Latest news with #mortality
Medscape
an hour ago
- Health
- Medscape
Oseltamivir Decreases Hospital Mortality Risk of Influenza
Treating patients with severe influenza with oseltamivir in the first 2 days after hospital admission was associated with a lower in-hospital mortality risk, earlier discharge, and lower readmission rate compared with supportive care, new data indicated. The additional evidence supports current guideline recommendations to treat all people hospitalized with influenza with an antiviral agent, regardless of how long they have been ill. The study, led by Anthony D. Bai, MD, assistant professor of infectious diseases at Queen's University in Kingston, Ontario, was published on June 10 in JAMA Network Open. Reduced Mortality Risk Each year, influenza causes 12,200 hospitalizations and 3500 deaths in Canada. It causes between 140,000 and 810,000 hospitalizations and 12,000 to 61,000 deaths in the United States. And despite guidelines in both countries that recommend treatment for all entering the hospital with influenza, clinical practice varies widely, Bai told Medscape Medical News . The researchers' study found that in Ontario, 30% of clinicians were not treating this population with oseltamivir. Researchers examined data from the General Medicine Inpatient Initiative database, which includes internal medicine and intensive care unit (ICU) patients admitted to participating hospitals in Ontario. Data included demographics, diagnoses, interventions, discharge, readmission, medication orders, and bloodwork results. The cohort study included 11,073 patients (average age, 72.6 years). Researchers found an adjusted risk reduction of 1.8% for in-hospital mortality when oseltamivir was given, compared with supportive care median length of stay was 4.4 days and 4.9 days in the oseltamivir and supportive care groups, respectively. After discharge, 645 patients (8.5%) in the oseltamivir group and 336 patients (9.8%) in the supportive care group were readmitted, with an adjusted risk difference of -1.5%. 'Some clinicians believe there won't be much benefit to treatment with oseltamivir,' said Bai, likely because of the dearth of evidence supporting the guidelines. 'There's been a lot of controversy about the benefit of oseltamivir in the outpatient population, where a recent meta-analysis showed it didn't really prevent hospitalizations. But there is a signal that it decreased in-hospital mortality. If a similar benefit is proven in a future randomized, controlled trial, it would add a lot of convincing evidence that there's a significant benefit to oseltamivir treatment.' The expanded version of the large RECOVERY randomized, controlled trial in the United Kingdom looks at that question, he noted. But until results are available, 'we should go by the current guideline recommendations.' Remaining Questions Wendy Sligl, MD, professor of critical care medicine and infectious diseases at the University of Alberta in Edmonton, told Medscape Medical News that the 1.8% in-hospital mortality reduction may seem small. 'Keep in mind, this is in all hospitalized patients, which includes a spectrum of disease severity from those not needing supplemental oxygen to those on a ventilator.' She pointed out that less than 10% of the patients in this study were admitted to the ICU. The number needed to treat is an important consideration with these results, she pointed out. 'Given this mortality reduction, you would need to treat approximately 55 patients to prevent one death. When the outcome is as devastating as death, and the drug is relatively safe and inexpensive, treatment seems reasonable, given even a small reduction in mortality.' Sligl also noted the need for high-quality evidence from randomized, controlled trials, including RECOVERY, in hospitalized patients with influenza. 'In addition, the most severe patients, those in the ICU with respiratory failure requiring high-flow oxygen or mechanical ventilation, should be specifically studied.' Beyond whether antiviral therapy is beneficial, she said, other questions remain, such as which antiviral is best and at what dose and duration. Other questions include whether an antiviral therapy should be used alone or in combination with another antiviral therapy and at what time in which patients. 'The best quality data we have for the treatment of influenza are in healthy outpatients, where treatment has been shown to reduce symptom severity and duration. Data for antiviral use in hospitalized patients with influenza are largely observational, suggesting a small mortality benefit with treatment,' Sligl explained. In the current study, she noted, 'target trial emulation with propensity scoring helped to minimize bias, which is a methodologic strength.' No funding source for this study was reported. Bai and Sligl reported having no relevant financial relationships.
The Independent
3 hours ago
- Health
- The Independent
The simple test that could predict how long you will live
A new study published in the European Journal of Preventive Cardiology explored whether a simple sitting-rising test could predict premature deaths. Researchers tested 4,282 adults aged 46-75 in Rio de Janeiro, Brazil, from 1998 to 2023, to evaluate non-aerobic physical fitness, including muscle strength, flexibility, and balance. The test required participants to sit and rise from the floor without using support from hands, elbows, or knees, with points deducted for any assistance or loss of balance. The study concluded that non-aerobic physical fitness, as assessed by this test, was a significant predictor of natural and cardiovascular mortality. After about 12 years, participants with a perfect 10 score had a 3.7 per cent death rate, while those scoring 0-4 points showed a dramatically higher death rate of 42.1 per cent.
The Independent
12 hours ago
- Health
- The Independent
How long will you live? This exercise test may have the answer
A new study has shown how a simple exercise could predict natural and cardiovascular causes of death. Researchers wanted to see whether non-aerobic physical fitness, assessed by a sitting-rising test, could predict premature deaths in middle-aged and older people, and on Wednesday, their results were published in the European Journal of Preventive Cardiology. They tested the theory on 4,282 adults aged 46-75 years from 1998 to 2023. Most of the participants, 68 percent, were men. 'None of them presented relevant physical or clinical limitations for fitness testing,' researchers said. All of the participants performed a sitting-rising test to evaluate the main components of non-aerobic physical fitness, which are muscle strength/power, flexibility, balance and body composition. The test was simple, yet not necessarily easy. Participants had to sit and rise from the floor without other body parts such as hands, elbows or knees touching the floor. Their instructions were as follows: ''Without worrying about the speed of movement, try to sit and then rise from the floor, using the minimum support that you believe is needed,'' the study's authors wrote. If participants used any extremities for support, they'd lose points. They also needed to steady themselves as a perceived partial loss of balance would knock down their score. Researchers found that non-aerobic physical fitness 'was a significant predictor' of natural and cardiovascular mortality in the participants. After following up with patients about 12 years later, researchers found there were 665 deaths due to natural causes. Those who scored a perfect 10 points on the sitting-rising test had death rates of 3.7 percent. Death rates tripled to 11.1 percent for people with a score of 8 points and 'dramatically increased' by 42.1 percent for those with a score of 0 to 4 points, according to researchers. The study was done at a private clinic in Rio de Janeiro, Brazil, and most of the participants 'belonged to upper socioeconomic and education strata of the country.'
Medscape
a day ago
- Health
- Medscape
Azithromycin Tops Doxycycline in Reducing Pneumonia Deaths
Among hospitalized patients with community-acquired pneumonia, those treated with azithromycin plus beta-lactams had lower in-hospital mortality and mortality rates at 30 and 90 days post-admission than those receiving doxycycline plus beta-lactams. METHODOLOGY: Researchers conducted a retrospective matched cohort study to compare mortality outcomes between patients hospitalized with community-acquired pneumonia treated with azithromycin and those treated with doxycycline, each in combination with beta-lactams. They enrolled 8492 patients (median age, 73 years; 54.3% men) who received azithromycin or doxycycline for at least 48 hours. Patients treated with doxycycline (n = 2671) were matched 1:1 with patients treated with azithromycin based on specific comorbidities, recent immunosuppressant use, and the pneumonia severity index. The primary outcome was mortality, assessed at hospital discharge and at 30 and 90 days post-admission; the secondary outcome was the number of hospital-free days within 28 days of admission. TAKEAWAY: The in-hospital mortality rates were significantly lower in the azithromycin group than in the doxycycline group (odds ratio, 0.71; P = .005). = .005). Treatment with azithromycin was associated with reduced 30-day mortality (hazard ratio [HR], 0.85; P = .041) and 90-day mortality (HR, 0.83; P = .005) compared with treatment with doxycycline. = .041) and 90-day mortality (HR, 0.83; = .005) compared with treatment with doxycycline. Patients receiving azithromycin had significantly more hospital-free days than those receiving doxycycline (adjusted estimate, 1.37; P < .001). < .001). Among patients who did not require ICU admission within 24 hours of hospitalization, azithromycin improved 90-day survival compared with doxycycline (adjusted HR, 0.85; P = .007). IN PRACTICE: 'Given that we found a difference in clinical outcomes between azithromycin vs doxycycline with beta-lactam therapy, our observational study suggests a potential benefit with using azithromycin for CAP [community-acquired pneumonia] treatment in contrast to the limited evidence available,' the authors wrote. SOURCE: This study was led by Yewande Odeyemi, MBBS, MS, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota. It was published online on May 16, 2025, in Clinical Infectious Diseases . LIMITATIONS: This study did not investigate the possible effects of specific beta-lactam antibiotics. It also did not assess the specific causes of community-acquired pneumonia, preventing the evaluation of the appropriateness of antibiotic treatments or the impact of atypical organisms. Additionally, other therapies or interventions were not considered, and outcomes were restricted to all-cause mortality. DISCLOSURES: This study did not receive any funding. One author reported receiving grant support from the National Institutes of Health. Another author reported receiving consulting fees from Wolters Kluwer and support for a speaking engagement from the American Society of Nephrology. The other authors reported having no conflicts of interest.
Daily Mail
2 days ago
- Entertainment
- Daily Mail
Ruby Wax, 71, tells Paloma Faith she's going to become a death doula - as star opens up on mortality and the tragic death of her good friend Alan Rickman
Ruby Wax revealed she's taking a course in order to become a death doula during an appearance on Paloma Faith's Mad Sad Bad podcast. The American comic, 71, has been candid about preparing for death in recent years, even admitting that the prospect of dying is her 'biggest fear'. 'I think about death at least four times a day and hundreds of times around my birthdays,' she wrote a few years ago in Huffpost. 'At New Year's Eve I'm already writing my epitaph. While everyone around me is popping balloons, I'm thinking I'm one year closer to the end.' Ruby has now opened up on mortality once again, making the revelation that she's planning on becoming a death doula. An end of life doula - or a death doula - is a 'compassionate, trained companion who supports individuals with terminal diagnosis and those close to them'. Offering practical and emotional support, many aspiring doulas undergo rigorous training in order to carry out their duties successfully. Ruby is planning on beginning her training in September. She told Paloma, 43, on the Brit singer's podcast this week: 'When was I last sad? Well I think there's a level of sadness all the time because I'm really aware we're going to die.' Paloma asked: 'Because the world's going to end or because we're mortal?', to which the 71-year-old quipped: 'Because I'm mortal. 'I think about it all the time. In September I've made a reservation - I'm going to become a death doula. 'Yeah, I'm going on a course. First of all, I'm interested in who else is going to be on my course, you know. So, I do a week (of the course) in September.' Over the years the comedian has been very open about both the prospect of death and her struggles with mental health. Ruby has battled depression, and in 2022 admitted that her mental illness had become 'so severe that it's hard to stay alive'. But speaking to Paloma, the 71-year-old affirmed that she's 'numb' and hasn't cried in years. 'I'm an example of numbness,' she said: 'I don't feel anything. 'I don't cry, you can never make me cry. But also I don't throw my head back screaming with laughter. Well, sometimes it cuts through and if someone that I knew died it would probably cut through.' Paloma then asked the American when the last time she cried was, to which she replied: 'When Alan Rickman died (in 2016). 'I thought he had a heart problem, so I was telling people to get him a heart specialist. But his partner said, "No, he's dying". 'And when I heard that I burst, I ran in there and I threw myself on him. I was like an animal, it was wild. 'Another time when my son was leaving for school (University) I turned into a howling animal. I was on all fours howling and he was only going to Southampton, because I knew metaphorically he was gone. I feel like everything's goodbye.' Reflecting on her friendship with Alan Rickman - who played Severus Snape in Harry Potter and died of cancer in 2016 - Ruby remembered the advice he gave her. 'When I used to do comedy and I was trying to please, he used to say "Pull it back. Make people come to you". 'It took a long time but now after 30 years I don't look like I'm hungry on stage. I do have an ego though and I want to be liked by large groups of people.' Indeed, in an exclusive interview with MailOnline in 2021, Ruby actually credited her good friend Alan with 'turning her into a comedian'. She said: 'He was hilarious. He was my mentor and he taught me how to do comedy. I would say he saved me. 'He took a c*** actress and then turned her into a comedian against all odds. He was my protector'. Alan died in January 2016 after battling pancreatic cancer in private. Ruby was only made aware of his illness two weeks before his death. The comedian paid tribute to him, saying: 'All of his friends would say he was the most generous man. I mean, I meet kids now and they say "Alan sent me to drama school and I never even met him". He took a lot of people under his wing - that's real generosity.' Following Alan's death, Ruby has been a vocal advocate and fundraiser for Pancreatic Cancer UK.
