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1
Al-Haider, Abdolmohsin S. "Modeling the Determinants of Hospital Mortality." VCU Scholars Compass, 1988. https://scholarscompass.vcu.edu/etd/4329.
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This study examined hospital characteristics that affected the differential in hospital mortality, while controlling for the effect of community attributes. Analytical models for the determinants of hospital mortality were formulated and validated through an empirical examination of 243 hospitals that had higher or lower mortality rates than expected for Medicare beneficiaries. The dependent variable for this study was death rates for 1984 Medicare patients in united states hospitals released in 1986 by the Health Care Financing Administration.
Structural equation models that portray the causal relation between organizational constructs and hospital mortality rate were formulated. This causal model was empirically validated. The findings suggest that the "size" effect on hospital mortality is a spurious one. Specialization was found to be negatively related to hospital mortality when the effects of other variables were simultaneously controlled. Hospitals having a higher degree of specialization tended to have a lower mortality rate. The effect of service intensity on hospital mortality was statistically significant when control variables were added into the equation. Thus, a hypothesized positive relationship between service intensity and hospital mortality was confirmed; the greater the service intensity, the higher the mortality.
Ownership and crude death rate both had a negligible effect on hospital mortality. The only control variable that was statistically significant is "teaching status". The teaching hospitals had a lower mortality rate than nonteaching hospitals did when other organizational factors were controlled.
2
Fan, Sheung Tat, and 范上達. "Hepatectomy for hepatocellular carcinoma: towards a zero hospital mortality." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1997. http://hub.hku.hk/bib/B31981653.
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Fan, Sheung-tat. "Hepatectomy for hepatocellular carcinoma : towards a zero hospital mortality /." Hong Kong : University of Hong Kong, 1997. http://sunzi.lib.hku.hk/hkuto/record.jsp?B19537220.
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Pangelinan, Michelle, Kathleen Whitmore, and Grant Skrepnek. "Charges and Mortality Associated with Melanoma Complications in a Hospital Setting." The University of Arizona, 2013. http://hdl.handle.net/10150/614277.
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Class of 2013 AbstractSpecific Aims: The purpose of this project was to determine inpatient charges, as well as define the frequency and mortality associated with the various sites of melanoma metastasis. Methods: Data was taken from the national database Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (H-CUP) Nationwide Inpatient Sample (NIS) and was collected on patients admitted into hospital with any diagnosis of melanoma with disease progression of distant metastasis. Logistic multivariate regression was used to find odds ration by patient characteristic. Overall charges were assessed using a gamma multivariant regression. Multiariant regression was used to determine other patient demographics. Main Results: Average inpatient charges for stage IV melanoma was $32,296 per patient with a national inpatient total bill of $5.56 billion. The metastatic sites associated with the highest inpatient charges were genitourinary tract (exp B = 1.276), gastrointestinal tract (exp B=1.146), bone (exp B=1.132), lung (exp B=1.097), and lymph (exp b=1.092). The most common sites of melanoma dissemination for in-patient mortality cases were lymph (21.7%), lung and respiratory (19.2%), central nervous system (17.1%), and bone (17.1%). Conclusion: The annual average hospital charges per patient for melanoma with distant metastasis is about $32,000. We suggest that metastases of the genitourinary tract, gastrointestinal tract, bone, lung, and lymphatic system are associated with the highest hospital charges, while metastases to the CNS, bone, liver, lung, GI, and wide dissemination are associated with increased mortality.
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Asadollahi, Khairollah. "Mortality association of routine laboratory variables in hospital admissions and introducing a new predictive mortality model." Thesis, University of Liverpool, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.430892.
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Chauke, Bafedile Evah. "A mortality profile of patients admitted to Dr George Mukhari Hospital in 2008." Thesis, University of Limpopo (Medunsa Campus), 2010. http://hdl.handle.net/10386/541.
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Thesis (M. Med. (Community Health))--University of Limpopo (Medunsa Campus), 2010.Introduction: Mortality profiles form very important components of the public health information system and are used widely to inform important planning decisions at managerial level. Aim: To determine and describe the mortality profile of patients admitted to Dr George Mukhari Hospital in 2008. Methods and quality: Cause of death information was collected from the death notification register situated in the hospital mortuary. A representative sample of 6 months out of the 12 months of the year was chosen in such a way as to represent all the seasons of the year to minimize bias from seasonal variation that could influence cause of death patterns. A total of 3790 deaths were captured in the death register for 2008 and 1968 deaths (52%) of the deaths were analyzed. 53% of the deaths occurred in males while 47% were in females. Most of the records captured were complete with very minimal missing data variables for analysis. Findings: Non-communicable conditions contributed to the highest burden of mortality at 43%, followed by communicable diseases at 38%. HIV and AIDS seemed to be prominently contributing to mortality in Dr George Mukhari Hospital. In keeping with global statistics, cancer was also a leading cause of death in the older age groups. The neonatal period was the highest risk period for death in children under 5 years of age. Post neonatal children die more from pneumonia, diarrhoeal conditions and malnutrition. Discussions and conclusions: Routine statistics collected by the hospital should be modified to include some important variables such as additional information on the broad causes of death or even utilization of the National Injury Surveillance System to assist with decision making. There should be strategies to improve more accurate capturing of HIV and AIDS deaths and Injury related deaths. Based on the similarity of the mortality profile to the rest of the province and the country, existing national and provincial programme strategies can be used for better planning for the illustrated health service needs.
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Molloy, Eamonn S. "Cardiovascular outcomes and in-hospital mortality in fiant cell arteritis." Cleveland, Ohio : Case Western Reserve University, 2008. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=case1212093974.
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Molloy, Eamonn S. "Cardiovascular Outcomes and In-Hospital Mortality in Giant Cell Arteritis." Case Western Reserve University School of Graduate Studies / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=case1212093974.
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Huang, Jiajia, and L. Lee Glenn. "Effect of Geographic Region and Seasonality on Clostridium Difficile Incidence and Hospital Mortality." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/7459.
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The recent study by Argamany et al1 concluded that the incidence and hospital mortality for Clostridium difficile infection (CDI) differed between major regions of the United States and across different seasonal times of the year. However, these conclusions were not supported by the data in their study because the authors based them exclusively on statistical significance without considering the effect size of their findings. The effect sizes of region and season on CDI were very low or near zero, contradicting their conclusion, as subsequently explained.
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Shin, Jung-Ho. "New outcome-specific comorbidity scores excelled in predicting in-hospital mortality and healthcare charges in administrative databases." Doctoral thesis, Kyoto University, 2021. http://hdl.handle.net/2433/263579.
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Wu, Yanlan, and 吴艳兰. "Risk factors for death in pediatric intensive care unit of a tertiary children's hospital in Guangzhou city." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206970.
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Background:
Most of the previous studies about risk factors associated with death in pediatric intensive care unit (PICU) were done in western countries and focused on physiological and laboratorial indexes. Some of them had inconsistent results. There were few studies about the epidemiologic profile of mortality and risk factors associated with death in the PICU in China. Compared with other countries, China has different health care policy, insurance system, population, culture, and socioeconomic situation that may affect disease outcomes differently. Some data showed that Chinese PICUs had higher mortality. It is important to know more about the possible factors associated with excess death in PICU in a Chinese setting.
Objectives:
The objectives of this study were to estimate mortality (incidence proportion of death) in pediatric intensive care unit (PICU) in a tertiary hospital and identify the main risk factors associated with death in PICU.
Methods:
This was a case-control study. We retrospectively investigated the clinical data of patients who were admitted to the PICU during January 2010 to December 2013 in a tertiary hospital in Guangzhou, China. All the dead cases in PICU during the studied period were chosen as cases, and the controls were randomly selected from the patients who were alive when they were discharged from the PICU during the same period. The incidence proportion of death was estimated, and then logistic regression model was carried out to explore the risk factors for death.
Results:
The overall mortality in this PICU was 6.5% (95% CI 5.6 % - 7.4%) during January 2010 to December 2013. The following factors were found to have significant association with higher risk for death: middle level socioeconomic status (OR 2.51, 95% 1.07 - 5.87) and low level socioeconomic status (OR 5.86, 95% CI 2.32 - 14.77) compared with the high level socioeconomic status; admission from pediatric emergency observation unit (OR 2.08, 95% CI 1.10 - 3.91) compared with admission from transfer system (i.e. other hospital); critical severity of disease (OR 2.62 , 95% CI 1.48 - 4.64), and seriously critical severity of disease (OR 8.41, 95% CI 3.26 - 21.67) compared with non-critical severity of disease ; existence of multiple organ dysfunction syndrome (OR 3.64, 95% CI 1.91- 6.91) compared with absence of multiple organ dysfunction syndrome; existence of comorbidity (OR 3.14, 95% CI 1.68 - 5.86) compared with absence of comorbidity; infectious disease (OR 2.42, 95% CI 1.07- 5.49), neoplasm (OR 4.53, 95% CI 1.63 - 12.62), neurological disease ( OR 4.21, 95% CI 1.85 - 9.59) and endocrine, immune and nutritional disease (OR 7.56,
95% CI 2.10 - 27.20 ) compared with respiratory disease .
Conclusion:
Our study was the first one to comprehensively investigate the risk factors for death in PICU of a tertiary hospital in China. We described profile of dead cases, estimated the mortality and investigated the risk factors associated with death in PICU. During January 2010 to December 2013 the mortality in the PICU was found to be 6.5%, and risk factors for higher mortality in PICU included lower level socioeconomic status, admission from the pediatric emergency observation unit, more severe conditions of disease, presence of comorbidity and multiple organ dysfunction syndrome, and disease categories of infectious diseases, neoplasm, neurological disease, and endocrine, immune and nutritional disease. Our study provided information for developing preventive strategy to reduce the mortality in PICU.published_or_final_version
Public Health
Master
Master of Public Health
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Hoang, Uy Hoang. "Characterising recent mortality trends in people with bipolar disorder and schizophrenia in England using linked hospital and mortality data." Thesis, King's College London (University of London), 2013. https://kclpure.kcl.ac.uk/portal/en/theses/characterising-recent-mortality-trends-in-people-with-bipolar-disorder-and-schizophrenia-in-england-using-linked-hospital-and-mortality-data(1bd34481-f6b2-42ca-ad96-02a684ff9a26).html.
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Background and objectives Mortality is higher in people with severe mental illness than others. An important policy goal is to reduce this ’mortality gap’. The objectives of this thesis were to investigate whether the gap has reduced in recent years in people with bipolar disorder or schizophrenia, to quantify the extent of ’avoidable mortality’ in these people, and to investigate whether the excess mortality risk extends to people with a physical illness as a main diagnosis and comorbid SMI. Method Three separate record linkage studies were undertaken study using Hospital Episode Statistics and death registration data about patients discharged from inpatient care in England between 1999 and 2007. Results Findings showed that the mortality gap widened over the last decade for people with bipolar disorder and schizophrenia. For people discharged with bipolar disorder the SMR increased from 1.3 to 1.9 between 1999 and 2006 (Poisson test of trend, P=0.06). Whilst for people discharged with schizophrenia the SMR increased from 1.6 to 2.2 (P<.001). Potentially avoidable deaths comprised 59-2% and 60.2% of all deaths in people with a diagnosis of bipolar disorder and schizophrenia respectively. The results showed that comorbidity with mental illness in people with a main diagnosis of CVD causes between 12-46% excess deaths compared with those without mental comorbidity, and between 43-68% excess deaths in people with a main diagnosis of Diabetes. Conclusion The total burden of premature deaths in these populations is substantial and increasing. excess in SMI by about 50%, but not eliminate it entirely. These results strongly point to the need for better understanding of the reasons for the persistent mortality gap; and for continued action to target risk factors for both natural and unnatural causes of death in people with SM.
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Nishigori, Tatsuto. "Impact of hospital volume on risk-adjusted mortality following oesophagectomy in Japan." 京都大学 (Kyoto University), 2017. http://hdl.handle.net/2433/225466.
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Clements, Linda. "CAREGIVERS’ INFLUENCE ON PATIENTS’ HEART FAILURE SELF-CARE, HOSPITAL READMISSION AND MORTALITY." UKnowledge, 2019. https://uknowledge.uky.edu/nursing_etds/48.
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Background: Heart failure (HF) is a leading cause of hospitalization, readmissions, and death in the United States. Patients hospitalized for HF are at risk for readmission, in- hospital mortality, and early post-discharge death. In the United States, inpatient care has been estimated to cost $83,980 over the lifetime of each patient with HF. The majority of patients with HF depend on caregiver support for successful HF self-care, which is essential for optimal patient outcomes. Support from caregivers is thought to be important for better self-care, and lower readmission and mortality rates. Yet, there are few studies considering the influence of caregivers on HF patient self-care, readmission, and mortality.
Objective: The purpose of my dissertation was to determine the influence of HF caregivers on patient self-care, readmission, and mortality. The specific aims of this dissertation were to: (1) to determine if caregiver depressive symptoms mediate the relationship between family functioning and caregiver quality of life, (2) to determine if there is an association between living arrangements (living with someone vs. living alone) and all-cause readmission and death in patients with HF, and (3) to determine the efficacy of an in-hospital, multi-session, educational intervention for caregivers on heart failure patients’ self-care and 30 day readmission rate, and to evaluate the efficacy of the intervention on caregivers’ knowledge, self-efficacy and perceived control.
Methods: Specific aim one was addressed by a secondary analysis of data from one- hundred and forty-three HF caregivers recruited from an outpatient clinic. Multiple regression with mediation analysis was used to determine whether depressive symptoms mediated the relationship between family functioning as measured using the three scales of the Family Assessment Device (i.e., general, problem-solving, communication) and caregiver quality of life. Specific aim two was addressed by a retrospective chart review of all 398 patients with a primary diagnosis of HF admitted to an academic medical center in one year. We collected data on patient sociodemographic, clinical characteristics, and patient living condition. The independent association of living alone with all-cause readmission or all-cause death was evaluated using Cox proportional hazards modeling adjusting for covariates. Specific aim three was addressed using a two-group (educational intervention for caregivers of patients with heart failure vs. usual educational care), prospective, repeated measures randomized controlled trial of 37 patient and caregiver dyads in which caregivers only received in-hospital HF education. Outcome measures included patient self-care, and patient all-cause readmission or all- cause death, as well as caregiver self-efficacy, knowledge, and perceived control. Patient self-care, and caregiver self-efficacy, knowledge, and perceived control were assessed at baseline (in hospital), at discharge, 7 and 30-days after patient discharge. Patient readmissions and death were assessed by a phone call at 30-days follow-up. The intervention directed only at caregivers consisted of three in-hospital, educational sessions with telephone follow-up. The educational sessions were designed to deliver HF information and skills to caregivers, thereby providing them with the resources needed to improve their self-efficacy, perceived control and HF knowledge thus improving patient self-care and readmission rates.
Results: Specific aim one: The three subscales of the Family Assessment Device predicted depressive symptoms (p < 0.001) and caregiver quality of life (p < 0.001). Depressive symptoms also predicting caregiver quality of life (p < 0.001). The inclusion of depressive symptoms in the final model with each subscale of the Family Assessment Device (i.e., general family functioning, problem-solving, communication) decreased the significance of family functioning as a predictor of caregiver quality of life indicating mediation by depressive symptoms. Specific aim two: Heart failure patients living with someone experienced a significantly longer time to rehospitalization than those living alone (290 vs. 201 days, p=0.005). In a Cox regression hazard regression model, adjusting for covariates, patients who lived alone were 1.42 times more likely to be rehospitalized one year after discharge than those who lived with someone (p=0.013). The relationship between living alone and all-cause death was not significant after adjustment for covariates. Specific aim three: A linear mixed-model analysis revealed that patients whose caregiver was in the intervention group had significantly better self- care maintenance (p < 0.001) and self-care management (p < 0.001) across time. Cox survival analysis demonstrated that patients whose caregiver did not receive the educational intervention were 11 times more likely (p=0.002) to experience cardiac readmission than patients whose caregiver did receive the educational intervention. Caregivers who received the educational intervention had higher perceived control (p < 0.001) for up to 30-days post-intervention versus the control group, however, there were no differences between caregiver groups in self-efficacy and HF knowledge.
Conclusion: In this dissertation, we found caregivers to play an important part in improving patient outcomes of self-care and readmission after discharge from a hospitalization for HF. Future large-scale studies are needed to develop and test interventions focused on caregivers to improve both patient and caregiver outcomes. Such studies will assist clinicians in understanding how better to support caregivers in their ability to positively influence HF self-care and readmission rates in patients with HF.
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George, Allison M., and Erin N. Baguley. "Clinical and Economic Characteristics of Inpatient Esophageal Cancer Mortality in the United States." The University of Arizona, 2010. http://hdl.handle.net/10150/623745.
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Class of 2010 AbstractOBJECTIVES: To assess disease-related and resource consumption characteristics of esophageal cancer mortality within hospital inpatient settings in the United States from 2002 to 2006. METHODS: This retrospective investigation of adults aged 18 years or older with diagnoses of malignant neoplasms of the esophagus (ICD-9: 150.x) utilized nationally-representative hospital discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample. Cases resulting in inpatient death were analyzed with respect to patient demographics, payer, hospital characteristics, number of procedures and diagnoses, Deyo-Charlson disease-based case-mix risk adjustor, and predominant comorbidities. RESULTS: Overall, 168,450 inpatient admissions for esophageal cancer were observed between 2002 and 2006, averaging 66.3 + or - 11.9 years, length of stay of 10.3 + or - 15.2 days, and charge of $51,600 + or _ 92,377. Predominant comorbidities within these persons included: secondary malignant neoplasms; disorders of fluid, electrolyte, and acid-base balance; pneumonia; respiratory failure/collapse or insufficiency; sepsis; anemia; hypertension; cardiac arrhythmias; obstructive pulmonary disease; acute or chronic renal disease; and heart failure. Significant predictors of increased charges included longer lengths of stay, higher numbers of diagnoses and procedures, median annual family income over $45k, urban hospital location, and presence of heart failure, chronic pulmonary disease, fluid and electrolyte disorders, or metastatic cancers (P< or = 0.05). Longer lengths of stay were associated with higher total charges, female sex, larger number of diagnoses and procedures, Medicaid, black race, increased case-mix severities, and fluid and electolyte disorders (P< or = 0.05). CONCLUSIONS: Patient mortality occurs in over one-tenth of esophageal cancer hospital admission cases. Further research is warranted to understand the impact of various comorbidities or treatment approaches and to assess potential disparities in lengths of stay.
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Motzkus, Christine. "Recent Trends in Sepsis Mortality, Associations between Initial Source of Sepsis and Hospital Mortality, and Predictors of Sepsis Readmission in Sepsis Survivors." eScholarship@UMMS, 2017. https://escholarship.umassmed.edu/gsbs_diss/891.
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Background: Sepsis, a leading cause of US deaths, is associated with high mortality, although advances in early recognition and treatment have increased survivorship. Many aspects of sepsis pathophysiology and epidemiology have not been fully elucidated; the heterogeneous nature of infections that lead to sepsis has made fully characterizing the underlying epidemiology challenging.
Methods: The University HealthSystem Consortium (UHC) from 2011-2014 and the Cerner HealthFacts® database from 2008-2014 were used. We examined associations between infection source and in-hospital mortality in the UHC dataset, stratified by age and presenting sepsis stage. We examined recent temporal trends in present-on-admission (POA) sepsis diagnoses and mortality and predictors of 30-day sepsis readmissions following sepsis hospitalizations using the HealthFacts® dataset.
Results: Patients with sepsis due to genitourinary or skin, soft tissue, or bone sources had lower mortality than patients with sepsis due to respiratory sources regardless of age or presenting sepsis stage. Overall diagnoses of sepsis increased from 2008-2014; however, POA diagnoses and case fatality rates decreased. Factors that predicted re-hospitalization for sepsis included discharge to hospice, admission from or discharge to a skilled nursing facility, and abdominal infection.
Conclusion: Further investigation will reveal more detail to explain the impact of infection source on in-hospital sepsis mortality for all age groups and sepsis stages. Decreasing mortality rates for all POA sepsis stages and all age groups suggest current approaches to sepsis management are having broad impact. Sepsis survivors are at significant risk for re-hospitalization; further studies are needed to understand the post discharge risks and needs of survivors.
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Motzkus, Christine. "Recent Trends in Sepsis Mortality, Associations between Initial Source of Sepsis and Hospital Mortality, and Predictors of Sepsis Readmission in Sepsis Survivors." eScholarship@UMMS, 2004. http://escholarship.umassmed.edu/gsbs_diss/891.
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Background: Sepsis, a leading cause of US deaths, is associated with high mortality, although advances in early recognition and treatment have increased survivorship. Many aspects of sepsis pathophysiology and epidemiology have not been fully elucidated; the heterogeneous nature of infections that lead to sepsis has made fully characterizing the underlying epidemiology challenging.
Methods: The University HealthSystem Consortium (UHC) from 2011-2014 and the Cerner HealthFacts® database from 2008-2014 were used. We examined associations between infection source and in-hospital mortality in the UHC dataset, stratified by age and presenting sepsis stage. We examined recent temporal trends in present-on-admission (POA) sepsis diagnoses and mortality and predictors of 30-day sepsis readmissions following sepsis hospitalizations using the HealthFacts® dataset.
Results: Patients with sepsis due to genitourinary or skin, soft tissue, or bone sources had lower mortality than patients with sepsis due to respiratory sources regardless of age or presenting sepsis stage. Overall diagnoses of sepsis increased from 2008-2014; however, POA diagnoses and case fatality rates decreased. Factors that predicted re-hospitalization for sepsis included discharge to hospice, admission from or discharge to a skilled nursing facility, and abdominal infection.
Conclusion: Further investigation will reveal more detail to explain the impact of infection source on in-hospital sepsis mortality for all age groups and sepsis stages. Decreasing mortality rates for all POA sepsis stages and all age groups suggest current approaches to sepsis management are having broad impact. Sepsis survivors are at significant risk for re-hospitalization; further studies are needed to understand the post discharge risks and needs of survivors.
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Linares-Linares, Mariela Alejandra, Jorge Arturo Figueroa-Tarrillo, Viacava Renato Cerna, Nilton Yhuri Carreazo, and Renzo P. Valdivia-Vega. "Risk factors associated to hospital mortality in patients with acute kidney injury on hemodialysis." Medwave, 2017. http://hdl.handle.net/10757/622342.
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INTRODUCTION: The worldwide incidence of acute kidney injury is 18% and the overall hospital mortality can rise above 50%. In Peru, there are few series about mortality of acute kidney injury in hemodialysis patients.
OBJECTIVES: To identify risk factors associated to hospital mortality of acute kidney injury in hemodialysis patients.
METHODS: This is a retrospective cohort of patients with acute kidney injury in hemodialysis of Hospital Nacional Edgardo Rebagliati Martins gathered between January 2013 and December 2015. The sample size was 154 patients which allowed a power of 80% and a CI of 95%. ICD-10 codes were used to identify medical records of patients with acute kidney injury (N.17) and hemodialysis (Z.49). The independent variable was oliguria, and the primary outcome was hospital mortality. Poisson regression was used for multivariate analysis.
RESULTS: We identified a total of 285 patients; 212 medical records were analyzed and 44 were excluded. Out of the 168 medical records, 129 belonged to living patients and 39 to deceased ones. The overall mortality incidence was 17.2%. The principal etiologies of acute kidney injury while in hemodialysis were sepsis (39.2%), and severe dehydration (10.8%). In the adjusted model, the risk factors associated to hospital mortality of acute kidney injury while in hemodialysis were elevated serum lactate (RR 1.09), elevated serum potassium (RR 0.93), and mean arterial pressure (RR 0.97).
CONCLUSIONS: Lactate is an objective parameter that can predict prognosis and contributes to a better management of acute kidney injury in hemodialysis patients.
INTRODUCCIÓN: La incidencia de insuficiencia renal aguda a nivel mundial es 18% y la mortalidad intrahospitalaria puede alcanzar más del 50%. En Perú, existen escasos estudios acerca de la mortalidad en pacientes con insuficiencia renal aguda en hemodiálisis.
OBJETIVOS: Identificar los factores de riesgo asociados a mortalidad intrahospitalaria en pacientes con insuficiencia renal aguda en hemodiálisis.
MÉTODOS: Es una cohorte retrospectiva, en la cual se estudió a los pacientes con insuficiencia renal aguda en hemodiálisis en el Hospital Nacional Edgardo Rebagliati Martins entre enero de 2013 y diciembre de 2015. Se halló un tamaño de muestra de 154 pacientes con una potencia de 80%, y un intervalo de confianza de 95%. Se utilizaron los códigos de la Clasificación Internacional de Enfermedades-10 para identificar las historias clínicas de pacientes con insuficiencia renal aguda (N.17) y hemodiálisis (Z.49). La variable independiente fue oliguria y la variable dependiente fue mortalidad intrahospitalaria. Para el análisis multivariado, se utilizó regresión de Poisson.
RESULTADOS: El universo fue de 285 pacientes. Se revisaron 212 historias clínicas y se excluyeron 44. De las 168 historias clínicas estudiadas, 129 pertenecían a pacientes vivos y 39 a fallecidos. La incidencia de mortalidad fue de 17,2%. Las principales causas de insuficiencia renal aguda en hemodiálisis fueron sepsis (39,2%) y deshidratación severa (10,8%). En el modelo ajustado, los factores de riesgo asociados a mortalidad intrahospitalaria de insuficiencia renal aguda en hemodiálisis fueron lactato (riesgo relativo 1,09), potasio (riesgo relativo 0,93), y presión arterial media (riesgo relativo 0,97).
CONCLUSIONES: El lactato es un parámetro objetivo que permite predecir el pronóstico y contribuye a un mejor manejo de los pacientes con insuficiencia renal aguda en hemodiálisis.
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Guanabara, Everardo de Macedo. "Perfil EpidemiolÃgico da Mortalidade Materna em Hospital TerciÃrio no Cearà - 2004 a 2008." Universidade Federal do CearÃ, 2010. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=5627.
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CoordenaÃÃo de AperfeiÃoamento de NÃvel SuperiorObjetivo. Analisar os Ãbitos maternos no Hospital Geral CÃsar Cals no perÃodo 2004 a 2008 quanto aos aspectos sociodemogrÃficos, assistenciais e a opiniÃo do comità de morte materna, constituindo o perfil epidemiolÃgico e clÃnico desta populaÃÃo. Metodologia. Estudo transversal, de carÃter descritivo e analÃtico de 70 Instrumentos de NotificaÃÃo de Ãbito de Mulher em Idade FÃrtil e de InvestigaÃÃo Confidencial do Ãbito Materno. Foram comparados os Ãbitos ocorridos por causas diretas e indiretas e aqueles ocorridos em pacientes provenientes de Fortaleza com aqueles de outros municÃpios. Foram empregados os testes qui-quadradro de Pearson e de Yates, teste exato de Fisher e teste nÃoparamÃtrico de Mann-Whitney. Considerou-se p< 0,05 como significativo. Resultados. A idade variou de 15 a 43 anos (mÃdia de 27,0  7,4 anos). Vinte e cinco (35,71%) eram procedentes da prÃpria Capital Fortaleza, e 45 (64,29%) de outros municÃpios. A maioria era de cor parda, vivia com companheiro, primÃparas ou secundÃparas. A maioria frequentou o prÃ-natal: elas iniciaram o prÃ-natal ainda no primeiro trimestre, mas realizaram menos de seis consultas. A maioria teve o parto por via abdominal com recÃm-nascidos vivos. A RMM foi de 227,37/100.000 NV (causas diretas 129,37/100.000 NV e indiretas 74,48/100.000 NV). As RMM geral e especÃficas (diretas e indiretas) apresentaram linhas de tendÃncia crescente ao longo dos anos avaliados. O tempo de internamento foi menor para os Ãbitos de causas diretas (p = 0,008) e para pacientes provenientes de municÃpios diferentes de Fortaleza (p<0,002). O inÃcio do prÃ-natal no primeiro trimestre foi mais frequente para as pacientes de fora da Capital (p = 0,027). Quanto a assistÃncia prÃ-natal, ao parto ou aborto e ao puerpÃrio, foi possÃvel realizar somente anÃlise descritiva para as pacientes da cidade de Fortaleza, segundo opiniÃo do Comità de Ãtica. ConclusÃes. A RMM no HGCC foi muito alta, com tendÃncia crescente. O tempo de internamento foi maior para as pacientes que evoluÃram para Ãbito por causas indiretas e de Fortaleza. Segundo o ComitÃ, a assistÃncia foi considerada inadequada para as pacientes provenientes de Fortaleza.
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Saliba, Patrick. "The epidemiology of catheter related bloodstream infections in Bellvitge University Hospital: Prevention and mortality." Doctoral thesis, Universitat Internacional de Catalunya, 2018. http://hdl.handle.net/10803/663574.
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• Vascular catheters are the most used medical devices in healthcare settings.For the last decade,catheter-related bloodstream infections (CRBSIs) have been a major threat to patient’s safety.In Bellvitge University Hospital (BUH), a bundle of intervention was applied sequentialy from 2003 to 2016 to decrease the rate of CRBSIs.This research work highlights the epidemiology of the peripheral catheter-related bloodstream infections (PVCR-BSI) throughout this study period following the application of the bundle and from the other side it reflects on the risk factors associated with mortality among these episodes of CRBSI. In conclusion, this PhD thesis work demonstrates the effectiveness of the application of the multimodal prevention program in BUH in terms of reducing CRBSI, and emphasize that staphylococcus aureus and the Candida infections and a comorbidity index of Charlson score > 4, are risk factors for mortality among patients with CRBSIs.• Els catèters vasculars són els dispositius mèdics més utilitzats en els entorns assistencials. Per a l'última dècada, les infeccions del corrent sanguini relacionades amb el catèter (CRBSIs) han estat una gran amenaça per a la seguretat del pacient. A l'Hospital Universitari de Bellvitge (BUH), s'aplicava seqüencialment un paquet d'intervencions 2003 a 2016 per disminuir la taxa de CRBSI. Aquest treball de recerca posa de relleu l'epidemiologia del CRBSI perifèric (PVCR-BSI) durant tot aquest període d'estudi després de l'aplicació del paquet i, d'altra banda, reflexiona sobre els factors de risc associats a la mortalitat entre aquests episodis de CRBSIs . En conclusió, aquest treball de tesi doctoral va demostrar l'efectivitat de l'aplicació del programa de prevenció multimodal a BUH en termes de reducció de CRBSI, i l'èmfasi que estableixen Staphylococcus aureus i les infeccions de Candida i un índex de comorbilitat de Charlson> 4, són factors de risc de mortalitat entre pacients amb CRBSI.
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Zhao, Wenxia (Helen). "Comorbidity in prediction of in-hospital mortality among diabetic patients: A study-derived index." Thesis, University of Ottawa (Canada), 2005. http://hdl.handle.net/10393/27100.
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The present study developed and validated a comorbidity index specifically for prediction of in-hospital mortality among diabetic inpatients in Canada. The analysis was based on data from the Hospital Person-Oriented Information Database (HPOI) for the study period from 1995/96 through 2000/01. The study included all the hospitalizations with a primary or secondary diagnosis of diabetes (ICD-9 code: 250.x) in acute care hospitals for patients aged 45 years or older with a length of stay of 90 days or less in ten provinces. All episodes of hospitalization for each patient were linked using a unique patient identifier, and one was randomly selected for the analyses. The study population of 578,222 diabetic inpatients was randomly divided into two parts, which were used either to develop or to validate the index. Multiple logistic regression models were used to develop and validate the index. A total of 22 diabetic comorbidities including 14 coexistent general medical conditions and 8 diabetic complications were included in the study-derived index, which had a better predictive performance as compared with D'Hoore-Charlson index and the simple count of comorbidities. The study-derived index can be used to control for potential confounding caused by comorbidity in the exploratory data analysis of diabetes research, to assist in creating more effective diabetes management system and to evaluate the prognosis of diabetic inpatients for health care provider.
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Wong, Jenna Chun-Lay. "Derivation and validation of a time-dependent risk prediction model for in-hospital mortality." Thesis, University of Ottawa (Canada), 2010. http://hdl.handle.net/10393/28829.
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Accurate risk prediction models for in-hospital mortality are important for unbiased comparisons of hospital performance (by producing risk-adjusted mortality rates) and improved patient outcomes (by identifying high-risk patients in need of special medical attention). No previous risk prediction models have properly used post-admission information to predict risk of death in-hospital.
In this study, we used administrative and laboratory data to derive and internally validate a Cox regression model (the "Escobar +" model) that predicts the risk of in-hospital death at any point during the admission. The model had excellent discrimination (c-statistic 0.895,95% confidence interval [CI] 0.889-0.902) and calibration.
The Escobar+ model is a powerful risk-adjustment methodology that can be used in studies where the start of observation occurs post-admission. The model could also improve the quality and timeliness of patient care by providing health care workers with highly specific and accurate estimates of in-hospital death risk during the patient's stay.
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Tavares, Camila. "Óbitos por tuberculose em hospital terciário em Goiânia, Brasil: estudo descritivo." Universidade Federal de Goiás, 2013. http://repositorio.bc.ufg.br/tede/handle/tede/3209.
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
Tuberculosis (TB) remains a serious global public health problem, being the main cause of deaths in patients with the acquired immunodeficiency syndrome, and the third cause of death by infectious diseases throughout the world. This situation is surprising because it is a disease that if treated properly displays high rates of healing. It is therefore important to characterize these patients to identify target populations for specific measures seeking to reduce TB deaths. We performed a retrospective descriptive study to analyze the cases of TB deaths in a State public hospital, reference for treatment of infectious diseases, located in the Central-West region of Brazil, in the period of January 1st, 2008 to December 31th, 2009. There were 283 diagnosed and reported cases of TB between 2008 and 2009, and 39 recorded deaths occurred, resulting in a lethality index of 14%. Mean age of 42 years and a median age of 37 years. Pulmonary TB was the most common form of TB (51.3% of the patients). Of the 39 TB patients who died, 56.4% (n = 22) were co-infected with HIV. The main immediate causes of death were acute respiratory failure (n = 12) and sepsis (n =8). Anemia and hypoalbuminemia were prevalent in this group, and 27 patients required mechanical ventilation. This study found that hospitalized patients who died had the following characteristics: bilateral pulmonary disease, low levels of hemoglobin and hematocrit, albumin, and those co-infected with HIV that has been admitted to the ICU required MV. Prospective studies aiming to analyze the risk factors for death from TB are needed to better understand this process.
A tuberculose (TB) continua a ser um grave problema de saúde pública mundial, sendo a principal causa de morte em pacientes com a síndrome da imunodeficiência adquirida, ea terceira causa de morte por doenças infecciosas em todo o mundo. Esta situação é surpreendente uma vez que é uma doença que se tratada adequadamente apresenta elevadas taxas de cura. Por isso, é importante caracterizar esses pacientes para identificar populações-alvo de medidas específicas visando reduzir mortes por tuberculose. Foi realizado um estudo descritivo e retrospectivo para analisar os casos de mortes por tuberculose em um hospital público do Estado, referência para o tratamento de doenças infecciosas, localizado na região Centro-Oeste do Brasil, no período de 01 de janeiro de 2008 a 31 de dezembro de 2009. Houve 283 casos diagnosticados e notificados de tuberculose entre 2008 e 2009 com 39 mortes, resultando em um índice de letalidade de 13,8%. A média de idade de 42 anos e uma média de idade de 37 anos. A TB pulmonar foi aforma mais comum da doença (51,3% dos pacientes). Dos 39 pacientes que morreram de tuberculose, 56,4% (n = 22) foram coinfectados com HIV. As principais causas imediatas de óbito foram insuficiência respiratória aguda (n = 12) e sepse (n = 8). Anemia e hipoalbuminemia foram prevalentes no grupo, e 27 pacientes necessitaram de ventilação mecânica. Este estudo identificou que os pacientes internados que evoluíram para o óbito tinham as seguintes características: doença pulmonar bilateral, baixos níveis de hemoglobina e hematócrito, albumina, e a maioria dos co-infectados com HIV com admissão na UTI e ventilação mecânica(VM). Estudos prospectivos com o objetivo de analisar os fatores de risco para morte por tuberculose são necessários para entender melhor este processo.
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Du, Toit Rene. "Risk adjusted mortality rates : Do they differ if bases on administrative data (hospital standardised mortality ratio) versus a physiological predictive model (APACHE IV ®)?" Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/15478.
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Background: The measurement of, and reporting on clinical outcomes, is an integral part of clinical governance but no consensus has been reached about which measures to use and the validity thereof. Objective: To compare an administrative predictive model (Hospital Standardised Mortality Ratio [HSMR]) with a physiological predictive model (APACHE ®IV) to determine the correlation in the predicted risk adjusted mortality rates. To determine whether stratifying the patients into low (<10%), medium (<50%) or high (>80%) risk bands will lead to more accurate comparisons. Design: Prospective cohort study Setting: 63 critical care units in 34 private acute care facilities across South Africa Methods: Both HSMR and APACHE ®IV are calculated routinely in all participating facilities and the research study will use the data generated. An additional audit process will be implemented to determine and ensure the integrity of the data. Ethics: The healthcare facilities have standard processes in place to ensure confidentiality and the statistician analysing the data is employed by the healthcare group and bound to a confidentiality agreement. Ethics approval has also been obtained by the University of Cape Town ethic committee before the approval of the research proposal.
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Lipovich, Carol Jean. "Analysis of Ventilator Associated Pneumonia Patients' Hospital and Intensive Care Charges, Length of Stay and Mortality." The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1366228755.
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Hillier, Kelty-Anne. "Impact of increasing antiretroviral therapy use on trends in pediatric admissions and in-hospital mortality at a large South African referral hospital." Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=92383.
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The human immunodeficiency virus (HIV) pandemic has ravaged South Africa, the country with the largest number of HIV-positive people in the world. In 2004, the South African government began providing antiretroviral therapy (ART) to eligible people with HIV. The program has been very successful in targeting pregnant women, and ART use has steadily increased since 2004. This study aims to assess whether this public health intervention has had a positive impact on reducing pediatric hospitalizations and in-hospital mortality at a large, tertiary care hospital in Soweto (Johannesburg). Pediatric hospital discharge summary data from two years were compiled: 2005 (just after the ART program began) and 2008 (when ART use had increased substantially). Between 2005 and 2008, there was a 16% reduction in the total number of hospital admissions, including a 23% reduction in admissions for HIV infection, 17% for tuberculosis (TB) and 13% for TB/HIV co-infection. During this same period, overall mortality in hospitalized children declined by 74%; for HIV the decline was 22%, 13% for TB and 34% in children with TB/HIV co-infection. In the absence of other explanatory evidence, this study suggests that the observed reductions in pediatric admissions and in-hospital mortality are likely due to the introduction of widespread ART in South Africa.La pandémie du virus de l'immunodéficience humaine (VIH) a ravagé l'Afrique du Sud, le pays ayant la population sero positive la plus élevée au monde. Au milieu de l'année 2004, le gouvernement Sud-Africain a commencé à fournir la thérapie antirétrovirale aux gens éligibles atteints du VIH. Ce programme s'est avéré un succès dans le ciblage des femmes enceintes. Cette étude présente des éléments probants qui suggèrent que cette intervention en santé publique a eu un impact positif sur les hospitalisations en pédiatrie et sur le taux de mortalité à l'hôpital. Entre 2005 et 2008 on peut noter une réduction de 16% du nombre total d'admissions, incluant une réduction de 23% du nombre d'admissions reliées au VIH, 17% à la tuberculose (TB) et 13% au VIH/TB. Pendant cette même période, le taux de mortalité a diminué de 74% au total et spécifiquement de 22% pour le VIH, 13% pour la TB et 34% chez les enfants atteints de TB/VIH. En l'absence de preuves suggérant une autre explication, cette étude suggère que la baisse du taux d'hospitalisations en pédiatrie et de mortalité à l'hôpital pourrait être due à l'introduction à grande échelle de la thérapie antirétrovirale pour traiter le VIH.
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Mwenyekonde, Elled. "Assessing some of the associations with perinatal mortality at Kamuzu central hospital in Lilongwe, Malawi." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/10619.
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Includes bibliographical references.The study objectives were to: determine the prevalence of perinatal mortality (PNM) and causes of early neonatal deaths (ENNDs), describe socio-demographic factors of mothers with PNM and assess some of the associations with PNM at Kamuzu Central Hospital.
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Mudaly, Vanessa. "Seasonal patterns of mortality in medical admissions at Groote Schuur Hospital, Cape Town: 2002-2009." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/13246.
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Includes bibliographical references.Across the world, studies have shown that hospital mortality may be influenced by seasonal factors. Very few studies examining this phenomenon have been conducted in South Africa. This study aimed to determine whether there are seasonal patterns of mortality associated with medical causes of admission to a hospital in Cape Town, and to identify demographic risk factors and specific disease categories that are associated with increased susceptibility to seasonal mortality. Part A is the protocol that was developed for the study. It begins with a summary of key aspects of the literature review. The aim, hypotheses and objectives of the study are then described, followed by a detailed account of the study methodology, ethical issues, plans for communication of the study findings and logistics. The protocol was approved by the Research Ethics Committee at University of Cape Town. Part B is the structured literature review, in which studies describing trends in seasonal mortality, and associated risk factors and determinants of excess seasonal mortality, are discussed. International and local studies were included, in order to provide an appropriated background for this study. Part C is a presentation of the study findings in the form of a journal-ready manuscript for the South African Medical Journal. Graphs have been used to illustrate the trends in mortality for each year of the study period, and the relationship between mortality and average temperatures and precipitation. Interactions with seasonal mortality and gender, socioeconomic status, ethnicity and age-groups have also been illustrated. Results have been quantified with the calculation of mortality rate ratios with 95% confidence intervals. Patterns of mortality for circulatory, respiratory and gastrointestinal diseases, and cancer, are analysed. There is a brief discussion of the findings with suggestions for further research and public health interventions to reduce excess seasonal mortality in this setting. Part D is comprised of appendices containing relevant analyses that were not be included in the article, as well as other documents pertaining to the study. Tables and graphs have been annotated, and reference is made to these appendices in the article.
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Pritchett, Lanae, Jennifer Knutson, and Grant Skrepnek. "Comorbidities Associated with Polycythemia Vera and Factors Influencing Cost and Mortality in Inpatient Hospital Settings." The University of Arizona, 2011. http://hdl.handle.net/10150/614608.
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Class of 2011 AbstractOBJECTIVES: To assess the role of patient, payer, clinical and disease-related factors in charges and mortality among adult inpatient cases of polycythemia vera in the United States from 2004 to 2008. METHODS: This retrospective cohort study utilized hospital discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) five consecutive years from 2004 to 2008. RESULTS: There were a total of 156,490 episodes of care involving polycythemia vera between 2004 and 2008. Average age upon admission was 65.94 years (±16.03), with 56% of cases being male (n=87,662). The mean length of stay was 5.14 days (±5.31) and inpatient mortality occurred in 3.1% of cases (n=4,927). The mean number of procedures performed was 1.43 (±2.08) and the mean number of diagnoses on record was 9.56 (±3.86). Charges for each episode of care averaged $32,620 (±42,801), summing to a national bill of $5.02 billion (2010 dollars) over the five-year time horizon. Higher charges were associated with longer length of stay, larger hospital bed size, urban hospital location, teaching status, increased number of diagnoses and procedures, private payer, Western U.S. region, and higher income bracket. Increased mortality was associated with increased age, increased number of diagnoses and procedures, self pay, payer other than Medicare, Medicaid, private or self, and the comorbidities of congestive heart failure, coagulopathy, and fluid/electrolyte disorders. CONCLUSION: Polycythemia vera is associated with considerable burden of illness.
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Hamdulay, Goolam. "A cost-analysis study of primary diabetes treatment at day-hospitals and a provincial hospital in the Western Cape." University of Western Cape, 1996. http://hdl.handle.net/11394/7517.
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Masters of CommerceThe provision of health care in South Africa is undergoing major restructuring. The aim is to achieve substantial, visible and sustainable improvements to the efficiency and accessibility of primary healthcare (PHC) services for all South Africans. One of the country's most critical problems is the weak and fragmented public sector PHC system. The most critical problems contributing to this are the maldistribution of resources (financial, physical and human) between hospitals and the primary care system, and between rural and urban areas. The health sector, therefore, faces the challenge of a complete restructuring and transformation of the national health care delivery system and related institutions. Choices need to be made about which services to cut, which to streamline and where savings can be made. Ways need to be found to use ALL of South Africa's resources optimally. This process of restructuring would be facilitated by the availability of accurate information on resource utilisation in the health sector. This study estimates the difference in the cost of primary diabetes treatment at dayhospitals and a provincial hospital in the Western Cape in 1992/93. Health economics is in its infancy in South Africa and serious data limitations exist. This study is therefore a pioneering effort in many ways. An appropriate methodological framework in which to conduct the costing had to be developed. The South African health sector, health spending arid the cost of primary diabetes treatment at day-hospitals and the provincial hospital are reviewed. Theoretical perspectives of the health care market and the methodologies of cost analysis are discussed. The cost analysis method of study is chosen, and arguments are advanced for its suitability in the South African context. A simple method of calculating the direct costs to obtain the average cost is proposed for the purpose of the study. Direct costs consist of staff costs and other related costs, such as medical supplies, non-medical supplies, building operations, equipment etc. These costs are then used to calculate the average costs per diabetic patient at the day-hospitals and the provincial hospital. The average cost per diabetic patient at day-hospitals amounted to R18.76, while at the provincial hospital the cost was R59.60. https://
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Bhat, Sundeep Ram. "Lactate Clearance Predicts 28-Day Survival Among Patients with Severe Sepsis and Septic Shock." Yale University, 2009. http://ymtdl.med.yale.edu/theses/available/etd-03182009-143432/.
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Severe sepsis and septic shock comprise a significant number of emergency department (ED) admissions annually. With the advent of early goal directed therapies, early identification and intervention have become paramount in this population. Few studies, however, have examined the role of serum lactate as a predictor of mortality or endpoint to resuscitation among this population. We aimed to show that improved lactate clearance is associated with decreased 28-day in-hospital mortality. We retrospectively examined data from the Yale Sepsis Registry for patients with severe sepsis or septic shock who had lactate levels that were measured initially in the ED and subsequently when the patient arrived on the floor. This study received institutional review board approval. Lactate clearance was calculated as a percentage, and comparison between patients who cleared lactate and those who did not were made for mortality data as well as baseline characteristics and interventions required between the two groups. 207 patients (110 male) with mean age and standard deviation (SD) of 63.17 ± 17.9 years were examined. 136 patients (65.7%) were diagnosed with severe sepsis and 71 patients (34.3%) had septic shock. Of those with identified sources of infection, pneumonia was the most common (54 patients, 26.1%). There were 171 patients in the clearance group and 36 patients in the non-clearance group, all of whom had a mean time of 9 hours 8 minutes ± 4 hours 6 minutes between lactate measurements. 28-day mortality rates were 15.2% (26 patients) in the lactate clearance group and 36.1% (13 patients) in the non-clearance group (p<0.01). Vasopressor support within 72 hours of admission was initiated among 61.1% (22 patients) in the non-clearance group compared with 36.8% (63 patients) in the clearance group (p<0.01). Mechanical ventilation was required for 36.3% (62 patients) in the clearance group and 66.7% (24 patients) in the non-clearance group (p=0.001). Rates of severe sepsis, mean number of SIRS and organ dysfunction criteria, and initial creatinine were similar between the two groups; however, only 86.1% (31 patients) in the non-clearance group received intravenous fluids in the ED compared with 98.8% (169 patients) in the clearance group (p=0.002). 33.3% (12 patients) in the non-clearance group had chronic obstructive pulmonary disease (COPD) compared with 15.2% (26 patients) in the clearance group (p<0.05). The mean Mortality in Emergency Department Sepsis (MEDS) scores were 8.78 ± 3.96 for the clearance group and 10.4 ± 4.48 for the non-clearance group (95% CI, -3.1 to -.14, p<0.05). These results show significantly higher mortality rates among patients who do not clear their lactate in the ED. Additionally, these patients require vasopressor support and mechanical ventilation more often. Lactate clearance was significantly associated with receipt of fluids and may also reflect lower MEDS score. Our findings suggest lactate clearance could be used as an endpoint for ED resuscitation and in stratifying mortality risk among patients with severe sepsis or septic shock. Future studies might seek to prospectively validate these findings and incorporate multivariate analysis to determine factors affecting lactate clearance.
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Pokras, Stan. "Outcomes and Opportunities for Reducing Heart Failure 30-Day Readmissions and Mortality for Acute Care Inter-Hospital Transfers at a Multi-Site Hospital System." Kent State University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=kent1585222151873158.
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Uematsu, Hironori. "Impact of weekend admission on in-hospital mortality in severe community-acquired pneumonia patients in Japan." 京都大学 (Kyoto University), 2017. http://hdl.handle.net/2433/225513.
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McIntyre, Lauralyn Ann. "Are fluid resuscitation strategies associated with hospital mortality in severely septic patients? A retrospective cohort study." Thesis, University of Ottawa (Canada), 2005. http://hdl.handle.net/10393/26977.
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Background. Fluid resuscitation is the foundation of severe sepsis management as it is a key factor for optimizing cardiac output, and hence restoring hemodynamic stability and perfusion to the tissues.
Objective. To examine for the association between quantity (primary), type (secondary) and method (secondary) of fluid administered in the first six hours after the identification of severe sepsis and hospital mortality.
Conclusion. In this retrospective cohort study, quantity and type of fluid administered in the first six hours after the identification of severe sepsis were not associated with hospital mortality. However, there was a trend toward a reduction in hospital mortality for the group that received fluid boluses and fluid infusions as compared to fluid infusions alone. Future research is required to determine optimal fluid resuscitation practices for patients with severe sepsis.
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Regan, Sandra R. "Characteristics of the registered nurse workforce : associations with mortality rates in general and hospital-based populations." Thesis, University of British Columbia, 2011. http://hdl.handle.net/2429/35923.
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Concerns regarding a shortage of registered nurses (RNs) have underscored the importance of improving methods for workforce planning. The goal of this dissertation was to contribute knowledge that could enhance nursing human resources (NHR) planning, with a particular focus on a population health, needs-based approach.
This research relied on descriptive-exploratory analyses using repeated measures of data obtained from the College of Registered Nurses of British Columbia (BC) and publicly available reports of the BC Vital Statistics Agency and Canadian Institute for Health Information. Three studies were conducted to: a) investigate the spatial and temporal patterns and trends in the BC RN workforce (Study one); b) examine the associations between selected characteristics of the RN workforce and indicators of population health (Study two); and c) examine the associations between selected characteristics of the RN workforce and the hospital standardized mortality ratio (HSMR) (Study three). Small area analysis (Studies two and three) and mixed effects statistical models (Studies two and three) were used.
The results of study one showed that geographic areas (BC’s local health areas [LHAs]) with low general population density (i.e., < 10,000 general population) differed from higher general population density areas in the patterns and trends of the selected RN workforce characteristics, both spatially and temporally. In study two, correlations between selected population health indicators and RN workforce characteristics were modest in magnitude and only a few of these correlations persisted in the three years of the study (2002 – 2004). No statistically significant relationships were found between the selected population health indicators and RN workforce characteristics. The findings of study three indicated that greater numbers of RN managers per 100 hospital beds were associated with lower HSMRs (lower hospital mortality). Findings from these studies suggest that geographic context at the small area level is an important consideration for NHR planning and that decision-makers need to look beyond the supply of RNs and examine how other workforce characteristics influence planning. Some of the limitations of currently available data and methods for planning NHR are identified, particularly related to needs-based planning, and avenues for further research regarding NHR planning are recommended.
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Smolina, Ekaterina. "Examination of the epidemiology of acute myocardial infarction in England using linked hospital and mortality data." Thesis, University of Oxford, 2011. http://ora.ox.ac.uk/objects/uuid:791b416e-140e-4ced-9703-76d76895e9f8.
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Background: Acute myocardial infarction (AMI) is a major public health concern. There are limited recent national-level population-based epidemiological data on AMI in England. As a result, the current burden of disease is difficult to quantify. Aim: This thesis addresses gaps in knowledge on AMI in England. It aims to provide a comprehensive analysis of AMI epidemiology over the last decade. Methods: This is a population-based study using person-linked routine hospital and mortality data for England for the period from 1 April 1998 to 31 March 2008. Main outcome measures include: trends in event rate, case fatality, and mortality for AMI, as well as trends in characteristics of, and hospital care for, the AMI patient population between 1999 and 2007; rates of occurrence and case fatality for first and recurrent AMI in 2007; and five-year survival and risk of a second AMI for 2003 to 2007. Results: Total age-standardised AMI mortality rate fell by around half, while the age-standardised event rate and case fatality rate each declined by around one third between 1999 and 2007. Approximately half of the decline in AMI mortality was attributed to a decline in event rate and half to improved survival. During the 2000s, the hospitalised AMI patient population became increasingly elderly, presented with more comorbidities, underwent more revascularisation procedures, and spent less time in hospital. In 2007, approximately 90,000 AMIs occurred in England, of which around one third were fatal, one in seven were reinfarctions, and three quarters were AMIs in those aged 65 years and older. Among 30-day survivors of a first AMI, around one in three men and one in four women died within five years, and about one in eight men and one in six women experienced a second AMI in the same time period. Conclusions: There have been substantial improvements in AMI occurrence, survival, and mortality over the last decade in England. This was driven by improvements in prevention and acute medical treatment. The results in this thesis emphasise the importance of both.
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Takeda, Chikashi. "Prophylactic sivelestat for esophagectomy and in-hospital mortality: a propensity score-matched analysis of claims database." Kyoto University, 2020. http://hdl.handle.net/2433/253147.
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Musafili, Aimable. "Child survival in Rwanda: Challenges and potential for improvement : Population- and hospital-based studies." Doctoral thesis, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-259476.
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After the 1994 genocide and collapse of the health system, Rwanda initiated major social and health reforms in order to reduce child mortality and health inequities in accordance with the Millennium Development Goals. The aim of this thesis was to assess trends in under-five mortality (U5M) and equity in child survival, to study social barriers for improved perinatal and neonatal survival, and to evaluate Helping Babies Breathe (HBB), a newborn resuscitation program. In paper I we analysed trends and social inequities in child mortality 1990−2010, using data from national Demographic and Health Surveys conducted in 2000, 2005, and 2010. The following papers were based on hospital studies in the capital of Rwanda. In paper II we explored social inequities in perinatal mortality. Using a perinatal audit approach, paper III assessed factors related to the three delays, which preceded perinatal deaths, and estimates were made of potentially avoidable deaths. Paper IV evaluated knowledge and skills gained and retained by health workers after training in HBB. Under-five mortality declined from the peak of 238 deaths per 1000 live births (95% CI 226 to 251) in 1994 to 65 deaths per 1000 live births (95% CI 61 to 70) in 2010 and concurred with decreased social gaps in child and neonatal survival between rural and urban areas and household wealth groups. Children born to women with no education still had significantly higher under-five mortality. Neonatal mortality also decreased but at a slower rate as compared to infant and U5M. Maternal rural residence or having no health insurance were linked to increased risk of perinatal death. Neither maternal education nor household wealth was associated with perinatal mortality risks. Lack of recognition of pregnancy danger signs and intrapartum-related suboptimal care were major contributors to perinatal deaths, whereof one half was estimated to be potentially avoidable. Knowledge significantly improved after training in HBB. This knowledge was sustained for at least 3 months following training whereas practical skills had declined. These results highlight the need for strengthening coverage of lifesaving interventions giving priority to underserved groups for improved child survival at community as well as at hospital levels.
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Sampaio, Ana Lucia Prezia. "Analise dos casos de obito em pacientes internados em Unidade Psiquiatrica de Hospital geral." [s.n.], 2007. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311620.
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Orientador: Paulo DalgalarrondoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Introdução: Estudos atuais mostram que indivíduos com transtornos mentais graves têm uma menor expectativa de vida quando comparados à população geral. Realizou-se um estudo retrospectivo e descritivo da população de pacientes internados na Unidade de Internação Psiquiátrica do Hospital de Clínicas da Unicamp que foram a óbito no período de 18 anos. Objetivo: Descrever o perfil sócio demográfico e clínico dos casos de óbitos ocorridos na Unidade de internação Psiquiátrica do Hospital de Clinicas da Unicamp, comparando-os com uma amostra dos que receberam alta hospitalar. Método: Foi realizada uma análise descritiva de todos os casos de óbito num período de 18 anos, e uma comparação entre esses casos e um grupo sorteado de casos que receberam alta hospitalar. Resultados: Verificou-se que os pacientes que foram a óbito tinham o seguinte perfil: masculinos (58%), média de idade de 47,2 (DP=14,6) anos, procedentes da Região Metropolitana de Campinas (92%). Os diagnósticos psiquiátricos mais freqüentes no grupo de óbito foram de transtornos de humor e transtornos decorrentes do uso de álcool e drogas, e as causas de óbitos mais freqüentes foram doenças cardio-respiratórias (54%). Conclusões: Esses resultados sugerem que pacientes com transtornos mentais graves parecem morrer mais cedo que a população da Unidade Psiquiátrica do Hospital de Clínicas da Unicamp e a concentrarem-se nos grupo masculino, com transtornos do humor e transtornos relacionados a álcool e drogas
Abstract: Introduction: Current studies show that individuals with severe mental illness have lower life expectancy when compared to the general population. This is a retrospective and descriptive study of the inpatient population who died at the Psychiatric Unit of the University Hospital of Unicamp in an 18-year period. Objective: Describe the sociodemographic and clinical profile of the deceased patients hospitalized at the Psychiatric Unit of the University Hospital of Unicamp, comparing them to a sample of those who were discharged from the hospital. Method: A descriptive analysis of mortality and a comparison between these cases and a randomly allocated group of patients among those who were discharged. Results: It was found that the patients who died had the following profile: males (58%), mean age 47.2 (SD=14.6) years, single (54%), from Campinas great metropolitan area (92%). The most frequent psychiatric diagnoses among the patients who died were affective and alcohol/drug disorders, while the most frequent cause of death were cardiorespiratory diseases (54%). Conclusions: These outcomes suggest that patients with severe mental disorders tend to die earlier than the population from Psychiatric Unit of the University Hospital of Unicamp. This group seems to be over represented by males, with affective disorders and alcohol/drugs disorders
Mestrado
Ciencias Biomedicas
Mestre em Ciências Médicas
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Sundareshan, Padma. "Clostridium difficile Infection (CDI) Incidence Rate and CDI-Associated Length of Stay, Total Hospital Charges and Mortality." The University of Arizona, 2009. http://hdl.handle.net/10150/623982.
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Class of 2009 AbstractOBJECTIVES: The purpose of the study was to determine the rate of Clostridium difficile infections (CDI) in hospitalized patients and the various factors that were associated with the risk of developing CDI by examining patient discharge data for hospitals in 37 states in the United States using Healthcare Cost and Utilization Project (HCUP). METHODS: Patient discharge information for all patients obtained using HCUP census for the years 2002-2005, either for primary or secondary (all-listed) occurrences of CDI using the ICD-9-CM code (008.45) specific for intestinal infections due to C. difficile, were included in the study. Regression analysis, either Generalized Linear Model log-link or power-link, or a logistic regression was employed to control for the multiple independent variables. RESULTS: The incidence rate for CDI was 9.4% for the years 2002-2005. Among the concomitant diagnoses and procedures, essential hypertension, volume depletion, congestive heart failure, urinary tract infection and venous catheterization were the top 5. The length of stay (LOS) for CDI was associated with being Black, Hispanic or Other race category, number of diagnoses and procedures, primary expected payer of Medicaid, private insurance and other (including worker’s compensation, CHAMPUS,CHAMPVA etc), and all groups classified based on median household income category for patient’s zip code. Predictors of CDI related to inpatient total hospital charges were being female, race (other than black), number of diagnoses and procedures, Death, LOS, patient location and with self-pay and no charge categories as primary expected payer. Predictors of higher CDI related inpatient hospital deaths were age, female sex, Hispanic race, number of diagnoses and procedures, LOS and having Medicaid, self-pay or other as primary expected payer. CONCLUSIONS: LOS, inpatient total hospital charges, and inpatient mortality were dependent on several patient and other characteristics.
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Taron, Marisa Cavaleiro Real Correia. "The sense of ending: the closing of a psychiatric hospital in Lisbon - Hospital Miguel Bombarda." Master's thesis, Faculdade de Ciências Médicas. Universidade Nova de Lisboa, 2012. http://hdl.handle.net/10362/8171.
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RESUMO: Este estudo foi realizado com o objectivo de conhecer os efeitos da desinstitucionalização dos doentes psiquiátricos crónicos durante o processo de encerramento do Hospital Miguel Bombarda (2007-2011). Este processo incluiu a fusão, em 2008, dos dois principais hospitais psiquiátricos de Lisboa- Hospital Miguel Bombarda (HMB) e Hospital Júlio de Matos (HJM), no Centro Psiquiátrico Hospitalar de Lisboa (CHPL). Foi criado um grupo controlo de pacientes ainda hospitalizados no CHPL (n=166) para comparação com o grupo de casos desinstitucionalizados (n=146). Desta amostra inicial (n=312) apenas 142 (76 casos e 66 controlos) foram incluídos, sendo as principais causas de exclusão: diagnóstico (patologia orgânica, demência ou debilidade mental, como diagnóstico primário) e transferência entre hospitais. A desinstitucionalização foi principalmente avaliada em termos de psicopatologia, utilização de serviços, satisfação, crime, condição de “sem abrigo” ou morte. Os resultados mostraram que a maioria dos doentes crónicos pode sair do hospital psiquiátrico para a comunidade sem agravamento da psicopatologia, aumento do crime ou da condição de “sem abrigo”. A satisfação parece estar aumentada na população desinstitucionalizada. A mortalidade, por outro lado, revelou-se uma questão problemática: apesar de não ter sido possível estabelecer uma comparação entre casos e controlos, a Taxa de Mortalidade Standard encontrada neste estudo foi muito superior ao esperado, de acordo com os resultados encontrados na literatura. Um estudo longitudinal da mesma população poderá ser objecto de futura investigação, possivelmente comparada com outra população similar de um programa de desinstitucionalização noutro país.---------
RÉSUMÉ: Cette étude a été menée afin de déterminer les effets de la désinstitutionnalisation des patients chroniques lors de la fermeture de l'hôpital Miguel Bombarda (2007-2011). Ce processus comprenait la fusion en 2008 de deux grands hôpitaux psychiatriques de Lisbonne: À savoir, Hôpital Miguel Bombarda (HMB) et Hôpital Julio de Matos (HJM), maintenant Centre de l'Hôpital Psychiatrique de Lisbonne (CHPL). Il a été créé un groupe contrôle des patients toujours hospitalisés à CHPL (n = 166) pour comparer avec les cas désinstitutionnalisés (n = 146). De cet échantillon initial (n= 312) à peine 142 (76 cas et 66 contrôles) ont été inclus, les principales raisons d'exclusion: diagnostique (maladie organique, démence ou d'arriération mentale comme diagnostic primaire) et les transferts entre hôpitaux. La désinstitutionnalisation a été principalement évaluée en termes de psychopathologie, de l'utilisation des services, la satisfaction, la criminalité, les “sans abri” et de la mort. Les résultats ont montré que la majorité des malades chroniques peuvent quitter l'hôpital psychiatrique et s´intégrer dans la communauté sans aggravation de la psychopathologie, augmentation de la criminalité ou du nombre de “sans-abri”. La satisfaction semble être en hausse dans la population désinstitutionnalisée. Toutefois, la mortalité s'est avéré être une question problématique, même si il n´a pas été possible d'établir une comparaison entre les cas et les contrôles, le Taux de Mortalité Standard estimé dans cette étude fut beaucoup plus élevé que prévu, en tenant compte des résultats établis dans la littérature. Une étude longitudinale de la même population pourra faire l'objet de futures recherches, peut-être comparé à une population similaire d'un programme de désinstitutionnalisation dans un autre pays.
----------- ABSTRACT:This study was conducted to assess the effects of deinstitutionalization of “long-stay” patients during the process of closing Hospital Miguel Bombarda (2007-2011). This process included the fusion, in 2008, of the two main psychiatric hospitals in Lisbon- Hospital Miguel Bombarda (HMB) and Hospital Júlio de Matos (HJM), into Centro Psiquiátrico Hospitalar de Lisboa (CHPL). A control group of still institutionalized patients in CHPL (n=166) was used as a comparison with the deinstitutionalized population (n=146). Of this 312 initial sample only 142 (76 cases and 66 controls) were included, the main causes of exclusion being diagnoses (organic disease, dementia and mental retardation- as first diagnoses) and transference between hospitals. Deinstitutionalization is mainly evaluated in terms of psychopathology, use of services, satisfaction, crime, vagrancy and deaths. The results show that most long-stay patients can successfully leave psychiatric hospitals and be relocated in the community without an increase in psychopathology, crime or vagrancy. Satisfaction seems to be improved in those patients. On the other hand, mortality remains an issue of concern: Although there was no possibility of comparing it between cases and controls, the Standard Mortality Rate (SMR) in our study was found to be much higher than expected judging by other studies results. A longitudinal further study of this same population will be the matter for a future investigation, possibily compared with another similar population from a desinstitutionalization programme in another country.
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Gamboa-Acuña, Brenda, Rayza Guillén-Zambrano, Grecia Lizzetti-Mendoza, Alonso Soto, and Aldo Lucchetti-Rodríguez. "Factores asociados a sobrevida en pacientes con co-infección VIH-TBC en el Servicio de Infectología del Hospital Nacional Arzobispo Loayza, Perú, durante los años 2004-2012." Sociedad Chilena de Infectologia, 2018. http://hdl.handle.net/10757/624648.
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Background: The main cause of death in HIV patients is tuberculosis (TB). However, few Latin American studies have evaluated the prognosis of patients with coinfection. Aim: To determine the factors associated with survival in patients with HIV-TB coinfection treated at a Peruvian referral hospital. Methods: A retrospective cohort study was performed based on clinical records of patients treated at the Department of Infectious Diseases in the Arzobispo Loayza National Hospital from 2004 to 2012. Survival was assessed using the Kaplan-Meier estimator and Cox Proportional Hazard Model. Results: From 315 patients, 82 died during the follow-up. The mean of follow for each patient was 730 days. The multivariate analysis showed that receiving HAART (HR: 0,31; IC: 0,20-0,50; p < 0,01) and having more weight (HR: 0,96; IC 0,94–0,98; p < 0,01) when the coinfection was diagnosed, were protective factors; while having a pathology different from TB (HR: 1,88; IC: 1,19-2,98; p < 0,01), age in years (HR: 1,76; IC: 1,12-2,74; p ≤ 0,01) and being hospitalized when diagnosed with TB (HR: 1,69; IC 1,02-2,80; p < 0,04) were associated with lower survival. Discussion: Receiving HAART and having more weight when the coinfection is diagnosed were associated with a higher chance of survival.Revisión por pares
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Mola, Edina da Rosa Durão. "Avaliação da qualidade do Sistema de Informação de Registro de Óbitos Hospitalares (SIS-ROH), Hospital Central da Beira, Moçambique." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/6/6132/tde-15032016-134408/.
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As informações de mortalidade são úteis para avaliar a situação de saúde de uma população. Dados de mortalidade confiáveis produzidos por um sistema de informação de saúde nacional constituem uma ferramenta importante para o planejamento de saúde. Em muitos países, sobretudo em desenvolvimento, o sistema de informação de mortalidade continua precário. Apesar dos esforços feitos em Moçambique para melhoria das estatísticas de mortalidade, os desafios ainda prevalecem em termos de tecnologias de informação, capacidade técnica de recursos humanos e em termos de produção estatística. O SIS-ROH é um sistema eletrônico de registro de óbitos hospitalares de nível nacional, implementado em 2008 e tem uma cobertura de apenas 4% de todos os óbitos anuais do país. Apesar de ser um sistema de nível nacional, ele presentemente funciona em algumas Unidades Sanitárias (US), incluindo o Hospital Central da Beira (HCB). Dada a importância deste sistema para monitorar o padrão de mortalidade do HCB e, no geral, da cidade da Beira, este estudo avalia a qualidade do SIS-ROH do HCB. É um estudo descritivo sobre a completitude, cobertura, concordância e consistência dos dados do SIS-ROH. Foram analisados 3.009 óbitos de menores de 5 anos ocorridos entre 2010 e 2013 e regsitrados no SIS-ROH e uma amostra de 822 Certificados de Óbitos (COs) fetais e de menores de 5 anos do HCB. O SIS-ROH apresentou uma cobertura inferior a 50% calculados com os dados de mortalidade estimados pelo Inquérito Nacional de Causas de Morte (INCAM). Verificamos a utilização de dois modelos diferentes de CO (modelo antigo e atual) para o registro de óbitos referentes ao ano de 2013. Observou-se completitude excelente para a maioria das variáveis do SISROH. Das 25 variáveis analisadas dos COs observou-se a seguinte situação: 9 apresentaram completitude muito ruim, sendo elas relativas à identificação do falecido (tipo de óbito e idade), relativas ao bloco V em que dados da mãe devem ser obrigatoriamente preenchidos em caso de óbitos fetais e de menores de 1 ano (escolaridade, ocupação habitual, número de filhos tidos vivos e mortos, duração da gestação) e relativas às condições e às causas de óbito (autópsia e causa intermédiacódigo); 3 variáveis apresentaram completitude ruim relativas à identificação do falecido (NID) e relativas às condições e causas de morte (causa intermédia - descrição e causa básica - código); 9 apresentaram completitude regular relativas à identificação do falecido (data de nascimento e idade), relativas ao bloco V (idade da mãe, tipo de gravidez, tipo de parto, peso do feto/bebé ao nascer, morte do feto/bebé em relação ao parto) e relativas às condições e causa de óbito (causa direta- código, causa básica descrição); 2 apresentaram completitude bom relativas à identificação do falecido (sexo e raça/cor) e, por último, 2 apresentaram completitude excelente relativas ao local de ocorrência de óbito (data de internamento e data de óbito ou desaparecimento do cadáver). Algumas variáveis do SIS-ROH e dos COS apresentaram inconsistências. Observou-se falta de concordância para causa direta entre o SIS-ROH e os COs. Conclusão: Moçambique tem feito esforços para aprimorar as estatísticas de mortalidade, porém há lacunas na qualidade; a análise rotineria dos dados pode identificar essas lacunas e subsidiar seu aprimoramento.The mortality information is useful to assess the health status of a population. Reliable mortality data produced by a national health information system is an important tool for health planning. In many countries, especially developing countries, the mortality information system is still precarious. Despite efforts in Mozambique to improve mortality statistics, challenges still prevail in terms of information technology, technical capacity and human resources and statistical production. The SIS-ROH is an electronic system of national-level hospital deaths registration, implemented in 2008 and has a coverage of only 4% of all annual deaths in the country. Despite being a national system, it currently works in some health units (US), including Beira Central Hospital (HCB). Given the importance of this system to monitor the mortality pattern of HCB and, in general, the city of Beira, this study evaluates the quality of SIS-ROH HCB. It is a descriptive study on the completeness, coverage, compliance and consistency of the SIS-ROH data and examined a sample of 822 HCB deaths Certificates (COs) of fetal and children under 5 years of age. We find the use of two different models of CO (former and current model) for the registration of deaths related to the year 2013. We observed excellent completeness for most SIS-ROH variables. Of the 25 variables of COs there was the following situation: 9 had very bad completeness, which were relating to the identification of the deceased (type of death and age) on the V block in the mother\'s data, where must be filled in case of stillbirths and children under 1 year of age (education, usual occupation, number of living children taken and killed, gestational age) and on the conditions and causes of death (autopsy and intermediate-code causes); 3 variables had bad completeness concerning the identification of the deceased (NID) and on the conditions and causes of death (intermediate cause - description and basic cause - code); 9 showed regular completeness concerning the identification of the deceased (date of birth and age) on the V block (mother\'s age, type of pregnancy, mode of delivery, weight of the fetus / baby birth, death of the fetus / baby compared to delivery) and on the conditions and causes of death (direct cause code, basic cause description); 2 showed good completeness concerning the identification of the deceased (sex and race / color) and, finally, 2 showed excellent completeness concerning the place of occurrence of death (date of admission and date of death or the disappearance corpse). The SIS-ROH had coverage below 50% calculated on mortality data estimated by the National Survey of Causes of Death (INCAM). Some SIS-ROH variables and COS showed inconsistencies. There was a lack of agreement to direct cause between SIS-ROH and COs.
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Farhat, Nawal. "The association of ozone and fine particulate matter with mortality and hospital admissions in 12 Canadian cities." Thesis, University of Ottawa (Canada), 2009. http://hdl.handle.net/10393/28271.
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Many recent epidemiological studies have linked health effects with short-term exposure to air pollution levels commonly found in North America. The association of ozone and fine particulate matter with mortality and hospital admissions in 12 Canadian cities was explored in a time-series study. City-specific estimates were obtained by Poisson regression models adjusting for the confounding effects of seasonality and temperature. Estimates were then pooled across cities using the inverse variance method. Results suggest significant associations across all outcomes except cardiovascular hospital admissions. Generally, stronger associations were found among the elderly. Effect estimates were robust to adjustment for seasonality confounding but were sensitive to lag structures. Considering the large population exposed to air pollution, reductions in ozone and particulate matter would lead to considerable health benefits.
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Beck, Christine Ann. "Aggressive care following hospital admission for acute myocardial infarction : analysis of effects on mortality using instrumental variables." Thesis, McGill University, 2001. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=31192.
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Certain regions adopt an aggressive approach (routine cardiac catheterization and frequent invasive revascularization) to care for acute myocardial infarction (AMI), while other regions adopt a conservative approach (selective use of invasive procedures). Administrative data provide a means to estimate the effects of these variations on patient outcomes, but they are limited by their potential for confounding bias due to unobserved case-mix variation as treatment assignment is not random. This study applied instrumental variables, a methodology that can account for this bias, to estimate the effectiveness of aggressive care in a Canadian patient population. The study used administrative data of hospital admissions and health services for all patients admitted for a first AMI in Quebec in 1988 (n = 8674). Incremental (marginal) mortality up to 4 years after admission was measured using distances to hospitals offering aggressive care as instrumental variables.Patients living closer to hospitals offering aggressive care were more likely to receive aggressive care than patients living further away (e.g. 26% versus 19%, respectively, received catheterization within 90 days). However, instrumental variable estimation found that aggressive care was not associated with marginal mortality benefits in comparison to conservative care (e.g. adjusted difference at 1 year: 4%; 95% CI: -11% to 20%).
The aggressive approach to post-AMI care is not associated with marginal mortality benefits in Quebec.
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Gunnarsdóttir, Oddný. "Users of a hospital emergency department : Diagnoses and mortality of those discharged home from the emergency department." Thesis, Nordic School of Public Health NHV, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-3323.
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Objectives – To ascertain the annual number of users who were discharged home after visits to the emergency department, grouped by age, gender and number of visits during the calendar year, and to assess whether an increasing number of visits to the department predicted a higher mortality. Methods – This is a retrospective cohort study, at the emergency department of Landspitali University Hospital, Reykjavik capital city area, Iceland. During the years of 1995 to 2001 19259 users visited the emergency department, and were discharged home and they were follow-up for cause specific mortality through a national registry. Standardised mortality ratio, with expected number based on national mortality rates was calculated and hazard ratios according to number of visits per calendar year using time dependent multivariate regression analysis were computed. Results – The annual increase of visits to the emergency department among the patients discharged home was seven to 14 per cent per age group during the period 1995 to 2001, with a highest increase among older men. The most common discharge diagnosis was the category Symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified. When emergency department users were compared with the general population, the standardised mortality ratio was 1.81 for men and 1.93 for women. Among those attending the emergency department two times, and three or more times in a calendar year, the mortality rate was higher than among those coming only once in a year. The causes of death which led to the highest mortality among frequent users of the emergency department were neoplasm, ischemic heart diseases, and the category external causes, particularly drug intoxication, suicides and probable suicides. Conclusions – The mortality of users of the emergency department who had been discharged home turned out to be higher than that of the general population. Frequent users of the emergency department had a higher mortality than those visiting the department no more than once in a year. Since the emergency department serves general medicine and surgery patients, not injuries, the high mortality due to drug intoxication, suicide and probable suicide is notable. Further studies are needed into the diagnosis at discharge of those frequently using emergency departments, in an attempt to understand and possibly prevent this mortalityISBN 91-7997-128-8
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García, James J. "Racial/ethnic Differences in Hospital Utilization for Cardiovascular-related Events: Evidence of a Survival and Recovery Advantage for Latinos?" Thesis, University of North Texas, 2014. https://digital.library.unt.edu/ark:/67531/metadc500102/.
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Evidence continues to demonstrate that racial/ethnic minority groups experience a disproportionate burden of disease and mortality in cardiovascular-related diseases (CVDs). However, emerging evidence suggests a health advantage for Latinos despite a high risk profile. The current study explored the hospital utilization trends of Latino and non-Latino patients and examined the possibility of an advantage for Latinos within the context of CVD-related events with retrospective data collected over a 12-month period from a local safety-net hospital. Contrary to my hypotheses, there was no advantage for in-hospital mortality, length of stay or re-admission in Latinos compared to non-Latinos; rather, Latinos hospitalized for a CVD-related event had a significantly longer length of stay and had greater odds for re-admission when compared to non-Latinos. Despite data suggesting a general health advantage, Latinos may experience a relative disparity within the context of hospital utilization for CVD-related events. Findings have implications for understanding the hospital utilization trends of Latinos following a CVD-related event and suggest a call for action to advance understanding of Latino cardiovascular health.
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Fletcher, Emily A., and Robert S. Lawson. "Characteristics of Hospital Inpatient Charges, Length of Stay, and Inpatient Mortality in Patients with Ovarian Cancer from 2002-2005." The University of Arizona, 2009. http://hdl.handle.net/10150/623991.
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Class of 2009OBJECTIVES: To determine and characterize the relative impact of patient demographics on hospital inpatient charges, length of stay, and inpatient mortality in patients with ovarian cancer from 2002-2005. METHODS: A retrospective database analysis of AHRQ’s Health Care Cost and Utilization Project (HCUP) Nationwide Inpatient Sample databases was conducted spanning from January 1, 2002, to December 31, 2005.Data were collected regarding age, race, payer status, median household income, location of hospital (urban/rural), comorbidities, procedures, total charges, length of stay, and inpatient mortality. Multivariate and gamma regression methods were utilized to examine incremental risks associated with length of stay, total charges, and inpatient mortality, after controlling for all other variables. RESULTS: Overall, data from 246,012 hospital admissions were obtained. The average length of stay of patients was 6.58 days (SD = 7.22), the average number of diagnoses was 7.18 (SD = 3.36), the average number of procedures performed was 2.71 (SD = 2.66). A total of 14,485 (5.9%) patients died during hospitalization. The average total charge was $29,698 (SD = $42,951). The IRR was 0.886 (95%CI, -0.105 to -0.04) for patients who were Hispanic, and 1.089 (95%CI, 0.017–0.153) for patients who were Black compared to patients who were white. When compared to patients who lived in large, metropolitan areas, the IRR was 0.88 (95%CI, -0.146 to - 0.109) for patients located in smaller, metropolitan areas, and the IRR was 0.74 (95%CI, -0.335 to -0.268) for patients located in non- urban areas. CONCLUSIONS: Patient demographics were found to have associations, both directly and indirectly, with length o
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Chen, Han-Yang. "Hospital Treatment Practices, 30-Day Hospital Readmissions, and Long-Term Prognosis in Patients Hospitalized with Acute Myocardial Infarction: A Dissertation." eScholarship@UMMS, 2015. http://escholarship.umassmed.edu/gsbs_diss/771.
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Background: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in the U.S. Acute myocardial infarction (AMI), with or without ST-segment elevation, is a common presentation of coronary heart disease and affected more than 800,000 American adults in 2010. The overall goal of this dissertation was to examine decade-long trends in the extent of delay in the receipt of a primary percutaneous coronary intervention (PCI) among patients hospitalized with ST-segment elevation myocardial infarction (STEMI), 30-day hospital readmission rates in patients having survived an AMI, and multiple decade long trends in 1-year post-hospital all-cause mortality, as well as factors associated with these outcomes, among patients hospitalized with AMI.
Methods: Data from the Worcester Heart Attack Study, a population-based chronic disease surveillance project that has been carried out among adult residents of the Worcester, MA, metropolitan area, hospitalized with AMI on a biennial basis from 1975 through 2009 at all medical centers in central MA, were used for this dissertation.
Results: Between 1999 and 2009, among patients hospitalized with STEMI, the likelihood of receiving a primary PCI within 90 minutes after emergency department arrival increased dramatically from 1999/2001 (11.6%) to 2007/2009 (70.5%). Between 1999 and 2009, among hospital survivors of an AMI, the 30-day all-cause rehospitalization rates decreased from 1999/2001 (20.3%) to 2007/2009 (16.7%). The overall cause-specific 30-day rehospitalization rates due to CVD, non-CVD, and AMI were 10.1%, 7.1%, and 1.8%, respectively, during the years under study. Between 1975 and 2009, among hospital survivors for a first AMI, the 1-year post-discharge mortality rates remained relatively stable from 1975-1984 (12.9%) to 1986-1997 (12.5%), but increased during 1999-2009 (15.8%). We identified several demographic, clinical and in-hospital treatment factors associated with an increased risk of failing to receive a primary PCI within 90 minutes after emergency department arrival, 30-day readmissions, and 1-year post-discharge mortality.
Conclusions: Our findings can hopefully lead to the enhanced development of innovative, patient-centered, intervention strategies which can further improve the treatment and transitions of care, as well as short and long-term prognosis, of men and women hospitalized with AMI.
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Coutinho, Joana Alexandra Caldeira de Sousa. "Estudo retrospetivo de 420 anestesias gerais em equídeos num hospital de referência em Portugal." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2021. http://hdl.handle.net/10400.5/21295.
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Dissertação de Mestrado Integrado em Medicina VeterináriaRESUMO - A anestesia geral é um procedimento que consiste na indução e manutenção da perda de consciência associada à perda da sensação e de dor. A anestesia geral tem como principal objetivo maximizar o bem-estar do paciente e tornar o procedimento cirúrgico o mais seguro e eficiente possível e é constituída por quatro fases, pré-medicação, indução, manutenção e recuperação. Este estudo consistiu numa análise retrospetiva de 420 procedimentos sob anestesia geral no SCUE FMV-UL no período de tempo compreendido entre 2016 e 2020. Os equídeos englobados neste estudo foram, maioritariamente, machos inteiros (60,2%), cuja raça mais registada foi o Puro Sangue Lusitano (PSL) com uma mediana de idades de 6 anos + 8 anos (IQR) e de peso de 500kg + 107,5kg (IQR). Relativamente à classificação ASA, 49,9% corresponderam a equídeos classificados em grau ASA1, sendo que apenas 4,5% das classificações correspondiam ao grau mais elevado, ASA5. Após tratamento dos dados recolhidos relativos aos procedimentos sob anestesia geral no hospital em questão, observou-se um aumento do número anual dos mesmos desde 2016 até 2020, sendo que nos últimos dois anos realizaram-se mais de 100 procedimentos deste tipo. De um total de 420 anestesias gerais verificou-se que 51,7% foram em contexto eletivo e 48,3% em contexto de urgência. Considerando as técnicas utilizadas, constatou-se que 66,2% recorreram à anestesia inalatória, 31,9% à anestesia parcial endovenosa e apenas 1,9% anestesia parcial endovenosa. A taxa de mortalidade associada ao procedimento anestésico (indução, manutenção e recobro) foi de 0.95% e, quando analisadas apenas as cirurgias eletivas, este valor baixou para 0,46%. No entanto, quando incluídas todas as causas de morte sob anestesia geral, a taxa de mortalidade até sete dias após o procedimento foi de 7,61%. Foi verificada ainda uma taxa de mortalidade de 15,27% associada às cirurgias de urgência e de 20,28% relativamente às cirurgias de cólica, verificando-se significância estatística consoante o grau ASA, alfa-2-agonista utilizado, técnica de anestesia, contexto e tipo de cirurgia no desfecho peri-anestésico. Relativamente à análise de complicações peri-anestésicas dos animais submetidos a anestesia geral, 96,9% não apresentaram registo de quaisquer complicações até sete dias após o procedimento. Após análise dos resultados foi possível concluir que a taxa de mortalidade peri-anestésica na casuística deste hospital é semelhante à relatada noutros estudos internacionais.
ABSTRACT - A RETROSPECTIVE STUDY OF 420 GENERAL ANESTHESIAS AT AN EQUINE REFERRAL HOSPITAL IN PORTUGAL - General anesthesia includes several aspects, such as, loss of consciousness, loss of sensation and pain management. This type of anesthesia has as main objective making the surgical procedure as safe and efficient as possible, maximizing the patient's well-being. This type of anesthesia consists of four phases: premedication, induction, maintenance and recovery. This retrospective study reviewed 420 procedures under general anesthesia at the SCUE FMV-UL in the period between 2016 and 2020. The equids included in this study were, mostly, stallions (60.2%), from which the most common breed was the Lusitano Purebred (PSL) with a median age of 6 years + 8 years (IQR) and a weight of 500kg + 107.5kg (IQR). Regarding the ASA classification, 49.9% were classified as grade 1, with only 4.5% of the classifications corresponding to the highest grade, 5. After processing the data related to the procedures under general anesthesia submitted to this hospital, there was an increase in their annual number from 2016 to 2020, with more than 100 procedures per year in the last two years. Of a total of 420 anesthesias, 51.7% were elective procedures and 48.3% were emergencies. Regarding the techniques used, 66.2% resorted to the inhalatory anesthesia, in 31.9% partial intravenous anesthesia was used and total intravenous anesthesia was only used in 1.9%. The mortality rate associated with the anesthetic procedure (induction, maintenance and recovery) was 0.95% and, which dropped to 0.46% when only elective surgeries were included. However, when all causes of death under general anesthesia were included, the mortality rate during the seven days after the procedure was 7.61%. The mortality rate of associated with emergency surgeries was 15.27% and 20.28% for colic surgeries, with a statistical significance according to the ASA grades, alpha-2-agonist used, anesthesia technique, context and type of surgery in the peri-anesthetic outcome. Regarding the analysis of peri-anesthetic complications in animals submitted to general anesthesia, 96.9% did not show any complications in the seven days post procedure. After accurate analysis of the results, it was possible to conclude that the peri-anesthetic mortality rate of the SCUE FMV-UL is similar to the results reported by other international studies.
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