Characteristics of Paediatric Death Cases at a Malaysian University Hospital

@#Introduction: Auditing of paediatric deaths has rarely been evaluated in hospitals especially in low and middle-income countries. The aim of the study is to describe the characteristics of paediatric death in hospitalised children and determine the predictors of death location in Hospital Universiti Sains Malaysia (USM). Method: Paediatric mortality cases for children aged between 29 days and 18 years old at the time of death were analyzed. These were documented cases between the year 2013 and 2020 at Hospital USM. Case notes were reviewed, and data were captured retrospectively. Multiple Logistic Regression was used to assess predictors of the location of death especially in the ward setting.Results: Out of 841 paediatric deaths identified during the period of the study, 544 cases were enrolled. The male gender has a higher proportion (1.4:1). The median age was 56 months, with infancy being the predominant age group. The median length of hospital stay was 10.5 days. More than half of the cases (58.3%) had underlying life-limiting illnesses. The majority of the patients had “Do Not Resuscitate” orders. A longer length of stay (prevalence odds ratio (POR 0.99, 95% CI 0.98, 0.99), being on ventilator (POR 3.42,95% CI 1.95, 6.01), being terminally ill (POR 0.40,95% CI 0.23, 0.70) and having underlying life limiting illness (POR 0.50, 95% CI 0.33, 0.75) were the significant predictors for the ward death. Conclusion: Understanding the characteristics of child death and the factors associated with death location is critical for improving paediatric care and treatment.

Preference for death at home and associated factors among older people in the city of Belo Horizonte, Brazil / Preferência por morrer em casa e fatores associados de pessoas idosas da cidade de Belo Horizonte, Brasil

Abstract We examined people's preferences for place of death and identified factors associated with a home death preference. We asked a representative sample (N = 400) of older people (≥ 60 years) residents in the city of Belo Horizonte, about their preferences for place of death in a situation of serious illness with less than a year to live. Data were analyzed using binomial regression to identify associated factors. 52.2% indicate home as the preferred place of death. Five variables were associated with preference for death at home: those living with 1 child (odds ratio (OR)0.41; 95% confidence interval (CI):0.18-0.92; ref: without children); being in education for up to 4 years (OR0.42; 95% CI:0.20-0.89; ref: higher education); finding it difficult to live with the present income (OR3.18; 95% CI:1.53-6.62; ref: living comfortably); self-assessed fair overall health (OR2.07; 95% CI:1.06-4.03; ref: very good health) and selecting "choosing who makes decisions about your care" as the care priority that would matter to them the most (OR2.43; 95%CI:1.34-4.40; ref: dying in the place you want). Most respondents chose home as preferred place of death. However, most residents of Belo Horizonte die in hospitals, suggesting that preferences are not being considered.

Resumo Examinamos as preferências das pessoas para o local da morte e identificamos os fatores associados com a preferência pela morte em casa. Perguntamos para uma amostra representativa (N = 400) de pessoas idosas (≥ 60 anos) residentes da cidade de Belo Horizonte, sobre suas preferências pelo local da morte numa situação de doença grave, com menos de um ano de vida. Os dados foram analisados utilizando regressão binomial para identificar os fatores associados. Indicaram a casa como o local preferido de morte, 52,2%. Cinco variáveis foram associadas à preferência por morte em casa: aqueles que vivem com 1 criança (odds ratio(OR)0,41; intervalo de confiança (CI)95%:0,18-0,92; ref: nenhuma criança); ter até 4 anos de escolaridade (OR0,42; CI95%:0,20-0,89; ref: ensino superior); ser difícil viver com o rendimento atual (OR3,18; CI95%:1,53-6,62; ref: vive confortavelmente); avaliar a sua saúde geral como razoável (OR2,07; CI95%:1,06-4,03; ref: saúde muito boa) e selecionar "escolher quem toma decisões sobre os cuidados" como a prioridade de cuidado mais importante (OR2,43; CI95%:1,34-4,40; ref: morrer no local que se quer). A maioria dos entrevistados expressaram preferência por morrer em casa. No entanto, a maioria dos residentes de Belo Horizonte morre nos hospitais, sugerindo que as preferências não estão sendo consideradas.

Research Progress on Determination of Drowning Site / 法医学杂志

The bodies found in water are one of the most common types in forensic practice. The dis-covery site of the body is often not the drowning site. However, the determination of drowning site is vital for the identification of victim. Inorganic particles and planktons, such as granular impurities, diatoms and bacteria, are valuable markers for the diagnosis of drowning. By comparing the granular impurities and planktons in tissues and suspicious drowning mediums, the drowning site can be concluded based on their similarity of types and distribution, which has practical applied value. In this paper, the research progress on determination of drowning site is summarized to provide reference for the peers.

Inpatient Expenditure of the Decedent Elderly in Japan.

End-of-life healthcare expenditure has much to do with the Japanese Government’s policies of promoting integrated care in communities and promoting end-of-life care at home or at nursing homes rather than at hospitals. We analyzed healthcare expenditure for decedent elderly during the one year prior to death, focusing on inpatient expenditure and place of death as well as differences between males and females. The share of inpatient expenditure was 78 percent for the decedent elderly as a whole, compared to 45 percent for the whole elderly population. Monthly inpatient expenditure of those decedent elderly who received inpatient care consecutively in the final 4 months, increased gradually as death month approached for each age group. However, a sharp increase was found in only a small portion of this group. Place of death was quite related to the healthcare expenditure during the one year prior to death, and frequency of inpatient care use in the final year is as important as place of death in determining the level of healthcare expenditure.

Caracterización de los pacientes oncológicos que fallecieron durante los años 2010 y 2011 en la unidad de alivio del Dolor y cuidados paliativos de Oncomed, Santiago, Chile / Characterization of cancer patients who died during 2010 and 2011 in the unit of pain relief and palliative care of Oncomed, Santiago, Chile

Objetivo: Averiguar las principales características de los pacientes pertenecientes a la Unidad de Alivio del Dolor y Cuidados Paliativos de Oncomed que fallecieron entre los años 2010 y 2011.Método: Se realizó un estudio retrospectivo, descriptivo y transversal de los pacientes pertenecientes a la Unidad que fallecieron durante los años 2010 y 2011. Se seleccionaron enfermos con patología oncológica terminal y que tuvieron como mínimo 1 atención médica. Se analizaron las variables de edad, sexo, patología oncológica, ciudad de residencia, tiempo de permanencia en la unidad y lugar de fallecimiento. Resultados: De los 832 pacientes, 46,2 por ciento fueron de sexo femenino y 53,8 por ciento masculino. Las edades fluctuaron entre los 3 y los 103 años, encontrándose el mayor número de enfermos entre los 40 y 80 años. Las patologías más comunes fueron cáncer de pulmón, próstata y gástrico, en el sexo masculino; y mama, pulmón y páncreas, en el sexo femenino. El mayor número de pacientes se localizó en la XIII Región. El tiempo promedio de sobrevida de los pacientes fue de 140 días, fluctuando entre 1 y 1.819 días. Un 73,4 por ciento de los pacientes falleció en el domicilio y un 26,6 por ciento hospitalizado. Conclusión: El estudio realizado resulta interesante ya que nos aporta conocimiento de las características de los pacientes que se atienden en nuestra unidad y eso nos ayuda a mejorar la planificación y organización de los servicios sanitarios, orientándolos a dar una mejor respuesta a las necesidades y demandas de nuestros enfermos.

Objective: To identify the main characteristics of patients belonging to the unit for Pain Relief and Palliative Care of Oncomed, who died in 2010 and 2011.Method: A retrospective, descriptive and transversal study has been done of the patients treated in the unit, who died during years 2010 and 2011. Patients with terminal cancer pathology have been selected, that have had at least one medical attention. The variables analyzed were age, sex, oncologic pathology, city of residence, length of stay in the unit and place of death. Results: Of the 832 patients, 46.2 percent were female and 53.8 percent male. The ages ranged from 3 to 103 years old, finding the largest number of patients between 40 and 80. The most common diseases were lung, prostate and gastric cancers in males and breast, lung and pancreas cancers in women. The largest number of patients was located in the XII Region. The median survival time of patients was 140 days, ranging between 1 and 1819 days. 73.4 percent of patients died at home and 26.6 percent at hospitals. Conclusion: The study shows interesting results, providing knowledge of the characteristics of our patients, helping us to improve the planning and organization of health services, focusing them to meet in a better way the requirements and demands of our patients.

Cuidado paliativo Domiciliario: Dos años de experiencia en Quito / Home palliative care: Two years of experience in Quito

Este artículo describe los dos primeros año de trabajo de un pequeño equipo de cuidado paliativo, trabajando en los domicilios, en la ciudad de Quito y la filosofía de este cuidado. De los 66 pacientes atendidos, el 77% conocía su diagnóstico. El 81% de pacientes fallecieron en su domicilio, esto en comparación con otros países es un porcentaje muy alto, por lo que explicamos las posibles causas.

This article describes the first two years of work of a small palliative care team, working at home in the city of Quito and the philosophy of this care. Of the 66 patients attended, 77% knew their diagnosis. 81% of patients died at home, this compared to other countries is a very high percentage, so we explain the possible causes.

Preferred place of death of elderly women in seoul

BACKGROUND: The present it is getting to be on aged society there is increasing that hospital has higher rate for place of death than home. Because we can expect that many patients who are faced with death come to hospital or hospice in the future, we have studied preferred place of death with an old women in seoul to have essential material of plan to understand asking for medical service of death, to divide medical manpowers and equipments and to supplement and to revise of medical educations. METHODS: Through the internet, 71 schools for the elderly. Of 277 an old woman who attending the schools out of 7 schools. We research into preferred place of death by self answering way through the June to July in 2000. RESULTS: The average age was 72.4 years. Of 277 respondents, 87 respondents(32.46%) reply their homes as a place of death and 166(61.94%) reply hospital, 15(5.6%) reply hospice, missing is 9. Statistical significance has connections with only level of education. The highest reason(47.5%) why respondents choose the hospital or hospice is only to reduce their children's burdens. Unlike respondents that education attending period is below 6 year, the relative risk of choosing the hospital or hospice between respondents who are 6 9year and above 9 year is each of 3.66, 5.58. CONCLUSION: This research shows that an elderly women in seoul prefer hospitals or hospice to homes as their place of death.

Factors associated with the place of death in Korea; a population based study

BACKGROUND: In western countries the proportion of deaths in the hospital has somewhat decreased. While that of Korea has continuously increased, it is interesting things that the hospital death rate in Korea is less than that in western countries. Therefore we tried to find the factors associated with the place of death in Korea. METHODS: We obtained the data from the National Statistical Office. They are composed of address, occupation, cause of death, marital status, and level of education. Causes of death were classified by ICD 10. Univariate and Mutivariate analysis were done to find the effect of each variable for the place of death. RESULTS: Total number of the study population was 242,362 (male;136,063, female;106,299). Female died more in the hospital. The younger are more likely to die in the hospital. People having lived in metropolitan, having educated to higher level and professionals died more in the hospital. And the people having had ischemic heart disease and cancer death were more likely to die in the hospital. The single(unmarried, divorced) died more in the hospital. In multivariate analysis, the place of death was significantly different by sex, age, address, occupation, cause of death, and level of education. CONCLUSION: In Korea sex, age, address, occupation, cause of death, and level of education are helpful in predicting the palce of death.