scholarly journals Mortality in Emergency Services in a University Teaching Hospital: A Retrospective Study

2019 ◽  
Vol 41 (2) ◽  
pp. 17-20
Author(s):  
Tirtha Man Shrestha ◽  
Ramesh P Aacharya ◽  
Ram P Neupane ◽  
Bigyan Prajapati
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Septic Shock ◽  
Mortality Rate ◽  
Cause Of Death ◽  
Causes Of Death ◽  
Emergency Services ◽  
University Teaching ◽  
Chronic Obstructive ◽  
Age Group ◽  
Obstructive Pulmonary Disease

Introduction: Emergency services are the gateway between the community and hospital that provides 24-hour access for most needy patients in critical and emergency conditions. Mortality rate varies in emergency department across the world and even in different emergency units of the same hospital. This retrospective study was done in adult emergency services of a tertiary hospital to determine mortality rate and analyze causes of death. Methods: A retrospective observational study of mortality cases to analyze mortality rate and causes of death of patients for a period of 6 months between October 2017 to March 2018 was carried out in the adult emergency services of Tribhuvan University Teaching Hospital, Kathmandu. Data required were collected from copies of death certificates. Results: During the study period, a total of 128 patients died in emergency, accounting 0.5% of total patient. Male deaths (52.3%) were slightly higher compared to female deaths (47.7%). Age group 66-75 years had the highest (24.2%) of total mortalities in the emergency. The most common immediate cause of death was sepsis/septic shock (21.9%) followed by cardiopulmonary arrest, aspiration, respiratory failure, other causes of shock and poisoning. The commonest antecedent cause of death was attributed to respiratory causes. Similarly, the most common contributory cause of death was chronic obstructive pulmonary disease. Conclusion: Older age group is prone to the mortality risk. Sepsis/septic shock was the most common immediate cause of death. Pneumonia was the most common antecedent causes of death. Chronic obstructive pulmonary disease was the commonest contributory cause.

scholarly journals Assessment of rotahaler inhalation technique among patients with chronic obstructive pulmonary disease in a teaching hospital of Nepal

2017 ◽  
Vol 5 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Diksha Sapkota ◽  
Yogesh Raj Amatya
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Teaching Hospital ◽  
Dry Powder Inhaler ◽  
Cross Sectional Study ◽  
University Teaching ◽  
Inhalation Technique ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease

Background: Inhalation mode of drug delivery is the mainstay treatment for chronic obstructive pulmonary disease, however; incorrect technique prevents patients from receiving maximal therapeutic benefi ts.Objectives: To assess usage technique of rotahaler among patients with chronic obstructive pulmonary disease and identify factors affecting its performance.Methods: Descriptive cross sectional study was conducted to assess rotahaler (single unit dose dry powder inhaler) inhalation technique among patients with chronic obstructive pulmonary disease in Kathmandu University Teaching Hospital. The study population consisted of 100 respondents using rotahaler for at least one year. Data collection was done by standard checklist, semi structured questionnaire via observation and interview methods respectively.Results: Correct inhalation technique was found in 37% of total respondents. Nearly two out of three respondents (61%) failed to breathe out deeply before inhaling. Majority of the respondents (59%) failed to hold breath for at least 10 second and 25% were unable to breathe in deeply. Age, occupation, source of inhalation instruction and re-demonstration of the technique were found to be signifi cantly associated with the correct inhalation technique (p <0.05).Conclusion: More than half of the respondents had incorrect inhalation technique, so health education program targeting the common identifi ed errors should be carried out. Arrangements should be made for regular involvement of pharmacist in teaching and re-demonstration to ensure good inhaler technique. This would ultimately lead to a greater clinical response and improved patient compliance.Journal of Kathmandu Medical CollegeVol. 5, No. 1, Issue 15, Jan.-Mar., 2016, Page: 11-17

scholarly journals Coinfection and delayed diagnosis of visceral leishmaniasis: Died predecessors factors

2019 ◽  
Vol 6 (1) ◽  
pp. 19
Author(s):  
Jaciel de Oliveira Clementino ◽  
Daniel Gallina Martins Abrahão ◽  
Manoel Sebastião Da Costa Lima Junior ◽  
Herintha Coeto Neitzke Abreu
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Septic Shock ◽  
Human Immunodeficiency Virus ◽  
Visceral Leishmaniasis ◽  
Leishmania Infantum ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Immunodeficiency Virus

Visceral leishmaniasis (VL) is an anthropozoonosis caused by Leishmania infantum in most Brazilian states and is known for its significant lethality resulting from improper diagnosis and treatment. VL is difficult to diagnose because its clinical manifestations and laboratory abnormalities are analogous to several other pathologies. We report a case of a 54-year-old man, negative for Human Immunodeficiency Virus (HIV), with VL who was initially diagnosed with anemia, consumptive syndrome, pneumonia, chronic obstructive pulmonary disease, and septic shock and died due to a delayed diagnosis of VL. 

scholarly journals P099: Extending the trimodal distribution of death; trauma patients die at increased rates after discharge. Linking trauma registry data to vital statistics and hospital datasets identifies opportunities to save life

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S100-S100
Author(s):  
J. French ◽  
C. Somayaji ◽  
D. Dutton ◽  
S. Benjamin ◽  
P. Atkinson
Keyword(s):  
Mortality Rate ◽  
Cause Of Death ◽  
Causes Of Death ◽  
Trauma Registry ◽  
Vital Statistics ◽  
Trauma Patients ◽  
Age Group ◽  
Post Discharge ◽  
One Year

Introduction: The New Brunswick Trauma Registry is a database of injury admissions from eight hospitals throughout the province. Data tracks individuals in-hospital. By linking this information with vital statistics, we are able to observe outcomes post-discharge and can model health outcomes for participants. We want to know how outcomes for trauma patients compare with the general population post discharge. Methods: Using data from 2014-15, we followed over 2100 trauma registry observations for one year and tracked mortality rate per 1,000 people by age-group. We also compared the outcomes of this group to all Discharge Abstract Database (DAD) entries in the province (circa. 7500 total). We tracked mortality in-hospital, at six months, and one year after discharge. We truncated age into groups aged 40-64, 65-84, and 85 or older. Results: In-hospital mortality among those in the trauma registry is approximately 20 per 1,000 people for those age 40-64, 50 per 1,000 people for those aged 65-84, and 150 per 1,000 people aged 85 or older. For the oldest age group this is in line with the expected population mortality rate, for the younger two groups these estimates are approximately 2-4 times higher than expected mortality. The mortality at six-month follow-up for both of the younger groups remains higher than expected. At one-year follow-up, the mortality for the 65-84 age group returns to the expected population baseline, but is higher for those age 40-64. Causes of death for those who die in hospital are injury for nearly 50% of observations. After discharge, neoplasms and heart disease are the most common causes of death. Trends from the DAD are similar, with lower mortality overall. Of note, cardiac causes of death account for nearly as many deaths in the 6 months after the injury in the 40 -64 age group as the injury itself. Conclusion: Mortality rates remain high upon discharge for up to a year later for some age groups. Causes of death are not injury-related. Some evidence suggests that the injury could have been related to the eventual cause of death (e.g., dementia), but questions remain about the possibility for trauma-mitigating care increasing the risk of mortality from comorbidities. For example, cardiac death, which is largely preventable, is a significant cause of death in the 40-64 age group after discharge. Including an assessment of Framingham risk factors as part of the patients rehabilitation prescription may reduce mortality.

scholarly journals Management of chronic obstructive pulmonary disease exacerbations in Internal Medicine

2013 ◽  
pp. 199-214
Author(s):  
Gelorma Belmonte ◽  
Marilena Muratori ◽  
Paolo Leandri ◽  
Angelo Pasquale ◽  
Massimo Reta ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Chronic Obstructive Pulmonary Disease ◽  
Health Care ◽  
Pulmonary Disease ◽  
Cause Of Death ◽  
Easy Access ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Wide Range

Introduction: Chronic obstructive pulmonary disease (COPD) is the second leading cause of hospitalization in Internal Medicine departments in Italy and the fourth leading cause of death all over the word. By 2020, COPD will be the third leading cause of death and the fifth leading cause of disability. It is — along with chronic congestive heart failure — one of the most common causes of unscheduled hospital readmissions, and as such it represents a significant economic burden for the health-care system. Exacerbations of COPD are important events in the natural history of this prevalent condition. Discussion: This review provides a comprehensive state-of-the-art look at prevention and management of COPD exacerbations. Treatment of these episodes has to be tailored to the severity of the clinical presentation. We now have a wide range of therapeutic available options, based on the results of clinical trials. Management of the acute event should include the necessary measures (mainly the administration of inhaled short-acting bronchodilators, inhaled or oral corticosteroids, and antibiotics), with or without oxygen and ventilator support. Conclusions: To improve the management of COPD exacerbations, the focus of care must be shifted from the episodic acute complications to their systematic prevention. The management of COPD, which is often associated with multiple co-morbidities, is complex and requires a tailored, multifaceted and multidisciplinary approach. Integrated care for COPD also requires that patients be informed about their condition, that they participate actively in their care, and that they have easy access to the necessary health-care services.

Prevalence of Inhaled Corticosteroid Use among Patients with Chronic Obstructive Pulmonary Disease: A Survey

1997 ◽  
Vol 31 (2) ◽  
pp. 160-164 ◽  
Author(s):  
Cynthia A Jackevicius ◽  
Kenneth R Chapman
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Medical Records ◽  
Tertiary Care ◽  
Hospitalized Patients ◽  
University Teaching ◽  
Chronic Obstructive ◽  
Inhaled Corticosteroid ◽  
Obstructive Pulmonary Disease ◽  
Patient Demographics

Objective To determine the extent of inhaled corticosteroid use among patients with chronic obstructive pulmonary disease (COPD). Design Review of medical records. Setting Tertiary-care university teaching hospital. Patients Seventy-two consecutive patients prescribed an inhaled corticosteroid during hospitalization. Intervention None. Measurements Patient demographics, inhaled corticosteroid regimen, respiratory diagnosis, and inhaled corticosteroid use before and during hospitalization. Results The majority of patients (85%) were receiving their prescribed corticosteroid inhaler prior to admission. Beclomethasone dipropionate 250 μg/puff was the most commonly prescribed inhaled corticosteroid formulation accounting for 43% of the total corticosteroid inhaler orders. COPD was the most common respiratory diagnosis (43%) associated with inhaled corticosteroid use, followed by asthma (37%), COPD/asthma (13%), and no diagnosis (7%). During the study period, the proportion of all hospitalized patients with COPD who also received inhaled corticosteroid prescriptions (35%) was not significantly different from all hospitalized patients with asthma who received inhaled corticosteroid prescriptions (33%). Conclusions The rate of inhaled corticosteroid use far exceeds the rate expected among the general population of patients with COPD. Educational intervention is needed to encourage compliance with published guidelines for the management of COPD.

scholarly journals Four Decades of COPD Mortality Trends: Analysis of Trends and Multiple Causes of Death

2021 ◽  
Vol 10 (5) ◽  
pp. 1117
Author(s):  
Alberto Fernández-García ◽  
Mónica Pérez-Ríos ◽  
Alberto Fernández-Villar ◽  
Gael Naveira ◽  
Cristina Candal-Pedreira ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Causes Of Death ◽  
Chronic Obstructive ◽  
Joinpoint Regression ◽  
Mortality Trend ◽  
Mortality Trends ◽  
Obstructive Pulmonary Disease ◽  
Underlying Cause Of Death ◽  
Copd Mortality ◽  
Age Of Death

There is little information on chronic obstructive pulmonary disease (COPD) mortality trends, age of death, or male:female ratio. This study therefore sought to analyze time trends in mortality with COPD recorded as the underlying cause of death from 1980 through 2017, and with COPD recorded other than as the underlying cause of death. We conducted an analysis of COPD deaths in Galicia (Spain) from 1980 through 2017, including those in which COPD was recorded other than as the underlying cause of death from 2015 through 2017. We calculated the crude and standardized rates, and analyzed mortality trends using joinpoint regression models. There were 43,234 COPD deaths, with a male:female ratio of 2.4. Median age of death was 82 years. A change point in the mortality trend was detected in 1996 with a significant decrease across the sexes, reflected by an annual percentage change of −3.8%. Taking deaths into account in which COPD participated or contributed without being the underlying cause led to an overall 42% increase in the mortality burden. The most frequent causes of death when COPD was not considered to be the underlying cause were bronchopulmonary neoplasms and cardiovascular diseases. COPD mortality has decreased steadily across the sexes in Galicia since 1996, and age of death has also gradually increased. Multiple-cause death analysis may help prevent the underestimation of COPD mortality.

scholarly journals Recommendations for the early diagnosis of COPD: the AIMAR view

2015 ◽  
Vol 10 ◽  
Author(s):  
Bartolome R. Celli
Keyword(s):  
United States ◽  
Chronic Obstructive Pulmonary Disease ◽  
Health Care ◽  
Early Diagnosis ◽  
Causes Of Death ◽  
The United States ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Appropriate Treatment ◽  
The World

Chronic obstructive pulmonary disease (COPD) has the dubious distinction of being one of the few major causes of death that continues to rise in the United States and the world. In that sense, its prevention, early diagno- sis when clinically present, and finally its appropriate treatment should constitute a priority item in today’s health care agenda. [...]

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