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@#Abstract: Objective China was certified by World Health Organization as a malaria-free country in 2021. Malaria has become a rare infectious disease, and preventing the re-transmission of imported malaria and reducing deaths are the main challenges facing China after elimination of malaria. To analyze and clarify the characteristics of imported malaria deaths, and to provide prevention and treatment recommendations for overseas workers and health care workers. Methods The data of 17 imported malaria deaths in the analysis of malaria deaths from 2016 to 2020 by the National Severe Malaria Treatment Expert Group were collected, and the relevant clinical epidemiological data and disease course records were analyzed. Results The 17 malaria deaths were all imported from Africa with Plasmodium falciparum infection (malarial cerebral type), with no obvious regularity in the month of onset. Among them, 16 were male patients, 5 cases with underlying diseases such as diabetes mellitus, and 10 patients were first diagnosed in a second-level or lower hospital. Excluding patients who died of respiratory cardiac arrest in ambulances, the mean time difference between first onset and malaria diagnosis in 16 patients was 6.8 days (median 5.5 days), and the mean time between first onset and antimalarial treatment was 7.4 days (median 6 days), the mean time difference from initial onset to death was 10.3 days (median 8.5 days). Excluding cases with onset abroad and unknown time of return, all 14 patients developed the disease within 30 days after returning to China. Conclusion All the fatal cases were infected with Plasmodium falciparum imported from Africa. The patients' awareness of actively seeking medical treatment is weak, and the delay in seeking medical treatment caused by the insufficient diagnosis and treatment capacity of health institutions at the township level and below is the main reason for the deaths. It is recommended to strengthen the self-protection awareness of staff in malaria-endemic areas overseas and raise their awareness of malaria. For returnees from areas with high malaria risk, primary medical institutions should pay attention to the patient's travel history in Africa, improve the awareness of malaria diagnosis, malaria diagnosis and treatment capabilities.
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Objective To understand the report of death cases in the First Affiliated Hospital of Xinjiang Medical University in the past five years, and to put forward measures to improve the quality of death case reports. Methods The death cases reported by the death registration information system of the First Affiliated Hospital of Xinjiang Medical University from January 1, 2014 to July 31, 2019 were analyzed, the timeliness of the report, the quality of the report of the root cause of death and the distribution of the root cause of death were evaluated. Results In the past five years, the main places of death were medical and health institutions. Males were significantly more than females. Ages were more concentrated in groups over 60 years old and under 80 years old. They were mostly retirees and those with junior high school or below education. Most of the diagnostic criteria were clinical + physical and physicochemical. The proportion of the time of death differ from the date of filling in the card and the proportion of the time of death differ from the date of filling in the card exceeding 7 days were gradually decreasing. The proportion of diseases directly leading to death differ from the underlying causes of death, and the proportion of diseases directly leading to death differ from ICD codes of underlying causes of death ranked first in 2017. The top three causes of death in the case of death are in turn: cause codes I, C, and J. Conclusions The timeliness of death case report in the First Affiliated Hospital of Xinjiang Medical University has increased year by year in recent five years, but the error rate of death cause coding is high, and the work of determining the underlying cause of death needs to be improved.
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Objective To analyze the death cases of the oncology inpatients of the First Hospital of Hunan University of Chinese Medicine (hereinafter referred to as "this hospital") during 2007-2016; To provide the basis for the prevention and treatment of cancer, prognosis improvement and rational allocation of TCM health resources. Methods The death cases of the oncology inpatients from 2007 to 2016 were analyzed by retrospective medical history method from the aspects of causes of death, hospitalization costs and survival time. Results There were 830 death cases of the oncology inpatients in the hospital during 2007-2016, with 548 males and 282 females, and the mortality rate decreased year by year. The average hospitalization costs for patients was 39 630.86 yuan, of which TCM treatment cost 6206.98 yuan (15.66%). Patients with colon cancer had the highest proportion of TCM treatment costs (20.10%), followed by lung cancer, breast cancer, and liver cancer. The top five causes of death were lung cancer, liver cancer, breast cancer, colon cancer, and rectal cancer. The sex ratio of patients who died of lung cancer was 1.61:1. The average survival time of male patients was 446.3 days, which was far lower than the 738.3 days of female patients. The cancers with long-term survival periods were cervical cancer, breast cancer, and rectal cancer. The cancers with shorter survival periods were pancreatic cancer, liver cancer, and lung cancer. Conclusion The structure of death causes of the oncology inpatients in the hospital has a certain degree of representation. The prevention and control of lung cancer, especially male lung cancer should be strengthened; TCM health resources and prevention should be utilized rationally; the prognosis of patients with liver cancer should be improved, to improve the overall survival and quality of life of patients with breast cancer or cervical cancer, which is important for the prevention and treatment of malignant tumor.
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Objective@#To conduct an epidemiological investigation of two leptospirosis death cases reported in Guizhou Province in 2014.@*Methods@#The information of the patients were investigated and analyzed. The serological detection, samples of the two patients was detected using ELISA and microscopic agglutination test (MAT). Leptospira carrier status of murine host animal in the living environment of the two patients was investigated in October and November of 2014. Leptospires in the kidney were cultured and isolated, the isolates were identified using Leptospira specific PCR and further identified with serogroup specific PCR and the conventional MAT. The relativity between the carrier status of murine and the death cases of human leptospirosis was analyzed.@*Results@#The two death cases of human leptospirosis came from Liping County and the clinical symptoms were consistent with the diagnosis criteria for Leptospirosis. The results of ELISA detection showed that the anti-Leptospira antibody was positive for one of the death cases, MAT identified the serum reacted with sera-group icterohaemorrhagiae Leptospira, while the serum sample of the other case was failed to perform antibody detection due to hemolysis. 1 600 traps were placed in the living environment of the two death cases and 183 murine rodents were trapped. The murine density was 11.44% (183/1 600); 40 leptospirea suspected strains were isolated and all of them were isolated from Apodemus agrarius. The positive rate was 21.86% (40/183); 95 Apodemus agrarius were trapped and the murine density was 5.93% (95/1 600). Species specific PCR identified all the 40 strains as Leptospire. Serogroup specific PCR further identification showed that they were iterohaemorrahgiae serogroup Leptospria. interrogans.@*Conclusion@#Anti-iterohaemorrahgiae Leptospira antibody was detected from one of the two patients. 40 strains of iterohaemorrahgiae serogroup Leptospira interrogans were isolated and all of them were isolated from Apodemus agrarius in the living environment and the serogroup of the Leptospira matched with the serological detection results from patients, which indicated that the two death cases were caused by the infection of iterohaemorrahgiae serogroup Leptospira interrogans, and Apodemus agrarius were the potential source of infection.
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Objective To investigate the general information and death causes in the emergency department ( ED) with an epidemiological study in the death cases.Methods The clinical records of 1007 death cases in the ED admitted in three years from 2011 to 2013 were collected and statistically analyzed.Methods The clinical records of 1 007 death cases in the ED admitted in three years from 2011 to 2013 were collected and statistically analyzed.Results The mean age of the 1 007 deaths was ( 75.95 ±13.89 ) ears, and the mean score of APACHEⅡ at admission was ( 27.19 ±6.44 ) .Malignant neoplasm, pulmonary infection, chronic obstructive pulmonary disease, coronary heart disease, stroke, sepsis, acute coronary syndromes were main underlying causes of death, while respiratory failure, circulatory collapse, generalized debility, multiple organ dysfunction syndrome, emaciation from malignant neoplasm, septic shock, severe pulmonary infection were main direct lethal causes of death.Most patients were vulnerable to be dead in the spring season, January and around midnight from 23: 00 to 1: 00 (zi time).It is noteworthy that pulmonary infection accounted for 74.75%(151/202 ) of the nosocomial infection. Hyperlactacidemia and low oxygenation index indicated a poor prognosis.Conclusions The deaths were predominant in old age, and the order of incidence of the underlying death causes from high to low arranged was consistent with the sequence of death causes of the cities in China in 2010.To identify carefully the risk factors of death and concern about the early symptoms of exacerbation of underlying diseases can make a big difference in enhancing the success rate of rescuing the critical emergency patients.Besides, it's worth pondering over that the medical care of patients with malignant neoplasm spent abundant emergency resources.
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Objective To explore methods of quickly identifying loopholes in medical quality management and to improve medical quality by means of analyzing low-risk death cases.Methods Two rounds of analysis of 1 14 low-risk death cases of hospitals in Beijing in 2012 in terms of data quality and medical procedures,in an effort to identify problems and to verify the feasibility and accuracy of the method through interaction with other data.Results Totally 585 760 inpatients were discharged in 2012 from 21 hospitals,of whom 1 5 1 1 93 being low-risk cases.Such cases included 1 14 low-risk death cases, accounting for 0.01 9% of the total discharged,and 0.075% of low-risk discharged cases.Analysis of these medical records found 50 cases of problematic diagnosis (43.86%),45 cases of possible defects in diagnosis and treatment (39.47%),39 cases of missing items of secondary diagnosis (34.21%),and 28 cases of missing items of surgery/operation (24.56%). Some of the abovementioned cases had overlapping mistakes.Conclusion Analysis of low-risk death cases can help focus among massive data of medical records,problems of diagnostic and therapeutic insufficiency,pinpointing common problems in medical service and improving medical quality and fine management of hospitals.
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Objectives To analysis the main characteristics and changes of the internal death in pediatric intensive care unit (PICU) in the past five years. Methods The clinical data of 330 death cases in PICU internal medicine were retrospectively analyzed from January 2008 to December 2012. Results The mortality rate in PICU dropped from 5.85%to 3.96% from 2008 to 2012. Among 330 death cases, 136 cases (41.2%) were infants, 73 cases (22.1%) were toddlers, 51 cases (15.45%) were preschoolers, and 70 cases (21.21%) were school-age and adolescence. In different years, the differences of distribution of death in different age groups were statistical significance (χ2=6.90, P=0.009). In all years, the infant had the highest death rate. As the time progresses, the death rate of the infant and young children decreases, while the death rate of the school-age and adolescence increases. Among the diseases caused death, the cardiovascular disease was the most common disease (33.94%), followed by hematologic malignancy (31.52%). The difference of distribution of the diseases caused death in different age group was statistically significant (P<0.01). The cardiovascular disease was main cause of death in infant, and the hematologic malignancy was the main cause of death in other three age groups. Within 24 h admission, the pediatric critical illness score (PCIS) had been assessed, 67.49% was critical and 15.48%was extremely critical. The hospitalization time was negatively correlated with PCIS (r=-0.313, P<0.001). Conclusions In the past five years, the mortality in PICU declined year by year. Cardiovascular disease in infancy and hematologic malignancy in non infancy are the leading cause of death in children. Admission in critical or extremely critical condition is the reason of early death in hospital.
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Objective To study the space distribution probability model of death cases of hemorrhagic fever with renal syndrome,so as to provide basic information for hemorrhagic fever with renal syndrome prevention and control policy making.Methods Poisson distribution and negative binomial distribution were used to fit the hemorrhagic fever with renal syndrome deaths spatial distribution in Kaijiang county,Dazhou city,Sichuan province between 1979-2010.Results The actual distribution of death cases of hemorrhagic fever with renal syndrome in Kaijiang county was not Poisson distribution (x2 =40.64,P ＜ 0.01),but subjected to the negative binomial distribution(x2 =1.86,P ＞ 0.50).Conclusions The space distribution of death cases of HFRS in Kaijiang county is not random,but has strict regional aggregation,which may be related to the local medical conditions,patient' s lack of knowledge about health care and other factors.
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The paper described practices in QC management pathway of death cases of the hospital.These refer to intensive education,clarification of access standard,death cases quarterly readings and administrative investigation,strict supervision among others.Authors pointed out that QC pathway can improve quality of care significantly,yet QC pathway calls for fair accountability,systemic care for patient safety,and all-staff involvement in QC improvement.