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

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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Properties of Portland cement concrete cast with magnetized water: a review

The water utilized in concrete manufacture plays an important role within the concrete mix, beginning from controlling the process of hydration of cement, besides appropriate curing to achieve the required strength, not to mention controlling the workability and durability of the concrete structure. The utmost significant challenge for concrete technology is to improve the properties of concrete. Nowadays, the engineering field needs to produce structures in harmony with the concept of sustainable development through the utilization of high-performance materials with an eco-friendly impact that is produced at a low-cost. The magnetic water (MW) provides one of the utmost towards this objective. The cost of magnetizing water is low because of the simple instruments used and the cost can be adapted to the scale of the work. In the last two decades, a new technology, so-called MW technology, has been extended to use in concrete manufacturing. Therefore, currently, the researchers are interested in the use of MW in the manufacture of cementitious materials helping to rationalize the cement usage and reducing reliance on chemical additives that have a negative environmental impact. Consequently, this paper presents the effect of the magnetization process in the structure of water molecules, the main properties of water. Additionally, the effect of using MW on the fresh and mechanical properties, as well as the durability characteristics and performance of cementitious materials have been reviewed. Moreover, the factors that affect the magnetization process of water, which highlighted discuss in this study. The results revealed that using MW significantly enhances the flowability and the characteristic strengths of cementitious materials as well as the durability properties

Wpływ samooceny przedsiębiorczości na przetrwanie : czy literacyjność finansowa i pasja przedsiębiorczości mają zastosowanie?

The primary purpose of the current study is to investigate the entrepreneurial self-efficacy as an antecedent to persistency among entrepreneurs. In addition to that, the study examines the mediating role of entrepreneurial passion between entrepreneurial self-efficacy and entrepreneurial persistence. Lastly, the study explored the relationship between financial literacy and persistence and its moderating role between entrepreneurial passion and persistence. Structural equation modeling through of partial least square bootstrapping resampling was used for hypotheses testing to analyze the data collected from a sample of 273 Malaysian entrepreneurs. The results of the study supported all arguments broached in the current research for the subjective norm, entrepreneurial self-efficacy, which showed a significant impact on entrepreneurial passion and entrepreneurial persistence. The moderating effect of financial literacy on entrepreneurial passion and entrepreneurial persistency was also highly significant. The current work is among the pioneering studies that examine entrepreneurial self-efficacy, entrepreneurial passion, financial literacy and entrepreneurial persistence among entrepreneurs.Głównym celem niniejszego badania jest zbadanie własnej skuteczności przedsiębiorczej jako czynnika poprzedzającego wytrwałość wśród przedsiębiorców. Ponadto badanie bada mediacyjną rolę pasji przedsiębiorczej między samowystarczalnością przedsiębiorczą a wytrwałością przedsiębiorczą. Wreszcie w badaniu zbadano związek między znajomością finansów a wytrwałością oraz jej moderującą rolą między pasją przedsiębiorczości a wytrwałością. Do testowania hipotez wykorzystano modelowanie równań strukturalnych za pomocą częściowego ponownego próbkowania ładowania metodą najmniejszych kwadratów, aby przeanalizować dane zebrane z próby 273 malezyjskich przedsiębiorców. Wyniki badania potwierdziły wszystkie argumenty poruszone w bieżących badaniach na rzecz subiektywnej normy, własnej skuteczności przedsiębiorczej, która wykazała znaczący wpływ na pasję przedsiębiorczą i trwałość przedsiębiorczą. Bardzo istotny był również moderujący wpływ wiedzy finansowej na pasję przedsiębiorczości i trwałość przedsiębiorcy. Obecna praca należy do pionierskich badań, w których analizuje się skuteczność przedsiębiorczą, pasję przedsiębiorczą, znajomość finansów i wytrwałość przedsiębiorczą wśród przedsiębiorców

The key organizational factors in healthcare waste management practices of Libyan public hospitals

From MDPI via Jisc Publications RouterHistory: accepted 2021-11-10, pub-electronic 2021-11-19Publication status: PublishedThis study aims to investigate factors contributing to healthcare waste management practices among Libyan public hospitals. The organizational culture and structure are proposed to have their effect upon hospital organizational units in charge of healthcare waste production by a theoretical review to develop two main hypotheses. Hence, this study used the stratified random sampling technique to select respondents such as top management officials, heads of departments, and administrators who work in all the hospitals located in the south of Libya, from whom data was collected. The data for the study was gathered via a survey questionnaire from Libyan public hospitals in the country’s southern region. A total of 210 questionnaires were distributed and 171 usable responses were received, yielding a 70% response rate. Though the findings of the study show some inconsistency, the two dimensions of the culture examined in this study are found to have a positive relationship and significant influence on the management practices of health waste. Besides, it shows the positive relationship between organizational structure and healthcare waste management practices (HWMP). However, the findings of this study suggested that nurses and cleaners’ practices should critically consider structure dimensions such as formalization as well as moderating variables such as hospital location and type of services supplied on the interactions to improve the management of healthcare waste in Libya’s public hospitals.13pubpub2

The strategic plan for combating antimicrobial resistance in Gulf Cooperation Council States

Summary: The Gulf Cooperation Council Center for Infection Control (GCC-IC) has placed the emergence of antimicrobial resistance (AMR) on the top of its agenda for the past four years. The board members have developed the initial draft for the GCC strategic plan for combating AMR in 2014. The strategic plan stems from the WHO mandate to combat AMR at all levels. The need for engaging a large number of stakeholders has prompted the GCC-IC to engage a wider core of professionals in finalizing the plan. A multi-disciplinary group of more than 40 experts were then identified. And a workshop was conducted in Riyadh January 2015 and included, for the first time, representation of relevant ministries and agencies as well as international experts in the field. Participants worked over a period of two and a half days in different groups. International experts shared the global experiences and challenges in addressing human, food, animal, and environmental aspects of controlling AMR. Participants were then divided into 4 groups each to address the human, animal, microbiological and diagnostic, or the environmental aspect of AMR. At the end of the workshop, the strategic plan was revised and endorsed by all participants. The GCC-IC board members then approved it as the strategic plan for AMR. The document produced here is the first GCC strategic plan addressing AMR, which shall be adopted by GCC countries to develop country-based plans and related key performance indicators (KPIs). It is now the role of each country to identify the body that will be accountable for implementing the plan at the country level. Keywords: Strategic plan, Antimicrobial resistance, AMR, GCC, Saudi Arabia, United Arab Emirates, Qatar, Bahrain, Oman, Kuwai

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit