scholarly journals Analysis of Complaints to a Tertiary Care Pain Clinic Over a Nine-Year Period

2010 ◽  
Vol 15 (1) ◽  
pp. 17-23 ◽  
Author(s):  
Angela Mailis-Gagnon ◽  
Keith Nicholson ◽  
Luis Chaparro
Keyword(s):  
Psychological Factors ◽  
Tertiary Care ◽  
Internal Audit ◽  
Pain Clinic ◽  
Toronto Western Hospital ◽  
Pertinent Literature ◽  
Inappropriate Use ◽  
Western Hospital ◽  
Patient Relations ◽  
Staff Interactions

BACKGROUND: The present study is the result of an internal audit and examines the profiles of complainants and the sources and nature of complaints toward the staff in a tertiary care pain clinic, the Comprehensive Pain Program of the Toronto Western Hospital in Toronto, Ontario.METHODS: All sources of complaints over a nine-year period were reviewed, which included the following: Toronto Western Hospital Patient Relations (PR) records, with a subset of the files qualitatively analyzed in depth regarding the nature of complaints and complainants; complaints that bypassed PR and were addressed directly to the program director against members of the staff; complaints to the College of Physicians and Surgeons of Ontario; and complaints recorded anonymously at rateMDs.com.RESULTS: Although the prevalence of PR complaints was very low (1.73 complaints per 1000 visits), several other sources of complaints were identified. The typical complainant was a Canadian-born woman acting on her behalf or on behalf of a family member. More than one-half of the complaints were directed against the physicians regarding their opinion of psychological factors augmenting the patient’s presentation and/or inappropriate use of opioids. Defensive techniques instituted by the Comprehensive Pain Program staff in reaction to the complaints are discussed, and pertinent literature is reviewed.CONCLUSION: The present study is the first to examine the nature of complaints and complainants from a Canadian pain clinic. Further studies are needed to explore the complex issues of patient and staff interactions, and complaints in the era of ‘patient-centred care’.

Treatment of headache disorders with acupuncture: a 6-year retrospective study

2021 ◽  
pp. 096452842098757
Author(s):  
Javier Mata ◽  
Pilar Sanchís ◽  
Pedro Valentí ◽  
Beatriz Hernández ◽  
Jose Luis Aguilar
Keyword(s):  
Real World ◽  
Tertiary Care ◽  
Group Versus ◽  
Clinical Effectiveness ◽  
Outcome Data ◽  
Pain Clinic ◽  
Number Needed To Treat ◽  
Headache Disorders ◽  
Electronic Health Record Data ◽  
Clinical Benefits

Objective: Existing systematic reviews and meta-analyses indicate that acupuncture has similar clinical effectiveness in the prevention of headache disorders (HDs) as drug therapy, but with fewer side effects. As such, examining acupuncture’s use in a pragmatic, real-world setting would be valuable. The purpose of this study was to compare the effects of acupuncture and prophylactic drug treatment (PDT) on headache frequency in patients with HDs, under real-world clinical conditions. Methods: Retrospective cohort study of patients with HDs referred to a pain clinic, using electronic health record data. Patients continued with tertiary care (treatment of acute headache attacks and lifestyle, meditation, exercise and dietary instructions) with PDT, or received 12 sessions of acupuncture over 3 months, instead of PDT under conditions of tertiary care. The primary outcome data were the number of days with headache per month, and groups were compared at baseline and at the end of the third month of treatment. Results: Data were analysed for 482 patients with HDs. The number of headache days per month decreased by 3.7 (standard deviation (SD) = 2.9) days in the acupuncture group versus 2.9 (SD = 2.3) in the PDT group (p = 0.007). The proportion of responders was 39.5% versus 16.3% (p < 0.001). The number needed to treat was 4 (95% confidence interval = 3–7). Conclusion: Our study has shown that patients with HDs in tertiary care who opted for treatment with acupuncture appeared to receive similar clinical benefits to those that chose PDT, suggesting these treatments may be similarly effective of the prevention of headache in a real-world clinical setting.

AEROBIC BACTERIOLOGICAL PROFILE WITH ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF PUS SAMPLES AT A TERTIARY CARE HOSPITAL IN JAIPUR

2021 ◽  
pp. 65-67
Author(s):  
Hemendra K Sharma ◽  
Niketa Gupta ◽  
Mahesh Yadav ◽  
Aruna Vyas ◽  
Rajni Sharma
Keyword(s):  
Antimicrobial Susceptibility ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Diffusion Method ◽  
Care Hospital ◽  
Susceptibility Pattern ◽  
Gram Positive ◽  
Gram Negative ◽  
Inappropriate Use ◽  
Antimicrobial Susceptibility Pattern

Background: Pyogenic infections can be caused by various microorganisms and may co-exist as poly microbial infections which require antibiotic therapy. The inappropriate use of antibiotics has led to major problems of MDRO's contributing to morbidity and mortality. Even though the bacteriological prole of pus samples in many studies remain the same, antimicrobial susceptibility pattern of these isolates has shown a lot of variation. This study was conducted to assess bacteriological prole of pus samples and their antimicrobial susceptibility pattern Materials and Methods:Aretrospective study was carried out from April to June 2021. 540 pus culture aerobic bacterial isolates were included. The samples were cultured on Blood and MacConkey agar. After aerobic incubation at 37oC for 18-24 hrs, organisms were identied by conventional bacteriology methods as per laboratory protocol and antimicrobial susceptibility was tested by Kirby Bauer disc diffusion method as per CLSI 2020 guideline. Results: Out of 540 pus isolates , 452(83.7%)were gram negative bacili and 88(16.3%) were gram positive cocci Pseudomonas spp. 173(31.9%), was most common gram negative isolate while S.. aureus 66(12.19%) was most common Gram positive isolate. Most of gram negative isolates were susceptible to Imipenem and Polymyxin and gram positive isolates to vancomycin and linezolid . Conclusion: To combat resistance irrational use of antibiotics should be avoided. Also regular surveillance helps in implementing better therapeutic strategies to reduce morbidity and mortality

scholarly journals Study of antimicrobial use in paediatric inpatients in a tertiary care hospital in Ahmedabad, India

2020 ◽  
Vol 8 (1) ◽  
pp. 35
Author(s):  
Hetal N. Jeeyani ◽  
Rutvik H. Parikh ◽  
Sheena Sivanandan ◽  
Harsh J. Muliya ◽  
Shivam N. Badiyani ◽  
...  
Keyword(s):  
Bacterial Resistance ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Care Hospital ◽  
Antimicrobial Drugs ◽  
Prescribing Indicators ◽  
Inappropriate Use ◽  
Increased Risk ◽  
The Mean

Background: Inappropriate use and overuse of antibiotics are important factors leading to increased bacterial resistance apart from increased risk of adverse reactions. The aim of this study was to derive antibiotic use percentage, study its pattern and compare antibiotic prescribing indicators with standard indicators.Methods: This prospective observational study was conducted from 1st August 2018 to 31st July 2019 on paediatric inpatients from 1 month to 14 years. All the relevant data was taken from the case records of patients at the time of discharge. The data included: age, sex, hospital stay, clinical diagnosis and details of antimicrobial treatment.Results: From 989 patients, 85.9% were diagnosed with infectious illness, of which 60.1% had viral and 36.7% had bacterial infection. The use of antimicrobial drugs was 42.7% and antibiotics was 40.4%. The mean number of antibiotics received was 1.13±0.31. 90% patients received single antibiotic. 88.8% drugs were prescribed by generic name and 99% drugs were prescribed from essential drug formulary. 17 different antibiotics were used out of which ceftriaxone (62.5%) was the most commonly used. Groupwise, antibiotic use was cephalosporins (68.4%), penicillin (20.2%), aminoglycosides (4.31%), fluoroquinolones (0.9%) and macrolides (0.22%). The use of higher antibiotics like vancomycin (3.86%) and carbapenems (0.68%) was quite less.Conclusions: The antibiotic use in our hospital was higher than the WHO standard but less as compared to majority of other studies. Use of cephalosporins was more and penicillin was less as compared to other studies. This suggests that there is a need of implementing antibiotic stewardship programs to enhance rational antibiotic prescribing.

scholarly journals Implementation of Pharmacist-driven Antifungal Stewardship Program in A Tertiary Care Hospital

2021 ◽  
Author(s):  
Emre Kara ◽  
Gokhan Metan ◽  
Aygin Bayraktar-Ekincioglu ◽  
Dolunay Gulmez ◽  
Sevtap Arikan-Akdagli ◽  
...  
Keyword(s):  
Antifungal Therapy ◽  
Clinical Pharmacist ◽  
Fungal Infections ◽  
Tertiary Care ◽  
Antifungal Drugs ◽  
Care Hospital ◽  
Antifungal Stewardship ◽  
Inappropriate Use ◽  
Stewardship Program ◽  
Antifungal Use

Objectives: Antifungal stewardship (AFS) is recommended to reduce the inappropriate use of antifungal drugs. In this study, the role of AFS in providing appropriate antifungal therapy was evaluated. Methods: This study included three periods as observation, feedback/education, and daily AFS activities. In observation period, the use of systemic antifungals was evaluated for a baseline measurement of appropriateness. In second period, monthly meetings were organized to provide feedback and education to physicians regarding antifungal therapy and the rate of adherence to the clinical guidelines. In final period, a clinical pharmacist participated in daily ward rounds to evaluate appropriateness of the antifungal therapy. A scoring system for appropriateness was used for comparison between the three periods. Results: Four hundred and eighteen episodes of antifungal therapy were evaluated. Baseline demographics of patients were similar in all three periods for age, gender, and the number of comorbidities. The indications for antifungal use were for prophylaxis in 22.7%, Candida infections in 58.6%, and invasive mould infections in 18.7%. During the third period, 157 (78.9%) recommendations were made and 151 (96.2%) were accepted. The overall appropriateness of antifungal use increased significantly for prophylaxis (30.8%, 17.9%, 46.3%, p=0.046) and treatment of fungal diseases (27.8%, 32.4%, 71.9%, p<0.001) between the first, second and third periods, respectively. A 30-day mortality was not significantly changed between the three periods (19%, 15.6% and 27.5%; p=0.050). Conclusions: Appropriateness in antifungal therapy can be augmented by the integration of an AFS program. A team-based evaluation of fungal infections and assessment of patients by a clinical pharmacist with a therapeutic perspective may help to increase the quality of antifungal therapy.

scholarly journals Pain Characteristics and Demographics of Patients Attending a University-Affiliated Pain Clinic in Toronto, Ontario

2007 ◽  
Vol 12 (2) ◽  
pp. 93-99 ◽  
Author(s):  
Angela Mailis-Gagnon ◽  
Balaji Yegneswaran ◽  
SF Lakha ◽  
Keith Nicholson ◽  
Amanda J Steiman ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Tertiary Care ◽  
Pain Clinic ◽  
Pain Clinics ◽  
Chronic Pain Patients ◽  
Musculoskeletal Problems ◽  
Pain Duration ◽  
Study Population ◽  
Age Range ◽  
Pain Patients

BACKGROUND: Pain clinics tend to see more complex chronic pain patients than primary care settings, but the types of patients seen may differ among practices.OBJECTIVE: The aim of the present observational study was to describe the pain and demographic characteristics of patients attending a university-affiliated tertiary care pain clinic in Toronto, Ontario.METHODS: Data were collected on 1242 consecutive new patients seen over a three-year period at the Comprehensive Pain Program in central Toronto.RESULTS: Musculoskeletal problems affecting large joints and the spine were the predominant cause of pain (more prevalent in women), followed by neuropathic disorders (more prevalent in men) in patients with recognizable physical pathology. The most affected age group was in the 35- to 49-year age range, with a mean pain duration of 7.8 years before the consultation. While 77% of the Comprehensive Pain Program patients had relevant and detectable physical pathology for pain complaints, three-quarters of the overall study population also had significant associated psychological or psychiatric comorbidity. Women, in general, attended the pain clinic in greater numbers and had less apparent physical pathology than men. Finally, less than one in five patients was employed at the time of referral.CONCLUSIONS: The relevance of the data in relation to other pain clinics is discussed, as well as waiting lists and other barriers faced by chronic pain patients, pain practitioners and pain facilities in Ontario and Canada.

Experience with the Toronto Western Hospital Permanent Peritoneal Catheter

1984 ◽  
Vol 4 (2) ◽  
pp. 95-98 ◽  
Author(s):  
Ramesh Khanna ◽  
Sharron Izatt ◽  
Debby Burke ◽  
Raymond Mathews ◽  
Stephen Vas ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Exit Site ◽  
Peritoneal Catheter ◽  
Toronto Western Hospital ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Tenckhoff Catheter ◽  
Western Hospital ◽  
Catheter Tip ◽  
Catheter Failure

Prospective controlled trial with Tenckhoff, Toronto Western Hospital and Goldberg catheter showed a lower incidence of catheter-tip dislodgement from the pelvis with the Toronto Western Hospital catheter. A 1982 retrospective review of experiences, revealed significantly better one and two year catheter survival with the Toronto Western Hospital catheter #2 compared to the straight Tenckhoff catheter inserted at the bed side but not compared to the surgically inserted Tenckhoff catheter. Early dialysate leak was a significant compilation observed with the use of all catheters. Lateral placement of catheters has practically eliminated this complication. Catheter exit site infection now is the major cause of catheter failure.

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