Specialised Commissioning Alert: mortality

Showing posts with label mortality. Show all posts

20 July 2020

The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study.
Lancet Oncol 2020, 20 July 2020; https://doi.org/10.1016/S1470-2045(20)30388-0
See Online/Comment https://doi.org/10.1016/S1470-2045(20)30391-0

In this study the authors estimate the impact of delays in diagnosis on cancer survival outcomes in four major tumour types: breast cancer, colorectal cancer, oesophageal cancer, and lung cancer. For these four tumour types, these data correspond with 3291–3621 additional deaths across the scenarios within 5 years.

A literature search identified 4 articles which reported ICU outcome data for patients admitted to ICU with a COVID-19 diagnosis (n=10,150). The largest patient group was in the Intensive Care National Audit and Research Centre (ICNARC) study from the UK.
In patients with completed ICU admissions with COVID-19 infection, combined ICU mortality was 41.6% (95%CI 34.0-49.7%, I2 = 93.2%). Subgroup analysis by continent showed that mortality is broadly consistent across the globe. The in-ICU mortality from COVID-19 is higher than usually seen in ICU admissions with other viral pneumonias. The mortality from completed episodes of ICU differs considerably from the crude mortality rates in some early reports.

Summary

"The model estimated 6,270 excess deaths at 1 year in England."
"In England, the proportion of patients with incident cancer with≥1 comorbidity was 65.2%. The number of comorbidities was strongly associated with can-cer mortality risk. "

Read a commentary on this research here:

Deaths in people with cancer could rise by at least 20%
Imperial College Health Data Research Hub for Cancer 29 April 2020

An investigation into the association between quality of care quality and outcomes among children and young people with epilepsies in England concludes that

among adolescents with epilepsy, greater involvement of tertiary specialists in paediatric care is associated with decreased all-cause mortality in the period after transition to adult services.
Reduced access to an epilepsy specialist nurse was associated with an increase in paediatric epilepsy admissions.

Data: Epilepsy12 national clinical audit, death registrations from the UK Office for National Statistics and data for unplanned hospital admissions from Hospital Episode Statistics.
Nuffield Trust blog: Invest early: how to improve the health of young adults with epilepsy

A population-based, longitudinal cohort study of the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man, to assess the influence of BMI on the risk of primary total hip replacement revision and 90-day mortality. 38% of the patients were classified as obese.
The authors conclude that, although long-term revision rates following total hip replacement were higher among obese patients, they believe that the rates remained acceptable by contemporary standards and were balanced by a lower risk of 90-day mortality.

Cancer outcomes in children and young people have improved dramatically over the last few decades with over 80% of those diagnosed now being cured of their disease. This report deliberately focuses on a sample of patients who were a high-risk group who died or who had an unexpected admission to intensive care.
One of the recommendations is that the audit and quality improvement methods, with action plans, are essential for on-going improvement but require access to data eg prescribing, which are not always available.

Mortality data for 2015-17 for Alcohol-related liver disease, hepatitis B, hepatitis C and Non-alcoholic fatty liver disease.
For trends see the Liver disease profiles: short statistical commentary

This guidance is for NHS trusts, NHS foundation trusts and for services provided through NHS England specialised commissioning. It consolidates existing guidance and provides perspectives from family members who have experienced a bereavement within the NHS. It details how trusts should support and engage families after a loved one’s death in their organisation’s care.
The guidance is complemented by "Information for families following a bereavement" (Annex 1)