Medical Certificates of Cause of Death for people with intellectual disabilities: A systematic literature review

Background

Mortality studies can help reduce health inequalities by informing public policy through a better understanding of causes of death and comorbidities. Mortality studies often rely on Medical Certificates of Cause of Death (MCCD) for data.

Method

A systematic review was undertaken to identify the extent and nature of issues in recording causes of death for people with intellectual disability on MCCD.

Results

Fifteen of the 25 articles included in the literature review raised concerns about the accuracy of MCCD in identifying the cause(s) of death of people with intellectual disability. The most frequent issues were the under‐reporting of intellectual disability on MCCD, and listing intellectual disability or an associated condition as an underlying cause of death.

Conclusions

Concerns about the accuracy and reliability of MCCD for people with intellectual disability raise questions about mortality data based on MCCD. Clear guidance is required from WHO for those completing MCCD for people with intellectual disability.     

Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: a systematic review

Objectives

To assess the effect of Traditional Chinese Herbal Medicine (CHM) in the management of female infertility and on pregnancy rates compared with Western Medical (WM) treatment.

Methods

We searched the Medline and Cochrane databases and Google Scholar until February 2010 for abstracts in English of studies investigating infertility, menstrual health and Traditional Chinese Medicine (TCM). We undertook meta-analyses of (non-)randomised controlled trials (RCTs) or cohort studies, and compared clinical pregnancy rates achieved with CHM versus WM drug treatment or in vitro fertilisation (IVF). In addition, we collated common TCM pattern diagnosis in infertility in relation to the quality of the menstrual cycle and associated symptoms.

Results

Eight RCTs, 13 cohort studies, 3 case series and 6 case studies involving 1851 women with infertility were included in the systematic review. Meta-analysis of RCTs suggested a 3.5 greater likelihood of achieving a pregnancy with CHM therapy over a 4-month period compared with WM drug therapy alone (odds ratio = 3.5, 95% CI: 2.3, 5.2, p < 0.0001, n = 1005). Mean (SD) pregnancy rates were 60 ± 12.5% for CHM compared with 32 ± 10% using WM drug therapy. Meta-analysis of selected cohort studies (n = 616 women) suggested a mean clinical pregnancy rate of 50% using CHM compared with IVF (30%) (p < 0.0001).

Conclusions

Our review suggests that management of female infertility with Chinese Herbal Medicine can improve pregnancy rates 2-fold within a 4 month period compared with Western Medical fertility drug therapy or IVF. Assessment of the quality of the menstrual cycle, integral to TCM diagnosis, appears to be fundamental to successful treatment of female infertility.     

Self-referral, access and physiotherapy: patients’ knowledge and attitudes—results of a national trial

Objectives

To identify service users’ views and attitudes to access, physiotherapy and patient-autonomous health-seeking behaviours.

Study design

Mixed qualitative and quantitative questionnaire.

Setting

Twenty-six locations representing a range of socio-economic and geographical settings throughout Scotland.

Participants

Three thousand and ten patients over 16 years of age.

Methods

Postal questionnaires containing a mix of open and closed questions, attitude statements and free text for comments were sent to all consenting patients 4 weeks after discharge from physiotherapy. Responses were analysed by referral group: self-referred patients; patients referred by their general practitioner (GP); and patients referred at the suggestion of their GP.

Results

A response rate of 72% (2177/3010) was achieved. Males, females and all age groups were represented. Strong support for the effectiveness of physiotherapy was reported by all groups (>90%). Despite more than 80% of respondents claiming that they were able to confidently predict when they needed physiotherapy, less than 23% reported being knowledgeable or very knowledgeable about physiotherapy, with no significant association between level of knowledge and referral group (P = 0.129). Self-referred patients were more satisfied (P < 0.001), more supportive of being able to self-refer (83% vs 69% of GP-referred patients and 71% of patients referred at the suggestion of their GP), and more supportive of physiotherapists making decisions about their fitness for work or activities (59% vs 53% of GP-referred patients and 53% of patients referred at the suggestion of their GP).

Conclusions

Physiotherapy was regarded positively by all referral groups, particularly by self-referred patients, despite there being a distinct lack of knowledge about the profession. There is a clear need to raise awareness and knowledge of physiotherapy if autonomous health-seeking behaviours are to be encouraged and self-referral schemes progressed appropriately.     

Lung cancer screening: utility of molecular applications in conjunction with low-dose computed tomography guidelines

Finding early-stage lung cancer where there is a higher chance for patient survival remains a major healthcare challenge. Low-dose spiral computed tomography for high-risk patients can increase the detection of cancers with certain tradeoffs, such as increased radiation exposure and surgical risks for false-positive cases. New molecular markers and assays show considerable promise to further reduce healthcare costs and improve lung cancer survival rates but require further validation. This review summarizes and discusses the current state of research in lung cancer screening and highlights developments in biomarker research for lung cancer diagnostics.     

A systematic-analysis of predicted miR-21 targets identifies a signature for lung cancer

Introduction

The well-known oncomiR-miR-21 was previously reported oncogenic activity in lung cancer. We sought to determine the expression of all predicted target genes of miR-21 and their potential function, pathways and networks, which are involved in the biological behavior of lung cancer.

Methods

After a systematic review of English language studies of lung cancer-related molecules were pooled; genes were classified in three functional groups by gene ontology (GO) analysis. The key molecules were indentified by establishing lung cancer related networks and pathways. MiR-21 targets were predicted by computational method, followed by screening for matched gene symbols in NCBI human sequences and GO, pathway and network analysis. MiR-21 targets and their network, which are involved in the malignant mechanisms of lung cancer, were obtained by the final integrative analysis.

Result

We indentified the potential functions, pathways and networks of lung cancer relating molecules and miR-21 targets respectively in the initial analysis. In the final integrative analysis of lung cancer related miR-21-targets analysis, 24 hub genes were identified by overlap calculation, suggesting that miR-21 may play an important role in the development and progression of lung cancer through JAK/STAT signal pathway, MAPK signaling pathway, Wnt signaling pathway, cell cycle, PPAR signaling pathway, apoptosis pathway and other pathways.

Conclusion

Our data may help researchers to predict the molecular mechanisms of miR-21 in the development and progression of lung cancer comprehensively. Moreover, the present data indicate that miR-21-targets may be a series of promising candidates as biomarkers for lung cancer.     

Why patients with lung cancer do not want help with some needs

Goal

The purpose of this exploratory study was to understand what motivates patients to ask or not ask for assistance when they have expressed need in specific areas.

Materials and methods

A qualitative approach was used to explore the desire for assistance of patients with lung cancer who attended a regional cancer centre. The research questions were: (1) Why do patients with lung cancer not desire help for certain areas of need?; (2) What resources currently exist outside the cancer centre that patients with lung cancer use to help meet their needs?; and (3) What resources (internal and external to the cancer centre) would be helpful for patients with lung cancer? Fifty-nine patients participated in this study by completing a self-report questionnaire; 34 of these patients were then interviewed using a semi-structured interview guide.

Main results

The data indicated varied reasons for not asking for help, such as believing that staff were too busy or the problem would go away over time. Participants identified a number of outside resources they currently used and gave suggestions about needed resources within the cancer centre and in the community.

Conclusions

Patients with lung cancer may have a number of supportive care concerns, but they do not always ask for help with those issues. Some patients may be unaware of possible help, and others may not want help from professionals. Supportive care needs must be identified quickly and effectively so that appropriate interventions can be offered to those who want them.

     

Fear of Cancer Recurrence Inventory: development and initial validation of a multidimensional measure of fear of cancer recurrence

Background

Despite the fact that the fear of cancer recurrence is to varying degrees almost universal in cancer survivors, there is a lack of validated multidimensional instruments to evaluate this issue specifically.

Purpose

The goal of this study was to develop and empirically validate a multidimensional self-report scale for assessing the fear of cancer recurrence, the Fear of Cancer Recurrence Inventory (FCRI).

Methods

A provincial medical databank was used to randomly select a pool of 1,704 French-Canadian patients who had been treated for breast, prostate, lung, and colorectal cancer within the past 10 years. Of these, 300 patients were asked to complete the FCRI on two occasions.

Results

The factorial analysis conducted on the final 42-item scale revealed a seven-component solution (64% of the variance) including the following factors: triggers, severity, psychological distress, coping strategies, functioning impairments, insight, and reassurance. The results also supported the internal consistency (α?=?0.95) and the temporal stability (r?=?0.89) of the FCRI, as well as its construct validity with other self-report scales assessing fear of cancer recurrence (r?=?0.68 to 0.77) or related constructs such as psychological distress (r?=?0.43 to 0.77) and quality of life (r?=??0.20 to ?0.36).

Conclusions

This study suggests that the French-Canadian version of the FCRI is a reliable and valid instrument for evaluating the multidimensional aspects of the fear of cancer recurrence.     

Quality of life, symptom experience and distress of lung cancer patients undergoing chemotherapy

The diagnosis of lung cancer in the advanced stage of illness, the poor prognosis associated with the disease, and the side effects of chemotherapy all have an impact on various dimensions of quality of life (QoL).

The purpose of the research

The current study was designed to describe the QoL and symptom distress of lung cancer patients undergoing chemotherapy and to explore the relationships between demographic/treatment-related characteristics and QoL.

Methods and sample

The sample consisted of 154 lung cancer patients undergoing chemotherapy. The symptom experiences and QoL of lung cancer patients undergoing chemotherapy were evaluated using the Memorial Symptom Assessment Scale and Quality of Life Index – Cancer Version.

Results

The lung cancer patients had low QoL scores. The scores on the Health and Functioning subscale were the lowest (20.33 ± 5.59), while those of the Family subscale were the highest (27.66 ± 2.77). The most common physical symptoms experienced by lung cancer patients were lack of energy, coughing, pain, lack of appetite, and nausea, while the psychological symptoms were feeling nervous, difficulty sleeping, feeling sad, and worrying. There was a negative relationship between the symptom distress and quality of life scores (r = −0.45; p < 0.000). Females and those with low income levels and performance status experienced greater symptom distress.

Conclusions

Lung cancer patients receiving chemotherapy suffer many limitations due to the symptoms and disruptions to their QoL, arising from both the disease process and its treatment. Lung cancer patients need to be assessed regularly and supported.     

Acupuncture in children and adolescents with bronchial asthma: a randomised controlled study

Objective

This randomised controlled trial evaluates the immediate effects of acupuncture as an add-on therapy in in-patient rehabilitation of children and adolescents with bronchial asthma.

Patients and methods

In a pre–post design, the severity of symptoms, lung function, illness-specific quality of life (Paediatric Asthma Quality of Life Questionnaire – PAQLQ) and general and asthma-specific level of anxiety (State-Trait Anxiety Inventory for Children – STAIC) were investigated in 46 acupuncture and 47 control patients. In addition to asthma sports, climate therapy and behavioural training, the intervention group received acupuncture treatment with a standardised needle pattern (12× 30 min.).

Results

With acupuncture, the peak expiratory flow variability differs significantly (p < 0.01) from that of the control patients’ group. Moreover, the acupuncture group differs significantly in their rehabilitation response at the time of discharge concerning perceived anxiety (STAIC-S). The lung function tests do not present differences between groups.

Conclusion

After additional acupuncture, amelioration of peak expiratory flow variability and anxiety can be shown, without any difference in objective lung function tests and quality of life between study groups. Further studies might evaluate the effects of acupuncture on childhood asthma in an outpatient setting.     

Back pain and leg complaints that revealed non–small cell carcinoma: a case study

Objective

The purpose of this case study is to describe the clinical presentation of a patient with a chief complaint of low back and leg pain with no prior diagnosis of lung cancer.

Clinical Features

A 48-year-old man with a history of back pain presented to a chiropractic office with a complaint of low back and left leg pain.

Intervention and Outcome

Abnormal examination and radiographic findings were discovered. The patient was immediately referred to the pulmonologist for co-management. Through the use of advanced imaging and biopsy, stage 4 lung cancer was diagnosed.

Conclusion

Low back pain recurrence in an established patient should constitute a reevaluation of the problem. The cause cannot be assumed to be musculoskeletal in origin even though this may have been the case with the initial complaint. Metastatic disease should be considered with any type of recurrent low back pain.     

308例死亡疾病谱统计分析

目的 了解舞钢市人民医院各科患者死亡病谱的年龄、性别及死亡原因,为疾病预防治疗提供科学依据.方法 对308例死亡患者的年龄、性别、疾病种类进行统计分析.结果 2008年至2012年共收治患者52 571例,死亡308例,病死率为0.59%.308例死亡病例中死因排序依次是创伤、肿瘤、心血管疾病、脑血管疾病、意外死亡及呼吸系统疾病等,在前10种死亡疾病中,前5类疾病中心血管疾病及肿瘤（支气管或肺恶性肿瘤、肝癌、胃食管癌）位居首位,颅脑创伤伴蛛网膜下腔出血位居第二,脑血管疾病（脑出血、脑梗死）位居第三,猝死位居第四,肺炎位居第五.男性高于女性,60岁以上年龄组最多.结论 加强交通管理,普及安全意识,加强老年疾病特别是对肿瘤的防治和研究,提高社会人群对癌症预防的认知度,对中老年人群进行定期身体筛查,早发现、早诊断、早治疗,改善环境、戒除不良嗜好,普及预防保健知识,早期识别猝死的高危人群并及时救治是降低病死率的主要措施.     

A narrative review of manual muscle testing and implications for muscle testing research

Objective

Manual muscle testing (MMT) is used for a variety of purposes in health care by medical, osteopathic, chiropractic, physical therapy, rehabilitation, and athletic training professionals. The purpose of this study is to provide a narrative review of variations in techniques, durations, and forces used in MMT putting applied kinesiology (AK) muscle testing in context and highlighting aspects of muscle testing important to report in MMT research.

Method

PubMed, the Collected Papers of the International College of Applied Kinesiology–USA, and related texts were searched on the subjects of MMT, maximum voluntary isometric contraction testing, and make/break testing. Force parameters (magnitude, duration, timing of application), testing variations of MMT, and normative data were collected and evaluated.

Results

“Break” tests aim to evaluate the muscle's ability to resist a gradually increasing pressure and may test different aspects of neuromuscular control than tests against fixed resistances. Applied kinesiologists use submaximal manual break tests and a binary grading scale to test short-term changes in muscle function in response to challenges. Many of the studies reviewed were not consistent in reporting parameters for testing.

Conclusions

To increase the chances for replication, studies using MMT should specify parameters of the tests used, such as exact procedures and instrumentation, duration of test, peak force, and timing of application of force.     

Clinical significance of serum mitochondrial DNA in lung cancer

Objectives

The aim of the study was to investigate the clinical significance of serum mitochondrial DNA (mtDNA) in lung cancer.

Design and methods

Serum mtDNA from 65 lung cancer patients, 20 patients with benign lung diseases and 55 healthy individuals was quantified using real-time fluorescent quantitative polymerase chain reaction (FQ-PCR). Data were analyzed using statistical software SPSS 13.0.

Results

Serum mtDNA levels in lung cancer patients were significantly higher, compared to those in patients with benign lung diseases and healthy individuals (u = 108, p = 0.000; u = 293, p = 0.000), and closely associated with TNM stage (p = 0.01). The use of serum mtDNA facilitated detection of lung cancer at a cutoff value of 0.74 × 10⁴ copies/μL with a sensitivity of 86.2% and specificity of 80.7%. However, serum mtDNA levels were not associated with patient age, gender, histological type, and lymph node metastasis (p > 0.05).

Conclusions

Quantification of serum mtDNA using FQ-PCR potentially serves as a novel complementary tool to improve the clinical screening and detection of lung cancer.     

Scientific, legal, and ethical challenges of end-of-life organ procurement in emergency medicine

Aim

We review (1) scientific evidence questioning the validity of declaring death and procuring organs in heart-beating (i.e., neurological standard of death) and non-heart-beating (i.e., circulatory-respiratory standard of death) donation; (2) consequences of collaborative programs realigning hospital policies to maximize access of procurement coordinators to critically and terminally ill patients as potential donors on arrival in emergency departments; and (3) ethical and legal ramifications of current practices of organ procurement on patients and their families.

Data sources

Relevant publications in peer-reviewed journals and government websites.

Results

Scientific evidence undermines the biological criteria of death that underpin the definition of death in heart-beating (i.e., neurological standard) and non-heart-beating (i.e., circulatory-respiratory standard) donation. Philosophical reinterpretation of the neurological and circulatory-respiratory standards in the death statute, to avoid the appearance of organ procurement as an active life-ending intervention, lacks public and medical consensus. Collaborative programs bundle procurement coordinators together with hospital staff for a team-huddle and implement a quality improvement tool for a Rapid Assessment of Hospital Procurement Barriers in Donation. Procurement coordinators have access to critically ill patients during the course of medical treatment with no donation consent and with family or surrogates unaware of their roles. How these programs affect the medical care of these patients has not been studied.

Conclusions

Policies enforcing end-of-life organ procurement can have unintended consequences: (1) erosion of care in the patient's best interests, (2) lack of transparency, and (3) ethical and legal ramifications of flawed standards of declaring death.     

Lack of association between genetic variations in the KALRN region and ischemic stroke

Objectives

To investigate whether KALRN gene variation is associated with ischemic stroke (IS).

Design and methods

Associations to overall IS and IS subtypes were investigated in SAHLSIS, which comprises 844 patients with IS and 668 controls.

Results

Associations between KALRN SNPs and overall IS and cardioembolic stroke were detected. Associations for overall IS were investigated in two additional Swedish samples, but could not be replicated.

Conclusion

KALRN gene variation is not associated with overall IS.     

Palliative care for patients with cancer: what are the educational needs of community pharmacists?

Aims The objective of this study was to determine the educational needs of community pharmacists in Australia related to palliative cancer care, to guide the development of an online educational program for pharmacists.Methods Questionnaires were posted to a random sample of community pharmacies in Australia. The questionnaire sought information pertaining to pharmacists: demographics; educational needs by rating the importance of learning more about 18 palliative cancer care topics and self-perceived level of knowledge of them; preference for format(s) for the program; willingness to participate in the program; and perception regarding their practice of palliative cancer care. Results were analysed using Statistical Package for the Social Sciences (SPSS) version 11.5 software.Main results A questionnaire return rate of 10.3% was achieved. The characteristics of respondents were reflective of community pharmacy practice in Australia when compared with the latest available labour force figures by the Australian Institute of Health and Welfare. Pharmacists rated all 18 topics as important/essential, and their level of knowledge of them as poor/good. Pharmacists preferred information provided in these formats: text (89.8%), case studies (80.6%) and multi-choice questions (69.4%). Most pharmacists (85.2%) indicated that they would participate in the program. The majority of pharmacists (71.3%) reported that they deliver palliative cancer care services; usually less-than-monthly (24.1%) or weekly (21.3%).Conclusions Educational needs of community pharmacists in palliative cancer care were identified. The information gathered will assist in guiding the development of an online educational program for pharmacists to improve their knowledge and skills in palliative cancer care.     

Bedside ultrasound as a predictive tool for acute chest syndrome in sickle cell patients

Background

Acute chest syndrome (ACS) is the leading cause of death for patients with sickle cell disease (SCD). Early recognition of ACS improves prognosis.

Body temperature effects on lung injury in ventilated preterm lambs

Aims

Mechanical ventilation causes lung injury in premature infants. Hypothermia may protect against and hyperthermia may augment lung injury. We tested the effects of hypo- and hyperthermia on ventilation induced acute lung injury in preterm lambs.

Methods

Twin sheep fetuses at 128 d GA (term 150 d) were surgically delivered and randomized to unventilated control (UVC), normothermia (38-39 °C) without lung injury (NTNI), or to 1 of 3 injurious ventilation groups: hypothermic (33-34 °C, LT), normothermic (38-39 °C, NT) or hyperthermic (40-41 °C, HT). NT, LT and HT groups had 15 min of injurious ventilation (PEEP 0 cmH₂O, V_T escalation to 15 mL/kg) following delivery and prior to surfactant. The animals were then gently ventilated (PEEP 5 cmH₂O, V_T 7.5 mL/kg) for 2 h 45 min. NTNI lambs received surfactant at birth prior to gentle ventilation. The lambs were then euthanized, and bronchoalveolar lavage (BAL) fluid and lung tissue were used to evaluate lung injury, inflammatory cell counts, inflammatory markers and cytokine mRNA.

Results

Target temperatures were achieved by 15 min of age and maintained for 3 h. All ventilated groups had increased BAL protein, lung inflammation and increased cytokine mRNA. HT animals developed acidosis, premature death, pneumothoraces, impaired lung function and increased inflammatory mRNA expression. LT animals remained clinically stable without pneumothoraces or death, had improved ventilatory efficiency and trended toward lower inflammatory mRNA expression than NT animals.

Conclusion

Hyperthermia exacerbated ventilator induced lung injury, while hypothermia may protect against lung injury in the preterm lamb.     

Temporal trends in recording of diabetes on death certificates: results from Translating Research Into Action for Diabetes (TRIAD)

OBJECTIVE

To determine the frequency that diabetes is reported on death certificates of decedents with known diabetes and describe trends in reporting over 8 years.

RESEARCH DESIGN AND METHODS

Data were obtained from 11,927 participants with diabetes who were enrolled in Translating Research into Action for Diabetes, a multicenter prospective observational study of diabetes care in managed care. Data on decedents (N = 2,261) were obtained from the National Death Index from 1 January 2000 through 31 December 2007. The primary dependent variables were the presence of the ICD-10 codes for diabetes listed anywhere on the death certificate or as the underlying cause of death.

RESULTS

Diabetes was recorded on 41% of death certificates and as the underlying cause of death for 13% of decedents with diabetes. Diabetes was significantly more likely to be reported on the death certificate of decedents dying of cardiovascular disease than all other causes. There was a statistically significant trend of increased reporting of diabetes as the underlying cause of death over time (P < 0.001), which persisted after controlling for duration of diabetes at death. The increase in reporting of diabetes as the underlying cause of death was associated with a decrease in the reporting of cardiovascular disease as the underlying cause of death (P < 0.001).

CONCLUSIONS

Death certificates continue to underestimate the prevalence of diabetes among decedents. The increase in reporting of diabetes as the underlying cause of death over the past 8 years will likely impact estimates of the burden of diabetes in the U.S.In 2005, the National Center for Health Statistics ranked diabetes as the fifth leading cause of death in the U.S (1). Although it is difficult to determine the true extent to which diabetes should be recorded as a cause of death, this is likely an underestimate since diabetes is listed anywhere on the death certificate of fewer than half of people with known diabetes who die (2–5). Although using mortality data for epidemiologic studies is a common practice, it has drawbacks. When one studies mortality rates over time using death certificates one generally assumes that the likelihood of recording the condition remains constant over time, so that observed changes in mortality reflect true changes in the rate and not simply changes in recording practices. The last national study investigating trends in reporting of diabetes on death certificates used the 1986 and 1993 National Mortality Follow-back Survey and documented consistent underreporting over time (2). One smaller, more recent study looking at the sensitivity and specificity of reporting of diabetes on death certificates reported similar results (4).We hypothesize that diabetes reporting on death certificates may have improved since 2000 because of the increasing prevalence of diabetes and the increased media attention to diabetes. The objective of this study was to determine the frequency of reporting of diabetes on death certificates of decedents with known diabetes and to describe trends over 8 years using data from Translating Research into Action for Diabetes (TRIAD). TRIAD was ideal for this study because it involved a racially and ethnically diverse sample of adults with diabetes from six sites across the United States and because all participants had been diagnosed with diabetes for at least 1 year before enrollment.