'A Great Stride Forward': The Post-Discharge Re-establishment Order (PC 7633) of 1 October 1941

2010 ◽  
Vol 23 (2) ◽  
pp. 207-232
Author(s):  
Peter Neary
Keyword(s):  
Post Discharge ◽  
Great Stride

Post Discharge Clinically Overt Venous Thromboembolism in Orthopaedic Surgery Patients with Negative Venography -an Overview Analysis

1996 ◽  
Vol 76 (06) ◽  
pp. 0887-0892 ◽  
Author(s):  
Serena Ricotta ◽  
Alfonso lorio ◽  
Pasquale Parise ◽  
Giuseppe G Nenci ◽  
Giancarlo Agnelli
Keyword(s):  
Venous Thromboembolism ◽  
Orthopaedic Surgery ◽  
Diagnostic Methods ◽  
Future Research ◽  
Post Discharge ◽  
Pharmacological Prophylaxis ◽  
Vein Thrombosis ◽  
Overview Analysis ◽  
Major Orthopaedic Surgery

SummaryA high incidence of post-discharge venous thromboembolism in orthopaedic surgery patients has been recently reported drawing further attention to the unresolved issue of the optimal duration of the pharmacological prophylaxis. We performed an overview analysis in order to evaluate the incidence of late occurring clinically overt venous thromboembolism in major orthopaedic surgery patients discharged from the hospital with a negative venography and without further pharmacological prophylaxis. We selected the studies published from January 1974 to December 1995 on the prophylaxis of venous thromboembolism after major orthopaedic surgery fulfilling the following criteria: 1) adoption of pharmacological prophylaxis, 2) performing of a bilateral venography before discharge, 3) interruption of pharmacological prophylaxis at discharge in patients with negative venography, and 4) post-discharge follow-up of the patients for at least four weeks. Out of 31 identified studies, 13 fulfilled the overview criteria. The total number of evaluated patients was 4120. An adequate venography was obtained in 3469 patients (84.1%). In the 2361 patients with negative venography (68.1%), 30 episodes of symptomatic venous thromboembolism after hospital discharge were reported with a resulting cumulative incidence of 1.27% (95% C.I. 0.82-1.72) and a weighted mean incidence of 1.52% (95% C.I. 1.05-1.95). Six cases of pulmonary embolism were reported. Our overview showed a low incidence of clinically overt venous thromboembolism at follow-up in major orthopaedic surgery patients discharged with negative venography. Extending pharmacological prophylaxis in these patients does not appear to be justified. Venous thrombi leading to hospital re-admission are likely to be present but asymptomatic at the time of discharge. Future research should be directed toward improving the accuracy of non invasive diagnostic methods in order to replace venography in the screening of asymptomatic post-operative deep vein thrombosis.

Serum Magnesium Levels in Exacerbation of COPD: A Single Centre Prospective Study from Kashmir, India.

JMS SKIMS ◽  
2010 ◽  
Vol 13 (1) ◽  
pp. 15-19
Author(s):  
Bashir Ahmed Shah ◽  
Muzafar Ahmed Naik ◽  
Sajjad Rajab ◽  
Syed Muddasar ◽  
Ghulam Nabi Dhobi ◽  
...  
Keyword(s):  
Acute Exacerbation ◽  
Serum Magnesium ◽  
Stage Iii ◽  
Advanced Stage ◽  
Copd Exacerbation ◽  
Post Discharge ◽  
Duration Of Symptoms ◽  
Copd Patients ◽  
Exacerbation Of Copd ◽  
Time Of Admission

Objective: To study the significance of serum magnesium levels during COPD exacerbation and stability.Materials & Methods: The patient population consisted of all patients of COPD admitted as acute exacerbation as defined by the Anthonisens criteria, from June 2006 to may 2008. Same patients one month post discharge presenting to the OPD for routine check up as stable COPD served as controls. Results: A total number of 77 patients of COPD presenting as acute exacerbation were included in the study. The incidence of Hypomagnesaemia was 33.8% at admission; 5% at discharge and 4% at one month of post discharge in COPD patients. The mean serum magnesium levels were significantly lower in cases than controls (1.88±0.67mg/ dl V/S 2.3±0.36mg/dl; p<0.0001). Also, hypomagnesemia was present in higher number of cases (22/77, 33.8%) compared to controls, 3/75, 4.0%; (p<0.0001). Patients of COPD with acute exacerbation and hypomagnesemia, had longer duration of symptoms and had advanced stage III of COPD (p<0.001); and had raised mean corpuscle volume (p<0.045) and longer hospital stay (p<0.008).  Conclusion: We conclude COPD exacerbation is associated with hypomagnesemia. The duration of symptoms of more than 8 days, advanced stage of COPD (stage III) and raised MCV were associated with hypomagnesemia. We recommend to monitor serum magnesium levels in COPD patients with acute exacerbation at the time of admission and during their stay in the hospital.J Med Sci.2010;13(1);15-19

Baby Steps: A Post-Discharge Home Visiting Program By Neonatology Fellows

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 489A-489A
Author(s):  
Janice E. Hobbs ◽  
Jacky M. Jennings ◽  
Megan Tschudy ◽  
Brenda Hussey-Gardner ◽  
Renee Boss
Keyword(s):  
Home Visiting ◽  
Post Discharge ◽  
Discharge Home ◽  
Home Visiting Program

Post-Hospital Syndrome (PHS) and Potentially Preventable Hospitalizations(PPH) in Adults. MonashWatch adult cohort patient telehealth journeys (Preprint)

2018 ◽  
Author(s):  
Associate Professor Martin ◽  
Narelle Hinckley ◽  
Keith Stockman ◽  
Donadl Campbell
Keyword(s):  
Adverse Outcomes ◽  
Phone Call ◽  
Post Discharge ◽  
Patient Journey ◽  
Preventable Hospitalizations ◽  
Acute Admission ◽  
Avoidable Hospitalizations ◽  
Self Rated Health ◽  
Phone Calls ◽  
Potentially Preventable Hospitalizations

BACKGROUND Monash Watch (MW) aims to reduce avoidable hospitalizations in a cohort above a risk ‘threshold’ identified by HealthLinks Chronic Care (HLCC) algorithms using personal, diagnostic, and service data, excluding surgical and psychiatric admissions. MW conducted regular patient monitoring through outbound phone calls using the Patient Journey Record System (PaJR). PaJR alerts are intended to act as a self-reported barometer of health perceptions with more alerts per call indicating greater risk of Potentially Preventable Hospitalizations (PPH) and Post Hospital Syndrome (PHS). Most knowledge of PPH and PHS occurs at a macro-level with little understanding of fine-grained dynamics. OBJECTIVE To describe patterns of self-reported concerns and self-rated health 10 days before and after acute hospital admission in the telehealth intervention cohort of MonashWatch in the context of addressing PPH and PHS. METHODS Participants: 173 who had an acute admission of the of the 232 HLCC cohort with predicted 3+ admissions/year, in MW service arm for >40 days. Measures: Self-reported health and health care status in 764 MW phone call records which were classified into Total Alerts (all concerns - self-reported) and Red Alerts (concerns judged to be higher risk of adverse outcomes/admissions -acute medical and illness symptoms). Acute (non-surgical) admissions from Victorian Admitted Episode database. Analysis: Descriptive Timeseries homogeneity metrics using XLSTAT. RESULTS Self-reported problems (Total Alerts) statistically shifted to a higher level 3 days before an acute admission and stayed at a high level for the 10 days post discharge; reported acute medical and illness symptoms (Red Alerts) increased 1 day prior to admission and but remained at a higher level than before admission. Symptoms of concern did not change before admission or after discharge. Self-rated health and feeling depressed were reported to worsen 5 days post discharge. Patients reported more medication changes up to 2 days before acute admission. CONCLUSIONS These descriptive findings in a cohort of high risk individuals suggest a prehospital phase of what is termed PHS, which persisted on discharge and possibly worsened 5 days after discharge with worse self-rated health and depressive symptoms. Further research is needed. The role and place of community and hospital in such a cohort needs further investigation and research into PPH and PHS.

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