Maternal and Neonatal Death Review (MNDR): A Useful Approach to Identifying Appropriate and Effective Maternal and Neonatal Health Initiatives in Bangladesh

Objectives: To identify the effects of Maternal and Neonatal Death Review (MNDR) in terms of improving maternal and neonatal health at the community level in Bangladesh. Methods: Both quantitative and qualitative methods were undertaken for collecting data in Kashipur Union, Bangladesh. Death notifications from households, subsequent data collections from a focus-group discussion (FGD), a group discussion (GD) and in-depth interviews (IDIs) were obtained using structured tools and guidelines. Results: A total of four maternal deaths, 21 neonatal deaths and 15 still births were reported in the MNDR death notification system at Kashipur Union in 2010. Data were presented to local programme managers, who took various initiatives including awareness programmes, pregnancy registration, antenatal care, birth planning, and also the revitalization of a community clinic. The coverage of antenatal care, delivery in clinics, postnatal care and referral of complications increased through the active participation of the community. Community healthcare providers, care recipients and members of the community expressed satisfaction with the quality of maternal and neonatal services. In the preceding two years, maternal and neonatal deaths substantially reduced in Kashipur (in 2011 maternal death = 1, neonatal death = 20, still birth = 8;in 2012 maternal death = 1, neonatal death = 8, still birth = 13). Conclusions: The MNDR system successfully delivered notification of all maternal and neonatal deaths in the defined area and collected information for the formulation and implementation of specific interventions, which resulted in visible and tangible changes in care-seeking and client satisfaction.

Review of Maternal Deaths over 3 and a Half Years at the Kara University Hospital Center, Northern Togo: About 65 Cases

Objective: To analyze maternal deaths, identify causes and dysfunctions leading to these deaths in order to contribute to the implementation of strategies to reduce maternal mortality at CHU Kara. Method: Cross-sectional descriptive study involving 65 cases of maternal deaths recorded at CHU-Kara from January 1, 2018 to June 30, 2021. Results: Our study focused on 65 cases of maternal deaths recorded at the maternity ward of CHU-Kara. The average age was 30 years, with a range of 15 to 45 years. They were mostly housewives (52.3%), uneducated (38.5%), multiparous (41.5%), and referred (86.2%). The causes were mainly direct obstetric causes (81.54%), with preeclampsia and its complications (28.30%) and immediate postpartum hemorrhage (20.75%) being the most common. However, uterine rupture (20.5%) and post-abortion sepsis (16.4%) were the most lethal etiologies. Delayed evacuation (46.43%), inadequate transportation (91%), and insufficient prenatal care (72.31%) were the dysfunctions before referral. Within the CHU Kara, delays in management (58.46%), unavailability of blood and labile products (18%), and insufficient monitoring were the dysfunctions identified. Ninety-five point four percent (95.4%) of the deaths were preventable. Conclusion: The magnitude of intrahospital maternal deaths, the various dysfunctions observed in the occurrence of maternal deaths before referral/evacuation and within the hospital highlight the importance of effectively implementing recommendations from audits in the fight against maternal mortality. The majority of the deaths were preventable (95.38%).

Hospitalization and Occurrence of Death in Frail Older Adults: An Integrative Review

Objective: To identify the relationship between hospitalization and occurrence of death among frail older adults in the scientific productions on the topic. Method: An integrative literature review is conducted by elaborating the research question, searching in the databases using descriptors, presenting and interpreting the results, and synthesizing the knowledge. Results: The search performed in April 2023 yielded 5804 studies, of which seven remained after applying the inclusion/exclusion criteria. There was an association between frailty and postoperative mortality in the older adults, p p Conclusion: An association was verified between frailty and in-hospital death, signaling frailty as a prognosis for negative outcomes. It is considered fundamental to assess frailty in frail aged people.

Review of Maternal Deaths in Two Health Regions of Togo: About 69 Cases (Epidemiological and Sociodemographic Aspects)

Introduction: Maternal mortality is a public health problem. It is common in hospitals in Togo. From 401 per 100,000 live births in 2013, in 2017 we are 396 per 100,000 live births. Despite several programs ranging from subsidized caesarean section (CARMA) yezou (assistance for pregnant women), the establishment of maternal death reviews in maternity wards to compensate for avoidable causes;we are seeing preventable maternal and fetal deaths in our hospitals. No study on these reviews has been done since its establishment. The objective of our study was to determine the frequency of reviews of maternal deaths, the epidemiological, sociodemographic aspects and the causes of these reviewed maternal deaths. Method: This was a descriptive and cross-sectional, multicenter study lasting four and a half years, from the 1st of January 2018 to the 30th of June 2022, relating to the review of maternal deaths in three reference hospitals of two health regions of south Togo. Any maternal death occurring in one of these hospitals during the study period was included in this survey. The data collected using a collection sheet were analyzed using Epi Info version 7 software. Results: During the study period, the maternal mortality ratio in the three hospitals was 722.3 per 100,000 live births. Only 12.2% of maternal deaths were reviewed in the three hospitals. The patients were young with an average age of 29.9 years, housewives (71%), uneducated (21.7%). The causes of maternal deaths were dominated by direct obstetric causes (89.7%). The main cause was hemorrhage (72.5%), the main cause being immediate postpartum hemorrhage (50.7%). Conclusion: This study shows that the maternal mortality ratio still remains high in our country with a low frequency of maternal death reviews. Young, poor, uneducated women are the most affected by these deaths, the main cause of which remains hemorrhage. Preventive measures deserve to be taken at all levels with a view to reducing maternal mortality.

护士死亡态度现状及影响因素的研究进展

该文介绍了死亡态度的起源与内涵,总结了国内评估护士死亡态度常用的2个工具,描述了急诊、重症监护病房、肿瘤科护士死亡态度现状,依据纽曼系统模式从个体内、人际间、个体外3个方面归纳护士死亡态度的影响因素。旨在提高我国护士对死亡态度的认识与关注度,为构建基于纽曼系统模式下护士死亡态度干预方案提供参考。

临终患者死亡准备度的研究进展

由于文化禁忌和患者医疗决策权家庭化等因素的影响,我国临终患者死亡准备度处于较低水平。该文从临终患者死亡准备度的概念内涵、评估工具、影响因素、干预措施等方面进行综述,以期为提高患者死亡质量、减轻家属照顾负担、实现优逝提供理论指导和实践参考。

The Maternal Deaths at the Obstetrics and Gynaecology Department of the Ignace Deen National Hospital, University Teaching Hospital (CHU) Conakry, Guinea

Objectives: 1) To calculate the ratio of maternal mortality. 2) To describe the socio-demographic characteristics of deceased patients. 3) To identify the main causes of maternal deaths. Methodology: This was a retrospective study of the 12-month period from January 1st to December 31st, 2015 performed at the Gynaecology Obstetrics Department of the Ignace Deen National Hospital, Conakry, Guinea. The study included women who died during pregnancy, childbirth, and in its peripheries according to WHO’s maternal death report. Results: We collected 38 cases of maternal deaths out of 4404 live births, accounting a ratio of 863 per 100,000 live births. The socio-demographic characteristics of these 38 patients were: 20 - 24 years of age (26%), married (78%), housewives (37%), students (44%), and nulliparous (29%), no prenatal follow-up (47%), and home-birth (49%). The 1st and 3rd type of delay amounted for 40% and 53%, respectively. Patients consulted after 12 hours after symptom-onsets accounted 47%, whereas those before 6 hours accounted for 19%, suggesting the delay of first medication. The final diagnosis and diagnosis at admission coincided in 69% of cases. The emergency kit was available for all. The opinion of a specialist was available in 16 patients. Blood was available in 40% of the patients who required it. Death caused by conditions directly related to pregnancy/delivery accounted for 71%. Haemorrhage was the most frequent cause of death. Death occurred within the first 24 hours of admission in 73% of cases. Conclusion: We here shed light on the maternal death in this area. Although we did not demonstrate the method/procedure to reduce this high rate of maternal mortality, the present study may provide a fundamental data to reduce maternal death in this area.

Causes of Maternal Mortality According to Reports of Maternal Death Audits in the University Teaching Hospital Bogodogo (UTH-B) from January to December 2017

Objective: To study causes of maternal mortality according to reports of maternal death audits in the University Teaching Hospital Bogodogo (UTH-B) of Ouagadougou, Burkina Faso. Materials and Method: This was a prospective study that took place over a year from 1 January to 31 December 2017.? It concerned maternal deaths that occurred during this period in the obstetrics and gynecology department of the University Teaching Hospital Bogodogo (UTH-B). All maternal deaths were systematically audited by the audit committee;interviews with providers and families were sometimes conducted. The record books of all patients were analyzed by the audit committee;if necessary, interviews were conducted with care providers and families. The main information collected were recorded on individual files, entered and analyzed using the software Epi-info 7. Result: During the study period, we recorded 32 maternal deaths i.e., 587 per 100,000 live births. Deceased women under age 20 were the most numerous, followed by women aged 20 to 24. The death occurred in most cases in the puerperium in 69.80% of cases. Complications of pregnancy were the most incriminated causes in maternal deaths. Bleeding was the leading cause, accounting for 34.3%. They are followed by hypertensive disorders of pregnancy (21.8%) and infections (18.8%). In the contributing factors, resource factors were incriminated in 56.2% of cases, social factors in 43.7% of cases and medical factors in 25.4% of cases. Death was non-preventable in 76.2% of cases compared to 23.8% of preventable deaths. Conclusion: Maternal mortality is a major public health problem at the maternity hospital of the university hospital Yalgado Ouedraogo. Hemorrhage is the first cause of death. Hypertensive diseases are more and more worrying. Solutions must be found to improve the practice of audits in the obstetrics and gynecology department of UTH-B.

我国临床护士死亡教育研究的范围综述

目的:对我国临床护士死亡教育的相关研究进行范围综述,为我国面向临床护士开展死亡教育的研究与实践提供参考依据。方法:按照范围综述的研究方法,系统检索相关中英文数据库,由2名研究者根据纳入、排除标准完成文献筛选和提取,采用描述性分析及主题分析法对提取结果进行整理。结果:共检索到1678篇文献,最终纳入19篇文献。研究以横断面研究和类实验研究为主,主要发现包括死亡教育需求、死亡教育内容、死亡教育开展方式等。结论:目前,我国临床护士死亡教育尚处于实践探索阶段,未来应借鉴国外研究成果和经验,进一步重视死亡教育内容的实用性、丰富死亡教育开展方式、完善死亡教育研究工具等,推动我国临床护士死亡教育的持续发展。

髋部骨折患者术后30天死亡风险预测模型的范围综述

目的对髋部骨折患者术后30 d死亡风险预测模型进行范围综述,为临床护理实践及研究提供借鉴。方法聚焦髋部骨折患者术后30 d死亡风险预测模型,系统检索PubMed、Embase、Web of Science、中国知网、万方数据库、中国生物医学文献数据库及维普中文期刊服务平台等,筛选相关中英文文献,提取数据。结果共纳入21篇文献,髋部骨折患者术后30 d死亡率高达4.73%~33.76%,模型的总体预测效能良好,但整体偏倚风险较高。结论髋部骨折患者术后30 d死亡风险预测模型研究处于发展阶段,未来以期开发和/或验证低偏倚风险和高适应性的预测模型,指导临床实践。

针刺调节神经元程序性细胞死亡的机制研究进展

神经系统疾病的发生和发展过程中常伴随着异常的神经元程序性细胞死亡。针刺作为神经系统疾病的常用防治手段,其调控失衡的神经元程序性细胞死亡的作用值得深入探讨。针刺主要可通过调控神经元凋亡、焦亡、自噬、铁死亡来治疗脑缺血、脑出血、颅脑外伤、脊髓损伤、阿尔茨海默病等疾病。故本文就针刺之于神经元程序性细胞死亡的作用机制进行综述,以期挖掘针刺在多种神经系统疾病治疗过程中的共同生物学机制,为深入开展相关研究提供新思路。

纤维肌性发育不良的研究现状及法医学意义

纤维肌性发育不良(fibromuscular dysplasia,FMD)是累及全身中小动脉的原发性、节段性、非动脉粥样硬化性、非炎症性动脉壁肌层疾病,以女性多见。FMD的病因及发病机制仍未完全明确,目前多认为可能是遗传(基因变异)和环境因素(激素、炎症以及血管机械刺激等)共同作用的结果。FMD分为内膜型、中膜型、外膜型及混合型。中膜型FMD最常见,占80%~90%,主要表现为动脉壁中膜平滑肌细胞发生成纤维细胞样转化,细胞和细胞外基质增生并排列紊乱,致使动脉扭曲、管壁厚薄不均,管腔不同程度狭窄。FMD累及冠状动脉、颅颈动脉可引发心源性猝死或颅内缺血性、出血性病变。本文综述FMD的研究进展,以期提高法医工作者对FMD的认识,为法医学精准死亡原因推断提供参考依据。

铁死亡在肿瘤免疫中的作用研究进展

铁死亡(ferroptosis)是由亚铁离子和脂质过氧化物过量堆积所导致的新型细胞死亡模式,能够以自噬依赖的方式释放损伤相关分子模式,作为免疫原性细胞死亡的佐剂,激活适应性免疫和固有免疫。肿瘤细胞和免疫细胞铁死亡受多种因素的调控且相互影响,对肿瘤的发展、治疗和预后起着重要作用。文中总结了肿瘤微环境中,T细胞、巨噬细胞、中性粒细胞、 B细胞等免疫细胞与肿瘤细胞铁死亡之间的相关生物学效应。

m6A甲基化修饰非编码RNA调控病理性心脏重塑的作用

背景:m6A甲基化修饰非编码RNA是病理性心脏重塑形成机制的研究热点,在心血管疾病的发生发展中起着重要作用。目的:总结m6A甲基化修饰非编码RNA对调控病理性心肌肥大、心肌细胞死亡、心肌纤维化与血管重塑等病理性心脏重塑主要过程的可能作用机制。方法:以“m6A甲基化修饰,非编码RNA,病理性心肌肥大,心肌细胞凋亡,心肌细胞焦亡,心肌细胞铁死亡,心肌纤维化,血管重塑”为中文主题词,以“m6A、non-coding RNA,pathological cardiac hypertrophy,cardiomyocyte apoptosis,cardiomyocyte pyroptosis,cardiomyocyte ferroptosis,myocardial fibrosis,vascular remodeling”为英文主题词,检索中国知网、PubMed、Web of Science数据库1974年1月至2023年4月发表的相关文献,对符合筛选标准的86篇文献进行综述。结果与结论:①m6A甲基化修饰是一种动态可逆的表观遗传修饰方式;②病理性心脏重塑主要包括病理性心肌肥大、心肌细胞死亡、心肌纤维化、血管重塑,m6A相关酶可调控病理性心脏重塑相关进程;③m6A甲基化修饰相关酶可通过多种非编码RNA与不同信号通路参与调控病理性心脏重塑过程,可作为心血管疾病新的潜在干预方式;④在病理性心脏重塑中,m6A甲基化修饰与非编码RNA之间的调控关系仍处于起步阶段,随着表观遗传学的发展,m6A甲基化修饰非编码RNA来调控病理性心脏重塑有望有新的发展。

假体周围骨溶解中的新型细胞程序性死亡

背景:最近的研究发现,在假体周围骨溶解中还发现了除凋亡外的新型细胞程序性死亡途径,参与了局部慢性炎症的调节以及成骨细胞和破骨细胞病理条件下的转归,对假体周围骨溶解的治疗和预后有着重要价值。目的:通过总结有关新型细胞程序性死亡的研究,为防治假体周围骨质溶解提供新的思路和策略。方法:由第一作者应用计算机检索2005-2022年出版的文献,以“磨损颗粒,假体周围骨溶解,细胞程序性死亡,凋亡,自噬,焦亡,坏死性凋亡,铁死亡”等为中文检索词检索中国知网、万方和维普数据库;以“osteolysis,wear debris,wear particles,peri*prosthetic osteolysis,PPOL,aseptic loosening,autophagy,regulated cell death,programmed cell death,apoptosis,pyroptosis,autophagic cell death,autophagy,necroptosis,ferroptosis”等为英文检索词检索PubMed和Web of Science数据库,按照入选标准最终共纳入68篇文章。结果与结论:①自噬不足或过度激活都将引起细胞死亡,抑制成骨功能并促进破骨功能,引起骨代谢紊乱和骨溶解;②焦亡在假体周围骨溶解中的研究近年来备受关注,NOD样受体蛋白3炎性小体在局部炎症中扮演着重要角色,抑制焦亡可有效缓解骨溶解;③坏死性凋亡在体外已被证明可以抑制成骨细胞和破骨细胞的形成和功能,从而影响骨吸收和骨破坏过程;④铁死亡作为一种最新发现的细胞程序性死亡方式,受到复杂的信号通路和机制调控,目前尚未完全阐明;⑤自噬、焦亡、坏死性凋亡及铁死亡在假体周围骨溶解的发生发展中具有重要作用,其相关信号通路、基因等仍需要更深入的研究。

成骨细胞调节性细胞死亡在牙周病中的作用研究进展

牙周病是以牙槽骨渐进性破坏为特征的慢性炎症性疾病。牙槽骨破坏最关键的机制是骨稳态失衡,而成骨细胞介导的骨基质合成在骨稳态调节中发挥重要作用。在炎性微环境和骨稳态调控中调节性细胞死亡举足轻重。慢性炎症、氧化应激等因素可直接参与线粒体、死亡受体介导的信号通路,调节B细胞淋巴瘤蛋白2家族和胱天蛋白酶(caspase)的活性,调节成骨细胞凋亡,从而影响牙槽骨稳态;慢性炎症与细胞损伤可经由RIPK1/RIPK3/MLKL信号通路诱发成骨细胞坏死性凋亡,从而加剧炎症反应并加速牙槽骨破坏;病原微生物、细胞损伤等刺激可通过caspase-1依赖或非依赖性信号通路及GSDMD家族蛋白活化,促进成骨细胞焦亡,并释放促炎性细胞因子,介导牙槽骨破坏;牙周病中铁过载和脂质过氧化可诱发成骨细胞铁死亡,影响成骨细胞的存活和功能,从而导致骨稳态失衡。本文围绕牙周病通过调节性细胞死亡影响骨稳态的机制,以期探讨调控牙周病患者牙槽骨稳态失衡的对策。

终末期患者死亡质量的研究进展

恶性肿瘤、ICU、急诊科终末期患者及家属对死亡质量的需求不尽相同,改善终末期癌症患者死亡质量已成为临床上需要迫切解决的问题。该文系统综述了终末期患者死亡质量的研究现状和进展,强调了疼痛管理、心理社会支持、患者家属参与等方面的重要性。

不稳定冠状动脉粥样斑块病理特征及分类

冠状动脉粥样硬化性心脏病猝死的法医学重要诊断指标如急性或慢性心肌缺血改变,有时由于死亡过程短暂、组织缺少反应时间,使得缺血部位定位困难,部分案件中死者首次发病即猝死,导致法医难以准确作出诊断。然而临床医学对于冠状动脉不稳定斑块的研究揭示了其病变引发的冠状动脉痉挛、血栓形成在冠心病猝死过程中所起的关键作用。本文主要归纳整理了基于临床医学研究的不稳定冠状动脉粥样斑块的病理特征,包括斑块破裂、斑块侵蚀和钙化结节,以及导致斑块不稳定的影响因素,并简述粥样斑块研究进展与研究技术方法,以期通过诊断冠状动脉粥样斑块的不同病理状态,完善冠心病猝死死亡机制研究,提高冠心病猝死法医学诊断的准确性。

老年人优逝期望与需求研究进展

主要对优逝的概念及内涵、国内外老年人优逝期望与需求研究现状、影响因素和实现优逝的途径和方法进行综述,指出未来应当进行更多的质性研究,探讨老年人优逝期望与需求的群体差异性,提高我国老年人终末期死亡质量。

急性缺血性心脏病猝死法医学诊断研究进展

急性缺血性心脏病猝死死因诊断是法医学鉴定工作中的重点、难点。本文就国内外急性缺血性心脏病猝死法医学诊断研究现状及存在问题进行综述,探索急性缺血性心脏病猝死死因鉴定的未来可行方案,为相关研究提供新思路。