Victoria General Hospital

Victoria, Canada

Victoria General Hospital

Victoria, Canada

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Marcellus L.,University of Victoria | Harrison A.,Victoria General Hospital | Harrison A.,University of British Columbia
Neonatal Network | Year: 2012

Quality improvement (QI) and patient safety are becoming increasingly powerful drivers for health care planning and delivery. In this two-part series, the concept of QI will be introduced and implications for neonatal nursing care will be discussed. Part I reviews trends in the fields of QI and patient safety and introduces how neonatal practitioners are currently taking up QI and patient safety in their practice. Part II, to come, is titled "Using a Plan-Do-Study-Act Process to Introduce a Step-wise Framework for Establishing Oral Feeds in Premature Infants" will present the QI process "in action" by describing a QI project conducted in a Level III NICU on introducing and testing a new process for improving the transition from tube to oral feeding for preterm infants. © 2012 Springer Publishing Company.


Genuis K.,University of Victoria | Pewarchuk J.,Victoria General Hospital | Pewarchuk J.,University of Victoria
Journal of Medical Case Reports | Year: 2014

Introduction: Granulomatosis with polyangiitis poses a significant diagnostic dilemma due its diverse presentations. Seemly isolated sites of disease, such as oral ulcers, may present to physicians working in primary care settings, the emergency room, and subspecialty fields as well as to dentists. Oral presentations are particularly challenging to identify and require a high index of suspicion and a detailed knowledge of the condition in order to diagnose and treat. We detail a case of granulomatosis with polyangiitis presenting as necrotizing gingivitis, one of the first of its kind to be reported. Case presentation: An otherwise healthy 32-year-old, Caucasian woman presented to various physicians with progressive, painful oral ulcers. Following consultations with multiple primary care physicians and subspecialties, an initial diagnosis of severe infectious necrotizing gingivitis was made resulting in combination antibiotic treatment as well as surgical debridement involving extraction of all maxillary and three mandibular teeth. With the discovery of a positive cytoplasmic anti-neutrophil cytoplasmic antibody and a constellation of associated systemic symptoms, our patient was subsequently diagnosed with granulomatosis with polyangiitis. The treatment regimen of rituximab and methylprednisone was chosen in consideration of our patient's desire for future fertility and has been successful in inducing and maintaining remission. Conclusions: Following the case presentation, we review the current literature regarding granulomatosis with polyangiitis presentation, diagnosis and treatment. In discussing features of granulomatosis with polyangiitis presentation, diagnostic tests, and important new treatment options, we seek to enable physicians of all specialties to better recognize and begin appropriate treatment for this complex condition. © 2014 Genuis and Pewarchuk; licensee BioMed Central Ltd.


Dennie J.,Victoria General Hospital | Pillay S.,National Womens Hospital | Watson D.,Townsville Hospital | Grover S.,Royal Childrens Hospital
Fertility and Sterility | Year: 2010

Objective: To describe a novel technique for the acute management of a transverse vaginal septum with hematocolpos. Design: Retrospective case series. Setting: Secondary- and tertiary-care centers in Australia and New Zealand. Patient(s): Three patients with a transverse vaginal septum presenting with pain and a hematocolpos. Intervention(s): Laparoscopic drainage of the hematocolpos. Main Outcome Measure(s): Pain relief until definitive resection of the transverse vaginal septum. Result(s): All patients were free of pain after the procedure. Two patients had a second laparoscopic procedure to drain the hematocolpos which had reaccumulated while awaiting definitive surgery. All three patients have undergone resection of the septum. Conclusion(s): Laparoscopic drainage provides a novel approach to the acute management of a transverse vaginal septum, providing pain relief without compromising the success of definitive surgery which can be performed at a later date. Copyright © 2010 American Society for Reproductive Medicine, Published by Elsevier Inc.


Peeling L.,University of Saskatchewan | Hentschel S.,Victoria General Hospital | Fox R.,University of Alberta | Hall H.,Canadian Spine Society | Fourney D.R.,University of Saskatchewan
Canadian Journal of Surgery | Year: 2010

Background: Intraoperative spinal cord and nerve root monitoring is used to identify an insult to the neural elements with the goal of preventing injury. There are 2 major categories of monitoring: evoked potentials (somatosensory evoked potentials and motor evoked potentials) and electromyography. The availability of intraoperative neuromonitoring and the indications for use vary widely. In this study, we aimed to document the current practices and opinions of Canadian spine surgeons with regards to intraoperative spinal monitoring. Methods: We surveyed members of the Canadian Spine Society about the availability and use of various types of intraoperative neuromonitoring modalities for surgical procedures. Results: We distributed 105 surveys and received 95 responses (90%). Somatosensory evoked potentials were the most commonly available form of intraoperative neuromonitoring, although it was available to only 65.3% of respondents. Surgeons in either full-time or part-time academic practice used monitoring more frequently than those in private practice (p < 0.001), but this association was not based on surgeon preference after controlling for availability. Years of practice and training background (orthopedic or neurosurgical) did not influence the use of monitoring. Canadian spine surgeons overwhelmingly reported that they use intraoperative neuromonitoring to reduce the risk of adverse operative events, rather than because of liability concerns. Most respondents believed that monitoring should be used in the correction of major deformity and scoliosis. Conclusion: The availability of spinal monitoring in Canada is variable. Most surgeons believe that it is an important adjunct to improve patient safety. © 2010 Association médicale canadienne.


Curran S.,Health Elements | Brotto L.A.,University of British Columbia | Fisher H.,Health Elements | Knudson G.,University of British Columbia | Cohen T.,Victoria General Hospital
Journal of Sexual Medicine | Year: 2010

Introduction: Provoked vestibulodynia (PVD) is a distressing genital pain condition affecting 12% of women. Treatment modalities vary and although vestibulectomy has the highest efficacy rates, it is usually not a first-line option. Acupuncture has a long history in the traditional Chinese medicine (TCM) system and operates on the premise that pain results from the blockage or imbalance of important channels. The main principle of treatment is to move Qi and blood to cease genital pain. Aim.: To explore effect sizes and feasibility in a pilot study of acupuncture for women with PVD. Methods.: Eight women with PVD (mean age 30 years) underwent 10 1-hour acupuncture sessions. Specific placement of the needles depended on the woman's individual TCM diagnosis. TCM practitioners made qualitative notes on participants' feedback after each session. Main Outcome Measures.: Self-reported pain (investigator-developed), pain-associated cognitions (Pain Catastrophizing Scale [PCS], Pain Vigilance and Awareness Questionnaire), and sexual response (Female Sexual Function Index) were measured before and after treatment sessions 5 and 10. Qualitative analyses of TCM practitioner notes were performed along with one in-depth case report on the experience of a participant. Results.: A repeated measures analysis of variance revealed significant decreases in pain with manual genital stimulation and helplessness on the PCS. An examination of effect sizes also revealed strong (though nonsignificant) effects for improved ability to have intercourse and sexual desire. Qualitative analyses were overall more positive and revealed an improvement in perceived sexual health, reduced pain, and improved mental well-being in the majority of participants. Conclusions.: Effect sizes and qualitative analyses of practitioner-initiated interviews showed overall positive effects of acupuncture, but there were statistically significant improvements only in pain with manual genital stimulation and helplessness. These findings require replication in a larger, controlled trial before any definitive conclusions on the efficacy of acupuncture for PVD can be made. © 2009 International Society for Sexual Medicine.


Lynch T.,Public Health Agency of Canada | Chong P.,Public Health Agency of Canada | Zhang J.,Public Health Agency of Canada | Hizon R.,Public Health Agency of Canada | And 8 more authors.
PLoS ONE | Year: 2013

Background: Clostridium difficile are Gram-positive, spore forming anaerobic bacteria that are the leading cause of healthcare-associated diarrhea, usually associated with antibiotic usage. Metronidazole is currently the first-line treatment for mild to moderate C. difficile diarrhea however recurrence occurs at rates of 15-35%. There are few reports of C. difficile metronidazole resistance in the literature, and when observed, the phenotype has been transient and lost after storage or exposure of the bacteria to freeze/thaw cycles. Owing to the unstable nature of the resistance phenotype in the laboratory, clinical significance and understanding of the resistance mechanisms is lacking. Methodology/Principal Findings: Genotypic and phenotypic characterization was performed on a metronidazole resistant clinical isolate of C. difficile. Whole-genome sequencing was used to identify potential genetic contributions to the phenotypic variation observed with molecular and bacteriological techniques. Phenotypic observations of the metronidazole resistant strain revealed aberrant growth in broth and elongated cell morphology relative to a metronidazole-susceptible, wild type NAP1 strain. Comparative genomic analysis revealed single nucleotide polymorphism (SNP) level variation within genes affecting core metabolic pathways such as electron transport, iron utilization and energy production. Conclusions/Significance: This is the first characterization of stable, metronidazole resistance in a C. difficile isolate. The study provides an in-depth genomic and phenotypic analysis of this strain and provides a foundation for future studies to elucidate mechanisms conferring metronidazole resistance in C. difficile that have not been previously described. © 2013 Lynch et al.


Millo N.,University of Alberta | Boroditsky R.,Victoria General Hospital | Lyons E.A.,University of Manitoba
Journal of Obstetrics and Gynaecology Canada | Year: 2010

Objective: To evaluate whether changes on ultrasound in uterine and fibroid volume and fibroid vascularity correlate with changes in symptom severity and health-related quality of life (HRQL) perceived by patients after uterine artery embolization (UAE). Materials and Methods: Sixty-four women (mean age 45.3) with symptomatic uterine fibroids underwent UAE at the Hysterectomy Alternatives (HAlt) clinic in Winnipeg, Manitoba. They completed a validated questionnaire assessing symptom severity and HRQL at baseline and at three and six months post-embolization, and ultrasound was also performed at these intervals. Changes in uterine and fibroid volume were compared with changes in symptom severity and HRQL. Data from patients with residual fibroid vascularity, extremes of baseline fibroid volume, and concomitant adenomyosis were analyzed to determine whether the outcomes were different in these patient groups. Results: Changes in uterine and fibroid volumes did not correlate with changes in symptom severity or HRQL after UAE (P> 0.05). Residual fibroid vascularity was a negative predictor of reduction in uterine and fibroid volume (P< 0.05), but did not affect changes in symptom severity or HRQL. Extremes of baseline volume in the dominant fibroid did not affect symptom severity or HRQL. Patients with concomitant adenomyosis experienced greater improvement in symptoms than those without adenomyosis (P< 0.05). Conclusion: We found poor correlation between imaging findings and patient- perceived outcomes after UAE. Ultrasound cannot be used to predict improvement in symptoms or HRQL after UAE. © 2010 Society of Obstetricians and Gynaecologists of Canada.


Yee R.,University of British Columbia | Manoharan S.,University of British Columbia | Hall C.,Victoria General Hospital | Hayashi A.,Victoria General Hospital
American Journal of Surgery | Year: 2015

Background This retrospective study evaluates factors that are associated with an inadequate bowel preparation. Methods A chart review was performed on 2,101 patients who underwent colonoscopy. The quality of preparation was classified as adequate or inadequate. Univariate and multivariate regression analyses identified factors associated with inadequate preparations. Results A total of 91.5% of preparations were adequate. Standard preparations using polyethylene glycol-electrolyte solution and sodium picosulfate alone were 91.1% adequate. Regimens with adjuncts were 91.9% adequate. Factors that predicted an inadequate preparation include the following: stroke/dementia (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.6 to 7.7, P =.002), opioids (OR 2.3, 95% CI 1.1 to 4.6, P =.02), male sex (OR 2.0, 95% CI 1.4 to 2.9, P =.000), calcium channel blockers (OR 1.9, 95% CI 1.1 to 3.3, P =.03), and antidepressants (OR 1.7, 95% CI 1.1 to 2.7, P =.02). Conclusions Several factors are associated with inadequate preparations. Adjuncts do not improve preparation quality. The effect of patient education on preparation quality is an area for further research. © 2015 Elsevier Inc. All rights reserved.


Weinerman B.H.,Victoria General Hospital
Telemedicine journal and e-health : the official journal of the American Telemedicine Association | Year: 2012

A clinical study to examine the barriers to using telehealth for oncologic visits was performed by the British Columbia Cancer Agency's Vancouver Island Centre (BCCAVIC) and the Vancouver Island Health Authority in 2006-2007. One of the major barriers encountered was physician engagement. The current observational study was to determine whether patients' enthusiasm and the introduction of telehealth in a study resulted in telehealth becoming integrated within BCCAVIC. Telehealth appointment statistics continued to be kept after the original study was completed. Data were kept on the number of visits, the type of visit (follow-up or new patient), the oncologist seeing the patient, the location of the patient, and the type of cancer. During the study, 106 patients were seen via telehealth. In the years following the trial, the number of telehealth follow-up patients seen markedly increased, so that in 2010-2011, close to 1,200 patients were seen. Medical oncology saw 91.4% of these. The introduction of oncology telehealth in BCCSVIC/Vancouver Island Health Authority was in an ethics-approved study. Following the completion of the trial, there was a 10-fold increase in follow-up patients seen using this modality. Reluctance to see new patients through telehealth probably relates to the necessity to change the patient encounter paradigm. There is a need to develop a model where patients who are a distance from specialists concentrated in larger centers have reasonable access to the same standard of care, without incurring the time and financial burdens. Telehealth would be a part of that model.


Alshaikh B.,University of Calgary | Dersch-Mills D.,Alberta Health Services | Taylor R.,Victoria General Hospital | Akierman A.R.,University of Calgary | Yusuf K.,University of Calgary
Acta Paediatrica, International Journal of Paediatrics | Year: 2012

Aim: To evaluate an extended interval dosing (EID) regimen of gentamicin in neonates ≤28-week gestation. Methods: In 2008, an EID regimen for gentamicin was introduced for all neonates admitted to the NICU in Calgary. The dosing interval was based on a 22 h level after the first dose of 5mg/kg. We conducted an observational study in 33 infants ≥28-week gestation on the EID regimen from the first day of life and compared gentamicin peak and trough levels with a historical control of 34 infants who received gentamicin in a dose of 2.5 mg/kg every 24 h (TID, traditional interval dosing). Results: In the EID group, based on the 22 h level, dosing interval was 36 h in 20 neonates and 48 h in 13 neonates. All neonates, except one, achieved therapeutic peak and trough levels. Compared to the TID group, the EID group had higher peak levels (median 9.8 μg/mL vs. 4.6 μg/mL, p < 0.001) with no difference in trough levels. With target peak levels of 5-12 μg/mL and trough levels of <2 μg/mL, a higher proportion of neonates in the TID group would need dose adjustment. Conclusion: In neonates ≤ 28-week gestation, an EID regimen from day one of life, using a single level 22 h after the first dose for dosing interval, achieves therapeutic peak and trough levels and more optimum peak levels as compared to a TID regimen. © © 2012 The Author(s)/Acta Pædiatrica © 2012 Foundation Acta Pædiatrica.

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