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PubMedDate not supplied

System care improves trauma outcome: patient care errors dominate reduced preventable death rate.

UNLABELLED: A review of 452 trauma deaths in Hillsborough County, Florida, in 1984 documented that 23% of non-CNS trauma deaths were preventable and occurred because of inadequate resuscitation or delay in proper surgical care. In late 1988 Hillsborough County organized a County Trauma Agency (HCTA) to coordinate trauma care among prehospital providers and state-designated trauma centers. The purpose of this study was to review county trauma deaths after the inception of the HCTA to determine the frequency of preventable deaths. RESULTS: 504 trauma deaths occurring between October 1989 and April 1991 were reviewed. Through committee review, 10 deaths were deemed preventable; 2 occurred outside the trauma system. Of the 10 deaths, 5 preventable deaths occurred late in severely injured patients. CONCLUSION: The preventable death rate has decreased to 7.0% with system care. The causes of preventable deaths have changed from delayed or inadequate intervention to postoperative care errors.

Adolescent↗
PubMed1982

Addict death rates during a four-year posttreatment follow-up.

Mortality rates were examined among 3,324 Black and White daily opioid drug users for a four-year period following treatment in community-based agencies located across the United States. A total of 179 of these addicts died during this follow-up period, yielding a death rate of 15.2 per 1,000 person-years at risk. When adjusted for age, addict death rates were found to be three to 14 times higher than those in the general US population. Life table analysis was also used to examine these rates in relation to client demographic, background, and treatment variables obtained prospectively, both prior to and during treatment. Age, alcohol use, and criminal history were positively associated with higher death rates. With regard to causes of death, age proved to be the only significant predictor; older addicts (over 30) had the highest percentages of deaths due to "natural" causes, while over three-fourths of the deaths among younger addicts were drug related or involved violence.

Adult↗
PubMed1990

Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities.

Logistic regression analysis was applied to a sample of more than 12,000 hemodialysis patients to evaluate the association of various patient descriptors, treatment time (hours/treatment), and various laboratory tests with the probability of death. Advancing age, white race, and diabetes were all associated with a significantly increased risk of death. Short dialysis times were also associated with high death risk before adjustment for the value of laboratory tests. Of the laboratory variables, low serum albumin less than 40 g/L (less than 4.0 g/dL) was most highly associated with death probability. About two thirds of patients had low albumin. These findings suggest that inadequate nutrition may be an important contributing factor to the mortality suffered by hemodialysis patients. The relative risk profiles for other laboratory tests are presented. Among these, low serum creatinine, not high, was associated with high death risk. Both serum albumin concentration and creatinine were directly correlated with treatment time so that high values for both substances were associated with long treatment times. The data suggest that physicians may select patients with high creatinine for more intense dialysis exposure and patients with low creatinine for less intense treatment. In a separate analysis, observed death rates were compared with rates expected on the basis of case mix for these 237 facilities. The data suggest substantial volatility of observed/expected ratios when facility size is small. Nonetheless, a minority of facilities (less than or equal to 2%) may have higher rates than expected when compared with the pool of all patients in this sample. The effect of various laboratory variables on mortality is substantial, while relatively few facilities have observed death rates that exceed their expected values. Therefore, we suggest that strategies designed to improve the overall mortality statistic for dialysis patients in the United States would be better directed toward improving the quality of care for all patients, particularly high-risk patients, within their usual treatment settings rather than trying to identify facilities with high death rate for possible regulatory intervention.

Adult↗
PubMed1983

Homicide death rates in childhood in 23 developed countries: U.S. rates atypically high.

World Health Organization vital statistics data were used to compare U.S. homicide death rates with those in 23 other developed countries. Using rank ordering and comparison with mean and median rates for the other countries, U.S. homicide rates for the general population were found to be exceptionally high among developed countries. Similarly, U.S. homicide death rates for infants and for 1-4-year-olds were atypically high. The U.S. infant homicide rates were also unusual because of a male predominance. After infancy, high female homicide rates in the U.S. were more unusual than the male rates. The atypically high homicide risk in the U.S. apparently begins in early childhood, affecting particularly male infants and females after infancy. The data and other cited information suggest that features of U.S. society may promote homicide in childhood. The scope and nature of the U.S. childhood homicide problem warrants a focused effort to develop specific preventive approaches.

Age Factors↗
PubMedDate not supplied

Rural vs urban motor vehicle crash death rates: 20 years of FARS data.

OBJECTIVES: Historically, motor vehicle crash (MVC)-related mortality is higher in rural areas than in urban areas. The authors evaluated whether the difference in rural and urban MVC deaths is persisting, and whether the frequency of patients being found dead at the scene, particularly in rural areas, is increasing. METHODS: Fatal Accident Reporting System (FARS) data for 1977 through 1996 were reviewed. The authors determined the frequency with which crash deaths occurred, and calculated population-based and vehicle-miles-traveled-based crash death rates. They compared rates for urban and rural areas. RESULTS: A total of 875,405 crash deaths were included in the analysis. Both population-based and vehicle-miles-traveled-based MVC deaths have decreased over the last 20 years, but rural rates remain significantly higher than urban rates. Dead-at-scene rates may be increasing, and the rural dead-at-scene rate is higher than the urban rate. CONCLUSION: While MVC death rates are declining, the rural MVC death rate is still higher than the urban rate. Although these data may indicate some positive movement in the area of MVC-related deaths, differences in the rural and urban rates and the number of patients found dead on-scene remain as issues that require attention.

Accidents, Traffic↗
PubMed1992

Some results for an SEIR epidemic model with density dependence in the death rate.

This paper deals with an SEIR epidemic model for an infectious disease where the death rate depends on the number of individuals in the population. It is also assumed that there is an additional death rate suffered by infected individuals. It is found that there are three steady-state values: one where the population is extinct, one where the population maintains itself at a constant level and the disease is extinct, and one where there is a unique equilibrium with disease present. An interesting and unusual feature is that it is possible for this third equilibrium to exist and be locally unstable. Numerical work and simulation show that we can have cycles of disease incidence with increasing amplitude, a constant amplitude, and a decreasing amplitude, depending on the parameter values of the model.

Animals↗
PubMed2004

A stage structured predator-prey model and its dependence on maturation delay and death rate.

Many of the existing models on stage structured populations are single species models or models which assume a constant resource supply. In reality, growth is a combined result of birth and death processes, both of which are closely linked to the resource supply which is dynamic in nature. From this basic standpoint, we formulate a general and robust predator-prey model with stage structure with constant maturation time delay (through-stage time delay) and perform a systematic mathematical and computational study. Our work indicates that if the juvenile death rate (through-stage death rate) is nonzero, then for small and large values of maturation time delays, the population dynamics takes the simple form of a globally attractive steady state. Our linear stability work shows that if the resource is dynamic, as in nature, there is a window in maturation time delay parameter that generates sustainable oscillatory dynamics.

Animals↗
PubMed1978

In vivo monitoring of the death rate of artificial murine pulmonary micrometastases.

A system is described for direct monitoring of the death rate of artificial murine pulmonary microscopic metastases in vivo. Metastatic fibrosarcoma cells or benign connective tissue cells labeled with [125I]iododeoxyuridine were injected i.v. Comparison of the long-term radioactive decay rate of these two cell types in the lung permitted identification of the portion of the decay curve reflecting the initial period of micrometastasis development and growth. About 5% of the injected tumor cells were retained in the lung in micrometastasis, and their average death rate could be monitored by loss of radioactivity from the lung. Systemic methotrexate (75.0 mg/kg) was administered as a single dose 80 hr after injection of tumor cells at a time when micrometastases had not yet become vascularized. This treatment killed about 60% of the micrometases and suppressed the appearance of gross metastases at 14 days.

Animals↗
PubMedDate not supplied

Death rate in patients submitted to the surgical treatment of fracture of the proximal femur.

The death rate 6 and 12 months after surgery in 389 patients who had been treated for fracture of the proximal femur between 1989 and 1993 (1st semester) was studied. All of the patients submitted to surgery were traced through the official records on the population of the City of Padova. The overall death rate after 6 months was 16%, that after 12 months 23%. The best survival rate was observed in patients who had been submitted to gamma nail arthroplasty (p < 0.01).

Age Factors↗
PubMed1980

[Analysis of the true death-rate due to alcoholism (author's transl)].

For various administrative and technical/registrational reasons, statistics on the death rate of chronic alcoholism are wrong. Exact studies have shown that official figures have to be multiplied by a factor of between 45 and 69 to arrive at the true rate. If one also takes into consideration the reduction in the collective life expectancy, the factor increases to about 100. The common practice of identifying death due to alcoholism by equating it with the number of deaths due to cirrhosis of the liver, provides a figure which is too low for the Central European area. Various suggestions are made on how to obtain the true death-rate.

Accidents, Traffic↗
PubMed1983

The use of statistics to examine the association between fluoride in drinking water and cancer death rates.

"The basis of statistical tests of significance of association between fluoride level in drinking water and cancer death rates is discussed. Reference is made to two reported studies in each of which cancer death rates of a number of [U.S.] cities were used. It is argued that between city variation should be taken into account when performing tests of significance. In one of the two studies this was done informally; in the other between city variation was ignored."

Americas↗
PubMed2004

The effect of copper on the death rate of Salmonella typhimurium DT104:30 in food substrates acidified with organic acids.

AIMS: The objective of this study was to investigate the effect of copper ions on the survival of Salmonella typhimurium DT104:30 in acidified liquid food substrates. METHODS AND RESULTS: The decimal reduction time (Dvalue) of Salm. typhimurium DT104:30 was determined in acidified liquid pig feed (LPF) and skimmed milk (SM) containing a range of copper concentrations (0-50 ppm). As copper concentration increased, the death rate of Salm. typhimurium DT104:30 increased. In LPF acidified with 150 mmol l-1 lactic acid the presence of 50 ppm copper resulted in a 10-fold increase in the death rate. CONCLUSIONS: The presence of copper salts in acidic liquid food substrates significantly increases the death rate of Salm. typhimurium DT104:30. SIGNIFICANCE AND IMPACT OF THE STUDY: This finding could influence policy on levels of copper in pig feed.

Acetic Acid↗
PubMed1968

National motives predict psychogenic death rates 25 years later.

Achievement motivation scores derived fromn analyses of content of children's stories from 16 countries predicted death rates dut to ulcers and hypertension, and power motivation scores predicted death rates due to murder, suicide, and cirrhosis of the liver 25 years later.

Achievement↗
PubMed1987

Secular decline in death rates due to ischemic heart disease in Mexican Americans and non-Hispanic whites in Texas, 1970-1980.

Although the decline in ischemic heart disease mortality is now entering its third decade, there has been no definitive information on the experience of Mexican Americans, the nation's second largest minority group. Earlier studies carried out in the 1970s were hampered by the unavailability of satisfactory population data beyond 1970. In the present study we have used 1970 and 1980 census data to compute death rates in Mexican Americans and non-Hispanic whites from Texas for the periods 1969-1971 and 1979-1981. All four sex-ethnic groups showed statistically significant declines in death rates due to all causes, due to total ischemic heart disease, and due to acute myocardial infarction between 1969-1971 and 1979-1981. Declines in the latter two causes of death were least marked in Mexican American men. This sex-ethnic group was also the only one that failed to show a decline in death rates due to chronic ischemic heart diseases. The fact that Mexican Americans have been shown to be less well informed about and less likely to adopt lifestyle changes aimed at reducing heart disease risk than non-Hispanic whites may account for the less striking mortality decline observed in Mexican American men, but is harder to reconcile with the apparent equal decline in Mexican American women compared with non-Hispanic whites.

Adult↗
PubMed1999

Oregon's low in-hospital death rates: what determines where people die and satisfaction with decisions on place of death?

Where Americans die is much more influenced by what part of the country they live in than by what their preferences are for location of death. Although most Americans report a preference for death at home, a majority still die in acute care hospitals. We describe the experiences of patients who died in Oregon (the state that currently has the lowest in-hospital death rate in the United States--31%) and the views of their families. We examine the factors influencing respect for dying patients' preferred location of death. Data from Oregon studies confirm that decisions to avoid hospital admission are far more common than discharge of the actively dying. Do-not-resuscitate orders were reported for 91% of nursing home residents in one study and living wills were reported for 67% of a random sample of adult Oregon decedents in a second study. In the second study, decisions not to start treatment were far more common than decisions to stop treatment (79% compared with 21%). Only 2.4% of families reported that "too little" treatment was given. Throughout the United States, use and availability of beds in acute care hospitals have been confirmed to be the principal determining factors in location of death. Within that constraint, however, the availability of other resources and services both facilitates the process of arranging for patients to die outside the hospital and improves satisfaction with the quality of terminal care.

Advance Care Planning↗
PubMed1996

Does increased spending on alcoholism treatment lead to lower cirrhosis death rates?

The purpose of this study was to see if recent changes in the funding of alcoholism programmes in the United States were related to changes in liver cirrhosis death rates. Data on per-capita spending, per-capita alcohol consumption and cirrhosis death rates were gathered from various sources for the years 1979 and 1989 for the 50 states and the District of Columbia. Regression analysis showed that greater increases in spending on alcoholism across US states were associated with greater declines in cirrhosis mortality rates. Since alcohol-related deaths cause large productivity losses and treatment is relatively cheap this creates large savings for society.

Alcoholism↗
PubMed1994

Indications of a considerable decrease in the death rate in mycosis fungoides by PUVA treatment.

PUVA therapy has its roots in ancient India and Egypt and began to come into general use in the highly developed countries in the middle of the 1970's (1). The first reports of PUVA treatment of mycosis fungoides were published in 1976 (2); these were followed by several other studies in the two following years (3-7). Some of the early work on PUVA therapy was carried out in Sweden (8,9), and the modality was in general use in most major clinics by 1977. The dramatic effect on mycosis fungoides of PUVA therapy is well known, but whether the death rate is influenced is not known. For ethical reasons no controlled clinical studies have been performed. Sweden is a highly organized country with reliable death statistics at least for diseases as conspicuous as mycosis fungoides. The purpose of the present study was to provide data on the death rate in mycosis fungoides in Sweden from 1961 to 1990, which we think is relevant to the question whether PUVA treatment decreases the death rate in mycosis fungoides.

Humans↗
PubMed1998

Thermal death rate of ascospores of Neosartorya fischeri ATCC 200957 in the presence of organic acids and preservatives in fruit juices.

Heat-resistant molds, including Neosartorya fischeri, are known to spoil thermally processed fruit products. The control measures required for such problems must not cause an appreciable loss of the organoleptic qualities of the final products. In the present study we determined the thermal death rates of ascospores of N. fischeri ATCC 200957 in fruit juices containing organic acids and preservatives. The ascospores were able to survive for more than 6 h of heating at 75 degrees C, 5 h at 80 degrees C, and 3 to 4 h at 85 degrees C in mango or grape juice. Of the four organic acids tested, citric acid exhibited the maximal destruction of ascospores in mango juice at 85 degrees C (1/k = 27.22 min), and tartaric acid the least (1/k = 61.73 min). The effect of common preservatives on the thermal death rates of ascospores at .85 degrees C in mango and grape juices was studied. Almost similar effects on thermal inactivation of ascospores were noted when potassium sorbate (1/k = 29.38 min) or sodium benzoate (1/k = 27.64 min) or the combination of both (1/k = 27.53 min) was used in mango juice. In grape juice, potassium sorbate (1/k = 25.07 min) was more effective than sodium benzoate (1/k = 50.08 min) or the combination of both (1/k = 40.79 min) in inactivation of ascospores of the mold. The thermal death rate (1/k) values in mango and grape juices in the absence of any preservative were 63.51 and 69.27 min respectively.

Ascomycota↗