A Patient-Centred Approach to Early Pregnancy Loss: The First 18 Months of a Canadian Outpatient Program for Early Pregnancy Loss (OPEL).

OBJECTIVE: Manual vacuum aspiration is a safe surgical option for the management of early pregnancy loss. To provide rapid, patient-centred access to MVA, an Outpatient Program for Early pregnancy Loss ("OPEL") was established at our institution. Objectives were to (1) assess complete uterine evacuation rates; (2) assess complication rates, and (3) assess patient satisfaction with the program. METHODS: With REB approval, a retrospective study was performed. Patient records from the first 18 months of OPEL (November 2015 to April 2017) were reviewed. Anonymous patient satisfaction questionnaires were completed immediately post-procedure. RESULTS: A total of 162 patients received treatment. Missed abortions accounted for 94 cases (58%). Median delay from referral to clinic appointment was 4.0 (interquartile range [IQR] 2.0-6.0) days. Average length of stay was 3.0 (IQR 2.5-3.0) hours. Efficacy of the procedure was 95.1%. Complication rate (immediate and delayed) was 14.2% and included intraoperative hemorrhage (3.1%; 5/162), Asherman's syndrome (1.9%; 3/162), retained products of conception requiring further treatment (4.9%; 8/162), and postoperative infection requiring antibiotic therapy (1.9%; 3/162). A total of 151 post-procedure satisfaction surveys were completed (93%); 100% agreed/strongly agreed that the nursing staff and physicians provided professional and compassionate care; 99.3% were satisfied with their care overall. Qualitative feedback was positive. CONCLUSION: Pregnant patients experiencing early pregnancy loss benefit from safe, timely, accessible, patient-centred care in the outpatient OPEL program. Similar models should be adopted nationally to ensure women experiencing this common pregnancy complication receive safe and compassionate care.

Systematic review of public education and policy for stroke prevention.

INTRODUCTION: Stroke is a leading cause of disability and death around the world. METHODS: We conducted a systematic review of peer reviewed articles published since 1999 on the topics of public education and policy for stroke prevention. A research librarian conducted the search using Pubmed and the International Pharmacy Abstracts (IPA). We reviewed the abstracts from the search results to determine if they met the inclusion criteria. Then we abstracted the relevant data from the articles using an evaluation criteria and data abstraction instrument. RESULTS: The searches of Pubmed and the IPA returned 446 articles, of which 36 were included in the review. Thirty-two were educational programs and four were policies. Twenty-two of the programs were directed at patients, four at providers, and seven at both. Seven of the educational programs were judged successful using the evaluation criteria. They included two large scale programs and five narrowly targeted programs. The policies included two articles presenting guidelines for treatment for stroke prevention in specific patient populations and two articles presenting recommendations for changes in systems of care for stroke prevention and treatment. CONCLUSIONS: Future efforts to evaluate these programs will require global efforts with a special emphasis on testing and validating with international patient populations. Barriers remain for translating stroke prevention policies into clinical practice. "This material is based upon work supported by the North Florida/South Georgia Veterans Health System, the Office of Research and Development, Rehabilitation R&D Service, and Health Services R&D Service, Department of Veteran Affairs."