scholarly journals Pediatric Discharges Against Medical Advice: A Review of Cases in Ado-Ekiti, Nigeria

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Adefunke Olarinre Babatola ◽  
Oladele Simeon Olatunya ◽  
Ezra Olatunde Ogundare ◽  
Ayotunde Emmanuel Ajibola ◽  
Temitope Olumuyiwa Ojo ◽  
...  
Keyword(s):  
Perinatal Asphyxia ◽  
Age Groups ◽  
Complete Information ◽  
Relevant Information ◽  
Medical Advice ◽  
University Teaching ◽  
State University ◽  
Cross Sectional ◽  
Against Medical Advice ◽  
Common Diagnosis

Background: Knowledge of the profile of pediatric discharge against medical advice (DAMA) may help design interventions to reduce its prevalence. Objectives: This study aimed to assess the profile of pediatric DAMA at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Ekiti State, Nigeria. Methods: This retrospective cross-sectional descriptive study included all pediatric cases of DAMA from January 2012 to December 2018. Relevant information was extracted from the patients’ case notes. Data was analyzed using the statistical package for social sciences (SPSS) version 23. Results: The overall prevalence of pediatric DAMA was 3.8%. Of the 233 pediatric DAMA with complete information, 127 (54.5%) were males. Severe malaria (27.3%) was the most common diagnosis among DAMA cases at the children emergency ward (CEW), while severe perinatal asphyxia (25.0%) and neonatal sepsis (25.0%) were the most common at the special care baby unit (SCBU). Only 1 (0.4%) patient was enrolled in the National Health Insurance Scheme (NHIS). Moreover, 43 (18.5%) parents took DAMA due to financial constraints, and 55% of the patients had their DAMA form signed by their fathers. In addition, among the patients who referred for follow-up, 11 (4.7%) patients fully recovered, 2 (0.8%) recovered with disability, 1 (0.4%) was readmitted, and 1 (0.4%) died. The highest and lowest DAMA rates were in the months of May and December, respectively. Patients aged under five years old who took DAMA significantly had infectious diseases compared to older age groups (P

scholarly journals Profile of Children Admitted for Severe Acute Malnutrition in a Tertiary Hospital in Southwestern Nigeria

2019 ◽  
Vol 39 (1) ◽  
pp. 42-48
Author(s):  
Adefunke Olarinre Babatola ◽  
Oladele Simeon Olatunya ◽  
Temitope Olumuyiwa Ojo ◽  
Adekunle Bamidele Taiwo ◽  
Joseph Olusesan Fadare
Keyword(s):  
Severe Acute Malnutrition ◽  
Tertiary Hospital ◽  
Medical Advice ◽  
University Teaching ◽  
Acute Malnutrition ◽  
Southwestern Nigeria ◽  
Cross Sectional ◽  
Against Medical Advice ◽  
Presenting Symptoms ◽  
Morbid Conditions

Introduction: This study assessed the socio-demographic profile, outcomes of treatment and challenges encountered in the management of children admitted for Severe Acute Malnutrition at the Paediatric Unit of a State University Teaching Hospital, Ado-Ekiti, Nigeria.  Methods: A retrospective cross-sectional study was conducted. The records of twenty-five children with SAM admitted from March 2013-March 2018 were reviewed. SAM was defined according to the Wellcome Classification based on child’s weight and oedema status. Data on demographic characteristics, presenting symptoms, co-morbid conditions, duration of admission and outcome were extracted. Results: There were 13 (52.0%) males and 12 (48.0%) females. The median age of children with SAM was eight months. Eighteen children (72%) were marasmic, four (16%) had kwashiorkor while three (12%) had marasmic-kwashiorkor. Common presenting symptoms included poor weight gain (59.1%), fever (54.5%) and diarrhoea (36.4%). Majority (84.0%) of the patients had co-morbid conditions which included sepsis (66.7%), anaemia (37.5%), hypoglycaemia (16.7%) and hypothermia (16.7%). Twenty-one (84.0%) children were fully vaccinated for age, two (8.0%) had partial vaccination while two (8.0%) were never vaccinated. Only two (8.0%) had exclusive breastfeeding, 19 (76.0%) had mixed feeding from birth. Majority (60%) of the children had one or more social challenges such as teenage parents and financial constraints. Mean duration of admission was 4.56 days. Twelve (48.0%) left against medical advice, nine (36.0%) were discharged, one (4.0%) was referred to another tertiary facility and three (12.0%) deaths were recorded. Conclusions: Many of the children admitted for SAM in our study had social problems and almost half of them left the hospital against medical advice. Besides health problem, social factors may play more role in SAM.

scholarly journals Analyzing Predictors of Control Measures and Psychosocial Problems Associated with COVID-19 Pandemic: Evidence from Eight Countries

2021 ◽  
Vol 11 (8) ◽  
pp. 106
Author(s):  
Sheikh Saifur Rahman Jony ◽  
Ubydul Haque ◽  
Nathaniel J. Webb ◽  
Emily Spence ◽  
Md. Siddikur Rahman ◽  
...  
Keyword(s):  
Psychological Health ◽  
Age Groups ◽  
Psychosocial Problems ◽  
Relevant Information ◽  
The United States ◽  
Control Measures ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Primary Determinant

COVID-19 has harshly impacted communities globally. This study provides relevant information for creating equitable policy interventions to combat the spread of COVID-19. This study aims to predict the knowledge, attitude, and practice (KAP) of the COVID-19 pandemic at a global level to determine control measures and psychosocial problems. A cross-sectional survey was conducted from July to October 2020 using an online questionnaire. Questionnaires were initially distributed to academicians worldwide. These participants distributed the survey among their social, professional, and personal groups. Responses were collected and analyzed from 67 countries, with a sample size of 3031. Finally, based on the number of respondents, eight countries, including Bangladesh, China, Japan, Malaysia, Mexico, Pakistan, the United States, and Zambia were rigorously analyzed. Specifically, questionnaire responses related to COVID-19 accessibility, behavior, knowledge, opinion, psychological health, and susceptibility were collected and analyzed. As per our analysis, age groups were found to be a primary determinant of behavior, knowledge, opinion, psychological health, and susceptibility scores. Gender was the second most influential determinant for all metrics except information about COVID-19 accessibility, for which education was the second most important determinant. Respondent profession was the third most important metric for all scores. Our findings suggest that greater encouragement from government health authorities and the promotion of health education and policies are essential in the dissemination of COVID-19-awareness and increased control of the spread of COVID-19.

scholarly journals Discharge against medical advice from the emergency department in a university hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Feras H. Abuzeyad ◽  
Moonis Farooq ◽  
Salah Farhat Alam ◽  
Mudhaffar Ismael Ibrahim ◽  
Luma Bashmi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cross Sectional Study ◽  
Small Sample ◽  
Medical Advice ◽  
University Hospital ◽  
High Risk Population ◽  
Cross Sectional ◽  
Against Medical Advice ◽  
Level 3 ◽  
Collection Form

Abstract Background Patients discharged against medical advice (DAMA) act as a high-risk population for the Emergency Department (ED), regardless of their presentations, and can pose a serious burden for the hospital. This study examines the prevalence, demographic and clinical characteristics, reasons, and clinical outcomes of a small sample of DAMA patients in a teaching university hospital, including readmission, morbidity, and mortality. Methods A prospective, descriptive cross-sectional study was conducted in the ED of King Hamad University Hospital (KHUH) with 98,992 patient visits during a 1-year period from June 2018 to June 2019. Consenting DAMA patients were asked to complete a data collection form. Results Patients (n = 413) had a mean age of 44.1 years with a female majority (57.1%). The majority were categorized as triage level-3 (87.7%). The main reasons for DAMA included refusal of the procedure/operation (23.2%), long ED waiting time (22.2%), subjective improvement with treatment (17.7%), and children at home (14.8%), whereas the least selected reason was dissatisfaction with medical care (1.2%). Follow-up of DAMA patients revealed that 86 cases (20.8%) were readmitted to the ED within 72 h of which 41 (47.7%) cases were morbidity and 2 (2.3%) were mortality. Marital status was a predictor of DAMA patients who revisit the ED within 72 h. Conclusion The results act as a pilot study to examine a small sample of DAMA patients’ characteristics, diagnosis, and ED revisits. Hospitals should investigate further the DAMA population on a larger scale, reasons for refusing procedures, and utilize this knowledge to improve the healthcare process.

scholarly journals Difficulties in the diagnosis of soft tissue sarcomas

1970 ◽  
Vol 32 (2) ◽  
pp. 26-29
Author(s):  
R Jha
Keyword(s):  
Soft Tissue ◽  
Age Distribution ◽  
Age Groups ◽  
Soft Tissue Sarcomas ◽  
Vascular Tumor ◽  
University Teaching ◽  
Institute Of Medicine ◽  
Diagnostic Challenge ◽  
Study Results ◽  
Common Diagnosis

Introduction: Soft tissue tumors represent diagnostic challenge to general practicing pathologists because of overlap in morphologic features. The usual approach is to diagnose by presumed cell lineage. A major utility of immunohistochemistry is to identify a tumor being mesenchymal or nonmesenchymal and once mesenchymal lineage has been confirmed, histologic sub typing according to specific lineage may be achieved with help of lineage specific markers. Methods: The objective of this study was to analyse different types of soft tissue malignancies according to their type, site and age distribution, discuss the difficulties faced during morphologic examination and review the literature for role of ancillary techniques, particularly immunohistochemistry in diagnosing soft tissue sarcomas.All soft tissue malignancies reported from Tribhuvan University Teaching Hospital in three years period from April 2008 to March 2010 were included in the study. Results: Total 87 soft tissue malignancies were reported during study period. Most of these patients (58.6%) were male and the rest were female. These malignancies were found in all age groups. Youngest patient was newborn who was born with tongue mass and biopsy was performed on 13th day of life. However maximum numbers of tumors (41.4%) were seen in first two decades of life. Head and neck was the most common site .Rhabdomyosarcoma was the most common diagnosis. In 20 cases (23%) a definite opinion was not possible and vague terms like sarcoma, small round cell tumor, spindle cell malignancy, vascular tumor “likely” were used. Immunohistochemistry was advised in these cases. Conclusions: Only light microscopic examination of hematoxylin and eosin stained slide not sufficient at all times because there is morphologic overlap of soft tissue sarcomas with each other and with carcinomas and melanomas. Though immunohistochemistry is not a substitute for skilled interpretation of routinely stained slides but prove helpful to reach a more definite diagnosis. Keywords: Immunohistichemistry; sarcoma; soft tissue DOI: http://dx.doi.org/10.3126/joim.v32i2.4941 Journal of Institute of Medicine, August, 2010; 32: 26-29

Comparing uninsured and privately insured hospital patients: admission severity, health outcomes and resource use

2001 ◽  
Vol 14 (3) ◽  
pp. 203-210 ◽  
Author(s):  
R. C. Bradbury ◽  
Joseph H. Golec ◽  
Paul M. Steen
Keyword(s):  
Health Outcomes ◽  
Severity Of Illness ◽  
Medical Advice ◽  
Service Needs ◽  
Uninsured Patients ◽  
Cross Sectional ◽  
Against Medical Advice ◽  
Mortality And Morbidity ◽  
Hospital Patients ◽  
Privately Insured

This paper compares uninsured hospital patients with privately insured patients in terms of severity of illness on admission, emergency department use, leaving the hospital against medical advice, length of stay, and in-hospital mortality and morbidity rates. This cross-sectional study includes 29 237 admissions to 100 US hospitals in 1993 and 1994. We found that uninsured patients are sicker, indicating that hospitals should expect uninsured patients to have increased service needs. Our results indicate that the uninsured exhibit higher likelihood of leaving against medical advice, shorter lengths of stay and poorer health outcomes suggest that the uninsured may not be receiving necessary care. Further studies are needed.

scholarly journals Incidence and Predictors of Mortality Among Newborns With Perinatal Asphyxia: A 4-Year Prospective Study of Newborns Delivered in Health Care Facilities in Enugu, South-East Nigeria

2017 ◽  
Vol 11 ◽  
pp. 117955651774664 ◽  
Author(s):  
Uchenna Ekwochi ◽  
Nwabueze I Asinobi ◽  
Chidiebere DI Osuorah ◽  
Ikenna K Ndu ◽  
Christian Ifediora ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
Perinatal Asphyxia ◽  
Mode Of Delivery ◽  
Case Fatality ◽  
Health Care Facilities ◽  
University Teaching ◽  
State University ◽  
Low Oxygen ◽  
Gestational Age At Delivery

Fatalities from perinatal asphyxia remain high in developing countries, and continually assessing its risk factors will help improve outcomes in these settings. We explored how some identified risk factors predict mortality in asphyxiated newborns, to assist clinicians in prioritizing interventions. This was a 4-year prospective study conducted at the Enugu State University Teaching Hospital, Enugu, Nigeria. All newborns who met the study criteria that were admitted to this facility in this period were enrolled and monitored. Data collected were analysed with SPSS Version 18. A total of 161 newborns with perinatal asphyxia were enrolled into the study with an in-hospital incidence rate of 12.81 per 1000 birth and a case fatality rate of 18%. Overall, the APGAR scores were severe in 10%, moderate in 22%, mild to normal in 68%, whereas the SARNAT stages were III in 24%, II in 52%, and I in 25%. In terms of mortality, 66.7%, 22.2%, and 11.1% mortalities were, respectively, observed with SARNAT scores III, II, and I ( P = .003), whereas the findings with APGAR were 31.2% (severe), 25.0% (moderate), 25.0% (mild), and 18.8% (normal) ( P = .030). Fatality outcome was more correlated with SARNAT ( R = .280; P = .000) than APGAR ( R = −.247; P = .0125). The SARNAT score significantly differentiated between the degrees of asphyxia in newborns based on gestational age at delivery ( P = .010), place of delivery ( P = .032), and mode of delivery ( P = .042). Finally, it was noted that newborns that were female ( P = .007), or born outside the hospital ( P = .010), or with oxygen saturations <60% ( P = .001), or with heart rate <120 ( P = .000), and those with respiratory rate <30 ( P = .003), all have significantly higher likelihood of deaths from asphyxia. Therefore, predictors of neonatal mortality from perinatal asphyxia in our centre include being female and being born outside the hospital, as well as low oxygen saturations, heart rates, and respiratory rates at presentation.

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 Sonographic estimation of foetal weight versus actual birth weight at term

2021 ◽  
Vol 10 (5) ◽  
pp. 1782
Author(s):  
Akinshola A. Ero-Phillips ◽  
Faosat O. Jinadu ◽  
Abimbola T. Ottun ◽  
Ayokunle M. Olumodeji
Keyword(s):  
Birth Weight ◽  
Pregnant Women ◽  
Predictive Value ◽  
Cross Sectional Study ◽  
University Teaching ◽  
Percentage Error ◽  
State University ◽  
Singleton Pregnancy ◽  
Cross Sectional ◽  
Delivery Accuracy

Background: Estimated foetal weight is very critical to decision making in the management of pregnant women. It is therefore important to evaluate the accuracy of ultrasound estimated foetal weight (USEFW) at term in our environment. We compared ultrasound estimated foetal weight at term with the actual foetal birth weight at delivery.Methods: This was a prospective, comparative cross-sectional study at the Lagos State University Teaching Hospital over a 6-month period. Four hundred and five pregnant women with normal singleton pregnancy, who had sonographic estimation of foetal weight at term, using the Hadlock IV formula, were followed up and had their actual birth weight (ABW) determined at delivery. Accuracy was determined by proportion of estimates within 10% of actual birth weight and mean absolute percentage error (MAPE). The p<0.05 was considered significant at 95% confidence interval.Results: The prevalence of macrosomia was 10.3%. At 10% margin of error, ultrasound accurately estimated the weights of 73.3% of babies. The mean USEFW was 3559.89±316.9g and mean ABW was 3477.42±422.9g with a mean difference of 82.44g (p<0.001) and MAPE of 7.11. There was positive correlation (r=0.669) between the EFW and ABW (p<0.001). The USEFW had a sensitivity of 66.7%, specificity of 91.5%, positive predictive value of 47.5% and negative predictive value of 96.0% in predicting macrosomia.Conclusions: Ultrasound estimation of foetal weight at term is reliably accurate in predicting actual birth weight in south-western Nigeria. 

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