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At least 1,135 records · Page 63Linked to original sources
PubMed2000

Cardiovascular and cerebrovascular morbidity and mortality among women with end-stage renal disease attributable to lupus nephritis.

Cardiovascular and cerebrovascular diseases are common causes of morbidity and mortality in women with systemic lupus erythematosus (SLE) and are also common in patients with end-stage renal disease (ESRD). To determine whether women with ESRD caused by lupus nephritis are at greater risk for morbidity from these conditions than women with other causes of ESRD, data from the US Renal Data System were used to compare incidence rates of hospitalizations for acute myocardial infarction and cerebrovascular accident between women with ESRD caused by lupus nephritis and women with ESRD from other causes. The age- and race-adjusted incidences of hospitalizations for acute myocardial infarction during dialysis were 16.4 hospitalizations/1,000 patient-years among women with ESRD caused by lupus nephritis and 17.3 hospitalizations/1,000 patient-years among women in the comparison group (adjusted hazard ratio, 0.80; 95% confidence interval [CI], 0.58 to 1.08; P = 0.14). Adjusted incidence rates for acute myocardial infarction after renal transplantation also did not differ between these groups. Adjusted incidence rates for hospitalizations for cerebrovascular accident during dialysis were 18.5 hospitalizations/1,000 patient-years among women with ESRD caused by lupus nephritis and 19.2 hospitalizations/1,000 patient-years among women in the comparison group (adjusted hazard ratio, 0.87; 95% CI, 0.66 to 1.14; P = 0.30); incidence rates after transplantation also did not differ between groups. Risks for death from cardiovascular or cerebrovascular diseases also were not increased among women with ESRD caused by lupus nephritis. Sepsis was the most common cause of death in this group. Morbidity and mortality from acute myocardial infarction and cerebrovascular accident were substantially greater among women with ESRD caused by diabetes mellitus. Although morbidity and mortality from cardiovascular and cerebrovascular diseases are common among women with SLE, risks for these outcomes are not greater among women with ESRD caused by lupus nephritis than among other women without diabetes with ESRD.

Adult↗
PubMedDate not supplied

Care of the morbidly obese patient in a long-term care facility.

Morbidly obese patients in a long-term care (LTC) facility have special physical and emotional needs that must be considered when planning care. Special attention to the skin, vital sign monitoring, and rehabilitative care are among the interventions that must be integrated into the otherwise standard care of the morbidly obese patient. A case study is used to illustrate the challenges and special needs of such patients in an LTC facility in New York state. Morbidly obese people (nonambulatory people who are obese) frequently are unable to perform self-care. The care of the morbidly obese adult who resides in an LTC or postacute care facility, in particular, offers unique challenges to nursing staff.

Activities of Daily Living↗
PubMed2004

Ibandronate reduces skeletal morbidity in patients with breast cancer.

Three phase III studies have assessed the efficacy of intravenous (IV) and oral ibandronate over 96 weeks for metastatic bone disease in patients with breast cancer. The primary endpoint for each trial was the skeletal morbidity period rate, defined as the number of 12-week periods with new bone complications, adjusted for the time spent on study. Both IV ibandronate 6 mg every 3 to 4 weeks and oral ibandronate 50 mg once daily significantly reduced the skeletal morbidity period rate compared with placebo ( P = .004 in each case). The studies were not powered to detect statistical significance on individual components of the skeletal morbidity period rate. Nevertheless, IV ibandronate significantly reduced vertebral fractures and the need for radiotherapy, while oral ibandronate led to significantly fewer bone events needing radiotherapy or surgery than placebo. Using a multivariate Poisson regression model, the mean reduction in the relative risk of new bone events compared with placebo was 40% with IV ibandronate 6 mg ( P = .0033), and 38% with oral ibandronate 50 mg ( P <.001). The clinical equivalence of IV and oral ibandronate was confirmed by a post-hoc Anderson-Gill analysis of time to multiple skeletal events. These results show that IV and oral ibandronate effectively reduce skeletal morbidity in breast cancer patients with bone metastases.

Administration, Oral↗
PubMed2002

Validation of a preoperative risk index as a predictor of perioperative morbidity and hospital costs in coronary artery bypass graft surgery.

OBJECTIVE: To validate a previously developed model (CABDEAL) for predicting postoperative morbidity for coronary artery bypass graft (CABG) surgery patients using the New York State Statewide Planning and Research Cooperative System (SPARCS) database and to examine the effects of preoperative risk factors, postoperative complications, and death on costs of care for CABG surgery. DESIGN: Retrospective database review. SETTING: Governmental agency database of cardiac surgery. PARTICIPANTS: CABG surgery patients (n = 15,388). INTERVENTIONS: A previously developed preoperative risk model (CABDEAL) was applied to all patients. Predicted length of hospital stay and costs were compared with actual length of stay and costs, using a charge-to-cost conversion formula. MEASUREMENTS AND MAIN RESULTS: The CABDEAL model was moderately predictive of outcomes. The specificity was 64%, the sensitivity was 73.8%, and the receiver operating characteristic curve area was 0.728. Morbidity in the form of postoperative complications was recorded in 24.5% (3,770 patients), and the mortality rate was 3.4% (527 patients). The mean (+/- SD) total hospital cost was 28,408 US dollars +/-28,982, and the median cost was 21,644 US dollars. Based on the linear regression model, an equation was developed for predicting total costs: Cost (in US dollars) = 22,952 + (3,277. [CABDEAL score]). CONCLUSION: The previously developed CABDEAL model was predictive of increased morbidity in the SPARCS database. Total hospital costs increased nearly linearly with increasing CABDEAL score. These results encourage the development of models for preoperative estimation of costs related to perioperative morbidity.

Aged↗
PubMed2003

Laparoscopic Roux-en-Y gastric bypass in morbidly obese adolescents.

BACKGROUND/PURPOSE: Obesity has contributed significantly to morbidity and premature deaths in the adolescent population. Because many patients do not respond to dietary modification, exercise regimens, or pharmacologic treatment, weight reduction surgery has become a viable alternative, although the morbidity of conventional gastric bypass has tempered enthusiasm for this approach. Experience with the laparoscopic approach has not been reported previously. The authors examined the outcome of adolescents undergoing laparoscopic Roux-En-Y gastric bypass (lap RYGB). METHODS: Medical records of patients less than 20 years of age (n = 4; 3 girls, 1 boy) who had undergone lap RYGB for morbid obesity were reviewed. All patients met National Institute of Health criteria for bariatric surgery. Outcome variables examined included weight; body mass index (BMI); hospital length of stay (LOS); comorbid conditions; and tolerance of a regular diet. Mean time to follow-up was 17 months. RESULTS: All procedures were completed laparoscopically. There were no complications. The average LOS was 2 days. Patients with greater than 20-month follow-up lost an average of 87% of their excess body weight and had nearly complete resolution of comorbidities (including hypertriglyceridemia, hypercholesterolemia, asthma, and gastroesophageal reflux disease). CONCLUSION: Laparoscopic gastric bypass is a safe alternative in morbidly obese adolescents who have not responded to medical therapy.

Adolescent↗
PubMed2002

[Development, state of the art and future perspectives of surgery for morbid obesity].

Obesity is the most common form of malnutrition and morbid obesity is increasingly recognized as a major health concern. Drug treatments of the morbid obese have entirely failed in the long run. These circumstances have constituted incentives for surgeons to develop techniques resulting in malabsorptive or restrictive effects on food intake. Several techniques achieve weight loss through both these mechanisms and most likely also by changing the gastrointestinal signalling system. Within the last 50 years surgery for morbid obesity has been developed stepwise, like other surgical methods. More than 50 surgical anti-obesity techniques have been described. Half a dozen techniques have been left over and are performed mainly laparoscopically now a days. The outcome of these techniques over the last 30 years is reported in this article. It is the aim to illustrate that bariatric surgery is safe and so far more long-term efficient than any other technique available for the treatment of morbid obesity.

Cross-Sectional Studies↗
PubMed1998

Morbidity after transsternal thymectomy for myasthenia gravis: a changing perspective?

A detailed assessment of recent changes in morbidity and mortality after transsternal thymectomy for myasthenia gravis is pending. To this end, a retrospective analysis was carried out of morbidity and mortality rates in 125 patients subjected to transsternal thymectomy for myasthenia gravis in the periods 1976-85 (1st decade) and 1986-95 (2nd decade). Composition of patients did not change much over time, except for more concomitant preoperative disease in the second decade (p = 0.001). None the less, complication rates were not higher, nor did the pattern of complications alter. Mortality was nil in both decades. There was no difference over the decades as to length of ventilation, intensive care treatment, or overall hospitalization. Most complications did not reveal a monocausal relationship, suggesting that a combination of risk factors was implicated. Further reductions in future morbidity rates after transsternal thymectomy for myasthenia gravis seem unlikely as patient preoperative state is unlikely to improve. In the light of the deteriorating preoperative patient condition, constant postoperative morbidity rates indicate that patient care has in fact improved.

Adult↗
PubMed1998

[Mortality and morbidity conference in radiology].

PURPOSE: To establish a morbidity and mortality conference in a radiology department as an instrument of quality assurance. METHODS: Since April 1995 a monthly conference is held in the radiology department. Complications of invasive diagnostic procedures (angiography and biopsy) and minimal invasive interventions are presented. Cases of morbidity (major complications) and mortality (deceased patients, who were examined or treated in the radiology department before) are discussed. The identification of cases was possible due to a data base that included all such procedures prospectively. RESULTS: Twenty cases of major complications were identified and discussed during 18 morbidity and mortality conferences in 1996 and 1997. Out of the 9 patients who died in our hospital and previously had an interventional procedure in the radiology department, one case was identified as being procedure-related. An analysis of this case was performed. CONCLUSION: With a formalised structure of case detection, the morbidity and mortality conference becomes a tool of a complete analysis of complications and a meaningful instrument for the solution of problems concerning procedure-related complications.

Aged↗
PubMed1981

Effect of the hemodialysis prescription on patient morbidity: report from the National Cooperative Dialysis Study.

This report summarizes morbidity in 151 patients in a cooperative trial designed to evaluate the clinical effects of different dialysis prescriptions. Four treatment groups were divided along two dimensions: dialysis treatment time (long or short), and blood urea nitrogen (BUN) concentration averaged with respect to time (TACurea) (high or low). Dietary protein was not restricted. There was no difference in mortality between the groups. Withdrawal of patients from the high-BUN groups for medical reasons was significantly greater than withdrawal from the low-BUN groups. Hospitalization was also greater in the high-BUN groups, but dialysis treatment time had no significant effects. The data indicate that the occurrence of morbid events is affected by the dialysis prescription. Increased morbidity appears to accompany prescriptions associated with a relatively high BUN. Conversely, morbidity may be decreased by prescriptions associated with more efficient removal of urea if the dietary intake of protein and other nutrients is adequate.

Adolescent↗
PubMed1994

Effect of surfactant on morbidity, mortality, and resource use in newborn infants weighing 500 to 1500 g.

BACKGROUND: The administration of surfactant decreased mortality, morbidity, and costs of care for very-low-birth-weight infants in clinical trials. The extent to which these benefits can be achieved in the usual clinical settings is not known. METHODS: We analyzed clinical and financial data obtained from 1985 to 1990 at 14 perinatal centers in the United States on 5629 neonates weighing 500 to 1500 g. The infants were divided into groups according to whether they were born before or after surfactant was introduced into clinical practice. Regression models controlling for race, sex, and birth weight were used to assess mortality, morbidity, and use of resources. Mortality rates specific for these variables were projected to the nation as a whole with reference to the 1985 U.S. birth cohort. RESULTS: The odds of death in the hospital for very-low-birth-weight infants were reduced by 30 percent after surfactant was introduced. Among infants with bronchopulmonary dysplasia, mortality declined 40 percent. Projections of mortality nationwide declined 5 percent. Eighty percent of the decline in the U.S. infant mortality rate between 1989 and 1990 could be attributed solely to the use of surfactant. Among the survivors, the overall odds of morbidity did not change, whether or not we adjusted for changes in race, sex, and birth weight. The odds of respiratory distress syndrome and pulmonary interstitial emphysema among the survivors declined by 20 percent and 40 percent, respectively, with surfactant. Inflation-adjusted charges per survivor declined by 10 percent, or $5,800, whereas the cost of care for each infant who died declined by 31 percent, or $4,400. CONCLUSIONS: The introduction of surfactant has led to decreased mortality and morbidity in very-low-birth-weight infants and to decreased use of resources both for infants who survive and for those who die.

Female↗
PubMed2001

Nutrition and maternal morbidity and mortality.

Nearly 600 000 women die every year from pregnancy related conditions and the maternal mortality rates (MMR = deaths per 100 000 live births) in developing countries may be as high as 1000 compared with less than ten in industrialised countries. In the light of the striking impact of deficiencies of micronutrients such as vitamin A and zinc on immune function, morbidity and mortality in children it seems reasonable to suggest that such deficiencies might play a contributing role in the high rates of morbidity and mortality in mothers. Hitherto, there has been rather little published on the contribution of malnutrition to maternal morbidity or mortality but recent results of micronutrient supplementation show a major effect of vitamin A or beta carotene supplementation on maternal mortality in Nepal and an impressive effect of a multiple micronutrient mixture on pregnancy outcome in Tanzania. There is now data showing that subclinical mastitis, a potential risk factor for mother to child transmission of HIV by increasing levels of virus in breast milk, is influenced by maternal diet in Tanzania and feeding patterns in South Africa. Considering the massive tragedy of maternal mortality the recent data provides opportunities for new, innovative nutritional interventions for the reduction of the global burden of maternal morbidity and mortality.

Ascorbic Acid↗
PubMed1995

The epidemiology of malaria in the Wosera area, East Sepik Province, Papua New Guinea, in preparation for vaccine trials. II. Mortality and morbidity.

Malaria mortality and morbidity were studied in a rural population of 4000 in the Wosera area, East Sepik Province, Papua New Guinea. Malaria accounted for 4.9% of the 162 deaths investigated by verbal autopsy and for 12.2% of the 49 deaths assessed through medical records. Malaria was the first cause of death in children aged 0.5-4 years. Of the 7795 subjects interviewed and bled during six cross-sectional community-based surveys, children of 1-4 years had the highest malaria-related morbidity. In this age group, point prevalences of fever, fever associated with parasitaemia, and fever plus Plasmodium falciparum (Pf) parasitaemia > or = 10,000 parasites/microliters blood were 5%, 4.1% and 1.5%, respectively. The corresponding figures for adults were 2%, 0.9% and 0.1%, respectively. The calculation of attributable fraction (AF) using a multiple logistic regression model showed that malaria accounted for 0.44 of all fevers in children of 1-4 years and 0.08 of the fevers in adults. Prevalence data derived from the AF estimate were compared with those calculated using different accepted density thresholds. The prevalences which best approximated the results from the logistic regression model were obtained using parasitaemia cut-offs of > or = 1000 Pf parasites/microliter in children aged 1-4 years and adults older than 19 years and of > or = 10,000 parasites/microliter in those aged 5-19 years. Prevalence of fever associated with parasitaemia was highly seasonal, with a peak at the beginning of the wet season. The geographical distribution of malaria morbidity was not uniform. The measurement of malaria-related morbidity, the identification of significant seasonal and local variation as well as the assessment of different methods of defining a clinical episode of Pf malaria are crucial for the design and evaluation of intervention studies, including field trials of antimalarial vaccines.

Adolescent↗
PubMed2000

Morbidity related to axillary irradiation in the treatment of breast cancer.

Some of the most debilitating morbidity after surgery and radiotherapy for breast cancer is related to treatment of the axilla. This includes persistent arm lymphoedema, impaired shoulder mobility and brachial plexopathy. Considerable research efforts have been carried out on the radiation pathogenesis and the clinical radiobiology of these clinical endpoints, which has enabled their severity and incidence to be minimized. It is clear that the radiation dose-response relationships for these late endpoints are very steep. In other words, even small changes in the exact dose fractionation and physical dose distribution can cause major changes in toxicity. In particular, in many treatment schedules dose fractions larger than 2 Gy have been used without a sufficient reduction in total dose to avoid increased late effects. This is important, as much of the available literature reports side effects after suboptimal dose-fractionation schedules and inferior radiotherapy techniques. Such reports are not representative of what can be achieved using modern radiotherapy. An interesting parallelism to the problems encountered in reviewing historical experience is found in the British breast litigation, the current status of which is presented in this article. Furthermore, morbidity after radiotherapy is strongly influenced by concomitant surgery and/or chemotherapy, and this should be allowed for when designing the overall treatment. Apart from other therapeutic modalities, it has been suggested that other exogenous factors have an influence on the risk of radiotherapy-related morbidity. However, patients' age and, in the case of lymphoedema, also obesity are the only factors that have been established with some certainty. Routine adjustment of radiotherapy dose in these cases is not recommended. Two current developments may strengthen the role of radiotherapy in the treatment of breast cancer. Sentinel node biopsy may allow nodal staging without major surgical excision of axillary nodes and this opens the possibility for a more optimal combination of radiotherapy and surgery in the management of the axilla. With more cancers now being detected by systematic screening programmes, this will also increase the possibilities for conservative management, which in most cases involves radiotherapy. In conclusion, the improved understanding of the clinical radiobiology of late sequelae after radiotherapy allows treatment schedules and techniques to be devised that are therapeutically effective while maintaining a minimal risk of serious, late morbidity.

Axilla↗
PubMed1998

Morbidity and mortality with dihydropyridines.

Calcium antagonists (CaAs) of the dihydropyridine type are widely used in the treatment of hypertension and other cardiovascular disorders. They are markedly effective in lowering elevated arterial pressure, and are well tolerated. Data from long-term intervention trials are emerging, which also show a beneficial effect on cardiovascular morbidity with the use of CaAs in the treatment of hypertension. The first such evidence was from the Shanghai Trial of Nifedipine in the Elderly (STONE), and, in February 1997, the Systolic Hypertension in Europe (Syst-Eur) trial was stopped prematurely because the active treatment, based on a CaA, was found to be significantly better than placebo in preventing cardiovascular disease. In addition, ongoing trials with dihydropyridine CaAs (e.g. the Hypertension Optimal Treatment [HOT] Study and the Swedish Trial in Old Patients with Hypertension-2 [STOP-2]) are close to termination. Final results are not yet available, but cardiovascular morbidity appears to be lower than expected in the HOT Study, suggesting a positive effect of the CaA-based therapeutic regimen. Claims of increased morbidity and mortality from the use of CaAs have been clearly refuted by the thorough scrutiny of all available data by a committee formed by the World Health Organization and the International Society of Hypertension. It can therefore be concluded that the available evidence on the use of dihydropyridine CaAs shows that these agents have a beneficial effect on morbidity. Whether this effect of CaAs is greater than that obtained with conventional therapies, such as diuretics and/or beta-blockers, will be shown by the STOP-2 Study, which is expected to be completed in 1998.

Calcium Channel Blockers↗
PubMed2002

Vertical gastric banding for morbid obesity: a long-term follow-up study.

OBJECTIVE: To investigate the long-term results of vertical gastric banding for morbid obesity. DESIGN: Follow-up study. SETTING: County hospital, Denmark. PATIENTS: 56 patients aged 20-55 years, 45 of whom were women. The median preoperative body mass index (BMI) was 41. INTERVENTIONS: Vertical gastric banding. MAIN OUTCOME MEASURES: Morbidity, weight and BMI before and 6, 12,24, and 36 months after the operation as well as in late 1999, a median of 15 years after the operation, together with a simple quality of life assessment. RESULTS: Minor complications were seen in 13 patients (23%) and major complications in 2 (4%). One patient died (2%). The median reduction in BMI 15 years after the operation was 22% (p < 0.0001). Thirteen patients (23%) had the gastric band removed because of penetration or stenosis. There was no significant difference in weight loss between these patients and the others. 41 (79%) of the 52 surviving patients attended the final follow-up. Late symptoms, dysphagia and heartburn, were seen in 16 (39%) and 24 (59%) of these 41 patients, respectively. Twenty-seven of the 41 patients (66%) stated that their quality of life had improved. The improvement in quality of life was significantly related to loss of weight (p < 0.01). CONCLUSION: Vertical gastric banding is an effective operation for morbid obesity with a low morbidity and mortality.

Adult↗
PubMed2003

Work characteristics and morbidity as predictors of self-perceived health status in Norwegian physicians.

AIMS: The purpose of this study was to assess whether work characteristics and morbidity are predictors of physical, psychological, and social functioning in physicians. METHODS: A cross-sectional study was undertaken of 1126 Norwegian physicians. For comparison of health status scores, the Short Form 36 questionnaire was used, adjusting for differences in age and gender where applicable. Somatic morbidity was classified on the basis of self-reported conditions and psychiatric morbidity with score on the 25-item Hopkins symptom checklist using a cut-off indicating clinical psychiatric disease. Multiple logistic regression analysis was used with SF-36 dimension score below/above the 10th percentile as the dependent variable. RESULTS: In the multivariate model, psychiatric comorbidity was a significant predictor in 7 of 8 dimensions of health status (odds ratio 0.17 to 0.49), and somatic comorbidity in 6 of 8 dimensions of health status (odds ratio 0.33 to 0.59). Working hours was a significant predictor of only one dimension of health status, general health, after adjustment for demographic and work-related variables. CONCLUSIONS: The most important predictors for most dimensions of health status among Norwegian physicians were the presence or absence of self-reported somatic or psychiatric morbidity, while working hours, choice of specialty, and position were less important.

Adult↗
PubMed2003

Cost, morbidity, and control of asthma in Hungary: The Hunair Study.

OBJECTIVE: To assess asthma-related morbidity, symptom control, and societal cost of asthmatic patients in Hungary. Secondary objective was to assess the relationship between asthma symptom control and costs incurred. METHODS: Three hundred seventy-eight pediatric asthma patients (6-14 years of age) and 711 adult asthma patients (18-55 years of age) in 19 pulmonary clinics were interviewed by their physicians regarding asthma-related drug therapy and recent (past 2 weeks) asthma morbidity (daytime asthma symptoms, nocturnal symptoms, limitation in daily activities resulting from asthma and asthma exacerbation). Physicians estimated patients' level of asthma control based on the Global Initiative of Asthma guidelines. Direct and indirect costs for asthma-related resources were determined based on patient reported 6 months' data except for drug costs that were based on patient reported 2 weeks of data. All cost data were annualized. RESULTS: Patients in the study were mostly prescribed inhaled controller medications for asthma symptom management (76.2% pediatric and 92.3% adult) during the 2 weeks preceding the survey. Asthma-related morbidity was experienced by 15% of pediatric patients and 30% of the adult patients at least once during the 2 weeks preceding the survey. Physician classified 69% of pediatric patients as having good control, 27.5% as having moderate control, and 2.8% as having poor control of their asthma. In the adult population, 50.7% were classified as having good control, 36.6% as having moderate control, and 12.7% as having poor control. The average total annual costs (direct and indirect costs) per patient were 833 EUR (897 USD) for pediatric patients and 632 EUR (681 USD) for adult patients. In both pediatric and adult patients the total costs were highest for patients with poor asthma control. The total cost per patient increased in the ratios of 1 to 1.4 to 2.4 for pediatric patients and 1 to 1.5 to 2.9 for adult patients with good, moderate, and poor control of asthma, respectively. CONCLUSION: Inhaled corticosteroids was the most frequent treatment prescribed for asthma patients in the study. However, patients reported substantial asthma-related morbidity. Children used more resources than adults, despite being classified as having better control. Patients with poor control of asthma symptoms incurred the highest societal cost, improving patient control may reduce cost to society by 40% or more.

Administration, Inhalation↗
PubMed2004

A primer on bariatric surgery: treatment of last resort for morbid obesity.

Morbid obesity represents the highest risk state of a growing national problem that is eminently preventable and therefore highly relevant to the disease management community. The obesity epidemic, the failure of conservative treatments to achieve long-term weight loss and heightened media attention to positive short-term results of bariatric procedures among national celebrities has resulted in a dramatic increase in the number of surgeries performed every year. Familiarity with the clinical issues surrounding morbid obesity and bariatric surgery is therefore essential to the disease management community. This paper reviews the state of bariatric surgery, common surgical approaches, their effectiveness, complications, impact on co-morbidities, cost and evolving insurance coverage policies. I also will propose a proactive approach to arrest disease progression to morbid obesity.

Adolescent↗