Dermatologists Communication Skills and Performance From Point of View of Patients

Introduction: Effective communication is an important issue in patient-doctor interaction which is even more important regarding chronic disorders which need a strong relationship between patient and clinician for better compliance and optimal control disease. Objectives: This study was aimed to develop the best cultural adapted Persian version of the 28-item Calgary- Cambridge Observation Guide (CCOG) questionnaire. Methods: In this descriptive‑analytic study, data collected from 400 patients attending the outpatient dermatology clinics of 3 major hospitals in Tehran using the modified Persian version of CCOG questionnaire, both before and after being visited by dermatologists. Results: The difference of CCG scores for all of questions, except for questions number 1,16 and 22, was statistically significant. The highest score, both before and after visiting, attained by question regarding being respectful. The lowest scores for necessary behavior and the adequate amount of execution were related to questions number 3 (Introducing self) and 4 (Introducing role), respectively. Age and educational level of patients were significantly correlated with their expectations regarding communication skills of clinician. Conclusions: This study showed the acceptable validity of modified Persian version of CCOG-24 item questionnaire. Our findings also demonstrated that there was a significant difference between what patients expected from a dermatologist and the manner they actually were treated regarding physician communication skills

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Comparison of coasting with Cabergoline administration for prevention of early severe OHSS in ART cycles

Background: One of the major and life-threatening side effects of Assisted Reproductive Technique (ART) is ovarian hyperstimulation syndrome (OHSS). The available data however, have been showed that both Cabergoline (anti VEGF) and coasting reduce the severity of OHSS. Objective: We aimed to compare coasting and Cabergoline administration in prevention of severe OHSS. Materials and Methods: A total of 60 IVF/ICSI cycles were selected. Patients at risk of developing OHSS were divided into two groups as patient's convenience. For 30 patients in coasting group, exogenous gonadotropins were withheld to allow E2 to decrease while GnRH-a was maintained. Then 10,000 unit hCG was administrated and oocyte retrieval was performed 36 hours later. In Cabergoline group, 30 patients were administered with 0.5mg Cabergoline tablet on day of hCG injection, continued for 8 days. Results: The mean number of retrieved, good quality, mature oocytes and the mean number of embryos were significantly different in two groups (p<0.05). The clinical pregnancy rate was 13.3% in coasting and 26.7% in Cabergoline group that was not significantly different (p>0.05). The incidence of severe OHSS was similar in two groups. Conclusion: The Cabergoline was as effective as coasting in the prevention of early severe OHSS in high risk patients, but yielded more retrieved oocytes

Energy Intensity and Greenhouse Gas Emissions from Oil Production in the Eagle Ford Shale

A rapid increase in horizontal drilling and hydraulic fracturing in shale and “tight” formations that began around 2000 has resulted in record increases in oil and natural gas production in the U.S. This study examines energy consumption and greenhouse gas (GHG) emissions from crude oil and natural gas produced from ∼8,200 wells in the Eagle Ford Shale in southern Texas from 2009 to 2013. Our system boundary includes processes from primary exploration wells to the refinery entrance gate (henceforth well-to-refinery or WTR). The Eagle Ford includes four distinct production zonesblack oil (BO), volatile oil (VO), condensate (C), and dry gas (G) zoneswith average monthly gas-to-liquids ratios (thousand cubic feet per barrelMcf/bbl) varying from 0.91 in the BO zone to 13.9 in the G zone. Total energy consumed in drilling, extracting, processing, and operating an Eagle Ford well is ∼1.5% of the energy content of the produced crude and gas in the BO and VO zones, compared with 2.2% in the C and G zones. On average, the WTR GHG emissions of gasoline, diesel, and jet fuel derived from crude oil produced in the BO and VO zones in the Eagle Ford play are 4.3, 5.0, and 5.1 gCO₂e/MJ, respectively. Comparing with other known conventional and unconventional crude production where upstream GHG emissions are in the range 5.9–30 gCO₂e/MJ, oil production in the Eagle Ford has lower WTR GHG emissions