A Disclosure About Death Disclosure: Variability in Circulatory Death Determination

Introduction. Circulatory-respiratory death declaration is a common duty of physicians, but little is known about the amount of education and physician practice patterns in completing this examination. Methods. We conducted an online survey of physicians evaluating the rate of formal training and specific examination techniques used in the pronouncement of circulatory-respiratory death. Data, including level of practice, training received in formal death declaration, and examination components were collected. Results. Respondents were attending physicians (52.4%), residents (30.2%), fellows (10.7%), and interns (6.7%). The majority of respondents indicated they had received no formal training in death pronouncement, however, most reported self-perceived competence. When comparing examination components used by our cohort, 95 different examination combinations were used for death pronouncement. Conclusions. Formal training in death pronouncement is uncommon and clinical practice varies. Implementation of formal training and standardization of the examination are necessary to improve physician competence and reliability in death declarations.

The Relationship Between Short-Term Exposure To Air Pollution With Hospitalization and Mortality of Cardiovascular (CVD) and Respiratory Diseases in Shahrekord, Iran

Background and objectives: Air pollution has been widely considered as an important factor in causing heart disease, respiratory disease, and death. This study sought to determine the relationship between short-term exposure to air pollutants and hospital admissions, cardiovascular and respiratory deaths and total mortality rate in Shahrekord, Iran.Procedure: This is a time series and ecological research. We collected data on hospital admissions and cardiovascular mortality and total mortality from 2012 to 2018. The study used the quasi-Poisson regression combined with linear distributed lag models, adjusted for trend, seasonality, temperature, relative humidity, weekdays and holidays.Results: Our results show a direct and significant statistical relationship between: O3 exposure in lag4 for total mortality, PM10 exposure in lag1 for total mortality and in lag4 and lag1 for respiratory death, PM2.5 exposure for total cardiovascular admissions in lag5, respiratory mortality in lag4, total respiratory admissions in lag3, NO2 exposure to respiratory mortality in lag1, and cardiovascular mortality in lag0, increased risk of death and pathogenesis.The results show a statistically significant inverse relationship between: NO and total admissions in lag3 and for respiratory mortality in lag1 between PM2.5 and cardiovascular mortality in lag1, NO with respiratory mortality in lag1 and cardiovascular admissions in lag3, NO2 with cardiovascular admissions in lag1 and NOX with respiratory death in lag0, which reduces the risk of death and pathogenesis.Conclusion: Air pollution has a significant relationship with the number of hospital admissions and mortality in Shahrekord, Iran.

Respiratory mortality of childhood, adolescent and young adult cancer survivors

BackgroundExposure to radiation and/or chemotherapy during cancer treatment can compromise respiratory function. We investigated the risk of long-term respiratory mortality among 5-year cancer survivors diagnosed before age 40 years using the British Childhood Cancer Survivor Study (BCCSS) and Teenage and Young Adult Cancer Survivor Study (TYACSS).MethodsThe BCCSS comprises 34 489 cancer survivors diagnosed before 15 years from 1940 to 2006 in Great Britain. The TYACSS includes 200 945 cancer survivors diagnosed between 15 years and 39 years from 1971 to 2006 in England and Wales. Standardised mortality ratios and absolute excess risks were used.FindingsOverall, 164 and 1079 respiratory deaths were observed in the BCCSS and TYACSS cohorts respectively, which was 6.8 (95% CI 5.8 to 7.9) and 1.7 (95% CI 1.6 to 1.8) times that expected, but the risks varied substantially by type of respiratory death. Greatest excess numbers of deaths were experienced after central nervous system (CNS) tumours in the BCCSS and after lung cancer, leukaemia, head and neck cancer and CNS tumours in the TYACSS. The excess number of respiratory deaths increased with increasing attained age, with seven (95% CI 2.4 to 11.3) excess deaths observed among those aged 50+ years in the BCCSS and three (95% CI 1.4 to 4.2) excess deaths observed among those aged 60+ years in the TYACSS. It was reassuring to see a decline in the excess number of respiratory deaths among those diagnosed more recently in both cohorts.ConclusionsPrior to this study, there was almost nothing known about the risks of respiratory death after cancer diagnosed in young adulthood, and this study addresses this gap. These new findings will be useful for both survivors and those involved in their clinical management and follow-up.

Underweight as a risk factor for respiratory death in the Whitehall cohort study: exploring reverse causality using a 45-year follow-up

Underweight adults have higher rates of respiratory death than the normal weight but it is unclear whether this association is causal or reflects illness-induced weight loss (reverse causality). Evidence from a 45-year follow-up of underweight participants for respiratory mortality in the Whitehall study (N=18 823; 2139 respiratory deaths) suggests that excess risk among the underweight is attributable to reverse causality. The age-adjusted and smoking-adjusted risk was 1.55-fold (95% CI 1.32 to 1.83) higher among underweight compared with normal weight participants, but attenuated in a stepwise manner to 1.14 (95% CI 0.76 to 1.71) after serial exclusions of deaths during the first 5–35 years of follow-up (Ptrend<0.001).