Exploring patient satisfaction of a joint-consultation clinic for trigeminal neuralgia: Enabling improved decision-making

Background: Trigeminal neuralgia (TN) is a relatively rare condition which has a profound impact not only on the patient but also on those around them. There is no cure for TN, and the management of the condition is complex. The most effective forms of treatment are either through medication, neurosurgery, or combination of the two. Each option has risks and implications for the patient. As with all clinical decisions, it is important for patients to understand and be fully informed of the treatments available to them. A London UK unit adopted a joint-consultation clinic approach where the patient meets with both physician and neurosurgeon at the same time to discuss treatment options. The purpose of this evaluation is to understand patients’ level of satisfaction with the joint-consultation clinic and evaluate utilisation of a clinical decision-making tool. Method: Patients who had attended the joint-consultation clinic over a period of 12 months were invited to participate in a telephone or paper survey (N = 55). Responses were analysed using descriptive statistics and thematic analysis. Results: Forty-one patients (77% response rate) participated in the survey, and the results were overwhelmingly positive for the joint-consultation clinic regarding satisfaction. The benefits were broad ranging including increased understanding, collaboration and confidence in decision-making. Conclusions: A joint-consultation clinic comprising a neurosurgeon and a physician for the treatment of TN is valued by patients who become better informed and able to make decisions about their care. Positive application of clinical decision-making aids in this situation offers potential across specialities

IMO\u27s role in promoting oil spill preparedness

The International Convention on Oil Pollution Preparedness, Response and Co-operation, 1990 (OPRC Convention, 1990) came into force on 13 May 1995. The main objectives of the OPRC Convention are to facilitate international co-operation and mutual assistance in preparing for and responding to a marine pollution incident and to encourage states to develop and maintain adequate capability to deal credibly with oil pollution emergiencies. The paper outlines and describes in some detail the strategy adopted by IMO in the implementation of the OPRC Convention, the mechanisms established to address/discuss issues of mutual concern amongst the member states of IMO and the oil industry, and the various activities undertaken by IMO in co-operation with relevant sister UN organizations and the oil industry to assist countries requiring assistance including the mobilization/provision of technical assistance to countries on an individual basis. It is apparent that IMO\u27s role as a provider of technical advice and delivery of project assistance, as a co-ordinator for the mobilization of international assistance to major marine pollution incidents upon the request of countries in need, as a Forum for discussion/overseeing the implementation of the OPRC Convention (through the meetings of the OPRC Working Group) including the development of marine pollution preparedness and response training programmes is set to become more important given its pro-active approach to promoting oil spill preparedness in co-operation with industry and governments

Long term evaluation of a multidisciplinary trigeminal neuralgia service

BACKGROUND: Trigeminal neuralgia is an episodic severe neuralgic pain and can be managed both medically and surgically. If possible, this should be directed by a Multidisciplinary Team (MDT) of specialised surgeons, physicians, dentists, psychologists and specialist nurses with access to all treatment modalities, which enables patients to make an informed decision about their future management. OBJECTIVE: The aim of this study was to review the outcomes of patients managed by an MDT clinic, in a single institute over an eleven-year period. METHODS: A prospective database was used to identify patients with trigeminal neuralgia or its variants who had attended a joint MDT clinic. The electronic notes were examined for demographics, onset and duration of trigeminal neuralgia, medications history, pain scores and details of surgical procedures if any by two independent assessors. RESULTS: Three hundred thirty-four patients attended the MDT between 2008–2019. Forty-nine of them had surgery before being referred to the service and were included but analysed as a subgroup. Of the remaining patients, 54% opted to have surgery following the MDT either immediately or at a later date. At the last reported visit 55% of patients who opted to have surgery were pain free and off medications, compared to 15.5% of medically managed patients. Surgical complications were mostly attributable to numbness and in the majority of cases this was temporary. All patients who were not pain free, had complications after surgery or opted to remain on medical therapy were followed up in a facial pain clinic which has access to pain physicians, clinical nurse specialists and a tailored pain management program. Regular patient related outcome measures are collected to evaluate outcomes. CONCLUSION: An MDT clinic offers an opportunity for shared decision making with patients deciding on their personal care pathway which is valued by patients. Not all patients opt for surgery, and some continue to attend a multidisciplinary follow up program. Providing a full range of services including psychological support, improves outcomes