Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

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

Uniqueness and convergence of the analytical solution of nonlinear diffusion equation

We have discussed the problems of uniqueness of the physical solution of the nonlinear diffusion equation. Here are considered two different ways to express the solutions in the power series. In the first case we will use the power‐series expansion about the zero point. The accuracy of the obtained physical solution is evaluated. However, in this case we get an infinity of different solutions and the problem of the choice of the unique physical solution is considered using the expansion about the point of maximum penetration of the impurities. Then we get only two solutions which differ one from other only in the directions of the diffusion. Neteisinės difuzijos lygties analizinio sprendinio vienatinumas ir konvergavimas Santrauka Klasikine tiesine difuzijos lygtis yra išvesta iš Fokerio‐Planko lygties darant prielaida, kad difuzijos procesas yra letas. Tačiau tai negali būti taikoma klasikines tiesines difuzijos lygties sprendinio er fc (x/2√Dt) asimptotikai, aprašančiai difunduojančiu priemaišu isiskverbima medž]iagoje neribotai dideliuose atstumuose x. Iš Brauno judejimo teorijos seka, kad per baigtini laika t difunduojančios daleles gali isiskverbti medž]iagoje tik iki baigtinio atstumo nuo difunduojančiu daleliu šaltinio, kuris apytikriai lygus vidutiniam kvadratiniam difunduojančiu daleliu poslinkiui √2Dt). Netiesine difuzijos lygtis pakankamai tiksliai aprašanti difunduojančiu priemaišu pasiskirstyma puslaidininkiuose gauta padarius prielaida, kad difunduojančiu daleliu srauto tankis yra apibrežiamas difuzijos koeficientu D proporcingu priemaišu koncentracijai N. Tuomet srityje, kur priemaišu koncentracija lygi nuliui, difuzijos koeficientas lygus nuliui taip pat. Taip užtikrinama fizikine salyga, kad per baigtini laika priemaišos medžiagoje turi isiskverbti i baigtini gyli. Darbe išdestytas netiesines difuzijos lygties sprendimas, nagrinejant vienmate difuzija iš begalinio šaltinio (kai kieto kūno paviršiuje priemaišu koncentracija Ns yra pastovi), laipsninemis eilutemis dviem skirtingais būdais. First Published Online: 14 Oct 201

SchrAodinger equation in potential representation for woods-saxon potential

Method of potential representation for solution of SchrДodinger equation was proposed in [1], [2] for nucleus scattering calculations using optical model. Main features of that method is expression of wave functions or solutions of SchrДodinger equation like functions of potential [1].The theorem for new multiplicative perturbation theory was presented [2]. According this theorem, when a new potential is added, the new solution can be obtained multiplying previous solution by the function depending on the new potential

The Nonlinear Diffusion Equation Describing Spread of Impurities of High Density

The nonlinear diffusion equation is derived by taking into account the local variations in the solvent density, within a mechanism of diffusion driven by random particle collisions. Analytical solutions for the case of spherical-symmetric nonlinear diffusion equation for spread of impurities in gas and solids are obtained and discussed. In this case, the solutions of the nonlinear diffusion equation are similar to solutions of Bernoulli equation. We note that the obtained solutions can be used to describe the shapes of impurity gas of high concentration or smoke clouds

Lithuanian Comics: Unused Cultural and Educations Instrument

Straipsnyje autorius kelia hipotezę, kad stipri komiksų industrija gali tapti svarbiu elementu, efektyviai siekiant įvykdyti Lietuvos kultūros ir Švietimo ministerijų XXI amžiui iškeltus strateginius nacionalinius uždavinius. Straipsnyje pateikiamas JAV komiksų medijos diskursas ir nuodugniai analizuojama Lietuvos komiksų industrijos padėtis, atliekant kokybines ir kiekybines apklausas. Rezultatai atskleidžia, kad tarp jauniausios Lietuvos kartos de facto yra įsitvirtinusi komiksų kultūra.In this paper the author suggests that strong national comic book industry could be an important element to effectively fulfil strategies goals for Lithuanian Ministry of Culture and Ministry of Education. Article analyse the power of USA comic book to create symbolic and cultural capital, and if this effect could be repeated in Lithuania. To determine Lithuanians attitude towards national and foreign comic book products quantitate (13k people) and qualitative questionnaire survey was carried out. The survey results show that comic book culture is de facto part of Lithuanian youth