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Acta Neurochirurgica Sep 2023To determine existing trends concerning in-hospital mortality in patients with traumatic subaxial cervical spinal cord injury (SCI) over the last four decades. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To determine existing trends concerning in-hospital mortality in patients with traumatic subaxial cervical spinal cord injury (SCI) over the last four decades.
METHODS
We searched MEDLINE and EMBASE to assess the role of the following factors on in-hospital mortality over the last four decades: neurological deficit, age, surgical decompression, use of computed tomography (CT) and magnetic resonance imaging (MRI), use of methylprednisolone in the acute post-injury period, and study location (developing versus developed countries).
RESULTS
Among 3333 papers after deduplication, 21 studies met the eligibility criteria. The mortality rate was 17.88% [95% confidence interval (CI): 12.9-22.87%]. No significant trend in mortality rate was observed over the 42-year period (meta-regression coefficient = 0.317; p = 0.372). Subgroup analysis revealed no significant association between acute subaxial cervical SCI-related mortality when stratified by use of surgery, administration of methylprednisolone, use of MRI and CT imaging, study design (prospective versus retrospective study), and study location. The mortality rate was significantly higher in complete SCI (20.66%, p = 0.002) and American Spinal Injury Association impairment scale (AIS) A (20.57%) and B (9.28%) (p = 0.028).
CONCLUSION
A very low level of evidence showed that in-hospital mortality in patients with traumatic subaxial cervical SCI did not decrease over the last four decades despite diagnostic and therapeutic advancements. The overall acute mortality rate following subaxial cervical SCI is 17.88%. We recommend reporting a stratified mortality rate according to key factors such as treatment paradigms, age, and severity of injury in future studies.
Topics: Humans; Hospital Mortality; Cervical Cord; Prospective Studies; Retrospective Studies; Neck Injuries; Spinal Cord Injuries; Methylprednisolone
PubMed: 37480505
DOI: 10.1007/s00701-023-05720-5 -
Heart & Lung : the Journal of Critical... 2021Hypoglycemia frequently occurs in patients with sepsis. The status of prognosis of sepsis patients varies with the cause of hypoglycemia. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Hypoglycemia frequently occurs in patients with sepsis. The status of prognosis of sepsis patients varies with the cause of hypoglycemia.
OBJECTIVE
A meta-analysis was performed to obtain a reliable basis for assessing the severity of disease in sepsis patients.
METHODS
A search of electronic databases was performed. The random-effects model was employed to calculate the overall odds ratio (OR) and 95% CI.
RESULTS
Five cohort studies were included. Decreased blood glucose level was associated with an increased risk of death [OR:1.68; 95% CI (1.12-2.53)]. Incidents of mortality were analyzed based on the causative factor of hypoglycemia. Patients with spontaneous hypoglycemia showed a significantly higher mortality rate than the control subjects[OR 1.65; 95% CI (1.20-2.28); p = 0.002].
CONCLUSION
In the early stages of sepsis, the occurrence of spontaneous hypoglycemia may be associated with the severity of the disease.
Topics: Blood Glucose; Hospital Mortality; Humans; Hypoglycemia; Prognosis; Sepsis
PubMed: 34433111
DOI: 10.1016/j.hrtlng.2021.07.017 -
JBI Evidence Synthesis Jan 2023The objective of this review was to determine the timing of overall and cause-specific neonatal mortality and severe morbidity during the postnatal period (1-28 days). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The objective of this review was to determine the timing of overall and cause-specific neonatal mortality and severe morbidity during the postnatal period (1-28 days).
INTRODUCTION
Despite significant focus on improving neonatal outcomes, many newborns continue to die or experience adverse health outcomes. While evidence on neonatal mortality and severe morbidity rates and causes are regularly updated, less is known on the specific timing of when they occur in the neonatal period.
INCLUSION CRITERIA
This review considered studies that reported on neonatal mortality daily in the first week; weekly in the first month; or day 1, days 2-7, and days 8-28. It also considered studies that reported on timing of severe neonatal morbidity. Studies that reported solely on preterm or high-risk infants were excluded, as these infants require specialized care. Due to the available evidence, mixed samples were included (eg, both preterm and full-term infants), reflecting a neonatal population that may include both low-risk and high-risk infants.
METHODS
MEDLINE, Embase, Web of Science, and CINAHL were searched for published studies on December 20, 2019, and updated on May 10, 2021. Critical appraisal was undertaken by 2 independent reviewers using standardized critical appraisal instruments from JBI. Quantitative data were extracted from included studies independently by 2 reviewers using a study-specific data extraction form. All conflicts were resolved through consensus or discussion with a third reviewer. Where possible, quantitative data were pooled in statistical meta-analysis. Where statistical pooling was not possible, findings were reported narratively.
RESULTS
A total of 51 studies from 36 articles reported on relevant outcomes. Of the 48 studies that reported on timing of mortality, there were 6,760,731 live births and 47,551 neonatal deaths with timing known. Of the 34 studies that reported daily deaths in the first week, the highest proportion of deaths occurred on the first day (first 24 hours, 38.8%), followed by day 2 (24-48 hours, 12.3%). Considering weekly mortality within the first month (n = 16 studies), the first week had the highest mortality (71.7%). Based on data from 46 studies, the highest proportion of deaths occurred on day 1 (39.5%), followed closely by days 2-7 (36.8%), with the remainder occurring between days 8 and 28 (23.0%). In terms of causes, birth asphyxia accounted for the highest proportion of deaths on day 1 (68.1%), severe infection between days 2 and 7 (48.1%), and diarrhea between days 8 and 28 (62.7%). Due to heterogeneity, neonatal morbidity data were described narratively. The mean critical appraisal score of all studies was 84% (SD = 16%).
CONCLUSION
Newborns experience high mortality throughout the entire postnatal period, with the highest mortality rate in the first week, particularly on the first day. Ensuring regular high-quality postnatal visits, particularly within the first week after birth, is paramount to reduce neonatal mortality and severe morbidity.
Topics: Female; Humans; Infant, Newborn; Infant Mortality; Postpartum Period; Time Factors; Morbidity; Asphyxia Neonatorum; Infections; Diarrhea
PubMed: 36300916
DOI: 10.11124/JBIES-21-00479 -
Psychosomatic Medicine 2020The aim of the study was to investigate the association between sense of coherence (SOC) and all-cause mortality in the general adult population. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of the study was to investigate the association between sense of coherence (SOC) and all-cause mortality in the general adult population.
METHODS
We conducted a systematic review and meta-analysis of prospective cohort studies. We searched eight electronic bibliographic databases for eligible studies. A random effects model and the restricted maximum likelihood method were used to calculate the pooled effect size.
RESULTS
Eight studies were eligible for the meta-analysis. The studies included 48,138 participants, of whom 5307 died during a median follow-up of 14.1 years (range, 8-29.5 years). Their age ranged from 20 to 80 years, and 53% of them were men. In the meta-analysis model of crude values, the risk of all-cause mortality for individuals with a weak SOC (lowest tertile) was 1.30 (95% confidence interval [CI] = 1.09-1.55, p = .003, I = 78.84%) compared with individuals with a strong SOC (highest tertile). In the model adjusted for age, the risk remained almost the same (risk ratio = 1.26, 95% CI = 1.15-1.38, p < .001, I = 69.59%). In the model adjusted for several other risk factors for mortality, the risk was still 1.17 (95% CI = 1.07-1.27, p < .001, I = 57.85%).
CONCLUSIONS
This meta-analysis shows that a weak SOC is associated with an increased risk of all-cause mortality in the general adult population. Future studies are needed to further develop assessment tools for SOC with good psychometric properties and to determine the disease processes that mediate the association of SOC with mortality.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Mortality; Sense of Coherence; Young Adult
PubMed: 32398414
DOI: 10.1097/PSY.0000000000000812 -
JAMA Surgery Dec 2023Morbidity and mortality conferences (MMCs) are thought to advance trainee education, quality improvement (QI), and faculty development. However, there is considerable...
IMPORTANCE
Morbidity and mortality conferences (MMCs) are thought to advance trainee education, quality improvement (QI), and faculty development. However, there is considerable variability with regard to their completion.
OBJECTIVE
To compile and analyze the literature describing the format, design, and other attributes of MMCs that appear to best advance their stated objectives related to QI and practitioner education.
EVIDENCE REVIEW
For this systematic review, a literature search with terms combining conference and QI or morbidity and mortality was performed in January 2022, using the PubMed, Embase, and ERIC (Education Resources Information Center) databases with no date restrictions. Included studies were published in English and described surgical or nonsurgical MMCs with explicit reference to quality or system improvement, education, professional development, or patient outcomes; these studies were classified by design as survey based, intervention based, or other methodologies. For survey-based studies, positively and negatively regarded attributes of conference design, format, and completion were extracted. For intervention-based studies, details of the intervention and their impact on stated MMC objectives were abstracted. Principal study findings were summarized for the other group. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). Abstract screening, full-text review, and data extraction and analysis were completed between January 2022 and December 2022.
FINDINGS
A total of 59 studies met appropriateness for study inclusion. The mean MERSQI score for the included studies was 6.7 (range, 5.0-9.5) of a maximum possible 18, which implied that the studies were of average quality. The evidence suggested that preparation and postconference follow-up regarding QI initiatives are equally as important as both (1) succinctly presenting case details, opportunities for improvement, and educational topics and (2) creating a constructive space for accountability, engagement, and multistakeholder discussion.
CONCLUSIONS AND RELEVANCE
These findings suggest that the published literature on MMCs provides substantial insight into the optimal format, design, and related attributes of an effective MMC. This systematic review provides a road map for surgical departments to improve MMCs in order to align their format and design with their principal objectives related to practitioner and trainee education, error prevention, and QI.
Topics: Humans; Morbidity; Quality Improvement; Congresses as Topic; Mortality
PubMed: 37851458
DOI: 10.1001/jamasurg.2023.4672 -
Acta Anaesthesiologica Scandinavica Oct 2023The objective was to conduct a systematic review of mortality and factors independently associated with mortality of older patients admitted to an intensive care unit... (Review)
Review
PURPOSE
The objective was to conduct a systematic review of mortality and factors independently associated with mortality of older patients admitted to an intensive care unit (ICU) for COVID-19.
MATERIALS AND METHODS
Data sources were MEDLINE, EMBASE, the Cochrane Library, and references of included studies. Two reviewers independently selected studies evaluating mortality of older patients (≥ 70 years) admitted to an ICU for COVID-19. They extracted general characteristics, mortality rate, and factors independently associated with mortality. The methodological quality of each study was evaluated by using the Critical Appraisal Skills Programme checklist.
RESULTS
We selected 36 studies (11,989 patients). Many of the studies were conducted in Europe (42%) and many were retrospective (61%) and multicenter (61%). ICU mortality ranged from 8% to 90%, 1-month mortality from 33% to 90% and 3-month mortality, reported in five studies, from 46% to 60%. Frailty, assessed by the Clinical Frailty Score (CFS), was significantly associated with 1-month and 3-month mortality respectively in two studies (hazard ratio [HR]: 3.2 [2.56-4.13] and HR: 2.83 [95% CI: 1.96-4.08]).
CONCLUSION
In this systematic review of older patients admitted to an ICU with COVID-19, we documented high heterogeneity of mortality rates.
Topics: Humans; Aged; COVID-19; Retrospective Studies; Frailty; Hospitalization; Intensive Care Units; Hospital Mortality; Multicenter Studies as Topic
PubMed: 37323022
DOI: 10.1111/aas.14299 -
International Journal of Public Health 2022This study aimed to investigate the risk of stillbirth, perinatal and neonatal mortality in immigrant women compared to native-origin women in host countries. A... (Meta-Analysis)
Meta-Analysis Review
This study aimed to investigate the risk of stillbirth, perinatal and neonatal mortality in immigrant women compared to native-origin women in host countries. A systematic literature review and meta-analysis was conducted. Relevant studies were identified using a thorough literature search and their quality was appraised. The analysis of heterogeneous data was carried out using the random effects model and publication bias was assessed using the Harbord-test. Also, the pooled odds ratio of events was calculated through the DerSimonian and Laird, and inverse variance methods. In the search process 45 studies were retrieved consisting of 8,419,435 immigrant women and 40,113,869 native-origin women. The risk of stillbirth (Pooled OR = 1.35, 95% CI = 1.22-1.50), perinatal mortality (Pooled OR = 1.50, 95% CI = 1.35-1.68), and neonatal mortality (Pooled OR = 1.09, 95% CI = 1.00-1.19) in the immigrant women were significantly higher than the native-origin women in host countries. According to the sensitivity analyses, all results were highly consistent with the main data analysis results. The immigrant women compared to the native-origin women had the higher risks of stillbirth, perinatal and neonatal mortality. Healthcare providers and policy makers should improve the provision of maternal and neonatal healthcare for the immigrant population.
Topics: Emigrants and Immigrants; Female; Humans; Infant Mortality; Infant, Newborn; Perinatal Mortality; Pregnancy; Stillbirth
PubMed: 35664648
DOI: 10.3389/ijph.2022.1604479 -
Aesthetic Plastic Surgery Feb 2023Perceived age is defined as how old a person looks to external evaluators. It reflects the underlying biological age, which is a measure based on physical and...
INTRODUCTION
Perceived age is defined as how old a person looks to external evaluators. It reflects the underlying biological age, which is a measure based on physical and physiological parameters reflecting a person's aging process more accurately than chronological age. People with a higher biological age have shorter lives compared to those with a lower biological age with the same chronological age. Our review aims to find whether increased perceived age is a risk factor for overall mortality risk or comorbidities.
METHODS
A literature search of three databases was conducted following the PRISMA guidelines for studies analyzing perceived age or isolated facial characteristics of old age and their relationship to mortality risk or comorbidity outcomes. Data on the number of patients, type and characteristics of evaluation methods, evaluator characteristics, mean chronologic age, facial characteristics studied, measured outcomes, and study results were collected.
RESULTS
Out of 977 studies, 15 fulfilled the inclusion criteria. These studies found an increase in mortality risk of 6-51% in older-looking people compared to controls (HR 1.06-1.51, p < 0.05). In addition, perceived age and some facial characteristics of old age were also associated with cardiovascular risk and myocardial infarction, cognitive function, bone mineral density, and chronic obstructive pulmonary disease (COPD).
CONCLUSION
Perceived age promises to be a clinically useful predictor of overall mortality and cardiovascular, pulmonary, cognitive, and osseous comorbidities.
LEVEL OF EVIDENCE III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Aged; Humans; Comorbidity; Age Factors; Mortality
PubMed: 35650301
DOI: 10.1007/s00266-022-02932-5 -
Canadian Journal of Surgery. Journal... May 2020In medical and surgical departments around the world, morbidity and mortality conferences (MMC) serve dual roles: they are cornerstones of quality-improvement programs...
BACKGROUND
In medical and surgical departments around the world, morbidity and mortality conferences (MMC) serve dual roles: they are cornerstones of quality-improvement programs and provide timely opportunities for education within the urgent context of clinical care. Despite the widespread adoption of MMCs, adverse events and preventable errors remain high or incompletely characterized, and opportunities to learn from and adjust to these events are frequently lost. This review examines the published literature on strategies to improve surgical MMCs.
METHODS
We searched OVID Medline, PubMed, Embase and CENTRAL. We defined our combination of search terms using a PICO (population, intervention, comparison, outcome) model, focusing on the use of MMCs in general surgery.
RESULTS
The MMC literature focused on 5 themes: educational value, error analysis, case selection and representation, attendance and dissemination. Strategies used to increase educational value included limiting case presentation time to 15-20 minutes, mandatory brief literature reviews, increasing audience interaction, and standardizing presentations using a PowerPoint template or SBAR (situation, background, assessment, recommendation) format. Interventions to improve error analysis included focused discussion on causative factors and taxonomic error analysis. Case selection was improved by using an electronic clinical registry, such as the National Surgery Quality Improvement Program, to better capture incidence of morbidity and mortality. Attendance was improved with teleconferencing. Dissemination strategies included MMC newsletters, incorporating MMCs into plan-do-check-act cycles, and surgeon report cards.
CONCLUSION
Greater standardization of best practices may increase the quality improvement and educational impact of MMCs and provide a baseline to measure the effect of new MMC format innovations on the clinical and educational performance of surgical systems.
Topics: Global Health; Humans; Medical Errors; Morbidity; Orthopedic Procedures; Quality Improvement; Survival Rate
PubMed: 32386469
DOI: 10.1503/cjs.009219 -
Global Health Action Oct 2021The COVID-19 pandemic is having significant direct and associated effects on many health outcomes, including maternal mortality. As a useful marker of healthcare system... (Review)
Review
BACKGROUND
The COVID-19 pandemic is having significant direct and associated effects on many health outcomes, including maternal mortality. As a useful marker of healthcare system functionality, trends in maternal mortality provide a lens to gauge impact and inform mitigation strategies.
OBJECTIVE
To report the findings of a rapid systematic review of studies on levels of maternal mortality before and during the COVID-19 pandemic.
METHODS
We systematically searched for studies on the 1st March 2021 in MEDLINE and Embase, with additional studies identified through MedRxiv and searches of key websites. We included studies that reported levels of mortality in pregnant and postpartum women in time-periods pre- and during the COVID-19 pandemic. The maternal mortality ratio was calculated for each study as well as the excess mortality.
RESULTS
The search yielded 3411 references, of which five studies were included in the review alongside two studies identified from grey literature searches. Five studies used data from national health information systems or death registries (Mexico, Peru, Uganda, South Africa, and Kenya), and two studies from India were record reviews from health facilities. There were increased levels of maternal mortality documented in all studies; however, there was only statistical evidence for a difference in maternal mortality in the COVID-19 era for four of these. Excess maternal mortality ranged from 8.5% in Kenya to 61.5% in Uganda.
CONCLUSIONS
Measuring maternal mortality in pandemics presents many challenges, but also essential opportunities to understand and ameliorate adverse impact both for women and their newborns. Our systematic review shows a dearth of studies giving reliable information on levels of maternal mortality, and we call for increased and more systematic reporting of this largely preventable outcome. The findings help to highlight four measurement-related issues which are priorities for continuing research and development.
Topics: COVID-19; Family; Female; Health Facilities; Humans; Infant, Newborn; Maternal Mortality; Pandemics; Pregnancy
PubMed: 35377289
DOI: 10.1080/16549716.2021.1974677