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At least 145 records · Page 8Linked to original sources
PubMed2007

Unanticipated death after discharge home from the emergency department.

STUDY OBJECTIVE: We measured the frequency of unanticipated death among patients discharged from the emergency department (ED) and reviewed these cases for patterns of potential preventable medical error. METHODS: This was a retrospective cohort of ED patients who were discharged to home from an urban tertiary-care facility after their evaluation, with subsequent case review. Subjects were aged 10 years and older, representing 387,334 visits among 186,859 individuals, February 1994 through November 2004. The main outcome was mortality. Deaths were assessed for relatedness to the last ED visit, whether the death was expected, and whether there was possible medical error. Deaths that were unexpected and related to the ED visit were analyzed using grounded theory to identify common themes among these cases. Error cases were identified as a subset of this group. RESULTS: We identified and reviewed 117 patients, or 30.2 deaths within 7 days of discharge per 100,000 ED discharges home (95% confidence interval [CI] 25.2 to 36.2 deaths). Of the 117 cases, 58 (50%) were unexpected but related to the ED visit and 35 (60%) of these had a possible error. For the unexpected, related group, there were 15.0 deaths within 7 days per 100,000 discharges home (95% CI 11.6 to 19.4 deaths); for the possible error group, there were 9.0 (95% CI 6.5 to 12.6 deaths). Four themes repeatedly emerged: atypical presentation of an unusual problem, chronic disease with decompensation, abnormal vital signs, and mental disability or psychiatric problem or substance abuse that may have made it less likely that the patient would return for worsening symptoms. CONCLUSION: Monitoring of death records can identify unanticipated deaths after health care encounters. Further hypothesis-driven research is needed to identify, prevent, or mitigate problems in care and reduce the rate of death after ED visit.

Adolescent↗
PubMed1975

Lung cancer mortality in World War I veterans with mustard-gas injury: 1919-1965.

A study of the mortality experience of three samples of World War I veterans totaling 7,151 U.S. white males was extended from 1956 through 1965 to learn whether a single exposure to mustard gas with respiratory injury was associated with increased risk of lung cancer in later life. Rosters of men born between 1889 and 1893 [2,718 exposed to mustard gas, 1,855 hospitalized with pneumonia in 1918, and 2,578 with wounds of the extremities (controls)] were traced via the Veterans Administration's death records. The 4,136 deaths reported were 95% of that expected. The conclusions of the original study were not altered by the additional 10 years of follow-up. Observed deaths from lung cancer numbered 69, or 2.5% for the mustard-gas group as compared to 33, or 1.8%, for the pneumonia group and 50, or 1.9%, for the controls. The risk of death from lung cancer among men gassed relative to that for the controls was estimated as 1.3, with 95% confidence limits of 0.9-1.9. These figures failed to make a strong case for a carcinogenic effect, apparently because a suffcient dose of mustard gas was not received,

Adult↗
PubMed2025

MUC5B promoter variant and survival in rheumatoid arthritis-associated interstitial lung disease.

OBJECTIVE: The objective of this study was to investigate the association between the MUC5B rs35705950 promoter variant and survival in RA-associated interstitial lung disease (RA-ILD). METHODS: We studied participants in the Veteran Affairs Rheumatoid Arthritis (VARA) registry with validated ILD diagnoses. Participants were followed until death or till the end of the study period. The MUC5B rs35705950 promoter variant was measured using an Infinium genotyping array, assuming autosomal dominant inheritance. Survival and cause of death were determined from VA death records and the National Death Index. Associations of the MUC5B promoter variant with survival were tested in Cox regression models, adjusting for potential confounders. RESULTS: Among 263 participants with RA-ILD (mean age 69 years, 95% male, 73% White, 85% smoking history), the MUC5B promoter variant was present in 33.5%. The mortality rate was similar between those with [12.2/100 PY (95% CI: 9.4, 15.8)] and without [11.1/100 PY (95% CI: 9.1, 13.5)] the variant. MUC5B status was not significantly associated with survival overall [aHR 0.97 (95% CI: 0.68, 1.37)] or when stratified by ILD pattern [clinical usual interstitial pneumonia (UIP) aHR 0.86 (95% CI: 0.55, 1.35); clinical non-UIP aHR 1.15 (95% CI: 0.63, 2.09)]. Further, MUC5B status was not significantly associated with respiratory-related [aHR 0.83 (95% CI: 0.42, 1.66)] or non-respiratory causes of death [aHR 1.08 (95% CI: 0.72, 1.62)]. CONCLUSION: While associated with RA-ILD risk, the MUC5B promoter variant was not predictive of survival among RA-ILD patients in this multicentre cohort. Further studies are needed to identify other genetic and non-genetic prognostic factors in RA-ILD to inform disease management.

Humans↗
PubMed1996

Accuracy of recording of deaths from asthma in the UK: the false negative rate.

BACKGROUND: A study was carried out to determine the extent to which asthma deaths are wrongly attributed to another cause on UK death certificates. METHODS: Deaths from all causes occurring anywhere in the UK were identified amongst 2382 subjects aged 16-64 years within three years of discharge following hospital treatment for asthma (ICD9 493) in hospitals in the South East Thames region. The deaths were reviewed by an expert panel to assess the proportion of asthma deaths identified by the panel which were attributed to another cause of death on the death certificate (false negatives). RESULTS: Eighty five deaths from all causes were identified in a mean follow up period of two years and three months. In 61 cases (72%) there was sufficient information for the expert panel to be confident about the cause of death. The panel identified 22 deaths from asthma, four of which were certified as non-asthma deaths (two as deaths from chronic obstructive pulmonary disease (COPD) and two as deaths from cardiovascular disease). The proportion of false negative death certificates was four of 22 (18%, 95% confidence interval (CI) 5 to 40). CONCLUSIONS: There is evidence that asthma deaths in the UK are wrongly certified as deaths from both chronic obstructive pulmonary disease and diseases of the cardiovascular system.

Adolescent↗
PubMed2006

Complications associated with neoadjuvant radiotherapy in the multidisciplinary treatment of retroperitoneal sarcomas.

INTRODUCTION: Retroperitoneal sarcomas (RPS) remain a therapeutic challenge due to high local recurrence rates. Preoperative RT offers theoretical advantages in the multidisciplinary care of RPS. The purpose of our study was to evaluate our experience using preoperative radiotherapy (PRT) in the treatment of RPS. METHODS: This is a single-institution review of patients with RPS treated with PRT from 1994 until 2004. Three radiation oncologists and four surgical oncologists were involved. Medical records, tumor registries, and death records were reviewed. RESULTS: Fourteen patients were included; nine were treated for primary presentation and five for recurrent disease. Histologic grade was grade I (n = 3), grade II (n = 3), and grade III (n = 8). Five patients received additional IORT. Radiotherapy complications were generally mild, including nausea (n = 3), diarrhea (n = 1), dehydration (n = 1), anemia (n = 1), and skin changes (n = 1); one required early cessation due to nausea. Thirteen patients had gross negative margins; while 7/13 had negative microscopic margins. Operative complications included anastomotic bleeding (n = 1), fluid collections (n = 2), ileus (n = 3), ascites (n = 2), temporary leg weakness (n = 1), and uncomplicated wound infections (n = 2). In patients with R0 or R1 resections, one and two year local control rates were 64 and 50%. Overall survival for all patients was 90% at 1 year and 74% at 2 years with median survival of 21 months. CONCLUSION: PRT and IORT can be administered effectively in carefully selected patients with resectable RPS. Larger multi-center studies are needed to delineate the role of PRT and IORT to improve local recurrence and survival rates in the treatment of RPS.

Aged↗
PubMed1984

Completeness of the Swedish Cancer Register. Non-notified cancer cases recorded on death certificates in 1978.

Of the death certificates issued in Sweden in 1978 and stating cancer as the underlying or contributory cause of death, 1634 cases were unrecorded in the national cancer register. In 62 per cent of the cases the criteria for cancer registration were fulfilled. The non-reported cases represented a total deficit of 4.5 per cent calculated on cancer deaths in 1978. The factors responsible for the deficit were investigated. When the diagnosis had been histologically/cytologically confirmed the deficit was less than 2 per cent but was about 30 per cent when the diagnostic basis was only clinical. More than half of the non-notified cancer patients were older than 75 years. Exclusion of this age group and of myeloma and leukaemia cases gave a cancer-register deficit of 2.3 per cent. Non-notification to the Swedish cancer registry can be diminished by supplementation with data from death certificates, as practised in other Nordic countries. On regional basis these death certificates will now be collected and used as a supplement to the cancer notification in Sweden.

Adolescent↗
PubMed1994

Functional status of persons with HIV infection in an ambulatory setting.

The objective of this project was to study the functional status of HIV-infected persons seen in an ambulatory care setting. We reviewed baseline clinical and demographic data on patients with HIV infection presenting for care between December 1988 and May 1991 at the HIV Clinic of the Johns Hopkins Hospital, an urban, primary care institution. Functional status was assessed at baseline in a comprehensive psychosocial assessment. Patients were asked to report on their ability to perform six activities of daily living (ADL) and nine instrumental activities of daily living (IADL). The main outcome measures were dependency in one or more ADL and death as ascertained by review of clinic death records and Maryland State Death Registries. All 728 patients had assessments of functional status. Of these, 18% reported dependencies in one or more activity, with most of these (14%) reporting dependencies in IADLs only. Dependencies were more common in persons with an AIDS diagnosis (32% vs. 15%, p < 0.001). The majority of the dependencies reported by AIDS patients were also in IADLs. Mean CD4 counts were lower for persons reporting dependencies than for those who reported no dependencies (p = 0.02). No independent associations were found between functional limitation and demographic variables. The risk of death was greater in patients with dependencies than in patients with no dependencies, even when adjusting for CD4 count and AIDS diagnosis (O.R. = 2.32, p = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed2002

Epilepsy and mortality: a record linkage study in a U.K. population.

PURPOSE: To examine patterns of mortality for a population with epilepsy compared with the nonepilepsy population. METHODS: The study used cross-sectional record linkage, combining an electronic death register with an epilepsy patient register constructed from a variety of routine health data sources collected from 1991 to 1997. The study was conducted in Cardiff and the Vale of Glamorgan, Wales, U.K., and included all deaths recorded between 1993 and 1996. RESULTS: There were 352 deaths for patients with epilepsy, 2.0% of all deaths. The crude mortality rates for patients with and without epilepsy were 36.2 and 9.9 per 1,000. The Standardised Mortality Ratio was 2.14 (95% CI, 1.74-2.55) for 1996 deaths. The single most common disease group was cancer, accounting for 66 (18.8%) of deaths for people with epilepsy (SMR, 1.47; 95% CI, 1.11-1.82). Significant excesses were demonstrated for cerebrovascular disease, diseases of the digestive system, respiratory diseases, and other causes of death. CONCLUSIONS: People with epilepsy have an increased mortality over the population as a whole. The main causes of death are those most common in the population as a whole and those that underlie the epilepsy itself.

Adult↗
PubMed2004

The effects of regional characteristics on alcohol-related mortality-a register-based multilevel analysis of 1.1 million men.

The aim of this study is to assess to what extent selected characteristics of functional regions affect alcohol-related mortality among men in Finland after adjusting for individual-level characteristics. The study was conducted as a multilevel Poisson regression analysis, with individuals (n = 1.1 million) as the first level and functional regions of Finland (n = 84) as the second level. The analysis covered men aged 25-64. The data are based on the 1990 census records, which were linked to death records in 1991-1996. The outcome measure was alcohol-related mortality, which was defined using information on the underlying and contributory causes of death. The individual-level covariates included age, education, socioeconomic status, marital status and mother tongue. The area-level variables considered were the proportion of manual workers, unemployment level, median household income, Gini coefficient of income, family cohesion, voting turnout, level of urbanisation and proportion of Swedish-speaking inhabitants. A high proportion of manual workers and of unemployed and low social cohesion (family cohesion and voting turnout) were found to produce adverse effects on alcohol-related mortality, and the independent effects of these variables remained after adjustment for all individual-level and area-level characteristics. The protective effect of high level of urbanisation was revealed after adjustment for other individual- and area-level characteristics. Neither mean income nor income inequality were related to alcohol-related mortality. Adjusting for individual-level variables diminished the average relative deviation of alcohol-related mortality among the functional regions by 41%. The inclusion of area-level characteristics in the model resulted in a total diminution of variation of 79%. The area characteristics considered in this study had a notable effect on alcohol-related mortality, although these effects were smaller than those of the individual-level characteristics. Fuller understanding of the mechanisms underlying the effects of area measures of social structure and cohesion on risky alcohol consumption and alcohol-related mortality is needed.

Adult↗
PubMed1994

[Use of vital statistics in maternal mortality prevention programs].

"In the first part of the article the vital statistics system of the Republic of Argentina is presented, highlighting its characteristics as a data source, the integrity of its death records, the quality of the medical certification as to the cause of death by means of indirect indicators and the under registration of maternal causes. In the second part, the results of a research on maternal mortality carried out in the Federal Capital from 1987 to 1989, which was later extended to other jurisdictions of the country (Cordoba, Tucuman and Corrientes), is synthesized.... The principal objectives were...to know the real structure of maternal mortality in the Federal Capital and to identify the factors associated with it, in order to orient the activity of the health services and reduce these deaths." (SUMMARY IN ENG)

Americas↗
PubMed1995

Changes in surgical strategies for peptic ulcers before and after the introduction of H2-receptor antagonists and endoscopic hemostasis.

A total of 902 surgical patients with peptic ulcer disease were evaluated to clarify the effects of H2-receptor antagonists and endoscopic hemostasis on surgical treatment. Following the introduction of these treatments to our institute in 1982, the number of operations performed annually decreased by 40%, or 36 cases per year. However, a remarkable increase in the frequency of surgical emergency intervention since 1982 was concurrently observed, with the ratio of emergency procedures to the total number of operated cases increasing to 72.5% in the last 5 years of the study. Moreover, intractability as an indication for surgery decreased to 34.1%, compared with an increase in the number of patients with bleeding and perforated ulcers requiring operation. There were 13 postoperative deaths recorded (1.4%). All of the deaths were in patients who had undergone emergency surgery in poor health. Of these 13 patients, 10 had bleeding ulcers. A study of bleeding ulcers for which endoscopic hemostasis had been unsuccessful revealed that shock on admission and a concomitant medical condition had been evident in all the patients who died, and in 52.2% and 30.4% of the survivors, respectively. The current study suggests that the frequency of high-risk patients requiring surgery is increasing since the introduction of H2-receptor antagonists and endoscopic hemostasis, and thus, prompt surgical treatment and intensive management for such patients is essential.

Emergencies↗
PubMed1992

Mortality of intravenous drug users: attenders of the Wellington Drug Clinic, 1972-89.

A mortality study of 997 patients registered for treatment at the Wellington Drug Clinic since 1971 was undertaken by examining the New Zealand death records. Sixty-seven known deaths were reported. The mortality rates were increased 11.5 times under the age of 25 years, and 5.8 times for age 25-34 years, but not significantly thereafter. There were 7 deaths from trauma, 8 from suicide, and 28 accidental deaths. Myocarditis was the cause of death in four cases. In the 28 drug-related deaths the principle drugs incriminated were dextropropoxyphene, barbiturates, chloral hydrate, methadone and other opiates. Twenty-one deaths were due to unrelated diseases. It was considered important to document mortality in intravenous drug users in the 'pre-HIV' era. This study demonstrates quite low death rates from opioid drugs themselves.

Journal Article↗
PubMed1984

Reactions to the death of a parent. Results from patients and field subjects.

The authors studied two groups of persons who had experienced either the death of a mother or father. One group consisted of patients who had sought treatment because of pathological aspects of bereavement. The other group consisted of volunteers selected from a review of hospital death records, which indicated the recent death of their parent. The study used a nonequivalent groups design, where both groups were followed over time. The field subjects were initially seen much sooner after the death than the patients. The patient group received a time-limited dynamic therapy focused on the stress response syndrome induced by the death. At the pretherapy evaluation point, the patient sample had significantly higher levels of symptomatic distress than did the nonpatient sample. The distress declined over a 13-month period, so that patients had comparable levels of distress to that of the field subjects. After adjusting for initial values, the main difference was that patients reduced their avoidant operations more than did the field subjects. Intervening variables were assessed for the prediction of change in symptoms over time as related to the parental death. The variables that showed significant correlations to symptomatic change were cumulative negative life events from varied sources, occupation, social class, developmental level of the self-concept, identity of the deceased parent, and attribution of blame for the death. Social support did not relate to change in symptoms over time.

Adaptation, Psychological↗
PubMed1998

[Quality of death certificates in cases of cancer death in France].

International mortality statistics are based on death certificates on which the causes of death are coded using the World Health Organization's International Classification of Diseases. Most of these statistics are based on the underlying cause of death and do not use the contributory causes of death. We studied the validity of death certificates in a sample of 1,194 French patients known to have died of cancer, comparing the cause of death reported on the death certificate with the cause of death found in the medical record. Death certificates correctly identify cancer as the cause of death in 95% of the cases and with the exact site in 86% of the cases.

Cause of Death↗
PubMed1985

Changes in incidence and prognosis of ischaemic heart disease in Finland: a record linkage study of data on death certificates and hospital records for 1972 and 1981.

The components of the decline in mortality from ischaemic heart disease in Finland were studied by analysing the changes in incidence and prognosis between 1972 and 1981. Using personal identification numbers, hospital discharge records and death certificates were linked for all men and women aged 40-64. During this period mortality decreased 15.9% in men and 23.5% in women, incidence 14.2% in men and 19.3% in women, being greatest among 40-49 year olds living in urban areas, and case fatality 7.3% in men and 10.3% in women, owing primarily to a decrease in patients dying of ischaemic heart disease without being admitted to hospital; survival was also better among patients admitted to hospital. Factors explaining these changes remain unknown because data on risk factors and factors influencing prognosis are limited and largely ecological.

Adult↗