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

Social Responsibility concept; a contribution to the debate on the future of the Common Agricultural Policy

Celem artykułu było określenie przydatności koncepcji CSR (Corporate Social Responsibility) w dyskusji nad przyszłym kształtem WPR oraz w tworzeniu systemu wsparcia rolnictwa i sektora rolno-żywnościowego. W artykule omówiono syntetycznie proponowane kierunki zmian w WPR po 2013 r. Następnie na podstawie wyników debaty publicznej określono oczekiwania społeczne wobec sektora rolnego i polityki rolnej. Na tle tych rozważań przeniesiono model koncepcji CSR na zależności pomiędzy uczestnikami łańcucha rolno-żywnościowego. Podjęto też próbę porównania koncepcji CSR z modelem wielofunkcyjnego i zrównoważonego rolnictwa tworzących podstawowe wytyczne do tworzenia Wspólnej Polityki Rolnej.The aim of the article was to discuss the corporate social responsibility concept in the context of debate on the future of the Common Agricultural Policy. The discussion begins with a short description of new policy goals as a response for the need of Common Agriculture Policy legitimation. It further shows the public response to proposed changes and some general views of Europeans on CAP and agriculture. In this context the relationship between concepts of CSR, multifunctionality and sustainable development are analyzed

Emerging of agricultural producer groups and price variability

Horizontal integration of farmers in the form of agricultural producer groups is considered to be one of the most effective ways of strengthening bargaining power of individual producers and the resulting improvement of their income. Measures undertaken in Poland in order to encourage farmers to join together did not bring satisfying results so far. Literature indicates a number of social and economic factors, which hamper the process of creating agricultural producer groups. Dependencies between a degree of price variability of selected agricultural products and a degree of farmer’s organisation in individual sectors of agricultural production are analysed in this article. Research shows that the bigger price variability is – the less is farmers’ tendency to take joint actions. Programmes supporting the creation of producer groups, if implemented separately from measures aiming at increasing price stability may run into difficulties

Effects of cooperation in producers' groups - transaction costs approach

W artykule wskazano na konieczność podejmowania w analizach efektywności grup producenckich problematyki związanej z możliwością redukcji przez te podmioty kosztów transakcyjnych działania pojedynczych rolników. Określono funkcjonujące w literaturze podejścia do pomiaru kosztów transakcyjnych oraz problemy z pomiarem tej kategorii kosztów. Przeanalizowano efekty współpracy rolników w 30 grupach producenckich w zakresie redukcji kosztów transakcyjnych.The paper discusses the efficiency of producer groups from the transaction costs perspective. Empirical data from 60 interviews with members of fruit and vegetable producer groups were analyzed. In most cases joining a marketing group enabled reduction of transaction costs, especially in the area of negotiations, finding a new client and risk of obtaining very low prices

Direct payments and costs of agricultural production in the European Union countries

Płatności bezpośrednie w Polsce kształtują się na poziomie niższym niż przeciętnie we Wspólnocie ze względu na warunki akcesji do UE wynegocjowane przed 2004 rokiem. Propozycja Komisji Europejskiej dotycząca Wspólnej Polityki Rolnej po 2013 roku nie przewiduje istotnych zmian w sposobie naliczania kopert krajowych płatności bezpośrednich. W artykule przedstawiono propozycję Komisji Europejskiej w odniesieniu do dystrybucji płatności bezpośrednich pomiędzy krajami członkowskimi. Następnie, na podstawie danych FADN, przedstawiono wyniki analizy zróżnicowania kosztów produkcji rolnej w UE oraz relacji płatności bezpośrednich i kosztów produkcji rolnej. Relacja ta charakteryzowała się jednak wysoką zmiennością. Oznacza to, że płatności w różny sposób rekompensują koszty produkcji (czy to ogółem, zużycia pośredniego, czy też bezpośrednie koszty produkcji roślinnej) ponoszone przez gospodarstwa w różnych krajach UE. Utrzymania obecnego sposobu naliczania kopert krajowych nie można zatem uzasadniać zróżnicowanym poziomem kosztów.Distribution of direct payments within the first pillar of Common Agricultural Policy is unequal in the European Union and depends on historical criteria which have no economic justification. Apart from slight modifications suggested by the European Commission, the mechanism of distribution of direct payments among EU countries is going to be maintained in the coming financial perspective for 2014-2020. The aim of the article was to discuss relations between the level of direct payments and the costs of agricultural production. There is a positive correlation between these two variables (in euro per ha). However, the level of variation of relation payments vs costs (different categories) is high. It proves that, first of all, the level of payments received by farmers does not reflect costs. Secondly, the existing differences in payments per ha in different countries can not be explained by different cost levels

Imposing personal income tax on agricultural activity in Poland

W obecnie obowiązującym systemie podatkowym w Polsce dochody z działalności rolniczej są zwolnione z opodatkowania podatkiem od osób fizycznych, jednocześnie rolnicy zobowiązani są do płacenia podatku rolnego o charakterze majątkowym. Wyniki przeprowadzonej symulacji włączenia działalności rolniczej w powszechny system opodatkowania wskazują, że wpływy do budżetu państwa z tytułu PIT od działalności rolniczej byłyby na poziomie zbliżonym do wpływów uzyskiwanych z tytułu podatku rolnego. Zmieniłby się zaś rozkład zobowiązań podatkowych obciążających rolników.Current regulations require farmers to pay agricultural tax, while simultaneously exempting them from PIT (with the exception of so-called special sectors of agricultural production) in Poland. The article presents the calculations of implementing rules of personal income tax on income from farming. Results show that imposing PIT on farmers (general rules) would decrease farmers’ income by at least 10%. The level of public (state budget) revenues from PIT paid by farmers would be comparable to revenues from the current agricultural tax. However, the distribution of tax burden among farmers would differ in the case of PIT than the current agricultural tax

Is Basal Cell Carcinoma an Itchy Tumor? Clinical Characteristics of Itch in Basal Cell Carcinoma

In common knowledge, basal cell carcinoma (BCC) is known to be asymptomatic, but in clinical practice, at least some patients complain of itching. The present study group comprised of 180 patients with histologically confirmed BCC. Detailed information on demographics, clinical history, and physical findings was recorded. Moreover, various clinical features of itch (including intensity, localization, quality, descriptors) and the most common factors responsible for its aggravation or alleviation were examined. The itch was present in 21.1% of patients with BCC and was limited to the tumor. The mean intensity of the itch was 3.1 ± 1.2 points (Numerical Rating Scale), indicating moderate itch intensity. Among the patients, 22.4% reported that itching occurred constantly, every day. BCC-associated itch seems to be moderately frequent, although being a seemingly underestimated problem among patients with BCC