Intrathecal pain pump in 206 Neurosurgery clinics worldwide with additional parameter

Good day. My name is Olena, I am from the city of Khmelnytskyi. I am writing my review in this format to show the REAL picture. On March 27, my mother was operated on in this center (brain tumor) by doctor Taras Stepanovych Gavryliv. To say that I thank him is not enough. Because he is a doctor from whom everyone should take an example. Responsible, tactful and, in general, professionally treats his patients and people in general. It has been more than half a year since the operation. My mother feels great. She speaks, she is not paralyzed as they told me in our hospital, as they told me in Kyiv. I will also tell you that I don't have a week without people contacting me to get some information, feedback. Because I understand the things that I myself had to go through. But in the center of Neurosurgery, everything is so well thought out, everything is so professionally selected that you fully surrender yourself to the doctor and are no longer afraid. I read a bad review about resuscitation. I do not know of such a case, I have not seen with my own eyes sloppy treatment of people on the part of the staff, and I myself, believe me, do not have a very good character!!! The doctors in the intensive care unit looked after the patients normally and professionally. I was even amazed, and I saw and heard the feedback of other people, patients. I was once given such advice that I would listen to my doctor with my heart. Так і сталося ! working from 8 a.m. to 10 p.m., doctor Taras Stepanovych also held online consultations late in the evening. And he did not pick up the phone, did not grumble on the phone, but on the contrary, gave answers calmly, answering questions, reassuring. Я дуже , дуже рекомендую цю клініку і свого лікаря . Я писала пост в фейсбуці на рахунок лікарні ,щоб люди знали що є таке місце де допоможуть , де не скалічать , де не стоіть питання перше - скільки ви маєте коштів ! я зверталася по місцю в нас в управління охорони здоров"я , з питанням - ЧОМУ ????? чому в нас не можна таке зробити всюди ????? в кожному місті !!! Чому в нас діє тільки коррупція . А питання о житті паціента стоіть на останньому місті . ? Я не бот , я не наймана людина центру Володимира Смоланки . Я - звичайний пацієнт . І дуже дуже дякую лікареві Тарасу Степановичу та його команді за спасіння моєї мами . Бо коли ще живі батьки, то і діти почувають себе - дітьми .

3 weeks ago, I came to this hospital for rehabilitation, but it turned out that it was necessary to perform a lower back operation and correct the mistake of another doctor. Thank you very much to Dmytro Serhiyovych Sikorsky and Oleksandr Oleksandrovich Yarty for correcting the mistake and taking care of me throughout my stay in the hospital. Thank you for teaching me how to sit down and try to stand up. Regarding rehabilitation, we can only wish for the best. While the head of rehabilitation is Kateryna Oleksandrivna Zinov'eva - I do not recommend it.

From the bottom of our hearts, we would like to thank the best professional in his field, MYTRIK IVAN IVANOVYCH, and his well-coordinated team for their true professionalism. Ivan Ivanovich is a doctor from God and a man with a capital letter. A huge thank you and a low bow for your work, patience and sincerity, for your golden hands and for a successful operation for my mother, who once again experienced the taste of life, namely walking on her own feet, without any help. THANKS.

02/15/2021 was at the clinic, 02/18/2021 has already been operated on!!! To say that I am happy is beyond words! So many years of torment and wandering around doctors either refused or did not give any encouraging forecasts even in the most famous clinics in the country !!! Myopia - 10.5, large astigmatism, cataracts, bad cornea. And now the miracle doctor Armen Andranikovich Ginoyan is a genius, a magician, a jeweler and just a warm-hearted person!!! Gave me back my sight and a new life!!! Everyone before him predicted a difficult rehabilitation for me within six months. But I see and feel great on the second day!!! No discomfort The operated eye feels better than before the operation!!! I walk without dark glasses, my eyes do not water in the sun. I cry only from happiness that we have such talented people and kind hearts in our country!!! I pray to God that he be happy and healthy and that his golden hands could help so many hopeless people!!! In general, the entire staff of the clinic is an amazing collection of talented generous people, starting from the administrator and nurses!!! Cozy homely, calm, family atmosphere. Throughout the operation, I felt the support and warm hands of doctors and nurses. I noticed that people in wheelchairs come there from all over the world and all with deep gratitude to the doctors!!! I could write many more words of impressions and gratitude, but I cannot express in any words what I feel now, what joy !!! I just want to wish prosperity to this clinic, health, happiness and well-being to all the staff!!! God bless you!!!! 🙏💐♥️

At my dad's request I am leaving this review. As a result of long and intense work at the computer, as well as for age-related reasons, my dad’s eyesight deteriorated significantly. By the time of contacting the MedElect clinic to A.A. For Ginoyan, my dad’s initial situation with his eyes looked like this. Left eye: myopia -5.5 diopters, early stage of cataract. Right eye: -9.5 diopters, cataract. Dad was amazed and very pleased by the thoroughness and comprehensiveness of the study of the initial state of the eyes using various equipment (even a tomography of each eye was carried out!..). As a result of this detailed, but very quick examination, naturally, it was possible to accurately determine the choice of diopters and the type of artificial lenses (monofocal lenses were chosen). First, surgery was performed on the right eye, and 1 month later on the left. The teamwork and coordination of the entire operating team, the experience and skill of the surgeon are at their best - A.A. Ginoyan. I was surprised by the attention even to such a small detail: a special cushion was placed under the knees of the person being operated on, which made being on the operating table very comfortable. The operations themselves were absolutely painless and did not take long (about 10-15 minutes for each eye). After the operation, my father became farsighted, but at the same time retained the ability to work at the computer without glasses. Even after all the operations A.A. Ginoyan did not leave my father without attention: he monitored the condition of his eyes in detail and the dynamics of possible changes. Many thanks to A.A. Ginoyan and his colleagues for their excellent work!

Great clinic. Very attentive and friendly staff. Doctors are generally a special class: specialists of the highest qualifications and skill. But even among them, Armen Andranikovich Ginoyan stands out for his skill and professionalism. Huge gratitude and appreciation to everyone for the returned opportunity to see the world again in all its diversity and beauty. Nechaev Leonid Germanovich

While I appreciated the procedure being done my beef is this places billing department only affords you 6 months to pay your balance. So even tho I have insurance through my place of employment and reached my déductible prior to surgery, and even though I have been making payments monthly for the remaining 20% ... if my balance isn't paid in full within 6 months their "policy" is to send it to collections. Now I was offered 'financial assistance' IF I submit two or three years of taxes, plus several paycheck stucs. (So basically all of my personal information) which is not only time consuming but also invasive. I'm just a single gal trying to make ends meet. I needed the surgery to prevent further complications down the road so I elected to have it done. Perhaps I missed information prior to getting the surgery? But I NEVER thought that even though I am paying monthly a fair amount towards the remaining balance that I would STILL be threatened with having it go to collections. And just for that reason I would NEVER recommend this place to anyone. Period

The Nurses, CNAs, PTs, & Staff were all AMAZING!!! My mom had knee surgery a week ago and our experience there was great!! Everyone was kind and helpful from admission to post op. I can’t remember everyone’s names but I did take some down! We loved how kind and helpful her nurse Kaylani was!!! The most important part to us was having a Spanish speaking nurse on staff. My mom only speaks Spanish and it was so comforting to us knowing at night she was left with someone she could understand and communicate with! Thank you to Josephina and Nasthja for taking such good care of my mom! The physical therapist, Ruth is incredible!!! My mom adored her and made us feel confident about taking her home!! Special thank you to KASS, CNA!!!! She provides excellent patient care. Spine and Joint hospital provided quality care!

Arizona Spine and Joint Hospital gave me outstanding service and care during my stay. I would also like to thank Dr. T, his wife Kate, and Dr. Kralik for their great skills and knowledge. I'm so thankful my wife and I found these skilled surgeons. I'd also like to thank the nurses and staff who took care of me while there: Debbie, Cathy, Karen, Deanna, Becky, Dickson, Katherine and Veronica! Thanks again. My drive from Lake Havasu was well worth it!

Super 👌

Very professional stuff. Waiting period is longer so needto be patient.

I had my total hip replacement surgery here six days ago and everything went great. Dr.Ravnihar is great and he took his time to make everything perfect for me. His staff at B2 ward is full of love for patients and find it not hard to do their job. One more thing that was very good to me. Food at this hospital is excelent and some restaurants might be envy of the cook here. All in all,if you need some joint replaced,come here and you will not be dissapointed.

Nobody answers the phone (I was on hold for 45 minutes). When someone answered, they were unwelcoming/rude. The doctor was not available for a week she said. The doctor Marcin Panek does not know how to use a computer, he could not view/open my x-ray CD. He does not know how to type on a keyboard (takes very long time to type with two fingers). before even looking at my x-ray(because it would not open on his computer) he said I needed surgery(!?!). He recommended two hospitals/doctors for surgery, but after looking them up I saw bad/low reviews for these places. I got two more opinions at other orthopedic offices and they said surgery was not necessary. He only has 3 reviews on znanylekarz.pl... they do not do surgeries here anymore. EFFI was good when DR Łukasz Budziazek worked there, but he no longer is there. They have changed the name of EFFI to "New medical+"

I have been waiting 3 weeks for a report that was suppose to take ten days, I called to confirm when and they said one more day and now they push me straight to voicemail. I do not recommend. Very unprofessional. Then the doctor told me I immediately needed surgery and a metal plate put in my neck! I went for two other opinions and both others disagreed fully. These people are not good and knife crazy. Scary stuff. STAY AWAY.

[EDIT] After contact with the manager of the facility, who was very helpful and understanding, she arranged for an earlier appointment and apologized for the situation. ----------------------------------------------------------------------------------------------- I would give a minus rating if I could. First appointment they forgot to book it in the system and I drove there 40 min for nothing, no apology or anything, just normal for them.. Second time I arrived right on schedule just to be told I couldn’t go in as i HAD to be there 20 min earlier while their message confirming my appointment only requested to be 20 min earlier more in a suggestive manner. Lovely place..

Not only do they have great caring staff they also sell the best date scones from the cafeteria

I was at Burwood Hospital for 2 weeks in the Rehab Ward going to Physio and working on my injured left ankle. Thanks to the fine work of everyone involved I was able to regain my independence with what I had learned. Everyone who worked there and it didn't matter who it was encouraged me with their attitude,good work ethic and duty of care.They were able to get the best out of me despite the fact the Health Sector is having various problems of it's own to deal with. Although my opinion may differ greatly from others I'm sticking to my opinion that these people who despite working under pressure at times showed me how to get the job done with a smile and I will be forever grateful to them all for the effort they all put in helping me on the road to recovery

I can't speak highly enough of staff and facilities at Burwood. Nice green areas, top quality Cafe.

Visited the clinic for a second opinion regarding Cobalt values ​​based on M.O.M. hips, have to wait more than 2 months. The staff is friendly and helpful with digital transactions that we are not very good with

Super

Very good hospital, awesome and experienced specialists! Doctors, nurses, physio therapists, people from administration - everyone very kind and friendly. Food is also very tasty 😋

Really good service: appointment on time, explanation of the diagnostic, good intervention process. Personnel are knowing well their job. Perhaps the pharmacy service need to be improved a little bit because waited some time to catch up my medicine.

Best place for the caring and treatment Today I had done a surgery with Dr Tamar and Dr Nabeel. As a staff of Harley Street I understood how my colleagues treat a patient, they treated me well, it doesn't mean I am the staff, they are treating everyone like this. My husband is also wondered bcz their love and care. Thank you Harley Street family for this great experience 🙏🏼

Some of their providers are really good and you can get in pretty quickly. The back thing is everything else. They told me to expect test results in 2-3 days. I called a week later. No results. They called me back later that day with the results and seemed agitated, "Well the doctor had to read them first mam." Well don't tell me 2 to 3 days then. The second incident they called me and said I needed to take x-rays or I couldn't proceed with services. I had two upcoming appointments. I asked them to cancel those appointments because I was unable to get in for an x-ray in the next two weeks. They called me the day before my appointment to remind me to come in. I told them it was canceled and gave them the date. Oh will call you back. No one ever called me back. I called them that same evening and again someone will call you back. No one called me back. I called the very next morning and no one picked up the phone. They called me back later that evening and said we noticed that you called today. I explain the situation and the man said the appointments had never been canceled as requested but they would cancel them now. He also told me I could come in for my x-rays at any time. I decided to go the next day. When I got there the next day, they were confused about why I was there and said there was no order for an x-ray. The doctor that I had seen was not there and they were trying to get someone to write the order. I waited for 30 minutes and I told them I would just leave and call back. They had forgotten. As I was driving away, they called me and told me to come back and take the x-ray. I'm going to finish this particular service. But after that I will not be getting any additional medical treatment here.

I am very happy with Dr Sangeeta mam, Dr lalit Gulati. Really appreciate all. Thanks for the services. Best hospital from my side.

Very happy with the doctor, dr summit Rabi, and all staff. Treatment and everything is good

Doctor are so good . Specially Rahul sir is so perfect .nursing staffs are good. Almost everything is fine. Thanks 🙏

I had knee meniscus arthroscopy surgery at RNOH hospital in Stanmore (via the Private Care Unit) and I was truly satisfied with the results. All of the staff were genuinely amazing in helping me feel welcomed, relaxed and taken care of. ***FYI, I found this hospital through the NHS hospitals reviews website as being the best in the UK when dealing with joints issues like mine.*** Special thanks to Dr Chethan Jayadev (my surgeon) and his team in the operation theatre. Also special thanks to the Senior Nurse Sima who made sure everything is prepared and ready for me before and after the operation - she was amazing in every given moment even when I was leaving the hospital she made sure I can hop in the car in a safe for my knee way... I mean wow it does not cost much to be nice to others. Frankly speaking my experience as being positive matched with the reviews I read about this hospital few years ago. It is nice to see that they are keeping up with the reputation and level of service. I wish you very best if you are planning to go for a surgery at this hospital and I am sure whichever path you choose either funded through NHS or though Private Health Insurance Provider you will be treated very well - saying that as I had the opportunity to see and experience both pathways and levels of treatments. ❤️👍

I would like to say a big thank you to mr Cullen and his team, the doctors,the nurses. You all have made my stay on private care very comfortable The food was nutrition lovely food well balanced menu which you can choose from every day The cleaners even helpful the rooms are bright colours really beautiful and well kept clean I really can't fault private care Thank you all so much for your wonderful care I received in here after having my ankle fusion

I recently had a spinal procedure under the care of Mr Leong. I am extremely grateful for the level of care and attention I received, from being offered alternatives before I was ready to take the plunge with surgery, to the surgery itself and after care. It was lovely to feel complete faith in my consultant but also to hear other doctors speak so highly of him. The whole team at RNOH were so helpful and attentive and I am truly grateful to Mr Leong, for his kind & caring attitude and for getting me back on my feet again.

I had a surgery done here recently under the talented hands of Dr David Williamson. I was impressed by everyone I came into contact with. I was a little nervous, and very excited upon arrival. All of the nurses and doctors I talked to made me feel safe and welcome from the moment I walked in. I received amazing care from each and every one. ❤️

Had surgery today at OHSC can't say enough good was looked after extremely well from the moment I walked in and through the surgical process from staff-nurses-Anthesiologist Bruno and Doctor O'Brien. Thank you to all for the best surgical experience I could hope for. Highly recomment OHSC

I went here to ask for Lazer skin care surgery for moderate to medium severe unknown facial scarring… I paid $6,000 for 1500 Needles to be punctured into my skin with some sort of medicine that must have just been sterile water… it actually looks ten times worse than it did before I started; had I not mentioned I had an inheritance; I might not have been sent to a random room…. They might have actually given me the first possible treatment too work for my skin, instead they figured I’d go back for the rest of the 14 other rooms of mechanical devices they had to offer for skin care. WHEN I SPECIFICALLY ASKED FOR LAZER TREATMENT… when I arrived she just grabbed this huge machine with a needle device (PUHHHWOOOPHTSHHHHHUUUUHHHGHAHGHAGHA) it was a retarded puncture device with a huge needle going in and out of your cheeks and such, completely missing my nose which was half of my worry to begin with. I’m thinking of sueing concidering that treatment isn’t even listed on their website!!! I’m very upset. It looks way worse and with more puncture marks than before :,( HANDS DOWN THE STUPIDEST PLACE TO GO FOR ACNE TREATMENT IN THE WORLD… have fun guys. Get ripped off then!!!

I had surgery with DR Cláudio Kawasaki on my knee at the hospital, I was hospitalized for one night, the food at dinner and snacks were excellent, but not the same as the attention given by the girls and boys, nursing technicians and nurses, super attentive and patient surreal, even with a lot of pain they did everything they could to minimize it and give it all their attention. I recommend it 100%

Excellent physical structure, reception service, wonderful attentive and human nursing team, in the cafeteria in the afternoon the attendant was very polite, calm, super human, I watched and she even knows who the patients are.

My experience was undoubtedly a wonderful show, everything was impeccable from the entrance to the exit, I believe that I will hardly have a treatment like this anywhere else, congratulations to the entire team for a high-end humanized service.

I was there from November 20th to November 27th because of a cervical disc prosthesis. If only I had had this clinic last year I could have saved myself an operation. This clinic is really great. Doctors, nursing staff and so on, everyone is super nice and always has a smile. I couldn't complain about the food. Some other clinics can learn a lesson from this clinic. You're all really great, keep it up and stay the way you are. Some disadvantages are that there is no cafeteria so you can sit for a bit. 🤣 Thanks a million to all of you.

I had a hip operation in July, the preparation and organization was great. The staff, nurses and doctors were all excellent, only the food could be improved. I can only recommend this clinic.

I had hip surgery in Hohwald 4 months ago and am very satisfied with the result. The doctors and nurses are all very nice. Unless Doctor Cancler should think about how he treats his patients. Telling a patient the day before surgery that her prognosis doesn't look good is not the most sensitive way.

A really big THANK YOU to Dr Bernard for his remarkable and exceptional skill in saving my limp. Been in road accident twice, yet I'm lucky enough to met with Dr Bernard. A very well experienced, talented and down to earth Orthopaedic doctor that put his life long skill into saving my limp. Not only he is being helpful to my needs during my recent admission, he also explained in details about my surgery and conditions. Yet after the surgery, I do not suffer any severe pain and I recover well.

It’s been around 3 months since my second cataract operation and I’m still marvelling at going around without glasses, for the first time in almost 60 years! Summer’s coming and I can wear RayBans without contact lenses, thanks to Doctor Howard and his team. Thanks also to the management and staff at Sungai Long Specialist Hospital for their friendly professionalism.

Good place and friendly staff here. From security guard, front desk, customer service staff, nurse and even the doctors here are very helpful, caring and friendly. Super thanks to Dr. Ng C.K who help deliver my baby. My wife have a pleasant delivery experience for our first born baby. And also thanks to Dr. Alex who really care with babies. Thank you for the follow up too. The midwife here are very friendly and willing to teach you how to feed baby if you are first time daddy/mummy. Especially the gentle Indian midwife lady, very knowledgeable on how to take care babies and teach my wife on latching the baby. Best things is the car park area are free. Although space is limited, but security guard able to guide you to park and they allow you to double park by providing phone number. So if someone getting their car, they able to call you. Such a lovely and super friendly specialist hospital. Just like their name “博爱医院”. A hospital that filled with love and care.

Great spine hospital in Korea,minimal invasive spine surgery.I have been here for take MISS course.Great experience for me.From Thailand.

I visited Wooridul Spine Hospital in January 2017 and treated for Posterior Foraminotomy C6/7 and also PELAN at L4/5. Prior to coming in to Wooridul, I had been suffering terrible neck pain for 5-6 months prior to visiting Wooridul and have visited 3-4 Doctors in Singapore and Indonesia, went to 2 Chiropractors, etc with no result. I was lucky, I was referred to Dr. Sang-ho LEE and decided to go to Wooridul Hospital. I am very impressed with the whole procedures from the time I entered the hospital until I was discharged 4 days later. The surgery, done by Dr. Sang-ho LEE and Dr. Keum, went very well and I was out of the hospital like a new person. The equipment is first class, all nurses are very nice and professional, and while I was there, Ms. Sujung Lee was always ready to help. She is a very nice person. I would recommend Wooridul Hospital to anyone having spine problem. Best regards, Sumanto Hartanto

I have had the opportunity to visit Wooridul Spine Hospital for three times. I will never forget the hospitality and the effort of Dr. Sang Ho Lee and the Wooridul team at my first visit to the center for endoscopic surgery training. Dr. Gun Choi and Dr. Chanshik Shim were my initial trainers. I am so glad to have had the chance to apply all I had learned there at my own country. One of the most memorable moments of my first visit was my assistance at the operating theatre upon the kind invitation of Professor Dr. Sang Ho Lee. Later on, Wooridul Center welcomed the junior members of our team and trained them as well, as expected from a distinguished and well established institution with a high training quality. Wooridul Spine Hospital, will always be a pioneering and successful center of excellence, deserving and meeting its motto “less is more” under the leadership of Dr. Sang Ho Lee. With our best regards from Turkey.

Had total hip replacement surgery yesterday under Mr Rhodri Williams and Team. The care I have received has been amazing. Everything was explained in detail so I knew exactly what would be happening which really helped me process and deal with post op recovery. Absolutely amazing hospital and caring staff. Nothing is too much trouble

I was treated amazingly by everyone that I met from the healthcare assistant to the consultant. The consultant was amazing and reassured me all the way through my surgery and the theatre nurse was amazing too as she held my hand and reassured me too as I have claustrophobia and had to have my face covered and it was so reassuring having her there talking to me throughout the operation. I can not thank the staff enough and would definitely 100% recommend the hospital to anyone in a position to be able to pay for treatment

My experience at Werndale Hospital was fantastic. Having never been to a private hospital before it has truly opened my eyes with regards to how nicely I was treated. All the staff were friendly, polite and professional, nothing was too much trouble. Thank you so much to the whole team for making me feel at ease before, during and after my operation. I will highly recommend.

On November 21, 2023, I underwent knee arthroscopy. Heartfelt thanks for any help, care, advice and, above all, the professionalism of the doctors, nurses and staff on duty.

On November 24, I was at the emergency clinic. The approach of the nurses and doctors was very professional and humane. Thank you for everything and I wish them good health and patience in their demanding work.

I was there in the emergency room with my 1 and a half year old son when he cut off his belly on his finger. We didn't wait, they took us right away, there were wonderful nurses who calmed me down too. They played songs and sang to their son while they sewed up his finger, and there were also students trying to cheer him up. Before I left, they also packed bandages, gauze, etc. if I needed it at home. I was very surprised by the approach and I'm glad that I came across a great shift.

Today I went to ORL department at ST Michaels because of the pain in my left ear. While sailing on Danube we were just passing by and I had to run and jump in without appointment. Not only did the MUDr. Matúš Čentéš find the time for me, help me with spot on diagnose and best treatment, but he also went his way to show me where the pharmacy is, he took a few minutes out of his busy schedule to explain prescribed medicine. He is the true role model for his proffesion. Doc I hope you read this, I wish you all the best, may God bless you and keep you. Thanks again. Elmir

I needed immediate medical attention and they sent me away to another hospital 10km away because I’m am neither a policeman nor a firefighter

Hospitality perfect, the servis too. In different hospital they wanted to operate my hernia discs, i relocated here and in 3 days they fixed me up prkperly wothout operation. Thumbs up! Also food is much better then other hospitals and doctors are very friendly and will always properly explain whats going on and discuss various options for you. I will reccomend this hospital anytime!

Wonderful clinic! Absolute purity. The doctors are amazing. Today I was at a reception with Nadezhda Fedorovna’s Daisies. Excellent doctor, explained everything in detail and prescribed treatment. Prosperity to the clinic and health to all employees. We need you!

4.11.23 I came at 8:00 to donate blood. As a result, the nurse arrived only at 8:30. I went to the receptionist twice and asked where the nurse was, she said she went to give an injection in the emergency room. Such a mess. I paid the money and waited another 30 minutes for the nurse. Is this a high tech clinic???

I took tests at the WMT clinic on Postovaya and registered at the reception without any problems. The administrators helped me connect my personal account, which received all my test results the next day. I was pleased with the cafe and water coolers on each floor. It’s convenient to eat after taking tests on an empty stomach

State of the art hospital and wonderfully caring staff. Amazing attentiveness from all the doctors, technicians and engineers; the staff are very professional and genuinely kind. They answer any questions and are incredibly comforting and patient. I had an MRI of 2 sections done here, was really well taken care of. Special thanks to head nurse Katarina and the engineer Zvonimir Matic. An extraordinary team. Would definitely recommend.

Amazing Hospital! Incredible service, very attentive staff, extremely accommodating and takes excellent care of patients. The facilities are state of the art and impeccably clean. Definitely worth the money! The level of service is fantastic! Thank you to Katarina, the head nurse at radiology, who was lovely! Pat

Billed the examination directly to me even though it was covered by my insurance. Refused to fix the mistake when pointed out. Definitely avoid