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China's Mental Health Law Reform
Published in Bo Chen, Mental Health Law in China, 2023
For those service users detained on the basis of posing a risk to others, a mental health facility may decide when discharge is appropriate; whilst the procedure has to be completed by the service user or, when service users are ‘unable’ to complete hospital discharge procedures, the guardians.111Problematically, the MHL is silent on the determination of such ability. If a service user under detention for treatment is automatically deemed unable to make any treatment decision, their liberty is left to their guardian to decide. This is the case even when the mental health facility believes he or she should be discharged.112This provision may cause considerable problems in practice.
Care
Published in Henry J. Woodford, Essential Geriatrics, 2022
The standard aim of rehabilitation is to reduce the impact of physical or cognitive illness. This will mean different things to different individuals. Ideally, the person will return to their former functional level. If this cannot be done, then new techniques or strategies may be adopted to circumvent the problems. This may include the adaptation of the person's living environment. Common sense and lateral thinking are often more important than scientific knowledge to solve problems for any individual. Rehabilitation should begin as soon as possible in the course of an illness to prevent further physical deterioration (i.e. deconditioning). For this reason, rehabilitation services should be integrated with acute care but may continue beyond hospital discharge, including within the person's own home. It is an active process and never a period of ‘bed rest' or ‘convalescence'. It does not only occur in dedicated rehabilitation units (e.g. wards within acute hospital sites, based in community hospitals or care homes). Nobody should be ‘awaiting rehab', therapy input should be available in all departments and unnecessary ward moves avoided to reduce the risk of developing delirium.
Short-term rehabilitation after an acute coronary event
Published in K Sarat Chandra, AJ Swamy, Acute Coronary Syndromes, 2020
Manish Bansal, Rajeev Agarwala
Given this encouraging evidence, there has been an increasing emphasis in the guidelines on formal cardiac rehabilitation for all patients with ACS. Referral to a structured cardiac rehabilitation programme is assigned class I recommendation in the latest American Heart Association (AHA)/American College of Cardiology (ACC) guidelines for management of both ST-segment elevation myocardial infraction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) [4,5]. Similarly, the European Society of Cardiology (ESC) guidelines provide class I and class IIa recommendations, respectively, for referral to cardiac rehabilitation for patients with STEMI and NSTEMI [6,7]. It is further recommended that the referral should take place either prior to hospital discharge or during the first follow-up office visit. For low-risk patients, a home-based cardiac rehabilitation programme is recommended as a reasonable alternative to a supervised, centre-based programme.
Readmissions, costs, and duration to subsequent outpatient visit after hospital discharge among Medicaid beneficiaries utilizing oral versus long-acting injectable antipsychotics in bipolar disorder or schizophrenia
Published in Current Medical Research and Opinion, 2022
Laura M. Tidmore, Shellie L. Keast, Heidi C. Waters, Kristin L. Pareja, Terry Cothran, Grant H. Skrepnek
Among the subgroup of 468 members incurring an inpatient admission or ED visit and having a psychiatry-related outpatient visit afterward, the average age was 41.2 ± 12.1 years, 75.0% were female, 32.1% involved claims with diagnoses codes for both bipolar disorder and schizophrenia, and 13.5% utilized LAIs (Table 3). The mean duration to subsequent outpatient visit after hospital discharge was approximately 2.5 months, at 83.2 ± 94.7 days. Over one-third (37.2%) incurred multiple hospitalizations. No statistical difference was observed in the univariate analysis of LAI versus OAP groups according to age, race, rural residence, or health resource utilization (p > .05). Members utilizing LAIs in this subgroup were associated with a lower mean comorbidity index (D-CCILAI = 1.1 ± 1.7 versus D-CCIOAP 1.6 ± 2.2, p < .05) and a higher proportion of both bipolar disorder and schizophrenia diagnoses (60.3 vs. 27.7%, p < .001). Table 3 presents full descriptive statistics of the acute care subgroup.
Managing hospitalized patients with a COPD exacerbation: the role of hospitalists and the multidisciplinary team
Published in Postgraduate Medicine, 2022
Alpesh N. Amin, Sharon Cornelison, J. Andrew Woods, Nicola A. Hanania
Self-management action plans and medication reconciliation are important for patients with COPD who are transitioning from the hospital setting [80]. Action plans may encourage self-management and use of appropriate treatments among patients with COPD [81]. The importance of maintenance treatments for long-term care should be emphasized, and the use of emergency medications (eg, short-acting bronchodilators, antibiotics, and oral corticosteroids) in case of another exacerbation. The COPD action plan should instruct patients to contact their case manager, hospitalist, or primary care physician (PCP) immediately if symptoms return or worsen to guarantee that the appropriate measures are taken and to decrease the risk of hospitalization. Manual or automated hospital discharge checklists may enable the health care team to communicate appropriate next steps with patients, caregivers, and outpatient health care providers. A predischarge COPD algorithm is proposed in Figure 2.
Importance of diabetes management during the COVID-19 pandemic
Published in Postgraduate Medicine, 2021
A recent study from Wuhan [13] showed that nearly 70% of patients with type 2 diabetes and laboratory-confirmed COVID-19 had suboptimal blood glucose control. The authors suggested the following as potential reasons for this: (1) a relative shortage of endocrinologists, leading to delay or absence of professional advice; (2) lack of provision of dietary advice; (3) inability to exercise; 4) anxiety from COVID-19 inducing hyperglycemia; (5) glucose metabolism disorders arising from pancreatic tissue being a potential target of viral infection. Further, the adverse effect of the pandemic manifests in patients living with diabetes delaying seeking care due to concern about contracting COVID-19, leading to missed diagnoses, delays in treatment, and potential undertreatment with poor glucose control [6]. Furthermore, it is now known that the risks of morbidity and mortality for those who survive hospitalization with COVID-19 do not end with hospital discharge, with the serious effects of ‘long-COVID’ or ‘post-COVID syndrome’ becoming more apparent. Results of a recent study in England revealed that of 47,780 people who were discharged from hospital after COVID-19, nearly one-third were readmitted and over 12.3% died after discharge [14]. Rates of diabetes were significantly increased in people with COVID-19, being diagnosed in 4.9% of individuals after discharge – a rate 1.5 times higher than in the matched control group from the general population.