Death Notification Research Articles

The National Coronial Information System: Saving Lives through the Power of Data

AbstractThe National Coronial Information System (NCIS) is a secure database of mortality‐specific information on deaths reported to a coroner in Australia and New Zealand. The NCIS contains data on over 380,000 cases, investigated by a coroner. Data include demographic information on the deceased, contextual details on the nature of the fatality and searchable medico‐legal case reports including the coronial finding, autopsy and toxicology report and police notification of death. The database is available to coroners to assist investigations and appropriate access is available on application for research or monitoring projects.

Unsuccessful, Unwanted, and Unwarranted Resuscitation: Exploring Ambulance Personnel Preparation and Support for Death in the Field

Introduction:In many countries, ambulance personnel are authorized to start or stop resuscitation efforts in accordance with clinical guidelines. Research shows that decisions to withhold or terminate resuscitation and manage patient death scenes can be particularly challenging.Aim:To identify preparation and support mechanisms for ambulance personnel who are authorized to withhold or terminate resuscitation efforts, and manage patient death in the field.Methods: A scoping review provided an overview of international research in this area. A qualitative exploratory study was then undertaken. Focus groups were held with senior ambulance personnel currently working in clinical education, managerial, or pastoral support roles across New Zealand.Results:Well-supported clinical experiential learning and resolved personal experiences with grief and death were considered most useful to increase self-efficacy and coping with patient death. Participants felt some of the personal and interpersonal skills needed to manage death in the field were difficult to teach. Relatively little time is spent preparing ambulance personnel for the non-technical skills associated with resuscitation decision-making, particularly communicating with family and bystanders. Ambulance personnel responses and support-needs during or after the event are idiosyncratic. Ambulance personnel appear to primarily rely on colleagues and managers checking in and offering informal debriefing.Discussion:Results from this study identify opportunities for improvement in the preparation and support of ambulance personnel faced with managing patient death in the field. Clinical experience with supportive mentoring may provide the best opportunities for learning, but novices may not get exposure to patient death in this context. Ambulance personnel may benefit from training, which includes opportunities to role-play death notification and communication with family and bystanders at the scene of a patient death. Ambulance employers should allow downtime to facilitate personalized peer and managerial support where needed.

HIV-Related Deaths in Nairobi, Kenya: Results From a HIV Mortuary Surveillance Study, 2015

Death is an important but often unmeasured endpoint in public health HIV surveillance. We sought to describe HIV among deaths using a novel mortuary-based approach in Nairobi, Kenya. Cadavers aged 15 years and older at death at Kenyatta National Hospital (KNH) and City Mortuaries were screened consecutively from January 29 to March 3, 2015. Cause of death was abstracted from medical files and death notification forms. Cardiac blood was drawn and tested for HIV infection using the national HIV testing algorithm followed by viral load testing of HIV-positive samples. Of 807 eligible cadavers, 610 (75.6%) had an HIV test result available. Cadavers from KNH had significantly higher HIV positivity at 23.2% (95% CI: 19.3 to 27.7) compared with City Mortuary at 12.6% (95% CI: 8.8 to 17.8), P < 0.001. HIV prevalence was significantly higher among women than men at both City (33.3% vs. 9.2%, P = 0.008) and KNH Mortuary (28.8% vs. 19.0%, P = 0.025). Half (53.3%) of HIV-infected cadavers had no diagnosis before death, and an additional 22.2% were only diagnosed during hospitalization leading to death. Although not statistically significant, 61.9% of males had no previous diagnosis compared with 45.8% of females (P = 0.144). Half (52.3%) of 44 cadavers at KNH with HIV diagnosis before death were on treatment, and 1 in 5 (22.7%) with a previous diagnosis had achieved viral suppression. HIV prevalence was high among deaths in Nairobi, especially among women, and previous diagnosis among cadavers was low. Establishing routine mortuary surveillance can contribute to monitoring HIV-associated deaths among cadavers sent to mortuaries.

A survey of perioperative clinician’s knowledge and application of the law regarding the classification of deaths in the perioperative period

Background: Doctors complete death notification forms poorly, in South Africa and globally. This reduces accuracy of mortality statistics in South Africa, which is needed by policymakers and clinicians to focus on healthcare improvement initiatives. The law on procedure-related deaths was changed in 2008, directly informing on the practice of anaesthesiologists. Perioperative deaths continue to be misclassified, possibly related to doctors’ lack of knowledge or understanding of the law. This study aimed to determine if perioperative clinicians working in theatre and the Intensive Care Unit (ICU) knew and understood the law pertaining to deaths in the perioperative period. Method: A survey was conducted at eight hospitals in the Durban area amongst specialists and non-specialists who work in theatre and ICU. The questionnaire had three parts: definitions, medico-legal experiences and clinical scenarios. Results: Eighty responses were received, a response rate of 74%. More non-specialists responded (57%). When undecided on how to classify a death, clinicians mostly seek assistance from their private medico-legal insurance or a senior colleague. However, specialists are unable to define or classify unnatural and procedure-related deaths any better than non-specialists. Conclusion: Specialist and non-specialist knowledge and application of the law relating to unnatural deaths in the perioperative period is poor. Forensic pathologist assistance is underutilised. More needs be done to empower doctors on medico-legal issues affecting perioperative clinical practice.

Engaging communities in collecting and using results from verbal autopsies for child deaths: an example from urban slums in Freetown, Sierra Leone.

BackgroundVerbal autopsies (VAs) can provide important epidemiological information about the causes of child deaths. Though studies have been conducted to assess the validity of various types of VAs, the programmatic experience of engaging local communities in collecting and using VA has received little attention in the published literature. Concern Worldwide, an international non-governmental organization (NGO), in collaboration with the Ministry of Health and Sanitation (MOHS), has implemented a VA protocol in five urban slums of Freetown, Sierra Leone. This paper provides VA results and describes lessons learned from the VA process.MethodsUnder-five child deaths were registered by Community Health Workers (CHWs) in five urban slums between 2014 and 2017, and a specially trained local clinician used a VA protocol to interview caretakers. Symptoms were analysed using InterVA-4 computerized algorithm, a probabilistic expert-driven model to determine the most likely cause of death. Themes in care-seeking were extracted from multiple-choice and open-ended questions. VAs were implemented in collaboration with the community and the results were shared with community stakeholders in participatory review meetings.ResultsMain challenges included limitations in death notification and capacity to conduct VA for all notified deaths. A total of 215 VA were available for analysis. Among 79 neonatal deaths aged 0-27 days, the most common cause of death was neonatal pneumonia (55%); among 136 children deaths aged 1-4 years, the most common causes were malaria (56%) and pneumonia (41%). Key themes in care-seeking identified included use of traditional medicine (14% of deaths), absence of care-seeking (23% of deaths), and difficultly reaching the health facility (8% of deaths that occurred at home) during fatal illness.ConclusionsConducting VAs as a collaborative process with communities is challenging but can provide valuable data that can be used for local-level decision-making. The findings have practical implications for engaging the community and CHWs in reducing the number of these preventable deaths through expanded efforts at prevention, early and appropriate treatment, and reduction of barriers to care-seeking. A functional end-to-end VA system can enhance meaningful routine vital events monitoring by community, national, and international stakeholders.

Accuracy of mortality statistics in Palestine: a retrospective cohort study

ObjectiveTo examine the accuracy of mortality statistics in Palestine, to identify gaps and to provide evidence-based recommendations to improve mortality statistics in Palestine.Study design and settingA retrospective death registry-based study...

Evaluation of the Maternal Death Surveillance and response system in Hwange District, Zimbabwe, 2017

BackgroundMaternal Death Surveillance and Response (MDSR) system was established to provide information that effectively guides actions to eliminate preventable maternal mortality. In 2016, Hwange district sent six maternal death notification forms (MDNF) to the province without maternal death audit reports. Timeliness of MDNF reaching the province is a challenge. Two MDNF for deaths that occurred in February and May 2016 only reached the provincial office in September 2016 meaning the MDNF were seven and four months late respectively. We evaluated the MDSR system in Hwange district.MethodsA descriptive cross-sectional study was conducted. Health workers in the sampled facilities were interviewed using questionnaires. Resource availability was assessed through checklists. Epi Info 7 was used to calculate frequencies, means and proportions.ResultsWe recruited 36 respondents from 11 facilities, 72.2% were females. Inadequate health worker knowledge, lack of induction on MDSR, unavailability of guidelines and notification forms and lack of knowledge on the flow of information in the system were reasons for late notification of maternal deaths. Workers trained in MDSR were 83.8%. Only 36.1% of respondents had completed an MDNF before. Respondents who used MDSR data at their level were 91.7%, and they reported that MDSR system was useful. Responsibility to complete the MDNF was placed on health workers. Maternal death case definitions were available in 2/11 facilities, 4/11 facilities had guidelines for maternal death audits. It costs $60.78 to notify a maternal death.ConclusionReasons for late notification of maternal deaths were inadequate knowledge, lack of induction, unavailability of guidelines and notification forms at facilities. The MDSR system is useful, acceptable, flexible, unstable, reliable but not simple. Maternal case definitions and maternal death audit guidelines should be distributed to all facilities. Training of all health workers involved in MDSR is recommended.

Risk of Cardiovascular Disease and Mortality in Young Adults With End-stage Renal Disease

Cardiovascular disease (CVD) is a leading cause of death among patients with end-stage renal disease (ESRD). Young adult (ages 22-29 years) have risks for ESRD-associated CVD that may vary from other ages. To test the hypothesis that young adult-onset ESRD is associated with higher cardiovascular (CV) hospitalizations and mortality with different characteristics than childhood-onset disease. This population-based cohort study used the US Renal Data System to categorize patients who initiated ESRD care between 2003 and 2013 by age at ESRD onset (1-11, 12-21, and 22-29 years). Cardiovascular hospitalizations were identified via International Classification of Diseases, Ninth Revision discharge codes and CV mortality from the Centers for Medicare & Medicaid ESRD Death Notification Form. Patients were censored at death from non-CVD events, loss to follow-up, recovery, or survival to December 31, 2014. Adjusted proportional hazard models (95% CI) were fit to determine risk of CV hospitalization and mortality by age group. Data analysis occurred from May 2016 and December 2017. Onset of ESRD. Cardiovascular mortality and hospitalization. A total of 33 156 patients aged 1 to 29 years were included in the study population. Young adults (aged 22-29 years) had a 1-year CV hospitalization rate of 138 (95% CI, 121-159) per 1000 patient-years. Young adults had a higher risk for CV hospitalization than children (aged 1-11 years; hazard ratio [HR], 0.41 [95% CI, 0.26-0.64]) and adolescents (aged 12-21 years; HR, 0.86 [95% CI, 0.77-0.97]). Of 4038 deaths in young adults, 1577 (39.1%) were owing to CVD. Five-year cumulative incidence of mortality in this group (7.3%) was higher than in younger patients (adolescents, 4.0%; children, 1.7%). Adjusted HRs for CV mortality were higher for young adults with all causes of ESRD than children (cystic, hereditary, and congenital conditions: HR, 0.22 [95% CI, 0.11-0.46]; P < .001; glomerulonephritis: HR, 0.21 [95% CI, 0.10-0.44]; P < .001; other conditions: HR, 0.33 [95% CI, 0.23-0.49]; P < .001). Adolescents had a lower risk for CV mortality than young adults for all causes of ESRD except glomerulonephritis (cystic, hereditary, and congenital conditions: HR, 0.45 [95% CI, 0.27-0.74]; glomerulonephritis: HR, 0.99 [95% CI, 0.76-1.11]; other: HR, 0.47 [95% CI, 0.40-0.57]). Higher risks for CV hospitalization and mortality were associated with lack of preemptive transplant compared with hemodialysis (hospital: HR, 14.24 [95% CI, 5.92-34.28]; mortality: HR, 13.64 [95% CI, 8.79-21.14]) and peritoneal dialysis [hospital: HR, 8.47 [95% CI, 3.50-20.53]; mortality: HR, 7.86 [95% CI, 4.96-12.45]). Nephrology care before ESRD was associated with lower risk for CV mortality (HR, 0.77 [95% CI, 0.70-0.85]). Cardiovascular disease accounted for nearly 40% of deaths in young adults with incident ESRD in this cohort. Identified risk factors may inform development of age-appropriate ESRD strategies to improve the CV health of this population.

Quality of data in death notification forms in the Gaza governorate: a descriptive study

BackgroundThe Cause of Death Registry data are derived from death notification forms (DNFs). These data are used to formulate mortality statistics that are used in the development of health systems and in public health planning. This study assessed the quality of registered data in DNFs in Gaza to form a basic understanding of the current situation, and with a view to providing evidence-based recommendations to improve data quality. MethodsIn 2016, the Ministry of Health issued 4861 DNFs in the Gaza governorate. A representative sample of 509 DNFs was selected using proportional systematic random sampling. A set of indicators was identified using the WHO guidelines for DNF data quality assessment. 13 data items were identified to represent administrative data plus nine items to represent medical data, and a total score for completeness was calculated. The quality of medical data was examined by a doctor trained to analyse the quality of mortality data. Administrative approval was obtained from the Ministry of Health. The assessment did not include any personal data (and all data were anonymous). FindingsThe completeness of administrative and medical data was 89·0% (5500 of 6180) and 47·3% (2168 of 4581), respectively. For the underlying cause of death, completeness was 36·5% (186 of 509). The completeness of ICD-10 coding was 46·8% (238 of 509) for the direct cause of death and 12·6% (64 of 509) for the underlying cause. Only 23·0% (three of 13) of DNFs for women of reproductive age indicated whether the woman was pregnant or not and whether her death was related to maternal health problems. The ICD-10 codes with the written cause of death were checked and the ICD-10 documentation was correct in 58·0% (138 out of 238) of DNFs for the direct cause of death and 67·2% (43 out of 64) of DNFs for the underlying cause of death. InterpretationThe completeness and accuracy of medical data in DNFs is low. There is an urgent need to train physicians and medical interns to give the correct death sequence and ICD-10 codes, particularly for the underlying cause of death. FundingNone.

Using a Standardized Client Encounter to Practice Death Notification after theUnexpected Death of a Feline Patient Following Routine Ovariohysterectomy.

Death notification is an important skill for health care providers to carry out, yet few clinicians feel adequately prepared to complete this task. To address these gaps in clinical training, some medical educators have incorporated standardized patients (SPs) into the curriculum to allow students to practice death notification in a safe, controlled environment. Veterinary educators agree that end-of-life communication skills are essential for success in clinical practice, and many rely on standardized clients (SCs) for role-play concerning euthanasia. However, anticipatory loss is distinct from unexpected death, and death notification is strikingly absent from the veterinary literature. To introduce students to death notification, Midwestern University College of Veterinary Medicine (MWU CVM) developed a communications curriculum that culminated in a scripted encounter, "Basil, the Scottish Fold." Students must explain to an SC that his kitten died following routine ovariohysterectomy. Pre- and post-event surveys completed by 19 students demonstrated valuable lessons in death notification word choice, particularly what not to say. I hope that this teaching tool may be adapted for use by other colleges of veterinary medicine to allow students to practice death notification.

Tense Relationships between Homicide Co-Victims and Detectives in the Wake of Murder

ABSTRACTIn the aftermath of a murder, homicide detectives and the loved ones of slain victims have no choice but to interact with one another over a lengthy period of time. These relationships are among the most mutually unwelcome and emotionally challenging that beset the criminal justice system. Drawing upon interviews with homicide detectives and homicide co-victims, the purpose of this study is to examine the patterned aspects of these relationships as they unfold across three predictable phases of the postmortem process: at the crime scene, during the death notification, and throughout the follow up investigation. We document distinct themes to how both groups perceive the stress and trauma that they experience across each phase of the relationship. In doing so, we seek to theorize a largely underappreciated aspect of the criminal justice process and provide direction for policy makers.

Early withdrawal and non-withdrawal death in the months following hemodialysis initiation: A retrospective cohort analysis.

Whether and how factors associated with elective hemodialysis withdrawal differ from those associated with non-withdrawal death soon after maintenance hemodialysis initiation have not been well studied. A retrospective cohort analysis was performed using USRDS data from 2011 to 2014. Patients were randomly categorized 2:1 into training and validation samples. Elective withdrawal deaths were identified using the Death Notification form. Multinomial logistic regression was used to fit a prediction model for three outcome categories (withdrawal, non-withdrawal death, survival at 6 months) as a function of demographic, comorbidity, and functional status. The training sample comprised 80,284 hemodialysis patients. Mean age was 71.7 ± 11.4 years, 44.9% were female, 72.9% were white, and 22.8% were black. Within 6 months, 19.1% died, of whom 2099 (2.6%) withdrew and 13,223 (16.5%) died of a non-withdrawal cause; 13.7% of all deaths were withdrawals. Baseline characteristics and event rates were similar among the 40,142 patients in the validation sample. The model was calibrated adequately and could discriminate moderately well between withdrawal and survival (area under ROC curve [AUC]: 0.77) and between non-withdrawal death and survival (AUC: 0.73). However, discrimination between withdrawal and non-withdrawal death was relatively low (AUC: 0.62). Older age and white, compared with non-white, race were each associated with greater odds of death, and these associations were stronger for withdrawal than for non-withdrawal death. Advanced age and white, as opposed to black, race were most strongly associated with early elective hemodialysis withdrawal compared with non-withdrawal death. However, it is difficult to differentiate between patients who will experience early withdrawal vs. non-withdrawal death, as many factors are similarly associated with both outcomes.

Long-Term Follow-up or Lost to Follow-up? Driving Distance and Continuity of Follow-up Care after Allogeneic Transplantation

Introduction Long-term follow-up (LTFU) clinics overcome any potential survival disadvantage from long driving distances in hematopoietic stem cell transplant (HCT) recipients (Ragon et al, 2014; Khera et al, 2017). However, omitting pts who are lost to follow-up (f/u) – defined as no phone/electronic communication or appointment requests in 12+ mos – may introduce selection bias. We hypothesized that long driving distances lead to higher ‘lost' rates in HCT survivors. Methods We conducted a landmark analysis of HCT survivors > 12 mos after allogeneic HCT seen at least once in our clinic between 1/1/02 & 6/30/18. We identified each pt's last point of contact with our institution (including admissions & death notifications). For pts not known to have died, we calculated ‘no-contact' intervals since last points of contact. No-contact intervals of 12+ mos constituted being lost to f/u. We used the 75th percentile of driving distance (as done by Ragon et al) to delineate closer-living vs. furthest-living groups, calculating percentiles within f/u cohorts (1-4.9 yrs, 5-9.9 yrs, or 10+ yrs after HCT) to account for catchment area changes over time. Results We analyzed 437 pts, of whom 22 (5%) had received HCTs at other centers. Compared to the closer-living group (median distance 24.1 mi, interquartile range [IQR] 13.9-33.3), the furthest-living group (median distance 78.4 mi, IQR 66.2-117.0) was more likely to be white but was otherwise comparable by age, gender, insurance, HCT indication, & GVHD distribution. The two groups had similar overall survival (median 32.0 vs. 31.0 mos, p = 0.94). Among patients not known to have died (n = 272), lost to f/u rates were almost 2x as high (17% vs. 9%) in the furthest-living group; however, this difference did not reach significance (p = 0.13). Only 1/4 of lost pts (n = 30) had documented reasons for ceasing contact, e.g. preference for local care or transfer to another center. The furthest-living group had significantly longer no-contact intervals than the closer-living group (p Discussion Our sample size was relatively small, and we were unable to assess HCT recipients not seen in our ambulatory LTFU clinic. Nevertheless, our single-center study suggests that long-distance pts may disproportionately become lost to f/u. LTFU clinics should ensure adequate inclusion, e.g. via telehealth, of long-distance HCT survivors in clinical care and research.

Immediate aftermath of a client’s death: the experience of home health aides

ABSTRACTThis study investigated Home Health Aides’ (HHAs) experiences in the immediate aftermath of client death. Semi-structured in-person interviews with 80 HHAs explored how notification of death and reassignment to a new client were handled. Only 42.5% of HHAs were notified of the death; 40% had to notify the agency; 17.5% were not notified at all and had a negative experience. Reassignment preferences varied, but HHAs had a better experience when their preferences were taken into consideration. Study findings suggest that more mindful approaches to transitions following client death would be valued by HHAs and could improve their work experience.

How are Ambulance Personnel Prepared and Supported to Withhold or Terminate Resuscitation and Manage Patient Death in the Field? A Scoping Review

Introduction Research shows that ambulance personnel can find it challenging to withhold or terminate resuscitation and manage patient death in the field. This scoping review provides a synthesis of published research that has addressed three main questions. Each relates to ambulance personnel enacting decisions to withhold or terminate resuscitation and manage patient death: How are they prepare; what supports and coping strategies are utilised; and what preparation and support needs have been identified? Methods Using Arksey and O'Malley's five-stage scoping review framework this review identifies what is known and what further research is needed in this area. Results Sixteen methodologically heterogenous papers were located. Half of the studies were conducted in the United States, with the remainder in Canada, Singapore, Spain, Sweden and the United Kingdom. Ambulance personnel receive little formal training and feel unprepared to manage situations where resuscitation is unsuccessful or unwarranted, particularly communicating with family, breaking bad news and managing death scenes. These aspects of termination of resuscitation are so challenging that distancing and avoidance are sometimes used as coping strategies, even when medical futility has been established. In addition to formal counselling for personal loss and stressors, ambulance personnel value downtime and informal peer debriefing, following difficult resuscitation decisions and patient deaths. Conclusion Ambulance personnel feel inadequately prepared to withhold or terminate resuscitation and manage patient death in the field. They want more opportunities to learn about death notification, communication with bereaved families and safe, sensitive management of death scenes. More research is needed to determine how best to prepare and support ambulance personnel for the challenges of resuscitation decision-making and patient death.

Smoking counts: experience of implementing questions on smoking on official death certification systems

We describe our experience in several settings, following a suggestion in 1983 to add questions on the smoking status of the deceased on the UK death certificate as an effective way to monitor the evolution of the smoking epidemic. In South Africa in 1997 and in Tianjin Municipality, China, in 2010, questions about the smoking habits of the deceased were inserted on the official death certificates. In both places a system now exists to routinely collect information on smoking status in relation to causes of death. Results from two million South African and 300000 Chinese deceased individuals have been reported, and the sample size in both places continues to grow. An unsuccessful attempt was made in 2008 to insert smoking questions on the Australian death notification forms but comments and concerns from the registrars of births, marriages and deaths have international applicability. In both China and South Africa, inserting questions on smoking on the death notification forms was not a trivial task-in each it required, as a minimum, significant commitment from several government agencies. Benefits, however, include a better local understanding of the smoking epidemic and allowing for planning and monitoring of tobacco control programmes. Documenting the varied experiences of collecting information on smoking on death notification forms is useful to those wishing to introduce such questions in their own settings. This is pertinent especially at a time when vital registration systems are being improved, with an aim to monitoring sustainable development goals.

Standardized Patients to Assess Resident Interpersonal Communication Skills and Professional Values Milestones.

It has been a challenge to assess communication and professional values Milestones in emergency medicine (EM) residents using standardized methods, as mandated by the Accreditation Council for Graduate Medical Education (ACGME). This paper outlines an innovative method of assessing these Milestones using an established instructional method. EM faculty mapped the communication and professional values Milestones to an existing communication and interpersonal skills scale. We identified six communication-focused scenarios: death notification; informed consent; medical non-compliance; medical error; treatment refusal; and advanced directives. In a pilot, 18 EM residents completed these six standardized patient (SP) encounters. Our experience suggests SP encounters can support standardized direct observation of residents’ achievement of ACGME Milestones. Further effort can be made to create a tailored, behaviorally-anchored tool that uses the Milestones as the conceptual framework.

Body mass index and kidney disease-related mortality in midlife: A nationwide cohort of 2.3 million adolescents

Objective This study aimed to evaluate the association of body mass index (BMI) in adolescence with mortality attributed to kidney disease. Methods In this study, 2,294,139 Jewish Israeli adolescents with measured weight and height at 17 years old during the military fitness assessment were analyzed with a follow-up extending up to 45 years. All kidney-related outcomes, coded by the Central Bureau of Statistics from death notifications as the underlying cause of death, were obtained by linkage. Cox hazards models were applied. Results During 42,297,007 person-years of follow-up (median 18.4 years), 226 deaths related to kidney disease were recorded. There was an increased risk for kidney-related death among adolescents with overweight and obesity with adjusted hazard ratios of 2.7 (95% CI: 1.8-3.9) and 8.4 (5.1-13.8), respectively, with BMI between 18.5 and 22.0 kg/m2 as the reference. A 15% increased risk for kidney-related mortality (1.11-1.19) per unit increment in BMI was observed. Furthermore, a multivariable spline model indicated a minimum risk for kidney-related mortality starting at BMI of 18.6 kg/m2 with significantly increased risk seen above values of 22.8 kg/m2 . The results withstood extensive sensitivity analyses, including stratification of kidney-related death attributed to acute, chronic, and total kidney disease. Conclusions Adolescent overweight and obesity are risk markers for kidney-related mortality over 4 decades.

Death notification delivery and training methods

For a paramedic, delivering a death notification (DN) is one of the most difficult and stressful messages they will have to communicate in practice. Stress and anxiety in both recipients and paramedics have been documented through a limited literature base. The current review seeks to understand the existing educational tools and training around DN, and evaluates the applicability of these in the pre-hospital environment.

Cause of kidney disease and cardiovascular events in a national cohort of US patients with end-stage renal disease on dialysis: a retrospective analysis.

End-stage renal disease (ESRD) is a strong cardiovascular risk factor. We aimed to determine the extent to which cause of kidney disease independently contributes to this risk. Using a national US ESRD registry, we selected patients with eight different causes of ESRD who initiated dialysis 1997-2014. We used proportional sub-distribution hazard models, with non-cardiovascular death or kidney transplantation as competing risks, to estimate hazard ratios (HRs) for a first composite cardiovascular event (myocardial infarction, ischaemic stroke, or cardiovascular or cerebrovascular death), by cause of ESRD. The population was restricted to those using Medicare insurance at Day 91 after dialysis initiation (when most patients become Medicare eligible). Outcomes were ascertained from Medicare claims or Death Notifications. Among the 658 168 patients identified, composite event rates ranged from 3.5/100 person-years in IgA nephropathy to 14.6/100 person-years in diabetic nephropathy (DN). After adjusting for demographics, socioeconomic factors, comorbidities, dialysis modality, and laboratory values, cardiovascular event HRs differed significantly by cause of ESRD. Comparing to IgA nephropathy, the adjusted HR was highest for DN [aHR = 2.97, 95% confidence interval (CI) 2.77-3.20], next highest for lupus nephritis (aHR = 1.86, 95% CI 1.71-2.03), and thereafter ranged from 1.29 (95% CI 1.19-1.39) in autosomal dominant polycystic kidney disease to 1.67 (95% CI 1.52-1.83) in membranous nephropathy. High cardiovascular event rates in dialysis patients vary considerably by cause of ESRD. Determining underlying reasons for these differences might provide new insights in to cardiovascular disease mechanisms as well as inform future drug development and clinical trial design.