95例入院1天内死亡新生儿死因分析

为提高对新生儿、围产儿疾病的诊断和急救水平，降低病死率、减少后遗症，本文就我院1985－1995年间新生儿入院1天内死亡病例95例进行了死因分析。资料与分析一、一般资料同期共收治新生儿病例2737例，死亡341例，病死率12．5％。入院1天内死亡95例，占死亡总数的27．9％。95例中农村患婴85例占89．5％，城区10例占10．5％，男68例女27例，男：女=2．5：1。出生体重≤1．5kg12例占12．6％，～2．5kg33例占34．8％，＞2．5kg50例占52．6％。入院日龄≤1天48例，～7天34例，＞7天13例；≤7天占86．3％（82／95）。发病日龄≤1天54例，～7天35…     

住院精神病人死亡案例分析

目的探讨降低精神病人住院死亡率及医疗纠纷的措施。方法对我科1998年至2007年共10年期间住院死亡的精神病人病案进行回顾性调查,内容包括死亡原因及相关因素。结果研究期间总住院7682人次,住院期间死亡12例,死亡率0.16%;死亡原因：自杀4例,躯体疾病死亡3例,中毒3例,猝死及多脏器衰竭各1例;死亡案例中,有6例发生医疗纠纷。结论自杀是我科住院精神病人死亡的主要原因,其次为躯体疾病致死、中毒死亡;对风险较大的患者,从各个环节采取相应措施,更有利于降低精神病人住院死亡率及医疗纠纷。     

猝死尸体解剖28例分析

目的 分析猝死的原因、特点及不明原因死亡的疾病分布。方法 收集不明原因死亡的尸体解剖材料116例，进行病理组织学检查，部分做了法医学的毒物分析。结果 在116例尸检中，90．5％明确了死亡的主要病因。猝死28例，其中以心血管系统疾病占首位，共16例；其次为中枢神经系统、生殖系统疾病、青壮年猝死综合征、呼吸系统疾病和婴幼儿猝死综合征。结论 科学、正确地进行尸体解剖，不但可明确死因、丰富和发展相关临床学科的内容，而且对提高临床诊治水平及准确鉴定医疗纠纷具有重要意义。     

综合性医院躯体疾病伴发精神障碍临床调查

目的旨在对综合医院各临床科住院病人躯体疾病同时伴发精神卫生问题的“共病现象”进行探索性研究。对住院的各类躯体疾病病人中的精神卫生问题、负性情绪、躯体疾病伴发精神障碍早发现、早诊断、早治疗。方法应用心理测量量表（SAS、SDS、综合情况调查表）在本院内科、外科、妇产、老年、慢性病等科室随机抽样278名不同性别、不同职业,年龄在18～73岁住院病人中进行调查与分析;同时在医院进行正常体检表不同年龄,不同职业、不同性别正常人群中随机抽样100名进行测量、分析并做对照研究。结果研究组：焦虑（SAS）检出率31％;抑郁（SDS）检出率23％,总的焦虑、抑郁负性情绪发生率为54％;对照组：SAS检出率14％;SDS检出率5％．总的焦虑、抑郁负性情绪发生率为19％。两组负性情绪总的检出率经秩和检验P〈0．05～0．01．SAS、SDS各个年龄组均分经统计学分析显示P〈0．01,两组存在显著性差异。结论综合医院住院病人的精神卫生问题明显高于正常人群。综合医院住院病人的精神卫生问题、负性情绪、躯体痰病同时伴发精神障碍的“共病现象”发生应引起特别关注。     

近30年来精神科住院病人死因变迁分析

目的探讨近30年精神科住院病人死亡原因变迁。方法对我院精神科1975～2004年期间住院病人18948例中死亡的112例作回顾性调查，比较3个阶段（每10年为一阶段）住院精神病人的死亡率，并分析死亡原因。结果总死亡率为0．59％，逐年呈下降趋势，躯体疾病为主要死亡原因，其下降趋势趋于平稳，自杀为第二位，其下降趋势明显。结论30年来医院管理水平、医疗质量有所提高，但精神科工作者在日常工作中，除了加强生活护理和心理护理，更应重视基础知识的学习，重视体格检查。     

1998年～2007年巢湖市一院儿科住院死亡病例分析

目的：分析儿科住院死亡儿童年龄分布、死亡原因、死亡率及其变化趋势。方法：对巢湖市一院儿科1998年～2007年住院10365例中99例死亡病例进行回顾性统计分析。结果：1998年～2007年住院儿童总病死率为9．5％,10年间病死率总体呈下降趋势。新生儿病死病例最多,占各年龄组死亡比例为61．62％;不同年龄组儿童死亡原因不同,居前三位的分别是新生儿疾病、呼吸系统疾病和神经系统疾病。结论：降低儿童病死率的关键是加强围生期和新生儿期保健。根据不同年龄组的发病特点,采取不同的疾病防治措施。     

猝死37例死因分析

目的 分析不明原因死亡患者的疾病分布及尸检病理学特点。方法 收集不明原因死亡尸体107例，解剖结果显示37例为猝死，占35％，对其进行组织病理学检查。结果 37例猝死的疾病分布以心血管最常见，共16例，占43．2％，其次为呼吸系统、神经系统、消化系统疾病。结论 通过尸体解剖和病理学检查，为解决医疗纠纷和明确猝死死因提供科学的鉴定依据，对提高医疗质量起到积极的作用。     

新生儿死亡原因分析（附104例报告）

目的：为了解新生儿死亡原因,提高临床诊断率及治愈率。方法：对1987年～1996年间出生后1～28天内死亡新生儿104例(男56例,女48例)进行尸检,各脏器均经病理制片观察。结果：呼吸系统疾病62例(59．6％),消化系统疾病13例(12．5％),遗传性疾病15例(14．4％),其它病变14例(13．5％)。结论：肺部感染是新生儿主要致死原因,但产伤致死不可忽视。     

2003年-2013年江门地区5岁以下儿童死亡监测结果及干预措施分析

目的通过分析我市5岁以下儿童死亡情况，了解儿童死亡的变化趋势，探讨有力的干预措施，提高儿童保健服务的质量，改善儿童的生存状况。方法收集2003年～2013年江门市5岁以下儿童死亡报告卡及当年的漏报调查资料，根据国际疾病分类进行死亡情况的系统分析。结果11#-间江门市各年龄段的死亡率总体呈下降趋势，从2003年的8．75％o、7．26％0、4．30％0，下降到2013年6．75％0、5．23％o、3．59‰，具有明显的统计学差异（P〈O．001）；婴儿死亡633例，占5岁以下儿童死亡的77．43％；新生儿死亡435例，占婴儿死亡的68．72％；早产低体重、先天性心脏病和新生儿重度窒息是主要引起儿童死亡的病因。结论降低5岁以下儿童病死率的关键在于降低新生儿死亡率。重点是做好婚前医学检查，孕期保健，提倡住院分娩和科学接生。     

住院精神病人死亡原因分析

广州市精神病医院江村、鹤洞住院部主要以收治病程长、反复发作、难以治愈，对社会和家庭有一定危害的慢性精神病人．为了弄清这类精神病人的死亡原因、特点以及与死亡有关的因素，我们对1950～1997年间死亡的423例精神病人作了分析。1死亡原因1．1理体疾病342冽（占死亡总数80．9％，下同）①全身衰竭145例（占躯体疾病总数《24％，下同），其中92例为慢性退缩。生活闲散、长期卧床、进食少、体质差的病人，另53例则因兴奋、躁动、木且、拒食、幻觉妄想等精神症状所致。②肺部疾病73例（21．3％），肺炎、肺结核、肺气肿合并急性肺部感染。…     

Respiratory syncytial virus-associated hospitalizations over three consecutive seasons in children with congenital heart disease

The purpose of this investigation was to analyze the burden of respiratory syncytial virus (RSV)-related hospitalizations in infants and children with congenital heart disease (CHD) over three consecutive RSV seasons. Retrospectively, all children with hemodynamically significant (HS-CHD) and not significant (HNS-CHD) CHD born between 2004 and 2008 at a tertiary care university hospital and identified by ICD-10 diagnoses were included. Data on RSV-related hospitalizations over the first three years of life covering at least three RSV seasons (November–April) were analyzed. The overall incidence of RSV-related hospitalization was 9.6 % (58/602), without a statistically significant difference between HS-CHD and HNS-CHD (7.3 % vs. 10.4 %; p?=?0.258). Recommendation of palivizumab prophylaxis did not influence the RSV hospitalization rates between groups. Patients with HS-CHD and early surgery were significantly less often hospitalized due to RSV compared to those with delayed surgery (1.3 % vs. 14.3 %; p?=?0.003). The median duration of hospitalization was 8.5 days (HS-CHD: 14 vs. HNS-CHD: 7 days; p?=?0.003). Thirteen patients (22.4 %) were admitted to the intensive care unit (ICU), for a median of 10 days. The median age at admission was 2 months, with a significant difference between HS-CHD and HNS-CHD (6 vs. 2 months; p?=?0.001). The majority (97 %) of RSV-related hospitalizations occurred before 12 months of age. Patients with HS-CHD had a significantly more severe course of RSV disease and were older at the time of hospitalization. Early surgery seemed to significantly reduce the risk of RSV hospitalization during the first RSV season.     

Sudden cardiac death: an 11-year postmortem analysis in the region of Epirus, Greece

The aim of the study was to determine the rate of sudden cardiac death in people aged between 1 and 80 years, and to investigate its etiology. All autopsies performed during an 11-year period were reviewed. Circumstances of death, individual's information, and post-mortem findings were determined. Among 1254 sudden death autopsies performed during the study period, 688 cases were recognized as sudden cardiac death (79.8% males). The estimated annual frequency of sudden cardiac death in the region of Epirus was 18.6/100,000. The major cause of death was ischemic heart disease (82%), and in 2.6%, death was unexplained. Among our study's total population, 4.1% were <35 years old. The estimated annual rate of sudden cardiac death in the population 1-35 years old was 1.78/100,000. The most common etiology in that age group was atherosclerosis (17.8%), myocarditis (10.7%), and cardiomyopathies (10.7%), whereas 39.3% exhibited structurally normal heart. Although ischemic heart disease accounts for most of sudden cardiac death episodes, many other causes contribute. Most sudden deaths in the young were "unascertained". The likely cause of death in these cases might be a primary arrhythmogenic disorder. Correct identification of such cases at autopsy will enable an appropriate clinical screening of surviving relatives.     

Multisystem burden of neurofibromatosis 1 in Denmark: registry- and population-based rates of hospitalizations over the life span

PurposeThe aim was to assess lifetime risk for hospitalization in individuals with neurofibromatosis 1 (NF1).MethodsThe 2467 individuals discharged with a diagnosis indicating NF1 or followed in a clinical center for NF1 were matched to 20,132 general population comparisons. Based on diagnoses in 12 main diagnostic groups and 146 subcategories, we calculated rate ratios (RRs), absolute excess risks (AERs), and hazard ratios for hospitalizations.ResultsThe RR for any first hospitalization among individuals with NF1 was 2.3 (95% confidence interval 2.2–2.5). A high AER was seen for all 12 main diagnostic groups, dominated by disorders of the nervous system (14.5% of all AERs), benign (13.6%) and malignant neoplasms (13.4%), and disorders of the digestive (10.5%) and respiratory systems (10.3%). Neoplasms, nerve and peripheral ganglia disease, pneumonia, epilepsy, bone and joint disorders, and intestinal infections were major contributors to the excess disease burden caused by NF1. Individuals with NF1 had more hospitalizations and spent more days in hospital than the comparisons. The increased risk for any hospitalization was observed for both children and adults, with or without an associated cancer.ConclusionNF1 causes an overall greater likelihood of hospitalization, with frequent and longer hospitalizations involving all organ systems throughout life.     

Cardiopulmonary hospitalizations during influenza season in adults and adolescents with advanced HIV infection

The etiologic role of influenza in hospitalizations and deaths among persons infected with HIV since the introduction of highly active antiretroviral therapy (HAART) is not known. A retrospective cohort study was performed of all persons aged 15 to 50 years with AIDS or advanced HIV infection enrolled in the Tennessee Medicaid program from 1995 through 1999, representing 7368 person-years of follow-up. The influenza season was defined based on local virus surveillance, and hospitalizations were measured for acute cardiopulmonary causes and deaths from any cause throughout the year. From 1995 through 1999, cardiopulmonary hospitalization rates in HIV-infected patients declined by 53% and death rates declined by 77%. The influenza-attributable hospitalization rate was 48 (95% confidence interval [CI]: 16-91) per 1000 persons in 1995 and 5 (95% CI: -0.5-11) per 1000 persons per year during 1996 through 1999, after the introduction of HAART. Influenza-associated hospitalizations have declined in patients with HIV infection in the post-HAART era. Rates remain comparable to rates in other high-risk groups for which annual influenza vaccination is recommended, however.     

Increasing hospitalizations due to angioedema in the United States

BACKGROUND: Angioedema may occur in patients taking angiotensin-converting enzyme inhibitors. With the more prevalent use of this class of medications in the United States, it is not known whether angioedema hospitalizations have increased nationally in recent years. OBJECTIVES: To profile the trends in angioedema hospitalizations and to examine associated demographic factors and comorbid diseases in the United States. METHODS: A national database of hospitalizations in the United States was queried for hospitalizations with a principal diagnosis of angioedema and other major acute allergic disorders (anaphylaxis, urticaria, and allergy unspecified). Subsequent analysis was performed to determine the current angioedema hospitalization trends (1998-2005) and to examine clinical and demographic variables that distinguished angioedema from the other allergic disease admissions. RESULTS: The angioedema hospitalization rate was 3.3 in 100,000 in 1998 and rose to 4.0 in 100,000 in 2005. In contrast, the combined hospitalization rate for nonangioedema allergic disorders showed an overall decline and was exceeded by angioedema hospitalization rates after 2000. African American patients had consistently higher hospitalization rates (> or = 2 times) for angioedema compared with non-African American patients. Hypertension, increasing age, and African American ethnicity were associated with angioedema hospitalizations. Twenty-four percent of hospitalizations for angioedema were coded for an adverse effect due to cardiovascular or antihypertensive agents. CONCLUSIONS: Angioedema has become the dominant allergic disorder that results in hospitalization in the United States. Angioedema hospitalizations have a distinct epidemiologic pattern that differs from that observed in other atopic disease hospitalizations.     

Heart Failure Remote Monitoring: Evidence From the Retrospective Evaluation of a Real-World Remote Monitoring Program

Background

Given the magnitude of increasing heart failure mortality, multidisciplinary approaches, in the form of disease management programs and other integrative models of care, are recommended to optimize treatment outcomes. Remote monitoring, either as structured telephone support or telemonitoring or a combination of both, is fast becoming an integral part of many disease management programs. However, studies reporting on the evaluation of real-world heart failure remote monitoring programs are scarce.

Objective

This study aims to evaluate the effect of a heart failure telemonitoring program, Connected Cardiac Care Program (CCCP), on hospitalization and mortality in a retrospective database review of medical records of patients with heart failure receiving care at the Massachusetts General Hospital.

Methods

Patients enrolled in the CCCP heart failure monitoring program at the Massachusetts General Hospital were matched 1:1 with usual care patients. Control patients received care from similar clinical settings as CCCP patients and were identified from a large clinical data registry. The primary endpoint was all-cause mortality and hospitalizations assessed during the 4-month program duration. Secondary outcomes included hospitalization and mortality rates (obtained by following up on patients over an additional 8 months after program completion for a total duration of 1 year), risk for multiple hospitalizations and length of stay. The Cox proportional hazard model, stratified on the matched pairs, was used to assess primary outcomes.

Results

A total of 348 patients were included in the time-to-event analyses. The baseline rates of hospitalizations prior to program enrollment did not differ significantly by group. Compared with controls, hospitalization rates decreased within the first 30 days of program enrollment: hazard ratio (HR)=0.52, 95% CI 0.31-0.86, P=.01). The differential effect on hospitalization rates remained consistent until the end of the 4-month program (HR=0.74, 95% CI 0.54-1.02, P=.06). The program was also associated with lower mortality rates at the end of the 4-month program: relative risk (RR)=0.33, 95% 0.11-0.97, P=.04). Additional 8-months follow-up following program completion did not show residual beneficial effects of the CCCP program on mortality (HR=0.64, 95% 0.34-1.21, P=.17) or hospitalizations (HR=1.12, 95% 0.90-1.41, P=.31).

Conclusions

CCCP was associated with significantly lower hospitalization rates up to 90 days and significantly lower mortality rates over 120 days of the program. However, these effects did not persist beyond the 120-day program duration.     

Mortality in a cohort of HIV-infected adults started on a protease inhibitor-containing therapy: standardization to the general population

Death rates in the APROCO cohort of 1,157 HIV-1 infected adults starting for the first time a protease inhibitor-containing therapy were standardized to the 1996 French general population mortality rates stratified by age and gender. Median follow-up was 23 months and mortality rate was 2.2% person-years (95% confidence interval [CI] = 1.6-2.9). Overall mortality was 7.8 times higher than in the general population (95% CI = 5.7-10.4), 4.7 in men and 19.5 in women. Among the 144 patients considered complete responders, the death rate was 1.2% person-years (95% CI = 0.2-3.5) and mortality remained 5.1 times higher (95% CI = 1.0-14.9) than in the general population. Failure of treatment, long-term adverse effects, or less favorable socio-demographic status could explain these trends.     

Temporary employment, absence of stable partnership, and risk of hospitalization or death during the course of HIV infection

OBJECTIVE: To estimate the independent association between socioeconomic conditions and the risk of all-cause hospitalization or death during the course of HIV disease in the highly active antiretroviral therapy (HAART) era. METHODS: Patients in the French PRIMO multicenter prospective cohort of 319 individuals were enrolled during primary HIV-1 infection between 1996 and 2002. Associations between social characteristics (ie, employment status, stable partnership) and the risk of hospitalization or death were assessed using generalized estimating equations. RESULTS: During a median follow-up of 2.5 years, 109 hospitalizations among 84 patients (26.3%) and 3 deaths occurred. Even after adjustment for classic determinants of HIV-infected patients' health status, social characteristics were independently associated with the risk of hospitalization or death, with a significantly increased risk for patients with temporary employment compared with those with stable employment (adjusted odds ratio [OR] = 2.5, 95% confidence interval: 1.1 to 5.6) and for patients without a stable partnership compared with those with a stable partnership (OR = 1.6, 95% confidence interval: 1.0 to 2.7). CONCLUSIONS: In the era of HAART, adverse social conditions constitute independent risk factors of hospitalization or death during the course of HIV disease.     

Hospitalization in hemodialysis patients in one region of Lithuania

INTRODUCTION AND METHODS: The objective of our study was to evaluate hospitalization rates in hemodialysis patients in the region of Kaunas, the second largest city in Lithuania. We analysed ambulatory case records of 187 ESRD patients dialysed in all 7 hemodialysis centers in the Kaunas region over the year 2002. RESULTS: During the year 2002 the unadjusted hospitalization rate over a 1 year period in all dialysed patients (the prevalent patients, n=187) was 1.4 hospitalizations per patient year at risk. There were 17.5 hospital days per patient year at risk, the mean length of one hospitalization being 12.5 days. The most frequent causes of hospitalization were cardiovascular diseases (25%), infections (22%), and access related complications (10%). Of the 187 patients, 55 started hemodialysis in the year 2002 (incident patients). The comparison of prevalent patients with incident patients revealed a higher hospitalization rate in the incident patients (unadjusted hospitalization rate was 1.9 hospitalizations per patient year at risk). The length of hospitalization (29.1 hospital days per patient year at risk) and the mean length of one hospitalization (15.1 days) were longer in the incident patients than the prevalent patients. In the year 2002, the National Sickness Fund paid $361 per year for hospitalizations of one hemodialysis patient and $10,800 per year for the dialysis procedures of one hemodialysis patient. CONCLUSIONS: The hospitalization rate in Lithuania for patients undergoing hemodialysis is similar to that of other European countries while hospitalization costs are lower.     

Pattern of hospitalizations for angioedema in New York between 1990 and 2003.

BACKGROUND: The epidemiologic characteristics of angioedema have not been well described in the United States, especially regarding hospitalization patterns. This fact is particularly relevant given the increased use of angiotensin-converting enzyme inhibitors, a known cause of angioedema. OBJECTIVE: To profile hospital admissions for angioedema in New York State with respect to age, sex, race, comorbidities, and year. METHODS: A database of all acute hospitalizations in New York State was examined between 1990 and 2003. Patient admissions that had the principal admission diagnoses of angioedema and other acute allergic disorders (anaphylaxis, urticaria, or allergy unspecified) were extracted. Characteristics of angioedema admissions were tabulated and compared with those of other acute allergic disease admissions with respect to demographic variables and comorbidities. RESULTS: There were 6,775 hospitalizations for angioedema during the study period. The number of angioedema hospitalizations increased progressively from 293 in 1990 to 636 in 2003, which exceeded the number of hospitalizations for anaphylaxis that year. African Americans constituted 42% of the angioedema admissions despite being less than 16% of the state population. The increase in hospitalizations for angioedema was most marked in patients with a diagnosis of hypertension, and for each study year, patients admitted with angioedema were consistently older than those admitted with other allergic disorders. CONCLUSIONS: Angioedema has become the most common nonasthmatic acute allergic disorder that results in hospitalization in New York State. The predilection for angioedema occurring in patients with hypertension suggests that angiotensin-converting enzyme inhibitor use may play a role in this trend.