.591 to 0.708, and ischemic stroke (OR 0.588, 95% CI = 0.532 to 0.649. In multivariable analyses, older age, male, basic health insurance, multiple comorbidities and severity of disease were linked to higher odds of in-hospital mortality. CONCLUSIONS: The mortality of stroke hospitalizations decreased likely reflecting advancements in stroke care and prevention. Decreasing of mortality with increasing of severe stroke patients indicated that we should pay more attention to rehabilitation and life quality of stroke patients. Specific individual and hospital-level characteristics may be targets for facilitating further declines.

  7. Predictors of in-hospital mortality among older patients

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    Thiago J. A. Silva

    2009-01-01

    Full Text Available OBJECTIVE: The objective of this study was to determine predictors of in-hospital mortality among older patients admitted to a geriatric care unit. INTRODUCTION: The growing number of older individuals among hospitalized patients demands a thorough investigation of the factors that contribute to their mortality. METHODS: This was a prospective observational study implemented from February 2004 to October 2007 in a tertiary university hospital. A consecutive sample of 922 patients was evaluated for possible inclusion in this study. Patients hospitalized for palliative care, those who declined to participate, and those with incomplete data were excluded, resulting in a group of 856 patients aged 60 to 104 years. Bivariate and multivariate analyses were performed to determine associations between in-patient mortality and gender, age, length of stay, number of prescribed medications and diagnoses at admission, history of heart failure, neoplastic disease, immobility syndrome, delirium, infectious disease, and laboratory tests at admission (serum albumin and creatinine. RESULTS: The overall mortality rate was 16.4%. The following factors were associated with higher in-hospital mortality: delirium (OR=4.13, CI=2.65-6.44, P1.3mg/dL (OR=2.39, CI=1.53-3.72, P<.001, history of heart failure (OR=1.97, CI=1.20-3.22, P=.007, immobility (OR=1.84, CI=1.16-2.92, P =.009, and advanced age (OR=1.03, CI=1.01-1.06, P=.019. CONCLUSIONS: This study strengthens the perception of delirium as a mortality predictor among older inpatients. Cancer, immobility, low albumin levels, elevated creatinine levels, history of heart failure and advanced age were also related to higher mortality rates in this population.

  8. Prognostic Factors in Tuberculosis Related Mortalities in Hospitalized Patients

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    Ghazal Haque

    2014-01-01

    Full Text Available Setting. The study was undertaken at the Department of Pulmonology at a public, tertiary care centre in Karachi, Pakistan. Objectives. To evaluate factors concerned with in-hospital deaths in patients admitted with pulmonary tuberculosis (TB. Design. A retrospective case-control audit was performed for 120 patients hospitalised with pulmonary TB. Sixty of those discharged after treatment were compared to sixty who did not survive. Radiological findings, clinical indicators, and laboratory values were compared between the two groups to identify factors related to poor prognosis. Results. Factors concerned with in-hospital mortality listed late presentation of disease (P<0.01, noncompliance to antituberculosis therapy (P<0.01, smoking (P<0.01, longer duration of illness prior to treatment (P<0.01, and low body weight (P<0.01. Most deaths occurred during the first week of admission (P<0.01 indicating late referrals as significant. Immunocompromised status and multi-drug resistance were not implicated in higher mortality. Conclusions. Poor prognosis was associated with noncompliance to therapy resulting in longer duration of illness, late patient referrals to care centres, and development of complications. Early diagnosis, timely referrals, and monitored compliance may help reduce mortality. Adherence to a more radically effective treatment regimen is required to eliminate TB early during disease onset.

  9. In-hospital Mortality from Cerebrovascular Disease in the Province of Cienfuegos

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    Ada Sánchez Lozano

    2014-12-01

    Full Text Available Background: cerebrovascular disease is the second leading cause of death in some countries, causing 10 million annual deaths. In-hospital mortality from these diseases is high in our country. Objective: to describe mortality from cerebrovascular disease at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos during 2006-2010. Methods: a retrospective case series study involving all patients (4449 diagnosed with cerebrovascular disease discharged from the Dr. Gustavo Aldereguía Lima University General Hospital from January 1st, 2006 to December 31, 2010 was conducted. The variables analyzed included age, sex, status at discharge, types of cerebrovascular disease and hospital stay. Results: in-hospital mortality from cerebrovascular disease in the study period was 23.8 %. It was higher in men than in women (24.5 % and 22.9 %, respectively. According to the type of cerebrovascular disease, mortality rate of ischemic stroke was 20 %, subarachnoid hemorrhage, 22.4 % and intraparenchymal hemorrhage, 71.2 %. Conclusions: in-hospital mortality from cerebrovascular disease in Cienfuegos shows a downward trend, though it increased in 2010. It was more common in men. Death from stroke tends to decrease and, to a lesser extent, mortality due to brain hemorrhage, which remains high. There is also an increase in subarachnoid hemorrhage.

  10. Trends in mortality decrease and economic growth

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    Niu, G.; Melenberg, B.

    2014-01-01

    The vast literature on extrapolative stochastic mortality models focuses mainly on the extrapolation of past mortality trends and summarizes the trends by one or more latent factors. However, the interpretation of these trends is typically not very clear. On the other hand, explanation methods are

  11. Ionizing radiation decreases human cancer mortality rates

    International Nuclear Information System (INIS)

    Luckey, T.D.

    1997-01-01

    Information from nine studies with exposed nuclear workers and military observers of atmospheric bomb explosions confirms the results from animal studies which showed that low doses of ionizing radiation are beneficial. The usual ''healthy worker effect'' was eliminated by using carefully selected control populations. The results from 13 million person-years show the cancer mortality rate of exposed persons is only 65.6% that of carefully selected unexposed controls. This overwhelming evidence makes it politically untenable and morally wrong to withhold public health benefits of low dose irradiation. Safe supplementation of ionizing radiation should become a public health service. (author)

  12. Predictors of in-hospital mortality in a cohort of elderly Egyptian patients with acute upper gastrointestinal bleeding.

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    Elsebaey, Mohamed A; Elashry, Heba; Elbedewy, Tamer A; Elhadidy, Ahmed A; Esheba, Noha E; Ezat, Sherif; Negm, Manal Saad; Abo-Amer, Yousry Esam-Eldin; Abgeegy, Mohamed El; Elsergany, Heba Fadl; Mansour, Loai; Abd-Elsalam, Sherief

    2018-04-01

    Acute upper gastrointestinal bleeding (UGIB) affects large number of elderly with high rates of morbidity and mortality. Early identification and management of the factors predicting in-hospital mortality might decrease mortality. This study was conducted to identify the causes of acute UGIB and the predictors of in-hospital mortality in elderly Egyptian patients.286 elderly patients with acute UGIB were divided into: bleeding variceal group (161 patients) and bleeding nonvariceal group (125 patients). Patients' monitoring was done during hospitalization to identify the risk factors that might predict in-hospital mortality in elderly.Variceal bleeding was the most common cause of acute UGIB in elderly Egyptian patients. In-hospital mortality rate was 8.74%. Increasing age, hemodynamic instability at presentation, co-morbidities (especially liver cirrhosis associated with other co-morbidity) and failure to control bleeding were the predictors of in-hospital mortality.Increasing age, hemodynamic instability at presentation, co-morbidities (especially liver cirrhosis associated with other co-morbidity) and failure to control bleeding should be considered when triaging those patients for immediate resuscitation, close observation, and early treatment.

  13. Estimating population cause-specific mortality fractions from in-hospital mortality: validation of a new method.

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    Christopher J L Murray

    2007-11-01

    Full Text Available Cause-of-death data for many developing countries are not available. Information on deaths in hospital by cause is available in many low- and middle-income countries but is not a representative sample of deaths in the population. We propose a method to estimate population cause-specific mortality fractions (CSMFs using data already collected in many middle-income and some low-income developing nations, yet rarely used: in-hospital death records.For a given cause of death, a community's hospital deaths are equal to total community deaths multiplied by the proportion of deaths occurring in hospital. If we can estimate the proportion dying in hospital, we can estimate the proportion dying in the population using deaths in hospital. We propose to estimate the proportion of deaths for an age, sex, and cause group that die in hospital from the subset of the population where vital registration systems function or from another population. We evaluated our method using nearly complete vital registration (VR data from Mexico 1998-2005, which records whether a death occurred in a hospital. In this validation test, we used 45 disease categories. We validated our method in two ways: nationally and between communities. First, we investigated how the method's accuracy changes as we decrease the amount of Mexican VR used to estimate the proportion of each age, sex, and cause group dying in hospital. Decreasing VR data used for this first step from 100% to 9% produces only a 12% maximum relative error between estimated and true CSMFs. Even if Mexico collected full VR information only in its capital city with 9% of its population, our estimation method would produce an average relative error in CSMFs across the 45 causes of just over 10%. Second, we used VR data for the capital zone (Distrito Federal and Estado de Mexico and estimated CSMFs for the three lowest-development states. Our estimation method gave an average relative error of 20%, 23%, and 31% for

  14. A Review Of In-Hospital Surgical Mortality At The Nnamdi Azikiwe ...

    African Journals Online (AJOL)

    Aims and Objectives: A retrospective study to determine In-hospital surgical mortality rate, gender and age distribution of cases and operations associated with In-hospital surgical mortality at the Nnamdi Azikiwe University Teaching Hospital, Nnewi. Patients and Methods: Data was collected from the theatre operation ...

  15. Do socioeconomic mortality differences decrease with rising age?

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    Rasmus Hoffmann

    2005-08-01

    Full Text Available The impact of SES on mortality is an established finding in mortality research. I examine, whether this impact decreases with age. Most research finds evidence for this decrease but it is unknown whether the decline is due to mortality selection. My data come from the US-HRS Study and includes 9376 persons aged 59+, which are followed over 8 years. The variables allow a time varying measurement of SES, health and behavior. Event-history-analysis is applied to analyze mortality differentials. My results show that socioeconomic mortality differences are stable across ages whereas they decline clearly with decreasing health. The first finding that health rather than age is the equalizer combined with the second finding of unequally distributed health leads to the conclusion that in old age, the impact of SES is transferred to health and is stable across ages.

  16. Performance of in-hospital mortality prediction models for acute hospitalization: Hospital Standardized Mortality Ratio in Japan

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    Motomura Noboru

    2008-11-01

    Full Text Available Abstract Objective In-hospital mortality is an important performance measure for quality improvement, although it requires proper risk adjustment. We set out to develop in-hospital mortality prediction models for acute hospitalization using a nation-wide electronic administrative record system in Japan. Methods Administrative records of 224,207 patients (patients discharged from 82 hospitals in Japan between July 1, 2002 and October 31, 2002 were randomly split into preliminary (179,156 records and test (45,051 records groups. Study variables included Major Diagnostic Category, age, gender, ambulance use, admission status, length of hospital stay, comorbidity, and in-hospital mortality. ICD-10 codes were converted to calculate comorbidity scores based on Quan's methodology. Multivariate logistic regression analysis was then performed using in-hospital mortality as a dependent variable. C-indexes were calculated across risk groups in order to evaluate model performances. Results In-hospital mortality rates were 2.68% and 2.76% for the preliminary and test datasets, respectively. C-index values were 0.869 for the model that excluded length of stay and 0.841 for the model that included length of stay. Conclusion Risk models developed in this study included a set of variables easily accessible from administrative data, and still successfully exhibited a high degree of prediction accuracy. These models can be used to estimate in-hospital mortality rates of various diagnoses and procedures.

  17. A Risk Prediction Model for In-hospital Mortality in Patients with Suspected Myocarditis.

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    Xu, Duo; Zhao, Ruo-Chi; Gao, Wen-Hui; Cui, Han-Bin

    2017-04-05

    Myocarditis is an inflammatory disease of the myocardium that may lead to cardiac death in some patients. However, little is known about the predictors of in-hospital mortality in patients with suspected myocarditis. Thus, the aim of this study was to identify the independent risk factors for in-hospital mortality in patients with suspected myocarditis by establishing a risk prediction model. A retrospective study was performed to analyze the clinical medical records of 403 consecutive patients with suspected myocarditis who were admitted to Ningbo First Hospital between January 2003 and December 2013. A total of 238 males (59%) and 165 females (41%) were enrolled in this study. We divided the above patients into two subgroups (survival and nonsurvival), according to their clinical in-hospital outcomes. To maximize the effectiveness of the prediction model, we first identified the potential risk factors for in-hospital mortality among patients with suspected myocarditis, based on data pertaining to previously established risk factors and basic patient characteristics. We subsequently established a regression model for predicting in-hospital mortality using univariate and multivariate logistic regression analyses. Finally, we identified the independent risk factors for in-hospital mortality using our risk prediction model. The following prediction model for in-hospital mortality in patients with suspected myocarditis, including creatinine clearance rate (Ccr), age, ventricular tachycardia (VT), New York Heart Association (NYHA) classification, gender and cardiac troponin T (cTnT), was established in the study: P = ea/(1 + ea) (where e is the exponential function, P is the probability of in-hospital death, and a = -7.34 + 2.99 × [Ccr model demonstrated that a Ccr prediction model for in-hospital mortality in patients with suspected myocarditis. In addition, sufficient life support during the early stage of the disease might improve the prognoses of patients with

  18. In Hospital Stroke Mortality: Rates and Determinants in Southwestern Saudi Arabia

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    Adel A. Alhazzani

    2018-05-01

    Full Text Available Objectives: The present study analyzed in-hospital first-time stroke mortality in southwestern Saudi Arabia over one-year to assess the in-hospital stroke case fatality rate, mortality rate and explore the factors associated with in-hospital stroke mortality. Study Design: Hospital based follow-up study. Methods: First-time stroke patients admitted to all hospitals in Asser region over one-year period (January through December 2016 were included in the study. Data about personal characteristics, pre-stroke history and clinical criteria, on admission clinical criteria, in-hospital complications and survival status were collected. The last reported Aseer region population was used to calculate age and sex stroke mortality rate per 100,000 population/year. Hazard ratios (HR and concomitant 95% confidence intervals (95% CI were computed using multivariate Cox regression survival analysis. Kaplan-Meier curve survival analysis for stroke patients were plotted. Results: A total of 121 in-hospital deaths out of 1249 first-time stroke patients giving an overall case fatality rate (CFR of 9.7%. Non-significant difference with gender and age were observed in CFR. Overall, in-hospital stroke mortality rate was 5.58 per 100,000/year. Males and elders showed a significantly higher mortality rates. Multivariable Cox regression analyses revealed pre-stroke smoking (HR = 2.36, pre-stroke hypertension (HR = 1.77, post-stroke disturbed consciousness (HR = 6.86, poor mobility (HR = 2.60 and developing pulmonary embolism (HR = 2.63 as significant predictors of in-hospital stroke mortality. Conclusions: In Southwestern Saudi Arabia, the in-hospital stroke mortality rate is higher in men and increases with aging. The prognosis of acute stroke could be improved by smoking cessation, better control of hypertension and prevention of in hospital complication particularly pulmonary embolism.

  19. Decreasing child mortality, spatial clustering and decreasing disparity in North-Western Burkina Faso.

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    Becher, Heiko; Müller, Olaf; Dambach, Peter; Gabrysch, Sabine; Niamba, Louis; Sankoh, Osman; Simboro, Seraphin; Schoeps, Anja; Stieglbauer, Gabriele; Yé, Yazoume; Sié, Ali

    2016-04-01

    Within relatively small areas, there exist high spatial variations of mortality between villages. In rural Burkina Faso, with data from 1993 to 1998, clusters of particularly high child mortality were identified in the population of the Nouna Health and Demographic Surveillance System (HDSS), a member of the INDEPTH Network. In this paper, we report child mortality with respect to temporal trends, spatial clustering and disparity in this HDSS from 1993 to 2012. Poisson regression was used to describe village-specific child mortality rates and time trends in mortality. The spatial scan statistic was used to identify villages or village clusters with higher child mortality. Clustering of mortality in the area is still present, but not as strong as before. The disparity of child mortality between villages has decreased. The decrease occurred in the context of an overall halving of child mortality in the rural area of Nouna HDSS between 1993 and 2012. Extrapolated to the Millennium Development Goals target period 1990-2015, this yields an estimated reduction of 54%, which is not too far off the aim of a two-thirds reduction. © 2016 John Wiley & Sons Ltd.

  20. Changes in the in-hospital mortality and 30-day post-discharge mortality in acutely admitted older patients: retrospective observational study

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    van Rijn, Marjon; Buurman, Bianca M.; MacNeil-Vroomen, Janet L.; Suijker, Jacqueline J.; ter Riet, Gerben; van Charante, Eric P. Moll; de Rooij, Sophia E.

    2016-01-01

    to compare changes over time in the in-hospital mortality and the mortality from discharge to 30 days post-discharge for six highly prevalent discharge diagnoses in acutely admitted older patients as well as to assess the effect of separately analysing the in-hospital mortality and the mortality

  1. In-hospital mortality pattern of severely injured children

    DEFF Research Database (Denmark)

    Do, Hien Quoc; Steinmetz, Jacob; Rasmussen, Lars S

    2012-01-01

    the mortality pattern of severely injured children admitted to a Danish level I trauma centre. METHODS: We included trauma patients aged 15 years or less, who subsequent a trauma team activation were admitted during the 9-year period 1999-2007. Data were collected prospectively for subjects who had a length...

  2. Performance of risk-adjusted control charts to monitor in-hospital mortality of intensive care unit patients: A simulation study

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    Koetsier, Antonie; de Keizer, Nicolette F.; de Jonge, Evert; Cook, David A.; Peek, Niels

    2012-01-01

    Objectives: Increases in case-mix adjusted mortality may be indications of decreasing quality of care. Risk-adjusted control charts can be used for in-hospital mortality monitoring in intensive care units by issuing a warning signal when there are more deaths than expected. The aim of this study was

  3. In-hospital mortality following acute myocardial infarction in Kosovo : A single center study

    International Nuclear Information System (INIS)

    Gani Bajraktari

    2010-01-01

    Randomized trials have demonstrated that primary angioplasty is more effective than intravenous thrombolysis in reducing mortality and morbidity in patients with acute myocardial infarction (AMI). The aim of this study was to assess the in-hospital mortality of patients with AMI admitted to the only tertiary care center in Kosovo, where coronary percutaneous intervention procedures are unavailable. We also assessed the impact of age and gender on in-hospital mortality. Patients and Consecutive patients with the diagnosis of AMI, admitted in our institution between 1999 and 2007, were included in this retrospective study. Of 2848 patients (mean age 61±11.3 years, 73.4% males) admitted with AMI, 292 (10.25%) patients died during in-hospital stay. The overall in-hospital mortality was 12.3% for women and 9.5% for men (P<.05). Women were significantly older than men (64.2±11 years vs 59.7±11.8 years, P<.05). Mean length of stay was 12.0±94 for women and 10.7±7.6 for men. From 1999 to 2007 there was an increase in the age of patients with AMI but the mortality rate remained stable.Compared to developed countries, patients with AMI in Kosovo present at an earlier age but have a higher mortality rate. Women with AMI had a significantly higher in-hospital mortality rate than men. The lack of percutaneous coronary intervention procedures in AMI patients may have contributed to the high in-hospital mortality in our population (Author).

  4. In-hospital mortality following acute myocardial infarction in Kosovo: Asingle center study

    International Nuclear Information System (INIS)

    Bajraktari, G.; Gjoka, S.; Rexhepaj, N.; Daullxhiu, I.; Thaqi, K.; Pacolli, S.; Sylejmani, X.; Elezi, S.

    2008-01-01

    Randomized trials have demonstrated that primary angioplasty is moreeffective than intravenous thrombolysis in reducing mortality and morbidityin patients with acute myocardial infarction (AMI). The aim of this study wasto assess the in-hospital mortality of patients with AMI admitted to the onlytertiary care center in Kosovo, where coronary percutaneous interventionprocedures are unavailable. We also assessed the impact of age and gender onin-hospital mortality. Consecutive patients with the diagnosis of AMI,admitted in our institution between 1999 and 2007, were included in thisretrospective study. Of 2848 patients (mean age 61+- 1.3 years, 73.4% males)admitted with AMI, 292 (10.25%) died during in-hospital stay. The overallin-hospital mortality was 12.3% for women and 9.5% for men (P<05). Women weresignificantly older than men (64.2+-11 years vs. 59.7+-11.8 years, P<.05).Mean length of stay was 12.0+-94 for women and 10.7+-7.6 for men. From 1999break was detected by the application of thepatients with Ami but themortality rate remained stable. Compared to developed countries, patientswith AMI in Kososvo present at an early age but have a higher mortality rate.Women with AMI had a significantly higher in-hospital mortality rate thanmen. The lack of percutaneous coronary intervention procedures in AMIpatients may have contributed to the high in-hospital mortality in ourpopulation. (auhor)

  5. Colorectal Surgery Fellowship Improves In-hospital Mortality After Colectomy and Proctectomy Irrespective of Hospital and Surgeon Volume.

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    Saraidaridis, Julia T; Hashimoto, Daniel A; Chang, David C; Bordeianou, Liliana G; Kunitake, Hiroko

    2018-03-01

    General surgery residents are increasingly pursuing sub-specialty training in colorectal (CR) surgery. However, the majority of operations performed by CR surgeons are also performed by general surgeons. This study aimed to assess in-hospital mortality stratified by CR training status after adjusting for surgeon and hospital volume. The Statewide Planning and Research Cooperative system database was used to identify all patients who underwent colectomy/proctectomy from January 1, 2000, to December 31, 2014, in the state of New York. Operations performed by board-certified CR surgeons were identified. The relationships between CR board certification and in-hospital mortality, in-hospital complications, length of stay, and ostomy were assessed using multivariate regression models. Two hundred seventy thousand six hundred eighty-four patients underwent colectomy/proctectomy over the study period. Seventy-two thousand two hundred seventy-nine (26.7%) of operations were performed by CR surgeons. Without adjusting for hospital and surgeon volume, in-hospital mortality was lower for those undergoing colectomy/proctectomy by a CR surgeon (OR 0.49, CI 0.44-0.54, p = 0.001). After controlling for hospital and surgeon volume, the odds of inpatient mortality after colectomy/proctectomy for those operated on by CR surgeons weakened to 0.76 (CI 0.68-0.86, p = 0.001). Hospital and surgeon volume accounted for 53% of the reduction in in-hospital mortality when CR surgeons performed colectomy/proctectomy. Patients who underwent surgery by a CR surgeon had a shorter inpatient stay (0.8 days, p = 0.001) and a decreased chance of colostomy (OR 0.86, CI 0.78-0.95, p accounting for hospital and surgeon volume.

  6. Predicting in-hospital mortality after redo cardiac operations: development of a preoperative scorecard.

    Science.gov (United States)

    Launcelott, Sebastian; Ouzounian, Maral; Buth, Karen J; Légaré, Jean-Francois

    2012-09-01

    The present study generated a risk model and an easy-to-use scorecard for the preoperative prediction of in-hospital mortality for patients undergoing redo cardiac operations. All patients who underwent redo cardiac operations in which the initial and subsequent procedures were performed through a median sternotomy were included. A logistic regression model was created to identify independent preoperative predictors of in-hospital mortality. The results were then used to create a scorecard predicting operative risk. A total of 1,521 patients underwent redo procedures between 1995 and 2010 at a single institution. Coronary bypass procedures were the most common previous (58%) or planned operations (54%). The unadjusted in-hospital mortality for all redo cases was higher than for first-time procedures (9.7% vs. 3.4%; pscorecard was generated using these independent predictors, stratifying patients undergoing redo cardiac operations into 6 risk categories of in-hospital mortality ranging from risk to >40%. Reoperation represents a significant proportion of modern cardiac surgical procedures and is often associated with significantly higher mortality than first-time operations. We created an easy-to-use scorecard to assist clinicians in estimating operative mortality to ensure optimal decision making in the care of patients facing redo cardiac operations. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Prognostic Importance of Low Admission Serum Creatinine Concentration for Mortality in Hospitalized Patients.

    Science.gov (United States)

    Thongprayoon, Charat; Cheungpasitporn, Wisit; Kittanamongkolchai, Wonngarm; Harrison, Andrew M; Kashani, Kianoush

    2017-05-01

    The study objective was to assess the association between low serum creatinine value at admission and in-hospital mortality in hospitalized patients. This was a retrospective single-center cohort study conducted at a tertiary referral hospital. All hospitalized adult patients between 2011 and 2013 who had an admission creatinine value available were identified for inclusion in this study. Admission creatinine value was categorized into 7 groups: ≤0.4, 0.5 to 0.6, 0.7 to 0.8, 0.9 to 1.0, 1.1 to 1.2, 1.3 to 1.4, and ≥1.5 mg/dL. The primary outcome was in-hospital mortality. Logistic regression analysis was performed to obtain the odds ratio of in-hospital mortality for the various admission creatinine levels, using a creatinine value of 0.7 to 0.8 mg/dL as the reference group in the analysis of all patients and female patients and of 0.9 to 1.0 mg/dL in the analysis of male patients because it was associated with the lowest in-hospital mortality. Of 73,994 included patients, 973 (1.3%) died in the hospital. The association between different categories of admission creatinine value and in-hospital mortality assumed a U-shaped distribution, with both low and high creatinine values associated with higher in-hospital mortality. After adjustment for age, sex, ethnicity, principal diagnosis, and comorbid conditions, very low creatinine value (≤0.4 mg/dL) was significantly associated with increased mortality (odds ratio, 3.29; 95% confidence interval, 2.08-5.00), exceeding the risk related to a markedly increased creatinine value of ≥1.5 mg/dL (odds ratio, 2.56; 95% confidence interval, 2.07-3.17). The association remained significant in the subgroup analysis of male and female patients. Low creatinine value at admission is independently associated with increased in-hospital mortality in hospitalized patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Changes in the in-hospital mortality and 30-day post-discharge mortality in acutely admitted older patients : retrospective observational study

    NARCIS (Netherlands)

    van Rijn, Marjon; Buurman, Bianca M.; Vroomen, Janet L. Macneil; Suijker, Jacqueline J.; ter Riet, Gerben; van Charante, Eric P. Moll; de Rooij, Sophia E.

    Objectives: to compare changes over time in the in-hospital mortality and the mortality from discharge to 30 days postdischarge for six highly prevalent discharge diagnoses in acutely admitted older patients as well as to assess the effect of separately analysing the in-hospital mortality and the

  9. Relationship Between Preoperative Anemia and In-Hospital Mortality in Children Undergoing Noncardiac Surgery.

    Science.gov (United States)

    Faraoni, David; DiNardo, James A; Goobie, Susan M

    2016-12-01

    The relationship between preoperative anemia and in-hospital mortality has not been investigated in the pediatric surgical population. We hypothesized that children with preoperative anemia undergoing noncardiac surgery may have an increased risk of in-hospital mortality. We identified all children between 1 and 18 years of age with a recorded preoperative hematocrit (HCT) in the 2012, 2013, and 2014 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) pediatric databases. The endpoint was defined as the incidence of in-hospital mortality. Children with preoperative anemia were identified based on their preoperative HCT. Demographic and surgical characteristics, as well as comorbidities, were considered potential confounding variables in a multivariable logistic regression analysis. A sensitivity analysis was performed using propensity-matched analysis. Among the 183,833 children included in the 2012, 2013, and 2014 ACS NSQIP database, 74,508 had a preoperative HCT recorded (41%). After exclusion of all children children were anemic, and 39,071 (76%) were nonanemic. The median preoperative HCT was 33% (interquartile range, 31-35) in anemic children, and 39% (interquartile range, 37-42) in nonanemic children (P anemia was associated with higher odds for in-hospital mortality (OR, 2.17; 95% CI, 1.48-3.19; P anemia was also associated with higher odds of in-hospital mortality (OR, 1.75; 95% CI, 1.15-2.65; P = .004). Our study demonstrates that children with preoperative anemia are at increased risk for in-hospital mortality. Further studies are needed to assess whether the correction of preoperative HCT, through the development of a patient blood management program, improves patient outcomes or simply reduces the need for transfusions.

  10. Atrial fibrillation is a predictor of in-hospital mortality in ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Ong CT

    2016-06-01

    Full Text Available Cheung-Ter Ong,1,2 Yi-Sin Wong,3 Chi-Shun Wu,1 Yu-Hsiang Su1 1Department of Neurology, Chia-Yi Christian Hospital, 2Department of Nursing, Chung Jen Junior College of Nursing, Health Science and Management, Chiayi, 3Department of Family Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan, Republic of China Background/purpose: In-hospital mortality rate of acute ischemic stroke patients remains between 3% and 18%. For improving the quality of stroke care, we investigated the factors that contribute to the risk of in-hospital mortality in acute ischemic stroke patients.Materials and methods: Between January 1, 2007, and December 31, 2011, 2,556 acute ischemic stroke patients admitted to a stroke unit were included in this study. Factors such as demographic characteristics, clinical characteristics, comorbidities, and complications related to in-hospital mortality were assessed.Results: Of the 2,556 ischemic stroke patients, 157 received thrombolytic therapy. Eighty of the 2,556 patients (3.1% died during hospitalization. Of the 157 patients who received thrombolytic therapy, 14 (8.9% died during hospitalization. History of atrial fibrillation (AF, P<0.01 and stroke severity (P<0.01 were independent risk factors of in-hospital mortality. AF, stroke severity, cardioembolism stroke, and diabetes mellitus were independent risk factors of hemorrhagic transformation. Herniation and sepsis were the most common complications of stroke that were attributed to in-hospital mortality. Approximately 70% of in-hospital mortality was related to stroke severity (total middle cerebral artery occlusion with herniation, basilar artery occlusion, and hemorrhagic transformation. The other 30% of in-hospital mortality was related to sepsis, heart disease, and other complications.Conclusion: AF is associated with higher in-hospital mortality rate than in patients without AF. For improving outcome of stroke patients, we also need to focus to reduce serious neurological

  11. Comparison of in-hospital versus 30-day mortality assessments for selected medical conditions.

    Science.gov (United States)

    Borzecki, Ann M; Christiansen, Cindy L; Chew, Priscilla; Loveland, Susan; Rosen, Amy K

    2010-12-01

    In-hospital mortality measures such as the Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicators (IQIs) are easily derived using hospital discharge abstracts and publicly available software. However, hospital assessments based on a 30-day postadmission interval might be more accurate given potential differences in facility discharge practices. To compare in-hospital and 30-day mortality rates for 6 medical conditions using the AHRQ IQI software. We used IQI software (v3.1) and 2004-2007 Veterans Health Administration (VA) discharge and Vital Status files to derive 4-year facility-level in-hospital and 30-day observed mortality rates and observed/expected ratios (O/Es) for admissions with a principal diagnosis of acute myocardial infarction, congestive heart failure, stroke, gastrointestinal hemorrhage, hip fracture, and pneumonia. We standardized software-calculated O/Es to the VA population and compared O/Es and outlier status across sites using correlation, observed agreement, and kappas. Of 119 facilities, in-hospital versus 30-day mortality O/E correlations were generally high (median: r = 0.78; range: 0.31-0.86). Examining outlier status, observed agreement was high (median: 84.7%, 80.7%-89.1%). Kappas showed at least moderate agreement (k > 0.40) for all indicators except stroke and hip fracture (k ≤ 0.22). Across indicators, few sites changed from a high to nonoutlier or low outlier, or vice versa (median: 10, range: 7-13). The AHRQ IQI software can be easily adapted to generate 30-day mortality rates. Although 30-day mortality has better face validity as a hospital performance measure than in-hospital mortality, site assessments were similar despite the definition used. Thus, the measure selected for internal benchmarking should primarily depend on the healthcare system's data linkage capabilities.

  12. [in-hospital mortality in patient with acute ischemic and hemorrhagic stroke].

    Science.gov (United States)

    Sadamasa, Nobutake; Yoshida, Kazumichi; Narumi, Osamu; Chin, Masaki; Yamagata, Sen

    2011-09-01

    There is a lack of evidence to compare in-hospital mortality with different types of stroke. The purpose of this study was to elucidate the in-hospital mortality after acute ischemic/hemorrhagic stroke and compare the factors associated with the mortality among stroke subtypes. All patients admitted to Kurashiki Central Hospital in Japan between January 2009 and December 2009, and diagnosed with acute ischemic/hemorrhagic stroke were included in this study. Demographics and clinical data pertaining to the patients were obtained from their medical records. Out of 738 patients who had an acute stroke, 53 (7.2%) died in the hospital. The in-hospital mortality was significantly lower in the cerebral infarction group than in the intracerebral hemorrhage and subarachnoid hemorrhage group (3.5%, 15.1%, and 17.9%, respectively; Phemorrhage group than in the other 2 groups. With regard to past history, diabetes mellitus was significantly found to be a complication in mortality cases of intracranial hemorrhage. Further investigation is needed to clarify the effect of diabetes on mortality after intracranial hemorrhage.

  13. Exercise Decreases and Smoking Increases Bladder Cancer Mortality.

    Science.gov (United States)

    Liss, Michael A; White, Martha; Natarajan, Loki; Parsons, J Kellogg

    2017-06-01

    The aim of this study was to investigate modifiable lifestyle factors of smoking, exercise, and obesity with bladder cancer mortality. We used mortality-linked data from the National Health Information Survey from 1998 through 2006. The primary outcome was bladder cancer-specific mortality. The primary exposures were self-reported smoking status (never- vs. former vs. current smoker), self-reported exercise (dichotomized as "did no exercise" vs. "light, moderate, or vigorous exercise in ≥ 10-minute bouts"), and body mass index. We utilized multivariable adjusted Cox proportional hazards regression models, with delayed entry to account for age at survey interview. Complete data were available on 222,163 participants, of whom 96,715 (44%) were men and 146,014 (66%) were non-Hispanic whites, and among whom we identified 83 bladder cancer-specific deaths. In multivariate analyses, individuals who reported any exercise were 47% less likely (adjusted hazard ratio [HR adj ], 0.53; 95% confidence interval [CI], 0.29-0.96; P = .038) to die of bladder cancer than "no exercise". Compared with never-smokers, current (HR adj , 4.24; 95% CI, 1.89-9.65; P = .001) and former (HR adj , 2.95; 95% CI, 1.50-5.79; P = .002) smokers were 4 and 3 times more likely, respectively, to die of bladder cancer. There were no significant associations of body mass index with bladder cancer mortality. Exercise decreases and current smoking increases the risk of bladder cancer-specific mortality. These data suggest that exercise and smoking cessation interventions may reduce bladder cancer death. Published by Elsevier Inc.

  14. Variability in Very Preterm Stillbirth and In-Hospital Mortality Across Europe

    DEFF Research Database (Denmark)

    Draper, Elizabeth S; Manktelow, Bradley N; Cuttini, Marina

    2017-01-01

    to determine what proportion of the variation in stillbirth and in-hospital VPT mortality rates persists after adjusting for population demographics, case-mix, and timing of death. METHODS: Standardized data collection for a geographically defined prospective cohort of VPTs (22(+0)-31(+6) weeks gestation...

  15. Risk Factors for In-Hospital Mortality among Ischemic Stroke Patients in Southern Taiwan

    Directory of Open Access Journals (Sweden)

    Cheung-Ter Ong

    2016-06-01

    Conclusion: Nearly 30% of in-hospital mortality is associated with preventable factors. The prognosis of acute stroke can be improved by increased focus on reducing serious complications after stroke, particularly on the prevention of infection, heart disease, and increased intracranial pressure.

  16. Trends in hospital admissions, re-admissions, and in-hospital mortality among HIV-infected patients between 1993 and 2013: Impact of hepatitis C co-infection.

    Science.gov (United States)

    Meijide, Héctor; Mena, Álvaro; Rodríguez-Osorio, Iria; Pértega, Sonia; Castro-Iglesias, Ángeles; Rodríguez-Martínez, Guillermo; Pedreira, José; Poveda, Eva

    2017-01-01

    New patterns in epidemiological characteristics of people living with HIV infection (PLWH) and the introduction of Highly Active Antiretroviral Therapy (HAART) have changed the profile of hospital admissions in this population. The aim of this study was to evaluate trends in hospital admissions, re-admissions, and mortality rates in HIV patients and to analyze the role of HCV co-infection. A retrospective cohort study conducted on all hospital admissions of HIV patients between 1993 and 2013. The study time was divided in two periods (1993-2002 and 2003-2013) to be compared by conducting a comparative cross-sectional analysis. A total of 22,901 patient-years were included in the analysis, with 6917 hospital admissions, corresponding to 1937 subjects (75% male, mean age 36±11 years, 37% HIV/HCV co-infected patients). The median length of hospital stay was 8 days (5-16), and the 30-day hospital re-admission rate was 20.1%. A significant decrease in hospital admissions related with infectious and psychiatric diseases was observed in the last period (2003-2013), but there was an increase in those related with malignancies, cardiovascular, gastrointestinal, and chronic respiratory diseases. In-hospital mortality remained high (6.8% in the first period vs. 6.3% in the second one), with a progressive increase of non-AIDS-defining illness deaths (37.9% vs. 68.3%, P<.001). The admission rate significantly dropped after 1996 (4.9% yearly), but it was less pronounced in HCV co-infected patients (1.7% yearly). Hospital admissions due to infectious and psychiatric disorders have decreased, with a significant increase in non-AIDS-defining malignancies, cardiovascular, and chronic respiratory diseases. In-hospital mortality is currently still high, but mainly because of non-AIDS-defining illnesses. HCV co-infection increased the hospital stay and re-admissions during the study period. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y

  17. Association of In-Hospital Mortality and Dysglycemia in Septic Patients.

    Directory of Open Access Journals (Sweden)

    Hsiao-Yun Chao

    Full Text Available The associations between dysglycemia and mortality in septic patients with and without diabetes are yet to be confirmed. Our aim was to analyze the association of diabetes and sepsis mortality, and to examine how dysglycemia (hyperglycemia, hypoglycemia and glucose variability affects in-hospital mortality of patients with suspected sepsis in emergency department (ED and intensive care units.Clinically suspected septic patients admitted to ED were included, and stratified into subgroups according to in-hospital mortality and the presence of diabetes. We analyzed patients' demographics, comorbidities, clinical and laboratory parameters, admission glucose levels and severity of sepsis. Odds ratio of mortality was assessed after adjusting for possible confounders. The correlations of admission glucose and CoV (blood glucose coefficients of variation and mortality in diabetes and non-diabetes were also tested.Diabetes was present in 58.3% of the patients. Diabetic patients were older, more likely to have end-stage renal disease and undergoing hemodialysis, but had fewer malignancies, less sepsis severity (lower Mortality in Emergency Department Sepsis Score, less steroid usage in emergency department, and lower in-hospital mortality rate (aOR:0.83, 95% CI 0.65-0.99, p = 0.044. Hyperglycemia at admission (glucose≥200 mg/dL was associated with higher risks of in-hospital mortality among the non-diabetes patients (OR:1.83 vs. diabetes, 95% CI 1.20-2.80, p = 0.005 with the same elevated glucose levels at admission. In addition, CoV>30% resulted in higher risk of death as well (aOR:1.88 vs. CoV between 10 and 30, 95%CI 1.24-2.86 p = 0.003.This study indicates that while diabetes mellitus seems to be a protective factor in sepsis patients, hyper- or hypoglycemia status on admission, and increased blood glucose variation during hospital stays, were independently associated with increased odds ratio of mortality.

  18. Multiple sclerosis and alcohol use disorders: In-hospital mortality, extended hospital stays, and overexpenditures.

    Science.gov (United States)

    Gili-Miner, M; López-Méndez, J; Vilches-Arenas, A; Ramírez-Ramírez, G; Franco-Fernández, D; Sala-Turrens, J; Béjar-Prado, L

    2016-10-22

    The objective of this study was to analyse the impact of alcohol use disorders (AUD) in patients with multiple sclerosis (MS) in terms of in-hospital mortality, extended hospital stays, and overexpenditures. We conducted a retrospective observational study in a sample of MS patients obtained from minimal basic data sets from 87 Spanish hospitals recorded between 2008 and 2010. Mortality, length of hospital stays, and overexpenditures attributable to AUD were calculated. We used a multivariate analysis of covariance to control for such variables as age and sex, type of hospital, type of admission, other addictions, and comorbidities. The 10,249 patients admitted for MS and aged 18-74 years included 215 patients with AUD. Patients with both MS and AUD were predominantly male, with more emergency admissions, a higher prevalence of tobacco or substance use disorders, and higher scores on the Charlson comorbidity index. Patients with MS and AUD had a very high in-hospital mortality rate (94.1%) and unusually lengthy stays (2.4 days), and they generated overexpenditures (1,116.9euros per patient). According to the results of this study, AUD in patients with MS results in significant increases in-hospital mortality and the length of the hospital stay and results in overexpenditures. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Gender differences in in-hospital mortality and mechanisms of death after the first acute myocardial infarction

    International Nuclear Information System (INIS)

    Fabijanic, D.; Culic, V.; Bozic, I; Miric, D.; Stipic, S.S.; Radic, M.; Vucinovic, Z.

    2006-01-01

    There are conflicting data about gender differences in short-term mortality after acute myocardial infarction (AMI) after adjusting for age and other prognostic factors. Therefore, we investigated the risk profile, clinical presentation, in-hospital mortality and mechanisms of death in women and men after the first AMI. The data was obtained from a chart review of 3382 consecutive patients, 1184 (35%) women (69.7+-10.9 years) and 2198 (65%) men (63.5+-11.8 years) with first AMI. The effect of gender and its interaction with age, risk factors and thrombolytic therapy on overall mortality and mechanisms of death were examined using logistic regression. Unadjusted in-hospital mortalty was higher in women (OR 1.77, 95% CI 1.47-2.15). Adjustment that included both age only and age and other base-line differences (Hypertension, diabetes mellitus, hypercholesterolemia, smoking, AMI type, AMI site, mean peak CK value, thrombolytic therapy)decreased the magnitude of the relative risk of women to men but did not eliminate it (OR 1.26, 95% CI 1.03-1.54 and OR 1.31 95% CI 1.03-1.66, respectively). Multivariate analysis revealed that female gender was an independent predictor of in-hospital mortality after the first AMI. Women were dying more often because of mechanical complications-refractory pulmonary edema and cardiogenic shock (P=0.02) or electromechanical dissociation (P=0.03), and men were dying mostly by arrhythmic death, primary ventricular tachycardia/fibrillation (P=0.002). Female gender was independently associated with mechanical death (OR 1.56, 95% CI 1.35-2.58; P=0.01) and anterior AMI was independently associated with arrhythmic death (OR 0.54, 95% CI 0.34-0.86; P=0.01). Our result demonstrate significant differences in mechanisms of in-hospital death after the first AMI in women, and men, suggesting the possibility that higher in-hospital mortality in women exists primarily because of the postponing AMI death due to the gender-related differences in

  20. Age-related in-hospital mortality among patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Abid, A.R.; Rafique, S.; Ahmed, R.Z.; Anjum, A.H.; Tarin, S.M.A.

    2004-01-01

    Objective: To evaluate the in-hospital mortality of acute myocardial infarction among different age groups. Subjects and Methods: The subjects were 460 admitted patients of acute myocardial infarction who fulfilled our inclusion criteria. Patients were divided into four age groups. Group-I included patients in 20-40 years, group-II (41-50 years), group-III (51-60 years) and group-IV (>60 years). Mortality was compared between different age groups by Chi-square and linear-regression models. Results: The total in-hospital mortality was 16.7%. It gradually increased from 5.6% in group-I (20-40 years) patients to 21% in group-IV (>60 years) patients. While mortality in groups group-II (41-50 years) and group-III (51-60 years) patients was 16.7% and 18.6% respectively. A marked increase in mortality was noted with increase in age. Group- IV (>60 years) patients presented 2 hours late to the hospital than the group-I (20-40 years) patients. There was no statistical difference in site of infarction in different age groups. Old age (group-IV i.e. >60 years old) was more associated with heart failure (higher Killip class) on presentation. Lesser number of patients in group-IV received thrombolytic therapy than group-I. Only 31.09% patients in group-IV and 62.5% patients in group-I received streptokinase therapy respectively. Conclusion: In patients with acute myocardial infarction age was a powerful independent predictor of in-hospital mortality and complications. (author)

  1. Patient-prosthesis mismatch has no influence on in-hospital mortality after aortic valve replacement.

    Science.gov (United States)

    Yottasurodom, Chaiwut; Namthaisong, Kriengkrai; Porapakkham, Pramote; Kasemsarn, Choosak; Chotivatanapong, Taweesak; Chaiseri, Pradistchai; Wongdit, Suwannee; Yasotarin, Suwanna

    2012-08-01

    To analyze the relationship between prosthetic aortic valve orifice and body surface area (Effective Orifice Area Index, EOAI) and in-hospital mortality after aortic valve replacement. A prospective study was conducted between October 2007 to September 2010, 536 patients underwent isolated aortic valve replacement (AVR) was recorded on preoperative, operative and postoperative data. Patient Prosthesis Mismatch (PPM) was classified by Effective Orifice Area Indexed (EOAI) by prosthetic valve area divided by body surface area as mild or no significance if the EOAI is greater than 0.85 cm2/m2, moderate if between 0.65 cm2/m2 and 0.85 cm2/m2, and severe if less than 0.65 cm2/m2. Statistical differences were analyzed by Chi-square and student t-test with p-value less than 0.05 considered significant. There were 304 men, mean age was 60.98 years, mean valve orifice area 1.69 cm2, body surface area 1.60 m2, cross clamp time 1.13 hrs., bypass time 1.67 hrs. Mechanical valves were used in 274 patients (51.2%) and Bioprosthesis were used in 181 patients (48.8%). PPM was found in 33.7%, 6.7% was severe PPM, 27% was moderate PPM and 66.3% has no significant PPM Over all in-hospital mortality was 1.5%. There was no significant difference in hospital mortality between no PPM group, moderate PPM and severe PPM group (1.4% vs. 1.4% vs. 5.4%, p-value = 0.86). In a large aortic valve surgery population, moderate and severe patient prosthesis mismatch occurred in 35.6% of patients but had no influence on in-hospital mortality.

  2. Simple Scoring System to Predict In-Hospital Mortality After Surgery for Infective Endocarditis.

    Science.gov (United States)

    Gatti, Giuseppe; Perrotti, Andrea; Obadia, Jean-François; Duval, Xavier; Iung, Bernard; Alla, François; Chirouze, Catherine; Selton-Suty, Christine; Hoen, Bruno; Sinagra, Gianfranco; Delahaye, François; Tattevin, Pierre; Le Moing, Vincent; Pappalardo, Aniello; Chocron, Sidney

    2017-07-20

    Aspecific scoring systems are used to predict the risk of death postsurgery in patients with infective endocarditis (IE). The purpose of the present study was both to analyze the risk factors for in-hospital death, which complicates surgery for IE, and to create a mortality risk score based on the results of this analysis. Outcomes of 361 consecutive patients (mean age, 59.1±15.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in-hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver operating characteristic curve analysis. Score validation procedures were carried out. Fifty-six (15.5%) patients died postsurgery. BMI >27 kg/m 2 (odds ratio [OR], 1.79; P =0.049), estimated glomerular filtration rate 55 mm Hg (OR, 1.78; P =0.032), and critical state (OR, 2.37; P =0.017) were independent predictors of in-hospital death. A scoring system was devised to predict in-hospital death postsurgery for IE (area under the receiver operating characteristic curve, 0.780; 95% CI, 0.734-0.822). The score performed better than 5 of 6 scoring systems for in-hospital death after cardiac surgery that were considered. A simple scoring system based on risk factors for in-hospital death was specifically created to predict mortality risk postsurgery in patients with IE. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  3. Informed switching strongly decreases the prevalence of antibiotic resistance in hospital wards.

    Directory of Open Access Journals (Sweden)

    Roger D Kouyos

    2011-03-01

    Full Text Available Antibiotic resistant nosocomial infections are an important cause of mortality and morbidity in hospitals. Antibiotic cycling has been proposed to contain this spread by a coordinated use of different antibiotics. Theoretical work, however, suggests that often the random deployment of drugs ("mixing" might be the better strategy. We use an epidemiological model for a single hospital ward in order to assess the performance of cycling strategies which take into account the frequency of antibiotic resistance in the hospital ward. We assume that information on resistance frequencies stems from microbiological tests, which are performed in order to optimize individual therapy. Thus the strategy proposed here represents an optimization at population-level, which comes as a free byproduct of optimizing treatment at the individual level. We find that in most cases such an informed switching strategy outperforms both periodic cycling and mixing, despite the fact that information on the frequency of resistance is derived only from a small sub-population of patients. Furthermore we show that the success of this strategy is essentially a stochastic phenomenon taking advantage of the small population sizes in hospital wards. We find that the performance of an informed switching strategy can be improved substantially if information on resistance tests is integrated over a period of one to two weeks. Finally we argue that our findings are robust against a (moderate preexistence of doubly resistant strains and against transmission via environmental reservoirs. Overall, our results suggest that switching between different antibiotics might be a valuable strategy in small patient populations, if the switching strategies take the frequencies of resistance alleles into account.

  4. Causes and predictors of mortality in hospitalized lupus patient in Sarawak General Hospital, Malaysia.

    Science.gov (United States)

    Teh, C L; Ling, G R

    2013-01-01

    Systemic lupus erythematosus (SLE) is a serious autoimmune disease that can be life threatening and fatal if left untreated. Causes and prognostic indicators of death in SLE have been well studied in developed countries but lacking in developing countries. We aimed to investigate the causes of mortality in hospitalized patients with SLE and determine the prognostic indicators of mortality during hospitalization in our center. All SLE patients who were admitted to Sarawak General Hospital from January 1, 2006 to December 31, 2010, were followed up in a prospective study using a standard protocol. Demographic data, clinical features, disease activities and damage indices were collected. Logistic regression and Cox regression analysis were used to determine the prognostic indicators of mortality in our patients. There were a total of 251 patients in our study, with the female to male ratio 10 to 1. Our study patients were of multiethnic origins. They had a mean age of 30.5 ± 12.2 years and a mean duration of illness of 36.5 ± 51.6 months. The main involvements were hematologic (73.3%), renal (70.9%) and mucocutaneous (67.3%). There were 26 deaths (10.4%), with the main causes being: infection and flare (50%), infection alone (19%), flare alone (19%) and others (12%). Independent predictors of mortality in our cohort of SLE patients were the presence of both infection and flare of disease (hazard ratio (HR) 5.56) and high damage indices at the time of admission (HR 1.91). Infection and flare were the main causes of death in hospitalized Asian patients with SLE. The presence of infection with flare and high damage indices at the time of admission were independent prognostic indicators of mortality.

  5. Basic geriatric assessment does not predict in-hospital mortality after PEG placement

    Directory of Open Access Journals (Sweden)

    Smoliner Christine

    2012-09-01

    Full Text Available Abstract Background Percutaneous endoscopic gastrostomy (PEG is an established procedure for long-term nutrition. However, studies have underlined the importance of proper patient selection as mortality has been shown to be relatively high in acute illness and certain patient groups, amongst others geriatric patients. Objective of the study was to gather information about geriatric patients receiving PEG and to identify risk factors associated with in-hospital mortality after PEG placement. Methods All patients from the GEMIDAS database undergoing percutaneous endoscopic gastrostomy in acute geriatric wards from 2006 to 2010 were included in a retrospective database analysis. Data on age, gender, main diagnosis leading to hospital admission, death in hospital, care level, and legal incapacitation were extracted from the main database of the Geriatric Minimum Data Set. Self-care capacity was assessed by the Barthel index, and cognitive status was rated with the Mini Mental State Examination or subjectively judged by the clinician. Descriptive statistics and group comparisons were chosen according to data distribution and scale of measurement, logistic regression analysis was performed to examine influence of various factors on hospital mortality. Results A total of 1232 patients (60.4% women with a median age of 82 years (range 60 to 99 years were included. The mean Barthel index at admission was 9.5 ± 14.0 points. Assessment of cognitive status was available in about half of the patients (n = 664, with 20% being mildly impaired and almost 70% being moderately to severely impaired. Stroke was the most common main diagnosis (55.2%. In-hospital mortality was 12.8%. In a logistic regression analysis, old age (odds ratio (OR 1.030, 95% confidence interval (CI 1.003-1.056, male sex (OR 1.741, 95% CI 1.216-2.493, and pneumonia (OR 2.641, 95% CI 1.457-4.792 or the diagnosis group ‘miscellaneous disease’ (OR 1.864, 95% CI 1

  6. Predictors of in-hospital mortality in surgically treated valvular infective endocarditis cases at National Heart Institute, Egypt

    Directory of Open Access Journals (Sweden)

    Ahmed Elmasry

    2017-03-01

    Conclusions: Surgery for IE continues to be challenging. EuroSCORE II has a good discrimination ability to predict in-hospital mortality in IE surgery. Satisfactory results can be obtained with valve repair in IE.

  7. Extravasation of contrast (Spot Sign) predicts in-hospital mortality in ruptured arteriovenous malformation.

    Science.gov (United States)

    Ye, Zengpanpan; Ai, Xiaolin; Zheng, Jun; Hu, Xin; You, Chao; Andrew M, Faramand; Fang, Fang

    2017-10-09

    The spot sign is a highly specific and sensitive predictor of hematoma expansion in following primary intracerebral hemorrhage (ICH). Rare cases of the spot sign have been documented in patients with intracranial hemorrhage secondary to arteriovenous malformation (AVM). The purpose of this retrospective study is to assess the accuracy of spot sign in predicting clinical outcomes in patients with ruptured AVM. A retrospective analysis of a prospectively maintained database was performed for patients who presented to West China Hospital with ICH secondary to AVM in the period between January 2009 and September 2016. Two radiologists blinded to the clinical data independently assessed the imaging data, including the presence of spot sign. Statistical analysis using univariate testing, multivariate logistic regression testing, and receiver operating characteristic curve (AUC) analysis was performed. A total of 116 patients were included. Overall, 18.9% (22/116) of subjects had at least 1 spot sign detected by CT angiography, 7% (8/116) died in hospital, and 27% (31/116) of the patients had a poor outcome after 90 days. The spot sign had a sensitivity of 62.5% and specificity of 84.3% for predicting in-hospital mortality (p = .02, AUC 0.734). No correlation detected between the spot sign and 90-day outcomes under multiple logistic regression (p = .19). The spot sign is an independent predictor for in-hospital mortality. The presence of spot sign did not correlate with the 90 day outcomes in this patient cohort. The results of this report suggest that patients with ruptured AVM with demonstrated the spot sign on imaging must receive aggressive treatment early on due to the high risk of mortality.

  8. Association between delirium superimposed on dementia and mortality in hospitalized older adults: A prospective cohort study.

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    Thiago J Avelino-Silva

    2017-03-01

    Full Text Available Hospitalized older adults with preexisting dementia have increased risk of having delirium, but little is known regarding the effect of delirium superimposed on dementia (DSD on the outcomes of these patients. Our aim was to investigate the association between DSD and hospital mortality and 12-mo mortality in hospitalized older adults.This was a prospective cohort study completed in the geriatric ward of a university hospital in São Paulo, Brazil. We included 1,409 hospitalizations of acutely ill patients aged 60 y and over from January 2009 to June 2015. Main variables and measures included dementia and dementia severity (Informant Questionnaire on Cognitive Decline in the Elderly, Clinical Dementia Rating and delirium (Confusion Assessment Method. Primary outcomes were time to death in the hospital and time to death in 12 mo (for the discharged sample. Comprehensive geriatric assessment was performed at admission, and additional clinical data were documented upon death or discharge. Cases were categorized into four groups (no delirium or dementia, dementia alone, delirium alone, and DSD. The no delirium/dementia group was defined as the referent category for comparisons, and multivariate analyses were performed using Cox proportional hazards models adjusted for possible confounders (sociodemographic information, medical history and physical examination data, functional and nutritional status, polypharmacy, and laboratory covariates. Overall, 61% were women and 39% had dementia, with a mean age of 80 y. Dementia alone was observed in 13% of the cases, with delirium alone in 21% and DSD in 26% of the cases. In-hospital mortality was 8% for patients without delirium or dementia, 12% for patients with dementia alone, 29% for patients with delirium alone, and 32% for DSD patients (Pearson Chi-square = 112, p < 0.001. DSD and delirium alone were independently associated with in-hospital mortality, with respective hazard ratios (HRs of 2.14 (95% CI

  9. In-hospital Mortality due to Respiratory Diseases in the Provincial Hospital of Cienfuegos. 2010-2014

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    Liuva Leyva Rodríguez; Orlando Morera Álvarez; Daylin Madruga Jiménez; Heidy Caridad Cordero Cabrera; Reinaldo José Pino Blanco

    2016-01-01

    Background: in-hospital mortality is a health indicator commonly used as a measure of quality of care. Respiratory diseases are a major cause of deaths in hospitals. Objective: to describe mortality from respiratory diseases at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos. Methods: a descriptive study of all patients over 18 years old who died from respiratory diseases in the hospital of Cienfuegos from 2010 to 2014 was conducted. The variables analyzed were: age,...

  10. Improving Providers' Role Definitions to Decrease Overcrowding and Improve In-Hospital Cardiac Arrest Response.

    Science.gov (United States)

    Leary, Marion; Schweickert, William; Neefe, Stacie; Tsypenyuk, Boris; Falk, Scott Austin; Holena, Daniel N

    2016-07-01

    How nontechnical factors such as inadequate role definition and overcrowding affect outcomes of in-hospital cardiac arrest (IHCA) is unknown. Using a bundled intervention, we sought to improve providers' role definitions and decrease overcrowding during IHCA events. To determine if a bundled intervention consisting of a nurse/physician leadership dyad, visual cues for provider roles, and a "role check" would lead to reductions in crowding and improve perceptions of communication and team leadership. Baseline data on the number and type of IHCA providers were collected. Providers were asked to complete a postevent survey rating communication and leadership. A bundled intervention was then introduced. Data were then obtained for the subsequent IHCA events. Twenty ICHA events were captured before and 34 after the intervention. The number of physicians present at pulse checks 2 (median [interquartile range]: 6 [5-8] before vs 5 [3-6] after, P = .02) and 3 (7 [5-9] vs 4 [4-5], P = .004) decreased significantly after the intervention. The overall number of providers at the third pulse check (18 [14-22] before vs 14 [12-16] after, P = .04) also decreased after the intervention. On a 10-point Likert scale, ratings of communication (8 [7-8]) and physician leadership (8 [7-9]) did not differ significantly from before to after the intervention. Both the physician leads (90%) and patients' primary nurses (97%) were able to identify clear nurse leaders. A bundled intervention targeted at improving IHCA response led to a decrease in overcrowding at ICHA events without substantial changes in the perceptions of communication or physician leadership. ©2016 American Association of Critical-Care Nurses.

  11. Predictors of In-Hospital Mortality for Stroke in Douala, Cameroon

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    N. Y. Mapoure

    2014-01-01

    Full Text Available Background. The objective of this study was to describe complications in hospitalized patients for stroke and to determine the predictive factors of intrahospital mortality from stroke at the Douala General Hospital (DGH in Cameroon. Patients and Methods. A prospective cross-sectional study was carried out from January 1, 2010 to December 31, 2012, at the DGH. All the patients who were aged more than 15 years with established diagnosis of stroke were included. A univariate analysis was done to look for factors associated with the risk of death, whilst the predictive factors of death were determined in a multivariate analysis following Cox regression model. Results. Of the 325 patients included patients, 68.1% were males and the mean age was 58.66 ± 13.6 years. Ischaemic stroke accounted for 52% of the cases. Sepsis was the leading complications present in 99 (30.12% cases. Independent predicting factors of in-hospital mortality were Glasgow Coma Scale lower than 8 (HR = 2.17 95% CI 4.86–36.8; P=0.0001, hyperglycaemia at admission (HR = 3.61 95% CI 1.38–9.44; P=0.009, and hemorrhagic stroke (HR = 5.65 95% CI 1.77–18; P=0.003. Conclusion. The clinician should systematically diagnose and treat infectious states and hyperglycaemia in stroke.

  12. DTP with or after measles vaccination is associated with increased in-hospital mortality in Guinea-Bissau

    DEFF Research Database (Denmark)

    Aaby, Peter; Biai, Sidu; Veirum, Jens Erik

    2007-01-01

    The sequence of routine immunisations may be important for childhood mortality. Three doses of diphtheria-tetanus-pertussis vaccine (DTP) should be given at 6, 10, and 14 weeks and measles vaccine (MV) at 9 months of age. The sequence is not always respected. We examined in-hospital mortality...... of children having received DTP with or after measles vaccine....

  13. Changes in hospitalization rate and mortality after acute myocardial infarction in Denmark after diagnostic criteria and methods changed

    DEFF Research Database (Denmark)

    Abildstrøm, Steen Zabell; Rasmussen, Søren; Madsen, Mette

    2004-01-01

    AIMS: To analyse the effect of the change in diagnostic criteria for acute myocardial infarction (AMI) and the use of troponin as a diagnostic marker on the hospitalization rate and mortality of hospitalized AMI patients from 1994 to 2001. METHODS AND RESULTS: Patients (> or =30 years) admitted...... for their first AMI were identified using the National Patient Registry in Denmark. We registered when each hospital introduced troponin as a diagnostic marker. The reported hospitalization rate decreased until 1998 and then increased substantially from 1999 to 2001 from 3472 to 4163 per million inhabitants (19.......9%) for men and from 1648 to 2020 per million inhabitants (22.6%) for women. Troponin use was associated with a significant 14% increase in hospitalization rate in this period [rate ratio 1.14, 95% confidence interval (CI) 1.11-1.18]. The effect of troponin was greatest among patients 70 years and older (rate...

  14. Early mortality and complications in hospitalized adult Californians with acute myeloid leukaemia.

    Science.gov (United States)

    Ho, Gwendolyn; Jonas, Brian A; Li, Qian; Brunson, Ann; Wun, Ted; Keegan, Theresa H M

    2017-06-01

    Few studies have evaluated the impact of complications, sociodemographic and clinical factors on early mortality (death ≤60 days from diagnosis) in acute myeloid leukaemia (AML) patients. Using data from the California Cancer Registry linked to hospital discharge records from 1999 to 2012, we identified patients aged ≥15 years with AML who received inpatient treatment (N = 6359). Multivariate logistic regression analyses were used to assess the association of complications with early mortality, adjusting for sociodemographic factors, comorbidities and hospital type. Early mortality decreased over time (25·3%, 1999-2000; 16·8%, 2011-2012) across all age groups, but was higher in older patients (6·9%, 15-39, 11·4%, 40-54, 18·6% 55-65, and 35·8%, >65 years). Major bleeding [Odds ratio (OR) 1·5, 95% confidence interval (CI) 1·3-1·9], liver failure (OR 1·9, 95% CI 1·1-3·1), renal failure (OR 2·4, 95% CI 2·0-2·9), respiratory failure (OR 7·6, 95% CI 6·2-9·3) and cardiac arrest (OR 15·8, 95% CI 8·7-28·6) were associated with early mortality. Higher early mortality was also associated with single marital status, low neighbourhood socioeconomic status, lack of health insurance and comorbidities. Treatment at National Cancer Institute-designated cancer centres was associated with lower early mortality (OR 0·5, 95% CI 0·4-0·6). In conclusion, organ dysfunction, hospital type and sociodemographic factors impact early mortality. Further studies should investigate how differences in healthcare delivery affect early mortality. © 2017 John Wiley & Sons Ltd.

  15. Pathway from Delirium to Death: Potential In-Hospital Mediators of Excess Mortality.

    Science.gov (United States)

    Dharmarajan, Kumar; Swami, Sunil; Gou, Ray Y; Jones, Richard N; Inouye, Sharon K

    2017-05-01

    (1) To determine the relationship of incident delirium during hospitalization with 90-day mortality; (2) to identify potential in-hospital mediators through which delirium increases 90-day mortality. Analysis of data from Project Recovery, a controlled clinical trial of a delirium prevention intervention from 1995 to 1998 with follow-up through 2000. Large academic hospital. Patients ≥70 years old without delirium at hospital admission who were at intermediate-to-high risk of developing delirium and received usual care only. (1) Incident delirium; (2) potential mediators of delirium on death including use of restraining devices (physical restraints, urinary catheters), development of hospital acquired conditions (HACs) (falls, pressure ulcers), and exposure to other noxious insults (sleep deprivation, acute malnutrition, dehydration, aspiration pneumonia); (3) death within 90 days of admission. Among 469 patients, 70 (15%) developed incident delirium. These patients were more likely to experience restraining devices (37% vs 16%, P delirium was 4.2 (95% CI = 2.8-6.3) in bivariable analyses, increased in a graded manner with additional exposures to restraining devices, HACs, and other noxious insults, and declined by 10.9% after addition of these potential mediator categories, providing evidence of mediation. Restraining devices, HACs, and additional noxious insults were more frequent among patients with delirium, increased mortality in a graded manner, and were responsible for a significant percentage of the association of delirium with death. Additional efforts to prevent potential downstream mediators through which delirium increases mortality may help to improve outcomes among hospitalized older adults. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  16. The prediction of in-hospital mortality by mid-upper arm circumference

    DEFF Research Database (Denmark)

    Opio, Martin Otyek; Namujwiga, Teopista; Nakitende, Imaculate

    2018-01-01

    There are few reports of the association of nutritional status with in-hospital mortality of acutely ill medical patients in sub-Saharan Africa. This is a prospective observational study comparing the predictive value of mid-upper arm circumference (MUAC) of 899 acutely ill medical patients...... patients in a resource-poor hospital in sub-Saharan Africa....... admitted to a resource-poor sub-Saharan hospital with mental alertness, mobility and vital signs. Mid-upper arm circumference ranged from 15 cm to 42 cm, and 12 (24%) of the 50 patients with a MUAC less than 20 cm died (OR 4.84, 95% CI 2.23-10.37). Of the 237 patients with a MUAC more than 28 cm only six...

  17. Decreased mortality associated with prompt Gram staining of blood cultures.

    Science.gov (United States)

    Barenfanger, Joan; Graham, Donald R; Kolluri, Lavanya; Sangwan, Gaurav; Lawhorn, Jerry; Drake, Cheryl A; Verhulst, Steven J; Peterson, Ryan; Moja, Lauren B; Ertmoed, Matthew M; Moja, Ashley B; Shevlin, Douglas W; Vautrain, Robert; Callahan, Charles D

    2008-12-01

    Gram stains of positive blood cultures are the most important factor influencing appropriate therapy. The sooner appropriate therapy is initiated, the better. Therefore, it is reasonable to expect that the sooner Gram stains are performed, the better. To determine the value of timely Gram stains and whether improvement in Gram stain turnaround time (TAT) is feasible, we compared data for matched pairs of patients with cultures processed promptly ( or =1 hour TAT) and then monitored TAT by control charting.In 99 matched pairs, average difference in time to detection of positive blood cultures within a pair of patients was less than 0.1 hour. For the less than 1 hour TAT group, the average TAT and crude mortality were 0.1 hour and 10.1%, respectively; for the 1 hour or longer TAT group, they were 3.3 hours and 19.2%, respectively (P Gram stains.

  18. Using In-Hospital Mortality as an Indicator of Quality Care and Hospital Performance

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    Badia BISBIS

    2016-06-01

    Full Text Available The in-hospital mortality (MIH is used as a performance indicator and quality healthcare in hospital. However, the majority of deaths resulted from an inevitable disease process (severity of cases and / or co-morbidity, and not medical errors or changes in the quality of care. This work aims to make a distribution of deaths in the Regional Hospital of Eastern, Al Farabi hospital and to highlight that more studies on the MIH are required consistently with detailed clinical data at the admission. The MIH showed its limitation as a health care  indicator. The overall rate of in-hospital deaths within the Al Farabi hospital has averaged 2.4%, with 8.4% in the emergency unit, 28% in intensive care unit, 22% Neonatology unit, 1.6% in pediatric unit. The MIH may depend, firstly, on the condition of patients before hospitalization and secondly, on the conditions of their transfer from one institution to another that supports them as a last resort. Al Farabi hospital supports patients transferred from the provinces of the eastern region. Thus, 6% of patients who died in 2014 come from Berkane, 2% from  Nador, 2% from Bouarfa, 4% from  Taourirt and 2% from Jerrada. One might question about  the procedures and the conditions of such transfers. In conclusion, the overall MIH measured from routine data do not allow proper comparison between hospitals or the assessment of the quality of care and patient safety in the hospital. To do so, we should ideally have detailed clinical data on admission (e.g. type of admission, age of patient, sex, comorbidity, .... The MIH is however an important indicator to consider as a tool to detect potential  problems related to admission procedures and to suspect an area of "non-quality" in healthcare . The MIH is interesting for the patient and for the hospital because it serves the improvement of quality healthcare.

  19. The New York risk score for in-hospital and 30-day mortality for coronary artery bypass graft surgery.

    Science.gov (United States)

    Hannan, Edward L; Farrell, Louise Szypulski; Wechsler, Andrew; Jordan, Desmond; Lahey, Stephen J; Culliford, Alfred T; Gold, Jeffrey P; Higgins, Robert S D; Smith, Craig R

    2013-01-01

    Simplified risk scores for coronary artery bypass graft surgery are frequently in lieu of more complicated statistical models and are valuable for informed consent and choice of intervention. Previous risk scores have been based on in-hospital mortality, but a substantial number of patients die within 30 days of the procedure. These deaths should also be accounted for, so we have developed a risk score based on in-hospital and 30-day mortality. New York's Cardiac Surgery Reporting System was used to develop an in-hospital and 30-day logistic regression model for patients undergoing coronary artery bypass graft surgery in 2009, and this model was converted into a simple linear risk score that provides estimated in-hospital and 30-day mortality rates for different values of the score. The accuracy of the risk score in predicting mortality was tested. This score was also validated by applying it to 2008 New York coronary artery bypass graft data. Subsequent analyses evaluated the ability of the risk score to predict complications and length of stay. The overall in-hospital and 30-day mortality rate for the 10,148 patients in the study was 1.79%. There are seven risk factors comprising the score, with risk factor scores ranging from 1 to 5, and the highest possible total score is 23. The score accurately predicted mortality in 2009 as well as in 2008, and was strongly correlated with complications and length of stay. The risk score is a simple way of estimating short-term mortality that accurately predicts mortality in the year the model was developed as well as in the previous year. Perioperative complications and length of stay are also well predicted by the risk score. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Ways to Reduce In-Hospital Mortality in Patients with Cardiogenic Shock in Acute Coronary Syndrome

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    G. V. Artamonova

    2013-01-01

    Full Text Available Objective: to analyze a medical care system for acute coronary syndrome (ACS in a large city in terms of in-hospital cardiogenic shock mortality risk management. Materials and methods. The health care facility management system for a risk for cardiogenic shock (CS and its poor outcome (death was a methodological basis of this study. The information from case histories of ACS patients consecutively admitted to the Kemerovo Cardiology Dispensary (Kemerovo, Russia in the period 2006 to 2011 was used to develop an electronic database. Sampling included 19281 patients with ACS, 6537 with myocardial infarction (MI, 493 with CS. Results and discussion. The medical care system for patients with ACS encompasses an emergency team (a prehospital level, a specialized cardiac hospital (an in-hospital level with a multistage therapeutic and diagnostic process in relation the severity of a patient’s status. The management is based on the principle of continuity of care, by applying the well-defined activity algorithms through valid information exchange and risk stratification for poor outcomes of ACS. An antishock team working just in the admission unit of a hospital was set up to treat high CS risk patients. A systems approach allowed the strategy of early specialized medical care to be developed with a priority of primary percutaneous coronary interventions (PCI as reperfusion therapy in patients with ST-elevation MI. In 2006-2011, every three patients with suspected ACS had verified MI that was com_ plicated by CS in 7.5%. In the CS group, the in-hospital mortality rates totaled 88.0% of cases; that after primary Адрес для корреспонденции (Correspondence to: PCI was 62.2%. In the examined period, the introduction of innovation clinical and organizational approaches provided a reduction in this indicator by 17.6 and 37.5%, respectively. Conclusion. The efficiency of risk management for CS and its poor outcomes in patients with ACS is

  1. The Change of Perinatal Mortality Over Three Decades in a Reference Centre in the Aegean Region: Neonatal Mortality has decreased but Foetal Mortality Remains Unchanged

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    Nilgün Kültürsay

    2017-12-01

    Full Text Available Background: Perinatal, foetal and neonatal mortality statistics are important to show the development of a health care system in a country. However, in our country there are very few national and regional data about the changing pattern of perinatal neonatal mortality along with the development of new technologies in this area. Aims: Evaluation of the changes in mortality rates and the causes of perinatal and neonatal deaths within years in a perinatal reference centre which serves a high-risk population. Study Design: Cross-sectional retrospective study. Methods: The perinatal, neonatal and foetal mortality rates in the years 1979-1980 (1st time point and 1988-1989 (2nd time point were compared with the year 2008 (3rd time point. The causes of mortality were assessed by Wigglesworth classification and death reports. The neonatal mortality in the neonatal intensive care unit was also calculated. Results: Foetal mortality rates were 44/1000, 31.4/1000 and 41.75/1000 births, perinatal mortality rates were 35.6/1000, 18.8/1000 and 9/1000 births, and neonatal mortality rates were 35.6/1000, 18.8/1000 and 9/1000 live births for the three study time points, respectively. The mortality rate in neonatal intensive care unit decreased consistently from 33%, to 22.6% and 10%, respectively, together with decreasing neonatal mortality rates. The causes of perinatal deaths were foetal death 85%, immaturity 4%, and lethal congenital malformations 8% according to Wigglesworth classification in 2008, showing the high impact of foetal deaths on this high perinatal mortality rate. Infectious causes of neonatal deaths decreased but congenital anomalies increased in the last decades. Conclusion: Although neonatal mortality rate decreased significantly; foetal mortality rate has stayed unchanged since the late eighties. In order to decrease foetal and perinatal mortality rates more efficiently, reducing consanguineous marriages and providing better antenatal care for

  2. Lipid paradox in acute myocardial infarction-the association with 30-day in-hospital mortality.

    Science.gov (United States)

    Cheng, Kai-Hung; Chu, Chih-Sheng; Lin, Tsung-Hsien; Lee, Kun-Tai; Sheu, Sheng-Hsiung; Lai, Wen-Ter

    2015-06-01

    Elevated low-density lipoprotein cholesterol and triglycerides are major risk factors for coronary artery disease. However, fatty acids from triglycerides are a major energy source, low-density lipoprotein cholesterol is critical for cell membrane synthesis, and both are critical for cell survival. This study was designed to clarify the relationship between lipid profile, morbidity as assessed by Killip classification, and 30-day mortality in patients with acute myocardial infarction. A noninterventional observational study. Coronary care unit in a university hospital. Seven hundred twenty-four patients with acute myocardial infarction in the coronary care program of the Bureau of Health Promotion were analyzed. None. Low-density lipoprotein cholesterol and triglyceride levels were significantly lower in high-Killip (III+IV) patients compared with low-Killip (I+II) patients and in those who died compared with those who survived beyond 30 days (both pvalues for predicting 30-day mortality and were associated with hazard ratios of 1.65 (95% CI, 1.18-2.30) and 5.05 (95% CI, 1.75-14.54), and the actual mortality rates were 23% in low low-density lipoprotein, 6% in high low-density lipoprotein, 14% in low triglycerides, and 3% in high triglycerides groups, respectively. To test the synergistic effect, high-Killip patients with triglycerides less than 62.5 mg/dL and low-density lipoprotein cholesterol less than 110 mg/dL had a 10.9-fold higher adjusted risk of mortality than low-Killip patients with triglycerides greater than or equal to 62.5 mg/dL and low-density lipoprotein cholesterol greater than or equal to 110 mg/dL (pparadox also improved acute myocardial infarction short-term outcomes prediction on original Killip and thrombolytic in myocardial infarction scores. Low low-density lipoprotein cholesterol, low triglycerides, and high Killip severity were associated with significantly higher 30-day in-hospital mortality in patients presenting with acute myocardial

  3. Patterns of injury, outcomes, and predictors of in-hospital and 1-year mortality in nonagenarian and centenarian trauma patients.

    Science.gov (United States)

    Hwabejire, John O; Kaafarani, Haytham M A; Lee, Jarone; Yeh, Daniel D; Fagenholz, Peter; King, David R; de Moya, Marc A; Velmahos, George C

    2014-10-01

    With the dramatic growth in the very old population and their concomitant heightened exposure to traumatic injury, the trauma burden among this patient population is estimated to be exponentially increasing. To determine the clinical outcomes and predictors of in-hospital and 1-year mortality in nonagenarian and centenarian trauma patients (NCTPs). All patients 90 years or older admitted to a level 1 academic trauma center between January 1, 2006, and December 31, 2010, with a primary diagnosis of trauma were included. Standard trauma registry data variables were supplemented by systematic medical record review. Cumulative mortality rates at 1, 3, 6, and 12 months after discharge were investigated using the Social Security Death Index. Univariate and multivariable analyses were performed to identify the predictors of in-hospital and 1-year postdischarge cumulative mortalities. Length of hospital stay, in-hospital mortality, and cumulative mortalities at 1, 3, 6, and 12 months after discharge. Four hundred seventy-four NCTPs were included; 71.7% were female, and a fall was the predominant mechanism of injury (96.4%). The mean patient age was 93 years, the mean Injury Severity Score was 12, and the mean number of comorbidities per patient was 4.4. The in-hospital mortality was 9.5% but cumulatively escalated at 1, 3, 6, and 12 months after discharge to 18.5%, 26.4%, 31.3%, and 40.5%, respectively. Independent predictors of in-hospital mortality were the Injury Severity Score (odds ratio [OR], 1.09; 95% CI, 1.02-1.16; P = .01), mechanical ventilation (OR, 6.23; 95% CI, 1.42-27.27; P = .02), and cervical spine injury (OR, 4.37; 95% CI, 1.41-13.50; P = .01). Independent predictors of cumulative 1-year mortality were head injury (OR, 2.65; 95% CI, 1.24-5.67; P = .03) and length of hospital stay (OR, 1.06; 95% CI, 1.02-1.11; P = .005). Cumulative 1-year mortality in NCTPs with a head injury was 51.1% and increased to 73.2% if the Injury Severity Score was 25 or

  4. Biochemical Markers as Predictors of In-Hospital Mortality in Patients with Severe Trauma: A Retrospective Cohort Study

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    Ha Nee Jang

    2017-08-01

    Full Text Available Background Initial evaluation of injury severity in trauma patients is an important and challenging task. We aimed to assess whether easily measurable biochemical parameters (hemoglobin, pH, and prothrombin time/international normalized ratio [PT/INR] can predict in-hospital mortality in patients with severe trauma. Methods This retrospective study involved review of the medical records of 315 patients with severe trauma and an injury severity score >15 who were managed at Gyeongsang National University Hospital between January 2005 and December 2015. We extracted the following data: in-hospital mortality, injury severity score, and initial hemoglobin level, pH, and PT/INR. The predictive values of these variables were compared using receiver operation characteristic curves. Results Of the 315 patients, 72 (22.9% died. The in-hospital mortality rates of patients with hemoglobin levels <8.4 g/dl and ≥8.4 g/dl were 49.8% and 9.9%, respectively (P < 0.001. At a cutoff hemoglobin level of 8.4 g/dl, the sensitivity and specificity values for mortality were 81.9% and 86.4%, respectively. At a pH cutoff of 7.25, the sensitivity and specificity values for mortality were 66.7% and 77.8%, respectively; 66.7% of patients with a pH <7.25 died versus 22.2% with a pH ≥7.25 (P < 0.001. The in-hospital mortality rates for patients with PT/INR values ≥1.4 and <1.4 were 37.5% and 16%, respectively (P < 0.001; sensitivity, 37.5%; specificity, 84%. Conclusions Using the suggested cutoff values, hemoglobin level, pH, and PT/INR can simply and easily be used to predict in-hospital mortality in patients with severe trauma.

  5. Predictors of in-hospital mortality after mitral valve surgery for post-myocardial infarction papillary muscle rupture.

    Science.gov (United States)

    Bouma, Wobbe; Wijdh-den Hamer, Inez J; Koene, Bart M; Kuijpers, Michiel; Natour, Ehsan; Erasmus, Michiel E; van der Horst, Iwan C C; Gorman, Joseph H; Gorman, Robert C; Mariani, Massimo A

    2014-10-18

    Papillary muscle rupture (PMR) is a rare, but often life-threatening mechanical complication of myocardial infarction (MI). Immediate surgical intervention is considered the optimal and most rational treatment for acute PMR, but carries high risks. At this point it is not entirely clear which patients are at highest risk. In this study we sought to determine in-hospital mortality and its predictors for patients who underwent mitral valve surgery for post-MI PMR. Between January 1990 and December 2012, 48 consecutive patients (mean age 64.9 ± 10.8 years) underwent mitral valve repair (n = 10) or replacement (n = 38) for post-MI PMR. Clinical data, echocardiographic data, catheterization data, and surgical reports were reviewed. Univariate and multivariate logistic regression analyses were performed to identify predictors of in-hospital mortality. Intraoperative mortality was 4.2% and in-hospital mortality was 25.0%. Univariate and multivariate logistic regression analyses revealed the logistic EuroSCORE and EuroSCORE II as independent predictors of in-hospital mortality. Receiver operating characteristics curves showed an optimal cutoff value of 40% for the logistic EuroSCORE (area under the curve 0.85, 95% CI 0.71-1.00, P optimal cutoff ≥ 40%), EuroSCORE II (optimal cutoff ≥ 25%), complete PMR, and intraoperative IABP requirement are strong independent predictors of in-hospital mortality in patients undergoing mitral valve surgery for post-MI PMR. These predictors may aid in surgical decision making and they may help improve the quality of informed consent.

  6. In-hospital mortality risk factors in community acquired pneumonia: evaluation of immunocompetent adult patients without comorbidities

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    Miguel Hernan Vicco

    2015-04-01

    Full Text Available Summary Objective: several scores were developed in order to improve the determination of community acquired pneumonia (CAP severity and its management, mainly CURB-65 and SACP score. However, none of them were evaluated for risk assessment of in-hospital mortality, particularly in individuals who were non-immunosuppressed and/or without any comorbidity. In this regard, the present study was carried out. Methods: we performed a cross-sectional study in 272 immunocompetent patients without comorbidities and with a diagnosis of CAP. Performance of CURB- 65 and SCAP scores in predicting in-hospital mortality was evaluated. Also, variables related to death were assessed. Furthermore, in order to design a model of in-hospital mortality prediction, sampled individuals were randomly divided in two groups. The association of the variables with mortality was weighed and, by multiple binary regression, a model was constructed in one of the subgroups. Then, it was validated in the other subgroup. Results: both scores yielded a fair strength of agreement, and CURB-65 showed a better performance in predicting in-hospital mortality. In our casuistry, age, white blood cell counts, serum urea and diastolic blood pressure were related to death. The model constructed with these variables showed a good performance in predicting in-hospital mortality; moreover, only one patient with fatal outcome was not correctly classified in the group where the model was constructed and in the group where it was validated. Conclusion: our findings suggest that a simple model that uses only 4 variables, which are easily accessible and interpretable, can identify seriously ill patients with CAP

  7. A European benchmarking system to evaluate in-hospital mortality rates in acute coronary syndrome: the EURHOBOP project.

    Science.gov (United States)

    Dégano, Irene R; Subirana, Isaac; Torre, Marina; Grau, María; Vila, Joan; Fusco, Danilo; Kirchberger, Inge; Ferrières, Jean; Malmivaara, Antti; Azevedo, Ana; Meisinger, Christa; Bongard, Vanina; Farmakis, Dimitros; Davoli, Marina; Häkkinen, Unto; Araújo, Carla; Lekakis, John; Elosua, Roberto; Marrugat, Jaume

    2015-03-01

    Hospital performance models in acute myocardial infarction (AMI) are useful to assess patient management. While models are available for individual countries, mainly US, cross-European performance models are lacking. Thus, we aimed to develop a system to benchmark European hospitals in AMI and percutaneous coronary intervention (PCI), based on predicted in-hospital mortality. We used the EURopean HOspital Benchmarking by Outcomes in ACS Processes (EURHOBOP) cohort to develop the models, which included 11,631 AMI patients and 8276 acute coronary syndrome (ACS) patients who underwent PCI. Models were validated with a cohort of 55,955 European ACS patients. Multilevel logistic regression was used to predict in-hospital mortality in European hospitals for AMI and PCI. Administrative and clinical models were constructed with patient- and hospital-level covariates, as well as hospital- and country-based random effects. Internal cross-validation and external validation showed good discrimination at the patient level and good calibration at the hospital level, based on the C-index (0.736-0.819) and the concordance correlation coefficient (55.4%-80.3%). Mortality ratios (MRs) showed excellent concordance between administrative and clinical models (97.5% for AMI and 91.6% for PCI). Exclusion of transfers and hospital stays ≤1day did not affect in-hospital mortality prediction in sensitivity analyses, as shown by MR concordance (80.9%-85.4%). Models were used to develop a benchmarking system to compare in-hospital mortality rates of European hospitals with similar characteristics. The developed system, based on the EURHOBOP models, is a simple and reliable tool to compare in-hospital mortality rates between European hospitals in AMI and PCI. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. In-Hospital Mortality among Rural Medicare Patients with Acute Myocardial Infarction: The Influence of Demographics, Transfer, and Health Factors

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    Muus, Kyle J.; Knudson, Alana D.; Klug, Marilyn G.; Wynne, Joshua

    2011-01-01

    Context/Purpose: Most rural hospitals can provide medical care to acute myocardial infarction (AMI) patients, but a need for advanced cardiac care requires timely transfer to a tertiary hospital. There is little information on AMI in-hospital mortality predictors among rural transfer patients. Methods: Cross-sectional retrospective analyses on…

  9. The New York State risk score for predicting in-hospital/30-day mortality following percutaneous coronary intervention.

    Science.gov (United States)

    Hannan, Edward L; Farrell, Louise Szypulski; Walford, Gary; Jacobs, Alice K; Berger, Peter B; Holmes, David R; Stamato, Nicholas J; Sharma, Samin; King, Spencer B

    2013-06-01

    This study sought to develop a percutaneous coronary intervention (PCI) risk score for in-hospital/30-day mortality. Risk scores are simplified linear scores that provide clinicians with quick estimates of patients' short-term mortality rates for informed consent and to determine the appropriate intervention. Earlier PCI risk scores were based on in-hospital mortality. However, for PCI, a substantial percentage of patients die within 30 days of the procedure after discharge. New York's Percutaneous Coronary Interventions Reporting System was used to develop an in-hospital/30-day logistic regression model for patients undergoing PCI in 2010, and this model was converted into a simple linear risk score that estimates mortality rates. The score was validated by applying it to 2009 New York PCI data. Subsequent analyses evaluated the ability of the score to predict complications and length of stay. A total of 54,223 patients were used to develop the risk score. There are 11 risk factors that make up the score, with risk factor scores ranging from 1 to 9, and the highest total score is 34. The score was validated based on patients undergoing PCI in the previous year, and accurately predicted mortality for all patients as well as patients who recently suffered a myocardial infarction (MI). The PCI risk score developed here enables clinicians to estimate in-hospital/30-day mortality very quickly and quite accurately. It accurately predicts mortality for patients undergoing PCI in the previous year and for MI patients, and is also moderately related to perioperative complications and length of stay. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  10. Effectiveness of the clinical pharmacist in reducing mortality in hospitalized cardiac patients: a propensity score-matched analysis

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    Zhai XB

    2016-02-01

    Full Text Available Xiao-bo Zhai,1 Zhi-chun Gu,2 Xiao-yan Liu2 1Department of Pharmacy, Shanghai East Hospital, Affiliated to Tongji University School of Medicine, 2Department of Pharmacy, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China Background: Pharmacist-led medication review services have been assessed in the meta-analyses in hospital. Of the 135 relevant articles located, 21 studies met the inclusion criteria; however, there was no statistically significant difference found between pharmacists’ interventions and usual care for mortality (odds ratio 1.50, 95% confidence interval 0.65, 3.46, P=0.34. These analyses may not have found a statistically significant effect because they did not adequately control the wide variation in the delivery of care and patient selection parameters. Additionally, the investigators did not conduct research on the cases of death specifically and did not identify all possible drug-related problems (DRPs that could cause or contribute to mortality and then convince physicians to correct. So there will be a condition to use a more precise approach to evaluate the effect of clinical pharmacist interventions on the mortality rates of hospitalized cardiac patients. Objective: To evaluate the impact of the clinical pharmacist as a direct patient-care team member on the mortality of all patients admitted to the cardiology unit. Methods: A comparative study was conducted in a cardiology unit of a university-affiliated hospital. The clinical pharmacists did not perform any intervention associated with improper use of medications during Phase I (preintervention and consulted with the physicians to address the DRPs during Phase II (postintervention. The two phases were compared to evaluate the outcome, and propensity score (PS matching was applied to enhance the comparability. The primary endpoint of the study was the composite of all-cause mortality during Phase I and Phase II

  11. A modified Elixhauser score for predicting in-hospital mortality in internal medicine admissions.

    Science.gov (United States)

    Fabbian, Fabio; De Giorgi, Alfredo; Maietti, Elisa; Gallerani, Massimo; Pala, Marco; Cappadona, Rosaria; Manfredini, Roberto; Fedeli, Ugo

    2017-05-01

    In-hospital mortality (IHM) is an indicator of the quality of care provided. The two most widely used scores for predicting IHM by International Classification of Diseases (ICD) codes are the Elixhauser (EI) and the Charlson Comorbidity indexes. Our aim was to obtain new measures based on internal medicine ICD codes for the original EI, to detect risk for IHM. This single-center retrospective study included hospital admissions for any cause in the department of internal medicine between January 1, 2000, and December 31, 2013, recorded in the hospital database. The EI was calculated for evaluation of comorbidity, then we added age, gender and diagnosis of ischemic heart disease. IHM was our outcome. Only predictors positively associated with IHM were taken into consideration and the Sullivan's method was applied in order to modify the parameter estimates of the regression model into an index. We analyzed 75,586 admissions (53.4% females) and mean age was 72.7±16.3years. IHM was 7.9% and mean score was 12.1±7.6. The points assigned to each condition ranged from 0 to 16, and the possible range of the score varied between 0 and 89. In our population the score ranged from 0 to 54, and it was higher in the deceased group. Receiver operating characteristic curve of the new score was 0.721 (95% CI 0.714-0.727, pInternal Medicine. Published by Elsevier B.V. All rights reserved.

  12. Mortality after acute trauma: Progressive decreasing rather than a trimodal distribution

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    Ionut Negoi

    2015-08-01

    Conclusions: The trimodal time distribution of mortality remains a milestone in trauma education and research. Nevertheless, it must be questioned in the modern and very efficient trauma systems, but still very actual for developing trauma care systems. In conclusion, the pattern of mortality due to major trauma seems decreasing continuously with time rather than presenting high peaks of frequency at some moments.

  13. Diagnostic performance of initial serum albumin level for predicting in-hospital mortality among aspiration pneumonia patients.

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    Kim, Hyosun; Jo, Sion; Lee, Jae Baek; Jin, Youngho; Jeong, Taeoh; Yoon, Jaechol; Lee, Jeong Moon; Park, Boyoung

    2018-01-01

    The predictive value of serum albumin in adult aspiration pneumonia patients remains unknown. Using data collected during a 3-year retrospective cohort of hospitalized adult patients with aspiration pneumonia, we evaluated the predictive value of serum albumin level at ED presentation for in-hospital mortality. 248 Patients were enrolled; of these, 51 cases died (20.6%). The mean serum albumin level was 3.4±0.7g/dL and serum albumin levels were significantly lower in the non-survivor group than in the survivor group (3.0±0.6g/dL vs. 3.5±0.6g/dL). In the multivariable logistic regression model, albumin was associated with in-hospital mortality significantly (adjusted odds ratio 0.30, 95% confidential interval (CI) 0.16-0.57). The area under the receiver operating characteristics (AUROC) for in-hospital survival was 0.72 (95% CI 0.64-0.80). The Youden index was 3.2g/dL and corresponding sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were 68.6%, 66.5%, 34.7%, 89.1%, 2.05 and 0.47, respectively. High sensitivity (98.0%) was shown at albumin level of 4.0g/dL and high specificity (94.9%) was shown at level of 2.5g/dL. Initial serum albumin levels were independently associated with in-hospital mortality among adult patients hospitalized with aspiration pneumonia and demonstrated fair discriminative performance in the prediction of in-hospital mortality. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Index to Predict In-hospital Mortality in Older Adults after Non-traumatic Emergency Department Intubations

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    Kei Ouchi

    2017-04-01

    Full Text Available Introduction: Our goal was to develop and validate an index to predict in-hospital mortality in older adults after non-traumatic emergency department (ED intubations. Methods: We used Vizient administrative data from hospitalizations of 22,374 adults ≥75 years who underwent non-traumatic ED intubation from 2008–2015 at nearly 300 U.S. hospitals to develop and validate an index to predict in-hospital mortality. We randomly selected one half of participants for the development cohort and one half for the validation cohort. Considering 25 potential predictors, we developed a multivariable logistic regression model using least absolute shrinkage and selection operator method to determine factors associated with in-hospital mortality. We calculated risk scores using points derived from the final model’s beta coefficients. To evaluate calibration and discrimination of the final model, we used Hosmer-Lemeshow chi-square test and receiver-operating characteristic analysis and compared mortality by risk groups in the development and validation cohorts. Results: Death during the index hospitalization occurred in 40% of cases. The final model included six variables: history of myocardial infarction, history of cerebrovascular disease, history of metastatic cancer, age, admission diagnosis of sepsis, and admission diagnosis of stroke/ intracranial hemorrhage. Those with low-risk scores (10 had 58% risk of in-hospital mortality. The Hosmer-Lemeshow chi-square of the model was 6.47 (p=0.09, and the c-statistic was 0.62 in the validation cohort. Conclusion: The model may be useful in identifying older adults at high risk of death after ED intubation.

  15. Demographic epidemiology of unstable pelvic fracture in the United States from 2000 to 2009: trends and in-hospital mortality.

    Science.gov (United States)

    Yoshihara, Hiroyuki; Yoneoka, Daisuke

    2014-02-01

    Unstable pelvic fracture is predominantly caused by high-energy blunt trauma and is associated with a high risk of mortality. The epidemiology in the United States is largely unknown. The purpose of this study was to examine the epidemiology of unstable pelvic fracture based on patient and hospital demographics in the United States during the last decade. The Nationwide Inpatient Sample was used to identify patients who were hospitalized with unstable pelvic fracture from 2000 to 2009, using the International Classification of Diseases--9th Rev.--Clinical Modification (ICD-9-CM) codes. The primary outcome parameter consisted of analyzing the temporal trends of in-hospital admissions for unstable pelvic fracture and the associated in-hospital mortality. The data were stratified by demographic variables, including age, sex, race, and hospital region in the United States. From 2000 to 2009, there were 24,059 patients in total; among these, 1,823 (7.6%) had open fractures, and 22,236 (92.4%) had closed fractures. The population growth-adjusted incidence was stable over time (p = 0.431). The incidence was the lowest in the northeastern region. The in-hospital mortality rate in patients with unstable pelvic fracture was 8.3% (21.3% for open fracture, 7.2% for closed fracture) and remained stable over time (p = 0.089). The in-hospital mortality rate was higher in several subgroups of patients, such as older patients, male patients, African-American patients, and patients in the northeastern region. During the last decade, the incidence of unstable pelvic fracture has remained stable over time in the United States. The in-hospital mortality rate in patients with unstable pelvic fracture was 8.3% and remained stable over time. The rate in patients with an open fracture was approximately three times higher than that in patients with a closed fracture. The incidence was the lowest, but the in-hospital mortality rate was the highest in the northeastern region compared with the

  16. Association of ventricular arrhythmia and in-hospital mortality in stroke patients in Florida: A nonconcurrent prospective study.

    Science.gov (United States)

    Dahlin, Arielle A; Parsons, Chase C; Barengo, Noël C; Ruiz, Juan Gabriel; Ward-Peterson, Melissa; Zevallos, Juan Carlos

    2017-07-01

    Stroke remains one of the leading causes of death in the United States. Current evidence identified electrocardiographic abnormalities and cardiac arrhythmias in 50% of patients with an acute stroke. The purpose of this study was to assess whether the presence of ventricular arrhythmia (VA) in adult patients hospitalized in Florida with acute stroke increased the risk of in-hospital mortality.Secondary data analysis of 215,150 patients with ischemic and hemorrhagic stroke hospitalized in the state of Florida collected by the Florida Agency for Healthcare Administration from 2008 to 2012. The main outcome for this study was in-hospital mortality. The main exposure of this study was defined as the presence of VA. VA included the ICD-9 CM codes: paroxysmal ventricular tachycardia (427.1), ventricular fibrillation (427.41), ventricular flutter (427.42), ventricular fibrillation and flutter (427.4), and other - includes premature ventricular beats, contractions, or systoles (427.69). Differences in demographic and clinical characteristics and hospital outcomes were assessed between patients who developed versus did not develop VA during hospitalization (χ and t tests). Binary logistic regression was used to estimate unadjusted and adjusted odds ratios and 95% confidence intervals (CIs) between VA and in-hospital mortality.VA was associated with an increased risk of in-hospital mortality after adjusting for all covariates (odds ratio [OR]: 1.75; 95% CI: 1.6-1.2). There was an increased in-hospital mortality in women compared to men (OR: 1.1; 95% CI: 1.1-1.14), age greater than 85 years (OR: 3.9, 95% CI: 3.5-4.3), African Americans compared to Whites (OR: 1.1; 95% CI: 1.04-1.2), diagnosis of congestive heart failure (OR: 2.1; 95% CI: 2.0-2.3), and atrial arrhythmias (OR: 2.1, 95% CI: 2.0-2.2). Patients with hemorrhagic stroke had increased odds of in-hospital mortality (OR: 9.0; 95% CI: 8.6-9.4) compared to ischemic stroke.Identifying VAs in stroke patients may help in

  17. [Efficacy of noninvasive ventilation on in-hospital mortality in patients with acute cardiogenic pulmonary edema: a meta-analysis].

    Science.gov (United States)

    Sun, Tongwen; Wan, Youdong; Kan, Quancheng; Yang, Fei; Yao, Haimu; Guan, Fangxia; Zhang, Jinying; Li, Ling

    2014-02-01

    To evaluate the efficacy of noninvasive ventilation on in-hospital mortality in adult patients with acute cardiogenic pulmonary edema (ACPE) . We searched PubMed, Embase, Wanfang, CNKI data to find relevant randomized controlled trials of noninvasive ventilation for ACPE, which were reported from January 1980 to December 2012. Meta-analysis was performed with software of RevMan 5.1. According to inclusive criteria and exclusion criteria, 35 randomized controlled trials with 3 204 patients were enrolled for analyses. Meta-analysis of the trials showed that continuous positive airway pressure (CPAP) reduced in-hospital mortality by 43% (RR = 0.57, 95%CI 0.43-0.75, P management strategies for these patients.

  18. Effects of aspiration pneumonia on the intensive care requirements and in-hospital mortality of hospitalised patients with acute cerebrovascular disease.

    Science.gov (United States)

    Güngen, Adil Can; Aydemir, Yusuf; Güngen, Belma Dogan; Yazar, Esra Ertan; Yağız, Orhan; Aras, Yeşim Güzey; Gümüş, Hatice; Erkorkmaz, Ünal

    2017-08-01

    In this study, we aimed to evaluate the effects of the development of aspiration pneumonia (AP) on the intensive care unit (ICU) requirements and in-hospital mortality of patients hospitalised in the neurology ward due to an acute cerebrovascular accident (CVA). Five hundred and three patients hospitalised in the neurology ward following an acute CVA were retrospectively analysed. The patients were divided into two groups: those with AP (group 1) and those without AP (group 2). Demographic characteristics and physical and radiological findings, including the localisation, lateralisation and aetiology of the infarction, in addition to ICU requirements and mortality, were evaluated. Aspiration pneumonia was detected in 80 (15.9%) patients during the in-hospital stay. Transfer to the ICU for any reason was required in 37.5% of the patients in group 1 and 4.7% of those in group 2 ( p < 0.001). In-hospital mortality occurred in 7.5% and 1.4% of the patients in group 1 and group 2, respectively ( p = 0.006). The incidence of AP was highest in patients with an infarction of the medial cerebral artery (MCA) ( p < 0.001). The AP was associated with older age ( p < 0.001), hypertension ( p = 0.007), echocardiography findings ( p = 0.032) and the modified Rankin Scale (mRS) score ( p < 0.001). Our findings suggest that the requirement rate for transfer to the ICU and the mortality rate appear to be significantly higher in patients with a diagnosis of AP. Precautions should be taken, starting from the first day of hospitalisation, to decrease the incidence of AP in patients with acute CVA, focusing especially on older patients and those with a severe mRS score.

  19. In-hospital mortality and treatment patterns in acute myocardial infarction patients admitted during national cardiology meeting dates.

    Science.gov (United States)

    Mizuno, Seiko; Kunisawa, Susumu; Sasaki, Noriko; Fushimi, Kiyohide; Imanaka, Yuichi

    2016-10-01

    Many hospitals experience a reduction in the number of available physicians on days when national scientific meetings are conducted. This study investigates the relationship between in-hospital mortality in acute myocardial infarction (AMI) patients and admission during national cardiology meeting dates. Using an administrative database, we analyzed patients with AMI admitted to acute care hospitals in Japan from 2011 to 2013. There were 3 major national cardiology meetings held each year. A hierarchical logistic regression model was used to compare in-hospital mortality and treatment patterns between patients admitted on meeting dates and those admitted on identical days during the week before and after the meeting dates. We identified 6,332 eligible patients, with 1,985 patients admitted during 26 meeting days and 4,347 patients admitted during 52 non-meeting days. No significant differences between meeting and non-meeting dates were observed for in-hospital mortality (7.4% vs. 8.5%, respectively; p=0.151, unadjusted odds ratio: 0.861, 95% confidence interval: 0.704-1.054) and the proportion of percutaneous coronary intervention (PCI) performed on the day of admission (75.9% vs. 76.2%, respectively; p=0.824). We also found that some low-staffed hospitals did not treat AMI patients during meeting dates. Little or no "national meeting effect" was observed on in-hospital mortality in AMI patients, and PCI rates were similar for both meeting and non-meeting dates. Our findings also indicated that during meeting dates, AMI patients may have been consolidated to high-performance and sufficiently staffed hospitals. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. Novel risk stratification with time course assessment of in-hospital mortality in patients with acute heart failure.

    Directory of Open Access Journals (Sweden)

    Takeshi Yagyu

    Full Text Available Patients with acute heart failure (AHF show various clinical courses during hospitalization. We aimed to identify time course predictors of in-hospital mortality and to establish a sequentially assessable risk model.We enrolled 1,035 consecutive AHF patients into derivation (n = 597 and validation (n = 438 cohorts. For risk assessments at admission, we utilized Get With the Guidelines-Heart Failure (GWTG-HF risk scores. We examined significant predictors of in-hospital mortality from 11 variables obtained during hospitalization and developed a risk stratification model using multiple logistic regression analysis. Across both cohorts, 86 patients (8.3% died during hospitalization. Using backward stepwise selection, we identified five time-course predictors: catecholamine administration, minimum platelet concentration, maximum blood urea nitrogen, total bilirubin, and C-reactive protein levels; and established a time course risk score that could sequentially assess a patient's risk status. The addition of a time course risk score improved the discriminative ability of the GWTG-HF risk score (c-statistics in derivation and validation cohorts: 0.776 to 0.888 [p = 0.002] and 0.806 to 0.902 [p<0.001], respectively. A calibration plot revealed a good relationship between observed and predicted in-hospital mortalities in both cohorts (Hosmer-Lemeshow chi-square statistics: 6.049 [p = 0.642] and 5.993 [p = 0.648], respectively. In each group of initial low-intermediate risk (GWTG-HF risk score <47 and initial high risk (GWTG-HF risk score ≥47, in-hospital mortality was about 6- to 9-fold higher in the high time course risk score group than in the low-intermediate time course risk score group (initial low-intermediate risk group: 20.3% versus 2.2% [p<0.001], initial high risk group: 57.6% versus 8.5% [p<0.001].A time course assessment related to in-hospital mortality during the hospitalization of AHF patients can clearly categorize a patient's on

  1. Reduced in-hospital mortality for heart failure with clinical pathways: the results of a cluster randomised controlled trial.

    Science.gov (United States)

    Panella, M; Marchisio, S; Demarchi, M L; Manzoli, L; Di Stanislao, F

    2009-10-01

    Hospital treatment of heart failure (HF) frequently does not follow published guidelines, potentially contributing to HF high morbidity, mortality and economic cost. The Experimental Prospective Study on the Effectiveness and Efficiency of the Implementation of Clinical Pathways was undertaken to determine how clinical pathways (CP) for hospital treatment of HF affected care variability, guidelines adherence, in-hospital mortality and outcomes at discharge. Methods/ Two-arm, cluster-randomised trial. Fourteen community hospitals were randomised either to the experimental arm (CP: appropriate therapeutic guidelines use, new organisation and procedures, patient education) or to the control arm (usual care). The main outcome was in-hospital mortality; secondary outcomes were length and appropriateness of the stay, rate of unscheduled readmissions, customer satisfaction, usage of diagnostic and therapeutic procedures during hospital stay and quality indicators at discharge. All outcomes were measured using validated instruments available in literature. In-hospital mortality was 5.6% in the experimental arm (n = 12); 15.4% in controls (n = 33, p = 0.001). In CP and usual care groups, the mean rates of unscheduled readmissions were 7.9% and 13.9%, respectively. Adjusting for age, smoking, New York Heart Association score, hypertension and source of referral, patients in the CP group, as compared to controls, had a significantly lower risk of in-hospital death (OR 0.18; 95% CI 0.07 to 0.46) and unscheduled readmissions (OR 0.42; 95% CI 0.20 to 0.87). No differences were found between CP and control with respect to the appropriateness of the stay, costs and patient's satisfaction. Except for electrocardiography, all recommended diagnostic procedures were used more in the CP group. Similarly, pharmaceuticals use was significantly greater in CP, with the exception of diuretics and anti-platelets agents. The introduction of a specifically tailored CP for the hospital

  2. In-hospital mortality after pre-treatment with antiplatelet agents or oral anticoagulants and hematoma evacuation of intracerebral hematomas.

    Science.gov (United States)

    Stein, Marco; Misselwitz, Björn; Hamann, Gerhard F; Kolodziej, Malgorzata; Reinges, Marcus H T; Uhl, Eberhard

    2016-04-01

    Pre-treatment with antiplatelet agents is described to be a risk factor for mortality after spontaneous intracerebral hemorrhage (ICH). However, the impact of antithrombotic agents on mortality in patients who undergo hematoma evacuation compared to conservatively treated patients with ICH remains controversial. This analysis is based on a prospective registry for quality assurance in stroke care in the State of Hesse, Germany. Patients' data were collected between January 2008 and December 2012. Only patients with the diagnosis of spontaneous ICH were included (International Classification of Diseases 10th Revision codes I61.0-I61.9). Predictors of in-hospital mortality were determined by univariate analysis. Predictors with Phematoma evacuation (odds ratio [OR]: 2.5; 95% confidence interval [CI]: 1.24-4.97; P=0.010) compared to patients without antiplatelet pre-treatment treatment (OR: 0.9; 95% CI: 0.79-1.09; P=0.376). In conclusion a higher rate of in-hospital mortality after pre-treatment with antiplatelet agents in combination with hematoma evacuation after spontaneous ICH was observed in the presented cohort. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Ascites Neutrophil Gelatinase-Associated Lipocalin Identifies Spontaneous Bacterial Peritonitis and Predicts Mortality in Hospitalized Patients with Cirrhosis.

    Science.gov (United States)

    Cullaro, Giuseppe; Kim, Grace; Pereira, Marcus R; Brown, Robert S; Verna, Elizabeth C

    2017-12-01

    Neutrophil gelatinase-associated lipocalin (NGAL) is a marker of both tissue injury and infection. Urine NGAL levels strongly predict acute kidney injury and mortality in patients with cirrhosis, but ascites NGAL is not well characterized. We hypothesized that ascites NGAL level is a marker of spontaneous bacterial peritonitis (SBP) and mortality risk in patients with cirrhosis. Hospitalized patients with cirrhosis and ascites undergoing diagnostic paracentesis were prospectively enrolled and followed until death or discharge. Patients with secondary peritonitis, prior transplantation, or active colitis were excluded. NGAL was measured in the ascites and serum. Ascites NGAL level was evaluated as a marker of SBP (defined as ascites absolute neutrophil count > 250 cells/mm 3 ) and predictor of in-patient mortality. A total of 146 patients were enrolled, and of these, 29 patients (20%) had SBP. Baseline characteristics were similar between subjects with and without SBP. Median (IQR) ascites NGAL was significantly higher in patients with SBP compared to those without SBP (221.3 [145.9-392.9] vs. 139.2 [73.9-237.2], p peritonitis in hospitalized patient with cirrhosis and an independent predictor of short-term in-hospital mortality, even controlling for SBP and MELD.

  4. Risk factors of all-cause in-hospital mortality among Korean elderly bacteremic urinary tract infection (UTI) patients.

    Science.gov (United States)

    Chin, Bum Sik; Kim, Myung Soo; Han, Sang Hoon; Shin, So Youn; Choi, Hee Kyung; Chae, Yun Tae; Jin, Sung Joon; Baek, Ji-Hyeon; Choi, Jun Yong; Song, Young Goo; Kim, Chang Oh; Kim, June Myung

    2011-01-01

    Urinary tract infection (UTI) is the most frequent cause of bacteremia/sepsis in elderly people and increasing antimicrobial resistance in uropathogens has been observed. To describe the characteristics of bacteremic UTI in elderly patients and to identify the independent risk factors of all-cause in-hospital mortality, a retrospective cohort study of bacteremic UTI patients of age over 65 was performed at a single 2000-bed tertiary hospital. Bacteremic UTI was defined as the isolation of the same organism from both urine and blood within 48 h. Eighty-six elderly bacteremic UTI patients were enrolled. Community-acquired infection was the case for most patients (79.1%), and Escherichia coli accounted for 88.6% (70/79) among Gram-negative organisms. Non-E. coli Gram-negative organisms were more frequent in hospital-acquired cases and male patients while chronic urinary catheter insertion was related with Gram-positive urosepsis. The antibiotic susceptibility among Gram-negative organisms was not different depending on the source of bacteremic UTI, while non-E. coli Gram-negative organisms were less frequently susceptible for cefotaxime, cefoperazone/sulbactam, and aztreonam. All-cause in-hospital mortality was 11.6%, and functional dependency (adjusted hazard ratio=HR=10.9, 95% confidence interval=95%CI=2.2-54.6) and low serum albumin (adjusted HR=27.0, 95%CI=2.0-361.2) were independently related with increased all-cause in-hospital mortality. Crown Copyright © 2010. Published by Elsevier Ireland Ltd. All rights reserved.

  5. Development and Validation of a Deep Neural Network Model for Prediction of Postoperative In-hospital Mortality.

    Science.gov (United States)

    Lee, Christine K; Hofer, Ira; Gabel, Eilon; Baldi, Pierre; Cannesson, Maxime

    2018-04-17

    The authors tested the hypothesis that deep neural networks trained on intraoperative features can predict postoperative in-hospital mortality. The data used to train and validate the algorithm consists of 59,985 patients with 87 features extracted at the end of surgery. Feed-forward networks with a logistic output were trained using stochastic gradient descent with momentum. The deep neural networks were trained on 80% of the data, with 20% reserved for testing. The authors assessed improvement of the deep neural network by adding American Society of Anesthesiologists (ASA) Physical Status Classification and robustness of the deep neural network to a reduced feature set. The networks were then compared to ASA Physical Status, logistic regression, and other published clinical scores including the Surgical Apgar, Preoperative Score to Predict Postoperative Mortality, Risk Quantification Index, and the Risk Stratification Index. In-hospital mortality in the training and test sets were 0.81% and 0.73%. The deep neural network with a reduced feature set and ASA Physical Status classification had the highest area under the receiver operating characteristics curve, 0.91 (95% CI, 0.88 to 0.93). The highest logistic regression area under the curve was found with a reduced feature set and ASA Physical Status (0.90, 95% CI, 0.87 to 0.93). The Risk Stratification Index had the highest area under the receiver operating characteristics curve, at 0.97 (95% CI, 0.94 to 0.99). Deep neural networks can predict in-hospital mortality based on automatically extractable intraoperative data, but are not (yet) superior to existing methods.

  6. Relationship Between a Sepsis Intervention Bundle and In-Hospital Mortality Among Hospitalized Patients: A Retrospective Analysis of Real-World Data.

    Science.gov (United States)

    Prasad, Priya A; Shea, Erica R; Shiboski, Stephen; Sullivan, Mary C; Gonzales, Ralph; Shimabukuro, David

    2017-08-01

    Sepsis is a systemic response to infection that can lead to tissue damage, organ failure, and death. Efforts have been made to develop evidence-based intervention bundles to identify and manage sepsis early in the course of the disease to decrease sepsis-related morbidity and mortality. We evaluated the relationship between a minimally invasive sepsis intervention bundle and in-hospital mortality using robust methods for observational data. We performed a retrospective cohort study at the University of California, San Francisco, Medical Center among adult patients discharged between January 1, 2012, and December 31, 2014, and who received a diagnosis of severe sepsis/septic shock (SS/SS). Sepsis intervention bundle elements included measurement of blood lactate; drawing of blood cultures before starting antibiotics; initiation of broad spectrum antibiotics within 3 hours of sepsis presentation in the emergency department or 1 hour of presentation on an inpatient unit; administration of intravenous fluid bolus if the patient was hypotensive or had a lactate level >4 mmol/L; and starting intravenous vasopressors if the patient remained hypotensive after fluid bolus administration. Poisson regression for a binary outcome variable was used to estimate an adjusted incidence-rate ratio (IRR) comparing mortality in groups defined by bundle compliance measured as a binary predictor, and to estimate an adjusted number needed to treat (NNT). Complete bundle compliance was associated with a 31% lower risk of mortality (adjusted IRR, 0.69, 95% confidence interval [CI], 0.53-0.91), adjusting for SS/SS presentation in the emergency department, SS/SS present on admission (POA), age, admission severity of illness and risk of mortality, Medicaid/Medicare payor status, immunocompromised host status, and congestive heart failure POA. The adjusted NNT to save one life was 15 (CI, 8-69). Other factors independently associated with mortality included SS/SS POA (adjusted IRR, 0.55; CI, 0

  7. Improved meal presentation increases food intake and decreases readmission rate in hospitalized patients.

    Science.gov (United States)

    Navarro, Daniela Abigail; Boaz, Mona; Krause, Ilan; Elis, Avishay; Chernov, Karina; Giabra, Mursi; Levy, Miriam; Giboreau, Agnes; Kosak, Sigrid; Mouhieddine, Mohamed; Singer, Pierre

    2016-10-01

    Reduced food intake is a frequent problem at a hospital setting, being a cause and/or consequence of malnutrition. Food presentation can affect food intake and induce nutritional benefit. To investigate the effect of improved meal presentation supported by gastronomy expertise on the food intake in adults hospitalized in internal medicine departments. Controlled before and after study. Two hundred and six newly hospitalized patients in internal medicine departments were included and divided in two groups, a) control: receiving the standard lunch from the hospital and b) experimental: receiving a lunch improved in terms of presentation by the advices received by the Institut Paul Bocuse, Ecully, Lyon, France together with the hospital kitchen of the Beilinson Hospital, without change in the composition of the meal. The amount of food left at the participants' plates was estimated using the Digital Imaging Method, which consisted in photographing the plates immediately to previous tray collection by the researcher. In addition, the nutritionDay questionnaire was used to measure other variables concerned to their food intake during hospitalization. Charlson Comorbidity Index was calculated. There was no significant difference between the groups regarding demography or Charlson Comorbidity Index. Patients who received the meal with the improved presentation showed significantly higher food intake than those who received the standard meal, despite reported loss in appetite. Participants from the experimental group left on their plate less starch (0.19 ± 0.30 vs. 0.52 + 0.41) (p  0.05). Both of the groups were asked how hungry they were before the meal and no significance was shown. More participants from the experimental group reported their meal to be tasty in comparison to those in the control group (49.5% vs. 33.7% p < 0.005). Length of stay was not different but readmission rate decreased significantly in the study group (p < 0.02) from 31.2% to 13

  8. Relationship between polycythemia and in-hospital mortality in chronic obstructive pulmonary disease patients with low-risk pulmonary embolism

    Science.gov (United States)

    Guo, Lu; Chughtai, Aamer Rasheed; Jiang, Hongli; Gao, Lingyun; Yang, Yan; Yang, Yang; Liu, Yuejian

    2016-01-01

    Backgrounds Pulmonary embolism (PE) is frequent in subjects with chronic obstructive pulmonary disease (COPD) and associated with high mortality. This multi-center retrospective study was performed to investigate if secondary polycythemia is associated with in-hospital mortality in COPD patients with low-risk PE. Methods We identified COPD patients with proven PE between October, 2005 and October, 2015. Patients in risk classes III–V on the basis of the PESI score were excluded. We extracted demographic, clinical and laboratory information at the time of admission from medical records. All subjects were followed until hospital discharge to identify all-cause mortality. Results We enrolled 629 consecutive patients with COPD and PE at low risk: 132 of them (21.0%) with and 497 (79.0%) without secondary polycythemia. Compared with those without polycythemia, the polycythemia group had significantly lower forced expiratory volume in one second (FEV1) level (0.9±0.3 vs. 1.4±0.5, P=0.000), lower PaO2 and SpO2 as well as higher PaCO2 (P=0.03, P=0.03 and P=0.000, respectively). COPD patients with polycythemia had a higher proportion of arrhythmia in electrocardiogram (ECG) (49.5% vs. 35.7%, P=0.02), a longer hospital duration time (15.3±10.1 vs. 9.7±9.1, P=0.001), a higher mechanical ventilation rate (noninvasive and invasive, 51.7% vs. 30.3%, P=0.04 and 31.0% vs. 7.9%, P=0.04, respectively), and a higher in-hospital mortality (12.1% vs. 6.6%, P=0.04). Multivariate logistic regression analysis revealed that polycythemia was associated with mortality in COPD patients with low-risk PE (adjusted OR 1.11; 95% CI, 1.04–1.66). Conclusions Polycythemia is an independent risk factor for all-cause in-hospital mortality in COPD patients with PE at low risk. PMID:28066591

  9. Meningococcal meningitis: clinical and laboratorial characteristics, fatality rate and variables associated with in-hospital mortality

    Directory of Open Access Journals (Sweden)

    Vanessa L. Strelow

    Full Text Available ABSTRACT Meningococcal meningitis is a public health problem. The aim of this study was to describe the clinical characteristics of patients with meningococcal meningitis, and to identify associated factors with mortality. This was a retrospective study, between 2006 and 2011, at a referral center in São Paulo, Brazil. Logistic regression analysis was used to identify factors associated with mortality. We included 316 patients. The median age was 16 years (IQR: 7–27 and 60% were male. The clinical triad: fever, headache and neck stiffness was observed in 89% of the patients. The cerebrospinal triad: pleocytosis, elevated protein levels and low glucose levels was present in 79% of patients. Factors associated with mortality in the multivariate model were age above 50 years, seizures, tachycardia, hypotension and neck stiffness. The classic clinical and laboratory triads of meningococcal meningitis were variable. The fatality rate was low. Age, seizures and shock signs were independently associated with mortality.

  10. Comparison of artificial neural network and logistic regression models for predicting in-hospital mortality after primary liver cancer surgery.

    Directory of Open Access Journals (Sweden)

    Hon-Yi Shi

    Full Text Available BACKGROUND: Since most published articles comparing the performance of artificial neural network (ANN models and logistic regression (LR models for predicting hepatocellular carcinoma (HCC outcomes used only a single dataset, the essential issue of internal validity (reproducibility of the models has not been addressed. The study purposes to validate the use of ANN model for predicting in-hospital mortality in HCC surgery patients in Taiwan and to compare the predictive accuracy of ANN with that of LR model. METHODOLOGY/PRINCIPAL FINDINGS: Patients who underwent a HCC surgery during the period from 1998 to 2009 were included in the study. This study retrospectively compared 1,000 pairs of LR and ANN models based on initial clinical data for 22,926 HCC surgery patients. For each pair of ANN and LR models, the area under the receiver operating characteristic (AUROC curves, Hosmer-Lemeshow (H-L statistics and accuracy rate were calculated and compared using paired T-tests. A global sensitivity analysis was also performed to assess the relative significance of input parameters in the system model and the relative importance of variables. Compared to the LR models, the ANN models had a better accuracy rate in 97.28% of cases, a better H-L statistic in 41.18% of cases, and a better AUROC curve in 84.67% of cases. Surgeon volume was the most influential (sensitive parameter affecting in-hospital mortality followed by age and lengths of stay. CONCLUSIONS/SIGNIFICANCE: In comparison with the conventional LR model, the ANN model in the study was more accurate in predicting in-hospital mortality and had higher overall performance indices. Further studies of this model may consider the effect of a more detailed database that includes complications and clinical examination findings as well as more detailed outcome data.

  11. Decreasing mortality and changes in treatment patterns in patients with acromegaly from a nationwide study.

    Science.gov (United States)

    Esposito, Daniela; Ragnarsson, Oskar; Granfeldt, Daniel; Marlow, Tom; Johannsson, Gudmundur; Olsson, Daniel S

    2018-05-01

    New therapeutic strategies have developed for the management of acromegaly over recent decades. Whether this has improved mortality has not been fully elucidated. The primary aim was to investigate mortality in a nationwide unselected cohort of patients with acromegaly. Secondary analyses included time trends in mortality and treatment patterns. A total of 1089 patients with acromegaly were identified in Swedish National Health Registries between 1987 and 2013. To analyse time trends, the cohort was divided into three periods (1987-1995, 1996-2004 and 2005-2013) based on the year of diagnosis. Using the Swedish population as reference, standardized mortality ratios (SMRs) were calculated with 95% confidence intervals (CIs). Overall SMR was 2.79 (95% CI: 2.43-3.15) with 232 observed and 83 expected deaths. Mortality was mainly related to circulatory diseases (SMR: 2.95, 95% CI: 2.35-3.55), including ischemic heart disease (2.00, 1.35-2.66) and cerebrovascular disease (3.99, 2.42-5.55) and malignancy (1.76, 1.27-2.26). Mortality decreased over time, with an SMR of 3.45 (2.87-4.02) and 1.86 (1.04-2.67) during the first and last time period, respectively ( P  = .015). During the same time periods, the frequency of pituitary surgery increased from 58% to 72% ( P  acromegaly, mainly related to circulatory and malignant diseases. Although still high, mortality significantly declined over time. This could be explained by the more frequent use of pituitary surgery, decreased prevalence of hypopituitarism and the availability of new medical treatment options. © 2018 European Society of Endocrinology.

  12. Trends in Hospitalization and Mortality Rates Due to Acute Cardiovascular Disease in Castile and León, 2001 to 2015.

    Science.gov (United States)

    López-Messa, Juan B; Andrés-de Llano, Jesús M; López-Fernández, Laura; García-Cruces, Jesús; García-Crespo, Julio; Prieto González, Miryam

    2018-02-01

    To analyze hospitalization and mortality rates due to acute cardiovascular disease (ACVD). We conducted a cross-sectional study of the hospital discharge database of Castile and León from 2001 to 2015, selecting patients with a principal discharge diagnosis of acute myocardial infarction (AMI), unstable angina, heart failure, or acute ischemic stroke (AIS). Trends in the rates of hospitalization/100 000 inhabitants/y and hospital mortality/1000 hospitalizations/y, overall and by sex, were studied by joinpoint regression analysis. A total of 239 586 ACVD cases (AMI 55 004; unstable angina 15 406; heart failure 111 647; AIS 57 529) were studied. The following statistically significant trends were observed: hospitalization: ACVD, upward from 2001 to 2007 (5.14; 95%CI, 3.5-6.8; P < .005), downward from 2011 to 2015 (3.7; 95%CI, 1.0-6.4; P < .05); unstable angina, downward from 2001 to 2010 (-12.73; 95%CI, -14.8 to -10.6; P < .05); AMI, upward from 2001 to 2003 (15.6; 95%CI, 3.8-28.9; P < .05), downward from 2003 to 2015 (-1.20; 95%CI, -1.8 to -0.6; P < .05); heart failure, upward from 2001 to 2007 (10.70; 95%CI, 8.7-12.8; P < .05), upward from 2007 to 2015 (1.10; 95%CI, 0.1-2.1; P < .05); AIS, upward from 2001 to 2007 (4.44; 95%CI, 2.9-6.0; P < .05). Mortality rates: downward from 2001 to 2015 in ACVD (-1.16; 95%CI, -2.1 to -0.2; P < .05), AMI (-3.37, 95%CI, -4.4 to -2, 3, P < .05), heart failure (-1.25; 95%CI, -2.3 to -0.1; P < .05) and AIS (-1.78; 95%CI, -2.9 to -0.6; P < .05); unstable angina, upward from 2001 to 2007 (24.73; 95%CI, 14.2-36.2; P < .05). The ACVD analyzed showed a rising trend in hospitalization rates from 2001 to 2015, which was especially marked for heart failure, and a decreasing trend in hospital mortality rates, which were similar in men and women. These data point to a stabilization and a decline in hospital mortality, attributable to established prevention measures. Copyright © 2017 Sociedad Española de Cardiología. Published by

  13. Impact of perioperative liver dysfunction on in-hospital mortality and long-term survival in infective endocarditis patients.

    Science.gov (United States)

    Diab, M; Sponholz, C; von Loeffelholz, C; Scheffel, P; Bauer, M; Kortgen, A; Lehmann, T; Färber, G; Pletz, M W; Doenst, T

    2017-12-01

    Infective endocarditis (IE) is often associated with multiorgan dysfunction and mortality. The impact of perioperative liver dysfunction (LD) on outcome remains unclear and little is known about factors leading to postoperative LD. We performed a retrospective, single-center analysis on 285 patients with left-sided IE without pre-existing chronic liver disease referred to our center between 2007 and 2013 for valve surgery. Sequential organ failure assessment (SOFA) score was used to evaluate organ dysfunction. Chi-square, Cox regression, and multivariate analyses were used for evaluation. Preoperative LD (Bilirubin >20 μmol/L) was present in 68 of 285 patients. New, postoperative LD occurred in 54 patients. Hypoxic hepatitis presented the most common origin of LD, accompanied with high short-term mortality. In-hospital mortality was higher in patients with preoperative and postoperative LD compared to patients without LD (51.5, 24.1, and 10.4%, respectively, p endocarditis is an independent predictor of short- and long-term mortalities. After surviving the hospital stay, 5-year prognosis is not different and quality of life is not affected by LD. S. aureus and duration of cardiopulmonary bypass represent risk factors for postoperative LD.

  14. Fasting Hyperglycemia Increases In-Hospital Mortality Risk in Nondiabetic Female Patients with Acute Myocardial Infarction: A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Guojing Luo

    2014-01-01

    Full Text Available Previous studies had shown that elevated admission plasma glucose (APG could increase mortality rate and serious complications of acute myocardial infarction (AMI, but whether fasting plasma glucose (FPG had the same role remains controversial. In this retrospective study, 253 cases of AMI patients were divided into diabetic (n=87 and nondiabetic group (n=166. Our results showed that: compared with the nondiabetic patients, diabetic patients had higher APG, FPG, higher plasma triglyceride, higher rates of painless AMI (P0.05. While nondiabetic patients were subgrouped in terms of APG and FPG (cut points were 11.1 mmol/L and 7.0 mmol/L, resp., the mortality rate had significant difference (P<0.01, whereas glucose level lost significance in diabetic group. Multivariate logistic regression analysis showed that FPG (OR: 2.014; 95% confidence interval: 1.296–3.131; p<0.01 but not APG was independent predictor of in-hospital mortality for nondiabetic patients. These results indicate that FPG can be an independent predictor for mortality in nondiabetic female patients with AMI.

  15. Serum angiotensin-converting enzyme 2 is an independent risk factor for in-hospital mortality following open surgical repair of ruptured abdominal aortic aneurysm

    Science.gov (United States)

    Nie, Wanpin; Wang, Yan; Yao, Kai; Wang, Zheng; Wu, Hao

    2016-01-01

    Open surgical repair (OSR) is a conventional surgical method used in the repair a ruptured abdominal aortic aneurysm (AAA); however, OSR results in high perioperative mortality rates. The level of serum angiotensin-converting enzyme 2 (ACE2) has been reported to be an independent risk factor for postoperative in-hospital mortality following major cardiopulmonary surgery. In the present study, the association of serum ACE2 levels with postoperative in-hospital mortality was investigated in patients undergoing OSR for ruptured AAA. The study enrolled 84 consecutive patients underwent OSR for ruptured AAA and were subsequently treated in the intensive care unit. Patients who succumbed postoperatively during hospitalization were defined as non-survivors. Serum ACE2 levels were measured in all patients prior to and following the surgery using ELISA kits. The results indicated that non-survivors showed significantly lower mean preoperative and postoperative serum ACE2 levels when compared with those in survivors. Multivariate logistic regression analysis also showed that, subsequent to adjusting for potential confounders, the serum ACE2 level on preoperative day 1 showed a significant negative association with the postoperative in-hospital mortality. This was confirmed by multivariate hazard ratio analysis, which showed that, subsequent to adjusting for the various potential confounders, the risk of postoperative in-hospital mortality remained significantly higher in the two lowest serum ACE2 level quartiles compared with that in the highest quartile on preoperative day 1. In conclusion, the present study provided the first evidence supporting that the serum ACE2 level is an independent risk factor for the in-hospital mortality following OSR for ruptured AAA. Furthermore, low serum ACE2 levels on preoperative day 1 were found to be associated with increased postoperative in-hospital mortality. Therefore, the serum ACE2 level on preoperative day 1 may be a potential

  16. Inter-Arm Blood Pressure Difference in Hospitalized Elderly Patients Is Not Associated With Excess Mortality.

    Science.gov (United States)

    Weiss, Avraham; Grossman, Alon; Beloosesky, Yichayaou; Koren-Morag, Nira; Green, Hefziba; Grossman, Ehud

    2015-10-01

    Inter-arm blood pressure difference (IAD) has been found to be associated with cardiovascular mortality. Its clinical significance and association with mortality in the elderly is not well defined. This study evaluated the association of IAD with mortality in a cohort of hospitalized elderly individuals. Blood pressure (BP) was measured simultaneously in both arms in elderly individuals (older than 65 years) hospitalized in a geriatric ward from October 2012 to July 2014. During the study period, 445 patients, mostly women (54.8%) with a mean age of 85±5 years, were recruited. Systolic and diastolic IAD were >10 mm Hg in 102 (22.9%) and 76 (17.1%) patients, respectively. Patients were followed for an average of 342±201 days. During follow-up, 102 patients (22.9%) died. Mortality was not associated with systolic or diastolic IAD. It is therefore questionable whether BP should be routinely measured in both arms in the elderly. © 2015 Wiley Periodicals, Inc.

  17. Standard assessments of frailty are validated predictors of mortality in hospitalized patients with cirrhosis.

    LENUS (Irish Health Repository)

    Tapper, Elliot B

    2015-04-04

    The risk of morbidity and mortality for hospitalized patients with cirrhosis is high and incompletely captured by conventional indices. We sought to evaluate the predictive role of frailty in an observational cohort study of inpatients with decompensated cirrhosis between 2010 and 2013. The primary outcome was 90-day mortality. Secondary outcomes included discharge to a rehabilitation hospital, 30-day readmission, and length of stay. Frailty was assessed with three metrics: activities of daily living (ADL), the Braden Scale, and the Morse fall risk score. A predictive model was validated by randomly dividing the population into training and validation cohorts: 734 patients were admitted 1358 times in the study period. The overall 90-day mortality was 18.3%. The 30-day readmission rate was 26.6%, and the rate of discharge to a rehabilitation facility was 14.3%. Adjusting for sex, age, Model for End-Stage Liver Disease, sodium, and Charlson index, the odds ratio for the effect of an ADL score of less than 12 of 15 on mortality is 1.83 (95% confidence interval [CI] 1.05-3.20). A predictive model for 90-day mortality including ADL and Braden Scale yielded C statistics of 0.83 (95% CI 0.80-0.86) and 0.77 (95% CI 0.71-0.83) in the derivation and validation cohorts, respectively. Discharge to a rehabilitation hospital is predicted by both the ADL (<12) and Braden Scale (<16), with respective adjusted odds ratios of 3.78 (95% CI 1.97-7.29) and 6.23 (95% CI 2.53-15.4). Length of stay was associated with the Braden Scale (<16) (hazard ratio = 0.63, 95% CI 0.44-0.91). No frailty measure was associated with 30-day readmission.

  18. Epidermal growth factor treatment decreases mortality and is associated with improved gut integrity in sepsis.

    Science.gov (United States)

    Clark, Jessica A; Clark, Andrew T; Hotchkiss, Richard S; Buchman, Timothy G; Coopersmith, Craig M

    2008-07-01

    Epidermal growth factor (EGF) is a cytoprotective peptide that has healing effects on the intestinal mucosa. We sought to determine whether systemic administration of EGF after the onset of sepsis improved intestinal integrity and decreased mortality. FVB/N mice were subjected to either sham laparotomy or 2 x 23 cecal ligation and puncture (CLP). Septic mice were further randomized to receive injection of either 150 microg kg(-1) d(-1) (i.p.) EGF or 0.9% saline (i.p.). Circulating EGF levels were decreased after CLP compared with sham animals but were unaffected by giving exogenous EGF treatment. In contrast, intestinal EGF levels increased after CLP and were further augmented by exogenous EGF treatment. Intestinal EGF receptor was increased after CLP, whether assayed by immunohistochemistry, real-time polymerase chain reaction, or Western blot, and exogenous EGF treatment decreased intestinal EGF receptor. Villus length decreased 2-fold between sham and septic animals, and EGF treatment resulted in near total restitution of villus length. Sepsis decreased intestinal proliferation and increased intestinal apoptosis. This was accompanied by increased expression of the proapoptotic proteins Bid and Fas-associated death domain, as well as the cyclin-dependent kinase inhibitor p21 cip1/waf Epidermal growth factor treatment after the onset of sepsis restored both proliferation and apoptosis to levels seen in sham animals and normalized expression of Bid, Fas-associated death domain, and p21 cip1/waf . To determine whether improvements in gut homeostasis were associated with a decrease in sepsis-induced mortality, septic mice with or without EGF treatment after CLP were followed 7 days for survival. Mortality decreased from 60% to 30% in mice treated with EGF after the onset of sepsis (P < 0.05). Thus, EGF may be a potential therapeutic agent for the treatment of sepsis in part due to its ability to protect intestinal integrity.

  19. Predictors of mortality in hospital survivors with type 2 diabetes mellitus and acute coronary syndromes.

    Science.gov (United States)

    Savonitto, Stefano; Morici, Nuccia; Nozza, Anna; Cosentino, Francesco; Perrone Filardi, Pasquale; Murena, Ernesto; Morocutti, Giorgio; Ferri, Marco; Cavallini, Claudio; Eijkemans, Marinus Jc; Stähli, Barbara E; Schrieks, Ilse C; Toyama, Tadashi; Lambers Heerspink, H J; Malmberg, Klas; Schwartz, Gregory G; Lincoff, A Michael; Ryden, Lars; Tardif, Jean Claude; Grobbee, Diederick E

    2018-01-01

    To define the predictors of long-term mortality in patients with type 2 diabetes mellitus and recent acute coronary syndrome. A total of 7226 patients from a randomized trial, testing the effect on cardiovascular outcomes of the dual peroxisome proliferator-activated receptor agonist aleglitazar in patients with type 2 diabetes mellitus and recent acute coronary syndrome (AleCardio trial), were analysed. Median follow-up was 2 years. The independent mortality predictors were defined using Cox regression analysis. The predictive information provided by each variable was calculated as percent of total chi-square of the model. All-cause mortality was 4.0%, with cardiovascular death contributing for 73% of mortality. The mortality prediction model included N-terminal proB-type natriuretic peptide (adjusted hazard ratio = 1.68; 95% confidence interval = 1.51-1.88; 27% of prediction), lack of coronary revascularization (hazard ratio = 2.28; 95% confidence interval = 1.77-2.93; 18% of prediction), age (hazard ratio = 1.04; 95% confidence interval = 1.02-1.05; 15% of prediction), heart rate (hazard ratio = 1.02; 95% confidence interval = 1.01-1.03; 10% of prediction), glycated haemoglobin (hazard ratio = 1.11; 95% confidence interval = 1.03-1.19; 8% of prediction), haemoglobin (hazard ratio = 1.01; 95% confidence interval = 1.00-1.02; 8% of prediction), prior coronary artery bypass (hazard ratio = 1.61; 95% confidence interval = 1.11-2.32; 7% of prediction) and prior myocardial infarction (hazard ratio = 1.40; 95% confidence interval = 1.05-1.87; 6% of prediction). In patients with type 2 diabetes mellitus and recent acute coronary syndrome, mortality prediction is largely dominated by markers of cardiac, rather than metabolic, dysfunction.

  20. The Absence of Fever Is Associated With Higher Mortality and Decreased Antibiotic and IV Fluid Administration in Emergency Department Patients With Suspected Septic Shock.

    Science.gov (United States)

    Henning, Daniel J; Carey, Jeremy R; Oedorf, Kimie; Day, Danielle E; Redfield, Colby S; Huguenel, Colin J; Roberts, Jonathan C; Sanchez, Leon D; Wolfe, Richard E; Shapiro, Nathan I

    2017-06-01

    This study evaluates whether emergency department septic shock patients without a fever (reported or measured) receive less IV fluids, have decreased antibiotic administration, and suffer increased in-hospital mortality. This was a secondary analysis of a prospective, observational study of patients with shock. The study was conducted in an urban, academic emergency department. The original study enrolled consecutive adult (aged 18 yr or older) emergency department patients from November 11, 2012, to September 23, 2013, who met one of the following shock criteria: 1) systolic blood pressure less than 90 mm Hg after at least 1L IV fluids, 2) new vasopressor requirement, or 3) systolic blood pressure less than 90 mm Hg and IV fluids held for concern of fluid overload. The current study is limited to patients with septic shock. Patients were grouped as febrile if they had a subjective fever or a measured temperature >100.4°F documented in the emergency department; afebrile patients lacked both. Among 378 patients with septic shock, 207 of 378 (55%; 50-60%) were febrile by history or measurement. Afebrile patients had lower rates of antibiotic administration in the emergency department (81% vs 94%; p < 0.01), lower mean volumes of IV fluids (2,607 vs 3,013 mL; p < 0.01), and higher in-hospital mortality rates (33% vs 11%; p < 0.01). After adjusting for bicarbonate less than 20 mEq/L, lactate concentration, respiratory rate greater than or equal to 24 breaths/min, emergency department antibiotics, and emergency department IV fluids volume, being afebrile remained a significant predictor of in-hospital mortality (odds ratio, 4.3; 95% CI, 2.2-8.2; area under the curve = 0.83). In emergency department patients with septic shock, afebrile patients received lower rates of emergency department antibiotic administration, lower mean IV fluids volume, and suffered higher in-hospital mortality.

  1. Butyrylcholinesterase Levels on Admission Predict Severity and 12-Month Mortality in Hospitalized AIDS Patients

    Science.gov (United States)

    Xu, Lijun; Huang, Ying; Yang, Zongxing; Sun, Jia; Xu, Yan; Zheng, Jinlei; Kinloch, Sabine; Yin, Michael T.; Weng, Honglei

    2018-01-01

    Background Butyrylcholinesterase (BChE) is synthesized mainly in the liver and an important marker in many infectious/inflammatory diseases, but its role in acquired immunodeficiency syndrome (AIDS) patients is not clear. We wished to ascertain if BChE level is associated with the progression/prognosis of AIDS patients. Methods BChE levels (in U/L) were measured in 505 patients; assessed. Kaplan–Meier curves and Cox proportional hazards model were used to assess associations between low BChE levels and mortality, after adjustment for age, CD4 count, WHO stage, and laboratory parameters. Results A total of 129 patients (25.5%) had a lower BChE level. BChE was closely associated with CD4 count, WHO stage, CRP level, and BMI (all P AIDS severity and is an independent risk factor for increased mortality in AIDS patients. PMID:29736152

  2. The effect of serum potassium level on in-hospital and long-term mortality in ST elevation myocardial infarction.

    Science.gov (United States)

    Keskin, Muhammed; Kaya, Adnan; Tatlısu, Mustafa Adem; Hayıroğlu, Mert İlker; Uzman, Osman; Börklü, Edibe Betül; Çinier, Göksel; Çakıllı, Yasin; Yaylak, Barış; Eren, Mehmet

    2016-10-15

    Current studies evaluating the effect of serum potassium levels on mortality in patients with ST elevation myocardial infarction (STEMI) are lacking. We analyzed retrospectively 3760 patients diagnosed with STEMI. Mean serum potassium levels were categorized accordingly: <3.0, 3.0 to <3.5, 3.5 to <4.0, 4.0 to <4.5, 4.5 to <5.0, 5.0 to <5.5, and ≥5.5mEq/L. The lowest mortality was determined in patients with serum potassium level of 4 to <4.5mEq/L whereas mortality was higher in patients with serum potassium levels of ≥5.0 and <3.5mEq/L. In a multivariable Cox-proportional regression analysis, the mortality risk was higher for patients with serum potassium levels of ≥5mEq/L [hazard ratio (HR), 2.11; 95% confidence interval (CI) 1.23-4.74 and HR, 4.20; 95% CI 1.08-8.23, for patients with potassium levels of 5 to <5.5mEq/L and ≥5.5mEq/L, respectively]. In-hospital and long-term mortality risks were also higher for patients with serum potassium levels of ≤3.5mEq/L. Conversely, ventricular arrhythmias were higher only for patients with serum potassium level of ≤3.5mEq/L. Furthermore, a significant relationship was found between the patient with serum potassium levels of ≤3.5mEq/L and ventricular arrhythmias. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Sex differences in hospital mortality following acute myocardial infarction in China: findings from a study of 45 852 patients in the COMMIT/CCS-2 study.

    Science.gov (United States)

    Chen, Yiping; Jiang, Lixin; Smith, Margaret; Pan, Hongchao; Collins, Rory; Peto, Richard; Chen, Zhengming

    2011-01-01

    To assess the sex difference in hospital mortality following ST elevation myocardial infarction (STEMI) in China. Observational study of patients enrolled into a large trial, adjusting for age, presenting characteristics and hospital treatments using logistic regression. 1250 hospitals in China during 1999-2005. 42 683 STEMI patients, including 31 309 men and 11 374 women. In the original trial, all patients received 162 mg of aspirin plus 75 mg of clopidogrel daily or matching placebo and metoprolol (15 mg intravenous then 200 mg oral daily) or matching placebo. All other aspects of patients' treatments were at the discretion of responsible doctors. Hospital mortality from any cause during the scheduled trial treatment period (ie, up to 4 weeks in hospital). Overall, 8% of the patients died in hospital, with the crude hospital mortality being twice as high in women as in men (12.6% vs 6.3%). After adjusting for age, the sex difference in hospital mortality attenuated but remained highly significant (OR 1.54; 95% CI 1.43 to 1.66). Further adjustment for other baseline characteristics and for the treatments given in hospital had little effect on the sex difference in hospital mortality (OR 1.50, 95% CI 1.38 to 1.62). The difference in hospital mortality was greater at a younger age, with the adjusted ORs being 2.14, 1.70, 1.48 and 1.18, respectively, for ages <55, 55-64, 65-74 and ≥75 years (p=0.0001 for trend). Compared with men of the same age, women had approximately a 50% higher mortality following hospital admission for STEMI, with a particularly higher excess risk at age <55 years.

  4. Direct to Operating Room Trauma Resuscitation Decreases Mortality Among Severely Injured Children.

    Science.gov (United States)

    Wieck, Minna M; Cunningham, Aaron J; Behrens, Brandon; Ohm, Erika T; Maxwell, Bryan G; Hamilton, Nicholas A; Adams, M Christopher; Cole, Frederick J; Jafri, Mubeen A

    2018-03-16

    Expediting evaluation and intervention for severely injured patients has remained a mainstay of advanced trauma care. One technique, direct to operating room (DOR) resuscitation, for selective adult patients has demonstrated decreased mortality. We sought to investigate the application of this protocol in children. All DOR pediatric patients from 2009-2016 at a pediatric Level I Trauma Center were identified. DOR criteria included penetrating injury, chest injuries, amputations, significant blood loss, cardiopulmonary resuscitation, and surgeon discretion. Demographics, injury patterns, interventions, and outcomes were analyzed. Observed mortality was compared to expected mortality, calculated using Trauma Injury Severity Score (TRISS) methodology, with two-tailed t-tests and a p-value 15, 33% had GCS≤8, and 9% were hypotensive. The most commonly injured body regions were external (66%), head (34%), chest (30%), and abdomen (27%). Sixty-seven patients (82%) required emergent procedural intervention, most commonly wound exploration/repair (35%), central venous access (22%), tube thoracostomy (19%) and laparotomy (18%). Predictors of intervention were ISS>15 (odds ratio=14, p=0.013) and GCS<9 (odds ratio=8.5, p=0.044). The survival rate to discharge for DOR patients was 84% compared with an expected survival of 79% (TRISS) (p=0.4). The greatest improvement relative to expected mortality was seen in the subgroup with penetrating trauma (84.5% vs. 74.4%, p=0.002). A selective policy of resuscitating the most severely injured children in the operating room can decrease mortality. Patients suffering penetrating trauma with the highest ISS and diminished GCS have the greatest benefit. Trauma centers with appropriate resources should evaluate implementing similar policies. Level II. Diagnostic tests or criteria.

  5. Spontaneous intracerebral hemorrhage: Clinical and computed tomography findings in predicting in-hospital mortality in Central Africans

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    Michel Lelo Tshikwela

    2012-01-01

    Full Text Available Background and Purpose: Intracerebral hemorrhage (ICH constitutes now 52% of all strokes. Despite of its deadly pattern, locally there is no clinical grading scale for ICH-related mortality prediction. The first objective of this study was to develop a risk stratification scale (Kinshasa ICH score by assessing the strength of independent predictors and their association with in-hospital 30-day mortality. The second objective of the study was to create a specific local and African model for ICH prognosis. Materials and Methods: Age, sex, hypertension, type 2 diabetes mellitus (T2DM, smoking, alcohol intake, and neuroimaging data from CT scan (ICH volume, Midline shift of patients admitted with primary ICH and follow-upped in 33 hospitals of Kinshasa, DR Congo, from 2005 to 2008, were analyzed using logistic regression models. Results: A total of 185 adults and known hypertensive patients (140 men and 45 women were examined. 30-day mortality rate was 35% (n=65. ICH volume>25 mL (OR=8 95% CI: 3.1-20.2; P 7 mm, a consequence of ICH volume, was also a significant predictor of mortality. The Kinshasa ICH score was the sum of individual points assigned as follows: Presence of coma coded 2 (2 × 2 = 4, absence of coma coded 1 (1 × 2 = 2, ICH volume>25 mL coded 2 (2 × 2=4, ICH volume of ≤25 mL coded 1(1 × 2=2, left hemispheric site of ICH coded 2 (2 × 1=2, and right hemispheric site of hemorrhage coded 1(1 × 1 = 1. All patients with Kinshasa ICH score ≤7 survived and the patients with a score >7 died. In considering sex influence (Model 3, points were allowed as follows: Presence of coma (2 × 3 = 6, absence of coma (1 × 3 = 3, men (2 × 2 = 4, women (1 × 2 = 2, midline shift ≤7 mm (1 × 3 = 3, and midline shift >7 mm (2 × 3 = 6. Patients who died had the Kinshasa ICH score ≥16. Conclusion: In this study, the Kinshasa ICH score seems to be an accurate method for distinguishing those ICH patients who need continuous and special management

  6. Components and possible determinants of decrease in Russian mortality in 2004-2010

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    Vladimir M. Shkolnikov

    2013-04-01

    Full Text Available BACKGROUND After a long decline, life expectancy in Russia substantially increased in 2004-2010; this is the longest period of health improvement that has been observed in the country since 1965. This study is the first analysis of this positive trend. OBJECTIVE We seek to determine the causes and age groups that account for the additional years of life gained in 2004-10 and the remaining gap between Russia and Western countries, to assess to what extent these recent trends represent a new development relative to previous mortality fluctuations, and to identify possible explanations for the improvement. METHODS We present an analysis of trends in life expectancy, and in age- and cause-specific mortality in Russia and selected countries in Eastern and Western Europe. We use decomposition techniques to examine the life expectancy rise in 2004-2010 and the Russia-UK life expectancy gap in 2010. RESULTS Like the previous mortality fluctuations that have occurred in Russia since the mid-1980s, the increase in life expectancy was driven by deaths at ages 15 to 60 from alcohol-related causes. Uniquely in the recent period, there were also improvements at older ages, especially in cerebrovascular disease mortality among women. In addition, there were reductions in deaths from avoidable causes, such as from tuberculosis and diabetes. The life expectancy gap between Russia and Western countries remains large, and is mostly attributable to deaths from cardiovascular disease, alcohol-related conditions, and violence. CONCLUSIONS The decrease in alcohol-related mortality may be attributable to measures taken in 2006 to control the production and sale of ethanol. The lower number of cerebrovascular-related deaths may reflect advancements in blood pressure control. The reduction in the number of deaths from tuberculosis and diabetes may be associated with a general improvement in health care. Although the decline in mortality since 2004 has been substantial

  7. Gender, TIMI risk score and in-hospital mortality in STEMI patients undergoing primary PCI: results from the Belgian STEMI registry.

    Science.gov (United States)

    Gevaert, Sofie A; De Bacquer, Dirk; Evrard, Patrick; Convens, Carl; Dubois, Philippe; Boland, Jean; Renard, Marc; Beauloye, Christophe; Coussement, Patrick; De Raedt, Herbert; de Meester, Antoine; Vandecasteele, Els; Vranckx, Pascal; Sinnaeve, Peter R; Claeys, Marc J

    2014-01-22

    The relationship between the predictive performance of the TIMI risk score for STEMI and gender has not been evaluated in the setting of primary PCI (pPCI). Here, we compared in-hospital mortality and predictive performance of the TIMI risk score between Belgian women and men undergoing pPCI. In-hospital mortality was analysed in 8,073 (1,920 [23.8%] female and 6,153 [76.2%] male patients) consecutive pPCI-treated STEMI patients, included in the prospective, observational Belgian STEMI registry (January 2007 to February 2011). A multivariable logistic regression model, including TIMI risk score variables and gender, evaluated differences in in-hospital mortality between men and women. The predictive performance of the TIMI risk score according to gender was evaluated in terms of discrimination and calibration. Mortality rates for TIMI scores in women and men were compared. Female patients were older, had more comorbidities and longer ischaemic times. Crude in-hospital mortality was 10.1% in women vs. 4.9% in men (OR 2.2; 95% CI: 1.82-2.66, pdiscrimination and calibration in women as well as in men (c-statistic=0.84 [95% CI: 0.809-0.866], goodness-of-fit p=0.53 and c-statistic=0.89 [95% CI: 0.873-0.907], goodness-of-fit p=0.13, respectively), but mortality prediction for TIMI scores was better in men (p=0.02 for TIMI score x gender interaction). In the Belgian STEMI registry, pPCI-treated women had a higher in-hospital mortality rate even after correcting for TIMI risk score variables. The TIMI risk score was effective in predicting in-hospital mortality but performed slightly better in men. The database was registered with clinicaltrials.gov (NCT00727623).

  8. Blood lactate as a predictor for in-hospital mortality in patients admitted acutely to hospital: A systematic review

    DEFF Research Database (Denmark)

    Kruse, Ole; Grunnet, Niels; Barfod, Charlotte

    2011-01-01

    to the hospital, or serial lactate measurements. Furthermore there is no consensus whether the sample should be drawn from arterial, peripheral venous, or capillary blood. The aim of this review was: 1) To examine whether blood lactate levels are predictive for in-hospital mortality in patients in the acute...... setting, i.e. patients assessed pre-hospitally, in the trauma centre, emergency department, or intensive care unit. 2) To examine the agreement between arterial, peripheral venous, and capillary blood lactate levels in patients in the acute setting. METHODS: We performed a systematic search using Pub......Med, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL up to April 2011. 66 articles were considered potentially relevant and evaluated in full text, of these ultimately 33 articles were selected. RESULTS AND CONCLUSION: The literature reviewed supported blood...

  9. Morbidity and Mortality conference as part of PDCA cycle to decrease anastomotic failure in colorectal surgery.

    Science.gov (United States)

    Vogel, Peter; Vassilev, Georgi; Kruse, Bernd; Cankaya, Yesim

    2011-10-01

    Morbidity and Mortality meetings are an accepted tool for quality management in many hospitals. However, it is not proven whether these meetings increase quality. It was the aim of this study to investigate whether Morbidity and Mortality meetings as part of a PDCA cycle (Plan, Do, Check, Act) can improve the rate of anastomotic failure in colorectal surgery. From January 1, 2004, to December 31, 2009, data for all anastomotic failures in patients operated on for colorectal diseases in the Department of Surgery (Klinikum Friedrichshafen, Germany) were prospectively collected. The events were discussed in Morbidity and Mortality meetings. On the basis of these discussions, a strategy to prevent anastomotic leaks and a new target were defined (i.e. 'Plan'). This strategy was implemented in the following period (i.e. 'Do') and results were prospectively analysed. A new strategy was established when the results differed from the target, and a new standard was defined when the target was achieved (i.e. 'Check, Act'). The year 2004 was set as the base year. In 2005 and 2006, new strategies were established. Comparing this period with the period of strategy conversion (2007-2009), we found a significant decrease in the anastomotic failure rate in colorectal surgery patients (5.7% vs 2.8%; p = 0.05), whereas the risk factors for anastomotic failure were unchanged or unfavourable. If Morbidity and Mortality meetings are integrated in a PDCA cycle, they can decrease anastomotic failure rates and improve quality of care in colorectal surgery. Therefore, the management tool 'PDCA cycle' should be considered also for medical issues.

  10. Delay in admission for elective coronary-artery bypass grafting is associated with increased in-hospital mortality

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    Levy Adrian R

    2008-09-01

    Full Text Available Abstract Background Many health care systems now use priority wait lists for scheduling elective coronary artery bypass grafting (CABG surgery, but there have not yet been any direct estimates of reductions in in-hospital mortality rate afforded by ensuring that the operation is performed within recommended time periods. Methods We used a population-based registry to identify patients with established coronary artery disease who underwent isolated CABG in British Columbia, Canada. We studied whether postoperative survival during hospital admission for CABG differed significantly among patients who waited for surgery longer than the recommended time, 6 weeks for patients needing semi-urgent surgery and 12 weeks for those needing non-urgent surgery. Results Among 7316 patients who underwent CABG, 97 died during the same hospital admission, for a province-wide death rate at discharge of 1.3%. The observed proportion of patients who died during the same admission was 1.0% (27 deaths among 2675 patients for patients treated within the recommended time and 1.5% (70 among 4641 for whom CABG was delayed. After adjustment for age, sex, anatomy, comorbidity, calendar period, hospital, and mode of admission, patients with early CABG were only 2/3 as likely as those for whom CABG was delayed to experience in-hospital death (odds ratio 0.61; 95% confidence interval [CI] 0.39 to 0.96. There was a linear trend of 5% increase in the odds of in-hospital death for every additional month of delay before surgery, adjusted OR = 1.05 (95% CI 1.00 to 1.11. Conclusion We found a significant survival benefit from performing surgical revascularization within the time deemed acceptable to consultant surgeons for patients requiring the treatment on a semi-urgent or non-urgent basis.

  11. Decrease of old age population mortality in Yugoslavia: Chance to increase anticipated life expectancy

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    Radivojević Biljana M.

    2002-01-01

    Full Text Available This study analyzes the level and structure of old age population mortality in Yugoslavia with an aim to determine the intensity of realized changes and to provide an answer to how much they are significant and to approach the positive trends noted in developed countries in the latest period. Although it was insufficiently represented in the demographic analysis, the analysis of mortality in old people is gaining importance in the world. Apart from the reasons which result from the increase in the number of old people and thus their greater participation in the total number of deceased, enviable results have been achieved in decreasing old age mortality, which are more and more in focus of interest. While earlier research reported on the dominant influence of the decrease of younger age mortality to the increase of the expectation of life at birth, recent analysis precisely confirm the importance of decreasing mortality in old people. In mortality conditions from 1997/98, an additional 13.4 years of life in average is expected for men in Yugoslavia, and 15.2 for women. During more than five decades, the anticipated life expectancy for people over the age of 65 increased for only 1.2 years for men and 1.9 years for women. Out of that, the greatest increase was realized in the period 1950/51 - 1960/61 in both sexes. A small decrease in the average life expectancy was marked with men in the period 1960/61 - 1970/71, and with women in the latest period. Otherwise, all up to the eighties, the annual rate of increase was considerably lower than the rate of increase for zero year. It was only in the period 1980/81-1990/91 that faster growth had an anticipated life expectancy for the 65 years old. However, during the nineties unfavorable changes continued with the older, especially, female population. When comparing the values of the average life expectancy for people over 65 in Yugoslavia with corresponding values in developed countries, the lagging in

  12. Patterns of in-hospital mortality and bleeding complications following PCI for very elderly patients: insights from the Dartmouth Dynamic Registry.

    Science.gov (United States)

    Li, Shawn X; Chaudry, Hannah I; Lee, Jiyong; Curran, Theodore B; Kumar, Vishesh; Wong, Kendrew K; Andrus, Bruce W; DeVries, James T

    2018-02-01

    Very elderly patients (age ≥ 85 years) are a rapidly increasing segment of the population. As a group, they experience high rates of in-hospital mortality and bleeding complications following percutaneous coronary intervention (PCI). However, the relationship between bleeding and mortality in the very elderly is unknown. Retrospective review was performed on 17,378 consecutive PCI procedures from 2000 to 2015 at Dartmouth-Hitchcock Medical Center. Incidence of bleeding during the index PCI admission (bleeding requiring transfusion, access site hematoma > 5 cm, pseudoaneurysm, and retroperitoneal bleed) and in-hospital mortality were reported for four age groups (PCI. Incidence of bleeding and in-hospital mortality increased monotonically with increasing age (mortality: 0.94%, 2.27%, 4.24% and 4.58%; bleeding: 3.96%, 6.62%, 10.68% and 13.99% for ages PCI increase with increasing age. For the very elderly, despite high rates of bleeding, bleeding is no longer predictive of in-hospital mortality following PCI.

  13. Weight-for-age standard score - distribution and effect on in-hospital mortality: A retrospective analysis in pediatric cardiac surgery

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    Antony George

    2015-01-01

    Full Text Available Objective: To study the distribution of weight for age standard score (Z score in pediatric cardiac surgery and its effect on in-hospital mortality. Introduction: WHO recommends Standard Score (Z score to quantify and describe anthropometric data. The distribution of weight for age Z score and its effect on mortality in congenital heart surgery has not been studied. Methods: All patients of younger than 5 years who underwent cardiac surgery from July 2007 to June 2013, under single surgical unit at our institute were enrolled. Z score for weight for age was calculated. Patients were classified according to Z score and mortality across the classes was compared. Discrimination and calibration of the for Z score model was assessed. Improvement in predictability of mortality after addition of Z score to Aristotle Comprehensive Complexity (ACC score was analyzed. Results: The median Z score was -3.2 (Interquartile range -4.24 to -1.91] with weight (mean±SD of 8.4 ± 3.38 kg. Overall mortality was 11.5%. 71% and 52.59% of patients had Z score < -2 and < -3 respectively. Lower Z score classes were associated with progressively increasing mortality. Z score as continuous variable was associated with O.R. of 0.622 (95% CI- 0.527 to 0.733, P < 0.0001 for in-hospital mortality and remained significant predictor even after adjusting for age, gender, bypass duration and ACC score. Addition of Z score to ACC score improved its predictability for in-hosptial mortality (δC - 0.0661 [95% CI - 0.017 to 0.0595, P = 0.0169], IDI- 3.83% [95% CI - 0.017 to 0.0595, P = 0.00042]. Conclusion: Z scores were lower in our cohort and were associated with in-hospital mortality. Addition of Z score to ACC score significantly improves predictive ability for in-hospital mortality.

  14. The ADOPT-LC score: a novel predictive index of in-hospital mortality of cirrhotic patients following surgical procedures, based on a national survey.

    Science.gov (United States)

    Sato, Masaya; Tateishi, Ryosuke; Yasunaga, Hideo; Horiguchi, Hiromasa; Matsui, Hiroki; Yoshida, Haruhiko; Fushimi, Kiyohide; Koike, Kazuhiko

    2017-03-01

    We aimed to develop a model for predicting in-hospital mortality of cirrhotic patients following major surgical procedures using a large sample of patients derived from a Japanese nationwide administrative database. We enrolled 2197 cirrhotic patients who underwent elective (n = 1973) or emergency (n = 224) surgery. We analyzed the risk factors for postoperative mortality and established a scoring system for predicting postoperative mortality in cirrhotic patients using a split-sample method. In-hospital mortality rates following elective or emergency surgery were 4.7% and 20.5%, respectively. In multivariate analysis, patient age, Child-Pugh (CP) class, Charlson Comorbidity Index (CCI), and duration of anesthesia in elective surgery were significantly associated with in-hospital mortality. In emergency surgery, CP class and duration of anesthesia were significant factors. Based on multivariate analysis in the training set (n = 987), the Adequate Operative Treatment for Liver Cirrhosis (ADOPT-LC) score that used patient age, CP class, CCI, and duration of anesthesia to predict in-hospital mortality following elective surgery was developed. This scoring system was validated in the testing set (n = 986) and produced an area under the curve of 0.881. We also developed iOS/Android apps to calculate ADOPT-LC scores to allow easy access to the current evidence in daily clinical practice. Patient age, CP class, CCI, and duration of anesthesia were identified as important risk factors for predicting postoperative mortality in cirrhotic patients. The ADOPT-LC score effectively predicts in-hospital mortality following elective surgery and may assist decisions regarding surgical procedures in cirrhotic patients based on a quantitative risk assessment. © 2016 The Authors Hepatology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Hepatology.

  15. Decrease in mortality rate and hospital admissions for acute myocardial infarction after the enactment of the smoking ban law in São Paulo city, Brazil.

    Science.gov (United States)

    Abe, Tania M O; Scholz, Jaqueline; de Masi, Eduardo; Nobre, Moacyr R C; Filho, Roberto Kalil

    2017-11-01

    Smoking restriction laws have spread worldwide during the last decade. Previous studies have shown a decline in the community rates of myocardial infarction after enactment of these laws. However, data are scarce about the Latin American population. In the first phase of this study, we reported the successful implementation of the law in São Paulo city, with a decrease in carbon monoxide rates in hospitality venues. To evaluate whether the 2009 implementation of a comprehensive smoking ban law in São Paulo city was associated with a reduction in rates of mortality and hospital admissions for myocardial infarction. We performed a time-series study of monthly rates of mortality and hospital admissions for acute myocardial infarction from January 2005 to December 2010. The data were derived from DATASUS, the primary public health information system available in Brazil and from Mortality Information System (SIM). Adjustments and analyses were performed using the Autoregressive Integrated Moving Average with exogenous variables (ARIMAX) method modelled by environmental variables and atmospheric pollutants to evaluate the effect of smoking ban law in mortality and hospital admission rate. We also used Interrupted Time Series Analysis (ITSA) to make a comparison between the period pre and post smoking ban law. We observed a reduction in mortality rate (-11.9% in the first 17 months after the law) and in hospital admission rate (-5.4% in the first 3 months after the law) for myocardial infarction after the implementation of the smoking ban law. Hospital admissions and mortality rate for myocardial infarction were reduced in the first months after the comprehensive smoking ban law was implemented. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  16. Clinical characteristics, angiographic profile and in hospital mortality in acute coronary syndrome patients in south indian population

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    Rajni Sharma

    2014-01-01

    Full Text Available Aims: The aim was to study the clinical profile, risk factors prevalence, angiographic distribution, and severity of coronary artery stenosis in acute coronary syndrome (ACS patients of South Indian population. Materials and Methods: A total of 1562 patients of ACS were analyzed for various risk factors, angiographic pattern and severity of coronary heart disease, complications and in hospital mortality at Sri Jayadeva Institute of Cardiovascular Research and Sciences, Bengaluru, Karnataka, India. Results: Mean age of presentation was 54.71 ± 19.90 years. Majority were male 1242 (79.5% and rest were females. Most patients had ST elevation myocardial infarction (STEMI 995 (63.7% followed by unstable angina (UA 390 (25% and non-STEMI (NSTEMI 177 (11.3%. Risk factors; smoking was present in 770 (49.3%, hypertension in 628 (40.2%, diabetes in 578 (37%, and obesity in (29.64% patients. Angiography was done in 1443 (92.38% patients. left anterior descending was most commonly involved, left main (LM coronary artery was least common with near similar frequency of right coronary artery and left circumflex involvement among all three groups of ACS patients. Single-vessel disease was present in 168 (45.28% UA, 94 (56.29% NSTEMI and 468 (51.71% STEMI patients. Double-vessel disease was present in 67 (18.08% UA, 25 (14.97% NSTEMI and 172 (19.01% STEMI patients. Triple vessel disease was present in 28 (7.55% UA, 16 (9.58% NSTEMI, 72 (7.95% STEMI patients. LM disease was present in 12 (3.23% UA, 2 (1.19% NSTEMI and 9 (0.99% STEMI patients. Complications; ventricular septal rupture occurred in 3 (0.2%, free wall rupture in 2 (0.1%, cardiogenic shock in 45 (2.9%, severe mitral regurgitation in 3 (0.2%, complete heart block in 11 (0.7% patients. Total 124 (7.9% patients died in hospital after 2.1 ± 1.85 days of admission. Conclusion: STEMI was most common presentation. ACS occurred a decade earlier in comparison to Western population. Smoking was most prevalent

  17. Deferoxamine compensates for decreases in B cell counts and reduces mortality in enterovirus 71-infected mice.

    Science.gov (United States)

    Yang, Yajun; Ma, Jing; Xiu, Jinghui; Bai, Lin; Guan, Feifei; Zhang, Li; Liu, Jiangning; Zhang, Lianfeng

    2014-07-07

    Enterovirus 71 is one of the major causative agents of hand, foot and mouth disease in children under six years of age. No vaccine or antiviral therapy is currently available. In this work, we found that the number of B cells was reduced in enterovirus 71-infected mice. Deferoxamine, a marine microbial natural product, compensated for the decreased levels of B cells caused by enterovirus 71 infection. The neutralizing antibody titer was also improved after deferoxamine treatment. Furthermore, deferoxamine relieved symptoms and reduced mortality and muscle damage caused by enterovirus 71 infection. This work suggested that deferoxamine has the potential for further development as a B cell-immunomodulator against enterovirus 71.

  18. Effects of comprehensive stroke care capabilities on in-hospital mortality of patients with ischemic and hemorrhagic stroke: J-ASPECT study.

    Science.gov (United States)

    Iihara, Koji; Nishimura, Kunihiro; Kada, Akiko; Nakagawara, Jyoji; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Aruga, Toru; Miyachi, Shigeru; Nagata, Izumi; Toyoda, Kazunori; Matsuda, Shinya; Miyamoto, Yoshihiro; Suzuki, Akifumi; Ishikawa, Koichi B; Kataoka, Hiroharu; Nakamura, Fumiaki; Kamitani, Satoru

    2014-01-01

    The effectiveness of comprehensive stroke center (CSC) capabilities on stroke mortality remains uncertain. We performed a nationwide study to examine whether CSC capabilities influenced in-hospital mortality of patients with ischemic and hemorrhagic stroke. Of the 1,369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding CSC capabilities that queried the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs. Among the institutions that responded, data on patients hospitalized for stroke between April 1, 2010 and March 31, 2011 were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, comorbidities, and the number of fulfilled CSC items in each component and in total. Data from 265 institutions and 53,170 emergency-hospitalized patients were analyzed. Mortality rates were 7.8% for patients with ischemic stroke, 16.8% for patients with intracerebral hemorrhage (ICH), and 28.1% for patients with subarachnoid hemorrhage (SAH). Mortality adjusted for age, sex, and level of consciousness was significantly correlated with personnel, infrastructural, educational, and total CSC scores in patients with ischemic stroke. Mortality was significantly correlated with diagnostic, educational, and total CSC scores in patients with ICH and with specific expertise, infrastructural, educational, and total CSC scores in patients with SAH. CSC capabilities were associated with reduced in-hospital mortality rates, and relevant aspects of care were found to be dependent on stroke type.

  19. Impact of type 2 diabetes mellitus on in-hospital-mortality after major cardiovascular events in Spain (2002-2014).

    Science.gov (United States)

    de Miguel-Yanes, José M; Jiménez-García, Rodrigo; Hernández-Barrera, Valentín; Méndez-Bailón, Manuel; de Miguel-Díez, Javier; Lopez-de-Andrés, Ana

    2017-10-10

    Diabetes mellitus has long been associated with cardiovascular events. Nevertheless, the higher burden of traditional cardiovascular risk factors reported in high-income countries is offset by a more widespread use of preventive measures and revascularization or other invasive procedures. The aim of this investigation is to describe trends in number of cases and outcomes, in-hospital mortality (IHM) and length of hospital stay (LHS), of hospital admissions for major cardiovascular events between type 2 diabetes (T2DM) and matched non-diabetes patients. Retrospective study using National Hospital Discharge Database, analyzed in 4 years 2002, 2006, 2010, 2014, in Spain. We included patients (≥ 40 years old) with a primary diagnosis of myocardial infarction, ischemic and hemorrhagic stroke, aortic aneurysm and dissection and acute lower limb ischemia in people with T2DM. Cases were matched with controls (without T2DM) by ICD-9-CM codes, sex, age, province of residence and year. We selected 130,011 matched couples (50,427 with myocardial infarction, 60,236 with stroke, 2599 with aortic aneurysm and dissection and 16,749 with acute lower limb ischemia. Among T2DM patients we found increasing numbers of admissions overtime for stroke (10,794 in 2002 vs 17,559 in 2014), aortic aneurysm and dissection (390 vs 841) and acute lower limb ischemia (3854 vs. 4548). People were progressively older (except for myocardial infarction), had more comorbidities (especially T2DM patients), and were more frequently coded overtime for cardiovascular risk factors (smoking, obesity, hypertension, lipid disorders) and renal diseases. LHS and IHM declined overtime, though IHM only did it significantly in T2DM patients. Multivariable adjustment showed that T2DM patients had a significantly 15% higher mortality rate during admission for myocardial infarction, a 6% higher mortality for stroke, and a 6% higher mortality rate for "all cardiovascular events combined", than non

  20. Risk factors associated with in-hospital mortality in elderly patients admitted to a regional trauma center after sustaining a fall.

    Science.gov (United States)

    Cartagena, L J; Kang, A; Munnangi, S; Jordan, A; Nweze, I C; Sasthakonar, V; Boutin, A; George Angus, L D

    2017-06-01

    Falls are a significant cause of mortality in the elderly patients. Despite this, the literature on in-hospital mortality related to elderly falls remains sparse. Our study aims to determine the risk factors associated with in-hospital mortality in elderly patients admitted to a regional trauma center after sustaining a fall. All elderly case records with fall-related injuries between 2003 and 2013 were retrospectively analyzed for demographic characteristics, injury severities, comorbidity factors and clinical outcomes. Logistic regression analysis was used to examine the risk factors associated with in-hospital mortality. In total, 1026 elderly patients with fall-related injuries were included in the study. The average age of patients was 80.94 ± 8.16 years. Seventy seven percent of the patients had at least one comorbid condition. Majority of the falls occurred at home. More than half of the patients fell from ground level. Overall, the in-hospital mortality rate was 16 %. Head injury constituted the most common injury sustained in patients who died (77 %). In addition to age, ISS, GCS, ICU admission and anemia were significantly (P fall patients. Ground-level falls in the elderly can be devastating and carry a significant mortality rate. Elderly patients with anemia were two times more likely to die in the hospital after sustaining a fall in our study population. Increased focus on anemia which is often underappreciated in elderly fall patients can be beneficial in improving outcomes and reducing in-hospital mortality.

  1. Trends in stroke hospitalisation rates and in-hospital mortality in Aragon, 1998-2010.

    Science.gov (United States)

    Giménez-Muñoz, A; Ara, J R; Abad Díez, J M; Campello Morer, I; Pérez Trullén, J M

    2018-05-01

    Despite the impact of cerebrovascular disease (CVD) on global health, its morbidity and time trends in Spain are not precisely known. The purpose of our study was to characterise the epidemiology and trends pertaining to stroke in Aragon over the period 1998-2010. We conducted a retrospective, descriptive study using the data of the Spanish health system's Minimum Data Set and included all stroke patients admitted to acute care hospitals in Aragon between 1 January 1998 and 31 December 2010. We present data globally and broken down by stroke subtype, sex, and age group. The number of cases increased by 13% whereas age- and sex-adjusted hospitalisation rates showed a significant decrease for all types of stroke (mean annual decrease of 1.6%). Men and women in younger age groups showed opposite trends in hospitalisation rates for ischaemic stroke. Case fatality rate at 28 days (17.9%) was higher in patients with intracerebral haemorrhage (35.8%) than in those with subarachnoid haemorrhage (26.2%) or ischaemic stroke (13%). CVD case fatality showed a mean annual decline of 2.8%, at the expense of the fatality rate of ischaemic stroke, and it was more pronounced in men than in women. Understanding stroke epidemiology and trends at the regional level will help establish an efficient monitoring system and design appropriate strategies for health planning. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Pre-resuscitation factors associated with mortality in 49,130 cases of in-hospital cardiac arrest: a report from the National Registry for Cardiopulmonary Resuscitation.

    Science.gov (United States)

    Larkin, Gregory Luke; Copes, Wayne S; Nathanson, Brian H; Kaye, William

    2010-03-01

    To evaluate key pre-arrest factors and their collective ability to predict post-cardiopulmonary arrest mortality. CPR is often initiated indiscriminately after in-hospital cardiopulmonary arrest. Improved understanding of pre-arrest factors associated with mortality may inform advance care planning. A cohort of 49,130 adults who experienced pulseless cardiopulmonary arrest from January 2000 to September 2004 was obtained from 366 US hospitals participating in the National Registry for Cardiopulmonary Resuscitation (NRCPR). Logistic regression with bootstrapping was used to model in-hospital mortality, which included those discharged in unfavorable and severely worsened neurologic state (Cerebral Performance Category >/=3). Overall in-hospital mortality was 84.1%. Advanced age, black race, non-cardiac, non-surgical illness category, pre-existing malignancy, acute stroke, trauma, septicemia, hepatic insufficiency, general floor or Emergency Department location, and pre-arrest use of vasopressors or assisted/mechanical ventilation were independently predictive of in-hospital mortality. Retained peri-arrest factors including cardiac monitoring, and shockable initial pulseless rhythms, were strongly associated with survival. The validation model's AUROC curve (0.77) revealed fair performance. Predictive pre-resuscitation factors may supplement patient-specific information available at bedside to assist in revising resuscitation plans during the patient's hospitalization. Copyright 2009. Published by Elsevier Ireland Ltd.

  3. Decreases in Smoking-Related Cancer Mortality Rates Are Associated with Birth Cohort Effects in Korean Men.

    Science.gov (United States)

    Jee, Yon Ho; Shin, Aesun; Lee, Jong-Keun; Oh, Chang-Mo

    2016-12-05

    Background: This study aimed to examine trends in smoking-related cancer mortality rates and to investigate the effect birth cohort on smoking-related cancer mortality in Korean men. Methods: The number of smoking-related cancer deaths and corresponding population numbers were obtained from Statistics Korea for the period 1984-2013. Joinpoint regression analysis was used to detect changes in trends in age-standardized mortality rates. Birth-cohort specific mortality rates were illustrated by 5 year age groups. Results: The age-standardized mortality rates for oropharyngeal decreased from 2003 to 2013 (annual percent change (APC): -3.1 (95% CI, -4.6 to -1.6)) and lung cancers decreased from 2002 to 2013 (APC -2.4 (95% CI -2.7 to -2.2)). The mortality rates for esophageal declined from 1994 to 2002 (APC -2.5 (95% CI -4.1 to -0.8)) and from 2002 to 2013 (APC -5.2 (95% CI -5.7 to -4.7)) and laryngeal cancer declined from 1995 to 2013 (average annual percent change (AAPC): -3.3 (95% CI -4.7 to -1.8)). By the age group, the trends for the smoking-related cancer mortality except for oropharyngeal cancer have changed earlier to decrease in the younger age group. The birth-cohort specific mortality rates and age-period-cohort analysis consistently showed that all birth cohorts born after 1930 showed reduced mortality of smoking-related cancers. Conclusions: In Korean men, smoking-related cancer mortality rates have decreased. Our findings also indicate that current decreases in smoking-related cancer mortality rates have mainly been due to a decrease in the birth cohort effect, which suggest that decrease in smoking rates.

  4. Decreases in Smoking-Related Cancer Mortality Rates Are Associated with Birth Cohort Effects in Korean Men

    Directory of Open Access Journals (Sweden)

    Yon Ho Jee

    2016-12-01

    Full Text Available Background: This study aimed to examine trends in smoking-related cancer mortality rates and to investigate the effect birth cohort on smoking-related cancer mortality in Korean men. Methods: The number of smoking-related cancer deaths and corresponding population numbers were obtained from Statistics Korea for the period 1984–2013. Joinpoint regression analysis was used to detect changes in trends in age-standardized mortality rates. Birth-cohort specific mortality rates were illustrated by 5 year age groups. Results: The age-standardized mortality rates for oropharyngeal decreased from 2003 to 2013 (annual percent change (APC: −3.1 (95% CI, −4.6 to −1.6 and lung cancers decreased from 2002 to 2013 (APC −2.4 (95% CI −2.7 to −2.2. The mortality rates for esophageal declined from 1994 to 2002 (APC −2.5 (95% CI −4.1 to −0.8 and from 2002 to 2013 (APC −5.2 (95% CI −5.7 to −4.7 and laryngeal cancer declined from 1995 to 2013 (average annual percent change (AAPC: −3.3 (95% CI −4.7 to −1.8. By the age group, the trends for the smoking-related cancer mortality except for oropharyngeal cancer have changed earlier to decrease in the younger age group. The birth-cohort specific mortality rates and age-period-cohort analysis consistently showed that all birth cohorts born after 1930 showed reduced mortality of smoking-related cancers. Conclusions: In Korean men, smoking-related cancer mortality rates have decreased. Our findings also indicate that current decreases in smoking-related cancer mortality rates have mainly been due to a decrease in the birth cohort effect, which suggest that decrease in smoking rates.

  5. More than clean air and tranquillity: Residential green is independently associated with decreasing mortality.

    Science.gov (United States)

    Vienneau, Danielle; de Hoogh, Kees; Faeh, David; Kaufmann, Marco; Wunderli, Jean Marc; Röösli, Martin

    2017-11-01

    Green space may improve health by enabling physical activity and recovery from stress or by decreased pollution levels. We investigated the association between residential green (greenness or green space) and mortality in adults using the Swiss National Cohort (SNC) by mutually considering air pollution and transportation noise exposure. To reflect residential green at the address level, two different metrics were derived: normalised difference vegetation index (NDVI) for greenness, and high resolution land use classification data to identify green spaces (LU-green). We used stratified Cox proportional hazard models (stratified by sex) to study the association between exposure and all natural cause mortality, respiratory and cardiovascular disease (CVD), including ischemic heart disease, stroke and hypertension related mortality. Models were adjusted for civil status, job position, education, neighbourhood socio-economic position (SEP), geographic region, area type, altitude, air pollution (PM 10 ), and transportation noise. From the nation-wide SNC, 4.2 million adults were included providing 7.8years of follow-up and respectively 363,553, 85,314 and 232,322 natural cause, respiratory and CVD deaths. Hazard ratios (and 95%-confidence intervals) for NDVI [and LU-green] per interquartile range within 500m of residence were highly comparable: 0.94 (0.93-0.95) [0.94 (0.93-0.95)] for natural causes; 0.92 (0.91-0.94) [0.92 (0.90-0.95)] for respiratory; and 0.95 (0.94-0.96) [0.96 (0.95-0.98)] for CVD mortality. Protective effects were stronger in younger individuals and in women and, for most outcomes, in urban (vs. rural) and in the highest (vs. lowest) SEP quartile. Estimates remained virtually unchanged after incremental adjustment for air pollution and transportation noise, and mediation by these environmental factors was found to be small. We found consistent evidence that residential green reduced the risk of mortality independently from other environmental

  6. Development and Evaluation of an Automated Machine Learning Algorithm for In-Hospital Mortality Risk Adjustment Among Critical Care Patients.

    Science.gov (United States)

    Delahanty, Ryan J; Kaufman, David; Jones, Spencer S

    2018-06-01

    Risk adjustment algorithms for ICU mortality are necessary for measuring and improving ICU performance. Existing risk adjustment algorithms are not widely adopted. Key barriers to adoption include licensing and implementation costs as well as labor costs associated with human-intensive data collection. Widespread adoption of electronic health records makes automated risk adjustment feasible. Using modern machine learning methods and open source tools, we developed and evaluated a retrospective risk adjustment algorithm for in-hospital mortality among ICU patients. The Risk of Inpatient Death score can be fully automated and is reliant upon data elements that are generated in the course of usual hospital processes. One hundred thirty-one ICUs in 53 hospitals operated by Tenet Healthcare. A cohort of 237,173 ICU patients discharged between January 2014 and December 2016. The data were randomly split into training (36 hospitals), and validation (17 hospitals) data sets. Feature selection and model training were carried out using the training set while the discrimination, calibration, and accuracy of the model were assessed in the validation data set. Model discrimination was evaluated based on the area under receiver operating characteristic curve; accuracy and calibration were assessed via adjusted Brier scores and visual analysis of calibration curves. Seventeen features, including a mix of clinical and administrative data elements, were retained in the final model. The Risk of Inpatient Death score demonstrated excellent discrimination (area under receiver operating characteristic curve = 0.94) and calibration (adjusted Brier score = 52.8%) in the validation dataset; these results compare favorably to the published performance statistics for the most commonly used mortality risk adjustment algorithms. Low adoption of ICU mortality risk adjustment algorithms impedes progress toward increasing the value of the healthcare delivered in ICUs. The Risk of Inpatient Death

  7. IL-36 receptor deletion attenuates lung injury and decreases mortality in murine influenza pneumonia.

    Science.gov (United States)

    Aoyagi, T; Newstead, M W; Zeng, X; Kunkel, S L; Kaku, M; Standiford, T J

    2017-07-01

    Influenza virus causes a respiratory disease in humans that can progress to lung injury with fatal outcome. The interleukin (IL)-36 cytokines are newly described IL-1 family cytokines that promote inflammatory responses via binding to the IL-36 receptor (IL-36R). The mechanism of expression and the role of IL-36 cytokines are poorly understood. Here, we investigated the role of IL-36 cytokines in modulating the innate inflammatory response during influenza virus-induced pneumonia in mice. The intranasal administration of influenza virus upregulated IL-36α mRNA and protein production in the lungs. In vitro, influenza virus-mediated IL-36α but not IL-36γ is induced and secreted from alveolar epithelial cells (AECs) through both a caspase-1 and caspase-3/7 dependent pathway. IL-36α was detected in microparticles shed from AECs and promoted the production of pro-inflammatory cytokines and chemokines in respiratory cells. IL-36R-deficient mice were protected from influenza virus-induced lung injury and mortality. Decreased mortality was associated with significantly reduced early accumulation of neutrophils and monocytes/macrophages, activation of lymphocytes, production of pro-inflammatory cytokines and chemokines, and permeability of the alveolar-epithelial barrier in despite impaired viral clearance. Taken together, these data indicate that IL-36 ligands exacerbate lung injury during influenza virus infection.

  8. Combination of Evidence-Based Medical Therapy in Acute Phase of Non-ST-Elevation Myocardial Infarction and Reduction of In-Hospital Mortality

    Czech Academy of Sciences Publication Activity Database

    Monhart, Z.; Grünfeldová, H.; Zvárová, Jana; Janský, P.

    2010-01-01

    Roč. 122, č. 2 (2010), e244 ISSN 0009-7322. [World Congress of Cardiology . 16.06.2010-19.06.2010, Beijing] Institutional research plan: CEZ:AV0Z10300504 Keywords : cardioloy * myocardial infarction * in-hospital mortality Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  9. Deferoxamine Compensates for Decreases in B Cell Counts and Reduces Mortality in Enterovirus 71-Infected Mice

    Directory of Open Access Journals (Sweden)

    Yajun Yang

    2014-07-01

    Full Text Available Enterovirus 71 is one of the major causative agents of hand, foot and mouth disease in children under six years of age. No vaccine or antiviral therapy is currently available. In this work, we found that the number of B cells was reduced in enterovirus 71-infected mice. Deferoxamine, a marine microbial natural product, compensated for the decreased levels of B cells caused by enterovirus 71 infection. The neutralizing antibody titer was also improved after deferoxamine treatment. Furthermore, deferoxamine relieved symptoms and reduced mortality and muscle damage caused by enterovirus 71 infection. This work suggested that deferoxamine has the potential for further development as a B cell-immunomodulator against enterovirus 71.

  10. Sex-related differences in the risk factors for in-hospital mortality and outcomes of ischemic stroke patients in rural areas of Taiwan.

    Science.gov (United States)

    Ong, Cheung-Ter; Wong, Yi-Sin; Sung, Sheng-Feng; Wu, Chi-Shun; Hsu, Yung-Chu; Su, Yu-Hsiang; Hung, Ling-Chien

    2017-01-01

    Sex-related differences in the clinical presentation and outcomes of stroke patients are issues that have attracted increased interest from the scientific community. The present study aimed to investigate sex-related differences in the risk factors for in-hospital mortality and outcome in ischemic stroke patients. A total of 4278 acute ischemic stroke patients admitted to a stroke unit between January 1, 2007 and December 31, 2014 were included in the study. We considered demographic characteristics, clinical characteristics, co-morbidities, and complications, among others, as factors that may affect clinical presentation and in-hospital mortality. Good and poor outcomes were defined as modified Ranking Score (mRS)≦2 and mRS>2. Neurological deterioration (ND) was defined as an increase of National Institutes of Health Stroke Score (NIHSS) ≥ 4 points. Hemorrhagic transformation (HT) was defined as signs of hemorrhage in cranial CT or MRI scans. Transtentorial herniation was defined by brain edema, as seen in cranial CT or MRI scans, associated with the onset of acute unilateral or bilateral papillary dilation, loss of reactivity to light, and decline of ≥ 2 points in the Glasgow coma scale score. Of 4278 ischemic stroke patients (women 1757, 41.1%), 269 (6.3%) received thrombolytic therapy. The in hospital mortality rate was 3.35% (139/4278) [4.45% (80/1757) for women and 2.34% (59/2521) for men, p stroke, 56.1% (1813/3231) showed good outcomes [47.4% (629/1328) for women and 62.2% (1184/1903) for men, p stroke history, and old age were factors contributing to poor outcomes in men and women. Hypertension was associated with poor outcomes in women but not in men in comparison with patients without hypertension. Stroke severity and increased intracranial pressure were associated with increased in-hospital mortality in men and women. AF was associated with increased in-hospital mortality in women but not in men compared with patients without AF. The in-hospital

  11. Incidence, hospital costs and in-hospital mortality rates of surgically treated patients with traumatic cranial epidural hematoma

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    Atci Ibrahim Burak

    2017-12-01

    Full Text Available Background: In this study, the patients who were operated in two clinics due to traumatic cranial epidural hematoma (EDH were assessed retrospectively and the factors that increase the costs were tried to be revealed through conducting cost analyses. Methods: The patients who were operated between 2010 and 2016 with the diagnosis of EDH were assessed in terms of age, sex, trauma etiology, Glasgow coma scale (GCS at admission, the period from trauma to hospital arrival, trauma-related injury in other organs, the localization of hematoma, the size of hematoma, length of stay in the intensive care unit (ICU, length of antibiotherapy administration, number of consultations conducted, total cost of in-hospital treatments of the patients and prognosis. Results: Distribution of GCS were, between 13-15 in 18 (36% patients, 9-13 in 23 (46% patients and 3-8 in 9 (18% patients. The reasons for emergency department admissions were fall from high in 29 (58% patients, assault in 11 (22% patients and motor vehicle accident in 10 (20% patients. The average cost per ICU stay was 2838 $ (range=343-20571 $. The average cost per surgical treatment was 314 $. ICU care was approximately 9 times more expensive than surgical treatment costs. The mortality rate of the study cohort was 14% (7 patients. Conclusion: The prolonged period of stay in the ICU, antibiotherapy and repeat head CTs increase the costs for patients who are surgically treated for EDH.

  12. The administration of dextrose during in-hospital cardiac arrest is associated with increased mortality and neurologic morbidity.

    Science.gov (United States)

    Peng, Teng J; Andersen, Lars W; Saindon, Brian Z; Giberson, Tyler A; Kim, Won Young; Berg, Katherine; Novack, Victor; Donnino, Michael W

    2015-04-10

    Dextrose may be used during cardiac arrest resuscitation to prevent or reverse hypoglycemia. However, the incidence of dextrose administration during cardiac arrest and the association of dextrose administration with survival and other outcomes are unknown. We used the Get With The Guidelines®-Resuscitation national registry to identify adult patients with an in-hospital cardiac arrest between the years 2000 and 2010. To assess the adjusted effects of dextrose administration on survival, we used multivariable regression models with adjustment for multiple patient, event, and hospital characteristics. We performed additional analyses to examine the effects of dextrose on neurological outcome and return of spontaneous circulation. Among the 100,029 patients included in our study, 4,189 (4.2%) received dextrose during cardiac arrest resuscitation. The rate of dextrose administration increased during the study period (odds ratio 1.11, 95% confidence interval (CI) 1.09-1.12 per year, P dextrose during resuscitation had lower rates of survival compared with patients who did not receive dextrose (relative risk 0.88, 95% CI 0.80-0.98, P = 0.02). Administration of dextrose was associated with worse neurological outcome (relative risk 0.88, 95% CI 0.79-0.99, P = 0.03) but an increased chance of return of spontaneous circulation (relative risk 1.07, 95% CI 1.04-1.10, P dextrose during resuscitation in patients with in-hospital cardiac arrest was found to be associated with a significantly decreased chance of survival and a decreased chance of good neurological outcome.

  13. High dietary fiber intake is associated with decreased inflammation and all-cause mortality in patients with chronic kidney disease

    OpenAIRE

    Raj Krishnamurthy, Vidya M.; Wei, Guo; Baird, Bradley C.; Murtaugh, Maureen; Chonchol, Michel B.; Raphael, Kalani L.; Greene, Tom; Beddhu, Srinivasan

    2011-01-01

    Chronic kidney disease is considered an inflammatory state and a high fiber intake is associated with decreased inflammation in the general population. Here, we determined whether fiber intake is associated with decreased inflammation and mortality in chronic kidney disease, and whether kidney disease modifies the associations of fiber intake with inflammation and mortality. To do this, we analyzed data from 14,543 participants in the National Health and Nutrition Examination Survey III. The ...

  14. Can volunteer community health workers decrease child morbidity and mortality in southwestern Uganda? An impact evaluation.

    Directory of Open Access Journals (Sweden)

    Jennifer L Brenner

    Full Text Available BACKGROUND: The potential for community health workers to improve child health in sub-Saharan Africa is not well understood. Healthy Child Uganda implemented a volunteer community health worker child health promotion model in rural Uganda. An impact evaluation was conducted to assess volunteer community health workers' effect on child morbidity, mortality and to calculate volunteer retention. METHODOLOGY/PRINCIPAL FINDINGS: Two volunteer community health workers were selected, trained and promoted child health in each of 116 villages (population ∼61,000 during 2006-2009. Evaluation included a household survey of mothers at baseline and post-intervention in intervention/control areas, retrospective reviews of community health worker birth/child death reports and post-intervention focus group discussions. Retention was calculated from administrative records. Main outcomes were prevalence of recent child illness/underweight status, community health worker reports of child deaths, focus group perception of effect, and community health worker retention. After 18-36 months, 86% of trained volunteers remained active. Post-intervention surveys in intervention households revealed absolute reductions of 10.2% [95%CI (-17.7%, -2.6%] in diarrhea prevalence and 5.8% [95%CI (-11.5%, -0.003%] in fever/malaria; comparative decreases in control households were not statistically significant. Underweight prevalence was reduced by 5.1% [95%CI (-10.7%, 0.4%] in intervention households. Community health worker monthly reports revealed a relative decline of 53% in child deaths (<5 years old, during the first 18 months of intervention. Focus groups credited community health workers with decreasing child deaths, improved care-seeking practices, and new income-generating opportunities. CONCLUSIONS/SIGNIFICANCE: A low-cost child health promotion model using volunteer community health workers demonstrated decreased child morbidity, dramatic mortality trend declines and

  15. Designated Stroke Center Status and Hospital Characteristics as Predictors of In-Hospital Mortality among Hemorrhagic Stroke Patients in New York, 2008-2012.

    Science.gov (United States)

    Gatollari, Hajere J; Colello, Anna; Eisenberg, Bonnie; Brissette, Ian; Luna, Jorge; Elkind, Mitchell S V; Willey, Joshua Z

    2017-01-01

    Although designated stroke centers (DSCs) improve the quality of care and clinical outcomes for ischemic stroke patients, less is known about the benefits of DSCs for patients with intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Compared to non-DSCs, hospitals with the DSC status have lower in-hospital mortality rates for hemorrhagic stroke patients. We believed these effects would sustain over a period of time after adjusting for hospital-level characteristics, including hospital size, urban location, and teaching status. We evaluated ICH (International Classification of Diseases, Ninth Revision; ICD-9: 431) and SAH (ICD-9: 430) hospitalizations documented in the 2008-2012 New York State Department of Health Statewide Planning and Research Cooperative System inpatient sample database. Generalized estimating equation logistic regression was used to evaluate the association between DSC status and in-hospital mortality. We calculated ORs and 95% CIs adjusted for clustering of patients within facilities, other hospital characteristics, and individual level characteristics. Planned secondary analyses explored other hospital characteristics associated with in-hospital mortality. In 6,352 ICH and 3,369 SAH patients in the study sample, in-hospital mortality was higher among those with ICH compared to SAH (23.7 vs. 18.5%). Unadjusted analyses revealed that DSC status was related with reduced mortality for both ICH (OR 0.7, 95% CI 0.5-0.8) and SAH patients (OR 0.4, 95% CI 0.3-0.7). DSC remained a significant predictor of lower in-hospital mortality for SAH patients (OR 0.6, 95% CI 0.3-0.9) but not for ICH patients (OR 0.8, 95% CI 0.6-1.0) after adjusting for patient demographic characteristics, comorbidities, hospital size, teaching status and location. Admission to a DSC was independently associated with reduced in-hospital mortality for SAH patients but not for those with ICH. Other patient and hospital characteristics may explain the benefits of DSC

  16. Does diabetes mellitus comorbidity affect in-hospital mortality and length of stay? Analysis of administrative data in an Italian Academic Hospital.

    Science.gov (United States)

    Valent, Francesca; Tonutti, Laura; Grimaldi, Franco

    2017-12-01

    Hospitalized patients with comorbid diabetes mellitus may have worse outcomes than the others. We conducted a study to assess whether comorbid diabetes affects in-hospital mortality and length of stay. For this population-based study, we analyzed the administrative databases of the Regional Health Information System of the Region Friuli Venezia Giulia, where the Hospital of Udine is located. Hospital discharge data were linked at the individual patient level with the regional Diabetes Mellitus Registry to identify diabetic patients. For each 3-digit ICD-9-CM discharge diagnosis code, we assessed the difference in length of stay and in-hospital mortality between diabetic and non-diabetic patients. We conducted both univariate and multivariate analyses, adjusted for age, sex, Charlson's comorbidity score, and urgency of hospitalization, through linear and logistic regression models. After adjusting for potential confounders, diabetes significantly increased the risk of in-hospital death among patients hospitalized for bacterial pneumonia (OR = 1.94) and intestinal obstruction (OR = 4.23) and length of stay among those admitted for several diagnoses, including acute myocardial infarction and acute renal failure. Admission glucose blood level was associated with in-hospital death in patients with pneumonia and intestinal obstruction, and increased length of stay for several conditions. Patients with diabetes mellitus who are hospitalized for other health problems may have increased risk of in-hospital death and longer hospital stay. For this reason, diabetes should be promptly recognized upon admission and properly managed.

  17. Effects of Comprehensive Stroke Care Capabilities on In-Hospital Mortality of Patients with Ischemic and Hemorrhagic Stroke: J-ASPECT Study

    Science.gov (United States)

    Iihara, Koji; Nishimura, Kunihiro; Kada, Akiko; Nakagawara, Jyoji; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Aruga, Toru; Miyachi, Shigeru; Nagata, Izumi; Toyoda, Kazunori; Matsuda, Shinya; Miyamoto, Yoshihiro; Suzuki, Akifumi; Ishikawa, Koichi B.; Kataoka, Hiroharu; Nakamura, Fumiaki; Kamitani, Satoru

    2014-01-01

    Background The effectiveness of comprehensive stroke center (CSC) capabilities on stroke mortality remains uncertain. We performed a nationwide study to examine whether CSC capabilities influenced in-hospital mortality of patients with ischemic and hemorrhagic stroke. Methods and Results Of the 1,369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding CSC capabilities that queried the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs. Among the institutions that responded, data on patients hospitalized for stroke between April 1, 2010 and March 31, 2011 were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, comorbidities, and the number of fulfilled CSC items in each component and in total. Data from 265 institutions and 53,170 emergency-hospitalized patients were analyzed. Mortality rates were 7.8% for patients with ischemic stroke, 16.8% for patients with intracerebral hemorrhage (ICH), and 28.1% for patients with subarachnoid hemorrhage (SAH). Mortality adjusted for age, sex, and level of consciousness was significantly correlated with personnel, infrastructural, educational, and total CSC scores in patients with ischemic stroke. Mortality was significantly correlated with diagnostic, educational, and total CSC scores in patients with ICH and with specific expertise, infrastructural, educational, and total CSC scores in patients with SAH. Conclusions CSC capabilities were associated with reduced in-hospital mortality rates, and relevant aspects of care were found to be dependent on stroke type. PMID:24828409

  18. Effects of comprehensive stroke care capabilities on in-hospital mortality of patients with ischemic and hemorrhagic stroke: J-ASPECT study.

    Directory of Open Access Journals (Sweden)

    Koji Iihara

    Full Text Available BACKGROUND: The effectiveness of comprehensive stroke center (CSC capabilities on stroke mortality remains uncertain. We performed a nationwide study to examine whether CSC capabilities influenced in-hospital mortality of patients with ischemic and hemorrhagic stroke. METHODS AND RESULTS: Of the 1,369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding CSC capabilities that queried the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs. Among the institutions that responded, data on patients hospitalized for stroke between April 1, 2010 and March 31, 2011 were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, comorbidities, and the number of fulfilled CSC items in each component and in total. Data from 265 institutions and 53,170 emergency-hospitalized patients were analyzed. Mortality rates were 7.8% for patients with ischemic stroke, 16.8% for patients with intracerebral hemorrhage (ICH, and 28.1% for patients with subarachnoid hemorrhage (SAH. Mortality adjusted for age, sex, and level of consciousness was significantly correlated with personnel, infrastructural, educational, and total CSC scores in patients with ischemic stroke. Mortality was significantly correlated with diagnostic, educational, and total CSC scores in patients with ICH and with specific expertise, infrastructural, educational, and total CSC scores in patients with SAH. CONCLUSIONS: CSC capabilities were associated with reduced in-hospital mortality rates, and relevant aspects of care were found to be dependent on stroke type.

  19. High dietary fiber intake is associated with decreased inflammation and all-cause mortality in patients with chronic kidney disease.

    Science.gov (United States)

    Krishnamurthy, Vidya M Raj; Wei, Guo; Baird, Bradley C; Murtaugh, Maureen; Chonchol, Michel B; Raphael, Kalani L; Greene, Tom; Beddhu, Srinivasan

    2012-02-01

    Chronic kidney disease is considered an inflammatory state and a high fiber intake is associated with decreased inflammation in the general population. Here, we determined whether fiber intake is associated with decreased inflammation and mortality in chronic kidney disease, and whether kidney disease modifies the associations of fiber intake with inflammation and mortality. To do this, we analyzed data from 14,543 participants in the National Health and Nutrition Examination Survey III. The prevalence of chronic kidney disease (estimated glomerular filtration rate less than 60 ml/min per 1.73 m(2)) was 5.8%. For each 10-g/day increase in total fiber intake, the odds of elevated serum C-reactive protein levels were decreased by 11% and 38% in those without and with kidney disease, respectively. Dietary total fiber intake was not significantly associated with mortality in those without but was inversely related to mortality in those with kidney disease. The relationship of total fiber with inflammation and mortality differed significantly in those with and without kidney disease. Thus, high dietary total fiber intake is associated with lower risk of inflammation and mortality in kidney disease and these associations are stronger in magnitude in those with kidney disease. Interventional trials are needed to establish the effects of fiber intake on inflammation and mortality in kidney disease.

  20. The derivation and validation of a simple model for predicting in-hospital mortality of acutely admitted patients to internal medicine wards.

    Science.gov (United States)

    Sakhnini, Ali; Saliba, Walid; Schwartz, Naama; Bisharat, Naiel

    2017-06-01

    Limited information is available about clinical predictors of in-hospital mortality in acute unselected medical admissions. Such information could assist medical decision-making.To develop a clinical model for predicting in-hospital mortality in unselected acute medical admissions and to test the impact of secondary conditions on hospital mortality.This is an analysis of the medical records of patients admitted to internal medicine wards at one university-affiliated hospital. Data obtained from the years 2013 to 2014 were used as a derivation dataset for creating a prediction model, while data from 2015 was used as a validation dataset to test the performance of the model. For each admission, a set of clinical and epidemiological variables was obtained. The main diagnosis at hospitalization was recorded, and all additional or secondary conditions that coexisted at hospital admission or that developed during hospital stay were considered secondary conditions.The derivation and validation datasets included 7268 and 7843 patients, respectively. The in-hospital mortality rate averaged 7.2%. The following variables entered the final model; age, body mass index, mean arterial pressure on admission, prior admission within 3 months, background morbidity of heart failure and active malignancy, and chronic use of statins and antiplatelet agents. The c-statistic (ROC-AUC) of the prediction model was 80.5% without adjustment for main or secondary conditions, 84.5%, with adjustment for the main diagnosis, and 89.5% with adjustment for the main diagnosis and secondary conditions. The accuracy of the predictive model reached 81% on the validation dataset.A prediction model based on clinical data with adjustment for secondary conditions exhibited a high degree of prediction accuracy. We provide a proof of concept that there is an added value for incorporating secondary conditions while predicting probabilities of in-hospital mortality. Further improvement of the model performance

  1. Decreasing perinatal mortality in the Netherlands, 2000-2006: a record linkage study

    OpenAIRE

    Ravelli , Anita C J; Tromp , Miranda; Van Huis , Marian M; Steegers , Eric A P; Tamminga , Pieter; Eskes , Martine; Bonsel , Gouke J

    2009-01-01

    Abstract Background: The European PERISTAT-1 study showed that in 1999 perinatal mortality, especially fetal mortality, was substantially higher in the Netherlands when compared to other European countries. The aim of this study was to analyze the recent trend in Dutch perinatal mortality and the influence of risk factors. Methods: A nationwide retrospective cohort study of 1,246,440 singleton births in 2000-2006 in the Netherlands. The source data were available fro...

  2. Timing of surgery for hip fracture and in-hospital mortality: a retrospective population-based cohort study in the Spanish National Health System

    Directory of Open Access Journals (Sweden)

    Librero Julián

    2012-01-01

    Full Text Available Abstract Background While the benefits or otherwise of early hip fracture repair is a long-running controversy with studies showing contradictory results, this practice is being adopted as a quality indicator in several health care organizations. The aim of this study is to analyze the association between early hip fracture repair and in-hospital mortality in elderly people attending public hospitals in the Spanish National Health System and, additionally, to explore factors associated with the decision to perform early hip fracture repair. Methods A cohort of 56,500 patients of 60-years-old and over, hospitalized for hip fracture during the period 2002 to 2005 in all the public hospitals in 8 Spanish regions, were followed up using administrative databases to identify the time to surgical repair and in-hospital mortality. We used a multivariate logistic regression model to analyze the relationship between the timing of surgery ( Results Early surgery was performed on 25% of the patients. In the unadjusted analysis early surgery showed an absolute difference in risk of mortality of 0.57 (from 4.42% to 3.85%. However, patients undergoing delayed surgery were older and had higher comorbidity and severity of illness. Timeliness for surgery was not found to be related to in-hospital mortality once confounding factors such as age, sex, chronic comorbidities as well as the severity of illness were controlled for in the multivariate analysis. Conclusions Older age, male gender, higher chronic comorbidity and higher severity measured by the Risk Mortality Index were associated with higher mortality, but the time to surgery was not.

  3. Delayed endovascular aortic repair is associated with reduced in-hospital mortality in patients with blunt thoracic aortic injury.

    Science.gov (United States)

    Marcaccio, Christina L; Dumas, Ryan P; Huang, Yanlan; Yang, Wei; Wang, Grace J; Holena, Daniel N

    2018-02-13

    The traditional approach to stable blunt thoracic aortic injury (BTAI) endorsed by the Society for Vascular Surgery is early (<24 hours) thoracic endovascular aortic repair (TEVAR). Recently, some studies have shown improved mortality in stable BTAI patients repaired in a delayed manner (≥24 hours). However, the indications for use of delayed TEVAR for BTAI are not well characterized, and its overall impact on the patient's survival remains poorly understood. We sought to determine whether delayed TEVAR is associated with a decrease in mortality compared with early TEVAR in this population. We conducted a retrospective cohort study of adult patients with BTAI (International Classification of Diseases, Ninth Revision diagnosis code 901.0) who underwent TEVAR (International Classification of Diseases, Ninth Revision procedure code 39.73) from 2009 to 2013 using the National Sample Program data set. Missing physiologic data were imputed using chained multiple imputation. Patients were parsed into groups based on the timing of TEVAR (early, <24 hours, vs delayed, ≥24 hours). The χ 2 , Mann-Whitney, and Fisher exact tests were used to compare baseline characteristics and outcomes of interest between groups. Multivariable logistic regression for mortality was performed that included all variables significant at P ≤ .2 in univariate analyses. A total of 2045 adult patients with BTAI were identified, of whom 534 (26%) underwent TEVAR. Patients with missing data on TEVAR timing were excluded (n = 27), leaving a total of 507 patients for analysis (75% male; 69% white; median age, 40 years [interquartile range, 27-56 years]; median Injury Severity Score [ISS], 34 [interquartile range, 26-41]). Of these, 378 patients underwent early TEVAR and 129 underwent delayed TEVAR. The two groups were similar with regard to age, sex, race, ISS, and presenting physiology. Mortality was 11.9% in the early TEVAR group vs 5.4% in the delayed group, with the early group

  4. Decreasing systolic blood pressure and declining mortality rates in an untreated population

    DEFF Research Database (Denmark)

    Andersen, Ulla O; Marott, Jacob L; Jensen, Gorm B

    2011-01-01

    The aim of the present study was to evaluate developments in 30 years mortality risk that may be associated with developments in population systolic blood pressure (SBP) and to evaluate possible secular trends in BP-associated mortality risk in the untreated population....

  5. External validation of a multivariable claims-based rule for predicting in-hospital mortality and 30-day post-pulmonary embolism complications

    Directory of Open Access Journals (Sweden)

    Craig I. Coleman

    2016-10-01

    Full Text Available Abstract Background Low-risk pulmonary embolism (PE patients may be candidates for outpatient treatment or abbreviated hospital stay. There is a need for a claims-based prediction rule that payers/hospitals can use to risk stratify PE patients. We sought to validate the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT prediction rule for in-hospital and 30-day outcomes. Methods We used the Optum Research Database from 1/2008-3/2015 and included adults hospitalized for PE (415.1x in the primary position or secondary position when accompanied by a primary code for a PE complication and having continuous medical and prescription coverage for ≥6-months prior and 3-months post-inclusion or until death. In-hospital and 30-day mortality and 30-day complications (recurrent venous thromboembolism, rehospitalization or death were assessed and prognostic accuracies of IMPACT with 95 % confidence intervals (CIs were calculated. Results In total, 47,531 PE patients were included. In-hospital and 30-day mortality occurred in 7.9 and 9.4 % of patients and 20.8 % experienced any complication within 30-days. Of the 19.5 % of patients classified as low-risk by IMPACT, 2.0 % died in-hospital, resulting in a sensitivity and specificity of 95.2 % (95 % CI, 94.4–95.8 and 20.7 % (95 % CI, 20.4–21.1. Only 1 additional low-risk patient died within 30-days of admission and 12.2 % experienced a complication, translating into a sensitivity and specificity of 95.9 % (95 % CI, 95.3–96.5 and 21.1 % (95 % CI, 20.7–21.5 for mortality and 88.5 % (95 % CI, 87.9–89.2 and 21.6 % (95 % CI, 21.2–22.0 for any complication. Conclusion IMPACT had acceptable sensitivity for predicting in-hospital and 30-day mortality or complications and may be valuable for retrospective risk stratification of PE patients.

  6. External validation of a multivariable claims-based rule for predicting in-hospital mortality and 30-day post-pulmonary embolism complications.

    Science.gov (United States)

    Coleman, Craig I; Peacock, W Frank; Fermann, Gregory J; Crivera, Concetta; Weeda, Erin R; Hull, Michael; DuCharme, Mary; Becker, Laura; Schein, Jeff R

    2016-10-22

    Low-risk pulmonary embolism (PE) patients may be candidates for outpatient treatment or abbreviated hospital stay. There is a need for a claims-based prediction rule that payers/hospitals can use to risk stratify PE patients. We sought to validate the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) prediction rule for in-hospital and 30-day outcomes. We used the Optum Research Database from 1/2008-3/2015 and included adults hospitalized for PE (415.1x in the primary position or secondary position when accompanied by a primary code for a PE complication) and having continuous medical and prescription coverage for ≥6-months prior and 3-months post-inclusion or until death. In-hospital and 30-day mortality and 30-day complications (recurrent venous thromboembolism, rehospitalization or death) were assessed and prognostic accuracies of IMPACT with 95 % confidence intervals (CIs) were calculated. In total, 47,531 PE patients were included. In-hospital and 30-day mortality occurred in 7.9 and 9.4 % of patients and 20.8 % experienced any complication within 30-days. Of the 19.5 % of patients classified as low-risk by IMPACT, 2.0 % died in-hospital, resulting in a sensitivity and specificity of 95.2 % (95 % CI, 94.4-95.8) and 20.7 % (95 % CI, 20.4-21.1). Only 1 additional low-risk patient died within 30-days of admission and 12.2 % experienced a complication, translating into a sensitivity and specificity of 95.9 % (95 % CI, 95.3-96.5) and 21.1 % (95 % CI, 20.7-21.5) for mortality and 88.5 % (95 % CI, 87.9-89.2) and 21.6 % (95 % CI, 21.2-22.0) for any complication. IMPACT had acceptable sensitivity for predicting in-hospital and 30-day mortality or complications and may be valuable for retrospective risk stratification of PE patients.

  7. Impact of coronary collaterals on in-hospital and 5-year mortality after ST-elevation myocardial infarction in the contemporary percutaneous coronary intervention era: a prospective observational study

    Science.gov (United States)

    Hara, Masahiko; Sakata, Yasuhiko; Nakatani, Daisaku; Suna, Shinichiro; Nishino, Masami; Sato, Hiroshi; Kitamura, Tetsuhisa; Nanto, Shinsuke; Hori, Masatsugu; Komuro, Issei

    2016-01-01

    Objectives To evaluate the short-term and long-term prognostic impacts of acute phase coronary collaterals to occluded infarct-related arteries (IRA) after ST-elevation myocardial infarction (STEMI) in the percutaneous coronary intervention (PCI) era. Design A prospective observational study. Setting Osaka Acute Coronary Insufficiency Study (OACIS) in Japan. Participants 3340 patients with STEMI from the OACIS database who were admitted to hospitals within 24 hours from the onset and who had a completely occluded IRA. Interventions Patients were divided into 4 groups according to the Rentrop collateral score (RCS) by angiography on admission (RCS-0, no visible collaterals; RCS-1, collaterals without IRA filling; RCS-2, collaterals with partial IRA filling; and RCS-3, collaterals with complete IRA filling). Primary outcome measures In-hospital and 5-year mortality. Results Patients with RCS-0/3 were older than patients with RCS-1/2, and the prevalence of previous myocardial infarction was highest in patients with RCS-3. Median peak creatinine phosphokinase levels decreased as RCS increases (p<0.001), suggesting the acute cardioprotective effects of collaterals. Although RCS-1 and RCS-2 collaterals were associated with better in-hospital mortality (adjusted OR 0.48, p=0.046 and 0.38, p=0.010 for RCS-1 and RCS-2, respectively) and 5-year mortality (adjusted HR 0.53, p=0.004 and 0.46, p<0.001 for RCS-1 and RCS-2, respectively) as compared with R-0, presence of RCS-3 collaterals was not associated with improved in-hospital (adjusted OR 1.35, p=0.331) and 5-year mortality (adjusted HR 0.98, p=0.920), possibly because worse clinical profiles in patients with RCS-3 may mask mortality benefit of coronary collaterals. Conclusions Presence of acute phase coronary collaterals such as RCS-1 and RCS-2 were associated with better in-hospital and 5-year mortality after STEMI in the contemporary PCI era. PMID:27412101

  8. Effects of Antihypertensive, Hypolipidemic and Reperfusion Therapy on In-Hospital Mortality in Predominantly Hypertensive Patients with the First Myocardial Infarction (Fmi)

    Czech Academy of Sciences Publication Activity Database

    Peleška, Jan; Grünfeldová, H.; Reissigová, Jindra; Tomečková, Marie; Monhart, Z.; Ryšavá, D.; Velimský, T.; Ballek, L.; Hubač, J.

    2010-01-01

    Roč. 28, e-Supplement A (2010), e548 ISSN 0263-6352. [European Meeting on Hypertension /20./. 18.06.2010-21.06.2010, Oslo ] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : in-hospital mortality for the first myocardial infarction * piloty registry of myocardial infarction * effects of pharmacotherapy and reperfusion therapy Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  9. Impact of Combination Evidence-Based Medical Therapy Used at Admission on In-Hospital Mortality in Patients With Non-ST-Elevation Myocardial Infarction

    Czech Academy of Sciences Publication Activity Database

    Monhart, Z.; Faltus, Václav; Grünfeldová, Hana; Janský, P.

    2008-01-01

    Roč. 117, č. 19 (2008), s. 21-22 ISSN 0009-7322. [The 2008 World Congress on Cardiology. 18.05.2008-21.05.2008, Buenos Aires] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : acute myocardial infarction * risk factors * in-hospital mortality Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  10. Clinical and epidemiological characteristics and risk factors for mortality in patients with candidemia in hospitals from Bogotá, Colombia

    Directory of Open Access Journals (Sweden)

    Jorge Alberto Cortés

    2014-11-01

    Conclusions: Candidemia is associated with a high mortality rate. Age and shock increase mortality, while the use of fluconazole was shown to be a protective factor. A higher resistance rate with new breakpoints was noted.

  11. Increasing incidence but decreasing in-hospital mortality of adult Staphylococcus aureus bacteraemia between 1981 and 2000

    DEFF Research Database (Denmark)

    Benfield, Thomas; Espersen, F; Frimodt-Møller, N

    2007-01-01

    Staphylococcus aureus is a leading cause of bacteraemia. This study analysed temporal trends from 18,702 adult cases of S. aureus bacteraemia in Denmark between 1981 and 2000. After stratification for mode of acquisition, 57% of cases were hospital-acquired (HA), 28% were community-acquired (CA...... associated with S. aureus bacteraemia declined significantly between 1981 and 2000, but incidence rates doubled, so that the total number of deaths increased. These data emphasise the public health importance of S. aureus bacteraemia and the need for further preventive measures and improved care in order...

  12. All-cause and disease-specific mortality in hospitalized patients with Clostridium difficile infection: a multicenter cohort study

    NARCIS (Netherlands)

    Hensgens, Marjolein P. M.; Goorhuis, Abraham; Dekkers, Olaf M.; van Benthem, Birgit H. B.; Kuijper, Ed J.

    2013-01-01

    Mortality among patients with Clostridium difficile infection (CDI) is high. Because of high age and multiple underlying diseases, CDI-related mortality is difficult to estimate. We estimated CDI-related mortality in an endemic situation, not influenced by outbreaks and consequently certain patients

  13. Clinical profile and factors associated with mortality in hospitalized patients with HIV/AIDS: a retrospective analysis from Tripoli Medical Centre, Libya, 2013.

    Science.gov (United States)

    Shalaka, N S; Garred, N A; Zeglam, H T; Awasi, S A; Abukathir, L A; Altagdi, M E; Rayes, A A

    2015-10-02

    In Libya, little is known about HIV-related hospitalizations and in-hospital mortality. This was a retrospective analysis of HIV-related hospitalizations at Tripoli Medical Centre in 2013. Of 227 cases analysed, 82.4% were males who were significantly older (40.0 versus 36.5 years), reported injection drug use (58.3% versus 0%) and were hepatitis C virus co-infected (65.8% versus 0%) compared with females. Severe immunosuppression was prevalent (median CD4 count = 42 cell/μL). Candidiasis was the most common diagnosis (26.0%); Pneumocystis pneumonia was the most common respiratory disease (8.8%), while cerebral toxoplasmosis was diagnosed in 8.4% of patients. Current HAART use was independently associated with low risk of in-hospital mortality (OR 0.33), while central nervous system symptoms (OR 4.12), sepsis (OR 6.98) and low total lymphocyte counts (OR 3.60) were associated with increased risk. In this study, late presentation with severe immunosuppression was common, and was associated with significant in-hospital mortality.

  14. Decreased Time from 9-1-1 Call to PCI among Patients Experiencing STEMI Results in a Decreased One Year Mortality.

    Science.gov (United States)

    Studnek, Jonathan R; Infinger, Allison; Wilson, Hadley; Niess, Gary; Jackson, Patrick; Swanson, Doug

    2018-03-29

    The impact on mortality due to prompt recognition of ST-segment Elevation Myocardial Infarction (STEMI) patients by EMS has not been well described. The objective of this study was to describe the association between the time interval, 9-1-1 call to percutaneous intervention (PCI), and mortality at one year. This retrospective analysis included patients that were transported by EMS as a "code STEMI" and underwent PCI.  Total time from 9-1-1 call to PCI was calculated for each patient and was the independent variable of interest. Each patient's mortality status at one year was the outcome variable, collected by querying medical records and the national death index. Confounding variables were abstracted from hospital records. Logistic regression was conducted to determine the likelihood of survival given differences in time to PCI. A total of 550 patients were included in the analyses of which 68% were male with an average age 59.8 (SD 12.8). Mean reperfusion time was 81.8 min (SD 20.0) and was significantly lower in patients alive at one year (80.8 min, SD 19.7) vs. deceased at one year (93.9 min, SD 19.6), respectively. Odds of survival at one year decreased by 3% (OR 0.97; 95% CI 0.96-0.99) for every one minute increase in time to PCI. This relationship practically represents a 30% increase in mortality for every 10 minute delay from 9-1-1 call to PCI. The model produced suggests that a linear relationship exists between time to PCI and mortality in the prehospital environment with the probability of survival decreasing significantly as time to PCI increases.

  15. [Reduction of in-hospital mortality and improved secondary prevention after acute myocardial infarction. First results from the registry of secondary prevention after acute myocardial infarction (SAMI)].

    Science.gov (United States)

    Tebbe, U; Messer, C; Stammwitz, E; The, G S; Dietl, J; Bischoff, K-O; Schulten-Baumer, U; Tebbenjohanns, J; Gohlke, H; Bramlage, P

    2007-07-30

    In hospital mortality of acute myocardial infarction (AMI) has been reduced due to the availability of better therapeutic strategies. But there is still a gap between mortality rates in randomised trials and daily clinical practice. Thus, it was aim of the present registry to document the course and outcome of patients with AMI and to improve patient care by implementing recent guidelines. In a nationwide registry study in hospitals in Germany with a cardiology unit or an internal medicine department data on consecutive patients were recorded for six to twelve months at admission, discharge and during a follow-up of one year. From 02/2003 until 10/2004 a total of 5,353 patients with acute myocardial infarction (65.7 % male, mean age of 67.6 +/- 17.7 years; 55.1 % of them with ST elevation myocardial infarction (STEMI) were included in the registry. Of the patients with STEMI, 76.6 % underwent acute intervention, 37.1 % had thrombolysis, 69.7 % percutaneous transluminal coronary angioplasty (PTCA). 40.0 % of those with non-Stemi (NSTEMI) had an acute intervention, 6.6 % thrombolysis, 73.5 % PTCA. Recommended secondary prevention consisted of ASS (93.2 %), beta-blockers (93.0 %), CSE-inhibitors (83.5 %), ACE-inhibitors (80.9 %) and clopidogrel (74.0 %). In-hospital mortality was 10.5 % (STEMI) and 7.4 % (NSTEMI). The 9 % mortality among patients with acute myocardial infarction treated in the hospitals participating in the SAMI registry is low compared to that in similar collectives. The high number of patients who had thrombofibrinolysis and coronary interventions as well as the early initiation of drug therapy contributed to these results. Medical treatment in the prehospital phase of these patients remains still insufficient and to a substantial extent contributes to the mortality of acute myocardial infarction.

  16. [Door-to-balloon time and in-hospital mortality in patients with ST-evaluation myocardial infarction: a network experience in a province in northwest Tuscany, Italy].

    Science.gov (United States)

    Paradossi, Umberto; Palmieri, Cataldo; Trianni, Giuseppe; Ravani, Marcello; Vaghetti, Marco; Rizza, Antonio; Gianetti, Jacopo; Cardullo, Simona; Chabane, Hakim; Maffei, Stefano; Berti, Sergio

    2010-05-01

    A network system for ST-elevation myocardial infarction (STEMI) patients offers a quick diagnosis and a rapid transfer to a specialized center for primary percutaneous coronary intervention. The aim of our study was to evaluate the relationship between door-to-balloon time and in-hospital mortality in our network of STEMI patients. Our Hub & Spoke network in the province of Massa-Carrara in the northwest of Tuscany Region, Italy, began in April 2006. This program involved 5 Spoke and 1 Hub centers, 1 medical helicopter, 3 advanced life support ambulances with direct transmission of the ECG and vital parameters to our cath lab on call 24h a day for primary percutaneous coronary intervention. Data regarding clinical, echocardiographic and hemodynamic parameters, the door-to-balloon (DTB) time and their impact on mortality were analyzed. Up to January 2008, 312 STEMI patients were enrolled (242 male, mean age 66.6 +/- 12.3 years). The DTB time was 93 min (79-117, 25th-75th percentile, respectively). The gold standard of a DTB mountain area. Patients from the coast (n = 238) had a DTB time lower than patients from the mountain area (89.5 vs 122.5 min, p < 0.0001), and the risk of in-hospital mortality was significantly and independently correlated with the increase in DTB time (p = 0.04). CONCLUSIONS; Our data confirm the correlation between DTB time and in-hospital mortality. More efforts are necessary to reduce the time to treatment and mortality rates.

  17. [The medical organizational aspects of decreasing of preventable mortality in the case of traffic accident in municipal district].

    Science.gov (United States)

    Voloshina, L V; Plutnitskiĭ, A N

    2010-01-01

    The article deals with the results of the study of such actual issue as decreasing of preventable mortality in the case of traffic accident in municipal district. The analysis was based on the mortality statistical data and the expertise of causes of lethal outcomes of traffic accidents. The results are used to develop the measures of improving the organization and quality of medical care of victims of road accident on the pre-hospital and hospital stages on the level of municipal health care to decrease the human losses caused by traffic accident.

  18. U-curve association between timing of renal replacement therapy initiation and in-hospital mortality in postoperative acute kidney injury.

    Directory of Open Access Journals (Sweden)

    Chih-Chung Shiao

    Full Text Available BACKGROUND: Postoperative acute kidney injury (AKI is associated with poor outcomes in surgical patients. This study aims to evaluate whether the timing of renal replacement therapy (RRT initiation affects the in-hospital mortality of patients with postoperative AKI. METHODOLOGY: This multicenter retrospective observational study, which was conducted in the intensive care units (ICUs in a tertiary hospital (National Taiwan University Hospital and its branch hospitals in Taiwan between January, 2002, and April, 2009, included adult patients with postoperative AKI who underwent RRT for predefined indications. The demographic data, comorbid diseases, types of surgery and RRT, and the indications for RRT were documented. Patients were categorized according to the period of time between the ICU admission and RRT initiation as the early (EG, ≦1 day, intermediate (IG, 2-3 days, and late (LG, ≧4 days groups. The in-hospital mortality rate censored at 180 day was defined as the endpoint. RESULTS: Six hundred forty-eight patients (418 men, mean age 63.0±15.9 years were enrolled, and 379 patients (58.5% died during the hospitalization. Both the estimated probability of death and the in-hospital mortality rates of the three groups represented U-curves. According to the Cox proportional hazard method, LG (hazard ratio, 1.527; 95% confidence interval, 1.152-2.024; P = 0.003, compared with IG group, age (1.014; 1.006-1.021, diabetes (1.279; 1.022-1.601; P = 0.031, cirrhosis (2.147; 1.421-3.242, extracorporeal membrane oxygenation support (1.811; 1.391-2.359, initial neurological dysfunction (1.448; 1.107-1.894; P = 0.007, pre-RRT mean arterial pressure (0.988; 0.981-0.995, inotropic equivalent (1.006; 1.001-1.012; P = 0.013, APACHE II scores (1.055; 1.037-1.073, and sepsis (1.939; 1.536-2.449 were independent predictors of the in-hospital mortality (All P<0.001 except otherwise stated. CONCLUSIONS: The current study found a U

  19. Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department - a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Barfod Charlotte

    2012-04-01

    Full Text Available Abstract Background Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerød Acute Process Triage (HAPT system and the outcome measures; Admission to Intensive Care Unit (ICU and in-hospital mortality, and to identify the vital signs, scored and categorized at admission, that are most strongly associated with the outcome measures. Methods The HAPT system is a minor modification of the Swedish Adaptive Process Triage (ADAPT and ranks patients into five level colour-coded triage categories. Each patient is assigned a triage category for the two main descriptors; vital signs, Tvitals, and presenting complaint, Tcomplaint. The more urgent of the two determines the final triage category, Tfinal. We retrieved 6279 unique adult patients admitted through the Emergency Department (ED from the Acute Admission Database. We performed regression analysis to evaluate the association between the covariates and the outcome measures. Results The covariates, Tvitals, Tcomplaint and Tfinal were all significantly associated with ICU admission and in-hospital mortality, the odds increasing with the urgency of the triage category. The vital signs best predicting in-hospital mortality were saturation of peripheral oxygen (SpO2, respiratory rate (RR, systolic blood pressure (BP and Glasgow Coma Score (GCS. Not only the type, but also the number of abnormal vital signs, were predictive for adverse outcome. The presenting complaints associated with the highest in-hospital mortality were 'dyspnoea' (11.5% and 'altered level of consciousness' (10.6%. More than half of the patients had a Tcomplaint more urgent than Tvitals

  20. A regional multilevel analysis: can skilled birth attendants uniformly decrease neonatal mortality?

    Science.gov (United States)

    Singh, Kavita; Brodish, Paul; Suchindran, Chirayath

    2014-01-01

    Globally 40 % of deaths to children under-five occur in the very first month of life with three-quarters of these deaths occurring during the first week of life. The promotion of delivery with a skilled birth attendant (SBA) is being promoted as a strategy to reduce neonatal mortality. This study explored whether SBAs had a protective effect against neonatal mortality in three different regions of the world. The analysis pooled data from nine diverse countries for which recent Demographic and Health Survey data were available. Multilevel logistic regression was used to understand the influence of skilled delivery on two outcomes-neonatal mortality during the first week of life and during the first day of life. Control variables included age, parity, education, wealth, residence (urban/rural), geographic region (Africa, Asia and Latin America/Caribbean), antenatal care and tetanus immunization. The direction of the effect of skilled delivery on neonatal mortality was dependent on geographic region. While having a SBA at delivery was protective against neonatal mortality in Latin America/Caribbean, in Asia there was only a protective effect for births in the first week of life. In Africa SBAs were associated with higher neonatal mortality for both outcomes, and the same was true for deaths on the first day of life in Asia. Many women in Africa and Asia deliver at home unless a complication occurs, and thus skilled birth attendants may be seeing more women with complications than their unskilled counterparts. In addition there are issues with the definition of a SBA with many attendants in both Africa and Asia not actually having the needed training and equipment to prevent neonatal mortality. Considerable investment is needed in terms of training and health infrastructure to enable these providers to save the youngest lives.

  1. In-hospital outcomes and long-term mortality according to sex and management strategy in acute myocardial infarction. Insights from the French ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2005 Registry.

    Science.gov (United States)

    Donataccio, Maria Pia; Puymirat, Etienne; Parapid, Biljana; Steg, Philippe Gabriel; Eltchaninoff, Hélène; Weber, Simon; Ferrari, Emile; Vilarem, Didier; Charpentier, Sandrine; Manzo-Silberman, Stéphane; Ferrières, Jean; Danchin, Nicolas; Simon, Tabassome

    2015-12-15

    The early mortality of acute myocardial infarction (AMI) has dramatically decreased in the recent past. Whether the previously reported sex disparities in use of invasive strategies (IS) persist and translate into differences in outcomes deserves to be examined. We used the data from a nationwide French prospective multicentre registry from 3,670 AMI patients (1155 women (31.5%), 2515 men (68.5%)) recruited in 223 centres in 2005 and followed-up for 5 years. We examined in-hospital outcomes and 5-year mortality in patients categorized according to sex and use of IS (i.e. coronary angiography during the hospitalisation with a view to revascularisation). IS was less frequently used in women than in men (adjusted OR=0.66; 95% CI: 0.52-0.85), regardless of the type of AMI, age group or risk category, while use of recommended medications was similar at 48 hours and discharge. In-hospital mortality did not differ according to sex, whatever the age group and use of an IS. At 5 years, overall and post-discharge mortality were similar in men and women. However, IS was associated with lower 5-year mortality in women (HR=0.66; 95% CI: 0.51-0.86) as in men (HR=0.48; 95% CI: 0.38-0.60) and there was no sex-strategy interaction. Invasive strategy remains less frequently used in women than in men, yet is associated with improved five-year survival irrespective of sex. Whether reducing the sex gap in its use would translate into a higher survival in women remains an open question. NCT 00673036. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. Decrease of perinatal mortality associated with congenital anomalies after prenatal screening was introduced in the Netherlands

    DEFF Research Database (Denmark)

    Faber, H. H.; Bouman, K.; Walle, H. E. K.

    2015-01-01

    OBJECTIVES: There has been much discussion about the relatively high perinatal mortality seen in the Netherlands (Buitendijk 2004, Europeristat 2009), for which congenital anomalies (CA) are known to be one of the four main risk factors. There was no nationwide routine prenatal screening for CA...... in the Netherlands until 2007. We have analysed data for a 14-year period from the EUROCAT registries to investigate the effect of the introduction of screening for CA on the perinatal mortality rate in the Netherlands and compared the results with those from other European registries. METHODS: We used data from...... of 1.35 per 1000 births in the period 1998-2006 to 1.15 per 1000 births in the period 2007-2011. In the northern Netherlands, it dropped from 1.73 per 1000 births in the period 1998-2006 to 1.00 per 1000 births in the period 2007- 2011. In 2011, the perinatal mortality associated with CA...

  3. Dietary restriction of rodents decreases aging rate without affecting initial mortality rate -- a meta-analysis.

    Science.gov (United States)

    Simons, Mirre J P; Koch, Wouter; Verhulst, Simon

    2013-06-01

    Dietary restriction (DR) extends lifespan in multiple species from various taxa. This effect can arise via two distinct but not mutually exclusive ways: a change in aging rate and/or vulnerability to the aging process (i.e. initial mortality rate). When DR affects vulnerability, this lowers mortality instantly, whereas a change in aging rate will gradually lower mortality risk over time. Unraveling how DR extends lifespan is of interest because it may guide toward understanding the mechanism(s) mediating lifespan extension and also has practical implications for the application of DR. We reanalyzed published survival data from 82 pairs of survival curves from DR experiments in rats and mice by fitting Gompertz and also Gompertz-Makeham models. The addition of the Makeham parameter has been reported to improve the estimation of Gompertz parameters. Both models separate initial mortality rate (vulnerability) from an age-dependent increase in mortality (aging rate). We subjected the obtained Gompertz parameters to a meta-analysis. We find that DR reduced aging rate without affecting vulnerability. The latter contrasts with the conclusion of a recent analysis of a largely overlapping data set, and we show how the earlier finding is due to a statistical artifact. Our analysis indicates that the biology underlying the life-extending effect of DR in rodents likely involves attenuated accumulation of damage, which contrasts with the acute effect of DR on mortality reported for Drosophila. Moreover, our findings show that the often-reported correlation between aging rate and vulnerability does not constrain changing aging rate without affecting vulnerability simultaneously. © 2013 John Wiley & Sons Ltd and the Anatomical Society.

  4. In-hospital mortality, 30-day readmission, and length of hospital stay after surgery for primary colorectal cancer: A national population-based study.

    Science.gov (United States)

    Pucciarelli, S; Zorzi, M; Gennaro, N; Gagliardi, G; Restivo, A; Saugo, M; Barina, A; Rugge, M; Zuin, M; Maretto, I; Nitti, D

    2017-07-01

    The simultaneous assessment of multiple indicators for quality of care is essential for comparisons of performance between hospitals and health care systems. The aim of this study was to assess the rates of in-hospital mortality and 30-day readmission and length of hospital stay (LOS) in patients who underwent surgical procedures for colorectal cancer between 2005 and 2014 in Italy. All patients in the National Italian Hospital Discharge Dataset who underwent a surgical procedure for colorectal cancer during the study period were included. The adjusted odd ratios for risk factors for in-hospital mortality, 30-day readmission, and LOS were calculated using multilevel multivariable logistic regression. Among the 353 941 patients, rates of in-hospital mortality and 30-day readmission were 2.5% and 6%, respectively, and the median LOS was 13 days. High comorbidity, emergent/urgent admission, male gender, creation of a stoma, and an open approach increased the risks of all the outcomes at multivariable analysis. Age, hospital volume, hospital geographic location, and discharge to home/non-home produced different effects depending on the outcome considered. The most frequent causes of readmission were infection (19%) and bowel obstruction (14.6%). We assessed national averages for mortality, LOS and readmission and related trends over a 10-year time. Laparoscopic surgery was the only one that could be modified by improving surgical education. Higher hospital volume was associated with a LOS reduction, but our findings only partially support a policy of centralization for colorectal cancer procedures. Surgical site infection was identified as the most preventable cause of readmission. Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  5. Impact of previous vascular burden on in-hospital and long-term mortality in patients with ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Consuegra-Sánchez, Luciano; Melgarejo-Moreno, Antonio; Galcerá-Tomás, José; Alonso-Fernández, Nuria; Díaz-Pastor, Angela; Escudero-García, Germán; Jaulent-Huertas, Leticia; Vicente-Gilabert, Marta

    2014-06-01

    Patients with a current acute coronary syndrome and previous ischemic heart disease, peripheral arterial disease, and/or cerebrovascular disease are reported to have a poorer outcome than those without these previous conditions. It is uncertain whether this association with outcome is observed at long-term follow-up. Prospective observational study, including 4247 patients with ST-segment elevation myocardial infarction. Detailed clinical data and information on previous ischemic heart disease, peripheral arterial disease, and cerebrovascular disease ("vascular burden") were recorded. Multivariate models were performed for in-hospital and long-term (median, 7.2 years) all-cause mortality. One vascular territory was affected in 1131 (26.6%) patients and ≥ 2 territories in 221 (5.2%). The total in-hospital mortality rate was 12.3% and the long-term incidence density was 3.5 deaths per 100 patient-years. A background of previous ischemic heart disease (odds ratio = 0.83; P = .35), peripheral arterial disease (odds ratio = 1.30; P = .34), or cerebrovascular disease (stroke) (odds ratio = 1.15; P = .59) was not independently predictive of in-hospital death. In an adjusted model, previous cerebrovascular disease and previous peripheral arterial disease were both predictors of mortality at long-term follow-up (hazard ratio = 1.57; P cerebrovascular disease and peripheral arterial disease were predictors of mortality at long-term after hospital discharge. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  6. Decreasing incidence and mortality among hospitalized patients suffering a ventilator-associated pneumonia: Analysis of the Spanish national hospital discharge database from 2010 to 2014.

    Science.gov (United States)

    de Miguel-Díez, Javier; López-de-Andrés, Ana; Hernández-Barrera, Valentín; Jiménez-Trujillo, Isabel; Méndez-Bailón, Manuel; Miguel-Yanes, José M de; Del Rio-Lopez, Benito; Jiménez-García, Rodrigo

    2017-07-01

    The aim of this study was to describe trends in the incidence and outcomes of ventilator-associated pneumonia (VAP) among hospitalized patients in Spain (2010-2014).This is a retrospective study using the Spanish national hospital discharge database from year 2010 to 2014. We selected all hospital admissions that had an ICD-9-CM code: 997.31 for VAP in any diagnosis position. We analyzed incidence, sociodemographic and clinical characteristics, procedures, pathogen isolations, and hospital outcomes.We identified 9336 admissions with patients suffering a VAP. Incidence rates of VAP decreased significantly over time (from 41.7 cases/100,000 inhabitants in 2010 to 40.55 in 2014). The mean Charlson comorbidity index (CCI) was 1.08 ± 0.98 and it did not change significantly during the study period. The most frequent causative agent was Pseudomonas and there were not significant differences in the isolation of this microorganism over time. Time trend analyses showed a significant decrease in in-hospital mortality (IHM), from 35.74% in 2010 to 32.81% in 2014. Factor associated with higher IHM included male sex, older age, higher CCI, vein or artery occlusion, pulmonary disease, cancer, undergone surgery, emergency room admission, and readmission.This study shows that the incidence of VAP among hospitalized patients has decreased in Spain from 2010 to 2014. The IHM has also decreased over the study period. Further investigations are needed to improve the prevention and control of VAP.

  7. Decreased carbon limitation of litter respiration in a mortality-affected pinon-juniper woodland

    Science.gov (United States)

    Erin Berryman; John D. Marshall; Thom Rahn; Marcie Litvak; John Butnor

    2013-01-01

    Microbial respiration depends on microclimatic variables and carbon (C) substrate availability, all of which are altered when ecosystems experience major disturbance. Widespread tree mortality, currently affecting pinon-juniper ecosystems in southwestern North America, may affect C substrate availability in several ways, for example, via litterfall pulses and loss of...

  8. Use of vitamin K to decrease allograft failure and patient mortality after organ transplantation

    NARCIS (Netherlands)

    de Borst, Martin; Vermeer, Cees

    2013-01-01

    Poor vitamin K status is provided as an independent risk factor for allograft failure and mortality in patients who received organ transplantation and who are under immunosuppressive medication. Various forms and recommended dosagesof vitamin K, optionally combined with vitamin D and/or other

  9. Dietary restriction of rodents decreases aging rate without affecting initial mortality rate a meta-analysis

    NARCIS (Netherlands)

    Simons, Mirre J. P.; Koch, Wouter; Verhulst, Simon

    Dietary restriction (DR) extends lifespan in multiple species from various taxa. This effect can arise via two distinct but not mutually exclusive ways: a change in aging rate and/or vulnerability to the aging process (i.e. initial mortality rate). When DR affects vulnerability, this lowers

  10. Decreases in male and female mortality and missing women in Bangladesh

    NARCIS (Netherlands)

    Alam, N.; van Ginneken, J.K.S.; Bosch, A.M.; Attané, I.; Guilmoto, C.Z.

    2007-01-01

    The objectives of our study are to examine whether discrimination against girls persists or has shifted over time and to identify the behavioural mechanisms involved in these changes. This study will focus on male/female differentials in mortality of infants and children aged 1-4 years and

  11. Early tracheostomy in severe traumatic brain injury: evidence for decreased mechanical ventilation and increased hospital mortality

    Science.gov (United States)

    Dunham, C Michael; Cutrona, Anthony F; Gruber, Brian S; Calderon, Javier E; Ransom, Kenneth J; Flowers, Laurie L

    2014-01-01

    Objective: In the past, the authors performed a comprehensive literature review to identify all randomized controlled trials assessing the impact of early tracheostomy on severe brain injury outcomes. The search produced only two trials, one by Sugerman and another by Bouderka. Subjects and methods: The current authors initiated an Institutional Review Board-approved severe brain injury randomized trial to evaluate the impact of early tracheostomy on ventilator-associated pneumonia rates, intensive care unit (ICU)/ventilator days, and hospital mortality. Current study results were compared with the other randomized trials and a meta-analysis was performed. Results: Early tracheostomy pneumonia rates were Sugerman-48.6%, Bouderka-58.1%, and current study-46.7%. No early tracheostomy pneumonia rates were Sugerman-53.1%, Bouderka-61.3%, and current study-44.4%. Pneumonia rate meta-analysis showed no difference for early tracheostomy and no early tracheostomy (OR 0.89; p = 0.71). Early tracheostomy ICU/ventilator days were Sugerman-16 ± 5.9, Bouderka-14.5 ± 7.3, and current study-14.1 ± 5.7. No early tracheostomy ICU/ventilator days were Sugerman-19 ± 11.3, Bouderka-17.5 ± 10.6, and current study-17 ± 5.4. ICU/ventilator day meta-analysis showed 2.9 fewer days with early tracheostomy (p = 0.02). Early tracheostomy mortality rates were Sugerman-14.3%, Bouderka-38.7%, and current study-0%. No early tracheostomy mortality rates were Sugerman-3.2%, Bouderka-22.6%, and current study-0%. Randomized trial mortality rate meta-analysis showed a higher rate for early tracheostomy (OR 2.68; p = 0.05). Because the randomized trials were small, a literature assessment was undertaken to find all retrospective studies describing the association of early tracheostomy on severe brain injury hospital mortality. The review produced five retrospective studies, with a total of 3,356 patients. Retrospective study mortality rate meta-analysis demonstrated a larger mortality for early

  12. Tree Mortality Decreases Water Availability and Ecosystem Resilience to Drought in Piñon-Juniper Woodlands in the Southwestern U.S.: Tree Mortality in Semiarid Biomes

    Energy Technology Data Exchange (ETDEWEB)

    Morillas, L. [Department of Biology, University of New Mexico, Albuquerque NM USA; Now at Department of Earth, Ocean and Atmospheric Sciences, University of British Columbia, Vancouver British Columbia Canada; Pangle, R. E. [Department of Biology, University of New Mexico, Albuquerque NM USA; Maurer, G. E. [Department of Biology, University of New Mexico, Albuquerque NM USA; Now at Department of Environmental Science, Policy, and Management, University of California, Berkeley CA USA; Pockman, W. T. [Department of Biology, University of New Mexico, Albuquerque NM USA; McDowell, N. [Earth Systems Analysis and Modeling, Pacific Northwest National Laboratory, Richland WA USA; Huang, C. -W. [Department of Biology, University of New Mexico, Albuquerque NM USA; Krofcheck, D. J. [Department of Biology, University of New Mexico, Albuquerque NM USA; Fox, A. M. [School of Natural Resources and the Environment, University of Arizona, Tucson AZ USA; Sinsabaugh, R. L. [Department of Biology, University of New Mexico, Albuquerque NM USA; Rahn, T. A. [Earth and Environmental Sciences Division, Los Alamos National Laboratory, Los Alamos NM USA; Litvak, M. E. [Department of Biology, University of New Mexico, Albuquerque NM USA

    2017-12-01

    Climate-driven tree mortality has increased globally in response to warmer temperature and more severe drought. To examine how tree mortality in semi-arid biomes impacts surface water balance, we experimentally manipulated a piñon-juniper (PJ) woodland by girdling all adult piñon trees in a 4 ha area, decreasing piñon basal area by ~65%. Over 3.5 years (2009-2013), we compared water flux measurements from this girdled site with those from a nearby intact PJ woodland. Before and after girdling, the ratio of evapotranspiration (ET) to incoming precipitation was similar between the two sites. Girdling altered the partitioning of ET such that the contribution of canopy transpiration to ET decreased 9-14% over the study period, relative to the intact control, while non-canopy ET increased. We attributed the elevated non-canopy ET in the girdled site each year to winter increases in sublimation, and summer increases in both soil evaporation and below-canopy transpiration. Although we expected that mortality of a canopy dominant would increase the availability of water and other resources to surviving vegetation, we observed a decrease in both soil volumetric water content and sap flow rates in the remaining trees at the girdled site, relative to the control. This post-girdling decrease in the performance of the remaining trees occurred during the severe 2011-2012 drought, suggesting that piñon mortality may trigger feedback mechanisms that leave PJ woodlands drier relative to undisturbed sites, and potentially more vulnerable to drought.

  13. Rabies vaccine is associated with decreased all-cause mortality in dogs.

    Science.gov (United States)

    Knobel, Darryn L; Arega, Sintayehu; Reininghaus, Bjorn; Simpson, Gregory J G; Gessner, Bradford D; Stryhn, Henrik; Conan, Anne

    2017-07-05

    Evidence suggests that rabies vaccine may have non-specific protective effects in animals and children. We analyzed four years of data (2012-2015) from an observational study of the health and demographics of a population of owned, free-roaming dogs in a low-income community in South Africa. The objective of this analysis was to assess the association between rabies vaccine and all-cause mortality in dogs, stratified by age group (0-3months, 4-11months, and 12months and older), and controlling for the effects of sex and number of dogs in the residence. Rabies vaccination reduced the risk of death from any cause by 56% (95% CI=16-77%) in dogs aged 0-3months, by 44% (95% CI=21-60%) in dogs aged 4-11months and by 16% (95% CI=0-29%) in dogs aged 12months and older. We hypothesize that the protective association between rabies vaccination status and all-cause mortality is due to a protective effect of rabies vaccine against diseases other than rabies. Existence of a strong non-specific protective effect of rabies vaccine on mortality in dogs would have implications for the design of dog rabies control programs that aim to eliminate dog-mediated human rabies cases. Further, we propose that owned domestic dogs in high mortality settings provide a useful animal model to better understand any non-specific protective effect of rabies vaccine in children, due to dogs' high numbers, high morbidity and mortality rates, relatively short lifespan, exposure to a variety of infectious and parasitic diseases, and shared environment with people. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  14. Better Nurse Autonomy Decreases the Odds of 30-Day Mortality and Failure to Rescue

    Science.gov (United States)

    Rao, Aditi D.; Kumar, Aparna; McHugh, Matthew

    2017-01-01

    Research Purpose Autonomy is essential to professional nursing practice and is a core component of good nurse work environments. The primary objective of this study was to examine the relationship between nurse autonomy and 30-day mortality and failure to rescue (FTR) in a hospitalized surgical population. Study Design This study was a secondary analysis of cross-sectional data. It included data from three sources: patient discharge data from state administrative databases, a survey of nurses from four states, and the American Hospital Association annual survey from 2006–2007. Methods Survey responses from 20,684 staff nurses across 570 hospitals were aggregated to the hospital level to assess autonomy measured by a standardized scale. Logistic regression models were used to estimate the relationship between nurse autonomy and 30-day mortality and FTR. Patient comorbidities, surgery type, and other hospital characteristics were included as controls. Findings Greater nurse autonomy at the hospital level was significantly associated with lower odds of 30-day mortality and FTR for surgical patients even after accounting for patient risk and structural hospital characteristics. Each additional point on the nurse autonomy scale was associated with approximately 19% lower odds of 30-day mortality (p autonomy place their surgical patients at an increased risk for mortality and FTR. Clinical Relevance Patients receiving care within institutions that promote high levels of nurse autonomy have a lower risk for death within 30 days and complications leading to death within 30 days. Hospitals can actively take steps to encourage nurse autonomy to positively influence patient outcomes. PMID:28094907

  15. Decreased mortality in patients hospitalized due to respiratory diseases after installation of an intensive care unit in a secondary hospital in the interior of Brazil.

    Science.gov (United States)

    Diogo, Luciano Passamani; Bahlis, Laura Fuchs; Wajner, André; Waldemar, Fernando Starosta

    2015-01-01

    To evaluate the association between the in-hospital mortality of patients hospitalized due to respiratory diseases and the availability of intensive care units. This retrospective cohort study evaluated a database from a hospital medicine service involving patients hospitalized due to respiratory non-terminal diseases. Data on clinical characteristics and risk factors associated with mortality, such as Charlson score and length of hospital stay, were collected. The following analyses were performed: univariate analysis with simple stratification using the Mantel Haenszel test, chi squared test, Student's t test, Mann-Whitney test, and logistic regression. Three hundred thirteen patients were selected, including 98 (31.3%) before installation of the intensive care unit and 215 (68.7%) after installation of the intensive care unit. No significant differences in the clinical and anthropometric characteristics or risk factors were observed between the groups. The mortality rate was 18/95 (18.9%) before the installation of the intensive care unit and 21/206 (10.2%) after the installation of the intensive care unit. Logistic regression analysis indicated that the probability of death after the installation of the intensive care unit decreased by 58% (OR: 0.42; 95%CI 0.205 -0.879; p = 0.021). Considering the limitations of the study, the results suggest a benefit, with a decrease of one death per every 11 patients treated for respiratory diseases after the installation of an intensive care unit in our hospital. The results corroborate the benefits of the implementation of intensive care units in secondary hospitals.

  16. Effects of age, comorbidity and adherence to current antimicrobial guidelines on mortality in hospitalized elderly patients with community-acquired pneumonia.

    Science.gov (United States)

    Han, Xiudi; Zhou, Fei; Li, Hui; Xing, Xiqian; Chen, Liang; Wang, Yimin; Zhang, Chunxiao; Liu, Xuedong; Suo, Lijun; Wang, Jinxiang; Yu, Guohua; Wang, Guangqiang; Yao, Xuexin; Yu, Hongxia; Wang, Lei; Liu, Meng; Xue, Chunxue; Liu, Bo; Zhu, Xiaoli; Li, Yanli; Xiao, Ying; Cui, Xiaojing; Li, Lijuan; Purdy, Jay E; Cao, Bin

    2018-04-24

    Limited information exists on the clinical characteristics predictive of mortality in patients aged ≥65 years in many countries. The impact of adherence to current antimicrobial guidelines on the mortality of hospitalized elderly patients with community-acquired pneumonia (CAP) has never been assessed. A total of 3131 patients aged ≥65 years were enrolled from a multi-center, retrospective, observational study initiated by the CAP-China network. Risk factors for death were screened with multivariable logistic regression analysis, with emphasis on the evaluation of age, comorbidities and antimicrobial treatment regimen with regard to the current Chinese CAP guidelines. The mean age of the study population was 77.4 ± 7.4 years. Overall in-hospital and 60-day mortality were 5.7% and 7.6%, respectively; these rates were three-fold higher in those aged ≥85 years than in the 65-74 group (11.9% versus 3.2% for in-hospital mortality and 14.1% versus 4.7% for 60-day mortality, respectively). The mortality was significantly higher among patients with comorbidities compared with those who were otherwise healthy. According to the 2016 Chinese CAP guidelines, 62.1% of patients (1907/3073) received non-adherent treatment. For general-ward patients without risk factors for Pseudomonas aeruginosa (PA) infection (n = 2258), 52.3% (1094/2090) were over-treated, characterized by monotherapy with an anti-pseudomonal β-lactam or combination with fluoroquinolone + β-lactam; while 71.4% of intensive care unit (ICU) patients (120/168) were undertreated, without coverage of atypical bacteria. Among patients with risk factors for PA infection (n = 815), 22.9% (165/722) of those in the general ward and 74.2% of those in the ICU (69/93) were undertreated, using regimens without anti-pseudomonal activity. The independent predictors of 60-day mortality were age, long-term bedridden status, congestive heart failure, CURB-65, glucose, heart rate, arterial oxygen

  17. The ADHF/NT-proBNP risk score to predict 1-year mortality in hospitalized patients with advanced decompensated heart failure.

    Science.gov (United States)

    Scrutinio, Domenico; Ammirati, Enrico; Guida, Pietro; Passantino, Andrea; Raimondo, Rosa; Guida, Valentina; Sarzi Braga, Simona; Canova, Paolo; Mastropasqua, Filippo; Frigerio, Maria; Lagioia, Rocco; Oliva, Fabrizio

    2014-04-01

    The acute decompensated heart failure/N-terminal pro-B-type natriuretic peptide (ADHF/NT-proBNP) score is a validated risk scoring system that predicts mortality in hospitalized heart failure patients with a wide range of left ventricular ejection fractions (LVEFs). We sought to assess discrimination and calibration of the score when applied to patients with advanced decompensated heart failure (AHF). We studied 445 patients hospitalized for AHF, defined by the presence of severe symptoms of worsening HF at admission, severely depressed LVEF, and the need for intravenous diuretic and/or inotropic drugs. The primary outcome was cumulative (in-hospital and post-discharge) mortality and post-discharge 1-year mortality. Separate analyses were performed for patients aged ≤ 70 years. A Seattle Heart Failure Score (SHFS) was calculated for each patient discharged alive. During follow-up, 144 patients (32.4%) died, and 69 (15.5%) underwent heart transplantation (HT) or ventricular assist device (VAD) implantation. After accounting for the competing events (VAD/HT), the ADHF/NT-proBNP score's C-statistic for cumulative mortality was 0.738 in the overall cohort and 0.771 in patients aged ≤ 70 years. The C-statistic for post-discharge mortality was 0.741 and 0.751, respectively. Adding prior (≤6 months) hospitalizations for HF to the score increased the C-statistic for post-discharge mortality to 0.759 in the overall cohort and to 0.774 in patients aged ≤ 70 years. Predicted and observed mortality rates by quartiles of score were highly correlated. The SHFS demonstrated adequate discrimination but underestimated the risk. The ADHF/NT-proBNP risk calculator is available at http://www.fsm.it/fsm/file/NTproBNPscore.zip. Our data suggest that the ADHF/NT-proBNP score may efficiently predict mortality in patients hospitalized with AHF. Copyright © 2014 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  18. Tracheostomy is associated with decreased hospital mortality after moderate or severe isolated traumatic brain injury.

    Science.gov (United States)

    Baron, David Marek; Hochrieser, Helene; Metnitz, Philipp G H; Mauritz, Walter

    2016-06-01

    Data regarding the impact and timing of tracheostomy in patients with isolated traumatic brain injury (TBI) are ambiguous. Our goal was to evaluate the impact of tracheostomy on hospital mortality in patients with moderate or severe isolated TBI. We performed a retrospective cohort analysis of data prospectively collected at 87 Austrian intensive care units (ICUs). All patients continuously admitted between 1998 and 2010 were evaluated for the study. In total, 4,735 patients were admitted to ICUs with isolated TBI. Of these patients, 2,156 had a moderate or severe TBI (1,603 patients were endotracheally intubated only, 553 patients underwent tracheostomy). Epidemiological data (trauma severity, treatment, and outcome) of the two groups were compared. Patients with moderate or severe isolated TBI undergoing tracheostomy had a similar Glasgow Coma Scale score, median (interquartile range): 6 (3-8) vs 6 (3-8); p = 0.90, and Simplified Acute Physiology Score II, 45 (37-54) vs 45 (35-56); p = 0.86, compared with intubated patients not undergoing tracheostomy. Furthermore, patients undergoing tracheostomy exhibited higher Abbreviated Injury Scale Head scores and had a longer ICU stay for survivors, 30 (22-42) vs 9 (3-17) days; p tracheostomy compared with patients who remained intubated, observed-to-expected mortality ratio (95 % confidence interval): 0.62 (0.53-0.72) vs 1.00 (0.95-1.05) respectively. Despite the greater severity of head injury, patients with isolated TBI who underwent tracheostomy had a lower risk-adjusted mortality than patients who remained intubated. Reasons for this difference in outcome may be multifactorial and require further investigation.

  19. Modeling of in hospital mortality determinants in myocardial infarction patients, with and without stroke: A national study in Iran

    Directory of Open Access Journals (Sweden)

    Ali Ahmadi

    2016-01-01

    Full Text Available Background: The data and determinants of mortality due to stroke in myocardial infarction (MI patients are unknown. This study was conducted to evaluate the differences in risk factors for hospital mortality among MI patients with and without stroke history. Materials and Methods: This study was a retrospective, cohort study; 20,750 new patients with MI from April, 2012 to March, 2013 were followed up and their data were analyzed according to having or not having the stroke history. Stroke and MI were defined based on the World Health Organization′s definition. The data were analyzed by logistic regression in STATA software. Results: Of the 20,750 studied patients, 4293 had stroke history. The prevalence of stroke in the studied population was derived 20.96% (confidence interval [CI] 95%: 20.13-21.24. Of the patients, 2537 (59.1% had ST-elevation MI (STEMI. Mortality ratio in patients with and without stroke was obtained 18.8% and 10.3%, respectively. The prevalence of risk factors in MI patients with and without a stroke is various. The adjusted odds ratio of mortality in patients with stroke history was derived 7.02 (95% CI: 5.42-9 for chest pain resistant to treatment, 2.39 (95% CI: 1.97-2.9 for STEMI, 3.02 (95% CI: 2.5-3.64 for lack of thrombolytic therapy, 2.2 (95% CI: 1.66-2.91 for heart failure, and 2.17 (95% CI: 1.6-2.9 for ventricular tachycardia. Conclusion: With regards to the factors associated with mortality in this study, it is particularly necessary to control the mortality in MI patients with stroke history. More emphasis should be placed on the MI patients with the previous stroke over those without in the interventions developed for prevention and treatment, and for the prevention of avoidable mortalities.

  20. Association of positive screening for dysphagia with nutritional status and long-term mortality in hospitalized elderly patients.

    Science.gov (United States)

    Mañas-Martínez, Ana B; Bucar-Barjud, Marina; Campos-Fernández, Julia; Gimeno-Orna, José Antonio; Pérez-Calvo, Juan; Ocón-Bretón, Julia

    2018-04-24

    To assess the prevalence of oropharyngeal dysphagia (OD) using the Eating Assessment Tool (EAT-10) and its association with malnutrition and long-term mortality. A retrospective cohort study of patients admitted to the general internal medicine ward. In the first 48hours after hospital admission, OD was assessed using the EAT-10, and presence of malnutrition with the Mini Nutritional Assessment-Short Form (MNA-SF). Association of OD to malnutrition and long-term mortality was analyzed. Ninety patients with a mean age of 83 (SD: 11.8) years were enrolled. Of these, 56.7% were at risk of OD according to EAT-10. This group of patients had greater prevalence rates of malnutrition (88.2% vs. 48.7%; P=.001) and mortality (70% vs 35.9%; P=.001). During follow-up for 872.71 (SD: 642.89) days, risk of DO according to EAT-10 was an independent predictor of mortality factor in a multivariate analysis (HR: 2.8; 95%CI: 1.49-5.28; P=.001). The EAT-10 is a useful tool for screening OD. Adequate screening for OD is important because of its associated risks of malnutrition and long-term mortality. Copyright © 2018 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. A Multidisciplinary Clinical Pathway Decreases Rib Fracture-Associated Infectious Morbidity and Mortality in High-Risk Trauma Patients

    Science.gov (United States)

    2006-01-01

    RT respiratory therapy ; PT physical therapy ; OT occupational therapy ; GCS Glasgow Coma Scale. 808 S.R. Todd et al. / The American Journal of...Morbidity form rib fractures increases after age 45. J Am Coll Surg 2003;196:549–55. [14] Pierson DJ, Kacmarek R. Foundations of Respiratory Care. New...Papers presented A multidisciplinary clinical pathway decreases rib fracture –associated infectious morbidity and mortality in high-risk trauma

  2. Breast cancer in South-Eastern European countries since 2000: Rising incidence and decreasing mortality at young and middle ages.

    Science.gov (United States)

    Dimitrova, Nadya; Znaor, Ariana; Agius, Dominic; Eser, Sultan; Sekerija, Mario; Ryzhov, Anton; Primic-Žakelj, Maja; Coebergh, Jan Willem

    2017-09-01

    Marked variations exist in the incidence and mortality trends of major cancers in South-Eastern European (SEE) countries which have now been detailed by age for breast cancer (BC) to seek clues for improvement. We brought together and analysed data from 14 cancer registries (CRs), situated in SEE countries or directly adjacent. Age-standardised rate at world standard (ASRw) and truncated incidence and mortality rates during 2000-2010 by year, and for four age groups, were calculated. Average annual percentage change of rates was estimated using Joinpoint regression. Annual incidence rates increased significantly in countries and age groups, by 2-4% (15-39 years), 2-5% (40-49), 1-4% (50-69) and 1-6% (at 70+). Mortality rates decreased significantly in all age-groups in most countries, but increased up to 5% annually above age 55 in Ukraine, Serbia, Moldova and Cyprus. The BC data quality was evaluated by internationally agreed indicators which appeared suboptimal for Moldova, Bosnia and Herzegovina and Romania. The observed variations of incidence trends reflect the influence of risk factors, as well as levels of early detection activities (screening). While mortality rates were mostly decreasing, probably due to improved cancer care and introduction of more effective systemic treatment regimens, the worrying increasing mortality trends in the 55-plus age groups in some countries have to be addressed by health professionals and policymakers. In order to assess and monitor the effects of cancer control activities in the region, the CRs need substantial investments. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. The endogenous bacteria alter gut epithelial apoptosis and decrease mortality following Pseudomonas aeruginosa pneumonia.

    Science.gov (United States)

    Fox, Amy C; McConnell, Kevin W; Yoseph, Benyam P; Breed, Elise; Liang, Zhe; Clark, Andrew T; O'Donnell, David; Zee-Cheng, Brendan; Jung, Enjae; Dominguez, Jessica A; Dunne, W Michael; Burd, Eileen M; Coopersmith, Craig M

    2012-11-01

    The endogenous bacteria have been hypothesized to play a significant role in the pathophysiology of critical illness, although their role in sepsis is poorly understood. The purpose of this study was to determine how commensal bacteria alter the host response to sepsis. Conventional and germ-free (GF) C57Bl/6 mice were subjected to Pseudomonas aeruginosa pneumonia. All GF mice died within 2 days, whereas 44% of conventional mice survived for 7 days (P = 0.001). Diluting the dose of bacteria 10-fold in GF mice led to similar survival in GF and conventional mice. When animals with similar mortality were assayed for intestinal integrity, GF mice had lower levels of intestinal epithelial apoptosis but similar levels of proliferation and intestinal permeability. Germ-free mice had significantly lower levels of tumor necrosis factor and interleukin 1β in bronchoalveolar lavage fluid compared with conventional mice without changes in systemic cytokine production. Under conventional conditions, sepsis unmasks lymphocyte control of intestinal epithelial apoptosis, because sepsis induces a greater increase in gut apoptosis in Rag-1 mice than in wild-type mice. However, in a separate set of experiments, gut apoptosis was similar between septic GF Rag-1 mice and septic GF wild-type mice. These data demonstrate that the endogenous bacteria play a protective role in mediating mortality from pneumonia-induced sepsis, potentially mediated through altered intestinal apoptosis and the local proinflammatory response. In addition, sepsis-induced lymphocyte-dependent increases in gut epithelial apoptosis appear to be mediated by the endogenous bacteria.

  4. [Epidemiological characteristics and mortality risk factors in patients admitted in hospitals with soft tissue infections. A multicentric STIMG (Soft Tissue Infections Malacitan Group) study results].

    Science.gov (United States)

    Salgado Ordóñez, F; Villar Jiménez, J; Hidalgo Conde, A; Villalobos Sánchez, A; de la Torre Lima, J; Aguilar García, J; da Rocha Costa, I; García Ordóñez, M A; Nuño Alvarez, E; Ramos Cantes, C; Martín Pérez, M

    2006-07-01

    To describe the characteristics of patients admitted in hospitals with soft tissue infections, and analyse the variables whose died, in order to define risk groups. retrospective analysis of medical reports of all patient admitted during 2002 year for soft tissue infections in public malacitans hospitals. We excluded the patient with soft tissue infections associated with burns, surgery, pressure ulcers, and orbit cellulitis. We analysed clinical, biochemical variables and indications for yields and imaging tests, so the empiric antibiotic treatment established and its correlations with practice guidelines. We analysed 391 admissions of 374 patients. Cellulitis was the most frequent diagnosis (69.3%). We did imaging tests in 51.6%. In 94.3% of cases were treated with empirics antibiotics. The most prescribed drug was amoxiciline plus clavulanate (39%). 27 patients died, 40.7% of them for septic cause. All deceased patients had chronic diseases. The only biochemical parameters associated with mortality were serum proteins and albumina (55 +/- 9 g/L vs. 63 +/- 8 g/L; p = 0.0231) and (22 +/- 7 g/L vs. 29 +/- 7 g/L; p = 0.0125) respectively. Cellullitis are the most frequent soft tissue infections that requires admissions in hospitals. We overuse imaging test and don t follow the practice guidelines recommendations in antibiotic therapy. Primary soft issue infection s mortality is low and it s restricted to people with chronic illness, deep infections and bad nutritional status.

  5. Impact of Arterial Hypertension on Short-Therm Mortality and in Hospital Complications of Patiens with Acute Myocardial Infarction:

    Czech Academy of Sciences Publication Activity Database

    Monhart, Z.; Faltus, Václav; Grünfeldová, H.; Ryšavá, D.; Velimský, T.; Ballek, J.; Hubač, J.; Janský, P.

    2007-01-01

    Roč. 25, Suppl. 2 (2007), S 360-S361 ISSN 0952-1178. [European Meeting on Hypertension /17./. 15.06.2007-19.06.2007, Milan] Institutional research plan: CEZ:AV0Z10300504 Keywords : arterial hypertension * myocardial infarction * short-term mortality

  6. Decreased carbon limitation of litter respiration in a mortality-affected piñon–juniper woodland

    Directory of Open Access Journals (Sweden)

    E. Berryman

    2013-03-01

    Full Text Available Microbial respiration depends on microclimatic variables and carbon (C substrate availability, all of which are altered when ecosystems experience major disturbance. Widespread tree mortality, currently affecting piñon–juniper ecosystems in southwestern North America, may affect C substrate availability in several ways, for example, via litterfall pulses and loss of root exudation. To determine piñon mortality effects on C and water limitation of microbial respiration, we applied field amendments (sucrose and water to two piñon–juniper sites in central New Mexico, USA: one with a recent (2 flux on the girdled site and a non-significant increase on the control. We speculate that the reduction may have been driven by water-induced carbonate dissolution, which serves as a sink for CO2 and would reduce the net flux. Widespread piñon mortality may decrease labile C limitation of litter respiration, at least during the first growing season following mortality.

  7. Cochrane systematic reviews are useful to map research gaps for decreasing maternal mortality.

    Science.gov (United States)

    Chapman, Evelina; Reveiz, Ludovic; Chambliss, Amy; Sangalang, Stephanie; Bonfill, Xavier

    2013-01-01

    To use an "evidence-mapping" approach to assess the usefulness of Cochrane reviews in identifying research gaps in the maternal health. The article describes the general mapping, prioritizing, reconciling, and updating approach: (1) identifying gaps in the maternal health research using published systematic reviews and formulating research questions, (2) prioritizing questions using Delphi method, (3) reconciling identified research priorities with the existing literature (i.e., searching of ongoing trials in trials registries), (4) updating the process. A comprehensive search of Cochrane systematic reviews published or updated from January 2006 to March 2011 was performed. We evaluated the "Implications for Research" section to identify gaps in the research. Our search strategy identified 695 references; 178 systematic reviews identifying at least one research gap were used. We formulated 319 research questions, which were classified into 11 different categories based on the direct and indirect causes of maternal mortality: postpartum hemorrhage, abortion, hypertensive disorders, infection/sepsis, caesarean section, diabetes, pregnancy prevention, preterm labor, other direct causes, indirect causes, and health policies and systems. Most research questions concerned the effectiveness of clinical interventions, including drugs (42.6%), nonpharmacologic interventions (16.3%), and health system (14.7%). It is possible to identify gaps in the maternal health research by using this approach. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Ketoanalogues supplementation decreases dialysis and mortality risk in patients with anemic advanced chronic kidney disease.

    Directory of Open Access Journals (Sweden)

    Che-Hsiung Wu

    Full Text Available The benefit of alpha-Ketoanalogues (KA supplementation for chronic kidney disease (CKD patients that followed low-protein diet (LPD remains undetermined.We extracted longitudinal data for all CKD patients in the Taiwan National Health Insurance from January 1, 2000 through December 31, 2010. A total of 1483 patients with anemic advanced CKD treated with LPD, who started KA supplementation, were enrolled in this study. We analyzed the risks of end stage renal disease and all-cause mortality using Cox proportional hazard models with influential drugs as time-dependent variables.A total of 1113 events of initiating long-term dialysis and 1228 events of the composite outcome of long-term dialysis or death occurred in patients with advanced CKD after a mean follow-up of 1.57 years. Data analysis suggests KA supplementation is associated with a lower risk for long-term dialysis and the composite outcome when daily dosage is more than 5.5 tablets. The beneficial effect was consistent in subgroup analysis, independent of age, sex, and comorbidities.Among advanced CKD patients that followed LPD, KA supplementation at an appropriate dosage may substantially reduce the risk of initiating long-term dialysis or of developing the composite outcome. KA supplementation represents an additional therapeutic strategy to slow the progression of CKD.

  9. Association between Highly Active Antiretroviral Therapy and Type of Infectious Respiratory Disease and All-Cause In-Hospital Mortality in Patients with HIV/AIDS: A Case Series.

    Directory of Open Access Journals (Sweden)

    Renata Báez-Saldaña

    Full Text Available Respiratory manifestations of HIV disease differ globally due to differences in current availability of effective highly active antiretroviral therapy (HAART programs and epidemiology of infectious diseases.To describe the association between HAART and discharge diagnosis and all-cause in-hospital mortality among hospitalized patients with infectious respiratory disease and HIV/AIDS.We retrospectively reviewed the records of patients hospitalized at a specialty hospital for respiratory diseases in Mexico City between January 1st, 2010 and December 31st, 2011. We included patients whose discharge diagnosis included HIV or AIDS and at least one infectious respiratory diagnosis. The information source was the clinical chart. We analyzed the association between HAART for 180 days or more and type of respiratory disease using polytomous logistic regression and all-cause hospital mortality by multiple logistic regressions.We studied 308 patients, of whom 206 (66.9% had been diagnosed with HIV infection before admission to the hospital. The CD4+ lymphocyte median count was 68 cells/mm3 [interquartile range (IQR: 30-150]. Seventy-five (24.4% cases had received HAART for more than 180 days. Pneumocystis jirovecii pneumonia (PJP (n = 142, tuberculosis (n = 63, and bacterial community-acquired pneumonia (n = 60 were the most frequent discharge diagnoses. Receiving HAART for more than 180 days was associated with a lower probability of PJP [Adjusted odd ratio (aOR: 0.245, 95% Confidence Interval (CI: 0.08-0.8, p = 0.02], adjusted for sociodemographic and clinical covariates. HAART was independently associated with reduced odds (aOR 0.214, 95% CI 0.06-0.75 of all-cause in-hospital mortality, adjusting for HIV diagnosis previous to hospitalization, age, access to social security, low socioeconomic level, CD4 cell count, viral load, and discharge diagnoses.HAART for 180 days or more was associated with 79% decrease in all-cause in-hospital mortality and lower

  10. Deferoxamine Compensates for Decreases in B Cell Counts and Reduces Mortality in Enterovirus 71-Infected Mice

    OpenAIRE

    Yang, Yajun; Ma, Jing; Xiu, Jinghui; Bai, Lin; Guan, Feifei; Zhang, Li; Liu, Jiangning; Zhang, Lianfeng

    2014-01-01

    Enterovirus 71 is one of the major causative agents of hand, foot and mouth disease in children under six years of age. No vaccine or antiviral therapy is currently available. In this work, we found that the number of B cells was reduced in enterovirus 71-infected mice. Deferoxamine, a marine microbial natural product, compensated for the decreased levels of B cells caused by enterovirus 71 infection. The neutralizing antibody titer was also improved after deferoxamine treatment. Furthermore...

  11. A Retrospective Audit of In-Hospital 30-day Mortality from Acute Myocardial Infarction in Connolly Hospital Blanchardstown

    LENUS (Irish Health Repository)

    Hensey, M

    2017-09-01

    In 2015, The Department of Health published the first annual report of the “National Healthcare Quality Reporting System.” Connolly Hospital was reported to a mortality rate within 30 days post-Acute Myocardial Infarction (AMI) of 9.87 per 100 cases which was statistically significantly higher than the national rate. We carried out a retrospective audit of patients who were HIPE-coded as having died within 30 days of AMI from 2011-2013 and identified 42 patients. On review, only 23 patients (54.8%) were confirmed as having had an AMI. We identified 12 patients who had AMI included on death certificate without any evidence for same. If the 22 patients incorrectly coded were excluded, the mortality rate within 30 days post-AMI in CHB would fall to 4.14 deaths per 100 cases, well below the national average. Inaccuracies of data collection can lead to erroneous conclusions when examining healthcare data.

  12. The analysis of perinatal morbidity and mortality in conditions of perinatal center and the ways of its decrease

    Directory of Open Access Journals (Sweden)

    Нана Мерабівна Пасієшвілі

    2016-01-01

    Full Text Available Aim of research. The analysis of perinatal morbidity and mortality in the condition of one perinatal center of Ukraine and optimization of the possible ways of its decrease.Methods of research. There was analyze the work of Kharkiv regional center in 2011–2015 years taking into account the rates of perinatal morbidity and mortality and factors that have influence on it. There were studied the next parameters: the number of newborns, its apportionment on the weight category, survival, general morbidity, mortality structure of the full-term and premature children. Statistical processing of the received results was carried out using Statistica 6.0 program.Results of research. The frequency of normal delivery in perinatal center is in average 58,9 %. The rates of neonatal mortality decreased– 4,11 ‰ (in 2011 year – 8,23 ‰ and early neonatal one – 3,34 ‰ (in 2011 year – 6,44 ‰. The survival of newborns with extremely low body weight (500- 999 g in first 0-168 hours was 62,50 %; with body weight 1000 – 1499 g – 82,35 %; with body weight at delivery 1500-2499 g was 98,17 %, survival of newborns with body weight > 2500 g in the first 0-6 days was 99,75 % .The morbidity structure of full-term children still almost unchangeable during the last 5 years: asphyxia, congenital defects of development, arrest of foetus growth, cerebral ischemia, intrauterine infection, birth trauma. The morbidity structure of premature ones: respiratory disorder syndrome, intrauterine infection; asphyxia, congenital defects of development, arrest of foetus growth.Among the mortality causes the main ones were congenial defects of development (prevailed in full-term children and intrauterine infection (on the first place in premature children. The perinatal mortality rate in 2015 year was 18,22 %о, in 2011year – 26,65 %о . The maternal foetus infection is the very frequent cause of stillbirth and pre-term birth and as the result the birth of small

  13. Echocardiographic findings predict in-hospital and 1-year mortality in left-sided native valve Staphylococcus aureus endocarditis

    DEFF Research Database (Denmark)

    Lauridsen, Trine K.; Park, Lawrence; Tong, Steven Y C

    2015-01-01

    BACKGROUND: Staphylococcus aureus left-sided native valve infective endocarditis (LNVIE) has higher complication and mortality rates compared with endocarditis from other pathogens. Whether echocardiographic variables can predict prognosis in S aureus LNVIE is unknown. METHODS AND RESULTS......: Consecutive patients with LNVIE, enrolled between January 2000 and September 2006, in the International Collaboration on Endocarditis were identified. Subjects without S aureus IE were matched to those with S aureus IE by the propensity of having S aureus. Survival differences were determined using log...

  14. Traditional chinese medicine Xuebijing treatment is associated with decreased mortality risk of patients with moderate paraquat poisoning.

    Directory of Open Access Journals (Sweden)

    Ping Gong

    Full Text Available Paraquat poisoning causes multiple organ injury and high mortality due to severe toxicity and lack of effective treatment. Xuebijing (XBJ injection, a traditional Chinese medicine preparation of five Chinese herbs (Radix Salviae Miltiorrhiae, Rhizoma Chuanxiong, Flos Carthami, Angelica Sinensis and Radix Paeoniae Rubra, has an anti-inflammatory effect and is widely used in the treatment of sepsis. This retrospective study was designed to evaluate the effects of XBJ combined with conventional therapy on mortality risk of patients with acute paraquat poisoning. Out of 68 patients, 27 were treated with conventional therapy (control group and 41 were treated with intravenous administration of XBJ (100 ml, twice a day, up to 7 days plus conventional therapy (XBJ group. Vital organ function, survival time within 28 days and adverse events during the treatment were reviewed. Results indicated that XBJ treatment significantly increased median survival time among patients ingesting 10-30 ml of paraquat (P=0.02 compared with the control group. After adjustment for covariates, XBJ treatment was associated significantly with a lower mortality risk (adjusted HR 0.242, 95% CI 0.113 to 0.516, P=0.001 compared with the control group. Additionally, compared with Day 1, on Day 3 the value of PaO2/FiO2 was significantly decreased, and the values of serum alanine aminotransferase, creatinine and troponin T were significantly increased in the control group (all P<0.05, but these values were significant improved in the XBJ group (all P<0.05. Only one patient had skin rash with itch within 30 minutes after injection and no severe adverse events were found in the XBJ group. In conclusion, XBJ treatment is associated with decreased mortality risk of patients with moderate paraquat poisoning, which may be attributed to improved function of vital organs with no severe adverse events.

  15. Diabetic ketosis during hyperglycemic crisis is associated with decreased all-cause mortality in patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Kruljac, Ivan; Ćaćić, Miroslav; Ćaćić, Petra; Ostojić, Vedran; Štefanović, Mario; Šikić, Aljoša; Vrkljan, Milan

    2017-01-01

    Patients with type 2 diabetes mellitus have impaired ketogenesis due to high serum insulin and low growth hormone levels. Evidence exists that ketone bodies might improve kidney and cardiac function. In theory, improved ketogenesis in diabetics may have positive effects. We aimed to assess the impact of diabetic ketosis on all-cause mortality in patients with type 2 diabetes mellitus presenting with hyperglycemic crisis. We analyzed 486 patients with diabetic ketosis and 486 age and sex-matched patients with non-ketotic hyperglycemia presenting to the emergency department. Cox proportional hazard models were used to analyze the link between patient characteristics and mortality. During an observation time of 33.4 months, death of any cause occurred in 40.9 % of the non-ketotic hyperglycemia group and 30.2 % of the DK group (hazard ratio in the diabetic ketosis group, 0.63; 95 % confidence interval 0.48-0.82; P = 0.0005). Patients with diabetic ketosis had a lower incidence of symptomatic heart failure and had improved renal function. They used less furosemide and antihypertensive drugs, more metformin and lower insulin doses, all of which was independently associated with decreased mortality. Plasma glucose and glycated hemoglobin levels were similar in both groups. Patients with hyperglycemic crisis and diabetic ketosis have decreased all-cause mortality when compared to those with non-ketotic hyperglycemia. diabetic ketosis might be a compensatory mechanism rather than a complication in patients with hyperglycemic crises, but further prospective studies are warranted.

  16. Traditional chinese medicine Xuebijing treatment is associated with decreased mortality risk of patients with moderate paraquat poisoning.

    Science.gov (United States)

    Gong, Ping; Lu, Zhidan; Xing, Jing; Wang, Na; Zhang, Yu

    2015-01-01

    Paraquat poisoning causes multiple organ injury and high mortality due to severe toxicity and lack of effective treatment. Xuebijing (XBJ) injection, a traditional Chinese medicine preparation of five Chinese herbs (Radix Salviae Miltiorrhiae, Rhizoma Chuanxiong, Flos Carthami, Angelica Sinensis and Radix Paeoniae Rubra), has an anti-inflammatory effect and is widely used in the treatment of sepsis. This retrospective study was designed to evaluate the effects of XBJ combined with conventional therapy on mortality risk of patients with acute paraquat poisoning. Out of 68 patients, 27 were treated with conventional therapy (control group) and 41 were treated with intravenous administration of XBJ (100 ml, twice a day, up to 7 days) plus conventional therapy (XBJ group). Vital organ function, survival time within 28 days and adverse events during the treatment were reviewed. Results indicated that XBJ treatment significantly increased median survival time among patients ingesting 10-30 ml of paraquat (P=0.02) compared with the control group. After adjustment for covariates, XBJ treatment was associated significantly with a lower mortality risk (adjusted HR 0.242, 95% CI 0.113 to 0.516, P=0.001) compared with the control group. Additionally, compared with Day 1, on Day 3 the value of PaO2/FiO2 was significantly decreased, and the values of serum alanine aminotransferase, creatinine and troponin T were significantly increased in the control group (all Ptreatment is associated with decreased mortality risk of patients with moderate paraquat poisoning, which may be attributed to improved function of vital organs with no severe adverse events.

  17. Winter excess in hospital admissions, in-patient mortality and length of acute hospital stay in stroke: a hospital database study over six seasonal years in Norfolk, UK.

    Science.gov (United States)

    Myint, Phyo K; Vowler, Sarah L; Woodhouse, Peter R; Redmayne, Oliver; Fulcher, Robert A

    2007-01-01

    Several studies have examined the incidence and mortality of stroke in relation to season. However, the evidence is conflicting partly due to variation in the populations (community vs. hospital-based), and in climatic conditions between studies. Moreover, they may not have been able to take into account the age, sex and stroke type of the study population. We hypothesized that the age, sex and type of stroke are major determinants of the presence or absence of winter excess in morbidity and mortality associated with stroke. We analyzed a hospital-based stroke register from Norfolk, UK to examine our prior hypothesis. Using Curwen's method, we performed stratified sex-specific analyses by (1) seasonal year and (2) quartiles of patients' age and stroke subtype and calculated the winter excess for the number of admissions, in-patient deaths and length of acute hospital stay. There were 5,481 patients (men=45%). Their ages ranged from 17 to 105 years (median=78 years). There appeared to be winter excess in hospital admissions, deaths and length of acute hospital stay overall accounting for 3/100,000 extra admissions (winter excess index of 3.4% in men and 7.6% in women) and 1/100,000 deaths (winter excess index of 4.7 and 8.6% in women) due to stroke in winter compared to non-winter periods. Older patients with non-haemorrhagic stroke mainly contribute to this excess. If our findings are replicated throughout England and Wales, it is estimated that there are 1,700 excess admissions, 600 excess in-patient deaths and 24,500 extra acute hospital bed days each winter, related to stroke within the current population of approximately 60 million. Further research should be focused on the determinants of winter excess in morbidity and mortality associated with stroke. This may subsequently reduce the morbidity and mortality by providing effective preventive strategies in future. (c) 2007 S. Karger AG, Basel.

  18. Reduced in-hospital mortality after improved management of children under 5 years admitted to hospital with malaria

    DEFF Research Database (Denmark)

    Biai, Sidu; Rodrigues, Amabelia; Gomes, Melba

    2007-01-01

    in the use of the standardised guidelines for the management of malaria, including strict follow-up procedures. Nurses and doctors were randomised to work on intervention or control wards. Personnel in the intervention ward received a small financial incentive ($50 (25 pounds sterling; 35 euros......OBJECTIVE: To test whether strict implementation of a standardised protocol for the management of malaria and provision of a financial incentive for health workers reduced mortality. DESIGN: Randomised controlled intervention trial. SETTING: Paediatric ward at the national hospital in Guinea......-Bissau. All children admitted to hospital with severe malaria received free drug kits. PARTICIPANTS: 951 children aged 3 months to 5 years admitted to hospital with a diagnosis of malaria randomised to normal or intervention wards. INTERVENTIONS: Before the start of the study, all personnel were trained...

  19. New-Onset Heart Failure and Mortality in Hospital Survivors of Sepsis-Related Left Ventricular Dysfunction.

    Science.gov (United States)

    Vallabhajosyula, Saraschandra; Jentzer, Jacob C; Geske, Jeffrey B; Kumar, Mukesh; Sakhuja, Ankit; Singhal, Akhil; Poterucha, Joseph T; Kashani, Kianoush; Murphy, Joseph G; Gajic, Ognjen; Kashyap, Rahul

    2018-02-01

    The association between new-onset left ventricular (LV) dysfunction during sepsis with long-term heart failure outcomes is lesser understood. Retrospective cohort study of all adult patients with severe sepsis and septic shock between 2007 and 2014 who underwent echocardiography within 72 h of admission to the intensive care unit. Patients with prior heart failure, LV dysfunction, and structural heart disease were excluded. LV systolic dysfunction was defined as LV ejection fraction <50% and LV diastolic dysfunction as ≥grade II. Primary composite outcome included new hospitalization for acute decompensated heart failure and all-cause mortality at 2-year follow-up. Secondary outcomes included persistent LV dysfunction, and hospital mortality and length of stay. During this 8-year period, 434 patients with 206 (48%) patients having LV dysfunction were included. The two groups had similar baseline characteristics, but those with LV dysfunction had worse function as demonstrated by worse LV ejection fraction, cardiac index, and LV diastolic dysfunction. In the 331 hospital survivors, new-onset acute decompensated heart failure hospitalization did not differ between the two cohorts (15% vs. 11%). The primary composite outcome was comparable at 2-year follow-up between the groups with and without LV dysfunction (P = 0.24). Persistent LV dysfunction was noted in 28% hospital survivors on follow-up echocardiography. Other secondary outcomes were similar between the two groups. In patients with severe sepsis and septic shock, the presence of new-onset LV dysfunction did not increase the risk of long-term adverse heart failure outcomes.

  20. Greek Acute Coronary Syndrome Score for the Prediction of In-hospital and 30-Day Mortality of Patients With an Acute Coronary Syndrome.

    Science.gov (United States)

    Panagiotakos, Demosthenes B; Pitsavos, Christos; Georgousopoulou, Ekavi N; Notara, Venetia; Stefanadis, Christodoulos

    2015-01-01

    Risk evaluation of patients hospitalized with acute coronary syndrome (ACS) may contribute to their short-term prognosis improvement. The aim of this work was to develop a prediction index (score) for the risk assessment of 30-day death of ACS patients, using clinical and biological measurements at hospital admission. A sample of 6 Greek hospitals was selected, and almost all consecutive 2172 ACS patients from October 2003 to September 2004 were enrolled. Sociodemographic, biochemical, clinical, and lifestyle characteristics were recorded. Using as components age, systolic blood pressure, white blood cell count, creatine kinase-MB, and creatinine levels at the time of admission and the time between the onset of symptoms and presentation at hospital, a risk score (Greek Acute Coronary Syndrome score; range, 6-36) was developed and tested against in-hospital and 30-day outcome of the patients. The Greek Acute Coronary Syndrome score showed strong discriminating ability for in-hospital mortality (area under the receiver operating characteristic curve, 0.812; 95% confidence interval, 0.750-0.874; P period.

  1. Association of admission serum calcium levels and in-hospital mortality in patients with acute ST-elevated myocardial infarction: an eight-year, single-center study in China.

    Directory of Open Access Journals (Sweden)

    Xin Lu

    Full Text Available OBJECTIVE: The relationship between admission serum calcium levels and in-hospital mortality in patients with acute ST-segment elevation myocardial infarction (STEMI has not been well definitively explored. The objective was to assess the predictive value of serum calcium levels on in-hospital mortality in STEMI patients. METHODS: From 2003 to 2010, 1431 consecutive STEMI patients admitted to the First Affiliated Hospital of Nanjing Medical University were enrolled in the present study. Patients were stratified according to quartiles of serum calcium from the blood samples collected in the emergency room after admission. Between the aforementioned groups,the baseline characteristics, in-hospital management, and in-hospital mortality were analyzed. The association of serum calcium level with in-hospital mortality was calculated by a multivariable Cox regression analysis. RESULTS: Among 1431 included patients, 79% were male and the median age was 65 years (range, 55-74. Patients in the lower quartiles of serum calcium, as compared to the upper quartiles of serum calcium, were older, had more cardiovascular risk factors, lower rate of emergency revascularization,and higher in-hospital mortality. According to univariate Cox proportional analysis, patients with lower serum calcium level (hazard ratio 0.267, 95% confidence interval 0.164-0.433, p<0.001 was associated with higher in-hospital mortality. The result of multivariable Cox proportional hazard regression analyses showed that the Killip's class≥3 (HR = 2.192, p = 0.026, aspartate aminotransferase (HR = 1.001, p<0.001, neutrophil count (HR = 1.123, p<0.001, serum calcium level (HR = 0.255, p = 0.001, and emergency revascularization (HR = 0.122, p<0.001 were significantly and independently associated with in-hospital mortality in STEMI patients. CONCLUSIONS: Serum calcium was an independent predictor for in-hospital mortality in patients with STEMI. This widely

  2. Mortality decrease according to socioeconomic groups during the economic crisis in Spain: a cohort study of 36 million people.

    Science.gov (United States)

    Regidor, Enrique; Vallejo, Fernando; Granados, José A Tapia; Viciana-Fernández, Francisco J; de la Fuente, Luis; Barrio, Gregorio

    2016-11-26

    8) for the low group, 2·4% (2·0 to 2·7) for the medium group and 2·5% (1·9 to 3·0) for the high group in 2008-11. The low socioeconomic group showed the largest effect size for both wealth indicators. In Spain, probably due to the decrease in exposure to risk factors, all-cause mortality decreased more during the economic crisis than before the economic crisis, especially in low socioeconomic groups. None. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Intravenous lignocain 2 percent (plain) efficacy in attenuation of stress response to laryngoscopy and endotracheal intubation with impact on in-hospital morbidity and mortality

    International Nuclear Information System (INIS)

    Ahmed, M.S.; Qureshi, M.N.; Uddin, S.S.; Hussain, R.M.

    2016-01-01

    Objective: To evaluate the efficacy of plain lignocain in attenuation of stress response to laryngoscopy and endotracheal intubation with impact on in-hospital mortality or morbidity. Study Design: A randomized control trial. Place and Duration of Study: Our study was carried out from December 2013-14, at tertiary-care hospital. Material and Methods: Patients (n=100 total) were randomized, using non-probability convenient sampling, dividing the population in two groups. Group A (n=50) as control, and in group B (n=50) Injection lignocain plain 2 percent at the rate 1.5 mg/kg was used 3 minutes prior to intubation. Both the groups were observed for changes in hemodynamic parameters i.e. heart rate (HR) systolic and diastolic blood pressure, Mean Arterial Pressure for every minute after baseline (0) and for 5 consecutive minutes (1, 2, 3, 4, and 5). Deviation of >20 percent from baseline was considered significant. The mortality (death within hospital, irrespective of cause) and morbidity (defined as emergence of 4 condition as hypertensive encephalopathy, Acute Coronary Syndrome, Lab proven Myocardial Infarction and negative pulmonary edema) within 10 days of hospitalization were noted. Results: Statistically significant (p-value extremely significant at confidence interval of 98 degrees) results were obtained in the effect of study drug; however, 10 days of hospitalization remained inconclusive for emerging morbidity categories strictly due to the intubation reflexes. We consider few technicalities in peri-operative management resulted in such events. Conclusion: Lignocain is effective in blunting the pressor response towards laryngoscopy and intubation. However the impact on mortality/ morbidity for four conditions remained inconclusive. (author)

  4. Prediction of In-hospital Mortality in Emergency Department Patients With Sepsis: A Local Big Data-Driven, Machine Learning Approach.

    Science.gov (United States)

    Taylor, R Andrew; Pare, Joseph R; Venkatesh, Arjun K; Mowafi, Hani; Melnick, Edward R; Fleischman, William; Hall, M Kennedy

    2016-03-01

    Predictive analytics in emergency care has mostly been limited to the use of clinical decision rules (CDRs) in the form of simple heuristics and scoring systems. In the development of CDRs, limitations in analytic methods and concerns with usability have generally constrained models to a preselected small set of variables judged to be clinically relevant and to rules that are easily calculated. Furthermore, CDRs frequently suffer from questions of generalizability, take years to develop, and lack the ability to be updated as new information becomes available. Newer analytic and machine learning techniques capable of harnessing the large number of variables that are already available through electronic health records (EHRs) may better predict patient outcomes and facilitate automation and deployment within clinical decision support systems. In this proof-of-concept study, a local, big data-driven, machine learning approach is compared to existing CDRs and traditional analytic methods using the prediction of sepsis in-hospital mortality as the use case. This was a retrospective study of adult ED visits admitted to the hospital meeting criteria for sepsis from October 2013 to October 2014. Sepsis was defined as meeting criteria for systemic inflammatory response syndrome with an infectious admitting diagnosis in the ED. ED visits were randomly partitioned into an 80%/20% split for training and validation. A random forest model (machine learning approach) was constructed using over 500 clinical variables from data available within the EHRs of four hospitals to predict in-hospital mortality. The machine learning prediction model was then compared to a classification and regression tree (CART) model, logistic regression model, and previously developed prediction tools on the validation data set using area under the receiver operating characteristic curve (AUC) and chi-square statistics. There were 5,278 visits among 4,676 unique patients who met criteria for sepsis. Of

  5. Length of stay, hospitalization cost, and in-hospital mortality in US adult inpatients with immune thrombocytopenic purpura, 2006-2012.

    Science.gov (United States)

    An, Ruopeng; Wang, Peizhong Peter

    2017-01-01

    In this study, we examined the length of stay, hospitalization cost, and risk of in-hospital mortality among US adult inpatients with immune thrombocytopenic purpura (ITP). We analyzed nationally representative data obtained from Nationwide/National Inpatient Sample database of discharges from 2006 to 2012. In the US, there were an estimated 296,870 (95% confidence interval [CI]: 284,831-308,909) patient discharges recorded for ITP from 2006 to 2012, during which ITP-related hospitalizations had increased steadily by nearly 30%. The average length of stay for an ITP-related hospitalization was found to be 6.02 days (95% CI: 5.93-6.10), which is 28% higher than that of the overall US discharge population (4.70 days, 95% CI: 4.66-4.74). The average cost of ITP-related hospitalizations was found to be US$16,594 (95% CI: US$16,257-US$16,931), which is 48% higher than that of the overall US discharge population (US$11,200; 95% CI: US$11,033-US$11,368). Gender- and age-adjusted mortality risk in inpatients with ITP was 22% (95% CI: 19%-24%) higher than that of the overall US discharge population. Across diagnosis related groups, length of stay for ITP-related hospitalizations was longest for septicemia (7.97 days, 95% CI: 7.55-8.39) and splenectomy (7.40 days, 95% CI: 6.94-7.86). Splenectomy (US$25,262; 95% CI: US$24,044-US$26,481) and septicemia (US$18,430; 95% CI: US$17,353-US$19,507) were associated with the highest cost of hospitalization. The prevalence of mortality in ITP-related hospitalizations was highest for septicemia (11.11%, 95% CI: 9.60%-12.63%) and intracranial hemorrhage (9.71%, 95% CI: 7.65%-11.77%). Inpatients with ITP had longer hospital stay, bore higher costs, and faced greater risk of mortality than the overall US discharge population.

  6. Heart rate at admission is a predictor of in-hospital mortality in patients with acute coronary syndromes: Results from 58 European hospitals: The European Hospital Benchmarking by Outcomes in acute coronary syndrome Processes study.

    Science.gov (United States)

    Jensen, Magnus T; Pereira, Marta; Araujo, Carla; Malmivaara, Anti; Ferrieres, Jean; Degano, Irene R; Kirchberger, Inge; Farmakis, Dimitrios; Garel, Pascal; Torre, Marina; Marrugat, Jaume; Azevedo, Ana

    2018-03-01

    The purpose of this study was to investigate the relationship between heart rate at admission and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Consecutive ACS patients admitted in 2008-2010 across 58 hospitals in six participant countries of the European Hospital Benchmarking by Outcomes in ACS Processes (EURHOBOP) project (Finland, France, Germany, Greece, Portugal and Spain). Cardiogenic shock patients were excluded. Associations between heart rate at admission in categories of 10 beats per min (bpm) and in-hospital mortality were estimated by logistic regression in crude models and adjusting for age, sex, obesity, smoking, hypertension, diabetes, known heart failure, renal failure, previous stroke and ischaemic heart disease. In total 10,374 patients were included. In both STEMI and NSTE-ACS patients, a U-shaped relationship between admission heart rate and in-hospital mortality was found. The lowest risk was observed for heart rates between 70-79 bpm in STEMI and 60-69 bpm in NSTE-ACS; risk of mortality progressively increased with lower or higher heart rates. In multivariable models, the relationship persisted but was significant only for heart rates >80 bpm. A similar relationship was present in both patients with or without diabetes, above or below age 75 years, and irrespective of the presence of atrial fibrillation or use of beta-blockers. Heart rate at admission is significantly associated with in-hospital mortality in patients with both STEMI and NSTE-ACS. ACS patients with admission heart rate above 80 bpm are at highest risk of in-hospital mortality.

  7. [Factors affecting in-hospital mortality in patients with sepsis: Development of a risk-adjusted model based on administrative data from German hospitals].

    Science.gov (United States)

    König, Volker; Kolzter, Olaf; Albuszies, Gerd; Thölen, Frank

    2018-05-01

    Inpatient administrative data from hospitals is already used nationally and internationally in many areas of internal and public quality assurance in healthcare. For sepsis as the principal condition, only a few published approaches are available for Germany. The aim of this investigation is to identify factors influencing hospital mortality by employing appropriate analytical methods in order to improve the internal quality management of sepsis. The analysis was based on data from 754,727 DRG cases of the CLINOTEL hospital network charged in 2015. The association then included 45 hospitals of all supply levels with the exception of university hospitals (range of beds: 100 to 1,172 per hospital). Cases of sepsis were identified via the ICD codes of their principal diagnosis. Multiple logistic regression analysis was used to determine the factors influencing in-hospital lethality for this population. The model was developed using sociodemographic and other potential variables that could be derived from the DRG data set, and taking into account current literature data. The model obtained was validated with inpatient administrative data of 2016 (51 hospitals, 850,776 DRG cases). Following the definition of the inclusion criteria, 5,608 cases of sepsis (2016: 6,384 cases) were identified in 2015. A total of 12 significant and, over both years, stable factors were identified, including age, severity of sepsis, reason for hospital admission and various comorbidities. The AUC value of the model, as a measure of predictability, is above 0.8 (H-L test p>0.05, R 2 value=0.27), which is an excellent result. The CLINOTEL model of risk adjustment for in-hospital lethality can be used to determine the mortality probability of patients with sepsis as principal diagnosis with a very high degree of accuracy, taking into account the case mix. Further studies are needed to confirm whether the model presented here will prove its value in the internal quality assurance of hospitals

  8. In-hospital mortality risk factors for patients with cerebral vascular events in infectious endocarditis. A correlative study of clinical, echocardiographic, microbiologic and neuroimaging findings.

    Science.gov (United States)

    González-Melchor, Laila; Kimura-Hayama, Eric; Díaz-Zamudio, Mariana; Higuera-Calleja, Jesús; Choque, Cinthia; Soto-Nieto, Gabriel I

    2015-01-01

    Cardiac complications in infectious endocarditis (IE) are seen in nearly 50% of cases, and systemic complications may occur. The aim of the present study was to determine the characteristics of inpatients with IE who suffered acute neurologic complications and the factors associated with early mortality. From January 2004 to May 2010, we reviewed clinical and imaging charts of all of the patients diagnosed with IE who presented a deficit suggesting a neurologic complication evaluated with Computed Tomography or Magnetic Resonance within the first week. This was a descriptive and retrolective study. Among 325 cases with IE, we included 35 patients (10.7%) [19 males (54%), mean age 44-years-old]. The most common underlying cardiac disease was rheumatic valvulopathy (n=8, 22.8%). Twenty patients survived (57.2%, group A) and 15 patients died (42.8%, group B) during hospitalization. The main cause of death was septic shock (n=7, 20%). There was no statistical difference among groups concerning clinical presentation, vegetation size, infectious agent and vascular territory. The overall number of lesions was significantly higher in group B (3.1 vs. 1.6, p=0.005) and moderate to severe cerebral edema were more frequent (p=0.09). Sixteen patients (45.7%) (12 in group A and 4 in group B, p=0.05) were treated by cardiac surgery. Only two patients had a favorable outcome with conservative treatment (5.7%). In patients with IE complicated with stroke, the number of lesions observed in neuroimaging examinations and conservative treatment were associated with higher in-hospital mortality. Copyright © 2014 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  9. Association between in-hospital mortality and renal dysfunction in 186,219 patients hospitalized for acute stroke in the Emilia-Romagna region of Italy.

    Science.gov (United States)

    Fabbian, Fabio; Gallerani, Massimo; Pala, Marco; De Giorgi, Alfredo; Salmi, Raffaella; Dentali, Francesco; Ageno, Walter; Manfredini, Roberto

    2014-11-01

    Using a regional Italian database, we evaluated the relationship between renal dysfunction and in-hospital mortality (IHM) in patients with acute stroke (ischemic/hemorrhagic). Patients were classified on the basis of renal damage: without renal dysfunction, with chronic kidney disease (CKD), and with end-stage renal disease (ESRD). Of a total of 186,219 patients with a first episode of stroke, 1626 (0.9%) had CKD and 819 (0.4%) had ESRD. Stroke-related IHM (total cases) was independently associated with CKD, ESRD, atrial fibrillation (AF), age, and Charlson comorbidity index (CCI). In patients with ischemic stroke (n=154,026), IHM remained independently associated with CKD, ESRD, AF, and CCI. In patients with hemorrhagic stroke (n=32,189), variables that were independently associated with IHM were CKD, ESRD, and AF. Renal dysfunction is associated with IHM related to stroke, both ischemic and hemorrhagic, with even higher odds ratios than those of other established risk factors, such as age, comorbidities, and AF. © The Author(s) 2013.

  10. Colostrum and milk pasteurization improve health status and decrease mortality in neonatal calves receiving appropriate colostrum ingestion.

    Science.gov (United States)

    Armengol, Ramon; Fraile, Lorenzo

    2016-06-01

    The objective of the study was to evaluate if on-farm heat treatment of colostrum and bulk tank milk can improve calf health status and morbidity and mortality rates during the first 21d of life in neonatal Holstein calves receiving appropriate colostrum ingestion. A total of 587 calves were randomly assigned to 2 groups of males and females over 18mo. The nonpasteurized group (n=287, 143 males and 144 females) was fed frozen (-20°C) colostrum (6-8L during the first 12h of life) that was previously reheated up to 40°C. They were also fed refrigerated (4°C) raw milk from the bulk tank that was also reheated up to 40°C (1.8L every 12h). The pasteurized group (n=300, 150 males and 150 females) was also fed colostrum and milk, but both were pasteurized before freezing. Blood samples were drawn from all calves to obtain serum at 2 to 5d of life. Serum total protein (g/dL) was determined using a commercially available refractometer. Colostrum and milk underwent routine bacteriological analysis to determine total plate counts (cfu/mL) and total coliform counts (cfu/mL). All the calves underwent clinical examination every 24h during the first 21d of life. Every day, calves were clinically diagnosed either as being healthy or suffering from respiratory disease, neonatal calf diarrhea, or suffering other diseases. On-farm heat treatment for colostrum and milk reduced total plate counts and total coliform counts between 1 and 2 log10. Pasteurization of colostrum and milk significantly decreased the morbidity and mortality (5.2 and 2.8%) in comparison with calves receiving nonpasteurized colostrum and milk (15.0 and 6.5%), respectively, during the first 21d of life, even in animals receiving appropriate colostrum ingestion. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  11. Decreased early mortality associated with the treatment of acute myeloid leukemia at National Cancer Institute-designated cancer centers in California.

    Science.gov (United States)

    Ho, Gwendolyn; Wun, Ted; Muffly, Lori; Li, Qian; Brunson, Ann; Rosenberg, Aaron S; Jonas, Brian A; Keegan, Theresa H M

    2018-05-01

    To the authors' knowledge, few population-based studies to date have evaluated the association between location of care, complications with induction therapy, and early mortality in patients with acute myeloid leukemia (AML). Using linked data from the California Cancer Registry and Patient Discharge Dataset (1999-2014), the authors identified adult (aged ≥18 years) patients with AML who received inpatient treatment within 30 days of diagnosis. A propensity score was created for treatment at a National Cancer Institute-designated cancer center (NCI-CC). Inverse probability-weighted, multivariable logistic regression models were used to determine associations between location of care, complications, and early mortality (death ≤60 days from diagnosis). Of the 7007 patients with AML, 1762 (25%) were treated at an NCI-CC. Patients with AML who were treated at NCI-CCs were more likely to be aged ≤65 years, live in higher socioeconomic status neighborhoods, have fewer comorbidities, and have public health insurance. Patients treated at NCI-CCs had higher rates of renal failure (23% vs 20%; P = .010) and lower rates of respiratory failure (11% vs 14%; P = .003) and cardiac arrest (1% vs 2%; P = .014). After adjustment for baseline characteristics, treatment at an NCI-CC was associated with lower early mortality (odds ratio, 0.46; 95% confidence interval, 0.38-0.57). The impact of complications on early mortality did not differ by location of care except for higher early mortality noted among patients with respiratory failure treated at non-NCI-CCs. The initial treatment of adult patients with AML at NCI-CCs is associated with a 53% reduction in the odds of early mortality compared with treatment at non-NCI-CCs. Lower early mortality may result from differences in hospital or provider experience and supportive care. Cancer 2018;124:1938-45. © 2018 American Cancer Society. © 2018 American Cancer Society.

  12. Why is the gender gap in life expectancy decreasing? The impact of age- and cause-specific mortality in Sweden 1997-2014.

    Science.gov (United States)

    Sundberg, Louise; Agahi, Neda; Fritzell, Johan; Fors, Stefan

    2018-04-13

    To enhance the understanding of the current increase in life expectancy and decreasing gender gap in life expectancy. We obtained data on underlying cause of death from the National Board of Health and Welfare in Sweden for 1997 and 2014 and used Arriaga's method to decompose life expectancy by age group and 24 causes of death. Decreased mortality from ischemic heart disease had the largest impact on the increased life expectancy of both men and women and on the decreased gender gap in life expectancy. Increased mortality from Alzheimer's disease negatively influenced overall life expectancy, but because of higher female mortality, it also served to decrease the gender gap in life expectancy. The impact of other causes of death, particularly smoking-related causes, decreased in men but increased in women, also reducing the gap in life expectancy. This study shows that a focus on overall changes in life expectancies may hide important differences in age- and cause-specific mortality. It also emphasizes the importance of addressing modifiable lifestyle factors to reduce avoidable mortality.

  13. Noncommunicable Diseases: Three Decades Of Global Data Show A Mixture Of Increases And Decreases In Mortality Rates.

    Science.gov (United States)

    Ali, Mohammed K; Jaacks, Lindsay M; Kowalski, Alysse J; Siegel, Karen R; Ezzati, Majid

    2015-09-01

    Noncommunicable diseases are the leading health concerns of the modern era, accounting for two-thirds of global deaths, half of all disability, and rapidly growing costs. To provide a contemporary overview of the burdens caused by noncommunicable diseases, we compiled mortality data reported by authorities in forty-nine countries for atherosclerotic cardiovascular diseases; diabetes; chronic respiratory diseases; and lung, colon, breast, cervical, liver, and stomach cancers. From 1980 to 2012, on average across all countries, mortality for cardiovascular disease, stomach cancer, and cervical cancer declined, while mortality for diabetes, liver cancer, and female chronic respiratory disease and lung cancer increased. In contrast to the relatively steep cardiovascular and cancer mortality declines observed in high-income countries, mortality for cardiovascular disease and chronic respiratory disease was flat in most low- and middle-income countries, which also experienced increasing breast and colon cancer mortality. These divergent mortality patterns likely reflect differences in timing and magnitude of risk exposures, health care, and policies to counteract the diseases. Improving both the coverage and the accuracy of mortality documentation in populous low- and middle-income countries is a priority, as is the need to rigorously evaluate societal-level interventions. Furthermore, given the complex, chronic, and progressive nature of noncommunicable diseases, policies and programs to prevent and control them need to be multifaceted and long-term, as returns on investment accrue with time. Project HOPE—The People-to-People Health Foundation, Inc.

  14. Anemia intrahospitalaria y descenso de hemoglobina en pacientes internados Hospital-acquired anemia and decrease of hemoglobin levels in hospitalized patients

    Directory of Open Access Journals (Sweden)

    Carina V. Gianserra

    2011-06-01

    estadía hospitalaria prolongada, la presencia de leucocitosis, la hidratación parenteral y colocación de acceso venoso central fueron factores predictivos de descenso de hemoglobina = 2 g/dl.It is common to observe the development of anemia in hospitalized patients, especially in critical cases. Few studies have evaluated its prevalence and associated factors in patients in the general ward. The purpose of this study is to determine the prevalence, characteristics and associated clinical factors of hospital-acquired anemia and the drop of hemoglobin concentration in hospitalized patients. This is a cross-sectional, prospective and descriptive study. A total of 192 consecutive in-patients in the general ward were studied. Associated risk factors to the drop in hemoglobin by = 2g/dl were analyzed; 139 patients (72.4% presented anemia; 89 of them (46.4% had it at admission and 50 (26% developed hospital-acquired anemia, 47 out of 192 showed a drop in hemoglobin = 2 g/dl(24.48%. They also presented lower values of hematocrite and hemoglobin at discharge (p = 0.01, parenteral hydration at a higher volume (p = 0.01, and lengthier hospitalizations (p = 0.0001. In the univariate analysis, the following variables were statistically significant risk factors: leukocytosis = 11 000 mm³ (OR; IC95%: 2,02; 1.03-4; p = 0.01, hospitalization days = 7 (OR; IC95%:3.39; 1.62-7.09; p = 0.0006, parenteral hydration = 1500 ml/day (OR; IC95%: 2.47; 1.06-6.4; p = 0.01, central venous access (OR; IC95%:10.29; 1.75-108.07; p = 0.003 and hospital-acquired anemia (OR; IC95%: 7.06; 3.41-15.83; p = 0.00000004. In the multivariate analysis, the following variables were independent predictive factors of the hemoglobin decrease = 2 g/dl: leukocytosis = 11 000 mm³ (OR; IC95%: 2.45; 1.14-5,27; p = 0.02, hospitalization days = 7 (OR; IC95%:5.15; 2.19-12.07; p = 0.0002, parenteral hydration = 1500 ml/day (OR; IC95%: 2.95; 1.13-7.72; p = 0.02, central venous access (OR; IC95%:8.82; 1.37-56.82; p = 0

  15. Ratio of systolic blood pressure to left ventricular end-diastolic pressure at the time of primary percutaneous coronary intervention predicts in-hospital mortality in patients with ST-elevation myocardial infarction.

    Science.gov (United States)

    Sola, Michael; Venkatesh, Kiran; Caughey, Melissa; Rayson, Robert; Dai, Xuming; Stouffer, George A; Yeung, Michael

    2017-09-01

    To determine the ability of simple hemodynamic parameters obtained at the time of cardiac catheterization to predict in-hospital mortality following ST-elevation myocardial infarction (STEMI). Hemodynamic parameters measured at the time of primary percutaneous coronary intervention (PPCI) could potentially identify high-risk patients who would benefit from aggressive hemodynamic support in the Cardiac Catheterization laboratory. This is a retrospective single-center study of 219 consecutive patients with STEMI. Left ventricular end-diastolic pressure (LVEDP), systolic blood pressure (SBP), and aortic diastolic blood pressure were obtained after successful revascularization. The prognostic ability of LVEDP, pulse pressure, and SBP/LVEDP ratio were compared to major mortality risk scores. Patients had a mean age of 60 ±14 years, were predominantly white (73%), male (64%), with anterior wall infarcts in 39%. Comorbidities included diabetes mellitus (27%), heart failure (9%), and chronic kidney disease (7%). In-hospital mortality was 9%. Patients with SBP/LVEDP ≤ 4 had increased risk of in-hospital death (32% vs. 5.3%, P  4. The area under curve (AUC) for SBP/LVEDP ratio for in-hospital mortality (0.69) was more predictive than LVEDP (0.61, P = 0.04) or pulse pressure (0.55, P = 0.02) but similar to Shock Index (ratio of heart rate to SBP) and Modified Shock Index (ratio of HR to mean arterial pressure). An SBP/LVEDP ratio ≤ 4 identified a group of STEMI patients at high risk of in-hospital death. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  16. Effect of plasma exchange on in-hospital mortality in patients with pulmonary hemorrhage secondary to antineutrophil cytoplasmic antibody-associated vasculitis: A propensity-matched analysis using a nationwide administrative database.

    Science.gov (United States)

    Uechi, Eishi; Okada, Masato; Fushimi, Kiyohide

    2018-01-01

    Secondary pulmonary hemorrhage increases the risk of mortality in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV); plasma exchange therapy may improve outcomes in these patients. We conducted a retrospective cohort study to investigate the effect of plasma exchange therapy on short-term prognoses in patients with pulmonary hemorrhage secondary to AAV. This study utilized the Diagnosis Procedure Combination database, which is a nationwide inpatient database in Japan. We checked the abstract data and medical actions and identified the patients with pulmonary hemorrhage secondary to AAV who required proactive treatment between 2009 and 2014. To compare the in-hospital mortality, we performed propensity score matching between the plasma exchange and non-plasma exchange groups at a ratio of 1:1. Of the 52,932 patients with AAV, 940 developed pulmonary hemorrhage as a complication. A total of 249 patients from 194 hospitals were eligible for the study. Propensity score matching at a ratio of 1:1 was performed, and 59 pairs were formed (plasma exchange group, n = 59; non-plasma exchange group, n = 59). A statistically significant difference was found in the all-cause in-hospital mortality between the plasma exchange and non-plasma exchange groups (35.6% vs. 54.2%; p = 0041; risk difference, -18.6; 95% confidence interval (CI), -35.4% to -0.67%). Thus, plasma exchange therapy was associated with improved in-hospital mortality in patients with pulmonary hemorrhage secondary to AAV.

  17. All-cause mortality rates and home deaths decreased in children with life-limiting diagnoses in Denmark between 1994 and 2014

    DEFF Research Database (Denmark)

    Lykke, Camilla; Ekholm, Ola; Schmiegelow, Kjeld

    2018-01-01

    %). The relative proportion of hospital deaths increased, while home deaths decreased. CONCLUSION: All-cause mortality rate decreased markedly, and the relative proportion of hospital deaths increased. The results may reflect more aggressive and effective treatment attempts to save lives, but some terminally ill...... deaths. The decline in infant mortality (26%) primarily reflected fewer deaths due to congenital malformations and chromosomal abnormalities (68%) and perinatal deaths (30%). In children aged one year to 17 years, the substantial decrease (65%) was due to external causes (75%) and neoplasms (57......AIM: Specialised paediatric palliative care has not previously been a priority in Denmark. The aim of this study was to support its development and organisation, by examining why and where children died using official national data for 1994-2014. METHODS: We obtained data on 9462 children who died...

  18. The Patient- And Nutrition-Derived Outcome Risk Assessment Score (PANDORA: Development of a Simple Predictive Risk Score for 30-Day In-Hospital Mortality Based on Demographics, Clinical Observation, and Nutrition.

    Directory of Open Access Journals (Sweden)

    Michael Hiesmayr

    Full Text Available To develop a simple scoring system to predict 30 day in-hospital mortality of in-patients excluding those from intensive care units based on easily obtainable demographic, disease and nutrition related patient data.Score development with general estimation equation methodology and model selection by P-value thresholding based on a cross-sectional sample of 52 risk indicators with 123 item classes collected with questionnaires and stored in an multilingual online database.Worldwide prospective cross-sectional cohort with 30 day in-hospital mortality from the nutritionDay 2006-2009 and an external validation sample from 2012.We included 43894 patients from 2480 units in 32 countries. 1631(3.72% patients died within 30 days in hospital. The Patient- And Nutrition-Derived Outcome Risk Assessment (PANDORA score predicts 30-day hospital mortality based on 7 indicators with 31 item classes on a scale from 0 to 75 points. The indicators are age (0 to 17 points, nutrient intake on nutritionDay (0 to 12 points, mobility (0 to 11 points, fluid status (0 to 10 points, BMI (0 to 9 points, cancer (9 points and main patient group (0 to 7 points. An appropriate model fit has been achieved. The area under the receiver operating characteristic curve for mortality prediction was 0.82 in the development sample and 0.79 in the external validation sample.The PANDORA score is a simple, robust scoring system for a general population of hospitalised patients to be used for risk stratification and benchmarking.

  19. Decreasing trends in hospitalizations during anti-TNF therapy are associated with time to anti-TNF therapy: Results from two referral centres.

    Science.gov (United States)

    Mandel, Michael D; Balint, Anita; Golovics, Petra A; Vegh, Zsuzsanna; Mohas, Anna; Szilagyi, Blanka; Szabo, Agnes; Kurti, Zsuzsanna; Kiss, Lajos S; Lovasz, Barbara D; Gecse, Krisztina B; Farkas, Klaudia; Molnar, Tamas; Lakatos, Peter L

    2014-11-01

    Hospitalization is an important outcome measure and a major driver of costs in patients with inflammatory bowel disease. We analysed medical and surgical hospitalization rates and predictors of hospitalization before and during anti-TNF therapy. Data from 194 consecutive patients were analysed retrospectively (males, 45.4%, median age at diagnosis, 24.0 years, infliximab/adalimumab: 144/50) in whom anti-TNF therapy was started after January 1, 2008. Total follow-up was 1874 patient-years and 474 patient-years with anti-TNF exposure. Hospitalization rates hospitalization decreased only in Crohn's disease (odds ratio: 0.59, 95% confidence interval: 0.51-0.70, median 2-years' anti-TNF exposure) with a same trend for surgical interventions (p=0.07), but not in ulcerative colitis. Need for hospitalization decreased in Crohn's disease with early (within 3-years from diagnosis, p=0.016 by McNemar test), but not late anti-TNF exposure. At logistic regression analysis complicated disease behaviour (p=0.03), concomitant azathioprine (p=0.02) use, but not anti-TNF type, gender, perianal disease or previous surgeries were associated with the risk of hospitalization during anti-TNF therapy. Hospitalization rate decreased significantly in patients with Crohn's disease but not ulcerative colitis after the introduction of anti-TNF therapy and was associated with time to therapy. Complicated disease phenotype and concomitant azathioprine use were additional factors defining the risk of hospitalization. Copyright © 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  20. A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population (Japanese) using a web-based data entry system: the 30-day and in-hospital mortality rates for pancreaticoduodenectomy.

    Science.gov (United States)

    Kimura, Wataru; Miyata, Hiroaki; Gotoh, Mitsukazu; Hirai, Ichiro; Kenjo, Akira; Kitagawa, Yuko; Shimada, Mitsuo; Baba, Hideo; Tomita, Naohiro; Nakagoe, Tohru; Sugihara, Kenichi; Mori, Masaki

    2014-04-01

    To create a mortality risk model after pancreaticoduodenectomy (PD) using a Web-based national database system. PD is a major gastroenterological surgery with relatively high mortality. Many studies have reported factors to analyze short-term outcomes. After initiation of National Clinical Database, approximately 1.2 million surgical cases from more than 3500 Japanese hospitals were collected through a Web-based data entry system. After data cleanup, 8575 PD patients (mean age, 68.2 years) recorded in 2011 from 1167 hospitals were analyzed using variables and definitions almost identical to those of American College of Surgeons-National Surgical Quality Improvement Program. The 30-day postoperative and in-hospital mortality rates were 1.2% and 2.8% (103 and 239 patients), respectively. Thirteen significant risk factors for in-hospital mortality were identified: age, respiratory distress, activities of daily living within 30 days before surgery, angina, weight loss of more than 10%, American Society of Anesthesiologists class of greater than 3, Brinkman index of more than 400, body mass index of more than 25 kg/m, white blood cell count of more than 11,000 cells per microliter, platelet count of less than 120,000 per microliter, prothrombin time/international normalized ratio of more than 1.1, activated partial thromboplastin time of more than 40 seconds, and serum creatinine levels of more than 3.0 mg/dL. Five variables, including male sex, emergency surgery, chronic obstructive pulmonary disease, bleeding disorders, and serum urea nitrogen levels of less than 8.0 mg/dL, were independent variables in the 30-day mortality group. The overall PD complication rate was 40.0%. Grade B and C pancreatic fistulas in the International Study Group on Pancreatic Fistula occurred in 13.2% cases. The 30-day and in-hospital mortality rates for pancreatic cancer were significantly lower than those for nonpancreatic cancer. We conducted the reported risk stratification study for PD

  1. Activation of α7 nicotinic acetylcholine receptor decreases on-site mortality in crush syndrome through insulin signaling-Na/K-ATPase pathway

    Directory of Open Access Journals (Sweden)

    Bo-Shi eFan

    2016-03-01

    Full Text Available On-site mortality in crush syndrome remains high due to lack of effective drugs based on definite diagnosis. Anisodamine is widely used in China for treatment of shock, and activation of α7 nicotinic acetylcholine receptor (α7nAChR mediates such antishock effect. The present work was designed to test whether activation of α7nAChR with anisodamine decreased mortality in crush syndrome shortly after decompression. Sprague-Dawley rats and C57BL/6 mice with crush syndrome were injected with anisodamine (20 mg/kg and 28 mg/kg respectively, i.p. 30 min before decompression. Survival time, serum potassium, insulin, and glucose levels were observed shortly after decompression. Involvement of α7nAChR was verified with methyllycaconitine (selective α7nAChR antagonist and PNU282987 (selective α7nAChR agonist, or in α7nAChR knockout mice. Effect of anisodamine was also appraised in C2C12 myotubes. Anisodamine reduced mortality and serum potassium and enhanced insulin sensitivity shortly after decompression in animals with crush syndrome, and PNU282987 exerted similar effects. Such effects were counteracted by methyllycaconitine or in α7nAChR knockout mice. Mortality and serum potassium in rats with hyperkalemia were also reduced by anisodamine. Phosphorylation of Na/K-ATPase was enhanced by anisodamine in C2C12 myotubes. Inhibition of tyrosine kinase on insulin receptor, phosphoinositide 3-kinase, mammalian target of rapamycin, signal transducer and activator of transcription 3, and Na/K-ATPase counteracted the effect of anisodamine on extracellular potassium. These findings demonstrated that activation of α7nAChR could decrease on-site mortality in crush syndrome, at least in part based on the decline of serum potassium through insulin signaling-Na/K-ATPase pathway.

  2. Omega-9 Oleic Acid Induces Fatty Acid Oxidation and Decreases Organ Dysfunction and Mortality in Experimental Sepsis.

    Directory of Open Access Journals (Sweden)

    Cassiano Felippe Gonçalves-de-Albuquerque

    Full Text Available Sepsis is characterized by inflammatory and metabolic alterations, which lead to massive cytokine production, oxidative stress and organ dysfunction. In severe systemic inflammatory response syndrome, plasma non-esterified fatty acids (NEFA are increased. Several NEFA are deleterious to cells, activate Toll-like receptors and inhibit Na+/K+-ATPase, causing lung injury. A Mediterranean diet rich in olive oil is beneficial. The main component of olive oil is omega-9 oleic acid (OA, a monounsaturated fatty acid (MUFA. We analyzed the effect of OA supplementation on sepsis. OA ameliorated clinical symptoms, increased the survival rate, prevented liver and kidney injury and decreased NEFA plasma levels in mice subjected to cecal ligation and puncture (CLP. OA did not alter food intake and weight gain but diminished reactive oxygen species (ROS production and NEFA plasma levels. Carnitine palmitoyltransferase IA (CPT1A mRNA levels were increased, while uncoupling protein 2 (UCP2 liver expression was enhanced in mice treated with OA. OA also inhibited the decrease in 5' AMP-activated protein kinase (AMPK expression and increased the enzyme expression in the liver of OA-treated mice compared to septic animals. We showed that OA pretreatment decreased NEFA concentration and increased CPT1A and UCP2 and AMPK levels, decreasing ROS production. We suggest that OA has a beneficial role in sepsis by decreasing metabolic dysfunction, supporting the benefits of diets high in monounsaturated fatty acids (MUFA.

  3. The prediction of the in-hospital mortality of acutely ill medical patients by electrocardiogram (ECG) dispersion mapping compared with established risk factors and predictive scores--a pilot study.

    LENUS (Irish Health Repository)

    Kellett, John

    2011-08-01

    ECG dispersion mapping (ECG-DM) is a novel technique that analyzes low amplitude ECG oscillations and reports them as the myocardial micro-alternation index (MMI). This study compared the ability of ECG-DM to predict in-hospital mortality with traditional risk factors such as age, vital signs and co-morbid diagnoses, as well as three predictive scores: the Simple Clinical Score (SCS)--based on clinical and ECG findings, and two Medical Admission Risk System scores--one based on vital signs and laboratory data (MARS), and one only on laboratory data (LD).

  4. Lithium is associated with decrease in all-cause and suicide mortality in high-risk bipolar patients: A nationwide registry-based prospective cohort study.

    Science.gov (United States)

    Toffol, Elena; Hätönen, Taina; Tanskanen, Antti; Lönnqvist, Jouko; Wahlbeck, Kristian; Joffe, Grigori; Tiihonen, Jari; Haukka, Jari; Partonen, Timo

    2015-09-01

    Mortality rates, in particular due to suicide, are especially high in bipolar patients. This nationwide, registry-based study analyses the associations of medication use with hospitalization due to attempted suicides, deaths from suicide, and overall mortality across different psychotropic agents in bipolar patients. Altogether 826 bipolar patients hospitalized in Finland between 1996-2003 because of a suicide attempt were followed-up for a mean of 3.5 years. The relative risk of suicide attempts leading to hospitalization, completed suicide, and overall mortality during lithium vs. no-lithium, antipsychotic vs. no-antipsychotic, valproic acid vs. no-valproic acid, antidepressant vs. no-antidepressant and benzodiazepine vs. no-benzodiazepine treatment was measured. The use of valproic acid (RR=1.53, 95% CI: 1.26-1.85, p<0.001), antidepressants (RR=1.49, 95% CI: 1.23-1.8, p<0.001) and benzodiazepines (RR=1.49, 95% CI: 1.23-1.80, p<0.001) was associated with increased risk of attempted suicide. Lithium was associated with a (non-significantly) lower risk of suicide attempts, and with significantly decreased suicide mortality in univariate (RR=0.39, 95% CI: 0.17-0.93, p=0.03), Cox (HR=0.37, 95% CI: 0.16-0.88, p=0.02) and marginal structural models (HR=0.31, 95% CI: 0.12-0.79, p=0.02). Moreover, lithium was related to decreased all-cause mortality by 49% (marginal structural models). Only high-risk bipolar patients hospitalized after a suicide attempt were studied. Diagnosis was not based on standardized diagnostic interviews; treatment regimens were uncontrolled. Maintenance therapy with lithium, but not with other medications, is linked to decreased suicide and all-cause mortality in high-risk bipolar patients. Lithium should be considered for suicide prevention in high-risk bipolar patients. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. Validation of the MARS (Medical Admission Risk System): A combined physiological and laboratory risk prediction tool for 5- to 7-day in-hospital mortality.

    Science.gov (United States)

    Ohman, Malin Charlotta; Atkins, Tara E Holm; Cooksley, Tim; Brabrand, Mikkel

    2018-03-10

    The MARS (Medical Admission Risk System) uses 11 physiological and laboratory data and had promising results in its derivation study for predicting 5 and 7 day mortality. To perform an external independent validation of the MARS score. An unplanned secondary cohort study. Patients admitted to the medical admission unit (MAU) at The Hospital of South West Jutland were included from 2 October 2008 until 19 February 2009 and 23 February 2010 until 26 May 2010 were analysed. Validation of the MARS score using 5 and 7 day mortality was the primary endpoint. 5858 patients were included in the study. 2923 (49.9%) patients were women with a median age of 65 years (15-107). The MARS score had an AUROC of 0.858 (95% CI: 0.831-0.884) for 5-day mortality and 0.844 (0.818-0.870) for 7 day mortality with poor calibration for both outcomes. The MARS score had excellent discriminatory power but poor calibration in predicting both 5 and 7-day mortality. The development of accurate combination physiological/laboratory data risk scores has the potential to improve the recognition of at risk patients.

  6. Systemic inflammatory response syndrome and model for end-stage liver disease score accurately predict the in-hospital mortality of black African patients with decompensated cirrhosis at initial hospitalization: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Mahassadi AK

    2018-04-01

    Full Text Available Alassan Kouamé Mahassadi,1 Justine Laure Konang Nguieguia,1 Henriette Ya Kissi,1 Anthony Afum-Adjei Awuah,2 Aboubacar Demba Bangoura,1 Stanislas Adjeka Doffou,1 Alain Koffi Attia1 1Medicine and Hepatogastroenterology Unit, Centre Hospitalier et Universitaire de Yopougon, Abidjan, Côte d’Ivoire; 2Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana Background: Systemic inflammatory response syndrome (SIRS and model for end-stage liver disease (MELD predict short-term mortality in patients with cirrhosis. Prediction of mortality at initial hospitalization is unknown in black African patients with decompensated cirrhosis.Aim: This study aimed to look at the role of MELD score and SIRS as the predictors of morbidity and mortality at initial hospitalization.Patients and methods: In this retrospective cohort study, we enrolled 159 patients with cirrhosis (median age: 49 years, 70.4% males. The role of Child–Pugh–Turcotte (CPT score, MELD score, and SIRS on mortality was determined by the Kaplan–Meier method, and the prognosis factors were assessed with Cox regression model.Results: At initial hospitalization, 74.2%, 20.1%, and 37.7% of the patients with cirrhosis showed the presence of ascites, hepatorenal syndrome, and esophageal varices, respectively. During the in-hospital follow-up, 40 (25.2% patients died. The overall incidence of mortality was found to be 3.1 [95% confidence interval (CI: 2.2–4.1] per 100 person-days. Survival probabilities were found to be high in case of patients who were SIRS negative (log-rank test= 4.51, p=0.03 and in case of patients with MELD score ≤16 (log-rank test=7.26, p=0.01 compared to the patients who were SIRS positive and those with MELD score >16. Only SIRS (hazard ratio (HR=3.02, [95% CI: 1.4–7.4], p=0.01 and MELD score >16 (HR=2.2, [95% CI: 1.1–4.3], p=0.02 were independent predictors of mortality in multivariate analysis except CPT, which was not relevant in our study

  7. Survival curves to support quality improvement in hospitals with excess 30-day mortality after acute myocardial infarction, cerebral stroke and hip fracture: a before-after study.

    Science.gov (United States)

    Kristoffersen, Doris Tove; Helgeland, Jon; Waage, Halfrid Persdatter; Thalamus, Jacob; Clemens, Dirk; Lindman, Anja Schou; Rygh, Liv Helen; Tjomsland, Ole

    2015-03-25

    To evaluate survival curves (Kaplan-Meier) as a means of identifying areas in the clinical pathway amenable to quality improvement. Observational before-after study. In Norway, annual public reporting of nationwide 30-day in-and-out-of-hospital mortality (30D) for three medical conditions started in 2011: first time acute myocardial infarction (AMI), stroke and hip fracture; reported for 2009. 12 of 61 hospitals had statistically significant lower/higher mortality compared with the hospital mean. Three hospitals with significantly higher mortality requested detailed analyses for quality improvement purposes: Telemark Hospital Trust Skien (AMI and stroke), Østfold Hospital Trust Fredrikstad (stroke), Innlandet Hospital Trust Gjøvik (hip fracture). Survival curves, crude and risk-adjusted 30D before (2008-2009) and after (2012-2013). Unadjusted survival curves for the outlier hospitals were compared to curves based on pooled data from the other hospitals for the 30-day period 2008-2009. For patients admitted with AMI (Skien), stroke (Fredrikstad) and hip fracture (Gjøvik), the curves suggested increased mortality from the initial part of the clinical pathway. For stroke (Skien), increased mortality appeared after about 8 days. The curve profiles were thought to reflect suboptimal care in various phases in the clinical pathway. This informed improvement efforts. For 2008-2009, hospital-specific curves differed from other hospitals: borderline significant for AMI (p=0.064), highly significant (p≤0.005) for the remainder. After intervention, no difference was found (p>0.188). Before-after comparison of the curves within each hospital revealed a significant change for Fredrikstad (p=0.006). For the three hospitals, crude 30D declined and they were non-outliers for risk-adjusted 30D for 2013. Survival curves as a supplement to 30D may be useful for identifying suboptimal care in the clinical pathway, and thus informing design of quality improvement projects

  8. Intestine-Specific Mttp Deletion Decreases Mortality and Prevents Sepsis-Induced Intestinal Injury in a Murine Model of Pseudomonas aeruginosa Pneumonia

    Science.gov (United States)

    Dominguez, Jessica A.; Xie, Yan; Dunne, W. Michael; Yoseph, Benyam P.; Burd, Eileen M.; Coopersmith, Craig M.; Davidson, Nicholas O.

    2012-01-01

    Background The small intestine plays a crucial role in the pathophysiology of sepsis and has been referred to as the “motor” of the systemic inflammatory response. One proposed mechanism is that toxic gut-derived lipid factors, transported in mesenteric lymph, induce systemic injury and distant organ failure. However, the pathways involved are yet to be defined and the role of intestinal chylomicron assembly and secretion in transporting these lipid factors is unknown. Here we studied the outcome of sepsis in mice with conditional, intestine-specific deletion of microsomal triglyceride transfer protein (Mttp-IKO), which exhibit a block in chylomicron assembly together with lipid malabsorption. Methodology/Principal Findings Mttp-IKO mice and controls underwent intratracheal injection with either Pseudomonas aeruginosa or sterile saline. Mttp-IKO mice exhibited decreased seven-day mortality, with 0/20 (0%) dying compared to 5/17 (29%) control mice (p<0.05). This survival advantage in Mttp-IKO mice, however, was not associated with improvements in pulmonary bacterial clearance or neutrophil infiltration. Rather, Mttp-IKO mice exhibited protection against sepsis-associated decreases in villus length and intestinal proliferation and were also protected against increased intestinal apoptosis, both central features in control septic mice. Serum IL-6 levels, a major predictor of mortality in human and mouse models of sepsis, were elevated 8-fold in septic control mice but remained unaltered in septic Mttp-IKO mice. Serum high density lipoprotein (HDL) levels were reduced in septic control mice but were increased in septic Mttp-IKO mice. The decreased levels of HDL were associated with decreased hepatic expression of apolipoprotein A1 in septic control mice. Conclusions/Significance These studies suggest that strategies directed at blocking intestinal chylomicron secretion may attenuate the progression and improve the outcome of sepsis through effects mediated by

  9. Intestine-specific Mttp deletion decreases mortality and prevents sepsis-induced intestinal injury in a murine model of Pseudomonas aeruginosa pneumonia.

    Directory of Open Access Journals (Sweden)

    Jessica A Dominguez

    Full Text Available The small intestine plays a crucial role in the pathophysiology of sepsis and has been referred to as the "motor" of the systemic inflammatory response. One proposed mechanism is that toxic gut-derived lipid factors, transported in mesenteric lymph, induce systemic injury and distant organ failure. However, the pathways involved are yet to be defined and the role of intestinal chylomicron assembly and secretion in transporting these lipid factors is unknown. Here we studied the outcome of sepsis in mice with conditional, intestine-specific deletion of microsomal triglyceride transfer protein (Mttp-IKO, which exhibit a block in chylomicron assembly together with lipid malabsorption.Mttp-IKO mice and controls underwent intratracheal injection with either Pseudomonas aeruginosa or sterile saline. Mttp-IKO mice exhibited decreased seven-day mortality, with 0/20 (0% dying compared to 5/17 (29% control mice (p<0.05. This survival advantage in Mttp-IKO mice, however, was not associated with improvements in pulmonary bacterial clearance or neutrophil infiltration. Rather, Mttp-IKO mice exhibited protection against sepsis-associated decreases in villus length and intestinal proliferation and were also protected against increased intestinal apoptosis, both central features in control septic mice. Serum IL-6 levels, a major predictor of mortality in human and mouse models of sepsis, were elevated 8-fold in septic control mice but remained unaltered in septic Mttp-IKO mice. Serum high density lipoprotein (HDL levels were reduced in septic control mice but were increased in septic Mttp-IKO mice. The decreased levels of HDL were associated with decreased hepatic expression of apolipoprotein A1 in septic control mice.These studies suggest that strategies directed at blocking intestinal chylomicron secretion may attenuate the progression and improve the outcome of sepsis through effects mediated by metabolic and physiological adaptations in both intestinal and

  10. Effectivity of immunostimulant from Zoothamnium penaei protein membrane for decreasing the mortality rate of white shrimp (Litopenaeus vannamei) in traditional plus pond

    Science.gov (United States)

    Mahasri, G.; Kusdarwati, R.; Kismiyati; Rozi; Gustrifandi, H.

    2018-04-01

    The purpose of this research was to analys immunogenic membrane protein as immunostimulant development material to control the mortality of white shrimp in traditional plus pond. This research was designed to use explorative experiment and experimental laboratory methods which used completed random sampling design. Collected data was analyzed with analysis of variance for examination of survival rate (SR), total haemocyte count (THC) and differensial haemocyte Count (DHC). The research divided into 2 part of riset: (1) Identification, cultivation Zoothamnium penaei, analysed of membrane protein by SDS-PAGE, (2) Field test protein membran on Survival Rate level, immune response (THC and/or DHC level) and infestation of Zoothamnium penaei in traditional plus pond. The result showed that there were seven bands membrane protein of Zoothamnium penaei with molecular weight 38 kDa, 48 kDa, 67 kDa, 71 kDa, 77 kDa, 98 kDa dan 104 kDa by using SDS-PAGE. Immunogenicity tested decrease by using ELISA and western blotting there are only found three bands with molecular weight 38 kDa, 48 kDa dan 67 kDa. The membrane protein could increase the immun respons and decrease the mortality, by subsequenly, it could increase the survival rate from 17% until 68% and pressured the parasite infestation of white shrimp.

  11. Goal directed fluid therapy decreases postoperative morbidity but not mortality in major non-cardiac surgery: a meta-analysis and trial sequential analysis of randomized controlled trials.

    Science.gov (United States)

    Som, Anirban; Maitra, Souvik; Bhattacharjee, Sulagna; Baidya, Dalim K

    2017-02-01

    Optimum perioperative fluid administration may improve postoperative outcome after major surgery. This meta-analysis and systematic review has been aimed to determine the effect of dynamic goal directed fluid therapy (GDFT) on postoperative morbidity and mortality in non-cardiac surgical patients. Meta-analysis of published prospective randomized controlled trials where GDFT based on non-invasive flow based hemodynamic measurement has been compared with a standard care. Data from 41 prospective randomized trials have been included in this study. Use of GDFT in major surgical patients does not decrease postoperative hospital/30-day mortality (OR 0.70, 95 % CI 0.46-1.08, p = 0.11) length of post-operative hospital stay (SMD -0.14; 95 % CI -0.28, 0.00; p = 0.05) and length of ICU stay (SMD -0.12; 95 % CI -0.28, 0.04; p = 0.14). However, number of patients having at least one postoperative complication is significantly lower with use of GDFT (OR 0.57; 95 % CI 0.43, 0.75; p infection (p = 0.002) and postoperative hypotension (p = 0.04) are also decreased with used of GDFT as opposed to a standard care. Though patients who received GDFT were infused more colloid (p infection, abdominal complications and postoperative hypotension is reduced.

  12. Bed-side inferior vena cava diameter and mean arterial pressure predict long-term mortality in hospitalized patients with heart failure: 36 months of follow-up.

    Science.gov (United States)

    Torres, Daniele; Cuttitta, Francesco; Paterna, Salvatore; Garofano, Alessandro; Conti, Giosafat; Pinto, Antonio; Parrinello, Gaspare

    2016-03-01

    In discharged patients with heart failure (HF), diverse conditions can intervene to worsen outcome. We would investigate whether such factors present on hospital admission can affect long-term mortality in subjects hospitalized for acute HF. One hundred twenty-three consecutive patients hospitalized for acute HF (mean age 74.8 years; 57% female) were recruited and followed for 36 months after hospitalization. At multivariate Cox model, only inferior vena cava (IVC) diameter and mean arterial pressure (MAP) registered bed-side on admission, resulted, after correction for all confounders factors, the sole factors significantly associated with a higher risk of all-cause mortality in long-term (HR 1.06, p=0.0057; HR 0.97, p=0.0218; respectively). Study population was subdivided according to median values of IVC diameter (23 mm) and MAP (93.3 mm Hg). The Kaplan–Meier curve showed that HF patients with both IVC ≥ 23 mm and MAP b93.3 mm Hg on admission had reduced probability of survival free from all-cause death (log rank p = 0.0070 and log rank p = 0.0028, respectively). In patients hospitalized for acute HF, IVC diameter, measured by hand-carried ultrasound (HCU), and MAP detected on admission are strong predictors of long-term all-cause mortality. The data suggest the need for a careful clinical-therapeutic surveillance on these patients during the post-discharge period. IVC diameter and MAP can be utilized as parameters to stratify prognosis on admission and to be supervised during follow-up. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  13. The changing course of aortic valve disease in Scotland: temporal trends in hospitalizations and mortality and prognostic importance of aortic stenosis.

    Science.gov (United States)

    Berry, Colin; Lloyd, Suzanne M; Wang, Yanzhong; Macdonald, Alyson; Ford, Ian

    2013-06-01

    To investigate the contemporary clinical course of aortic valve disease types. We performed a retrospective population-level epidemiological study of hospitalized care in Scotland from 1 January 1997 to 31 December 2005 using electronic case identification of hospital admissions and deaths. Time-to-event analyses were performed using Cox Proportional-Hazards models. A total of 19 733 adults with an index hospitalization and a final diagnosis of non-congenital aortic valve disease were identified. Aortic stenosis, aortic insufficiency, mixed aortic valve disease, or unspecified aortic valve disease occurred in 13 220 (67.0%), 2807 (14.2%), 699 (3.5%), and 3007 (15.2%), individuals, respectively. The majority of hospitalizations occurred in elderly persons aged 80 and older. In total, 9981 (50.6%) patients had died by 31 December 2006. When compared with aortic stenosis, the risk of death was less with aortic insufficiency [hazard ratio (95% confidence interval) 0.79 (0.74, 0.84)] and mixed aortic valve disease [0.83 (0.74, 0.93)]. Female gender, admission year, and hypertension were associated with lower mortality in patients with aortic stenosis. Patients with aortic stenosis had increased risk of death or heart failure (adjusted P valve replacement of whom 73.2% had aortic stenosis, 11.9% aortic valve disease (unspecified),10.0% aortic insufficiency, and 4.9% aortic stenosis with insufficiency. Patients with aortic stenosis with insufficiency had increased likelihood of aortic valve replacement [1.19 (1.02, 1.38)]. Age, female gender, and co-morbidity reduced the likelihood of aortic valve replacement. The incidence of aortic valve stenosis has substantially increased in Scotland in recent years. Aortic stenosis predicts morbidity and mortality when compared with other types of aortic valve disease.

  14. High mortality in HIV-infected children diagnosed in hospital underscores need for faster diagnostic turnaround time in prevention of mother-to-child transmission of HIV (PMTCT) programs.

    Science.gov (United States)

    Wagner, Anjuli; Slyker, Jennifer; Langat, Agnes; Inwani, Irene; Adhiambo, Judith; Benki-Nugent, Sarah; Tapia, Ken; Njuguna, Irene; Wamalwa, Dalton; John-Stewart, Grace

    2015-02-15

    Despite expanded programs for prevention of mother-to-child HIV transmission (PMTCT), HIV-infected infants may not be diagnosed until they are ill. Comparing HIV prevalence and outcomes in infants diagnosed in PMTCT programs to those in hospital settings may improve pediatric HIV diagnosis strategies. HIV-exposed infants turnaround time for tests were compared between PMTCT programs and hospital sites. Among the enrolled cohort, baseline characteristics, survival, and timing of antiretroviral therapy (ART) initiation were compared between infants diagnosed in PMTCT programs versus hospital. Among 1,923 HIV-exposed infants, HIV prevalence was higher among infants tested in hospital than PMTCT early infant diagnosis (EID) sites (41% vs. 11%, p 3 times as likely to die (HR = 3.1, 95% CI = 1.3-7.6). Among HIV-exposed infants, hospital-based testing was more likely to detect an HIV-infected infant than PMTCT testing. Because young symptomatic infants diagnosed with HIV during hospitalization have very high mortality, every effort should be made to diagnose HIV infections before symptom onset. Systems to expedite turnaround time at PMTCT EID sites and to routinize inpatient pediatric HIV testing are necessary to improve pediatric HIV outcomes.

  15. Under-ascertainment of Aboriginality in records of cardiovascular disease in hospital morbidity and mortality data in Western Australia: a record linkage study

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    Katzenellenbogen Judy M

    2010-12-01

    Full Text Available Abstract Background Measuring the real burden of cardiovascular disease in Australian Aboriginals is complicated by under-identification of Aboriginality in administrative health data collections. Accurate data is essential to measure Australia's progress in its efforts to intervene to improve health outcomes of Australian Aboriginals. We estimated the under-ascertainment of Aboriginal status in linked morbidity and mortality databases in patients hospitalised with cardiovascular disease. Methods Persons with public hospital admissions for cardiovascular disease in Western Australia during 2000-2005 (and their 20-year admission history or who subsequently died were identified from linkage data. The Aboriginal status flag in all records for a given individual was variously used to determine their ethnicity (index positive, and in all records both majority positive or ever positive and stratified by region, age and gender. The index admission was the baseline comparator. Results Index cases comprised 62,692 individuals who shared a total of 778,714 hospital admissions over 20 years, of which 19,809 subsequently died. There were 3,060 (4.9% persons identified as Aboriginal on index admission. An additional 83 (2.7% Aboriginal cases were identified through death records, increasing to 3.7% when cases with a positive Aboriginal identifier in the majority (≥50% of previous hospital admissions over twenty years were added and by 20.8% when those with a positive flag in any record over 20 years were incorporated. These results equated to underestimating Aboriginal status in unlinked index admission by 2.6%, 3.5% and 17.2%, respectively. Deaths classified as Aboriginal in official records would underestimate total Aboriginal deaths by 26.8% (95% Confidence Interval 24.1 to 29.6%. Conclusions Combining Aboriginal determinations in morbidity and official death records increases ascertainment of unlinked cardiovascular morbidity in Western Australian

  16. ASA classification and in-hospital deaths in surgery | Chianakwana ...

    African Journals Online (AJOL)

    Background: ASA (American Society of Anesthesiologists') classification appears to have a direct relationship to in-hospital mortality in surgery, provided other factors that can equally affect mortality are favorable. Aims and objectives: To study the relationship between ASA classification and in-hospital mortality within the ...

  17. Expression of chicken interleukin-2 by a highly virulent strain of Newcastle disease virus leads to decreased systemic viral load but does not significantly affect mortality in chickens.

    Science.gov (United States)

    Susta, Leonardo; Diel, Diego G; Courtney, Sean; Cardenas-Garcia, Stivalis; Sundick, Roy S; Miller, Patti J; Brown, Corrie C; Afonso, Claudio L

    2015-08-08

    In mammals, interleukin 2 (IL-2) has been shown to decrease replication or attenuate pathogenicity of numerous viral pathogens (herpes simplex virus, vaccinia virus, human respiratory syncytial virus, human immunodeficiency virus) by activating natural killer cells (NK), cytotoxic T lymphocytes and expanding subsets of memory cells. In chickens, IL-2 has been shown to activate T cells, and as such it might have the potential to affect replication and pathogenesis of Newcastle disease virus (NDV). To assess the effect of IL-2 during NDV infection in chickens, we produced a recombinant virulent NDV strain expressing chicken IL-2 (rZJ1-IL2). The effects of IL-2 expression were investigated in vivo using the intracerebral pathogenicity index (ICPI) in day-old chicks and pathogenesis experiments in 4-week-old chickens. In these studies, rZJ1-IL2 was compared to a control virus expressing the green fluorescent protein (rZJ1-GFP). Assessed parameters included survival curves, detailed histological and immunohistochemical grading of lesions in multiple organs, and virus isolation in blood, spleen and mucosal secretions of infected birds. At the site of infection (eyelid), expression of IL-2 was demonstrated in areas of rZJ-IL2 replication, confirming IL-2 production in vivo. Compared to rZJ1-GFP strain, rZJ1-IL2 caused milder lesions and displayed decreased viral load in blood, spleen and mucosal secretions of infected birds. In the rZJ1-IL2-infected group, virus level in the blood peaked at day 4 post-infection (pi) (10(3.46) EID50 /0.1 ml) and drastically decreased at day 5 pi (10(0.9) EID50/0.1 ml), while in the rZJ1-GFP-infected group virus levels in the blood reached 10(5.35) EID50/0.1 ml at day 5. However, rZJ1-IL2-infected groups presented survival curves similar to control birds infected with rZJ1-GFP, with comparable clinical signs and 100 % mortality. Further, expression of IL-2 did not significantly affect the ICPI scores, compared to rZJ1-GFP strain. Increased

  18. WAYS TO DECREASE INFANT MORTALITY IN A LARGE AGRO INDUSTRIAL REGION IN RUSSIAN NORTH WEST BASED ON A PROGRAMMED GOAL ORIENTED APPROACH (MATERIALS FROM VOLOGDA REGION

    Directory of Open Access Journals (Sweden)

    V.I. Orel

    2007-01-01

    Full Text Available The authors analyze infant mortality situation in a large agroindustrial region to the north west of Russia. Basing on a programmed goal oriented approach and the example of Vologda region, the authors suggest ways to reduce the sickness rate, perinatal, early neonatal and infant mortality, as well as the methods to improve medical aid to early children.Key words: infant mortality, maternity and infant health protection, sickness rate, organization of health services.

  19. Endocardite infecciosa em adolescentes. Análise dos fatores de risco de mortalidade intra-hospitalar Infective endocarditis in adolescents. analysis of risk factors for in-hospital mortality

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    Nádia Barreto Tenório Aoun

    1997-12-01

    patients. Congenital heart disease (24% and cardiac prosthesis (12% were the other affections involved. The majority of patients (78% were in functional class III and IV, with more deaths than the 22% who were in functional class I and II (p=0.01. Staphylococcus aureus was the most frequently isolated agent (42% of the positive blood cultures, followed by Staphylococcus viridans, 21%. Multivariate analysis identified total leukocyte count above 10,000/mm³ and functional class, both at admission (p=0.01 and p=0.004, respectively, and the occurrence of embolic complications (p=0.03 as independent predictors of in-hospital mortality. CONCLUSION: Rheumatic heart disease remains, as in adults, the main predisposing factor for infective endocarditis in adolescents, and S.aureus is, like in children, the leading agent. Mortality is high and functional class at hospital admission, embolic complications and leukocytosis are independent predictors of in-hospital mortality.

  20. Hip fracture in hospitalized medical patients

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    Zapatero Antonio

    2013-01-01

    Full Text Available Abstract Background The aim of the present study is to analyze the incidence of hip fracture as a complication of admissions to internal medicine units in Spain. Methods We analyzed the clinical data of 2,134,363 adults who had been admitted to internal medicine wards. The main outcome was a diagnosis of hip fracture during hospitalization. Outcome measures included rates of in-hospital fractures, length of stay and cost. Results A total of 1127 (0.057% admittances were coded with an in-hospital hip fracture. In hospital mortality rate was 27.9% vs 9.4%; p  Conclusions In-hospital hip fracture notably increased mortality during hospitalization, doubling the mean length of stay and mean cost of admission. These are reasons enough to stress the importance of designing and applying multidisciplinary plans focused on reducing the incidence of hip fractures in hospitalized patients.

  1. Meta-analysis: low-dose intake of vitamin E combined with other vitamins or minerals may decrease all-cause mortality.

    Science.gov (United States)

    Jiang, Shan; Pan, Zhenyu; Li, Hui; Li, Fenglan; Song, Yanyan; Qiu, Yu

    2014-01-01

    It has been suggested that vitamin E alone or combined with other vitamins or minerals can prevent oxidative stress and slow oxidative injury-related diseases, such as cardiovascular disease and cancer. A comprehensive search of PubMed/MEDLINE, EMBASE and the Cochrane Library was performed. Relative risk was used as an effect measure to compare the intervention and control groups. A total of 33 trials were included in the meta-analysis. Neither vitamin E intake alone (RR=1.01; 95% CI, 0.97 to 1.04; p=0.77) nor vitamin E intake combined with other agents (RR=0.97; 95% CI, 0.89 to 1.06; p=0.55) was correlated with all-cause mortality. Subgroup analyses revealed that low-dose vitamin E supplementation combined with other agents is associated with a statistically significant reduction in all-cause mortality (RR=0.92; 95% CI, 0.86 to 0.98; p=0.01), and vitamin E intake combined with other agents is associated with a statistically significant reduction in mortality rates among individuals without probable or confirmed diseases (RR=0.92; 95% CI, 0.86 to 0.99; p=0.02). Neither vitamin E intake alone nor combined with other agents is associated with a reduction in all-cause mortality. But a low dose (vitamin E combined with other agents is correlated with a reduction in all-cause mortality, and vitamin E intake combined with other agents is correlated with a reduction in the mortality rate among individuals without probable or confirmed diseases.

  2. β-Blockers on Discharge From Acute Atrial Fibrillation Are Associated With Decreased Mortality and Lower Cerebrovascular Accidents in Patients With Heart Failure and Reduced Ejection Fraction.

    Science.gov (United States)

    Abi Khalil, Charbel; Zubaid, Mohammad; Asaad, Nidal; Rashed, Wafa A; Hamad, Adel Khalifa; Singh, Rajvir; Al Suwaidi, Jassim

    2018-04-01

    The benefits of β-blockers in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and atrial fibrillation (AF) are controversial. The Gulf Survey of Atrial Fibrillation Events was a prospective, multinational, observational registry of consecutive patients with AF recruited from the emergency department (ED). We studied the incidence of 6- and 12-month mortality, hospitalization for HF or AF, and stroke/transient ischemic attacks (TIAs) in patients with HFrEF, in relation to β-blockers on discharge from the ED or the subsequent hospital stay. Of the 344 patients with HFrEF and AF in the GULF-SAFE, 177 patients (53%) were discharged on β-blockers. Mortality was lower in those patients compared with the non-β-blockers group at 6 and 12 months (odds ratios [ORs] 0.31, 95% CI [0.16-0.61]; OR 0.30, 95% CI [0.16-0.55]; P = .001 for both, respectively), so was the risk of stroke/TIAs. However, hospitalizations for AF increased in the β-blockers group. Even after adjustment for several risk variables in 2 different models, the beneficial effect of β-blockers on mortality persisted, at the cost of more hospitalization for AF.

  3. Decreased systolic blood pressure is associated with increased risk of all-cause mortality in patients with type 2 diabetes and renal impairment: A nationwide longitudinal observational study of 27,732 patients based on the Swedish National Diabetes Register.

    Science.gov (United States)

    Svensson, Maria K; Afghahi, Henri; Franzen, Stefan; Björk, Staffan; Gudbjörnsdottir, Soffia; Svensson, Ann-Marie; Eliasson, Björn

    2017-05-01

    Previous studies have shown a U-shaped relationship between systolic blood pressure and risk of all-cause of mortality in patients with type 2 diabetes and renal impairment. To evaluate the associations between time-updated systolic blood pressure and time-updated change in systolic blood pressure during the follow-up period and risk of all-cause mortality in patients with type 2 diabetes and renal impairment. A total of 27,732 patients with type 2 diabetes and renal impairment in the Swedish National Diabetes Register were followed for 4.7 years. Time-dependent Cox models were used to estimate risk of all-cause mortality. Time-updated mean systolic blood pressure is the average of the baseline and the reported post-baseline systolic blood pressures. A time-updated systolic blood pressure blood pressure > 10 mmHg between the last two observations was associated with higher risk of all-cause mortality (-10 to -25 mmHg; hazard ratio: 1.24, 95% confidence interval: 1.17-1.32). Both low systolic blood pressure and a decrease in systolic blood pressure during the follow-up are associated with a higher risk of all-cause mortality in patients with type 2 diabetes and renal impairment.

  4. The German Quality Network Sepsis: study protocol for the evaluation of a quality collaborative on decreasing sepsis-related mortality in a quasi-experimental difference-in-differences design.

    Science.gov (United States)

    Schwarzkopf, Daniel; Rüddel, Hendrik; Gründling, Matthias; Putensen, Christian; Reinhart, Konrad

    2018-01-18

    While sepsis-related mortality decreased substantially in other developed countries, mortality of severe sepsis remained as high as 44% in Germany. A recent German cluster randomized trial was not able to improve guideline adherence and decrease sepsis-related mortality within the participating hospitals, partly based on lacking support by hospital management and lacking resources for documentation of prospective data. Thus, more pragmatic approaches are needed to improve quality of sepsis care in Germany. The primary objective of the study is to decrease sepsis-related hospital mortality within a quality collaborative relying on claims data. The German Quality Network Sepsis (GQNS) is a quality collaborative involving 75 hospitals. This study protocol describes the conduction and evaluation of the start-up period of the GQNS running from March 2016 to August 2018. Democratic structures assure participatory action, a study coordination bureau provides central support and resources, and local interdisciplinary quality improvement teams implement changes within the participating hospitals. Quarterly quality reports focusing on risk-adjusted hospital mortality in cases with sepsis based on claims data are provided. Hospitals committed to publish their individual risk-adjusted mortality compared to the German average. A complex risk-model is used to control for differences in patient-related risk factors. Hospitals are encouraged to implement a bundle of interventions, e.g., interdisciplinary case analyses, external peer-reviews, hospital-wide staff education, and implementation of rapid response teams. The effectiveness of the GQNS is evaluated in a quasi-experimental difference-in-differences design by comparing the change of hospital mortality of cases with sepsis with organ dysfunction from a retrospective baseline period (January 2014 to December 2015) and the intervention period (April 2016 to March 2018) between the participating hospitals and all other German

  5. A matched pair cluster randomized implementation trail to measure the effectiveness of an intervention package aiming to decrease perinatal mortality and increase institution-based obstetric care among indigenous women in Guatemala: study protocol.

    Science.gov (United States)

    Kestler, Edgar; Walker, Dilys; Bonvecchio, Anabelle; de Tejada, Sandra Sáenz; Donner, Allan

    2013-03-21

    design. Our main outcome measures will be the change in perinatal mortality and in the proportion of institution-based deliveries. A unique feature of this protocol is that we are not proposing an individual intervention, but rather a package of interventions, which is designed to address the complexities and realities of maternal and perinatal mortality in developing countries. To date, many other countries, has focused its efforts to decrease maternal mortality indirectly by improving infrastructure and data collection systems rather than on implementing specific interventions to directly improve outcomes. ClinicalTrial.gov,http://NCT01653626.

  6. Additive prognostic value of left ventricular ejection fraction to the TIMI risk score for in-hospital and long-term mortality in patients with ST segment elevation myocardial infarction.

    Science.gov (United States)

    Wei, Xue-Biao; Liu, Yuan-Hui; He, Peng-Cheng; Jiang, Lei; Zhou, Ying-Ling; Chen, Ji-Yan; Tan, Ning; Yu, Dan-Qing

    2017-01-01

    To investigate whether the addition of left ventricular ejection fraction (LVEF) to the TIMI risk score enhances the prediction of in-hospital and long-term death in ST segment elevation myocardial infarction (STEMI) patients. 673 patients with STEMI were divided into three groups based on TIMI risk score for STEMI: low-risk group (TIMI ≤3, n = 213), moderate-risk group (TIMI 4-6, n = 285), and high-risk group (TIMI ≥7, n = 175). The predictive value was evaluated using the receiver operating characteristic. Multivariate logistic regression was used to determine risk predictors. The rates of in-hospital death (0.5 vs 3.2 vs 10.3 %, p risk group. Multivariate analysis showed that TIMI risk score (OR 1.24, 95 % CI 1.04-1.48, P = 0.015) and LVEF (OR 3.85, 95 % CI 1.58-10.43, P = 0.004) were independent predictors of in-hospital death. LVEF had good predictive value for in-hospital death (AUC: 0.838 vs 0.803, p = 0.571) or 1-year death (AUC: 0.743 vs 0.728, p = 0.775), which was similar to TIMI risk score. When compared with the TIMI risk score alone, the addition of LVEF was associated with significant improvements in predicting in-hospital (AUC: 0.854 vs 0.803, p = 0.033) or 1-year death (AUC: 0.763 vs 0.728, p = 0.016). The addition of LVEF to TIMI risk score enhanced net reclassification improvement (0.864 for in-hospital death, p value to TIMI risk score.

  7. Predictors of in-hospital mortality for patients admitted with ST-elevation myocardial infarction: a real-world study using the Myocardial Infarction National Audit Project (MINAP) database.

    Science.gov (United States)

    Gale, C P; Manda, S O M; Batin, P D; Weston, C F; Birkhead, J S; Hall, A S

    2008-11-01

    Although early thrombolysis reduces the risk of death in STEMI patients, mortality remains high. We evaluated factors predicting inpatient mortality for patients with STEMI in a "real-world" population. Analysis of the Myocardial Infarction National Audit Project (MINAP) database using multivariate logistic regression and area under the receiver operating curve analysis. All acute hospitals in England and Wales. 34 722 patients with STEMI from 1 January 2003 to 31 March 2005. Inpatient mortality was 10.6%. The highest odds ratios for inpatient survival were aspirin therapy given acutely and out-of-hospital thrombolysis, independently associated with a mortality risk reduction of over half. A 10-year increase in age doubled inpatient mortality risk, whereas cerebrovascular disease increased it by 1.7. The risk model comprised 14 predictors of mortality, C index = 0.82 (95% CI 0.82 to 0.83, pmodel comprising age, systolic blood pressure (SBP) and heart rate (HR) offered a C index of 0.80 (0.79 to 0.80, pmodels have focused on age, SBP and HR We have confirmed the importance of these predictors in the discrimination of death after STEMI, but also demonstrated that other potentially modifiable variables impact upon the prediction of short-term mortality.

  8. Prognosis of ventricular fibrillation in hospital

    DEFF Research Database (Denmark)

    Jensen, G V; Torp-Pedersen, C; Køber, L

    1992-01-01

    In a retrospective study of 520 patients with in-hospital ventricular fibrillation 421 (81%) had acute myocardial infarction (MI), 66 (13%) had ischaemic heart disease (IHD) without MI, 33 (6%) had no signs of IHD. The in-hospital mortality of these three groups was 51%, 52%, and 27%, respectively...... (P = 0.01). Logistic regression analysis demonstrated that heart failure and cardiogenic shock were significant risk factors for in-hospital death among patients with IHD. Among discharged patients 1 and 5 years survival was 78% and 51% for patients with MI, 63% and 25% for patients with IHD, 67...... with known IHD suffering in-hospital VF without AMI have a very poor short- and long-term prognosis. These patients need extensive cardiac examination....

  9. Cerebral oxygen transport failure?: decreasing hemoglobin and hematocrit levels after ischemic stroke predict poor outcome and mortality: STroke: RelevAnt Impact of hemoGlobin, Hematocrit and Transfusion (STRAIGHT)--an observational study.

    Science.gov (United States)

    Kellert, Lars; Martin, Evgenia; Sykora, Marek; Bauer, Harald; Gussmann, Philipp; Diedler, Jennifer; Herweh, Christian; Ringleb, Peter A; Hacke, Werner; Steiner, Thorsten; Bösel, Julian

    2011-10-01

    Although conceivably relevant for penumbra oxygenation, the optimal levels of hemoglobin (Hb) and hematocrit (Hct) in patients with acute ischemic stroke are unknown. We identified patients from our prospective local stroke database who received intravenous thrombolysis based on multimodal magnet resonance imaging during the years 1998 to 2009. A favorable outcome at 3 months was defined as a modified Rankin Scale score≤2 and a poor outcome as a modified Rankin Scale score≥3. The dynamics of Hemoglobin (Hb), Hematocrit (Hct), and other relevant laboratory parameters as well as cardiovascular risk factors were retrospectively assessed and analyzed between these 2 groups. Of 217 patients, 114 had a favorable and 103 a poor outcome. In a multivariable regression model, anemia until day 5 after admission (odds ratio [OR]=2.61; 95% CI, 1.33 to 5.11; P=0.005), Hb nadir (OR=0.81; 95% CI, 0.67 to 0.99; P=0.038), and Hct nadir (OR=0.93; 95% CI, 0.87 to 0.99; P=0.038) remained independent predictors for poor outcome at 3 months. Mortality after 3 months was independently associated with Hb nadir (OR=0.80; 95% CI, 0.65 to 0.98; P=0.028) and Hb decrease (OR=1.34; 95% CI, 1.01 to 1.76; P=0.04) as well as Hct decrease (OR=1.12; 95% CI, 1.01 to 1.23; P=0.027). Poor outcome and mortality after ischemic stroke are strongly associated with low and further decreasing Hb and Hct levels. This decrease of Hb and Hct levels after admission might be more relevant and accessible to treatment than are baseline levels.

  10. National Trends in Patients Hospitalized for Stroke and Stroke Mortality in France, 2008 to 2014.

    Science.gov (United States)

    Lecoffre, Camille; de Peretti, Christine; Gabet, Amélie; Grimaud, Olivier; Woimant, France; Giroud, Maurice; Béjot, Yannick; Olié, Valérie

    2017-11-01

    Stroke is the leading cause of death in women and the third leading cause in men in France. In young adults (ie, stroke was observed at a local scale between 1985 and 2011. After the implementation of the 2010 to 2014 National Stroke Action Plan, this study investigates national trends in patients hospitalized by stroke subtypes, in-hospital mortality, and stroke mortality between 2008 and 2014. Hospitalization data were extracted from the French national hospital discharge databases and mortality data from the French national medical causes of death database. Time trends were tested using a Poisson regression model. From 2008 to 2014, the age-standardized rates of patients hospitalized for ischemic stroke increased by 14.3% in patients hemorrhagic stroke was stable (+2.0%), irrespective of age and sex. The proportion of patients hospitalized in stroke units substantially increased. In-hospital mortality decreased by 17.1% in patients with ischemic stroke. From 2008 to 2013, stroke mortality decreased, except for women between 45 and 64 years old and for people aged ≥85 years. An increase in cardiovascular risk factors and improved stroke management may explain the increase in the rates of patients hospitalized for ischemic stroke. The decrease observed for in-hospital stroke mortality may be because of recent improvements in acute-phase management. © 2017 American Heart Association, Inc.

  11. Increasing trends in hospital care burden of atrial fibrillation in Korea, 2006 through 2015

    DEFF Research Database (Denmark)

    Kim, Daehoon; Yang, Pil-Sung; Jang, Eunsun

    2018-01-01

    OBJECTIVE: Temporal changes in the healthcare burden of atrial fibrillation (AF) are less well known in rapidly ageing Asian countries. We examined trends in hospitalisations, costs, treatment patterns and outcomes related to AF in Korea. METHODS: Using the National Health Insurance Service (NHIS...... hospitalisations mainly due to ischaemic stroke and myocardial infarction decreased. The total cost of care increased even after adjustment for inflation from €68.4 million in 2006 to €388.4 million in 2015, equivalent to 0.78% of the Korean NHIS total expenditure. Overall in-hospital mortality decreased from 7...

  12. Research in Hospitality Management

    African Journals Online (AJOL)

    Research in Hospitality Management. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 5, No 1 (2015) >. Log in or Register to get access to full text downloads.

  13. Research in Hospitality Management

    African Journals Online (AJOL)

    Research in Hospitality Management (RHM) is a peer-reviewed journal ... to the quintessential managerial areas of Finance, Human Resources, Operations, ... competency and career development of hospitality management students · EMAIL ...

  14. Nutrition support in hospitals

    DEFF Research Database (Denmark)

    Kondrup, Jens

    2005-01-01

    Nutrition support in hospitals is becoming an area of focus because of the evidence showing improved clinical outcome with nutrition support, its status as a human rights issue and its integration into quality assurance.......Nutrition support in hospitals is becoming an area of focus because of the evidence showing improved clinical outcome with nutrition support, its status as a human rights issue and its integration into quality assurance....

  15. Multidisciplinary in-hospital teams improve patient outcomes: A review.

    Science.gov (United States)

    Epstein, Nancy E

    2014-01-01

    The use of multidisciplinary in-hospital teams limits adverse events (AE), improves outcomes, and adds to patient and employee satisfaction. Acting like "well-oiled machines," multidisciplinary in-hospital teams include "staff" from different levels of the treatment pyramid (e.g. staff including nurses' aids, surgical technicians, nurses, anesthesiologists, attending physicians, and others). Their enhanced teamwork counters the "silo effect" by enhancing communication between the different levels of healthcare workers and thus reduces AE (e.g. morbidity/mortality) while improving patient and healthcare worker satisfaction. Multiple articles across diverse disciplines incorporate a variety of concepts of "teamwork" for staff covering emergency rooms (ERs), hospital wards, intensive care units (ICUs), and most critically, operating rooms (ORs). Cohesive teamwork improved communication between different levels of healthcare workers, and limited adverse events, improved outcomes, decreased the length of stay (LOS), and yielded greater patient "staff" satisfaction. Within hospitals, delivering the best medical/surgical care is a "team sport." The goals include: Maximizing patient safety (e.g. limiting AE) and satisfaction, decreasing the LOS, and increasing the quality of outcomes. Added benefits include optimizing healthcare workers' performance, reducing hospital costs/complications, and increasing job satisfaction. This review should remind hospital administrators of the critical need to keep multidisciplinary teams together, so that they can continue to operate their "well-oiled machines" enhancing the quality/safety of patient care, while enabling "staff" to optimize their performance and enhance their job satisfaction.

  16. Facility-Level Variation in Hospitalization, Mortality, and Costs in the 30 Days After Percutaneous Coronary Intervention: Insights on Short-Term Healthcare Value From the Veterans Affairs Clinical Assessment, Reporting, and Tracking System (VA CART) Program.

    Science.gov (United States)

    Bradley, Steven M; O'Donnell, Colin I; Grunwald, Gary K; Liu, Chuan-Fen; Hebert, Paul L; Maddox, Thomas M; Jesse, Robert L; Fihn, Stephan D; Rumsfeld, John S; Ho, P Michael

    2015-07-14

    Policies to reduce unnecessary hospitalizations after percutaneous coronary intervention (PCI) are intended to improve healthcare value by reducing costs while maintaining patient outcomes. Whether facility-level hospitalization rates after PCI are associated with cost of care is unknown. We studied 32,080 patients who received PCI at any 1 of 62 Veterans Affairs hospitals from 2008 to 2011. We identified facility outliers for 30-day risk-standardized hospitalization, mortality, and cost. Compared with the risk-standardized average, 2 hospitals (3.2%) had a lower-than-expected hospitalization rate, and 2 hospitals (3.2%) had a higher-than-expected hospitalization rate. We observed no statistically significant variation in facility-level risk-standardized mortality. The facility-level unadjusted median per patient 30-day total cost was $23,820 (interquartile range, $19,604-$29,958). Compared with the risk-standardized average, 17 hospitals (27.4%) had lower-than-expected costs, and 14 hospitals (22.6%) had higher-than-expected costs. At the facility level, the index PCI accounted for 83.1% of the total cost (range, 60.3%-92.2%), whereas hospitalization after PCI accounted for only 5.8% (range, 2.0%-12.7%) of the 30-day total cost. Facilities with higher hospitalization rates were not more expensive (Spearman ρ=0.16; 95% confidence interval, -0.09 to 0.39; P=0.21). In this national study, hospitalizations in the 30 day after PCI accounted for only 5.8% of 30-day cost, and facility-level cost was not correlated with hospitalization rates. This challenges the focus on reducing hospitalizations after PCI as an effective means of improving healthcare value. Opportunities remain to improve PCI value by reducing the variation in total cost of PCI without compromising patient outcomes. © 2015 American Heart Association, Inc.

  17. Conservative fluid management prevents age-associated ventilator induced mortality.

    Science.gov (United States)

    Herbert, Joseph A; Valentine, Michael S; Saravanan, Nivi; Schneck, Matthew B; Pidaparti, Ramana; Fowler, Alpha A; Reynolds, Angela M; Heise, Rebecca L

    2016-08-01

    Approximately 800 thousand patients require mechanical ventilation in the United States annually with an in-hospital mortality rate of over 30%. The majority of patients requiring mechanical ventilation are over the age of 65 and advanced age is known to increase the severity of ventilator-induced lung injury (VILI) and in-hospital mortality rates. However, the mechanisms which predispose aging ventilator patients to increased mortality rates are not fully understood. Ventilation with conservative fluid management decreases mortality rates in acute respiratory distress patients, but to date there has been no investigation of the effect of conservative fluid management on VILI and ventilator associated mortality rates. We hypothesized that age-associated increases in susceptibility and incidence of pulmonary edema strongly promote age-related increases in ventilator associated mortality. 2month old and 20month old male C57BL6 mice were mechanically ventilated with either high tidal volume (HVT) or low tidal volume (LVT) for up to 4h with either liberal or conservative fluid support. During ventilation, lung compliance, total lung capacity, and hysteresis curves were quantified. Following ventilation, bronchoalveolar lavage fluid was analyzed for total protein content and inflammatory cell infiltration. Wet to dry ratios were used to directly measure edema in excised lungs. Lung histology was performed to quantify alveolar barrier damage/destruction. Age matched non-ventilated mice were used as controls. At 4h, both advanced age and HVT ventilation significantly increased markers of inflammation and injury, degraded pulmonary mechanics, and decreased survival rates. Conservative fluid support significantly diminished pulmonary edema and improved pulmonary mechanics by 1h in advanced age HVT subjects. In 4h ventilations, conservative fluid support significantly diminished pulmonary edema, improved lung mechanics, and resulted in significantly lower mortality rates in

  18. Marijuana use and mortality following orthopedic surgical procedures.

    Science.gov (United States)

    Moon, Andrew S; Smith, Walter; Mullen, Sawyer; Ponce, Brent A; McGwin, Gerald; Shah, Ashish; Naranje, Sameer M

    2018-03-20

    The association between marijuana use and surgical procedures is a matter of increasing societal relevance that has not been well studied in the literature. The primary aim of this study is to evaluate the relationship between marijuana use and in-hospital mortality, as well as to assess associated comorbidities in patients undergoing commonly billed orthopedic surgeries. The National Inpatient Sample (NIS) database from 2010 to 2014 was used to determine the odds ratios for the associations between marijuana use and in-hospital mortality, heart failure (HF), stroke, and cardiac disease (CD) in patients undergoing five common orthopedic procedures: hip (THA), knee (TKA), and shoulder arthroplasty (TSA), spinal fusion, and traumatic femur fracture fixation. Of 9,561,963 patients who underwent one of the five selected procedures in the four-year period, 26,416 (0.28%) were identified with a diagnosis of marijuana use disorder. In hip and knee arthroplasty patients, marijuana use was associated with decreased odds of mortality compared to no marijuana use (pmarijuana use (0.70%), which was associated with decreased odds of mortality (p = 0.0483), HF (p = 0.0076), and CD (p = 0.0003). For spinal fusions, marijuana use was associated with increased odds of stroke (pMarijuana use in patients undergoing shoulder arthroplasty was associated with decreased odds of mortality (pmarijuana use was associated with decreased mortality in patients undergoing THA, TKA, TSA and traumatic femur fixation, although the significance of these findings remains unclear. More research is needed to provide insight into these associations in a growing surgical population.

  19. Neurologic disorders, in-hospital deaths, and years of potential life lost in the USA, 1988-2011.

    Science.gov (United States)

    Rosenbaum, Benjamin P; Kelly, Michael L; Kshettry, Varun R; Weil, Robert J

    2014-11-01

    Premature mortality is a public health concern that can be quantified as years of potential life lost (YPLL). Studying premature mortality can help guide hospital initiatives and resource allocation. We investigated the categories of neurologic and neurosurgical conditions associated with in-hospital deaths that account for the highest YPLL and their trends over time. Using the Nationwide Inpatient Sample (NIS), we calculated YPLL for patients hospitalized in the USA from 1988 to 2011. Hospitalizations were categorized by related neurologic principal diagnoses. An estimated 2,355,673 in-hospital deaths accounted for an estimated 25,598,566 YPLL. The traumatic brain injury (TBI) category accounted for the highest annual mean YPLL at 361,748 (33.9% of total neurologic YPLL). Intracerebral hemorrhage, cerebral ischemia, subarachnoid hemorrhage, and anoxic brain damage completed the group of five diagnoses with the highest YPLL. TBI accounted for 12.1% of all inflation adjusted neurologic hospital charges and 22.4% of inflation adjusted charges among neurologic deaths. The in-hospital mortality rate has been stable or decreasing for all of these diagnoses except TBI, which rose from 5.1% in 1988 to 7.8% in 2011. Using YPLL, we provide a framework to compare the burden of premature in-hospital mortality on patients with neurologic disorders, which may prove useful for informing decisions related to allocation of health resources or research funding. Considering premature mortality alone, increased efforts should be focused on TBI, particularly in and related to the hospital setting. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Hip fracture in hospitalized medical patients.

    Science.gov (United States)

    Zapatero, Antonio; Barba, Raquel; Canora, Jesús; Losa, Juan E; Plaza, Susana; San Roman, Jesús; Marco, Javier

    2013-01-08

    The aim of the present study is to analyze the incidence of hip fracture as a complication of admissions to internal medicine units in Spain. We analyzed the clinical data of 2,134,363 adults who had been admitted to internal medicine wards. The main outcome was a diagnosis of hip fracture during hospitalization.Outcome measures included rates of in-hospital fractures, length of stay and cost. A total of 1127 (0.057%) admittances were coded with an in-hospital hip fracture. In hospital mortality rate was 27.9% vs 9.4%; p patients with a hip fracture (20.7 days vs 9.8 days; p hip-fracture patients (6927€ per hospitalization vs 3730€ in non fracture patients). Risk factors related to fracture were: increasing age by 10 years increments (OR 2.32 95% CI 2.11-2.56), female gender (OR 1.22 95% CI 1.08-1.37), admission from nursing home (OR 1.65 95% CI 1.27-2.12), dementia (1.55 OR 95% CI1.30-1.84), malnutrition (OR 2.50 95% CI 1.88-3.32), delirium (OR 1.57 95% CI 1.16-2.14), and anemia (OR 1.30 95%CI 1.12-1.49). In-hospital hip fracture notably increased mortality during hospitalization, doubling the mean length of stay and mean cost of admission. These are reasons enough to stress the importance of designing and applying multidisciplinary plans focused on reducing the incidence of hip fractures in hospitalized patients.

  1. Survival and neurological outcome following in-hospital paediatric cardiopulmonary resuscitation in North India.

    Science.gov (United States)

    Rathore, Vinay; Bansal, Arun; Singhi, Sunit C; Singhi, Pratibha; Muralidharan, Jayashree

    2016-05-01

    Data on outcome of children undergoing in-hospital cardiopulmonary resuscitation (CPR) in low- and middle-income countries are scarce. To describe the clinical profile and outcome of children undergoing in-hospital CPR. This prospective observational study was undertaken in the Advanced Pediatric Center, PGIMER, Chandigarh. All patients aged 1 month to 12 years who underwent in-hospital CPR between July 2010 and March 2011 were included. Data were recorded using the 'Utstein style'. Outcome variables included 'sustained return of spontaneous circulation' (ROSC), survival at discharge and neurological outcome at 1 year. The incidence of in-hospital CPR in all hospital admissions (n = 4654) was 6.7% (n = 314). 64.6% (n = 203) achieved ROSC, 14% (n = 44) survived to hospital discharge and 11.1% (n = 35) survived at 1 year. Three-quarters of survivors had a good neurological outcome at 1-year follow-up. Sixty per cent of patients were malnourished. The Median Pediatric Risk of Mortality-III (PRISM-III) score was 16 (IQR 9-25). Sepsis (71%), respiratory (39.5%) and neurological (31.5%) illness were the most common diagnoses. The most common initial arrhythmia was bradycardia (52.2%). On multivariate logistic regression, duration of CPR, diagnosis of sepsis and requirement for vasoactive support prior to arrest were independent predictors of decreased hospital survival. The requirement for in-hospital CPR is common in PGIMER. ROSC was achieved in two-thirds of children, but mortality was higher than in high-income countries because of delayed presentation, malnutrition and severity of illness. CPR >15 min was associated with death. Survivors had good long-term neurological outcome, demonstrating the value of timely CPR.

  2. Ionizing radiation in hospitals

    International Nuclear Information System (INIS)

    Blok, K.; Ginkel, G. van; Leun, K. van der; Muller, H.; Oude Elferink, J.; Vesseur, A.

    1985-10-01

    This booklet dels with the risks of the use of ionizing radiation for people working in a hospital. It is subdivided in three parts. Part 1 treats the properties of ionizing radiation in general. In part 2 the various applications are discussed of ionizing radiation in hospitals. Part 3 indicates how a not completely safe situation may be improved. (H.W.). 14 figs.; 4 tabs

  3. Patient life in hospital

    DEFF Research Database (Denmark)

    Ludvigsen, Mette Spliid

    Patient life in hospital.A qualitative study of informal relationships between hospitalised patients Introduction Within a patientology framework, this PhD dissertation is about an empirical study on patient life that provides insight into the nature of informal relationships between patients...... are created through stories about three roughly framed aspects of hospitalisation: A. Being together with fellow patients entails a constant dilemma, B. Relationships between patients are restricted and extended and C. Shifting perspectives in solidarity. Conclusion Patients' hospitalisation is strongly...

  4. Preventing falls in hospital.

    Science.gov (United States)

    Pearce, Lynne

    2017-02-27

    Essential facts Falls are the most frequent adverse event reported in hospitals, usually affecting older patients. Every year, more than 240,000 falls are reported in acute hospitals and mental health trusts in England and Wales, equivalent to more than 600 a day, according to the Royal College of Physicians (RCP). But research shows that when nurses, doctors and therapists work together, falls can be reduced by 20-30%.

  5. Myocardial Revascularization in Dyalitic Patients: In-Hospital Period Evaluation

    International Nuclear Information System (INIS)

    Miranda, Matheus; Hossne, Nelson Américo Jr.; Branco, João Nelson Rodrigues; Vargas, Guilherme Flora; Fonseca, José Honório de Almeida Palma da; Pestana, José Osmar Medina de Abreu; Juliano, Yara; Buffolo, Enio

    2014-01-01

    Coronary artery bypass grafting currently is the best treatment for dialytic patients with multivessel coronary disease, but hospital morbidity and mortality related to procedure is still high. Evaluate results and in-hospital outcomes of coronary artery bypass grafting in dialytic patients. Retrospective unicentric study including 50 consecutive and not selected dialytic patients, who underwent coronary artery bypass grafting in a tertiary university hospital from 2007 to 2012. High prevalence of cardiovascular risk factors was observed (100% hypertensive, 68% diabetic and 40% dyslipidemic). There was no intra-operative death and 60% of the procedures were performed off-pump. There were seven (14%) in-hospital deaths. Postoperative infection, previous heart failure, cardiopulmonary bypass, abnormal ventricular function and surgical re-exploration were associated with increased mortality. Coronary artery bypass grafting is feasible to dialytic patients although high in-hospital morbidity and mortality. It is necessary better understanding about metabolic aspects to plan adequate interventions

  6. Myocardial Revascularization in Dyalitic Patients: In-Hospital Period Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Miranda, Matheus, E-mail: matheus10miranda@gmail.com; Hossne, Nelson Américo Jr.; Branco, João Nelson Rodrigues; Vargas, Guilherme Flora; Fonseca, José Honório de Almeida Palma da; Pestana, José Osmar Medina de Abreu [Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Juliano, Yara [Universidade de Santo Amaro, São Paulo, SP (Brazil); Buffolo, Enio [Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil)

    2014-02-15

    Coronary artery bypass grafting currently is the best treatment for dialytic patients with multivessel coronary disease, but hospital morbidity and mortality related to procedure is still high. Evaluate results and in-hospital outcomes of coronary artery bypass grafting in dialytic patients. Retrospective unicentric study including 50 consecutive and not selected dialytic patients, who underwent coronary artery bypass grafting in a tertiary university hospital from 2007 to 2012. High prevalence of cardiovascular risk factors was observed (100% hypertensive, 68% diabetic and 40% dyslipidemic). There was no intra-operative death and 60% of the procedures were performed off-pump. There were seven (14%) in-hospital deaths. Postoperative infection, previous heart failure, cardiopulmonary bypass, abnormal ventricular function and surgical re-exploration were associated with increased mortality. Coronary artery bypass grafting is feasible to dialytic patients although high in-hospital morbidity and mortality. It is necessary better understanding about metabolic aspects to plan adequate interventions.

  7. Infant Mortality

    Science.gov (United States)

    ... After hours (404) 639-2888 Contact Media Infant Mortality Recommend on Facebook Tweet Share Compartir On This ... differences in rates among population groups. About Infant Mortality Infant mortality is the death of an infant ...

  8. Appetite - decreased

    Science.gov (United States)

    Loss of appetite; Decreased appetite; Anorexia ... Any illness can reduce appetite. If the illness is treatable, the appetite should return when the condition is cured. Loss of appetite can cause weight ...

  9. Radiation protection in hospitals

    International Nuclear Information System (INIS)

    MOuld, R.F.

    1985-01-01

    A book on radiation protection in hospitals has been written to cater for readers with different backgrounds, training and needs by providing an elementary radiation physics text in Part I and an advanced, comprehensive Part II relating to specific medical applications of X-rays and of radioactivity. Part I includes information on basic radiation physics, radiation risk, radiation absorption and attenuation, radiation measurement, radiation shielding and classification of radiation workers. Part II includes information on radiation protection in external beam radiotherapy, interstitial source radiotherapy, intracavitary radiotherapy, radioactive iodine-131 radiotherapy, nuclear medicine diagnostics and diagnostic radiology. (U.K.)

  10. Fraud in Hospitals

    OpenAIRE

    Musau, Steve; Vian, Taryn

    2008-01-01

    Hospitals are vulnerable to corruption. In the U.S., health care fraud has been stimated to cost $60 billion per year, or 3% of total health care expenditures - much of it in the hospital sector. Hospitals account for 50% or more of health care pending in many countries. Fraud and corruption in hospitals negatively affect access and quality, as public servants make off with resources which could have been used to reduce out-of-pocket expenditures for patients, or improve needed services. This...

  11. Tree Mortality

    Science.gov (United States)

    Mark J. Ambrose

    2012-01-01

    Tree mortality is a natural process in all forest ecosystems. However, extremely high mortality also can be an indicator of forest health issues. On a regional scale, high mortality levels may indicate widespread insect or disease problems. High mortality may also occur if a large proportion of the forest in a particular region is made up of older, senescent stands....

  12. Insuficiência renal oculta acarreta risco elevado de mortalidade após cirurgia de revascularização miocárdica Hidden renal dysfunction causes increased in-hospital mortality risk after coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Mathias Alexandre Volkmann

    2011-09-01

    Full Text Available INTRODUÇÃO E OBJETIVOS: Insuficiência renal crônica pré operatória é fator preditivo independente para mortalidade em cirurgia cardíaca. Como creatinina sérica normal não representa obrigatoriamente função renal normal, comparamos as taxas de mortalidade, de permanência hospitalar total e de permanência hospitalar pós-operatória em pacientes submetidos à cirurgia de revascularização miocárdica isolada com creatinina 60 mL/min (Grupo A e 1.226 com INTRODUCTION AND OBJECTIVES: Preoperative chronic renal dysfunction is an independent predictor of mortality in cardiac surgery. As normal range serum creatinine is not representative of normal renal function, we compared mortality rates, total hospital stay and post-surgical hospital stay for patients who underwent isolated coronary artery bypass surgery with serum creatinine 60mL/min (Group A, and 1,226 with <60mL/min (Group B. Group B patients had significantly higher total hospital stay and post-surgical hospital stay than those in Group A (respectively 2.85 and 1.79 more days - P<0.0001. Relative risk of in-hospital death was 2.09 to Group B (95%CI:1.54-2.84 when compared to Group A. CONCLUSIONS: More than one quarter of the patients with serum creatinine <1.5mg/dL had creatinine clearance <60 mL/min. This expressive number of patients, that would not have their renal dysfunction detected by the serum creatinine parameter alone, had double the risk of death, longer total hospital stay and post-surgical hospital stay than the other patients with serum creatinine < 1.5mg/dL

  13. Predictors of in-hospital mortality following non- cardiac surgery ...

    African Journals Online (AJOL)

    associated with an almost four-fold increased risk of postoperative .... as in the validation study of Lee's RCRI.[14] .... Steyn K, Sliwa K, Hawken S, et al. ... A cross-sectional analysis using data from the new UK general practitioner 'Quality and ...

  14. Nonelective surgery at night and in-hospital mortality

    DEFF Research Database (Denmark)

    van Zaane, Bas; van Klei, Wilton A; Buhre, Wolfgang F

    2015-01-01

    BACKGROUND: Evidence suggests that sleep deprivation associated with night-time working may adversely affect performance resulting in a reduction in the safety of surgery and anaesthesia. OBJECTIVE: Our primary objective was to evaluate an association between nonelective night-time surgery and in...

  15. Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality

    NARCIS (Netherlands)

    de Wilde, R. F.; Besselink, M. G. H.; van der Tweel, I.; de Hingh, I. H. J. T.; van Eijck, C. H. J.; Dejong, C. H. C.; Porte, R. J.; Gouma, D. J.; Busch, O. R. C.; Molenaar, I. Q.

    Background: The impact of nationwide centralization of pancreaticoduodenectomy (PD) on mortality is largely unknown. The aim of this study was to analyse changes in hospital volumes and in-hospital mortality after PD in the Netherlands between 2004 and 2009. Methods: Nationwide data on International

  16. Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality

    NARCIS (Netherlands)

    de Wilde, R. F.; Besselink, M. G. H.; van der Tweel, I.; de Hingh, I. H. J. T.; van Eijck, C. H. J.; Dejong, C. H. C.; Porte, R. J.; Gouma, D. J.; Busch, O. R. C.; Molenaar, I. Q.

    2012-01-01

    Background: The impact of nationwide centralization of pancreaticoduodenectomy (PD) on mortality is largely unknown. The aim of this study was to analyse changes in hospital volumes and in-hospital mortality after PD in the Netherlands between 2004 and 2009. Methods: Nationwide data on International

  17. Socioeconomic factors and mortality in emergency general surgery: trends over a 20-year period.

    Science.gov (United States)

    Armenia, Sarah J; Pentakota, Sri Ram; Merchant, Aziz M

    2017-05-15

    Socioeconomic factors such as race, insurance, and income quartiles have been identified as independent risk factors in emergency general surgery (EGS), but this impact has not been studied over time. We sought to identify trends in disparities in EGS-related operative mortality over a 20-y period. The National Inpatient Sample was used to identify patient encounters coded for EGS in 1993, 2003, and 2013. Logistic regression models were used to examine the adjusted relationship between race, primary payer status, and median income quartiles and in-hospital mortality after adjusting for patients' age, gender, Elixhauser comorbidity score, and hospital region, size, and location-cum-teaching status. We identified 391,040 patient encounters. In 1993, Black race was associated with higher odds of in-hospital mortality (odds ratio [95% confidence interval]: 1.35 [1.20-1.53]) than White race, although this difference dissipated in subsequent years. Medicare, Medicaid, and underinsured patients had a higher odds of mortality than those with private insurance for the entire 20-y period; only the disparity in the underinsured decreased over time (1993, 1.63 [1.35-1.98]; 2013, 1.41 [1.20-1.67]). In 2003 (1.23 [1.10-1.38]) and 2013 (1.23 [1.11-1.37]), patients from the lowest income quartile were more likely to die after EGS than patients from the highest income quartile. Socioeconomic disparities in EGS-related operative morality followed inconsistent trends. Over time, while gaps in in-hospital mortality among Blacks and Whites have narrowed, disparities among patients belonging to lowest income quartile have worsened. Medicare and Medicaid beneficiaries continued to experience higher odds of in-hospital mortality relative to those with private insurance. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Occupational mortality

    DEFF Research Database (Denmark)

    Lynge, Elsebeth

    2011-01-01

    -1975 revealed a considerable social class gradient in male mortality where university teachers and farmers had a 40% lower mortality and waiters and seamen had an about 100% higher mortality than the average for economically active men. The social class gradient was less steep for women. A similar pattern...

  19. Recognized Obstructive Sleep Apnea is Associated With Improved In-Hospital Outcomes After ST Elevation Myocardial Infarction.

    Science.gov (United States)

    Mohananey, Divyanshu; Villablanca, Pedro A; Gupta, Tanush; Agrawal, Sahil; Faulx, Michael; Menon, Venugopal; Kapadia, Samir R; Griffin, Brian P; Ellis, Stephen G; Desai, Milind Y

    2017-07-20

    Obstructive sleep apnea (OSA) is an independent risk factor for many cardiovascular conditions such as coronary artery disease, myocardial infarction, systemic hypertension, pulmonary hypertension, and stroke. However, the association of OSA with outcomes in patients hospitalized for ST-elevation myocardial infarction remains controversial. We used the nation-wide inpatient sample between 2003 and 2011 to identify patients with a primary discharge diagnosis of ST-elevation myocardial infarction and then used the International Classification of Diseases, Clinical Modification code 327.23 to identify a group of patients with OSA. The primary outcome of interest was in-hospital mortality, and secondary outcomes were in-hospital cardiac arrest, length of stay and hospital charges. Our cohort included 1 850 625 patients with ST-elevation myocardial infarction, of which 1.3% (24 623) had documented OSA. OSA patients were younger and more likely to be male, smokers, and have chronic pulmonary disease, depression, hypertension, known history of coronary artery disease, dyslipidemia, obesity, and renal failure ( P ST-elevation myocardial infarction patients with recognized OSA had significantly decreased mortality compared with patients without OSA. Although patients with OSA had longer hospital stays and incurred greater hospital charges, there was no difference in incidence of in-hospital cardiac arrest. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  20. Mortality associated with phaeochromocytoma.

    Science.gov (United States)

    Prejbisz, A; Lenders, J W M; Eisenhofer, G; Januszewicz, A

    2013-02-01

    Two major categories of mortality are distinguished in patients with phaeochromocytoma. First, the effects of excessive circulating catecholamines may result in lethal complications if the disease is not diagnosed and/or treated timely. The second category of mortality is related to development of metastatic disease or other neoplasms. Improvements in disease recognition and diagnosis over the past few decades have reduced mortality from undiagnosed tumours. Nevertheless, many tumours remain unrecognised until they cause severe complications. Death resulting from unrecognised or untreated tumour is caused by cardiovascular complications. There are also numerous drugs and diagnostic or therapeutic manipulations that can cause fatal complications in patients with phaeochromocytoma. Previously it has been reported that operative mortality was as high as 50% in unprepared patients with phaeochromocytoma who were operated and in whom the diagnosis was unsuspected. Today mortality during surgery in medically prepared patients with the tumour is minimal. Phaeochromocytomas may be malignant at presentation or metastases may develop later, but both scenarios are associated with a potentially lethal outcome. Patients with phaeochromocytoma run an increased risk to develop other tumours, resulting in an increased mortality risk compared to the general population. Phaeochromocytoma during pregnancy represents a condition with potentially high maternal and foetal mortality. However, today phaeochromocytoma in pregnancy is recognised earlier and in conjunction with improved medical management, maternal mortality has decreased to less than 5%. © Georg Thieme Verlag KG Stuttgart · New York.

  1. Assessment of hospitalization and mortality of scleroderma in-patients: a thirteen-year study

    Directory of Open Access Journals (Sweden)

    Saeedeh Shenavandeh

    2017-08-01

    Full Text Available Objective: Systemic sclerosis (SSc is an uncommon non-hereditary sporadic disease that increases the risk of premature death, especially in diffuse type. We determined the prevalence of SSc in the last 13 years in our rheumatologic hospitals as a referral center for southern Iranian patients, the causes of hospitalization, the average length of stay (LOS, the mortality rate, and the reason for their mortality. Material and methods : A cross-sectional study was performed in Shiraz University of Medical Sciences, Iran. The studied population included all patients diagnosed with systemic sclerosis. We calculated the hospitalization rates, in-hospital mortality rates, and mean LOS. Results: There were 446 admissions by 181 patients with SSc. The female to male ratio was about 10.7 : 1. The overall mean LOS was 5.95 days. Digital ulcer and interstitial lung disease (ILD were the most common causes of hospitalizations among the SSc-related events. For those with a non-SSc-related condition, infection was the most prevalent event. Most of the deaths were due to ILD and pulmonary artery hypertension(PAH, and the overall in-hospital mortality rate was 16.5%. Conclusions : Women with SSc had higher rates of hospitalization but lower in-hospital mortality than men.There were some differences between our study and other similar studies in the causes of hospitalization and in-hospital death among SSc patients, especially the lower age of death. The patients with digital ulcers and those with intestinal lung disease or pulmonary hipertension were most commonly admitted to the hospital in our study group. Probably, increasing the skin care of these patients and asking other specialty groups to cooperate will decrease the high rate of hospitalizations in our population.

  2. Short Communication - Hospital-Based Mortality in Federal Capital ...

    African Journals Online (AJOL)

    Background: Cause-specific mortality data are important to monitor trends in mortality over time. Medical records provide reliable documentation of the causes of deaths occurring in hospitals. This study describes all causes of mortality reported at hospitals in the Federal Capital Territory (FCT) of Nigeria. Methods: Deaths ...

  3. β-Blocker Therapy Prior to Admission for Acute Coronary Syndrome in Patients Without Heart Failure or Left Ventricular Dysfunction Improves In-Hospital and 12-Month Outcome: Results From the GULF-RACE 2 (Gulf Registry of Acute Coronary Events-2).

    Science.gov (United States)

    Abi Khalil, Charbel; AlHabib, Khalid F; Singh, Rajvir; Asaad, Nidal; Alfaleh, Hussam; Alsheikh-Ali, Alawi A; Sulaiman, Kadhim; Alshamiri, Mostafa; Alshaer, Fayez; AlMahmeed, Wael; Al Suwaidi, Jassim

    2017-12-20

    The prognostic impact of β-blockers (BB) in acute coronary syndrome (ACS) patients without heart failure (HF) or left ventricular dysfunction is controversial, especially in the postreperfusion era. We sought to determine whether a BB therapy before admission for ACS has a favorable in-hospital outcome in patients without HF, and whether they also reduce 12-month mortality if still prescribed on discharge. The GULF-RACE 2 (Gulf Registry of Acute Coronary Events-2) is a prospective multicenter study of ACS in 6 Middle Eastern countries. We studied in-hospital cardiovascular events in patients hospitalized for ACS without HF in relation to BB on admission, and 1-year mortality in relation to BB on discharge. Among the 7903 participants, 7407 did not have HF, of whom 5937 (80.15%) patients were on BB. Patients on BB tended to be older and have more comorbidities. However, they had a lower risk of in-hospital mortality, mitral regurgitation, HF, cardiogenic shock, and ventricular tachycardia/ventricular fibrillation. Furthermore, 4208 patients were discharged alive and had an ejection fraction ≥40%. Among those, 84.1% had a BB prescription. At 12 months, they also had a reduced risk of mortality as compared with the non-BB group. Even after correcting for confounding factors in 2 different models, in-hospital and 12-month mortality risk was still lower in the BB group. In this cohort of ACS, BB therapy before admission for ACS is associated with decreased in-hospital mortality and major cardiovascular events, and 1-year mortality in patients without HF or left ventricular dysfunction if still prescribed on discharge. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  4. In-hospital stroke: characteristics and outcomes.

    LENUS (Irish Health Repository)

    Briggs, R

    2015-01-01

    In-hospital stroke (IS) made up 6.5% of strokes recorded in the Irish National Stroke Register in 2012. International research has demonstrated poorer outcomes post IS compared to out of hospital stroke (OS). We aimed to profile all IS and OS over a 22 month period and compare the two groups by gathering data from the HIPE portal stroke register. The study site is a primary stroke centre. IS represented 11% (50\\/458) of total strokes with over half (27\\/50, 54%) admitted initially with medical complaints. IS patients had a significantly longer length of stay (79.2 +\\/- 87.4 days vs. 21.9 +\\/- 45.9 days, p < 0.01) and higher mortality (13\\/50 vs. 39\\/408, p < 0.01). Patients in the IS group were also less likely to receive stroke unit care (1\\/50 vs. 136\\/408, p < 0.01). This study demonstrates the significant morbidity and mortality associated with IS and highlights the need for efforts to be made to optimize identification and management of acute stroke in this cohort.

  5. Functional textiles in hospital interiors

    DEFF Research Database (Denmark)

    Mogensen, Jeppe

    This PhD thesis explores the possibilities and design qualities of using functional textiles in the interior of hospital environments, and is the result of a three years collaboration between Aalborg University, Department of Civil Engineering, and VIA University College, VIA Design. The project...... that the physical environments affect the patients’ level of stress and influence their process of recovery and healing. However, although research in this field of hospital design has increased substantially in recent years, knowledge on the use of new materials and textiles in hospital interiors is still rather...... limited. Concerned with the design potentials of using textiles in hospital interiors, the purpose of the PhD project has been to explore the possibilities and design qualities of using these materials in hospital design. Relating to both technical and aesthetic aspects of using functional textiles...

  6. Research in Hospitality Management: Submissions

    African Journals Online (AJOL)

    Before submitting a manuscript, authors should peruse and consult a recent issue of the Journal for format and style. ... The submission of a manuscript by the authors implies that they automatically agree to assign exclusive copyright to the publishers of the Research in Hospitality Management, NISC (Pty) Ltd. There are no ...

  7. Recent age- and gender-specific trends in mortality during stroke hospitalization in the United States.

    Science.gov (United States)

    Ovbiagele, Bruce; Markovic, Daniela; Towfighi, Amytis

    2011-10-01

    Advancements in diagnosis and treatment have resulted in better clinical outcomes after stroke; however, the influence of age and gender on recent trends in death during stroke hospitalization has not been specifically investigated. We assessed the impact of age and gender on nationwide patterns of in-hospital mortality after stroke. Data were obtained from all US states that contributed to the Nationwide Inpatient Sample. All patients admitted to hospitals between 1997 and 1998 (n=1 351 293) and 2005 and 2006 (n=1 202 449), with a discharge diagnosis of stroke (identified by the International Classification of Diseases, Ninth Revision procedure codes), were included. Time trends for in-hospital mortality after stroke were evaluated by gender and age group based on 10-year age increments (84) using multivariable logistic regression. Between 1997 and 2006, in-hospital mortality rates decreased across time in all sub-groups (all P84 years. In unadjusted analysis, men aged >84 years in 1997-1998 had poorer mortality outcomes than similarly aged women (odds ratio 0·93, 95% confidence interval=0·88-0·98). This disparity worsened by 2005-2006 (odds ratio 0·88, 95% confidence interval=0·84-0·93). After adjusting for confounders, compared with similarly aged women, the mortality outcomes among men aged >84 years were poorer in 1997-1998 (odds ratio 0·97, 95% confidence interval=0·92-1·02) and were poorer in 2005-2006 (odds ratio 0·92, 95% confidence interval=0·87-0·96), P=0·04, for gender × time trend. Over the last decade, in-hospital mortality rates after stroke in the United States have declined for every age/gender group, except men aged >84 years. Given the rapidly ageing US population, avenues for boosting in-hospital survival among very elderly men with stroke need to be explored. © 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.

  8. Effects of nurse staffing, work environments, and education on patient mortality: an observational study.

    Science.gov (United States)

    Cho, Eunhee; Sloane, Douglas M; Kim, Eun-Young; Kim, Sera; Choi, Miyoung; Yoo, Il Young; Lee, Hye Sun; Aiken, Linda H

    2015-02-01

    While considerable evidence has been produced showing a link between nursing characteristics and patient outcomes in the U.S. and Europe, little is known about whether similar associations are present in South Korea. To examine the effects of nurse staffing, work environment, and education on patient mortality. This study linked hospital facility data with staff nurse survey data (N=1024) and surgical patient discharge data (N=76,036) from 14 high-technology teaching hospitals with 700 or more beds in South Korea, collected between January 1, 2008 and December 31, 2008. Logistic regression models that corrected for the clustering of patients in hospitals were used to estimate the effects of the three nursing characteristics on risk-adjusted patient mortality within 30 days of admission. Risk-adjusted models reveal that nurse staffing, nurse work environments, and nurse education were significantly associated with patient mortality (OR 1.05, 95% CI 1.00-1.10; OR 0.52, 95% CI 0.31-0.88; and OR 0.91, CI 0.83-0.99; respectively). These odds ratios imply that each additional patient per nurse is associated with an 5% increase in the odds of patient death within 30 days of admission, that the odds of patient mortality are nearly 50% lower in the hospitals with better nurse work environments than in hospitals with mixed or poor nurse work environments, and that each 10% increase in nurses having Bachelor of Science in Nursing Degree is associated with a 9% decrease in patient deaths. Nurse staffing, nurse work environments, and percentages of nurses having Bachelor of Science in Nursing Degree in South Korea are associated with patient mortality. Improving hospital nurse staffing and work environments and increasing the percentages of nurses having Bachelor of Science in Nursing Degree would help reduce the number of preventable in-hospital deaths. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Cancer mortality

    International Nuclear Information System (INIS)

    Kato, H.

    1986-01-01

    The Radiation Effects Research Foundation (RERF) and its predecessor, the Atomic Bomb Casualty Commission (ABCC), have conducted mortality surveillance on a fixed sample, the Life Span Study (LSS), of 82,000 atomic bomb survivors and 27,000 nonexposed residents of Hiroshima and Nagasaki since 1950. The results of the most recent analysis of the LSS are summarized

  10. Mortality is predicted by Comorbidity Polypharmacy score but not Charlson Comorbidity Index in geriatric trauma patients.

    Science.gov (United States)

    Nossaman, Vaughn E; Larsen, Brett E; DiGiacomo, Jody C; Manuelyan, Zara; Afram, Renee; Shukry, Sally; Kang, Amiee Luan; Munnangi, Swapna; Angus, L D George

    2017-09-19

    Increased life expectancy has resulted in more older patients at trauma centers. Traditional assessments of injuries alone may not be sufficient; age, comorbidities, and medications should be considered. 446 older trauma patients were analyzed in two groups, 45-65 years and <65, using Injury Severity Score (ISS), the Charlson Comorbidity Index (CCI), and Comorbidity-Polypharmacy Score (CPS). CCI and CPS were associated with HLOS in patients <65. In patients aged 45-65, only CPS was associated with HLOS. CPS was inversely associated with in-hospital mortality in patients <65, but not patients aged 45-65. CCI score was not associated with in-hospital mortality in either group. Increased CCI and CPS were associated with increased HLOS. In patients over 65, increased CPS was associated with decreased mortality. This could be due to return toward physiologic normalcy in treated patients not seen in their peers with undiagnosed or untreated comorbidities. TABLE OF CONTENTS SUMMARY: In an analysis of 446 older trauma patients, the Charlson Comorbidity Index (CCI) and Comorbidity-Polypharmacy Score (CPS) were associated with increased hospital length of stay. In patients ≥65, increased CPS had a lower mortality, possibly due to a greater return toward physiologic normalcy not present in their untreated peers. Published by Elsevier Inc.

  11. Business Intelligence in Hospital Management.

    Science.gov (United States)

    Escher, Achim; Hainc, Nicolin; Boll, Daniel

    2016-01-01

    Business intelligence (BI) is a worthwhile investment, and will play a significant role in hospital management in the near future. Implementation of BI is challenging and requires resources, skills, and a strategy, but enables management to have easy access to relevant analysis of data and visualization of important key performance indicators (KPI). Modern BI applications will help to overcome shortages of common "hand-made" analysis, save time and money, and will enable even managers to do "self-service" analysis and reporting.

  12. Mortality Implications of Mortality Plateaus

    DEFF Research Database (Denmark)

    Missov, T. I.; Vaupel, J. W.

    2015-01-01

    This article aims to describe in a unified framework all plateau-generating random effects models in terms of (i) plausible distributions for the hazard (baseline mortality) and the random effect (unobserved heterogeneity, frailty) as well as (ii) the impact of frailty on the baseline hazard...

  13. In-hospital pediatric cardiac arrest in Honduras.

    Science.gov (United States)

    Matamoros, Martha; Rodriguez, Roger; Callejas, Allison; Carranza, Douglas; Zeron, Hilda; Sánchez, Carlos; Del Castillo, Jimena; López-Herce, Jesús

    2015-01-01

    The objective of this study was to analyze the characteristic and the prognostic factors of in-hospital pediatric cardiac arrest (CA) in a public hospital Honduras. A prospective observational study was performed on pediatric in-hospital CA as a part of a multicenter international study. One hundred forty-six children were studied. The primary end point was survival at hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each factor on mortality. Cardiac arrest occurred in the emergency department in 66.9%. Respiratory diseases and sepsis were predominant causes of CA. Return of spontaneous circulation was achieved in 60% of patients, and 22.6% survived to hospital discharge. The factors related with mortality were nonrespiratory cause of CA (odds ratio [OR], 2.55; P = 0.045), adrenaline administration (OR, 4.96; P = 0.008), and a duration of cardiopulmonary resuscitation more than 10 minutes (OR, 3.40; P = 0.012). In-hospital CA in children in a developing country has low survival. Patients with nonrespiratory causes and those who need adrenaline administration and prolonged resuscitation had worse prognosis.

  14. In-Hospital Outcomes of Atherectomy During Endovascular Lower Extremity Revascularization.

    Science.gov (United States)

    Panaich, Sidakpal S; Arora, Shilpkumar; Patel, Nilay; Patel, Nileshkumar J; Patel, Samir V; Savani, Chirag; Singh, Vikas; Jhamnani, Sunny; Sonani, Rajesh; Lahewala, Sopan; Thakkar, Badal; Patel, Achint; Dave, Abhishek; Shah, Harshil; Bhatt, Parth; Jaiswal, Radhika; Ghatak, Abhijit; Gupta, Vishal; Deshmukh, Abhishek; Kondur, Ashok; Schreiber, Theodore; Grines, Cindy; Badheka, Apurva O

    2016-02-15

    Contemporary data on clinical outcomes after utilization of atherectomy in lower extremity endovascular revascularization are sparse. The study cohort was derived from Healthcare Cost and Utilization Project nationwide inpatient sample database from the year 2012. Peripheral endovascular interventions including atherectomy were identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes. The subjects were divided and compared in 2 groups: atherectomy versus no atherectomy. Two-level hierarchical multivariate mixed models were created. The coprimary outcomes were in-hospital mortality and amputation; secondary outcome was a composite of in-hospital mortality and periprocedural complications. Hospitalization costs were also assessed. Atherectomy utilization (odds ratio, 95% CI, p value) was independently predictive of lower in-hospital mortality (0.46, 0.28 to 0.75, 0.002) and lower amputation rates (0.83, 0.71 to 0.97, 0.020). Atherectomy use was also predictive of significantly lower secondary composite outcome of in-hospital mortality and complications (0.79, 0.69 to 0.90, 0.001). In the propensity-matched cohort, atherectomy utilization was again associated with a lower rate of amputation (11.18% vs 12.92%, p = 0.029), in-hospital mortality (0.71% vs 1.53%, p 0.001), and any complication (13.24% vs 16.09%, p 0.001). However, atherectomy use was also associated with higher costs ($24,790 ± 397 vs $22635 ± 251, p Atherectomy use in conjunction with angioplasty (with or without stenting) was associated with improved in-hospital outcomes in terms of lower amputation rates, mortality, and postprocedural complications. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Cardiopulmonary resuscitation in hospitalized infants.

    Science.gov (United States)

    Hornik, Christoph P; Graham, Eric M; Hill, Kevin; Li, Jennifer S; Ofori-Amanfo, George; Clark, Reese H; Smith, P Brian

    2016-10-01

    Hospitalized infants requiring cardiopulmonary resuscitation (CPR) represent a high-risk group. Recent data on risk factors for mortality following CPR in this population are lacking. We hypothesized that infant demographic characteristics, diagnoses, and levels of cardiopulmonary support at the time of CPR requirement would be associated with survival to hospital discharge following CPR. Retrospective cohort study. All infants receiving CPR on day of life 2 to 120 admitted to 348 Pediatrix Medical Group neonatal intensive care units from 1997 to 2012. We collected data on demographics, interventions, center volume, and death prior to NICU discharge. We evaluated predictors of death after CPR using multivariable logistic regression with generalized estimating equations to account for clustering of the data by center. Our cohort consisted of 2231 infants receiving CPR. Of these, 1127 (51%) survived to hospital discharge. Lower gestational age, postnatal age, 5-min APGAR, congenital anomaly, and markers of severity of illness were associated with higher mortality. Mortality after CPR did not change significantly over time (Cochran-Armitage test for trend p=0.35). Mortality following CPR in infants is high, particularly for less mature, younger infants with congenital anomalies and those requiring cardiopulmonary support prior to CPR. Continued focus on at risk infants may identify targets for CPR prevention and improve outcomes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  16. Effect of delay in hospital presentation on clinical and imaging findings in acute pulmonary thromboembolism.

    Science.gov (United States)

    Jenab, Yaser; Alemzadeh-Ansari, Mohammad Javad; Fehri, Seyedeh Arezoo; Ghaffari-Marandi, Neda; Jalali, Arash

    2014-04-01

    There is limited information on the extent and clinical importance of the delay in hospital presentation of acute pulmonary thromboembolism (PTE). The aim of this study was to investigate the delay in hospital presentation of PTE and its association with clinical and imaging findings in PTE. This prospective study was conducted on patients admitted to our hospital with a diagnosis of acute PTE between September 2007 and September 2011. Relationships between delay in hospital presentation and clinical findings, risk factors, imaging findings, and in-hospital mortality were analyzed. Of the 195 patients enrolled, 84 (43.1%) patients presented 3 days after the onset of symptoms. Patients with chest pain, history of immobility for more than 3 days, recent surgery, and estrogen use had significantly less delayed presentation. Right ventricular dysfunction was significantly more frequent in patients with delayed presentation (odds ratio [OR] = 2.38; 95% confidence interval [CI] 1.27-4.44; p = 0.006); however, no relationship was found between delay in presentation and pulmonary computed tomographic angiography or color Doppler sonography findings. Patients with delayed presentation were at higher risk of in-hospital mortality (OR = 4.32; 95% CI 1.12-16.49; p = 0.021). Our study showed that a significant portion of patients with acute PTE had delayed presentation. Also, patients with delayed presentation had worse echocardiographic findings and higher in-hospital mortality. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. [Labor law issues in hospitals by structural changes and changes in hospital ownership].

    Science.gov (United States)

    Meyer, Peter

    2003-11-01

    The present article deals with the potential impact of structural changes and changes in hospital control or ownership on the employment contracts of the physicians concerned. While taking the applicable jurisdiction into consideration, the author examines the options of assigning new responsibilities or decreasing compensation opportunities, amending or even terminating employment contracts, outsourcing hospital-related services, or allowing physicians in the future to provide these services at their own risk. Furthermore, the article outlines the change in employer in various "change of control" scenarios such as in the case of hospital privatisation.

  18. Light Atmosphere in Hospital Wards

    DEFF Research Database (Denmark)

    Stidsen, Lone Mandrup

    by the patients in the ward. The project is based on the Danish Regulation for light in hospitals (DS703), which is a supplement to the regulation of artificial lighting in workplaces (DS700). The kick-off to the project was reading the DS703, second paragraph, chapter 2 about general requirements for lighting...... group has quite diverse needs and preferences, while the staff needs task lighting and the patient a space experienced as homely and pleasant. Categories such as ‘pleasure’ and ‘activities’ are also a part of the user aspect. The space is divided into subcategories as ‘location of the space...

  19. Acute myocardial infarction mortality in Cuba, 1999-2008.

    Science.gov (United States)

    Armas, Nurys B; Ortega, Yanela Y; de la Noval, Reinaldo; Suárez, Ramón; Llerena, Lorenzo; Dueñas, Alfredo F

    2012-10-01

    Acute myocardial infarction is one of the leading causes of death in the world. This is also true in Cuba, where no national-level epidemiologic studies of related mortality have been published in recent years. Describe acute myocardial infarction mortality in Cuba from 1999 through 2008. A descriptive study was conducted of persons aged ≥25 years with a diagnosis of acute myocardial infarction from 1999 through 2008. Data were obtained from the Ministry of Public Health's National Statistics Division database for variables: age; sex; site (out of hospital, in hospital or in hospital emergency room) and location (jurisdiction) of death. Proportions, age- and sex-specific rates and age-standardized overall rates per 100,000 population were calculated and compared over time, using the two five-year time frames within the study period. A total of 145,808 persons who had suffered acute myocardial infarction were recorded, 75,512 of whom died, for a case-fatality rate of 51.8% (55.1% in 1999-2003 and 49.7% in 2004-2008). In the first five-year period, mortality was 98.9 per 100,000 population, falling to 81.8 per 100,000 in the second; most affected were people aged ≥75 years and men. Of Cuba's 14 provinces and special municipality, Havana, Havana City and Camagüey provinces, and the Isle of Youth Special Municipality showed the highest mortality; Holguín, Ciego de Ávila and Granma provinces the lowest. Out-of-hospital deaths accounted for the greatest proportion of deaths in both five-year periods (54.8% and 59.2% in 1999-2003 and 2004-2008, respectively). Although risk of death from acute myocardial infarction decreased through the study period, it remains a major health problem in Cuba. A national acute myocardial infarction case registry is needed. Also required is further research to help elucidate possible causes of Cuba's high acute myocardial infarction mortality: cardiovascular risk studies, studies of out-of-hospital mortality and quality of care

  20. Hyperglycemia and in-hospital outcomes after first myocardial infarction

    International Nuclear Information System (INIS)

    Khan, A.N.; Ambreen, F.; Qureshi, I.Z.

    2006-01-01

    To determine in-hospital outcomes post AMI hyperglycemia. 109 patients of acute myocardial infarction were included in this study. Physical examination, ECG tracings, random plasma glucose, serum cholesterol, triglycerides and cardiac enzymes (CPK, LDH and AST) were measured. Hyperglycemic patients (plasma glucose 126 mg/dl) were sub-divided into those with a previous history of diabetes and those without any such history. Post AMI plasma glucose levels were exceptionally higher in female patients aged 61-70 years while they were moderately higher in males of age groups 31-40 and 51-60, and females of age group 41-50 years. In-hospital mortality rate was greater in hyperglycemic patients. Most importantly also, significantly greater complications of the heart were encountered in hyperglycemics. Post AMI patients are at a greater risk of developing diabetes and concurrent AMI attack. (author)

  1. Asthma mortality in Uruguay, 1984-1998.

    Science.gov (United States)

    Baluga, J C; Sueta, A; Ceni, M

    2001-08-01

    Asthma mortality rates have increased worldwide during the past several years despite the increased availability of new and effective medications. Few studies show reliable data from Latin American countries. To determine asthma mortality rates from 1984 to 1998 and to relate mortality to sales of asthma medications. We conducted a retrospective epidemiologic study in the total population of Uruguay. Data were obtained from the Department of Statistics of the Ministry of Public Health. Trends in mortality rates were analyzed using linear regression procedures. Spearman rank correlations were used to relate mortality rates to sales of asthma medications. The mean overall mortality rate was 5.10 per 100,000 during the period 1984 to 1998, (range 6.08 to 3.39) and showed a decreasing trend (P = 0.001). During the period 1995 to 1998, a more pronounced decrease was observed (mean mortality rate, 4.10 per 100,000). In the 5- to 34-year-old age group the mean mortality rate was 0.43 (range 0.65 to 0.13). Similarly, the mortality rate in this age group decreased particularly in the 1994 to 1998 period (mean 0.19; P = 0.005). Finally, the mortality rate was inversely correlated with sales of inhaled corticosteroids; for the overall mortality rate, p = -0.71, P = 0.003; for 5- to 34-year-old age group, p = -0.63, P = 0.01. Although mortality attributable to asthma seems to be decreasing, the overall mortality rate is still high compared with more economically developed countries. A more pronounced decrease in asthma mortality has been seen in the 5- to 34-year-old group. At present, Uruguay is a Latin American country with a low rate of asthma mortality. This is probably related to the use of new therapies to treat asthma.

  2. Missed injury – decreasing morbidity and mortality: A literature review

    African Journals Online (AJOL)

    Advanced Trauma Life Support®), although they may also be inju- ries identified after a defined .... highly recommended for practice quality assurance. ... when injuries are missed, continuous audit is essential in prevent- ing repeated errors!

  3. Enterostomy can decrease the mortality of patients with Fournier gangrene.

    Science.gov (United States)

    Li, Yan-Dong; Zhu, Wei-Fang; Qiao, Jian-Jun; Lin, Jian-Jiang

    2014-06-28

    To determine the significance of enterostomy in the emergency management of Fournier gangrene. The clinical data of 51 patients (49 men and 2 women) with Fournier gangrene who were treated at our hospital over the past 12 years were retrospectively analyzed. The patients were divided into two groups according the surgical technique performed: enterostomy combined with debridement (the enterostomy group, n = 28) or debridement alone (the control group, n = 23). Patients in the enterostomy group received thorough debridement during surgery and adequate local drainage after surgery, as well as administration of broad-spectrum antibiotics. The clinical data and outcomes in both groups were analyzed. The surgical procedures were successful in both patient groups. In the enterostomy group, 10 (35.8%) patients required skin grafting with a total of six debridement procedures. While in the control group, six (26.1%) patients required four debridement procedures. However, this difference was not statistically significant. Following surgery, the time to normal body temperature (6 d vs 8 d, P Fournier gangrene.

  4. Persisting high hospital and community childhood mortality in an urban setting in Guinea-Bissau

    DEFF Research Database (Denmark)

    Veirum, Jens Erik; Biai, Sidu; Jakobsen, Marianne

    2007-01-01

    AIM: To describe paediatric hospitalization in a West African capital in relation to overall childhood mortality in the community and to evaluate the potential impact of improved management at the hospital. METHODS: Hospital data on child admissions in a 6-year period were linked to information...... been hospitalized, and 24% of all deaths in the community occurred in-hospital. Community infant and under-three mortality rates were 110 and 207 per 1,000 person-years, respectively. In-hospital mortality remained persistently high from 1991 to 1996 and the overall in-hospital mortality was 12...... minor improvements in acute case management of sick children attending the hospital would be expected to result in substantial reduction in overall childhood mortality. Persistently high acute in-hospital mortality reflects the need of immediate and appropriate care at the hospital. Treatment should...

  5. Excess winter mortality and cold temperatures in a subtropical city, Guangzhou, China.

    Directory of Open Access Journals (Sweden)

    Chun-Quan Ou

    Full Text Available BACKGROUND: A significant increase in mortality was observed during cold winters in many temperate regions. However, there is a lack of evidence from tropical and subtropical regions, and the influence of ambient temperatures on seasonal variation of mortality was not well documented. METHODS: This study included 213,737 registered deaths from January 2003 to December 2011 in Guangzhou, a subtropical city in Southern China. Excess winter mortality was calculated by the excess percentage of monthly mortality in winters over that of non-winter months. A generalized linear model with a quasi-Poisson distribution was applied to analyze the association between monthly mean temperature and mortality, after controlling for other meteorological measures and air pollution. RESULTS: The mortality rate in the winter was 26% higher than the average rate in other seasons. On average, there were 1,848 excess winter deaths annually, with around half (52% from cardiovascular diseases and a quarter (24% from respiratory diseases. Excess winter mortality was higher in the elderly, females and those with low education level than the young, males and those with high education level, respectively. A much larger winter increase was observed in out-of-hospital mortality compared to in-hospital mortality (45% vs. 17%. We found a significant negative correlation of annual excess winter mortality with average winter temperature (rs=-0.738, P=0.037, but not with air pollution levels. A 1 °C decrease in monthly mean temperature was associated with an increase of 1.38% (95% CI:0.34%-2.40% and 0.88% (95% CI:0.11%-1.64% in monthly mortality at lags of 0-1 month, respectively. CONCLUSION: Similar to temperate regions, a subtropical city Guangzhou showed a clear seasonal pattern in mortality, with a sharper spike in winter. Our results highlight the role of cold temperature on the winter mortality even in warm climate. Precautionary measures should be strengthened to mitigate

  6. Risk Factors and In-Hospital Outcomes following Tracheostomy in Infants.

    Science.gov (United States)

    Lee, Jan Hau; Smith, P Brian; Quek, M Bin Huey; Laughon, Matthew M; Clark, Reese H; Hornik, Christoph P

    2016-06-01

    To describe the epidemiology, risk factors, and in-hospital outcomes of tracheostomy in infants in the neonatal intensive care unit. We analyzed electronic medical records from 348 neonatal intensive care units for the period 1997 to 2012, and evaluated the associations among infant demographics, diagnoses, and pretracheostomy cardiopulmonary support with in-hospital mortality. We also determined the trends in use of infant tracheostomy over time. We identified 885 of 887 910 infants (0.1%) who underwent tracheostomy at a median postnatal age of 72 days (IQR, 27-119 days) and a median postmenstrual age of 42 weeks (IQR, 39-46 weeks). The most common diagnoses associated with tracheostomy were bronchopulmonary dysplasia (396 of 885; 45%), other upper airway anomalies (202 of 885; 23%), and laryngeal anomalies (115 of 885; 13%). In-hospital mortality after tracheostomy was 14% (125 of 885). On adjusted analysis, near-term gestational age (GA), small for GA status, pulmonary diagnoses, number of days of forced fraction of inspired oxygen >0.4, and inotropic support before tracheostomy were associated with increased in-hospital mortality. The proportion of infants requiring tracheostomy increased from 0.01% in 1997 to 0.1% in 2005 (P Tracheostomy is not commonly performed in hospitalized infants, but the associated mortality is high. Risk factors for increased in-hospital mortality after tracheostomy include near-term GA, small for GA status, and pulmonary diagnoses. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Pain prevalence in hospitalized children

    DEFF Research Database (Denmark)

    Walther-Larsen, S; Pedersen, M T; Friis, S M

    2017-01-01

    admitted the same day. The single most common painful procedure named by the children was needle procedures, such as blood draw and intravenous cannulation. CONCLUSION: This study reveals high pain prevalence in children across all age groups admitted to four Danish university hospitals. The majority......BACKGROUND: Pain management in hospitalized children is often inadequate. The prevalence and main sources of pain in Danish university hospitals is unknown. METHODS: This prospective mixed-method cross-sectional survey took place at four university hospitals in Denmark. We enrolled 570 pediatric...... patients who we asked to report their pain experience and its management during the previous 24 hours. For patients identified as having moderate to severe pain, patient characteristics and analgesia regimes were reviewed. RESULTS: Two hundred and thirteen children (37%) responded that they had experienced...

  8. CURRENT TRENDS IN HOSPITALITY INDUSTRY

    Directory of Open Access Journals (Sweden)

    Ivica Batinić

    2013-10-01

    Full Text Available Hospitality industry is a complex product-service economic activity which besides accommodation, food and beverages offers a variety of complementary and ancillary services in order to meet modern needs, demands and desires of tourists consumers. Contemporary needs, demands and desires of tourists consumers (increased need for security and preservation of health; emphasis on ecology and healthy food; pure nature stay; growing demand for adventure activities and excitement; convention facilities and incentive offerings; visits to towns, big sports, cultural, religious, business events; new travel motivation have led to the emergence of new trends in hospitality offering design. Wellness and spa hotels, boutique hotels, all inclusive hotels, slow-food restaurants, and wine and lounge bars are just some of the main trends, and successful hoteliers and caterers will examine each of the trends and devise development politics in accordance with the new requirements and global market needs.

  9. Fungal contamination in hospital environments.

    Science.gov (United States)

    Perdelli, F; Cristina, M L; Sartini, M; Spagnolo, A M; Dallera, M; Ottria, G; Lombardi, R; Grimaldi, M; Orlando, P

    2006-01-01

    To assess the degree of fungal contamination in hospital environments and to evaluate the ability of air conditioning systems to reduce such contamination. We monitored airborne microbial concentrations in various environments in 10 hospitals equipped with air conditioning. Sampling was performed with a portable Surface Air System impactor with replicate organism detection and counting plates containing a fungus-selective medium. The total fungal concentration was determined 72-120 hours after sampling. The genera most involved in infection were identified by macroscopic and microscopic observation. The mean concentration of airborne fungi in the set of environments examined was 19 +/- 19 colony-forming units (cfu) per cubic meter. Analysis of the fungal concentration in the different types of environments revealed different levels of contamination: the lowest mean values (12 +/- 14 cfu/m(3)) were recorded in operating theaters, and the highest (45 +/- 37 cfu/m(3)) were recorded in kitchens. Analyses revealed statistically significant differences between median values for the various environments. The fungal genus most commonly encountered was Penicillium, which, in kitchens, displayed the highest mean airborne concentration (8 +/- 2.4 cfu/m(3)). The percentage (35%) of Aspergillus documented in the wards was higher than that in any of the other environments monitored. The fungal concentrations recorded in the present study are comparable to those recorded in other studies conducted in hospital environments and are considerably lower than those seen in other indoor environments that are not air conditioned. These findings demonstrate the effectiveness of air-handling systems in reducing fungal contamination.

  10. The efficacy of pharmaceutical combination of glucose, insulin, potassium, and magnesium along with thrombolytic therapy on the mortality of patients with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Mohammad Garakyaraghi

    2012-03-01

    Full Text Available BACKGROUND: Despite conventional treatment methods of acute myocardial infarction, its complications and mortality rates are still very high. Finding new cost-effective treatments like regulation of ischemic muscle metabolism at the time of thrombolytic therapy can meet this requirement to some extent. This study investigated the efficacy of the pharmaceutical combination of glucose, insulin, potassium (GIK and magnesium along with thrombolytic therapy.METHODS: In a double-blind, controlled clinical trial, 200 patients with acute myocardial infarction who had the indication for thrombolytic treatment were selected and divided to 6 groups of almost 30 people. A specific treatment protocol was designed for each group. The patients in the first 5 groups were compared with the ones in the sixth group as the control group in terms of frequency of complications and in-hospital mortality and also mortality during 3 and 6 months after the treatment.RESULTS: Mean age of the patients was 58.77 ± 2.6 years. Males constituted 77% of the study population. Heart failure, in-hospital arrhythmia and ejection fraction (EF at discharge showed favorable results in the five groups which received metabolic regulations as compared to the control group. In-hospital mortality of no groups was different from that of the control group (P > 0.05. Three months after the treatment, mortality of the group that received GIK and magnesium was lower than that of the control group (P < 0.05. After 6 months, none of the patients who received high-dose GIK and magnesium along with thrombolytic therapy died while the mortality rate of the control group was 44.4% (P < 0.05.CONCLUSION: The infusion of GIK and magnesium solution along with thrombolytic therapy can lead to a decrease in the long-term mortality and complications in patients with acute myocardial infarction.Keywords: Acute Myocardial Infarction, Glucose, Insulin, Potassium, Magnesium, Thrombolytic Therapy

  11. The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review

    Science.gov (United States)

    2017-01-01

    coverage and marginally decrease mortality in hospital-related settings. PMID:28837665

  12. The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review.

    Directory of Open Access Journals (Sweden)

    Christopher E Curtis

    Full Text Available Inappropriate antimicrobial use has been shown to be an important determinant of the emergence of antimicrobial resistance (AMR. Health information technology (HIT in the form of Computerised Decision Support (CDS represents an option for improving antimicrobial prescribing and containing AMR.To evaluate the evidence for CDS in improving quantitative and qualitative measures of antibiotic prescribing in inpatient hospital settings.A systematic literature search was conducted of articles published from inception to 20th December 2014 using eight electronic databases: MEDLINE, EMBASE, PUBMED, Web of Science, CINAHL, Cochrane Library, HMIC and PsychINFo. An updated systematic literature search was conducted from January 1st 2015 to October 1st 2016 using PUBMED. The search strategy used combinations of the following terms: (electronic prescribing OR (clinical decision support AND (antibiotic or antibacterial or antimicrobial AND (hospital or secondary care or inpatient. Studies were evaluated for quality using a 10-point rating scale.Eighty-one studies were identified matching the inclusion criteria. Seven outcome measures were evaluated: adequacy of antibiotic coverage, mortality, volume of antibiotic usage, length of stay, antibiotic cost, compliance with guidelines, antimicrobial resistance, and CDS implementation and uptake. Meta-analysis of pooled outcomes showed CDS significantly improved the adequacy of antibiotic coverage (n = 13; odds ratio [OR], 2.11 [95% CI, 1.67 to 2.66, p ≤ 0.00001]. Also, CDS was associated with marginally lowered mortality (n = 20; OR, 0.85 [CI, 0.75 to 0.96, p = 0.01]. CDS was associated with lower antibiotic utilisation, increased compliance with antibiotic guidelines and reductions in antimicrobial resistance. Conflicting effects of CDS on length of stay, antibiotic costs and system uptake were also noted.CDS has the potential to improve the adequacy of antibiotic coverage and marginally decrease mortality in

  13. Risk of Cardiovascular Morbidity and Mortality in Relation to Temperature

    Science.gov (United States)

    Mathes, Robert; Ito, Kazuhiko; Matte, Thomas

    2013-01-01

    outcomes. For our sensitivity analysis, we included PM2.5 and O3 in our model. Results During the cold season, CVD-related ED visits and hospitalizations increased, while mortality decreased, with increasing mean temperature on the same day and lagged days. Extremely cold temperature was associated with a small increase of same day in-hospital mortality though generally cold temperatures did not appear to be associated with higher mortality. The opposite was observed in the warm season as ED visits and hospitalizations decreased, and mortality increased, with increasing mean temperature on the same day and on lagged days. Our sensitivity analysis, in which we controlled for PM2.5 and O3, demonstrated little effect of these air pollutants on the relationship between temperature and CVD outcomes. Conclusions Our results suggest a decline in risk of a CVD-related ED visit and hospitalization during extreme temperatures on the same day and on recent day lags for both cold and warm seasons. In contrast, our findings for mortality indicate an increase in risk of CVD-related deaths during hot temperatures. No mortality effect was observed during cold temperatures. The effects of extreme temperatures on CVD-related morbidity may be explained by behavioral patterns, as people are more likely to stay indoors on the coldest and hottest days.

  14. Severe maternal morbidity in Zanzibar's referral hospital: Measuring the impact of in-hospital care

    NARCIS (Netherlands)

    Herklots, T.; Acht, L. van; Meguid, T.; Franx, A.; Jacod, B.C.

    2017-01-01

    OBJECTIVE: to analyse the impact of in-hospital care on severe maternal morbidity using WHO's near-miss approach in the low-resource, high mortality setting of Zanzibar's referral hospital. SETTING: Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania. METHODS: We identified all

  15. The epidemiology of Scottish trauma: A comparison of pre-hospital and in-hospital deaths, 2000 to 2011.

    Science.gov (United States)

    Morrison, Jonathan J; Yapp, Liam Z; Beattie, Anne; Devlin, Eimar; Samarage, Milan; McCaffer, Craig; Jansen, Jan O

    2016-02-01

    To characterise the temporal trends and urban-rural distribution of fatal injuries in Scotland through the analysis of mortality data collected by the National Records of Scotland. The prospectively collected NRS database was queried using ICD-10 codes for all Scottish trauma deaths during the period 2000 to 2011. Patients were divided into pre-hospital and in-hospital groups depending on the location of death. Incidence was plotted against time and linear regression was used to identify temporal trends. A total of 13,100 deaths were analysed. There were 4755 (36.3%) patients in the pre-hospital group with a median age (IQR) of 42 (28-58) years. The predominant cause of pre-hospital death related to vehicular injury (27.8%), which had a decreasing trend over the study period (p = 0.004). In-hospital, patients had a median age of 80 (58-88) years and the majority (67.0%) of deaths occurred following a fall on the level. This trend was shown to increase over the decade of study (p = 0.020). In addition, the incidence of urban incidents remained static, but the rate of rural fatal trauma decreased (p Scottish trauma patients die prior to hospital admission and the predominant mechanism of injury is due to road traffic accidents. This contrasts with in-hospital deaths, which are mainly observed in elderly patients following a fall from standing height. Further research is required to determine the preventability of fatal traumatic injury in Scotland. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  16. Pre-hospital antibiotic treatment and mortality caused by invasive meningococcal disease, adjusting for indication bias

    Directory of Open Access Journals (Sweden)

    Matute-Cruz Petra

    2009-04-01

    Full Text Available Abstract Background Mortality from invasive meningococcal disease (IMD has remained stable over the last thirty years and it is unclear whether pre-hospital antibiotherapy actually produces a decrease in this mortality. Our aim was to examine whether pre-hospital oral antibiotherapy reduces mortality from IMD, adjusting for indication bias. Methods A retrospective analysis was made of clinical reports of all patients (n = 848 diagnosed with IMD from 1995 to 2000 in Andalusia and the Canary Islands, Spain, and of the relationship between the use of pre-hospital oral antibiotherapy and mortality. Indication bias was controlled for by the propensity score technique, and a multivariate analysis was performed to determine the probability of each patient receiving antibiotics, according to the symptoms identified before admission. Data on in-hospital death, use of antibiotics and demographic variables were collected. A logistic regression analysis was then carried out, using death as the dependent variable, and pre-hospital antibiotic use, age, time from onset of symptoms to parenteral antibiotics and the propensity score as independent variables. Results Data were recorded on 848 patients, 49 (5.72% of whom died. Of the total number of patients, 226 had received oral antibiotics before admission, mainly betalactams during the previous 48 hours. After adjusting the association between the use of antibiotics and death for age, time between onset of symptoms and in-hospital antibiotic treatment, pre-hospital oral antibiotherapy remained a significant protective factor (Odds Ratio for death 0.37, 95% confidence interval 0.15–0.93. Conclusion Pre-hospital oral antibiotherapy appears to reduce IMD mortality.

  17. Malnutrition in hospitalized patients: results from La Rioja.

    Science.gov (United States)

    Martín Palmero, Ángela; Serrano Pérez, Andra; Chinchetru Ranedo, Mª José; Cámara Balda, Alejandro; Martínez de Salinas Santamarí, Mª Ángeles; Villar García, Gonzalo; Marín Lizárraga, Mª Del Mar

    2017-03-30

    There is a high malnutrition prevalence in hospitalized patients. To determine the malnutrition prevalence in hospitalized patients of La Rioja Community (Spain) when evaluated with different screening/ evaluation tools and its relationship with hospital stay and mortality. Cross sectional observational study of hospitalized adult patients (age > 18 years old) from medical and surgical departments that underwent within 72 h of their admission a nutritional screening with Malnutrition Universal Screening Tool (MUST), Nutritional Risk Screening (NRS) 2002, Controlling Nutritional Status (CONUT) y Subjective Global Assessment (SGA). 384 patients (273 medical and 111 surgical) were evaluated. Almost fifty percent of them were considered malnourished independently of the screening/assessment tool used. High concordance was found between SGA and NRS-2002 (k = 0.758). Malnourished patients had a longer hospital stay than those well-nourished (9.29 vs. 7.10 days; p = 0.002), used a greater number of medicines (9.2 vs. 7.4; p = 0.001) and underwent a higher number of diagnostic tests (16.4 vs. 12.5; p = 0,002). Half of the hospitalized patients in the medical and surgical department of La Rioja are malnourished. This is associated with a longer hospital stay, higher use of medicines, diagnostics tests and greater mortality. Malnutrition could be detected with easy screening tools to treat it appropriately.

  18. Mortality in Patients with Endogenous Cushing's Syndrome.

    Science.gov (United States)

    Javanmard, Pedram; Duan, Daisy; Geer, Eliza B

    2018-06-01

    Cushing's syndrome is associated with increased morbidity and mortality. Cardiovascular events, sepsis, and thromboembolism are the leading causes of mortality. Patient's with Cushing's due to a pituitary adenoma and those with Cushing's due to benign adrenal adenoma have relatively good survival outcomes often mirroring that of the general population. Persistent or recurrent disease is associated with high mortality risk. Ectopic Cushing's syndrome and Cushing's due to adrenocortical carcinoma confer the highest mortality risk among Cushing's etiologies. Prompt diagnosis and treatment, and specific monitoring for and treatment of associated comorbidities are essential to decrease the burden of mortality from Cushing's. Copyright © 2018 Elsevier Inc. All rights reserved.

  19. [Impact of HIV infection in hospital environment].

    Science.gov (United States)

    Martínez Avilés, P; López Benito, I; Berbegal Serra, J

    1998-12-01

    Retrospective study to review the admissions at the Hospital Marina Alta due to infection for HIV or its complications and look for risk factors. Clinical charts of patients admitted at the hospital from 1989 to 1996 were analyzed. From 11,932 admissions, 199 (1.7%) were due to patients with infection from HIV, resulting in the 2.4% of the total stay. The medium stays were higher (8.6 +/- 7.4 vs 6 +/- 4.5) more re-admissions (42.7% vs 25.5%) and higher mortality (11% vs 7.8%). The parasitic infestations of the nervous central system and cardiovascular were the most numerous number of admissions and also the longer stays. Throughout the years we saw a increase in the patients at the outpatient clinic with HIV infection and a paradogic decrease in the inpatient admissions, and also a decrease in the media stay and total stays. There is a decrease in the admissions at the inpatient level in contrast with a increment of the prevalence in the outpatients with HIV infection. The improved treatments, the experience of the physicians, the use of the Day Hospital and the use of the service of Home Care Hospitalization allows to keep more patients with less admissions and more outpatient visits.

  20. Decreasing medical complications for total knee arthroplasty: Effect of Critical Pathways on Outcomes

    Directory of Open Access Journals (Sweden)

    Solomon Daniel H

    2010-07-01

    Full Text Available Abstract Background Studies on critical pathway use have demonstrated decreased length of stay and cost without compromise in quality of care. However, pathway effectiveness is difficult to determine given methodological flaws, such as small or single center cohorts. We studied the effect of critical pathways on total knee replacement outcomes in a large population-based study. Methods We identified hospitals in four US states that performed total knee replacements. We sent a questionnaire to surgical administrators in these hospitals including items about critical pathway use and hospital characteristics potentially related to outcomes. Patient data were obtained from Medicare claims, including demographics, comorbidities, 90-day postoperative complications and length of hospital stay. The principal outcome measure was the risk of having one or more postoperative complications. Results Two hundred ninety five hospitals (73% responded to the questionnaire, with 201 reporting the use of critical pathways. 9,157 Medicare beneficiaries underwent TKR in these hospitals with a mean age of 74 years (± 5.8. After adjusting for both patient and hospital related variables, patients in hospitals with pathways were 32% less likely to have a postoperative complication compared to patients in hospitals without pathways (OR 0.68, 95% CI 0.50-0.92. Patients managed on a critical pathway had an average length of stay 0.5 days (95% CI 0.3-0.6 shorter than patients not managed on a pathway. Conclusion Medicare patients undergoing total knee replacement surgery in hospitals that used critical pathways had fewer postoperative complications than patients in hospitals without pathways, even after adjusting for patient and hospital related factors. This study has helped to establish that critical pathway use is associated with lower rates of postoperative mortality and complications following total knee replacement after adjusting for measured variables.

  1. Deciphering infant mortality

    Science.gov (United States)

    Berrut, Sylvie; Pouillard, Violette; Richmond, Peter; Roehner, Bertrand M.

    2016-12-01

    This paper is about infant mortality. In line with reliability theory, "infant" refers to the time interval following birth during which the mortality (or failure) rate decreases. This definition provides a systems science perspective in which birth constitutes a sudden transition falling within the field of application of the Transient Shock (TS) conjecture put forward in Richmond and Roehner (2016c). This conjecture provides predictions about the timing and shape of the death rate peak. It says that there will be a death rate spike whenever external conditions change abruptly and drastically and also predicts that after a steep rise there will be a much longer hyperbolic relaxation process. These predictions can be tested by considering living organisms for which the transient shock occurs several days after birth. Thus, for fish there are three stages: egg, yolk-sac and young adult phases. The TS conjecture predicts a mortality spike at the end of the yolk-sac phase and this timing is indeed confirmed by observation. Secondly, the hyperbolic nature of the relaxation process can be tested using very accurate Swiss statistics for postnatal death rates spanning the period from one hour immediately after birth through to age 10 years. It turns out that since the 19th century despite a significant and large reduction in infant mortality, the shape of the age-specific death rate has remained basically unchanged. Moreover the hyperbolic pattern observed for humans is also found for small primates as recorded in the archives of zoological gardens. Our overall objective is to identify a series of cases which start from simple systems and move step by step to more complex organisms. The cases discussed here we believe represent initial landmarks in this quest.

  2. Incidence and Outcome of Acute Cardiorenal Syndrome in Hospitalized Children.

    Science.gov (United States)

    Athwani, Vivek; Bhargava, Maneesha; Chanchlani, Rahul; Mehta, Amar Jeet

    2017-06-01

    To determine the incidence, etiology and outcome of Cardiorenal syndrome (CRS) in hospitalized children. A prospective cohort study was carried out in 242 children between 6 mo to 18 y of age hospitalized with primary cardiac, renal or any systemic disorder at a tertiary care center in India. The primary outcome was the development of CRS. Univariate and multivariate logistic regression analysis were performed to determine the risk of mortality secondary to CRS. Among 242 children, 67 (27.7%) children developed CRS and the rest 175 (72.3%) did not. Among those with CRS, 40.3%, 20.9%, and 38.8% had CRS-1, 3 and 5, respectively. Cardiac diseases leading to CRS were myocarditis (40.7%) followed by congenital heart disease (25.9%), rheumatic heart disease (18.5%), and dilated cardiomyopathy (7.4%); renal disease associated with CRS was acute glomerulonephritis (100%) and major systemic disorders leading to CRS were septicemia (53.8%), malaria (23.1%), scrub typhus (7.7%), and acute gastroenteritis (3.8%). The occurrence of CRS was associated with an increased risk of mortality (OR 6.3, 95% CI: 2.8, 14.1; p 0.000). A subgroup analysis revealed that children with CRS having acute kidney injury stage 2 and 3 also had a higher risk of mortality (p 0.001). The incidence of CRS is quite high in children with cardiac, renal or systemic diseases and is associated with a significant risk of mortality. Children presenting with these illnesses should be monitored for the occurrence of CRS so that early intervention may reduce mortality.

  3. Quality of Care at Hospitals Identified as Outliers in Publicly Reported Mortality Statistics for Percutaneous Coronary Intervention.

    Science.gov (United States)

    Waldo, Stephen W; McCabe, James M; Kennedy, Kevin F; Zigler, Corwin M; Pinto, Duane S; Yeh, Robert W

    2017-05-16

    Public reporting of percutaneous coronary intervention (PCI) outcomes may create disincentives for physicians to provide care for critically ill patients, particularly at institutions with worse clinical outcomes. We thus sought to evaluate the procedural management and in-hospital outcomes of patients treated for acute myocardial infarction before and after a hospital had been publicly identified as a negative outlier. Using state reports, we identified hospitals that were recognized as negative PCI outliers in 2 states (Massachusetts and New York) from 2002 to 2012. State hospitalization files were used to identify all patients with an acute myocardial infarction within these states. Procedural management and in-hospital outcomes were compared among patients treated at outlier hospitals before and after public report of outlier status. Patients at nonoutlier institutions were used to control for temporal trends. Among 86 hospitals, 31 were reported as outliers for excess mortality. Outlier facilities were larger, treating more patients with acute myocardial infarction and performing more PCIs than nonoutlier hospitals ( P fashion (interaction P =0.50) after public report of outlier status. The likelihood of in-hospital mortality decreased at outlier institutions (RR, 0.83; 95% CI, 0.81-0.85) after public report, and to a lesser degree at nonoutlier institutions (RR, 0.90; 95% CI, 0.87-0.92; interaction P <0.001). Among patients that underwent PCI, in-hospital mortality decreased at outlier institutions after public recognition of outlier status in comparison with prior (RR, 0.72; 9% CI, 0.66-0.79), a decline that exceeded the reduction at nonoutlier institutions (RR, 0.87; 95% CI, 0.80-0.96; interaction P <0.001). Large hospitals with higher clinical volume are more likely to be designated as negative outliers. The rates of percutaneous revascularization increased similarly at outlier and nonoutlier institutions after report of outlier status. After outlier

  4. The effects of price competition and reduced subsidies for uncompensated care on hospital mortality.

    Science.gov (United States)

    Volpp, Kevin G M; Ketcham, Jonathan D; Epstein, Andrew J; Williams, Sankey V

    2005-08-01

    To determine whether hospital mortality rates changed in New Jersey after implementation of a law that changed hospital payment from a regulated system based on hospital cost to price competition with reduced subsidies for uncompensated care and whether changes in mortality rates were affected by hospital market conditions. State discharge data for New Jersey and New York from 1990 to 1996. Study Design. We used an interrupted time series design to compare risk-adjusted in-hospital mortality rates between states over time. We compared the effect sizes in markets with different levels of health maintenance organization penetration and hospital market concentration and tested the sensitivity of our results to different approaches to defining hospital markets. The study sample included all patients under age 65 admitted to New Jersey or New York hospitals with stroke, hip fracture, pneumonia, pulmonary embolism, congestive heart failure, hip fracture, or acute myocardial infarction (AMI). Mortality among patients in New Jersey improved less than in New York by 0.4 percentage points among the insured (p=.07) and 0.5 percentage points among the uninsured (p=.37). There was a relative increase in mortality for patients with AMI, congestive heart failure, and stroke, especially for uninsured patients with these conditions, but not for patients with the other four conditions we studied. Less competitive hospital markets were significantly associated with a relative decrease in mortality among insured patients. Market-based reforms may adversely affect mortality for some conditions but it appears the effects are not universal. Insured patients in less competitive markets fared better in the transition to price competition.

  5. Factors associated with mortality in tuberculosis patients

    Directory of Open Access Journals (Sweden)

    Roya Alavi-Naini

    2013-01-01

    Full Text Available Background: Tuberculosis (TB is one of the main causes of morbidity and mortality in different societies. Understanding factors leading to death following diagnosis of TB is important to predict prognosis in TB patients. The aim of this study was to identify common risk factors associated with death in patients with an in-hospital diagnosis of TB, in a city in Iran with the highest prevalence and incidence of TB in the country. Materials and Methods: A retrospective study was conducted at a university-affiliated hospital, Zahedan, in the south-east of Iran, which is a referral center for TB. To identify factors leading to death, medical records of 715 patients ≥15 years old with pulmonary TB from February 2002 to February 2011 have been evaluated. Registered factors included smoking, human immune deficiency virus (HIV infection, using drugs, lung cancer, drug hepatitis following anti-TB medications, diabetes mellitus, previous TB treatment, anemia; and results of sputum smears. Univariate comparison and multiple logistic regression were performed to identify factors associated with mortality in TB patients. Results: Among 715 registered TB patients, 375 (52.5% patients were male; among those, 334 (53% were in the alive group and 41 (54% in the death group. Seventy-five (10.5% of the total number of TB patients died during TB treatment. The multivariate model showed that anemia (AOR: 19.8, 95% CI: 5.6-35.5, positive sputum smear (AOR: 13.4, 95% CI: 6.8-33.6, smoking (AOR: 12.9, 95% CI: 3.9-27.3, drug hepatitis (AOR: 12.3, 95% CI: 6.7-24.7, diabetes mellitus (AOR: 9.7, 95% CI: 2.9-32.0, drug use (AOR: 7.8, 95% CI: 2.4-25.5, and history of previous TB (AOR: 6.8, 95% CI: 2.2-21.3 were major risk factors for death in TB patients. Conclusion: Monitoring co-morbid conditions like diabetes mellitus and anemia are important to reduce death rate in TB patients. Preventive measures for smoking and drug addiction also play an important role to decrease

  6. Fifty consecutive pancreatectomies without mortality

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    Enio Campos Amico

    Full Text Available Objective: to report the group's experience with a series of patients undergoing pancreatic resection presenting null mortality rates. Methods: we prospectively studied 50 consecutive patients undergoing pancreatic resections for peri-ampullary or pancreatic diseases. Main local complications were defined according to international criteria. In-hospital mortality was defined as death occurring in the first 90 postoperative days. Results: patients' age ranged between 16 and 90 years (average: 53.3. We found anemia (Hb < 12g/dl and preoperative jaundice in 38% and 40% of cases, respectively. Most patients presented with peri-ampullary tumors (66%. The most common surgical procedure was the Kausch - Whipple operation (70%. Six patients (12% needed to undergo resection of a segment of the mesenteric-portal axis. The mean operative time was 445.1 minutes. Twenty two patients (44% showed no clinical complications and presented mean hospital stay of 10.3 days. The most frequent complications were pancreatic fistula (56%, delayed gastric emptying (17.1% and bleeding (16%. Conclusion : within the last three decades, pancreatic resection is still considered a challenge, especially outside large specialized centers. Nevertheless, even in our country (Brazil, teams seasoned in such procedure can reach low mortality rates.

  7. Trends in hospitalization of preterm infants with intraventricular hemorrhage and hydrocephalus in the United States, 2000-2010.

    Science.gov (United States)

    Christian, Eisha A; Jin, Diana L; Attenello, Frank; Wen, Timothy; Cen, Steven; Mack, William J; Krieger, Mark D; McComb, J Gordon

    2016-03-01

    OBJECT Even with improved prenatal and neonatal care, intraventricular hemorrhage (IVH) occurs in approximately 25%-30% of preterm infants, with a subset of these patients developing hydrocephalus. This study was undertaken to describe current trends in hospitalization of preterm infants with posthemorrhagic hydrocephalus (PHH) using the Nationwide Inpatient Sample (NIS) and the Kids' Inpatient Database (KID). METHODS The KID and NIS were combined to generate data for the years 2000-2010. All neonatal discharges with ICD-9-CM codes for preterm birth with IVH alone or with IVH and hydrocephalus were included. RESULTS There were 147,823 preterm neonates with IVH, and 9% of this group developed hydrocephalus during the same admission. Of patients with Grade 3 and 4 IVH, 25% and 28%, respectively, developed hydrocephalus in comparison with 1% and 4% of patients with Grade 1 and 2 IVH, respectively. Thirty-eight percent of patients with PHH had permanent ventricular shunts inserted. Mortality rates were 4%, 10%, 18%, and 40%, respectively, for Grade 1, 2, 3, and 4 IVH during initial hospitalization. Length of stay has been trending upward for both groups of IVH (49 days in 2000, 56 days in 2010) and PHH (59 days in 2000, 70 days in 2010). The average hospital cost per patient (adjusted for inflation) has also increased, from $201,578 to $353,554 (for IVH) and $260,077 to $495,697 (for PHH) over 11 years. CONCLUSIONS The number of neonates admitted with IVH has increased despite a decrease in the number of preterm births. Rates of hydrocephalus and mortality correlated closely with IVH grade. The incidence of hydrocephalus in preterm infants with IVH remained stable between 8% and 10%. Over an 11-year period, there was a progressive increase in hospital cost and length of stay for preterm neonates with IVH and PHH that may be explained by a concurrent increase in the proportion of patients with congenital cardiac anomalies.

  8. Treatment in hospital for alcohol-dependent patients decreases attentional bias

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    Flaudias V

    2013-05-01

    Full Text Available Valentin Flaudias,1,2 Georges Brousse,1,2 Ingrid De Chazeron,1,2 François Planche,2 Julien Brun,2 Pierre-Michel Llorca1,2 1Clermont Université, EA 7280 NPsy-Sydo, Clermont-Ferrand, France; 2Pôle Psychiatrie B, CHU Gabriel-Montpied, Clermont-Ferrand, France Background and objectives: Previous studies in alcohol-dependent patients have shown an attentional bias (AB under related substance cues, which can lead to relapse. This AB can be evaluated by the alcohol Stroop test (AST. The AST is a modified Stroop task in which participants have to name the color of an alcohol-related word or a neutral word. AB is the response-time difference between these two types of words. The goal of the current study was to examine modification of AB during specialized hospitalization for alcohol dependence, with the suppression of a training bias that could be present in within-subject design. Methods: Individuals with alcohol-dependence disorders (Diagnostic and Statistical Manual of Mental Disorders, 4th edition and admitted for withdrawal in the addiction unit of the University Hospital of Clermont-Ferrand (test group, n = 42 and persons with no alcohol or psychiatric disorder (control group, n = 16, recruited among colleagues and friends of the staff, performed the AST. A subgroup of the test group performed the AST in admission (admission group, n = 19, and another subgroup undertook the test immediately before discharge (discharge group, n = 23. Results: Results showed an AB only for patients seen at admission (F[1,55] = 3.283, P = 0.075. Moreover, we observed that the AB in the admission group (mean = 34 ms, standard deviation [SD] = 70.06 was greater than the AB in the control group (mean = 23 ms, SD = 93.42, itself greater than the AB in the discharge group (mean = −12 ms, SD = 93.55 (t[55] = −1.71; P = 0.09. Conclusion: Although the results are preliminary, the present study provides evidence for changes in the AB during alcohol-addiction treatment and for the value of these methods to diminish AB during detoxification. Keywords: alcohol Stroop test, addiction, attentional bias

  9. Determinants of all cause mortality in Poland.

    Science.gov (United States)

    Genowska, Agnieszka; Jamiołkowski, Jacek; Szpak, Andrzej; Pajak, Andrzej

    2012-01-01

    The study objective was to evaluate quantitatively the relationship between demographic characteristics, socio-economic status and medical care resources with all cause mortality in Poland. Ecological study was performed using data for the population of 66 subregions of Poland, obtained from the Central Statistical Office of Poland. The information on the determinants of health and all cause mortality covered the period from 1st January 2005 to 31st December 2010. Results for the repeated measures were analyzed using Generalized Estimating Equations GEE model. In the model 16 independent variables describing health determinants were used, including 6 demographic variables, 6 socio-economic variables, 4 medical care variables. The dependent variable, was age standardized all cause mortality rate. There was a large variation in all cause mortality, demographic features, socio-economic characteristics, and medical care resources by subregion. All cause mortality showed weak associations with demographic features, among which only the increased divorce rate was associated with higher mortality rate. Increased education level, salaries, gross domestic product (GDP) per capita, local government expenditures per capita and the number of non-governmental organizations per 10 thousand population was associated with decrease in all cause mortality. The increase of unemployment rate was related with a decrease of all cause mortality. Beneficial relationship between employment of medical staff and mortality was observed. Variation in mortality from all causes in Poland was explained partly by variation in socio-economic determinants and health care resources.

  10. Evaluation of clinical, laboratory, and electrophoretic profiles for diagnosis of malnutrition in hospitalized dogs

    Directory of Open Access Journals (Sweden)

    Andrei Kelliton Fabretti

    2015-02-01

    Full Text Available Malnutrition is a major factor associated with increased rates of mortality and readmission, longer hospital stays, and greater health care spending. Recognizing malnourished or at-risk animals allows for nutritional intervention and improved prognosis. This study evaluated the association between clinical, laboratory, and electrophoretic variables and the nutritional status (NS of hospitalized dogs in order to generate a profile of the sick dog and to facilitate the diagnosis of malnutrition. We divided 215 dogs into groups according to the severity of the underlying disease and we determined the clinical NS based on the assessment of the body condition score and the muscle mass score. The NS was classified as clinically well nourished, clinical moderate malnutrition, or clinical severe malnutrition. Statistical analyses were conducted by using the chi-square test or Fisher’s exact test; the Kruskal-Wallis test was used for continuous variables. A strong association was found between malnutrition and the severity of the underlying disease. In hospitalized dogs, low body mass index values, anemia, low hemoglobin concentrations, high fibrinogen concentrations, decreased albumin fraction, and increased gamma-globulin fraction (in electrophoresis were associated with malnutrition, reinforcing the classification of poor NS. However, the skin and coat characteristics, the total number of lymphocytes, blood glucose, cholesterol, and total protein concentration were not found to be good predictors of NS.

  11. Progreso en el logro de los Objetivos de Desarrollo del Milenio: la mortalidad por cáncer de cérvix desciende en Colombia / Progress in the achievement of the millennium development goals: the rate of mortality by cervical cancer decreases in Colombia

    Directory of Open Access Journals (Sweden)

    Jancy A. Huertas Q.

    2015-09-01

    Full Text Available Resumen Colombia cumpliendo en 2015 la fecha establecida para el alcance de los Objetivos de Desarrollo del Milenio (odm, ha logrado un descenso progresivo en las tasas de incidencia y mortalidad por cáncer de cuello uterino durante el decenio 2000 - 2010. En este período, la tasa de mortalidad descendió significativamente para las mujeres de todas las edades (11,4% en 1998 – 6,9 en 2011, meta a 2015: 6,8% y aumentó la proporción de casos in situ detectados oportunamente (63,31% en 2012. Colombia asumió el cáncer como un problema de salud pública y logró posicionarlo en la agenda pública. De igual forma, el cambio en el conocimiento y el autocuidado de la población, dieron como resultado un aumento en el pronóstico de las pacientes. A pesar de estos avances, el país continúa concentrando esfuerzos en reducir tasas de incidencia y mortalidad, aumentar los niveles de tecnología y promover mayor desarrollo en las regiones, mejorar sustancialmente el derecho de las mujeres a ser protegidas contra esta enfermedad, a través de acceso sin barreras a los programas de tamización y tratamientos del cáncer de cuello uterino. Y finalmente, la inclusión más amplia de la vacuna contra el vph con intervalo de cada 5 años, y que tiene un mayor potencial, especialmente entre las mujeres más jóvenes. La pregunta clave hoy en día es cómo acelerar ese ritmo de progreso en los indicadores propuestos por la agenda para el desarrollo después del 2015: Objetivos de Desarrollo Sostenible (ods, y ofrecer suficientes ejemplos de estrategias eficaces y adecuadas, y proporcionar experiencias en un contexto latinoamericano./ Abstract Two years before the deadline set for the achievement of the Millennium Development Goals (MDG, Colombia is experiencing a steady decline in the incidence and mortality rates of cervical cancer during the 2000-2010 decade. During this time, the mortality rate decreased significantly for women of all ages (11,4% in

  12. Chapter 5 - Tree Mortality

    Science.gov (United States)

    Mark J. Ambrose

    2014-01-01

    Tree mortality is a natural process in all forest ecosystems. Extremely high mortality, however, can also be an indicator of forest health issues. On a regional scale, high mortality levels may indicate widespread insect or disease problems. High mortality may also occur if a large proportion of the forest in a particular region is made up of older, senescent stands....

  13. The management of constipation in hospital inpatients.

    Science.gov (United States)

    Greenfield, Simon M

    2007-03-01

    This article reviews the causes of constipation in hospital and how it can be prevented with simple measures. A review of laxatives available on hospital words is provided for the reader and recommendations are made.

  14. Management Development in Hospitality and Tourism.

    Science.gov (United States)

    Teare, Richard, Ed.; And Others

    1990-01-01

    A theme issue devoted to management development in hospitality and tourism includes nine articles on assessing human resource needs and priorities, management development and training, preparing managers, curriculum design, supervised work experience, manager role, and the current business environment. (JOW)

  15. Research in Hospitality Management: Editorial Policies

    African Journals Online (AJOL)

    Research in Hospitality Management is a peer-reviewed journal publishing papers that ... financial management, marketing, strategic management, economics, ... Articles covering social theory and the history and politics of the hospitality ...

  16. Editorial | Cavagnaro | Research in Hospitality Management

    African Journals Online (AJOL)

    Research in Hospitality Management. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 6, No 1 (2016) >. Log in or Register to get access to full text downloads.

  17. Editorial | Lashley | Research in Hospitality Management

    African Journals Online (AJOL)

    Research in Hospitality Management. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 7, No 2 (2017) >. Log in or Register to get access to full text downloads.

  18. Hospitality and prosumption | Ritzer | Research in Hospitality ...

    African Journals Online (AJOL)

    Research in Hospitality Management. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 5, No 1 (2015) >. Log in or Register to get access to full text downloads.

  19. Editorial | Lashley | Research in Hospitality Management

    African Journals Online (AJOL)

    Research in Hospitality Management. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 7, No 1 (2017) >. Log in or Register to get access to full text downloads.

  20. Editorial | Lashley | Research in Hospitality Management

    African Journals Online (AJOL)

    Research in Hospitality Management. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 5, No 2 (2015) >. Log in or Register to get access to full text downloads.

  1. Women in leadership | Tweebeck | Research in Hospitality ...

    African Journals Online (AJOL)

    Research in Hospitality Management. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 7, No 2 (2017) >. Log in or Register to get access to full text downloads.

  2. Factors Associated With Mortality of Thyroid Storm

    Science.gov (United States)

    Ono, Yosuke; Ono, Sachiko; Yasunaga, Hideo; Matsui, Hiroki; Fushimi, Kiyohide; Tanaka, Yuji

    2016-01-01

    Abstract Thyroid storm is a life-threatening and emergent manifestation of thyrotoxicosis. However, predictive features associated with fatal outcomes in this crisis have not been clearly defined because of its rarity. The objective of this study was to investigate the associations of patient characteristics, treatments, and comorbidities with in-hospital mortality. We conducted a retrospective observational study of patients diagnosed with thyroid storm using a national inpatient database in Japan from April 1, 2011 to March 31, 2014. Of approximately 21 million inpatients in the database, we identified 1324 patients diagnosed with thyroid storm. The mean (standard deviation) age was 47 (18) years, and 943 (71.3%) patients were female. The overall in-hospital mortality was 10.1%. The number of patients was highest in the summer season. The most common comorbidity at admission was cardiovascular diseases (46.6%). Multivariable logistic regression analyses showed that higher mortality was significantly associated with older age (≥60 years), central nervous system dysfunction at admission, nonuse of antithyroid drugs and β-blockade, and requirement for mechanical ventilation and therapeutic plasma exchange combined with hemodialysis. The present study identified clinical features associated with mortality of thyroid storm using large-scale data. Physicians should pay special attention to older patients with thyrotoxicosis and coexisting central nervous system dysfunction. Future prospective studies are needed to clarify treatment options that could improve the survival outcomes of thyroid storm. PMID:26886648

  3. Reduction in Acute Myocardial Infarction Mortality in the United States

    Science.gov (United States)

    Krumholz, Harlan M.; Wang, Yun; Chen, Jersey; Drye, Elizabeth E.; Spertus, John A.; Ross, Joseph S.; Curtis, Jeptha P.; Nallamothu, Brahmajee K.; Lichtman, Judith H.; Havranek, Edward P.; Masoudi, Frederick A.; Radford, Martha J.; Han, Lein F.; Rapp, Michael T.; Straube, Barry M.; Normand, Sharon-Lise T.

    2012-01-01

    Context During the last 2 decades, health care professional, consumer, and payer organizations have sought to improve outcomes for patients hospitalized with acute myocardial infarction (AMI). However, little has been reported about improvements in hospital short-term mortality rates or reductions in between-hospital variation in short-term mortality rates. Objective To estimate hospital-level 30-day risk-standardized mortality rates (RSMRs) for patients discharged with AMI. Design, Setting, and Patients Observational study using administrative data and a validated risk model to evaluate 3 195 672 discharges in 2 755 370 patients discharged from nonfederal acute care hospitals in the United States between January 1, 1995, and December 31, 2006. Patients were 65 years or older (mean, 78 years) and had at least a 12-month history of fee-for-service enrollment prior to the index hospitalization. Patients discharged alive within 1 day of an admission not against medical advice were excluded, because it is unlikely that these patients had sustained an AMI. Main Outcome Measure Hospital-specific 30-day all-cause RSMR. Results At the patient level, the odds of dying within 30 days of admission if treated at a hospital 1 SD above the national average relative to that if treated at a hospital 1 SD below the national average were 1.63 (95% CI, 1.60-1.65) in 1995 and 1.56 (95% CI, 1.53-1.60) in 2006. In terms of hospital-specific RSMRs, a decrease from 18.8% in 1995 to 15.8% in 2006 was observed (odds ratio, 0.76; 95% CI, 0.75-0.77). A reduction in between-hospital heterogeneity in the RSMRs was also observed: the coefficient of variation decreased from 11.2% in 1995 to 10.8%, the interquartile range from 2.8% to 2.1%, and the between-hospital variance from 4.4% to 2.9%. Conclusion Between 1995 and 2006, the risk-standardized hospital mortality rate for Medicare patients discharged with AMI showed a significant decrease, as did between-hospital variation. PMID:19690309

  4. The inpatient economic and mortality impact of hepatocellular carcinoma from 2005 to 2009: analysis of the US nationwide inpatient sample.

    Science.gov (United States)

    Mishra, Alita; Otgonsuren, Munkhzul; Venkatesan, Chapy; Afendy, Mariam; Erario, Madeline; Younossi, Zobair M

    2013-09-01

    Hepatocellular carcinoma (HCC) is an important complication of cirrhosis. Our aim was to assess the inpatient economic and mortality of HCC in the USA METHODS: Five cycles of Nationwide Inpatient Sample (NIS) conducted from 2005 to 2009 were used. Demographics, inpatient mortality, severity of illness, payer type, length of stay (LoS) and charges were available. Changes and associated factors related to inpatient HCC were assessed using simple linear regression. Odds ratios and 95% CIs for hospital mortality were analysed using log-linked regression model. To estimate the sampling variances for complex survey data, we used Taylor series approach. SAS(®) v.9.3 was used for statistical analysis. From 2005 to 2009, 32,697,993 inpatient cases were reported to NIS. During these 5 years, primary diagnosis of HCC increased from 4401 (2005), 4170 (2006), 5065 (2007), 6540 (2008) to 6364 (2009). HCC as any diagnosis increased from 68 per 100,000 discharges (2005) to 99 per 100,000 (2009). However, inpatient mortality associated with HCC decreased from 12% (2005) to 10% (2009) (P < 0.046) and LoS remained stable. However, median inflation-adjusted charges at the time of discharge increased from $29,466 per case (2005) to $31,656 per case (2009). Total national HCC charges rose from $1.0 billion (2005) to $2.0 billion (2009). In multivariate analysis, hospital characteristic was independently associated with decreasing in-hospital mortality (all P < 0.05). Liver transplantation for HCC was the main contributor to high inpatient charges. Longer LoS and other procedures also contributed to higher inpatient charges. There is an increase in the number of inpatient cases of HCC. Although inpatient mortality is decreasing and the LoS is stable, the inpatient charges associated with HCC continue to increase. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Distinguishing in-hospital and out-of-hospital status epilepticus: clinical implications from a 10-year cohort study.

    Science.gov (United States)

    Sutter, R; Semmlack, S; Spiegel, R; Tisljar, K; Rüegg, S; Marsch, S

    2017-09-01

    The aim was to determine differences of clinical, treatment and outcome characteristics between patients with in-hospital and out-of-hospital status epilepticus (SE). From 2005 to 2014, clinical data were assessed in adults with SE treated in an academic medical care centre. Clinical characteristics, treatment and outcomes were compared between patients with in-hospital and out-of-hospital SE. Amongst 352 patients, 213 were admitted with SE and 139 developed in-hospital SE. Patients with in-hospital SE had more acute/fatal aetiologies (60% vs. 35%, P Status Epilepticus Severity Score (STESS) was an independent predictor for death in both groups, increased Charlson Comorbidity Index and treatment refractory SE were associated with death only in patients with in-hospital SE. Continuous anaesthesia for refractory SE was associated with increased mortality only in patients with out-of-hospital SE. The area under the receiver operating curve was 0.717 for prediction of death by STESS in patients with in-hospital SE and 0.811 in patients with out-of-hospital SE. Patients with in-hospital SE had more fatal aetiologies and comorbidities, refractory SE, less return to functional baseline, and increased mortality compared to patients with out-of-hospital SE. Whilst the STESS was a robust predictor for death in both groups, the association between continuous anaesthesia and death was limited to out-of-hospital SE. © 2017 EAN.

  6. Patterns of malaria-related hospital admissions and mortality among Malawian children: an example of spatial modelling of hospital register data

    Directory of Open Access Journals (Sweden)

    Kleinschmidt Immo

    2006-10-01

    Full Text Available Abstract Background Malaria is a leading cause of hospitalization and in-hospital mortality among children in Africa, yet, few studies have described the spatial distribution of the two outcomes. Here spatial regression models were applied, aimed at quantifying spatial variation and risk factors associated with malaria hospitalization and in-hospital mortality. Methods Paediatric ward register data from Zomba district, Malawi, between 2002 and 2003 were used, as a case study. Two spatial models were developed. The first was a Poisson model applied to analyse hospitalization and minimum mortality rates, with age and sex as covariates. The second was a logistic model applied to individual level data to analyse case-fatality rate, adjusting for individual covariates. Results and conclusion Rates of malaria hospitalization and in-hospital mortality decreased with age. Case fatality rate was associated with distance, age, wet season and increased if the patient was referred to the hospital. Furthermore, death rate was high on first day, followed by relatively low rate as length of hospital stay increased. Both outcomes showed substantial spatial heterogeneity, which may be attributed to the varying determinants of malaria risk, health services availability and accessibility, and health seeking behaviour. The increased risk of mortality of children referred from primary health facilities may imply inadequate care being available at the referring facility, or the referring facility are referring the more severe cases which are expected to have a higher case fatality rate. Improved prognosis as the length of hospital stay increased suggest that appropriate care when available can save lives. Reducing malaria burden may require integrated strategies encompassing availability of adequate care at primary facilities, introducing home or community case management as well as encouraging early referral, and reinforcing interventions to interrupt malaria

  7. Mortality after hemorrhagic stroke

    DEFF Research Database (Denmark)

    González-Pérez, Antonio; Gaist, David; Wallander, Mari-Ann

    2013-01-01

    OBJECTIVE: To investigate short-term case fatality and long-term mortality after intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) using data from The Health Improvement Network database. METHODS: Thirty-day case fatality was stratified by age, sex, and calendar year after ICH...... = 0.03). CONCLUSIONS: More than one-third of individuals die in the first month after hemorrhagic stroke, and patients younger than 50 years are more likely to die after ICH than SAH. Short-term case fatality has decreased over time. Patients who survive hemorrhagic stroke have a continuing elevated......, 54.6% for 80-89 years; SAH: 20.3% for 20-49 years, 56.7% for 80-89 years; both p-trend stroke patients...

  8. Reduction in acute myocardial infarction mortality in the United States: risk-standardized mortality rates from 1995-2006.

    Science.gov (United States)

    Krumholz, Harlan M; Wang, Yun; Chen, Jersey; Drye, Elizabeth E; Spertus, John A; Ross, Joseph S; Curtis, Jeptha P; Nallamothu, Brahmajee K; Lichtman, Judith H; Havranek, Edward P; Masoudi, Frederick A; Radford, Martha J; Han, Lein F; Rapp, Michael T; Straube, Barry M; Normand, Sharon-Lise T

    2009-08-19

    During the last 2 decades, health care professional, consumer, and payer organizations have sought to improve outcomes for patients hospitalized with acute myocardial infarction (AMI). However, little has been reported about improvements in hospital short-term mortality rates or reductions in between-hospital variation in short-term mortality rates. To estimate hospital-level 30-day risk-standardized mortality rates (RSMRs) for patients discharged with AMI. Observational study using administrative data and a validated risk model to evaluate 3,195,672 discharges in 2,755,370 patients discharged from nonfederal acute care hospitals in the United States between January 1, 1995, and December 31, 2006. Patients were 65 years or older (mean, 78 years) and had at least a 12-month history of fee-for-service enrollment prior to the index hospitalization. Patients discharged alive within 1 day of an admission not against medical advice were excluded, because it is unlikely that these patients had sustained an AMI. Hospital-specific 30-day all-cause RSMR. At the patient level, the odds of dying within 30 days of admission if treated at a hospital 1 SD above the national average relative to that if treated at a hospital 1 SD below the national average were 1.63 (95% CI, 1.60-1.65) in 1995 and 1.56 (95% CI, 1.53-1.60) in 2006. In terms of hospital-specific RSMRs, a decrease from 18.8% in 1995 to 15.8% in 2006 was observed (odds ratio, 0.76; 95% CI, 0.75-0.77). A reduction in between-hospital heterogeneity in the RSMRs was also observed: the coefficient of variation decreased from 11.2% in 1995 to 10.8%, the interquartile range from 2.8% to 2.1%, and the between-hospital variance from 4.4% to 2.9%. Between 1995 and 2006, the risk-standardized hospital mortality rate for Medicare patients discharged with AMI showed a significant decrease, as did between-hospital variation.

  9. Impact on Mortality of Different Network Systems in the Treatment of ST-segment Elevation Acute Myocardial Infarction. The Spanish Experience.

    Science.gov (United States)

    Cequier, Ángel; Ariza-Solé, Albert; Elola, Francisco J; Fernández-Pérez, Cristina; Bernal, José L; Segura, José V; Iñiguez, Andrés; Bertomeu, Vicente

    2017-03-01

    To analyze the association between the development of network systems of care for ST-segment elevation myocardial infarction (STEMI) in the autonomous communities (AC) of Spain and the regional rate of percutaneous coronary intervention (PCI) and in-hospital mortality. From 2003 to 2012, data from the minimum basic data set of the Spanish taxpayer-funded health system were analyzed, including admissions from general hospitals. Diagnoses of STEMI and related procedures were codified by the International Diseases Classification. Discharge episodes (n = 302 471) were distributed in 3 groups: PCI (n = 116 621), thrombolysis (n = 46 720), or no reperfusion (n = 139 130). Crude mortality throughout the evaluation period was higher for the no-PCI or thrombolysis group (17.3%) than for PCI (4.8%) and thrombolysis (8.6%) (P < .001). For the aggregate of all communities, the PCI rate increased (21.6% in 2003 vs 54.5% in 2012; P < .001) with a decrease in risk-standardized mortality rates (10.2% in 2003; 6.8% in 2012; P < .001). Significant differences were observed in the PCI rate across the AC. The development of network systems was associated with a 50% increase in the PCI rate (P < .001) and a 14% decrease in risk-standardized mortality rates (P < .001). From 2003 to 2012, the PCI rate in STEMI substantially increased in Spain. The development of network systems was associated with an increase in the PCI rate and a decrease in in-hospital mortality. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  10. Clinical profile and improving mortality trend of scrub typhus in South India.

    Science.gov (United States)

    Varghese, George M; Trowbridge, Paul; Janardhanan, Jeshina; Thomas, Kurien; Peter, John V; Mathews, Prasad; Abraham, Ooriapadickal C; Kavitha, M L

    2014-06-01

    Scrub typhus, a bacterial zoonosis caused by Orientia tsutsugamushi, may cause multiorgan dysfunction syndrome (MODS) and is associated with significant mortality. This study was undertaken to document the clinical and laboratory manifestations and complications and to study time trends and factors associated with mortality in patients with scrub typhus infection. This retrospective study, done at a university teaching hospital, included 623 patients admitted between 2005 and 2010 with scrub typhus. The diagnosis was established by a positive IgM ELISA and/or pathognomonic eschar with PCR confirmation where feasible. The clinical and laboratory profile, course in hospital, and outcome were documented. Factors associated with mortality were analyzed using multivariate logistic regression analysis. The most common presenting symptoms were fever (100%), nausea/vomiting (54%), shortness of breath (49%), headache (46%), cough (38%), and altered sensorium (26%). An eschar was present in 43.5% of patients. Common laboratory findings included elevated transaminases (87%), thrombocytopenia (79%), and leukocytosis (46%). MODS was seen in 34% of patients. The overall case-fatality rate was 9.0%. Features of acute lung injury were observed in 33.7%, and 29.5% required ventilatory support. On multivariate analysis, shock requiring vasoactive agents (relative risk (RR) 10.5, 95% confidence interval (CI) 4.2-25.7, p<0.001), central nervous system (CNS) dysfunction (RR 5.1, 95% CI 2.4-10.7, p<0.001), and renal failure (RR 3.6, 95% CI 1.7-7.5, p=0.001) were independent predictors of mortality. Over 4 years, a decreasing trend was observed in the mortality rate. Scrub typhus can manifest with potentially life-threatening complications such as lung injury, shock, and meningoencephalitis. MODS occurred in a third of our patients. The overall case-fatality rate was 9%, with shock, renal failure, and CNS associated with a higher mortality. Copyright © 2014 The Authors. Published by

  11. Malnutrition in hospital: the clinical and economic implications.

    Science.gov (United States)

    Löser, Christian

    2010-12-01

    Undernutrition and malnutrition are common in hospitalized patients. Their combined prevalence on admission is estimated at 25% and is rising. Selective literature review with special consideration of current guidelines and meta-analyses. The nutritional state of every patient should be assessed on admission with simple, established parameters, and patients suffering from under- or malnutrition should be treated with a targeted nutritional intervention based on the established stepwise treatment algorithm. Under- and malnutrition are an independent risk and cost factor with a significant influence on mortality, morbidity, length of hospital stay, and quality of life. Their direct costs alone amount to some 9 billion Euros in Germany each year. Therapeutic trials and meta-analyses have clearly documented the therapeutic benefit and cost-effectiveness of oral nutritional supplements and tube feeds. Targeted nutritional intervention is an integral part of medical treatment and prevention. Undernutrition and malnutrition are common in hospitalized patients and are both medically and economically harmful. If they are detected early by targeted assessment and then treated appropriately according to the established stepwise treatment algorithm, better clinical outcomes and lower costs will result.

  12. Screening for nutritional risk in hospitalized children with liver disease.

    Science.gov (United States)

    Song, Tiantian; Mu, Ying; Gong, Xue; Ma, Wenyan; Li, Li

    2017-01-01

    Malnutrition is a major contributor to morbidity and mortality from pediatric liver disease. We investigated the prevalence of both malnutrition and high nutritional risk in hospitalized children with liver disease as well as the rate of in-hospital nutritional support. A total of 2,874 hospitalized children and adolescents with liver disease aged 1 to 17 years (inclusive) were enrolled. Malnutrition was screened by anthropometric measures (height-for-age, weight-for-height, weight-for-age, and BMI- for-age z-scores). The Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) was used to evaluate nutritional risk status. Nutrition markers in blood, rate of nutritional support, length of hospital stay, and hospital fees were compared among nutritional risk groups. The overall prevalence of malnutrition was 38.6%. About 20.0% of children had high nutritional risk, and prevalence of malnutrition was markedly greater in the high nutritional risk group compared with the moderate risk group (67.9% vs 31.3%). Serum albumin and prealbumin differed significantly between high and moderate risk groups (pnutritional risk and 3.5% with moderate nutritional risk received nutrition support during hospitalization. Children with high nutritional risk had longer hospital stays and greater hospital costs (pnutritional risk is also prevalent at admission. Albumin and prealbumin are sensitive markers for distinguishing nutritional risk groups. High nutritional risk prolongs length of stay and increases hospital costs. The nutritional support rate is still low and requires standardization.

  13. Exposure to an atomic bomb explosion is a risk factor for in-hospital death after esophagectomy to treat esophageal cancer.

    Science.gov (United States)

    Nakashima, Y; Takeishi, K; Guntani, A; Tsujita, E; Yoshinaga, K; Matsuyama, A; Hamatake, M; Maeda, T; Tsutsui, S; Matsuda, H; Ishida, T

    2015-01-01

    Esophagectomy, one of the most invasive of all gastrointestinal operations, is associated with a high frequency of postoperative complications and in-hospital mortality. The purpose of the present study was to determine whether exposure to the atomic bomb explosion at Hiroshima in 1945 might be a preoperative risk factor for in-hospital mortality after esophagectomy in esophageal cancer patients. We thus reviewed the outcomes of esophagectomy in 31 atomic bomb survivors with esophageal cancer and 96 controls (also with cancer but without atomic bomb exposure). We compared the incidences of postoperative complications and in-hospital mortality. Of the clinicopathological features studied, mean patient age was significantly higher in atomic bomb survivors than in controls. Of the postoperative complications noted, atomic bomb survivors experienced a longer mean period of endotracheal intubation and higher incidences of severe pulmonary complications, severe anastomotic leakage, and surgical site infection. The factors associated with in-hospital mortality were exposure to the atomic bomb explosion, pulmonary comorbidities, and electrocardiographic abnormalities. Multivariate analysis revealed that exposure to the atomic bomb explosion was an independent significant preoperative risk factor for in-hospital mortality. Exposure to the atomic bomb explosion is thus a preoperative risk factor for in-hospital death after esophagectomy to treat esophageal cancer. © 2013 Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

  14. Mortality table construction

    Science.gov (United States)

    Sutawanir

    2015-12-01

    Mortality tables play important role in actuarial studies such as life annuities, premium determination, premium reserve, valuation pension plan, pension funding. Some known mortality tables are CSO mortality table, Indonesian Mortality Table, Bowers mortality table, Japan Mortality table. For actuary applications some tables are constructed with different environment such as single decrement, double decrement, and multiple decrement. There exist two approaches in mortality table construction : mathematics approach and statistical approach. Distribution model and estimation theory are the statistical concepts that are used in mortality table construction. This article aims to discuss the statistical approach in mortality table construction. The distributional assumptions are uniform death distribution (UDD) and constant force (exponential). Moment estimation and maximum likelihood are used to estimate the mortality parameter. Moment estimation methods are easier to manipulate compared to maximum likelihood estimation (mle). However, the complete mortality data are not used in moment estimation method. Maximum likelihood exploited all available information in mortality estimation. Some mle equations are complicated and solved using numerical methods. The article focus on single decrement estimation using moment and maximum likelihood estimation. Some extension to double decrement will introduced. Simple dataset will be used to illustrated the mortality estimation, and mortality table.

  15. Decreasing Relative Risk Premium

    DEFF Research Database (Denmark)

    Hansen, Frank

    relative risk premium in the small implies decreasing relative risk premium in the large, and decreasing relative risk premium everywhere implies risk aversion. We finally show that preferences with decreasing relative risk premium may be equivalently expressed in terms of certain preferences on risky......We consider the risk premium demanded by a decision maker with wealth x in order to be indifferent between obtaining a new level of wealth y1 with certainty, or to participate in a lottery which either results in unchanged present wealth or a level of wealth y2 > y1. We define the relative risk...... premium as the quotient between the risk premium and the increase in wealth y1–x which the decision maker puts on the line by choosing the lottery in place of receiving y1 with certainty. We study preferences such that the relative risk premium is a decreasing function of present wealth, and we determine...

  16. Excess mortality in general hospital patients with delirium: A 5-year follow-up of 519 patients seen in psychiatric consultation

    NARCIS (Netherlands)

    A.M. van Hemert (Bert); R.C. van der Mast (Roos); M.W. Hengeveld (Michiel); M. Vorstenbosch (Marielle)

    1994-01-01

    textabstractMortality was determined in 519 patients with delirium who were seen in psychiatric consultation in two general hospitals. Among 419 patients with simple delirium (DSM-III: 293.00) in-hospital mortality was 26%. As compared to average hospital patients the age adjusted in-hospital excess

  17. Decreasing Serial Cost Sharing

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Østerdal, Lars Peter

    The increasing serial cost sharing rule of Moulin and Shenker [Econometrica 60 (1992) 1009] and the decreasing serial rule of de Frutos [Journal of Economic Theory 79 (1998) 245] have attracted attention due to their intuitive appeal and striking incentive properties. An axiomatic characterization...... of the increasing serial rule was provided by Moulin and Shenker [Journal of Economic Theory 64 (1994) 178]. This paper gives an axiomatic characterization of the decreasing serial rule...

  18. Decreasing serial cost sharing

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Østerdal, Lars Peter Raahave

    2009-01-01

    The increasing serial cost sharing rule of Moulin and Shenker (Econometrica 60:1009-1037, 1992) and the decreasing serial rule of de Frutos (J Econ Theory 79:245-275, 1998) are known by their intuitive appeal and striking incentive properties. An axiomatic characterization of the increasing serial...... rule was provided by Moulin and Shenker (J Econ Theory 64:178-201, 1994). This paper gives an axiomatic characterization of the decreasing serial rule....

  19. Severe maternal morbidity in Zanzibar's referral hospital: Measuring the impact of in-hospital care.

    Directory of Open Access Journals (Sweden)

    Tanneke Herklots

    Full Text Available to analyse the impact of in-hospital care on severe maternal morbidity using WHO's near-miss approach in the low-resource, high mortality setting of Zanzibar's referral hospital.Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania.We identified all cases of morbidity and mortality in women admitted within 42 days after the end of pregnancy at Mnazi Mmoja Hospital in the period from April to October 2016. The severity of complications was classified using WHO's near-miss approach definitions: potentially life-threatening condition (PLTC, maternal near-miss (MNM or maternal death (MD. Quality of in-hospital care was assessed using the mortality index (MI defined as ratio between mortality and severe maternal outcome (SMO where SMO = MD + MNM, cause-specific case facility rates and comparison with predicted mortality based on the Maternal Severity Index model.5551 women were included. 569 (10.3% had a potentially life-threatening condition and 65 (1.2% a severe maternal outcome (SMO: 37 maternal near-miss cases and 28 maternal deaths. The mortality index was high at 0.43 and similar for women who developed a SMO within 12 hours of admission and women who developed a SMO after 12 hours. A standardized mortality ratio of 6.03 was found; six times higher than that expected in moderate maternal mortality settings given the same severity of cases. Obstetric haemorrhage was found to be the main cause of SMO. Ruptured uterus and admission to ICU had the highest case-fatality rates. Maternal death cases seemed to have received essential interventions less often.WHO's near-miss approach can be used in this setting. The high mortality index observed shows that in-hospital care is not preventing progression of disease adequately once a severe complication occurs. Almost one in two women experiencing life-threatening complications will die. This is six times higher than in moderate mortality settings.

  20. Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death

    DEFF Research Database (Denmark)

    Regueiro, Ander; Linke, Axel; Latib, Azeem

    2016-01-01

    IMPORTANCE: Limited data exist on clinical characteristics and outcomes of patients who had infective endocarditis after undergoing transcatheter aortic valve replacement (TAVR). OBJECTIVE: To determine the associated factors, clinical characteristics, and outcomes of patients who had infective...... endocarditis after TAVR. DESIGN, SETTING, AND PARTICIPANTS: The Infectious Endocarditis after TAVR International Registry included patients with definite infective endocarditis after TAVR from 47 centers from Europe, North America, and South America between June 2005 and October 2015. EXPOSURE: Transcatheter...... aortic valve replacement for incidence of infective endocarditis and infective endocarditis for in-hospital mortality. MAIN OUTCOMES AND MEASURES: Infective endocarditis and in-hospital mortality after infective endocarditis. RESULTS: A total of 250 cases of infective endocarditis occurred in 20...

  1. A new parametric model to assess delay and compression of mortality

    NARCIS (Netherlands)

    de Beer, J.A.A.; Janssen, F.

    2016-01-01

    Background A decrease in mortality across all ages causes a shift of the age pattern of mortality, or mortality delay, while differences in the rate of decrease across ages cause a change in the shape of the age-at-death distribution, mortality compression or expansion. Evidence exists for both

  2. A new parametric model to assess delay and compression of mortality

    NARCIS (Netherlands)

    de Beer, Joop; Janssen, Fanny

    2016-01-01

    BACKGROUND: A decrease in mortality across all ages causes a shift of the age pattern of mortality, or mortality delay, while differences in the rate of decrease across ages cause a change in the shape of the age-at-death distribution, mortality compression or expansion. Evidence exists for both

  3. Hospital Mortality in the United States following Acute Kidney Injury

    Directory of Open Access Journals (Sweden)

    Jeremiah R. Brown

    2016-01-01

    Full Text Available Acute kidney injury (AKI is a common reason for hospital admission and complication of many inpatient procedures. The temporal incidence of AKI and the association of AKI admissions with in-hospital mortality are a growing problem in the world today. In this review, we discuss the epidemiology of AKI and its association with in-hospital mortality in the United States. AKI has been growing at a rate of 14% per year since 2001. However, the in-hospital mortality associated with AKI has been on the decline starting with 21.9% in 2001 to 9.1 in 2011, even though the number of AKI-related in-hospital deaths increased almost twofold from 147,943 to 285,768 deaths. We discuss the importance of the 71% reduction in AKI-related mortality among hospitalized patients in the United States and draw on the discussion of whether or not this is a phenomenon of hospital billing (coding or improvements to the management of AKI.

  4. Insulin Therapy for the Management of Hyperglycemia in Hospitalized Patients

    Science.gov (United States)

    McDonnell, Marie E.; Umpierrez, Guillermo E.

    2013-01-01

    It has long been established that hyperglycemia with or without a prior diagnosis of diabetes increases both mortality and disease-specific morbidity in hospitalized patients1–4 and that goal-directed insulin therapy can improve outcomes.5–9 During the past decade, since the widespread institutional adoption of intensified insulin protocols after the publication of a landmark trial,5,10 the pendulum in the inpatient diabetes literature has swung away from achieving intensive glucose control and toward more moderate and individualized glycemic targets.11,12 This change in clinical practice is the result of several factors, including challenges faced by hospitals to coordinate glycemic control across all levels of care,13,14 publication of negative prospective trials,15,16 revised recommendations from professional organizations,17,18 and increasing evidence on the deleterious effect of hypoglycemia.19–22 This article reviews the pathophysiology of hyperglycemia during illness, the mechanisms for increased complications and mortality due to hyperglycemia and hypoglycemia, beneficial mechanistic effects of insulin therapy and provides updated recommendations for the inpatient management of diabetes in the critical care setting and in the general medicine and surgical settings.23,24 PMID:22575413

  5. Telomere Length and Mortality

    DEFF Research Database (Denmark)

    Kimura, Masayuki; Hjelmborg, Jacob V B; Gardner, Jeffrey P

    2008-01-01

    Leukocyte telomere length, representing the mean length of all telomeres in leukocytes, is ostensibly a bioindicator of human aging. The authors hypothesized that shorter telomeres might forecast imminent mortality in elderly people better than leukocyte telomere length. They performed mortality...

  6. Factors affecting mortality of critical care trauma patients | Hefny ...

    African Journals Online (AJOL)

    The most common mechanism of injury was road traffic collisions (72.3 %). The overall mortality was 13.9%. A direct logistic regression model has shown that factors that affected mortality were decreased GCS (p < 0.0001), mechanism of injury (p = 0.004) with burns having the highest mortality, increased age (p = 0.004), ...

  7. Increasing Sex Mortality Differentials among Black Americans, 1950-1978.

    Science.gov (United States)

    Gee, Ellen M.; Veevers, Jean E.

    1985-01-01

    In regard to sex differentials in mortality among Blacks, explores (1) age groups responsible for increasing the differential, (2) causes of death that have contributed to the increased differential, and (3) whether the phenomenon derives from decreased female mortality, increased male mortality, or both rates moving in the same direction at…

  8. Recent trends in cancer mortality in Uruguay

    International Nuclear Information System (INIS)

    Garau, M.; Alonso, R.; Musetti, C.; Barrios, E.

    2010-01-01

    Objective: To analyze trends in cancer mortality in Uruguay in the period 1989-2008. Methodology: The National Cancer Registry (NCR) collects information from cancer mortality from the death certificates: 147 631 deaths were identified in the period from cancer, which was recorded topography, sex and age. They were calculated for each year mortality rates adjusted for age (TMAE) using as standard the world population. Trends were assessed using the method and calculated the joinpoint Estimated Annual Percent Change (ESPP). Results: The TMAE presents downward trend in both sexes (ESPP = significant -0.60 in men and -0.49 In women). In the period studied, mortality presented decreasing trend when it comes to cancer breast cancer in women (ESPP -0.79, significant), and increased for prostate cancer (ESPP = 0.70) and kidney (ESPP = 1.82 and 1.71 in men and women respectively). As regards the digestive system decreased mortality observed for esophageal cancer (ESPP in = -1.93 men and women = -1.78) and stomach (ESPP = -2.22 men and women -2.24 ). Mortality for cancer of colorectum is stable in men (ESPP = 0.35 No significant (NS)) and shows a decline slight but steady in women (ESPP -0.5). As for cancers that show strong association with smoking, decreased mortality observed lung and laryngeal cancer in men (ESPP = -1.11 and -2.05 respectively), confirming the trend found between 1990 and 2001; in women there is increased mortality from lung cancer (ESPP = 2.76) that is not accompanied by increased mortality from laryngeal cancer (-0.1 ESPP = NS). Mortality from cancers oral cavity and pharynx is stable, but in women a significant increase (ESPP = 1.84) is observed when the oral cavity is analyzed in isolation (lip, tongue, gums, palate). As cervical cancer, mortality trends in 20 years is to increase (ESPP = 1.14), however, if consider only the past decade, mortality appears stabilized (ESPP = 0.57 NS). Conclusions: The overall trend of cancer mortality (all sites

  9. Macroeconomic Conditions, Health and Mortality

    OpenAIRE

    Christopher J. Ruhm

    2004-01-01

    Although health is conventionally believed to deteriorate during macroeconomic downturns, the empirical evidence supporting this view is quite weak and comes from studies containing methodological shortcomings that are difficult to remedy. Recent research that better controls for many sources of omitted variables bias instead suggests that mortality decreases and physical health improves when the economy temporarily weakens. This partially reflects reductions in external sources of death, suc...

  10. Excess mortality in hyperthyroidism

    DEFF Research Database (Denmark)

    Hjelm Brandt Kristensen, Frans; Pedersen, Dorthe Almind; Christensen, Kaare

    2012-01-01

    Hyperthyroidism is associated with severe comorbidity, such as stroke, and seems to confer increased mortality. However, it is unknown whether this increased mortality is explained by hyperthyroidism per se, comorbidity, and/or genetic confounding.......Hyperthyroidism is associated with severe comorbidity, such as stroke, and seems to confer increased mortality. However, it is unknown whether this increased mortality is explained by hyperthyroidism per se, comorbidity, and/or genetic confounding....

  11. An inquiry - aesthetics of art in hospitals.

    Science.gov (United States)

    Gates, Jillian

    2008-09-01

    Historically, art has served a significant purpose within hospital waiting rooms. However, in recent times we have experienced cuts in funding and less interest in improving the aesthetic of art displayed in Australian hospitals. This article briefly discusses the history of art in hospitals and explores a methodology for researching the preference of Australian patients today. Potentially, Australians waiting in hospitals and medical clinics could benefit from art works that reflect their preferences; this may help to ease the pain, anxiety, and boredom of waiting.

  12. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study.

    Science.gov (United States)

    Aiken, Linda H; Sloane, Douglas M; Bruyneel, Luk; Van den Heede, Koen; Griffiths, Peter; Busse, Reinhard; Diomidous, Marianna; Kinnunen, Juha; Kózka, Maria; Lesaffre, Emmanuel; McHugh, Matthew D; Moreno-Casbas, M T; Rafferty, Anne Marie; Schwendimann, Rene; Scott, P Anne; Tishelman, Carol; van Achterberg, Theo; Sermeus, Walter

    2014-05-24

    Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. For this observational study, we obtained discharge data for 422,730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26,516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031-1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886-0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared

  13. Variability in the measurement of hospital-wide mortality rates.

    Science.gov (United States)

    Shahian, David M; Wolf, Robert E; Iezzoni, Lisa I; Kirle, Leslie; Normand, Sharon-Lise T

    2010-12-23

    Several countries use hospital-wide mortality rates to evaluate the quality of hospital care, although the usefulness of this metric has been questioned. Massachusetts policymakers recently requested an assessment of methods to calculate this aggregate mortality metric for use as a measure of hospital quality. The Massachusetts Division of Health Care Finance and Policy provided four vendors with identical information on 2,528,624 discharges from Massachusetts acute care hospitals from October 1, 2004, through September 30, 2007. Vendors applied their risk-adjustment algorithms and provided predicted probabilities of in-hospital death for each discharge and for hospital-level observed and expected mortality rates. We compared the numbers and characteristics of discharges and hospitals included by each of the four methods. We also compared hospitals' standardized mortality ratios and classification of hospitals with mortality rates that were higher or lower than expected, according to each method. The proportions of discharges that were included by each method ranged from 28% to 95%, and the severity of patients' diagnoses varied widely. Because of their discharge-selection criteria, two methods calculated in-hospital mortality rates (4.0% and 5.9%) that were twice the state average (2.1%). Pairwise associations (Pearson correlation coefficients) of discharge-level predicted mortality probabilities ranged from 0.46 to 0.70. Hospital-performance categorizations varied substantially and were sometimes completely discordant. In 2006, a total of 12 of 28 hospitals that had higher-than-expected hospital-wide mortality when classified by one method had lower-than-expected mortality when classified by one or more of the other methods. Four common methods for calculating hospital-wide mortality produced substantially different results. This may have resulted from a lack of standardized national eligibility and exclusion criteria, different statistical methods, or

  14. Morbidity from in-hospital complications is greater than treatment failure in patients with Staphylococcus aureus bacteraemia.

    Science.gov (United States)

    Holmes, Natasha E; Robinson, J Owen; van Hal, Sebastiaan J; Munckhof, Wendy J; Athan, Eugene; Korman, Tony M; Cheng, Allen C; Turnidge, John D; Johnson, Paul D R; Howden, Benjamin P

    2018-03-05

    Various studies have identified numerous factors associated with poor clinical outcomes in patients with Staphylococcus aureus bacteraemia (SAB). A new study was created to provide deeper insight into in-hospital complications and risk factors for treatment failure. Adult patients hospitalised with Staphylococcus aureus bacteraemia (SAB) were recruited prospectively into a multi-centre cohort. The primary outcome was treatment failure at 30 days (composite of all-cause mortality, persistent bacteraemia, or recurrent bacteraemia), and secondary measures included in-hospital complications and mortality at 6- and 12-months. Data were available for 222 patients recruited from February 2011 to December 2012. Treatment failure at 30-days was recorded in 14.4% of patients (30-day mortality 9.5%). Multivariable analysis predictors of treatment failure included age > 70 years, Pitt bacteraemia score ≥ 2, CRP at onset of SAB > 250 mg/L, and persistent fevers after SAB onset; serum albumin at onset of SAB, receipt of appropriate empiric treatment, recent healthcare attendance, and performing echocardiography were protective. 6-month and 12-month mortality were 19.1% and 24.2% respectively. 45% experienced at least one in-hospital complication, including nephrotoxicity in 19.5%. This study demonstrates significant improvements in 30-day outcomes in SAB in Australia. However, we have identified important areas to improve outcomes from SAB, particularly reducing renal dysfunction and in-hospital treatment-related complications.

  15. Severe maternal morbidity in Zanzibar’s referral hospital : Measuring the impact of in-hospital care

    NARCIS (Netherlands)

    Herklots, Tanneke; Van Acht, Lieke; Meguid, Tarek; Franx, Arie; Jacod, Benoit

    2017-01-01

    Objective: to analyse the impact of in-hospital care on severe maternal morbidity using WHO’s near-miss approach in the low-resource, high mortality setting of Zanzibar’s referral hospital. Setting: Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania. Methods: We identified all

  16. Decreasing relative risk premium

    DEFF Research Database (Denmark)

    Hansen, Frank

    2007-01-01

    such that the corresponding relative risk premium is a decreasing function of present wealth, and we determine the set of associated utility functions. We find a new characterization of risk vulnerability and determine a large set of utility functions, closed under summation and composition, which are both risk vulnerable...

  17. Decreasing asthma morbidity

    African Journals Online (AJOL)

    1994-12-12

    Dec 12, 1994 ... Apart from the optimal use of drugs, various supplementary methods have been tested to decrease asthma morbidity, usually in patients from reiatively affluent socio-economic backgrounds. A study of additional measures taken in a group of moderate to severe adult asthmatics from very poor socio- ...

  18. Effect of air pollution control on mortality and hospital admissions in Ireland.

    Science.gov (United States)

    Dockery, Douglas W; Rich, David Q; Goodman, Patrick G; Clancy, Luke; Ohman-Strickland, Pamela; George, Prethibha; Kotlov, Tania

    2013-07-01

    and 1998 bans, adjusting for influenza epidemics, weekly mean temperature, and local admissions for digestive diagnoses. Mean BS concentrations fell in all affected population centers post-ban compared with the pre-ban period, with decreases ranging from 4 to 35 microg/m3 (corresponding to reductions of 45% to 70%, respectively), but we observed no clear pattern in SO2 measured as total gaseous acidity associated with the bans. In comparisons with the pre-ban periods, no significant reduction was found in total death rates associated with the 1990 (1% reduction), 1995 (4% reduction), or 1998 (0% reduction) bans, nor for cardiovascular mortality (0%, 4%, and 1% reductions for the 1990, 1995, and 1998 bans, respectively). Respiratory mortality was reduced in association with the bans (17%, 9%, and 3%, respectively). We found a 4% decrease in hospital admissions for cardiovascular disease associated with the 1995 ban and a 3% decrease with the 1998 ban. Admissions for respiratory disease were not consistently lower after the bans; admissions for pneumonia, chronic obstructive pulmonary disease (COPD), and asthma were reduced. However, underreporting of hospital admissions data and lack of control and comparison series tempered our confidence in these results. The successive coal bans resulted in immediate and sustained decreases in particulate concentrations in each city or town; with the largest decreases in winter and during the heating season. The bans were associated with reductions in respiratory mortality but no detectable improvement in cardiovascular mortality. The changes in hospital admissions for respiratory and cardiovascular disease were supportive of these findings but cannot be considered confirming. Detecting changes in public health indicators associated even with clear improvements in air quality, as in this case, remains difficult when there are simultaneous secular improvements in the same health indicators.

  19. One-year mortality in coagulase-negative Staphylococcus and Staphylococcus aureus infective endocarditis

    DEFF Research Database (Denmark)

    Rasmussen, Rasmus V; Snygg-Martin, Ulrika; Olaison, Lars

    2009-01-01

    The aim of this study was to investigate in-hospital mortality and 12-month mortality in patients with coagulase-negative Staphylococcus (CoNS) compared to Staphylococcus aureus (S. aureus) infective endocarditis (IE). We used a prospective cohort study of 66 consecutive CoNS and 170 S. aureus IE...

  20. Economic aspects of radiation safety in hospitals

    International Nuclear Information System (INIS)

    Subrahmanian, G.; Venkataraman, G.

    1977-01-01

    Radiation protection procedures to be adhered to while using radiological equipment in hospitals both for the patients and the medical personnel are described in detail. The hazards resulting from careless handling of equipment and the need for adequately trained staff to handle the equipment is stressed. (A.K.)

  1. Corrigendum | Gehrels | Research in Hospitality Management

    African Journals Online (AJOL)

    Li, L. (2016). Are social media applications a facilitator or barrier to learning for tourism and hospitality management students? Research in Hospitality Management, 6 (2), 195–202. https://doi.org/10.1080/22243534.2016.1253289. Acknowledgement — I thank University of Surrey, University of Derby, and Bath Spa ...

  2. Survival trends and predictors of mortality in severe pelvic trauma

    DEFF Research Database (Denmark)

    Pohlemann, Tim; Stengel, Dirk; Tosounidis, Georgios

    2011-01-01

    STUDY OBJECTIVE: To determine longitudinal trends in mortality, and the contribution of specific injury characteristics and treatment modalities to the risk of a fatal outcome after severe and complex pelvic trauma. METHODS: We studied 5048 patients with pelvic ring fractures enrolled in the German...... Pelvic Trauma Registry Initiative between 1991 and 1993, 1998 and 2000, and 2004 and 2006. Complete datasets were available for 5014 cases, including 508 complex injuries, defined as unstable fractures with severe peri-pelvic soft tissue and organ laceration. Multivariable mixed-effects logistic...... regression analysis was employed to evaluate the impact of demographic, injury- and treatment-associated variables on all-cause in-hospital mortality. RESULTS: All-cause in-hospital mortality declined from 8% (39/466) in 1991 to 5% (33/638) in 2006. Controlling for age, Injury Severity Score, pelvic vessel...

  3. Association of Peak Changes in Plasma Cystatin C and Creatinine with Mortality post Cardiac Surgery

    Science.gov (United States)

    Park, Meyeon; Shlipak, Michael G.; Thiessen-Philbrook, Heather; Garg, Amit X.; Koyner, Jay L.; Coca, Steven G.; Parikh, Chirag R.

    2015-01-01

    Background Acute kidney injury is a risk factor for mortality in cardiac surgery patients. Plasma cystatin C and creatinine have different temporal profiles in the post-operative setting, but the associations of simultaneous changes in both filtration markers as compared to change in only one marker with prognosis following hospital discharge are not well described. Methods This is a longitudinal study of 1199 high-risk adult cardiac surgery patients in the TRIBE-AKI (Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury) Consortium who survived hospitalization. We examined in-hospital peak changes of cystatin C and creatinine in the 3 days following cardiac surgery. We evaluated associations of these filtration markers with mortality, adjusting for demographics, operative characteristics, medical comorbidities, pre-operative estimated glomerular filtration rate, pre-operative urinary albumin to creatinine ratio, and site. Results During the first 3 days of hospitalization, nearly twice as many patients had a ≥ 25% rise in creatinine (30%) compared to a ≥ 25% peak rise in cystatin C (15%). Those with elevations in either cystatin C or creatinine had higher mortality risk (adjusted hazard ratio cystatin C 1.83 (95% CI 1.4–2.37) and creatinine 1.90 (95% CI 1.32–2.72)) compared with persons who experienced a post-operative decrease in either filtration marker, respectively. Patients who had simultaneous elevations of ≥ 25% in both cystatin C and creatinine were at similar adjusted risk for 3 year mortality (HR 1.79, 95% CI 1.03–3.1) as those with ≥ 25% increase in cystatin C alone (HR 2.2, 95% CI 1.09–4.47). Conclusions Elevations in creatinine post-operatively are more common than elevations in cystatin C. However, elevations in cystatin C appeared to be associated with higher risk of mortality after hospital discharge. PMID:26921980

  4. Effect of healthcare on mortality: trends in avoidable mortality in Umbria, Italy, 1994-2009

    Directory of Open Access Journals (Sweden)

    Fabrizio Stracci

    2013-06-01

    Full Text Available OBJECTIVE: Avoidable mortality trends over the period 1994-2009 were calculated to evaluate health intervention by the health system of Umbria, a region of central Italy. MATERIALS AND METHODS: Mortality data were supplied by the regional causes of death registry. Rates were standardized to the 2001 census Italian population. Joinpoint regression was used to analyze the trends. RESULTS: Overall avoidable mortality rates decreased significantly both in males (-3.9% per year and in females (-3.6% per year. Mortality rates from ischemic heart and cerebrovascular disease about halved in the study period in both sexes. Avoidable mortality increased slightly only for a few causes (e.g. lung cancer in females. CONCLUSION: The overall trend of avoidable mortality indicates that the regional health/ preventive system is performing well.

  5. Type 2 diabetes and in-hospital complications after revision of total hip and knee arthroplasty.

    Directory of Open Access Journals (Sweden)

    Ana López-de-Andrés

    Full Text Available To assess the effect of type 2 diabetes (T2DM on hospital outcomes such as in hospital postoperative complications (IHPC, length of hospital stay (LOHS and in-hospital mortality (IHM after the revision of total hip arthroplasty (RHA and total knee arthroplasty (RKA and to identify factors associated with IHPC among T2DM patients undergoing these procedures.We performed a retrospective study using the Spanish National Hospital Discharge Database, 2005-2014. We included patients who were ≥40 years old that had undergone RHA and RKA. For each T2DM patient, we selected a year-, gender-, age- and Charlson Comorbidity Index-matched non-diabetic patient.We identified 44,055 and 39,938 patients who underwent RHA (12.72% with T2DM and RKA (15.01% with T2DM. We matched 4,700 and 5,394 couples with RHA and RKA, respectively. Any IHPC was more frequent among patients with T2DM than among non-T2DM patients (19% vs. 15.64% in the RHA cohort and 12.94% vs. 11.09% in the RKA cohort, respectively. For patients who underwent RHA, postoperative infection (4.51% vs. 2.94%, p<0.001, acute post-hemorrhagic anemia (9.53% vs. 7.70%, p<0.001, mean LOHS and IHM were significantly higher in patients with T2DM. Among RKA patients, the incidence of acute posthemorrhagic anemia (7.21% vs. 5.62%; p = 0.001 and urinary tract infection (1.13% vs. 0.72%; p = 0.029 was significantly higher in patients with diabetes. Older age, obesity, infection due to internal joint prosthesis, myocardial infarction, congestive heart failure, mild liver disease and renal disease and emergency room admission were significantly associated with a higher risk of IHPC in T2DM patients. IHPC decreased over time only in T2DM patients who underwent RHA (OR 0.94, 95%CI 0.89-0.98.Patients with T2DM who underwent RHA and RKA procedures had more IHPC after controlling for the effects of possible confounders. LOHS and IHM were also higher among RHA patients with diabetes. Older age, comorbidity, obesity

  6. Divergent mortality trends by ethnicity in Fiji.

    Science.gov (United States)

    Taylor, Richard; Carter, Karen; Naidu, Shivnay; Linhart, Christine; Azim, Syed; Rao, Chalapati; Lopez, Alan D

    2013-12-01

    To examine trends in infant mortality rate (IMR), adult mortality and life expectancy (LE) in the two major Fijian ethnic groups since 1975. Estimates of IMR, adult mortality (15-59 years) and LE by ethnicity are calculated from previously unreported Fiji Ministry of Health data and extracted from published sources. Over 1975-2008: IMR decreased from 33 to 20 deaths/1,000 live births in i-Taukei (Fiji Melanesians); and 38 to 18 in Fijians of Indian descent. Increased adult male mortality among i-Taukei and decline among Fijians of Indian descent led to an equal probability of dying in 2007 of 29%; while in female adults the probability trended upwards in i-Taukei to 25%, and declined in Fijians of Indian descent to 17%. Life expectancy in both ethnicities increased until 1985 (to 64 years for males; 68 for females) then forming a plateau in males of both ethnicities, and Fijian females of Indian descent, but declining in i-Taukei females to 66 years in 2007. Despite IMR declines over 1975-2008, LE for i-Taukei and Fijians of Indian descent has not increased since 1985, and has actually decreased in i-Taukei women, consistent with trends in adult mortality (15-59 years). Mortality analyses in Fiji that consider the entire population mask divergent trends in the major ethnic groups. This situation is most likely a consequence of non-communicable disease mortality, requiring further assessment and a strengthened response.

  7. Time Trends in Hospital Admissions for Bronchiectasis: Analysis of the Spanish National Hospital Discharge Data (2004 to 2013.

    Directory of Open Access Journals (Sweden)

    Gema Sánchez-Muñoz

    Full Text Available To analyze changes in the incidence, diagnostic procedures, comorbidity, length of hospital stay (LOHS, costs and in-hospital mortality (IHM for patients with bronchiectasis who were hospitalized in Spain over a 10-year period.We included all admissions for patients diagnosed with bronchiectasis as primary or secondary diagnosis during 2004-2013.282,207 patients were admitted to the study. After controlling for possible confounders, we observed a significant increase in the incidence of hospitalizations over the study period when bronchiectasis was a secondary diagnosis. When bronchiectasis was the primary diagnosis we observed a significant decline in the incidence. In all cases, this pathology was more frequent in males, and the average age and comorbidity increased significantly during the study period (p<0.001. When bronchiectasis was the primary diagnosis, the most frequent secondary diagnosis was Pseudomonas aeruginosa infection. When bronchiectasis was the secondary diagnosis, the most frequent primary diagnosis was COPD. IHM was low, tending to decrease from 2004 to 2013 (p<0.05. The average LOHS decreased significantly during the study period in both cases (p<0.001. The mean cost per patient decreased in patients with bronchiectasis as primary diagnosis, but it increased for cases of bronchiectasis as secondary diagnosis (p<0.001.Our results reveal an increase in the incidence of hospital admissions for patients with bronchiectasis as a secondary diagnosis from 2004 to 2013, as opposed to cases of bronchiectasis as the primary diagnosis. Although the average age and comorbidity significantly increased over time, both IHM and average LOHS significantly decreased.

  8. Prognostic effects of delirium motor subtypes in hospitalized older adults: A prospective cohort study.

    Science.gov (United States)

    Avelino-Silva, Thiago Junqueira; Campora, Flavia; Curiati, Jose Antonio Esper; Jacob-Filho, Wilson

    2018-01-01

    To investigate the association between delirium motor subtypes and hospital mortality and 12-month mortality in hospitalized older adults. Prospective cohort study conducted from 2009 to 2015. Geriatric ward of a university hospital in Sao Paulo, Brazil. We included 1,409 consecutive admissions of acutely ill patients aged 60 years and over. We excluded admissions for end-of-life care, with missing data on the main variables, length of stay shorter than 48 hours, or when consent to participate was not given. Delirium was detected using the Confusion Assessment Method and categorized in hypoactive, hyperactive, or mixed delirium. Primary outcomes were time to death in the hospital, and time to death in 12 months (for the discharged sample). Comprehensive geriatric assessment was performed at admission and included socio-demographic, clinical, functional, cognitive, and laboratory variables. Further clinical data were documented upon death or discharge. Multivariate analyses used Cox proportional hazards models adjusted for possible confounders. We included 1,409 admissions, with a mean age of 80 years. The proportion of in-hospital deaths was 19%, with a cumulative mortality of 38% in 12 months. Delirium occurred in 47% of the admissions. Hypoactive delirium was the predominant motor subtype (53%), followed by mixed delirium (30%) and hyperactive delirium (17%). Hospital mortality rates were respectively 33%, 34% and 15%. We verified that hypoactive and mixed delirium were independently associated with hospital mortality, with respective hazard ratios of 2.43 (95%CI = 1.64-3.59) and 2.31 (95%CI = 1.53-3.50). Delirium motor subtypes were not independently predictive of 12-month mortality. One in three acutely ill hospitalized older adults who suffered hypoactive or mixed delirium died in the hospital. Clinicians should be aware that hypoactive symptoms of delirium, whether shown exclusively or in alternation with hyperactive symptoms, are indicative of a worse

  9. Loneliness, health and mortality

    DEFF Research Database (Denmark)

    Henriksen, J; Larsen, E R; Mattisson, C

    2017-01-01

    Aims.: Literature suggests an association between loneliness and mortality for both males and females. Yet, the linkage of loneliness to mortality is not thoroughly examined, and need to be replicated with a long follow-up time. This study assessed the association between loneliness and mortality...... not been previously reported. If replicated, our results indicate that loneliness may have differential physical implications in some subgroups. Future studies are needed to further investigate the influence of gender on the relationship....

  10. Listed installations for environmental protection in hospitals

    International Nuclear Information System (INIS)

    Mullot, J.U.; Chaulet, J.F.; Thual, A.; Lafon, M.

    1999-01-01

    This work deals with the implications of different French rules and regulations concerning the environmental protection in hospitals. A special place is given to listed installations for environmental protection, because of their importance. A summary of important regulatory texts is presented concerning these installations, and also an inventory of installations or activities concerned, and the definition of the necessary procedures. Some ideas are also given about the much needed creation of an 'environmental network' inside hospitals, in order to cope with these concerns. Then, we briefly deal with more recent developments concerning the environmental protection, which will, no doubt, extend to hospitals, such as the French water law, air law, and procedures for the management of medical waste. Finally, the stakes of environmental decisions in hospitals and the chemist's place in these decisions are debated. (authors)

  11. Quality assurance and organizational effectiveness in hospitals.

    OpenAIRE

    Hetherington, R W

    1982-01-01

    The purpose of this paper is to explore some aspects of a general theoretical model within which research on the organizational impacts of quality assurance programs in hospitals may be examined. Quality assurance is conceptualized as an organizational control mechanism, operating primarily through increased formalization of structures and specification of procedures. Organizational effectiveness is discussed from the perspective of the problem-solving theory of organizations, wherein effecti...

  12. Recognition of dementia in hospitalized older adults.

    Science.gov (United States)

    Maslow, Katie; Mezey, Mathy

    2008-01-01

    Many hospital patients with dementia have no documented dementia diagnosis. In some cases, this is because they have never been diagnosed. Recognition of Dementia in Hospitalized Older Adults proposes several approaches that hospital nurses can use to increase recognition of dementia. This article describes the Try This approaches, how to implement them, and how to incorporate them into a hospital's current admission procedures. For a free online video demonstrating the use of these approaches, go to http://links.lww.com/A216.

  13. Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children.

    Science.gov (United States)

    Moler, Frank W; Silverstein, Faye S; Holubkov, Richard; Slomine, Beth S; Christensen, James R; Nadkarni, Vinay M; Meert, Kathleen L; Browning, Brittan; Pemberton, Victoria L; Page, Kent; Gildea, Marianne R; Scholefield, Barnaby R; Shankaran, Seetha; Hutchison, Jamie S; Berger, John T; Ofori-Amanfo, George; Newth, Christopher J L; Topjian, Alexis; Bennett, Kimberly S; Koch, Joshua D; Pham, Nga; Chanani, Nikhil K; Pineda, Jose A; Harrison, Rick; Dalton, Heidi J; Alten, Jeffrey; Schleien, Charles L; Goodman, Denise M; Zimmerman, Jerry J; Bhalala, Utpal S; Schwarz, Adam J; Porter, Melissa B; Shah, Samir; Fink, Ericka L; McQuillen, Patrick; Wu, Theodore; Skellett, Sophie; Thomas, Neal J; Nowak, Jeffrey E; Baines, Paul B; Pappachan, John; Mathur, Mudit; Lloyd, Eric; van der Jagt, Elise W; Dobyns, Emily L; Meyer, Michael T; Sanders, Ronald C; Clark, Amy E; Dean, J Michael

    2017-01-26

    events, as well as 28-day mortality, did not differ significantly between groups. Among comatose children who survived in-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a favorable functional outcome at 1 year. (Funded by the National Heart, Lung, and Blood Institute; THAPCA-IH ClinicalTrials.gov number, NCT00880087 .).

  14. Troponin T is a strong marker of mortality in hospitalized patients

    DEFF Research Database (Denmark)

    Iversen, Kasper; Køber, Lars; Gøtze, Jens Peter

    2013-01-01

    hospitalized population are unknown. METHODS: Consecutive patients aged >40years admitted to a district hospital between 1 April 1998 and 31 March 1999 were included. A comprehensive medical interview and clinical examination were performed including echocardiography and measurement of natriuretic peptides...... and troponin T with a high-sensitivity assay (hs-TnT). RESULTS: Serum for analyses of hs-TnT was available from 1176 patients. Patients were 73.7years old on average (interquartile range, 64.5-80.0years), 59.2% were women and median follow-up was 11.4years. The prevalence of elevated hs-TnT (> 99th percentile...

  15. Conifer Decline and Mortality in Siberia

    Science.gov (United States)

    Kharuk, V.; Im, S.; Ranson, K.

    2015-12-01

    "Dark needle conifer" (DNC: Abies sibirica, Pinus sibirica and Picea obovata) decline and mortality increase were documented in Russia during recent decades. Here we analyzed causes and scale of Siberian pine and fir mortality in Altai-Sayan and Baikal Lake Regions and West Siberian Plane based on in situdata and remote sensing (QuickBird, Landsat, GRACE). Geographically, mortality began on the margins of the DNC range (i.e., within the forest-steppe and conifer-broadleaf ecotones) and on terrain features with maximal water stress risk (narrow-shaped hilltops, convex steep south facing slopes, shallow well-drained soils). Within ridges, mortality occurred mainly along mountain passes, where stands faced drying winds. Regularly mortality was observed to decrease with elevation increase with the exception of Baikal Lake Mountains, where it was minimal near the lake shore and increased with elevation (up to about 1000 m a.s.l.). Siberian pine and fir mortality followed a drying trend with consecutive droughts since the 1980s. Dendrochronology analysis showed that mortality was correlated with vapor pressure deficit increase, drought index, soil moisture decrease and occurrence of late frosts. In Baikal region Siberian pine mortality correlated with Baikal watershed meteorological variables. An impact of previous year climate conditions on the current growth was found (r2 = 0.6). Thus, water-stressed trees became sensitive to bark beetles and fungi impact (including Polygraphus proximus and Heterobasidion annosum). At present, an increase in mortality is observed within the majority of DNC range. Results obtained also showed a primary role of water stress in that phenomenon with a secondary role of bark beetles and fungi attacks. In future climate with increased drought severity and frequency Siberian pine and fir will partly disappear from its current range, and will be substituted by drought-tolerant species (e.g., Pinus silvestris, Larix sibirica).

  16. Primary coronary angioplasty in 9,434 patients during acute myocardial infarction: predictors of major in- hospital adverse events from 1996 to 2000 in Brazil

    Directory of Open Access Journals (Sweden)

    Mattos Luiz Alberto

    2002-01-01

    Full Text Available OBJECTIVE: To verify the results after the performance of primary coronary angioplasty in Brazil in the last 4 years. METHODS: During the first 24 hours of acute myocardial infarction onset, 9,434 (12.2% patients underwent primary PTCA. We analyzed the success and occurrence of major in-hospital events, comparing them over the 4-year period. RESULTS: Primary PTCA use increased compared with that of all percutaneous interventions (1996=10.6% vs. 2000=13.1%; p<0.001. Coronary stent implantation increased (1996=20% vs. 2000=71.9%; p<0.001. Success was greater (1998=89.5% vs. 1999=92.5%; p<0.001. Reinfarction decreased (1998=3.9% vs. 99=2.4% vs. 2000=1.5%; p<0.001 as did emergency bypass surgery (1996=0.5% vs. 2000=0.2%; p=0.01. In-hospital deaths remained unchanged (1996=5.7% vs. 2000=5.1%, p=0.53. Balloon PTCA was one of the independent predictors of a higher rate of unsuccessful procedures (odds ratio 12.01 [CI=95%] 1.58-22.94, and stent implantation of lower mortality rates (odds ratio 4.62 [CI=95%] 3.19-6.08. CONCLUSION: The success rate has become progressively higher with a significant reduction in reinfarction and urgent bypass surgery, but in-hospital death remains nearly unchanged. Coronary stenting was a predictor of a lower death rate, and balloon PTCA was associated with greater procedural failure.

  17. Prevalence of prediabetes in patients with acute coronary syndrome: impact on in-hospital outcomes.

    Science.gov (United States)

    AbuShady, M M; Mohamady, Y; Enany, B; Nammas, W

    2015-02-01

    Prediabetes is a serious condition that is associated with an increase in cardiovascular morbidity and mortality. We sought to explore the prevalence of prediabetes in patients admitted with acute coronary syndrome (ACS) who were not known to have diabetes and to determine the impact of prediabetes on in-hospital clinical outcomes versus non-diabetic patients. Prospectively, we enrolled 200 patients not known to have diabetes or prediabetes, admitted with ACS. Laboratory tests included fasting plasma glucose (FPG), 2-h plasma glucose (2hPG) after 75 g glucose, HbA1c and lipid profile. Electrocardiogram and echocardiography were done. The primary end-point was in-hospital major adverse cardiovascular events (MACE). Mean age was 50.9 ± 6.8 years (70.5% males). The prevalence of patients with diabetes and patients with prediabetes was 24.5% and 20% respectively. Newly discovered diabetic patients were excluded. Compared with patients without diabetes, prediabetic patients had a higher body mass index (BMI) (P = 0.002) and a longer hospital stay (P = 0.09). In-hospital MACE occurred in 10 (25%) patients with prediabetes versus six (5.4%) in patients without diabetes (P = 0.001). In-hospital MACE correlated with prediabetes (r = 0.28, P prediabetes as the only independent predictor of in-hospital MACE. Prediabetes is common in patients presenting with ACS who are not previously known to have diabetes. Prediabetic patients had worse in-hospital clinical outcomes compared with patients without diabetes. © 2014 Royal Australasian College of Physicians.

  18. Under-Five Mortality

    African Journals Online (AJOL)

    under-five mortality rate (U5MR) by two thirds between. 1990 and 2015. For Zambia, this means ... 1Institute of Economic and Social Research, University of Zambia ... live births;. 2. Neonatal mortality: Deaths during the first 28 days of life. 3. Post-neonatal ... children born/woman) and rapid (3%) population growth on living ...

  19. Mortality in ankylosing spondylitis

    DEFF Research Database (Denmark)

    Exarchou, Sofia; Lie, Elisabeth; Lindström, Ulf

    2016-01-01

    OBJECTIVES: Information on mortality in ankylosing spondylitis (AS) is scarce. Our study therefore aimed to assess: (1) mortality in AS versus the general population, and (2) predictors of death in the AS population. METHODS: Nationwide cohorts of patients with AS diagnosed at rheumatology or int...

  20. Pre-hospital physical activity status affects in-hospital course of elderly patients with acute myocardial infarction.

    Science.gov (United States)

    Miyamoto, Takamichi; Obayashi, Tohru; Hattori, Eijirou; Yamauchi, Yasuteru; Niwa, Akihiro; Isobe, Mitsuaki

    2010-03-01

    The clinical course of elderly patients with acute myocardial infarction (AMI) can sometimes unexpectedly result in an adverse outcome even when therapy appears to be successful. We suspect that specific factors may characterize this worsening of status during hospitalization. This study examines whether the pre-hospital physical activity status of the elderly treated with percutaneous coronary intervention (PCI) for AMI affects their in-hospital course. We studied 110 consecutive patients, aged 80 or older, who had undergone emergent PCI for AMI. Patients were divided into two groups based on clinical presentation: Better Killip class (Killip classes I and II) and Worse Killip class (Killip classes III and IV). Patients were also divided into two groups based on pre-hospital physical activity status, determined retrospectively by review of medical records: Good physical activity (n=57) comprising those able to go out alone independently and Poor physical activity comprising those mainly confined to home (n=53). The overall in-hospital mortality rate was 9.1% for the study population. The Worse Killip class group had a higher in-hospital mortality rate than the Better Killip class group (27.8% vs 5.4%, respectively; p=0.0102). In addition, the Poor physical activity group had a higher in-hospital mortality rate than the Good physical activity group (15.1% vs. 3.5%, respectively; p=0.047). These data suggest that pre-hospital physical activity status in elderly patients with AMI may affect in-hospital mortality as well as Killip class.

  1. Maternal Mortality in Texas.

    Science.gov (United States)

    Baeva, Sonia; Archer, Natalie P; Ruggiero, Karen; Hall, Manda; Stagg, Julie; Interis, Evelyn Coronado; Vega, Rachelle; Delgado, Evelyn; Hellerstedt, John; Hankins, Gary; Hollier, Lisa M

    2017-05-01

    A commentary on maternal mortality in Texas is provided in response to a 2016 article in Obstetrics & Gynecology by MacDorman et al. While the Texas Department of State Health Services and the Texas Maternal Mortality and Morbidity Task Force agree that maternal mortality increased sharply from 2010 to 2011, the percentage change or the magnitude of the increase in the maternal mortality rate in Texas differs depending on the statistical methods used to compute and display it. Methodologic challenges in identifying maternal death are also discussed, as well as risk factors and causes of maternal death in Texas. Finally, several state efforts currently underway to address maternal mortality in Texas are described. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  2. Gallstone disease and mortality

    DEFF Research Database (Denmark)

    Shabanzadeh, Daniel Mønsted; Sørensen, Lars Tue; Jørgensen, Torben

    2017-01-01

    OBJECTIVES: The objective of this cohort study was to determine whether subjects with gallstone disease identified by screening of a general population had increased overall mortality when compared to gallstone-free participants and to explore causes of death. METHODS: The study population (N...... built. RESULTS: Gallstone disease was present in 10%. Mortality was 46% during median 24.7 years of follow-up with 1% lost. Overall mortality and death from cardiovascular diseases were significantly associated to gallstone disease. Death from unknown causes was significantly associated to gallstone...... disease and death from cancer and gastrointestinal disease was not associated. No differences in mortality for ultrasound-proven gallstones or cholecystectomy were identified. CONCLUSIONS: Gallstone disease is associated with increased overall mortality and to death from cardiovascular disease. Gallstones...

  3. Predictors of In-Hospital Death After Aneurysmal Subarachnoid Hemorrhage: Analysis of a Nationwide Database (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]).

    Science.gov (United States)

    Stienen, Martin Nikolaus; Germans, Menno; Burkhardt, Jan-Karl; Neidert, Marian C; Fung, Christian; Bervini, David; Zumofen, Daniel; Röthlisberger, Michel; Marbacher, Serge; Maduri, Rodolfo; Robert, Thomas; Seule, Martin A; Bijlenga, Philippe; Schaller, Karl; Fandino, Javier; Smoll, Nicolas R; Maldaner, Nicolai; Finkenstädt, Sina; Esposito, Giuseppe; Schatlo, Bawarjan; Keller, Emanuela; Bozinov, Oliver; Regli, Luca

    2018-02-01

    To identify predictors of in-hospital mortality in patients with aneurysmal subarachnoid hemorrhage and to estimate their impact. Retrospective analysis of prospective data from a nationwide multicenter registry on all aneurysmal subarachnoid hemorrhage cases admitted to a tertiary neurosurgical department in Switzerland (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]; 2009-2015). Both clinical and radiological independent predictors of in-hospital mortality were identified, and their effect size was determined by calculating adjusted odds ratios (aORs) using multivariate logistic regression. Survival was displayed using Kaplan-Meier curves. Data of n=1866 aneurysmal subarachnoid hemorrhage patients in the Swiss SOS database were available. In-hospital mortality was 20% (n=373). In n=197 patients (10.6%), active treatment was discontinued after hospital admission (no aneurysm occlusion attempted), and this cohort was excluded from analysis of the main statistical model. In the remaining n=1669 patients, the rate of in-hospital mortality was 13.9% (n=232). Strong independent predictors of in-hospital mortality were rebleeding (aOR, 7.69; 95% confidence interval, 3.00-19.71; P <0.001), cerebral infarction attributable to delayed cerebral ischemia (aOR, 3.66; 95% confidence interval, 1.94-6.89; P <0.001), intraventricular hemorrhage (aOR, 2.65; 95% confidence interval, 1.38-5.09; P =0.003), and new infarction post-treatment (aOR, 2.57; 95% confidence interval, 1.43-4.62; P =0.002). Several-and among them modifiable-factors seem to be associated with in-hospital mortality after aneurysmal subarachnoid hemorrhage. Our data suggest that strategies aiming to reduce the risk of rebleeding are most promising in patients where active treatment is initially pursued. URL: http://www.clinicaltrials.gov. Unique identifier: NCT03245866. © 2018 American Heart Association, Inc.

  4. Antimicrobial drug use in hospitalized children

    NARCIS (Netherlands)

    Liem, T.B.Y.

    2011-01-01

    The discovery of antibiotics represents one of the milestones in modern medicine and has since the beginning of the 20th century made a major contribution to the reduction in mortality and morbidity from infectious diseases. The shadow side of their success is antimicrobial drug resistance which is

  5. Effects of patient safety auditing in hospital care: results of a mixed-method evaluation (part 1).

    Science.gov (United States)

    Hanskamp-Sebregts, Mirelle; Zegers, Marieke; Westert, Gert P; Boeijen, Wilma; Teerenstra, Steven; van Gurp, Petra J; Wollersheim, Hub

    2018-06-15

    To evaluate the effectiveness of internal auditing in hospital care focussed on improving patient safety. A before-and-after mixed-method evaluation study was carried out in eight departments of a university medical center in the Netherlands. Internal auditing and feedback focussed on improving patient safety. The effect of internal auditing was assessed 15 months after the audit, using linear mixed models, on the patient, professional, team and departmental levels. The measurement methods were patient record review on adverse events (AEs), surveys regarding patient experiences, safety culture and team climate, analysis of administrative hospital data (standardized mortality rate, SMR) and safety walk rounds (SWRs) to observe frontline care processes on safety. The AE rate decreased from 36.1% to 31.3% and the preventable AE rate from 5.5% to 3.6%; however, the differences before and after auditing were not statistically significant. The patient-reported experience measures regarding patient safety improved slightly over time (P audit. The SWRs showed that medication safety and information security were improved (P auditing was associated with improved patient experiences and observed safety on wards. No effects were found on adverse outcomes, safety culture and team climate 15 months after the internal audit.

  6. Infant mortality in the Marshall Islands.

    Science.gov (United States)

    Levy, S J; Booth, H

    1988-12-01

    Levy and Booth present previously unpublished infant mortality rates for the Marshall Islands. They use an indirect method to estimate infant mortality from the 1973 and 1980 censuses, then apply indirect and direct methods of estimation to data from the Marshall Islands Women's Health Survey of 1985. Comparing the results with estimates of infant mortality obtained from vital registration data enables them to estimate the extent of underregistration of infant deaths. The authors conclude that 1973 census appears to be the most valid information source. Direct estimates from the Women's Health Survey data suggest that infant mortality has increased since 1970-1974, whereas the indirect estimates indicate a decreasing trend in infant mortality rates, converging with the direct estimates in more recent years. In view of increased efforts to improve maternal and child health in the mid-1970s, the decreasing trend is plausible. It is impossible to estimate accurately infant mortality in the Marshall Islands during 1980-1984 from the available data. Estimates based on registration data for 1975-1979 are at least 40% too low. The authors speculate that the estimate of 33 deaths per 1000 live births obtained from registration data for 1984 is 40-50% too low. In round figures, a value of 60 deaths per 1000 may be taken as the final estimate for 1980-1984.

  7. Hip fracture in hospitalized medical patients

    OpenAIRE

    Zapatero Antonio; Barba Raquel; Canora Jesús; Losa Juan E; Plaza Susana; San Roman Jesús; Marco Javier

    2013-01-01

    Abstract Background The aim of the present study is to analyze the incidence of hip fracture as a complication of admissions to internal medicine units in Spain. Methods We analyzed the clinical data of 2,134,363 adults who had been admitted to internal medicine wards. The main outcome was a diagnosis of hip fracture during hospitalization. Outcome measures included rates of in-hospital fractures, length of stay and cost. Results A total of 1127 (0.057%) admittances were coded with an in-hosp...

  8. Radio frequency identification applications in hospital environments.

    Science.gov (United States)

    Wicks, Angela M; Visich, John K; Li, Suhong

    2006-01-01

    Radio frequency identification (RFID) technology has recently begun to receive increased interest from practitioners and academicians. This interest is driven by mandates from major retailers such as Wal-Mart, Target and Metro Group, and the United States Department of Defense, in order to increase the efficiency and visibility of material and information flows in the supply chain. However, supply chain managers do not have a monopoly on the deployment of RFID. In this article, the authors discuss the potential benefits, the areas of applications, the implementation challenges, and the corresponding strategies of RFID in hospital environments.

  9. Review of nuclear pharmacy practice in hospitals

    International Nuclear Information System (INIS)

    Kawada, T.K.; Tubis, M.; Ebenkamp, T.; Wolf, W.

    1982-01-01

    An operational profile for nuclear pharmacy practice is presented, and the technical and professional role of nuclear pharmacists is reviewed. Key aspects of nuclear pharmacy practice in hospitals discussed are the basic facilities and equipment for the preparation, quality control, and distribution of radioactive drug products. Standards for receiving, storing, and processing radioactive material are described. The elements of a radiopharmaceutical quality assurance program, including the working procedures, documentation systems, data analysis, and specific control tests, are presented. Details of dose preparation and administration and systems of inventory control for radioactive products are outlined

  10. Atherosclerotic Heart Disease: Prevalence and Risk Factors in Hospitalized Men with Hemophilia A

    Science.gov (United States)

    Ragni, Margaret V.; Moore, Charity G.

    2011-01-01

    Summary Background Atherosclerotic heart disease (ASHD) is a common cause of morbidity and mortality in Western society. Few studies have determined prevalence and predictors of ASHD in hemophilia (HA), a population whose survival is improving with safer blood products and effective treatments for AIDS and hepatitis C. Objectives The purpose of this study was to determine prevalence and factors associated with ASHD in hemophilia A patients in Pennsylvania. Methods The prevalence of ASHD (myocardial infarction, angina, coronary disease), cardiac catheterization, coronary angiography, co-morbidities, and in-hospital mortality were assessed on statewide ASHD discharge data, 2001–2006, from the Pennsylvania Health Care Cost Containment Council (PHC4). Results The prevalence of hemophilia ASHD admissions fluctuated between 6.5% and 10.5% for 2001 to 2006, p=0.62. Compared to HA without ASHD, HA with ASHD were older and more likely to be hypertensive, hyperlipidemic, and diabetic, all pHemophilia patients with ASHD have similar cardiovascular risk factors, admitting diagnoses, severity of illness, and in-hospital mortality as the general population. These findings suggest cardiovascular prevention measures should be promoted in hemophilia. PMID:21371197

  11. Recurrent spine surgery patients in hospital administrative database

    Directory of Open Access Journals (Sweden)

    M. Sami Walid

    2012-02-01

    Full Text Available Introduction: Hospital patient databases are typically used by administrative staff to estimate loss-profit ratios and to help with the allocation of hospital resources. These databases can also be very useful in following rehospitalization. This paper studies the recurrence of spine surgery patients in our hospital population based on administrative data analysis. Methods: Hospital data on 4,958 spine surgery patients operated between 2002 and 2009 were retrospectively reviewed. After sorting the cohort per ascending discharge date, the patient official name, consisting of first, middle and last names, was used as the variable determining duplicate cases in the SPSS statistical program, designating the first case in each group as primary. Yearly recurrence rate and change in procedure distribution were studied. In addition, hospital charges and length of stay were compared using the Wilcoxon-Mann-Whitney test. Results: Of 4,958 spine surgery patients 364 (7.3% were categorized as duplicate cases by SPSS. The number of primary cases from which duplicate cases emerged was 327 meaning that some patients had more than two spine surgeries. Among primary patients (N=327 the percentage of excision of intervertebral disk procedures was 33.3% and decreased to 15.1% in recurrent admissions of the same patients (N=364. This decrease was compensated by an increase in lumbar fusion procedures. On the other hand, the rate of cervical fusion remained the same. The difference in hospital charges between primary and duplicate patients was $2,234 for diskectomy, $6,319 for anterior cervical fusion, $8,942 for lumbar fusion – lateral technique, and $12,525 for lumbar fusion – posterior technique. Recurrent patients also stayed longer in hospital, up to 0.9 day in lumbar fusion – posterior technique patients. Conclusion: Spine surgery is associated with an increasing possibility of additional spine surgery with rising invasiveness and cost.

  12. Turbine related fish mortality

    International Nuclear Information System (INIS)

    Eicher, G.J.

    1993-01-01

    A literature review was conducted to assess the factors affecting turbine-related fish mortality. The mechanics of fish passage through a turbine is outlined, and various turbine related stresses are described, including pressure and shear effects, hydraulic head, turbine efficiency, and tailwater level. The methodologies used in determining the effects of fish passage are evaluated. The necessity of adequate controls in each test is noted. It is concluded that mortality is the result of several factors such as hardiness of study fish, fish size, concentrations of dissolved gases, and amounts of cavitation. Comparisons between Francis and Kaplan turbines indicate little difference in percent mortality. 27 refs., 5 figs

  13. Mortality after shoulder arthroplasty

    DEFF Research Database (Denmark)

    Amundsen, Alexander; Rasmussen, Jeppe Vejlgaard; Olsen, Bo Sanderhoff

    2016-01-01

    BACKGROUND: The primary aim was to quantify the 30-day, 90-day, and 1-year mortality rates after primary shoulder replacement. The secondary aims were to assess the association between mortality and diagnoses and to compare the mortality rate with that of the general population. METHODS: The study...... included 5853 primary operations reported to the Danish Shoulder Arthroplasty Registry between 2006 and 2012. Information about deaths was obtained from the Danish Cause of Death Register and the Danish Civil Registration System. Age- and sex-adjusted control groups were retrieved from Statistics Denmark...

  14. Simulation of robotic courier deliveries in hospital distribution services.

    Science.gov (United States)

    Rossetti, M D; Felder, R A; Kumar, A

    2000-06-01

    Flexible automation in the form of robotic couriers holds the potential for decreasing operating costs while improving delivery performance in hospital delivery systems. This paper discusses the use of simulation modeling to analyze the costs, benefits, and performance tradeoffs related to the installation and use of a fleet of robotic couriers within hospital facilities. The results of this study enable a better understanding of the delivery and transportation requirements of hospitals. Specifically, we examine how a fleet of robotic couriers can meet the performance requirements of the system while maintaining cost efficiency. We show that for clinical laboratory and pharmaceutical deliveries a fleet of six robotic couriers can achieve significant performance gains in terms of turn-around time and delivery variability over the current system of three human couriers per shift or 13 FTEs. Specifically, the simulation results indicate that using robotic couriers to perform both clinical laboratory and pharmaceutical deliveries would result in a 34% decrease in turn-around time, and a 38% decrease in delivery variability. In addition, a break-even analysis indicated that a positive net present value occurs if nine or more FTEs are eliminated with a resulting ROI of 12%. This analysis demonstrates that simulation can be a valuable tool for examining health care distribution services and indicates that a robotic courier system may yield significant benefits over a traditional courier system in this application.

  15. Management strategies in hospitals: scenario planning

    Directory of Open Access Journals (Sweden)

    Ghanem, Mohamed

    2015-06-01

    Full Text Available Background: Instead of waiting for challenges to confront hospital management, doctors and managers should act in advance to optimize and sustain value-based health. This work highlights the importance of scenario planning in hospitals, proposes an elaborated definition of the stakeholders of a hospital and defines the influence factors to which hospitals are exposed to. Methodology: Based on literature analysis as well as on personal interviews with stakeholders we propose an elaborated definition of stakeholders and designed a questionnaire that integrated the following influence factors, which have relevant impact on hospital management: political/legal, economic, social, technological and environmental forces. These influence factors are examined to develop the so-called critical uncertainties. Thorough identification of uncertainties was based on a “Stakeholder Feedback”. Results: Two key uncertainties were identified and considered in this study: According to the developed scenarios, complementary education of the medical staff as well as of non-medical top executives and managers of hospitals was the recommended core strategy. Complementary scenario-specific strategic options should be considered whenever needed to optimize dealing with a specific future development of the health care environment. Conclusion: Strategic planning in hospitals is essential to ensure sustainable success. It considers multiple situations and integrates internal and external insights and perspectives in addition to identifying weak signals and “blind spots”. This flows into a sound planning for multiple strategic options. It is a state of the art tool that allows dealing with the increasing challenges facing hospital management.

  16. Clinical diagnosis of hyposalivation in hospitalized patients

    Directory of Open Access Journals (Sweden)

    Soraya de Azambuja Berti-Couto

    2012-04-01

    Full Text Available OBJECTIVE: The aim of this study was to evaluate the effectiveness of clinical criteria for the diagnosis of hyposalivation in hospitalized patients. MATERIAL AND METHODS: A clinical study was carried out on 145 subjects (48 males; 97 females; aged 20 to 90 years. Each subject was clinically examined, in the morning and in the afternoon, along 1 day. A focused anamnesis allowed identifying symptoms of hyposalivation, like xerostomia complaints (considered as a reference symptom, chewing difficulty, dysphagia and increased frequency of liquid intake. Afterwards, dryness of the mucosa of the cheecks and floor of the mouth, as well as salivary secretion during parotid gland stimulation were assessed during oral examination. RESULTS: Results obtained with Chi-square tests showed that 71 patients (48.9% presented xerostomia complaints, with a significant correlation with all hyposalivation symptoms (p <0.05. Furthermore, xerostomia was also significantly correlated with all data obtained during oral examination in both periods of evaluation (p<0.05. CONCLUSION: Clinical diagnosis of hyposalivation in hospitalized patients is feasible and can provide an immediate and appropriate therapy avoiding further problems and improving their quality of life.

  17. Creativity and Innovation Encouraged in Hospital X

    Directory of Open Access Journals (Sweden)

    Mateja Bogovič

    2014-02-01

    Full Text Available Research Question (RQ: Are creativity and innovation encouraged in Hospital X? Does satisfaction of employees at the workplace depend on the length of their employment? Does employee satisfaction depend on innovation? Purpose: It is important that creativity and innovation of employees are noticed in Hospital X in a timely manner. Various approaches can be used to motivate their creative thinking (using different professional factors. Method: Qualitative method, questionnaire with 8 questions and processing of results with χ2 test and frequency distribution. Results: The results of the research showed that 60% of employees at Hospital X were encouraged to be creative and innovative, whereas satisfaction at the workplace in connection with the period of employment did not have an effect on their satisfaction within the organization. Organization: The research results will give the management a clearer idea of employees’ opinions concerning their creativity and innovation. Society: Opinion of workers in a certain organization can encourage other organizations to be more creative and innovative. Originality: It is a small organization and results of the research refer to its originality. Limitations/Future Research: The limitation of this study was with regard to time and for this reason data collection was carried out only in the surgical unit of Hospital X.

  18. Fundamental discrepancies in abortion estimates and abortion-related mortality: A reevaluation of recent studies in Mexico with special reference to the International Classification of Diseases

    Science.gov (United States)

    Koch, Elard; Aracena, Paula; Gatica, Sebastián; Bravo, Miguel; Huerta-Zepeda, Alejandra; Calhoun, Byron C

    2012-01-01

    In countries where induced abortion is legally restricted, as in most of Latin America, evaluation of statistics related to induced abortions and abortion-related mortality is challenging. The present article reexamines recent reports estimating the number of induced abortions and abortion-related mortality in Mexico, with special reference to the International Classification of Diseases (ICD). We found significant overestimations of abortion figures in the Federal District of Mexico (up to 10-fold), where elective abortion has been legal since 2007. Significant overestimation of maternal and abortion-related mortality during the last 20 years in the entire Mexican country (up to 35%) was also found. Such overestimations are most likely due to the use of incomplete in-hospital records as well as subjective opinion surveys regarding induced abortion figures, and due to the consideration of causes of death that are unrelated to induced abortion, including flawed denominators of live births. Contrary to previous publications, we found important progress in maternal health, reflected by the decrease in overall maternal mortality (30.6%) from 1990 to 2010. The use of specific ICD codes revealed that the mortality ratio associated with induced abortion decreased 22.9% between 2002 and 2008 (from 1.48 to 1.14 deaths per 100,000 live births). Currently, approximately 98% of maternal deaths in Mexico are related to causes other than induced abortion, such as hemorrhage, hypertension and eclampsia, indirect causes, and other pathological conditions. Therefore, only marginal or null effects would be expected from changes in the legal status of abortion on overall maternal mortality rates. Rather, maternal health in Mexico would greatly benefit from increasing access to emergency and specialized obstetric care. Finally, more reliable methodologies to assess abortion-related deaths are clearly required. PMID:23271925

  19. Rural versus urban academic hospital mortality following stroke in Canada.

    Science.gov (United States)

    Fleet, Richard; Bussières, Sylvain; Tounkara, Fatoumata Korika; Turcotte, Stéphane; Légaré, France; Plant, Jeff; Poitras, Julien; Archambault, Patrick M; Dupuis, Gilles

    2018-01-01

    Stroke is one of the leading causes of death in Canada. While stroke care has improved dramatically over the last decade, outcomes following stroke among patients treated in rural hospitals have not yet been reported in Canada. To describe variation in 30-day post-stroke in-hospital mortality rates between rural and urban academic hospitals in Canada. We also examined 24/7 in-hospital access to CT scanners and selected services in rural hospitals. We included Canadian Institute for Health Information (CIHI) data on adjusted 30-day in-hospital mortality following stroke from 2007 to 2011 for all acute care hospitals in Canada excluding Quebec and the Territories. We categorized rural hospitals as those located in rural small towns providing 24/7 emergency physician coverage with inpatient beds. Urban hospitals were academic centres designated as Level 1 or 2 trauma centres. We computed descriptive data on local access to a CT scanner and other services and compared mean 30-day adjusted post-stroke mortality rates for rural and urban hospitals to the overall Canadian rate. A total of 286 rural hospitals (3.4 million emergency department (ED) visits/year) and 24 urban hospitals (1.5 million ED visits/year) met inclusion criteria. From 2007 to 2011, 30-day in-hospital mortality rates following stroke were significantly higher in rural than in urban hospitals and higher than the Canadian average for every year except 2008 (rural average range = 18.26 to 21.04 and urban average range = 14.11 to 16.78). Only 11% of rural hospitals had a CT-scanner, 1% had MRI, 21% had in-hospital ICU, 94% had laboratory and 92% had basic x-ray facilities. Rural hospitals in Canada had higher 30-day in-hospital mortality rates following stroke than urban academic hospitals and the Canadian average. Rural hospitals also have very limited local access to CT scanners and ICUs. These rural/urban discrepancies are cause for concern in the context of Canada's universal health care system.

  20. Coral Reefs: Beyond Mortality?

    Directory of Open Access Journals (Sweden)

    Charles Sheppard

    2000-01-01

    Full Text Available The scale of the collapse of coral reef communities in 1998 following a warming episode (Wilkinson, 2000 was unprecedented, and took many people by surprise. The Indian Ocean was the worst affected with a coral mortality over 75% in many areas such as the Chagos Archipelago (Sheppard, 1999, Seychelles (Spencer et al., 2000 and Maldives (McClanahan, 2000. Several other locations were affected at least as much, with mortality reaching 100% (to the nearest whole number; this is being compiled by various authors (e.g., CORDIO, in press. For example, in the Arabian Gulf, coral mortality is almost total across many large areas of shallow water (Sheppard, unpublished; D. George and D. John, personal communication. The mortality is patchy of course, depending on currents, location inside or outside lagoons, etc., but it is now possible to swim for over 200 m and see not one remaining living coral or soft coral on some previously rich reefs.

  1. Old age mortality and macroeconomic cycles.

    Science.gov (United States)

    Rolden, Herbert J A; van Bodegom, David; van den Hout, Wilbert B; Westendorp, Rudi G J

    2014-01-01

    As mortality is more and more concentrated at old age, it becomes critical to identify the determinants of old age mortality. It has counter-intuitively been found that mortality rates at all ages are higher during short-term increases in economic growth. Work-stress is found to be a contributing factor to this association, but cannot explain the association for the older, retired population. Historical figures of gross domestic product (Angus Maddison) were compared with mortality rates (Human Mortality Database) of middle aged (40-44 years) and older people (70-74 years) in 19 developed countries for the period 1950-2008. Regressions were performed on the de-trended data, accounting for autocorrelation and aggregated using random effects models. Most countries show pro-cyclical associations between the economy and mortality, especially with regard to male mortality rates. On average, for every 1% increase in gross domestic product, mortality increases with 0.36% for 70-year-old to 74-year-old men (p<0.001) and 0.38% for 40-year-old to 44-year-old men (p<0.001). The effect for women is 0.18% for 70-year-olds to 74-year-olds (p=0.012) and 0.15% for 40-year-olds to 44-year-olds (p=0.118). In developed countries, mortality rates increase during upward cycles in the economy, and decrease during downward cycles. This effect is similar for the older and middle-aged population. Traditional explanations as work-stress and traffic accidents cannot explain our findings. Lower levels of social support and informal care by the working population during good economic times can play an important role, but this remains to be formally investigated.

  2. Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death.

    Science.gov (United States)

    Regueiro, Ander; Linke, Axel; Latib, Azeem; Ihlemann, Nikolaj; Urena, Marina; Walther, Thomas; Husser, Oliver; Herrmann, Howard C; Nombela-Franco, Luis; Cheema, Asim N; Le Breton, Hervé; Stortecky, Stefan; Kapadia, Samir; Bartorelli, Antonio L; Sinning, Jan Malte; Amat-Santos, Ignacio; Munoz-Garcia, Antonio; Lerakis, Stamatios; Gutiérrez-Ibanes, Enrique; Abdel-Wahab, Mohamed; Tchetche, Didier; Testa, Luca; Eltchaninoff, Helene; Livi, Ugolino; Castillo, Juan Carlos; Jilaihawi, Hasan; Webb, John G; Barbanti, Marco; Kodali, Susheel; de Brito, Fabio S; Ribeiro, Henrique B; Miceli, Antonio; Fiorina, Claudia; Dato, Guglielmo Mario Actis; Rosato, Francesco; Serra, Vicenç; Masson, Jean-Bernard; Wijeysundera, Harindra C; Mangione, Jose A; Ferreira, Maria-Cristina; Lima, Valter C; Carvalho, Luiz A; Abizaid, Alexandre; Marino, Marcos A; Esteves, Vinicius; Andrea, Julio C M; Giannini, Francesco; Messika-Zeitoun, David; Himbert, Dominique; Kim, Won-Keun; Pellegrini, Costanza; Auffret, Vincent; Nietlispach, Fabian; Pilgrim, Thomas; Durand, Eric; Lisko, John; Makkar, Raj R; Lemos, Pedro A; Leon, Martin B; Puri, Rishi; San Roman, Alberto; Vahanian, Alec; Søndergaard, Lars; Mangner, Norman; Rodés-Cabau, Josep

    2016-09-13

    Limited data exist on clinical characteristics and outcomes of patients who had infective endocarditis after undergoing transcatheter aortic valve replacement (TAVR). To determine the associated factors, clinical characteristics, and outcomes of patients who had infective endocarditis after TAVR. The Infectious Endocarditis after TAVR International Registry included patients with definite infective endocarditis after TAVR from 47 centers from Europe, North America, and South America between June 2005 and October 2015. Transcatheter aortic valve replacement for incidence of infective endocarditis and infective endocarditis for in-hospital mortality. Infective endocarditis and in-hospital mortality after infective endocarditis. A total of 250 cases of infective endocarditis occurred in 20 006 patients after TAVR (incidence, 1.1% per person-year; 95% CI, 1.1%-1.4%; median age, 80 years; 64% men). Median time from TAVR to infective endocarditis was 5.3 months (interquartile range [IQR], 1.5-13.4 months). The characteristics associated with higher risk of progressing to infective endocarditis after TAVR was younger age (78.9 years vs 81.8 years; hazard ratio [HR], 0.97 per year; 95% CI, 0.94-0.99), male sex (62.0% vs 49.7%; HR, 1.69; 95% CI, 1.13-2.52), diabetes mellitus (41.7% vs 30.0%; HR, 1.52; 95% CI, 1.02-2.29), and moderate to severe aortic regurgitation (22.4% vs 14.7%; HR, 2.05; 95% CI, 1.28-3.28). Health care-associated infective endocarditis was present in 52.8% (95% CI, 46.6%-59.0%) of patients. Enterococci species and Staphylococcus aureus were the most frequently isolated microorganisms (24.6%; 95% CI, 19.1%-30.1% and 23.3%; 95% CI, 17.9%-28.7%, respectively). The in-hospital mortality rate was 36% (95% CI, 30.0%-41.9%; 90 deaths; 160 survivors), and surgery was performed in 14.8% (95% CI, 10.4%-19.2%) of patients during the infective endocarditis episode. In-hospital mortality was associated with a higher logistic EuroSCORE (23.1% vs 18.6%; odds ratio

  3. Reducing infant mortality.

    Science.gov (United States)

    Johnson, T R

    1994-01-01

    Public health and social policies at the population level (e.g., oral rehydration therapy and immunization) are responsible for the major reduction in infant mortality worldwide. The gap in infant mortality rates between developing and developed regions is much less than that in maternal mortality rates. This indicates that maternal and child health (MCH) programs and women's health care should be combined. Since 1950, 66% of infant deaths occur in the 1st 28 days, indicating adverse prenatal and intrapartum events (e.g., congenital malformation and birth injuries). Infection, especially pneumonia and diarrhea, and low birth weight are the major causes of infant mortality worldwide. An estimated US$25 billion are needed to secure the resources to control major childhood diseases, reduce malnutrition 50%, reduce child deaths by 4 million/year, provide potable water and sanitation to all communities, provide basic education, and make family planning available to all. This cost for saving children's lives is lower than current expenditures for cigarettes (US$50 billion in Europe/year). Vitamin A supplementation, breast feeding, and prenatal diagnosis of congenital malformations are low-cost strategies that can significantly affect infant well-being and reduce child mortality in many developing countries. The US has a higher infant mortality rate than have other developed countries. The American College of Obstetricians and Gynecologists and the US National Institutes of Health are focusing on prematurity, low birth weight, multiple pregnancy, violence, alcohol abuse, and poverty to reduce infant mortality. Obstetricians should be important members of MCH teams, which also include traditional birth attendants, community health workers, nurses, midwives, and medical officers. We have the financial resources to allocate resources to improve MCH care and to reduce infant mortality.

  4. Acute Myocardial Infarction Population Incidence and Mortality Rates, and 28-day Case-fatality in Older Adults. The REGICOR Study.

    Science.gov (United States)

    Vázquez-Oliva, Gabriel; Zamora, Alberto; Ramos, Rafel; Marti, Ruth; Subirana, Isaac; Grau, María; Dégano, Irene R; Marrugat, Jaume; Elosua, Roberto

    2017-11-22

    Our aims were to determine acute myocardial infarction (AMI) incidence and mortality rates, and population and in-hospital case-fatality in the population older than 74 years; variability in clinical characteristics and AMI management of hospitalized patients, and changes in the incidence and mortality rates, case-fatality, and management by age groups from 1996 to 1997 and 2007 to 2008. A population-based AMI registry in Girona (Catalonia, Spain) including individuals with suspected AMI older than 34 years. The incidence rate increased with age from 169 and 28 cases/100 000 per year in the group aged 35 to 64 years to 2306 and 1384 cases/100 000 per year in the group aged 85 to 94 years, in men and women, respectively. Population case-fatality also increased with age, from 19% in the group aged 35 to 64 years to 84% in the group aged 85 to 94 years. A lower population case-fatality was observed in the second period, mainly explained by a lower in-hospital case-fatality. The use of invasive procedures and effective drugs decreased with age but increased in the second period in all ages up to 84 years. Acute myocardial infarction incidence, mortality, and case-fatality increased exponentially with age. There is still a gap in the use of invasive procedures and effective drugs between younger and older patients. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  5. Regulations on radioactive waste in hospitals

    International Nuclear Information System (INIS)

    Beiso, M.L.

    2017-01-01

    In hospitals that have a radiotherapy service, the contaminated sewage follows a specific way, first it comes from specific toilets that must be use by patients undergoing a radiotherapy treatment, and secondly it is stored in tanks and its radioactivity is measured regularly and when the radioactivity level is in conformity with regulations, sewage is disposed as any non-contaminated sewage. Regulations impose a radioactive level below 100 Becquerel per liter for I 131 and 10 Becquerel per liter for other nuclides for the sewage to be disposed. A new system named ST-10 allows the in-line and real-time measurement and the identification of nuclides in sewage and can say if the measured values are consistent with the patient treatment. (A.C.)

  6. Service quality for facilities management in hospitals

    CERN Document Server

    Sui Pheng, Low

    2016-01-01

    This book examines the Facilities Management (FM) of hospitals and healthcare facilities, which are among the most complex, costly and challenging kind of buildings to manage. It presents and evaluates the FM service quality standards in Singapore’s hospitals from the patient’s perspective, and provides recommendations on how to successfully improve FM service quality and achieve higher patient satisfaction. The book also features valuable supplementary materials, including a checklist of 32 key factors for successful facilities management and another checklist of 24 service attributes for hospitals to achieve desirable service quality in connection with facilities management. The book adopts a unique approach of combining service quality and quality theory to provide a more holistic view of how FM service quality can be achieved in hospitals. It also integrates three instruments, namely the SERVQUAL model, the Kano model and the QFD model to yield empirical results from surveys for implementation in hosp...

  7. ["Lean management" in hospitals: potentials and limitations].

    Science.gov (United States)

    Glossmann, J P; Schliebusch, O; Diehl, V; Walshe, R

    2000-08-15

    Little attention has yet been payed on establishing modern and competitive organizational structures in German hospitals. In this paper, we attempt to apply elements of lean management to the work of physicians working in an inpatient setting. Traditional ways of communication and their disadvantages are discussed. These include loss of motivation, bureaucratic structures and a lack of interdisciplinary cooperation. Using Maslow's theory of motivation, possible improvements are discussed, such as the reduction of restrictive job characteristics, an increase of physicians' spheres of competence and the use of their innovative potentials. These suggestions are explained using practical examples. The aim of the study is to contribute to quality management in hospitals by increasing personal responsibilities according to lean management.

  8. Management strategies in hospitals: scenario planning.

    Science.gov (United States)

    Ghanem, Mohamed; Schnoor, Jörg; Heyde, Christoph-Eckhard; Kuwatsch, Sandra; Bohn, Marco; Josten, Christoph

    2015-01-01

    Instead of waiting for challenges to confront hospital management, doctors and managers should act in advance to optimize and sustain value-based health. This work highlights the importance of scenario planning in hospitals, proposes an elaborated definition of the stakeholders of a hospital and defines the influence factors to which hospitals are exposed to. Based on literature analysis as well as on personal interviews with stakeholders we propose an elaborated definition of stakeholders and designed a questionnaire that integrated the following influence factors, which have relevant impact on hospital management: political/legal, economic, social, technological and environmental forces. These influence factors are examined to develop the so-called critical uncertainties. Thorough identification of uncertainties was based on a "Stakeholder Feedback". Two key uncertainties were identified and considered in this study: the development of workload for the medical staff the profit oriented performance of the medical staff. According to the developed scenarios, complementary education of the medical staff as well as of non-medical top executives and managers of hospitals was the recommended core strategy. Complementary scenario-specific strategic options should be considered whenever needed to optimize dealing with a specific future development of the health care environment. Strategic planning in hospitals is essential to ensure sustainable success. It considers multiple situations and integrates internal and external insights and perspectives in addition to identifying weak signals and "blind spots". This flows into a sound planning for multiple strategic options. It is a state of the art tool that allows dealing with the increasing challenges facing hospital management.

  9. Predicting in-hospital death during acute presentation with pulmonary embolism to facilitate early discharge and outpatient management.

    Directory of Open Access Journals (Sweden)

    Jerrett K Lau

    Full Text Available Pulmonary embolism continues to be a significant cause of death. The aim was to derive and validate a risk prediction model for in-hospital death after acute pulmonary embolism to identify low risk patients suitable for outpatient management.A confirmed acute pulmonary embolism database of 1,426 consecutive patients admitted to a tertiary-center (2000-2012 was analyzed, with odd and even years as derivation and validation cohorts respectively. Risk stratification for in-hospital death was performed using multivariable logistic-regression modelling. Models were compared using receiver-operating characteristic-curve and decision curve analyses.In-hospital mortality was 3.6% in the derivation cohort (n = 693. Adding day-1 sodium and bicarbonate to simplified Pulmonary Embolism Severity Index (sPESI significantly increased the C-statistic for predicting in-hospital death (0.71 to 0.86, P = 0.001. The validation cohort yielded similar results (n = 733, C-statistic 0.85. The new model was associated with a net reclassification improvement of 0.613, and an integrated discrimination improvement of 0.067. The new model also increased the C-statistic for predicting 30-day mortality compared to sPESI alone (0.74 to 0.83, P = 0.002. Decision curve analysis demonstrated superior clinical benefit with the use of the new model to guide admission for pulmonary embolism, resulting in 43 fewer admissions per 100 presentations based on a risk threshold for admission of 2%.A risk model incorporating sodium, bicarbonate, and the sPESI provides accurate risk prediction of acute in-hospital mortality after pulmonary embolism. Our novel model identifies patients with pulmonary embolism who are at low risk and who may be suitable for outpatient management.

  10. Impact of coronary dominance on in-hospital outcomes after percutaneous coronary intervention in patients with acute coronary syndrome.

    Directory of Open Access Journals (Sweden)

    Toshiki Kuno

    Full Text Available OBJECTIVE: This study evaluated the manner in which coronary dominance affects in-hospital outcomes of acute coronary syndrome (ACS patients undergoing percutaneous coronary intervention (PCI. BACKGROUND: Previous studies have shown that left dominant coronary anatomies are associated with worse prognoses in patients with coronary artery disease. METHODS: Data were analyzed from 4873 ACS patients undergoing PCI between September 2008 and April 2013 at 14 hospitals participating in the Japanese Cardiovascular Database Registry. The patients were grouped based on diagnostic coronary angiograms performed prior to PCI; those with right- or co-dominant anatomy (RD group and those with left-dominant anatomy (LD group. RESULTS: The average patient age was 67.6±11.8 years and both patient groups had similar ages, coronary risk factors, comorbidities, and prior histories. The numbers of patients presenting with symptoms of heart failure, cardiogenic shock, or cardiopulmonary arrest were significantly higher in the LD group than in the RD group (heart failure: 650 RD patients [14.7%] vs. 87 LD patients [18.8%], P = 0.025; cardiogenic shock: 322 RD patients [7.3%] vs. 48 LD patients [10.3%], P = 0.021; and cardiopulmonary arrest: 197 RD patients [4.5%] vs. 36 LD patients [7.8%], P = 0.003. In-hospital mortality was significantly higher among LD patients than among RD patients (182 RD patients [4.1%] vs. 36 LD patients [7.8%], P = 0.001. Multivariate logistic regression analysis revealed that LD anatomy was an independent predictor for in-hospital mortality (odds ratio, 1.75; 95% confidence interval, 1.06-2.89; P = 0.030. CONCLUSION: Among ACS patients who underwent PCI, LD patients had significantly worse in-hospital outcomes compared with RD patients, and LD anatomy was an independent predictor of in-hospital mortality.

  11. Characteristics and in-hospital outcomes of patients with acute coronary syndromes and heart failure in the United Arab Emirates.

    Science.gov (United States)

    Shehab, Abdulla; Al-Dabbagh, Bayan; Almahmeed, Wael; Bustani, Nazar; Nagelkerke, Nicolaas; Yusufali, Afzal; Wassef, Adel; Ibrahim, Mohamed; Brek, Azan Bin

    2012-09-26

    Heart failure (HF) is a serious complication of acute coronary syndromes (ACS), and is associated with high in-hospital mortality and poor long-term survival. The aims of this study were to describe the clinical characteristics, management and in-hospital outcomes of coronary syndrome (ACS) patients with HF in the United Arab Emirates. The study was selected from the Gulf Registry of Acute Coronary Events (Gulf RACE), a prospective multi-national, multicenter registry of patients hospitalized with ACS in six Middle East countries. The present analysis was focused on participants admitted to various hospitals in the UAE with a diagnosis of ACS in 2007 and were analyzed in terms of HF (Killip class II/III and IV) on admission. Of 1691 patients (mean age: 52.6 ± 11.7 years; 210 Females, 1481 Males) with ACS, 356 (21%) had an admission diagnosis of HF (Killip class II/III and IV). HF patients were less frequently males (19.2% vs. 34.3%; P < 0.001). HF was more frequently associated with hypertension (64.3% vs. 43.9%; P < 0.001), hyperlipidemia (49.4% vs. 31.8%; P < 0.001) and diabetes mellitus (DM) (51.1% vs. 36.2%; P < 0.001). HF was significantly associated with in-hospital mortality (OR = 11.821; 95% CI: 5.385-25.948; P < 0.001). In multivariate logistic regression, age, hyperlipidemia, heart rate and DM were associated with higher in-hospital HF. HF is observed in about 1 in 5 patients with ACS in the UAE and is associated with a significant increase in in-hospital mortality and other adverse outcomes.

  12. Risk Factors for Mortality in Lower Intestinal Bleeding

    Science.gov (United States)

    Strate, Lisa L.; Ayanian, John Z.; Kotler, Gregory; Syngal, Sapna

    2009-01-01

    Background and Aims Previous studies of Lower Intestinal Bleeding (LIB) have limited power to study mortality. We sought to identify characteristics associated with in-hospital mortality in a large cohort of patients with LIB. Methods We used the 2002 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) to study a cross-sectional cohort of 227,022 hospitalized patients with discharge diagnoses indicating LIB. Predictors of mortality were identified using multiple logistic regression. Results In 2002, an estimated 8,737 patients with LIB (3.9%) died while hospitalized. Independent predictors of in-hospital mortality were age (age >70 vs. <50, odds ratio (OR) 4.91; 95% CI 2.45–9.87), intestinal ischemia (OR 3.47; 95% CI 2.57–4.68), comorbid illness (≥ 2 vs. 0 comorbidities, OR 3.00; 95% CI 2.25–3.98), bleeding while hospitalized for a separate process (OR 2.35; 95% CI 1.81–3.04), coagulation defects (OR 2.34; 95% CI 1.50–3.65), hypovolemia (OR 2.22; 95% CI 1.69–2.90), transfusion of packed red blood cells (OR 1.60; 95% CI 1.23–2.08), and male gender (OR 1.52; 95% CI 1.21–1.92). Colorectal polyps (OR 0.26, 95% CI 0.15–0.45), and hemorrhoids (OR 0.42; 95% CI 0.28–0.64) were associated with a lower risk of mortality, as was diagnostic testing for LIB when added to the multivariate model (OR 0.37, 95% CI 0.28–0.48; p<0.001). Hospital characteristics were not significantly related to mortality. Predictors of mortality were similar in an analysis restricted to patients with diverticular bleeding. Conclusions The all-cause in-hospital mortality rate in LIB is low (3.9%). Advanced age, intestinal ischemia and comorbid illness were the strongest predictors of mortality. PMID:18558513

  13. Vitamin D supplementation for prevention of mortality in adults

    DEFF Research Database (Denmark)

    Bjelakovic, Goran; Gluud, Lise Lotte; Nikolova, Dimitrinka

    2014-01-01

    Available evidence on the effects of vitamin D on mortality has been inconclusive. In a recent systematic review, we found evidence that vitamin D3 may decrease mortality in mostly elderly women. The present systematic review updates and reassesses the benefits and harms of vitamin D...

  14. Use of ventilator associated pneumonia bundle and statistical process control chart to decrease VAP rate in Syria.

    Science.gov (United States)

    Alsadat, Reem; Al-Bardan, Hussam; Mazloum, Mona N; Shamah, Asem A; Eltayeb, Mohamed F E; Marie, Ali; Dakkak, Abdulrahman; Naes, Ola; Esber, Faten; Betelmal, Ibrahim; Kherallah, Mazen

    2012-10-01

    Implementation of ventilator associated pneumonia (VAP) bundle as a performance improvement project in the critical care units for all mechanically ventilated patients aiming to decrease the VAP rates. VAP bundle was implemented in 4 teaching hospitals after educational sessions and compliance rates along with VAP rates were monitored using statistical process control charts. VAP bundle compliance rates were steadily increasing from 33 to 80% in hospital 1, from 33 to 86% in hospital 2 and from 83 to 100% in hospital 3 during the study period. The VAP bundle was not applied in hospital 4 therefore no data was available. A target level of 95% was reached only in hospital 3. This correlated with a decrease in VAP rates from 30 to 6.4 per 1000 ventilator days in hospital 1, from 12 to 4.9 per 1000 ventilator days in hospital 3, whereas VAP rate failed to decrease in hospital 2 (despite better compliance) and it remained high around 33 per 1000 ventilator days in hospital 4 where VAP bundle was not implemented. VAP bundle has performed differently in different hospitals in our study. Prevention of VAP requires a multidimensional strategy that includes strict infection control interventions, VAP bundle implementation, process and outcome surveillance and education.

  15. Mortality in epilepsy.

    Science.gov (United States)

    Hitiris, Nikolas; Mohanraj, Rajiv; Norrie, John; Brodie, Martin J

    2007-05-01

    All studies report an increased mortality risk for people with epilepsy compared with the general population. Population-based studies have demonstrated that the increased mortality is often related to the cause of the epilepsy. Common etiologies include neoplasia, cerebrovascular disease, and pneumonia. Deaths in selected cohorts, such as sudden unexpected death in epilepsy (SUDEP), status epilepticus (SE), suicides, and accidents are more frequently epilepsy-related. SUDEP is a particular cause for concern in younger people, and whether and when SUDEP should be discussed with patients with epilepsy remain problematic issues. Risk factors for SUDEP include generalized tonic-clonic seizures, increased seizure frequency, concomitant learning disability, and antiepileptic drug polypharmacy. The overall incidence of SE may be increasing, although case fatality rates remain constant. Mortality is frequently secondary to acute symptomatic disorders. Poor compliance with treatment in patients with epilepsy accounts for a small proportion of deaths from SE. The incidence of suicide is increased, particularly for individuals with epilepsy and comorbid psychiatric conditions. Late mortality figures in patients undergoing epilepsy surgery vary and are likely to reflect differences in case selection. Future studies of mortality should be prospective and follow agreed guidelines to better quantify risk and causation in individual populations.

  16. In-hospital outcome in patients with ST elevation myocardial infarction and right bundle branch block. A sub-study from RENASICA II, a national multicenter registry.

    Science.gov (United States)

    Juárez-Herrera, Ursulo; Jerjes Sánchez, Carlos; González-Pacheco, Héctor; Martínez-Sánchez, Carlos

    2010-01-01

    Compare in-hospital outcome in patients with ST-elevation myocardial infarction with right versus left bundle branch block. RENASICA II, a national Mexican registry enrolled 8098 patients with final diagnosis of acute coronary syndrome secondary to ischemic heart disease. In 4555 STEMI patients, 545 had bundle branch block, 318 (58.3%) with right and 225 patients with left (41.6%). Both groups were compared in terms of in-hospital outcome through major cardiovascular adverse events; (cardiovascular death, recurrent ischemia and reinfarction). Multivariable analysis was performed to identify in-hospital mortality risk among right and left bundle branch block patients. There were not statistical differences in both groups regarding baseline characteristics, time of ischemia, myocardial infarction location, ventricular dysfunction and reperfusion strategies. In-hospital outcome in bundle branch block group was characterized by a high incidence of major cardiovascular adverse events with a trend to higher mortality in patients with right bundle branch block (OR 1.70, CI 1.19 - 2.42, p right bundle branch block accompanying ST-elevation myocardial infarction of any location at emergency room presentation was an independent predictor of high in-hospital mortality.

  17. Neonatal mortality in Utah.

    Science.gov (United States)

    Woolley, F R; Schuman, K L; Lyon, J L

    1982-09-01

    A cohort study of neonatal mortality (N = 106) in white singleton births (N = 14,486) in Utah for January-June 1975 was conducted. Using membership and activity in the Church of Jesus Christ of Latter-day Saints (LDS or Mormon) as a proxy for parental health practices, i.e., tobacco and alcohol abstinence, differential neonatal mortality rates were calculated. The influence of potential confounding factors was evaluated. Low activity LDS members were found to have an excess risk of neonatal death five times greater than high activity LDS, with an upper bound of a two-sided 95% confidence interval of 7.9. The data consistently indicate a lower neonatal mortality rate for active LDS members. Non-LDS were found to have a lower rate than either medium or low activity LDS.

  18. Occupational Mortality, Background on

    DEFF Research Database (Denmark)

    Lynge, Elsebeth

    2016-01-01

    in England and Wales from 1851 to 1979–1983, and these studies have provided key data on social inequalities in health. Death certificate studies have been used for identification of occupational groups with high excess risks from specific diseases. Follow-up studies require linkage of individual records......The study of occupational mortality involves the systematic tabulation of mortality by occupational or socioeconomic groups. Three main methods are used to conduct these studies: cross-sectional studies, death certificate studies, and follow-up studies. Cross-sectional studies were undertaken...

  19. Impact of hyperglycemia on ischemic stroke mortality in diabetic and non-diabetic patients

    International Nuclear Information System (INIS)

    Kes, V.B.; Solter, V.V.; Supanc, V.; Demarin, V.

    2007-01-01

    Previous studies suggest that infarct expansion may be responsible for increased mortality after stroke onset in patients with prolonged stress hyperglycemia on stroke mortality in patients with and without diabetes. For 630 stroke patients admitted to the neurological intensive care department within 24 hours of stroke onset, we correlated mean blood glucose levels (MBGL) at admission and 72 hours after admission in diabetic and non-diabetic patients with final outcome. Blood glucose levels higher then 6.1 mmol/L (121mg/dL) was treated as hyperglycemia. Of 630 patients (mean age 71+-6), 410 were non-diabetic (mortality, 25%) and 220 patients were diabetic (mortality, 20%). All patients who died within 28 days of hospitalization had prolonged hyperglycemia at admission and after 72 hours, despite insulin therapy). The unadjusted relative risk of in-hospital mortality within 28 days of all stroke patients was 0.68 (95% CI, 0.14-1.9) for non-diabetic patients and 0.39 (95% CI, 0.27-1.56) for diabetic patients. The unadjusted relative risk of in-hospital mortality within 28 days in ischemic stroke in patients with MBGL> 6.1-8.0 mmol/L (121-144 mg/dL) at admission after 72 hours was 1.83 (95% CI, 0.41-5.5) for non-diabetic patients and 1.13 (95% CI, 0.78-4.5) for diabetic patients and 1.13 (95%, 0.78-4.5) for diabetic patients. Non-diabetic patients with hyperglycemia had a 1.7 times higher relative risk of in-hospital 28-day mortality than patients with diabetes. Prolonged stress hyperglycemia in ischemic stroke patients increases the risk of in-hospital 28-day mortality, especially in non-diabetic patients. (author)

  20. Effect of Boarding on Mortality in ICUs.

    Science.gov (United States)

    Stretch, Robert; Della Penna, Nicolás; Celi, Leo Anthony; Landon, Bruce E

    2018-04-01

    Hospitals use a variety of strategies to maximize the availability of limited ICU beds. Boarding, which involves assigning patients to an open bed in a different subspecialty ICU, is one such practice employed when ICU occupancy levels are high, and beds in a particular unit are unavailable. Boarding disrupts the normal geographic colocation of patients and care teams, exposing patients to nursing staff with different training and expertise to those caring for nonboarders. We analyzed whether medical ICU patients boarding in alternative specialty ICUs are at increased risk of mortality. Retrospective cohort study using an instrumental variable analysis to control for unmeasured confounding. A semiparametric bivariate probit estimation strategy was employed for the instrumental model. Propensity score matching and standard logistic regression (generalized linear modeling) were used as robustness checks. The medical ICU of a tertiary care nonprofit hospital in the United States between 2002 and 2012. All medical ICU admissions during the specified time period. None. The study population consisted of 8,429 patients of whom 1,871 were boarders. The instrumental variable model demonstrated a relative risk of 1.18 (95% CI, 1.01-1.38) for ICU stay mortality for boarders. The relative risk of in-hospital mortality among boarders was 1.22 (95% CI, 1.00-1.49). GLM and propensity score matching without use of the instrument yielded similar estimates. Instrumental variable estimates are for marginal patients, whereas generalized linear modeling and propensity score matching yield population average effects. Mortality increased with boarding of critically ill patients. Further research is needed to identify safer practices for managing patients during periods of high ICU occupancy.

  1. What happens in hospitals does not stay in hospitals: antibiotic-resistant bacteria in hospital wastewater systems.

    Science.gov (United States)

    Hocquet, D; Muller, A; Bertrand, X

    2016-08-01

    Hospitals are hotspots for antimicrobial-resistant bacteria (ARB) and play a major role in both their emergence and spread. Large numbers of these ARB will be ejected from hospitals via wastewater systems. In this review, we present quantitative and qualitative data of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli, vancomycin-resistant enterococci and Pseudomonas aeruginosa in hospital wastewaters compared to community wastewaters. We also discuss the fate of these ARB in wastewater treatment plants and in the downstream environment. Published studies have shown that hospital effluents contain ARB, the burden of these bacteria being dependent on their local prevalence. The large amounts of antimicrobials rejected in wastewater exert a continuous selective pressure. Only a few countries recommend the primary treatment of hospital effluents before their discharge into the main wastewater flow for treatment in municipal wastewater treatment plants. Despite the lack of conclusive data, some studies suggest that treatment could favour the ARB, notably ESBL-producing E. coli. Moreover, treatment plants are described as hotspots for the transfer of antibiotic resistance genes between bacterial species. Consequently, large amounts of ARB are released in the environment, but it is unclear whether this release contributes to the global epidemiology of these pathogens. It is reasonable, nevertheless, to postulate that it plays a role in the worldwide progression of antibiotic resistance. Antimicrobial resistance should now be seen as an 'environmental pollutant', and new wastewater treatment processes must be assessed for their capability in eliminating ARB, especially from hospital effluents. Copyright © 2016. Published by Elsevier Ltd.

  2. The changing power equation in hospitals.

    Science.gov (United States)

    Rayburn, J M; Rayburn, L G

    1997-01-01

    This research traces the origins, development, and reasons for change in the power equation in the U.S. hospitals between physicians, administrators and accountants. The paper contains three major sections: a review of the literature concerning authority, power, influence, and institutional theory; a review of the development of the power of professions, especially physicians, accounting and healthcare administrators, and the power equilibrium of a hospital; and, a discussion of the social policy implications of the power struggle. The basis for physicians' power derives from their legal ability to act on which others are dependent, such as choosing which hospital to admit patients, order tests and procedures for their patients. The Federal Government's prospective payment system and the hospitals' related case-mix accounting systems appear to influence the power structure in hospitals by redistributing that power. The basis of the accountants' power base is control of financial information. Accountants have a definite potential for influencing which departments receive financial resources and for what purpose. This moves hospital accountants into the power equation. The basis of the hospital administrators' power is their formal authority in the organization. Regardless of what actions federal government agencies, hospital accountants, or hospital administrators take, physicians are expected to remain the dominant factor in the power equation. Without major environmental changes to gain control of physician services, only insignificant results in cost containment will occur.

  3. [Nutritional status and risk in hospitalized children].

    Science.gov (United States)

    Hankard, R; Bloch, J; Martin, P; Randrianasolo, H; Bannier, M F; Machinot, S; Cézard, J P

    2001-11-01

    A few studies report malnutrition in hospitalized patients. This one-day cross-sectional survey performed in January 1999 assessed nutritional status and protein-energy intake in a pediatric population hospitalized in medicine or surgery units. Every child older than six months, hospitalized for more than 48 h and free of nutritional support (parenteral, enteral, or special regimens for metabolic diseases) was included. Fifty-eight children among the 183 present the day of the study met the inclusion criteria and were included in the statistical analysis. They were hospitalized in medicine (48%), psychiatry (31%) and surgery (21%). The body mass index (BMI) was below -2 standard deviations (DS) in 21% of them. Excluding patients with anorexia nervosa, BMI was +2 SD, or in between these limits in respectively 12, 14 and 74%. Energy intake measured at the hospital was below 75% of the recommended dietary allowances in two-thirds of the children whether malnourished or not. Fifty percent of the malnourished children had been referred to a dietician the day of the study. Malnutrition is frequent in a population of hospitalized children. Energy intake and referral to a dietician are insufficient.

  4. Symptomatic subsyndromal depression in hospitalized hypertensive patients.

    Science.gov (United States)

    Chiaie, Roberto Delle; Iannucci, Gino; Paroli, Marino; Salviati, Massimo; Caredda, Maria; Pasquini, Massimo; Biondi, Massimo

    2011-12-01

    Clinicians generally agree on the association between depression and hypertension. Less clear is if the nature of the link is direct or indirect and if this should be considered confined only to syndromal forms or if it concerns also subsyndromal affective presentations. This study investigated the nature of the association between hypertension and subsyndromal depression in hospitalized hypertensive patients. 196 hypertensive and 96 non hypertensive inpatients underwent a SCID interview, to exclude patients positive for any Axis I or Axis II diagnosis. Symptomatic Subsyndromal Depression (SSD) was identified according to criteria proposed by Judd. Psychopathological assessment was performed with Anxiety Sensitivity Index (ASI) and Hopkins Symptom Checklist-90 (SCL-90). Clinical assessments included blood pressure measurement, evaluation of general health conditions and screening cardiovascular risk factors (smoke, alcohol, body weight, sedentary life style). Hypertensives met more frequently criteria for SSD. They also scored higher on ASI and SCL-90. However, those with more severe physical conditions, if compared with more healthy patients, did not show increased psychopathological severity. Similarly, psychopathological symptom severity did not differ among hypertensives positive for other cardiovascular risk factors, commonly more frequent among depressed subjects. Further analyses are needed to explore the potential advantage obtained on blood pressure control by treating SSD. Hospitalized hypertensives, more frequently satisfied criteria for Symptomatic Subsyndromal Depression. These milder affective forms are probably directly linked to the presence of hypertension, rather than being indirectly associated to physical impairment or to higher prevalence of other cardiovascular risk factors. Copyright © 2011. Published by Elsevier B.V.

  5. Informal caregivers in hospitals: Opportunities and threats.

    Science.gov (United States)

    Amiresmaili, Mohammadreza; Emrani, Zahra

    2018-05-20

    High hospital costs are a challenge that health system face. Additionally, studies identified manpower deficiency as a problem in health system. Hospital is a place where patients with different physical and mental conditions come to. Their families and friends' companionship can facilitate this situation for them. This study illustrates the roles of informal caregivers in hospital. This is a phenomenological qualitative study. Data were gathered through semistructured interviews. We interviewed 22 informal caregivers and 9 nurse staffs from different departments of hospital. They were selected through purposeful and snowball sampling approach. The framework method was used for data analysis. We found 3 main themes including (a) roles of informal caregivers, (b) opportunities of presence of the informal caregivers in the hospital, and (c) threats of presence of informal caregivers. This study shows some roles for informal caregivers including mental supports, consultation, decision-making, and care roles. Concerning the shortage of manpower in Iran's hospitals, nurses have less time to take care of each patient; therefore, using informal caregivers as an implicit strategy to overcome nursing shortage and to reduce hospital costs seems to be beneficial. We suggest that an appropriate plan is necessary to make use of them for filling this gap to some extent, as well as providing training sessions and facilities for companions acting as informal caregivers. Copyright © 2018 John Wiley & Sons, Ltd.

  6. Can soda fountains be recommended in hospitals?

    Science.gov (United States)

    Chaberny, Iris F; Kaiser, Peter; Sonntag, Hans-Günther

    2006-09-01

    Mineral water (soda water) is very popular in Germany. Therefore, soda fountains were developed as alternatives to the traditional deposit bottle system. Nowadays, different systems of these devices are commercially available. For several years, soda fountains produced by different companies have been examined at the University Hospital of Heidelberg. In 1998, it was possible for the first time to observe and evaluate one of these systems over a period of 320 days in a series of microbiological examinations. The evaluation was implemented on the basis of the German drinking water regulation (Anonymous, 1990. Gesetz über Trinkwasser und Wasser für Lebensmittelbetriebe (Trinkwasserverordnung - TrinkwV) vom 12. Dezember 1990. Bundesgesetzblatt 66, 2613ff). Initially, the bacteria counts exceeded the reference values imposed by the German drinking water regulation in almost 50% of the analyses. Pseudomonas aeruginosa was also detected in almost 38% of the samples. After a re-arrangement of the disinfection procedure and the removal of the charcoal filter, Pseudomonas aeruginosa was not detectable any more. However, the bacteria counts still frequently exceeded the reference values of the German drinking water regulation. Following our long-term analysis, we would not recommend soda fountains in high-risk areas of hospitals. If these devices are to be used in hospitals, the disinfection procedures should be executed in weekly or fortnightly intervals and the water quality should be examined periodically.

  7. A risk score for in-hospital death in patients admitted with ischemic or hemorrhagic stroke.

    Science.gov (United States)

    Smith, Eric E; Shobha, Nandavar; Dai, David; Olson, DaiWai M; Reeves, Mathew J; Saver, Jeffrey L; Hernandez, Adrian F; Peterson, Eric D; Fonarow, Gregg C; Schwamm, Lee H

    2013-01-28

    We aimed to derive and validate a single risk score for predicting death from ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Data from 333 865 stroke patients (IS, 82.4%; ICH, 11.2%; SAH, 2.6%; uncertain type, 3.8%) in the Get With The Guidelines-Stroke database were used. In-hospital mortality varied greatly according to stroke type (IS, 5.5%; ICH, 27.2%; SAH, 25.1%; unknown type, 6.0%; Pmortality and to assign point scores for a prediction model in the overall population and in the subset with the National Institutes of Health Stroke Scale (NIHSS) recorded (37.1%). The c statistic, a measure of how well the models discriminate the risk of death, was 0.78 in the overall validation sample and 0.86 in the model including NIHSS. The model with NIHSS performed nearly as well in each stroke type as in the overall model including all types (c statistics for IS alone, 0.85; for ICH alone, 0.83; for SAH alone, 0.83; uncertain type alone, 0.86). The calibration of the model was excellent, as demonstrated by plots of observed versus predicted mortality. A single prediction score for all stroke types can be used to predict risk of in-hospital death following stroke admission. Incorporation of NIHSS information substantially improves this predictive accuracy.

  8. [Relationship between previous severity of illness and outcome of in-hospital cardiac arrest].

    Science.gov (United States)

    Serrano, M; Rodríguez, J; Espejo, A; del Olmo, R; Llanos, S; Del Castillo, J; López-Herce, J

    2014-07-01

    To analyze the relationship between previous severity of illness, lactic acid, creatinine and inotropic index with mortality of in-hospital cardiac arrest (CA) in children, and the value of a prognostic index designed for adults. The study included total of 44 children aged from 1 month to 18 years old who suffered a cardiac arrest while in hospital. The relationship between previous severity of illness scores (PRIMS and PELOD), lactic acid, creatinine, treatment with vasoactive drugs, inotropic index with return of spontaneous circulation and survival at hospital discharge was analyzed. The large majority (90.3%) of patients had a return of spontaneous circulation, and 59% survived at hospital discharge. More than two-thirds (68.2%) were treated with inotropic drugs at the time of the CA. The patients who died had a higher lactic acid before the CA (3.4 mmol/L) than survivors (1.4 mmol/L), P=.04. There were no significant differences in PRIMS, PELOD, creatinine, inotropic drugs, and inotropic index before CA between patients who died and survivors. A high lactic acid previous to cardiac arrest could be a prognostic factor of in-hospital cardiac arrest in children. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  9. Affine stochastic mortality

    NARCIS (Netherlands)

    Schrager, D.F.

    2006-01-01

    We propose a new model for stochastic mortality. The model is based on the literature on affine term structure models. It satisfies three important requirements for application in practice: analytical tractibility, clear interpretation of the factors and compatibility with financial option pricing

  10. Mortality and GH deficiency

    DEFF Research Database (Denmark)

    Stochholm, Kirstine; Gravholt, Claus Højbjerg; Laursen, Torben

    2007-01-01

    into childhood onset (CO) and adult onset (AO), discriminated by an age cutoff below or above 18 years at onset of GHD. METHOD: Data on death were identified in national registries. Sex- and cause-specific mortalities were identified in CO and AO GHD when compared with controls. RESULTS: Mortality was increased......OBJECTIVE: To estimate the mortality in Denmark in patients suffering from GH deficiency (GHD). DESIGN: Mortality was analyzed in 1794 GHD patients and 8014 controls matched on age and gender. All records in GHD patients were studied and additional morbidity noted. Patients were divided...... in CO and AO GHD in both genders, when compared with controls. The hazard ratio (HR) for CO males was 8.3 (95% confidence interval (CI) 4.5-15.1) and for females 9.4 (CI 4.6-19.4). For AO males, HR was 1.9 (CI 1.7-2.2) and for females 3.4 (CI 2.9-4.0). We found a significantly higher HR in AO females...

  11. Caesarean section and mortality

    African Journals Online (AJOL)

    Hawkins JL, Gibbs CP, Orleans M, et al. Obstetric anesthesia work force survey, versus 1992. Anesthesiology. 1981;1997(87):135–43. 2. Bert CJ, Atrash HK, Koonin KM, et al. Pregnacy related mortality in the. United States, 1987–1990. Obstet Gynecol. 1996;88:161–7. Received: 10-08-2015 Accepted: 14-08-2015.

  12. Stillbirth and Infant Mortality

    DEFF Research Database (Denmark)

    Nøhr, Ellen Aagaard

    2012-01-01

    mechanisms behind these associations remain largely unknown. Although maternal obesity is associated with a wide range of complications in the mother and neonate that may impair fetal and infant survival, the increased risk of stillbirth and infant mortality is virtually unchanged when accounting...

  13. Stent type used does not impact complication rate or placement time but can decrease treatment cost for benign and malignant esophageal lesions

    Institute of Scientific and Technical Information of China (English)

    Camille; McGaw[1; Ahmad; Alkaddour[2; Kenneth; J; Vega[3; Juan; Carlos; Munoz[1

    2016-01-01

    AIM: To evaluate if differences exist between selfexpanding esophageal metal stents (SEMS) and selfexpanding esophageal plastic stents (SEPS) when used for benign or malignant esophageal disorders with regard to safety, efficacy, clinical outcomes, placement ease and cost.METHODS: A retrospective analysis was performed to evaluate outcome in patients having SEPS/SEMS placed for malignant or benign esophageal conditions from January 2005 to April 2012. Inclusion criteria was completed SEMS/SEPS placement. Outcomes assessed included technical success of and time required for stent placement, procedure-related complications, need for repeat intervention, hospital stay, mortality and costs.RESULTS: Forty-three patients underwent stent placement for either benign/malignant esophageal disease during the study period. Thirty patients had SEMS (25 male, mean age 59.6 years old) and 13 patients had SEPS (10 male, mean age 61.7 years old). Placement outcome as well as complication rate (SEPS 23.1%, SEMS 25.2%) and in-hospital mortality (SEPS 7.7%, SEMS 6.7%) after placement did not differ between stent types. Migration was the most frequent complication reported occurring equally between types (SEPS 66.7%, SEMS 57.1%). SEPS was less costly than SEMS, decreasing institutional cost by $255/stent. CONCLUSION: SEPS and SEMS have similar outcomes when used for benign or malignant esophageal conditions. However, SEPS use results in decreased costs without impacting care.

  14. Stent type used does not impact complication rate or placement time but can decrease treatment cost for benign and malignant esophageal lesions

    Institute of Scientific and Technical Information of China (English)

    Camille McGaw; Ahmad Alkaddour; Kenneth J Vega; Juan Carlos Munoz

    2016-01-01

    AIM: To evaluate if differences exist between selfexpanding esophageal metal stents(SEMS) and selfexpanding esophageal plastic stents(SEPS) when used for benign or malignant esophageal disorders with regard to safety, efficacy, clinical outcomes, placement ease and cost.METHODS: A retrospective analysis was performed to evaluate outcome in patients having SEPS/SEMS placed for malignant or benign esophageal conditions from January 2005 to April 2012. Inclusion criteria was completed SEMS/SEPS placement. Outcomes assessed included technical success of and time required for stent placement, procedure-related complications, need for repeat intervention, hospital stay, mortality and costs.RESULTS: Forty-three patients underwent stent placement for either benign/malignant esophagealdisease during the study period. Thirty patients had SEMS(25 male, mean age 59.6 years old) and 13 patients had SEPS(10 male, mean age 61.7 years old). Placement outcome as well as complication rate(SEPS 23.1%, SEMS 25.2%) and in-hospital mortality(SEPS 7.7%, SEMS 6.7%) after placement did not differ between stent types. Migration was the most frequent complication reported occurring equally between types(SEPS 66.7%, SEMS 57.1%). SEPS was less costly than SEMS, decreasing institutional cost by $255/stent.CONCLUSION: SEPS and SEMS have similar outcomes when used for benign or malignant esophageal conditions. However, SEPS use results in decreased costs without impacting care.

  15. Sex differentials in mortality.

    Science.gov (United States)

    1970-06-01

    The questions leing considered are whether a higher female than male mortality rate exists in Ceylon, India, and Pakistan, and whether this sex differential can account for the observed high male sex ratios. There is a choice between explaining the recorded masculinity of the Indian population by assuming that the subordinate position of women caused their omission from the census or that it caused their unrecorded death in childhood. The 1951 census report of India states that there is a traditional fondness for male issues in most parts of the country and a corresponding dislike for female children. However, a life table for India applied to the 1951 census gave a higher average female age at death 34.7 years as opposed to 33.5 years for male. Other estimates for India and Pakistan for the period 1951-1961 give 37.8 years for life expectancy for males and 36.98 for females. In 1953 the female death rate in Ceylon was over 80% higher than that of the males in the most reproductive ages, 20-29. In 1963 the female excess mortality at the same ages was still 25%, and in the age group 30-34 almost a 1/3 higher. In India the female death rate at ages 15-44 was 38% higher than that of the males in the 1958-1959 survey and as much as 174% higher in the Khanna rural survey, 1956-1960. In Pakistan a Population growth Estimate experiment conducted during 1962-1965 on a national probability sample has shown that in the ages 15-44 the female death rate was 75% higher than that of the males. High maternal mortality was the major reason. In addition, female mortality among young children over age 1 year was 24% higher in 1965 and 1963. There was little difference between the rates of mortality of the 2 sexes at age 45 and above. Recent trends in Ceylon show considerable improvement in maternal mortality which has reduced by 22% the ratio of female to male mortality at age 15-44. Also the ratio at ages 1-9 fell by 8%. to .1 of a year for every calendar year to 1980.

  16. The effect of college education on mortality.

    Science.gov (United States)

    Buckles, Kasey; Hagemann, Andreas; Malamud, Ofer; Morrill, Melinda; Wozniak, Abigail

    2016-12-01

    We exploit exogenous variation in years of completed college induced by draft-avoidance behavior during the Vietnam War to examine the impact of college on adult mortality. Our estimates imply that increasing college attainment from the level of the state at the 25th percentile of the education distribution to that of the state at the 75th percentile would decrease cumulative mortality for cohorts in our sample by 8 t