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Lower Mortality Rate (lower + mortality_rate)
Selected AbstractsThe Debrecen Stroke Database: demographic characteristics, risk factors, stroke severity and outcome in 8088 consecutive hospitalised patients with acute cerebrovascular diseaseINTERNATIONAL JOURNAL OF STROKE, Issue 5 2009D. Bereczki Background High stroke mortality in central,eastern European countries might be due to higher stroke incidence, more severe strokes or less effective acute care than in countries with lower mortality rate. Hospital databases usually yield more detailed information on risk factors, stroke severity and short-term outcome than population-based registries. Patients and methods The Debrecen Stroke Database, data of 8088 consecutively hospitalised patients with acute cerebrovascular disease in a single stroke centre in East Hungary between October 1994 and December 2006, is analysed. Risk factors were recorded and stroke severity on admission was scored by the Mathew stroke scale. The modified Glasgow outcome scale was used to describe patient condition at discharge. Results Mean age was 68±13 years, 11·4% had haemorrhagic stroke. The rate of hypertension on admission was 79% in men, and 84% in women, 40·3% of men and 19·8% of women were smokers, and 34% of all patients had a previous cerebrovascular disease in their history. Case fatality was 14·9%, and 43% had some disability at discharge. Outcome at discharge was worse with higher age, higher glucose, higher blood pressure, higher white cell count and erythrocyte sedimentation rate and more severe clinical signs on admission. In multivariate analysis admission blood pressure lost its significance in predicting outcome. Conclusions In this large Hungarian stroke unit database hypertension on admission, smoking and previous cerebrovascular disease were more frequent than in most western databases. These findings indicate major opportunities for more efficient stroke prevention in this and probably other eastern European countries. [source] Simulation of the population dynamics and social structure of the Virunga mountain gorillasAMERICAN JOURNAL OF PRIMATOLOGY, Issue 4 2004Martha M. Robbins Abstract An agent-based model was developed to simulate the growth rate, age structure, and social system of the endangered mountain gorillas (Gorilla beringei beringei) in the Virunga Volcanoes region. The model was used to compare two types of data: 1) estimates of the overall population size, age structure, and social structure, as measured by six censuses of the entire region that were conducted in 1971,2000; and 2) information about birth rates, mortality rates, dispersal patterns, and other life history events, as measured from three to five habituated research groups since 1967. On the basis of the research-group data, the "base simulation" predicted a higher growth rate than that observed from the census data (3% vs. 1%). This was as expected, because the research groups have indeed grown faster than the overall population. Additional simulations suggested that the research groups primarily have a lower mortality rate, rather than higher birth rates, compared to the overall population. Predictions from the base simulation generally fell within the range of census values for the average group size, the percentage of multimale groups, and the distribution of females among groups. However, other discrepancies predicted from the research-group data were a higher percentage of adult males than observed, an overestimation of the number of multimale groups with more than two silverbacks, and an overestimated number of groups with only two or three members. Possible causes for such discrepancies include inaccuracies in the census techniques used, and/or limitations with the long-term demographic data set obtained from only a few research groups of a long-lived species. In particular, estimates of mortality and male dispersal obtained from the research groups may not be representative of the entire population. Our final simulation addressed these discrepancies, and provided a better basis for further studies on the complex relationships among individual life history events, group composition, population age structure, and growth rate patterns. Am. J. Primatol. 63:201,223, 2004. © 2004 Wiley-Liss, Inc. [source] Survival Advantage of Pediatric Recipients of a First Kidney Transplant Among Children Awaiting Kidney TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 12 2008D. L. Gillen The mortality rate in children with ESRD is substantially lower than the rate experienced by adults. However, the risk of death while awaiting kidney transplantation and the impact of transplantation on long-term survival has not been well characterized in the pediatric population. We performed a longitudinal study of 5961 patients under age 19 who were placed on the kidney transplant waiting list in the United States. Of these, 5270 received their first kidney transplant between 1990 and 2003. Survival was assessed via a time-varying nonproportional hazards model adjusted for potential confounders. Transplanted children had a lower mortality rate (13.1 deaths/1000 patient-years) compared to patients on the waiting list (17.6 deaths/1000 patient-years). Within the first 6 months of transplant, there was no significant excess in mortality compared to patients remaining on the waiting list (adjusted Relative Risk (aRR) = 1.01; p = 0.93). After 6 months, the risk of death was significantly lower: at 6,12 months (aRR = 0.37; p < 0.001) and at 30 months (aRR 0.26; p < 0.001). Compared to children who remain on the kidney transplant waiting list, those who receive a transplant have a long-term survival advantage. With the potential for unmeasured bias in this observational data, the results of the analysis should be interpreted conservatively. [source] The Relationship Between the Emergent Primary Percutaneous Coronary Intervention Quality Measure and Inpatient Myocardial Infarction MortalityACADEMIC EMERGENCY MEDICINE, Issue 8 2010Rahul K. Khare MD ACADEMIC EMERGENCY MEDICINE 2010; 17:793,800 © 2010 by the Society for Academic Emergency Medicine Abstract Background:, In the setting of acute ST-segment elevation myocardial infarction (STEMI), reperfusion therapy with emergent primary percutaneous coronary intervention (PCI) significantly reduces mortality. It is unknown whether a hospital's performance on the Centers for Medicare & Medicaid Services (CMS) quality metric for time from patient arrival to angioplasty is associated with its overall hospital acute myocardial infarction (AMI) mortality rate. Objectives:, The objective of this study was to evaluate if hospitals with higher performance on the time-to-PCI quality measure are more likely to achieve lower mortality for patients admitted for any type of AMI. Methods:, Using merged 2006 data from the Nationwide Inpatient Sample (NIS), the American Hospital Association (AHA) annual survey, and CMS Hospital Compare quality indicator data, we examined 69,101 admissions with an International Classification of Diseases, Ninth Revision (ICD-9)-coded principal diagnosis of AMI in the 116 hospitals that reported more than 24 emergent primary PCI admissions in that year. Hospitals were categorized into quartiles according to percentage of admissions in 2006 that achieved the primary PCI timeliness threshold (time-to-PCI quality measure). Using a random effects logistic regression model of inpatient mortality, we examined the significance of the hospital time-to-PCI quality measure after adjustment for other hospital and individual patient sociodemographic and clinical characteristics. Results:, The unadjusted inpatient AMI mortality rate at the 27 top quartile hospitals was 4.3%, compared to 5.1% at the 32 bottom quartile (worst performing) hospitals. The risk-adjusted odds ratio (OR) of inpatient death was 0.83 (95% confidence interval [CI] = 0.72 to 0.95), or 17% lower odds of inpatient death, among patients admitted to hospitals in the top quartile for the time-to-PCI quality measure compared to the case if the hospitals were in the bottom 25th percentile. Conclusions:, Hospitals with the highest and second highest quartiles of time-to-PCI quality measure had a significantly lower overall AMI mortality rate than the lowest quartile hospitals. Despite the fact that a minority of all patients with AMI get an emergent primary PCI, hospitals that perform this more efficiently also had a significantly lower mortality rate for all their patients admitted with AMI. The time-to-PCI quality measure in 2006 was a potentially important proxy measure for overall AMI quality of care. [source] Antimalarial treatment may have a time-dependent effect on lupus survival: Data from a multinational Latin American inception cohortARTHRITIS & RHEUMATISM, Issue 3 2010Samuel K. Shinjo Objective To evaluate the beneficial effect of antimalarial treatment on lupus survival in a large, multiethnic, international longitudinal inception cohort. Methods Socioeconomic and demographic characteristics, clinical manifestations, classification criteria, laboratory findings, and treatment variables were examined in patients with systemic lupus erythematosus (SLE) from the Grupo Latino Americano de Estudio del Lupus Eritematoso (GLADEL) cohort. The diagnosis of SLE, according to the American College of Rheumatology criteria, was assessed within 2 years of cohort entry. Cause of death was classified as active disease, infection, cardiovascular complications, thrombosis, malignancy, or other cause. Patients were subdivided by antimalarial use, grouped according to those who had received antimalarial drugs for at least 6 consecutive months (user) and those who had received antimalarial drugs for <6 consecutive months or who had never received antimalarial drugs (nonuser). Results Of the 1,480 patients included in the GLADEL cohort, 1,141 (77%) were considered antimalarial users, with a mean duration of drug exposure of 48.5 months (range 6,98 months). Death occurred in 89 patients (6.0%). A lower mortality rate was observed in antimalarial users compared with nonusers (4.4% versus 11.5%; P< 0.001). Seventy patients (6.1%) had received antimalarial drugs for 6,11 months, 146 (12.8%) for 1,2 years, and 925 (81.1%) for >2 years. Mortality rates among users by duration of antimalarial treatment (per 1,000 person-months of followup) were 3.85 (95% confidence interval [95% CI] 1.41,8.37), 2.7 (95% CI 1.41,4.76), and 0.54 (95% CI 0.37,0.77), respectively, while for nonusers, the mortality rate was 3.07 (95% CI 2.18,4.20) (P for trend < 0.001). After adjustment for potential confounders in a Cox regression model, antimalarial use was associated with a 38% reduction in the mortality rate (hazard ratio 0.62, 95% CI 0.39,0.99). Conclusion Antimalarial drugs were shown to have a protective effect, possibly in a time-dependent manner, on SLE survival. These results suggest that the use of antimalarial treatment should be recommended for patients with lupus. [source] Low-Flux Versus High-Flux Synthetic Dialysis Membrane in Acute Renal Failure: Prospective Randomized StudyARTIFICIAL ORGANS, Issue 12 2001Jadranka Buturovi, Ponikvar Abstract: The influence of dialyzer membrane on the morbidity and mortality of patients with acute renal failure remains a matter of debate. The aim of the prospective randomized clinical study was to assess the influence of the flux of a synthetic dialyzer membrane on patients' survival rate, restitution of renal function, and duration of hemodialysis treatment of patients with acute renal failure as a part of multiorgan failure. Seventy-two patients treated in intensive care units of the University Medical Center Ljubljana were randomized according to the dialyzer used throughout the duration of hemodialysis treatment. There were 38 patients in the low-flux group (dialyzer F6, low-flux polysuphone, Fresenius, Bad Homburg, Germany) and 34 patients in the high-flux group (dialyzer Filtral 12, sulphonated high-flux polyacrylonitrile, Hospal, Industrie Meyzieu, France). Both groups were balanced in terms of sex, age, APACHE II score, oliguria before dialysis, cause of acute renal failure, innotropic support, mechanical ventilation, and the number of failing organs. The patients' survival rate was 18.7% in the low-flux group and 20.6% in the high-flux group. Ten patients (26.3%) recovered their renal function in the low-flux group and 8 (23.5%) in the high-flux group. Hemodialysis treatment lasted 11.2 days in the low-flux and 10.7 days in the high-flux group. An analysis of subgroups with a lower mortality rate (subgroup of patients without oliguria and subgroup of patients with less than 4 failed organ systems) did not show significant differences between the low-flux and high-flux groups in terms of survival rate, recovery of renal function, and duration of hemodialysis treatment. In conclusion, no significant differences were found in the results of low-flux versus high-flux synthetic membrane dialyzer treatment in patients with acute renal failure as a part of multiorgan failure in terms of survival rate, recovery of renal function, incidence of oliguria during hemodialysis, and duration of hemodialysis treatment. The number of failing organs seems to be the most important single factor determining the survival of patients with acute renal failure as a part of multiorgan failure. [source] Renal dysfunction and prolonged visceral ischaemia increase mortality rate after suprarenal aneurysm repair,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2003C. D. Bicknell Background: Elective juxtarenal abdominal aneurysm repair has a significantly lower mortality rate than suprarenal repair. Identification of factors affecting outcome may lead to a reduction in mortality rate for suprarenal repair. Methods: Data were collected prospectively between 1993 and 2000 for 130 patients who underwent type IV thoracoabdominal aneurysm (TAA) repair and 44 patients who had juxtarenal aneurysm (JRA) repair. Preoperative risk factors and operative details were compared between groups and related to outcome after TAA repair (there were only two deaths in the JRA group). Results: The in-hospital mortality rate was significantly higher following TAA repair (20·0 per cent; 26 of 130 patients) than JRA repair (4·5 per cent; two of 44). Raised serum creatinine concentration was the only preoperative factor (P = 0·013) and visceral ischaemia the only significant operative factor (P = 0·001) that affected mortality after TAA repair. Conclusion: JRA repair was performed with similar risks to those of infrarenal aneurysm repair. Impaired preoperative renal function was related to death following TAA repair and conservative treatment should be considered for patients with a serum creatinine level above 180 µmol/l. Reducing the duration of visceral ischaemia might improve outcome. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Copepod life cycle adaptations and success in response to phytoplankton spring bloom phenologyGLOBAL CHANGE BIOLOGY, Issue 6 2009HANNO SEEBENS Abstract In a seasonal environment, the timing of reproduction is usually scheduled to maximize the survival of offspring. Within deep water bodies, the phytoplankton spring bloom provides a short time window of high food quantity and quality for herbivores. The onset of algal bloom development, however, varies strongly from year to year due to interannual variability in meteorological conditions. Furthermore, the onset is predicted to change with global warming. Here, we use a long-term dataset to study (a) how a cyclopoid copepod, Cyclops vicinus, is dealing with the large variability in phytoplankton bloom phenology, and (b) if bloom phenology has an influence on offspring numbers. C. vicinus performed a two-phase dormancy, that is, the actual diapause of fourth copepodid stages at the lake bottom is followed by a delay in maturation, that is, a quiescence, within the fifth copepodid stage until the start of the spring bloom. This strategy seems to guarantee a high temporal match of the food requirements for successful offspring development, especially through the highly vulnerable naupliar stages, with the phytoplankton spring bloom. However, despite this match with food availability in all study years, offspring numbers, that is, offspring survival rates were higher in years with an early start of the phytoplankton bloom. In addition, the phenology of copepod development suggested that also within study years, early offspring seems to have lower mortality rates than late produced offspring. We suggest that this is due to a longer predator-free time period and/or reduced time stress for development. Hence, within the present climate variability, the copepod benefited from warmer spring temperatures resulting in an earlier phytoplankton spring bloom. Time will show if the copepod's strategy is flexible enough to cope with future warming. [source] Physical and psychological health of first and second generation Turkish immigrants in Germany,AMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 4 2010Ashwin A. Kotwal Recent studies in Germany suggest that first generation Turkish immigrants have lower mortality rates compared to native Germans. Conversely, studies examining morbidity, though not national in scope, have demonstrated that first generation Turks may have poorer health than native Germans. Additionally, little is known about the health of the emerging second generation Turkish population in Germany. To evaluate the discrepancy between mortality and morbidity trends and contribute to a better understanding of second generation Turkish immigrant health, this paper uses a nationally-representative dataset, including the 2005 German Gender and Generations Study (GGS) (n = 10,017) and the 2006 GGS Turkish supplement (n = 4,045), to assess three health outcomes: chronic illness, self-assessed health, and feelings of emptiness. The paper investigates whether sex, age, socioeconomic status, emotional support, or duration of residence in Germany predict these dimensions of health. Results establish clear health status differences between Turks and native Germans. Surprisingly, both first and second generation Turks tend to have lower chronic illness rates and rate their health as better than Germans at younger ages, but the advantage diminishes among higher age strata for the first generation. Feelings of emptiness results generally indicate an increased susceptibility to psychological problems for both generations of Turks. Controlling for socioeconomic status and age reduces these health differences modestly, pointing to their likely role as mediators. The relatively higher risks for all three health outcomes among Turkish females of both generations compared to their German counterparts suggest that female Turkish immigrants and their female offspring may be particularly vulnerable. Am. J. Hum. Biol. 2010. © 2010 Wiley-Liss, Inc. [source] HP10 LAPAROSCOPIC RESECTION OF SUBMUCOSAL GASTRIC LESIONS , THE WHANGAREI EXPERIENCEANZ JOURNAL OF SURGERY, Issue 2007J. Y. Yang Purpose To evaluate safety of laparoscopic resection of submucosal gastric lesions performed in Whangarei Based Hospital. Methodology From November 2002 to December 2006, 8 consecutive patients underwent the above mention surgery. (M : F = 5 : 3; Average age 63 [range, 43,83]). All patients underwent pre-operative gastroscopy. Wedge resections were performed for anterior wall lesions. (n = 3). Posterior wall lesions were resected via transgastric approach. (n = 4). Retroperitoneal resection was performed for the foregut duplication cyst. (n = 1). All except one lesion were resected using endoscopic GIA stapler. The medical records of the patients were reviewed retrospectively. Results All patients were successfully treated laparoscopically. No conversion to open surgery. Pathology included: Gastrointestinal-stromal tumor (GIST) (n = 5), Malignant leiomyosarcoma (n = 1), Ectopic pancreas (n = 1), and Foregut duplication cysts (n = 1). All achieved adequate negative surgical margin. Average operation time was 106.14 minutes. [Range, 75,150]. Average length of hospital stay was 3.42 days [range, 1,5]. Complication included one wound infection, and one pyloric stenosis. Average length of follow up was 10.96 months [range, 0.46,31.73]. No recurrence detected and all are still alive till date. Conclusion Laparoscopic resection of submucosal gastric lesions is a safe and appropriate alternative to open surgery. Its main advantage over open technique includes shorter length of hospital stay, lower recurrence rate and lower mortality rates. Surgical technique depends very much on tumor size and location. Outcome of the patients described from our centre is comparable to the others published till date. [source] | |||||||||||||