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Adnan I. Qureshi, Malik M. Adil, Negin Shafizadeh and Shahram Majidi

Object

Despite the recognition of racial or ethnic differences in preterm gestation, such differences in the rate of intraventricular hemorrhage (IVH), frequently associated with preterm gestation, are not well studied. The authors performed the current study to identify racial or ethnic differences in the incidence of IVH-related mortality within the national population of the US.

Methods

Using the ICD-10 codes P52.0, P52.1, P52.2, P52.3, and P10.2 and the Multiple Cause of Death data from 2000 to 2009, the authors identified all IVH-related mortalities that occurred in neonates and infants aged less than 1 year. The live births for whites and African Americans from the census for 2000–2009 were used to derive the incidence of IVH-related mortality for whites and African Americans per 100,000 live births. The IVH rate ratio (RR, 95% confidence interval [CI]) and annual percent change (APC) in the incidence rates from 2000 to 2009 were also calculated.

Results

A total of 3249 IVH-related mortality cases were reported from 2000 to 2009. The incidence rates of IVH were higher among African American infants (16 per 100,000 live births) than among whites (7.8 per 100,000 live births). African American infants had a 2-fold higher risk of IVH-related mortality compared with whites (RR 2.0, 95% CI 1.2–3.2). The rate of increase over the last 10 years was less in African American infants (APC 1.6%) than in white infants (APC 4.3%).

Conclusions

The rate of IVH-related mortality is 2-fold higher among African American than white neonates and infants. Further studies are required to understand the underlying reasons for this prominent disparity in one of the most significant causes of infant mortality.

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Kiersten Norby, Farhan Siddiq, Malik M. Adil and Stephen J. Haines

Object

The effects of sleep deprivation on performance have been well documented and have led to changes in duty hour regulation. New York State implemented stricter duty hours in 1989 after sleep deprivation among residents was thought to have contributed to a patient's death. The goal of this study was to determine if increased regulation of resident duty hours results in measurable changes in patient outcomes.

Methods

Using the Nationwide Inpatient Sample (NIS), patients undergoing neurosurgical procedures at hospitals with neurosurgery training programs were identified and screened for in-hospital complications, in-hospital procedures, discharge disposition, and in-hospital mortality. Comparisons in the above outcomes were made between New York hospitals and non–New York hospitals before and after the Accreditation Council for Graduate Medical Education (ACGME) regulations were put into effect in 2003.

Results

Analysis of discharge disposition demonstrated that 81.9% of patients in the New York group 2000–2002 were discharged to home compared with 84.1% in the non–New York group 2000–2002 (p = 0.6, adjusted multivariate analysis). In-hospital mortality did not significantly differ (p = 0.7). After the regulations were implemented, there was a nonsignificant decrease in patients discharged to home in the non–New York group: 84.1% of patients in the 2000–2002 group compared with 81.5% in the 2004–2006 group (p = 0.6). In-hospital mortality did not significantly change (p = 0.9). In New York there was no significant change in patient outcomes with the implementation of the regulations; 81.9% of patients in the 2000–2002 group were discharged to home compared with 78.0% in the 2004–2006 group (p = 0.3). In-hospital mortality did not significantly change (p = 0.4). After the regulations were in place, analysis of discharge disposition demonstrated that 81.5% of patients in the non–New York group 2004–2006 were discharged to home compared with 78.0% in the New York group 2004–2006 (p = 0.01). In-hospital mortality was not significantly different (p = 0.3).

Conclusions

Regulation of resident duty hours has not resulted in significant changes in outcomes among neurosurgical patients.