ObjectiveCanada's cesarean delivery (CD) rate continues to increase. The Society of Obstetricians and Gynaecologists of Canada advocates the use of the modified Robson classification for comparisons. This study describes national and provincial CD rates according to this classification system.MethodsAll 2016-2017 in-hospital births in Canada (outside Québec) reported to the Discharge Abstract Database were categorized using the modified Robson classification system. CD rates, group size, and contributions of each group to the overall volume of CD were reported. Rates by province and hospital peer group were also examined (Canadian Task Force Classification III).ResultsA total of 286 201 women gave birth; among these, 83 262 (29.1%) had CDs. Robson group 5 (term singleton previous CD) had a CD rate of 80.5% and was the largest contributing group to the overall number of CD (36.6%). Women whose labour was induced (Robson group 2A) had a CD rate almost double the rate of women with spontaneous labour (Robson group 1): 33.5% versus 18.4%. These latter two groups made the next largest contributions to overall CD (15.7% and 14.1%, respectively). There were substantial variations in CD rates across provinces and among hospital peer groups.ConclusionThe study found large variations in CD rates across provinces and hospitals within each Robson group, thus suggesting that examining variations to determine the groups contributing the most to CD rates (Robson groups 5, 2A, and 1) may provide valuable insight for reducing CD rates. This study provides a benchmark for measuring the impact of future initiatives to reduce CD rates in Canada.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: Primary objective: to assess the effectiveness of glucose in preterm and full term neonates undergoing skin‐breaking procedures, including heel lance, venipuncture, arterial puncture, central line placement, lumbar puncture, suprapubic aspiration, intramuscular or subcutaneous immunization, or other injections. Secondary objective: to assess the safety of glucose in preterm and full term neonates undergoing skin‐breaking procedures.
Objective: Pain from vaccine injections remains undertreated, despite the availability of numerous pain-relieving strategies. Healthcare providers report lack of time within current office workflows as a major barrier to routine pain management. The objective was to document the total time involved in outpatient vaccine appointments to test the hypothesis that offering pain-relieving strategies can be practically implemented when considering the element of time to vaccine injection. Patients and Methods: Prospective naturalistic study in 8 urban outpatient primary care clinics (4 pediatric and 4 family practice) in Toronto. For 48 to 59 consecutive childhood vaccination appointments at each site, child waiting time from clinic arrival until first vaccine injection was tracked. Results: Altogether, 405 vaccine appointments were included. The median age of the child undergoing vaccination was 12 months. The mean (SD) time from clinic arrival until first vaccine injection was 41.6 minutes (20.9), with a range of 7 to 132 minutes. Linear regression identified a significant (P<0.05) difference according to clinic [ranging from 19.4 min (6.5) to 57.5 min (20.2)] and number of family members in the appointment [ranging from 40.6 min (21.0) for an appointment in the index child only to 50 min (14.3) for an appointment in the index child and 2 other family members]. Conclusions: Contrary to healthcare provider perceptions, the timing of outpatient childhood vaccine appointments allows for the inclusion of pain management interventions. Efforts should now focus on educating healthcare providers and parents about the value of pain management and how to implement evidence-based strategies.
OBJECTIVES We conducted a retrospective population-based study to explore: (i) the prevalence of opioid use among adults referred for a sleep disorder assessment and (ii) the relationship between opioid use and initiation of positive airway pressure (PAP) treatment.METHODS All adults who underwent an initial diagnostic sleep study (index date) in Ontario (Canada) between 2013 and 2016 were identified through provincial health administrative data. Opioid use was identified as active or recent opioid prescriptions (at or close to the index date) and being on opioids at any time in the last year. Cause specific hazard models were utilized.RESULTS Of 268,293 adults, about 5% had an active or recent opioid prescription, 25% were on opioids in the last year, and 39% initiated PAP in a median of 17.4 months. Among active opioid users, 12% were treated with a daily dose ≥200 mg morphine equivalent, 37% were treated with long-acting opioids, and 38% were on benzodiazepines in the last year. Only opioid use in the last year was significantly associated with PAP initiation (1.08; 1.06–1.09), but not an active or recent opioid prescription. Among active opioid users, long-acting opioid users and those on high opioid daily dosage were less likely to initiate PAP.CONCLUSIONS We found a high degree of prior opioid exposure among people referred for a sleep disorder assessment with a large proportion on long-acting opioids, higher opioid dosages and on benzodiazepines among active opioid users. However, active opioid treatment was not associated with a higher likelihood of PAP initiation; active opioid users at higher risk of impaired breathing in sleep were less likely to initiate PAP.
Background. Clinician-led tactile stimulation (rubbing the skin adjacent to the injection site or applying pressure) has been demonstrated to reduce pain in children and adults undergoing vaccination. Objective. To evaluate the analgesic effectiveness of clinician-led tactile stimulation in infants undergoing vaccination. Methods. This was a partially blinded randomized controlled trial that included infants undergoing vaccination in a private clinic in Toronto. Infants were randomly allocated to tactile stimulation or no tactile stimulation immediately prior to, during, and after vaccination. The primary outcome was infant pain, assessed using a validated observational measure, the Modified Behavioral Pain Scale (MBPS; range = 0-10). Results. Altogether, 121 infants participated (n = 62 tactile stimulation; n = 59 control); demographics did not differ ( P > .05) between groups. MBPS scores did not differ between groups: mean = 7.2 (standard deviation = 2.4) versus 7.6 (1.9); P = .245. Conclusion. Tactile stimulation cannot be recommended as a strategy to reduce vaccination pain in infants because of insufficient evidence of a benefit.
Abstract Little is known about the economic burden of chronic pain and how chronic pain affects health care utilization. We aimed to estimate the annual per-person incremental medical cost and health care utilization for chronic pain in the Ontario population from the perspective of the public payer. We performed a retrospective cohort study using Ontario health care databases and the electronically linked Canadian Community Health Survey (CCHS) from 2000 to 2011. We identified subjects aged ≥12 years from the CCHS with chronic pain and closely matched them to individuals without pain using propensity score matching methods. We used linked data to determine mean 1-year per-person health care costs and utilization for each group and mean incremental cost for chronic pain. All costs are reported in 2014 Canadian dollars. After matching, we had 19,138 pairs of CCHS respondents with and without chronic pain. The average age was 55 years (SD = 18) and 61% were female. The incremental cost to manage chronic pain was $1742 per person (95% confidence interval [CI], $1488-$2020), 51% more than the control group. The largest contributor to the incremental cost was hospitalization ($514; 95% CI, $364-$683). Incremental costs were the highest in those with severe pain ($3960; 95% CI, $3186-$4680) and in those with most activity limitation ($4365; 95% CI, $3631-$5147). The per-person cost to manage chronic pain is substantial and more than 50% higher than a comparable patient without chronic pain. Costs are higher in people with more severe pain and activity limitations.
