Factors Influencing Patients to Decide to Discharge Themselves against Medical Advice at Tertiary Hospitals: A Cross-Sectional Study

Background: Discharged against medical advice (DAMA) is defined as any instance when a patient wants to leave the hospital against the managing physician’s decision. This study aimed to identify factors that influence patients to decide to be DAMA. Methods: A descriptive, cross-sectional study. The study was conducted in the emergency department (ED) of King Fahad Medical City (KFMC)-Saudi Arabia-Riyadh city. A questionnaire in both Arabic and English was distributed to all participants to fill in either English or Arabic. Results: Between 1 March and 30 April 2021, 510 responses were collected. Most of the study participants (31.4%) were over the age of 54. Our findings showed that 12.5% of our participants had taken discharge against medical advice in the past. Results Regarding Factors That Influence Patients to Decide on DAMA Showed: Regarding Inappropriate behavior and disrespect of the physician or staff to the patient and his relatives, 262 (51.4%) participants, 85 (16.7%) participants, and 163 (32%) participants agreed, neutral, and disagreed, respectively. Regarding the Lack of physicians’ and nurses’ attention to the patient and his relatives (emotionally), our result showed that 278 (54.5%) participants, 95 (18.6%) participants, and 137 (26.9%) participants agreed, neutral, and disagree, respectively. Regarding failure to inform the patient or his relatives of his condition, it showed that 257 (50.4%) participants, 95 (18.6%) participants, and 158 (31%) participants agreed, neutral, and disagreed, respectively. Regarding feeling better from DAMA, our result showed 226 (44.3%) participants, 119 (23.3%) participants, and 165 (32.4%) participants agreed, neutral, and disagreed, respectively. Regarding patients’ or their relative’s tiredness of hospital stay, the result showed that 166 (32.5%) participants, 104 (20.4%) participants, and 240 (47.1%) participants agreed, neutral, and disagreed, respectively. Conclusion: The long wait time to be seen by a physician was the major factor that forced patients to leave the emergency department against medical advice.

Reasons of Discharge Against Medical Advice Among Children in Oman： A Teaching Hospital Experience

Discharge against medical advice （DAMA） is a serious problem in healthcare delivery, as it can lead to further complications of the diseases that patients are suffering from. This study aimed to evaluate the reasons for signing DAMA for children in a tertiary teaching hospital in Oman. A prospective study was performed through telephone interviews with the mothers of children who were DAMA during one year （November 2013-November 2014）. Out of 3,647 discharges in general pediatric wards, there were 38 cases of DAMA, giving a prevalence rate of 1%. The DAMA happened within 24 hours of admission in 63.8%. Around two thirds of the patients were infants （65.96%）. In some cases, the diagnosis at time of discharge was life threatening diseases. The most common reason for the DAMA as stated by the mothers was child improvement, based on clinical and laboratory findings （40.4%o）, while social problems attributed for 29.8% of DAMA. However, the reasons were not documented in the electronic medical files of 57.4% of the patients, 57.4% of the cases reported by the mothers to be better two weeks after DAMA and the remaining either remained the same, readmitted or were following up in the clinic. Despite the low prevalence rate of DAMA found in this study, this is a stressing phenomenon occurring in a tertiary hospital in Oman, thus, further studies should be conducted to establish specific protocols to protect children from such practices.

Results of the Traditional Treatment of Fractures of Patients Discharged against Medical Advice from the Orthopedics Department of the Ouahigouya Regional University Hospital (Burkina Faso)

Introduction: Binding retains an important place in Africa. Leaving a health facility to see a bonesetter is common there, but a source of complications. The purpose of this work was to analyze the results obtained by bonesetter after discharge against medical advice. Methodology: Analytical cross-sectional study over a period of one year, including all patients admitted for limb fracture, discharged against medical advice for treatment with a bonesetter. Results: Thirty-nine patients were selected. The average age was 36.9 years, and the sex ratio was 5.50. The fractures were open in 35.9%. At a mean follow-up of 19 months, the course was marked by pain in 34.4% and inequality in limb length in 62.5%. Thirteen fractures (40.6%) were consolidated with axis defect, and 11 were without axis defect (34.4%). There were eight non-union (25%), and eleven patients (34.4%) presented with stiffness in one or more joints. Seven patients had died. Discussion: The problem of discharge against medical advice is found in all hospitals but is particularly marked for fractures in our context. The absence of an X-ray and ignorance of the rules of asepsis lead to complications. Only the fractures of the two bones of the leg had progressed well (5/8 good results). The rate of vicious calluses (40.6%) and non-union (25%) is high. Conclusion: Although a few cases have progressed favorably, the results of patients traditionally treated after discharge against medical advice are generally poor.

U.S.Medical Advice for Diabetics:Take a Walk

提示:请问,对老人来说,怎样的运动是最理想的运动。科学实验证明:步行。本文的调查又证明了这一点。糖尿病患者只消每周步行两小时,就会大大减少其早死率。本文最有文采的一句:Walking Was associated with lowel mortalityacross a diverse spectrum of adults with diabetes.(步行和形形色色的患糖尿病的成年人的低死亡率有关。)

推动长三角地区跨省异地就医门急诊费用直接结算的实践

分析长三角地区跨省异地就医门急诊费用直接结算的需求,总结长三角地区跨省异地就医门急诊费用直接结算试点的主要做法及初步成效,提出对长三角地区医疗保险一体化建设的思考。

A Specific Pattern in the Basal Body Temperature Chart during the First Week of Pregnancy May Warn of a Miscarriage Crisis

We studied the efficiency of acupuncture for patients who were unable to give birth though they had experienced conventional infertility treatment for more than 2 years by medical specialists. We then investigated characteristics of difficult pregnancy cases with measurement of body temperature and observation of basal body temperature (BBT) charts. Thirty-three patients had acupuncture every week for more than 2 years and 17 of them delivered. At the same time, their cutaneous body temperature was measured at five locations. Moreover, patients and acupuncturists had a weekly discussion of the patient’s BBT chart. The delivery group showed more balanced and higher cutaneous body temperatures than the miscarriage and no pregnancy groups. The delivery group showed a smooth increase in the BBT chart while the miscarriage group showed a specific pattern in shifting temperatures from low to high zones. Acupuncture might suppress excess sympathetic dominance, which induced hyperthermia as well as interruption of pregnancy. Additionally, weekly discussion and medical advice could help patients. However, further study of males, healthy women, or larger, comparative studies exploring the social and cultural background of other countries were needed to add support to these factors.