Cause Of Discharge Research Articles

Discharge Against Medical Advice from Neonatal Intensive Care Unit and Some Influencing Factors in an Academic Center

Background: Early discharge from the hospital against medical advice poses a significant threat to the health of patients, particularly neonates, who are a vulnerable population. Objectives: This study aimed to determine the frequency of neonatal discharge with personal consent and identify the most influential factors. Methods: This retrospective cross-sectional study was conducted at Alzahra Hospital in Rasht from 2020 to 2021. Using a census method, information on all infants discharged against medical advice was extracted from the hospital's clinical records available in the information system. Data on the reason for neonatal hospitalization and discharge against medical advice, neonatal age, weight, maternal education, and insurance status were recorded. Results: Among 2327 neonates, 581 (24.96%) were discharged from the hospital against medical advice. The primary cause of early discharge was related to family problems (64.4%), followed by dissatisfaction with the hospital and treatment process (15.3%), prolonged hospitalization (11%), and financial problems (9.3%). A significant association was found between neonatal age, weight, type of delivery, maternal education, insurance status, and the reason for hospitalization with the reason for discharge against medical advice (all P < 0.001). Conclusions: The rate of discharge against medical advice in this study was notably higher compared to other studies, possibly due to the timing of the study coinciding with the peak of COVID-19 and the different reasons for hospitalization, such as icterus versus sepsis. Family problems were identified as the main cause of discharge against medical advice, while financial problems were the least common. Therefore, practical and preventive solutions should be provided to families whenever possible.

Concept of Leucorrhoea & its Understanding in the Light of Unani Medicine

Leucorrhea or vaginal discharge is a common symptom among females. It is a complaint with which each women suffers atleast once in a lifetime. It is a frequent gynecological complaint that accounts for more than 1/4th gynaec visit to gynecologist. It is typically whitish, yellowish, or greenish vaginal discharge in females that may be natural or an infection symptom. It is almost mucus discharge which exhibits vaginal epithelial cell exfoliation due to the influence of estrogen on the vaginal mucosa. The cause of discharge may be physiological, pathological & inflammatory. If, it is not treated in initial stage then it may convert into chronic form and leads to Pelvic inflammatory disease (PID). According to Unani concept Sailan-ur- Rahem is a chronic inflammatory disease & it is due to derangement in quality and quantity of Humors (Akhlat), especially Phlegm (Balgham) and because of accumulation of excessive morbid material (Mawad-e-Fasida) in the uterus due to weaken repulsive power (Zoaf-e-quwat-e-dafea).The main aim of the study is to spread knowledge of Leucorrhoea described in Traditional Unani system of Medicine and its treatment with the available single and compound formulations widely used in Unani Medicine with minimal side effects.

Association Between Door-to-Doctor Time and Discharge Against Medical Advice in Patients with COVID-19 from the ED

The cause of Discharge Against Medical Advice (DAMA) is a long response time/doorto- doctor time, which is not according to the recommendation of 5 minutes. This study aimed to determine the association between Door to Doctor Time and DAMA incidence in patients with COVID-19 from the ED. The research design used is a cross-sectional study. This study used a purposive sampling technique (n = 414) in patients with COVID-19 symptoms who came or were referred to the ED in December 2020-April 2021. The data analysis used the Spearman correlation test. The results of this study indicate that most response times with response time indicators arrive until the initial action is not according to recommendations, namely 75 patients (18.1%). In contrast, the response time (response time for initial treatment to supporting laboratory examinations) is dominated by the same response time as many as 54 patients (13.0%). The results of the Spearman correlation show a positive correlation between the two waiting times / Door to Doctor time with an indicator (response time to achieve initial action) with the incidence of DAMA in COVID-19 patients. The correlation value is 0.000 (sig < 0.05), which is 0.436, and (the response to initial handling time until laboratory examination) has a correlation value of 0.413 with the same relationship, namely positive and unidirectional. At the same time, the strength of associations was moderate. The door to Doctor Time / Response time with indicators (response time from arrival to initial action and response time to initial treatment to supporting laboratory tests) is associated with the incidence of DAMA in patients with Covid-19 in the ED. The longer the response time will affect the incidence of DAMA in COVID-19 patients.
 Keywords: discharge against medical advice, door to the doctor time, COVID-19, ED

Ten-year hospitalization trends in Mexico: Examining the profile of national and transient and migrants.

In Mexico, as in other societies, migrants are seen as over-users of health services. However, the extent, distribution, and trends of use over time are unknown. Evidence is needed to inform health policies and improve health services for foreign patients. The objective of this study was to examine factors associated with the distribution and trends of Mexican and foreign resident hospitalizations in Mexican public hospitals from 2010 to 2020. A graphical and statistical analysis (descriptive and correlational) of discharge trends in public hospitals was carried out. Hospitalization trends were analyzed by country of habitual residence (Mexico, US, Central and South America, and Other Continents), age, sex, primary discharge category, and region of service delivery. Adjusted Poisson modeling was used to examine the factors associated with annual hospitalizations of Mexican and foreign residents. Between 2010 and 2020, there were 26,780,808 hospitalizations in Mexican public hospitals. Of these, 0.05% were of foreign residents. Hospitalizations for Mexican residents remained stable from 2010 to 2019, while those for foreign residents trended upward over the same period. In 2020, hospitalizations of Mexican residents fell by 36.6%, while foreign resident hospitalizations fell by 348.8%. The distribution of hospitalizations by sex was higher among females for all categories of habitual residence, except among US residents. Obstetric discharges were the most common reason for hospitalization among Mexican residents (42.45%), Central and South American residents (42.24%), and residents from Other Continents (13.73%). The average hospital stay was 2 days. Poisson regression confirmed these results, showing that hospitalizations was higher among women (except among foreign residents) and in the ≤ 17 age group. Poisson modeling also showed that trauma injury was the leading cause of discharge for foreign residents after obstetric causes. It is unlikely the upward trend in hospitalizations among foreign residents in Mexico from 2010 to 2019 affected the Mexican public health system, given the small proportion (0.05%) of hospitalizations and the brief length of hospital stay. The increased number of hospitalizations during the study period may be explained by local and national measures to facilitate foreign residents' access to hospital services, while the decrease in hospital utilization in 2020 is likely associated with COVID-19. Geographic location and the most frequent primary discharge categories of hospitalizations within each population could provide evidence for modifications to public health policy in Mexico.

Health Services in Huntington Disease: A Systematic Literature Review.

Clinical trials for Huntington disease (HD) have primarily focused on managing chorea and, more recently, the development of disease-modifying therapies (DMTs). Nonetheless, understanding health services among patients with HD is essential for assessing new therapeutics, development of quality metrics, and overall quality of life of patients and families with HD. Health services assess health care utilization patterns, outcomes, and health care-associated costs, which can help shape the development of therapeutics and aid in policies that affect patients with a specific condition. In this systematic literature review, we analyze data of published studies looking at causes of hospitalization, outcomes, and health care costs in HD. The search yielded 8 articles published in the English language and comprising data from the United States, Australia, New Zealand, and Israel. The most common cause of hospitalization among patients with HD was dysphagia or dysphagia-related complications (e.g., aspiration pneumonia or malnutrition), followed by psychiatric or behavioral symptoms. Patients with HD had more prolonged hospitalizations than non-HD patients, and it was most prominent among those with advanced disease. Patients with HD were more likely to be discharged to a facility. A small percentage received inpatient palliative care consultation, and behavioral symptoms were a primary cause of discharge to another facility. Interventions such as gastrostomy tube placement had associated morbidity, and it was common among patients with HD with a diagnosis of dementia. Palliative care consultation and specialized nursing care were associated with more routine discharges and fewer hospitalizations. In terms of cost, patients with HD with private and public insurances had the highest expenditure with more advanced disease, and expenses were associated with hospitalization and medication costs. In addition to DMTs, HD clinical trial development should also consider the leading causes of hospitalization, morbidity, and mortality in patients with HD, including dysphagia and psychiatric disease. No research study, to our knowledge, has systematically reviewed health services research studies in HD. Evidence from health services research is needed to evaluate the efficacy of pharmacologic and supportive therapies. This type of research is also critical in understanding health care costs associated with the disease and to better advocate and shape policies that can benefit this patient population.

Concerning partial discharge detection in cable lines using high-frequency sensors

Partial discharges result in cable line faults that can occur in defective insulation systems made of rubber, polyethylene, XLPE, and flexible PVC. Insulation defects may occur due to disruptions in their production process, cable installation, and operational conditions. Therefore, the diagnostic and monitoring of partial discharge occurrence in cable insulation help prevent emergencies in damaged cable line sections. Partial discharge registration is a non-destructive diagnostic method that helps assess the cable line condition and localize the detected defects. There are various methods of operational monitoring and partial discharge cause analysis based on operative partial discharge sensors. The assessment of cable line condition depends on the efficiency of signal detection and processing by the sensors used. This article reviews the problems of detecting and localizing partial discharges in cable lines and junction boxes using HFCT and UHF sensors. Having analyzed the capabilities of these sensors, we believe that the combined usage of HFCT and UHF sensors is the best method of detecting and localizing partial discharge within the entire cable system (lines and junction boxes).

Mine blast injury of the spine and spinal cord: a case report

Many soldiers who were wounded during the war in Ukraine with Russia increased the number of cases of spinal injury. As a result of the Russia-Ukraine war, the number of patients with spine and spinal cord injuries increased significantly. According to the literature, gunshot wounds to the spine and spinal cord accounted for 0.26% of all soldier injuries during the American Civil War, with a mortality rate of 55%. According to the U.S. military data, spinal and spinal cord injuries accounted for 1.2% of war-related deaths during the Korean War, 1.0% - during the Vietnam War and the Gulf War, 6.0% - during the US invasion of Panama, 11.1% - during the war in Afghanistan and Iraq. Disability related to spinal cord injuries (14.0%) is currently the leading cause of discharge from military service for U.S. soldiers who have been injured. Patient M., 32 years old, male sustained mine blast injury. Immediately after the injury there was tetraplegia. Surgery was performed to correct vertebrae С7–Тh1, decompression of the spinal cord at the level of vertebrae С7–Тh1. Sixteen days after surgery, the neurological deficit regressed to the Frankel C clinical group. The patient was transferred to rehabilitation treatment. A clear, consistent, rapid algorithm of action in spinal cord injuries allowed to provide highly qualified care, which allowed to achieve significant results in the regression of neurological deficits in the postoperative period.

Adult sports-related traumatic spinal injuries: do different activities predispose to certain injuries?

Sports injuries are known to present a high risk of spinal trauma. The authors hypothesized that different sports predispose participants to different injuries and injury severities. The authors conducted a retrospective cohort analysis of adult patients who experienced a sports-related traumatic spinal injury (TSI), including spinal fractures and spinal cord injuries (SCIs), encoded within the National Trauma Data Bank from 2011 through 2014. Multiple imputation was used for missing data, and multivariable linear and logistic regression models were estimated. The authors included 12,031 cases of TSI, which represented 15% of all sports-related trauma. The majority of patients with TSI were male (82%), and the median age was 48 years (interquartile range 32-57 years). The most frequent mechanisms of injury in this database were cycling injuries (81%), skiing and snowboarding accidents (12%), aquatic sports injuries (3%), and contact sports (3%). Spinal surgery was required during initial hospitalization for 9.1% of patients with TSI. Compared to non-TSI sports-related trauma, TSIs were associated with an average 2.3-day increase in length of stay (95% CI 2.1-2.4; p < 0.001) and discharge to or with rehabilitative services (adjusted OR 2.6, 95% CI 2.4-2.7; p < 0.001). Among sports injuries, TSIs were the cause of discharge to or with rehabilitative services in 32% of cases. SCI was present in 15% of cases with TSI. Within sports-related TSIs, the rate of SCI was 13% for cycling injuries compared to 41% and 49% for contact sports and aquatic sports injuries, respectively. Patients experiencing SCI had a longer length of stay (7.0 days longer; 95% CI 6.7-7.3) and a higher likelihood of adverse discharge disposition (adjusted OR 9.69, 95% CI 8.72-10.77) compared to patients with TSI but without SCI. Of patients with sports-related trauma discharged to rehabilitation, one-third had TSIs. Cycling injuries were the most common cause, suggesting that policies to make cycling safer may reduce TSI.

Assessment of an electronic patient record system on discharge prescribing errors in a Tertiary University Hospital

BackgroundPrescribing error represent a significant source of preventable harm to patients. Prescribing errors at discharge, including omission of pre-admission medications (PAM), are particularly harmful as they frequently propagate following discharge. This study assesses the impact of an educational intervention and introduction of an electronic patient record (EPR) in the same centre on omission of PAM at discharge using a pragmatic design. A survey of newly qualified doctors is used to contextualise findings.MethodsDischarge prescriptions and discharge summaries were reviewed at discharge, and compared to admission medicine lists, using a paper-based chart system. Discrepancies were noted, using Health Information and Quality Authority guidelines for discharge prescribing. An educational intervention was conducted. Further review of discharge prescriptions and discharge summaries took place. Following introduction of an EPR, review of discharge summaries and discharge prescriptions was repeated. A survey was administered to recently qualified doctors (interns), and analysed using descriptive statistics and thematic analysis.ResultsOmission of PAM as prescribed or discontinued items at discharge occurs frequently. An educational intervention did not significantly change prescribing error rates (U = 1255.5, p = 0.206). EPR introduction did significantly reduce omission of PAM on discharge prescribing (U = 694, p < 0.001), however there was also a reduction in the rate of deliberate discontinuation of PAM at discharge (U = 1237.5, p = 0.007). Survey results demonstrated that multiple sources are required to develop a discharge prescription. Time pressure, access to documentation and lack of admission medicine reconciliation are frequently cited causes of discharge prescribing error.ConclusionThis study verified passive educational interventions alone do not improve discharge prescribing. Introduction of EPR improved discharge prescribing, but negatively impacted deliberate discontinuation of PAM at discharge. This is attributable to reduced access to key sources of information used in formulating discharge prescriptions, and separation of the discontinuation function from the prescribing function on the EPR discharge application.

Time trends in hospital discharges in patients aged 85\u2009years and older in Spain: data from the Spanish National Discharge Database (2000\u20132015)

BackgroundThe aging population is an increasing concern in Western hospital systems. The aim of this study was to describe the main characteristics and hospitalization patterns in inpatients aged 85 years or more in Spain from 2000 to 2015.MethodsRetrospective observational study analyzing data from the minimum basic data set, an administrative registry recording each hospital discharge in Spain since 1997. We collected administrative, economic and clinical data for all discharges between 2000 and 2015 in patients aged 85 years and older, reporting results in three age groups and four time periods to assess differences and compare trends.ResultsThere were 4,387,326 discharges in very elderly patients in Spain from 2000 to 2015, representing 5.32% of total discharges in 2000–2003 and 10.42% in 2012–2015. The pace of growth was faster in older age groups, with an annual percentage increase of 6% in patients aged 85–89 years, 7.79% in those aged 90–94 years, and 8.06% in those aged 95 and older. The proportion of men also rose (37.30 to 39.70%, p < 0.001).The proportion of patients that died during hospital admission decreased from 14.64% in 2000–2003 to 13.83% in 2012–2015 (p < 0.001), and mean length of stay from 9.98 days in 2000–2003 to 8.34 days in 2012–2015.Some of the most frequent primary diagnoses became even more frequent relative to the total number of primary diagnoses, such as heart failure (7.84 to 10.62%), pneumonia (6.36 to 7.36%), other respiratory diseases (3.87 to 8.49%) or other alterations of urinary tract (3.08 to 5.20%). However, there was a relative decrease in the proportion of femoral neck fractures (8.07 to 6.77%), neoplasms (7.65 to 7.34%), ischemic encephalopathy (6.97 to 5.85%), COPD (4.23 to 3.15%), ischemic cardiomyopathy (4.20 to 8.49%) and cholelithiasis (3.07 to 3.28%).ConclusionsDischarges in the very elderly population are increasing in both relative and absolute terms in Spanish hospitals. Within this group, discharged patients are getting older and more frequently male. The mean length of stay and the proportion of patients that died during hospital admission are decreasing. Acute-on-chronic organ diseases, neoplasms, acute cardiovascular diseases, and infections are the most common causes of discharge.

The causes of discharge against medical advice and suggestions for its reduction in Tabriz Sina Medical Center (phenomenological study)

Objectives: Patient satisfaction is an issue that has attracted increasing attention to the health industry today. Discharge against medical advice (DAMA) is one of the symptoms of patient dissatisfaction that has adverse effects on patient treatment and increases hospital costs. The purpose of this study was to identify the causes of DAMA by patients admitted to Sina educational and therapeutic center (one of the teaching hospitals of Tabriz University of Medical Sciences) and finally to provide strategies for reducing DAMA. Material and Methods: This study is qualitative research with a phenomenological approach. The data gathering tool is in-depth interviews. The study population consisted of all patients who completed the DAMA form in 2017 and left the hospital with their satisfaction. The sampling method was purposeful and interviewing. The method of analysis is thematic analysis. Results: Final findings indicate that the rate of DAMA in Sina training and medical center has a significant proportion that needs intervention and evaluation. Most of the patients in this study were male, non-native of Tabriz, admitted to surgery, discharged in the morning shift, as well as average stay over 2 days. The reasons for DAMA after an interview with patients were classified into three themes: (1) Problems with the patient, (2) problems with care issues, and (3) problems with hospital facilities. Conclusion: The most common reasons for DAMA in Sina educational and medical center were problems related to the patient.

Discharge of psychiatric patients against psychiatrist's advice.

Background: Discharge from the hospital against the doctor’s advice and refusal of receiving treatment is one of the significant issues at the time of hospitalization, which is especially crucial in relation to psychiatric patients. It can exacerbate the disorder and the subsequent complications and increase further hospital admissions. The present study was designed to evaluate the causes of discharge from the hospital and the refusal of receiving treatment against medical advice in hospitalized patients in Iran Psychiatric Hospital. Methods: The present study was a descriptive cross-sectional study. One hundred patients hospitalized in Iran Psychiatric Hospital discharged with personal consent against medical advice from July to December 2018 were studied. Two methods were used for assessment; the fulfillment of a routine ministry-approved checklist by the dischargers themselves and the face-to-face interview with both the patient and discharger based on a researcher-made checklist. Cohen’s Kappa coefficient was used to assess the agreement of the answers of patients to both routine ministry-approved and researcher-made checklists by SPSS software version 16.0 with an overall accuracy of 95%. Results: Based on the results extracted from the researcher-made checklist, 43 (43%) of the discharges were generally based on patient-related factors. The personal insistence to discharge by the patient was cited as the main reason for discharge. Cohen’s Kappa coefficient showed no significant agreement between the patient’s answers to the interview and what they have previously filled in the routine ministry-approved checklist. More specifically, the measure of agreement for answers of patients to questions in the standard checklist and the questions asked by the interviewer was 0.078 (p=0.167). Conclusion: From the results of this study, it can be concluded that the face-to-face interview based on the researcher-made checklist can more effectively determine the reasons for discharge of patients due to the accuracy of the interview.

Trends in inpatient discharges with drug or alcohol admission diagnoses to a skilled nursing facility among older adults, New York City 2008\u20132014

BackgroundRecent research shows an increase in drug and alcohol-related hospitalizations in the USA, especially among older adults. However, no study examines trends in discharges to a skilled nursing facility (SNF) after a drug or alcohol-related hospitalization. Older adults are more likely to need post-hospital care in a SNF after a hospitalization due to an increased presence of chronic diseases and functional limitations. Therefore, the objective of this study was to estimate trends in drug or alcohol-related hospitalizations with discharge to a SNF among adults age 55 and older.MethodsWe analyzed data from New York State’s Statewide Planning and Research Cooperative System to calculate the number of cannabis, cocaine, opioid, and alcohol-related hospitalizations in New York City that resulted in discharge to a SNF from 2008 to 2014 among adults age 55 and older. Using New York City population estimates modified from US Census Bureau, we calculated age-specific rates per 100,000 adults. Trend tests were estimated using joinpoint regressions to calculate annual percentage change (APC) with 95% confidence intervals (CI) and stratified by adults age 55–64 and adults age 65 and older.ResultsDuring the study period, among adults age 55–64, there were significant increases in cocaine, cannabis, and opioid-related hospitalizations that resulted in discharge to a SNF. For adults ≥ 65 years, there were sharp increases across all substances with larger increases in opioids (APC of 10.66%) compared to adults 55–64 (APC of 6.49%). For both age groups and among the four substances, alcohol-related hospitalizations were the leading cause of discharge to a SNF.ConclusionsWe found an increase in hospital discharges to SNFs for patients age 55 and older admitted with alcohol or drug-related diagnoses. Post-acute and long-term care settings should prepare to care for an increase in older patients with substance use disorders by integrating a range of harm reduction interventions into their care settings.

Evaluation of Lacrimal Drainage Function in the Anophthalmic Socket by Dacryoscintigraphy.

To investigate whether impaired lacrimal pump function is a possible cause of discharge in patients wearing an artificial eye compared with the remaining healthy eye. Consecutive patients wearing unilateral ocular prosthesis for ≥6 months were included in this retrospective study. Excluded were any deformities of eyelids or nasal passage, socket complications such as entropion, ectropion, ptosis, infection, pyogenic granuloma, contracted socket, obstruction of nasolacrimal duct diagnosed with lacrimal irrigation and a difference greater than 2 mm in terms of protrusion between two eyes detected by Hertel exophthalmometry. Patients were asked to score the levels of tearing and mucopurulent discharge between 0 and 5 to assess lacrimal drainage function subjectively. Furthermore, dacryoscintigraphy was performed to assess the functional status of the lacrimal system objectively. Included were 32 subjects (12 females, 20 males; aged 32.94 ± 17.62, range 13-78). Mean duration of prosthetic wearing 26.41 ± 21.30 (6-72) months. The mean subjective scores of tearing and mucopurulent discharge were 1.56 ± 1.67 and 1.94 ± 1.63, respectively. The rate of functional stenosis was significantly higher in the anophthalmic socket side as compared to the healthy side (P = 0.002). The rates of a presac, preduct, and intraduct obstruction was notes as n = 9, n = 10, n = 1 and n = 0, n = 6, n = 2 in the anophthalmic side and the companion eye, respectively (P = 0.021). Compared to paired healthy eyes, the ocular prosthesis exhibited significantly higher rates of functional lacrimal duct obstruction, especially at the presac level. The alterations in orbital volume and tear film composition in addition to reduced corneal reflex blinking may lead to the failure of lacrimal pump function in artificial eyes.

Charged with Discharge: A Case-based Review of Nipple Discharge Using the American College of Radiology's Appropriateness Guidelines.

Nipple discharge, a relatively common presenting symptom for women of all ages, may be due to both benign and malignant conditions. Men can also present with nipple discharge, and when they do, they have a higher likelihood of malignancy than women. Radiologists vary in their evaluation of patients with nipple discharge, although the American College of Radiology practice guidelines for nipple discharge provides data-driven appropriate algorithms. In patients with physiologic discharge, imaging is not typically indicated. For those with pathologic nipple discharge, imaging typically starts with diagnostic mammography and retroareolar ultrasound for women over 40 years of age, diagnostic mammogram or ultrasound for women aged 30-39 years, and ultrasound for women younger than 30 years. Finally, contrast-enhanced breast MRI or galactography are usually reserved for identifying the cause of discharge when initial imaging with mammography and ultrasound is unrevealing.

\u03b2-blockers after myocardial infarction and 1-year clinical outcome \u2013 a retrospective study

BackgroundLong term β-blocker therapy after myocardial infarction (MI) reduces mortality and recurrent MI but evidence for this treatment predates contemporary acute coronary care. β-blocker treatment is a key quality of care indicator in the Swedish national quality register for acute coronary care, Riks-HIA. Between 2011 and 2015 a declining number of MI-patients discharged with a β-blocker from the coronary care unit (CCU) at Helsingborg and other hospitals was reported. This retrospective observational study aimed to investigate the causes for discharge without a β-blocker and relate it to outcome, compared to patients discharged with a β-blocker.MethodsMI-patients registered in Riks-HIA discharged without β-blocker during 2011–2015 (no-β-group) and a control group (β-group) comprised of patients discharged with β-blocker treatment between January 1 to December 31, 2013, were matched by RIKS-HIA criteria for β-blocker use. Clinical characteristics, date of death, readmission for MI, other cardiovascular events were collected from Riks-HIA and medical records.ResultsThe no-β-group included 141 patients, where 65.2% had a justified reason for non-β-blocker use. The β-group included 206 patients. There was no difference in cardiovascular risk factor profile. There were a trend towards a higher number of readmissions for MI in the no-β-group was (n = 8 (5.7%) vs n = 2 (1.0%), p = 0.02), but not mortality (6 (4.3%) vs 2 (1.0%), p = 0.07) and combined readmission for angina pectoris, heart failure, arrhythmias or stroke/TIA (n = 23 (16.3%) vs n = 25 (12.1%), p = 0.27).ConclusionA majority of the patients in the no-β-group had a justified absence of a β-blocker. β-blocker treatment post-MI showed a trend towards fewer readmissions for MI. But important quality information is lacking to make a firm conclusion of the effect on outcome.

Evaluation and management of pathological nipple discharges without using intraductal imaging methods.

The most common cause of pathological nipple discharge (PND) is single papilloma, which is a benign intraductal lesion (BIL). However, underlying malign (MIL) or high-risk intraductal lesions (HIL) should be considered during examination. To reveal the value of conventional imaging methods (CIM), discharge characteristics, and cytology in lack of intraductal imaging methods to detect intraductal lesions (IL) and MIL that cause PND. We compared the pathological findings with the characteristics of discharge, CIM, and cytology findings of the patients who admitted to our clinic with nipple discharge and underwent duct excision (n = 111). IL were detected in 69 (62.2%) patients as BIL (n = 31), HIL (n = 23), and MIL (n = 15). Most of the IL was observed with bloody, serosanguineous, and serous discharges (83.3%, 76.2%, and 69.2%, respectively). The sensitivities of ultrasonography, MRI, and cytology in detecting IL were found to be 50.7%, 42.6%, and 74.1%, while their specificities were found to be 73.8%, 88.2%, and 48.6%, respectively. None of the CIM was sufficient to detect MIL in 5 (33.3%) patients. The appearance of red blood cells detailed in cytology was significantly related to IL (p < 0.01), whereas the presence of inflammatory cells was related to ductal ectasia and periductal mastitis (p < 0.001). Although patients' physical examinations, CIM, and cytology findings were normal, duct excision procedures should be applied to exclude MIL or HIL, which can be a cause of discharge in case of suspicious color. The details in cytology reports have a role in increasing the value of cytology.

Potential vaginal probiotics: safety, tolerability and preliminary effectiveness.

Vaginal discharge is one of the common reasons for gynaecologist consultation, as bacterial vaginosis and candidiasis are the main causes of discharge. These patients frequently experience numerous problems due to recurrent infections, side effects and drug resistance therefore alternative drugs are needed. Our primary aim was to evaluate safety and tolerability of the potentially probiotic Lactobacillus crispatus strains in volunteer women considering themselves healthy. We also monitored the effects of these strains on vaginal health parameters and lactobacilli counts in vagina and intestine. Forty women were recruited into trial. Absence of chronic diseases was confirmed by questionnaire and blood analysis at screening visit. In randomised double-blind placebo-controlled crossover study the eligible participants were randomly allocated to one of four groups and had to consume one of the two study products (Pro I or Pro II) - a capsule containing 3 strains, 109 cfu per strain, or placebo for 1 week. Treatment period was followed by 2-week washout period and continued with second treatment and washout period. Individuals receiving firstly probiotic, received later placebo and vice versa. Blood, vaginal and faecal samples were collected, and self-reported questionnaires were applied. Thirty subjects completed the trial. The probiotic capsules were well-tolerated. The Pro II intake resulted in a significant decrease in Nugent score (from median 3.0 to 2.0, mean 3.9 to 2.6, P=0.002) and reduction in Gardnerella vaginalis counts (log10 3.57 to 2.38; P=0.027). Reduction of total vaginal bacterial counts was revealed in Pro I group (log10 7.99 to 7.72; P=0.048). In conclusion, the selected vaginal L. crispatus strains are well tolerable and Pro II mixture is prospectively effective in reducing Nugent score and vaginal counts of G. vaginalis. Therefore, these strains seem to be promising candidates for development of novel evidence-based well-focused probiotics to target female urogenital tract disorders.

Prospects for improving legislation about causes for discharge from punishment for pregnant women and women with children under three years of age

Prospects for improving legislation about causes for discharge from punishment for pregnant women and women with children under three years of age

Case management program for complex chronic patients with mental health disorders

Introduction: Chronic Complex Patients have been a priority for National Health Systems recently. A care program for Complex Chronic Patients with Mental Health Disorders (CCP-MHD) was developed in MutuaTerrassa in 2013. The goal of this program was to take care of patients with specific diagnosis and a particular social and clinical setting, giving them an integrated, coordinated, proactive, efficient and adapted attention. Goals: Assess the impact of this care program for CCP- MHD in preventing unplanned hospital admissions. Description: In 2013 a care program for the CCP-MH was designed and carried out a year later throughout the territory depending on the Community Hospital. The goal was to treat patients with at least one of the following criteria of complexity: a) 2 or more hospital admissions in the last year b) Individual Support Program discharge (ISP) c) one clinical criteria of poor prognosis according to the medical team (poor compliance of medication, absenteeism from scheduled appointments, insufficient family support or being under multiple medications). The multidisciplinary team chooses the patients, defines their Individualized Therapeutic Plan (ITP) and labels their medical record to be seen by all professionals. A nurse case manager follows up all patients and is in charge of coordinating their multidisciplinary attention with defined care routes and performing patients and family visits follow-ups, home visits and multiple phone calls to patients. Results: In June 2014, the CCP-MHD program was launched. 45 patients have been included so far: 20 male and 25 female, mean age 44.7 and 48.5 respectively. Patients were classified according to their diagnosis: schizophrenic disorders (n = 29), borderline personality (n = 7), bipolar (n = 7), schizotypal (n = 1) and recurrent depressive (n = 1). Poor compliment of treatment was the first cause to be included (n=18), poor family support (n=11), emergency hospital admissions in the last months (n=8, mean: 2.6), absenteeism to scheduled appointments (n=5) and clinical instability after hospital discharge (n=3). From June 2014 to December 2015, 14 out of 45 patients were discharged from the program; mean time of assistance was 301 days. Among the causes of discharge are clinical improvement (n=7), being accepted in a different care unit (n=5), prison admission (n=1) and death (n=1). Eight patients were included for having 2 or more emergency admissions, with a total of 21 hospital admissions. Four of they were discharged after 211 days and there were only 2 admissions during follow-up. Ten patients who had had 1 emergency admission along the previous year, with a total of 10 hospital admissions, presented 2 re-admissions and 27 patients admitted in the program for other reasons had no urgent hospital admission during follow-up. Conclusion and impact: The care program for Complex Chronic Patients with Mental Health Disorders in this Community Hospital has fostered better control and management of the most fragile patients. This program has reduced significantly the number of readmissions. The nurse case manager has optimized the resources and the possibilities of each patient.