An East Texas family is taking the Gregg County Jail to court after their loved one died in the jail's custody earlier this year.
51-year-old Bobby Madewell Junior died in the Gregg County Jail on March 21st. Medical examiners say he died of an apparent seizure.
Madewell's family filed a lawsuit against the jail on August 6th, in the Marshall Federal Court.
The lawsuit claims Madewell was not given the right medication while in custody.
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By Chris Kaiser, Cardiology Editor, MedPage Today Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse PlannerHeart disease deaths are over-reported in the U.S.A hospital-level intervention to reduce heart disease over-reporting led to substantial changes in other leading causes of death, changing the leading cause of premature death.Hospitals in the U.S. tend to over-report death from heart disease, researchers found, but a simple intervention can improve the quality of cause-of-death reporting.
Hospitals involved in the intervention reduced their reports of heart disease as the leading underlying cause of death from 69% before the intervention to 32% afterwards -- a relative decline of 54%, according to Teeb Al-Samarrai, MD, of the Santa Clara County Department of Public Health in San Jose, Calif., and colleagues.
As reports of heart disease deaths declined, there were increases in four other conditions as leading underlying causes of death, the most dramatic being a 252% relative increase for reported deaths from chronic lower respiratory disease (absolute increase from 2% to 5%), they reported in the latest issue of the CDC's Preventing Chronic Disease.
The other three causes of death that spiked after the intervention were: Influenza and pneumonia -- 193% relative increase, going from 4% to 11% Cerebrovascular disease -- 115% relative increase, going from 2% to 4%Malignant neoplasms -- 48% relative increase, going from 11% to 16%
However, the hospitals not involved in the intervention saw minimal relative changes in leading causes of death -- all 6% or less.
The investigators also determined that the postintervention changes were not an effect of a trend that might have begun before the intervention. A secondary analysis revealed that between 2000 and 2009 (pre-intervention), deaths from heart disease at the hospitals that subsequently were involved in the intervention remained steady -- around 60% to 71%.
Al-Samarrai, who was formerly with the CDC, and colleagues noted that they took on this study because the quality of the information on death certificates "affects the usefulness of vital statistics for public health action."
Lack of physician training serves as the greatest contributor of poor quality of mortality data, they wrote, adding that "Cause-of-death assignment practices also appear to vary by region."
One group for which determining the cause of death is particularly difficult is patients of advanced ages, the researchers noted. "This suggests that inaccurate reporting of cause of death for patients aged 85 or older reflects not only lack of training but also the complexity and challenge of identifying a single underlying condition or clear sequence of events leading to death. Death certificates force physicians to simplify what might be a complex medical situation."
"As the population lives longer and multiple chronic medical conditions become more common, documenting which disease is the underlying cause of death will become more challenging," they continued. "Therefore, using the current 1-cause-to-1-death model for cause-of-death coding might not be appropriate when describing mortality among persons ages 85 or older."
To assess whether the situation could be improved, the investigators performed an intervention consisting of training and communication with staff at eight hospitals in New York City. The pre-intervention period was from July though December 2009. Postintervention spanned January to June 2010.
The total number of deaths at the intervention hospitals was similar in the pre- and postintervention periods (2,120 and 2,069, respectively).
In the pre-intervention period, the total number of deaths attributed to heart disease in the intervention hospitals ranged from 58% to 80%. This dropped in the postintervention period by 28 to 53 percentage points -- to a range of 26% to 44%, researchers noted.
In a subgroup analyses, researchers found that sex and race/ethnicity had no impact on the ranking of leading cause of death.
When researchers restricted for cause of premature death (ages 35 to 74), however, malignant neoplasm took the lead over heart disease (26% versus 25%). No such change was seen in the nonintervention hospitals.
After the intervention, influenza and pneumonia as a leading cause of death moved from third to second; no change occurred in the nonintervention hospitals. Importantly, the largest increase in influenza and pneumonia deaths occurred among those 85 years or older.
When Al-Samarrai and colleagues controlled for age, heart disease as the leading cause of death declined in the intervention group from 36% to 17%. In the nonintervention hospitals, however, this number increased from 16% to 18%.
"To our knowledge, this is the first study to investigate the impact of reducing heart disease over-reporting on other leading causes of death," Al-Samarrai and colleagues wrote. No prior study had demonstrated a reduction in heart disease death concomitant with an increase in other leading causes of death, they added.
The intervention in this study has been expanded to more New York City hospitals, "with preliminarily positive results."
The limitations of the study include the fact that death certificates were not validated, individual physician understanding of death certificates was not evaluated, standardizing for race/ethnicity could have hidden reporting differences, and results may not apply to other settings.
Preventing Chronic Disease is a publication of the CDC.
The authors had no financial or conflicts of interest to disclose.
From the American Heart Association:
Chris Kaiser
Cardiology Editor
Chris has written and edited for medical publications for more than 15 years. As the news editor for a United Business Media journal, he was awarded Best News Section. He has a B.A. from La Salle University and an M.A. from Villanova University. Chris is based outside of Philadelphia and is also involved with the theater as a writer, director, and occasional actor.
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By Ed Susman, Contributing Writer, MedPage Today Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse PlannerNote that this study was published as an abstract and presented at a conference. These data and conclusions should be considered preliminary until published in a peer-reviewed journal.Note that this large retrospective study documented higher mortality rates among patients admitted to the ICU with septic shock based upon source of the infection.PHILADELPHIA -- The anatomic site where an infection originates seems to predict mortality among patients diagnosed with septic shock, researchers reported at the American Thoracic Society conference.
In scouring a database that includes 8,000 septic shock patients in the U.S., Canada, and Saudi Arabia, those ICU patients with hydronephrosis, for instance, had a mortality of 21.1%, said Peter Dodek, MD, MHSc, professor of medicine at the University of British Columbia in Vancouver. But patients with ischemic bowel-caused infections experienced a mortality of 77.8%, he said.
"As many people realize, septic shock is a big issue in critical care medicine," Dodek said at a press conference sponsored by ATS. "Septic shock is associated with a high mortality -- in this study overall mortality was 52.4%."
He said that recently the mortality is decreasing, but "there are a lot of concerns because we haven't found a silver bullet to help treat septic shock."
A major problem in finding a suitable treatment is the heterogeneity of patients, which prevents researchers from focusing on a particular set of patients for clinical trials. With that in mind, Dodek said he and his colleagues asked the question: Are there meaningful differences in hospital mortality among patients who have septic shock, stratified by the location of the original infection?
The answer turns out to be Yes. Their research revealed the following sources and mortality rates: Disseminated infections, 84.5%Spontaneous bacterial peritonitis, 76%Toxic megacolon, 68.3%Other abdominal infections, 66.7%Pulmonary infections, 54%Pyelonephritis, 34.5%Enterocolitis/diverticulosis, 28%
Dodek's study used a dataset that was established to examine patients who have septic shock over the past 20 years, beginning in 1989. Even after using multiple regression analysis and adjusting for age, degree of illness at admission and multiple other factors, Dodek said the differences in infection sites still remained.
"There are meaningful differences in hospital mortality by source of infection," he told MedPage Today. "This may help us to stratify patients into groups for clinical trials of sepsis. Those with the highest risk may be the ones we want to try these disease-modifying agents on." But he suggested that it may be wise to think about scaling back on antibiotics for those who have a lower mortality.
"At the moment the tools we have to treat septic shock are early detection, early use of antibiotics which had been shown in some observational studies to make a difference and there have been a variety of drugs and other agents that have been tested but it is still a big conundrum," he said.
Gary Martin, MD, associate professor of medicine at Emory University in Atlanta, who served as the press conference moderator at which Dodek presented his work, told MedPage Today, "Septic shock is a condition that is difficult to study. You want to be able to target a population where you will have the best chance for intervention. This study may help us understand the mechanism and risk of septic shock."
"Heterogeneity is a major problem," he said. "Some of these patients have cancer, some do not; some are older, some are younger. All these patients are in an intensive care unit. They are all critically ill."
Dodek and Martin had no relevant disclosures.
Primary source: American Thoracic Society
Source reference:
Leligdowicz A, et al "Association between source of infection and hospital mortality in patients admitted to the intensive care unit because of septic shock" ATS 2013.
Pedestrians stop to read details of a death notice at a street in Damascus, April 3, 2013.
Credit: Reuters/StringerDAMASCUS | Wed Apr 17, 2013 10:25am EDT
DAMASCUS (Reuters) - In Damascus, even death offers no respite from the suffocating conflict encroaching on the Syrian capital.
The once secure central neighborhoods of the city are being sucked into the turmoil ravaging Syria as rebel fighters battle President Bashar al-Assad's forces on its periphery and step up rocket fire into central Damascus.
Relatives of people killed in and around the city cannot retrieve bodies before signing a mountain of paperwork absolving government forces of blame - just the first obstacle to be overcome before they can start a mourning process that is itself highly restricted.
Victims of violence cannot be described as "martyrs" in the death notices pasted on city walls and along narrow alleys unless they die fighting alongside President Bashar al-Assad's forces. Only vague phrases, such as "due to a tragic accident", are acceptable.
Bodies cannot be taken to mosques for funeral prayers in case they become a platform for anti-Assad protest.
And when mourners finally lay their loved one to rest, prayers are conducted in haste under the watchful eye of security forces who roam cemeteries to guard against the smallest display of anti-government sentiment.
The killing of a Damascus merchant, a distant relative of this reporter, at a checkpoint just a few weeks ago - a death described by his immediate family as random and unnecessary - highlighted both the new daily perils of Damascus life and the tribulations after death.
A trader in his 60s from the Old City in central Damascus, Aboudi was killed by a government sniper as his brother drove him and his son through a checkpoint on a morning errand to buy bread, his relatives told me. I have given only his family name to protect his identity.
The men passed through the area regularly and were known to the soldiers manning the checkpoint, who often waved them through. On this morning Aboudi's partially deaf brother saw a guard nod his assent, and drove through the checkpoint, unaware that another guard was shouting at him to stop.
A jittery conscript providing cover to the guards assumed the men were trying to flee and opened fire, killing Aboudi and wounding his brother and the young man in the back seat.
For the family, grief over their loss was compounded by the bureaucracy which followed.
"They had to sign papers that say it was terrorists who did it, and that the government had no role at all in his death," said Aboudi's daughter-in-law. "They didn't release the body until all forms were signed and sealed with thumb prints."
Describing her husband as "heart-broken" over his father's death, she said he and others in the neighborhood have vowed revenge on the soldier, who has not been seen since.
The dead man, popular in the Old City because of his reputation for giving money to the needy and poor, was buried in a muted ceremony without fanfare, under supervision of the security forces.
Family members said they were denied a full prayer service for him at a local mosque "for security reasons".
TWO STEPS FROM DEATH
Aboudi's killing was just one of many in a mounting death toll that is now part of everyday existence in the capital. Every Damascene today is just one or two degrees removed from the latest casualty.
On a daily basis we hear the sonic booms and air raids of fighter jets, the shelling from government-mounted missile batteries stationed in the hills overlooking north Damascus, and rocket and mortar fire from rebels on the outskirts.
Sometimes we count the shells; the other day we heard two dozen just seconds apart.
Another day, a Friday before midday prayers, I heard thuds and booms from the edge of the city as government MiG jets unleashed their bombs on the farming area of Sbeineh, where in happier days we went to get fresh air and pick apples.
The bombs also fell on Daraya, a working-class suburb that fell to the rebels months ago and has been reduced to a ghost town by relentless government shelling.
From my kitchen window, I saw black smoke rising from Daraya. Dense, acrid and slow-moving, it spread over the city, following a path taken by Daraya's families who have fled their district and dispersed around Damascus, doubled and tripled up in small flats with relatives.
One Daraya family of five has been squatting for months in the basement of my building, inside a cramped janitor's room.
FRUSTRATION
In these tense times, Damascenes complain of frustration and ennui. This is especially true on Fridays, the start of the Syrian weekend and the original day of protests in the early months of Syria's uprising, which has now spiraled into a civil war which the United Nations says has killed 70,000 people.
Determined to prevent protests, authorities increase security at checkpoints and deny entry to the city from the suburbs, questioning drivers within the city at length.
Nowadays hardly anyone goes out on a Friday, but I had promised to visit relatives so I ventured out, on foot to avoid questioning at checkpoints. The short walking tour brought home how the city has changed.
Damascus today feels smaller and emptier, shrunk to the dozen or so districts under government control known collectively as the 'Square of Security'. You can walk briskly from one end to the other in under two hours.
As it shrinks, Damascenes with a dark sense of humor have taken to calling it the Triangle of Security.
It includes the historic Old City, where the biblical Saint Paul walked on the Street Called Straight. All the city's major commercial districts are also in the Square-turned-Triangle, including the ancient bazaar and contemporary shopping malls.
It includes middle class districts, parliament, various ministries and intelligence branches. It is here that Assad and most government officials live.
Assad's forces are increasingly bringing artillery into the centre of this area, firing from the densely populated area towards the rebels outside.
"We hear it discharge and we hear it pierce the air," one of my friends told me.
"We hear its whistle as if it's flying past our window, and we hear it when it falls - the thud and the explosion," he said, adding that his whole family have been kept awake since the artillery was deployed in his neighborhood a few days ago.
"No matter how hard we try to get used to it, we get startled every time."
I once had many relatives and friends here. Most of them fled the country when the violence reached their doorstep and life became unbearable.
Such was the case of my cousin when I arrived to bid her farewell. Frazzled and unsure of the future, she and her husband had packed their belongings and were preparing for departure.
It was still light when I returned home. Back in my kitchen, as I prepared my dinner, I looked out the window and saw more smoke. The fighter jets were at their work.
(The journalist's name has been withheld for security reasons)
(Editing by Dominic Evans and Sonya Hepinstall)
