scholarly journals Clinical characteristics and radiological domains among patients with recurrent strokes-a descriptive cross-sectional study from a tertiary care center in central Nepal

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 757
Author(s):  
Binod Bhattarai ◽  
Shashi Bhushan Sah
Keyword(s):  
Multivariate Analysis ◽  
Tertiary Care ◽  
Area Under The Curve ◽  
Medical Advice ◽  
Receiver Operating Curve ◽  
Motor Score ◽  
Against Medical Advice ◽  
Decision To Leave ◽  
Recurrent Strokes ◽  
Receiver Operating

Background: Stroke is a significant global health hazard that ripples continuum multi-spectral effects to the patients as well their caretakers.   Methods: We studied 28 consecutive cohorts of patients with recurrent strokes managed in our centre within the last two years.  Results: The most common recurrence stroke pattern was of that of hemorrhagic to hemorrhagic subtype observed in 50% of the patients. The most common anatomical region of involvement was cortical – cortical seen in 39.28% of our cohorts. The surgical intervention was required in 17.85% whereas 42.85% of them were managed conservatively. Paradoxically, 39.28% of patients left against medical advice. The receiver operating curve (ROC) predicting mode of management was highest (area under the curve (AUC) =0.635) for compliance to therapy followed by stroke territory (AUC=0.578), age (AUC=0.457) and motor grading (AUC=0.374). The receiver operating curve (ROC) for influencing decision to leave against medical advice was highest (area under the curve (AUC) =0.861) for motor score followed by sex (AUC=0.701) and age (AUC=0.564). The analysis of variance (ANOVA) study pertaining to the mode of management was significantly connoted by the motor score and the stroke territory only. The ANOVA study pertaining to the decision to leave against medical advice was significantly governed by the motor score, stroke territory, and sex respectively. The multivariate analysis for variables governing mode of management was significant for motor score and the stroke territory only. The multivariate analysis for variables governing leave against medical advice was significant for sex, motor score and the stroke territory.  Conclusions: This study aims to appraise early dichotomization of high-risk patients for recurrent strokes to reduce the continuum of neurological events as well as to mitigate the financial aspects governing stroke care.

Psychiatric Management of Patients Who Threaten to Sign out against Medical Advice

1974 ◽  
Vol 5 (2) ◽  
pp. 153-160 ◽  
Author(s):  
Thomas N. Wise
Keyword(s):  
Medical Advice ◽  
Hospital Environment ◽  
Loss Of Control ◽  
Against Medical Advice ◽  
Difficult Situation ◽  
Decision To Leave ◽  
Case Examples ◽  
Effective Evaluation ◽  
Distorted Communication ◽  
Seriously Ill

Patients who are seriously ill are often unable to tolerate the stress of hospitalization and threaten to sign out against medical advice. Such a crisis often evolves because of inadequate or distorted communication with persons in the hospital environment such as physician and other patients. Physical illness, which stirs up issues of autonomy or loss of control, can compromise an individual's ability to cope. The patient, fearing loss of control, can utilize denial in his decision to leave the hospital prematurely. By exploring these factors, the psychiatric consultant can effectively evaluate and then manage this difficult situation, from his own position in the small group comprised of patient, staff and consultant. Case examples illustrate effective evaluation and management of the patient who threatens to sign out against medical advice.

scholarly journals Leaving Against Medical Advice From In-patients Departments Rate, Reasons and Predicting Risk Factors for Re-visiting Hospital Retrospective Cohort From a Tertiary Care Hospital

2019 ◽  
Vol 8 (8) ◽  
pp. 474-479 ◽  
Author(s):  
Obada Hasan ◽  
Muhammad Adeel Samad ◽  
Hamza Khan ◽  
Maryam Sarfraz ◽  
Shahryar Noordin ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Medical Advice ◽  
Outcome Variable ◽  
Care Hospital ◽  
Forward Selection ◽  
Against Medical Advice ◽  
Logistic Regression Models ◽  
Hospital Patients

Background: Approximately 1% to 2% of hospitalized patients get discharged or leave from the hospital against medical advice and up to 26% in some centers. They have higher readmission rate and risk of complications than patients who receive complete care. In this study we aimed to determine the rate of leave against medical advice (LAMA) and reasons for the same across different in-patient departments of a tertiary care hospital. Methods: Retrospective cohort study on patients admitted in all departments at our institute over a 1-year period. All patients who were admitted to an in-patient ward at the hospital and who left against medical advice by submitting a duly filled LAMA form were included. Univariate and multivariate logistic regression models with forward selection methods were employed. Revisit to hospital within 30 days; to clinic or emergency department was outcome variable for regression. Results: From June 2015 to May 2016 there were 429 LAMA patients, accounting for 0.7% of total admissions. Females were 223 (52%) compared to males 206 (48%). Finances were quoted as the most common reason for LAMA by 174 (41%) patients followed by domestic problems 78 (18%). Internal medicine was the service with the highest number of LAMA patients ie, 153 (36%) followed by Pediatric medicine with 73 (17%). Of the 429 patients, 147 (34%) patients revisited the hospital within 30 days. Sixty-one percent of these ‘bounced-back’ LAMA patients had worsening or persistence of same problem, or new problem/s had developed. In unadjusted bivariate logistic model, patients who were advised for follow-up during discharge against medical advice were four times more likely to revisit the hospital. Patients who were married had an increased odd of revisiting the hospital. Conclusion: Financial reasons are the most common stated reasons to LAMA. Patients who LAMA are at a high risk of clinical worsening and ‘bouncing back.’ This is the first study from our region on in-patient LAMA rates, to our knowledge. The results can be used for planning measures to reduce LAMA rates and its consequences.

scholarly journals Cases of Left Against Medical Advice from the Emergency Department of a Tertiary Care Hospital in Kathmandu: A Descriptive Cross-Sectional Study

2020 ◽  
Vol 58 (232) ◽  
Author(s):  
Manish Nath Pant ◽  
Saswat Kumar Jha ◽  
Sauravi Shrestha
Keyword(s):  
Emergency Department ◽  
Informed Consent ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Medical Advice ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Against Medical Advice

Introduction: Left against medical advice is a worldwide phenomenon. Patients leaving against Left against medical advice do not provide the health professionals with legal impunity. A well-informed consent should be present with surety that they are well understood by the patient before they leave. The study was undertaken to study the prevalence of patients that leave against medical advice. Methods: This is a descriptive cross-sectional study done in the emergency department of a tertiary care hospital from 1st February 2020 to 31 July 2020. Ethical approval was taken from the Institutional Review Committee (ref. no. 130120205). The sample size was calculated and the convenient sampling method was used. Data were analyzed in the Statistical Package of the Social Sciences version 22. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 5834 visits, 332 (5.96%) (4.70-7.22 at 95% Confidence Interval) patients left against medical advice. The mean age was 36.48 years (3 days-91 years) and males 173 (52.3%) were prone to leave than females. Only 50 (15.1%) cases had well-informed consent with complications documented. Hundred (30.5%) patients had wanted to come on follow up the next day in the out-patient department while 41 (12.4%) had to leave because of financial reasons. Only seven (2.9%) of well-oriented patients gave their consent and the remaining 233 (97.1%) were by the kin present. Only 76 (23%) patients were sent home with a well-documented medicine prescription. Conclusions: The proportion of patients who left against medical advice was more than the studies done in a similar setting.

scholarly journals Assessment of severity of illness on admission using SICK score and evaluation of the risk factors associated with mortality in children admitted in a paediatric urban tertiary care centre in south India

2021 ◽  
Vol 8 (4) ◽  
pp. 636
Author(s):  
N. Rajeshwari ◽  
A. Savitha ◽  
J. Prahada
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Assisted Ventilation ◽  
Receiver Operating Curve ◽  
Multivariate Logistic Regression Model ◽  
Operating Characteristics ◽  
Multivariate Logistic Regression ◽  
Receiver Operating

Background: “Signs of inflammation that can kill” (SICK) score is one of the severities scoring systems used for predicting outcome of children at admission. The aim of the present study was to study the clinical and demographic profile of children admitted to Paediatric ward, to assess the usefulness of SICK score in predicting the mortality and evaluate the risk factors in predicting mortality.  Methods: SICK scoring was done for 369 children on admission. The outcome was recorded as death or discharge. The associated factors were analysed using SPSS software package analysis. Receiver operating curve was used to arrive at the cut-off point of SICK score for predicting mortality. Quantitative data differences between children who died and children who were discharged from the hospital were analysed using student independent t test. Need for assisted ventilation, presence of shock, age less than 3 years, and SICK score>2 were studied to find their association with mortality. Statistical analysis was done using univariate analysis and those factors that were significantly associated with mortality were subjected multivariate logistic regression analysis.Results: The performance of SICK score was “excellent” in discriminating between death and survival with area under the receiver operating characteristics curve 0.94. Age<3-year presence of shock, need for mechanical ventilation and SICK score>2 showed statistically significant association with mortality as evidenced by multivariate logistic regression model.  Conclusions: SICK score performed extremely well in predicting mortality on admission. Age<3 years, SICK score>2, Presence of Shock and need for assisted ventilation showed statistically significant association with mortality.

scholarly journals Study on demographic factors of discharge against medical advice in pediatric population

2020 ◽  
Vol 7 (2) ◽  
pp. 359
Author(s):  
Vidya B. U. ◽  
Anil Shetty K.
Keyword(s):  
Lumbar Puncture ◽  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
Medical Advice ◽  
P Value ◽  
Against Medical Advice ◽  
Female Ratio ◽  
Significant Difference ◽  
Discharge Against Medical Advice

Background: Discharge against medical advice (DAMA) is of serious concern among the pediatrics population. Parent(s)/guardians understanding about the disease and various other factors play role in their decision of DAMA. The aim of this study is to know the prevalence of DAMA in a tertiary care center and to observe the gender stratification in DAMA.Methods: A retrospective survey of medical records of children discharge against medical advice during the period January 2017 to January 2019. Demographic data, length of hospital stay, clinical diagnosis and procedure refused was collected.Results: Total 12977 were discharged during the study period of which, 387 children were DAMA, prevalence of DAMA was 2.9%, male to female ratio among DAMA patients is 1.2:1. The mean length of stay was 4.8 days. Among the DAMA patients’ newborns were predominant (61.6 %), p value = 0.0001, highly significant. No significant difference with respect to age and gender (p value = 0.535). Out of 370 DAMA patients, 211 patients who required further investigations and procedure was refused by parents/guardians (p value = 0.0001) highly significant. Phototherapy refusal was most common among newborn (59.7%), followed by neuroimaging and lumbar puncture in children (10.9%).Conclusions: DAMA was observed more among the newborns compared to infants, toddlers and children. Among newborns, phototherapy refusal was most common. In infants and children neuroimaging and lumbar puncture was the most commonly refused procedure. There was no gender bias.

scholarly journals Prevalence of elderly patients who refuse to get discharge from coronary intensive care unit in a tertiary care hospital of North India: a pilot study

2019 ◽  
Vol 7 (11) ◽  
pp. 4223
Author(s):  
Sanjeev Kumar Singla ◽  
Ankush Singla ◽  
Mridul Panditrao ◽  
Ishan Bansal ◽  
Rakendra Singh
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Elderly Patients ◽  
Elderly Population ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
The Elderly ◽  
Medical Advice ◽  
Care Hospital ◽  
Against Medical Advice

Background: The elderly population ≥60 years is increasing as the life span is increasing. So is the number of elderly patients who are refusing to get discharge from the hospital is also increasing. Authors are conducting this study in the elderly population who want to stay against medical advice.The aim to find the prevalence of elderly patients who refuse to get discharge from Coronary Care Unit (CCU) in a Tertiary care hospital of North IndiaMethods: A retrospective, observational study conducted in patients of age ≥60 years admitted to the coronary intensive care unit of a tertiary health care centre who refused discharge from the unit, were included in the study. Results: Of the 575 patients 44(7.65%) were willing to stay against medical advice. Of these 24(54.5%) were males and 20(45.5%) females. 6(13.6%) patients were terminally ill suffering from malignancies. Among all the patients who were willing to stay against medical advice, 8(18.2%) were covered by some health insurance scheme of either State or Central Government. 3(6.8%) patients were discharged after 24 hours, 22(50%) patients after 48 hours, 14(31.9%) patients after 72 hours and 5(11.3%) patients after 96 hours of advising discharge from hospital.Conclusions: As the intensive care beds at tertiary healthcare level are limited, the treatment of other salvageable sick patients who need the intensive care is affected by the unnecessary stay in hospital. Apart from the worsened nurse to patient ratio this increases the cost of treatment. This is need of hour to provide safe environment for the elderly outside the hospital settings and increase resources to provide better homecare.

scholarly journals Discharge against Medical Advice (DAMA) from an Emergency Department of a Tertiary Care Hospital in Saudi Arabia

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Ashraf El-Metwally ◽  
Nesreen Suliman Alwallan ◽  
Ali Amin Alnajjar ◽  
Nida Zahid ◽  
Khalid Alahmary ◽  
...  
Keyword(s):  
Emergency Department ◽  
Saudi Arabia ◽  
Tertiary Care ◽  
Medical Advice ◽  
Urgent Care ◽  
Categorical Variables ◽  
Care Hospital ◽  
Against Medical Advice ◽  
Discharge Against Medical Advice ◽  
Effect Of Age

Background. The discharge against medical advice (DAMA) in the Emergency Department (ED) is an issue of great concern because it may result in adverse consequences at a later stage. The reported worldwide prevalence of DAMA ranges from 0.07 to 20% for emergency admissions. The outcomes of DAMA can have significantly damaging effects, causing possible relapses of disease, readmission, and increases in medical costs for the patient. Therefore, it is imperative to identify the predictors of DAMA in ED. Methods. It was a cross-sectional study. The medical records used were those of all the patients (n = 11513) admitted to the Emergency Department (ED) of King Abdullah Bin Abdulaziz University Hospital (KAAUH) in Riyadh, Saudi Arabia, between 2017 and 2018. A thorough analysis was performed using IBM SPSS Statistics version 22. Descriptive statistics were reported for quantitative and categorical variables and assessed by independent t-test/chi-square/ANOVA (analysis of variance), where appropriate. Unadjusted and adjusted odds ratios with their 95% CI (confidence interval) were reported by performing logistic regression. A p value of ≤0.05 was considered statistically significant throughout the study. Results. The prevalence of DAMA in our study was 1%. In a multivariable analysis, after adjusting for the other covariates, we observed a significant interaction between age and gender. It was observed that the odds of DAMA for ≤40-year-old males were 3.12 times higher than those of a ≤40-year-old female (p value < 0.1). To further investigate this interaction, men and women were modeled separately in multivariable models using the same covariates. We found that, for men, the effect of age (≤40 years) was significant (OR = 3.94, 95% CI 1.31–11.80, p=0.014), while, for women, the effect of age (≤40 years) was not as pronounced (OR = 1.27, 95% CI = 0.66–2.42, p=0.27). Conclusions. Our study concluded that DAMA was more likely among younger male patients (≤40 years of age). Most of the patients with DAMA were presented to the urgent care of the Emergency Department. We recommend that patients be given some financial support to bear the expenses of the hospital stay from the healthcare facility or from the state. Future studies should assess the socioeconomic status of the patients and estimate the cost that is incurred by the patients.

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