Browsing by Author "Russ, Jason"

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    Abdominal Pain at an Altitude
    (Elsevier, 2022-04) Russ, Jason; Kara, Areeba; Medicine, School of Medicine
    A 29-year-old man presented for evaluation to the Emergency Department with 3 days of worsening abdominal pain. The pain was described as severe and was located in the left lower quadrant without radiation. It improved with assuming the supine position and was exacerbated by movement. On the day of presentation, he developed nausea, vomiting, and diarrhea. He was traveling in Peru when the pain began and thought it was related to something he ate, so he did not initially seek medical attention. Upon returning to the United States, he sought evaluation as his symptoms escalated. He had no known chronic medical problems and was not taking any prescription medications.
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    Discharges against medical advice: time to take another look. A retrospective review of discharges against medical advice focused on prevention
    (Taylor & Francis, 2023) Jaydev, Fnu; Gavin, Warren; Russ, Jason; Holmes, Emily; Kumar, Vinod; Sadowski, Joshua; Kara, Areeba; Medicine, School of Medicine
    Background Discharges against medical advice (DAMA) increase the risk of death. Methods We retrieved DAMA from five hospitals within a large health system and reviewed 10% of DAMA from the academic site between 2016 and 2021. Results DAMA increased at the onset of the pandemic. Patients who discharged AMA multiple times accounted for a third of all DAMA. Detailed review was completed for 278 patients who discharged AMA from the academic site. In this sample, women comprised 52% of those who discharged AMA multiple times. Relative to the proportion of all discharges from the academic site during the study period, Black patients were overrepresented among DAMA (21% vs. 34%, p < .05). Patients with multiple AMA discharges were younger, more likely to be unmarried, or have substance use disorders (SUD) than those who discharged AMA once. The most common reason for requesting premature discharge noted in n = 77, 28% of instances was related to patient obligations outside the hospital. Hospital policies and procedures contributed in n = 29, 10% of instances. Reasons for requesting premature discharge and documentation of key safety processes were similar by gender and race however the sample may be underpowered to detect differences. Capacity was evaluated in 109 (39%). Among those who consumed alcohol (n = 81 (29%)) or had SUDs (n = 112 (40%)), information on the amount or timing of last use was missing in n = 39 (48%) and n = 74 (66%), respectively. Critical tools to manage illness were provided in 45 (16%) of DAMA reviewed. Conclusions Drivers of AMA discharge may differ by AMA discharge frequency. Recognition of the common reasons for requesting premature discharge may help destigmatize AMA discharges and also identifies early assessments by social work colleagues as an important prevention strategy. Opportunities also exist in anticipating and preventing withdrawal symptoms and in revising hospital practices that contribute to DAMA.