The Bereavement Support Program, as an annual event, sought to assist the individuals and families of the deceased patient in this difficult transition process.
DEATH

A systematic review in 2007 on truth-telling in discussing prognosis in terminally ill cases revealed that patients frequently have misunderstandings about their illness prognosis and goals of treatment as a result of poor disclosure practice. A common reason is the reluctance of physicians to communicate bad news, due in part to apprehension as to patient wishes on disclosure and its after-effects. Without proper disclosure, families cannot move towards appropriate decision making on end-of-life care. As physician lack of awareness to patients' desires is the rate-limiting step in communicating bad news, this study aimed to clarify if primary healthcare providers perception coincide with patients' general preferences on death and disclosure of poor prognosis. Comparison of primary health care perspectives and patient preferences were based on the following issues on death and disclosure of poor prognosis: acceptance of death as a natural part of the circle of life, desire to accept news of poor prognosis, preference as to the more appropriate person to deliver bad news, desire whether to be told of poor prognosis at the earliest possible time, desire to postpone the discussion of death, and views on maintaining hope in the face of poor prognosis. Methodology: A cross sectional study was done. The patient population were recruited from those who sought consult at the Family Medicine Clinic. Primary health care providers were represented by PGH residents from the FM and IM departments. One hundred four patients and 52 resident physicians based on the conservative estimate of 1:2 ratio of resident trainee to patients was the calculated sample size. A self-administered survey questionnaire was developed from extensive literature review of various references on end-of-life care. Content validation was done through review of the questionnaire items by an expert panel. Descriptive statistical analysis was done. Coefficient of variation was used to compare patient and primary healthcare provider perceptions. Association of preferences to socio-demographic variables was measured using chi-square test. Results: A total of 200 patients and 73 primary healthcare physicians were included in the study. Mean age was 46 for patients and 29 for primary health care physicians. Majority of the respondents in both groups were female and of the Catholic faith. Most of the patient respondents were married whereas majority of the physicians were single. Highest educational attainment of the patients is mainly high school. Physician respondents were 37 FM residents and 35 IM residents almost equally distributed by year level. Comparison of patient and primary healthcare provider perspectives revealed significantly different results for accepting death as a natural part of the circle of life and perception that disclosure will destroy hope. This means that the respondents answers to these 2 questions were varied. As opposed to the similar computed values for patients prefer disclosure from a doctor and patients prefer to postpone discussion of death. Association of patient preference to socio-demographic profile is statistically significant for age, gender and educational attainment. Results show that older patients prefer family members to disclose poor prognosis. Male patients do not want to know that they are terminally-ill or dying and patients who only received elementary education do not want to know their prognosis and prefer to avoid discussion of death. Civil status and religion of primary healthcare providers affect their perception. Single physicians believe that patients do not want to know that they are dying, and are less likely to choose family members to deliver bad prognosis. Conclusion: The study showed that in PGH, primary healthcare providers, perceptions generally coincide with patient preferences, specifically with regards to patients' desire to accept news of poor prognosis, the more appropriate person to deliver bad news, and the desire for disclosure but with preference to postponing discussions of death as much as possible. Varied responses were seen in the question of death being a natural part of the circle of life, reflecting some issues on acceptance of death and dying among patients. Physicians had a diverse response to maintaining hope in the face of poor prognosis, contrary to the almost homogenous patient response that disclosure will not destroy hope. Based on socioodemographic factors: Older patients prefer family members or loved ones to disclose poor prognosis. Male patients prefer not to know that they are terminally-ill or dying. Those who only received elementary education do not want disclosure of poor prognosis and are more likely to postpone discussions of death. It is recommended that these results be kept in mind when disclosure of poor prognosis and death is warranted. The following are also recommended: to correct the misperception of physicians that disclosure of poor prognosis destroy patient hope and more in-depth investigation of the issues tackled, particularly, patient issues behind the acceptance of death as a natural part of the circle of life and the circumstances surrounding patient desire to accept disclosure of poor prognosis and at the soonest time yet wanting to postpone discussions of death as much as possible.
DEATH

No abstract available.
Death, Sudden*

No abstract available.
Fetal Death*

No abstract available.
Death, Sudden*

Researching 485 cases of death in two years (2002-2003) at Bavi district, the findings showed that: The crude death rate in the whole of district is 5.20%o in the year 2002 and 4.68%o in the year 2003. The death rate is higher in men than women (5.66%o) compared to 4.77%o and compared to 3.62%o). YPLL in the years of 2002-2003: The burden of mortality is higher in men than women (2002: men/women = 1.24/1; 2003: men/women: 2.6/1).The burden of mortality focused on groups of under 5, over 60 and 20-60 years old. The burden of mortality in group of school ages is lowest. By group of disease, YPLL is highest at external causes (death from drowning, injury, accident).
Death ; Epidemiology

No abstract available.
Fetal Death*

No abstract available.
Fetal Death*

Introduction: Cardiac-related diseases contributed approximately 50-60% of sudden natural death cases. This study aimed to describe the cardiac troponin T (cTnT) findings in post mortem subjects irrespective of the cause and manner of death, and the possible use of post mortem serum cTnT as a modality in investigating sudden natural death. Methods: The study samples comprised 140 subjects aged 18 to 50 years old, natural and unnatural causes of sudden death brought to the Department of Forensic Medicine, Hospital Sungai Buloh (HSgB) and Hospital Sultanah Aminah Johor Bahru (HSAJB) for a period of 12 months. The subjects were categorised into 5 groups: cardiovascular disease (CVD), sudden unexplained death (SUD), thoracic trauma (TT), non-thoracic trauma (NTT) and other diseases (OD). Results: Median troponin concentration in cases of CVD, SUD, TT, NTT, and OD were 0.51 µg/L, 0.17 µg/L, 0.62 µg/L, 0.90 µg/L and 0.51 µg/L respectively. We found no significant difference of troponin T level in different causes of death (p ≥ 0.05). NTT has the highest median troponin concentration with 0.90 µg/L, SUD possessed the lowest median concentration with 0.17 µg/L. Conclusion: Troponin T is neither specific nor useful as cardiac biomarker for post mortem sample. Therefore, it may not be a useful diagnostic tool at autopsy.
cardiac death

Both death certificates and postmortem examination certificates are used as proof of death. These certificates sometimes contain erroneous information but how frequently they do so is unknown. In particular, only a few studies have measured the accuracy of the cause and manner of death on Korea death documents. In this study, we compared the cause and manner of death on both kinds of certificates with those on autopsy reports to determine the frequency of errors, and to identify way to improve the accuracy of these certificates. In 2012, 528 autopsies were requested of out institute, and certificates were submitted in 241 of the cases. The manner of death was classified as natural, unnatural, or unknown. The cause of death in the autopsy report matched that on the death certificate in 37 of 63 cases (58.7%), and the manner of death matched in 40 of 63 cases (63.5%). The cause of death in the autopsy report matched that on the postmortem examination certificate in 62 of 178 cases (34.8%), and the manner of death matched in 74 of 178 cases (41.6%). Death certificates and postmortem examination certificates are important documents. We identified many incorrect reports of causes and manners of death on both kinds of documents, especially the postmortem death certificates. These inaccuracies are presumably due to a lack of forensic information and education, as well as lack of interest on the part of medical doctors.
Autopsy* ; Cause of Death ; Death Certificates* ; Education ; Korea