ADR is an important public health problem which reduces quality of care patients receive and increases cost to healthcare system. Little is known about the incidence and economic burden of ADR-related ED visits and subsequent hospitalizations in Canada. This study estimated the incidence and cost of ADR-related ED visits and subsequent hospitalizations for patients (>65 years) in Ontario, and explored patient, drug and system factors associated with severe ADRs. In a population-based retrospective cohort of Ontario older adults, 7222 (0.75%) of all ED visits were ADR-related, and among these patients 21.56% were hospitalized in 2007; In 2007, the total measured cost of ADR-related visits and subsequent hospitalizations amounted to $13.6 million with the cost being $333.47 and $7528.64 per person for ED visits and subsequent hospitalizations, respectively. Severe ADRs were associated with sex, age, comorbidity, multiple drugs, multiple pharmacies, newly prescribed drugs, recent ED visit, recent hospitalization and LTC residents.

In an attempt to improve patient care and compensate for growing demands, new tools and strategies are under constant review and development for improvements and analyses. Advances in technology, analyses of the use of public funding, acquiring additional capital, and adapting practical tools and resources from other industries are commonly considered to improve the situation. This work provides a series of recommendations and analyses of solutions for emergency healthcare developed with Oakville Trafalgar Memorial Hospital (OTMH) in mind that can be scaled and adapted for all hospitals and emergency departments. Solutions applied were analyzed for their effect on patient care and health care providers. Recommendations for future improvements and work have been made and numerous concepts were drawn from previous studies and applications in other industries, and adapted for OTMH. It is concluded that the solutions had a positive effect on both the staff experience as well as patient throughput.

The recommendations for stroke best practice suggest that mild stroke patients could receive their therapy within an ambulatory environment. However, a significant number of mild stroke patients continue to be admitted to inpatient rehabilitation. A retrospective chart audit was conducted for acute stroke discharges from two centres in Ontario. Stroke cases with a Projected Full FIM® > 80, we're stratified into two groups: discharged home - discharged to inpatient rehabilitation. There were 813 patients eligible for inclusion. Overall, 33% of mild stroke patients were admitted to inpatient rehabilitation. The results did not explain why so many mild stroke patients are admitted to inpatient rehabilitation. The two groups did not differ in rates of recurrent stroke or re-admission to hospital at follow-up. According to the results, milder stroke patients may effectively be managed in the community where rehabilitation services are available.

In an attempt to improve patient care and compensate for growing demands, new tools and strategies are under constant review and development for improvements and analyses. Advances in technology, analyses of the use of public funding, acquiring additional capital, and adapting practical tools and resources from other industries are commonly considered to improve the situation. This work provides a series of recommendations and analyses of solutions for emergency healthcare developed with Oakville Trafalgar Memorial Hospital (OTMH) in mind that can be scaled and adapted for all hospitals and emergency departments. Solutions applied were analyzed for their effect on patient care and health care providers. Recommendations for future improvements and work have been made and numerous concepts were drawn from previous studies and applications in other industries, and adapted for OTMH. It is concluded that the solutions had a positive effect on both the staff experience as well as patient throughput.

The recommendations for stroke best practice suggest that mild stroke patients could receive their therapy within an ambulatory environment. However, a significant number of mild stroke patients continue to be admitted to inpatient rehabilitation. A retrospective chart audit was conducted for acute stroke discharges from two centres in Ontario. Stroke cases with a Projected Full FIM® > 80, we're stratified into two groups: discharged home - discharged to inpatient rehabilitation. There were 813 patients eligible for inclusion. Overall, 33% of mild stroke patients were admitted to inpatient rehabilitation. The results did not explain why so many mild stroke patients are admitted to inpatient rehabilitation. The two groups did not differ in rates of recurrent stroke or re-admission to hospital at follow-up. According to the results, milder stroke patients may effectively be managed in the community where rehabilitation services are available.

ADR is an important public health problem which reduces quality of care patients receive and increases cost to healthcare system. Little is known about the incidence and economic burden of ADR-related ED visits and subsequent hospitalizations in Canada. This study estimated the incidence and cost of ADR-related ED visits and subsequent hospitalizations for patients (>65 years) in Ontario, and explored patient, drug and system factors associated with severe ADRs. In a population-based retrospective cohort of Ontario older adults, 7222 (0.75%) of all ED visits were ADR-related, and among these patients 21.56% were hospitalized in 2007; In 2007, the total measured cost of ADR-related visits and subsequent hospitalizations amounted to $13.6 million with the cost being $333.47 and $7528.64 per person for ED visits and subsequent hospitalizations, respectively. Severe ADRs were associated with sex, age, comorbidity, multiple drugs, multiple pharmacies, newly prescribed drugs, recent ED visit, recent hospitalization and LTC residents.

Cancer cells require access to blood vessels for oxygen and nutrients to enable growth and metastasis, making the tumour vasculature an attractive potential target for cancer therapies. Recent evidence suggests that the tumour vasculature plays a significant role in tumour response to high dose radiation therapy; however this effect is not well characterized due to limitations in quantitative imaging of the microvasculature. Speckle variance optical coherence tomography is an emerging imaging modality capable of 3D, non-invasive imaging of in vivo microvasculature. This thesis outlines the work done to test the hypothesis that svOCT imaging can be used to quantitatively monitor the vascular effects of high dose radiotherapy in a preclinical model. This was achieved through the development of a quantification pipeline for longitudinal 3-D svOCT images of microvascular radioresponse.

Cancer cells require access to blood vessels for oxygen and nutrients to enable growth and metastasis, making the tumour vasculature an attractive potential target for cancer therapies. Recent evidence suggests that the tumour vasculature plays a significant role in tumour response to high dose radiation therapy; however this effect is not well characterized due to limitations in quantitative imaging of the microvasculature. Speckle variance optical coherence tomography is an emerging imaging modality capable of 3D, non-invasive imaging of in vivo microvasculature. This thesis outlines the work done to test the hypothesis that svOCT imaging can be used to quantitatively monitor the vascular effects of high dose radiotherapy in a preclinical model. This was achieved through the development of a quantification pipeline for longitudinal 3-D svOCT images of microvascular radioresponse.

Introduction: Peripherally Inserted Central Catheters (PICCs) are commonly used in medium or long-term infusion therapy. This study aims to assess the costs associated with PICCs and its determinants. Methods: A retrospective cohort of patients with PICCs inserted at the Hospital for Sick Children between Jan.1, 2008 and Dec.31, 2008, were reviewed and followed until their PICCs were removed. Cost analysis, theoretical cost comparison with peripheral intravenous therapy (PIV), and multiple linear regressions were applied from the societal perspective. Findings: The average total cost is $2763.75/catheter/day, including inpatient ward cost. Age, male, ward, home care, catheter dwell days, and complications were found to be significant factors influencing the total cost. PICCs can become a cost saving device, compared to PIV, but is affected by several factors. Conclusion: Information gleaned from this study will inform decision makers maximizing the benefits of better resource allocation.

Incident reporting systems offer rich opportunities for learning from errors in health care. However, little attention has been given to understanding how the implementation of reporting system characteristics impact analysis and communication activities. This research explored the characteristics of reporting systems that promote analysis and communication activities. Ten characteristics were identified through a comprehensive literature review. Two reporting systems were then compared to assess how differences in the implementation of the characteristics impact the contents of the database. The results demonstrated that differences in the characteristics’ implementation have an effect on the ability to extract information essential to analysis activities. Next, the reporting processes of the two systems were mapped onto a hierarchical framework to highlight how the characteristics influence the communication of incident information across the health care system. The presented work furthers the understanding of characteristics needed to design reporting systems more effective at promoting learning.