Sub Logo

Dr K K Aggarwal

Hospital safety incidents have 20% mortality

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on Hospital safety incidents have 20% mortality

Patients who experience a patient safety incident have a 20% chance of dying as a result of the incident. The 16 different patient safety concerns are:

  1. Complications of anesthesia
  2. Death in low mortality diagnosis related groups
  3. Bed sores
  4. Failure to rescue
  5. Foreign body left in during procedure
  6. Physician–induced pneumothorax (air in the lungs)
  7. Selected infections due to medical care
  8. Post–operative hip fracture
  9. Postoperative hemorrhage or hematoma
  10. Postoperative physiologic and metabolic derangements
  11. Postoperative lung failure
  12. Postoperative pulmonary embolism or deep vein thrombosis (clot in the legs or the lungs)
  13. Postoperative infections
  14. Postoperative wound dehiscence in abdominopelvic surgical patients
  15. Accidental puncture or laceration
  16. Transfusion reaction

All about depression

By Dr K K Aggarwal
Filed Under Spirituality - Science Behind Rituals | Tagged With: , , , , | | Comments Off on All about depression

  1. Depression is a major public health problem as a leading predictor of functional disability and mortality.
  2. Optimal depression treatment improves outcome for most patients.
  3. Most adults with clinical significant depression never see a mental health professional but they often see a primary care physician.
  4. A non–psychiatrist physician misses the diagnosis of depression 50% of times.
  5. All depressed patients must be specifically asked about suicidal ideations.
  6. Suicidal ideation is a medical emergency.
  7. Risk factors for suicide are psychiatric known disorders, medical illness, prior history of suicidal attempts, or family history of attempted suicide.
  8. Demographic reasons include older age, male gender, marital status (widowed or separated) and living alone.
  9. World over about 1 million people commit suicide every year.
  10. Seventy–nine percent of patients who commit suicide contact their primary care provider in the last one year before their death and only one–third contact their mental health service provider.
  11. Twice as many suicidal victims had contacted their primary care provider as against the mental health provider in the last month before suicide.
  12. Suicide is the 10th leading cause of death worldwide and account for 1.2% of all deaths.
  13. In the US, suicidal rate is 10.5 per 100,000 people.
  14. In America, suicide is increasing in middle aged adults.
  15. There are 10 to 40 non–fatal suicide attempts for every one completed suicide.
  16. The majority of suicides completed in US are accomplished with fire arm (57%); the second leading method of suicide in US is hanging for men and poisoning in women.
  17. Patients with prior history of attempted suicide are 5–6 times more likely to make another attempt.
  18. Fifty percent of successful victims have made prior attempts.
  19. One of every 100 suicidal attempt survivors will die by committing suicide within one year of the first attempt.
  20. The risk of suicide increases with increase in age; however, younger and adolescents attempt suicide more than the older.
  21. Females attempt suicide more frequently than males but males are successful three times more often.
  22. The highest suicidal rate is amongst those individuals who are unmarried followed by those who are widowed, separated, divorced, married without children or married with children in descending order.
  23. Living alone increases the risk of suicide.
  24. Unemployed and unskilled patients are at higher risk of suicide than those who are employed.
  25. A recent sense of failure may lead to higher risk.
  26. Clinicians are at higher risk of suicide.
  27. The suicidal rate in male clinicians is 1.41 and that in female clinicians is 2.27.
  28. Adverse childhood abuse and adverse childhood experiences increase the risk of suicidal attempts.
  29. The first step in evaluating suicidal risk is to determine presence of suicidal thoughts including their concerns and duration.
  30. Management of suicidal individual includes reducing mortality risk, underlying factors and monitoring and follow up.
  31. Major risk for suicidal attempts is in psychiatric disorders, hopelessness and prior suicidal attempts or threats.
  32. High impulsivity or alcohol or other substance abuse increase the risk.

(Disclaimer: The views expressed in this write up are my own).

Waist circumference a better indicator of mortality

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on Waist circumference a better indicator of mortality

A high body mass index (BMI) appears to be protective in certain populations.

Abdominal obesity –– measured using waist circumference ––was a better predictor of 5–year mortality among French survivors of an acute myocardial infarction (MI) than was BMI, according to a study presented by Tabassome Simon, MD, of HA′pital Saint Antoine in Paris.

Looking at BMI, there was an increased risk of dying for those with the lowest body mass (less than 22 kg/m2) and those with the highest (35 kg/m2 and higher), but not for those in the middle of those two groups, which included individuals who were overweight and mildly obese.

Within each category of BMI, however, increased waist circumference was associated with an elevated risk of dying within the follow–up period. After adjusting for BMI in a multivariate analysis, waist circumference in the upper quartile was associated with a 44% greater risk of dying through 5 years.

Coffee Consumption Reduces Mortality

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , | | Comments Off on Coffee Consumption Reduces Mortality

The largest prospective cohort study evaluated the impact of coffee consumption on all–cause mortality and involved 229,000 men and 173,000 women, who were followed for up to 13 years.

After adjustment for smoking status and other potential confounders, associations between coffee consumption (either caffeinated or decaffeinated) and reduced all–cause mortality were evident at relatively low levels of consumption (2 to 3 cups/day).

Compared to non–coffee drinkers, the risk of all-cause mortality among men and women who consumed 2 to 3 cups of coffee daily was 0.90 and 0.87.

The apparent benefit of coffee was similar for individuals with high levels of coffee consumption, including those who drank six or more cups of coffee per day. (UpToDate)

(Ref: Freedman ND, Park Y, Abnet CC, et al. Association of coffee drinking with total and cause–specific mortality. N Engl J Med 2012;366:1891).

Waist circumference a better indicator of mortality

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , , | | Comments Off on Waist circumference a better indicator of mortality

As per a press conference at the European Society of Cardiology meeting a high body mass index (BMI) appears to be protective in certain populations. Abdominal obesity –– measured using waist circumference –– was a better predictor of 5–year mortality among French survivors of an acute myocardial infarction (MI) than was BMI, according to a study presented by Tabassome Simon, MD, of HÀ’pital Saint Antoine in Paris. Looking at BMI, there was an increased risk of dying for those with the lowest body mass (less than 22 kg/m2) and those with the highest (35 kg/m2 and higher), but not for those in the middle of those two groups, which included individuals who were overweight and mildly obese. Within each category of BMI‚ however, increased waist circumference was associated with an elevated risk of dying within the follow–up period. After adjusting for BMI in a multivariate analysis, waist circumference in the upper quartile was associated with a 44% greater risk of dying through 5 years.

Swine flu update

By
Filed Under Wellness | Tagged With: , , , | | Comments Off on Swine flu update

Swine flu has killed 95 people in north India since 1st January.

1.       Swine flu causes fewer deaths than the routine seasonal flu.

2.      The Hong Kong Study of H1N1 (Between April and December 2009)

  • Overall attack rate 10.7 percent.
  • Case-hospitalization rate 0.47 to 0.87 percent among people aged 5 to 59 years.
  • Case-ICU rate 7.9 cases per 100,000 infections in children aged 5 to 14 years.
  • Case-ICU rate 75 cases per 100,000 infections in adults aged 50 and 59 years.
  • Case-fatality rate 0.4 cases per 100,000 in children aged 5 to 14 years.
  • Case-fatality rate 26.5 cases per 100,000 in adults aged 50 to 59 years.

3.   Case fatality is 0.4 – 26.5 cases per 100,000. This means 10 deaths would occur if one lakh people get the flu. To have 95 deaths, almost one crore people need to be infected. This again means 10% of the society suffering from flu or two patients per family. Either the figure 95 is wrong or the number of positive cases is incorrect.

4.   From 1st Jan to 7th Feb (flu season), in 38 days, 95 deaths means 2.5 deaths per day in flu season.  According to the Economy Survey of Delhi, a total of 868 people died of pneumonia in 2006 (year average per day 2.4) and 879 in 2007 (year average per day 2.4). This statistics is pre H1N1 era and will be true for seasonal flu.

5. 2.4 deaths in a year should mean that in the flu season the deaths would be many more. This proves the medical fact that swine flu cause fewer deaths than the seasonal flu. Then why panic?

6. US data

  • 0.3 percent of cases require admissions in theUnited States.
  • The mortality rate of 2009 to 2010 pandemic H1N1 influenza A infection was 0.12 deaths per 100,000 population.
  • The mortality is high in severe cases admitted to the ICU: In California, 31 percent of patients were admitted to the intensive care unit and 11 percent died of pneumonia and dehydration.
  • Only inMexico, the mortality burden was 0.6 to 2.6 times that of a typical influenza season but lower than that of the severe epidemic in 2003-2004.
  • Two-thirds of deaths occur in people with underlying chronic illness.

7.     Severity over time: During the second wave of influenza activity of the pandemic, which peaked in late October 2009 in the United States, there were higher rates of pediatric mortality and higher rates of hospitalization in children and young adults compared with previous influenza seasons. No change in severity was observed among hospitalized children and adults with pandemic H1N1 influenza A in the United States in the fall of 2009 compared with the spring of 2010. We do not expect this year’s H1Ni flu to be more severe.

8.      Age: High rates of morbidity and mortality were noted among children and young adults across the globe. In some regions, older adults also had high rates of morbidity and mortality.

9.      The highest mortality was seen in Mexico. From this trend, the case mortality will be higher in India because of overcrowding.

10.  In seasonal flu, deaths occur more in people above 65 years of age and in H1N1 flu, deaths are more in 50-64 years age group.