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

Said and Achebe: Writers at the Crossroads of Culture / ﺳﻌﻴﺪ ﻭﺃﺗﺸﻴﺒﻲ: ﻛﺎﺗﺒﺎﻥ ﻓﻲ ﻣﻔﺘﺮﻕ ﻃﺮﻕ ﺍﻟﺜﻘﺎﻓﺔ

[At a crucial point in the history of culture, a new generation of educated natives were finally able to use the tools they acquired through their encounter with the West to decode the deep-seated images of colonial representation and re-code new images of the self in order to escape stultification. In this context, Achebe\u27s article An Image of Africa (1975) became one of the first post-colonial attempts at re-reading canonical English texts (even before the term post-colonial was coined). In 1978, Said published his seminal book Orientalism theorizing many of the points raised by Achebe in his article. This study aims at examining the similarities and differences between these two influential writers who are situated both spatially and temporally at what Achebe calls the crossroads of culture. /‮ظهر خلال الخمسينيات والسيتينيات من القرن الماضي جيل من الشباب المتعلمين من أبناء الدول الخاضعة للاستعمار والذين استطاعوا تطويع الأدوات والخبرات التي اكتسبوها من خلال احتكاكهم بالغرب وتمكنوا من خلالها أن يعيدوا النظر في الطريقة التي طالما استخدمها الكتاب الغربيون في تصويرهم لسكان البلاد التي احتلوها وثقافاتهن ٠ وإن كان ظهور دراسات ما بعد ﺍﻻﺳﺘﻌﻤﺎﺭ كمدرسة مستقلة من مدارس النقد الأدبي يرتبط ارتباطاﹰ وثيقاﹰ بنشر كتاب الاستشراق لإدوارد سعيد عام ٨٧٩١، فإن الكثير من الأفكار التي بلورها سعيد في كتابه كانت مثارة بشكل فعلي من قبل ﻛﺘّﺎﺏ ﺁخرين خاصه شينوا أتشيبي، الأديب النيجيري، في مقاله الشهير صورة لأفريقيا ٠ ويهدف هذا البحث إلى تحليل نقاط التشابه والاختلاف بين إدوارد سعيد وشينوا أتشيبي وكيف استطاعا أن يغيرا الطريقة التي تتم بها قراءة العديد من عيون الأدب الغربي٠‬

ﺇﺷﻜﺎﻟﻴﺎﺕ ﺍﻟﺘﻤﺜﻴﻞ ﻓﻲ ﻣﺬﻛﺮﺍﺕ ﻋﺒﺪ ﺃﻣﺮﻳﻜﻲ ﻟﻔﺮﻳﺪﺭﻳﻚ ﺩﻭﺟﻼﺱ / The Problematics of Representation in Narrative of the Life of Frederick Douglass

[ﺗﺸﻜﻞ ﺍﻟﺴﻴﺮ ﺍﻟﺬﺍﺗﻴﺔ ﻟﻠﻌﺒﻴﺪ ﺻﻌﻮﺑﺔ ﺧﺎﺻﺔ ﻟﻠﻨﺎﻗﺪ ﺍﻟﻤﻌﺎﺻﺮ ﻧﻈﺮﺍﹰ ﻟﻠﺮﺅﻳﺔ ﺍﻟﻤﺘﺮﺳﺨﺔ ﻟﻬﺬﻩ ﺍﻟﻨﺼﻮﺹ ﺑﻮﺻﻔﻬﺎ ﺗﻌﺒﻴﺮﺍﹰ ﺣﻴﺎﹰ ﻋﻦ ﺣﻴﺎﺓ ﺍﻟﺰﻧﻮﺝ ﻓﻲ ﺃﻣﺮﻳﻜﺎ ﻓﻲ ﺍﻟﻘﺮﻥ ﺍﻟﺘﺎﺳﻊ ﻋﺸﺮ. ﻓﻜﻞ ﻣﺎ ﻧﻌﺮﻓﻪ ﻋﻦ ﺃﺣﻮﺍﻟﻬﻢ ﺍﻟﻤﻌﻴﺸﻴﺔ ﺃﺗﻰ ﺇﻟﻴﻨﺎ ﻋﻦ ﻃﺮﻳﻖ ﺃﻓﺮﺍﺩ ﻣﺜﻞ ﻓﺮﻳﺪﺭﻳﻚ ﺩﻭﺟﻼﺱ - ﺍﻟﻌﺒﺪ ﺍﻷﻣﺮﻳﻜﻲ - ﻣﻜﻨﺘﻬﻢ ﻇﺮﻭﻓﻬﻢ ﻣﻦ ﺃﻥ ﻳﻜﻮﻥ ﻟﻬﻢ ﺻﻮﺕ ﻣﺴﻤﻮﻉ ﻓﻲ ﺍﻷﻭﺳﺎﻁ ﺍﻷﻣﺮﻳﻜﻴﺔ ﺍﻟﺒﻴﻀﺎﺀ. ﻭﻣﻦ ﻫﻨﺎ ﺗﻨﺒﻊ ﺇﺷﻜﺎﻟﻴﺔ ﻗﺪﺭﺓ ﻓﺮﺩ ﺃﻭ ﺃﻓﺮﺍﺩ ﻋﻠﻰ ﺗﻤﺜﻴﻞ ﺷﻌﺐ ﺑﺄﻛﻤﻠﻪ، ﺍﻷﻣﺮ ﺍﻟﺬﻱ ﻳﺆﺩﻱ ﺇﻟﻰ ﻃﻤﺲ ﺍﻟﺤﺪﻭﺩ ﺑﻴﻦ ﺍﻟﻔﺮﺩﻱ ﻭﺍﻟﺠﻤﻌﻲ، ﺑﻴﻦ ﺍﻟﺨﺎﺹ ﻭﺍﻟﻌﺎﻡ. ﻭﻫﺬﺍ ﻻ ﻳﻨﺘﻘﺺ ﻣﻦ ﺍﻟﻘﻴﻤﺔ ﺍﻷﺩﺑﻴﺔ ﻟﻤﺬﻛﺮﺍﺕ ﻓﺮﻳﺪﺭﻳﻚ ﺩﻭﺟﻼﺱ، ﺍﻟﺘﻲ ﺗﺘﻨﺎﻭﻟﻬﺎ ﻛﺎﺗﺒﺔ ﺍﻟﻤﻘﺎﻟﺔ ﺑﺎﻟﺘﺤﻠﻴﻞ، ﻭﺇﻧﻤﺎ ﻓﻘﻂ ﻳﺸﻜﻚ ﻓﻲ ﺻﻼﺣﻴﺘﻬﺎ ﻣﺴﺘﻨﺪﺍﹰ ﺗﺎﺭﻳﺨﻴﺎﹰ ﻳﻤﻜﻦ ﻣﻦ ﺧﻼﻟﻪ ﺍﻟﻮﻗﻮﻑ ﻋﻠﻰ ﺣﻘﻴﻘﺔ ﺃﺣﻮﺍﻝ ﺍﻟﻌﺒﻴﺪ ﻣﻦ ﺍﻟﺴﻮﺩ ﻓﻲ ﺫﻟﻚ ﺍﻟﻮﻗﺖ . Slave narratives, in general, and Frederick Douglass’s works, in particular, have created a serious difficulty for their modern readers and interpreters as representations of the otherwise silent community of black slaves. Silence here denotes their inability to enter certain domains of discourse. Thus, they appear` silent despite the rich African American traditions of music, song, and story-telling, which helped to preserve their cultural identity but could not be written into the mainstream culture. The article poses questions concerning the ability of one intellectual voice to represent the collectivity of black experience and of black slaves. This does not diminish the literary value of Douglass\u27s writing but undermines the use of it as a historical document

V. S. Naipaul: The White Traveler under the Dark Mask / ﭪ. ﺱ. ﻧﺎﻳﭙﻮﻝ: ﺍﻟﺮﺣﺎﻟﺔ ﺍﻷﺑﻴﺾ ﺗﺤﺚ ﻗﻨﺎﻉ ﺍﻟﺒﺸﺮﺓ ﺍﻟﺪﺍﻛﻨﺔ

[V. S. Naipaul is a firm believer in an overarching universal culture built on progress and rationality. He represents the assimilated and monocular colonial self, attributing the failures of Third World societies he writes about to the inherent backwardness and indignity of its peoples, disregarding cultural specificity and falling into the trap of racist evaluations. This article examines Naipaul\u27s reification of age-old colonial images by concentrating on the synchronic realities of the places he writes about (particularly Africa), thus furthering the West\u27s Africanist discourse with all its ideological and imperialist connotations. ﺑﻴﻦ ﺍﻟﺤﻔﺎﻭﺓ ﺍﻟﺸﺪﻳﺪﺓ ﻣﻦ ﺍﻟﻨﻘﺎﺩ ﺍﻟﻐﺮﺑﻴﻴﻦ ﻭﺍﻟﻬﺠﻮﻡ ﺍﻷﺷﺪ ﻣﻦ ﻧﻘﺎﺩ ﺍﻟﻌﺎﻟﻢ ﺍﻟﺜﺎﻟﺚ ﻳﺒﺮﺯ ﺩﻭﺭ ﻧﺎﻳﭙﻮﻝ ﻛﻮﺍﺣﺪ ﻣﻦ ﺃﻫﻢ ﻛﺘﺎﺏ ﺃﺩﺏ ﺍﻟﺮﺣﻼﺕ ﻓﻲ ﺍﻟﻘﺮﻥ ﺍﻟﻌﺸﺮﻳﻦ٠ ﻭﺗﻮﺿّﺢ ﻫﺬﻩ ﺍﻟﻤﻘﺎﻟﺔ ﺗﺒﻨّﻲ ﻧﺎﻳﭙﻮﻝ ﻟﻠﻨﻤﻮﺫﺝ ﺍﻟﻐﺮﺑﻲ ﻓﻲ ﺗﺼﻮﻳﺮﻩ ﻟﺸﻌﻮﺏ ﺍﻟﻌﺎﻟﻢ ﺍﻟﺜﺎﻟﺚ ﺍﻟﺘﻲ ﺗﻨﺎﻭﻟﻬﺎ ﻓﻲ ﻛﺘﺎﺑﺎﺗﻪ (ﺧﺎﺻﺔ ﹰﺃﻓﺮﻳﻘﻴﺎ)؛ ﺣﻴﺚ ﻳﻤﻴﻞ ﻧﺎﻳﭙﻮﻝ ﺇﻟﻰ ﺇﻋﺎﺩﺓ ﺍﺳﺘﺨﺪﺍﻡ ﻧﻔﺲ ﺍﻟﻘﻮﺍﻟﺐ ﺍﻟﺠﺎﻣﺪﺓ ﺍﻟﺘﻲ ﻭﺭﺛﻬﺎ ﻋﻦ ﺃﺷﺪ ﺍﻟﻜﺘﺎﺏ ﻋﻨﺼﺮﻳﺔ ﻓﻲ ﻣﺤﺎﻭﻟﺔ ﻹﻟﻘﺎﺀ ﺍﻟﻼﺋﻤﺔ ﻋﻠﻰ ﺷﻌﻮﺏ ﻫﺬﻩ ﺍﻟﺪﻭﻝ٬ ﺑﺪﻻﹰ ﻣﻦ ﺇﻟﻘﺎﺀ ﺍﻟﻀﻮﺀ ﻋﻠﻰ ﺩﻭﺭ ﺍﻹﺳﺘﻌﻤﺎﺭ ﻭﺃﻋﻮﺍﻧﻪ٠ ﻭﻓﻲ ﺫﻟﻚ٬ ﻧﺠﺪ ﺃﻥ ﻧﺎﻳﭙﻮﻝ - ﺑﺎﻟﺮﻏﻢ ﻣﻦ ﺃﺻﻮﻟﻪ ﺍﻟﻬﻨﺪﻳﺔ - ﻻ ﻳﺨﺘﻠﻒ ﻛﺜﻴﺮﺍﹰ ﻓﻲ ﻛﺘﺎﺑﺎﺗﻪ ﻋﻦ ﻛﺘّﺎﺏ ﺍﻷﺩﺏ ﺍﻷﻭﺭﻭﺑﻲ ﺍﻹﺳﺘﻌﻤﺎﺭﻱ٬ ﺧﺎﺻﺔ ﻣﺎﻛُﺘِﺐَ ﻓﻲ ﺃﻭﺍﺧﺮ ﺍﻟﻘﺮﻥ ﺍﻟﺘﺎﺳﻊ ﻋﺸﺮ ﻭﺃﻭﺍﺋﻞ ﺍﻟﻘﺮﻥ ﺍﻟﻌﺸﺮﻳﻦ٠

From Page to Celluloid: Michael Cunningham\u27s The Hours / من الصفحة ٳلى شريط السينما: اقتباس رواية الساعات لمايكل كننجهام

[Michael Cunningham\u27s The Hours is a typical postmodern novel which relies on intertextuality, crossing boundaries between fact and fiction, and an interwoven narrative. This article examines the adaptation of this internal novel to a well-orchestrated sequence of audio-visual representations. It explores the novel\u27s formal and syntactical repetitions and their rendition in the iconic and pictorial cinematic medium. تتناول المقالة اقتباس رواية الساعات لمايكل كاننجهام للسينما. وهي الرواية التي تعد تجسيداً لخصاﺋﺺ الروايات ما بعد الحداثية باعتمادها على التناص وغياب الخط الفاصل بين الحقيقة والخيال، وأسلوبها السردي الذي يتصف بالتشظي والتشابك والتعقيد. وتوضح المقالة صعوبة تحويل هذه الرواية ٳلي مجموعة من المشاهد السينماﺋية القادرة علي ٳيجاد الترابط بين القصص المنفصلة التي يتكون منها السرد وتجسيد أفكار الشخوص الداخلية. وتتناول المقالة الأساليب السردية التي انتهجها كل من كاتب السيناريو والمخرج حتى استطاعا نقل الرواية ٳلي فيلم ناجح نال العديد من الجواﺋز .

Eight primary malignancies: case report and review of literature

The incidence of multiple primary malignancies has increased over the past years secondary to the long-term survival of cancer patients due to improvements in the early detection and adequate treatment of cancer. We present a patient with eight primary malignant tumors and review the relevant literature. Our patient was a 59-year-old female with Crohn disease with an otherwise non-contributory medical history. Risk factors for multiple primary tumors were not detected in our patient. At a follow-up of 108 months from the time of diagnosis of the first malignancy, our patient was still alive. Similar long-term survival has been reported in the literature. Due to the realistic potential for long-term survival, we recommend aggressive treatment of these patients

Stage I seminoma: treatment outcome at King Hussein Cancer Center in Jordan

<p>Abstract</p> <p>Background</p> <p>The aim of this report is to address treatment outcomes of patients with early-stage seminoma in a single institution with special reference to patients with history of surgical violation of the scrotum.</p> <p>Methods</p> <p>Seventy four patients with pure seminoma were treated at King Hussein Cancer Center (Amman, Jordan) between 2003 and 2010. All patients underwent orchiectomy. All but 3 patients received adjuvant radiotherapy. Patients who underwent surgical violation of the scrotum prior to referral were managed by further excision or irradiation of the scrotal scar. The follow-up ranged from 1 to 200 months (mean, 33 months).</p> <p>Results</p> <p>At the time of follow-up; all but one patient remain alive. The 3-year relapse-free survival for the entire cohort was 95.9%. Three patients developed relapse, all of whom received adjuvant irradiation following inguinal orchiectomy and initially harbored tumors larger than 4 cm upon pathological examination. Median time to relapse was 14 months (range, 8–25 months). None were associated with elevated tumor markers prior to detection of relapse. All but one patient were successfully salvaged by chemotherapy.</p> <p>Conclusions</p> <p>Our results confirm the excellent prognosis of patients with early-stage seminoma treated by orchiectomy and adjuvant radiotherapy in a developing country. Although all patients who developed relapse demonstrated adverse pathological findings upon initial assessment, no consistent predictor of relapse was found. Scrotal scar re-excision or irradiation in patients with prior history of surgical violation of the scrotum are effective measures in preventing local failure.</p

Global Burden of Cardiovascular Diseases and Risks, 1990-2022

Age-standardized CVD mortality rates by regionranged from 73.6 per 100,000 in High-income Asia Pacific to432.3 per 100,000 in Eastern Europe in 2022. Global CVDmortality decreased by 34.9% from 1990 to 2022. Ischemicheart disease had the highest global age-standardized DALYsof all diseases at 2,275.9 per 100,000. Intracerebralhemorrhage and ischemic stroke were the next highest CVDcauses for age-standardized DALYs. Age-standardized CVDprevalence ranged from 5,881.0 per 100,000 in South Asia to11,342.6 per 100,000 in Central Asia. High systolic bloodpressure accounted for the largest number of attributableage-standardized CVD DALYs at 2,564.9 per 100,000globally. Of all risks, household air pollution from solid fuelshad the largest change in attributable age-standardizedDALYs from 1990 to 2022 with a 65.1% decrease