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

Pant, Manish Nath; Jha, Saswat Kumar; Shrestha, Sauravi

doi:10.31729/jnma.5411

Cited by 3 publications

(4 citation statements)

References 10 publications

(28 reference statements)

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“…Although LAMA is a global phenomenon, it is quite high in Nepal and India and the most common reasons were financial limitations and anticipated poor prognosis. 23,24 There was only single in-hospital mortality in our study. A likely explanation for this finding is that patients often opt for LAMA in cases with anticipated poor prognosis.…”

Section: Discussionmentioning

confidence: 54%

Prognostic Value of the Neutrophil-to-Lymphocyte Ratio in Acute Pesticide Poisoning

Gauli,

Adhikari,

Pandey

et al. 2023

JCMC

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Background: Neutrophil to Lymphocyte ratio is a marker of oxidative stress and inflammation. It has gained increased attention in last few years for its prognostic value in several disease subsets. However, there is limited data about its potential role in setting of pesticide poisoning. This study aimed to explore the predictive value of NLR for severe clinical outcome in patients with acute pesticide poisoning. Methods: An observational study was done at medical ICU of Chitwan Medical College from October 2022 to March 2023 among 62 patients of acute pesticide poisoning. The primary endpoint was severe clinical outcome which was defined as a composite of requirement of mechanical ventilation, need for vasopressors, new renal replacement therapy, or in- hospital mortality. The study patients were divided based on patients with severe clinical outcome(n=13) and those without (n=49) for analysis. Results: The NLR ratio at hospital admission in patients with severe clinical outcome and those without were 2.8(1.9-5.9) and 3.3(2.6-11.6) respectively, higher in severe clinical outcome group but the difference was not statistically significant. The NLR had an area under receiver operating characteristics curve of 0.631 (95% confidence interval [CI], 0.472 to 0.790). NLR at hospital admission with a cut-off value ≥ 2.68 predicted severe clinical outcome with 76.9% sensitivity and 55% specificity. Conclusions: The NLR at hospital admission had sub-optimal prediction ability for severe clinical outcome in this study setting. Thus, this cannot be used solely for early identification of patients at risk of severe clinical outcome in acute pesticide poisoning.

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Section: Discussionmentioning

confidence: 54%

Prognostic Value of the Neutrophil-to-Lymphocyte Ratio in Acute Pesticide Poisoning

Gauli,

Adhikari,

Pandey

et al. 2023

JCMC

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“…Recent Nepalese studies from the ICU and emergency departments have reported the prevalence of LAMA to be 14.5% and 5.96% respectively. [10][11][12][13][14][15] Though our study excluded patients from the emergency department, the rate of LAMA in our study was comparable to it but less than a similar Nepalese study carried out in the ICU. The rate of neurosurgical LAMA-related discharge was higher in our study when compared to other in-patient departments across a wide range of studies.…”

Section: Discussionmentioning

confidence: 59%

Factors predicting leaving against medical advice in Neurosurgery: A prospective observational study from Nepal

Sapkota¹,

Karn²,

Neupane

et al. 2022

Nep J Neurosci

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Introduction: Though leave against medical advice (LAMA) is a common healthcare problem in low-income countries, there is paucity of studies exploring this aspect of care from Nepal. Our study aims to find out the prevalence of LAMA, its reasons and any differences that exist among patients in neurosurgery versus other specialties. Methods: A prospective, cross-sectional study was carried out among patients discharged against medical advice from September 2020 through February 2021 at Gandaki Medical College, Pokhara. Results: A total of 150 patients were included, 29.3% (n=44) from neurosurgery and 70.7% (n=106) from other departments. The overall rate of LAMA was 5.68%; 16.73% from neurosurgical service. In the neurosurgical cohort, mean age was 61.41±18.72 years and majority of patients were males (65.9%). Most patients were Hindu by religion (97.7%), illiterate (59.1%), married (93.2%), with history of substance abuse (63.6%), admitted directly to the ICU (88.6%) and lacked insurance (79.5%). Financial insufficiency (40.9%) followed by expected poor prognosis of the disease (25%) were reported as major reasons for LAMA. Statistically significant differences (p<0.05) were observed in neurosurgical patients when compared to patients from other departments in terms of age, gender, educational status, history of substance abuse, place of in-patient admission, treatment modality recommended, status of mechanical ventilation and insurance status. In-patient admission to the ICU and proposal of surgical intervention were predictive of LAMA among neurosurgical patients. Conclusions: The rate of LAMA was high in neurosurgery. Educating general public about neurosurgical care and widespread implementation of health insurance seem important policy-implications.

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“…It is also most likely to admit patients with chronic, serious illnesses requiring prolonged hospitalization and advanced cases which were referred from other hospitals in rural and sub-urban areas. Previous studies have postulated that these patients often refuse to stay in the hospital for a long time 3 as do patients presenting with non-specific complaints such as chest pain, headache, nausea and vomiting who require extensive workup in an internal medicine unit to rule out more serious conditions [14][15][16] .…”

Section: Discussionmentioning

confidence: 99%

“…LAMA is associated with increased litigation risk and poses a dilemmatic ethical and legal problem for clinicians. It is a big challenge in developing countries like Pakistan where problems of staff shortage, lack of insurance and centralization of healthcare services predominate the clinical scenario 3 .…”

Section: Introductionmentioning

confidence: 99%

Factors Predicting Leaving Against Medical Advice in Neurosurgery: A Prospective Observational Study

Abidin¹,

Buksh²,

Ti³

2023

PJMHS

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Introduction: The decision of a patient for leaving the hospital against medical advice (AMA)affects the patient management adversely by increasing morbidity, mortality and escalates the cost of treatment. Objectives: The main objective of the study is to find the factors predicting leaving against medical advice in neurosurgery. Material and methods: This cross-sectional study was conducted in King Edward Medical University during February 2022 to July 2022. Data was collected with the permission of ethical committee of hospital. Data on gender, age, marital status, day and time of admission and discharge, duration of stay, primary specialty for care, reason for leaving against medical advice, prior history of hospitalizations, mode of payment, medication and follow-up advice at time of LAMA, revisit to the hospital and development of morbidity at follow-up was collected from patient charts and the LAMA form. Results: Data was collected from 300 patients of both genders. There were 142 male and 158 female patients from age range 0 to 75 years. During the same period, 263 patients were discharged from the neurosurgical service and the rate of LAMA in the neurosurgery department was calculated to be 16.73%. Practical implication: This study will be helpful in neurology department of the hospital and used for the betterment of results. Conclusion: It is concluded that leaving AMA rates are high in neurological in-patients. Low income and level of health literacy were the most common causes of LAMA in this neurosurgical patient population. Keywords: LAMA, Patients, Surgical. Population, AMA, Health

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

Cited by 3 publications

References 10 publications

Prognostic Value of the Neutrophil-to-Lymphocyte Ratio in Acute Pesticide Poisoning

Prognostic Value of the Neutrophil-to-Lymphocyte Ratio in Acute Pesticide Poisoning

Factors predicting leaving against medical advice in Neurosurgery: A prospective observational study from Nepal

Factors Predicting Leaving Against Medical Advice in Neurosurgery: A Prospective Observational Study

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